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

Yet again the fact that the Midwife Professional Indemnity Legislation Amendment Bill 2011 is before the House today is proof that this government just cannot get anything right. The bill is yet another fix from Gillard Labor to legislation that it rushed into this parliament two years ago. It has been struggling to get it right ever since. Members will recall the troubled passage of the midwives and nurse practitioners bill and the midwife and professional indemnity bills throughout 2009 and 2010. The Minister for Health and Ageing tried to blame the opposition. She then tried to blame the Senate—anybody but herself—for the delays in this legislation passing through this parliament. In fact, it was a case of the minister and the government rushing headlong to get the legislation into the parliament without taking the time to ensure that they had got it right. In the end, it was the government that was introducing amendments to its own legislation as it moved through the parliament. Through the process Minister Roxon had to admit that she had got it wrong, and she had to backtrack. She had to placate concerned stakeholders, she had to clarify matters to a Senate committee and then the minister had to make amendments. Then, after the legislation had taken effect from July last year, the minister was forced to make new rules to cover the problems that this bill now seeks to remedy. And what were those problems?

The answer to this is that the minister had bungled things yet again. Perhaps we should say 'as usual', because if we look back over the last 3½ years it certainly has been a litany of failure and inability to deliver even the most basic of legislative programs, and this is a reflection on the broader dilemma that the government face: the public now realises that this is a government that just cannot deliver on what it is that they propose.

The drafting of the original legislation had actually excluded one group of midwives from accessing the indemnity contribution scheme. The legislation treated those who operated through their own companies and were in fact self-employed the same as it treated those who were employed by larger organisations, such as hospitals or medical practices, and therefore as employed midwives. The legislation had excluded employed midwives from the scheme. The government presents this as an oversight. It was 'not the government's original intention', they say. And this bill to remedy the situation is presented as a technical fix for a minor element of the act. What it is though is another error on the part of the government and of this minister. So, too, is the second matter this bill seeks to remedy. That mistake is presented as a 'typographical error'. Let me just explain what the typographical error goes to. What effectively the original legislation did was to enshrine in law a formula to tax insurers of midwives at a rate far higher than the premium income those insurers received from the midwives for their insurance coverage. That is some typo! It is also typical of a government that continually talks about grandiose schemes and ambitions but then completely fails to do the hard yards to get the detail right.

Exclude for the moment the monumental failures of the Rudd and Gillard governments with pink batts and school halls and green schemes. We have seen the failure to deliver time and time again in the area of health. Remember, for a start, the all-encompassing promise from Kevin Rudd to fix public hospitals: he was going to do it, remember, by mid-2009 and if he had not he was going to hold a referendum for the Commonwealth takeover of the nation's public hospitals. All we had by mid-2009 was a series of reports from the multitude of committees and commissions and working groups and inquiries that Rudd Labor had commissioned. All we had by 2010 was a hastily thrown-together plan branded the national health and hospitals reform so that the Rudd-Gillard government could actually look like it was doing something to honour those commitments made to Australians in mid-2007.

What did we get from the so-called reform? We certainly got lots of media releases, conferences and communiques, and plenty of colourful and expensive booklets outlining the grand health plan, some of which had to be pulped within days of being printed, such was the hubris surrounding Mr Rudd's and Ms Roxon's health reforms. Now, of course, it is a fact that Kevin Rudd was deposed. His historic reforms were shredded. Now we have the current Prime Minister saying 'historic health reforms'—this has a familiar ring to it—which amount at this stage to nothing more than an agreement with the premiers to get an agreement. An agreement to get an agreement. If anything sums Labor up, it is an intention to do something or an intention to have an intention to do something. An agreement to get an agreement—that is where this historic reform is as we stand in this parliament today. This is a government that has failed the Australian public in so many areas, as I have said before, but none more so in my view than in health.

Let us take another example: the so-called GP superclinics. They are so super that they resemble any other general practice across the country. Yet again, much was promised, but when we look at what is being delivered—we know what is being delivered—we see that it is taxpayers' money that is going to set up a practice in opposition to a practice which has been established through private investment. It is completely offensive, not just to the doctors and nurses who are involved but to patients as well. To make it worse, the government have decided that they will proffer preferential treatment in terms of the employment of the doctors, and presumably nurses in some cases as well, at these superclinics, which puts them at a competitive advantage to those practices which operate with the cost of capital being deployed into these centres. It is untenable that this situation continues. Ms Roxon had promised more than 60 of these so-called superclinics, and we know that just 10 of these clinics have opened across the country five years after they were promised, and completely and utterly over budget. Nothing this government touch does anything but turn to dust. The health portfolio contains one classic example after another of why Labor just cannot be trusted with the sort of legislation that is before the House today or, indeed, the general health program.

