House debates

Wednesday, 16 June 2021


Medical and Midwife Indemnity Legislation Amendment Bill 2021; Second Reading

5:47 pm

Photo of Ged KearneyGed Kearney (Cooper, Australian Labor Party, Shadow Assistant Minister for Health and Ageing) Share this | | Hansard source

I rise to speak on the Medical and Midwife Indemnity Legislation Amendment Bill 2021. I'd like to indicate that the opposition will be supporting the passage of this bill, although I also foreshadow that at the end of my remarks I'll be moving a second reading amendment.

This bill fixes an important anomaly for the independent practising midwives to be covered by indemnity insurance. It amends the Allied Health High Cost Claims Scheme and the Allied Health Exceptional Claims Indemnity Scheme to ensure businesses that employ midwives, regardless of endorsement status, will be covered by the schemes. By endorsement status I mean it covers both those midwives registered to provide midwifery care only as well as those registered and endorsed to prescribe scheduled medicines.

The bill extends the Midwife Professional Indemnity Scheme, or the MPIS, to cover midwives employed by private practice and removes the requirement that midwives must be the sole owners of a practice to receive the cover offered by the MPIS. Importantly, it will allow Aboriginal community controlled health services, or ACCHOs, to employ midwives without the barrier of having to pay excessive insurance premiums. This is vitally important in order to run the Birthing on Country program in First Peoples communities. Birthing on Country is an important step forward in improving maternity care and birthing outcomes in those communities.

The changes here were actually made some time ago, but the language in the original version was imprecise. The proposed amendments are a rewording that clarifies the intent of the original amendments. The Run off Cover Indemnity Scheme and changes to eligibility requirements for the Midwife Professional Indemnity Scheme are welcomed by the profession as they make it easier for midwives to move into private practice alongside midwives already working in private practice and make it easier for them to cease private practice without continued financial burden. The amendments however, do not cover home births. This is an outstanding issue for midwives, and extensive consultation must continue on this as many people in the community would prefer a home birth to hospitalisation. This issue of independent midwifery practice goes back a long way.

I'm proud to say that I sat on a committee established by the then health minister, Nicola Roxon, to look at what was viewed by many as a controversial decision to allow midwives to practice independently and to prescribe scheduled medicines. For some in the medical profession this was akin to heresy. Perhaps many doctors still believe it to be so. I was the federal secretary of the Australian Nursing and Midwifery Federation at the time and I knew, along with all of the others, that midwives were and still are highly skilled, highly responsible and worthy health practitioners. A healthy, normal birth can indeed be attended by a midwife without an obstetrician. In fact, I've got to say that I have had four children from three pregnancies and an obstetrician only attended one birth, which was a complicated twin breach. The other two children were delivered competently by midwives. Now women can choose to have an independently practising midwife deliver their babies.

Some hospitals offer collaborative arrangements with midwives doing the antenatal and delivery as part of a hospital program and these collaborative arrangements are incredibly successful. We need more independent midwives. I recently spoke with the Rural Doctors Association and part of the answer to poor access to healthcare in rural and regional areas is to better support the top of scope of practice of health practitioners like midwives and nurse practitioners. Hopefully, fixing this anomaly in the legislation will help attract more midwives to areas where they are needed and to improve women's choices for birthing. I'd like to acknowledge the ANMF and the Australian College of Midwives, who fought gallantly on behalf of their members to achieve this important outcome.

Insurance for midwives has long been vexed. This became a major problem when the Australian Health Practitioner Regulation Agency, APRA, made a requirement for all practitioners to have indemnity insurance in order to practise. Whilst obstetricians may well be able to better afford the excessive costs of the indemnity insurance, which can run into the tens of thousands of dollars a year, for midwives who earn considerably less than obstetricians, it was out of the question. While we acknowledge the gap that still exists for home births, we support this bill.

Fixing issues in the health system is not something this government is renowned for. We all know that successive Liberal governments have worked consistently to break down the provision of public health, to make patients pay more for health care, to try to dismantle Medicare. In my home state and elsewhere, conservative governments have tried to privatise public hospitals, mostly unsuccessfully, thanks to community outcry and campaigning by health unions and the Labor Party.

I personally, as a nurse, lived through the devastation caused to the Victorian health system by Jeff Kennett and his government, who reduced the nursing workforce by over 10,000 nurses and who wanted to privatise the Austin Hospital, a great public hospital where I worked. It took over a decade to rebuild the number of nurses working in public hospitals back to pre-Kennett numbers.

As the then president of the ACTU, I saw firsthand the horror of the Newman years in Queensland, attacking public hospitals, cutting services and wreaking havoc on health practitioners in the public system. The trauma the Queensland nurses felt waiting for that letter to appear in their letterboxes or pigeonholes at work that signalled their redundancy was just awful. The effect on their health and wellbeing during that time was terrible, but the impact on the Queensland health system was dreadful. It meant the people of Queensland removed Newman's government as quickly as possible.

Both Victoria and Queensland, with good Labor governments, have restored their public health systems. Victoria and Queensland have implemented nurse-patient ratios that ensure safe nursing care. On a federal level, conservative governments have tried to introduce a co-payment for Medicare. They've set up a privatisation committee to examine how best to privatise public health. They've undermined the provision of services with unexplained changes to the MBS that is causing havoc amongst the community. They've run down the administration, with cuts to the Public Service, which helps the community with access. You just can't trust the coalition with Medicare and public health services.

As I said yesterday, I received an email from a constituent just this week. She is 37 years old. She wrote: 'I'm writing to you because I'm very concerned about the recent media reports of changes to the Medicare rebates for a range of procedures. I don't have some groundbreaking, tear-inducing personal story to support my concerns.' She had had a number of minor surgeries in her lifetime, which she'd been able to afford through a combination of Medicare, private health and family support. She wrote: 'I'm worried by the death-by-a-thousand-cuts approach to universal health care and have major worries about the slide towards an American inspired, horrendously expensive and inequitable approach to health care. I see this as another way that inequality is becoming entrenched in Australian communities. The people proposing and supporting such changes come from an economic position of great advantage and will never feel the true impact of a high medical bill. I hope you are working hard in Canberra to ensure that relatively younger Australians, such as myself, don't continue to have the rug pulled out from under them as they grow older—pulled out by a generation of people, mainly politicians, who are undermining the Australian values of equity, compassion and universal access to health care.' This constituent of mine is just one of the vast majority of Australians who care deeply about the universal health system and are troubled by the cuts.

Another example of the government running down our health system is the disaster that is aged care. The royal commission found that aged care, the responsibility of the federal government, was suffering from deep neglect. Much has been said in this House and beyond about the complete disregard for, and bungling of, the aged-care system—a system so neglected that the pandemic forced open the cracks, creating a cavernous disaster when COVID raged through our communities. The bungling attitude and incompetence continued when the vaccination rollout began, which is, again, the sole responsibility of the federal government. The minister responsible, incredibly, said that he felt comfortable with the rollout of the vaccine in aged care. We know that he was the only one in the entire country who was feeling comfortable. Aged-care residents and their families were not feeling comfortable, and I can guarantee that the aged-care workforce were far from it as well.

As well as neglecting aged care and bungling the vaccine rollout, the federal government has totally abrogated its other main responsibility in a pandemic, which is quarantine. The constitution clearly states that this is a federal responsibility. Time and time again we have seen that hotel quarantine is not the ironclad protection Australians need and deserve. 'Oh,' says our Prime Minister, 'it's 99 per cent safe.' He said this while Victorians faced a fourth lockdown because a man contracted COVID in a South Australian hotel and he travelled, infectious, back to Victoria. This lockdown has been very hard. Businesses are so stressed, especially small, sole trader businesses. I've had so many contact me, just in my electorate, desperate for help. Workers once again have to cope with little or no income, depending on whether or not they were eligible for support. Billions of dollars were lost to the economy, and all because of the one per cent that the Prime Minister doesn't seem to worry about. I know there has now been a commitment to build a facility in Melbourne, but it's too little too late.

Why has the Prime Minister been dragged kicking and screaming to make any important decisions that benefit Australians, whether it was the banking royal commission, the aged-care royal commission, implementing JobKeeper, increasing JobSeeker, aged-care funding, changing—over and over—who and how the vaccine rollout was being handled, building purpose-built quarantine facilities or funding child care and mental health? All of these things the government have been brought to kicking and screaming. It's as if they are sitting there, thinking: 'If we say nothing, if we just sit on our hands and pretend we can't do anything, nobody will notice. It might go away. We can carry on doing nothing.' Then, of course, when the ALP and the community cry out in outrage, they think, 'Crikey, we're in trouble; we'd better do something.'

