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

I rise to continue what I was saying yesterday about theHealth 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 circumstances such as these, nurse practitioners can spend time in nursing homes and retirement villages ahead of and during a doctor’s visit, writing repeat prescriptions, ordering testing in advance of the doctor’s visit and following up on doctor diagnoses and paperwork to maximise the time spent in crucial diagnosis by the GP. It is not hard to see how doctors benefit from these collaborative arrangements. Nurse practitioners also benefit greatly from being able to expand their patient care into areas of particular competency and specialisation. This could be in areas such as immunisation, chronic condition management or aged care.

So, in several crucial ways, nurse practitioners can be a great bridge within primary care, as patient educators and as partners in the maintenance of chronic and complex care patients. Under the provisions of this legislation, doctors win, nurses win and, most especially, patients and the community win. All benefit from the expansion of capacity and efficiency within the primary healthcare system provided by this legislation. I commend the bills to the House.

Sharman Stone (Murray, Liberal Party, Shadow Minister for Immigration and Citizenship) Share this | Link to this | Hansard source

I too rise to talk to theHealth 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 am particularly concerned about midwives because they offer, in country Australia, an opportunity for a woman and her partner to have a birth at home—or indeed in hospital, but a birth that is a matter of their choice—where they are perhaps a very long distance from hospital, where there perhaps is not a gynaecologist, an obstetrician or a GP who still assists with births in their community.

There is a real problem with the changes to the legislation that were mooted by the federal minister, which in essence made midwives’ activities unlawful in most of Australia. It was said that you had to have indemnity if you practised as a midwife outside a hospital setting, but as a midwife operating outside a hospital you could not in fact seek and obtain insurance for your work, so both the people seeking the services of a midwife and the midwife were put into an extremely difficult situation.

Hence we had nearly 2,000 people—mostly women with their children but also some of the men who support those women—outside Parliament House yesterday in the rain protesting, saying, ‘This is Australia and this is the 21st century. How come in a country like this any government would choose to drive away from women a choice about where they give birth and how they give birth?’ It was quite an extraordinary circumstance and it reminds you, going right back, of medieval times, when women as midwives were subjected to the most extraordinary prosecution and persecution. You would have thought in the 21st century all of that was behind us but here we have the government of the day trying to say that a woman choosing to give birth at home cannot lawfully be assisted by a trained and highly professional midwife.

There is a lot of nonsense spoken about homebirths being less safe and more likely to have a catastrophic outcome than a birth in a hospital. That is a nonsense proposition given the data that is coming in from various developed countries where homebirths have been practised for a very long time. We know that there are risks associated with childbirth—and those risks, of course, are not eliminated with a homebirth. According to AIHW statistics from 2005, 601 planned homebirths in Australia were reported nationally, representing 0.2 per cent of all women who gave birth. It is a very small proportion but it is an important decision for those women. The highest proportion of homebirths occurred in Western Australia, and 27.1 per cent of women who had homebirths were mothers having their first baby.

A 2008 study of the homebirths of 24,000 women revealed that homebirth is an acceptable option for low-risk women and that it leads to reduced medical interventions. The same data states that planned homebirth—while it is very controversial and often causes great excitement amongst the medical fraternity, who would otherwise be receiving the fees for assisting as gynecologists, obstetricians or general practitioners—is not more dangerous than an in-hospital birth. The rate of infant deaths for both groups—for homebirths and those giving birth in hospital—was similar. In the 2008 study, of the 24,000 women who gave birth no mothers died. The number of babies born in poor condition—in other words, with low Apgar scores—was lower in the homebirth group, and the number of mothers with severe lacerations was lower in the homebirth group.

Midwives in Australia are highly trained and highly professional. They have been practising in association with gynecologists, obstetricians and general practitioners for a very long time, but they also practise alone. In my electorate of Murray there are very highly professional and skilled midwives who offer a private homebirthing service but who find that, even though their clients wish them to be supportive of their births right through to the actual delivery, if the mother presents at hospital the midwife is not allowed to attend to the woman, even though it is her choice and preference to have that midwife with her in the hospital. There is also the extraordinary circumstance that, even if the baby is born without the assistance of a GP, whether it is one who is on duty at the time at the hospital or one who cannot get to hospital in time, the GP is still paid the fee. The private practising midwife certainly does not receive any fee at the hospital.

This is a very serious matter when it is about the choice of women at one of the most important times in their life—giving birth. In Australia we always want to be sure that both the mother and the baby are safe, and it will always be the case that low-risk women will be most likely to have homebirths. But it is also the case in Australia right now that we have only seen a two-year moratorium with the status quo. It is no solution either for the women who wish to give birth at home or for the midwives who are trained to assist them.

We have to have a resolution of this problem once and for all. This government has to accept the fact that highly trained professional midwives should have insurance. They should be able to practise in the way that they do in other countries where homebirthing is understood to be an important alternative to births in hospitals. Midwives should not be treated as weird minority women who are more likely to be out knitting jumpers than attending to women’s needs. This is one of the unfortunate stereotypes that you see coming up again and again. I want to commend the midwives who work in my electorate. They are some of the most dedicated and compassionate women I have met anywhere. They have their patients’ and their babies’ futures always very firmly at the front of their minds as they advise and support women through birth.

Midwives and their clients are deeply distressed at the moment about the fact that there is no solution. Their choices are now even more seriously limited than they were before. We have no increase in gynecologists, obstetricians or GPs giving birth attention. In our region the numbers in those sorts of practices are declining. I just wish that this government would start to understand what women in this country want, that they would tune in to rural and regional Australia, that they would go out amongst the real people in real communities and understand that there is nothing more distressing for a woman than to have to go and attend a hospital for a birth when perhaps her first experience of a hospital was less than optimal or if she wishes to be surrounded by a supportive partner and others at the time of birth in a home environment. This is a very fundamental issue and I feel that women and midwives have been very much let down by this government. I am surprised; it should have known better.

A lot of lip-service is paid by the Labor Party to choice in the area of women’s reproductive health but, in this particular circumstance, women have been insulted, their rights have been trampled on, their choice has been severely limited and professional women who practise as midwives have been treated like backyarders with no cares and no skills to pass on to women as they come through one of the most important times of any woman’s life, and that is giving birth to a healthy baby. I have been told by my midwives and by a number of their clients who have had both a hospital and a homebirth experience that, if there is some trauma or distress during the experience of giving birth, in comparing their experience of professional care at a hospital to that of professional care at home, they had a much more supportive experience in the homebirthing situation when there was extra care needed or when some unforeseen difficulty arose. Women in the child-birthing situation felt that they had greater support than the women left in hospitals, often with very little attention or chance to understand what was going on.

This bill is a disappointment. I certainly believe that we are going to see a big change occur in the future in midwives’ rights in the area of insurance. It will be a shame if we have to wait until the next election, when the coalition is restored to government, for those changes to be made. I urge this government to make those changes.

John Murphy (Lowe, Australian Labor Party) Share this | Link to this | Hansard source

I rise this evening to speak in this place on the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009. I would like to begin by acknowledging the enormous contribution that all our allied health professionals have made to the quality of care in Australia, and I also take this opportunity to thank them for their outstanding efforts. Our health and medical professionals have ensured that Australia is one of the safest countries in which to give birth and, indeed, in which to be born. However, I also acknowledge the shortages we are currently experiencing in our medical workforce and the need for increased access to essential services with medical professionals, particularly in remote and regional areas. That is why our Minister for Health and Ageing, Nicola Roxon, has introduced these bills that support greater choice and access to health services. The bills aim to deliver a strong framework of quality and safety for mothers and babies in maternity care.

In 2008, Minister Roxon initiated the maternity services review headed by the Commonwealth Chief Nurse and Midwifery Officer, Rosemary Bryant. That review received over 900 submissions from various stakeholders, including health professionals, researchers, non-government organisations, representative organisations and individuals. The review found that many of the women who submitted their individual experiences noted the need for further models of midwifery care, while professional groups highlighted the importance of collaborative, multidisciplinary maternity care. In response to the review, the government announced $120.5 million worth of maternity measures in this year’s budget. The amendments proposed in the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related bills are part of that important $120.5 million maternity reform package.

Under the proposed changes in the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 midwives and nurse practitioners will have an enhanced role in providing quality care to patients. The bill will amend the Health Insurance Act 1973 and the National Health Act 1953. These amendments aim to support greater choice of access to health services for Australians. In particular, the bill proposes to extend the Medicare Benefits Schedule, the MBS, and the Pharmaceutical Benefits Scheme, the PBS, to patients of appropriately qualified and experienced nurse practitioners and midwives, including diagnostic imaging, pathology services and appropriate referrals.

Under the Health Insurance Act, a participating nurse practitioner or a participating midwife will be able to provide or request particular medical services, while under the National Health Act an authorised nurse practitioner or midwife will be authorised to prescribe certain PBS medicines. New MBS items for services will be created for participating nurse practitioners and midwives working with doctors, including antenatal, birthing and postnatal care. Participating nurses and midwives will also be able to refer their patients to specialists or consulting physicians under the MBS.

The bill requires the nurse practitioner or midwife to be an eligible nurse practitioner or midwife. The core requirement to become an eligible nurse practitioner or midwife is registration. Further, to access the MBS and PBS arrangements, midwives and nurse practitioners will have to show that they have collaborative arrangements with hospitals and doctors. The bill seeks to add authorised midwives and nurses as a new prescriber group. The list of prescription medications under PBS that they can prescribe will be limited and will correspond with the experience and scope of the authorised midwife or nurse. Of course, the extension of responsibility will also be in accordance with the relevant state or territory legislation.

It is estimated that the measures in this bill are expected to have a total cost of $111.3 million over four years, including administrative costs both for the department and Medicare Australia, and will be available from 1 November 2010. The costs, however, will be far outweighed by the overall responsiveness and efficiency of the health workforce with the introduction of these measures. These measures recognise our highly skilled and capable nursing and midwifery workforce by expanding their roles. Many other countries have already benefited from such measures. The definition of nurse practitioners as outlined by the Australian Nursing and Midwifery Council is, in part:

A registered nurse, educated and authorised to function autonomously and collaboratively in an advanced and extended clinical role. The role includes assessment and management of clients, using nursing knowledge and skills and may include, but is not limited to the direct referral of patients to other health care professionals, prescribing medications and ordering diagnostic investigations.

