Shayne Neumann (Blair, Australian Labor Party) Share this | Hansard source

I'm pleased to speak on the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Amendment Bill 2024. The background to this is that the role of midwives and the issue of health funding and insurance became very obvious back in 2002—indeed, probably prior to that, after the insurance market collapsed after 9/11. The landmark obstetric birth injury case which resulted in a payout of about $11 million initiated a crisis of confidence in the industry with respect to midwives around the country. At that time there were around 200 privately practising midwives, and they were paying about $800 a year in insurance. That's simply not a big enough pool of funds to contemplate a payout of that magnitude, and obviously insurance for midwives was a longstanding issue.

The coalition—then in government, by the way—had another six or seven years to resolve the issues but simply did nothing. In 2008 we directed the Commonwealth Chief Nurse and Midwifery Officer, Rosemary Bryant, to conduct a review of midwifery services in Australia. I and a number of my colleagues met with midwives and lobbied the government to resolve this issue. I met with midwives across Queensland and spoke at a number of events, including a forum that was held by a maternity coalition in the state of Queensland. There are a number of local advocates across South-East Queensland who push this issue. We brought three bills before the House in 2009 to support Australian midwives.

Some anomalies emerged after this legislation. The purpose of the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 and the associated Midwife Professional Indemnity (Runoff Cover Support Payment) Act 2010 was to support MBS and PBS arrangements enabling the establishment of a government supported professional indemnity scheme for eligible midwives by 1 July 2010. There was an unintended consequence in that the insurance seemed to cover in particular those who were dealing with private hospitals and large private obstetric practices as employers. But it didn't really cover midwives who were self-employed in private practice and in one-on-one settings or small settings.

There were also some tax anomalies that weren't covered. So we brought forward a piece of legislation back in 2011, the Midwife Professional Indemnity Legislation Amendment Bill 2011, to fix some of those anomalies that had created a higher tax on insurers of eligible midwives. We fixed a lot of those problems, but this issue really continued for another decade. Despite meeting with midwives across my electorate and elsewhere in South-East Queensland, this continued.

The Morrison, Abbott and Turnbull governments simply did nothing, frankly. It was a Labor government that attended to this issue previously, with prime ministers Rudd and Gillard. Then: crickets, under Abbott, Turnbull and Morrison. Now we've come in here, and I want to pay tribute to the fine work of the Assistant Minister for Health and Aged Care, the member for Cooper, who's driven this inside our government. It might have had something to do with her previous vocation as a nurse and her advocacy in terms of her leadership at the ACTU as well. But I want to pay tribute to Ged. Thank you very much for the work you've done, Member for Cooper.

At the outset, I want to say that we're committed to making sure midwives are empowered. We want to make sure we have a health workforce that is satisfied and retained. We want to enhance maternity care and ensure better health outcomes for Australian women and their families. And we want to improve choice. It's not all just about the medicalisation. Midwives have been around for millennia helping women, and we want to make sure women have the opportunity of choice. But we want to make sure those midwives are properly covered. If they're privately practising with the insurance system, if they're providing home births and intrapartum care outside of a hospital, they've got to have proper insurance coverage in today's world.

So, we're acting to cover this gap by providing privately practising midwives with a temporary exemption from the Health Practitioner Regulation National Law of 2009 to ensure that they continue to provide these services and give expectant mothers choice in how they want the birth of their child to occur. The 2024-25 budget then provided a permanent solution to the Commonwealth covering the costs of professional negligence claims for eligible midwives providing home-birth services, eligible midwives providing intrapartum care outside of a hospital and eligible entities, including birth centres, employing or engaging eligible midwives to provide intrapartum care outside of hospital as part of the birthing-on-country models of care. It's my hope that, after having spoken on this type of bill before on multiple occasions in parliament and outside, this bill fixes the problem that's been ongoing for decades.

This bill builds on the budget measures we have undertaken, amending the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010, which I referred to earlier in my speech. It ensures that eligible midwives practising outside of hospital settings have access to professional indemnity insurance. Tragically, there are some people in the medical profession and hospital administration that have an almost negative approach to midwives and who haven't understood that it should be up to women to choose. I believe it should be up to a woman to choose in relation to her pregnancy and the manner in which the birth should take place. The bill provides a framework under which the government will pay 100 per cent of eligible claims for relevant intrapartum services providers outside of hospital. The expansion of the act ensures the insurance coverage is there for home births and intrapartum care outside a hospital conducted in accordance with the Nursing and Midwifery Board of Australia's safety and quality guidelines for privately practising midwives. That's really important. The bill provides scope for rules to be made to specify the intrapartum services covered by the scheme.

