Thursday, September 30, 2010

Dissenting voices from ACMQ

This message has been distributed widely, and is posted here with permission of Dr Jenny Gamble, representing the Queensland Branch of the Australian College of Midwives.

E Bulletin from ACMQ Executive Regarding the Medicare Determination:

The distribution last Wednesday of an e bulletin from the ACM national office concerning the Medicare determination has caused considerable confusion amongst members in Queensland and we believe does not present all of the options available to us.

ACMQ Executive acknowledges that the ACM National President and Board members are working hard on this issue and making some difficult decisions representing the colleges view at a national level. This E bulletin to members is in no way meant to be divisive or to detract from the work undertaken at national level. However, ACM national has concentrated on one option in the e-bulletin and we seek to provide an alternative for consideration by members.

In agreement with ACM national ACMQ Executive unreservedly supports Medicare for midwives, but the determination needs to be changed.

ACM Queensland Executive continues to have a bottom line position that we will not accept a “collaborative arrangement” with a medical practitioner that requires a signed agreement or provides an opportunity for a doctor to veto a midwives ability to access Medicare funding.

ACMQ Executive does not endorse the ‘keep silent, don’t rock the boat it’s too high risk’ position proposed by ACM national. .
ACMQ does not promote putting Medicare at risk.

ACMQ Executive believes that by using fear-based tactics the minister’s advisors have created panic that Medicare will not start and thereby hope to prevent midwives lobbying to change the determination. It is the opinion of the ACMQ Executive that pressure from the government on ACM National to cease lobbying to alter the medical veto over midwifery practice is a deliberate strategy to stop pressure to change the wording of the determination.

The Minister has the ability to change the determination any time. She clearly does not want to do so (and is possibly under pressure not to do so by the medical lobby) and will not do so unless midwives lobby.
ACMQ Executive offers the alternative position that we do not change our lobbying strategy. Members continue to ask for the wording in the determination to be altered. We recognise that in the immediate term it is unlikely that this will cause the Minister to change the wording. However early next year, with more evidence, it may become more obvious that there is a real difficulty in the currently worded determination.

ACMQ Executive is of the opinion that the strongest strategy is to indicate that we do not accept the current wording allowing a medical veto and that we stick together on this.

ACMQ Executive believes continuing to lobby to change the determination before a motion to disallow can even be introduced, let alone voted on, does not carry the level of risk outlined by the ACM national e-bulletin.

Timeline for the Determination:
• Determination was signed off by Governor General on 16 July which means that the Medicare for Midwives legislation is ready to commence on 1 November.
• Parliamentary process requires that because the determination is only signed off by Governor General, it is tabled in parliament in first six sitting days of the new parliament (28, 29, 30 Sept 2010, 26, 27, 28 October 2010).
• On the day it is tabled a new timeline commences in which a motion to disallow can be introduced within 15 sitting days. Therefore, if the determination is tabled on 28 Sept (the first day of the new parliament) the last possible day on which a motion to disallow can be introduced is the first sitting day of 2011 which is late Feb or early March. There is nothing ACM can do to alter these timeline as it is a fixed parliamentary process.
• On 1 November Medicare for midwives will commence.

ACMQ Executive maintains the line that the determination is unacceptable, that we continue to lobby that it is unacceptable and that we demand a meeting with the Minister (not only her advisors).
All midwives who experience difficulty accessing Medicare due to an inability to obtain a signed medical agreement have the opportunity to keep the pressure on by notifying ACM national, ACMQ and the Minister’s office of the practical difficulties created by the determination.

If it turns out that the determination is working well and women have no difficulty accessing Medicare funded midwifery care this will soon become apparent. If this is the situation then any motion to disallow can be withdrawn as stated earlier.

ACMQ’s position involves lobbying to change the determination and buying time to see if the determination will or won’t work.

ACMQ Executive holds the view that a frank and fulsome communication between all members is required to ensure that a representative view can be tabled if the situation occurs that the determination will be voted on in the Senate/House of Representatives.

Before sending this communication we have considered all aspects of this complicated situation in detail. Thank you for considering this alternative option, it is now completely up to you as a member to decide if you would like to write to/contact your MP, the Minister, Jenny Gamble as our National Delegate and ACM National to lobby for the wording of the determination to be changed.

ACMQ Executive will continue to apply pressure and lobby to get the determination changed.

This e-bulletin is supported unanimously by the ACMQ Executive:
Hazel Brittain - President
Jodi Bunn – Executive Member
Jenny Gamble – National Delegate
Richard Hayes - Treasurer
Bec Jenkinson - Consumer
Marie McAuliffe – Executive Member
Mandy Ostrenski – Executive Member
Sue Rath – Executive Member
Mary Sidebotham – Vice President
Barb Soong – Executive Member
Teresa Walsh - Secretary
Kellie Wilton - Student

1 comment:

Joy Johnston said...

Having attended the Annual General Meeting of the Australian College of Midwives (ACM) today, it is clear that midwives are divided in our willingness to accept or reject the Determination.

The ACM President is encouraging members to accept the Determination, and work with it for at least six months. The advice from ACM is that if a motion to disallow was carried, which is a possiblity (although not very likely) in the current unstable arena of federal politics, midwives would lose any chance of access to Medicare.

Many privately practising midwives, as well as the Queensland Board of ACM, are holding to the opposing view: that the motion to disallow must be put, and that the Health Minister must know how very unsatisfactory this regulation is. The Minister has spent too much money on maternity reform to lose this jewel in her crown. She can alter the Determination if she wants to. She must be pressured to do so.

Midwives will not be compromised: by definition we must be able to practise in our own right, in any setting. Medicare is not worth the loss of that basic autonomy.

The way forward seems to be that all midwives who see the possibility of becoming eligible for a Medicare provider number to document any approach you make to doctors or hospitals, requesting collaborative arrangements that meet the requirements of the Determination. These examples will form the basis for an assessment over time of the workability (or lack thereof) of the Medicare reform process.