Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Link to 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—

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

Ms Roxon interjecting

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

Mr Deputy Speaker, I would ask that the minister withdraw those comments, which I find highly offensive.

Kevin Andrews (Menzies, Liberal Party) Share this | Link to this | Hansard source

If the member finds them offensive, I ask the minister to withdraw.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

If he is such a delicate petal, I will.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

I think the minister should do without the preamble. It would assist the House.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

If it assists the House, I withdraw.

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

The IVF parents around the country are delicate about this issue, because for them this is the difference between being able to start a family and not. This government has, unbelievably, cut the support to IVF parents around the country. Many people will not have the capacity to make a decision to have an IVF cycle. In many cases, people have to have several cycles. I have spoken in the House before about such instances where families have had to endure over a dozen cycles to make sure that they have every chance of bringing a child into this world.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

Mr Deputy Speaker, I rise on a point of order. We are 20 minutes into the member’s speech. This is a bill about extending MBS and PBS to midwives and nurses. He has not yet brought himself to say anything positive about nurses. He is not being relevant to the bill and I would like to bring him back to the debate. If he has nothing good to say about nurses, he should sit down.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

Order! The honourable member for Dickson will relate his remarks to the bill.

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

The characterisation by the minister, just for the sake of Hansard, is a complete misrepresentation. This is a minister who has championed the cause of women around the country—and, in particular, the rights of nurses—and yet in this very bill this minister is saying to nurses and to parents around the country who are making decisions about how they will birth their children, ‘You cannot have a midwife, because we are making the practice illegal and we are exposing people to a $30,000 fine.’ This is a minister who would slap nurses in the face in this bill.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

Mr Deputy Speaker, on a point of order on relevance again. As the shadow minister already indicated in his earlier comments, the bill that deals with ‘unlawfulness’, as the member puts it, is not currently before the House. That is the registration and accreditation bill. If the member for Dickson has nothing more to say on what are momentous changes for nurses and midwives across the country then he should sit down. He is required to be relevant to the bill.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

I understand the point of order. The minister will resume her seat. I asked the member to direct his comments to the bill, which he did.

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

Absolutely, Mr Deputy Speaker. The interjections by this minister are designed only to try and run the clock down. People should understand the strategy of the minister.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

Order! The member will resume his seat. The minister, on a further point of order?

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

Yes, it is, and I know that it is difficult as the chair in this situation to be across all of the detail of the bill. This bill does not have a $30,000 fine in it. He is speaking about an entirely different bill, which is not before the House. It just shows the shadow minister’s incompetence.

Don Randall (Canning, Liberal Party, Shadow Parliamentary Secretary for Energy and Resources) Share this | Link to this | Hansard source

On the point of order, Mr Deputy Speaker: the fact is that the member is very relevant, in that IVF cycles have a fair bit to do with midwifery, I would have thought.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

I have heard the arguments. I will continue to listen carefully to what the member for Dickson says. I repeat what I said before, and that is that his remarks should be related to the bills.

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

Thank you very much, Mr Deputy Speaker. I am not getting into some petty tit-for-tat with the minister, who obviously wants to distract from the message. This is a slap in the face for those 1,800 people who made submissions to the Senate inquiry on this very bill. These people were concerned about the fact that this government is going to, by way of this legislation before the House and the national registration and accreditation process, make it illegal for parents to have a homebirth with a midwife in attendance in this country. That is unacceptable from a government and from a minister, and it is no wonder that the backlash from the backbench and from her party has been quite outstanding.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

Mr Deputy Speaker, on a point of order. I am quite happy for the member to use other forms of the House to debate what is an important issue, but it is not part of any of the three bills that we are currently debating. The shadow minister, as a previous minister, knows that he should make his comments relevant.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

It is my ruling that the member for Dickson’s remarks are relevant to the long title of the bills.

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

Thank you very much, Mr Deputy Speaker. It is no wonder that these patients, these expectant mothers, these mothers who have been through the process of homebirthing and who have experienced the benefit of having a trained midwife in attendance, are so frustrated at the approach of this government, when you see the minister’s petty interjections in relation to this speech. I cannot believe that a Labor government with the people who sit opposite, who champion the cause of choice, of the rights of women, are effectively taking away the choice of those women around the country. It is no wonder that there has been revolt in the Labor Party caucus against the minister’s decision.

This is a bad outcome for those women who have a choice. Some people agree with homebirthing; others do not. But the reality is: they have a choice to make, and the fact that this government has taken that choice away is a very sad indictment of many people within the Labor Party—not just in this place but in the other place as well. I do not care what people in the Labor Party are saying in private to homebirth mothers; they are saying absolutely nothing in public. It is worthless for them to continue to show sympathy and to say that they are going to advocate behind the scenes on behalf of homebirth mothers when not one Labor female or male MP in this place, or Senator in the other place, has spoken out publicly against this minister’s stance. I know that there are dozens of people within the Labor Party who are talking to homebirth mothers in their electorates, in Canberra and in other parts of the country, and they are saying to people in those conversations that they do not agree with what this minister is doing. She does not have the support of the caucus and yet somehow this has been rammed through on them. It is a pathetic example of representational politics by the Labor Party in this country that many of those women are not speaking up.

Whether the Prime Minister has gagged them or whether the health minister has gagged them, if these people are going to stay true to the convictions that they commit to in private then they should be coming out to provide public support to their statements and they should be talking against this particular provision by Nicola Roxon. That is the important part: this provision is by Nicola Roxon, who has championed herself as some sort of advocate of nurses yet she is saying to midwives who want to continue in the practice of homebirth that effectively they are going to be fined $30,000. That is completely outrageous.

In looking at the outcomes in this bill, I have spoken to the positive outcomes and I have addressed the issues which I think need to be addressed. We now have the benefit of the Senate inquiry report, and we will certainly be looking at the option of moving amendments until this government gets it right. Until this government gets it right, we will continue to advocate on behalf of those thousands of mothers around the country who are currently being ignored by Labor members across the country. We will listen and stand up for their rights. We will stand up for choice. We will listen to their concerns because those concerns are not limited to a handful of people. Even people who do not agree with homebirthing say that those who choose to take up such an option should have that right into the future. That this health minister would take that away certainly underscores some of the difficulties not just around this policy and around the bill that is before the House but around the general approach to the issue of health in this country.

This is a government that say one thing one day and do something completely different the next day. They have not altered outcomes for the better in health over the course of the last 18 months. All Australians know, particularly in relation to public hospitals, that the situation has got worse over the last 18 months. The situation has got worse for our good, hardworking doctors and nurses around the country. They are working in conditions in hospitals—

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

Ms Roxon interjecting

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

This is a bill which relates to midwives and to nurse practitioners; these people are working in hospitals—

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

Ms Roxon interjecting

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

Nurses work in hospitals, Minister. I did not think she was that far out of touch, but nurses work in hospitals.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing) Share this | Link to this | Hansard source

Mr Deputy Speaker, I rise on a point of order. The shadow minister is straying far and wide, but MBS and PBS items are not available to staff that work in hospitals because they are state employees and, again, he is being irrelevant.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

Order! There is no point of order.