The definition of a midwife is:

A person who has completed a prescribed course of studies in midwifery and is registered or legally licensed to practice midwifery.

The midwife is recognised as a responsible and accountable professional, who works in partnership with women to give necessary support, care and advice during pregnancy, labour and the postpartum period.

I would like to point out this afternoon that, while members of the opposition have also recognised the quality of care nurse practitioners and midwives provide our community, for 11 years their recognition never extended to the formal legislative measures contained in these bills. I think it is important to note in this debate that it is the government, not the opposition, that is actually supporting nurse practitioners and midwives through these bills. It is the government, not the opposition, proposing measures to highlight the important role they play in our community and offering patients improved access to their services. The Consumers Health Forum noted in Health Voices that the review’s recommendations would deliver a more people-centred, flexible, team-centred health system. A people-centred, flexible, team oriented health system will surely provide improved patient care. The government is listening to the Australian people and delivering on major reforms across the board, including reforms in health and ageing.

The Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 will provide a government supported insurance scheme for midwives. It is important to note at this stage that midwives have not been covered by any indemnity insurance since 2002. This bill allows the Commonwealth to provide affordable professional indemnity insurance to eligible privately practising midwives. Due to market failure it was impossible for privately practising midwives to secure indemnity insurance policies. This is another measure in the maternity reform package which improves access to midwifery services by extending indemnity insurance to eligible midwives. In 2008 the Council of Australian Governments agreed to establish a national registration and accreditation program for certain health professionals, and it is due to complete in July 2010. The main purpose of the scheme was to provide more flexible and accountable arrangements for health professionals including, but not exclusive to, those in midwifery and nursing. The first stage of the legislation was passed in 2008 and, after extensive consultation with stakeholders, the Australian Health Workforce Ministerial Council released the exposure draft of the second stage of the legislation. Under the proposed legislation, practitioners will be required to have ‘suitable professional indemnity insurance during the period of their registration’.

A government supported professional indemnity insurance scheme for those midwives will offer more midwifery services in rural and remote communities and more scholarships for general practitioners and midwives, as well as a 24- hour, seven-days-a-week telephone helpline and information service to provide greater access to maternity information and support before and after birth. These bills refer to the implementation of the first two items. Further to the midwife professional indemnity scheme, the government has proposed the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009 which will be offered to midwives who cease practice. Under the midwife professional indemnity scheme the insurance policy will cover, through a tax levy, future claims made against eligible midwives who leave the workforce. This measure provides extra protection to midwives for periods that they are non-practising. The two bills relating to indemnity for midwives are estimated to cost approximately $25.2 million over four years.

The opposition have taken issue with the proposed midwife professional indemnity scheme. However, they did nothing in government, as I said earlier, to improve the situation when private midwives, mothers and babies were left without indemnity insurance. This government aims to improve access and quality in our health system, and the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related bills have received support from numerous stakeholders. The Maternity Coalition stated:

This is a historic breakthrough for Australia's health care system. It promises to, over time, improve the accessibility, quality, safety and cost-effectiveness of Australia's maternity services, by building a primary care foundation which is currently missing for most women.

While the legislation was welcomed by many groups, I acknowledge there is concern that the indemnity arrangements would effectively outlaw midwives assisting homebirth. In a recent meeting I had with a concerned mother and constituent, Robyn, she outlined the reasons why women choose homebirth and why it should continue without government restrictions—and I can understand that. In response to our meeting, Robyn put in writing to me her concerns and suggestions for midwives and homebirth and I would like to read out parts of her correspondence in this House today. She writes:

My main wish is at least to maintain the status quo. I want women to continue to be able to access homebirth with an independent midwife without this being unlawful or subject to $30 000 fines for consumers and midwives.

Robyn goes on to write:

It would be preferable for consumers and independent midwives to have access to indemnity insurance without that dictating a range of practice to the detriment of midwives’ informed professional opinion and women’s informed choices.

Robyn states that, ideally, homebirth should have equal access to funding and argues:

There is a growing set of evidence to support homebirth as a safe and arguably safer place for birth than hospital, there is a will within the government to reduce the burden on the hospital system and many women who would access homebirth if they could afford to.

Towards the end of her letter, my constituent states:

The loss of homebirth in this country would be a great loss for women who want natural style birth as well as those who want home birth.

One of Robyn’s requests to me is as follows:

Please call for any solution to recognise pregnant women’s autonomy as consumers with rights to informed choice, including informed refusal of hospitalisation.

I appreciate the concerns Robyn raised with me and I note that the minister responded to similar concerns by announcing last Friday, after consultation with the states and territories, that there will be a two-year exemption for homebirth midwives who are acting outside their state hospital system. I commend the minister for her swift and cooperative action with the state and territory health ministers on this issue. The exemption, however, does carry a number of conditions and requirements. The requirements include a number of reporting initiatives that will assist in accurate data collection. The data will provide further evidence based policy initiatives in the future. The reporting requirements may also highlight areas where further support could or should be given to midwives. It is important to reiterate that the minister’s priority is about seeking best possible patient outcomes.

This is another example of our government listening to the Australian people. Although homebirths account for approximately only a quarter of one per cent of all births in Australia, the choice of mothers concerning how to give birth and with whom is very important, and so is the paramount consideration of the safety of mother and child. Our government makes no secret of the fact that it endeavours to make our health system as efficient and effective as possible. That includes the significant investment in maternity care. Surely our health system, our maternity care framework, is worth this funding and investment proposed in these bills today.

Again I note that, since 2002, private midwives have not been insured. In a country as fortunate as ours, it is shameful that the opposition did nothing when in government to further assist midwives, particularly with indemnity insurance. It is a sad reflection of their dismissal of the important work of our midwives. The minister for health has announced a two-year exemption from indemnity insurance for private midwives. As I have previously stated, this will allow a closer examination of any possible alternative arrangements. However, it must remain that the health and safety of both mother and baby are paramount considerations in any decision. As stated by the minister, the government’s No. 1 priority is and always will be the improvement of patient outcomes.

The Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related bills will be subject to agreement with states and territories on a national services plan, particularly the investment and provision of birthing centres and rural maternity units. The nurse practitioner reform will improve access to primary care services. Greater use of nurse practitioners will again help to improve the efficiency and effectiveness of the health services workforce. It is obvious that there are chronic shortages in areas of our health system, despite calls from the opposition that these measures are unnecessary. So it is hardly surprising that, after some 11 years of neglect, members of the opposition do not support measures that aim to improve the efficiency and effectiveness of our health system.

The proposed measures seek to improve productivity and harness the full capability of our well-trained nurses to complement and improve our health system. It is untrue to suggest that the measures seek to replace doctors and specialists. On the contrary—the measures will ensure collaboration between our health professionals. Nurse practitioners will be assigned roles comparable with qualifications and skills and will only enhance the quality of our health system, not endanger it. Proposed measures will require midwives to meet the eligibility requirements for both federal and state law.

In a media release dated 23 June 2009, the Australian Nursing Federation congratulated the government ‘for recognising the benefits that highly skilled and educated nurse practitioners and midwives bring to the health of all Australians’. Our government recognises the need for reform and recognises the need for improved access and choice in maternity care. I believe that this legislation has married very well the call for greater choice from mothers and the call for a more collaborative approach by the health professionals.

The bills before us today have been reviewed by a Senate inquiry. On 25 June this year the Senate referred the bills to the Community Affairs Legislation Committee for inquiry and report by 7 August 2009. The committee subsequently presented an interim report on 7 August and on 17 August tabled its final report. Our government proposed these measures after extensive consultation, and the committee obviously recognised the benefits provided within these provisions. The committee received almost 2,000 submissions, and the final report states in its conclusion:

The Committee welcomes the initiatives contained in the three bills. The recognition of the professional skills and expertise of nurse practitioners and midwives is a significant step. In particular, the changes to allow these two groups of professionals to access the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme will strengthen the health system and the delivery of maternity services in Australia.

Further, the recommendation reads:

The Committee recommends that 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 be passed.

In conclusion, the committee appreciates the benefits provided under these bills, and even members of the opposition have conceded the positive proposals for maternity care in these three related bills. The Rudd government appreciates that midwives play an important role in the births of many children and that, although a small percentage of women choose homebirthing, it is an important decision. The two-year exemption gives sufficient time for any further consideration and changes to be made. I trust that these bills and subsequent amendments will ensure that Australians continue to enjoy one of the world’s safest health systems for both mothers and their babies. I commend these bills to the House.

Bruce Billson (Dunkley, Liberal Party, Shadow Minister for Sustainable Development and Cities) Share this | Link to this | Hansard source

I rise to talk about this package of three bills. For those listening, there are actually three pieces of legislation being discussed together before the chamber. There is, of course, the one that is most topical, which many have heard about, involving midwives and nurse practitioners—the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009but there is also legislation relating to the midwife professional indemnity Commonwealth contribution scheme and the midwife professional indemnity run-off cover support payment scheme.

Essentially these three bills have separate aims. The first one is to amend the health legislation to provide for eligible nurse practitioners and midwives to request diagnostic imaging and pathology services under Medicare arrangements and to prescribe a limited range of medicines under the Pharmaceutical Benefits Scheme. The second bill, theMidwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009, which is linked to the first bill, is to provide for a Commonwealth scheme with assistance for midwives in accessing indemnity for claims arising from their professional activities in a collaborative clinical setting. The third bill, the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009, imposes a tax on midwives’ professional indemnity insurance to cover run-on cover for midwives who have ceased practising. That is the package of bills before the House.

The first bill, in extending MBS and PBS access to nurse practitioners, is potentially a very valuable mechanism for a range of objectives. First of all, there are skills shortages in the medical field and doctor shortages, particularly in outer metropolitan areas and regional and rural areas. This is a trend that was started, in terms of expanding the role of nurse practitioners, under the Howard government. It is good to see that the Labor government is carrying on that tradition established by the Howard government. It reminded me a bit of the election campaign, where the Howard government seemed to make its views and election policies known and then those were echoed by the then Labor opposition. It is good to see that that practice is continuing now that Labor is in government!

