Danna Vale (Hughes, Liberal Party) Share this | Link to this | Hansard source

According to the explanatory memorandum, the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 supports the government’s 2009-10 budget measures purportedly by facilitating new arrangements to enhance and expand the role of nurse practitioners and midwives which allow them to take a greater role in providing quality health care.

For eligible nurse practitioners and midwives the bill will provide the right to request certain diagnostic imaging and pathology services for which a Medicare benefit may be paid, the right to prescribe certain medicines under the Pharmaceutical Benefits Scheme, and new Medicare items and referrals under the Medicare Benefits Schedule for midwives and nurse practitioners working in ‘collaborative’ arrangements with doctors.

The Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009 provide for the Commonwealth to contract with an insurer through a national tender process to provide indemnity insurance for independent midwives and the imposition of a run-off cover support payment as a levy on insurers’ midwife professional indemnity insurance premium income.

I note the coalition supports the referral of these bills to a Senate committee inquiry. The committee was due to report by 7 August 2009, but I understand that the committee’s report has been delayed for the time being. I look forward to seeing the committee’s ultimate report, because I share the concerns of many Australian women about the kind of health care they and their babies will receive at a most vulnerable time in their lives—that is, when giving birth.

I understand that the provisions in these bills regarding midwifery were recommended by the maternity services review. New medical benefits items and pharmaceutical benefits provisions are to be available from 1 November 2010. The new MBS items will provide for collaborative working arrangements between nurse practitioners and midwives and doctors, although there is a lack of certainty as to what form ‘working collaboratively’ will take in practice. It is expected that for participating midwives it will include antenatal, birthing and postnatal care arrangements between those midwives, obstetricians and GP obstetricians. The government points out that nurse practitioners will be limited to providing those services within their competency and authorised scope of practice. However, there is still no detail on exactly what this means. The legislation does provide that both nurse practitioners and participating midwives will be able to refer their patients under the MBS to specialist consultant physicians, and these measures are welcome.

Many of my constituents will be aware that private midwife practitioners are unable to access professional indemnity insurance in Australia. The insurance industry says that this is because, firstly, there is no accurate and up-to-date data with which to make an actuarial assessment of liability and, secondly, the potential premium pool is too small to support a market priced premium that would be affordable for midwives. Pursuant to the national accreditation and registration scheme, it will be a requirement of registration from 1 July 2010 that all health professionals have indemnity insurance. The government plans to contract with an insurer to provide professional indemnity insurance to certain midwives. In doing so, a database will be established and maintained to allow the insurance industry to then develop appropriate insurance products in the future. This is a sound provision.

Provisions in the Commonwealth contribution bill will allow the government to pay certain amounts for claims against an eligible midwife and, in the case of practising eligible midwives, these are as follows: (1) for each claim, the insurer will pay the first $100,000; (2) for each claim over $100,000 the government will pay 80 per cent of the cost that exceeds that threshold, up to a ceiling of $2 million—claims between $100,000 and $2 million are classed as level 1 Commonwealth contribution payments; and (3) for each claim that exceeds $2 million, the government will pay at the level 1 rate for the first $2 million plus 100 per cent of the cost of the claim above that threshold, which is classed as level 2.

This bill also provides for the government to change the $100,000 threshold, the $2 million threshold and the rate of subsidy applying to both levels by the rules. Provision is also made for ‘run-off’ cover for an eligible midwife who has ceased to practise. I note that these amendments providing for insurance cover for eligible midwives are largely in response to the recommendations of the maternity services review and are welcome amendments. However, the main concern that I and many of my constituents have is that this legislation does not provide any indemnity insurance cover for midwives supporting mothers at homebirths. I note that the minister has been persuaded to change her mind on this point. She has extended the time frame for the next two years. This extension of time will allow for discussion and debate and examination of the issue, which I know will be welcomed by the midwives association. It is a reversal that is welcome, and I acknowledge the work of the shadow minister in this regard.

The concerns raised state that privately practising midwives will not be able to provide homebirthing services after the introduction of the national registration and accreditation mandatory requirements for indemnity insurance in July 2010. It is claimed that this will drive the practice of homebirthing underground and increase the risks for mothers and babies. I understand that in 2006 less than 0.3 per cent of all births in Australia, approximately 700, were homebirths, so the minister’s reversal, allowing the debate and discussion to continue, is welcome. There are some jurisdictions in Australia that provide public midwifery homebirthing services in a limited number of locations, and that was never intended to be affected by the introduction of the national registration and accreditation scheme.

While many of the provisions of these bills are welcome, there is much confusion in some of the provisions as well as a real concern amongst women that this legislation denies them the choice of a homebirth for their baby. Firstly, the concept of ‘collaboration’ needs to be explained. The AMA says it needs to be clearer and that there needs to be genuine collaboration. Medical practitioners should refer patients to nurse practitioners and midwives but do not need to be co-located.

The Rural Doctors Association of Australia gives its broad support for greater PBS and MBS access for nurses and midwives and also expresses concerns that there needs to be a clearer protocol to: establish for midwives, hospitals and obstetricians how collaboration will work; articulate the circumstances when obstetricians and medical practitioners will be called in; ensure that the medical practitioner has knowledge of the history of the patient; and establish how the medical record of the patient will be managed.

The Australian College of Midwives welcomes the introduction of indemnity insurance, strongly supports the MBS and PBS access for midwives and suggests that an electronic health record for mobile health records needs to be developed to enable collaborative arrangements to work effectively. The college also suggests that there will need to be clear guidelines and principles established regarding consultation between patient, midwife and medical practitioner, for example, in those circumstances when a patient is transferred from a midwife to a doctor. The college also suggests that it is essential that midwives have visiting rights—that is, admitting privileges—at hospitals to enable continuity of patient care and that the concept of collaborative should not be too prescriptive as there needs to be a flexibility to adapt to varying circumstances in different regions and centres.

However, the real concern that many women have with this legislation, despite the welcome provisions and the two-year stay on the licensing of midwives who offer homebirthing, is that it will ultimately outlaw the traditional practice of homebirthing in Australia. We have this two-year gap, which the minister has agreed to extend, but there is still a real concern about afterwards, and I welcome the opportunity for debate on that.

The shadow minister for health pointed out that the coalition strongly believes that women should be able to make their own decisions about such a private matter and that this government is effectively putting a $30,000 fine on midwives who practise homebirthing. That is just not acceptable. At least, that was the government’s plan. My concern is that this legislation would have driven homebirthing underground and would have presented risks to the mother and baby in such circumstances. The legislation initially took an extreme position on homebirthing but there is a middle ground and now hopefully this middle ground can be explored over the next two years.

Apart from the important issue of freedom of choice for Australian mothers, which has been comprehensively addressed by other colleagues in the chamber, there is a case to be made, as the Australian College of Midwives points out, for being in a position to provide safe options for those women who wish to homebirth. While some jurisdictions already provide limited public homebirthing midwifery services, there is already a large unmet demand for these services. I understand that this will certainly be canvassed over the next two years.

Not every mother-to-be is an appropriate case for home delivery. Personally, I never would have chosen it for any of my four confinements. Indeed, I was not an appropriate candidate, as all my four children were premature. I was very grateful to my obstetrician, the late Dr Alexander Mackay McIntosh from Sutherland Hospital. And, on the occasion I did have a second obstetrician in attendance, my thanks and deep appreciation will forever remain with Dr John Mathews of Engadine.

I think that we all clearly understand that homebirthing is not appropriate for complex cases where the mother is known to have great risks. That is plain commonsense. That being said, there are many cases where homebirthing is appropriate and, given that there are many women who have had negative experiences giving birth in hospitals, they should be able to choose to give birth at home under the safe supervision of health professionals working in a cooperative and collaborative manner for their protection. Many women have expressed a need to have a greater input into and ownership of their own birthing experience. It is not rocket science. It is done in other jurisdictions and in other countries—for example, in New Zealand and England—and done very well. So why can’t it also be done in Australia?

The new national registration and accreditation regime will address the concerns of the present inconsistent registration requirements across states and ensure that midwives throughout the country meet requisite education, training and currency of experience requirements for the better protection of their patients. The Australian College of Midwives wants mothers to continue to have access to qualified homebirthing services and suggests that the government consider a number of options, which include: exempting independent midwives from indemnity insurance requirements under the national registration and accreditation for a transition period; extending the Commonwealth subsidy for indemnity insurance to midwives providing homebirthing services; or encouraging state and territory governments to increase provision of public homebirthing midwifery services. I am sure the Australian College of Midwives will clearly articulate their concerns and will have a major role in the considered examination and debate, as promised by the minister, over the coming two years.

However, the real issue for me with this particular legislation is that the provisions to ban homebirthing do not appear to take into account some very relevant considerations that constitute the reality for expectant mothers today. One is that there are fewer and fewer obstetricians amongst the medical profession today than there were even five years ago, and this seems to be a direct result of the extremely high indemnity insurance costs that obstetricians today must pay. My own obstetrician, Dr Mathews of Engadine, worked until he was well over the usual retirement age because he could not get another obstetrician to buy his practice.

The other reality about which mothers are genuinely concerned is the current state of our hospitals. When they read recent newspaper articles about the terrible neglect of women presenting in some of our local hospitals, many are simply horrified. Many are intent on having a homebirth mainly because of such reports. As a case in point I refer to an incident in my electorate at my own local Liverpool Hospital that occurred in July. After headlines in the local Liverpool Champion dated 29 July this year which read ‘Hospital sent home pregnant woman’ and the Daily Telegraph dated 24 July 2009 which read ‘Mum gives birth at home after being sent away by hospital’, why wouldn’t any mother want to arrange a homebirth with a registered and accredited midwife if she was assessed as being an appropriate patient.

