Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Hansard source

I rise today to speak on the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009. This is significant legislation and has generated a strong and emotive response. I wish to start with what I consider the most pertinent issue that has resulted from the minister’s bungled handling of these bills.

The bills extend Commonwealth subsidised indemnity insurance to ‘eligible midwives’. A lot of the detail giving force to these bills will follow by way of regulation. To date, we and the public have been given scant detail by the government on this critical future regulation. The government has yet to provide the actuarial modelling for the indemnity insurance scheme, other than a very simplified explanation provided to the Senate Community Affairs Legislation Committee inquiry by departmental officials. It causes concern that once again this minister has rushed headlong into legislation with the attitude, ‘We’ll work out the detail later.’ It is clearly not the responsible way to legislate and, as we have seen time and time again from this government, it leads to mistakes, oversights and bungling. The parliament and the public are entitled to the detail of the policy and legislation that is to be voted on.

According to the bills, an eligible midwife is a person who:

(a) is licensed, registered or authorised to practice midwifery by … the Commonwealth, a State or a Territory;

(b) meets such other requirements … as are specified in the Rules …; and

(c) is not included in a class of persons specified in the Rules for the purposes of this paragraph.

We learn of possible excluded classes of midwives from the minister’s second reading speech. The minister stated:

… the Commonwealth supported professional indemnity cover will not respond to claims relating to homebirths.

It is the intersection of these bills with the National Registration and Accreditation Scheme where serious and genuine concern has arisen. The exposure draft of the Health Practitioner Regulation National Law 2009, bill B, under ‘Eligibility for general registration’, states:

(d) there is, or will be, in force in relation to the individual appropriate professional indemnity insurance arrangements, including a policy held, or arrangements made, by the individual’s employer that will cover the individual,

Under this exposure draft, in accordance with clauses 128 and 129, an individual who practises as a midwife without indemnity insurance and is therefore unregistered may be subject to a maximum penalty of $30,000. Come 1 July 2010, given the minister’s current position, midwives will effectively be prohibited from providing birthing services outside of a clinical setting.

This is an issue that is fundamentally about choice. It is extraordinary for a health minister to effectively prohibit mothers and parents around the country from having an appropriately qualified health professional in attendance at childbirth. I acknowledge that there is a great diversity of opinion on homebirthing, both within the medical and health fraternity and in the wider community. At every stage, though, all reasonable parties to such debate would rightly acknowledge that homebirthing is not an appropriate option for all women, and I would certainly strongly recommend that any patient, in particular expectant mothers, be properly informed and that they consult relevant health professionals. However, I am not here today to debate the merits or otherwise of homebirthing; that is for others. I am here to defend the right of intelligent, informed Australian adults to have a choice—to be entitled to decide for themselves.

To date, homebirthing is the choice of only a small proportion of women—in 2006 it made up 0.26 per cent of all births. However, it is naive to suggest that all women will simply surrender this option. The Minister for Health and Ageing knows that there are a small proportion of mothers and parents who will continue to choose not to enter the hospital system for a childbirth. That is their choice. This measure will just drive homebirthing underground, with parents unable to access appropriate care, jeopardising the lives of not just the unborn babies but also the mothers themselves. Childbirth is an intimate and personal decision for families in consultation with health and medical professionals. It is not appropriate for the Rudd government or Minister Roxon to mandate the conditions of childbirth for all women across the country. This is a nanny-state Labor government treating with contempt the rights of mature adults to make informed decisions.

Families currently privately contract with registered midwives for services outside of a clinical setting. They should be entitled to continue to do so in accordance with appropriate medical guidelines and on the advice of health and medical practitioners. I have received many compelling and reasoned pleas from parents across the country on this issue, as have many members on both sides of this House. I have met with a number of parents and their children in my electorate and in other parts of the country. Today I would like to read to the House, and specifically to bring to the attention of the minister, the concerns of Rebecca and Darryl Jenkinson, who reside in my electorate. I had the pleasure of meeting with Rebecca and her two young children in my electorate office. Rebecca provided an insightful and personal perspective on the ill-considered effects of the government’s changes. Rebecca and Darryl articulate the reasonable concerns that are so evident in this debate, and I quote in part what they wrote:

We chose homebirth with a private midwife for the arrival of our two daughters, Indiana in 2007 and Saffron in 2009. It was an informed choice, made at the culmination of much research into our birthing options. While it is ‘the road less travelled’ in Australia, homebirth is the right choice for our family and we feel betrayed by the proposed legislation.