The provision and coordination of patient care by medical practitioners is a really central issue for all of us concerned about good health outcomes. Naturally this legislation has safeguards about who can exercise these expanded responsibilities. They are all designed within a framework aimed at protecting patients, their care and welfare. Midwives are included in the measure as part of the government’s response to the maternity services review and also a considerable lobbying effort by midwives and a number of patients of midwives, who have been very positive and very upbeat in describing the services that they have accessed—particularly where they have been looking for a low-intervention pregnancy—and the important role midwives play not only in those low-intervention pregnancies but also in pregnancies in general. The Howard government was very interested in pursuing this pathway. I recall, quite vividly, hosting a meeting in my office with then health minister Tony Abbott to discuss the mechanics of this kind of idea. It is good to see that that momentum created by the previous government is being carried on here.

There is a significant amount of money attached to this, and that is appropriate. It has been characterised in a number of different ways in this place. Some of that funding is actually to put the machinery in place to enable the PBS and MBS access. It has been characterised differently by some people, as some direct change in services or money going to maternity. Some of it is going to those activities but there is also quite an amount going to putting the infrastructure in place to enable that expanded access to MBS and PBS services by nurse practitioners. So it is encouraging that we are seeing a greater role for nurse practitioners and midwives.

I particularly want to point out some misunderstandings about the evidence. I think the body of evidence is absolutely clear that having nurses, nurse practitioners and midwives operating in a collaborative environment—recognising skills, qualification, experience and the input of other health professionals—delivers better health outcomes. That is why I am very keen to see an expansion of the role of midwives. I believe also that there are clear efficiency benefits. It seems to me that, in a highly skilled workforce, including a range of clinicians and medical practitioners, nurses are highly skilled and should be able to operate at their highest and best use. That is my understanding of efficiency—where people with those competencies and experience can fully exercise them. I am pleased to see that these measures go some way towards ensuring that that full contribution, using that full set of skills, that nurse practitioners and midwives can make can actually be made and delivered to the benefit of patients in a collaborative health system.

This is sometimes characterised as a response to workforce issues. Again, something that the Howard government pursued was a greater role for practice nurses and greater support for nursing generally. We had plans and took action to address the issues behind why nurses were not working in their profession. That not only included a range of issues around clinical support and opportunities but also related to poor hospital management, in some cases, where nurses were dissatisfied with the working environment and looking for an opportunity to fully exercise their skills. The Howard government had a plan and had an agenda for that. It is sad that some of those hospital management reforms, which would have increased the likelihood of ex-nurses returning to a career in nursing, have not been pursued quite as vigorously as I think they should have been. There is also an issue around greater support for nurses along with incentives to bring nurses back into the workforce. Again, that was an initiative implemented by the Howard government and carried forward by this Labor government.

I think it is also important to recognise the service enhancement potential of fully utilising the skill set of nurses, nurse practitioners and midwives. This is not solely about, as some would say, an alternative service delivery model where somehow a nurse may displace the activities of other medical specialists; it is actually about what nurses can bring to the task. This is about the way in which that skill set can work collaboratively in primary health care and the important collaboration with GPs and other doctors to have coordinated clinical support arrangements for better health outcomes.

I think the thing that struck me most in looking at this legislation was that it is all well and good to provide enhanced nursing access to the MBS and to the PBS but what I would have liked to have seen is some more action to enhance the availability of nurses. I am mindful of a very positive commitment the coalition made that, had the Howard government continued, we would have seen, for the first time, funding available for practice nurses to visit older Australians—veterans, war widows and widowers—in their home. You can imagine how enthusiastic I was, as the then Minister for Veterans Affairs, about that measure. I recognised that having the practice nurses undertake about 800,000 home visits over a four-year period would have made an enormous positive impact on the wellness and health care of that group in our community—many of whom may have found it difficult to visit their GP; many of whom may not have reflected on their wellness; and many of whom may not have been guided and given the pastoral care of a practice nurse visit to access wellness, health improvement and medical services to make sure that their quality of life was optimised. That was a great policy initiative. It is not something that the Rudd Labor government appears to have even addressed. If you believe, as I do, that nurse practitioners have considerable talents and skills to offer then let us not only expand their scope through measures such as this but also actually improve the availability of that through measures such as those proposed by the coalition prior to the last election.

Who knows what scope there may be to carry forward that kind of idea when the next election comes around. The way the budget is being managed and the extraordinary spending spree that federal Labor has gone on might mean very little scope for service enhancement initiatives such as the one that the coalition advocated prior to the last election. But let me just say that is an example of nurse practitioners being not only able to undertake a wider range of activities to support wellness and health services but also having the resources to go out and deliver that capability to a very deserving group of Australians for whom access to an in-clinic visit may have been difficult. So I put on the record an acknowledgement that that kind of service enhancement does not seem to be on this Labor government’s radar screen, when I would have thought that, if there were resources around, that would have been a priority. But, as I said, who knows what resources may be available once the Labor spending spree takes hold and very limited discretionary expenditure is available to benefit the Australian people. I think, though, that Labor should continue to follow that tradition of picking up the coalition’s lead, just as we saw with attracting former nurses back into the workforce with subsidies and recognising and expanding the role of practice nurses. I think that habit of following what the coalition is doing and proposing is something that Labor should reacquaint itself with.

The Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009 have caused quite a lot of interest in my electorate. It has been personally interesting to me as I join with my family to celebrate the 21st birthday of Isabella. It is 21 days that she has been on this planet. I pay great tribute to her mum, Kate, for her wonderful work. I have seen very recently and close at hand the work of midwives and I admire them greatly. At Andy Griffiths’ practice, a highly respected obstetrician on the Mornington Peninsula, the midwife, Kay—if not Andy’s foreman then certainly his concierge—makes sure Andy does all he needs to do. Then there is the remarkable team at the Bays Hospital in Mornington and the midwifery unit there—a remarkable group of dedicated professionals providing outstanding care. We thank them for their attentiveness.

One of the reasons I raise that recent experience is that it reminds me of how the care that is available to support the bringing of a child into the world is very much related to the situation, the assessment of risk and the medical circumstances and conditions which people face. In the case of my beautiful and extraordinarily talented wife, Kate, her blood group was rather mysterious. Monitoring her circumstance and making sure her blood type did not mix with Isabella’s was a very crucial task that required a high degree of monitoring, supervision, pathology testing and the like. But all of that went very well and we are very fortunate for it.

That is not everybody’s story though. There are in Australia, including in the Dunkley community, numbers of women preferring a very low-interventionist model or even a homebirth. That is a choice that I being a Liberal, with my side of politics believing in personal choice, believe we should facilitate. It is not a choice without serious considerations though. The fact that we are talking about professional medical indemnity and the like illustrates that it is a choice not without some risk, but those risks can be measured and evaluated and a low-interventionist homebirth pathway is entirely suitable for many women who choose that option.

One of the things that has activated the Dunkley community is the way in which these bills conspire to actually make homebirth illegal. The legislation does not say it is illegal; it just says that if you want to be a practising midwife there are certain conditions. One of those conditions involves professional indemnity insurance. If you do not have that then you will be fined. So if the health minister wants to challenge the characterisation of this legislation as making homebirth illegal, let us certainly say it makes homebirth unlawful, if that is more comforting to her. That is what has caused such outrage. The current arrangement of private practitioners providing midwifery services in the home as something that is undertaken between families, the mother and the medical practitioner, who is the midwife, is something that will be shut off by these bills.

This has caused great outrage. I know of a number of people from the Dunkley electorate who made the journey to Canberra. They got to feel the chill of a cold Canberra morning but did so because they feel strongly about this. I just want to put on the record some of those views. I will just pick a couple out. Meredith from Frankston conveyed to me:

I was upset to hear that Minister Nicola Roxon may take the advice of some ‘ill-informed others’ and make it very difficult in the future for a woman to choose a homebirth. The fact that women may not have the right to choose where they birth bothers me greatly. This unfortunately will make the normal and natural process of birth a mechanical and ‘risky’ one, not to mention the strain on the over stretched hospital system.

Meredith went on to say:

Healthy informed women should be able to birth at home, where they feel safe, nurtured and relaxed.

She went on to describe the advantages of that experience.

Other examples that were brought to my attention included one from Rita from Mount Eliza, who described her first birth in a clinical hospital setting and how through a process of further research and discussion she chose a homebirth for her second child. She said:

Needless to say, after much investigating, talking and reading I opted for a homebirth with my next pregnancy. I had continuous midwife care throughout the pregnancy and birth, and our baby was born calmly and joyfully at home. It was a far cry from the previous scenario. I felt comforted and empowered by my/our decision and I feel our baby was far better off with this start in life.

We also heard about other experiences. I will point to the insights shared with me by Kimberlie Furness. Kimberlie, who I have known for a very long time, conveyed to me her distress at the measures the health minister was putting in place—in her eyes, making a midwife-centred birth an option not available to her.

She contrasted the atmosphere and environment in Australia with what occurs in the UK, where low-intervention birthing, midwife-centred birthing and homebirthing are far more common. She conveyed to me that a recent study in the Netherlands, where one-third of women choose the homebirth option, found, in comparing home and hospital births, that there was no difference in death rates of either mothers or babies in 530,000 births. She was very keen to emphasise that, from a funding perspective, in most cases homebirth makes sense as it is so much cheaper, involving fewer costly drugs and less surgery and intervention. She said:

It is unfortunate that currently only 1% of the birthing population choose this option, perhaps through lack of information and education about the choices available and the safety record …

The point that Kimberlie was making is that if this is the choice of women who are well-informed about their own health and the circumstances of their birth why is it not supported? Janelle in Balnarring wrote of her experiences and said that ‘a medical model of care’ that medicalises birth is not for everybody. She too called on me to act to make sure that the choice of a midwife-centred, low-intervention homebirth is available.

In responding to this kind of concern raised by the community, I know that the announcement made by the Labor government is viewed by the women who have been in touch with me—many of whom attended the rally here on Monday—as of no comfort whatsoever. All it is is a stay of execution for a birthing option that they are attracted to and that should continue to be facilitated in our country. They saw the announcement from Minister Roxon as nothing more than political procrastination.

