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

The fact that the Midwife Professional Indemnity Legislation Amendment Bill 2011 is being considered by the Senate is proof yet again that this government cannot get anything right. The Minister for Health and Ageing tried to blame the opposition for the troubles that she has had with the midwives and nurse practitioners bill and the midwife and professional indemnity bills through 2009 and 2010, but it was all her fault. She also tried to blame the Senate for delays in the legislation passing through the parliament, but it was the minister and the government that rushed legislation into parliament without taking the time to dot the i's and cross the t's. Through the process Minister Roxon had to admit that she had got it wrong and she had to backtrack. Perhaps she can use the lessons learnt to backtrack on asking tobacco companies for money—or will she blame someone else for that as well?

This week, of course, represented an all-time low for Ms Roxon. Her sanctimonious prosecution of the nanny state has highlighted her sheer hypocrisy over her solicitation of donations from big tobacco. Minister Roxon sought financial support even though her party had publicly declared it would not accept funds from big tobacco. It was interesting that in the other place the government refused to debate an opposition motion that the minister explain to parlia­ment why she publicly criticised tobacco company donations to political parties but privately sought their financial support. What does she have to hide? But I digress.

I go back to the legislation. Minister Roxon had to placate the concerned stakeholders. She had to clarify matters to a Senate committee, and then the minister had to make amendments. Then, after the legislation took 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 drafting of the original legislation excluded one group of midwives from accessing the indemnity contribution scheme. The legisla­tion treated those who operated their own companies and were self-employed the same as it treated those employed by large organisations such as hospitals or medical practices. The legislation had excluded employed midwives from the scheme. The government present 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.

The second mistake is what the government has described as a 'typographical error'. What was the definition? What, effectively, the original legislation did was 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.

Health is rich with failures. We have had the then Prime Minister, Kevin Rudd, and Minister Roxon in scrubs, going to fix public hospitals by mid-2009. Minister Rudd—then Prime Minister Rudd—was going to take over the nation's public hospitals. By mid-2009, all we had was a series of reports from the multitude of committees, commissions, working groups and inquiries that the Rudd Labor government 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 look like it was actually doing something to honour those commitments made to Australians in mid-2007. This reform consisted of media releases, conferences and communiques but no actual reform. Prime Minister Gillard's health reforms have excluded mental health and aged care. They are not reforms at all but are an agreement to have an agreement. How agreeable!

GP superclinics are supercopies of existing general practices except that they use taxpayers' money 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 has decided that it will proffer preferential treatment in terms of the doctors—and, presumably, nurses in some cases as well—at these superclinics, which puts them at a competitive advantage over those practices which operate with the costs of capital being deployed into these centres. It is untenable that this situation continues. Minister Roxon promised more than 60 of these so-called superclinics. 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 touches 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 Senate today or, indeed, the general health program.

Of course, the biggest failure of this government is in its mental health announcement: $2.2 billion over five years boils down to $583 million over the next four years with only $47 million spent in the first year. No wonder people are starting to realise that they have been duped by a big dose of spin. There will be money in the fifth year. Oh wait! That is the third year of the next term of government. Prime Minister Gillard's fantasy is that she will be around long enough to implement the fifth year of a mental health strategy. What nonsense.

This is a government that promises big but delivers nothing. Midwives do not have that luxury. They do one of the most important jobs in the human condition of guiding new life into the world, but this government has treated these hardworking women and men with utter contempt. The Australian taxpayers are also being treated with utter contempt. Lack of attention to detail is not justifiable. The sooner this government is put out of its misery the better off we will all be.

The coalition 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 in certain employment circumstances could practise reasonably as a result of this legislation. As I said, 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.

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

The Midwife Professional Indemnity Legislation Amendment Bill 2011 has received a great deal of attention. Debating issues around better support for midwives has taken a great deal of the time of many senators. While the Greens were supportive of many of the measures the government introduced last year, we also flagged our concerns about some of the measures that were put in place, such as collaborative arrangements and the impact that the changes would have on those midwives wanting to support homebirth and also on mothers and families wanting homebirth.

I am aware of some of the concerns of midwives who are operating under the current system. I thought it was timely that I raise some of these issues, given that there will need to be some more changes by around this time next year when the homebirth exemptions expire. In other words, we need to start thinking about how we are going to deal with that now. Unfortunately, some of the concerns that the midwives raised at the Senate Community Affairs Committee inquiry and with individual senators appear to have been substantiated by events. For example, I am told at the moment there are approximately 50 eligible midwives under collaborative arrangements. To date, none has been able to provide continuity of care through labour and birth because they do not have visiting access to hospitals. While it looks like there are around 700 claims through Medicare, none of these is for birth care because of the lack of visiting access. That is a very strong concern.