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

The point out of all of this is that despite all the promises, all the rhetoric and all the spin lines—the way in which it was rehearsed and put at the last election that Labor had a plan to fix hospitals—I would ask people all around the country, and those nurses and doctors and other allied health professionals who are working in terrible conditions: has anything improved in your hospital over the last 18 months? Of course it has not. This is a government that have now walked away from their commitment to fix public hospitals and to make the situation better for nurses and doctors around the country. They are saying, ‘We cannot give you a guarantee—after 16 months of consultation with 10 of the country’s best health experts and despite coming up with 123 recommendations—that we will introduce any reform in health today, tomorrow, next month or indeed for the next six months.’ This is a prime minister who has now decided to go on a tour around the country for six months, visiting hospitals—

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

Order! The member for Dickson is now straying from the issue before the chair.

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

He is visiting hospitals where the hardworking nurses that we are talking about in these bills are working. These are people that deserve better working conditions and yet they have been condemned by this government to the same practices that have delivered bad health outcomes by Labor governments over the last 10 years. The pouring of more money into problems, which is always Labor’s solution, is not the solution in health—without the reform of the system. We need structural reform. We do not need good money being poured after bad. Reforms need to be made to get better health and patient outcomes. This is a government which has to start thinking about the patients. We cannot continue in this country in the 21st century to have people dying on waiting lists and to have parents waiting a dozen hours overnight in emergency departments. This is a government which still condones waiting lists that are being doctored—that are publicly acknowledged as being doctored—and fraudulently put to the Commonwealth to extort funds from the Commonwealth to fund them. And the waiting lists grow longer and longer. No wonder nurses around the country—

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

Order! The member for Dickson has now strayed beyond some reasonable bounds. I ask him to come back to the issue before the House.

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

No wonder they are expressing frustration. We need to continue to take the fight up in relation to this bill before the House. We will do that. We will hold this government to account because the Australian public knows that on health Kevin Rudd has only made the situation worse.

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

Before calling the next speaker, can I remind the member for Dickson that in future he should refer to members by their title or their office.

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

I would remind the member for Dickson that in October 2007 the Institute of Health and Welfare handed down a report, a damning critique of the Howard government’s tenure on the Treasury benches when it came to health and hospital reform in this country. Even the member for Warringah, the former Minister for Health and Ageing, had to concede that he did not attend—at a time when he was available—a debate on health and hospital reform with the shadow opposition spokesperson, the now Minister for Health and Ageing. He had to concede that they had effectively defunded the health and hospital system in this country compared to the states and territories and the private sector, which took up the slack for the failure of the Howard government.

The Howard government occupied the Treasury benches in this House from about March 1996 to November 2007. The real crisis when it came to midwives in this country developed in about 2001. We were not in office at that time. The Howard government had six years or more to resolve these issues. Did we hear any speeches from the member for Dickson in relation to the resolution of the issues concerning insurance, Medicare and PBS assistance for midwives and nurse practitioners? I cannot recall a speech on those issues during that time by the member for Dickson in relation to that. Due to the collapse of the insurance market after 9-11 and a landmark obstetrics birth injury case involving a payout of $11 million in 2002, this became a big crisis for midwives. With just over 200 privately practising midwives paying about $800 a year for insurance, there simply was not a large enough pool to fund a payout of that sort of magnitude. It is a bit rich for the member for Dickson to criticise us when those opposite did nothing for nearly 12 years to resolve these issues. It is almost like the slate has been wiped clean and the member for Dickson cannot understand what happened during that time.

This is a good reform that we are seeing today. I did not know whether the member for Dickson was supporting this legislation, the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and cognate bills, or whether he had some concrete amendments he wanted to put to the House. We heard a lot of huff and bluff but we did not see much by way of reform. (Quorum formed) It must be a pretty sorry state for the LNP in Queensland when the National Party have to protect them. Ignorance and idleness: that is what the tenure of the Howard government was when it came to assistance to midwives. I was just talking about the failures of the member for Dickson and putative member for McPherson at that time. He really does need to have a look at geography in Queensland if he wants to think about where to stand at the next election. He does not stand firmly on the side of midwives here. He might not be sure where he is standing geographically at the next election but he does not stand on the side of midwives. Midwives are supporting the three bills that are before the House.

I have spoken to members of the Maternity Coalition in Queensland. I have spoken to a number of people involved in this industry—people like Teresa Walsh, a constituent of mine. I have met with a lot of midwives and other people who are involved in homebirths in this country. I also had the privilege of serving on the local health community council with Cas McCullough, a very prominent person involved with the Maternity Coalition in Queensland.

We have taken decisive action and early action in assisting midwives and nurse practitioners. It was the Rudd Labor government, in fulfilment of what we said we would do, that commissioned a report. In June 2008 the Minister for Health and Ageing directed the Commonwealth Chief Nurse and Midwifery Officer, Rosemary Bryant, to conduct a review into the delivery of maternity services in Australia. I talked about this when I spoke to the local Maternity Coalition people in the Barry Jones Auditorium in Ipswich, in my electorate, some many months ago.

I support and have always supported the right of women to self-determination when it comes to issues of pregnancy and their birthing experiences. I believe, as a father of daughters, that it is my daughters’ right to choose in the circumstances what they do with their bodies and how they control their decision making concerning pregnancy and the birth of children. I have always taken that view because I believe it is important that we give women as much autonomy and self-determination as we possibly can.

When it comes to this issue of midwives and the assistance given to them, the report of the Maternity Services Review, which was released in February 2009, noted that Australia is one of the safest countries in the world in which a woman can give birth. There were many submissions to the review. The AMA expressed very strong views in its submission, saying that if support for funding arrangements for midwives were to be expanded it would need to be done on the basis that the services and assistance were in a medically supervised model. Many other organisations made submissions, as did many women who are involved in midwifery and nursing. The review made a number of recommendations such as the interesting one found on pages 20 and 21 of the report. There the review advised against premature support for homebirths to avoid ‘polarising the professions’ and noted that insurance premiums would be very high—and that is the reality.

In the budget we committed $120.5 million over four years to maternity services reform and $59.7 million over four years to expand the role of nurse practitioners because we believe nurse practitioners fulfil an important role in the delivery of primary health care. The bills before the House will establish a professional indemnity scheme for eligible midwives, which we believe is critical to ensuring assistance by way of MBS and PBS arrangements. We believe strongly that this will improve efficiency, capacity and productivity when it comes to our health workforce and that it is important for health and hospital reform, particularly in rural and regional areas and places like my electorate of Blair.

Nurse practitioners provide healthcare services already and prescribe medications in a number of jurisdictions. However, the legislation will enable their clients to access MBS and PBS subsidised services and medications. For midwives to be eligible to participate in the new arrangements, they will need to meet advanced practising requirements and be involved in collaborative arrangements with medical practitioners. We expect around 700 eligible midwives will participate over the next four years. We have listened to what the stakeholders, including doctors and the AMA, have said. We have taken note of their submissions and are following the recommendations of the review. We are not making homebirths unlawful and the various pieces of legislation before the House do not say that we are. But we are, as the minister said on 24 June this year in a speech to this House, removing barriers to the provision of care and we are ensuring that we improve services and the community’s access to services. We believe this is very important to enable our nursing and midwife workforce to be able to access the kind of assistance that will ensure they operate successfully in consultation with medical practitioners and the medical workforce, including in regional and rural areas. We have looked at a number of models of care and we think that being involved in a collaborative teamwork approach—particularly with obstetricians and GP obstetricians—is the best way to go forward. We think it is important to listen to what the doctors had to say on this and to take note of the more than 800 submissions. As the minister said in her speech, we have ‘listened to the collective voice of Australia’s mothers’ and also look forward to the viewpoints of midwives across the country.