Last night we saw the government make an announcement on mental health—an area of great importance to all Australians—that they tried to make people believe was in the order of $2.2 billion. But when you strip away that spin, the Australian public has discovered today that the government commits $583 million over the next four years, over the forward estimates. They have some money in the fifth year. But, strangely enough, five years time will be the third year of the next term of government. So, if you believe that Julia Gillard is going to last the next two years, she then has to last the next three years beyond that as Prime Minister to implement this plan that was announced last night. It is complete and utter fantasy.

This is a government that promises big. It promised big to the midwives, it promised big to the mental health community, but it has delivered nothing. This is a government that should hang its head in shame when it comes to the health portfolio because, whilst billions and billions of dollars has been squandered in pink batts, in all of these failed programs that the Labor government has delivered—

Kelvin Thomson (Wills, Australian Labor Party) Share this | Link to this | Hansard source

Order! I am reluctant—

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

money has not been directed into these sorts of areas, which are incredibly important—

Kelvin Thomson (Wills, Australian Labor Party) Share this | Link to this | Hansard source

The shadow minister will resume his seat when I am drawing his attention to a matter, otherwise I will have to sit him down. I am reluctant to interrupt shadow ministers and speakers, but so far the shadow minister has had precious little to say about the bill before the House. I draw his attention to the fact that we are debating the Midwife Professional Indemnity Legislation Amendment Bill.

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

What I have done in my speech thus far has been to demonstrate the failings of Labor, particularly in relation to this piece of legislation before the parliament. It is important for people to understand that this is yet another patch-up job by a government that just cannot get it right. I think it is completely reasonable, in drawing people's attention to the latest failings, this time in health, that we also draw their attention to Labor's other failings, because it gives people an understanding of the modus operandi of this government. They cannot get it right in the area of pink batts; they cannot give pink batts away for free. They cannot get the midwives legislation right.

Kelvin Thomson (Wills, Australian Labor Party) Share this | Link to this | Hansard source

I have told the shadow minister that he needs to be relevant to the bill. If he wishes to defy my ruling, I will sit him down and move to the next speaker.

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

Why this is completely relevant is because it shows a course of conduct by a government that is out of control. The point is that it is not just restricted to the area of health. More money is needed in the area for doctors and nurses and for midwives in particular, but this is a government that has wasted money and this is a government that has said to the Australian public that it has health as a priority, yet every act both inside this portfolio and across broader government points to completely the opposite. I think it is a crying shame for Australian patients, for midwives who are affected directly by this bill, for all allied health professionals, that they see so much promised and yet have so little delivered. This is just the latest example of why this government cannot be trusted going forward. The midwives of Australia look at this piece of legislation as yet the latest example of why this government cannot be trusted into the future.

We supported the original tranche of legislation in this area. We provided constructive input to the government. We warned them of some of the likely failings. Some of those failings have come to pass. They talk about typographical errors which in effect make the premium completely above and beyond what anybody could be expected to pay. Nobody could practise as a result of this legislation reasonably if they were in certain employment circumstances. As I say, we flagged the fact that this government would get yet another bill wrong. They did not let us down. Certainly they have let the Australian people down. We support the amendments because they make bad legislation better than it was, but ultimately what needs to be highlighted to this parliament and to the Australian people is that this is yet the latest example of a government that has failed at every turn, for which they should be condemned at the ballot box in two years time.

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

I rise to speak in support of the Midwife Professional Indemnity Legislation Amendment Bill 2011. The member for Dickson urged us to put more money into hospitals, doctors, nurses and the health system generally. This is a bit rich coming from those opposite, when the Institute of Health and Welfare in October 2007 produced a damning report on the state of the health and hospital system in this country under the tutelage of the then minister, who happens to be the opposition leader, and he was a longstanding health minister at that time. The institute damned the Howard coalition government, saying that they had actually defunded, vis-a-vis the states and territories and the private health sector, health and hospital funding in this country. Even the now opposition leader—and we have had about three of them since 2007—at that time actually admitted during a campaign that was not one of his best and finest performances in terms of timeliness and preparedness to debate issues, particularly with the now Minister for Health—

Bob Baldwin (Paterson, Liberal Party, Shadow Minister for Tourism) Share this | Link to this | Hansard source

Mr Deputy Speaker, I raise a point of order. I am mindful of how you brought the member for Dickson to order to address the bill. I would suggest that you bring your attention to ask the current speaker to address the actual issues in the bill.

Kelvin Thomson (Wills, Australian Labor Party) Share this | Link to this | Hansard source

The member for Paterson will be aware that the member for Dickson spoke for about 10 minutes before I drew his attention to the bill. But the member for Blair no doubt is aware of the contents of the bill and I ask him to draw his remarks to the bill.