The mother from Liverpool Hospital claimed she was forced to give birth on her bedroom floor after being turned away from the hospital because there were not enough beds. The mother was bleeding and in labour when she first arrived at Liverpool Hospital but was told the hospital did not have enough room on the night. She was told to go home because she would not be in labour for another 24 to 48 hours. Five hours later her baby was born on the bedroom floor of the family home, with the assistance of the shocked father and watched by her 18-month-old toddler. Is this the kind of experience the government offers to the mothers of Australia?

Then there are the horrific stories of young mothers waiting long hours in the hospital waiting room only to be left alone to miscarry in the public toilet of the hospital. What a disgrace to have such events occur in Australia. How do we defend such a hospital system, which we would expect to find in a Third World country, and, to add further insult to injury, then deny young women the right to choose a homebirth in a safe environment with professional assistance?

We can do better, and the advice from the Australian College of Midwives has some very sound suggestions whereby the provisions for collaborative, cooperative birthing support in these bills could well be the foundation by which all our health professionals work for the benefit and protection of Australian mothers and their babies—and not engage in what appears, to those of us outside the profession, to be a turf war. I do welcome the minister’s reversal of a former decision which will allow a further two years regarding the practitioners of midwifery for homebirthing. I think that is a very positive move and I know that it is one welcomed by the mothers and babies in my electorate.

Kerry Rea (Bonner, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in support of 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. I do so with great pleasure because this is probably one of the most significant pieces of health legislation that we have seen coming through this parliament in the last 18 months. Indeed it is an indication, once again, of the Rudd Labor government’s commitment to genuine and serious health reform.

This government was elected on a platform of health reform and it is very clear from many of the announcements made by the Minister for Health and Ageing in recent times—whether it is the report of the National Health and Hospitals Reform Commission; whether it is the report on preventive health or indeed the very significant reforms contained in these pieces of legislation regarding maternity services and the support for nurse practitioners—that the government is committed to honouring its election commitment to see major reform in the health system in order to support and improve the provision of health care to the broader Australian community.

What is important about these particular pieces of legislation is that, first and foremost, they acknowledge the very valuable contribution that midwives and nurse practitioners make in protecting the health of our community and indeed improving health services for individuals in all electorates across the country. This demonstrates that we acknowledge the significant role that health professionals, not just doctors but all health professionals, play in contributing to the improvement of health services in this country. It also demonstrates that we as a government are very strongly interested in focusing more on primary care and preventive health. Indeed I think anyone who talks with the general community, and any of us who talk with our own GPs and with many health professionals and providers within our own electorates, will acknowledge that if we can improve the services of primary care—if we can improve the medical services and allied health services available to those in our communities and in our suburbs—then that is one of the best ways in which we can actually ease the pressure which we all know is on our hospital system. This is not just a question of more dollars; it is a question of where you target those dollars and how you can best provide the health services that will give the best care for those members of our community and that will hopefully prevent people needing to go to hospital in the long term because of the primary care service we are providing.

This particular legislation does that by improving access and options for people—not just within our suburban areas but, most importantly, in regional and rural areas as well—by allowing nurse practitioners and midwives to prescribe certain medicines under the Pharmaceutical Benefits Scheme and to request or provide certain Medicare services, such as diagnostic imaging and pathology services. For midwives this will include antenatal, birthing and postnatal care and collaborative care arrangements with GPs and obstetricians. Of course these services have been argued for for a very long time by many within the health system. I know that, in particular, many nurses, nurse practitioners and those involved in midwifery have been arguing for many years that they should be allowed to have access to the PBS and to Medicare for the services that they provide and that there could be a greater easing of the demands on our health system if they were given the reforms contained in this legislation.

But of course these reforms and changes cannot be introduced without a level of responsibility, scrutiny and accountability when it comes to enabling nurse practitioners and midwives to access these services. For that reason they will, of course, be required to meet certain eligibility requirements in accessing these new arrangements. They will basically be required to be eligible nurse practitioners or eligible midwives as defined under the act. This also applies to those midwives and nurse practitioners wishing to access the government’s professional indemnity scheme, and indeed this legislation also provides for the introduction of professional indemnity insurance. Once again, this is a significant reform, initiated by this government, which will enable midwives and nurse practitioners to provide a greater service to the general community.

Currently, no private insurer offers an indemnity scheme, so the Commonwealth is introducing the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009 that will address this. The Commonwealth will subsidise claims against midwives as follows: 80 per cent of claim costs for those claims between $100,000 and $2 million, and 100 per cent of claim costs for claims over $2 million. It broadly represents the Commonwealth’s existing arrangements for eligible medical practitioners. As we know, there are requirements around eligibility, and midwives will need to be registered in order to take advantage of these reforms.

The bills also improve choices for Australian women when it comes to maternity services in particular. It is, in fact, a key component of the government’s $120.5 million maternity reform package that was introduced in this year’s budget by the health minister. What I think is a particularly interesting part of this package and will indeed address some of the issues raised by the member for Hughes, the previous speaker, when it comes to issues around the availability of obstetricians and professionals in the maternity services area, is that $8 million in this funding package will be spent over four years for two key scholarships. The first will enable 110 eligible GPs to receive up to $40,000 for training to become obstetricians or anaesthetists. As I said, the member for Hughes had already indicated that there is a serious shortage of obstetricians within the country at the moment, and there may well be a number of reasons for that, but I am sure a scholarship of this kind that 110 interested and eligible GPs across the country will be able to access will go a long way to ensuring that there are more obstetricians providing services within the Australian community. On top of that, 20 midwives each year will also gain a two-year scholarship of up to $30,000 to obtain formal qualifications that they need to provide the Medicare services and prescriptions under the PBS as outlined in these bills. This is a significant contribution to ensuring the reforms and the outcomes that we want to achieve as a result of those reforms will come to fruition because we will have the qualified practitioners in place to do so.

I do not think anyone could contribute to the debate on these particular pieces of legislation without acknowledging the statement that came out of the Health Ministers Conference on Friday and the concerns that have been raised by members of the midwifery community and many women who are obviously looking to homebirth as an option for their impending maternity. It is important that we address these issues and that we also address the criticisms that have been raised by the opposition.

As a result of the Health Ministers Conference, a very practical compromise has been reached on this very issue, I believe. Midwives who attend homebirths will have a two-year exemption from requiring insurance to stay registered. This is an issue that has been raised; indeed, many women in my own electorate of Bonner have come to visit me, concerned that they would not have the option of a homebirth if it meant that, as a result of attending homebirths, midwives that they have previously dealt with would not be registered.

They will of course only obtain registration if they do two key things: they must inform the expectant mother that she is not insured for a homebirth and they must also report the birth. I will come back to that matter in a moment because I believe that is one of the key conditions of registration that is very important if we are to address the issues, particularly the insurance issue of homebirth, over the long term. The first thing that we need is accurate data. We do not have that at the moment and this particular condition, as a result of the ministers conference on Friday, will give us the data that we need to address this issue for the long term.

It means that many women, as I said, will have genuine choice. They will have access to homebirths but they will do so informed of the insurance issue when they choose that. It also means, as many members in this place have already indicated, that any fears that homebirthing would go underground or that any dangers that would result from that to both the mother and the child will be addressed and it will not mean that we will see those sorts of activities occurring.

It actually means that the issues that the minister has announced in relation to registration should be applauded because, whilst many will still argue that midwives should have insurance for homebirths, I believe that this two-year exemption is a reasonable and responsible response. I say that because, whilst I, as a mother of three, am very clearly supportive of midwives and indeed of any woman having the right to choose the circumstances under which she wishes to give birth, including homebirth, we do need to be honest about the risks that are out there.

I know that many women undergo quite serious risks even within the hospital environment. I was talking to a constituent only last week who is choosing a homebirth for her third child because of the very unpleasant and difficult experiences that she suffered as a result of going through hospital—not the public hospital system but the private system. She now wants the option of a homebirth.

Nevertheless, we know that there are risks. As I alluded to before, the key thing about understanding those risks is that we actually do not have the data to give us the analysis of the level of risk. We do not actually know how many homebirths there are. We do not know the level of qualifications and skills of the practitioners who are delivering babies in a homebirth situation. I believe it would be irresponsible for us to support an insurance scheme that opened up a Pandora’s box such as this without really understanding what we are actually dealing with.

It is important to remember that we are of course here to administer taxpayers’ money. We have to be responsible about the policies that we initiate when it comes to actually funding insurance schemes such as this. I believe that all practitioners of homebirth—indeed, all midwives—would readily agree that we need to get the data together to understand and develop proper policies and protocols that will ensure women have a choice but one that is safe and also accountable in terms of the spending of taxpayers’ money.

That is why I believe the announcement that came from the health ministers on Friday is a very responsible, very practical one. I think it should be supported by this parliament and the broader community. We know that in two years—the period of the exemption that is being allowed for under the announcement—there will be a national nursing and midwifery board fully operating. We will have the professionals in this particular area operating as a board that will be able to give to this debate the sorts of expertise and guidance that we need. We know, as I have already said, that we will have two years of data collected to understand the needs of midwives who are practising homebirth and providing it for mothers and to understand what level of risk needs to be catered for. We will have an analysis of all of these things which will enable the government to develop protocols, options and good policy around indemnity insurance. It may well mean that in that time there will be private insurance options available; it may mean that the Commonwealth will have to look at a public scheme. But at least we will be able to have that debate and discussion with the information that we need to do it in a practical and responsible manner.