We are changing the laws to benefit women across the country, and I think an insurance scheme is very important. We see insurance schemes for all kinds of professional organisations: for example, lawyers, engineers and doctors have professional insurance schemes. One of the bills before the House, the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill, is important in providing insurance, as there has been no professional indemnity insurance product for midwives since about 2001. The legislation sets out thresholds that apply in claims against eligible midwives. For claims more than $100,000 but less than $2 million, the government will contribute 80c in the dollar and for claims of more than $2 million the government will contribute 100c in the dollar. That is important to ensure that people who have been injured or become ill as a result of, say, negligence by midwives get access to insurance. As someone who was a practising lawyer for a long time, I was involved in many medical negligence cases over the years. I can say that getting access to insurance funds and insurance assistance is critical in personal injury cases. This is particularly so where a child is injured during its birth. Such instances can have catastrophic long-term effects for the child and involve a lot of very costly care. That child may suffer not just pain and suffering but also economic loss of a catastrophic nature. For example, houses in which that child may need to be cared for will need modifications and very specific requirements.

There are issues concerning homebirths, and I have been one who has advocated strongly for homebirths in the past. My wife and I chose to have our children in a hospital setting, but I recognise the right of women to choose their own birthing experience. The Maternity Coalition in Queensland has provided me with some information concerning the rate of homebirths. According to the Australian Mothers and Babies report, in 2006 there were about 708 homebirths in Australia, but that report noted that homebirths are not always recorded. There were about 20,548 homebirths in the UK in 2007, which represents about 2.7 per cent of all births, according to the UK Office of National Statistics. The homebirth rate in New Zealand is estimated by the New Zealand College of Midwives at seven  per cent and the rate of homebirths in the Netherlands is approximately 30 per cent.

The situation is that women have the right to choose, and I believe that is the case. The minister has publicly said on numerous occasions that she recognises that a very small proportion of women would like to have homebirths, and she is currently investigating some way that this can be provided as an option, making it possible without making the indemnity insurance unaffordable. I urge the minister to work with all stakeholders to ensure that this issue can be resolved.

The shadow minister, the member for Dickson, raised a number of issues outside the scope of this particular series of bills that is before the House. I have no intention of discussing those in the middle of this speech, but what I will say is this: this is a very significant reform by the Rudd Labor government. Despite nearly seven years of the Howard government knowing about the issue of insurance and knowing about the troubles and travails in this industry they did absolutely nothing, so it is a bit galling for the shadow minister to come in here and give us lectures in relation to this particular issue. I urge the minister to continue to work with stakeholders, with midwives, with women who want a homebirth and with doctors and nurse practitioners across the country to ensure that women have the option and the right to determine how they will undertake what is honestly a beautiful experience, the sort of experience that they will cherish for the rest of their lives—giving birth to their children. Those of us who are parents in this place can remember and will always remember, however long we live, those occasions when our children were born—holding a young baby in our arms and realising the responsibility that we have for that child.

This is a sensitive and delicate issue and it needs a lot of attention and care. I commend the minister for this very significant reform and I urge further consultation to resolve any currently unresolved issues in relation to the matter.

Darren Chester (Gippsland, National Party) Share this | Link to this | Hansard source

I rise to speak in relation to the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related bills. I note at the outset the very diplomatic way in which the member for Blair concluded his speech in relation to the need for further negotiations. Without wishing to put words in his mouth, I think he was calling for some further consideration of the issue of choice, which I will get to a bit later on.

I note also at the outset that this is a complex and somewhat emotional issue for many people involved in the debate. Despite the fact that it is legislation which I do not believe adequately deals with the opportunity for Australian women to choose to have a homebirth in the future, I must say that I agree with most of the measures that are contained in the bills. During her second reading speech the minister highlighted the fact that the bills before the House will facilitate access by patients of appropriately qualified and experienced midwives and nurse practitioners to the Medicare Benefits Scheme and the Pharmaceutical Benefits Scheme. The bills seek to remove barriers to the provision of care and, like the minister, I am hopeful that this will lead to improved access to services for the community, particularly in regional areas, which I am most passionate about, where it is already very difficult to recruit and retain a range of health professionals. I see some opportunities coming out of these bills that may assist regional communities.

On that point, I would like to highlight an issue of major concern to residents of the Sale district at the moment, the impending closure of RMIT University’s nursing course in Sale. Like many other regional areas, Gippsland has a marked shortage of qualified health professionals. Just this week there was another letter to the editor in the local newspaper from a young mother who could not get her daughter in to see a GP in either Sale or Maffra. The baby was eventually diagnosed with pneumonia. Lack of qualified health professionals is causing health issues, which are always of great significance in regional communities. Causing great distress in my community is the news that RMIT University will end its partnership with the East Gippsland Institute of TAFE and no longer offer a nursing course in Sale. It will not accept any new students from next year, which is a cause for concern, but there is also a long-term impact on nursing resources in our region.

Of immediate concern, though, is the commitment which has already been made to the 40 students who are in their first or second year of study. These students have committed to the three years of the course and are now being told they will have to travel to Churchill or Bundoora to finish their studies. The students are coming to me most upset by the changes, which have been made mid-course. Many are mothers who need to be in Sale to collect children from school or who have part-time work commitments that will not allow them to make the trip to Churchill on a daily basis. Common sense would suggest that we need to do whatever we can as a community to make sure that these students get to complete their course at Sale, as we can benefit from having 40 or more qualified nurses with ties to our local community.

I have written to the state and federal health ministers to seek their support in this regard and I met with the minister’s office today. I must say in commendation to the minister and her staff that the process of having a drop-in centre regularly on the Thursday of sitting weeks is very much appreciated by backbenchers like me. It provides an opportunity to meet directly with her and her staff to raise issues of concern in our electorates. I commend the minister for taking the initiative and I encourage other ministers who may be listening today to consider the opportunity to do so themselves. It is a brief drop-in service, but the five minutes spent face to face with the minister can overcome a lot of concerns or issues within our communities.  It helps to build a better bridge between the parties and also to inform the minister regarding issues on the ground, which I think is of benefit to her and her staff. As a backbencher I certainly appreciate the opportunity to raise those issues directly with her.

Looking to the future, I believe there is a very real threat of not having enough nurses to service our local health systems throughout regional Australia. MPs from regional areas all understand that the evidence reflects that with the opportunity to train our own kids in the health professions there is more likelihood that they will return to offer those services to our communities in the future. The cancellation of this particular nursing course has been compounded by the proposed changes to youth allowance, which will leave many locals unable to afford to attend university. We need to explore all the options we can to create more opportunities for our young people to be trained in the local community and to overcome the accommodation and cost-of-living pressures which place a disproportionate burden on rural and regional students. I urge the government to work with RMIT to allow those local nursing students to complete their studies at Sale and to work with the East Gippsland Institute of TAFE to secure future opportunities for nursing and other health studies at Sale.

Returning directly to the legislation before the House: as the minister has stated, it is long-overdue recognition of our nursing and midwifery workforce. Coming from a regional area, I have seen first-hand the amazing contribution our midwifery workforce makes in maternity services. We have seen a situation throughout regional communities where there has been a gradual closing of birthing centres right across regional Victoria. I reflect on the situation I have in my electorate in the far east of the region, at Orbost. At a time when there are a lot of birthing centres being closed down around regional Victoria, the Orbost Regional Health service is taking steps in a completely different direction by increasing the number of births at Orbost. It has a very strong team of midwives leading the service, with professional support provided, I believe, through the Bairnsdale Regional Health Service. It provides a great opportunity for the mums in the Orbost community to not have to travel so much in order to give birth. I commend the Chief Executive Officer of the Orbost Regional Health service, Therese Tierney, and her approximately 150 staff based in Orbost and the services they provide to our community.