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

I am happy to do so, Mr Deputy Speaker. I will just respond on one issue, and that is the GP superclinics. I say to the member for Dickson that the GP superclinic in Ipswich, which I am proud to have supported and sought the funding for at $2.5 million, was a wonderful institution for the Ipswich community at the time of the floods, being situated next to the main evacuation centre in Ipswich at the showground. If the member for Dickson wants to go and have a look at the Ipswich GP superclinic he is most welcome to at some stage. It is operating now under the great leadership of Dr Simon Barnett.

I want to speak about what the coalition government failed to do with respect to midwifery and what we are doing in this legislation and what we have done since we were elected. The role of midwives and the issue of health funding and also insurance became very obvious back in about 2002 and also prior to that with the collapse of the insurance market after 9/11. There was a landmark obstetrics birth injury case which resulted in a payout of about $11 million and that initiated a crisis of confidence in the industry and also with respect to midwives across the country. With about 200 privately practising midwives paying about $800 a year for insurance, there simply was not a big enough pool of funds to contemplate a payout of that magnitude, and obviously insurance for midwives was a big issue.

The coalition was in power in 2001-06 and most of 2007, so it had over six years to resolve this issue. Surprisingly, it did not. It was too hard for those opposite—inaction and inactivity on the issue was their motto. They were simply spending too much time attacking workers and not enough time noticing what was happening in the midwife sector. Since we got into power we took steps to find out about the issues facing midwives across the nation. In 2008 we directed the Commonwealth Chief Nurse and Midwifery Officer, Rosemary Bryant, to conduct a review of midwifery services in Australia. In addition a number of my colleagues and I lobbied very hard on this issue. I met with midwives in Queensland and I spoke at fora put on by the Maternity Coalition in the state. I spoke to a number of people in the industry, including a very prominent midwife in the Ipswich area, Teresa Walsh. I wish her and the other midwives well in their venture in relation to maternity services and midwifery services in Ipswich, Toowoomba and the western corridor and the business they are currently conducting. I had the privilege of serving on the local health community council with Cas McCullough, a real mover and shaker in the Maternity Coalition in Queensland and someone who has argued strongly for reform for midwives. Cas has taken a very strong view that we need to make changes to support midwives and has certainly put into practice her commitment to caring for young children and for women who choose homebirths, as well as for women who choose to give birth in other ways. Cas's work is very well known in the West Moreton area, and I commend her for the work she is doing.

It was Labor that brought three bills before this House in 2009 to support Australia's midwives. Despite the great work done there, anomalies emerged from that legislation. The purpose of the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 and the associated Midwife Professional Indemnity (Run-off Cover Support Payment) Act 2010 was to support the new MBS and PBS arrangements by enabling the establishment of a government supported professional indemnity scheme for eligible midwives from 1 July 2010. An unintended consequence emerged from the enactment of the contribution scheme legislation whereby midwives who were self-employed and had formed companies through which to operate their services were not eligible for a Commonwealth contribution. That particular provision was set up to deal with private hospitals and large private obstetric practices as employers and was not intended to impact on companies established by a single midwife or a couple of midwives who were directors, shareholders and employees of that private company.

Within large companies such as private hospitals and large obstetric practices, claims to a Commonwealth contribution scheme could be made by the employer. But if the midwife, who may be the sole director and sole shareholder, was also an employee, this made them ineligible to make a contribution claim, and that was never the federal Labor government's intention. The Midwife Professional Indemnity Legislation Amendment Bill 2011 has the very important task of tidying up the Midwife Professional Indemnity Scheme created under the 2010 legislation. The bill before the chamber allows for a rule-making power to be established under section 11(3)(g), and thus tidies up the placement of the unintended words to a more appropriate part of the legislation. It also allows for future rules to be made as and when new and innovative midwife self-employment arrangements occur, without the need to seek a separate amendment to the legislation.

Of course, any new rules are subject to the scrutiny of the parliament to make sure the intention is consistent with the scheme legislation. As the member for Dickson pointed out, the bill does fix an error in the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2010, which became legislation, which would, if left unchanged, impose a higher than intended tax on insurers of eligible midwives.

This bill ensures that self-employed midwives can access the Commonwealth contribution scheme and amends the professional indemnity legislation of 2010 to ensure that the tax on insurers of eligible midwives is correctly calculated. These changes are important because self-employed midwives such as Teresa Walsh, whom I mentioned before, need to make sure that they can get access to that scheme and not fall foul of the previous provisions. We do not want them excluded from the operation of the provision.

Today we see the federal Labor government putting the health and wellbeing of Australians at the forefront of legislation in fixing up this problem. We saw health, education, infrastructure and many aspects of the Australian economy front and centre in the Treasurer's speech last night with respect to employment and participation. We need to make sure that midwives participate not just in the economy but in the lives of women who choose to use midwives in the birthing of their children. This is an important difference in terms of legislation. It fixes up some problems and puts the scheme in a better state. It makes sure that midwives have security and certainty and have access to the contribution, and it helps midwives such as Teresa Walsh in my electorate, and others, to access the scheme in the way that we always intended. For that reason, I commend the legislation to the House.

