Monday, May 11, 2009

Health Minister's Council

This report has been distributed to members of the Australian College of Midwives.

Last Friday, 8 May 2009, the Health Minister’s Council met to discuss some details of the National Registration Scheme for Health Professionals. A copy of the Communiqué is available at the website.

This Ministerial meeting was the latest in a project that has so far stretched over more than two years, with at least five such communiqués following Ministerial meetings.

Separate Registers for Nurses and Midwives

One positive decision of the Ministerial meeting was confirmation that there will be two separate registers managed by the Nursing and Midwifery Board of Australia – one for nurses and one for midwives. Previously it had been proposed that midwives would be members of a single register with nurses and enrolled nurses.

Midwives will be able to remain on both registers if they wish to, or elect to confirm their registration on the midwifery register but not the nursing one or vice versa. Separate registers will make possible distinct regulation of midwifery, as well as enhancing the ability for robust workforce data to be collected about midwives.

Continuing Professional Development

The Ministers also decided that all registrants in the new scheme will be required to demonstrate that they have participated in an approved professional development program during the preceding year. The Board for each profession will be responsible for determining which programs will be recognised.

The Nursing and Midwifery Board of Australia does not yet exist, but once it does ACM will apply for the MidPLUS program to become recognised programs that will assist midwives to meet this requirement. MidPLUS has already been endorsed by many of the existing state/territory Nursing and Midwifery Boards which is expected to assist with the application.

Professional Indemnity Insurance

In reviewing the Minister’s Communiqué, some people have concluded that it’s lack of reference to professional indemnity insurance means that this will not be required for registration. Unfortunately, this is not an accurate interpretation.

There was no discussion about professional indemnity -- for midwives or for any other health professional -- at this meeting because the meeting only addressed aspects of the scheme on which ministers and officials judged that changes were needed in light of consultations that have take place over the preceding six months.

We have not yet succeeded in persuading ministers to change the requirement that midwives, like all other registrants, be required to hold professional indemnity insurance, vicariously through an employer, or directly if self employed, even though such insurance is not currently available in Australia for private midwives.

ACM is continuing to lobby actively for federal government support to address the market failure in indemnity insurance for midwives, with a view to ensuring that all self employed midwives can access a policy before the new national register commences on 1 July 2010. We are also liaising with insurance industry representatives.

Mandatory Reporting

One of the areas of the Communiqué that raises some difficult questions is that of a decision by the Ministers that

“there will be a requirement that practitioners and employers (such as hospitals) report a registrant who is placing the public at risk of harm. Ministers agreed that reportable conduct will include conduct that places the public at substantial risk of harm either through a physical or mental impairment affecting practice or a departure from accepted professional standards. Practitioners who are practising while under the influence of drugs or alcohol, or have engaged in sexual misconduct during practice must also be reported. This requirement will deliver a greater level of protection to the Australian public”.

While ACM supports increased provisions to protect the public, we are at the same time concerned about how ‘a departure from accepted professional standards’ might be measured and applied. We will be seeking clarification on this point from the relevant officials at the earliest opportunity.

Handling of Complaints

Another potentially challenging aspect of the proposed new scheme is that there is not yet a clear and consistent process proposed for handling complaints of professional misconduct. The Health Ministers have essentially compromised differing interests and legislative requirements by agreeing that the details of how any such complaints will be handled will remain the responsibility of each State or Territory, which may choose to opt in to the national scheme processes, opt in for some aspects but not others, or continue to handle these things outside of the national scheme. This creates considerable uncertainty, and will impose an additional burden on midwives who may work in more than one jurisdiction as they will continue to need to be mindful of differing laws relating to their practice, as happens now. ACM will be actively seeking to ensure that the processes established by the Nursing and Midwifery Board of Australia follow appropriate processes of natural justice, and that appropriately experienced midwives are involved in all cases where the conduct of a midwife is being reviewed.

Student Register

Under the scheme, all students, including midwifery students, will be registered. The details of how and when are yet to be determined.

For more information about the proposed national registration scheme, visit the National Health Workforce Taskforce website link posted at the top of this email.

regards Barb
Dr Barbara Vernon
Executive Officer
Australian College of Midwives

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