But it's never enough. They are artful, that lot over there on that side of the House, putting bandaids on haemorrhages. But we are wise to that. We, on this side of the House, will expose those inadequacies constantly, and the people of Australia can see through the smoke and mirrors. To the government, politics is a game of tricks. 'Who can we trick,' they say, 'with our smirks and our slogans? Who can we ignore with diversions and big photo opportunities? Which workers can we make believe we care about them with crumbs and small handouts and weasel-worded pieces of legislation that seem good but, all the while, take away rights and services? Who can we kid about tax cuts being for everyone when they are mostly for high-income earners?' It goes on and on. But we on this side know that politics is about priorities. Labor has Medicare and the public health system at the very heart of its priorities. Australians know that very well. With those remarks, I move:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House urges the Government to deliver policies to better support the health of families and healthcare workers".

Photo of Sharon ClaydonSharon Claydon (Newcastle, Australian Labor Party) Share this | | Hansard source

Is the amendment seconded?

Photo of Amanda RishworthAmanda Rishworth (Kingston, Australian Labor Party, Shadow Minister for Early Childhood Education) Share this | | Hansard source

I second the amendment and reserve my right to speak.

6:01 pm

Photo of David GillespieDavid Gillespie (Lyne, National Party) Share this | | Hansard source

I rise to support the Medical and Midwife Indemnity Legislation Amendment Bill 2021. As we all know, in the last 20 or more years there have been a couple of insurance crises. First of all, in public liability in the late nineties, a lot of huge claims went through and bankrupted many entities, not in the health system but councils and the like, that had accidents on their public spaces. It stopped a lot of stuff from happening in Australia—and finally it was sorted out. Then came the medical indemnity crisis, where some of the claims were exceptionally high, leading to premiums of a couple of hundred thousand dollars per year in obstetrics in particular—and we fixed that too. And then there was a problem with that same sector of the health market: one couldn't afford to retire because your premiums in your run-off cover were higher than what you were earning or winding down. Obviously, when markets fail, the government has to step in—so they did that.

In 2010 this parliament introduced two schemes to cover a similar situation with privately practising midwives. There are two existing midwife schemes—the run-off cover one, which is similar to medical indemnity, and the Midwife Professional Indemnity Scheme. The government basically assists the nominated eligible entity—Medical Insurance Group Australia are the nominated provider of the indemnity product—and this covers exceptionally high claims. Eligible midwives who are insured through them—if they make a claim, their insurer will obviously deal with the matter. For a very high-cost claim—above $100,000—the scheme supports 80 per cent of it. But some of the claims are absolutely astounding. Some of them are in the millions of dollars. Clearly, if you don't have insurance it would be a really bad outcome for the healthcare system, for the midwife and for the people taking the action. So, if there's a claim above $2 million, the scheme picks up 100 per cent of it.

There were changes in 2019 where we were strengthening primary care and guaranteeing Medicare. And there was an anomaly when they created the Allied Health High Cost Claim Scheme and the Allied Health Exceptional Claims Scheme in a similar vein. In all these changes, Aboriginal Community Controlled Health Services were left in a bit of a limbo, and some employed midwives were similarly in a bit of a limbo. These amendments correct those anomalies so that, whether you're an employed endorsed midwife or a privately practising midwife, you will be covered by this scheme. Employed or privately practising, there will be a scheme that will cover you.

The one thing it won't cover, at this stage, is homebirths. They have looked at the reasons why they don't. The insurers think the risks don't add up. But that is a very select part of the obstetric services market. The main people that were being hampered by this were some of the more remote Aboriginal Community Controlled Health Services that deliver obstetric services in remote and regional Australia. We want good health outcomes across the nation. Hence the initiative to correct the anomalies.

There's a lot of machinery in this bill, but it's very important. All of us have been brought into this world by a midwife. It's a very well-trained profession, and they deserve the support that everyone else gets from the government through the Medicare system. We want everyone to be able to have good, safe obstetric care, wherever you are in Australia. I support the amendments in this bill.

6:06 pm

Photo of Anika WellsAnika Wells (Lilley, Australian Labor Party) Share this | | Hansard source

I rise today to support the Medical and Midwife Indemnity Legislation Amendment Bill 2021, because it amends the Medical Indemnity Act 2002 and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 to expand the coverage of professional indemnity insurance schemes to the midwives who are currently excluded.

This bill will open up the Midwife Professional Indemnity Scheme to all endorsed midwives, irrespective of their employment status, and provide access to an insurance policy for this class of midwives that includes intrapartum care. It closes an inexplicable gap in the scheme, so that independent practising midwives can be covered by indemnity insurance. Importantly, this bill will enable midwives working with Aboriginal Community Controlled Health Organisations to be covered for Birthing on Country models of care, which will be an important step forward in improving maternity care for our First Nations communities.

The cumulative effect of the bill's amendments will mean that claims against all privately practising midwives will be eligible under the Commonwealth's medical and midwife indemnity insurance scheme if an eligible indemnity claim is made. Hopefully, fixing this anomaly in the current indemnity scheme will help to attract more midwives to our regional and rural areas, where they are desperately needed, and will improve birthing choices for all Australian women. Empowering women with the option to access independently practising midwives to deliver their babies is so important. It gives them autonomy over their own bodies and the right to make informed decisions about their own health.

I welcome this opportunity to talk about midwifery and maternal health care in Australia. After the birth of my own twins late last year, I received an absolute influx of messages and emails from Northside families and families across the country who were relieved to have a representative who understood the economic and social costs of having a family—particularly a family with multiples. I'm proud to be here today as a voice for them on these issues: on improving our public healthcare system, instead of tearing it down; on expanding extended parental paid leave; on increasing the affordability of child care, making childcare universal and making it the best that it can be; and on tackling the rising cost of living so that families aren't scraping by, living from pay cheque to pay cheque.

In my electorate of Lilley, there is one place where you can give birth to babies, and that is where I gave birth—the North West Private Hospital, which has been helping to welcome new lives into the world for over 30 years. I can vouch for how wonderful the midwives of North West hospital are from my own experiences there, giving birth to Celeste, Ossian and Dashiell. I'll spare the House the gory details of childbirth and the things that midwives have to do. But, really, these people could not be paid enough for what it is that they see, what it is that they do, the counselling that they have to provide, the extended services, and the extended know-how and skills that they bring to what is often a dramatic scene, despite all the best Taylor Swift Spotify playlists you can prepare ahead of time for labour. I think what I experienced with Celeste was being an ordinary mum, living in Chermside and having my first baby, and I could not have felt more supported and cared for than I did with those midwives.

The second time I was at the hospital, also as the member for Lilley, giving birth to twins, at one point, at 4 am, one of the twins had gone down to sleep and the other one was refusing to settle. I was breastfeeding on one side—I hadn't learnt to do it tandem yet—so the midwife had to hand-express the other side so that we could all try to get 45 minutes of sleep before the first twin woke up again. That's part and parcel of being a midwife. She probably did that for about 15 minutes, and then at minute 16 she said, 'While I've got you, can I just talk to you about some workforce issues that we have?' Up to that point she hadn't let on that she even knew I was an elected representative. But she perfectly chose her moment to lobby on behalf of her colleagues for better working conditions for healthcare workers. To be honest, at 4 am, with her helping me to secure 45 minutes of sleep, she could not have found a more receptive audience to that call. God bless midwives.

But I do recognise, in telling this story about midwives at North West Private Hospital, that all of that comes with a certain level of privilege; it is certainly not a universal experience. My hope is that having people like me, with babies, in the parliament will help improve that experience for all mothers across Australia. While our universal healthcare system is arguably one of the greatest achievements of any Australian government, like all public policies it needs to be constantly built upon and constantly reworked as our community evolves. In the Australian public health system, pregnant women must choose either a six-week postnatal attendance by a participating midwife when the baby is six weeks old or a postnatal professional attendance with an obstetrician or a GP. They can't have both. A six-week postnatal attendance by a midwife is $55.05, with an 85 per cent benefit. It includes a comprehensive examination of the mother and baby to ensure normal postnatal recovery and referral of the mother to a GP for the ongoing care of mother and baby. A postnatal professional attendance with an obstetrician or a GP is $73.95 with an 85 per cent benefit. It must include a mental health assessment, must be in a hospital and can occur between four and eight weeks post birth.

