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- 16 September 2003
Nurses Amendment Bill
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Page: 3301
Second Reading
The Hon. TONY KELLY (Minister for Rural Affairs, Minister for Local Government, Minister for Emergency Services, and Minister Assisting the Minister for Natural Resources (Lands)) [8.15 p.m.]: I move:
That this bill be now read a second time.
I seek leave to have the second reading speech incorporated in Hansard.
Leave granted.
I have pleasure in introducing the Nurses Amendment Bill for the Parliament's consideration. The purpose of the Bill is to update the regulatory system pertaining to nurses and midwives in New South Wales in accordance with the recommendations of the recent review of the Nurses Act 1991.
The review of the Nurses Act, from which this Bill emanates, was conducted by the Department of Health under the auspices of the Competition Principles Agreement. That review has provided an excellent opportunity to review both the objectives that underpin the regulation of nurses and midwives and the mechanisms that are used to implement that regulation. The review concluded that the public interest is served by the regulation of nurses and midwives and that the regulatory system established by the Nurses Act 1991 is largely effective in ensuring that nurses and midwives are fit to practise and provide top quality health care services to the people of New South Wales.
However, the review also identified a number of areas in which the regulatory system can be updated and improved. Areas in which improvement is warranted include:
• Improving the powers of the Board to register or enrol a person subject to conditions. Increased flexibility in this area will allow the Board to be far more proactive in protecting the public in comparison to current arrangements that largely limit the Board to a reactive role.
• Amendments to allow the Board to appoint inspectors.
• Amendments to the mechanisms for the enrolment of nurses to afford applicants the same natural justice considerations as apply to applicants for registration.
• Updating of the Board's powers with respect to the emergency suspension of a practitioner where such action is necessary to protect the health or safety of a person, and with respect to impaired practitioners in the same manner as amendments to the Medical Practice Act.
Under the current Act recognition of competence to practise midwifery is by way of an additional authority granted to a registered nurse. Therefore all midwives must be registered nurses and are correctly known as registered nurses authorised to practise midwifery, rather than registered midwives. During the course of the review strong representations were received for a greater recognition of the professional status of midwifery within the Act. Whilst a wide range of views have been expressed about the form such recognition should take, the majority of practitioners, at the very least, see nursing and midwifery as linked by common education, philosophies and history. The outcome of the review acknowledged the benefits of nursing and midwifery being professionally linked in this way whilst recommending that midwifery be accorded a distinct status within the legislation.
Given this, and taking account of the increasing numbers of midwives from overseas who have training in midwifery alone without an underlying comprehensive nursing education, in other words direct entry midwives, the Bill establishes two separate registers, one for nurses and one for midwives. A person who is qualified as both a nurse and a midwife will as a condition of registration as a midwife also hold registration as a nurse. This will ensure there is no reduction in the flexibility within the workplace which dual qualifications in nursing and midwifery affords, particularly in rural and regional New South Wales.
It is also important that I place on the record the fact that all practitioners will continue to pay the same annual registration fee irrespective of whether they are registered as a nurse or as a midwife or both.
In keeping with this development midwives, who have demonstrated appropriate advanced practice to become eligible to be authorised nurse practitioners, will now be able to apply to be authorised midwife practitioners. The same criteria will apply to the approval by the Board of people to practise as nurse practitioners and midwife practitioners, and all such practice will continue to be under guidelines approved by the Director-General of Health.
These developments have the support of the New South Wales Nurses Association and the New South Wales Midwives Association.
The majority of the amendments contained in the Bill are designed to implement this development. Other significant changes in the Bill include:
• Proposed section 2A, which sets out the objectives of the legislation as:
(a) to protect the health and safety of the public by providing mechanisms to ensure that nurses and midwives are fit to practise, and
(b) to provide mechanisms to enable the public and employers to readily identify nurses and midwives who are fit to practise.