I want to spend time—as I believe many others will—in this debate focusing on the one area where the bills do not really accommodate my real concerns, which relate to the issue of midwife assisted home births. Under the maternity reforms, the government is refusing to extend these new arrangements for midwives to include home births. I quote directly from the minister’s speech:

Medicare benefits and PBS prescribing will not be approved for deliveries outside clinical settings, and the Commonwealth supported professional indemnity cover will not respond to claims relating to homebirths.

I accept again from the outset that there are many complex and competing issues to be addressed in this entire debate but we must, I believe, begin by setting aside our own personal prejudices. I come to this debate with only a small level of experience—four times in hospital for four healthy, beautiful young children. Our birthing experiences were very positive. I would suggest my wife and I did not even give a second thought to the idea of home birthing. It is something that certainly would not have crossed our minds as a personal choice. In both Sale and Bairnsdale, where we had our children, we had access to highly regarded obstetricians and an excellent team of nurses and midwives throughout the entire experience. As much as you can enjoy the experience, we did—perhaps me more so than my wife, I would have to admit. My wife certainly enjoyed the continuity of care that was provided. Being in a regional setting, we had close contact with the staff at all times, and the obstetrician was available at various stages during the labours. But the midwives in particular were on hand throughout each of our children’s births, and we could not have been happier with the outcomes.

But this is not always the case. I respect the right of a woman to choose, within reason, when, where and how she decides to give birth. This is a complex and—I agree—an emotional issue, and far be it from me, particularly as a man, to be telling women what is best for them or how they should plan to give birth; I see that the member for Ballarat, who is in the chamber, is nodding in agreement. Unfortunately, that is exactly what these bills before us seek to do. The bills effectively rule out home births as an option in the future. There is a very real risk, I believe, that such births will continue and that they will be forced underground. I think that is a less than ideal scenario, which I believe the minister herself has publicly acknowledged. It is a genuine concern for the mothers, babies and the government itself. I do acknowledge the minister has been questioned on the topic in the media. I think she is very conscious of the concern in the community that, if this results in the practice of home births being forced underground, that is not a desirable result for anyone—certainly not the minister or the government. The question before us is how we can prevent getting ourselves into a mess in this regard.

Under the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill, the minister claims that the bill will improve the choices that are available to women in relation to maternity care. As others have indicated already—and I do again today—the one choice that is effectively being ruled out is home birthing. The bill establishes a scheme to provide professional indemnity insurance cover for eligible midwives at an affordable cost, and I think that is a positive move. For the purpose of the bill, the definition of an ‘eligible midwife’ is one who is licensed, registered or authorised to practise midwifery under a state or territory law. The failure to extend the cover to midwife assisted home births needs further explanation, I believe, by the government. Has that decision been made on the basis of cost alone? If so, what modelling has been done to support that decision and has it been released publicly? But if the decision is based on the issue of medical risks then that argument needs to be debated more in public. Like many others, I have read information from both sides of the debate and I am not convinced that the risks are as great as some people in the medical profession like to present. I believe there is an element of a medical turf war behind some of the rhetoric that is used to discredit home births at the moment. Again I indicate that, as a personal choice, my wife and I would never have chosen to put ourselves in that homebirth situation but that is a choice we had the opportunity to make. I am not convinced that we are doing the right thing today by the women who choose to have a midwife assisted home birth.

I would like to spend a bit of time referring to the commentary about this issue as it has appeared in the popular press in recent times. In the Sunday Herald Sun there was a debate on the issue between a highly respected obstetrician, Peter Mourik, and the Homebirth Australia spokesperson, Justine Caines. Dr Mourik is, as I said, a highly respected obstetrician who has done some great work in regional Victoria. He supports the government’s position and believes the ruling will stop women from taking unnecessary risks. Dr Mourik says:

Women who choose to give birth at home expect everything to be normal but they don’t consider how far they are from expert help or even notify the ambulance service that they may need urgent assistance. 80 % of women can have their baby in a paddock but the problem is choosing these women. You just never know what will happen.

I am not for a second going to argue with Dr Mourik’s assessment. As I said, he is a highly respected obstetrician. But I will say that the midwives whom I have met with, and their clients, are also very aware of the potential risks. It is their belief that the continuity of care that they can provide allows them to follow a birth plan which acknowledges these risks and recognises when to seek further medical attention if required. They are absolutely passionate about the health of the mother and the baby and they make their assessments on whether it is appropriate to go ahead with a home birth at every step of the journey, in discussion with the family members.

Of course, things can go wrong—they go wrong in hospitals too—but the midwives I have met with would never proceed with a homebirth if they assessed the situation to be at a higher risk than normal. These women who choose a homebirth are so passionate about that choice that I believe they will go ahead with it anyway regardless of the government’s ruling on access to professional indemnity insurance for midwives. As Justine Caines argued in that same article I referred to earlier:

Women will still choose homebirth. Many mothers have had bad experiences in hospital and won’t repeat that. Why does the government fund women who are choosing to have c-sections but not women who are choosing to give birth at home?

Homebirth Australia would like the government to present a package for pregnant women that works a bit like the baby bonus. Every woman would be given a sum of money to spend on her pregnancy treatment, then it’s up to her whether she sees a midwife at home or an obstetrician in a hospital. It is putting the choice back into women’s hands.

Even under that scenario, there is no question in my mind that most women would still choose to give birth in a hospital, and that, of course, is their right. But I wonder: who are we to be taking away a woman’s right to choose a homebirth, as we are doing with this legislation before the House? By excluding midwives practising homebirths from the professional indemnity insurance cover and making insurance a condition of registration, we are effectively, if not technically, making it unlawful. Being subject to a $30,000 fine is certainly a huge discouragement to the midwives. I hold grave fears for the health and safety of women and their babies if we do in fact force homebirths underground.

The Senate Standing Committee on Community Affairs Legislation Committee received 2,000 submissions when it inquired into these bills. That is an amazing response, and it reflects, I believe, the level of community interest and the absolute passion in this debate. The submissions were primarily from midwives who provide homebirth services and from parents who described their experiences with homebirth and support for homebirths. The proposed legislation was generally supported in the submissions, but again the issue of the government’s failure to accommodate people who choose homebirths was a stumbling block for many of the people who made submissions. I quote from that Senate report:

Many submitters commented that homebirths will still occur but with an unregistered care provider who may or may not have qualifications or without any assistance.

One submission warned:

If homebirth is not available through registered midwives, the reality is that many women will still choose to birth at home either unsupported or with the help of nonregistered midwives—this will likely worsen outcomes for mothers and newborns.

Concerns were also expressed by a number of witnesses to the inquiry that the proposed changes would lead to an increase in free birthing—that is, giving birth without a trained care provider on site. I would suggest that this would be the worst possible result. If a certain cohort of mothers feel their choices have been taken away from them and they are attracted to free birthing without any trained support, I fear for the safety of the mothers and their unborn children. I do not wish to be scaremongering on the topic by any stretch of the imagination, but that is a genuine and legitimate concern. Mrs Elizabeth Wilkes, from the Australian Private Midwives Association, commented:

The disasters of women turning up bleeding, with babies unable to be born or whatever else that people are concerned about will certainly increase if this legislation goes ahead as it stands.

