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Tuesday, 16 March 2010
Page: 1872


Senator CAROL BROWN (12:45 PM) —I am very happy to contribute to the debate on the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009 and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009, which introduce significant changes for Australia’s nurses and midwives. These bills are an important component of the government’s maternity reform package. I would like to make a short contribution and put a number of issues on the record.

The purpose of the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 is to amend the Health Insurance Act 1973 and the National Health Act 1953 to support the inclusion of nurse practitioners and appropriately qualified and experienced midwives under the Medicare benefits schedule, MBS, and the Pharmaceutical Benefits Scheme, PBS, in line with the 2009-10 budget measures. The midwives and nurse practitioners bill will enable those health professionals to request appropriate diagnostic imaging and pathology services for which Medicare benefits may be paid and to prescribe certain medicines under the PBS. The 2009-10 budget measure also provides for the creation of new Medicare items and referrals under the MBS from these health professionals to specialist consultant physicians. The Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009 will support the new MBS and PBS arrangements by enabling the establishment of a government supported professional indemnity scheme for eligible midwives. These bills will commence on 1 July 2010.

The bills before us expand support for midwives and nurse practitioners in our community, improving choice and extending funding for a range of midwife and nurse practitioner services for the first time ever. The bills will enable patients of appropriately qualified and experienced midwives and nurse practitioners to access benefits under the Medical Benefits Schedule for improved access to maternity services and improved choice for women. The government was supported in their commitment to better services by witnesses to the Senate Standing Committee on Community Affairs inquiry into the bills, and I quote from the report:

The government’s commitment to increase women’s access to midwifery care by providing midwives with access to the MBS, PBS and affordable indemnity insurance was supported by witnesses. The Australian College of Midwives (ACM) stated:

Evidence confirms that women and babies benefit from continuity of care by a known midwife. We welcome the Minister’s recognition of this evidence and commitment to expanding women’s access to the choice of primary continuity of care by midwives in both hospital and the community.

It is fair to say that the two community affairs inquiries held into these bills, which recommended the passing of the bills, generated considerable interest. The committee received over 1,000 submissions.

It is important to note that these three bills do not take away any rights and that none of these bills make homebirth unlawful. The indemnity insurance issue as it relates to privately practising midwives—raised by community members and organisations with many members and senators—is dealt with.

I am pleased that the Minister for Health and Ageing, Nicola Roxon, announced back in September 2009 that she was able to achieve agreement from all state and territory health ministers to a transitional clause. The clause provides a two-year exemption, until June 2010, from holding indemnity insurance for privately practising midwives who are unable to obtain professional indemnity insurance for attending a homebirth. This issue was raised with me prior to the transitional arrangements being put in place, and after. I am pleased to say that the women I have spoken to have supported Ms Roxon’s approach.

At a recent meeting I had with representatives from the homebirth rally on their ‘national day of action’, they agreed that the exemption approach was a positive outcome. I spoke at the homebirth rally, which was held in Hobart on 18 February. It was attended by homebirth supporters, midwives and children. I had a meeting prior to the rally with rally representatives: Ms Jo Durdin, Director, Australian College of Midwives, Tasmania; Ms Lalita Holmes, one of the rally organisers; and an expectant mother, Ms Chernov. I also have had meetings with other individual midwives and interested individuals. The rally meeting was very constructive, and a number of issues were raised at the meeting which also have been raised by witnesses at the community affairs committee hearings.

An issue of concern was the impact of the requirement for midwives to have collaborative arrangements with medical practitioners. And, as the committee reported noted and has been repeated by interested parties that I have spoken to, the concept of collaboration to ensure appropriate care for women and their babies is supported. This was echoed by the Australian College of Midwives in their comment, ‘midwifery is a profession committed to the provision of collaborative care.’ They also stated that:

… there is no argument that women choosing the care of a private MBS funded midwife must have ready access to appropriate medical care if and when the need arises for themselves or their baby.

The ACM and others saw the issue as being how collaboration is ensured. The community affairs committee noted:

… effective collaborative arrangements amongst health professionals ensures the delivery of safe and high quality care. Collaborative arrangements are at the heart of the midwives and nurse practitioners reforms introduced by the Government and thus the Committee supports the principle of collaborative arrangements in legislation.

The details of the collaborative arrangements will be included in subordinate legislation and will continue to be the subject of consultations with health professionals. The majority report from the community affairs committee believes:

This consultation is critical to the effectiveness of the process and reflects the shared commitment and professional skills focused on safe birth practice.

These bills, as I have said, are a significant step towards improving access and services. I commend the bills to the Senate.