Ged Kearney (Cooper, Australian Labor Party, Assistant Minister for Health and Aged Care) Share this | Link to this | Hansard source

I move:

That this bill be now read a second time.

Today I am introducing the Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Bill 2024.

This bill represents more progress on the government's commitment to strengthen Medicare.

This is an historic day for Australia's healthcare workers.

This legislation represents a major blow, shattering the glass ceiling that, for too long, has held back our highly educated nurses and midwives—in particular those Australian women and men who have taken on years of extra training and study to become nurse practitioners and endorsed midwives.

Some of those are in the chamber today. I'd like to acknowledge the following: Diane Bowden, Kerrie Duggan, Alex Thomson, Kellie Wilton, Amar Sharma, Kayley Meredith, Dr Nicola Holmes, Alison Weatherstone and lots of my wonderful colleagues and friends from the Australian Primary Health Care Nurses Association, the Australian Nursing and Midwifery Federation and the Australian College of Midwives, who have all worked incredibly hard to get us here today.

This bill is about setting the conditions for those nurse practitioners and endorsed midwives to deliver the care that they are educated and qualified to deliver, allowing them to collaborate in a flexible way when patient needs require it, without limiting their professional scope of practice and autonomy.

It's about continuing to put our hardworking nurse practitioners and endorsed midwives at the heart of the Albanese government's Medicare reforms.

And, importantly, it's about taking necessary steps to unleash the full potential of our nursing and midwifery workforce.

Currently nurse practitioners and endorsed midwives are required to enter into a legislated so called 'collaborative arrangement' with a doctor to be able to prescribe Pharmaceutical Benefits Scheme medicines and to provide services under Medicare.

This creates a litany of issues, limiting their scope of practice, and creating unnecessary barriers to the delivery of care.

In order to demonstrate how significant this legislation is, as a turning point for Australia's nurse practitioners and endorsed midwives, I want to linger on the current situation for a moment, a situation which is not serving workers or the community.

Recently I visited a primary healthcare clinic in regional Victoria. The clinic has an affiliated nurse practitioner that delivers primary health care to a small town some 80 kilometres away.

The nurse practitioner does all the hard yards. She cares for her community. She treats patients. She prescribes drugs she is trained to prescribe, gives advice on chronic disease management like diabetes, manages wounds, looks after sick children and so on.

However, once a week the GP from the main clinic has to drive to her healthcare centre. He sees some patients that are outside the nurse practitioner's scope and whom she has referred to him, but also he has to tick a few boxes and sign off on some of her work in order for her and the clinic to attract MBS funding and for her patients to be able to claim the PBS subsidies.

The GP who owns the clinic told me that he values the nurse practitioner's work and recognises her expertise and crucial role in her community. The nurse practitioner told me that the system disrespected her work, her skills and her time.

This system has been one of unnecessary and unhelpful rigmarole. It also actively undermines the nurse practitioners' and endorsed midwives' professionalism and inhibits nurse practitioners' and endorsed midwives' earning capacity.

Instead of our system trusting that nurse practitioners know how to act within their scope of practice and education, just like the system trusts and presumes all doctors do, we have a system that treats them with suspicion and in need of a patronising rubber stamping, wasting everybody's time and precious resources.

In an environment when Australia's health system is groaning at the seams and people, particularly in rural and regional areas, struggle to access health care, we need to have every single nurse practitioner and endorsed midwife running at their full capacity.

Because you see, if a GP in a rural town refused to enter a collaborative arrangement or there simply wasn't a GP or a doctor in the town, the nurse practitioner or endorsed midwife would not realistically be able to practise, removing a vital access point for the community to quality health care and choice.

We need to ensure that a career as a nurse practitioner and an endorsed midwife is fulfilling and well supported, where they are valued for the professionals they are. Where they can practice autonomously, attract an income in their own right, and offer services to their patients that attract the appropriate subsidies.

Due to the changes today, we can assure our nurses and midwives that this is what our government will deliver for them and the people they serve.

This bill has been a long time coming. I personally have been campaigning for this alongside nurses and midwives from across the country for many years.

This is an issue I feel strongly about, as a nurse and as a former secretary of the Australian Nursing and Midwifery Federation. I know how much this means to our profession.

The bill comes following a recommendation by the Medicare Benefits Schedule Review Taskforce. As a result an independent review of collaborative arrangements was commissioned by the Department of Health and Aged Care. This included an analysis of Australian and international literature and extensive stakeholder consultation on the efficacy and appropriateness of collaborative arrangements.