We cannot say that we have not been warned when we have people in respected positions within the industry—if it can appropriately be called an industry—coming out and giving quite cautionary tales to members both on our side of the House and within the government.

It is also fair to say that, much as we have been warned, the medical profession is deeply divided on this issue. The President of the AMA, Dr Andrew Pesce, stated to the inquiry:

The government was absolutely correct when it decided not to extend these bills to cover home births. The fundamental goal of maternity care must be a healthy mother and a healthy baby … It is not appropriate for the Commonwealth to introduce payment and insurance arrangements that encourage or sanction activities that inherently carry more risk.

That position that it inherently carries more risk is disputed by many on the other side of the debate. There are many competing views, but the one point that they all agree on is that the welfare of Australian mothers and their unborn children must be paramount in our considerations. That is why I am uncomfortable with the failure of these bills to recognise the right of a woman to choose a homebirth with a qualified and registered midwife. If we do force this practice underground, we will regret the day that we voted to make it harder for women to choose a homebirth.

In recommending that these bills be passed, the Senate committee acknowledged that the minister is currently working with the states and territories on potential options to prevent homebirthing from going underground. The committee says that this will include investigating indemnity options for homebirths that could be progressed without making the insurance unaffordable. But I repeat my earlier comments: I cannot recall the minister actually releasing any facts and figures to suggest that it is unaffordable or impossible to progress the issue immediately.

I note that the Victorian government is attempting to come up with its own solution, and a report in the Age newspaper on 9 August describes a pilot program where the state government will work with two Melbourne hospitals to provide for midwives assisting in homebirths to be covered by the hospitals’ own indemnity insurance. That does sound like a positive move, and it may be a compromise position that can overcome this hurdle that we are confronted with. The Victorian scheme is expected to start next year, and homebirths will be restricted to low-risk pregnancies, although I must say that my understanding from discussions with midwives in my electorate is that homebirths are already setting that standard of working only with low-risk pregnancies. The pilot involves only two Melbourne hospitals at this stage and will not offer any comfort to the people in my electorate who are concerned by the legislation before the House. In any case, there are already midwives who have gone on the public record saying they do not want to work under that hospital system or situation again, so I believe it is an intractable position.

In conclusion, I would like to express my support for that fundamental right of choice in relation to this issue. I acknowledge, as do the registered midwives I have met with, that homebirthing is not an appropriate option for all women, nor is it the choice of the overwhelming majority of women, but it is the choice of a small number of Australian women and, if it were properly accommodated in the legislation, there would be the possibility, indeed, that more women would take up the option in the future. It is not something, as I said, that I would aspire to with my wife, but we are kidding ourselves as members of parliament if we think that homebirths will stop as a result of these bills going before the House. I am genuinely fearful of the impact the legislation will have if it forces the practice underground or leads to the more risky practice of free birthing. It is not in anyone’s interests for that to happen. I think the member for Blair put it very well: childbirth is an intensely personal experience, and the decisions which are made by expectant mothers need to be supported within reason.

No disrespect intended, but I am unconvinced by the mainstream medical profession’s more extreme arguments against homebirths. I accept there is an element of increased risk in some circumstances, but it is entirely manageable in the majority of cases with the care and attention of a highly qualified and registered midwife. I cannot escape from the fact that women should have choice when it comes to deciding what they do with their bodies, and that extends to the issue of childbirth. I strongly urge the minister to continue working with the states and territories to resolve the issue of indemnity insurance and amend the legislation to allow existing services to continue to be offered.

I will give my final comments to the convenor of the East Gippsland Birth Support Group, Cath Lanigan, who has written to me in relation to these bills. Cath lives in Metung, a beautiful village on the Gippsland Lakes. She says:

Only a small percentage of women currently seek homebirths but that doesn’t mean it’s not important or should be disregarded. It provides a choice which enables birth to be a very natural, normal event which in the vast majority of cases it is.

It provides women with the choice to involve other family members, midwives they know and trust, have their own autonomy, and the chance to have one of the most intimate moments in their life in the comfort of their own home surrounded by people who are invited to be there.

Cath continues:

I had a home birth with my second child, here in Metung, and I know what a beautiful and positive experience it can be for mother, baby and family. It would be an absolute travesty if this option was no longer available as a choice.

Ms Catherine King (Ballarat, Australian Labor Party) Share this | Link to this | Hansard source

I rise in support of the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and associated bills. These bills facilitate the inclusion of nurse practitioners and midwives under the Medicare Benefits Scheme and the Pharmaceutical Benefits Scheme. The bills also enable the establishment of a professional indemnity scheme for eligible midwives, which is critical to support the new MBS and PBS arrangements.

The purpose of the bills reflects the government’s commitment to improve maternity and primary care services. I think it is disappointing that the many positive aspects of these bills, which will make a significant difference to women’s access to midwifery services, have been overshadowed by concerns about homebirth. I will seek to address the issue of homebirth later in my contribution but I want to put on the record early my support for women’s decisions to homebirth. I thank the many women—and, on one occasion, a man—and their children who have come to see me and share their very personal experiences. I understand their concern that some of the provisions of these bills have created an issue with regard to homebirth and that we, as a government, need to continue to work to find a solution.

That said, I want to put it on the record that I absolutely support the extension of midwifery services in these bills. They will improve the health of women and their newborn children, and they give substantial support to women at one of the most wonderful but also challenging times of their lives. I think it is a great credit to the government that it has recognised that and is moving to allow the extension of midwifery services to a whole range of women who have previously not been able to access them. (Quorum formed) These bills improve health services for our community by utilising our highly skilled midwives and nursing practitioners.

This government has come a long way since being elected. We have come a long way in delivering on our election commitment to develop a national plan for maternity services in this country. That is, in essence, what these bills represent. Our processes have been open and transparent. In June 2008, the government called for a review of maternity services. The review received hundreds of submissions. We heard submissions from individuals, health professionals, non-government organisations, academics and others. The entire nation wanted to participate in the consultation process. It is an extremely important issue.

The level of community interest outlined the passion that Australian people have to participate in serious health reform. The report was delivered to the minister in February 2009, and it noted the great quality of our nation’s health system, which can be accessed by women giving birth. But the report noted that there was room for improvement. The report noted that the government could put measures in place to further assist women in need of maternity care.

In response to the review, the government announced $120.5 million for maternity services as part of the last federal budget. The announcement was part of our reforms to the health and hospital system. The package supports the maternity services workforce and assists Australian women with access to greater choices in maternity care. That is what the maternity services reform package is about: giving Australian women choice. We are working to provide Australian women with better access to services and a greater level of flexibility in the health workforce. This package recognises he central role midwives play as part of the birthing process. The package includes the introduction of an indemnity insurance scheme for eligible midwives, MBS and PBS benefits for services provided by those midwives, an expansion of the Medical Specialist Outreach Assistance Program, an increase in scholarships for GPs and midwives to address this critical area of need and a telephone helpline and information service to provide women and their families with an avenue of communication to discuss maternity information.