I would characterise it as one of the most perfect backflips we have seen. In politics, backflips are often used to characterise a change of mind or change of heart. But when you think about it, when someone does a backflip they actually end up facing the same direction. This was truly a backflip in that we had the fanfare and the spectacle and all the activity, some delay in the date from which homebirth will not be lawful, but essentially absolutely nothing has changed. We had much movement, much excitement and a lot of ‘ooh-aahing’ from those on the Labor Party side, who were trying to make it sound like something had changed, but nothing has changed except that the end date for homebirthing as a lawful and safe option for women will be two years later than the Rudd Labor government originally planned.

The coalition has argued that there needs to be some genuine action in examining what the pathway forward should look like. The coalition will be moving amendments that recognise that a full and informed debate requires the minister to table the actuarial modelling that she points to as giving rise to an inability to provide professional indemnity for midwives providing birthing services outside a clinical setting. We need a full and informed debate about a review into the provision of medical indemnity insurance and a canvassing of what options there may be—whether there can be a pooling of risk and a coordinated pooling of practitioners operating outside a clinical setting and whether there is some scope, recognising the savings to the taxpayer, for the government to facilitate medical cover. We do not know because we do not know what the data is. We call on the minister to release the data. Above all, we should always have regard for the wellbeing of the mother and child so they are not put at risk. That framework might require a birthing plan— (Time expired)

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

This evening I welcome the chance to make a contribution to this cognate debate on the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009, the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009. With thousands of Australian women, I welcome the Minister for Health and Ageing’s most recent backflip, which is that the government will offer a two-year reprieve—or, as the member for Dunkley said, a stay of execution—for midwives to attend homebirths. This was clearly the most controversial aspect of this legislation and, while it is not yet fully resolved, it is yet another embarrassing backflip for the Rudd Labor government.

The minister is all over the place on health decisions. Recently I spoke about the cuts to chemotherapy medication, following representations from several constituents—some seriously ill. Thankfully, the minister realised the error of her ways and backflipped on these plans as well. This government has had an array of shamefaced backdowns and has left serious uncertainty over a number of important issues—for example, private health, IVF treatment, youth allowance, funding for the National Academy of Music and cataract surgery. How can we forget the Deputy Prime Minister’s involvement in axing IVF funding after tabling a petition in 2005 calling for no changes to Medicare funding of IVF treatments. Ms Gillard said it is a cruel thing to do to Australian women, particularly older Australian women, whose only hope of falling pregnant is through the IVF process. But what did she do when she became a minister? Nothing.

The government’s hypocrisy is blatant and its approach to health is sickly. The shambolic decision making is the result of a government that is focused on re-election and focus group feedback rather than on the interests of the Australian public. If it were not for the public outcry, the 2,000-strong rally yesterday with women shouting ‘home birth rocks’ and the pressure from the coalition, the government would not be having a change of heart.

As we have heard, this legislation provides MBS and PBS access for nurse practitioners and midwives, which will commence on 1 November 2010, and Commonwealth subsidised indemnity insurance for midwives working in a ‘collaborative’ setting, to commence on 1 July 2010. These bills extend Commonwealth subsidised indemnity insurance to eligible midwives. It is the definition of eligibility that drew a strong public response. The indemnity insurance intention was not to cover midwives providing birthing services outside of a clinical setting, forcing homebirths underground and risking the health and wellbeing of mothers and babies. Coupled with the national registration and accreditation scheme to make indemnity insurance a mandatory requirement of registration, the unfortunate result made it effectively illegal for independent midwives to provide homebirthing services. Individuals who practised as midwives without registration could have faced a maximum penalty of $30,000.

The minister now appears to have adopted the position advocated by the coalition to maintain the status quo and allow midwives to continue to assist in homebirths. As I understand it, they will be exempt from holding indemnity insurance for the next two years, which will enable them to continue to assist in homebirths. While they can assist in homebirths, they will not be insured. I make this point: they will not be insured during that period, which is quite a problem. This is a step forward and it will allow for debate, costings and the examination over the next two years, but let us not forget that it should never have come to this in the first place.

Midwives and nurses are the cornerstone of health services. I am a proud father of two children and was present at the birth of my daughter and my son—I was not much help, by the way. The midwife in attendance did all the work. On a wet and rainy night, the obstetrician turned up almost after the first birth had occurred.

John Cobb (Calare, National Party, Shadow Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

Pretty normal.

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

That is right. We paid a large fee to the obstetrician, but the midwife did all the work. I take my hat off to midwives. Parents put great thought, time and effort into finding a birthing plan that is right for them. That is my point: choice. My wife chose to go to a major hospital. Many in my electorate who have contacted me about this want a choice. We on this side believe in choice. We are not part of the herd mentality; we believe in the individual’s right to choose. The Rudd government wants us to take such a nanny-state direction that fundamental choices are being taken away.

What right does the government have to determine how you give birth, one of the most personal and meaningful experiences in a woman’s life? I certainly do not profess to be an expert on the medical merits of birthing choices, but there have been plenty of experts who have entered the debate. The Senate Community Affairs Committee took over 2,000 submissions. The 2008 Review of homebirths in Western Australia commissioned by the Western Australia Department of Health looked into access and outcomes for homebirths. The report found that developing systems to support safe and satisfying systems of care that provide child-bearing women with diversity options are essential, and midwives are critical to this process.

Many women and families support homebirth because it is a safe, low-risk option for most women. They believe it offers continuity of care and caters for women who want to birth in the comfort of their own surroundings. Homebirths are a choice, I must say, for a relative few. Studies have shown that less than one per cent of Australian women have homebirths. So we are not talking about a huge cost here, particularly for a government that seems to want to throw money at everything at the moment. This has been a surprising potential cut. In fact, homebirths actually save money because it means that there is less pressure on public hospital systems.

Western Australia sees about 200 planned homebirths a year which are generally managed by the Community Midwifery program or by independent midwives. The Community Midwifery program offers a great service but does not extend beyond the Perth metropolitan area. This means that most women in my electorate of Canning rely on independent midwives because Canning has half its population in the metropolitan area and half in the outer metropolitan area. In terms of land mass, something like two-thirds of the electorate is outside the metropolitan area.

As an aside, I would like to take this opportunity to speak about midwifery training in my electorate of Canning. We are extremely lucky to have the Peel Campus of Murdoch University in Mandurah which specialises in nursing. The school offers a Bachelor of Nursing, which has been highly successful. It also offers masters of midwifery and advanced nursing. The best outcomes are that many of these locally trained nurses and midwives stay in the local area, working in hospitals in the Peel region and south-west corridor—and that was its intention.

Industry groups have been highly critical of the government’s initial attack on midwives. Homebirth Australia was outraged by the decision that would have seen homebirths with a privately practising midwife essentially made illegal. The organisation has acknowledged that Minister Roxon’s backflip is a step in the right direction but the failure to provide indemnity insurance remains highly unacceptable. The Australian Medical Association, the AMA, the peak body, said:

Actions by the government which favour one particular new model of care over another will generally not be in the interests patients, will restrict real choice and will be inequitable.

The Australian Private Midwives Association’s Liz Wilkes considered the decision ‘highly disappointing’ and said:

It looks like the voices of more than 2,000 women speaking out on fundamental women’s rights have been ignored and given the sheer magnitude of the evidence put forward and the results the committee has come up with, it looks like we are getting to the end of the line when it comes to options.

Ms Wilkes believes the government’s change of heart is merely a bandaid solution. Women and their partners do not make homebirth decisions lightly. Great consideration goes into this important decision and people make that on the basis of informed advice and knowledge.

Many Canning constituents have approached me, appalled by the government’s attempt to take away their choice. These women have either had a homebirth or support the option of homebirth. They support the choice. One said to me:

It is unacceptable that women are unable to choose the care of a registered midwife to give birth at home. I don’t understand how the Government would want to take away a safe option that saved them money in the long term as we are not using the hospital system.

You might have noticed in the media today there was quite a contingent of women from Western Australia at that rally yesterday. I can assure you they travelled a long way and at great expense to come to Canberra on a bleak, cold day. A Mount Nasura woman said to me:

If midwives in private practice are not assisted, they will be prevented from registering. If they practise unregistered they will face a jail term. If national registration proceeds as planned, women choosing homebirth will be unable to access a registered midwife and essentially the practise will go underground. It is not acceptable that women are unable to choose the care of a registered midwife to give birth at home. Homebirth is a nationally funded option in the United Kingdom, Canada, New Zealand and the Netherlands. I ask that you support a women’s right to choose where and with whom she gives birth.

Similarly, Mrs Cole from my electorate has said to me:

It is unacceptance to me and all women that any government has the right to control our bodies and take away the choice of where and with whom we give birth.

I conclude by saying that the coalition strongly believes that this is an issue which fundamentally is about choice. As I have already said, we are a party that believes in choice, whether it be in health, education or many other life areas. We do not believe in the herd mentality that comes from the other side. It should be for parents, in consultation with health and medical professionals, to make the very important and personal decision of the model of care for childbirth. We look forward to the health minister releasing the government’s costings, complete actuarial modelling and policy detail—and hope that this stay of proceedings is not just that; we hope that there is an eventual resolution to both the insurance and choice issues. I thank the House.

John Cobb (Calare, National Party, Shadow Minister for Agriculture, Fisheries and Forestry) Share this | Link to this | Hansard source

In speaking to the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related bills, I must say that, as somebody who has seven daughters and 15 grandchildren—and two more on the way—I think I have some knowledge, if not of having children then at least of dealing with those who do. I have been approached by midwives and mothers, some who are both and some who are one or the other. While I have to confess that, being a nervous father and grandfather, I would always prefer my children and their children who have children to do so with everything around them, I totally accept that a woman has a right to have a child in her own home with a registered and fully trained midwife. My only concern would be that they totally accept the advice of that midwife and, if there are likely to be any complications, that they do it within call of doctors or hospitals within a reasonable distance.

Most people, be they doctors or midwives, say to me that you really should be no more than three-quarters of an hour or so from more extensive help, should it be required. That seems to me pretty reasonable, because quite obviously an experienced and trained midwife will know reasonably early if there are likely to be any complications. During the course of a pregnancy, if it is likely to have any complications, I would hope nobody would go into labour outside of ready access to a doctor, hospital and everything that goes with them.