Geoff Lyons (Bass, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak in the House about the Midwives Professional Indemnity Legislation Amendment Bill 2011. Most people who provide professional services and advice to the general public take out a form of insurance that covers and protects them and their clients against adverse incidents that may lead to injury or some kind of financial loss. Civil engineers, for example, take out professional indemnity cover against the possibility that structures they build will become unsafe or may cause injury to people. Doctors take out medical indemnity cover against the possibility that they may injure their patients during the course of a medical procedure or as a result of a prescribed course of treatment.

In the 2009-10 budget, the government announced the 'improving maternity services package'. The package provides for the introduction of Medicare supported services to provide greater choice for women during pregnancy, birthing and postnatal maternity care, including the provision of professional indemnity for midwives. The Midwife Professional Indemnity Scheme, which commenced on 1 July 2010, enabled a Commonwealth contribution to be paid to insurers for the cost of eligible claims against eligible midwives. This act provides that the Commonwealth contribution and the run-off cover for Commonwealth contribution are not payable for a claim that should be covered by the midwife's employer. This is to ensure that there is no intentional cost-shifting from the employer to the Commonwealth.

Following the passage of this legislation, it was brought to the government's attention that the operation of this provision effectively excluded self-employed midwives. This exclusion was not the government's policy intention. The member for Dickson, a born-to-ruler from the other side, did not raise this oversight during the passage of the original legislation, even though the opposition would have us believe that they have some divine right to knowledge and ability. To give a little background on this issue, before the enactment of the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010, midwives were generally unable to obtain insurance to cover their practice. In order to protect their personal assets in case of a negligence suit, many midwives chose to set up a company, either alone or with other midwives, through which they operated. This meant that any legal actions taken were taken against the company, not the midwife personally.

This bill also amends the Midwife Professional Indemnity (Run-Off Cover Support Payment) Act 2010 to ensure that the tax on insurers of eligible midwives is correctly calculated.

This bill amends the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 to ensure that self-employed midwives can access the Commonwealth contribution. Essentially, this bill tidies up minor technical errors by placing the intended words in a more appropriate section of the act and corrects a typographical error.

This bill is an important component of the government's maternity reform package. The package aims to improve the choices that are available to women in relation to maternity care. The total cost over four years of the professional indemnity for midwives component of the package is $25.2 million. I commend these changes to the House.

Women and their babies must be the focus of maternity care. They should be able to feel they are in control of what is happening during pregnancy, childbirth and the postnatal period, based on their individual needs and having discussed the issues fully with their care providers. Australian women and their babies should be able to access high-quality, safe maternity services.

This government has a proud record of delivering better health services for all Australians. Helping Australia's hospital system to recover from the dark days of the Howard-Abbott years was a daunting task for Labor when we came to office in 2007. In 2008 we boosted hospital funding by $20 billion, a 50 per cent increase. We have also invested over $2.4 billion in health workforce measures. That is helping us to train over 1,000 nurses each year and double the number of GPs in training, and we have seen the Commonwealth's specialist training program expand from just 51, when Mr Abbott was the health minister, to 518 this year. Plus, we have made a record $872.1 million investment in preventative health. And just last night we announced measures to assist those with a mental illness.

The government is delivering major reforms across the health system to improve the quality of services, responsiveness at a local level and access to care. We are governing for Australia's future. We are supporting Australian families. This is a small but important amendment. I congratulate those opposite, as they do support this amendment because it promotes choice and protects our valuable midwives.

Steven Ciobo (Moncrieff, Liberal Party) Share this | Link to this | Hansard source

I rise to the speak to the Midwife Professional Indemnity Legislation Amendment Bill 2011, an important bill because it goes towards providing greater certainty and assurance to those midwives who are employed in their own businesses, in particular, following a series of changes that were made in the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010.

Under this bill, which is relatively technical in nature, there have been changes made to ensure that self-employed midwives are able to access the Midwife Professional Indemnity Scheme. The bill also amends the Midwife Professional Indemnity (Run-Off Cover Support Payment) Act 2010 to ensure that the tax on insurers of eligible midwives is correctly calculated, after there was a typographical error in the act that imposed a much higher tax on the premium income of insurers of midwives.

The situation that arose was that the tax payable exceeded the premium that was going to be charged. We are informed, as members of the opposition, that this was an unintentional consequence of a typographical error within the act. To the extent that this bill clarifies the intent of the original legislation and provides the assurance that is sought, the coalition is certainly supportive of it, as am I, as a member of the coalition.

