Minority Report
By Senator Rachel Siewert, the Australian
Greens
In my Dissenting
Report, dated August 17th, 2009 I welcomed the initiatives contained in the three pieces of
legislation - the Health Legislation Amendment (Midwives and Nurse
Practitioners) Bill 2009, the Midwife Professional Indemnity (Commonwealth
Contribution) Scheme Bill 2009 and the Midwife Professional Indemnity (Run-off
Cover Support Payment) Bill 2009 - however I was and remain concerned that these Bills do not address the needs of many Australian
women who make the choice to give birth outside the hospital system. I am concerned
that the option for a safe and accessible home birth, supported by an
appropriately qualified and registered midwife, will be limited or removed
altogether as a consequence of the introduction of these bills.
Collaborative Arrangements
The Government has
introduced an amendment to their legislation requiring midwives to have collaborative
arrangements in place with a medical practitioner in order to register. I acknowledge and
support the Minister’s intention that Medicare funded midwives should work
collaboratively with medical and other health professionals as needed in the
care of women and their babies. I do not however, agree that it is necessary to
legislate for collaborative arrangements in order to achieve this goal.
Collaboration with medical and other health professionals is already encoded in
the regulatory framework within which midwives work in Australia. Disciplinary
action may be taken by regulatory boards if midwives are found to practise in a
non-collaborative manner.
I agree with the
Australian College of Midwives that midwifery
is a profession committed to the provision of collaborative care. I believe it
is essential. I agree that, ‘There is no argument that women choosing the care
of a private MBS funded midwife must have ready access to appropriate medical
care if and when the need arises for themselves or their baby’[1].
I agree with the Australian College of Midwives that
the issue is how collaboration is ensured.
I believe the inclusion of
collaborative arrangements in legislation may undermine how midwives work
collaboratively with medical and other health professionals. I agree with the
Australian College of Midwives that a midwife should be able to demonstrate
their adherence to safe, collaborative practice through the use of formalised
maternity care notes for each woman for whom they provide care, which can be
audited by Medicare Australia or the Nursing and Midwifery Board of Australia
as appropriate.
I agree with the Australian
Nursing Federation that the consequence of the government's amendments to the
bills will mean that a medical practitioner could have veto over the ability of
a midwife to practice.
I agree with the Australian
Nursing and Midwifery Council who have argued that collaborative practice
between midwives, nurse practitioners and other health professionals are
already legislated through the professional framework developed by the
Australian Nursing and Midwifery Council.
The Department of Health and
Ageing commented during the inquiry that a consensus position on collaborative
arrangements had not yet quite been reached in the various advisory groups
associated with this legislation. I am concerned that legislation should be
presented before Parliament before advisory groups have been able to complete
their work and believe this has contributed to the confusion and concern felt
by many stakeholders not least the patients themselves.
Conclusion
I
support the Minister’s intention that Medicare funded midwives should work
collaboratively with medical and other health professionals as needed in the
care of women and their babies. I don’t agree that it is necessary to legislate
for collaborative arrangements in order to achieve this goal. In fact I believe
it will have a negative impact. Collaboration with medical and other health professionals
is already encoded in the regulatory framework within which midwives work in Australia.
Disciplinary action may be taken by regulatory boards if midwives are found to
practise in a non-collaborative manner.
Consultation
and referral (collaborative practice) appropriate to midwives’ scope of
practice is an area which is already regulated. Midwives currently have
competency standards which directly refer to consultation and referral and
collaborative practice, and clear practice guidelines on when to consult or
refer. The Government’s amendment changes the relationship giving one medical
profession, the doctors, control over the ability of another, the midwives, to
practice. This is not collaboration.
Many
women whose babies are due after 1 July 2010, when these requirements come into
force, have already commenced care with a private practice midwife. It will
remain unclear for some time under what conditions they can receive birth care
from their midwives, if at all. If these amendments proceed, these women’s
birth care will also be determined by their
midwives’
ability to establish the required collaborative arrangement between midwives
and medical practitioners.
Recommendation
That
the Health
Legislation Amendment (Midwives and Nurse Practitioners) Bill is amended by
replacing reference to ‘collaborative arrangements’ with a requirement that eligible midwives demonstrate
collaborative practice and that in the definition of a participating midwife, midwives would be required to demonstrate ‘collaborative
practice’ by using standardised clinical documentation for planning and provision
of care. This would record specific indications of collaborative practice, in
particular consultation and referral as required, with the consent of the women
for whom care is provided.
Senator Rachel Siewert
Australian Greens
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