Senate Community Affairs Legislation Committee [Part 2], , 3:39:51 to 3:53:31
Senator Sharma discusses the upcoming expiry of the insurance exemption for midwives and the new government-underwritten product for endorsed midwives attending home births.
Topics: Health, Workplace relations
Speakers: Prof Alison McMillan, Speaker 27, Celia Street, Unknown Speaker, Senator Ellie Whiteaker, Interjection
>> Thank you, Chair. >> Questions about the professional indemnity insurance exemption for So I understand the exemption that's in place that currently allows midwives to attend home births without professional indemnity insurance expires on the 31st of December or 1st of January.
>> Senator Allison McMillan, chief nurse. That's correct.
>> Okay. Um what will take its place,
>> Senator? There's now a insurance product available for privately practicing midwives and so there is no longer a need for the exemption. The exemption was introduced um at a time when no insurance product was available for privately practicing midwives.
>> Okay. And who will be providing that insurance product?
>> The insurance product is underwritten by the government. It's provided through an insurance company. Um whose name
>> that medical insurance group Austral
medical insurance company? Yes.
and who will be eligible to acquire that insurance product? My understanding is that um only endorsed midwives will be but so-called second midwives will not.
>> The exemption um will sunset at the end of this year. That's correct. the insurance product available is available for what is known as an endorsed midwife. So there's a midwife who's completed additional study and has been so endorsed by the nurse and midwiffrey
>> Okay. Is that product available for endorsed midwives now or will be available?
>> Yes, it is. It's been available for since um the middle of last year and and many we are aware that a number of midwives have taken up that insurance in preparation for the change in the exemption.
>> Okay. Um now as I said I understand and from people who are active in this community that it's relatively common especially in regional and rural areas for a second midwife to attend a home birth in the company of an endorsed midwife. Um and historically that second midwife has not has been covered by this exemption and has not they're obviously not endorsed because they're often in the process of training or acquiring the clinical hours. So what will be the situation uh from the 1st of January with respect to those second midwives?
>> Senator perhaps if I can um outline for you that all health professionals practitioners are required to have professional indemnity insurance in order to practice >> the situation was that at the time there was not a product available and the exemption was created um and approved by health ministers. the guidelines developed called safety and quality guidelines from the nurse and midwiffrey board of Australia require two a mid a midwife and another health professional to be uh attending at any home birth. There is a requirement for two um obviously for the importance of p of the woman and baby safety uh and to and to manage uh elements such as fatigue. So there is a requirement for two and in most cases senator it is two midwives who attend the birth at home um in support of that woman. Um both at the time because no um insurance product was available both um the primary and primary midwife and the u health professional the second health professional were exempt from insurance because the product was not available.
Now a product is available.
>> Correct.
>> But only one type of person is going to be eligible to
>> only those midwives who have been endorsed by the nurse and midwiffrey board of Australia. That's correct.
>> Yes. I understand there's public funding provided to the medical insurance group Australia to develop and administer this insurance product.
>> I'd need to take that on notice. I'm
figure of $3 million, >> but I I' be better to give you an
accurate figure than to to um
>> Okay.
>> Yeah.
>> Was there any consideration given to funding well given the Commonwealth was funding the development of this insurance product to ensuring that the coverage included second midwives or it provided some sort of group insurance model? I mean, was that option examined
>> when developing the policy proposal? Senator, a consideration was given as to the nature of the midwives who were delivering home birth. Um endorsed midwives have are also able to prescribe under the pharmaceutical benefit scheme and are able to access the medical benefit scheme. Um and also they have other access issues such as a what's called a midwiffery bag. it's the ability to carry medications um as part of their clinical practice. It was seen that endorsed midwives was an appropriate uh qualification or recognition for those that would be in elig would be eligible for the insurance product uh once it was introduced in July of 2025 and that was the policy position of government at that time.
>> Okay. I I just my understanding of the scenario for many home births in particularly in regional and rural Australas of Australia is that um firstly as you said you need at least two medical practitioners present. um the privately [clears throat] practicing endorsed midwife would not legally be able to attend to home birth without a second and particularly in regional and rural Australia, the seconds that are available tend to be non-endorsed. So what will happen? What's what are you going to do if you're a privately practicing midwife asked to attend a home birth in regional and rural Australia and the person you normally call on to accompany you to this home birth is is a second is not endorsed can't get insurance what happens then
>> so senator in this was quite a significant change uh in when the uh insurance product was um uh became available and so in preparation for an insurance product and the sun setting of the exemption. An 18-month period of time grace period was was allowed for in order to allow sufficient time for those that were intending to attend home births could um become eligible for the insurance. and in addition um an investment in um scholarships that um midwives were entitled to make an application for that would support them in the additional study required in order to complete the eligibility to become an endorsed midwife. So we put a number of mechanisms in place in preparation for the change from the removal of the exemption the 31st of December this year.