The role of midwives is crucial. My wife and I had the opportunity and indeed the great joy of having a child a little over two years ago now. There is no doubt that, for many women, midwives are a source of solid support, reassurance and knowledge when they take the journey of childbirth. The government should do anything it can to make it easier for women to practise the art of midwifery without the risk of there being a successful lawsuit hanging over their head for practices that are not negligent or reckless.

We know that in past years there has been a massive increase in the number of tort actions against, amongst others, midwives. We have seen the repercussions, with there being a large decrease in the number of midwives seeking to practise and changes in the structures that midwives adopt as employees, self-employed members of the community and indeed small business operators and proprietors, as they may well be.

This bill before the House today provides certainty. It delivers on the policy intent of making sure that there is support for them to undertake their practices, given their importance in the community and making sure that we as a society recognise that women seek support when they go through the process of childbirth and in the many months leading up to it.

As a husband, there was reassurance for me too to know that there was perhaps an alternative source of information that my wife could turn to beyond my mother-in-law or sisters. I was just grateful, frankly, that it wasn't me. In that vein, I think that we should be doing all that we can to make sure that the fine and delicate art of being a midwife is kept alive for as long as possible. It seems to me that, if anything should be labelled 'secret women's business', perhaps this should be. But then again that might just be an old-fashioned Steve Ciobo talking, rather than someone who is necessarily the most up-to-date—

Graham Perrett (Moreton, Australian Labor Party) Share this | Link to this | Hansard source

Snag. You're a snag!

Steven Ciobo (Moncrieff, Liberal Party) Share this | Link to this | Hansard source

snag. Having said all that, there remain some matters of interest for me that I have looked into with respect to midwifery for some of my constituents and which still to some extent remain unresolved, and they are around the issue of home births. We know that for many individuals the location they choose for having their child is a very personal choice. It might be in a hospital, but there are a number of women, I recognise, who hold the fundamental view that childbirth is a very natural thing—not something that requires medical intervention—and they often choose to have their child in the familiar, comfortable surroundings of their home. For those midwives who practice their art or their skills in people's homes, there is still, I am told by those in that industry, some uncertainty about their legal liabilities and their level of protection for homebirths. Although this act does not go directly to that matter, it is important to recognise that there are very active and vocal groups in many communities, not just in my own, who hold the view that we should be doing more to facilitate things for those women who would like to be midwives and for those women who would like to give birth in their own homes.

So I just put on the record my support for those who choose to go down that path. It was not the pathway that my wife and I chose to go down. Notwithstanding that, I recognise it as a personal choice, a choice that many women make. Again, in that sense, I think policy should be directed towards assisting them, recognising, though, what for me was an inescapable fact—that there is, I believe, an elevated risk as a result of homebirths. That elevated risk notwithstanding, the reality is that there is of course no aspect of life that is without risk and I recognise the rights of those who choose to have their child in their own home.

I am certainly pleased to support the bill before the House today. I recognise that it comes as a consequence of a typographical error. You would have thought, perhaps, that with so many eyes in the executive checking this legislation, and with so many others checking it, these kinds of errors would not take place. That notwithstanding, it has taken place, but it is being corrected and the opposition supports that. I commend the bill to the House.

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

I rise to support this piece of important legislation. The purpose of the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 and the associated Midwife Professional Indemnity (Run-off Cover Support Payment) Act 2011 was to support the new MBS and PBS arrangements by enabling the establishment of a government supported professional indemnity scheme for eligible midwives from 1 July last year. Those acts removed a longstanding barrier to appropriately qualified and experienced midwives wishing to provide high-quality midwifery services to Australian women as part of a collaborative team with doctors and other health professionals.

The Midwife Professional Indemnity (Commonwealth Contribution Scheme) Act 2010 currently excludes employed midwives from accessing a Commonwealth contribution and a run-off cover Commonwealth contribution. This exclusion is to ensure that there is no intentional cost-shifting from employers of midwives to the Commonwealth. The bill tidies up the act by placing the rule-making powers in a more appropriate section and thus ensures that eligible self-employed midwives are not excluded from access to Commonwealth contributions for claims that are made while they are in the workforce or for any claims that are made after they retire. By doing this, the act will continue to exclude other employed midwives, such as those employed by private hospitals, to prevent the cost-shifting—already referred to—from that sector to the Commonwealth by employers.

The changes to the act proposed by this bill will also allow a specific rule-making power to appropriately address any new and innovative midwife self-employment models that may arise in the future. This was an issue of particular concern to midwives when the previous bills were before the parliament. This rule-making power will ensure the bill will be able to accurately describe midwives and employment arrangements which are within the scope of the government's maternity reform policy.

The bill also corrects a typographical error in the Midwife Professional Indemnity (Run-Off Cover Support Payment) Act 2010 which would, if left unchanged, impose a higher than intended tax on insurers of eligible midwives. The Australian government is proud to be implementing historic reforms to maternity care which recognise the skills of our highly trained midwives and provide more choice for Australian women while maintaining Australia's strong record of high-quality, safe maternity services.