It also extends 100 per cent coverage to eligible entities such as Aboriginal community controlled health organisations, or ACCHOs, that employ midwives as part of birthing-on-country models of care. That's particularly important and also very important in your electorate, Deputy Speaker Scrymgour. The bill will take effect from 1 July 2025 and provide a permanent solution to address gaps in professional indemnity insurance coverage for eligible midwives. The bill supports eligible midwives to practise their full scope of practice, giving women greater choice, and I think it's important, as I said, for that access to be done in culturally safe birthing-on-country services, which is not always the case. This approach supports the delivery of safe and accessible care and reflects consultation feedback that raises concerns in relation to previous proposals to develop a definition of 'low-risk home birth'.

The bill promotes the rights of individuals to enjoy the highest attainable standard of physical and mental health as it improves economic access to maternity services. The bill provides certainty to the current professional indemnity insurer of the Commonwealth's ongoing commitment to subsidise the costs associated with professional negligence claims against eligible midwives and helps them manage claims with the government as insurer of last resort for those expanded services. Tragically, when I was a practising lawyer in my younger days, I did quite a number of medical negligence cases, some associated with the birth of children, and they were far more often in a hospital than in a home birth situation.

The legislation addresses a clear market failure, as I alluded to before, and I think this is a very positive outcome for Australian women and their families. Women can choose to birth at home with their choice of midwife knowing that professional indemnity insurance is available in the case of an adverse event. Aboriginal and Torres Strait Islander women or women pregnant with Aboriginal and Torres Strait Islander babies will have access to continuous, culturally safe birthing-on-country services with insured midwife. Eligible midwives will be able to practise their full scope of practice, offering home births and intrapartum care outside of hospital with the safety net of professional indemnity insurance.

There's been so much consultation in relation to this. As I say, this is about choice and control. It's about empowering women. It's about making sure they can choose their birthing environment. It aligns to our broader goal of gender equality and fosters an inclusive healthcare environment where women can have access to continuous, culturally safe care. It aligns with Woman-centred care: strategic directions for Australian maternity services. Of particular importance to Australian families is the fact that they need that high-quality, respectful maternity care. It recognises the need for women to make those choices.

We've made a number of reforms in this area to improve the space, to attract more people into midwifery and improve the financial viability of independent midwives. From 1 November this year, we removed the red tape that prevents endorsed midwives and nurse practitioners from operating their full scope of practice. Legislating to remove collaborative arrangements has meant that nursing and endorsed midwives will now be eligible to independently provide the full range of Medicare services and prescribe certain pharmaceutical benefits medications. This change empowers midwives to work to their full scope of practice, improving access to quality care, particularly in rural, regional and remote communities.

We've invested in the Australian health workforce by upskilling the nation's nurses and midwives through a $50.2 million scholarship. And the Primary Care Nursing And Midwifery Scholarship Program provides 1,850 postgraduate scholarships over four years for registered midwives and nurses to become nurse practitioners and endorsed midwives in primary and aged care. That program strengthens the health workforce, particularly in rural areas.

On top of this, the eligible students have access to $319.50 per week as part of the Albanese Labor government's establishment of a new Commonwealth prac payment for students to help them manage the costs associated with the undertaking of mandatory placements. This will support midwifery students to undertake their studies and, of course, address the cost of living.

We have provided additional supports, but I've got to tell you, I am very pleased about this. This is a longstanding issue that I have been involved in for a long time and advocated for, along with some of my colleagues, some of whom are not still here in this parliament. This is about the Albanese Labor government improving women's health outcomes by listening to women and addressing systemic biases in the health system against women and taking important steps to build women's health into the foundation of a stronger Medicare system.

I'm pleased to support this legislation. It's the culmination of a lot of work by a lot of advocates—too many to name. I think of the meetings I've had in my office and I think of the four that I've gone to. I want to thank all these advocates for what they've done. Know that this will help women who are fighting for greater choice in control of their bodies.

See this speech in context