BILLS (Second Reading): Medical and Midwife Indemnity Legislation Amendment Bill 2021

16 June 2021

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 first hand 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".