I also say that I welcome the indications from the state ministers, as a result of the announcement last Friday, that they will look at public hospitals being able to work in partnership with midwives to explore options around providing homebirths. I see in the chamber the member for Page, who I understand has in her electorate a hospital that is actually exploring some of those options around the provision of homebirths via the hospital system. A whole range of options will come out of these reforms that will make it so much better for women who are giving birth to do it in the circumstances that best suit them and their child.

I wish to conclude by putting on record my support for midwives and for the option of homebirths. I had three children through the public hospital system. I chose to do that because I support public hospitals and I knew that I would get the best level of care. On all three occasions, it was a midwife who delivered my children; I did not in fact see a GP until after the children were born. It was a great experience, and I want to say on a personal level that having a midwife in the birthing suite with me was certainly a very supportive, comfortable and encouraging environment.

I think that midwives do a wonderful job when it comes to giving birth. We know that historically it has always been the role of midwives. Long before there were obstetricians or medical doctors, it was the women in the community who assisted other women in giving birth. Indeed, the word ‘midwife’ comes from the Middle English word meaning ‘with woman’. It was developed as a result of acknowledging that it was women who were with the women giving birth. The word dates back to about the year 1300. We know that midwives had existed for many, many centuries before that. It is important that, nearly 709 years since the word came into existence, we now have legislation which acknowledges very clearly the important role that midwives play when it comes to giving birth, that they are a genuine option for many, many women and that they support and nurture women when they are going through that amazing experience of giving birth—an experience terrifying and amazing at the same time. For that reason, I am very proud to support this set of bills, and I encourage everyone in this parliament to do so.

Nola Marino (Forrest, Liberal Party) Share this | Link to this | Hansard source

I rise to speak on the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related bills. The original intention of these bills was to provide Medicare benefits to eligible nurse practitioners and qualified, experienced midwives who request diagnostic imaging and pathology services as well as allowing them to prescribe certain medicines through the Pharmaceutical Benefits Scheme under a collaborative arrangement and protocols with doctors and hospitals. The government will provide, through a contracted insurer, for professional indemnity insurance to eligible private midwives.

However, just like the government’s proposed changes to youth allowance, these bills have not been thought through in practical terms and there has been a clear failure to consider the effects on women and families in rural and regional communities. As a result of sustained pressure, Minister Roxon and the government have done a partial backflip on the legislation and agreed to maintain the status quo, allowing midwives to continue to assist in homebirths for two years. It was clear that the bills, in the form presented by the government, are of particular relevance in regional and rural communities and demonstrated very directly how this government continuously and deliberately fails to understand how rural and regional communities actually function—communities like those in my electorate of Forrest, where we have a shortage not only of general practitioners but also of obstetricians and gynaecologists. We also have limited maternity care options. The Forrest electorate is located in a regional area where there is no birth centre or government funded community midwifery program such as those available to and accessed by women living in the metropolitan areas.

There are women who, by choice, have already experienced a homebirth and want to be able to do so in the future, as well as those who want to experience their first homebirth. All these women need to have access to a midwife who will provide a particular type of maternity care for them in their own homes: the homebirth. A number of very concerned and upset mothers in my electorate, from Busselton and Margaret River, have spoken to me about the effects the original bill would have had on them and on the midwives they currently have access to, who have already safely delivered their babies. I rise to speak on behalf of these women from my electorate, to give voice to their issues here in federal parliament. The mothers I refer to are those who want to be able to have a homebirth with the same type of care and service they have already had in delivering their babies—or, alternatively, to have their first homebirth. However, the legislation as originally presented would have prevented them from doing so, because the midwife would have been acting outside their registration by not having the requisite indemnity insurance.

The mothers and families whom I met are extremely angry that this legislation did not make provision for safe midwife home based maternity care in their own homes. However, by far the most important issue to them is the issue of choice. They absolutely and completely believe it is their right to choose their own birthing option. They made it very clear to me that this decision is their choice. They want to choose and they emphatically believe it is their right to do so. I met Jane, a homebirth mother of three from my electorate, and I quote Jane’s subsequent email:

I live in a regional area where there is no access to a community midwifery program and I therefore depend on the independent midwives in the area for homebirth support. With the introduction of the proposed legislation I will be unable to access a homebirth with a qualified midwife. For any future births I would then have to choose between birthing in a hospital and freebirthing.

In Australia, elective surgery is a government supported and subsidised choice. In the case of childbirth, the safety of both mother and child is the priority. To many women, the right to choose how and where to give birth is also a priority, as I found with the mothers I met in Busselton and Margaret River. Women are able to make a number of decisions regarding their birth options and maternity care, but women who choose to birth with trained midwives in their own homes will have no choice except to have a hospital birth or to have their babies in their homes without the support and presence of a trained professional to assist them should the government continue with this legislation in the future. I am extremely concerned about this. The health and wellbeing of both mother and child are paramount.

I recently met with Andrea, a mother from Margaret River, in my electorate. Andrea has a 10-month-old daughter who was born in the hospital system but she is pregnant again and intends to have a homebirth. In fact, she was very relieved that, had the government persisted with the legislation, she would have delivered her baby in a homebirth situation before the legislation took effect. Andrea is a member of the Margaret River homebirth mothers group called Birth Choice. This free support group has approximately 40 members and meets once a month. I understand that at least one of the mothers in the group is prepared to have a freebirth if, as a result of this or subsequent legislation, she does not have access to a registered independent midwife. Freebirthing is a homebirth without the care or attendance of an experienced midwife or medical professional. It is an extremely dangerous practice where the safety of mother and child can be compromised. A reduction in the number of independent midwives as a result of this or subsequent legislation not only would lead to an increase in the number of hospitals births but could potentially increase the number of freebirths.

Some of the mothers expressed serious concerns that, if legislation were passed either now or in two years time and home-birthing services were abolished, it would only take one freebirth complication or serious problem for home birthing to never be legalised again. At present, at least 35 women choose to give birth at home with a registered midwife in the south west. Many more would like to birth at home but simply cannot afford to do so. The costs of employing a registered midwife to provide a homebirth are directly borne by the woman or family who make the choice of the home birth. Should indemnity insurance for independent midwives become available, it would need to be an affordable option because, in most cases, the cost would be passed on directly to the woman or family.

For the mothers I met in Busselton the cost of a homebirth, which cannot be reimbursed from either Medicare or private health funds, includes 10 to 12 antenatal checkups, the actual delivery of the baby and home visits for the first five days following birth, with direct contact and postnatal support for up to six weeks following the birth. As mentioned, postnatal support is given to new mothers for approximately six weeks after birth. For the mothers I met, this postnatal support and the ongoing friendship are almost as important as the actual birth. They have a personal belief that both the homebirth experience and the postnatal support actually lessened their potential for suffering postnatal depression. As we are all aware, postnatal depression is a very serious problem for women and their families.

I am concerned from reading this legislation, and given the minister’s backflip, that it appears to be yet another piece of this government’s rushed legislation, because it lacks detail on how this process will work on a practical level. There is no guidance as to what the definition of ‘eligible midwife’ is. If a midwife is not eligible, what further training or requirements will have to be completed for them to become eligible?

Another flaw is the lack of explanation as to what level of ‘consultation’ will be required between independent midwives and general practitioners. Independent midwives in my electorate tell me they have a very sound working relationship with local GPs and with other independent midwives. They believe that the collaborative care process between mothers, midwives, general practitioners and hospitals is imperative for the safety of home births. Homebirth mother of three Sharon said:

I felt safe and in capable care with all my children’s homebirths. My local GP was informed that I was in labour and phoned when my baby was born.

Will the existing collaborative approach used by the mothers in my electorate be considered adequate consultation under the legislation?

The intersection of the National Registration and Accreditation Scheme legislation with the midwifery and nurse practitioner legislation will make it impossible for independent midwives to register and practise as homebirth midwives. The NRAS, which is to be introduced on 1 July 2010, requires proof of professional indemnity insurance for midwifery registration. Under the original legislation, after 1 July 2010 any individual who practised as a midwife without registration was subject to a maximum penalty of $30,000. As we know, there is no professional indemnity insurance for independent midwives. Clearly, the government—until forced into a backflip—was deliberately excluding this choice for Australian mothers. It appears that homebirth midwives are the only health professionals who are unable to gain access to indemnity insurance.

Susan is an experienced midwife who has been living and working in my electorate for the last 7½ years. She has worked in a hospital maternity unit for over seven years, but during the last 3½ years she has shifted to the role of a privately practising midwife, or what is known as an independent midwife. Susan has said:

I find working as an independent midwife much more rewarding than working in the hospital system, as I am able to provide uninterrupted, continuity of care throughout the pregnancy, labour, birth and postnatal period. I am able to provide dedicated and thorough care to one woman at a time and because of this I believe it is SAFER, more COMPREHENSIVE and much more PERSONALISED than what I would be able to provide on the maternity ward.

I note that results from a comprehensive study conducted in the Netherlands released on 15 April 2009 concluded that planning a homebirth does not increase the risk of perinatal mortality and severe perinatal morbidity among low-risk women, provided a well-trained midwife is available.

I also note that at the Senate Standing Committee on Community Affairs hearings into this legislation, Associate Professor Hannah Dahlen from the Australian College of Midwives commented:

… what all this evidence tells us again and again is that homebirth for low-risk women attended by competent, networked, integrated midwives within a responsive system is safe.