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

The government responded to the report with a $120.5 million package to provide access for midwives to the Medicare Benefits Schedule and to Pharmaceutical Benefits Scheme medicines, and a government supported professional indemnity insurance scheme for eligible midwives. On 24 June 2009, the Minister for Health and Ageing introduced legislation to facilitate these new arrangements. These arrangements are available for appropriately qualified and experienced midwives working in cooperation with obstetricians and health facilities as recommended by the report. These changes enable the clients of midwives and nurse practitioners to access services and medications subsidised by the MBS and PBS. There are currently around 350 qualified nurse practitioners in Australia, generally working in public hospitals. Initially about 50 nurse practitioners were expected to access the MBS and PBS for their clients in certain private and community settings, particularly in primary care and rural areas, from November 2010.

For midwives to be eligible to participate in the new arrangements, they needed to meet advanced practice requirements and to have had collaborative arrangements with doctors. These requirements and collaborative arrangements were developed in consultation with midwives, doctors and other stakeholders. The reform initiatives supported by this legislation allow for incremental reform within a strong framework of quality and safety. It is expected that around 700 eligible midwives will be participating in this measure over the next three years. The government understands the concerns in the community about registration and professional indemnity insurance and how this affects the involvement of midwives in homebirths. Our legislation has expanded Commonwealth support for midwives and nurse practitioners in our community. They improve choice and extend Commonwealth funding for a range of midwife and nurse practitioner services for the first time ever, including providing antenatal care in the community and attending births in clinical settings. None of these bills have made homebirth unlawful.

However, under an agreement made last year the states, territories and the Commonwealth agreed to a two-year exemption for homebirthing midwives who are acting not within the state hospital system but in the private sector. A number of conditions and requirements were attached to that exemption, including that a homebirthing midwife must disclose to a mother who is interested in having a homebirth that they will not be insured for that procedure and making sure that people make an informed choice about undertaking a homebirth. The government asked homebirthing midwives to report each homebirth.

There is currently not any good data across the country of how many homebirths actually occur. Independent midwives are not currently required to notify state and territory authorities or hospitals, nor have they been asked to. We will require, however, participation in quality and safety frameworks—for example, reporting the results of homebirthing and incidents that are related to it.

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

The two-year exemption allows plenty more time for those protocols to be established and to be worked on. In the meantime, the arrangements ensure that homebirthing midwives can lawfully continue to provide the services in the jurisdictions currently allowed. They will continue to be uninsured—as they are currently. The government is collecting more data on homebirthing and there will be a process to further work through these protocols that would either bring more homebirthing services into the public system or potentially open the way in the future for an insurance product to be extended to cover them.

Homebirthing programs operate in a number of state and territory systems with participating midwives coming under the insurance cover of the public health system. Midwives who provide maternity services in an independent private capacity, including assisting with homebirths, currently do so without indemnity cover as there are no products currently commercially available.

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

In March 2009, the Council of Australian Governments signed an intergovernmental agreement to implement a single indemnity scheme which came into effect in July 2010. The scheme initially covered 10 health professions—medicine, nursing, midwifery, pharmacy, physiotherapy, podiatry, osteopathy, chiropractic, optometry and dental care including dentists, dental therapists, dental hygienists and dental prosthetists—and psychologists. Under the scheme there is a requirement for professional indemnity insurance as a mandatory condition of registration for all health professionals, including midwives. This is an important part of raising standards and providing public protection for patients and consumers. The Australian government is committed to building on our previous budget maternity services reform packages by working with the states and territories and with key stakeholders, to develop a national maternity service plan to ensure coordination of maternity services across Australia.

Many members have previously spoken about their personal experiences in relation to midwifery. I would like to share with the House some of mine, too. My daughter Matilda was born at Wyong Hospital where the only service is midwifery. So in some areas, workforce shortages mean that choices for women are limited. We had a terrific experience with a midwife. In fact, we are pregnant again and we are going back to the same midwife. Our experience of the midwifery profession was very positive. At Wyong Hospital, there is a room which looks like any room you would have at home with a big bath and a bed and a midwife to guide you. You do not have the option of epidurals because there is not an obstetrician available at Wyong Hospital. Mothers who are at potential risk are automatically transferred to Gosford Public Hospital. The group of mothers who have the opportunity to be involved with a midwife are certainly screened. That is very appropriate in making sure that we maintain safe outcomes for women giving birth. If developments in the birth cause concern, mothers are immediately transferred by ambulance to Gosford hospital, 10 minutes down the road, where obstetricians and medical practitioners are available. In a sense, our region provides a choice through necessity rather than through anything else. I am very much in favour of making sure that homebirths are an option because of the terrific experiences that many women have had on the Central Coast, including my wife. This is an opportunity to thank our midwife, Val Paynter, who has assisted in the births of hundreds of babies in the 30 years that she has been a midwife on the Central Coast. She is a great midwife and we were incredibly lucky. She has been midwife of the year twice, so we are indebted on the Central Coast for having someone of her experience there.