To care for us throughout our pregnancy and birth journey, we chose a healthcare professional whose expertise is normal pregnancy and birth; we chose a midwife. Prenatal visits were as much about preparation for parenting as they were about the clinical progress of the pregnancy. We discussed the various unexpected outcomes that could arise and how we would respond to those and, when necessary, our midwife referred us to a doctor for further advice. After those consultations we always returned to our midwife’s support for our ongoing care and it was that continuity which protected our safety. By the time ‘birthday’ actually arrived, we could simply patiently allow our baby’s birth to unfold and enjoy the experience. All the while, our midwife was the guardian of our safety and would alert us if we needed to activate any of our contingency plans.

Every family is different. Every family makes different choices and those choices must be respected and treated equally by our government. Making continuous care from a known midwife more available to women is fantastic. But where we choose to give birth should not affect our ability to access that care. Our choice, homebirth with a private midwife, is valid. As our elected government we ask you, simply, to sort this out and protect our right to birth where, how and with whom we choose.

Rebecca and Darryl’s experience highlights that through consultation and genuine collaboration between parents, midwives and doctors, decisions can be made that deliver good outcomes. It might be difficult for this government to accept, but the Prime Minister and the Minister Health and Ageing do not always know best—Australians are able to make informed, educated decisions that deliver good outcomes for themselves and their families. If the minister is unable to satisfactorily resolve the issue of indemnity insurance for midwives then at least the proposed registration requirements should be amended to allow existing services to continue—the so-called status quo option. In order to have an informed debate on the provision of indemnity insurance to cover affected midwives, the government needs to release the detailed actuarial modelling that it used for its proposal.

I now turn to the PBS and MBS access for midwives and nurse practitioners. There needs to be a more holistic approach to health care in Australia, especially in the areas of preventive health and chronic illness. The skills of all health and medical professionals should be utilised to their full potential in accordance with appropriate scope of practice. Practice nurses, for some time, have been an invaluable and integral part of primary health care in Australia, and their role, skills and professional development will be central as we go forward.

However, extending access to the PBS and MBS has significant ramifications in terms of scope of practice, patient safety and the economic viability of the health budget. The interest bill alone on the Rudd government’s huge debt will make it hard in future years to meet extra expenditure on these schedules and other expenditure across the health system. It is important that PBS and MBS access for all professions is carefully considered and monitored in accordance with professional qualifications and experience.

The coalition firmly believe that GPs are the cornerstone of primary health care in Australia and it is important that there is genuine collaboration between the other health professions and GPs in managing patient health care. We have not received any clear detail on the so-called collaborative model which is central to these bills. What we do not want to see is a two-tiered system in Australia. Anyone who wishes to see a doctor for their healthcare needs should be entitled to do so. We do not want to see a situation where Australians have to see a nurse not because they want to or because it is convenient but because it is an easier solution for this government.

We need to see a genuine model of collaboration, with GPs working with other health professionals and specialist practitioners in managing patient care. It is important that there are appropriate guidelines for scope of practice, ensuring patient safety and the economic viability of the PBS and MBS. The government’s current investment in the PBS and MBS is significant. As at 30 June 2007, the coalition government spent $6.4 billion per annum on pharmaceutical benefits. Coalition government expenditure on the MBS was some $11.7 billion as at 30 June 2007. This is a significant increase from 1995-96 amounts, under the last Labor administration, of $2.2 billion and $6 billion respectively.

It is important that these programs are utilised as efficiently as possible and that they remain viable into the future. However, in order to consider that issue, the government needs to release the detail under which this legislation will operate. There is a conspicuous and concerning lack of detail behind these bills. The creation of referral rights for nurse practitioners to specialists is another significant component of this legislation. However, once again, we need to be assured of the efficiency of such a model. Currently, GPs refer a only very small proportion of patients to specialists. We ask the government to release the modelling, or at least some sensible detail as to how this measure may affect the quantity of referrals, waiting times for specialists and the MBS.

