Brian Mitchell (Lyons, Australian Labor Party) Share this | Link to this | Hansard source

I was quite happy for the member for Wentworth to speak so I could get my breath; I just rushed up here! The Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Bill 2024 before the House today will help modernise Australia's healthcare sector, delivering better and more affordable health care to more Australians—like Medicare, the Pharmaceutical Benefits Scheme, urgent care clinics and cheaper medicines.

What we do today is build on the proud Labor tradition of improving Australian health care. That is because better and more affordable health care is in Labor's DNA. We know how important it is for Australians to be able to access quality health care without it sending them broke. When we look at what happens overseas, we know that Labor's approach to health care is better than just about anywhere else in the world. We reject utterly the failed model that applies for example in the United States, where so many Americans on low and middle incomes have no way to access quality, affordable health care and where an unanticipated injury or illness can literally send you broke.

In Australia, you should never have to put off getting health treatment when you need it. That is why, upon coming to government, we opened 58 Medicare urgent care clinics across Australia, including four in Tasmania. Those clinics are open extended hours and fully bulk-billed; all you need is your Medicare card. And they treat Australians for urgent, non-life-threatening health care. Hundreds of thousands of Australians have been treated at Medicare urgent care clinics, and that's hundreds of thousands of Australians who have not had to clog up emergency department waiting lines.

This Labor government has made the largest investment into bulk-billing in the proud 40-year history of Medicare. In our first 20 months in government, we have tripled incentives for GPs to bulk-bill children, pensioners and concession cardholders, delivering direct benefits to 11 million patients. In our first 20 months in government, we have delivered the biggest reduction to PBS medicine prices in the history of the PBS, saving Australians $250 million in 2023 alone. We're also cutting the cost of more than 300 common medicines by allowing doctors to prescribe 60-day prescriptions.

Today, we seek to expand the role that Australia's fantastic, incredible nurses get to play in delivering health care by allowing our most experienced and qualified nurses to work to their full scope of practice. In addition to about 35,000 midwives, Australia has 337,000 registered nurses, and amongst those are 2,250 nurse practitioners. A nurse practitioner is a registered nurse who holds a master's, who is highly experienced and who has undertaken extra training. It's a legally protected profession. Only people who meet the criteria and are dually registered with the appropriate agencies can call themselves a nurse practitioner. Nurse practitioners have the authority to practice independently in an expanded clinical role and provide Medicare Benefits Scheme and Pharmaceutical Benefits Scheme services. But, currently, they must be attached to a general practitioner. This legally required collaborative arrangement serves to limit the full scope of practice that nurse practitioners can offer the community. Instead of our medical system trusting that nurse practitioners know how to act within their scope of practice and education just like it does for general practitioners, it treats them with suspicion, requiring a GP to effectively look over their shoulder and tick a box on their work. Under the current system, a doctor in their first year on the job as a GP has more authority and is assumed to know more about a patient's health care than an NP with 30 years of clinical experience and a master's. When you consider that over 90 per cent of nurse practitioners are woman, you can see how patronising this has been and what a waste of time and resources it is.

The bill before the House today is transformative. It recognises midwives and nurse practitioners for the highly trained, highly qualified healthcare professionals that they are. It will serve to see more health care delivered throughout our cities, suburbs, towns and regions. I see the member for Indi is here to speak on this bill. I'm sure she will have great pleasure in talking about the benefits this bill will bring to her region in particular.

In response to a recommendation by the Medicare Benefits Schedule Review Taskforce, the government commissioned an independent review of the collaborative arrangements that are currently legally required for nurse practitioners to provide services under the Medicare benefits scheme. The review included analysis of Australian and international literature and extensive stakeholder consultation on the efficacy and appropriateness of these arrangements. The findings of the review supported the need for ongoing clinical cooperation between all health professionals. We all know the importance of multidisciplinary teams and of health professionals talking to each other, but what the review found was that the legislated requirement for collaborative arrangements duplicates existing professional standards and guidelines and can indeed create barriers to accessing care. Removing this legislated requirement for an arrangement will assist in removing barriers to primary care for Australians, particularly in regional, rural and remote areas, where there are big challenges in attracting and retaining general practitioners.