• Proposed section 4B, which provides a definition of competence to practise nursing or midwifery that includes adequate physical capacity, mental capacity, knowledge and skill to practise and an adequate command of the English language. This definition is important as it is linked to the proposed section 29A, which will allow the Board to refuse to register or enrol a person, or register or enrol the person subject to conditions following an inquiry into his or her competence. The procedure for such an inquiry is detailed in the proposed Schedule 1B. These provisions are in similar terms in all other recent health professional registration Acts and provide a valuable mechanism to help ensure that registered health professionals are competent to practise to the high standards that the community expects of them.
• The proposed increase by three in the size of the Nurses and Midwives Registration Board to provide a better balance and mix of skills. The additional positions are for:
o An additional nursing or midwifery academic. This position is required to ensure that the Board has adequate academic expert to manage the large amount of work involved in assessing and recognising tertiary education courses.
o An additional enrolled nurse to be appointed by the Minister. This change recognises that there are over 15 thousand enrolled nurses in New South Wales, who are very important and valued members of the health care team.
o An additional community representative to bring to a total of three the number of community representatives on the Board. Community representation recognises that the Board regulates the nursing and midwifery professions in the public interest and that consumers have a very important contribution to make to that process.
• The proposed establishment of the Nurses Practice Committee and the Midwives Practice Committee as standing committees of the Board. These committees are charged with advising the Board on educational matters to do with nursing and midwifery respectively and such other matters in the practices of nursing and midwifery as the Board may determine.
• The proposed Part 4 of Division 7, which will require nurses and midwives to provide the Board with a range of information when they renew their registration or enrolment each year and when charged with a criminal offence involving sex or violence that is committed in the course of practice or involves children. These provisions, which exist in similar terms in all other recent health professional registration Acts including the Medical Practice Act 1992, are appropriate within a protective jurisdiction and are designed to ensure that nurses and midwives are held to the same high standards of professional accountability another registered health professionals.
• Proposed sections 77A and 77B, which provide for the Board to appoint inspectors to investigate offences under the Act and for the powers of those inspectors.
The current Nurses Act includes a restriction on the practice of midwifery, although midwifery is not defined. This restriction recognises that the management of labour and childbirth is a skill that requires specialist training. Under those provisions only certain registered professionals and bona fide students are entitled to undertake midwifery practice.
The Nurses Registration Board has been unsuccessful in enforcing this restriction due to the difficulty of proving to the required standard of proof that a person has practised midwifery when the legislation does not include a definition of midwifery.
In response to this obvious problem the review recommended that the restriction on midwifery be replaced with a targeted restriction on those essential practices relating to childbirth that are of particular risk to mothers and babies if undertaken by inadequately qualified people. The Bill therefore proposes to amend the Public Health Act by inserting section 10AG into that Act. Proposed section 10AG will restrict the care and management of a pregnant woman during the three stages of labour to the same categories of health professionals and students as the current midwifery practice restriction, namely:
• registered midwives;
• registered medical practitioners,
• registered nurses and medical students acting under the supervision of a registered medical practitioner or a registered midwife; and
• midwifery students acting under the supervision of a registered midwife.
The proposed amendment addresses the problem of enforceability by providing a readily understood definition of the restricted practice thus providing an effective mechanism to help ensure that women in labour are cared for by appropriately qualified people.
I must stress that the existing restriction on the use of the title midwife will be retained and that title will only be available to registered midwives.
These changes have been supported by the Medical Services Committee, the New South Wales Nurses Association and the New South Wales Midwives Association.
There are minor amendments to the disciplinary system relating to nurses and midwives. These amendments do not seek to change the structure of the system, which will continue in its present form, but will update its operation in the same way as the disciplinary system under the Medical Practice Act has been updated. The important role played by the Health Care Complaints Commission, which is the independent complaints investigation body, will not be affected by the amendments introduced by the Bill.
As honourable members are no doubt aware nurses and midwives are rightly considered to form the backbone of the hospital system. The New South Wales Government has launched a number of initiatives designed to address the shortage of nurses and midwives, including the successful Nurses Re-connect program that allows nurses to be paid while undertaking an individualised and supported re-education program with the support of nurses already in the system. In this way nurses' skills are updated and recharged and there are no course fees because the scheme is fully funded by the Department of Health.
