Wednesday, 16 October 2019
Medical and Midwife Indemnity Legislation Amendment Bill 2019; Second Reading
I rise to speak to the Medical and Midwife Indemnity Legislation Amendment Bill 2019. Labor too supports this bill, as it helps to ensure stable premiums for providers and therefore makes their services much more affordable for their patients. By requiring all indemnity insurers to provide cover to all practitioners and providers who need it, instead of just the current four insurers who have contracts with the Commonwealth, our community, including birthing families, will have more choice. Having more players in this field will also increase competition amongst the insurers, which, hopefully, means that premium prices are actually competitive and kept lower. The scheme establishes separate high-cost claim schemes for allied health providers, including midwives, with an important review of the medical indemnity market to be done by February 2021 following the introduction of the bill on 1 July 2020.
I understand there is still consultation with stakeholders on the detailed regulations, and that is important because this bill does not address two major issues: there is a lack of cover for midwives for home births, and there is a monopoly held by the only provider of midwifery insurance cover. In 2002, Australia's largest medical indemnity insurer was placed in provisional liquidation, and this would have left 60 per cent of medical providers without cover, meaning their patients might not have been compensated for medical negligence. So the Indemnity Insurance Fund was set up by the Howard government. It made insurance more affordable for private doctors and midwives who work predominantly in public hospitals. The scheme has been reviewed, but the review recommended that it should be maintained, and the changes we see here with this bill are a result of that review.
In a past life I had the privilege of being a nurse and working very closely with midwives. I listened intently and with great interest to the previous speaker, the member for Indi, who of course is well known in this area and admired for her work. I'd like to acknowledge that.
At the Australian Nursing and Midwifery Federation where I worked, we had a great relationship with our midwifery members, and I worked very closely with the College of Midwives, who have long been advocating for midwifery led care. Midwives and nurses, as we know, are among the most trusted people in our community. We have heard from the member for Indi how outcomes for mums and babies are enhanced when there is continuity of care—of midwifery led care in particular. In Australia, over decades, we have seen that birthing of babies has become almost completely medicalised. Babies are born in hospital with the support and oversight of an obstetrician, a doctor. This hasn't happened in all countries. I am sure lots of us have seen the wonderful TV series Call the Midwife, which really illustrates beautifully how midwifery led care is a hallmark of British society, and there are lots of other countries that have similar systems set up, where midwives lead the care from the minute the mother notifies the service that they are pregnant right through to the birth.
Right now in Australia we see that this has changed. We don't really have a service like that anymore. There have been midwifery led care models set up very successfully around the country—and, again, we heard about very successful ones from the member for Indi. There are great models of care where midwives work in collaboration with GPs and obstetricians. I'm pleased to say that many public hospitals, particularly in my area in Melbourne, are now initiating the midwifery models of care that are run in conjunction with medical experts, but it is the midwives who actually do all of the initial assessments and ongoing care, and call in medical experts when they are needed.
When we live in a land where choice is valued so dearly in all aspects of life, it is amazing that, at the beginning of a life, when a mother is giving birth, her choices are severely limited and she is denied choice—because, as I said, this bill does not cover midwives who wish to help mums deliver in their own home. Homebirths are not covered, and I think this is unfortunate. We know that at the moment there are 150 private midwives doing homebirths in this country, but they are doing it without insurance. This is far from optimal for both the mum and the midwife if something were to go wrong. It makes it very difficult.
I do understand that there are benefits with this bill. I have been told by the ANMF and my colleagues at the College of Midwives that it is good for nurses practising in those private practices and also for nurses working in Aboriginal communities, where we know child mortality is a very important issue and something that we need to work on. Of course, as previous speakers have pointed out, we know that midwifery led care does have enhanced outcomes, and, in those Aboriginal communities in particular, I understand that we are getting really excellent outcomes.
So, whilst we do support this bill and we know it does enhance the very important work of midwives in our community, we are still concerned that it falls short in helping midwives to establish private practice and, in particular, to do homebirths. I think that is something this country is lacking when I see how successful such models are in other countries. We will support this bill but we do hope that these other issues are going to be addressed by this government.