Craig Thomson (Dobell, Australian Labor Party) Share this | Hansard source

I rise to support this piece of important legislation. The purpose of the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 and the associated Midwife Professional Indemnity (Run-off Cover Support Payment) Act 2011 was to support the new MBS and PBS arrangements by enabling the establishment of a government supported professional indemnity scheme for eligible midwives from 1 July last year. Those acts removed a longstanding barrier to appropriately qualified and experienced midwives wishing to provide high-quality midwifery services to Australian women as part of a collaborative team with doctors and other health professionals.

The Midwife Professional Indemnity (Commonwealth Contribution Scheme) Act 2010 currently excludes employed midwives from accessing a Commonwealth contribution and a run-off cover Commonwealth contribution. This exclusion is to ensure that there is no intentional cost-shifting from employers of midwives to the Commonwealth. The bill tidies up the act by placing the rule-making powers in a more appropriate section and thus ensures that eligible self-employed midwives are not excluded from access to Commonwealth contributions for claims that are made while they are in the workforce or for any claims that are made after they retire. By doing this, the act will continue to exclude other employed midwives, such as those employed by private hospitals, to prevent the cost-shifting—already referred to—from that sector to the Commonwealth by employers.

The changes to the act proposed by this bill will also allow a specific rule-making power to appropriately address any new and innovative midwife self-employment models that may arise in the future. This was an issue of particular concern to midwives when the previous bills were before the parliament. This rule-making power will ensure the bill will be able to accurately describe midwives and employment arrangements which are within the scope of the government's maternity reform policy.

The bill also corrects a typographical error in the Midwife Professional Indemnity (Run-Off Cover Support Payment) Act 2010 which would, if left unchanged, impose a higher than intended tax on insurers of eligible midwives. The Australian government is proud to be implementing historic reforms to maternity care which recognise the skills of our highly trained midwives and provide more choice for Australian women while maintaining Australia's strong record of high-quality, safe maternity services.

I will spend a little bit of time looking at the background to these reforms. Improving maternity services in Australia: the report of the Maternity Services Review highlighted the complex nature of maternity services, which involve a mix of Commonwealth, state, territory and private arrangements. The report was developed following consultation with a broad range of stakeholders including individuals, health professionals, industry groups, researchers, professional organisations and national peak bodies. The report made a number of recommendations which focused on the need to improve maternal and peri-natal outcomes for Indigenous and rural Australians, improve choices available for pregnant women, increase access to high-quality maternity services and provide support for the maternity services workforce.

The government responded to the report with a $120.5 million package to provide access for midwives to the Medicare Benefits Schedule and to Pharmaceutical Benefits Scheme medicines, and a government supported professional indemnity insurance scheme for eligible midwives. On 24 June 2009, the Minister for Health and Ageing introduced legislation to facilitate these new arrangements. These arrangements are available for appropriately qualified and experienced midwives working in cooperation with obstetricians and health facilities as recommended by the report. These changes enable the clients of midwives and nurse practitioners to access services and medications subsidised by the MBS and PBS. There are currently around 350 qualified nurse practitioners in Australia, generally working in public hospitals. Initially about 50 nurse practitioners were expected to access the MBS and PBS for their clients in certain private and community settings, particularly in primary care and rural areas, from November 2010.

For midwives to be eligible to participate in the new arrangements, they needed to meet advanced practice requirements and to have had collaborative arrangements with doctors. These requirements and collaborative arrangements were developed in consultation with midwives, doctors and other stakeholders. The reform initiatives supported by this legislation allow for incremental reform within a strong framework of quality and safety. It is expected that around 700 eligible midwives will be participating in this measure over the next three years. The government understands the concerns in the community about registration and professional indemnity insurance and how this affects the involvement of midwives in homebirths. Our legislation has expanded 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. None of these bills have made homebirth unlawful.

However, under an agreement made last year the states, territories and the Commonwealth agreed to a two-year exemption for homebirthing midwives who are acting not within the state hospital system but in the private sector. A number of conditions and requirements were attached to that exemption, including that a homebirthing midwife must disclose to a mother who is interested in having a homebirth that they will not be insured for that procedure and making sure that people make an informed choice about undertaking a homebirth. The government asked homebirthing midwives to report each homebirth.

There is currently not any good data across the country of how many homebirths actually occur. Independent midwives are not currently required to notify state and territory authorities or hospitals, nor have they been asked to. We will require, however, participation in quality and safety frameworks—for example, reporting the results of homebirthing and incidents that are related to it.