>> Okay. But to become endorsed, as I understand it, you need at least 5,000 hours or equivalent of three years of full-time clinical practice. How you going to do that in 18 months?
>> Well, it it doesn't you don't have to do it in 18 months to be able to demonstrate those 5,000 hours of of yeah of um experience.
>> But if you're a second midwife and you were told the exemption running out in 18 months, you think, "Oh, I better get endorsed." that you've only got 18 months of runway. Um, and that you need to get 5,000 hours, three years of experience.
>> So, Senator Selia Street, Deputy Secretary for System Strategy Group, it was over six years that they need to have built up that number of hours. So, that didn't need to be in the last 18 months.
>> But I mean, sorry, sorry, continue. I didn't mean to interrupt. Go ahead. No,
I was just so I was going to say it's not we weren't suggesting that within those 18 months that we were trying to make sure they'd had that number of hours they would have been able to bank some of those hours from previous service. Um so but I think we need to go back to the for the safety of the the birth. It's about making sure we have two qualified people that can support one another and this insure and all medical practitioners do need to have indemnity insurance. The exemption was because there weren't products available. the products are available. It's really it is important that we make sure that we're providing a safe
>> Yes. So, look, two two points on that. Firstly, um I take your point about within the past six years, but from what I understand, a lot of these people are at the very early they're commencing a career as a midwife, right? They don't have a past. They've only got a future. So, they're not going to be able to get there. Um certainly I mean I accept your policy rationale but isn't there a risk here that um you're going to push some of these things underground or off books so to speak. You'll have people doing home births um without any midwives. Uh I mean I don't understand what was thought given to designing a policy a product an insurance product that the Commonwealth was underwriting that would ensure that seconds had some level of
after this answer.
>> So, Senator, when the policy was considered um it was there was that this had been uh an issue for a number of years. The view was that the insurance product be available to endorse midwives. Endorsed midwives reflect a level of experience. You would want midwives attending a home birth who had completed uh 5,000 hours of experience or were were able to demonstrate that experience um because of the importance of identification of risk early escalation and the and the safe care of mother and baby um from a home may need um identification and movement to a hospital. So that that experienced midwife >> at home birth was considered an important part of the policy. Endorsed um are experienced midwives because of the requirement of the 5,000 hours before they're eligible to be endorsed. And with that comes the ability to prescribe and to order tests as well.
I I I I understand the explanation you're giving. I don't accept the rationale. I guess as my concern is that um we have a situation now where an endorsed midwife has in has a level of experience will always be attending the home birth. But we have a situation now where the person they would normally take with them in regional and rural areas where a lot lot of these other health practitioners are not readily available um uh are not going to be available or have insurance. So, you're either taking someone who doesn't have insurance potentially. I don't think you're doing that if you're an endorsed midwife. Or if you're committed to having a home birth, you're possibly doing it without any um medical assistance. I mean, has those consequences been modeled and thought through? Because from what I understand from groups like home birth Australia and others, this is their concern and then I'm happy to leave pass the
so that was a lot in one step. So the nurse doing currently are reviewing the the requirements for an endorsed midwife. That review is underway but it will not be complete before the end of this we have been working and meeting on a regular basis with home birth Australia as we did as um the chief midwife did today. and we continue to work with them in order that we can um encourage those making cho their birth choices around if a second midwife is not available at birth then then other birthing choices are offered to the woman in a timely way. Um and it is important to emphasize that that birthing without a health professional uh with you is a very dangerous thing to do and we would not encourage anyone to do that. We would encourage them to seek >> um guidance through their mid their midwife as to the best available option to them if home birth is no longer going to be a choice for them at that time. Senator, the other thing is that in this time that we've been working on this, the growth in public funded home birth has increased significantly and almost all states and territories are now delivering publicly funded home birth as well and the final state what um state is Tasmania and it is working towards publicly funded home birth as well.
>> Thank you. In the interest of time, I'm happy to save the culture. Thank you.
>> Thank you, Senator Sharma. Senator