Comparatively, an expectant mother in New Zealand can choose a midwife or a specialist doctor to provide maternity care during pregnancy, during labour and up to 46 weeks after the birth. Care from a midwife in New Zealand is free. Services that the midwife or specialist doctor will provide include developing a plan for labour and birth, giving advice on staying healthy during pregnancy, being with them during labour, providing referral to a specialist for support if that is needed, and making hospital or home visits at least five times after the baby is born. When the baby is six weeks old, care is transferred to a Well Child/Tamariki Ora provider. They will get free regular health checks from a nurse until the age of five. They also get assistance in enrolling at a local GP for doctor and practice nurse services.

The New Zealand experience shows us that there is a blueprint for how to roll out effective, comprehensive, compassionate maternal health care—just over the ditch. I implore the Morrison government to take that example and implement it in our own health system. If I have a small grievance about the legislation that we are seeking to amend tonight, it is that it doesn't go further and use this opportunity to do these kinds of things. When we support women in getting the perinatal care that they need, we improve women's health, we support Australian families and ultimately we boost women's participation and re-entry into the workforce. On that note, I would like to use this opportunity to throw my support behind the work of the member for Reid, who presented a petition last year to reinstate the MBS item for abdominoplasty surgery for women who have abdominal separation caused by pregnancy. As a woman who has given birth to three children, including two at once, I know the toll that pregnancy and childbirth can have on both your physical and mental health. One in three Australian mothers experience birth trauma and they sustain physical injuries that they must live with long after they leave hospital, and while caring for a newborn.

Abdominal separation is particularly prevalent in petite women, those carrying multiples, those who have had more than one pregnancy, those who fall pregnant later in life and those who have poor muscle tone or sway-back posture. Abdominal separation in pregnant and post-natal women is first treated through physiotherapy, where the condition may resolve naturally, but evidence has shown that this treatment has limited success in severe cases. Recent studies have shown that abdominoplasty surgery has high success rates for this type of injury, but for many women this life-changing surgery is out of reach because it costs up to 15 grand out of pocket. No woman should have to live with severe abdominal injuries, chronic pain and incontinence after they give birth—particularly because they can't afford surgery. I join the member for Reid and the Australian Society of Plastic Surgeons in calling on the Morrison government to relist abdominoplasty as a Medicare item, to restore the dignity and quality of life for women living with birth trauma.

Unfortunately, fixing issues in the health system is not something that the Liberal and National parties are known for. Consecutive Liberal-National governments have worked consistently to break down our public health system, trying to dismantle Medicare and make Australians pay more, out of pocket, for their health care. In 1983 the Liberal and National parties opposed Medicare, claiming it would bankrupt our nation. They went on to four elections—in 1984, in 1987, in 1990 and in 1993—promising to dismantle it if they were elected to government. In 2013 the Liberal-National government floated the idea of a $4 tax to visit your GP. In 2014 they cut $1.7 billion from Medicare. They proposed a $7 tax to visit your GP while cutting company tax by 1.5 percentage points. In 2015 they cut almost $1 billion and continued to pursue the privatisation of Medicare.

In 2021, amid a pandemic, the Liberal-National government snuck in almost 1,000 changes to the Medicare Benefits Schedule. These changes will directly impact the doctors, the nurses and the healthcare workers at the Prince Charles Hospital. With only two weeks until the changes come into practice, we still don't know exactly what rebates are changing. But we do know that the changes include general surgery, cardiothoracic surgery and orthopaedic surgeries, all of which are surgeries that happen at the Prince Charles Hospital every single day. Northsiders in my electorate of Lilley now face the prospect of life-changing surgeries being cancelled at the last minute or risk being left with huge US-style medical bills that they did not expect.

Healthcare costs are spiralling for northside families. In 2013, when the Liberal-National government first came to power, it cost northsiders $27.65 to see their GP. Today it costs $39.35 to see the GP. While real wages growth has flatlined over the past eight years, the Liberal-National government have waved through a 41 per cent increase in the cost of going to see your doctor. Healthcare costs take a huge chunk out of household budgets. Not long ago, I had a constituent named Leonie write to me to say that she went to an eye specialist and had to pay $530 for the appointment and only got $97 back once the Medicare claim was processed. You shouldn't have to wait until payday to book in to see your doctor. Going to see a specialist or a GP should not be a luxury; it should be a basic human right. The only card you should have to pull out at the doctor's office is your Medicare card. It's what generations of people have fought for, to have this as standard practice for Australians today. I will fight to protect Medicare because we know what happens when the health and the safety of Australians is privatised. Just look at our private aged-care system that is in absolute crisis right now.

I also want to use this opportunity, while we're talking about the role of midwives, to talk about stillbirth being a significant mental health issue that does not get the attention and dedicated public policy that it deserves. Every day, six Australian babies are stillborn. This number has remained unchanged since records were first kept, around 20 years ago, while the rate of stillbirth in other countries has dramatically dropped. It is long past time we break the silence and make stillbirth a national health priority. As Senator Keneally explained in the other place, collectively, as a country, we have considered stillbirth too sad to talk about; we have viewed it as a private tragedy rather than a public health problem.

The Senate Select Committee on Stillbirth Research and Education inquiry chaired by Senator McCarthy was the first national inquiry to report on the impact of stillbirth on Australian families and the Australian economy. The recommendations delivered by that inquiry are relatively simple and inexpensive, such as small changes in clinical care and education projected to reduce the stillbirth rate in Australia by 30 per cent. It is imperative to take swift action on the recommendations to reduce the terrible tragedies of lost pregnancy this country, especially those that are stillbirths.

Our communities are already leading the way here. In my electorate of Lilley, Susannah Holmes is a coordinator at Peach Tree Perinatal Wellness, a community organisation which provides educational and support services to expecting and new parents. This is one example of the type of service that saves babies' lives and one example of the type of service we need to see rolled out on a national scale. We must make haste in doing so, because with every day that passes another six babies are being lost to stillbirth. The Australian parents who live with lost pregnancies show some of the greatest courage in our communities, and this parliament should honour them by doing the same and making stillbirths a national public health priority.

With my remaining time, I would pay tribute to the Stillbirth Centre of Research Excellence located at the Mater Hospital in South Brisbane, who are a fabulous group, you would appreciate, of strong fantastic women and some very supportive men who work on stillbirth research in this area and on what needs to be done. They have been rolling out the Safer Baby Bundle across the country since just prior to the pandemic. They do excellent work. They don't get enough credit. They don't get enough funding. They don't get enough support. With my remaining time, I congratulate them on their work and recommit myself to doing what I can to further that cause with my time in this place.

6:21 pm

Photo of Fiona MartinFiona Martin (Reid, Liberal Party) Share this | | Hansard source

I rise to speak on the Medical and Midwife Indemnity Legislation Amendment Bill 2021. Having had four children, I can tell you midwives matter. Midwives matter because they assist with the health care of pregnant women and babies, and help bring new life into the world. Midwives matter because every pregnancy and birth is unique and different. Midwives matter because there are real risks in childbirth. Even in an advanced country like ours, maternal deaths still occur. Birth trauma, unfortunately, is quite common, and sometimes babies are born needing immediate assistance to stay alive. Midwives matter because a healthy mother-child attachment is the foundation for a healthy relationship. We know that perinatal depression and anxiety are a frightening reality for many parents and can get in the way of forming a healthy bond early on.

In Australia, there are approximately 33,500 registered midwives. In 2019, approximately 306,000 babies were born. The Medical and Midwife Indemnity Legislation Amendment Bill 2021 contains important measures that will ensure privately practising midwives have coverage under the Commonwealth's medical and midwife indemnity schemes. The Midwife Professional Indemnity Scheme commenced in 2010 and enables Commonwealth contributions to be paid to eligible insurers for the cost of claims against eligible midwives. Under the Midwife Professional Indemnity Scheme, the government assists in providing affordable cover for eligible midwives through a contracted insurer by covering 80 per cent of the costs of indemnity payouts over $100,000 and 100 per cent of payouts over $2 million.

The first measure will broaden eligibility to the Midwife Professional Indemnity Scheme and the Midwife Professional Indemnity Run-Off Cover Scheme to all eligible midwives in private practice, regardless of how they are covered under insurance policies—for example, their own insurance policy or that of their employers. Currently, these schemes are limited to privately practising midwives endorsed by the Nursing and Midwifery Board of Australia to prescribe scheduled medicines covered under their own insurance policy.

All midwives who are endorsed by the Nursing and Midwifery Board of Australia to prescribe scheduled medicines will have access under the Midwife Professional Indemnity Scheme and the midwife professional indemnity run-off cover scheme if they enter into an appropriate insurance contract with the eligible insurer under the scheme. This expansion in eligibility will enable the current provider of the Midwife Professional Indemnity Scheme to provide for critical Aboriginal community controlled health services. This will include a choice to take up appropriate indemnity insurance for their employed midwifes who are endorsed by the Nursing and Midwifery Board of Australia to provide scheduled medicines.