Midwives in my electorate only take on low-risk women. This, along with the collaborative relationship between the midwives, GPs and hospitals contribute to providing homebirth as a birthing option in the south-west of WA.

I understand that in their current form these bills will enable Medicare funding, access to the PBS and professional indemnity support for midwives providing care for women giving birth in hospitals. However, this will not be available to midwives assisting the families in my electorate who choose to give birth anywhere other than in a hospital. The original legislation, in the form the government presented, would have abolished the independent midwives industry in my electorate and throughout Australia. Alternatively, as I said earlier, what concerns me greatly is the possibility of ‘freebirthing’—birthing at home without a midwife’s support. This legislation, in its original form, actually denied women the right to choose a homebirth.

I well understand, as do the women in my electorate, that homebirthing is not an appropriate option for all women. But this is an issue that is fundamentally about choice. The women I met believe very strongly that they should have the right to choose how, where and with whom they give birth to their children. They feel so strongly, in fact, that four of them—Susan Mildwaters, Sharon Scott, Jane Reynolds and Catherine Evans, came from the south-west of WA, at their own cost and with their beautiful babies, to rally in Canberra today with other women from right across Australia. They rallied for their right to choose and they rallied against this government and this legislation.

I note that a minority report by the coalition members on the Senate inquiry, Senators Judith Adams and Sue Boyce, made a number of very sound recommendations. Two of these are:

… that the Department of Health and Ageing undertake an actuarial analysis on the risk profile of home births in Australia, with a distinction between professionally supported homebirthing and unsupported free births, and a full analysis of the costs involved in including homebirth midwives within the Commonwealth’s Professional Indemnity scheme.

And:

If the costs of including private homebirth midwives within the Commonwealth’s Professional Indemnity scheme proves to be feasible, Coalition Senators recommend that the Minister include midwives who perform homebirths as a category of ‘eligible midwife’ in the regulations and rules to be attached to the three Bills.

I commend all of the recommendations made by Senator Adams and Senator Boyce to the government.

The latest backflip by the government and Minister Roxon does not provide at this time any longer term certainty for independent midwives and mothers wishing to birth at home, and I call on the government to release the costing and the actuarial modelling for the provision of indemnity insurance for midwives.

Janelle Saffin (Page, Australian Labor Party) Share this | Link to this | Hansard source

I speak in support of the cognate bills 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. One of the key things here is that maternity care is being brought into its rightful place of primary care: for the first time ever we are going to provide Medicare funding for midwives. That will increase opportunities for women to have more choice about how they have children. That is one of the significant features of the package of bills around maternity care. I am going to talk about homebirths, particularly from the perspective of my seat but also from that of the North Coast Area Health Service, which is broader in area, the number of homebirths, the options that we have and the issue of professional indemnity insurance.

In the budget, the government committed $120.5 million over four years to maternity services. I commend them for that and commend the Minister for Health and Ageing. That was for maternity services reform and, over four years, $59.7 million of that is to expand the role of nurse practitioners. This is where the expanding role of midwives comes in. These bills will support the inclusion of nurse practitioners and midwives under the Medicare Benefits Schedule, the MBS, and the Pharmaceutical Benefits Scheme in line with these budget measures of 2009-10. They will also enable the establishment of a professional indemnity scheme for eligible midwives, which is critical to supporting the new MBS and PBS arrangements.

There are a number of independent midwives who practice, and do not have professional indemnity insurance. My memory is that professional indemnity insurance was taken away in 2001. When I say ‘taken away’, the insurers would no longer provide that. I do remember a particular case to do with an obstetrician, and I think there was a payout of around $12 million, or something like that. I remember it at the time and it has been written about again recently. I know it was after that time that professional indemnity was taken away.

I listened to speeches and contributions about midwives and homebirths today from the other side, and the first one I heard was the member for Groom. He said, ‘Well, you know, it’s been put off for two years.’ He said if he adopted a cynical view it could be that it was put off until after the next election. I have to say, on his comments, there is no cynical view about this. Since I came into this place in 2007 I have been in conversation with the Minister for Health and Ageing and other members of government about the issue of midwives, and particularly midwives and homebirths. Minister Roxon has been trying to find a way to address the issue of midwives who do homebirths and professional indemnity. The scheme that is being introduced, and this great reform that is being introduced, is part of a COAG agreement. So it is the federal government but it is with all the states and territories. It takes some doing to get that negotiated with the different schemes that operate across each state and territory.

I am pleased to say that I have stayed in that conversation with her up until even last week and continuing this week. Last Friday she was able to secure the agreement that made sure the professional indemnity issue would not be a barrier for the independent midwives. They practise now without it and most of them that I know do advise the women, the pregnant mothers, who are giving birth. A lot of women in that situation do sign the disclaimers. I have to commend her for that agreement because that was one of the things that was being worked towards.

I just want to say something else about professional indemnity. I once was the president of a health service, North Coast BreastScreen. The program was the North Coast Breast Screening Program. When that was introduced it was part of the national mammography screening program. Every other service in Australia that provided mammography provided it through a health service; thereby it attracted immediately all the professional indemnity. Ours did not. It was a non-government organisation.

We were incorporated under the Associations Incorporation Act. This was done with the permission of the federal and state ministers. There were certain agreements about what we would trial for attracting certain women, and particularly Indigenous women, into that scheme. So we did not have professional indemnity and I, as the president of that organisation, had to negotiate to get professional indemnity because we had to be covered. I did that with AMP. It took some time. It had to go to the national board—I think they had a meeting in New Zealand—and we actually got it. So I am speaking with a little bit of experience in the health field in getting that professional indemnity. It was not easy and I know it is not easy now, for all sorts of reasons. But that is why we need time, and the minister has got that time so that a whole lot of options can be looked at. That is just one option that I was able to do with that particular service, but we had to jump through a lot of hoops to get it. We had to undergo certain training—me included—that normally only medical people would go through and there were certain protocols we had to adhere to.

I saw that the agreement that the minister reached with the states and territories on Friday through COAG also referred to some of those protocols having to be in place. There would be a requirement that the independent midwives would notify women that they did not have professional indemnity insurance. As I said, most of them that I know do that. So they are really reasonable measures that have been introduced, alongside this period of two years, which gives us some time. On that particular issue, I see that as a good step forward.

Also, this is about accreditation and registration. This is one of those issues that has been lingering for a while. It has been in the mix but has never got to a point where we could have it. The minister has done that and there will be at least 10 areas that will come into that national scheme. That is a good thing. So there are a whole lot of good things about this bill. It was not that we were going to exclude independent midwives; it was about how we can find a way through this.

I also want to talk a little bit about the figures in my area and say that there was a review of homebirthing in the Northern Rivers health catchment. That was undertaken in 2004 by the clinical midwife consultant Sue England, who was with the North Coast Area Health Service. She is now with World Vision. She is a very experienced midwife, with experience in many settings. There was also a paper prepared by M Spain and H Gulliver in 2005-06 that looked at figures in our particular area. I will quote from their paper—and this comes from that report Sue England prepared. It says:

The Northern Rivers Area Health Service—

as it was then—

has a significant home birthing community and records the highest home birth rate in the state outside of metropolitan Sydney. To date, reliable data on the numbers of women choosing to birth at home has been difficult to quantify. The New South Wales Mothers and Babies report recorded 99 home births in the state, or 0.1 per cent of total births, and in the Northern Rivers 14 home births were recorded—0.5 per cent of total births. The real figure for the Northern Rivers Area Health Service is more likely to be around 100—approximately three per cent—based on advice from many sources accessed confidentially during 2004. Thus we can assume that this area has a significant home birthing community and will continue to do so.

Further in the paper it says:

In 2004 a total of 58 births, and an increase in 2005 to a total of 65 births, were registered to have occurred out of hospital.

This is from the register of births, deaths and marriages dated 2004. The paper goes on to say that, at the time the paper was written in 2004:

An average of three per cent of births in the North Coast Area Health Service occur out of hospital. This compares with the New South Wales state average of only 0.1 per cent of births occurring out of hospital in 2004.

My point is that there are a significant number of women who have their babies out of hospital settings as homebirths. I would like to quote from a couple of the women who are active in that area. I have an email, saying:

Dear Janelle,

Just wanted to say a big thanks to you and your staff for helping me to participate in yesterday’s consultation with the Prime Minister and Minister.

That is, Minister Roxon and Minister Eliot.

I thought it was a really productive few hours. I could sense they were very keen to listen and were very open to hearing new, innovative ideas.

It was a health consultation and the writer was there with the express purpose of talking about independent midwives and where the legislation was going. That has been the approach all the way through.

I would also like to mention that in my area, in Lindendale, which is just outside of Lismore on the road to Wollongbar, Alstonville and Ballina, there is a Natural Birth Education and Research Centre Inc. Women go there for homebirths in a supported setting. It is run by Margaret Spain. She is a midwife of longstanding and someone I have worked and collaborated with in the area of homebirths. I will talk a little bit about the centre. They have collected five years of data outcomes of their service, and the services at the centre have a clear standard of practice. Women receive information on the screening criteria and the knowledge that primary midwives are not insured. The centre has volunteer public liability insurance. They have a referring obstetrician who supports the centre, midwives and clients. He is informed of the outcome of each birth that occurs at home, hospital or the centre. All clients are required to book into Lismore Base Hospital should a transfer be required and all receive the appropriate 28-week and 36-week pathology.

