Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I table two supplementary explanatory memoranda relating to the government amendments to the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009. The memoranda were circulated in the chamber on 16 November 2009. I seek leave to move government amendments (1) to (4) together on sheet CN232 to the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009.

Leave granted.

I move:

(1)    Schedule 1, item 6, page 4 (line 10), omit paragraph (b) of the definition of participating midwife, substitute:

             (b)    otherwise—an eligible midwife;

so far as the eligible midwife renders a service in a collaborative arrangement or collaborative arrangements of a kind or kinds specified in the regulations, with one or more medical practitioners of a kind or kinds specified in the regulations, for the purposes of this definition.

(2)    Schedule 1, item 6, page 4 (line 18), omit paragraph (b) of the definition of participating nurse practitioner, substitute:

             (b)    otherwise—an eligible nurse practitioner;

so far as the eligible nurse practitioner renders a service in a collaborative arrangement or collaborative arrangements of a kind or kinds specified in the regulations, with one or more medical practitioners of a kind or kinds specified in the regulations, for the purposes of this definition.

(3)    Schedule 1, item 70, page 22 (line 2), at the end of the definition of authorised midwife, add “, so far as the eligible midwife provides midwifery treatment in a collaborative arrangement or collaborative arrangements of a kind or kinds specified in a legislative instrument made by the Minister for the purposes of this definition, with one or more medical practitioners of a kind or kinds specified in the legislative instrument”.

(4)    Schedule 1, item 71, page 22 (line 6), at the end of the definition of authorised nurse practitioner, add “, so far as the eligible nurse practitioner provides nurse practitioner treatment in a collaborative arrangement or collaborative arrangements of a kind or kinds specified in a legislative instrument made by the Minister for the purposes of this definition, with one or more medical practitioners of a kind or kinds specified in the legislative instrument”.

The government has, as I have indicated, always been clear about the fact that these arrangements will need to be provided collaboratively with other health professionals. The government continues to work cooperatively with the professions on the details of the collaborative arrangements. I do acknowledge that all parties have indicated that they recognise the importance of collaboration. There is no intention to provide a right of veto over another health professional’s practice. The intention is, and always has been, to provide safe, coordinated and quality care for Australians.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

I will go into a bit more detail on these issues when I move my amendment. While that may not be the government’s intention, that is exactly what is going to happen. These amendments provide for doctors to have veto over midwives. That is just the basic fact. The government can dress it up as much as they like, but that is effectively what they do.

I do not say this about all doctors, but a great many doctors have been in the media recently commenting on homebirths and claiming they are unsafe, and this is the issue we are worried about. In fact, the most recent episode quite misrepresented the findings of the study in South Australia. They spun that information and claimed that it shows that homebirths are unsafe, when, in fact, it did not show that at all.

Despite the government’s intent, these amendments essentially give doctors the right of veto over midwives. There are going to be very few doctors in Australia who will organise collaborative arrangements with midwives to provide homebirths. We discussed last night the government having to amend this legislation on a number of occasions. The first was to put in place the exemption on the NRAS so that midwives could provide homebirths without indemnity insurance. Those issues still have to be dealt with. We have two years now in which to resolve that issue. That essentially, as we discussed last night, made homebirths illegal. In fact, midwives could have been fined $30,000 for providing a homebirth. That sought to make them illegal and it was another way of stopping homebirths. These amendments could virtually have the same effect because, if a midwife cannot organise collaborative arrangements with a medical professional, they will not be able to provide services, support and homebirths.

I think this legislation will achieve to a certain extent what the government was previously trying to achieve and what a large number of medical professionals have been trying to achieve—that is, to stop homebirths. But you will not stop homebirths. A number of women will just free birth, and they have plainly said that to me. Does the government want to drive people into having unsupported homebirths, which are unsafe? Because that is what these amendments could achieve. That is why the Greens do not support these amendments.

I will move another amendment, which I will outline in more detail shortly. It will expand the organisations or places where midwives can seek to have collaborative practice arrangements rather than just with medical professionals. Essentially this legislation makes it all that more difficult for midwives to be able to arrange collaborative practices in the long term because, as I said, medical professionals will not agree to enter into those sorts of arrangements with midwives providing homebirths.

During the Senate inquiry we discussed a number of scenarios, including insurance perhaps not being available to the doctor if the doctor did enter into collaborative arrangements with a midwife providing homebirths. The department says that the insurance industry is not saying that. I think at the moment that is an open question. I accept that the department has followed that issue up. I still do not think that that issue is resolved. We have very strong concerns about what this means for the provision of midwife services, particularly for the provision of midwife services for homebirths.

Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Link to this | Hansard source

For the record, the coalition do not oppose the amendments for collaborative arrangements. We understand the concerns of some stakeholders and will carefully consider the regulations once they become available.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

I move Greens amendment (1) on sheet 5965:

(1)    Government amendments (1) to (4), sheet CN232, after “medical practitioners”, insert “or one or more health services”.

This amendment seeks to amend the government’s amendment. It seeks to put in place the ability for midwives to seek collaborative arrangements with other medical services, not just with a medical practitioner. This will widen the scope for midwives—the people with whom midwives could seek to have collaborative arrangements. As I articulated earlier, we are very concerned that the government’s amendment, as it stands, simply puts a power of veto in the hands of the medical profession, despite what the government says. Our amendment seeks to address that by widening the scope.

We are not saying no to collaborate arrangements and, as I articulated very clearly last night, the Greens strongly support collaborative practice and collaborative arrangements. In fact, it is part of the requirements for a midwife. Those requirements are already in place. This is the government bowing to pressure from organisations such as the AMA who say, ‘You need to put a medical practitioner in charge.’ That, essentially, is what this does. The government is clearly bowing to pressure from a sustained campaign by the medical profession who say, ‘We want control over midwives and, in particular, we want to make it as hard as possible to have a homebirth.’

As I said, there is plenty of media out there to clearly show the medical profession’s agenda. This is about ideology. This is about whether you support a woman’s right to choose a homebirth and to choose the location of birth. The location should not make a difference to the provision of midwife services but, unfortunately, in this country it does. That is what this government amendment is about. The government is bowing to pressure from the AMA. It is not good enough. It is not what the women of Australia want. That is very clear from the number of emails, letters and phone calls we have received. The women of Australia and the families of Australia want the right to choose a homebirth and the right to choose the location of birth, whether that be in a totally clinical environment, in a birthing suite or at home. This legislation takes another step along the road to making it as difficult as possible to have a midwife and a homebirth.

The Greens amendment is modest. Ideally, we would like to have seen the indemnity insurance scheme extended to the provision of homebirths or to the provision of indemnity insurance to midwives regardless of the location of birth. That did not get up in the second reading debate. We did not want to see the legislation go down because of it because overall the legislation is a step in the right direction, but the government’s amendment undermines that step in the right direction. So we have taken a step, but not the giant step which needs to be taken if we are properly to address the provision of maternity services in this country.

The Greens are moving this amendment to the government’s amendment to broaden the scope, enabling midwives to put in place collaborative arrangements. We, too, are disappointed that we have not seen the regulation on collaboration. We will be assessing it very clearly. We think that the regulations should have been available when we were discussing this legislation because, as per usual, so much of the legislation rides on the regulatory process. We think this is an important step, broadening out collaborative arrangements—who you can seek those collaborative arrangements with not being just limited to doctors.

We believe this is a very important amendment. If the government were truly supportive of choice for women, they would be supporting this important amendment. As I said, we will be watching the regulations. We also will be very carefully monitoring just what collaborative arrangements are put in place because the midwives and mothers will be on the phone straightaway when they are not able to access services for a homebirth. This issue is not resolved and, if the government think it is, they have another think coming because midwives and mothers of this country are deeply upset about the way homebirth services and support for homebirths have been undermined by this government.

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I understand the passion the Greens bring to this debate. I recognise and respect it. We do not agree with the Greens amendment to our amendment. We think our amendment provides a much better service. It provides for collaborative circumstances. It allows the work to be dealt with cooperatively with the professions. I do, though, acknowledge that all parties underpin the need for collaboration. However, the Greens position is not one the government can agree with. We have always been clear about the fact that these arrangements will need to be provided collaboratively with other health professionals, and our amendments do just that. Although I can say that I do recognise where the Greens are coming from in this debate, it is just a bit further than where the government currently thinks the balance properly sits.

Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Link to this | Hansard source

The opposition will not be supporting the Greens amendments. I reiterate the comments I made earlier. We will certainly deal with the regulations on collaboration when they become available.

Annette Hurley (SA, Australian Labor Party) Share this | Link to this | Hansard source

The question is that Senator Siewert’s amendment (1) to government amendments (1) to (4) be agreed to.

The Temporary Chairman:

The question now is that government amendments (1) to (4) to the Health Legislation Amendment (Midwives and Nurse Practitioners) Bill 2009 be agreed to.

Question agreed to.

Bill, as amended, agreed to.

Bill reported with amendments; report adopted.

The Temporary Chairman:

The question now is that the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off Cover Support Payment) Bill 2009 be agreed to without amendments or requests.

Bills agreed to.

Bills reported without amendments or requests; report adopted.

Progress reported.