This is an important issue and shows that we need to make sure that there are different models available so that women have choice and are given the maximum number of options. Not all women will choose to have birth assistance from a midwife, but those who do should be able to have that option.

This is important legislation that builds on the reforms. It builds on the recommendations made to the government back in 2009. This government has acted on those recommendations. It is important that this bill is supported, and I note that the opposition are supporting it and that is very much appreciated. This is part of the ongoing reform to make sure that women have better choices and that we maintain the high quality and high safety standards that exist in our maternity services throughout Australia. I commend this bill to the House.

Sharman Stone (Murray, Liberal Party) Share this | Link to this | Hansard source

The Midwife Professional Indemnity Legislation Amendment Bill 2011 is a very important piece of legislation. It aims to correct two serious flaws in the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010. Once amended, and the coalition supports this amendment, this will ensure self-employed midwives can access the insurance scheme—what an absurd omission that was at the time.

The amendments also aim to fix up the Midwife Professional Indemnity (Run-off Cover Support Payment) Act 2010. The error in the latter act was a miscalculation which imposed a far higher tax on the premium income of insurers of midwives. The insurer would have paid more in tax than the entirety of the net premium. This has been passed off by the government as a typographical error, but it really is another example of sloppy policymaking that has had enormous implications for the profession of midwifery. It is a profession that has been under strain and stress for generations in this country as the competition continues between the so-called rights of doctors—mostly male doctors—to deliver babies compared to the rights of women and families to have choice, and to have that choice include midwives who are properly and appropriately insured.

Obviously, we the coalition support the amendments to the act. We want to allow self-employed midwives into the scheme which gives a Commonwealth contribution to the insurer for the cost of eligible midwife claims. We support the correction of the so-called typographical error which imposed the wrong tax calculation on the insurer. But midwives continue to wonder what this government has against highly qualified and experienced midwives being able to take out government supported insurance for home births. Particularly for many in rural and regional Australia, a home birth can be not only a preferred way to have the joy of new baby come into the home but also the safest and best option when you are many kilometres away from a hospital or when the travelling conditions are difficult. In some sort of emergency, like our recent floods, a lot of our women are better off by being assured that a home birth is an option if a professionally qualified woman is nearby.

Under this government's policy, midwives assisting with home births are still not able to be insured. They have a two-year exemption for insurance cover, which will run out in June 2012. Why can't these women come under this Commonwealth assisted MIGA scheme right now? The lack of security about their futures and their insurance status is obviously very problematic. Meanwhile, the absurdity is that all midwives—whether they are assisting in home births or not—must have insurance for the ante- and post-natal consultations, which are invariably part of a home birth program. So the whole thing is absolutely absurd. Midwives cannot get insurance for the home delivery, but they must have insurance for their support visits before and after the birth. This system can make for a serious problem, obviously, if a midwife wants to work with a team of other professional midwives but they do not have the special insurance that is required to cover home births and post- and pre-natal consultations.

There is another very serious problem with this legislation and the government's policy, and it again particularly affects rural communities. It is a fact that the Commonwealth insurance program, which uses the Medical Insurance Group Australia, will not insure midwives who are called to assist in fewer than 30 baby deliveries per year. It might be fine in metropolitan Australia for a midwife to give assistance in more than 30 deliveries a year—they may assist in 30, 50 or 80 deliveries a year—but in regional Australia many midwives are very busy and fully employed in doing a range of post- and pre-natal support, but do not assist in more than 30 deliveries a year. Under this scheme they are not insurable because they do not have the magic 30 deliveries a year that make them eligible for this MIGA scheme. I ask this government to immediately address this problem because it is a serious issue for highly professional midwives in rural and regional areas, who often have even more years of midwifery experience than their sisters in metropolitan Australia.

Under this government's policy and the MIGA involvement in the insurance for midwives you need to have at least three years professional post-graduation experience before you are eligible to access the insurance scheme. That is absurd. So a young midwife who has just completed her training, who has graduated and who is a professional midwife cannot access this government supported insurance scheme for three years. What other profession has that sort of constraint? What does that do to a young woman planning to become a midwife when she realises that for the first three years she is going to have exceptionally higher costs in trying to find some insurance—if she can—to cover that three-year period? It is extremely difficult. I refer in particular to Ms Andrea Quanchi. She is a midwife with 25-plus years experience. Her daughter recently graduated and of course she is not eligible for insurance right now. She wants to join her mother as a midwife in private practice. Andrea is a brilliant, professional and highly respected midwife who is the only midwife in private practice serving a large part of southern New South Wales and all of northern Victoria. She is an extraordinary woman doing an extraordinary job. Her services are much sought after, but she is caught in this insurance trap whereby midwives must perform homebirths without insurance for two years. She is caught in the trap where she cannot bring on newly qualified midwives to assist her in homebirthing because of the three-year rule. She is also caught in the trap where she cannot get assistance from other midwives to do pre- and postnatal consultations with her homebirthing patients because those professional midwives must have the insurance to undertake pre- and postnatal visits.