As part of our reforms we also announced $59.7 million in the 2009-10 budget to fully utilise our highly qualified nursing practitioners. On 24 June the minister introduced these bills into the House for debate in recognition of the importance of addressing long overdue reform in our health system. I support these bills as they allow for the inclusion of midwives and nurse practitioners under the MBS and PBS schemes. The legislation allows for nurse practitioners and appropriately qualified and experienced midwives to request diagnostic imaging and pathology services to be paid for by Medicare. The legislation also allows such nurse practitioners and midwives to prescribe certain medicines on the Pharmaceutical Benefits Scheme. As I have earlier said, even in the face of the global financial crisis this government has put health and hospital reform at the top of its priority list. I would like to commend the minister as she has worked hard since the election to address significant inefficiencies across our health and hospital system. This is certainly a step that will make a significant difference to the many women and families giving birth across this country.

These measures seek to address some of the health workforce issues by utilising the expertise that currently exists among nursing practitioners and midwives. The number of nursing practitioners has steadily grown over recent years, with over 350 currently working across Australia. These highly qualified health professionals have proven crucial across our health system. Midwives play an integral part in our society. They work with women across all communities to give them vital support and professional advice throughout the birthing process, from pregnancy to labour and to post-pregnancy. I want to put on the record my own personal thanks to the midwives who cared for me when I gave birth to my son more than 12 months ago, to the midwives at my obstetrician’s consulting rooms, to Ballarat Health Services, where I chose to give birth, and particularly to Kathy Taylor, who has been a midwife for a very long period of time. As a new mother, and as an older parent, I found the experience a very difficult one, and having a highly experienced midwife helping me throughout the processes, particularly afterwards, was certainly something I valued. I think that every woman should have the opportunity to receive that assistance. I engaged Kathy in a private capacity, and I think that other women would certainly benefit from having more access to maternity care.

I would like to touch on the issue of professional indemnity insurance for eligible midwives and also on the issue of home birthing. Firstly, it is important to note that none of these bills make homebirth unlawful. Despite what is being said by those opposite, none of these bills actually make homebirth unlawful. Instead, these bills deliver greater support for nurse practitioners and midwives—support that will deliver greater choice for Australian women. The separate draft bill, to establish a national registration and accreditation scheme for health professionals, carries a proposal which will require health professionals from the 10 professions covered to carry insurance as a condition of registration.

This draft bill has been developed by COAG and is not yet before any parliament. I think most people who have been involved in either the law or medicine, or who have been consumers, will know that it is really important that any professional have a form of public liability insurance. It is extremely important, as we get into a society that is increasingly litigious, or where things go wrong, that there be an insurance product around and that people be protected by professional indemnity insurance. It is the interaction between the registration and accreditation scheme, the requirement for insurance and the lack of any affordable insurance product for private midwives assisting women to homebirth that has created the difficulty for homebirths. There is nothing inherent in this legislation that makes homebirth unlawful. Whilst it is only a very small proportion of women who choose the option of homebirth, as I stated at the outset this choice is just as valid and important as the birthing choices of women who do not homebirth. I am assured that the government is currently working with the states and territories, and the minister is working with her department, on this issue. It is certainly an issue that I wish to keep a close watch on.

That said, I want to again stress that in these bills the government is providing more choice and options for mothers than any previous government. I think it is unfortunate that the focus has been on the issue of homebirth, almost to the exclusion of the other really terrific things that are in this bill for women giving birth in this country. The whole issue of pregnancy and birth is fraught with politics—it always has been. It is important that this issue be regarded for what it is—it is not a debate about women’s choices versus women’s choices, and it should never be that. It is an issue about how to ensure that we have good access to maternity services across this country for women. The policy intention of the government in undertaking the maternity services review has been to make sure that women do have access to the best possible maternity services. That is what this legislation is about. The issue of homebirth has arisen and the government is seeking to resolve the issue. But the government’s intention in these bills is actually to improve substantially the health of women and their children across the country.

I would like to outline briefly some of the supportive things that other people are saying about this legislation. The Federal Secretary of the Australian Nursing Federation, Ged Kearney, stated:

The government has taken a practical, common sense approach to helping more people get safe, effective health care.

Dr Barbara Vernon, the Executive Officer of the Australian College of Midwives, has stated:

This national legislation recognises for the first time that midwives make a valuable contribution to maternity care in their own right. Evidence confirms that women who receive continuity of care from a known midwife have shorter labours, less need for surgical interventions during birth, reduced rates of admission to special care nursery for their babies, reduced vulnerability to postnatal depression and higher rates of breastfeeding.

I am very proud to be part of a government that for the first time is providing access to the MBS and the Pharmaceutical Benefits Scheme for nurse practitioners and midwives. These bills are not only good news for nurses and midwives; they are also extremely good news for patients. These changes bring to patients equal choice and convenience in terms of their birthing experience. Patients will now be able to receive referrals and tests from qualified midwives and nurse practitioners. This change will dramatically improve our nation’s maternity services system.

I want to briefly reflect on just how fantastic those services are when you have some comparison to the experience of women in countries which are not very far away from us that the Parliamentary Secretary for Pacific Island Affairs, who is here at the table, visited. I acknowledge in my own electorate the work of Zonta and the Ballarat Health Services, who have been putting birthing kits together for a long time now for the women of East Timor. I think if anyone gets an opportunity to go and participate in that experience you will get a pretty short, sharp reminder of just how the birthing experience is for women in the Pacific versus women here.

I think, whilst we are having this debate in this parliament, it is worth reflecting on just how lucky we are to be giving birth in this country. It is fantastic to see increased support being given to women’s birthing experiences in countries who are our neighbours, and certainly we should take the opportunity to thank organisations like Zonta but also to recognise that not everybody’s birthing experiences are as high quality as the medical care that we have here in this country. I just wanted to put that on the record. We are extremely fortunate in this country to have such fantastic access to maternity services. I think the changes that are part of these bills really do put our nation’s maternity services in the top of any in the world. It is a fantastic opportunity for us to have such access, which we have not had previously, to midwifery and nurse services as provided in this bill.

I look forward to the support of my parliamentary colleagues on this side of the House and hope that members opposite can support our nation’s highly skilled nurses and midwives that are represented in these bills. The government has proposed significant changes to the Medicare benefits schedule and the pharmaceutical benefits schedule to utilise our health system at a greater capacity. The government reforms are about providing a health system for the 21st century. These bills go a long way towards achieving this, and I commend them to the House.

Luke Simpkins (Cowan, Liberal Party) Share this | Link to this | Hansard source

It is not my intention to speak for very long, but I will make a contribution to 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. As a father, I have some appreciation of the subject of childbirth, but I am also thankful for not having had to have gone through the process. Not only do we as men not have to endure the pain—or as the medical professionals might call it, ‘discomfort’—but we do not have to endure the hormonal challenges that make a woman’s pregnancy even more of a difficult experience. What I do recall is the sense of fear I had at the birth of my two daughters as to whether everything would be all right. The experience for a father is that of physical detachment, but with a great degree of emotional concern. What is abundantly clear is that a man faces very little in comparison to the woman. Therefore, in my comments today I will seek to empathise, but I could never speak with the authority that comes with a woman’s experience and point of view regarding midwives and the bearing of children. Nevertheless, I take this opportunity today to make some comments on these bills. Like many others in this place, I support them in the main, but there are elements within this policy that I cannot say that I wholly support. However, I will be a little more specific later.

Before I go to the substance of the bills, I would just like to reflect on my limited but nevertheless valid experience in two hospitals and with the midwives at those two hospitals. My eldest daughter, Emily, was born in 1998 at the John James Hospital not far from here when I was posted here in Canberra in the Army. I was keen for Emily, being our first child, to be born in a hospital to ensure that, if anything went wrong, she and my wife, Kelly, would have access to immediate and substantial care. This was in spite of the fact that there was no indication of any likely problems. Being careful with my children’s safety began then and explains why later, whenever Emily or her sister, Rebecca, were climbing on play equipment when they were toddlers, I was always right behind them, ready to catch.