The Natural Birth Education and Research Centre has found the greatest deterrent to women receiving care through their services is financial because there are fees if you want to birth in such a centre. That is one of the issues that we are looking at. The centre has provided to me—and I have given it to the minister—a proposal about how the centre could operate in one of the models of care around midwifery. I note that this is not a new issue. The issue of midwifery has been around for a long time, as has the issue of women giving birth at home—or homebirths, as we call them. It is an issue of choice. It is not everybody’s choice but it is about choice. We have to make provision so that women can have that choice. I know that some of the medical profession say that there are no safe births outside the hospital; they want them to happen at the hospital. But when I look at the figures of the Natural Birth Education and Research Centre, all births there have been safe. When I look at figures from New Zealand and the Netherlands, where it is more normal to have homebirths, I do not see a problem there either. It is just that we operate differently. Everything that I have read shows that if women have that choice, they will take it up because having a baby does not have to be a medical event. It is a pretty natural thing that happens.

Turning specifically to the three bills, I would like to make a few points about the particular arrangements regarding midwives. For midwives to be eligible to participate in the new arrangements they will need to meet advanced practice requirements and have collaborative arrangements with doctors. A lot of them already do. These requirements and collaborative arrangements are being developed in consultation with midwives, doctors and other stakeholders. The reform initiatives supported by this legislation allow for this incremental reform within a strong framework of quality and safety. It is expected that around 700 eligible midwives will be participating in this measure over the next four years, and another 700 eligible midwives being involved in the scheme is a good thing. I have not heard any midwives object to being asked to report each homebirth, but there has not yet been a scheme or a system to allow them to do that. The Natural Birth Education and Research Centre in my area which I talked about do that. They have worked out that system with the local obstetrician, so there are ways that that can happen.

In supporting this reform, it was really pleasing that Minister Roxon initiated the maternity services review, because it was really important to have that. We have had many reviews in particular areas. I have read so many reviews about birthing and about maternity. A lot of them are very informative and useful, but there is not one that looks at it nationally with a view to having a national scheme in place. That is the great thing about this one, and it was important to do it. I know that the maternity services review did not recommend professional indemnity for midwives who do homebirths but, even though it was not recommended, it is one of the things that the minister has taken on in not only responding to it, but recognising and having knowledge of the situation in Australia—that is, a small number of independent midwives, a small number of homebirths. If they were brought into a system, if there were more choices available and if there were more financial incentive around it, I am absolutely certain, after everything I have read on this topic over the last 30 years, that a lot more women would choose to have either homebirths or births in centres such as the one run by Margaret Spain in my area at Lindendale that I described. I see these bills and this process as a way forward for all of that. It is a way forward for great reforms and, in commending the bills to the House, I also commend the work of the minister.

Greg Hunt (Flinders, Liberal Party, Shadow Minister for Climate Change, Environment and Water) Share this | Link to this | Hansard source

I rise to address 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. In doing so, I wear a number of different personal hats. Firstly, I am the son of a midwife; secondly, I am the husband of a nurse; and, thirdly, on 6 July 2009, just over nine weeks ago, I was present at the birth of my son, James Anthony Allan Hunt, who was brought into the world at the hands of three midwives. The obstetrician, Dr Andrew Griffiths, who does a fantastic job—indeed, he was the guiding light during the recent confinement of the member for Dunkley’s wife—was not able to be there for the denouement and there were three midwives present. So I have a deep, personal family history with the role, the work and the majesty of midwives in our society, and I thank them for what they have done for my family and for so many other families.

Having witnessed only a matter of weeks ago in the most human of circumstances the calmness of the three midwives who helped my family—the way they were able to lift the umbilical cord from around the neck of our little child, who faced a serious risk as a consequence of the way nature delivers things into the world—I have a sense of the extreme professionalism and compassion of midwives. Against that background, I have a deep and powerful belief in the professionalism and competence of midwives and the importance of the midwifery profession to our healthcare system, to our maternity system and to our general hospital and homebirthing system. In that context, let me make it clear that I fully support the push by those who work in home based midwifery to allow continued choice. That choice has been under assault. The choice of mothers around Australia to determine whether they will bring their child into this world in a hospital, as is the case for the overwhelming majority of people, or in their own home was about to be taken from mothers around Australia and from the home based midwifery sector in our society. The women are for the most part dedicated, committed, professional and have an extraordinary history of success.

We were about to see, at the hands of the Minister for Health and Ageing, an entire section of the health profession, and a major part of the personal choice of mothers, taken away. Fortunately the campaign waged by those involved in home based midwifery—with the common sense of the shadow minister for health, Mr Dutton, and the support of those on the coalition side, amongst others—has led to a reversal of the government’s position. This is a good thing. It is, however, only a partial reversal. We now have the grey situation where home based midwifery will be able to continue but only for two years. The government has given a two-year stay of execution on the entire profession and on the choice available to every mother in Australia. That is not an acceptable solution, we say to the minister. It is a partial, interim solution which gives no professional security, which gives no long-term choice and which is anything but an expansion of the services available to those who call upon midwifery in Australia.

Our view is very clear. We accept that, as an interim solution, this is better than what was on offer until last Friday. But that is all—it is better than what was on offer until last Friday. It does not provide a solution to the magnificent women I have met who work in home based midwifery on the Mornington Peninsula and who represent the role of midwife to so many expectant mothers who choose of their own volition to give birth in their own home. It is one of the most deeply personal experiences in life, and it must surely be up to the mothers to make that decision. Yet the government’s decision is temporary, the solution is uncertain and the future of the profession is in doubt. Against that background, let me say this to Minister Roxon: you have a very serious and profound duty to an entire profession to provide them with certainty. The minister must ensure that all of the actuarial figures on the success rate, the complications and the tragedies are released. This data will provide an unimpeachable base for real public debate. That material should be released by the minister posthaste. There can be no reason for failing to disclose such information—it is within the grasp of the government, it will enlighten public debate and it will allow us to give home based midwifery a certain future.

Having said that, I want to make two other comments. The first is specifically in relation to my electorate of Flinders. We have seen the closure of the midwifery unit at the Rosebud Hospital. This is a public hospital which has had its midwifery unit closed under a state Labor government. This in itself denies choice to mums and their partners on the Mornington Peninsula. In some cases it creates risk, in that emergency cases must be transported much further than they would otherwise have needed to be. It certainly creates inconvenience and in many cases it creates heartache. That support has not been provided by the state government in Victoria, and I urge them to rethink the closure of the maternity unit of Rosebud Hospital. They promised expanded services; they delivered diminished services.

Against that background, it is absolutely clear that the peninsula has lost its maternity services, but so has Bass Coast. Bass Coast, however, has been more ill treated. The entire Warley Hospital at Phillip Island has been closed, and it was closed as one of the first acts of the new federal government. Warley Hospital was not a private hospital, as has been asserted. It was a community hospital. It was in fact a bush nursing hospital. Its original purpose was midwifery. It carried on a midwifery service until a few years ago, when again the state Labor government would not support midwifery on the Bass Coast. So the people there have had a double blow. They have lost their midwifery unit and they have lost their hospital.

Against that background, there must be support for Warley Hospital. There must be support for a future hospital, whether it is a stand-alone unit or an integrated hospital, on Phillip Island. The federal government came to office claiming that it would end the blame game. Sadly, the first act of the Minister for Health and Ageing was to say, ‘It’s not mine; it’s the state’s.’ At the same time, the Victorian Premier, Mr Brumby, said, ‘It’s not mine; it’s the Commonwealth’s.’ So a hospital which we protected, nurtured, fostered and supported under the previous government lost its funding, lost its future and closed within the first three months of the new government, after eight decades of operation. That is a sad legacy to leave the people of regional Victoria.

The third thing that I want to address is that all of this is part of a broader pattern. One of the foundation promises upon which the Labor government came to power was that, if the hospitals were not fixed by 1 July 2009, the federal government would take over the hospitals. Well, the hospitals are not fixed. The hospitals that have been in the hands of state Labor governments have continued to deteriorate. Services have worsened and yet we see paralysis, inaction and a breach of a fundamental pledge to the Australian people. That must weigh heavily on the government. They should be called to account on this foundation promise which related to their election. This promise has been honoured only in the breach, which means that there is no calling to account the drift in services under the state Labor governments in our great hospital system.

Ultimately we believe deeply in better health services for people. I have seen taken away in recent years the Rosebud midwifery unit. I have seen Warley Hospital, which, during our time in office, we fought to protect, to preserve, to keep open, closed by a federal Labor government that said it was not its business and ignored by a state Labor government which said that it was Prime Minister Rudd’s business. Neither tier of government owned the hospital, and that hospital passed out of existence because of that collective indifference.

We will not let similar indifference cloud the future of the home based midwifery sector. We believe that sector is critical. We believe it provides choice. We believe we can trust those people. We do not take the view of Minister Roxon that these midwives are to be doubted, derided and denied the trust which is due to them on the basis of their historical performance. So I endorse wholeheartedly the push of the coalition to give certainty, to give a future and to give permanency to home based midwifery. Insofar as this legislation provides an interim solution, we will not stand in its way, but we will fight for permanency, certainty and a future for home based midwifery.

Craig Thomson (Dobell, Australian Labor Party) Share this | Link to this | Hansard source

I rise to support 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. The purpose of the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 is to amend the Health Insurance Act 1973 and the National Health Act 1953. This amendment will support the inclusion of nurse practitioners and appropriately qualified and experienced midwives under the Medicare Benefits Schedule, the MBS, and the Pharmaceutical Benefits Scheme, the PBS, in line with the 2009-10 budget measures. We have heard much in this debate about the coalition’s commitment to and undying respect for midwives and so forth, yet these aspects of the bill are issues that could have been addressed in the last 10 or 11 years but the coalition chose not to. It is worth pointing out that, since 2001, midwives in private practice have in fact been without indemnity insurance. Part of the purpose of these bills is to look at making a better situation for both the consumer and the midwives who are practising.