The bill has strong support from the nursing and midwifery sectors and is expected to result in very positive change for the Australian community. By supporting more effective use of the highly feminised nurse and midwife healthcare workforce—90 per cent of nurses and 98 per cent of midwives are women—this bill will improve gender equity and healthcare outcomes and access and take practical action to reduce the gender pay gap.

I would like to briefly talk about the Cygnet Family Practice in the Huon Valley, which became the first general practice in Australia to implement an urgent and after-hours service from April 2023. It's run solely by the practice's nurse practitioners within a collaborative arrangement with a GP. I had the pleasure of being invited to the practice's official opening in August last year. While it's quite a few kilometres outside of my own constituency—it's in the heart of the Huon Valley, around 50 minutes out of Hobart and Franklin—I was keen to get along there because I'd heard about the Cygnet Family Practice and what an amazing difference it was making for people in the south of the state. Kerrie Duggan and her team are doing an incredible job. I was delighted to meet Kerrie again when she visited Canberra last week for the launch of the initiative that is before the House today. The Cygnet Family Practice gives a real insight into how health care could be serviced in our regions in the future. In the first 10 weeks of opening, the Cygnet Family Practice saw more than 300 people in the after-hours clinic alone. It's clear that they are reducing the impact on our emergency departments, just like the government's Medicare urgent care clinics are.

This bill before the House today will pave the way for more regional practices like the Cygnet Family Practice to let our nurses and midwives do exactly what they need to do—help people in need when they need it and where they need it. We know in the care economy the highly feminised workforce is too often underpaid, undervalued and underutilised. I think we all remember those scenes during COVID. Everybody wanted to thank a nurse, But thanks only go so far. Nurses need support, they need pay and they need respect. This bill certainly delivers on the respect. A bill which empowers nurse practitioners and midwives is one that empowers women. By removing the requirement for collaborative arrangements, this bill also supports the implementation of the Women-centred care strategy by providing birthing women with greater choice and access to care and services. Removing the red tape that holds back our nurses, nurse practitioners and midwives from providing the high-quality care that Australians so clearly and dearly need will finally go some way to recognising this.

It builds on other Albanese Labor 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. Allowing women to choose to receive care by a nurse practitioner or midwife will go a long way to ensuring that women are always treated with respect and dignity in our maternity care system, whether they are the professional delivering the service or the person receiving the service. As the Albanese Labor government works to develop the National Strategy for the Care and Support Economy, we will continue to deliver practical and structural changes across our care workforce. As women make up the vast majority of workers in this sector, this bill will support women's economic equality.

We said that we would strengthen Medicare and that's exactly what we're doing with bills like this one before the House today. I get great pleasure in commending this bill to the House.

Helen Haines (Indi, Independent) Share this | Link to this | Hansard source

I endorse the words of the member for Lyons in his contribution this morning. This Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Bill 2024 is a very important bill, a timely bill, and one that gives me great personal excitement to see coming through the House.

So I rise today in support of this bill. I do so with the confidence that comes from having worked alongside nurse practitioners and endorsed midwives for many years, both clinically and in a research capacity. And I do so as someone who led a rural cohort of nurses studying for their Masters Degree in Advanced Practice Nurse Practitioner 15 years ago. These nurses went on to deliver desperately needed specialised care across aged care, critical care, emergency departments, mental health, palliative care, drug and alcohol services and diabetes. The educational program they undertake is rigorous, difficult and comprehensive. Added to that, these nurses come with extensive clinical experience leading into that masters degree preparation.

My first-ever published peer-reviewed journal article was about enablers and barriers to establishing a nurse practitioner model of care. My professional collaborations with local GPs and physicians during that time saw some fantastic teamwork, which has endured to this very day. I truly thank nurse practitioners and endorsed midwives for the extraordinary service and leadership they've given over such a long period of time, while being hamstrung by this particular collaborative agreement legislation that we're about to change. I thank the supportive general practitioners and medical practitioners who stepped up 15 years ago and who have championed and supported nurse practitioners and midwives over so many years. Our health service in Wangaratta produced Victoria's first-ever gerontic nurse practitioner, and many have followed since then. It wasn't easy; there were many barriers to getting this model of care off the ground. But, as they say, time honours the brave, and it kinda feels a bit special to be talking about this today. In addition to what I know about this, there has now been 20 years of Australian research accompanying this model of care. It has shown conclusively that nurse practitioners and endorsed midwives provide safe, satisfying and effective care.

