Friday, May 1, 2009

ACM and national registration - an update from Barb Vernon

I am writing to provide you with an update for ACM members on the vexed issue of national registration for midwives in private practise in 2010.

Firstly I'd like to reiterate that the ACM takes very seriously the potential for private midwives to be unable to re-register once national registration commences in 2010, due to the lack of affordable professional indemnity insurance and the insistence of the Council of Australian Governments that this requirement be linked to registration.

We have been active in pointing out to the Minister for Health and others the dire consequences if the insistence on evidence of professional indemnity is retained when private midwives are unable to comply with this requirement. The recent tragic death of a baby born to a mother who was unattended by a midwife reported in the media has given additional gravitas to the arguments put to government: that by effectively depriving women of registered midwives to provide care for birth at home, the risks to mothers and babies would become unacceptably high. Not to mention the totally preventable impact on members of the midwifery profession who are among the most experienced clinicians.

There is understandably much discussion on this issue among midwives providing care for homebirth, or interested in doing so, across Australia. It is important that such discussion is well informed To assist with informed discussion of the issues you may find it useful to be aware of the following points (not in any particular order of priority)

1. ACM has been advocating to the officials and ministers responsible for national registration of health professionals on the issue of access to indemnity for private midwives since the project commenced in 2006. This issue well and truly pre-dates the Rudd government, and the Maternity Services Review.

2. The national registration process seems to be proceeding apace but, frustratingly, there is no information about progress being shared by the officials leading the process at present. There was due to be a consultation form in April that was postponed indefinitely due to the creation of the Senate Inquiry into the National Registration Scheme Project, which may affect the timelines for implementation of the scheme

3. ACM has consistently opposed evidence of professional indemnity being a requirement of the scheme while private midwives are unable to access such indemnity. While we support the principle that consumers should have recourse to compensatory funding if they prove negligence (in the absence of any other funding support for parents or children with catastrophic injury related to childbirth, this is an ethical stance), but we have been advocating strongly to the federal health Minister, the department of Health and Ageing, the COAG officials and others since 2007 when the details of the scheme were first made public, that midwives are unable to meet this requirement and it must only be applied if midwives are again able to access affordable insurance as they were up to July 2001.

4. ACM has been actively collaborating with the member bodies of the Australian Peak Nursing and Midwifery Forum - which includes the Australian Nursing Federation, the Australian Nursing and Midwifery Council, the Royal College of Nursing Australia, the Congress of Aboriginal and Torres Strait Islander Nurses, and the Council of Deans of Nursing and Midwifery - in lobbying the Council of Australian Governments to respond to 2 key issues affecting midwives under the proposed national registration scheme. These include the establishment of a separate register for midwives from nursing (it was proposed midwifery would return to being a specialty of nursing) and the necessity of either exempting private midwives form the requirement to prove they hold professional indemnity, or resolving the market failure in indemnity to ensure they do have access to this before the national scheme begins. All APNF members have supported midwives in making these arguments to the ministers and officials. To date it looks as though there has been progress on gaining a separate register, but the indemnity issue remains yet.

5. APNMF has also submitted a submission to the Senate Inquiry into the National Registration scheme in the past week. APNMF members all endorsed additions by ACM to the submission which highlight the negative impact of the scheme on the safety and quality of maternity care if private midwives are unable to secure re-registration because of the lack of indemnity insurance.

6. The College has also prepared formal letters to all Australian health ministers, which will be sent out next week, on the issue of national registration and indemnity for midwives. I'll send you a copy of the letter once it is finalised. If any member who has not already done so wishes to write to their state health minister about these issues that would be useful. The health ministers have collective carriage of the national registration scheme implementation.

7. ACM has also met in recent weeks at 2 separate meetings with the CEO and Board of Directors of a major professional indemnity insurer. There is nothing concrete from these discussions as yet - but some promising lines of discussion. The insurer is targeting all health professions - not just medical practitioners and did not seem to have pre-conceived views of either midwifery or of homebirth. But there is much more discussion needed before we can be optimistic this might become a solution. Nevertheless it's an encouraging first step, more so than anything else over the past 8 years since indemnity became unavailable.

8. Lastly, and it probably goes without saying, the College has sought to advocate for midwives actively in the media. This has included mainstream television programs like the 7.30 Report, the Sunrise program and the Today Show, as well as in newsprint and radio media. A range of spokespeople have attempted to convey the importance of women being able to continue to choose the care of a midwife for birth at home after the advent of national registration. It is not always easy to get your message across. The appetite of the media for conflict as the basis for any story works against sensible and informed coverage of the issues sometimes. Nevertheless we are persisting.

Thank you to all members who are actively working to raise awareness of these issues with local, state and federal politicians, in your local media. It all helps. We will endeavour to keep you informed of any progress on this important issue.

regards Barb

Dr Barbara Vernon
Executive Officer
Australian College of Midwives


Tel: 02 6230 7333

Mob: 0438 855 529


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