Honourable members will also be aware that last year the Government announced the creation of further nurse practitioner positions in Emergency Departments, Intensive Care Units and Mental Health Services in Sydney, the Hunter and the Illawarra. The expansion of Nurse Practitioner positions will further improve the career path open to nurses in NSW and provide additional incentive for senior experienced nurses to stay in the profession providing services to the citizens of New South Wales and passing their expertise and experience on to other nurses and nursing students.
The provisions of this Bill will help to ensure that the public can continue to have confidence in the professionalism of nurses and midwives and to expect the highest standards of competence and conduct from them.
I commend the Bill to the House.
The Hon. ROBYN PARKER [8.17 p.m.]: I speak on behalf of the Opposition on the Nurses Amendment Bill. I note at the outset that we do not oppose the bill. I place on the record my admiration for the role that nurses and midwives play in our health system. It is my view that nurses and midwives are rightly considered to form the backbone of the hospital system. However, I cannot understand why the bill is not called the nurses and midwives amendment bill. The legislation is the result of a review of the Nurses Act 1991, conducted by the Department of Health under the auspices of the competition principles agreement. The purpose of the bill is to update the regulatory system pertaining to nurses and midwives in New South Wales in accordance with the recommendations of the recent review of the Nurses Act 1991.
The review provided an opportunity to re-examine both the objectives surrounding the regulation of nurses and midwives and the mechanisms used to implement the regulation. The review concluded that the public interest is served by the regulation of nurses and midwives, and that the regulatory system established by the Nurses Act 1991 is largely effective in ensuring that nurses and midwives are fit to practise and provide top-quality health care to the people of New South Wales. However, the review also identified a number of areas in which the regulatory system could be updated and improved—for example, by improving the powers of the board to register or enrol a person subject to conditions. The main change proposed by the legislation relates to the way in which midwives are dealt with under the legislation. Under the current Act recognition of competence to practise midwifery is through additional authority granted to a registered nurse.
All midwives, therefore, must be registered nurses and are correctly known as registered nurses authorised to practise midwifery rather than registered midwives. During the review strong representations were received for greater recognition of the professional status of midwifery within the Act. There are a variety of views about this issue, but I feel there is a great deal of commonality between nursing and midwifery through their training and overall philosophy. I support the notion that midwifery should have its own individual status within the legislation. Because of this, and the fact that increasing numbers of midwives from overseas have training in midwifery alone without a comprehensive nursing education, the bill establishes two separate registers, one for nurses and one for midwives. A person who is qualified as both a nurse and a midwife will also hold registration as a nurse.
In future, nurse practitioners who have demonstrated appropriate, advanced practice to become eligible to be authorised nurse practitioners will be able to apply to be authorised midwife practitioners. The same criteria will apply to the approval by the board of people who practise as nurse practitioners and midwife practitioners, and all such practice will continue to be under guidelines approved by the Director-General of Health. These developments have the support of the New South Wales Nurses Association and the New South Wales Midwives Association. The majority of the amendments contained in the bill are designed to implement this development.
As a result of these changes, other proposals in the legislation include changing the name of the Act and the name of the registration board to include both nurses and midwives. The Act will be changed to the Nurses and Midwives Act 1991. The registration board will be changed to the Nurses and Midwives Board. The bill provides for an expansion in the composition of the board to provide a better balance and mixture of skills. The expanded board will include additional community representatives. The number will increase to three, in recognition of the fact that consumers have a key role to play in the regulation of nurses and midwifery professionals.
In recognition of the fact that there are over 15,000 enrolled nurses in New South Wales, the Minister will appoint an additional enrolled nurse. Additional nursing or midwifery academic representatives will ensure that the board has adequate academic experience to manage the large amount of work involved in assessing and recognising tertiary education courses. There will also be strengthened disciplinary provisions. Nurses and midwives will need to provide the board with a range of information when they renew their registration or enrolment each year, and when charged with a criminal offence involving sex or violence that is committed in the course of practice or involves children.