This bill will close an eligibility gap that has resulted in the exclusion of all registered midwives indemnified from liability through their own insurance contract from the allied health schemes. The second measure in this bill will rectify this exclusion. Without change, any claims lodged by insurers relating to the affected midwives will not be eligible to receive the Commonwealth subsidy. These practitioners had eligibility under the Commonwealth high-cost claim scheme and the exceptional claims scheme before 1 July 2020. It was always intended that registered midwifes would have coverage under the newly formed allied health schemes from the 1 July 2020 implementation, and this bill rectifies this anomaly.

A bill like this does not come about easily, and there was much consultation before the government arrived at this point. The Commonwealth consulted with the Australian College of Midwives, medical indemnity insurers currently participating in the indemnity schemes and three Aboriginal community controlled health services who were seeking an indemnity solution for their midwives. The federal government also assisted in preparing thousands of additional nurses to ensure our healthcare system had the workforce, depth and capacity to respond to challenges during the pandemic.

In March 2020 the Australian government funded 3,000 scholarships for registered nurses to undertake online education to enable them to refresh their clinical skills. Over 5,000 nurses registered interest in taking part in this program, and all 3,000 scholarships were awarded. This was all about taking the action required to ensure our healthcare system was properly supported in the wake of a one-in-100-year event.

The Commonwealth's medical and midwife indemnity legislation does not preclude home births. However, the insurance product offered by Medical Insurance Australia under the Midwife Professional Indemnity Scheme does not cover this type of practice. Under the current arrangements, there is nothing preventing a midwife from approaching a medical indemnity insurer to request cover for home births under the Allied health schemes; however, it will be a matter for an insurer to determine whether they will provide this coverage, and this is because the Commonwealth cannot compel an insurer to cover this type of midwifery practice.

The Commonwealth currently only maintains an insurance contract with one eligible insurer under the Midwife Professional Indemnity Scheme to ensure eligible midwives have access to affordable professional indemnity insurance. There is no comparable arrangement under the allied high cost claims. Rather, this is a claims reimbursement scheme whereby the Commonwealth subsidises eligible insurers for 50 per cent of their costs of the claim above a threshold of $500,000.

The amendments in this bill will also support key Aboriginal community controlled health services to consider accessing appropriate professional indemnity insurance for their employed midwives who have been endorsed by the Nursing and Midwifery Board of Australia to provide scheduled medicines. The Aboriginal community controlled health services sought remedy from the government for access to an insurance product for their employed midwives. Through this bill, the Midwife Professional Indemnity Scheme will be opened up to all endorsed midwives irrespective of their employment status to support the current provider of the midwife professional indemnity scheme to provide insurance policy to these employed midwives under these arrangements should they wish to.

These legislative amendments will broaden the type of insurance arrangements that are eligible under the Midwife Professional Indemnity Scheme and enable appropriate insurance products to be provided to these health services. Without these amendments, no insurer has been willing to offer indemnity insurance to cover the scope of midwifery practice required by these services.

Following royal assent, these changes in schedule 1 of the bill to ensure all registered-only midwives have eligibility under the allied health service schemes will take effect retrospectively from 1 July 2020, while measures in schedule 2 of the bill, to remove all employment limitations in the Midwife Professional Indemnity Scheme, will commence on 1 July 2021. I commend this bill to the House.

6:29 pm

Photo of Mike FreelanderMike Freelander (Macarthur, Australian Labor Party) Share this | | Hansard source

I would like to endorse the comments of the member for Reid and the member for Lilley, who both expressed their appropriate support the Medical and Midwife Indemnity Legislation Amendment Bill 2021. I support the bill, although I think it is still quite a complex matter, and I think the bill itself doesn't go far enough in providing adequate insurance for practising midwives in Australia.

In this place, I've been a somewhat repetitive speaker about support for the health of children and young Australians. I think this bill will go part of the way to encouraging better pregnancy care in Australia, but there is certainly no real, comprehensive policy on perinatal care in Australia, and that is a great deficiency. Since I came into this parliament in 2016, I've been trying to promote a child health policy called The First 1,000 Days. This provides health care for children, from preconception, through pregnancy and up until the age of two years. If we can provide the very best health care that we can for children in that time frame—the first 1,000 days of life—then we know that the health and economic outcomes will be much, much better than trying to retrofit health policy once children are older. The First 1,000 Days, in particular, looks at the work that we can do for things like preventing stillbirth, which has already been mentioned; improving pregnancy outcomes; reducing premature birth; reducing the incidence of low-birth-weight babies; and reducing the number of preventable causes of neonatal disability, such as rubella, foetal alcohol syndrome and other infections during pregnancy. People are talking about a particular virus that can cause injury to an unborn child, cytomegalovirus, which there is a developing immunisation for. All these things mean that the outcomes for children are much, much better and therefore the health costs over life are much reduced.

Pregnancy is a dangerous time. Pregnancy loss amongst already recognised pregnancy is as high as 15 per cent, but unrecognised pregnancy loss is certainly much greater. Up to 50 per cent of all fertilised eggs are lost even before implantation. Miscarriages occur in up to one in five confirmed pregnancies before 20 weeks. However, having said that, Australia is one of the safest places in the world for a baby to be born. Perinatal death occurs, including stillbirth at term, about eight times per 1,000 births in Australia. There were 2,790 babies who died in the perinatal period in Australia in 2018. Three-quarters were stillbirths and the remaining almost 700 were neonatal deaths. We estimate that, with appropriate care, up to a third of the stillbirths and a third of the neonatal deaths could have been prevented. Part of the way that we can prevent it is by providing good pregnancy care. I've worked with many midwives over many years who have provided wonderful care to women during pregnancy.

But pregnancy care includes many other things. It includes things like advice about when to get pregnant and about contraception. It includes advice about how to stay healthy during pregnancy, avoiding toxins such as alcohol and cigarettes, avoiding recreational drugs, avoiding things like infections that could be prevented, avoiding poor diet, and treating illnesses that occur during pregnancy and trying to manage things like gestational diabetes. All of these are managed mostly by midwives. Whilst they can be managed through GPs, obstetricians and gynaecologists, in this day and age the gap costs of seeing doctors and midwives privately are quite expensive and beyond the reach of many of Australians, so people are having to resort to being seen in public hospital obstetric outpatient units. These are very good and they're staffed by excellent midwives, but waiting lists are long and in some of the rapidly growing suburbs they cannot cope with the load.

There's the cost of investigations during pregnancy. The gap cost for an obstetric ultrasound is as high as $100 in many areas of Australia, so people are avoiding them because of those gap costs and are not getting adequate investigations during pregnancy, and this can have outcomes for health care. There is no overall plan from this government and certainly from many of the state governments about Australia-wide obstetric care, and that's a huge deficiency in Australia.

In other countries, it's totally different. The Scandinavian countries have fantastic electronic records and fantastic pregnancy health care which is all provided by the state, free of charge. This includes midwifery care during pregnancy; it includes postnatal care, and that's very important; and it also includes hospital care. Yet, in Australia, if people want to see an obstetrician privately during their pregnancy and have regular follow-up care, the cost can run into many thousands of dollars. Again, that is prohibitive for many people, certainly in my electorate of Macarthur. The government has no plan to be able to reduce this, which is a great tragedy and which I think is not leading to the best possible care.

We rely on our midwives. This bill will improve the pool of midwives available for obstetric care, but it doesn't go far enough. We need an Australia-wide plan and Australia-wide support for this policy. There's nothing from the government on this. This tweaks that a little bit, but it doesn't really change the outcomes for many pregnancies.

The other thing that is very important in midwifery care is postnatal care. We've heard, from the member for Reid and the member for Lilley, about the problem of postnatal depression, but there are many other postnatal problems that can be avoided with appropriate midwifery care. They include postpartum infections, postpartum bleeding, postpartum iron deficiency and other vitamin deficiencies, difficulties with breastfeeding, difficulties with maternal infant bonding, problems with post-delivery contraception et cetera. These are things that can be managed very well by our very good midwives. As I said, I've worked with many, many of them, as a team, and certainly many of them have saved my bacon on a number of occasions. Because they have very good personal relationships with the mothers and also with the babies, they know when things are not right and they know when treatment is required. So the more we can do to support midwifery care the better. This bill doesn't go far enough and there's much more we could do.

This bill will support midwives who provide hospital care. It doesn't support those involved in homebirths, and, while I'm not a supporter of homebirths, it is a reality and we need to do more to support midwives who are providing homebirths. By doing that, I'm sure we can avoid some of the problems that can occur.