Similarly, despite no indications of any risk, there was no doubt in my mind or my wife’s mind that our second daughter would be born in hospital as well. My second daughter, Rebecca, was born at Glengarry Hospital in Perth in 2002. Our experiences of both of these hospitals were outstanding. The midwives did all the medical and professional health work to support my wife in the delivery and in the days afterwards. I therefore have the very highest confidence in the skills, training and professionalism of the midwives and the nurses that we had contact with in those two hospitals. In our local area in Cowan I have never heard a complaint about the work of nurses. Indeed, that confidence extends to the Joondalup Health Campus, which is the major hospital in the northern suburbs of Perth.

That being said, we never considered homebirth, and if we were intending to have more children we would still not consider homebirth. That is, above all, a matter of choice. I believe very much in free choice and the making of decisions by the mother and the father with due regard to and acceptance of the risks that are involved. I repeat that it is not a decision I would make, but there are very many people who stand by the advantages of homebirth. If that is a decision they wish to make, then no government should make that impossible or harder than it should be. Clearly then, while I support the majority of the changes foreshadowed in these bills and plans to come from the government, I see that amendments or changes would be required to those plans to maintain the options that some parents seek for having their children born at home.

I will now make some specific comments about the bills. As I previously stated, I support the majority of the items in these bills. Access to doctors, access to diagnostic tests and access to treatment options are clearly detrimental to the best possible health outcomes if they cannot be achieved within reasonable time frames. The authority of midwives and nurse practitioners to assume responsibility for some of these needs should allow better time frames for action on health concerns.

The legislation will give registered midwives and nurse practitioners the capacity to order certain diagnostic-imaging and pathology tests, for which a Medicare benefit can then be paid. The legislation will also allow these midwives and nurse practitioners to prescribe certain medicines under the PBS. The midwives and nurse practitioners will also, when they are working in collaborative arrangements with doctors, have new Medicare items and referrals listed under the Medicare Benefits Schedule. The bills that cover indemnity insurance matters will allow the Commonwealth to reach a contract with an insurer through a national tender process to provide indemnity insurance for midwives operating independently.

Clearly there are significant changes provided for in these bills. It is known that not all stakeholders support every part of the legislation. That is why the coalition supported the consideration of changes by a Senate committee. Unfortunately, the workload and number of submissions, being more than 200, have caused a delay in the finalisation of the report by the Senate committee.

I will now take the opportunity to mention some of the comments made by stakeholders with regard to these bills. I note that the AMA disagree with aspects of these bills, particularly where midwives and nurse practitioners would have access to the MBS and the PBS. They also believe that patient care should be coordinated by a medical practitioner. However, given the decision to pursue these changes, they want to have involvement in the details of the regulations to be created. On the other hand, the Rural Doctors Association have broadly supported the changes regarding access to the PBS and the MBS. However, they also ask for controls and guidelines to ensure good communication between doctors and midwives and nurse practitioners. Both the AMA and the Rural Doctors Association oppose homebirth. The Australian College of Midwives support the bills. However, they want provisions to allow homebirth options. It is worth noting that the college recognises that homebirth is not appropriate in complex or higher risk cases.

The issues raised by stakeholders seem to be consistent. The points raised generally support midwives and nurse practitioners having access to the PBS and the MBS under certain controls and provisions. The division comes with the increased physical separation between the activities of midwives and nurse practitioners and those of doctors. Doctors are less inclined to support midwives and nurse practitioners providing patient care when doctors are not in the immediate area, which explains their complete opposition to homebirth under the supervision of midwives.

The government have negotiated the middle path in this situation with the stakeholders. They have sought compromise on both sides. Where I object is that the choice of homebirth is basically prohibited under plans regarding registration and accreditation. I reiterate that my wife and I would never have sought the homebirth option, but some women do. If they examine and are willing to accept the risks involved in taking that decision then such a choice, which currently exists, should never be taken away from them. It is my view that the government should reconsider their registration and accreditation plans.

To conclude, I thank my constituent Kiera Pedley and others within the electorate of Cowan for bringing to my attention their concerns and perspectives on homebirth. As I said right at the start, childbirth is certainly not an experience that we men ever have to go through—and I for one am pretty happy about that! Provided women understand the risks and the challenges of homebirth then they should always have that choice, and we on this side will always support that choice.

Sharryn Jackson (Hasluck, Australian Labor Party) Share this | Link to this | Hansard source

I am delighted to speak in support of the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and two related bills, all of which concern midwives and nurse practitioners. These are three progressive pieces of legislation which in my view go beyond tinkering at the edges to genuinely reforming our health system, which the Labor government has recognised is at a tipping point.

Before dealing with the specifics of the legislation, I would like to say I am absolutely delighted with some of the federal government initiatives that we have seen in the health portfolio. Last December we saw $64 billion in the new health and hospitals agreement signed with the states. We have also seen the recent report of the Health and Hospitals Reform Commission, and I look forward to participating in discussions in my electorate regarding its recommendations. We have also had community consultations in my electorate regarding, in particular, the establishment of a GP superclinic, and I am pleased to say that the Minister for Health and Ageing has indicated that we can expect a decision on that soon.

There is also intended to be consultation on the Health and Hospitals Reform Commission recommendations at the Swan District Hospital at Midland in my electorate. We will be very pleased to welcome that discussion at our local hospital. I was also delighted with the announcement in this year’s budget of some $180.1 million of Commonwealth money going towards building a new Midland Health Campus in my electorate, a facility that is long overdue and that will ensure many more patients in my electorate get access to acute levels of care. I look forward to working with not only the Commonwealth government but also the state government and my local government in the City of Swan to see the Midland Health Campus come to fruition hopefully no later than 2013.

I have some wonderful healthcare professionals in Hasluck many of whom have been very supportive of these reforms and of this particular legislation. They provide wonderful care to our community from cradle to grave. In particular, I refer to the Division of General Practice in my electorate, the Perth Primary Care Network, formerly the Perth and Hills Division of General Practice, and also to a particular practice in the suburb of Midland, the Swan Medical Group. These organisations have been in advance of many others in their profession in supporting, recognising and acknowledging the role of nurse practitioners. Indeed, they run very efficient and responsive practices in my electorate already using the professional wisdom and competency of nurse practitioners. They were early advocates for nurse practitioners and I know that they join with me in being very pleased to see this legislation put before the Australian parliament. I know how stretched some of their resources are. Sometimes, unless you are prepared to wait, it is difficult to get an appointment. Nurse practitioners are part of a strategy of ensuring that there is better access to those primary care services in my electorate.

At a personal level I am delighted to see this legislation come to fruition. I was involved in the mid-1980s in discussions in my home state of Western Australia regarding the transfer of nurse education from the hospital sector to the territory sector. That was a very important move in recognising the complexity of their work and the high level of tertiary knowledge required by our registered and enrolled nurses to practise competently in our hospitals and healthcare settings. That is 20-odd years ago now and in those days nurses were often faced with very heavy stereotypes and were, frankly, treated in some cases as the handmaidens of general practitioners and doctors in our healthcare system. I am very glad to have seen the changes in attitudes that have developed over the past 20 years.