The midwives and nurse practitioners bill will enable these health professionals to request appropriate diagnostic imaging and pathology services for which Medicare benefits may be paid and prescribe certain medicines under the PBS. The 2009-10 budget measures also provide for the creation of new Medicare items and referrals under the MBS from these health professionals to specialists and consultant physicians. MBS and PBS benefits are to be available from 1 November 2010.

The Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the associated Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009 will support the new MBS and PBS arrangements by enabling the establishment of a government-supported professional indemnity scheme for eligible midwives. The Australian government is proud to be implementing historic reforms in maternity care which recognise the skills of our highly trained midwives and provide more choice for Australian women while maintaining Australia’s strong record of safe, high-quality maternity services.

The report Improving maternity services in Australia: the report of the Maternity Services Review highlighted the complex nature of maternity services, which involve a mix of Commonwealth, state and territory, and private arrangements. It was developed following consultation with a broad range of stakeholders, including individuals, health professionals, industry groups, researchers, professional organisations and national peak bodies. The report made a number of recommendations which focused on the need to improve the maternal and perinatal outcomes for Indigenous and rural Australians, improve choices available to pregnant women, increase access to high-quality maternity services and provide support for the maternity services workforce.

The government responded to the report with a $120.5 million package to provide access for midwives to the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme medicines and a government-supported professional indemnity insurance scheme for eligible midwives. On 24 June 2009 the health minister introduced legislation to facilitate these new arrangements. These arrangements will be available to appropriately qualified and experienced midwives working in collaboration with obstetricians and health facilities as recommended by the report and will not, at this stage, cover homebirths.

Let us look first at how these changes will affect nurse practitioners, and then I will come back to homebirths and the whole issue that has probably dominated most of the debate on these pieces of legislation. Nurse practitioners can already provide health-care services and prescribe medications in a majority of jurisdictions. However, the midwives and nurse practitioners legislation will enable their clients to access MBS- and PBS-subsidised services and medication. There are currently around 350 qualified nurse practitioners in Australia, generally working in public hospitals. Initially, around 50 nurse practitioners are expected to access the MBS and PBS for their clients in certain private and community settings, particularly in primary care and rural areas, from November 2010.

For midwives to be eligible to participate in the new arrangements they will need to meet advanced practice requirements and have collaborative arrangements with doctors. These requirements and collaborative arrangements are being developed in consultation with midwives, doctors and other stakeholders. The reform initiative supported by this legislation will allow for incremental reform within a strong framework of quality and safety. It is expected that around 700 eligible midwives will be participating in this measure over the next four years.

The government understands the concerns in the community about registration and professional indemnity insurance and how this affects the involvement of midwives in homebirths. The three bills before the House expand Commonwealth support for midwives and nurse practitioners in our community. They improve choice and extend Commonwealth funding for a range of midwife and nurse practitioner services for the first time ever, including providing antenatal care in the community and attending births in clinical settings. None of these bills makes homebirth unlawful.

The separate draft bill for the national registration and accreditation scheme for health professionals currently carries a proposal that will require health professionals from 10 professions covered to carry insurance as a condition of registration. The draft bill was prepared for all jurisdictions via a COAG agreement and is not yet before any parliament. Our government has been concerned about the unintended consequences of this provision on homebirth. That is why I am so pleased that last Friday, on 4 September, the Minister for Health and Ageing was able to achieve agreement from all health ministers around the country to a transitional clause in the current draft national registration and accreditation scheme legislation. This has been achieved with all governments working together to obtain an outcome that is progressive for the sector but will not make homebirths illegal.

The decision on Friday was significant, a very important breakthrough in the national registration and accreditation scheme. The registration and accreditation for 10 professions is about lifting standards and ensuring that people are registered and accredited and that to be registered they have to be insured. This presented, of course, a particular problem for homebirthing midwives, where no insurance product is currently available and where the Commonwealth’s budget package was not intended to cover these arrangements. But the states, territories and the Commonwealth have now agreed to a two-year exemption for homebirthing midwives who are acting, of course, not within the state hospital system but in the private sector.

There will be a number of conditions and requirements attached to that exemption, which include that a homebirthing midwife must disclose to a mother who is interested in having a homebirth that they will not be insured for that procedure and make sure that people are able to make an informed choice about undertaking a homebirth. The government will ask homebirthing midwives to report each homebirth. There is currently not any good data across the country of how many homebirths actually occur. Independent midwives are not currently required to notify state and territory authorities or hospitals, and nor have they been asked to. We will require, however, participation in quality and safety frameworks—for example, reporting the results of homebirthing and incidents that are related to it.

The government wants this work to be done in a collaborative way by way of a peer review process. That consultation process will be overseen by Victoria, which has chaired the national registration and accreditation process. The national Nursing and Midwifery Board will provide advice and protocols for homebirthing outside the publicly funded and auspices services. Privately practising midwives—some of whom currently provide homebirthing services but do it as part of their employment, either with the state or with a private practising obstetrician—would not be affected by these changes as their insurance is already covered through their employment status. Clearly this arrangement will not apply in jurisdictions where there is no lawful homebirthing occurring.

This two-year exemption allows plenty more time for those protocols to be established and to be worked on. In the meantime, the arrangements agreed to last Friday ensure that homebirthing midwives can lawfully continue to provide the services in the jurisdictions had currently allow that. They will continue to be uninsured, as they currently are. The government will be collecting more data on homebirthing and there will be a process to further work through these protocols that would either bring more homebirthing services into our public system or potentially open the way in the future for an insurance product to be extended to cover them. Homebirthing programs operate in a number of state and territory systems with participating midwives coming under the insurance cover of the public health system. Midwives who provide maternity services in an independent private capacity, including assisting with homebirths, currently do so without indemnity cover as there are no products currently commercially available.

I have met on a number of occasions with my local representatives of the Maternity Coalition. In fact, I first attended a meeting at a park in Long Jetty some three months ago where these concerns were raised. They are legitimate concerns about making sure that homebirthing is there as a choice for women. While homebirthing has been very much in the minority—in fact, much less than one per cent of pregnant women choose to give birth at home in Australia—it has nonetheless been at the forefront of innovation in relation to birthing. Water births and the like were products of homebirths. And I think everyone in this place must be a little concerned at the extremely high rates of caesarean operations that we have in this country, well over 30 per cent, when the World Health Organisation talks about 15 per cent being around what would naturally occur in most communities. On the Central Coast that problem is even greater, with Gosford private hospital having caesarean rates in excess of 50 per cent and Gosford public hospital having caesarean rates in excess of 40 per cent. So you can understand that women on the Central Coast do want to have options that involve midwives so that a caesarean is much less likely in those circumstances.

In March last year the Council of Australian Governments signed an intergovernmental agreement to implement a single indemnity scheme by 1 July 2010. The scheme will initially cover 10 health professions: medicine, nursing, midwifery, pharmacy, physiotherapy, podiatry, osteopathy, chiropractic, optometry, dental care—which includes dentists, dental therapists, dental hygienists and dental prosthesists—and psychologists. The current proposal under the draft legislation for the scheme requires professional indemnity insurance as a mandatory condition of registration for all health professionals, including midwives. This is an important part of raising standards and providing public protection for patients and consumers. The Australian government is committed to building on its 2009-10 budget maternity services reform package by working with the states and territories, and with key stakeholders, to develop a national maternity services plan to ensure coordination of maternity services across Australia.

The member for Flinders spoke about his personal experiences in relation to midwifery. And I would like to share with the House some of mine too. Seven weeks ago I was at the birth of my daughter, Matilda Arnold Thomson, who is seven weeks old today. We chose in our circumstances to have the delivery take place at Wyong Hospital, but at the birthing unit at Wyong Hospital, which is run by midwives. There are no obstetricians at Wyong Hospital. You essentially are under the care of a midwife from the time you know about the pregnancy and they are with you through the whole pregnancy. When it is time to deliver, you go to the hospital to a room that looks very much like a room would at home with the big bath and a bed and your midwife is there with you. You do not have the option of epidurals, you do not have an obstetrician there, but of course this is carefully screened to make sure that it is aimed at women who will not have difficulties with the delivery of their babies. Should something go wrong or not go according to plan, you are immediately whisked 10 minutes down the highway to Gosford Hospital, where there are obstetricians and medical practitioners available.

The reason that I am very much in favour of making sure that homebirths are an option is because of the terrific experience that we had with a first-class midwife, Val Paynter. She was in fact midwife of the year in New South Wales last year, and my experience with her leaves me in no doubt as to why she achieved that recognition. The experience we had could just as easily have happened at home at Bateau Bay, which is probably three or four minutes closer to Gosford Hospital had something gone wrong. What was essential was that we had a registered midwife who had indemnity insurance because she worked through the hospital, and we had the choice of this method of birth.

The only reason that the birthing unit at Wyong Hospital is open is that they adopted a new model and went to a midwife led birthing unit. Otherwise the inability to be able to attract an obstetrician to one of the most beautiful parts of Australia, the Central Coast, would have meant that this unit would have closed down. So the choice that was made by the hospital to adopt this model was probably one that was done out of practicality, but the result has been a terrific one for the citizens of Wyong and the surrounding areas. I very much want to place on record my thanks to the hospital and to the midwives who did such a magnificent job and do a magnificent job every day there.