The government wants this work to be done collaboratively, by way of a peer review process. The consultation process is being overseen by Victoria through the national registration and accreditation process. The national Nursing and Midwifery Board will provide advice and protocols for homebirthing outside the publicly funded and auspiced services. Privately practising midwives—some of whom currently provide homebirthing services but do it as part of their employment, either with the state or with a private practising obstetrician—would not be affected by these changes as their insurance is already covered through their employment status. Clearly this arrangement will not apply in jurisdictions where no lawful homebirthing is occurring.

The two-year exemption allows plenty more time for those protocols to be established and to be worked on. In the meantime, the arrangements ensure that homebirthing midwives can lawfully continue to provide the services in the jurisdictions currently allowed. They will continue to be uninsured—as they are currently. The government is collecting more data on homebirthing and there will be a process to further work through these protocols that would either bring more homebirthing services into the public system or potentially open the way in the future for an insurance product to be extended to cover them.

Homebirthing programs operate in a number of state and territory systems with participating midwives coming under the insurance cover of the public health system. Midwives who provide maternity services in an independent private capacity, including assisting with homebirths, currently do so without indemnity cover as there are no products currently commercially available.

I have met on a number of occasions with my local representatives of the Maternity Coalition. In fact, I first attended a meeting in my electorate of Dobell on the Central Coast some three years ago where these concerns were raised. They are legitimate concerns about making sure that homebirthing is there as a choice for women. While homebirthing has been very much in the minority—in fact, much less than one per cent of pregnant women choose to give birth at home in Australia—it has nonetheless been at the forefront of innovation in relation to birthing. Water births and the like were products of homebirths. Everyone in this place must be a little concerned at the extremely high rates of caesarean operations in this country—well over 30 per cent, when the World Health Organisation talks about 15 per cent being around what would occur in most communities. On the Central Coast that problem is even greater, with Gosford Private Hospital having caesarean rates in excess of 50 per cent and Gosford Public Hospital having caesarean rates in excess of 40 per cent. So you can understand that women on the Central Coast do want to have options that involve midwives—so that a caesarean is much less likely.

In March 2009, the Council of Australian Governments signed an intergovernmental agreement to implement a single indemnity scheme which came into effect in July 2010. The scheme initially covered 10 health professions—medicine, nursing, midwifery, pharmacy, physiotherapy, podiatry, osteopathy, chiropractic, optometry and dental care including dentists, dental therapists, dental hygienists and dental prosthetists—and psychologists. Under the scheme there is a requirement for professional indemnity insurance as a mandatory condition of registration for all health professionals, including midwives. This is an important part of raising standards and providing public protection for patients and consumers. The Australian government is committed to building on our previous budget maternity services reform packages by working with the states and territories and with key stakeholders, to develop a national maternity service plan to ensure coordination of maternity services across Australia.

Many members have previously spoken about their personal experiences in relation to midwifery. I would like to share with the House some of mine, too. My daughter Matilda was born at Wyong Hospital where the only service is midwifery. So in some areas, workforce shortages mean that choices for women are limited. We had a terrific experience with a midwife. In fact, we are pregnant again and we are going back to the same midwife. Our experience of the midwifery profession was very positive. At Wyong Hospital, there is a room which looks like any room you would have at home with a big bath and a bed and a midwife to guide you. You do not have the option of epidurals because there is not an obstetrician available at Wyong Hospital. Mothers who are at potential risk are automatically transferred to Gosford Public Hospital. The group of mothers who have the opportunity to be involved with a midwife are certainly screened. That is very appropriate in making sure that we maintain safe outcomes for women giving birth. If developments in the birth cause concern, mothers are immediately transferred by ambulance to Gosford hospital, 10 minutes down the road, where obstetricians and medical practitioners are available. In a sense, our region provides a choice through necessity rather than through anything else. I am very much in favour of making sure that homebirths are an option because of the terrific experiences that many women have had on the Central Coast, including my wife. This is an opportunity to thank our midwife, Val Paynter, who has assisted in the births of hundreds of babies in the 30 years that she has been a midwife on the Central Coast. She is a great midwife and we were incredibly lucky. She has been midwife of the year twice, so we are indebted on the Central Coast for having someone of her experience there.

This is an important issue and shows that we need to make sure that there are different models available so that women have choice and are given the maximum number of options. Not all women will choose to have birth assistance from a midwife, but those who do should be able to have that option.

This is important legislation that builds on the reforms. It builds on the recommendations made to the government back in 2009. This government has acted on those recommendations. It is important that this bill is supported, and I note that the opposition are supporting it and that is very much appreciated. This is part of the ongoing reform to make sure that women have better choices and that we maintain the high quality and high safety standards that exist in our maternity services throughout Australia. I commend this bill to the House.

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