There was an incident recently in my part of the world during the very serious flooding. Ms Quanchi had a patient who had given birth but, unfortunately, she was on the other side of the floodwaters. She asked a very competent local midwife to undertake the postnatal consultation for her but found that this midwife did not have the insurance. She then approached the local Wangaratta hospital and was told they could not support her because it had been a homebirth and, 'It was her problem.'

The member for Lyne praised homebirthing. In Australia, we should have the option to homebirth and with the birth of subsequent children enjoy the special additional support that is provided to women in the home. As our previous speaker highlighted, in Australia we have some of the highest levels of medical interventions in births in the developed world. An extraordinary number of caesareans are undertaken and too often it seems those caesareans are undertaken for the convenience of the medical profession rather than for the best health considerations of the women who are delivering.

As everybody knows, we have a chronic shortage of obstetricians and gynaecologists in rural Victoria, and indeed throughout rural Australia. That is why highly professional, competent midwives are so critical to the delivery of health services in rural Australia. It again highlights the problem with this government's refusal to amend its catastrophic independent youth allowance policy. The independent youth allowance enabled country students who had finished year 12 and been offered university places—for example, in nursing—to go somewhere else to train, typically in a capital city. Those would be future nurses cannot now access nursing training and midwifery training because too often their families cannot afford the $20,000 or more that it costs for country students to be supported in their studies while living away from home.

We have the absurd situation now from yesterday's budget where another 16,000 skilled migrants will be admitted into rural and regional areas under the regional skilled migration scheme. On the other hand, we have discrimination in the access to the independent youth allowance—

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

Order! I think I have been very generous to the member for Murray. I ask her to come back to the bill before the House.

Sharman Stone (Murray, Liberal Party) Share this | Link to this | Hansard source

The point I was making is that we have a shortage of nurses and midwives in rural Australia. We have a shortage of gynaecologists, obstetricians and GPs who will deliver babies. There is a policy solution to all this. Firstly, immediately remove the three-year qualification period after graduation when a midwife cannot access the new government supported insurance scheme. This government should immediately address the problem of homebirthing and insurance. With the exemption running out in June next year, midwives need to know what is going to happen after that in regard to insurance and homebirths. This government must also realise that a threshold of performing 30 births before you can access insurance is far too high for midwives in rural and regional Australia. Many of these midwives have decades of experience. They may be delivering 25 or 27 babies. There should be a case-by-case assessment of their insurance needs and competencies rather than a 30 baby cut-off in their ability to access this MIGA scheme.

I am concerned that the next generation of midwives who should be from rural and regional Australia and who are most likely to go back and practice in rural and regional Australia will not be able to access tertiary studies because of the new independent youth allowance policy implications. Their families cannot afford to help them live away from home during their years of study. They simply do not have the means.

As a member of the coalition, I support the fixing of the mistakes in these bills before us today, but the legislation does not comprehensively address the problems facing Australian midwives or the problems facing women and families wanting to have safe, well supported births in country areas, particularly those seeking homebirths. In the 21st century what is happening in Australia is a disgrace. It is akin to the discrimination against midwives that occurred centuries ago. We just have to get over it and understand that women need choices, and that professional midwives must be given the same insurance support and considerations that other professions receive.

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 members for their contributions to the debate on this bill. Unfortunately, a lot of members have strayed an extraordinarily long way from the topic. I might remind members opposite that to come in here and criticise the situation in relation to midwives, when it is the Labor government that for the first time ever has properly acknowledged and provided access to the MBS for midwives and it is also our government which is the first government to introduce an insurance scheme for midwives, and say that the situation in Australia is a disgrace and that other problems should be fixed, which their government in 12 years never ever addressed in any way, is a bit rich.

The amendment to this particular bill is relatively a minor one, but it is an important step in ensuring that appropriately qualified and experienced self-employed midwives will continue to have access to secure and reliable Commonwealth supported professional indemnity cover. This bill makes sense and gives certainty for self-employed midwives and the women and families that they care for. Like the government's recent investment in the Medical Benefits Scheme and the Pharmaceutical Benefits Scheme for access of patients to eligible midwives, this amendment bill will continue to ensure that there is improved access to maternity services and improved choices for Australian women. That is why our government took this action in the first place and we are very proud of our record. I commend the bill to the House.

Question agreed to.

Bill read a second time.