I want to speak briefly about my confidence too in the endorsed midwives. Prior to coming to this place, I worked clinically as a midwife for many years, including in caseload midwifery group practice, where, together with my team, we provided continuity of midwifery care for countless numbers of rural women. The evidence for this model of care is now overwhelming, from right across the world, that it reduces preterm and early birth, reduces the use of non-medical-required Caesarean sections and leads to great satisfaction—not just for women but for men too. It's important work, and I've been very proud to be part of it.

The report Woman-centred care: strategic directions for Australian maternity services clearly showed that women want greater access to continuity of midwifery care and, in accessing that care, they need access to midwives who can provide that care under Medicare and prescribe under the PBS. Most critically, women from First Nations settings want to access continuity of midwifery care alongside the principles of closing the gap through birthing on country. It's an absolutely critical campaign that we need to get behind in closing the gap for women and babies from First Nations communities.

The challenges facing our health system are enormous. We need only to look at the data to see that. The most recent ABS National Health Survey data from 2022 showed: 81.4 per cent of people in Australia had at least one long-term health condition; 49.9 per cent, so one in two people, had at least one chronic condition; mental and behavioural conditions sat at 26 per cent; back problems sat at 16 per cent; and arthritis, at 14.5 per cent, was the most common of the common chronic conditions. Many people with chronic conditions often have more than one condition, something we call multimorbidity. Then there are the almost one in three people living in areas of most disadvantage who have two or more chronic conditions compared to one in eight of those living in areas of least disadvantage. So the more disadvantaged you are the greater chance you have of chronic, long-term and multimorbidity conditions.

Added to this is the seemingly intractable problem reported by the Australian Institute of Health and Welfare time and time again that the number of employed full-time equivalent clinicians working in registered health professions decreases with increasing remoteness—a trend we've seen year on year. There are more registered clinical full-time equivalent health professionals in major cities than in all regional and remote areas of Australia combined. The single biggest group of health professionals, though, who are in rural and remote Australia are nurses and midwives. Right now, amongst these nurses and midwives are endorsed midwives and nurse practitioners who can only work to their full scope of practice if they have a collaborative agreement with a doctor. Patients cannot access their care and receive MBS and PBS rebates unless this collaborative agreement is in place. Nowhere is this more problematic than in rural, remote and regional Australia, where the needs are so great and where there is the greatest acute shortage of general practitioners and medical practitioners.

The Australian Rural Health Alliance commissioned work showing each person in rural Australia is missing out on nearly $850 per head per year of healthcare access, which equates to a total annual rural health spending deficit of $6.5 billion. The burden of disease in remote areas is 1.4 times that of major cities. So, in short, there is more work than the current system can handle, and the people who are most likely to miss out are the people who need care the most.

Nurse pensioners and endorsed midwives can contribute to bridging that gap, but right now we have built in redundancy to the capacity of our health workforce. Nowhere is this more evident than in rural Australia. This bill will help address that. The bill before us is sensible and timely because it enables two critical groups of highly trained and trusted health professionals—nurse practitioners and endorsed midwives—to put their considerable expertise to these health challenges without the handbrakes and hurdles that patients currently face in accessing their care. Currently these nurse practitioners and midwives are required to enter into a legislated so-called collaborative arrangement with a doctor to be able to prescribe under the PBS and to provide services funded for a Medicare rebate. They are the only health professions that have legislated collaborative agreements to enable them to access the MBS and PBS. If they can't find a medical practitioner to enter into this agreement, they cannot give their patients access to the MBS and PBS. The passing of this legislation will bring nurse practitioners and endorsed midwives into line with all other healthcare professions.

This bill will amend the National Health Act 1953 and the Health Insurance Act 1973 to remove the legislated requirement for a collaborative arrangement in order for an eligible midwife or eligible nurse practitioner to prescribe under PBS and provide services under Medicare. It's so critical, so important and so timely. This bill recognises that nurse practitioners and midwives are autonomous professionals who deliver high-quality care to patients within their scope of practice. Importantly, given my introductory remarks, this bill will remove barriers to health care for Australians, particularly in rural and remote Australia. It will support more a effective use of the existing health workforce, which was recommended by the Strengthening Medicare Taskforce report and the Nurse Practitioner Workforce Plan.