Having the far west of New South Wales as part of my electorate and having lived in the western division of New South Wales virtually my whole life, I know the tyranny of distance is quite a frightening thing. There are times when mothers and fathers are damned glad to have medical help of any kind. I think that is the main thing. I implore and plead that nobody has a child or allows themselves to be in a position where they have to give birth without medical help, be it a midwife or anything else. In particular, I would never be in favour of a mother putting herself in a position where she has to be out in the outback or anywhere else. I know these things happen—sometimes through misadventure. I will talk about some of those in a minute. But I believe that within the confines of which I speak a registered and trained midwife, having taken all due precautions to ensure that, everything being equal, there should not be undue complications, a woman should have the right to have a child in her own home with the assistance of that midwife and within a reasonable distance of further aid. I do not think any midwife—none that I have spoken to, anyway—has suggested for one second that they should be longer than the time period I mentioned away from further help should the unexpected arise. I am sure no mother would want to be.

I very much support the right of midwives to practise and mothers to make that decision with all of those safety valves in place, but I have to take this opportunity to talk about the current situation. The debate about midwives being able to continue to assist in homebirths brings up the Third World situation facing women in quite a lot of my electorate—certainly in the western part of my electorate, where they cannot have babies at their local hospital because there is no maternity service. Cobar, for example, is a town of 6,000 people. I believe that in this day and age in a town of 6,000 people in our country, let alone in New South Wales, you have a right to feel safe. I do not mean that things cannot go wrong; they can always go wrong, even if you are in Prince of Wales Hospital or whatever. I believe that in a place of that size you have a right to feel you are safe and you can have a child.

But women in Cobar have to wait until the last minute and call an ambulance to help with the delivery of their child, because they know that if they have not already gone they are not going to make it to Dubbo—which is the only serious medical centre there. There is nothing between Broken Hill and Dubbo, which is a distance of 800 kilometres. Cobar itself is 460 kilometres from Broken Hill and about 300 from Dubbo. Despite that being such a big centre and despite it being that far from the other cities, they do not want you to have children in Cobar. Those who decide to make the 300-kilometre trip to Dubbo do not always get there in time, and that is pretty understandable. More than one baby has been born on the side of the road.

A couple made it only as far as the Nevertire pub, which is about an hour or so from Dubbo, and it is just fortunate that the proprietor of that hotel happened to be married to a wonderful Irish nurse. I do not know if people actually thought, ‘I wonder if I can make it to Nevertire instead of Dubbo,’ but this has happened. And, as I said, when you have to leave a town of 6,000 people and rush to Dubbo 300 kilometres away, it is not good enough. Unfortunately, I believe that the Irish nurse who is married to my good friend who used to have the Nevertire Pub is no longer there, so I hope nobody thinks it is still an option.

In places like Nyngan, Trangie, Narromine, Warren and Brewarrina there is also no service for the delivery of babies. Even though they have a magnificent maternity section that is attached to the hospital in Condobolin, you are not allowed to have babies there either, you have to go to Parkes. There is nowhere in between Parkes and Broken Hill to have a baby, and that is a damn long way. There is no hospital between Wilcannia and Dubbo, a distance of over 500 kilometres, that would take a pregnant woman. There is a maternity unit at Broken Hill but it is the bare minimum. They do not have services to look after premature births and there is no guarantee that you will have a doctor. Broken Hill is a town of around 23,000 to 25,000 people. Bourke has a part-time service, which is lovely if your baby comes during the allocated hours, but it is not a good idea to have your baby out of hours.

Homebirthing is not an appropriate option for all women, but it is also far from appropriate for women to be forced to deliver their baby on the side of the road because the medical services are not available in a town, especially a town of up to 6,000 people. There are a couple of points here. Firstly, what is Kevin Rudd doing about this serious problem? He promised to fix the health system in August and November 2007, when he was the prospective Prime Minister. He promised he would fix it. He said, ‘The buck stops with me.’ He was going to have it fixed by June. But of which year? Was it 2010, 2011, 2012 or 2013? No, it was June 2009, two or three months ago. Secondly, if the government wants to change the status quo with regard to midwives helping in homebirths, they must provide appropriate medical services for pregnant women in rural areas. Midwives are incredibly well-trained people. Before we had RNs, we had nursing sisters. I remember that they used to be triple-certificate nurses, and midwifery was one of the certificates that they used to do.

As the previous speaker, the member for Canning, the colleague of my Western Australian friend here the member for Kalgoorlie, said just a minute ago, more often than not it is the nurse who delivers the children, even in a hospital. No-one can question the competency of our medical profession and particularly those who are trained as midwives. I do not have a problem with the desire of women within reasonable distance of help to have their children at home with the attention of one of those registered and very competent people. But I do have a problem with the fact that we have all these hospitals in western New South Wales with no provision for women to have their babies in their hometown. In New South Wales you are not allowed to have a child west of Parkes, you are not allowed to have a child west of Dubbo. If they can, they will not even leave you in Parkes or Forbes; they will push you on to Orange, which is the only place in central western and western New South Wales with a proper medical service.

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

There is no more deeply personal experience for most women than giving birth to a child. For most men who participate in or witness a birth, especially where it involves their child and their wife, there is no emotional experience that can replicate that event. What we are discussing with the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related legislation is something that goes to the very meaning of life. It goes to our sense of being. It goes to the values of this government.

These bills extend Commonwealth subsidised indemnity insurance to eligible midwives. According to the bills an eligible midwife is a person who:

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

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

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

From the minister’s second reading speech we learnt that Commonwealth supported professional indemnity cover will not respond to claims relating to homebirths. The impact of the bills as presented to this parliament, which are in response to recommendations of the maternity services review, is that indemnity insurance provisions will not cover midwives providing birthing services outside of a clinical setting. The National Registration and Accreditation Scheme will make indemnity insurance a mandatory requirement for registration as of 1 July 2010. Therefore, under the terms of the bill as introduced into this parliament, it will be effectively illegal for independent midwives to provide homebirthing services from this date. Indeed, individuals who practise as midwifes without registration face a maximum penalty of $30,000 in accordance with the Health Practitioner Regulation National Law 2009 exposure draft.

The response to these proposals was an outcry not only from midwives but from many members of the community. Most people do not choose to have a childbirth at home. Most choose to use the services of the major hospitals and allied clinics throughout Australia. Indeed, it is a statistic which, perhaps, we ought not to be so proud of that we have one of the highest rates of caesarean births in the world, far above what world health authorities regard as an acceptable level. But the reality, nonetheless, is that most women choose to make use of the services of major hospitals. Increasingly, some have chosen birthing units which are associated with those hospitals, which are a kind of halfway house between the traditional clinical birth and a homebirth experience; indeed, my wife and I did that for our last child. However, many people still believe that a parent—a mother in particular—ought to have the right, if she chooses and the family chooses, to have a birth at home. After all, this is not an uncommon experience in either human history or, indeed, the world of the present time.

Indeed, there are some studies from the World Health Organisation and others that suggest that there is no greater danger, in normal circumstances, for a birth at home than there would be for a birth within a hospital setting. A recent study of over 500,000 births showed no difference in the mortality rate for the baby and mother between home and hospitals. That was the 2009 study by de Jonge. Also, research by the World Health Organisation found that a homebirth is as safe as a hospital birth for healthy women having their first baby and that, for women having subsequent children, the result of a homebirth is significantly better than the result of a hospital birth. That was the report by Wiegers et al in 1996.

The result of this outcry and the protests we have had—I have had women from my electorate come to see me about this matter, as I suspect most members of the House have—is that last Friday the government partially backed down on this controversial provision when the Minister for Health and Ageing announced a two-year delay in regulations that require private midwives to have indemnity insurance for homebirths. Of course, private insurers will not cover homebirths and the government will not subsidise indemnity insurance for homebirth midwives. Midwives must tell their clients that they are not insured and must get informed consent from pregnant women who want a homebirth.

What troubles me about this partial backdown is that it is not clear what the government’s intention is in putting in place this two-year delay. Is it for the purpose of ascertaining whether or not indemnity insurance can be provided—I understand the reason it is not provided is not the risk factor or the risk ratio but that there is not a large enough cohort of midwives in this situation for insurers to provide that insurance—or is it because the government actually believes, as would have been the effect of this legislation, that homebirths should be banned? If it is the latter then the government should say clearly that that is the case. This should not be a backdoor method of banning homebirths in Australia.

The reason I retain a degree of scepticism about the government’s motives is that there is a track record in relation to some health matters. For example, we had the alcopops tax introduced. The reason given was that this was a health measure, but when looked at in some detail it became clear that in fact it was a tax measure. Therefore members of the community have a right to be suspicious about the government’s motives in relation to this matter. If it is the government’s argument that there should not be homebirths in Australia, it would be better if it came out and made the case for that situation.

The two-year delay has been put in place. I would hope that during this two-year period we have proper evidence provided to us—that is, where homebirths are taking place there should be proper reports of those circumstances, including any complications which arise. I understand that we are not just dealing with the mother. Many members have spoken about the woman’s rights, but the reality is that we are also dealing with the life of the child who is being born. That therefore leads one to having to balance in consideration the circumstances of both the mother and the child. If the evidence is overwhelming that this is a much more unsafe circumstance for the birth of a child that cannot be ameliorated by other measures such as the proximity of a hospital or other more intense clinical services, that can lead to a particular conclusion. But if the evidence—I have cited some which is available to me from global studies—is that there is no greater risk factor for homebirths than there is for births that occur within a hospital then there would seem to me to be no reason for what appears to be, on the face of it, discrimination against homebirths. That is evidence which I believe we as the opposition—and, I am sure, other members and senators—will be interested in as to what is produced over the next two years, after which this matter is ultimately coming back to the parliament. As I said, the situation in relation to hospitals is not entirely ideal either. I am not sure that we should be satisfied with the very high levels of caesarean births which occur in this country, but I have not seen any great examination of why that is occurring. There could be many factors in play with that.

But that is not the purpose of my contribution tonight. It is simply to say that I understand that, yes, you have to balance the situation of both mother and child, but at least on the evidence available to me it would seem that it is not a more unsafe practice in normal circumstances to have a homebirth. And, if the reality is that the government is providing a subsidy for indemnity insurance to other medical and health professionals, it does at least seem on the surface that there is some discrimination being practised or that some discrimination was about to be practised towards those midwives who were assisting those mothers who chose to have a birth at home.