These provisions, which exist in similar terms in all other recent health professional registration Acts including the Medical Practice Act 1992, are appropriate within a protective jurisdiction and are designed to ensure that nurses and midwives are held to the same high standards of professional accountability as are other registered health professionals. I stated at the outset that the Opposition does not oppose this bill. However, we have some concerns that we would like the Minister to address. It would appear from what the Government has said about the legislation that some registered midwives do not hold nursing qualifications. If that is correct, will it then be possible for midwives who do not hold nursing qualifications to become nurse practitioners?
Concern also has been expressed that new section 4B, which provides a definition of "competence to practise nursing or midwifery", is limited in that it does not articulate the current meaning of "competence" within the profession of nursing and midwifery, and does little to reassure the public that practitioners of either discipline are able to provide safe and effective care. The view has been put forward that better collaboration with some of the professional bodies involved with nursing in this State could lead to a more articulate, accurate and functional definition.
My colleague in the other place and shadow Minister for Health, Barry O'Farrell, has expressed the view that it is disappointing that there is no requirement in this bill for nurses to demonstrate ongoing competence, such as through continuing professional development or any other mechanism, apart from paying an annual free to remain on the register. Concern has also been expressed that in order to continue to be registered as a nurse in this State all that one has to do is pay an annual fee.
The Opposition would like some consideration to be given at some point to ongoing training, rather than a mere payment of a registration fee, in line with other health professional registration requirements. In this day and age, the current proposal is hardly sufficient when viewed in the context of national trends surrounding quality and safety in health care. I note in this regard the national review of nursing education by the Commonwealth in 2002. The report, entitled "National review of nursing education 2002: Our duty of care", states:
Nursing is a professional occupation and nurses are the largest professional group of workers in the healthcare system. However, the nursing workforce includes people with a very diverse range of skills, knowledge and experience.
It is crucial that these professional people are able to maintain their competence, develop it through lifelong learning, and maximise their contributions in the interests of both themselves and the overall health care system. Furthermore, the future work force is likely to involve nurses working with other health professionals and care workers, if the best outcomes are yet to be achieved. As for continuing education linked to registration, the report stated:
One area of debate centred on whether or not continuing education should be linked to registration requirements, on the basis that this was fundamental to quality patient care …
The Opposition requests the Minister to give consideration to the requirements for registration. Many comments referred to in the report recommended that all State and Territory nursing legislation have a requirement for continuing competency for practice to be assessed on a range of indicators, including continuing education, prior to re-registration. It is my view that continuing education is essential for the strengthening of the nursing profession. I ask the Minister to explain the rationale of the Department of Health in not addressing those issues as part of the review. To me, it appears that continuing professional development in all medical fields is important in this day and age. That is certainly the case in countries that have addressed those issues. Further, I would appreciate a commitment by the Minister to address as a matter of priority the issues that have not been addressed. In conclusion, the provisions of the bill will help to ensure that the public can continue to have confidence in the professionalism of nurses and midwives, and to expect the highest standard of competence and conduct from them. I commend the bill to the House.
Ms SYLVIA HALE [8.30 p.m.]: The Greens support the bill. However, once again, consultation with the relevant professional bodies has not been as extensive as it might have been. The Nurses Association was consulted, as were representatives of the College of Nursing, but input from the New South Wales Midwives Association has been largely ignored. Midwives make up a very important part of the health care system. As more women choose to give birth in birthing centres rather than in the maternity wards of large hospitals, it is imperative that the profession be adequately supported and represented. To that end midwives deserve more than one secure position on a 16-member professional body. For that reason the Greens will seek an amendment to ensure that midwives are given additional representation on the Nurses and Midwives Registration Board.