An independent review of collaborative arrangements was commissioned by the Department of Health and Aged Care, and 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. It's a no-brainer; of course you need to collaborate. However, it found that the current legislative requirements for these collaborative arrangements can create unnecessary barriers to care. There has been pushback from some professional groups who say this is not a good thing. However, again, if you look at the international research, local research and independent review you will see that there is indeed no evidence, not a scrap, to say that there is any danger, problem or reason why we would not get rid of these collaborative arrangements.

The skills and experience of nurse practitioners have been leveraged across the world for over 50 years, with the role formally legislated in Australia in 1998. I remember very well when Nicola Roxon, the then minister for health, was at the forefront of introducing nurse practitioner legislation to this House. The only problem at the time was that there was pushback from some professional groups, and the collaborative arrangement was inserted into the legislation. So here we are now, ready to wind it back.

The ability for nurse practitioners to work autonomously and collaboratively within a multidisciplinary health team, and their ability to undertake advanced clinical care, indicates they are well positioned to provide flexible and affordable health services to Australian communities, and we need them so desperately. Compared to the international experience, though, in Australia the roles of our nurse practitioners and endorsed midwives have been substantially underutilised, and this bill is going to help fix that. In her second reading speech, the minister said:

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.

In other words, the collaborative agreement is an add-on to what is already there under national law. It's simply not necessary. I'm really pleased to have read in the press that the coalition also supports this legislation, so this truly is a bipartisan reform, and that's really pleasing.

Let me conclude by using the words of two nurse practitioners from my home town of Wangaratta. Both of them are pioneers and outstanding clinicians, and they've had their shoulder to the wheel for longer than I care to remember. The first experience is that of an endorsed gerontic nurse practitioner—in fact the very first one to be trained and registered in Victoria. He's now had more than 15 years in the role. In 2020 he was called to the very first COVID-19 outbreak in Melbourne, at an aged-care facility. These are his words:

Everyone working together to achieve the best we could for our community, society and residents.

From my medical colleagues, there was no prejudice towards me about being an NP and my qualification. Collaborative arrangements were not mentioned. There was nothing but respect from the doctors for my clinical input and decision making. There was no thought of having to supervise my work. It was simply a team who had mutual respect for each other and striving for the best outcomes for the residents. I have never seen a more streamlined and unfragmented model before.

I dare say that the outcome would not have been the same if I had been hamstrung/restricted by doctors insisting on the full scope of CA's.

At this time, although the normal GPs did not come into the facility, I made every effort to communicate and collaborate with the GPs about their residents. They very much appreciated this. It reinforced to me that collaboration is about communication and the rules around current CA's were superfluous and a barrier.

A second nurse practitioner also caring for older people said:

I've been a Nurse Practitioner, caring for the older person, for the past 13 years in a regional/rural setting. I work in an in-reach program which endeavors to support Residential Aged care Facilities (RACF) to provide acute care outside of hospitals as much as possible. Older people don't always do well in the hospital system away from the familiarity of their home, family and carers. We are able to attend to such things as infections, chronic disease, pain and falls to name a few. We are also able to provide palliative care with symptom support for the person dying and emotional support for their family. This is, of course, happening in complete cooperation with their GPs. My medical colleagues in General Practice are increasingly stretched and it is only through our continued relationships and communication that we are able to achieve responsive health care for our most complex and frail community members. Please bear in mind that there are a growing number of older people in RACFs who are not able to secure the services of a GP …

And therefore no collaborative agreement can be reached, so they have no access to a nurse practitioner either.

Nurse practitioners have a unique insight into the care of people across our community. In closing, this legislation is important and necessary, and the time has come for it to be passed. I want to thank Assistant Minister Kearney for all the work she has done on this; it's substantial, important and right, and I look forward to further work around the health professional scope of practice. I commend this bill to the House with great joy.

Anne Stanley (Werriwa, Australian Labor Party) Share this | Link to this | Hansard source

All Australian citizens have access to what is arguably the best universal healthcare system in the world. It's called Medicare and it celebrated its 40th birthday this year. The green credit card sized piece of plastic is surely the envy of the world, and it comes as no surprise that it was a Labor idea. What other party in Australia apart from Labor could have possibly had the vision for Medicare? The simple answer is no-one. And what other party has continued to be committed to strengthening Medicare for the full 40 years? Again, no-one but us.