I will conclude my observations on this note: the ball is in the government’s court over the next two years to produce that evidence and to come forward with a proper rationale based on evidence. This is clearly an area where policy should be based on evidence, not based on the prejudices of anyone who happens to have a particular view about this matter.

Luke Hartsuyker (Cowper, National Party, Deputy Manager of Opposition Business in the House) Share this | Link to this | Hansard source

On the face of it, there is much to support in the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and cognate bills. There is even more to support following the minister’s spectacular backflip on the position of the government in relation to midwives. I shall have more to say on that later. It is very much an example of the government rushing to legislate on issues without paying attention to the detail and without thinking through the consequences of the government’s actions. For the moment, I will say that I welcome the minister’s partial backdown, which will allow the status quo in relation to midwives to continue until 2012.

For many years the Commonwealth has battled with the problems of labour shortages in the health services, particularly in regional Australia. We are familiar with the efforts made to increase the number of training places for doctors and nurses, to encourage the newly qualified to pursue a career in areas where they are most needed, and to attract suitably qualified practitioners from abroad to come to Australia to work. As in many areas of the health service, it is debatable whether we will ever be able to do enough to generate the size of workforce that we need to satisfy an ever-growing demand. Combined with the difficulties of providing costly services in sparsely populated areas, we have the problem of an ageing and therefore more demanding population with rising expectations of what the health service should deliver and new treatments being ever more complex and ever more expensive and requiring ever more highly trained practitioners to deliver.

The 2005 Productivity Commission report drew attention to the fact that there was no single solution to meeting the demand for health services and a multipronged approach was needed, so I welcome the moves contained in these bills to enable midwives and nurse practitioners to make a greater contribution to patient care. The Australian Medical Association and other medical professionals clearly have reservations, but I fully support the principle of enabling other health practitioners to share the load and to help ensure that people throughout Australia receive timely and effective health care.

Experience in the UK suggests that patients were generally satisfied with nurse practitioner consultations and that there were few differences in clinical care and clinical outcomes. Better utilisation of nurse practitioners could help to ease the load on our overstretched GP workforce. If we are running our GPs into the ground, we cannot expect them to be able to maintain the highest quality services for our communities, when they are just overworked. Patients would be treated more quickly, chronic conditions would be better supervised and health resources would be used to maximum benefit if we were to maximise the capabilities of our entire medical workforce. It is all about providing the appropriate level of care with the appropriate level of competency and the appropriate level of supervision. Why should a patient have to wait to see a doctor when their ailment or complaint could be quickly and effectively treated by a nurse or nurse practitioner, suitably supervised and under the watchful eye of GPs?

The principle of this legislation is good but, as with so much else that the government produces, when it comes to the detail it falls down. Let us look for a moment at the government’s mercifully short track record on getting the detail right—or, unfortunately, getting the detail completely wrong. When we had the global financial crisis, we needed a bank guarantee scheme. The air was thick with warnings that the scheme should not be unlimited, but the government, driven by its compulsion to be seen to be doing something and the need to grab the day’s headlines, went for an unlimited bank guarantee, and the result was chaos.

What about the changes to Youth Allowance? The lack of attention to detail threatened to derail the financial plans of many students in their gap year. What about the tax bonuses? Too many people thought they were going to receive a payment from the government when in fact, when you looked at the fine print, they missed out. What about computers in schools? What about flood relief payments? All too often, people were denied the assistance they needed and their rightful entitlements because the government schemes were not properly thought through. There were the issues of petrol prices and the failed Fuelwatch scheme. There was the failed GroceryWatch scheme. It was an election promise to put downward pressure on grocery and petrol prices, and the only responses to that were two failed schemes by this government.

The health service was going to be fixed by 30 June 2009 or the government was going to take it over. The government was going to step in. The buck stopped with the Prime Minister on health. The Prime Minister made a very clear, very unequivocal promise that if it was not corrected by 30 June 2009 he would step in and fill the gap. Sadly, it has not been fixed. The health service still faces severe challenges, and the government is rapidly backing away from its promise that the buck stopped with the federal government in relation to health services.

As I said earlier, the issue of extending the role of midwives and nurse practitioners is all about providing the appropriate level of care with the appropriate level of competency and the appropriate level of supervision. This is one of the areas where the legislation falls down. The coalition believes that GPs will continue to be the foundation of primary health care. They are called ‘general’ practitioners because their training enables them to properly assess the whole range of ailments and to recommend the most suitable next step for treatment. Of course, for the sake of patients and GPs, we should be trying to ease their burden. Transferring some of their work to midwives and nurse practitioners is one way of making sure that we maximise the output and clinical outcomes from our workforce.

While I have the utmost confidence in the professional judgment of medical staff to recognise the limits of their own training in diagnosis and treatment, what we need from the government is some idea—indeed, any idea—of the arrangements that will make these measures work. Who will decide whether a patient sees a nurse or a doctor—the GP’s receptionist? What level of supervision will the GP be expected to provide? How can that be provided given the GP’s own workload? Unless these details are considered, we could be moving toward a two-tier health service where a patient agrees to be seen by a nurse simply because it is quicker and more convenient. Surely there needs to be some clinical input at a very early stage to make all of this work, but the government has given us no guidance in relation to these crucial matters.

Before turning to the second area in which this legislation fails, the issue of midwives and homebirths, I will briefly mention costs. No one likes putting a price on health care but, as demand and costs rise, we have to do just that. In mid-2007, the coalition was spending some $6.4 billion a year on the Pharmaceutical Benefits Scheme and $11.7 billion on the MBS at a time when we were running a surplus. Those figures will inevitably grow at a time when the government is in the process of racking up a debt of over $300 billion. Against that background we need more clarity on what the government’s proposals are in relation to costs.

The proposals will give nurse practitioners the ability to refer patients to specialists. Currently, GPs only refer a small proportion of their patients to specialists. It seems reasonable to assume that referrals will increase but the proposals give no clue as to the effect on specialists’ waiting lists, how this might fit into a collaborative model or the impact on costs. Neither is there any detail of the workings or consequences of the new ability of midwives and nurse practitioners to order pathology and diagnostic services with a Medicare rebate. With the government strangely reluctant to release its economic modelling on this and other matters, one is left with the conclusion that they have something to hide or that they have nothing to hide because once again they have rushed out with another policy decision without fully examining the cost, without having done their homework.

I now turn to the failure in this legislation which has caused the greatest concern and the greatest controversy: that of midwives’ professional indemnity and homebirths. Again, we have a situation where the government has displayed a lack of attention to detail. Because of the interaction between these bills and the national registration and accreditation scheme, from July next year midwives would have been prevented from assisting at homebirths, effectively removing the option of women giving birth in their own home.

I acknowledge the great work done by the Coffs Coast Maternity Action Group in my electorate in defending the mother’s right to choose, and I know that they and many other groups around the country will be welcoming this humiliating—but welcome—backflip by the minister, albeit a temporary reprieve, until 2012. It is hard to tell whether her initial position of banning midwives from homebirths was an intended consequence or an unintended consequence of this legislation. Given that their brief legislative record is littered with unintended and unwanted consequences, it seems more likely that this was the result of the government’s habitual bungling.

The fact of the matter was that, under the new registration scheme, practitioners would have been required to have suitable professional indemnity insurance. While the government proposes to provide insurance to midwives in a clinical setting, it would not have extended to cover homebirths. Furthermore, the exposure draft of the Health Practitioner Regulation National Law 2009 (Bill B) states that an individual who practises as a midwife without indemnity insurance and is therefore unregistered may be subject to a maximum fine of $30,000, effectively making the choice of a homebirth illegal. It is absolutely astounding. It is highly unlikely that it would be practicable or viable for a midwife to arrange her own insurance to cover for homebirths.

From July next year, having a baby at home would have ceased to be an option. It is true that only a small proportion of mothers choose to have their baby at home. However, with the benefit of medical advice it should surely be the right of every mother to give birth in their own home rather than in a hospital. Indeed, given the parlous state of many of our hospitals, and the current pressures on staff—both matters that the government has pledged to fix—one would argue that mothers should be encouraged to give birth at home if that is their choice. By removing the midwife, the government was removing the right to choose for the mother.

However strongly they may feel that home is the right place to give birth, few mothers would feel it was in the best interests of themselves or their babies to give birth at home without a midwife. There was also the worrying aspect that policy on health care was being driven by the matter of insurance. If the government believes that homebirths are undesirable from a medical point of view, it should have said so. It appears that the government now believes, as we do, that, subject to medical advice, homebirths are a suitable option for many mothers.

It has adopted basically the position that has been proffered by the coalition. We certainly welcome that backflip that has delivered the status quo, at least for the time being. This decision has been very much a subject of some controversy. Certainly, people within my electorate have expressed very strong views about this. But it has been an embarrassing climbdown for the minister, an embarrassing backflip, but welcome all the same.

We still have to wait and see what happens after 2012 and what the situation will be in relation to the choice for mothers after that date. But we certainly, as I said, welcome the change that has been made. In my area we have a range of smaller hospitals that see their level of services constantly being downgraded. The maternity unit at Bellingen hospital has been the subject of a great deal of attention as to whether services will continue there. I know many people in the Bellinger valley would welcome the opportunity to continue having the option of homebirths for their children.

We do welcome the change of heart by the minister. Unfortunately it has caused a great deal of anguish amongst many people in my community who wish to maintain the option of homebirths. We are concerned about what the situation will be after 2012 but certainly the changes by the government have been welcomed.

Jason Wood (La Trobe, Liberal Party, Shadow Parliamentary Secretary for Justice and Public Security) Share this | Link to this | Hansard source

On Monday this week I went down to Old Parliament House, where I was met by over 1,000 protesters who were greatly concerned at the changes for the medical indemnity insurance for midwives, which will prevent midwives from providing care outside a clinical setting by restricting their access to insurance. I say right from the outset that this is an absolute disgrace.

It was quite amazing to see these protesters standing there in the rain—the majority were ladies, a number were actually pregnant, and there were a number with babies and small children—most without umbrellas, getting soaked for the simple reason that they deserve the right to choose how they wish to have a baby. That is an absolute disgrace.