We also need to do more with our Indigenous population. For them, it is very important to have birth on country, and we need to do more to support our Indigenous population to provide those services. In a couple of weeks time, I'm visiting the Shoalhaven area to look at a birthing unit run by the local Indigenous community. It's staffed by midwives and they provide a fantastic service to the local Indigenous population, and we need to do everything that we can to support units like Waminda around the country.

We need to do much more to improve obstetric services in our country towns and regional centres. It's been very difficult to recruit obstetric care, even to outer metropolitan electorates like my electorate of Macarthur, because the costs of insurance are high. The gap cost for providing obstetric care is prohibitive for many people, so fewer and fewer people are using private obstetricians and more reliance is put on the public hospitals. Many of our outer metropolitan, rural and regional obstetric services are not able to provide the levels of care that we would expect in 21st century Australia.

There is much, much more to be done, and from this government, again, we have no overall plan. They are nibbling at the edges but are not really providing a comprehensive policy solution to obstetric care in Australia, and it's time that we had it. It's all right if you live in the centre of Sydney close to the big teaching hospitals: North Shore Hospital, Prince Alfred Hospital, Prince of Wales Hospital. I've worked at all those hospitals, and they have wonderful obstetric services, but we need to look at ways of replicating those sorts of services in outer metropolitan, rural and regional areas. The only way we can do that is by improving the number of midwives available for services. Recently the midwives at my hospital at Campbelltown threatened to go on strike because of underfunding and understaffing. They were persistently made to work hours—double shifts et cetera—that they believed were not allowing them to provide the service that they wanted to their clients.

We need to do much, much more, and it requires a policy solution. It doesn't require just nibbling at the edges. There needs to be a comprehensive obstetric-care management plan for the whole of Australia, and that should include not just the teaching hospital inner-city areas. It needs to be in outer metropolitan, rural and regional areas. If you go to any rural area, you will find one of the biggest health complaints from young couples is that they cannot get obstetric care close to where they live. Many families have to relocate to the city to be able to have their babies. For poorer people that is prohibitively expensive. We need better outreach services from our major obstetric units. They need to take responsibility for the levels of care not just in their local areas but in the rest of the country. It's no longer reasonable that health care should be better if you live next door to North Shore Hospital or Prince Alfred Hospital than if you live in country New South Wales or the South Coast or the North Coast. We need to do much better with providing comprehensive care around Australia. We need to recruit more midwives. We need to make it viable for them to provide a service to people in the community, and we need to make sure that people can afford their care.

My personal view is that all obstetric care should not come at a cost to the patient, because we need the very best care for our children. I've mentioned the first thousand days. This is a comprehensive policy that provides health care from prior to conception, through the pregnancy and afterwards to the age of two and includes a whole range of things like child development, infant nutrition, breastfeeding, developmental assessment—a whole range of health issues that we can do through an appropriately trained and appropriately funded midwifery workforce. Some of the biggest supporters of the first-thousand-days policies have been midwives. Indeed, they have been Indigenous midwives, because they know how important those early times are for the future of their children and the future of their communities.

So, whilst I support this bill, it's only a very small part of the solution. All of us who are parents and grandparents understand how much we invest in our children, but the country needs to do that as a whole and make sure that all our children have access to the very, very best health care that they can get.

I'd like to say at the end how grateful I have been for all the midwives who have helped me in my career. The work they do is just fantastic. I have been privileged to work with some fantastic obstetric carers, including midwives and obstetricians. Long may they continue to provide the care that they do. Thank you.

6:44 pm

Photo of Dave SharmaDave Sharma (Wentworth, Liberal Party) Share this | | Hansard source

It's a privilege to talk on the Medical and Midwife Indemnity Legislation Amendment Bill 2021, which is fundamentally about giving mothers-to-be and parents-to-be choice and control. It's about supporting the principle that mothers-to-be should be at the centre of maternity care and the birthing process and that they should have access to a wide range of choices about how they give birth. The amendments made by this bill will mean that all privately practising midwives can access one of the Commonwealth's medical or midwife indemnity schemes.

The bill implements the 2021-22 budget measure in two distinct ways. Firstly, it expands the Midwife Professional Indemnity Scheme and the Midwife Professional Indemnity Run-off Cover Scheme to cover claims made against midwives in private practice whose registration has been endorsed by the Nursing and Midwifery Board of Australia to prescribe scheduled medicines—so-called eligible midwives—irrespective of whether the midwife is covered under a professional indemnity insurance policy as an employee or in an independent capacity. This addresses an anomaly that had arisen depending upon what sort of insurance policy midwives held, either as an employee or in an individual capacity, to make sure that both categories of midwife can nonetheless access the Midwife Professional Indemnity Scheme and the Midwife Professional Indemnity Run-off Cover Scheme. This was a particular request of the Aboriginal community-controlled health services, who sought government support to ensure access to an insurance product for their employed midwives, and this amendment will help ensure that. This cohort of midwives had been unable, up to this point, to obtain indemnity insurance to extend their services to intrapartum care under an indemnity insurer.

The second thing this bill does is amend the Medical Indemnity Act 2002 to ensure that claims made against midwives in private practice whose registration is not endorsed by the Nursing and Midwifery Board of Australia to prescribe scheduled medicines—so-called registered-only midwives—are nonetheless eligible under the Allied Health High Cost Claims Scheme and the Allied Health Exceptional Claims Scheme, where the claim relates to incidents that occurred on or from 1 July 2020. Previously, claims against some registered-only midwives were not eligible for the allied health schemes, based on whether the midwife could be expected to be covered by an employer's indemnity arrangements. What this does is create parity of arrangements for all other registered allied health professionals under the allied health schemes. It means that employed endorsed midwives currently not participating in the midwife schemes will have the choice to stay under their current arrangements, and if an eligible claim is made in these circumstances the allied health schemes will respond. This flexibility supports midwives to work in a variety of different arrangements without their indemnity insurance being a barrier. Amendments made by this bill will mean that claims against all privately practising midwives will be eligible under the Commonwealth's medical and midwife indemnity schemes if an eligible medical indemnity claim is made.

Continuity of midwifery care is the gold standard of maternity care because it leads to the best possible outcomes for mothers and babies. As we know from research, care from the one midwife throughout pregnancy, birth and the postnatal period results in better satisfaction with the birth experience for mothers, greater likelihood of carrying the baby to term, reduced birthing trauma for the mother and the baby, an increased chance of breastfeeding successfully and better outcomes for babies. The end result is happier parents, happier babies and less cost to the health system. Fundamentally, that is what this bill is about.

I have been a partner to three births in my own family, all of which were facilitated by midwives. The first birth was done in the midwife's home, the second birth, in the United States, was done at home and the third birth was in a midwifery centre attached to a hospital here in Australia. My wife and I are both great supporters of and believers in the valuable services that midwives provide and the level of care and support they provide to parents-to-be, both mothers and fathers, and of course to the babies. I know personally—and certainly my wife does as well—that we would not have had the birthing experience we enjoyed with our three children without the care and support, the attention and the nurturing love and affection of the midwives with whom we worked, both in the United States and in Australia.

We had our first two children in the United States, where many people would know that the practice of obstetrics is a highly medicalised one. My wife and I, having our first child, were quite put off by the directness of the obstetricians we dealt with and their insistence that things would have to run a certain way and that the birth would occur on a certain day in a certain fashion. That's why we sought out other assistance. We found midwives who practised at a clinic in Alexandria, Virginia. That's where we had our first baby, Diana. That experience was immensely positive. The midwives were thoroughly professional, caring, attentive and nurturing. They did their job exceptionally well, with a high level of care and to a high standard of care. That experience led us on to having our second child at home in Washington DC, with midwives in attendance, and then in Australia, because that was not an option, having our third child at a birthing centre attached to the hospital just down here in Deakin in the ACT.

As I said, midwives deserve all the support they can get from us here in the parliament and us in Australia. This bill, by helping to give mothers-to-be and parents-to-be choice and control, supports the principle that women should be at the centre of maternity care and birthing choices and that they should have access to a wide range of birthing choices. The amendments made by this bill will go some way to addressing some anomalies and ensuring midwives continue to play an important role in our society, in the life of families and in the arrival of new children into the world. I commend this bill to the House.