The determination around collaborative arrangements specifies that midwives have to demonstrate collaborative arrangements in one of four ways: being employed by a practice with an obstetrician, being referred by a specified medical practitioner, having a signed collaborative arrangement with a specified practitioner or having an acknowledgement of a collaborative arrange­ment from a specified medical practitioner. At this stage these are the only ways women can gain a Medicare rebate for midwifery care. Five midwives in Sydney are reported to have a signed collaborative arrangement in place. As far as we are aware, no-one else has a signed agreement. We understand that there are two practices that are using the employment mechanism. One midwife is employed by an obstetrician and two others are employed in an Aboriginal medical service. I have been told the rest of the midwives are struggling to use two of the other available options, which are gaining a referral from a specified medical practitioner or using the arrangement/acknowledgement from a specified medical practitioner.

While this should be generally reasonably straightforward for women who are using the public hospital system—some public hospital obstetricians are happy to provide an acknowledgement of collaboration for women seeking to give birth in a public hospital—unfortunately it is not occurring for those wishing to give birth in private hospitals with a private obstetrician and those wishing to give birth at home. We understand it is virtually impossible to gain a collaborative arrangement for antenatal care or birth. In other words, concerns remain about the collaborative arrangement approach. As I said, these concerns were articulated at the time and it is disappointing to have to report that there are still troubles with gaining access to collaborative arrangements.

The exemption for homebirths is only available until 30 June 2012, only a squeak over 12 months from now. This means, if you look at it this way, that women who fall pregnant from September this year will be back to where they were two years ago. In other words, it will be uncertain whether they will be able to access midwifery care for homebirth. I also understand that the cost of insurance has meant that many smaller midwife practices have ceased to practise, as they cannot afford to pay this insurance, which has particularly affected regional women wanting to have a homebirth. As we know, there are a number of women in regional areas who want to be able to choose to have a homebirth. So we are particularly concerned about that.

As has been stated here on a number of occasions, there have always been concerns about the ability of midwives to access insurance packages. There are rumours that, unfortunately, continue, and that I think need to be looked into, that insurers are refusing to extend insurance packages to include homebirths, due to a lack of data. At the same time, researchers have requested that data around homebirths be made available through the various state perinatal registers which is collected by AIHW nationally. We do not believe it should be claimed that these statistics do not exist; in fact, what somebody needs to do is collate the data. So there is an issue continuing around that.

Another issue that has been raised with me is to do with the prescribing course requirement, where eligible midwives sign an undertaking that they will complete a prescribing course within 18 months of gaining eligibility. That means that, in December, the first 15 midwives will have to have completed this course. Technically, it is possible that the eligibility could be removed because these courses have not been completed. However, at this stage, no prescribing course has been accredited by the ANMC and there does not appear to be a set of standards for which such a course could be developed. So that is another concern that midwives have about these collaborative arrangements.

So I do think there needs to be further engagement by the government in looking into these provisions, because such concerns remain. We also need to be looking at what is going to happen between now and next year in terms of dealing with the homebirth exemption. We had the same issues some time ago with the insurance requirements that meant that homebirths could not occur—in fact, there could potentially be big fines for supporting a homebirth—and, if this issue is not addressed, we will go back to that situation again. That is of course unacceptable to the Greens but particularly to many families out there who do wish to have a homebirth. I repeat: it is no good for the government and the medical profession to just bury their heads in the sand and say, 'Well, we'll just bring in measures to make it harder and harder to have a homebirth.' The situation that will eventuate is that women will what they call free-birth. Nobody can pretend that that will not happen, because people feel very strongly about it. We are much better off having a system where we provide a choice of births for mothers and families. Homebirth is one of those, and we need to ensure that homebirths can be supported in a very safe manner.

I urge the government to look at these issues, to support midwives, to look at the barriers to eligibility and collaborative arrangements, and to address this issue of eligibility, because there are only 12 months in which to do that. Many women who are pregnant in this half of the year will fall outside these exemption arrangements if something is not done fairly quickly. So I urge the government to take those messages on board.

Jan McLucas (Queensland, Australian Labor Party, Parliamentary Secretary for Disabilities and Carers) Share this | Link to this | Hansard source

I thank senators for their contributions to the debate on this bill. This amendment bill is a relatively minor but 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. The bill makes sense and gives certainty to self-employed midwives and the women and families they care for. Like the government's recent investment in Medicare Benefits Scheme and Pharmaceutical Benefits Scheme access for patients of eligible midwives, this amendment bill will continue to ensure there is improved access to maternity services and improved choice for Australian women. I commend the bill to the Senate.

Question agreed to.

Bill read a second time.