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Hon. Denis Napthine, MP Minister for Ports
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
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
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.