The findings of the independent review supported the need for clinical collaboration between all health professionals. However, it found that the current legislative requirements for collaborative arrangements can create barriers to accessing care.

This was not news to nurses and midwives.

That's why I'm so pleased to be part of an Albanese Labor government that listens and makes changes to empower our dedicated, talented healthcare workers.

This bill will finally remove the legislated arrangement—known as a 'collaborative arrangement'—between a nurse practitioner, or endorsed midwife, and a doctor . This will, in turn, assist in removing barriers to accessing primary care for Australians, particularly in rural and remote areas where a general practitioner can be hard to come by.

This bill recognises that nurse practitioners and endorsed midwives are autonomous professionals who can deliver high-quality care to patients within their scope of practice. Nurse practitioners and endorsed midwives will no longer need to have a specified legislated arrangement with a doctor to prescribe Pharmaceutical Benefits Scheme medicines and provide services under Medicare.

Removing the legislative requirement for collaborative arrangements will not impede clinical collaboration or the delivery of care. These health professionals are already regulated by the professional standards for practice and quality and safety guidelines issued by the Nursing and Midwifery Board of Australia, which require collaboration with other health professionals. This is an actionable standard under the Health Practitioner Regulation National Law Act as in force in each state and territory.

Currently, nurse practitioners and endorsed midwives are the only professions that have legislated collaborative arrangements requirements for MBS and PBS access. These changes today will bring them into line with other healthcare professions.

Moreover, the bill will contribute to the long-term goals of the Strengthening Medicare Taskforce, and the Nurse Practitioner Workforce Plan, and the Woman-centredcare report—all of which recognise that nurse practitioner and midwifery led care are crucial to ensuring all Australians receive timely health care.

And it is not only good for nurse practitioners and endorsed midwives; it's good for women.

We know the care economy—a highly feminised workforce—is often underpaid, undervalued, and underutilised. Women work longer hours for less across our care and support industries.

Economic equality and self-determination is so much harder to come by for working women when the work you do isn't appropriately regarded or remunerated. A bill that empowers nurse practitioners and endorsed midwives is one that empowers women, taking practical action to reduce the gender pay gap and enhance gender equality.

You don't have to look far into our past to see a world where all doctors were men and all nurses were women.

By boosting the status, financial viability and autonomy of this highly feminised workforce of nurses and midwives, we are taking a concrete step towards a healthcare system powered by gender equality, rather than continuing to labour under patriarchal norms and default settings.

It's particularly timely that our government released the Gender Equality Strategy less than two weeks ago, as supporting the more effective use of our predominantly female healthcare workforce will improve gender equality in healthcare access and outcomes.

Throughout consultation on Women-centred care: strategic directions for Australian maternity services, it was heard that women wanted greater access to continuity of care. Women feel more cared for and respected if they have a strong and enduring relationship with a single or small team of carers throughout their pregnancy.

The removal of legislated collaborative arrangements will bring us closer to this ideal, by strengthening access to endorsed midwives, including in First Nations settings, aligning with the principles of Closing the Gap through Birthing on Country.

I conclude by reinforcing that the Albanese government is determined to make it easier for people to access high-quality care when they need it, where they need it.

This bill will help to deliver this and further the government's commitment to strengthening Medicare—a commitment that has already seen an historic investment from Labor since we formed government.

But we won't stop here.

The Albanese government understands that there is no health system without nurses. And there is no Medicare without nurses—and midwives.

Removing the red tape that holds back our nurses and midwives from providing the high-quality care that Australians so dearly need will—finally—go some way to recognising this. And it builds on other Albanese government measures to recognise and support nurses and midwives, like more nursing and midwifery scholarships, opportunities for re-entry to practice, fee-free TAFE, and higher Medicare rebates for nurse practitioners.

Nurses and midwives are at the centre of everything we do.

I thank all nurses, nurse practitioners and midwives, and the organisations that support them, for their tireless work and advocacy.

I am proud to fight for nurses in this place, for nurses and midwives, to ensure that every single person in this country recognises their strengths and capabilities. Making practical, structural changes to our health system, for nurses and midwives, will go a long way to achieving this.

Supporting nurse practitioners and endorsed midwives to use their skills is good for patients, is good for the health system, and encourages more talented people to take up these professions.

Australia's healthcare system is powered by the sweat, hearts and expertise of nurses and midwives.

It's time to let them deliver the work and care that they are qualified to deliver. Thank you.

Debate adjourned.