Despite the constant attacks from those opposite, Medicare still continues to deliver for all Australians. This is particularly the case given the massive cash injections into Medicare announced by the Treasurer in the most recent budget, measures specifically aimed to bolster access to bulk-billing. Further, this government's changes to medicine, through the 60-day scripts, also strengthen our healthcare system, as does the recent, historic eighth Community Pharmacy Agreement. It all adds up to good news for Australians and our essential health services.

But, like in all matters, there is always more that needs to be done, reforms to be enacted and changes to be made, and that brings me to the legislation before the House today. Australia is home to the world's most trained and highly skilled health workforce. Our standards for training, regulation and continued development are second to none. Essential to our highly trained health workforce are nurses and midwives. Quite simply, without either of them, there would be no Medicare or health system.

Under current legislation, nurse practitioners and midwives are required to have a collaborative arrangement with a doctor in order to provide MBS services and prescribe PBS medications. The government commissioned the Medicare Benefits Schedule Review Taskforce to conduct an independent review of these collaborative arrangements. The review was thorough and included a literature review and extensive stakeholder consultation. The review affirmed the need for collaboration between healthcare professionals, but it also determined that the need for collaborative arrangements was duplicating existing professional standards and guidelines of the Nursing and Midwifery Board of Australia.

Further, the need for collaborative arrangements could indeed create any number of barriers to accessing care, especially for those living in regional, rural and remote areas. This is because there is a known challenge in attracting GPs to these areas. The professional standards for practice and safety quality guidelines issued by the NMBA already require registered nurses, midwives and nurse practitioners to engage collaboratively with other health professionals. These standards and guidelines are the most appropriate mechanism for the regulation of these health professionals, and they do it in a manner that does not impose the barriers to care that the legislative requirements for specific collaborative arrangements can create. Today's bill, therefore, is good news for all Australians, but especially for our nurse practitioners and midwives, as it further empowers them. Supporting these workers means that more may be encouraged to take up the professions and, in doing so, address some of the nation's workforce issues.

The bill is also good for women. It strongly aligns with the recently released Working for women: a strategy for gender equality and supports the implementation of a women-centred care strategy, by providing birthing women with greater choice and access to care. I know from my own experiences that it was the midwives who made a difference when I had my children, and they are the ones that I remember. It is good that the government is going to better support their ability to help many more women into the future.

There are a number of pillars to our healthcare system—Medicare, bulk-billing, research, quality hospitals, rigorous training and the PBS, just to name a few—but underpinning all these are the incredible staff that work in it. We see this every day in every clinical setting. This bill supports some of these staff—in particular, midwives and nurse practitioners—to do the very jobs they're trained to do, without the burdensome encumbrances. I commend the bill to the House as yet another significant step in ensuring that all Australians have access to the healthcare system they deserve.

Fiona Phillips (Gilmore, Australian Labor Party) Share this | Link to this | Hansard source

Residents in Gilmore, and indeed all Australians, are experiencing the real benefits of seeing nurse practitioners who have the experience, skills, qualifications and, importantly, passion to provide holistic care for a variety of health conditions. This government's Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Bill 2024, introduced by the Assistant Minister for Health and Aged Care, will dismantle the barriers to healthcare provision, particularly in rural and remote areas, where there are workforce shortages and gaining access to GPs can be very difficult. Removing the legislative requirement for collaborative arrangements will enhance healthcare accessibility and autonomy for nurse practitioners and eligible midwives and will give patients greater control over their own care.

Currently nurse practitioners and participating midwives are required to enter into a collaborative arrangement with a medical practitioner in order to prescribe Pharmaceutical Benefits Scheme medicines and to provide services under the Medicare Benefits Schedule. This requirement has complicated and hindered access to nurse practitioner care and restricted nurse practitioners' ability to provide well-rounded, immediate and affordable health care to people living in rural and regional communities like my electorate of Gilmore on the south coast of New South Wales.