What this shows is that there are many different models and many different choices available to women at the moment. The announcement that the minister made on Friday of last week means that the option of homebirth is still an option that is there. But in all of these considerations and in all of these choices we also have to be mindful of the safety of the pregnant woman and the safety of the child who is going to be delivered, and that is why this legislation goes to the issues of accreditation and registration and the issues of making sure that the standards are raised and are uniform across the country, and also importantly goes to the issue of indemnity insurance so that there is that protection there for the consumer as well.

This is a balanced package of legislation before this place, a package that meets the aims of improving midwifery, of placing a greater emphasis on it in our birthing models as well as balancing the issues of safety and accreditation. These are important pieces of legislation that do not outlaw homebirth, that make sure that there are schemes in place and the opportunity over the next two years to gather proper data on the Australian experience of homebirth and to see where that brings us in the evolving issues of maternity and birthing schemes operating around Australia. I commend these bills to the House as very important bills.

Michael Johnson (Ryan, Liberal Party) Share this | Link to this | Hansard source

As the federal member for Ryan it is a great pleasure to speak in the House of Representatives, this great chamber of democracy, on the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related legislation. At the outset, let me extend my very warm congratulations to my colleague from the Labor government Craig Thomson MP, the member for Dobell, on becoming a father. It is a wonderful gift of life that we men have the opportunity of becoming fathers. One of the joys of my life is my little three-year-old and I know that as the member for Dobell’s son grows up he will bring him immense joy, immense pleasure and, I hope, immense pride as well. On behalf of my wife, I extend my congratulations to him and his partner.

Being a father is my great joy and to some extent this collection of bills has relevance to fathers as well. I know on the surface of it, it seems it is all about mothers but I want to put on the record straightaway that I think this is not just about mothers exclusively or fathers exclusively; it is about parenthood. Fundamentally, it is about how those who are about to become parents choose to become parents.

Very briefly: the legislation introduced here in the parliament provides MBS and PBS access for nurse practitioners and midwives, to commence in November 2010, and Commonwealth subsidised indemnity insurance for midwives working in a collaborative setting. The legislation is in response to recommendations of the maternity services review. The indemnity insurance provisions will not cover midwives providing birthing services outside of a clinical setting. That is the starting point.

I was going to speak on this legislation with substantial anger, substantial frustration and substantial disappointment but I am going to now speak with measured anger, measured frustration and measured disappointment. It is measured because the Minister for Health and Ageing from the Rudd government has, I understand, in the last few days done a triple somersault and backflipped because of the pressure from the public, the pressure from all those wonderful women throughout Australia who have urged the government to see common sense. I will come to that in a moment because in my presentation in the parliament I want to talk about the larger issue that this legislation goes to.

Initially, a very significant part of these bills goes to midwives in the context of their registration and how they practise, whether they practise within the health system or external to the health system. On the face of it, those who practised as midwives without registration would have faced a maximum penalty of $30,000 had they not been exempted by the health minister’s backflip. Currently we know that insurers do not consider it viable to offer independent midwives indemnity insurance due to their small numbers and their lack of a risk profile. Women who have a homebirth privately contract with midwives without indemnity insurance, and this goes to the heart of the contention in this legislation. Some jurisdictions provide publicly funded homebirthing services, in a very limited number of locations, which should not be affected by this measure.

Of grave concern to me and to the hundreds and hundreds of women who have contacted me by phone, email and fax and the dozens of women who I have had the opportunity of meeting—and I want to thank them for taking valuable time out of their day to come and see me—is that this legislation seems to take away the choice for women. It seems to take away their right to choose to have their child at home with the professional care and skill of a midwife, forcing them to be part of the hospital system. Had this legislation gone through without that backflip, midwives would effectively have been forced to practise their skill underground. They would have been breaking the law, because this legislation would have put them in a category which would not be covered with insurance, and clearly that is just untenable.

I want to draw the House’s attention to the larger aspects of this bill, to its philosophical heart. The key aspect for the coalition in relation to the heart of this bill, as I touched on earlier, is the idea of choice for women. When Prime Minister Rudd gave his maiden speech on Wednesday, 11 November 1988, the very first lines were the following words:

Politics is about power. It is about the power of the state. It is about the power of the state as applied to individuals, the society in which they live and the economy in which they work.

I want to say to Mr Rudd, to all my colleagues in the House of Representatives—and, indeed, to my colleagues in the parliament—and certainly to all the constituents of Ryan: politics is not about power; politics is about empowerment. It is about empowering young people. It is about empowering individuals. It is about empowering businesspeople. It is about empowering entrepreneurs. It is about empowering women to make choices. That is what politics is about, and that is the fundamental divide between the government party and the opposition parties. We believe strongly, robustly, fervently and vigorously in choice. We believe that politics has a capacity to empower people.

We believe that women should be empowered to choose to have their births at home if they so wish. They know all the risks. They are informed. They are educated. It is not something, surely, that they would have taken on board lightly. Women have the right to choose to have homebirths and with the protection, the skill and the professionalism of midwives, who have trained for it. That is their role. No less so than a surgeon or a gynaecologist, they ought to be respected for their craft. They ought to be respected as an important profession that caters to a need in the community.

I certainly know that all the women of the Ryan electorate who came to see me, the dozens of them, and, I understand, the hundreds and hundreds who were here in cold, rainy Canberra today came to voice their statement of choice, to voice their preference for the right to choose. Why should a government say to these people, ‘You are criminals if you decide to have a midwife at home when you give birth’? Why should that midwife be classed as a criminal? Surely the government of Australia has bigger fish to fry. Surely the Commonwealth of Australia has greater priorities. Let us go out and catch the murderers, the rapists, those who destroy our society, the drug pushers. Let us go out and catch those people. They are the criminals. They are the ones who destroy our lives. They are the ones who destroy the fabric of Australian society. They are the ones that we should be pursuing with every national resource available to the Commonwealth government. Midwives are not criminals. But effectively, in two years time, when the provisions of this bill come up for review, when there is a reconsideration of the status of midwives, what will happen then?

I want to state very strongly on the record for the benefit of the people of Ryan, for the benefit of the women of Ryan and for the benefit of those who believe in their right to choose: I am for your choice, I am for your empowerment and I will continue to make public and to raise at every opportunity that the Rudd government is about the power of the state. It is about the power of the government, not about the empowerment of women and of individuals.

I went back to my maiden speech, just to compare it with what Mr Rudd had said in his maiden speech. This is what I said, for the benefit of the women of Ryan and for the women who believe in choice. This is what I said in my maiden speech, and it is very relevant:

Australia must always be a land of … abundance—one that is rich in opportunities for our people to pursue their hopes and dreams. ‘Equal opportunity, not equal outcomes’ is a description that sits at the heart of my Liberal political views. It is in this context that my philosophical view of the role of government takes shape. It must be the role of government to do all in its capacity to ensure that its citizens have the greatest opportunity of pursuing their life’s dreams. There must never be powerful state hindrance or cruel institutional barriers to individuals wanting to fulfil personal or professional goals.

‘There must never be powerful state hindrance’—well, this is state hindrance. This is the power of the state hindering those women. This is ‘cruel institutional barriers’. This is the barrier of legislation, a barrier to individuals who want to fulfil their personal choice to have their children at home.

I think a presentation like this would be remiss without me referring to the heartfelt thoughts of many women who came to see me to express their absolute anxiety, their absolute dismay, that a Labor government could go down this path, that a Labor government with, perhaps, a feminist minister would choose to close the door to women who wish to have their children at home, something which happens all around the world, where midwives are protected by law—whether or not they are protected with insurance. It absolutely astounded them. I want to make a reference to Hazel from Bellbowrie, who wrote to me:

Women will continue to exercise their right to choose where they give birth. By removing their option to be attended by a registered, skilled and competent Midwife, they will have no choice but to ‘free-birth’ (with no birth attendant at all) or employ a doula (an excellent supporter during childbirth, but not a practitioner trained and skilled in management of complications which may occur). This will lead to a totally unnecessary greater risk for mothers and babies, with potential for both neonatal and maternal morbidity and mortality.

I want to thank Hazel for her views there, going to the issue of the health and safety of those babies who would be born at home where mothers chose to exercise their fundamental right to have their baby at home.

This is from Carolyn of Kenmore Hills, a beautiful part of the Ryan electorate:

I … cannot fathom the reality that my beautiful birthing experiences will be lost to legislation and politics.

What I am saying is that the existence of CHOICE allowed me to choose the best birthing option for me. Hence allowing me to have the birthing experiences I had. Today I look into my daughter’s eyes and know I need to fight now for her right to CHOOSE her preferred place to birth. I will not take for granted the CHOICE I had and those who made it possible for me to choose.

Nicole from Chapel Hill says to me:

As my elected representative, I urge you to take women’s rights to maintain personal liberty and choose their care provider during pregnancy, birth and the postpartum period seriously. Please do not allow the Labor government to restrict women’s access to home birth and midwives in private practice.

There is that phrase again, ‘personal liberty’. It goes to the core of those on this side of the parliament—liberty, choice, freedom. Why would we decide to take that liberty away from individual educated, informed, smart women? These are not women that go into this decision lightly. We ought to respect that. Of course there are risks in doing that but they are being cared for by professional midwives and they are making that decision with the best information and advice. Let me go on to Jane from Taringa in the Ryan electorate, who says:

However, as an academic at UQ, and a practising midwife, I am particularly concerned that her [Roxon] announcement excluded support for home birth midwives. In particular I am concerned that Home Birth will go ‘underground’ and that women will be forced to birth at home without the support of a midwife, if they exercise their right to make a choice to birth at home.

