ACM President on the Determination

The following response has been received today, 30 September 2010, from Hannah Dahlen, President of the Australian College of Midwives. It is in response to an email from me, expressing my disagreement with the position taken by the ACM in accepting the Determination (see previous posts).
I consider it essential that our College should ensure that midwives are able to continue to practise midwifery on our own authority.
Hannah has asked me to post her comments at this blog. The message I received from Hannah is posted here without any change.
Joy Johnston

I agree this Determination is far from perfect and we have fought it in every way possible to have it changed. In New Zealand it took them 17 years to get a National Access Agreement and they had many little steps along the way to achieve the final outcome. We have received some concessions now from the Minister that take us away from sign off by an individual doctor and these include being able to have clinical privileging with a hospital (the old visiting rights) and this will be considered a collaborative agreement.
The National Maternity Plan, which is the most midwife friendly plan I have ever seen, contains an evaluative framework for the uptake of the Eligible midwife along with commitment to State and Territory clinical privileging, which as I said could in itself form a collaborative arrangement. This means we can keep a very close eye on where it is working and where it is not. The Minister has promised to us (ACM) and the ANF that she would change the Determination if is not working but this would not happen in the first months of roll out which is why the idea of disallowing and dragging out the debate until next year won¹t work. If it does drag on until next year Midwives could have started accessing Medicare and have women booked and it could all fall over and where would these women and midwives be left stranded. The Minister has made it clear that she will not change or put up a new Determination if it is disallowed. There are many midwives in the College that have fought for access to Medicare for twenty years now and the College cannot let this be lost at the last moment.


This not a good piece of legislation by any stretch of the imagination but you rarely get everything you want the first time in reform. I believe there are enough ways we can make this work and then hold the government to account for changes when it does not. The AMA have also been told the same thing by the Minister very clearly and I quote ³If we do not embrace these changes then pressure will mount on the Government to relax the requirement for collaborative arrangements to be in place² (Andrew Pesce).


We have sought legal advice over the best way to approach this as we desperately want the best for women and midwives and have clear advice that ³disallowance is not the appropriate means by which to seek amendments of the Determination² and it is highly risky with current volatile coalition who are willing to say NO to everything not because they care about midwifery but just want to say NO.


It is important to note that the Determination does not affect all midwives only those who choose to become eligible midwives and want to access Medicare. It is also important to note that the Determination has been removed from the Quality and Safety Framework after much protesting on ACM¹s part. It is also important to note that even the MIGA policy has a care plan option that gets around the collaborative arrangement with a doctor. There is nothing in VERO if that is the choice midwives make.


Just to remind people that we have made many changes and gains along the way in this reform process. We began with the Eligible midwife needing five years experience, a Masters degree and to be a Midwife Practitioner.
Homebirth was nearly going to be made illegal last year. We have got removed from the Insurance Bill the requirement for a collaborative arrangement with a named practitioner. We have had the Determination removed from the Safety and Quality Framework. These are big gains and yes we haven¹t got what we wanted from the Determination.


I think often with reform we need to take a foot in the door approach and then wedge that door open and get through with all the changes that need to be made. ACM has not given up on this and have sent a letter to the Minister for Health yesterday once again asking for named practitioner to be removed and acknowledgment to be removed. We will I promise not give up. There seem to be all sorts of rumours flying including a crazy one about the ACM doing a deal with the AMA. Can I assure you all this has not occurred and will not occur and we remain as committed to women and midwives as ever.


With respect and good wishes
Hannah Dahlen
President ACM