The changes proposed by the Albanese government will remove the shackles which for too long have prevented our highly educated nurses and midwives from operating to the full extent of their training, skills and experience, something that I know is front of mind for nurse practitioners and GP practices when I have visited local practices across my region. I want to be clear: nurse practitioners do not replace local GPs. However, they are able to offer services that complement their patients' existing health care. A nurse practitioner is a registered nurse with the experience, expertise and authority to diagnose and treat people of all ages who have a variety of acute or chronic health conditions. Nurse practitioners have completed additional university study at master's degree level and are the most senior and independent clinical nurses in our healthcare system. We see trusted nurse practitioners in our local GP practices, and they are absolutely vital to patient care. They are a vital part of our local GP practices.

Local nurse practitioner Natalie Moore runs her own clinic in Milton, in the Gilmore electorate. A registered nurse of more than 30 years and a former decorated ambulance paramedic, Natalie has worked as a geriatric nurse, theatre nurse and director of nursing in both the public and private health sectors. Highly trained and highly experienced, Natalie has worked as a nurse practitioner since 2019, primarily in aged care, where she provided health care for elderly patients living in aged-care facilities and nursing homes when they could not be visited by their doctor due to COVID-19 restrictions. It was during this time that Natalie recognised the need for accessible and affordable health care in her community. Thirteen months ago, Natalie opened her own health and skin cancer clinic, Moore than Health. Natalie is passionate about her community and passionate about providing preventive health care, something she says GPs often overlooked because they were busy addressing acute medical needs.

Natalie is understandably frustrated by the current collaborative arrangements, which require her and other nurse practitioners to be under the microscope of doctors in order to prescribe Pharmaceutical Benefits Scheme medicines to patients and to provide services under the Medicare Benefits Schedule. Having specialised as a nurse in skin cancer medicine, including skin checks and excisions, for almost 10 years, Natalie opened her own clinic and now treats around 40 patients per day. Since opening the doors to Moore than Health, Natalie has seen an increasing number of patients, particularly elderly patients, who have skipped their regular skin checks because they couldn't get in to see a doctor or couldn't afford to see one.

According to the Cancer Council of New South Wales, Australia has one of the highest rates of skin cancer in the world, and about two out of three Australians will be diagnosed with some form of skin cancer before the age of 70. Non-melanoma skin cancer is the most common cancer diagnosed in Australia, so it is important that health professionals like Natalie are on the front foot when it comes to skin checks and preventive medicine. As a nurse practitioner, Natalie can conduct skin checks and excisions and refer patients to a specialist or plastic surgeon if required. The work she does is important. The work she does saves lives, but the current restrictions mean Natalie doesn't get paid by the government for providing longer consultations and services, including surgery to remove skin cancers, under the Medicare Benefits Schedule. Natalie chooses not to pass the full cost of her time on to her patients, because she wants to ensure their health care remains affordable. She doesn't want them to have to choose between having a skin cancer removed and buying groceries. This is outrageous. Here we have a trained, skilled nurse practitioner saving lives, treating patients for potentially deadly skin cancers, yet her expert services are not covered by Medicare. This bill will change that.

Similarly, Natalie can prescribe skin cancer creams for her patients, but many are not available under the Pharmaceutical Benefits Scheme. However, those same medicines, if prescribed by a doctor, are covered by the PBS. Once again, it's the patients that are being hit in the hip pocket because of these legislative requirements. This bill will change that.

Nurse practitioners like Natalie continue to practice collaboratively with other health professionals to improve access to health care for Australian communities through health promotion, disease prevention and health management strategies. They have the expertise and authority to diagnose and treat people of all ages with a variety of acute or chronic health conditions, yet their skills are not being recognised, because many of their services are not covered by the Medicare Benefits Schedule. Our wonderful nurse practitioners have completed additional university study at master's degree level and are the most senior and independent clinical nurses in our health system.

In response to a recommendation by the Medicare Benefits Schedule Review Taskforce, the government commissioned an independent review of collaborative arrangements. The review included analysis of Australian and international literature and extensive stakeholder consultation on the efficiency and appropriateness of collaborative arrangements. The findings of the review supported the need for clinical collaboration between all health professionals. However, it found that the legislative requirement for collaborative arrangements duplicated existing professional standards and guidelines and could create barriers to accessing care. Removing the legislative requirement for a collaborative arrangement will assist in removing barriers to primary care for Australians, particularly in regional, rural and remote areas, where there are known challenges in attracting and retaining GPs.