6:51 pm

Photo of Helen HainesHelen Haines (Indi, Independent) Share this | | Hansard source

I rise in support of the Medical and Midwife Indemnity Legislation Amendment Bill 2021. This bill amends the Medical Indemnity Act 2002 and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 to expand eligibility for claims against privately practising midwives under the Commonwealth's medical and midwife indemnity schemes. Specifically, this bill amends the Medical Indemnity Act to ensure that claims against midwives in private practice whose registration is not endorsed by the Nursing and Midwifery Board of Australia to prescribe scheduled medicines, registered-only midwives and midwives covered under their own insurance contract are now eligible under the Allied Health High Cost Claim Indemnity Scheme and the Allied Health Exceptional Claims Indemnity Scheme where the claim relates to incidents that occurred on or from 1 July 2020.

This bill also amends the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act 2010 to expand the Midwife Professional Indemnity Scheme and the Midwife Professional Indemnity Scheme Run-off Cover Commonwealth Contributions Scheme, also known as the midwife schemes, to remove criteria relating to the employment arrangement of midwives that have resulted in certain privately practising midwives being excluded from the midwife schemes. Importantly, this amendment will enable key Aboriginal community controlled health services to choose to access professional indemnity insurance for their employed midwives who have been endorsed by the Nursing and Midwifery Board of Australia. These changes support flexibility in arrangements and supports midwives to work in a variety of different engagements without their indemnity insurance being a barrier.

This bill provides certainty to insurers of the Commonwealth's ongoing commitment to subsidise the costs associated with medical negligence claims against privately practising midwives, further incentivising insurers to provide professional indemnity insurance in midwives in private practice. This bill is being developed in consultation with the Australian College of Midwives.

I want to congratulate the minister and his office on bringing forward this bill. I want to note the minister sharing with the House that he is the son of a nurse and a midwife. I want to note that that shows, because he seems to truly understand the role of a midwife. I know that, because of his comments when he said, 'This is about giving mums-to-be choice and control. That's what is so fundamentally important as well as protection.' Midwives know that, and the minister knows that too. He went on to say, 'This supports the principle that women are the centre of maternity care and they should have access to a wide range of birthing choices.' I note, the comments from the member for Wentworth and his very heartfelt appreciation of the role that midwives played in the birth of his three children. He highlighted the role that midwives play in providing a choice for home birth. I commend him for his words. I appreciate them, as a midwife and on behalf of many midwives across the nation.

Importantly, this bill enables indemnity insurance for midwives working in ACCHOs. This is so important to ensure that culturally sensitive, enabling maternity care can be provided by midwives working with Aboriginal and Torres Strait Islander women in these settings, programs such as Birthing on Country. There is an urgency to redress unacceptable maternal and infant health outcomes for First Nations families in Australia, and Birthing on Country programs are a way forward to address this. The terms 'birthing on country' and 'birthing on country models' are generally not well understood. The Australian College of Midwives describes them as:

… a metaphor for the best start in life for Aboriginal and Torres Strait Islander babies and their families which provides an appropriate transition to motherhood and parenting, and an integrated, holistic and culturally appropriate model of care for all.

Birthing on Country models can be described as maternity services that are designed, developed, delivered and evaluated with Aboriginal and Torres Strait Islander women and that encompass some or all of the following points: they are community based and governed; they provide for the inclusion of traditional practices; they involve connections with land and country; they incorporate a holistic definition of health; they value Aboriginal and Torres Strait Islanders as well as other ways of knowing and learning; they encompass risk assessment and service delivery; and they are culturally competent. Accordingly, Birthing on Country models can be incorporated in any setting, whether in a rural setting or in a metropolitan one.

I want to highlight this evening a study reported in the Lancet Global Health journal in May 2021. It reported on a multiagency partnership between two Aboriginal community controlled health services and the Mater Mothers public hospital, where they designed, implemented and evaluated a new Birthing in Our Community service. Between 1 January 2013 and 30 June 2019, 1,867 First Nations babies were born at the Mater Mothers public hospital, and women receiving the Birthing on Country service were more likely to attend five or more antenatal visits, more likely to have exclusive breastfeeding on discharge, less likely to have a baby born preterm, and their outcomes were seen as being highly satisfying for the women. This study has shown the clinical effectiveness of the Birthing in Our Community service. It was co-designed by stakeholders and underpinned by Birthing on Country principles. The widespread scale-up of this new service should be prioritised.

I want to pay tribute to Professor Sue Kildea and Professor Sue Kruske, who have an enormous canon of work in this space and have contributed a significant evidence base to underpin public maternity services policy for First Nations women. They are truly champions. Dedicated funding, knowledge translation and implementation science are needed now to ensure that all First Nations families can access Birthing on Country services that are adapted for their specific context. I want to congratulate the government on the $15 million budget line for Aboriginal and Torres Strait Islander mothers and babies grant opportunities for Indigenous led research that translates into culturally safe pregnancy, birth and postpartum care. This is really important.

There's been a dramatic impact of COVID on women's choice and control during pregnancy and childbirth. This bill could assist in increasing women's access to the models of care that they really seek in order to feel safer and feel more in control of their births. Midwives are essential providers of public health care, and they contribute to enormously improved outcomes, especially for women who may not experience equitable access to maternity care. Midwives provide care, counselling, screening, vaccinations and sexual and reproductive health care in addition to pregnancy, birth and postnatal care.

There's a lack of understanding about the impact and the value of midwifery practice on public health outcomes. The WHO's State of the World's Midwifery 2021 report calls for the expansion of midwifery led models of care to promote the health and wellbeing of the globe's mothers and babies. This has never been more evident and important than during the COVID pandemic. To understand the impact of COVID on birthing women and their families, last year the Australian College of Midwives conducted a survey of women's experiences of maternity care at the height of the COVID-19 pandemic. They wanted to explore and gain insight into women's experiences as well as their challenges, uncertainties and fears. Almost 3,000 women completed that survey. Those respondents reported feeling isolated, alone and unsupported by the evolving changes of the pandemic, which led to anxiety, concern and distress. Wherever I meet them, midwives tell me that they have never before seen as many calls for help for mental health support for the women they care for. Many women expressed concern for their mental health in this survey. The results revealed that women were seeking alternative options to mainstream maternity care in an unprecedented way, and this included an exponential shift in looking for and asking for midwifery continuity-of-care services such as midwifery group practice, birthing centres and homebirth, either publicly provided or public-private provided.

Despite seeking other options, a large proportion of women indicated that they have not been able to find the kind of care they were really looking for. Alarmingly, three per cent of the more than 1,000 women who had reconsidered their care were considering birthing without any assistance at all at home—something known as free birth—and that's really disturbing.

It's imperative that the results of the survey and the views expressed by the women who contributed to it be considered in informing maternity policy in both the post-COVID-19 recovery phase and, importantly, a longer-term future. It's now clear that many low-risk Australian women consider homebirth a safe option when attended by qualified clinicians. The evidence on whom homebirth is safe for is now very well-established. Large population based studies and subsequent systematic reviews and meta-analyses consistently demonstrate that planned homebirth is a safe option for women with low-risk pregnancies.

This evidence means that there are real opportunities for service choice expansion and cost reduction. However, there remain many barriers to achieving this. On 18 September 2019, when speaking on the Medical and Midwife Indemnity Legislation Amendment Bill 2019, I highlighted the need to include intrapartum care for homebirth in the indemnity cover for privately practising registered endorsed midwives. Unfortunately, this amendment has still not addressed this aspect of midwifery practice. Right now, section 284 of the national law has a transitional period of exemption until 31 December this year. My understanding is that this will be extended until 2023, but that does not solve the fundamental issue of no insurance for intrapartum care in a home setting when women wish to choose this—and what we know is that more women do wish to choose this.

Meeting the needs of women is a hallmark of a high-quality maternity system. A decade of Australian maternity service reviews have highlighted that women want increased access to models of care that include homebirth. The majority of women who access homebirth options do so through engaging a privately practising midwife—and that's very expensive. Medicare is available for antenatal and postnatal care but not for the birth. The average out-of-pocket costs for women giving birth at home with a privately practising midwife is around $5,000. While there has been growth in publicly funded models across the country, with really reassuring evaluations, very few women can access this care.

This bill will certainly help optimise midwifery care, but there is much more policy tidying up to be done to ensure midwives can provide the care women want in the settings where they want it. For example, there is a practical safety problem when it comes to MBS item No. 82120 for the management of labour in a health service by a participating midwife. Anyone who has ever worked in a continuity-of-care model for birthing women—and I am someone who has—knows that the 12-hour rule is deeply problematic for any midwife who may be called to care for their client in labour when they have spent all day working in antenatal or postnatal care. The midwife must fulfil the 12 hours before transferring care to another participating midwife. This could easily be remedied by a change to the regulations around that item number. I'd be most pleased to work with the minister's office to set that right.

