Hansard debates

   Hon. Denis Napthine, MP
  Minister for Ports
Second reading

  Dr NAPTHINE (Minister for Ports) -- I move:
  That this bill be now read a second time.
The  purpose  of  this  bill  is  to  amend  the  Drugs,  Poisons and Controlled
Substances Act 1981  to authorise midwives  with  a prescribing  endorsement  to
possess, use, sell or  supply certain scheduled medicines required for midwifery
practice.

I  should point out that  in  due  course  the  Drugs,  Poisons  and  Controlled
Substances  Regulations 2006 will  also be amended to  facilitate these changes,
and a list of medicines required for midwifery  practice will be approved by the
minister in accordance with provisions of the act.
I would like first to provide the house with some background to this bill.
In 2008,  the commonwealth government made  an election commitment  to develop a
plan to promote  the  national coordination of  maternity services. A  maternity
services  review  was  then undertaken  by  the  commonwealth  chief  nurse  and
midwifery officer with a report published in February 2009.
The  report made a  number of recommendations  including  expanding the role  of
midwives to deliver  greater access to a range of maternity care services within
a collaborative multidisciplinary care environment.

In  response to  the  review the  Australian  government  announced a  maternity
services reform package in  its 2009-10 budget and a National Maternity Services
Plan  2010 was  developed  following  national  consultation  and  agreement  by
Australian governments.
The plan provides a five-year vision for maternity  care  in Australia and gives
effect to the commonwealth's maternity reform package of budgetary measures.
In  accordance  with  the  plan,  Victoria,  along  with  all  other  states and
territories,  agreed to 'use  best  endeavours to amend  the relevant drugs  and
poisons  legislation  to  enable  appropriate prescribing rights for midwives to
facilitate  access to pharmaceutical benefits  scheme  (or  PBS)  subsidies  for
women'.

To  facilitate  the maternity  services  reform package,  in  November  2010 the
Australian Parliament  passed  the Health  Legislation  Amendment (Midwives  and
Nurse  Practitioners)  Act 2010 which  amongst other things  amended  the Health
Insurance  Act 1973  and National  Health Act  1953 to  add  midwives  as  a new
prescriber group.
Granting PBS authority for midwives at a commonwealth level, however, is not  an
authority to prescribe. It  is an  authority to claim the rebate for certain PBS
medicines. Authority to prescribe is 

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granted through state and territory drugs and poisons legislation.
To give  effect to this PBS access for midwives, all states and territories have
either undertaken, or are currently making the necessary legislative changes, to
authorise prescribing by midwives.
With prescribing authority, midwives  will be able to provide a broader range of
midwifery  services, working in close collaboration  with medical practitioners.
Their clients will also be able to  benefit from the commonwealth rebate schemes
for these services.
Without this authority, Victoria's midwives will be unable to provide a range of
private midwifery services. Victorian women and families will be more limited in
their access to maternity services and will not  benefit  from the public rebate
schemes set up for this purpose and now in operation across most of Australia.

I  would like to address the  issue of  safeguards in  relation to  the proposed
amendment to the act.
Firstly,  the  Nursing and  Midwifery  Board of  Australia  has  a comprehensive
regulatory framework for midwives inclusive of registration standards for:
  notation as an 'eligible midwife', which is one of the requirements to qualify
  for MBS and PBS authority; and
  scheduled medicines endorsement for midwives under  section 94 of the national
  law.
The  latter  endorsement is  the one  that  is  relevant  to  the  bill  we  are
considering today.

Secondly,  midwives  must  satisfy  the  board  that  they  meet  a   number  of
requirements  to  gain  this endorsement. These requirements include evidence of
current  competence to provide  pregnancy,  labour,  birth  and  postnatal  care
through a professional practice review. Midwives must also demonstrate that they
hold an  approved  qualification  to  prescribe scheduled medicines required for
midwifery care.
Thirdly,  endorsed  midwives  are  required,  as   are   all  registered  health
professionals under the national law, to have professional  indemnity  insurance
(except  where otherwise exempt) and to complete additional mandatory continuing
professional development each year.
Lastly,  and in  all cases, midwives who access the Medicare  or PBS  scheme are
required under the commonwealth act to have in place a collaborative arrangement
with a designated medical practitioner.

This might  be an obstetrician,  a medical practitioner  who  provides obstetric
services or a medical practitioner employed or engaged by a hospital authority.
I would now like to turn to the key features of the bill itself.
The bill will amend the Drugs Poisons and Controlled Substances Act 1981.
The  definition of midwife to be included in section 4 of the act means a person
registered under the Health Practitioner Regulation National Law --
  to practise in the nursing and midwifery profession as a midwife  (other  than
  as a student); and
  in the register of midwives kept for that profession.

Section  5  of  the  bill  amends  section  13(1)  of  the  act  to  provide  an
authorisation for  a  midwife  who  has  been  endorsed  under section 94 of the
national law to  obtain  and have in his or her possession  and  to use, sell or
supply any  schedule 2, 3, 4 or  8 medicines approved by the Minister for Health
and specified in the endorsement in the lawful practice of his or her profession
as a midwife.
Various amendments to  the act authorise endorsed  midwives to prescribe  in the
same  way as other health professionals  with  scheduled  medicines  endorsement
under the national law.
As I  indicated earlier,  section 7 makes provision in the principal act for the
minister to approve a list of medicines for midwife prescribing.

There is also provision for the minister to limit the circumstances  in which  a
midwife can prescribe,  for example,  to a  class, list  or type of medicine, or
with  reference  to the  form of  the medicine,  or the  purpose for  which  the
medicine is used, sold or supplied.
It is expected the list of scheduled medicines the minister will approve will be
developed   in   due  course  in  consultation  with  clinical  experts,   other
jurisdictions and the  board to reflect contemporary evidence-based practice and
best practice guidelines.
Summary
In summary, the amendments will enable clients of an eligible midwife to receive
comprehensive services and not  need to also see a medical practitioner or nurse
practitioner to have medicines prescribed for their 

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routine maternity care where this referral is unnecessary.
These amendments are made in  the  context of a strong regulatory framework that
will ensure that  only midwives  endorsed as having the competence to do so will
be authorised  to prescribe. The commonwealth  law for the purposes  of Medicare
and  PBS access  also  builds  in the  important  requirement of maintaining  an
ongoing collaborative relationship with a medical practitioner.
This bill  is  widely supported by  key  stakeholders and  will  align Victorian
midwives' practice with their professional colleagues in other states.
This bill  will  enable Victoria  to  fully  participate in  national  maternity
services plan 2010,  especially with respect  to  its intention to  provide more
maternity services for rural and remote communities.

Furthermore,  birthing women will be able to receive a PBS rebate for  medicines
prescribed as a part of private midwifery practice.
I commend the bill to the house.
Debate adjourned on motion of Ms NEVILLE (Bellarine).
Debate adjourned until Wednesday, 14 March.