I would like to mention some of my local residents. Jacinta Munn, Iznaya Kennedy, Narelle Key, Melanie Cane, Karyn Peverill and Donna Sheppard-Wright were amongst the 100 from my electorate who attended the protest. I have been a member of parliament for five years, and there were a number of very contentious issues faced by us in government and there are a number that we face now in opposition. I have never seen so many people from my electorate visit Parliament House to have their voices heard on one issue. Why did they come? Because the Rudd Labor government would deny them the right to choose the method of delivering their children. The Rudd Labor government is denying women the choice of how they have their babies. It is just ludicrous.

I have been a strong supporter of the rights of families to choose homebirths since day one. Last October I attended the mothers and babies family picnic hosted by the Homebirths in the Hills group in support of homebirths. I met parents including Carolyn and Serge Charles, Tom Murdoch, Jan Deany, Gypsy O’Dea, Jade Leak, Kate Schultz, Sharizaar O’Heart, Linden Holder and Margaret Duncan, to name a few. I listened to their incredible stories of giving birth in their own home, with their loved ones surrounding them and a caring midwife on hand to provide assistance.

The Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and related legislation will force women into overcrowded public hospitals and strip them of their right to choose the best method of birth for them. That is their choice, not a government’s. It is a personal choice, and it is not a decision they take lightly. The federal Labor government claim they are acting in the best interests of mothers and their children. However, what they are actually doing is taking away mothers’ choice and turning Australia into a nanny state. It is not the government’s right to decide how a mother should deliver a baby; it is the mother’s.

Last Friday the government dished up a half-baked backflip to midwives and parents by exempting homebirth practitioners from needing to have indemnity insurance until June 2012. However, after June 2012, without proper intervention from the government by subsidising medical indemnity insurance for midwives, their geese will be cooked. The costs of getting indemnity insurance are prohibitively high for independent midwives, meaning that many will not be able to assist in homebirths. The Minister for Health and Ageing has admitted that requirements to have insurance could force many practitioners underground. That is the minister’s view.

Midwives who practise without registration could face a maximum penalty of $30,000, so the cost of practising homebirths without a licence is extremely high. Either way, the costs are too great, meaning that this option is effectively off the table for thousands of Australian women. Cynically, the government are pretending they are supporting the midwives by saying, ‘If you get insurance, you can practise and help deliver babies at home,’ knowing damn well midwives will never be able to get that insurance in the first place. And, if you do try to do it without insurance, you will get slugged $30,000. Why would the government ever consider this a way to treat mothers-to-be?

Providing an exemption for midwives until June 2012 is simply a stalling tactic. The government are delaying making a decision about the future of homebirths until after the next election. They are treating Australian women with contempt, hoping that their anger will subside over the next two years. I tell the minister and the Rudd Labor government this: the women who travelled 800 kilometres from my electorate of La Trobe and the thousands of women who travelled thousands of kilometres from across Australia to stand in the pouring rain to have their voices heard are outraged by the government’s proposed changes. Many have written to me about how concerned they are, and they will not let the government forget. I can tell the minister now: when I met the mothers down at Old Parliament House, even after the government’s decision on Friday, they were not happy.

For some women, giving birth in a hospital is not an option. They may live quite far away from the nearest hospital or may feel uncomfortable in the hospital environment. For others, it is a choice made to ensure that their child is born into a loving and peaceful setting and provides some comfort from the stress and noise of a hospital environment. Canada, the United Kingdom and New Zealand are amongst the many countries that publicly fund homebirths. A homebirth is not the best option for every mother-to-be, but to deny every woman the right to choose a homebirth will place even more pressure on our already underfunded public hospitals. No-one wants to see babies’ health jeopardised. However, for the majority of risk free pregnancies homebirth is a safe alternative method to hospital admittance. This is about ensuring women have control over their bodies and a choice in the way their child is brought into the world. It is not the government’s right; it is the mother’s right.

Sophie Mirabella (Indi, Liberal Party, Shadow Minister for Early Childhood Education, Childcare, Women and Youth) 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, which have caused hundreds and thousands of women to come to Canberra this week with their families in tow to protest and to have their voices heard. Admittedly, these women form a very small minority of women, but it was quite heartening to see their determination and their strong belief in the rightness of what they were doing. In our great democracy too often people accept government decisions and bureaucratic decisions and say of the state or a department: ‘They’re too big for us to fight. We know they’re wrong, we know they’re ignorant, we know they’re prejudiced and we know they haven’t got all the facts, but it’s all too hard.’ I find that very frustrating as someone who believes in the importance of engaging everyday Australians in decision making and not just leaving it to politicians, powerful interest groups and lobby groups. It is quite sad that this attitude of helplessness and apathy often pops up right across the nation when we discuss controversial issues.

But on this occasion, in relation to what would have been a severe limitation, if not a de facto banning, of homebirths in Australia, we did not see that: we saw something else. We saw something that was very encouraging, something that was very uplifting. We saw the determined spirit of so many women around Australia, from every corner—many from rural and regional Australia, including 80 from north-east Victoria, from my part of the world. We saw them come to stand as one and to have their voices heard. I think it surprised a lot of people. The publicity they have managed to generate for such a small group of women stands as a testament to their determination, their organisation and their intelligence. I am sure it surprised a lot of people around the country and it surprised the government.

I want to mention specifically my local support group, the North-East Victoria Homebirth Support Group, who came to see me with a local midwife, Wendy Buckland, and we discussed their concerns. They told me about their support network and they told me about some of their experiences. But what was critical was that here were these women, local women—you could not distinguish them from other women in the street—who were quite distressed but were determined to do something about it. They wanted not only to retain the choice that they had but also to ensure that that choice, regarding where woman would give birth in north-east Victoria and indeed right around the country, was maintained for the foreseeable future.

We have seen the hospital systems around the country collapse and we have heard the scandalous stories of what happens in the hospital system, particularly to some pregnant women. We heard the promise made by the then opposition leader at the 2007 federal election, when he promised to fix hospitals and health by June 2009 or he would seek a mandate to take hospitals over. That deadline has come and gone. Hospitals are not fixed and we see the same problems perpetuated but no solution to fix them. We see all of this and we see medical resources taken away in many parts of rural and regional Australia.

I will give one small example from my part of the world, in north-east Victoria. Under the government’s new remoteness area classification scheme, many parts of my electorate are going to be disadvantaged in trying to attract GPs to practise in towns that will be classified under RA2 as ‘inner regional’ areas—towns such as Myrtleford, Rutherglen, Euroa, Violet Town, Nagambie, Yackandandah, Beechworth and Chiltern. These towns are going to be forced to compete with medical clinics in larger areas for medical experts and for GPs. At a time when the public hospital system continues its decline and continues to come up with scandalous stories and when the government are changing the rural and remote index classification, they are trying also to severely limit homebirth—in fact, to outlaw it. That is what they should have said from the outset. They should have been honest in saying, ‘Well, we believe this homebirth thing isn’t on; we don’t like it, so we’ll ban it,’ instead of using the backdoor way of this new legislation.

At this time it is even more important to give women, particularly in rural, regional and remote areas but also in the cities, increased choices about their health care and increased choices about how they are going to give birth. The government introduced this legislation to provide some carrots—to provide MBS and PBS access for nurse practitioners and midwives. We saw the indemnity insurance provisions that, up until last Friday, were causing particular consternation. The provisions did not cover midwives providing birthing services outside a clinical setting. That would really take away the choice of many women to employ an independent midwife, because it would effectively make it illegal for midwives to provide homebirthing services, as the National Registration and Accreditation Scheme was going to make indemnity insurance a mandatory requirement of registration from 1 July next year. Midwives without registration would have faced a maximum penalty of $30,000, and we saw many anxious mothers and mothers-to-be. Currently, in many parts of Australia, women who do have a homebirth contract privately with midwives without indemnity insurance. Here we had the big nanny state moving in and saying: ‘We don’t think you’re smart enough to make that decision. We don’t think you’re smart enough to make the choice about homebirth and to come to an arrangement with your midwife.’

At the 11th hour last Friday, in a joint communique from the Australian health ministers, we saw what appeared to be a two-year breathing space from this exclusion of midwives. What the Minister for Health and Ageing has tried to do, really, is to buy some time. It was all too hard: this small group of women who she thought would not make much of a noise, who would not cause too much of a problem. She thought, ‘Maybe if we provide a two-year exemption for them, up until 2012, from holding indemnity insurance then maybe we’ll be able to see it through the next election without too many hassles.’ I am sure the Prime Minister knocked on her door and said: ‘Minister, this is all too much. I don’t need this problem. Fix it.’ In the fashion of this government she is trying for a very short-term fix. The argument has been ‘Let’s maintain the status quo for some time’ but we really do need to ask questions. Does it really maintain the status quo or does it actually introduce additional restrictions—that is, we will not have a situation that maintains the status quo up until June 2012 but additional hurdles will be introduced for some women around the country? These matters do need to be investigated. Part of the requirements to access the exemption includes, and I quote from one of the dot points in the communique:

Participating in a quality and safety framework which will be developed after consultation led by Victoria through the finalisation of the registration and accreditation process.

But within the quality and safety framework there needs to be provision for a woman to make an informed choice so that she can still access a midwife if she falls, for some reason, outside the framework. We know this framework does not currently exist, so if there is a framework imposing certain conditions, by definition it introduces new restrictions on the practice of homebirths with the use of midwives.

This would be consistent with medical practice, which allows patients to exercise their right to refuse treatment. I think it is very important for the minister and the government to know that homebirth mothers and midwives around the country have not been fooled by these provisions in the joint communique. They will watch very closely to see that the framework and guidelines that come out of it do not actually limit the genuine and real choice that mothers and midwives have.

There are some questions as well as to whether these provisions will actually apply to all jurisdictions. We do not know what the government means by some of the wording in the communique and whether some jurisdictions are excluded from having these provisions and if the so-called quality and safety framework applies to them. That really does need to be examined and looked at.

I have spent a lot of time over the last few weeks and months speaking to many concerned women, and it is interesting that there are a lot of women who are not homebirth mothers, who have not had that experience, but who feel so passionately and strongly about supporting the choice of women. We hear so much from the other side of politics, on convenient occasions, about the choice for women, but where is the Minister for the Status of Women? If I have missed something, could someone on the other side please correct me? She has probably been silent because she is embarrassed by the mismanagement and the arrogance with which the Minister for Health and Ageing has conducted this debate. The government needs to make sure that consumers, who have really been left out of the equation to date and ignored, do get included—they are critical to this debate. As we have seen this week, they will not let the government or anyone forget that they are important and that they do matter.

