HEALTH LEGISLATION AMENDMENT (MIDWIVES AND NURSE PRACTITIONERS)
Tuesday, 25 May 2010 04:13
DARREN CHEESEMAN SPEECH ON HEALTH LEGISLATION AMENDMENT (MIDWIVES AND NURSE PRACTITIONERS)
Mr Speaker, I welcome an opportunity to speak on these issues.
Having become a father recently, these are issues that I have given a lot of thought to.
It's great to see our Government bringing some improved clarity and science on these issues, particularly to home-birthing and the related insurance issues.
It's also nice to be speaking on an issue that is at the leading edge of the delivery of health services across Australia, particularly the issue of nurse practitioners.
Mr Speaker, I first want to congratulate the Minister on these Bills.
Minister Roxon has shown a lot of resolve to deliver a greater level of certainty into the midwifery area, and even more nerve to ensure the roll-out of nurse practitioners happens in a meaningful way.
I cannot understate the importance of the role of nurse practitioners to the reform process in our delivery of health services across Australia.
This is indeed a very important change.
I future years I think history will show this reform to be one of the most fundamentally important.
Mr Speaker, almost always when you make major change there is a push back within some part of the community.
The Minister had to stand up to this.
I watched the comments and the pressure put on by the various stakeholders in this debate.
It was a real test that was past with flying colours by the Federal Minister from Victoria, and so we are here talking about this health reform Bill today.
There are currently around 350 qualified nurse practitioners in Australia, generally working in public hospitals.
I personally believe the role of nurse practitioners is a terrific one.
It provides an appropriate level of care, and a more flexible, better integrated health workforce.
It also provides a fantastic new element to the nurses' career structure.
And I think it will help contain costs within the Australian health care system.
Nurse practitioners can already provide health care services and prescribe medications in the majority of jurisdictions.
However, the Midwives and Nurse Practitioners Bill will enable their clients to access MBS and PBS subsidised services and medication.
In the Budget, the Government committed $120.5 million over four years to maternity services reform and $59.7 million over four years to expand the role of nurse practitioners.
This Bill is delivering on that commitment.
These Bills will support the inclusion of nurse practitioners and midwives under the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS), in line with these 2009-10 Budget measures.
Mr Speaker, in addition to the Bills helping drive the nurse practitioners reform issue, they will also enable the establishment of a professional indemnity scheme for eligible midwives.
This is critical to supporting the new MBS and PBS arrangements.
The Midwives and Nurse Practitioners Bill will allow for nurse practitioners and advanced midwives, to request or provide specific Medicare subsidised services and prescribe certain PBS subsidised medicines.
New Medicare items covering these services will also be introduced, effective from 1 November 2010.
Mr. Speaker, I think there is an important point to make in relation to how the new arrangements will work.
What we are seeking to put in place is a more effective and appropriate health delivery structure, but with all the proper checks and balances.
Importantly, for midwives to be eligible to participate in the new arrangements, they will need to meet advanced practice requirements.
And they will have to have collaborative arrangements with doctors.
The Minister and the Department will be working through exactly what is required here, and a comprehensive consultation process with midwives, doctors and other stakeholders will take place.
The reform initiatives supported by this legislation will allow for incremental reform within a strong framework of quality and safety.
It is expected that around 700 eligible midwives will be participating in the measure over the next four years.
Mr. Speaker, I want to go through a few details in relation professional indemnity for eligible midwives, and the home birthing issue.
The three Bills before the House 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.
But, very importantly, none of these bills make homebirth unlawful.
As we know, there is still a strong home birthing movement in Australia.
Many Australian women and Australian families still take up this option.
There are many women and men who favour home birthing over the more clinical settings.
It is very important that in designing the new laws and overall framework for midwifery that there are still choices available.
We do not in any way want to establish a framework that makes home birthing illegal and drives it underground.
That would be an absolute disaster in my view, and most certainly end in tragedy.
To avoid this, the Minister for Health and Ageing, after considerable discussion with the state governments, has forged an agreement from all Health Ministers around the country to a transitional clause in the current draft National Registration and Accreditation Scheme legislation.
This transitional clause provides a two year exemption for privately practising midwives who are unable to obtain professional indemnity.
This clause will allow midwives who are currently practising to continue, although they will not be insured.
As most people are aware, there is currently no professional indemnity health product available for midwives working outside the state hospital systems.
Mr Speaker, there are a couple of other important aspects to these Bills that I think are very positive.
These bills:
- improve disclosure and better information for service users,
- provide better systems for collection of data, which will form the basis of future research so that we can continually refine and improve services.
- provide better overall health standards systems.
There will be a requirement on home birthing midwives to provide full disclosure and informed consent to clients that they do not have professional indemnity insurance.
This is important so clients are better informed of their rights and legal standing, should things go wrong.
As well, each homebirth must be reported.
This is important because in the past the data and recording of home births hasn't been as good as it could be.
There has been no reporting requirements previously.
People will also be required to participate in a quality and safety framework which will be developed after consultation led by Victoria through the finalisation of the registration and accreditation process.
We will, for example, ask the National Nursing and Midwifery Board to provide advice on protocols for home birthing outside the publicly funded and auspiced services.
Importantly Mr Speaker, the collection of better data on home birthing and the development of detailed protocols might actually bring more home birthing services into our public system, or potentially, open the way in the future for an insurance product to be extended to cover them.
And of course we will have a fully operational nursing and midwifery board in place as part of the changes that are established as a result of registration and accreditation.
So I think Mr Speaker there are multiple benefits of what we are doing here today with this Bill.
We are clearing up things that the previous Government never got around to.
This has been achieved with a determined effort by the Federal Minister, and with all Governments working together to obtain an outcome that is progressive for the health sector.
Overall, Mr. Speaker, the three Bills before the House expand 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.
I underline again, none of these bills make homebirth unlawful. In fact, I believe, they put in place some foundations that may well allow these services a long-term future.
The separate draft Bill for the National Registration and Accreditation Scheme for health professionals currently carries a proposal that will require health professionals from the 10 professions covered to carry insurance as a condition of registration.
This draft bill was prepared for all jurisdictions via a COAG agreement and is not yet before any parliament.
But this Bill goes hand in hand with some of the provisions of these Bills, and is another element in standardsing accreditation requirements, and a universally better system of health care.
Mr. Speaker, I think this Bill is very positive for my electorate, for example.
These measures will help improve the efficiency, capacity and productivity of Australia's health workforce, but they are particularly important in rural and remote areas.
As we know, many regional and rural areas struggle for GP services, and women giving birth sometimes have to travel a long way from their homes and home communities.
Whilst my electorate has recently taken some enormous strides in health services provision under the Rudd Government, as we build the capacity of the Deakin University Medical School and provide a regional GP Super Clinic, there are still areas where it is hard to get to see a doctor, or get the appropriate health care service, when you want to.
These changes will help to alleviate that problem.
These changes will mean more people will be able to get timely medical advice when they need it.
These changes support the Commonwealth's commitment to improve maternity and primary care services, and the Council of Australian Governments' health workforce reform agenda.
These changes will also lift the standard of care people get.
I commend the Bill to the house, Mr Speaker.
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