Unfortunately, some of those stereotypes have not changed with respect to the fixing of nurses’ wages and conditions. Whilst again I acknowledge that we have come a long way in those 20 years, we are still a long way short of pay equity for nurses in all of their capacities. The ones closest to my heart are enrolled nurses who have an associate diploma and perform a very vital role in our healthcare system. They are often not recognised for their highly skilled contribution to health care. I have been very closely involved with this profession for over 20 years and it is with great pride that I speak in favour of this legislation which will empower midwives and nurse practitioners to operate as professionals in their own right and to provide the best health care to Australian communities.

This legislation has received wide-ranging support. It has support from the Australian Medical Association, the Australian College of Midwives, the Australian College of Nurse Practitioners and various associations of healthcare professionals. It is receiving this support because it facilitates a collaborative model allowing the right healthcare professional to provide the health care needed. It is important to understand that these bills do not change the existing abilities through state and territory legislation for nurse practitioners to prescribe medication or to refer patients. Nurse practitioners are already able to do this and, to a varying extent in the state public health systems, they are in fact doing this. What is proposed is to confer access to services itemised under the Medicare Benefits Schedule and to confer authority to prescribe certain medicines under the Pharmaceutical Benefits Scheme.

I had the privilege of meeting recently with a nurse practitioner in my electorate of Hasluck. He is one of two practising in the emergency department at the Swan District Hospital located in the suburb of Middle Swan. He is understandably passionate about the value that the role of nurse practitioners brings to our health system. He is currently in a position where he can make referrals and write prescriptions for medication autonomously within the public health system. He makes assessments based on his high level of skill and his experience in the nursing profession. At present, he sometimes identifies the need to refer a patient to a private professional or to a specialist, such as a maxillofacial surgeon, or to prescribe medication for the patient to obtain from a pharmacy. Despite this coming within the scope of his training and experience, he still must find a doctor in the emergency department to provide the necessary documentation. In essence, the immediate ramifications of this legislation for him and his role now will merely make those processes less complicated and give him the professional recognition that he deserves. I am proud to say that these changes are consistent with the Labor Party platform where we indicated again at our recent national conference—(Quorum formed) I thank my colleagues. It is one of the small prices we pay for government and it is a pleasure to be in government. Thank you for popping in and listening to what I have to say on this legislation. I was talking about a nurse practitioner in my electorate of Hasluck, Robin Moon, who I am very pleased to say will see the immediate ramifications of this legislation for him in his role in the emergency department at Swan District Hospital Campus and also give him the professional recognition that he deserves. Unfortunately, in Western Australia it has taken some three years for Robin after he qualified as a nurse practitioner to be able to convince his employing hospital that there was a role for nurse practitioners within the hospital emergency department.

This is still a problem across my home state of Western Australia. We estimate that there are some 85 nursing practitioners currently registered, but around only 30 of those are working and recognised as nurse practitioners. This, in my view, is a great waste of a highly skilled and competent workforce and I encourage the Western Australian government to address this situation at the earliest opportunity.

We have seen a much more progressive attitude in the private sector in Western Australia where the benefits of this legislation will also be immediately utilised. The private sector in Western Australia is poised and ready to deliver community health care to Western Australians in ways that have never been imagined before. I have one large charitable organisation in Western Australia which is currently examining the concept of providing home services which are a virtual hospital. They can employ nurse practitioners and other health professionals to go out into patients’ homes and provide Medicare subsidised elements of health care ordinarily available only in hospitals. We know that that will have some distinct advantages in assisting people to remain in their own homes. Most of us prefer to be at home than to be admitted to hospital.

Another very exciting example of progressive change in health care in WA is shopfront health care. Appearing in WA shopping centres are what we call ‘revive’ clinics, which are staffed by nurse practitioners to treat minor illnesses, including being able to provide prescriptions for medications such as antibiotics where necessary and to provide coaching in areas such as weight loss or in assisting with stopping smoking. In country and regional areas such as Port Hedland in the Pilbara of Western Australia where there are some four doctors available to service the population, the ability of nurse practitioners to access Medicare when operating from such clinics will enable them to fill a critical gap in the provision of health care, especially in areas such as immunisation.

On the broader front of training these professionals, I am pleased that the government has recognised the need to invest in training for the future and that the government has already announced funding of $2.1 million to develop our nurse practitioner workforce. We have provided access to scholarships for up to $15,000 per annum for the two-year masters degree that it is necessary for nurse practitioners to undertake to get their qualification and recognition. I believe that when the WA state government finally starts utilising this resource we in the Commonwealth at least are ensuring that nurse practitioners will be ready, willing and available to fill this need.

I want to talk briefly about midwives. I am a great supporter of midwives and have had the pleasure of being part of the birthing team when my sister gave birth to her four beautiful children. These births occurred in the birthing centre at King Edward Memorial Hospital, a fine facility which is staffed entirely by midwives. My sister created the record for being the first person to have her four children in the birthing centre. My lovely nieces Lauren, Jessica, Emily and Amy were all delivered by a wonderful and competent team of midwives at the King Edward Memorial Hospital birthing centre, and I pay tribute to them. What a fantastic experience it was to be a party to their births.

For those of you who have been around at the birthing of children, I truly believe it is evidence that there is still magic in the universe and you will never forget that first breath that a baby takes upon being born. Being the stepmother of two children myself, I disappointed my mother when she asked me after I had been through this wonderful experience if I intended to have my own, to which I responded: ‘My goodness! Not now that I’ve seen where it all comes from.’ Nevertheless, it was a beautiful experience and I am honoured to have been party to it.

These bills will enable health professionals, midwives and nurse practitioners to work collaboratively with obstetricians and hospitals by giving them independent access to the relevant Medicare items and Pharmaceutical Benefits Scheme and addressing the market failure in indemnity insurance for these people. Currently, midwives have been unable to obtain professional indemnity cover for midwife-led birthing as opposed to obstetrician-led birthing, despite estimates by the Australian Government Actuary that the incidence of claims is likely to be comparable to that of obstetricians and procedural GPs.

This bill establishes a system whereby a private insurer will be able to offer a suitable professional indemnity product, with the Commonwealth assuming responsibility for a substantial part of the liability. I know that those opposite have criticised the legislation because it does not extend at this stage to supporting Medicare or PBS funding for homebirths. Can I say to those members present that none of these bills makes homebirths unlawful and none of these bills changes the current arrangement with respect to homebirths as they have always been. These three bills form part of the maternity services budget package. The Commonwealth is committed to underwriting midwives insurance to enable such an insurance product to be developed. I reiterate that we all look forward to seeing this come to fruition—

Andrew Laming (Bowman, Liberal Party) Share this | Link to this | Hansard source

Mr Laming interjecting

Ms Anna Burke (Chisholm, Deputy-Speaker) Share this | Link to this | Hansard source

Order! The member for Bowman will have his chance later.

Sharryn Jackson (Hasluck, Australian Labor Party) Share this | Link to this | Hansard source

The Commonwealth had not intended that this new product would be feasible or affordable if it included homebirthing. I know this causes significant and wide concern among some people, but we know that the minister is working hard on this issue, through her department and with the states and territories, to bring about a result which will see that professional indemnity cover eventually applied to midwives and homebirths.

I note the comments from members opposite, who held government for 12 long years and, in all that time, did nothing about the professional recognition or training of nurse practitioners—and I caution the member for Bowman in that regard. These are progressive pieces of legislation welcomed by professional nurse practitioners around Australia. I congratulate the minister on her legislation.

Debate (on motion by Mr Kerr) adjourned.