Chapter 1 - Introduction
Terms of reference
1.1
The matter was referred to the
Committee on 30
June 1999 for inquiry and report by 30 December 1999.
1.2
The complete terms of reference
are:
To inquire into and report by 30 December 1999 on childbirth procedures, with
particular reference to:
(a) the range and provision of antenatal
care services to ascertain whether interventions can be minimised through the
development of best practice in antenatal screening standards;
(b) the variation in childbirth practices
between different hospitals and different States, particularly with respect to
the level of interventions such as caesarean birth, episiotomy and epidural
anaesthetics;
(c) the variation in such procedures between
public and private patients;
(d) any variations in clinical outcomes
associated with the variation in intervention rates, including perinatal and
maternal mortality and morbidity indicators;
(e) the best practices for safe and
effective births being demonstrated in particular locations and models of care
and the desirability of more general application;
(f) early discharge programs, to ensure
their appropriateness;
(g) the adequacy of access, choice, models
of care and clinical outcomes for rural and remote Australians, for Aboriginal
and Torres Strait Islander women and for women of non-English speaking
backgrounds;
(h) whether best practice guidelines are
desirable, and, if so, how they should be developed and implemented;
(i) the adequacy of information provided to
expectant mothers and their families in relation to the choices for safe
practice available to them; and
- the
impact of the new Medicare rebate provided for complex births, including
the use of the term ‘qualified and unqualified neonates’ for funding
purposes, and the impact that this has had on improved patient care and
reduction of average gap payments.
Conduct of the inquiry
1.3
The inquiry was advertised in The Weekend Australian on 3 July 1999 and through the Internet. Submissions were also invited from
Federal, State and Territory Governments, hospitals, professional organisations
and other groups and individuals involved with childbirth in Australia.
The closing date for submissions was originally 6 August 1999, although the Committee continued to receive submissions throughout
the course of the inquiry.
1.4
The inquiry attracted wide
interest throughout Australia with the Committee receiving 190 public submissions and 5
confidential submissions. The Committee also received a substantial amount of
additional material from witnesses. Submissions were received from a wide range
of organisations and individuals including hospitals and health services,
practitioners, independent and hospital based midwives, welfare and peak
organisations, and individual mothers. The list of submissions and other written
material received by the Committee and for which publication was authorised is
at Appendix 1.
1.5
The Committee held six days of
public hearings in Canberra, Melbourne, Sydney, Adelaide, Brisbane and Perth.
Some hearings were held in hospitals: the Royal Women’s Hospital, Melbourne;
the Women’s and Children’s Hospital, North Adelaide; the King Edward Memorial
Hospital for Women, Perth; and the Mater Misericordiae Mothers’ Hospital,
Brisbane. While at these hospitals, the Committee took the opportunity to inspect
the maternity facilities available. The Committee also inspected maternity
facilities at the Mercy Hospital for Women in Melbourne and Queen Elizabeth
Hospital in Adelaide. On behalf of the Committee, the Chair visited the Kirwan
Hospital for Women, Townsville and inspected the maternity facilities including
the telemedicine project. Details of the public hearings and the witnesses who
gave evidence are listed in Appendix 2.
Acknowledgments
1.6
The Committee expresses its
appreciation to the individuals and organisations who made submissions to the
Committee or gave evidence to the inquiry. As always, the Committee places
great value on the submissions it receives as primary sources of information.
Many witnesses provided additional written information and copies of published
articles. This material was most helpful to the Committee during its
deliberations on the inquiry.
1.7
The Committee would like to
thank all the hospitals that opened their facilities for the Committee’s use
and also the hospital and medical staff who generously gave their time to
accompany Committee members on the inspections of maternity facilities. In
particular the Committee would like to thank Ms Therese Sampson from the Mercy
Hospital, Ms Ro Hogan and Ms Julie Webber from the Royal Women’s Hospital, Dr
Ross Sweet and Ms Joanne Harrison from the Women’s and Children’s Hospital, Dr
Brian Pridmore from the Queen Elizabeth Hospital, Ms Robyn Collins from the
King Edward Memorial Hospital, Mrs Jennifer Skinner and Professors Jeremy Oats
and David Tudehope from the Mater Misericordiae Mothers’ Hospital, and Mr John
Whitehall from the Kirwan Hospital.
1.8
The Committee’s inquiry was
greatly assisted through being able to discuss issues with Hospital staff and
to see first hand the services provided and the developments that are occurring
within hospitals.
1.9
The Committee would
particularly like to thank Mr Paul Mackey from the Social Policy Group of the
Department of the Parliamentary Library for the provision of material used by
the Committee in the preparation of this report.
1.10
A Bibliography has been
included at the end of the report. While not being comprehensive on the
subject, it lists recent reports, research outcomes and other source material
used by the Committee in the preparation of this report.
Consultancy
1.11
During the inquiry, the
Committee received conflicting evidence in relation to medical indemnity,
including the impact of escalating premiums for obstetricians, their fear of
litigation and subsequent loss to the profession. The Committee had minimal
success in attempting to obtain current data on medical indemnity to clarify
the situation.
1.12
The Committee engaged Ms Fiona
Tito to supply recent data on medical indemnity, including litigation in
obstetrics, and to provide an analysis of this data with observations and
recommendations relating to the escalation in litigation and costs. Ms Tito had
previously chaired the 1995 Review of Professional Indemnity Arrangements for
Health Care Professionals, which produced the report Compensation and Professional Indemnity in Health Care.
1.13
Ms Tito’s paper has been
incorporated, with some minor alterations and additions, as Chapter 10 of this
report. The Committee would like to thank Ms Tito for undertaking this work at
short notice and so late in the Committee’s inquiry.
Navigation: Previous Page | Index | Next Page