In summary, this is a good bill and it addresses some deficiencies in the last one. But there is still a lot to be done to make sure that, as the minister himself highlighted, women truly have quality of care, control and choice. A few more policy levers need to be pulled to make sure women have the safest, highest-quality care—and we know that, for low-risk women, that is continuity-of-care models. There is overwhelming evidence that continuity-of-care models, with midwives, lower the rate of stillbirth, lower the rate of birth interventions, increase the rate of breastfeeding and increase the woman and her family's satisfaction with the care that they have. Midwifery group practice, birthing centres and homebirth can make that happen. So we need more publicly funded models of homebirth. We need to fix the Medicare issue with homebirth by having privately practising midwives. We need to continue to grow the birthing-on-country models in both urban and regional settings. And we need to include indemnity cover for intrapartum care in the home by a privately practising midwife.

I wish to acknowledge the extraordinary work of midwives as champions of public health, as guardians of safe birth, as guardians of women's health and wellbeing and as the firm and loving hands that see a baby born into our nation and set them up for a high-quality healthy life into the future. I commend this bill to the House.

7:05 pm

Photo of Andrew LamingAndrew Laming (Bowman, Liberal Party) Share this | | Hansard source

Another strong supporter of these amendments for midwives—and it follows two decades of law reform both at the Commonwealth level, in indemnity, and through state tort law reforms for what was an escalating crisis 20 years ago. I found myself flying over the Gulf of Carpentaria when one of the largest medical indemnifiers collapsed in 2001. We landed, with the health minister, and we picked the phone up and discovered that we had an indemnity crisis that had been predicted by doctors. Government at the time had been slow to respond, mostly because there was some shifting of blame as to whether state or Commonwealth law reform was required. It was recognised that New South Wales was probably the worst jurisdiction in the world for medical litigation. That tort law reform in that state came far too late and was very much something that the rest of the nation was waiting for.

There's a bit of a story behind that for midwives. While we've seen plenty of lip service for midwives, it was during the Labor administration that there was insufficient evidence to protect homebirth midwives, and legislation that was passed put those midwives at significant risk. This side of the chamber fought very hard, in opposition, to ensure that that coverage occurred and that there was a victory. But today's not a day for pointing out what the other side of politics may or may not have done. That was done a little bit earlier, by an earlier speaker, a former president of the ACTU. In essence, Australia has a very good record of having made changes to medical indemnity for both doctors and nurses, and today is about fixing up some minor anomalies in the legislation. It was always intended to cover midwives and now will, as a result of the passage of this bill tonight.

But I want to spend a little bit of time just to make very clear the history of reforms, back in 2001 through to 2004, involving Kay Paterson, Helen Coonan and of course Prime Minister John Howard. The reason it's important is that those very same models not only have stood the test of time but now are being applied to midwives in this country. Australia had these unique challenges, which I'd like to run through very briefly, because doctors two decades ago faced the same concerns that midwives would today about inadequate coverage—a concern that obviously the insurers of doctors two decades did not capture, under AHPRA; they were basically mutuals, making their own rules, setting their own premia and reluctant to increase those premia, because they wanted to make sure they kept their customers. There was a time there to set up a medico-legal committee to make some of those tougher decisions.

Australia was witnessing, in the nineties, an increase in medical litigation. We could see the problem coming. It was like a train coming down the tracks. Prior to that, at the time of my graduation and in the late eighties, it wasn't a big issue for doctors; it wasn't seen as a major concern. But the failure to appropriately price in the changes to premia created an emerging gulf. So, the collapse of United was obviously expected to occur at one stage or another. The HIH collapse that came a couple of years later further compounded it because of the reinsurance model that involved other insurers.

A claims-incurred basis represented about three-quarters of the challenge here and hadn't been reported. So, Australia had to set up an exceptional-claims scheme, a high-cost claims scheme, an incurred-but-not-reported scheme and a run-off-cover scheme. And, as has been pointed out by a previous member on my side who's also a medical specialist, there was this invidious situation whereby, as you were winding down your practice, you simply couldn't earn enough money to pay your own indemnity cover. That is a big problem, because many of the cases that come before an insurer could be well after you've retired. This 'tail' that we talk about in indemnity is utterly important to cover as well.

At the time, there was an indemnity review. I remember the work of Kay Paterson in particular. I remember the work of the chief of staff and the senior advisers in this space, getting advice from the doctors as much as from insurance experts in Helen Coonan's area about how to design a solution. At the time, as I recall, UMP was insuring about 90 per cent of New South Wales doctors. This explosion in claims was a massive concern, and there was frustration that New South Wales wasn't taking the tort law response seriously enough to put some caps on these claims, which were increasingly viewed within the community as utterly ridiculous.

The IBNRs were contributing to this crisis. We could see that there was a devastating effect on medical confidence and the willingness to even continue practices. There was a case with UNP where, when they asked—to survive—their members to pay a year of premia in advance to keep some liquidity in their system, many members simply refused to pay and walked, which further compounded the situation. This is a classic example where the only solution is for government to move in and fix what effectively is a genuine failure in the market. Things took a turn for the worse, as I said, when we also lost HIH. As an early provider myself around the year 2004, it was so encouraging to know that, after a certain threshold, a certain percentage of your annual income, any further premia were covered—80 per cent of them—by the government. These same mechanisms will be there for midwives.

Of course, midwives operate in an even more fraught environment. Not all of them are employed in the public sector. Many do work in the Aboriginal community controlled sector. To them, I say: this legislation is for you. We want to make it possible that, in this large and dispersed nation, if you are in the care of an Aboriginal community controlled service and choose to have your baby on country, we can provide the most highly trained midwives with full confidence that they will have their medical indemnity up to date and effective. That's important, and it should be available to all endorsed midwives, irrespective of their employment status—and that is very important as well.

In conclusion, there were always, I think, very, very good intentions with this legislation. A very small anomaly has been identified that does get closed with this legislation. But, for every reason, both sides of this chamber can say to the nation that these laws provide the coverage that midwives deserve.

7:11 pm

Photo of Alicia PayneAlicia Payne (Canberra, Australian Labor Party) Share this | | Hansard source

I rise to speak on the Medical and Midwife Indemnity Legislation Bill 2021. This bill will amend the Medical Indemnity Act and the Midwife Professional Indemnity (Commonwealth Contribution) Scheme Act. It will expand the coverage of professional indemnity insurance schemes to a group of midwives who, due to gaps in the current legislation, have been excluded unfairly due to their employment status. In Australia, midwives are registered under the Australian Health Practitioners Regulation Agency by the Nursing and Midwifery Board of Australia. Midwives are characterised as either registered or endorsed.

Registered midwives are registered to provide midwifery care only, while endorsed midwives are registered to provide midwifery care and to prescribe medicines. Currently, if you are a midwife in Australia, you have two options when accessing professional indemnity insurance schemes. These are allied health schemes available to registered and endorsed midwives, and the professional midwife scheme, which only covers endorsed midwives. However, both schemes exclude midwives in certain circumstances. If you are a registered midwife who holds insurance through your employment contract, you are ineligible for the allied health scheme. In the professional midwife scheme, if your employer is not also a midwife and the other stakeholders and directors of the company you work for are not midwives, you are excluded. This has particularly impacted midwives working in Aboriginal community controlled health services and has meant that the range and quality of midwifery services being accessed in remote Indigenous communities has been restricted.

The changes made in this bill will be an important step forward in improving maternity care offered to First Nations communities and in closing the gap in outcomes between Indigenous and non-Indigenous mothers and babies. We must continue to do more to ensure that First Nations mothers are fully supported with culturally sensitive support and care throughout their pregnancies.

It is important that all midwives, irrespective of their personal employment contracts, have access to indemnity schemes. This bill will ensure that they do. These amendments bring our legislation into line with the established Commonwealth policy to ensure that claims made against all registered midwives have coverage and that there is parity in the arrangements for all registered allied health professionals. This bill explicitly ensures that all midwives who have previously been excluded will be able to access the scheme regardless of their individual employment status.

Key stakeholders have been advocating this change for a significant period of time. The College of Midwives in particular have been key to ensuring that this change is introduced, and I want to thank them and their members for their hard work in seeing this through. I'd also like to acknowledge the Australian Nursing & Midwifery Foundation, who have supported the implementation of the expanded access for midwives. However, there is still work to be done. Unfortunately, this bill fails to cover homebirths, largely as a result of resistance from insurance companies. I note and welcome the commitment of the minister to continue to work towards homebirth coverage and encourage Australia's medical insurance industry to engage constructively with the government and other stakeholders to ensure that this is achieved.