Whilst there is a logical argument for nurse practitioners and midwives to have some capacity to order pathology and diagnostic services attracting a Medicare rebate, the workability and efficiency of this proposal will entirely depend on the collaborative model, which we understand the government has not yet devised. Without a national e-health record, and without knowing how the government’s planned collaborative model will work, there is significant risk of duplication and overservicing in this area.

The health budget, provided by the taxpayers of Australia, is certainly not infinite and needs to be managed carefully to meet the worthy but almost endless demands placed on it. It is certainly one of the most difficult aspects of the health portfolio. There are many worthy causes that would benefit from funding in the health portfolio. However, the reality of the situation, and something which we all need to remind ourselves of, is that funding is provided by the hardworking taxpayers of this country and the pie is only so big. There is a duty, an obligation in fact, on government to ensure that taxpayers’ money is always used efficiently. Unfortunately this is clearly not something the Rudd government understands. We have seen billions of dollars of taxpayers’ money squandered on populist cash handouts—racking up over $300 billion in debt for the youth of this country to pay off.

As I say, the debt servicing requirements caused by the Rudd government’s reckless spending will cut deeply into key budget areas such as health in future years; and there are few portfolios where this obligation to ensure the best use of funds is more important than health. There is an opportunity cost to all initiatives. The stark reality of the situation is that taxpayers cannot fund everything. Policy needs to be considered and refined and there needs to be more consultation than what this government has committed itself to in the past. Taxpayers deserve, and the government is obliged to provide, the ‘best bang for the buck’.

The Senate Standing Committee on Community Affairs inquiry examining this legislation has received over 1,800 submissions and was due to report on 7 August 2009. The reporting date was moved to 17 August due to the overwhelming public reaction. Whilst we do not oppose the passage of this bill today on the basis of the homebirth outcome, we do reserve the right to move amendments in consideration of the recommendations of the Senate committee’s report. We are opposed to making homebirth illegal and we will fight for choice. I put the government on notice that we are carefully considering the committee’s recommendations that were released in this regard.

The minister’s bungled handling of this critical legislation follows this government’s complete mismanagement of the health portfolio. Mr Rudd and Minister Roxon made numerous explicit and unambiguous promises that a decision to hold a referendum to take financial control of public hospitals would be made by mid-2009. For example, a media release by Nicola Roxon and Kevin Rudd on 23 August 2007 stated:

If by mid-2009 the Commonwealth and the States and Territories have not begun implementing the National Health Reform Plan, a proposition for the Commonwealth to assume full funding responsibility will be developed and put to the Australian people.

As of 30 June 2009, Mr Rudd failed to state whether he would honour this promise. However, some confusion is understandable in relation to this promise, as Mr Rudd has gone to great lengths to retract it. In fact, a paragraph referring to the referendum was removed from the Prime Minister’s website between October 2008 and November 2008. Under questioning in this very parliament, the Prime Minister failed to respond as to why this had occurred. In addition, a heading ‘Fixing our hospitals’ on the Prime Minister’s website was replaced with ‘Improving our hospitals’ during the same period.

Despite Mr Rudd’s promise to fix the health system, I am inundated daily with complaints about the Rudd government’s ill-considered policy decisions and savage cuts to successful health programs. Since coming to office, the Rudd government has introduced measures to halve the Medicare rebate for patients undergoing cataract surgery, capped the Medicare safety net for a range of procedures, cut funding for chemotherapy drugs and slashed the private health insurance rebate. These measures will increase the cost of health care for many Australians and put more pressure on Australia’s already overstretched public hospitals.

We have seen as recently as this week, in question time, the minister’s inability to guarantee her own comments that IVF patients who are charged $6,000 or less per cycle will not be worse off because of the government’s cuts to the Medicare safety net. I issue the challenge to the minister, who is here in the chamber today, to live up to that guarantee, to repeat those words in this parliament. Minister, if you used those words in your second reading speech and you walked away from them during question time, why not come back and provide a guarantee to those thousands of parents right around the country—

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