Thank you, Jane from Taringa, for that statement. Here is a dig in the ribs to a Labor government:

But now I find that my ability to hire a private midwife is in jeopardy, and frankly I am quite disgusted.

That was from Kara from The Gap. Thank you, Kara, for making your feelings very clear indeed. Here is another from another part of the electorate, from Mary in Karana Downs:

Medicare funding for midwifery is long overdue. It is not acceptable however to exclude homebirth from the funding and indemnity arrangement. By doing this Australia is totally out of step with nations such as the United Kingdom, Canada, the Netherlands and New Zealand.

If Australia makes homebirth unlawful, it will be on par with the US state of Alabama where home birth is unlawful and capital punishment still exists.

Thank you, Mary from Karana Downs, for your very insightful remarks. As I said, I was going to speak earlier on with substantial anger, frustration and disappointment, but this is now more measured because the government has backflipped again. It has backflipped on this issue as it has backflipped, done a triple pike and a triple somersault on a whole bunch of policy issues. We should be accustomed to that by now from this Labor government. In power for 18 months, they are really out of their depth. They are all spin and very little substance and are superficially telling the people of Australia that they know best. They are extremely arrogant, and there can be no better example of the arrogance and the philosophical core of the Labor DNA.

I remember during the election campaign we were told that Mr Rudd was very similar to Mr Howard, that a Rudd Labor government would be a safe pair of hands and that they would be doing things pretty much similar to the Howard government. It would be steady as usual with a few differences here and there. Well, of course, now we know, after 18 months, that this Labor government has nothing on the quality of the Hawke government, for instance. This Prime Minister has nothing on the prime ministership of Bob Hawke. Certainly, Prime Minister Hawke would not have said that politics is about power; he would have said that politics is about empowerment.

I say to all those in the Ryan electorate, as I end my remarks, that the fundamental difference between the Labor DNA and the Liberal DNA is choice. It is about liberty, it is about personal responsibility and it is about empowerment. We are the party of liberty, we are the party of the individual, we are the party of personal responsibility and we are the party of empowerment. On this side of the parliament, I say to my colleagues very loudly, very clearly and very passionately that we must not let the Labor Party conquer that philosophy. We must stand firm. We must be resolute.

Liberalism is about minimal state intervention and liberalism is about being the driver of opportunity and options, not about being dictated by them. This remains the fundamental divide between this side of the parliament and that side of the parliament. I say to all my colleagues that, if you ever needed any cause to doubt, this is one policy example where even with a feminist Labor health minister they will have no qualms at all about intervening and intruding into every corner of our lives and into our lounge rooms. I use the example of lounge rooms because another battle is looming in relation to censorship of the internet. That is another superb example of the different DNA between a Labor government and a coalition government. We are not for intruding into the bedrooms of Australians and we are not for intruding into the lounge rooms of Australians. Certainly, we are the party of choice.

We stand resolute in favour and in support of all those courageous women around Australia who have said, ‘Enough is enough: get out of our lives, get your bureaucracy out of our lives and get your government out of our lives.’ Remember, politics is about empowerment; it is about choice and it is about liberty. It is not about power, Mr Rudd.

Belinda Neal (Robertson, Australian Labor Party) Share this | Link to this | Hansard source

I have to say that was certainly a stimulating and empowering speech from the member for Ryan. Well done! I rise in the House today to speak in support of the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009. This bill amends the Health Insurance Act 1973 and the National Health Act 1953. It formalises legislation already in place in many states and territories, recognising the role of midwives and nurse practitioners in the provision of primary health care. The bill provides patients under the care of nurse practitioners and midwives access to the Medicare Benefits Schedule. It is a great step forward and something not recognised by many speakers on the other side. It also allows these eligible nurses and midwives to prescribe certain medications subsidised under the Pharmaceutical Benefits Scheme.

The focus of this bill is, first, to increase the capacity, effectiveness and efficiency of the healthcare system and, second, to encourage a multidisciplinary team approach to primary care. The minister has said that nurses and midwives are the backbone of the healthcare system, and this is completely and utterly true. This bill provides for long overdue recognition of the full scope of their capacities and contributions to primary health care.

I am aware of concerns that have been raised by members of the community regarding the effect of this legislation on homebirth midwives. I myself had two births attended by midwives, not through planning but because the doctors did not get around to being there. But I have to say that I was probably lucky. I have been contacted by Central Coast residents such as Lisa Cuthbert, who has expressed her support for midwives in private practice and the service that they provide to some women in the community. This bill has always been about improving choice and extending Commonwealth funding for a range of midwife and nurse practitioner services—for the first time ever including providing antenatal care in the community and attending births in clinical settings.

I would like to commend the Minister for Health and Ageing, Nicola Roxon, for achieving agreement from all health ministers around the country to a transitional clause in the current draft national registration and accreditation scheme legislation—no mean feat in the present circumstances. This transitional clause provides a two-year exemption, until June 2012, from holding indemnity insurance for privately practising midwives who are unable to obtain professional indemnity insurance for attending a homebirth. In other words, there is an opportunity and a time delay to allow midwives to arrange appropriate indemnity insurance. The agreement provides a framework for collecting invaluable data and facilitating cooperation between different levels of government to move this sector forward. It also goes a long way to allaying community concern about the rights of women to choose the place and support that they want when they give birth. The minister’s swift and responsive actions have gone a long way to resolving concerns raised by midwives on this matter.

Today, however, I will focus on nurse practitioners and their vital role in primary care in the context of this bill. This bill enacts the government’s 2009-10 nurse practitioners workforce budget measure, worth $59.7 million. Expanding the role of nurse practitioners in the provision of primary care has a particular significance for the electorate of Robertson. The New South Wales Central Coast Division of General Practice, which covers most of my electorate, reports that GP-patient ratios are at one to 1,140. This appears to be a favourable figure when compared to the national average of one GP for every 1,404 patients recorded in 2003-04. However, in Robertson we have a population in which 18.6 per cent of people are aged over 65 years. The national average for the same age group is 13.2 per cent around the rest of Australia. Clearly the Central Coast of New South Wales attracts a higher proportion of retirees. In assessing the impact of this concentration of older Australians, it must be highlighted that this additional population of seniors brings with it a more intensive and regular demand on primary healthcare services. Accordingly, the impact on Central Coast GPs’ time from this age group is disproportionately high compared to that for the average member of the Australian national population. It means more complex, chronic and high-need patients per head of population than the national average.

Nurse practitioners have a vital role to play in addressing this increasing need for care in our ageing population. I know that in my electorate of Robertson, on the New South Wales Central Coast, the changes brought about in this bill will be warmly welcomed by hardworking healthcare services. They work overtime to provide adequate primary health care to patients in residential areas such as Gosford, Erina, Kincumber and Terrigal and on the Woy Woy Peninsula. Dr Jeremy Bramston is one of those hardworking general practitioners in my electorate, and he has said, ‘Co-locating general practitioners and registered nurses provides the most effective team to deliver the broadest range of treatment and medical support to patients.’ Of course, he is right. His general practice in Woy Woy on the New South Wales Central Coast, just 10 minutes from my home, already employs nurses to complement the work of the resident GPs. This one practice sees over 2,000 patients per week, and the contribution of nurses in the mix of healthcare practitioners is warmly acknowledged.

This model reflects the intention of the bill, which is to foster and expand the uptake of a collaborative, multidisciplinary team approach to the provision of primary health care. I offer two scenarios to demonstrate how this collaborative and multidisciplinary approach expands the capacity of the primary healthcare system, an obvious focus of this federal government. The differing but complementary skill sets of doctors and nurse practitioners are what make this team approach so important.

Firstly, by acknowledging the talents of nurse practitioners in the area of patient education, improvements can be made in health outcomes for patients with long-term chronic medical conditions. For example, suppose a patient walks into a general practice and is diagnosed by a doctor as having diabetes. That patient then spends time with a nurse practitioner to talk over what adjustments the patient must make to manage their condition in conjunction with the prescriptions provided by the GP. This patient is then able to return to the registered nurse with questions, and there can be follow-up testing and advice on managing that diabetes. This would occur in the context of the co-located doctors and nurse practitioners, with diagnostic oversight continuing to be the responsibility of the treating doctor. By drawing on a nurse’s undeniable educational skills to assist the patients with the ongoing lifestyle adjustments that accompany a diagnosis such as diabetes, the demands upon a GP are eased. The patient benefits from the communication and education skills that come as part of the nurse practitioner’s training. Arrangements such as these have the capacity to greatly boost a patient’s understanding and treatment of ongoing symptoms, complex care needs and prescriptions as well as expanding the capacity of the primary care system to meet increasing demand.

A second example relates to maximising doctor time in diagnosis and the skills of nurses in ongoing management and record keeping. The hours dedicated by doctors to visiting aged-care facilities are time-limited due to the various constraints from attending to the patient workloads in their surgeries. In aged-care facilities, where a diagnosis occurs, paperwork for that patient must be filled out in triplicate. A script must be written and notes made at the care facility and then duplicate notes for the same patient made back at the doctor’s surgery. In circumstances such as these, nurse practitioners spend time in nursing homes—

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

Order! It being 8.30 pm, the debate is interrupted in accordance with standing order 34. The resumption of the debate will be made an order of the day for the next sitting. The member for Robertson will have leave to continue speaking when the debate is resumed.