The Hon. Dr ARTHUR CHESTERFIELD-EVANS [8.31 p.m.]: The Democrats support this progressive bill, which will significantly raise the profile and status of midwives in New South Wales. The bill will amend the 1991 Nurses Act to include representation of midwives practising in New South Wales on the Nurses and Midwives Board. Currently the Register of Nurses is divided into two lists. The bill provides that the register be merged into one list and that a separate register be created for midwives. Midwife practitioners entitled to be registered as nurses and midwives will be required to place their names on both registers. The bill outlines registering and disciplinary procedures as well as appeal mechanisms, which I will not detail. However, some key aspects of the bill are worthy of comment.
The name of the Nurses Registration Board will be changed to the Nurses and Midwives Board. The board will now be authorised to recognise study courses conducted in other Australian jurisdictions, entitling a person who has successfully completed a recognised midwifery course to practise in New South Wales. Procedural fairness is also a key component of the bill. The age restriction on registered and enrolled nurses will be removed, and an applicant will be given an opportunity to appear before the board before it rules on refusing an application for registration.
Private institutions seeking course recognition from the board will also have an opportunity to have the board's decision reviewed by the Administrative Decisions Tribunal. The bill also amends the Public Health Act by inserting a provision to restrict the management of labour and the delivery of babies to registered midwives and medical practitioners, and registered nurses, medical students and midwifery students acting under appropriate supervision. That provision has an exception for emergency cases. Health care students under appropriate supervision will be able to conduct spinal manipulation and certain electrophysical treatments. The Democrats have had a long association with a wide variety of midwifery advocacy groups, lobbying both the Commonwealth and State governments to recognise the crucial role midwives play in delivering health services. I have lobbied the former and current Ministers for Health regarding indemnity insurance for private midwives and access to midwifery services across the State.
Last September the Democrats at both State and national level endorsed the Maternity Coalition's National Maternity Action Plan, which is about choice for Australian women—freedom for women to choose how they are supported during their pregnancy and during the birth of their child. Primary midwifery services offer a one-to-one continuity of care to healthy women with referral to specialists on an as-needs basis. As a medical practitioner, I believe that we in Australia are locked into an intervention-prone medical model for having our children. Australia has one of the highest rates for caesarean section in the developed world. In stark contrast, 70 per cent of women in New Zealand choose a midwife as their primary carer. In New South Wales only 5 per cent of women have access to midwife-led care. This initiative will greatly assist in expanding services, and I am sure will lead to fewer costs associated with the public health system.
I acknowledge and congratulate the following people for their good work and advocacy over the years: Pat Brodie, the President of the New South Wales Midwives Association; Jan Robinson, the National Co-ordinator of the Australian Society of Independent Midwives; and Denise Hynd and Virginia Miltrup from the Maternity Coalition. On a purely pragmatic level, as well as coping with the increased requirements of the national competition policy, it could be said that this bill has relaxed the provisions and made it easier for people trained overseas and in other States to practise in New South Wales. Of course, that is partly a matter of necessity: we have to get every midwife we can. A change to the age registration requirements was also necessary.
A news release by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists dated 22 August entitled "Who is going to be left holding the baby?" presented a depressing picture of the numbers in the profession and the ageing of its practitioners. The press release referred also to a drift away from private obstetrics, which, of course, is driven to a large extent by the rise in annual indemnity insurance. Between 2000 and 2002 that insurance has increased by almost 50 per cent, from a median of $35,000 to $49,000. Dr Andrew Pesce from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists said there were problems associated with alternatives to private obstetrics. In June the Medical Observer reported that Federal Government figures showed a drop of 27 per cent in general practitioner obstetric services over four years. The college stated in its news release:
A recent report on the midwifery workforce showed that there would be a shortage of about 1800 midwives within 10 years and Australia's midwives were ageing and mostly working part-time.
Dr Pesce said: "General lifestyle issues appear to be a more significant factor than the medical indemnity issues. The stress of being on-call 24 hours a day, seven days a week, is not appealing to the emerging generation of specialist obstetricians and the older ones have had enough.
In Australia, who will provide obstetric services in future? The bill is intelligently trying to maximise the number of practising midwives, as well it might. A survey conducted by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists found:
The percentage of … obstetricians and gynaecologists … aged over 60 had increased from the last survey in 2000 and the percentage under 40 had decreased. A quarter of fellows are aged 60 and over.