The professional standards for practice and the safety and quality guidelines issued by the Nursing and Midwifery Board of Australia require registered nurses, midwives and nurse practitioners to engage collaboratively with other health professionals. These standards and guidelines are the appropriate mechanism for the regulation of these health professionals. They do not impose the barriers to care that the legislative requirement for specified collaborative arrangements can cause for nurse practitioners like Natalie.

The title of 'nurse practitioner' can only be used by a person who has been endorsed by the Nursing and Midwifery Board of Australia. With strong support from the nursing and midwifery sectors, this bill will contribute to the long-term goals of the Strengthening Medicare Taskforce and the Nurse Practitioner Workforce Plan. Changing this legislation and supporting our nurse practitioners and midwives to use their skills is good for patients. It's good for the health system and it will encourage more talented people to take up these professions and further their study in health care. It will result in positive change for the Australian community.

This bill will not only bring about change for the nurse practitioners and midwives that are doing extraordinary and important work in our community; it will support women. This bill strongly aligns with the recently released Working for women: astrategy for gender equality. By supporting more effective use of our healthcare workforce, this bill will improve gender equity in healthcare outcomes and take practical action to reduce the gender pay gap. By removing the requirement for collaborative arrangements, this bill also supports the implementation of the women-centred care strategy by providing birthing women with greater choice and access to care and services. Allowing women to choose to receive care by a nurse practitioner or midwife will go a long way towards ensuring women are always treated with respect and dignity in our maternity care system.

We know the care economy, a highly feminised workforce, is often underpaid, undervalued and underutilised. A bill that empowers nurse practitioners and midwives is one that empowers women. As this government works to develop a national strategy for the care and support economy, we will continue to deliver practical, structural changes across our care workforce. As women make up the majority of workers in this sector, this bill will support women's economic equality.

As I said, our nurse practitioners and midwives are highly trained, highly skilled and extremely passionate about their jobs. Nurses have always been at the centre of health care, but under the previous government they had been significantly underutilised and undervalued. The Albanese Labor government has no higher priority than strengthening Medicare to make it easier and cheaper for Australians to get the health care they need when they need it. By removing the legislative requirement for collaborative arrangements, we will make it easier and cheaper for Australians to access health care. We will also unlock the full potential of our wonderful nurses and midwives. I commend this bill to the House.

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

I thank the members for their contributions to the debate on the Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Bill 2024. In conclusion, this bill will remove the legislative arrangement known as a collaborative arrangement between a nurse practitioner or endorsed midwife and a doctor. 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. This important reform recognises the important role nurse practitioners and endorsed midwives play in the delivery of healthcare services. It will support them to provide care to the full extent of their education and ability, allowing them to collaborate flexibly without limiting their professional scope.

Removing the legislative requirement for collaborative arrangements means nurse practitioners and endorsed midwives will now be able to prescribe Pharmaceutical Benefits Scheme medicines and provide services under Medicare without having to get a doctor to sign off on it. This 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 enforced in each state and territory. Currently, nurse practitioners and endorsed midwives are the only professions that have legislated collaborative arrangement requirements for MBS and PBS access. These changes today will bring them into line with other healthcare professions.

The impacts of this bill will be profound for Australians being cared for by nurse practitioners and endorsed midwives. For women, it will make it easier to get access to care—particularly for women who have an established relationship with an endorsed midwife, and for other women who have been attending nurse-practitioner-led clinics. Their skills and empathy can be valuable for many women's health issues, from menopause to family-planning advice. We also know that people living in rural and remote area struggle to access health care. By removing the legislative requirement to have a collaborative arrangement, this will support more nurse practitioner clinics to have financial viability, and these increase access to high-quality health care. Fewer people will need to travel hundreds of kilometres to access a medical petitioner to secure a collaborative arrangement. Moreover, the bill will contribute to the long-term goals of the Strengthening Medicare Taskforce and the Nurse Practitioner Workforce Plan.

This bill is good for nurse practitioners and endorsed midwives, it's good for patients and it's good for the entire Australian healthcare system. I thank all members of parliament.

Question agreed to.

Bill read a second time.

Message from the Governor-General recommending an appropriation announced.

Ordered that this bill be reported to the House without amendment.