In order that the choices for women—the intimate and personal decision that they make in consultation with their families—do not just get swept under the table and, effectively, banned, we do need to take some steps to look at these issues in the intervening period over the next two years. Although the government’s recent changes allow for a temporary reprieve, we do need to look at what more we can do. The first step would be for the government to release the actuarial modelling associated with the indemnity insurance scheme. Why have we asked for this? Because it would allow for informed consideration and actual debate—not just silence and backroom deals, but actual debate about the feasibility of including midwives providing homebirth services in the category of eligible midwives for the purposes of indemnity insurance. We know that is what the vast majority of women supporting homebirths and their midwives want. This is also consistent with the recommendations of the minority report of the Senate committee. I do not know why it has fallen on deaf ears; perhaps people power this week will make the minister listen to this particular request. To date we have only seen a very limited explanation as to why the feasibility of extending indemnity insurance to midwives providing homebirthing services has not been considered. The coalition continues to call for the release of this information.

We also call for a review into the provision of medical indemnity insurance for these midwives to be tabled in the parliament on or before 1 June 2012, prior to the conclusion of the proposed transition period under the draft national registration and accreditation legislation. We believe these measures are essential and, despite many opportunities to actually engage on this issue, the minister has failed to be a true minister of the Crown and take leadership on this issue. This has been dragging on for months and we are looking to take positive steps. That is why I will move the amendment circulated in my name, in an attempt to progress this issue—not to sweep it under the carpet but to ensure that we continue to investigate, to use the facts, to use the research and to use the information to see what we can do to facilitate real choice for women.

As shadow minister for, amongst other things, women, it gave me great pleasure this week to see the exercise of ‘woman power’. I know that the government and I can count on one thing: these women, who are well informed and well equipped, will not cease this campaign—and nor should they, because as consumers they have been left out of the equation and as homebirth mothers they have been ignored and pushed aside. But they have shown the government and the Australian people that it matters not that you are part of a small minority; if you believe in something strongly enough, and you have got the facts and figures to back you up, you can succeed. I believe they can, and I urge the government to support the amendment that has been circulated in my name. I move:

That all words after ‘That’ be omitted with a view to substituting the following words:‘whilst not declining to give the bill a second reading, the House:

(1)

acknowledges that the bill does not:

(a)

facilitate a full and informed debate by requiring the minister to table all actuarial modelling relating to the extension of Commonwealth medical indemnity insurance to midwives providing birthing services outside of a clinical setting;

(b)

further facilitate a full and informed debate by requiring a review into the provision of medical indemnity insurance to midwives providing birthing services outside of a clinical setting, with the review being tabled in parliament on or before 1 June 2012;

(c)

have in its objects the goal of not restricting the rights of women to choose home birth as an option provided the wellbeing of the mother and child are not put at risk; and

(2)

calls on the government to make such amendments to the bill as would rectify these flaws.’

Bruce Scott (Maranoa, National Party) Share this | Link to this | Hansard source

Is the amendment seconded?

Chris Pearce (Aston, Liberal Party, Shadow Minister for Financial Services, Superannuation and Corporate Law) Share this | Link to this | Hansard source

I second the amendment.

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

In summing up I want to thank the very large number of members of this House who have taken the time to contribute to the debate on these three bills. I think it is a measure of the community’s interest in midwifery and in changes to the workforce that allow recognition for midwives and nurse practitioners that we have heard so many members speaking on the bill, and I am very proud to be summing up the debate on these bills because they do introduce landmark changes for Australian nurses and midwives. This is something that for decades has been campaigned for. Under the long period of the previous government these pleas fell on deaf ears. It is a little surprising to hear contributions such as the one from the member for Indi, who never took any action as part of the government for 11 years to make any of these changes but is now demanding not only that these bills be introduced and these changes made but that every range of other issues that she thinks should now be raised must be delivered instantaneously by this government. It is pretty extraordinary that it has taken us until today to find out whether the Liberal Party would in fact support these important changes in the bill. I welcome and recognise that speakers today have acknowledged that the Liberal Party will belatedly, perhaps begrudgingly, support these bills. That is fantastic news for nurses, for midwives and for consumers across the country in our health system, which of course we all are at some point in our lives.

The bills enable patients of appropriately qualified and experienced midwives and nurse practitioners to access benefits under the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, opening the way forward for improved access to maternity services, improved choice for women and improved access to services provided by nurse practitioners. For example, these bills will lead to better access to breastfeeding support for many thousands of women across the country. They will lead to better access to midwifery support during pregnancy, birth and the postnatal period. These bills will lead to better access to services for those hard to reach sections of our community such as those with mental illness, residents of our aged care facilities and Australians living in our rural and remote communities. Of course, they will not deliver all of the solutions to those people, but they will enhance the workforce response that can be provided to servicing those many people in our community who need and want the assistance of nurses and midwives.

Alongside the further development of secondary legislation there are a range of activities taking place which will enable these arrangements to be put in place and onto the Medicare Benefits Schedule by November 2010. This includes consultation on the detailed development of the new arrangements with professions and other key stakeholders, the conduct of a tender for a provider of indemnity insurance, and Medicare Australia systems development and the communications activities required to implement these reforms. To some listening, that might sound like a long period of time, but I can assure people that the introduction of new Medicare benefit items is always a slow process. When you are introducing items for an entirely new group of health professionals, and when an indemnity insurance product also needs to be established, this does take time.

After having listened to the debate over the last few days I think it is important to clarify some misconceptions about the effect of these bills, particularly on homebirth in Australia. The three bills before the House expand Commonwealth support for midwives and nurse practitioners in our community, as I have said, improving choice and extending Commonwealth funding for a range of midwife and nurse practitioner services for the first time ever. These three bills do not take away any current rights and none of these bills make homebirth unlawful. There is, however, a separate exposure draft bill for the national registration and accreditation scheme for health professionals. This bill is in exposure draft form, prepared for all jurisdictions via a COAG agreement, and is not yet before any parliament. The exposure draft of that separate bill currently carries a proposal that will require all registrants across 10 professions covered, including nurses and midwives, to carry insurance. This is an important part of raising the standards and providing public protection for patients and consumers across 10 different professions within the health sector. However, amongst those 10 professions, midwives are in a unique position because indemnity insurance has not been available for midwives operating outside public health services in Australia since 2002.

I might note in passing, given the animated way that a number of members opposite have contributed to this debate, that since 2002—which, if I recall correctly, was when the Howard government was in power—no action was ever taken by the previous government to rectify the absence of indemnity insurance for midwives. We, of course, through the introduction of these three bills, intend to change that. However, we were concerned that an unintended consequence of the requirement in the national registration and accreditation draft bill might be that homebirths would be driven underground. That is why I have been working for some months with the states and territories on the potential options to prevent this from happening. And, as I advised the House yesterday and am pleased to be able to advise again today, on Friday at the health ministers’ meeting, the meeting between the states, the territories and the Commonwealth, I was able to achieve the agreement of all health ministers around the country to a transitional clause in the current draft national registration and accreditation scheme legislation.

What this means is that a two-year exemption will last until June 2012 from the requirement to hold indemnity insurance for privately practising midwives who are unable to obtain professional indemnity insurance for attending a homebirth. In order to access this exemption, it will be a requirement for midwives attending homebirths to provide full disclosure to and receive informed consent from their patients that they do not have professional indemnity insurance. They will be required to report each homebirth and to participate in quality and safety frameworks, which will be developed after consultation, led by Victoria, through the finalisation and accreditation process. This has been achieved with all governments working together to obtain an outcome that is progressive for the sector but that will not make homebirths illegal. It is vital to emphasise a point—which I think the Liberal Party has now acknowledged—that to vote against this package of bills would prevent a major expansion of services to many hundreds of thousands of women and prevent establishment of any type of indemnity insurance for midwives. This is an outcome I know, from my meetings with many homebirth advocates, they would not want to see eventuate.

The government is committed to supporting Australia’s nurses and midwives, the backbone of our health workforce. The changes in these bills are significant and are a practical step in improving access and choice for Australians. I can indicate to the House that the government will not be supporting the second reading amendment moved by the member for Indi. We are very proud of the steps we are taking to expand and support services provided by midwives and nurse practitioners. We believe the agreement that has been reached with the states and territories ensures that no woman who chooses—with the proper information being provided to her—to birth at home will be disadvantaged. The current arrangements will continue. The support activities and care provided by the midwife at home—if a mother has chosen to have her child at home and has been properly informed that the activity will not be insured, as is currently the case—will not be able to be deregistered and will not be made unlawful.

I know there are people who would like this to be different and would like the government’s reforms to go even further. It is something that the Liberal Party has been arguing with passionate—although, I have to say, without much of a record to show that this is something they truly believe in, no action having been taken ever in the time that they were in government. We certainly understand that some people would like the legislation to go further. They would like us to provide not only MBS and PBS rights for midwives who are undertaking a whole range of services but who do not attend homebirths but insurance cover to homebirthing midwives as well. But that was not recommended to us as part of the maternity services review. We accept the advice provided to us as a result of the detailed process and review conducted by the National Chief Nursing and Midwifery Officer, Rosemary Bryant. Therefore, we will not be supporting the amendments that are moved and we remain extremely proud of the new choices we are providing for thousands of women across the country and of the midwives who want to provide care for these women and the nurse practitioners who will have access, for the first time ever, to MBS and PBS entitlements.

Bruce Scott (Maranoa, National Party) Share this | Link to this | Hansard source

The question is that the words proposed to be omitted stand part of the question. A division is required. In accordance with standing order 133 the division is deferred until 8 pm. The debate is therefore adjourned until that time.

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

I understand—although the opposition will correct me if I am wrong—that the division will just be on this particular bill, in which case we might be able to conduct the business on the remaining bills, given that we need the debate to be adjourned until 8 pm for a division. But I am in the hands of the opposition if they would rather do all of them together. Perhaps you could provide us with that guidance.

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

On indulgence, we are happy to oblige to help the order of business in the House and are happy to assist in relation to this matter as well.