When it comes to midwifery and birth in Australia, homebirth isn't the only issue that requires more attention from this parliament and legislatures across Australia. I want to talk about continuity of care and the care that we give more generally to mothers here in Australia. These issues became more apparent to me because of two things. One was when I became a mother myself. The other was when I was preselected and then elected. It became apparent to me that these issues are so important to so many people in the community. They talked to me and asked if I would advocate on these issues. The key issues are around choice for mothers. Mothers want some choice, and homebirth is an issue there. Midwives don't have the coverage to enable more women to have that choice if that's what they want. When you're a first-time mother, you are very vulnerable to what you are told and the access to care that you have. In particular, women in First Nations communities, in remote Australia et cetera, are at the hands of whatever is available for them to have that care through pregnancy and birth.

I met with a wonderful group in my electorate called Maternal Health Matters. They were previously called Safe Motherhood. Their goal is for all mothers to have respectful care and safe motherhood. I had never thought about the concept of safe motherhood before. When we have our babies we are quite vulnerable. There is much that can be done to improve the care for women, and midwives are such an important part of that. I want to acknowledge the work that midwives do every day. They come into a moment that is incredibly transitional in the life of a family, not just for the mother but for the partner and baby as well. Midwives deal with what can be an incredibly stressful and challenging—and usually wonderful—situation. I want to thank them.

In particular, I want to acknowledge the midwives at the Canberra Hospital who helped me give birth to my two beautiful babies. When I met with Maternal Health Matters, early on, we talked about the care that mothers receive, particularly the call for continuity of care, which, evidence supports, is the most important thing for a mother to be able to access in terms of their outcome and that of their baby. The evidence points to this as being incredibly important for the health of mother and baby, during and following birth.

Here in Australia we do very well, in terms of mother and infant mortality, with the exception of First Nations communities. But we don't do so well on the comorbidities around motherhood. We have high rates of postnatal depression. Around a third of women describe birth as traumatic. There is a lot more we can do for that. Continuity of care with a known midwife throughout your pregnancy and birth can help a lot. As a relatively recent first-time mother, I can say that to have the same person that you were seeing throughout that pregnancy means so much. For me, that was my GP because I couldn't access the continuous midwife care here in the ACT—simply because it's so popular. So many people want to access that.

In discussing these issues with Maternal Health Matters they said we judge a society by how it treats its most vulnerable. A penny dropped for me: we don't see new mothers as vulnerable in this country. We see babies as vulnerable, not so much mothers. And they absolutely are. This is a huge transition in their lives that can really go either way. It's that support from their community, from doctors but also from midwives, that we could have through this continuity-of-care model.

Many constituents have also written to me about this issue and about a new documentary that's come out, called Birth Time, in which Australian mothers share their journey. I've not yet been able to see this, but I'm going to a screening of it with Maternal Health Matters in July. I hope many in our community will be able to come along to that. It highlights some of the shocking realities that women face, and it shines a light on the unspoken epidemic of postnatal depression. Suicide is the leading cause of maternal death in the developed world. There is more that the federal government can do about this issue, because only eight per cent of Australian women have access to this model of care. I really hope that, as a parliament, this is something we can consider further and work further on. Again, I'd like to acknowledge all the people in my community who've written to me about this issue, the great work that Maternal Health Matters does and the midwives who support new mothers and their babies every day.

7:21 pm

Photo of Matt KeoghMatt Keogh (Burt, Australian Labor Party, Shadow Minister for Defence Industry) Share this | | Hansard source

It's my privilege to be able to speak on this very important bill, the Medical and Midwife Indemnity Legislation Amendment Bill 2021, before the parliament today. Of course, we're happy to support the outcomes that are sought by this legislation, to make sure that we are extending the availability of insurance arrangements to this very important cohort in our medical and health system across Australia, in particular our midwives.

Photo of Ged KearneyGed Kearney (Cooper, Australian Labor Party, Shadow Assistant Minister for Health and Ageing) Share this | | Hansard source

Hear, hear!

Photo of Matt KeoghMatt Keogh (Burt, Australian Labor Party, Shadow Minister for Defence Industry) Share this | | Hansard source

I hear the support from the member for Cooper and gratefully receive it, given her great history in that profession and of representing that cohort in our health professions.

As a father of two, I have experienced the great work of midwives in our hospital system, but I'm very well aware—through friends and family who have utilised and sought to utilise midwifery services in a range of different modes—of the importance of making sure that they have that access to midwifery care and that it can be properly insured and made available to as many people as possible.

The member for Canberra was just remarking on continuity of midwifery care. I think this is really important. I've also been contacted about this issue by groups from across our community, including midwives who live in the electorate that I represent and work in the hospitals in and near my electorate. Indeed, some people I knew when I was in high school who are now midwives have raised this issue. Frankly, it was something that I had not thought that much about, even going through the birth of my own children. But, when the issues that relate to continuity of care were presented to me, as well as the better outcomes—not just for the babies but also for the mothers and the entire family—as a result of that different mode of care, it became very clear to me that we need to make sure something is done differently in terms of the funding mechanisms and models for midwifery care to enable and encourage the states, in their delivery of that care, to make sure that families get better outcomes as they go through this critical time.

As the member for Canberra was just remarking, often we can take for granted in 21st-century Australia—especially in our urban centres and cities, where we may be able to live very proximate to great hospitals and healthcare systems—just how dangerous and stressful the entire pregnancy period is, for the mother, for both the parents involved and for the soon-to-be siblings in that changing family environment. We forget how dangerous pending motherhood, pregnancy and childbirth actually are. It's really only very recently in our development that we've been able to take these great leaps forward in our medical care and in the availability and changing modes of midwifery care. We've learnt more about how we used to deliver that care and we've made sure that the modes that were available and have since become unavailable are available again but in a safer environment.

It was dangerous. We lost many mothers through childbirth. There were conditions that simply don't exist anymore or, where they do, we know how to treat properly. We know how to identify the risk factors involved and make sure that different types of care or child birthing procedures are used so that we don't place the mother or the child at risk. They are things that we didn't know 20, 30, 40 or 50 years ago but can pick up on now. If there is continuity of care, we can pick up on them better and we can relieve stress for mothers. We can relieve stress for mothers more by making sure that the way they wish to deliver is available to them and that we can meet families where they are at. That is not just about whether they get to utilise these services in a hospital, a birthing centre or at home but also about remembering that we don't all live next to or near tertiary or secondary hospitals. We should remember that many in our community who are giving birth, as they should quite rightly be able to do, are doing that in remote communities many thousands of kilometres away from the nearest hospital. Making sure that we're able to send out, make available or have locally available that midwifery care is so very important so that people can give birth on country, in their community, so that they can be surrounded by family and their key supports.

Think about the experience of the last 18 months, particularly the middle months of 2020. Many women were giving birth in hospital on their own because others weren't allowed to be in the hospital with them because of COVID. Many in our modern, 21st-century urban society experienced some of the difficulty, stress and anguish experienced by those who have to travel far away from country in order to give birth utilising the improved medical facilities that are available to support families in our cities but often are not available in regional areas, remote areas or on country. We need to make sure that we are able to support those different modes by making sure that there are insurance and indemnities available via the passage of this legislation is vitally important.

More broadly, we need to remember that there are conditions that we are now better able to treat and keep a better monitoring eye on. We continue to think about those in the context of physical ailment, whether it's increased blood pressure or other physiological conditions experienced by pregnant mothers. But it's important to recognise the very important role that continuity of midwifery care can and does play for mental health through being able to pick up and discern minor differences of disposition and demeanour or to ask key questions of an expectant mother, whether they are a first-time mother or this is their fourth or fifth child. It means being able to identify that—hang on!—there is something not quite right, asking key questions and getting them to do the scale test on a regular basis so that stressors on the family and particularly on the expectant mother are identified and that appropriate services are brought in or appropriate referrals are made. It means being ready to catch that family post childbirth so that we can make sure that the right services are available to them where there may be postnatal depression or related issues that can occur.

It's important that we reflect and acknowledge that postnatal depression or postnatal mental health issues or illness are not limited to mothers. They are also experienced by fathers. Whilst there can be stigma associated with any sort of depression, it is important to acknowledge here in the parliament that that is not something that fathers should feel stigmatised about. If they feel depressed, if they feel that they are suffering or are not able to cope with the pressures that come with fatherhood, whether it's their first time or their umpteenth time, they should feel able to seek help. They should feel that it's okay to do that. We should better fund those services as well so that entire families are supported, because, as we know in so many walks of life, it's not just the person who may be suffering from mental ill-health but the family, the friends and the support systems around them who may also need support to help them. That's why I am very happy to support this bill.