There was now a slight majority of female fellows in the 30-39 age group. In the profession as a whole, female fellows had grown from 21 percent in 2000 to 23.2 percent in 2003.
Fellows in their 30's were less likely to be practising obstetrics in the private sector than those in their 40's and 50's. Females across all age groups were less likely to practise private obstetrics than males.
Less than half the qualified fellows were practising obstetrics in the private sector.
Of the obstetricians planning to quit public practice, 26 percent nominated lifestyle as a reason, 23 percent nominated age, 16.4 percent stated medico-legal concerns and 10.6 percent mentioned family.
Total hours worked in the week of the survey was a median of 51, compared to 50 in the last survey in 2000, with females working, on average, five hours less than males. Specialists in their 30's and 40's worked fewer hours than those in their 50's.
More than half the specialists had at least one night's sleep interrupted by the needs of a patient during the week of the survey and 18 percent had three nights or more interrupted.
There are about 1162 specialists actively practising obstetrics and gynaecology in Australia. Less than half of those (551) are practising obstetrics and only 300 are practising private-only obstetrics.
Those figures obviously mean that obstetricians and gynaecologists are facing a problem, which has been flagged. And it seems, having regard to the demographics, that the problem is likely to get worse. A document published by the Maternity Coalition indicates that in 2000 there were a total of 86,460 births, of which 4.5 per cent were to teenage mothers, and 17.7 per cent to mothers over 35 years. Clearly there is a trend for women to have children later in life.
Aboriginal and Torres Strait Islander mothers represent 2.4 per cent of that figure, two-thirds of whom live in rural New South Wales. Interventions are increasing. Inductions of labour increased from 20.5 per cent in 1996 to 23.6 per cent in 2000; vaginal births decreased from 70.7 per cent in 1996 to 67.1 per cent in 2000; there was an increased use of epidurals; the number of people who had no pain relief decreased from 14.9 per cent in 1998 to 12.2 per cent in 2000; and caesarean sections increased from 17.6 per cent in 1996 to 21.3 per cent in 2000. The bottom line is that the trend has been towards more intervention.
People in the Royal Australian and New Zealand College of Obstetricians and Gynaecologists are leaving the profession. The Government is changing the Nurses Act in an attempt to rectify the situation by maximising the number of practising midwives. It is worth noting the huge increase in women in New Zealand obtaining primary care from midwives. Since 1990, when legislative changes gave women universal access to midwifery care in New Zealand, the maternity budget has been reducing. Seventy-two per cent of women choose the care of a midwife, which is up from 1 per cent in 1990. That massive change in who delivers babies in New Zealand is significant. I do not know whether we will see a trend like that in New South Wales from a base of about 5 per cent; however, demographics relating to doctors, obstetricians and gynaecologists suggest that it is possible.
The Government is addressing that issue by maximising the number of midwives who will be able to practise, and that is a sensible move. The Government needs also to examine medical indemnity. In debate on the public liability and workers compensation bills my position was to look, first, at the preventive aspects of delivering a quality service and not leave it up to tort law to determine the benefits later—an undesirable policy. People must monitor the incidence of risky medical interventions. They must compile records of those who are making mistakes and those who are achieving bad outcomes, analyse those places or those people, and determine what is being done wrongly to minimise the harm being done. All that must be done systematically. We cannot merely rely on tort lawyers, watch premiums rise, and then argue about who will pay for a bad outcome or decide which cases will not be reimbursed if things go wrong. This bill is a step in the right direction.
The Hon CARMEL TEBBUTT (Minister for Community Services, Minister for Ageing, Minister for Disability Services, and Minister for Youth) [8.43 p.m.], in reply: I thank all honourable members for their contribution to the debate on the Nurses Amendment Bill. This important piece of legislation. will facilitate protection of the health and safety of the people of New South Wales through the introduction of a combination of new initiatives and the updating of procedures for ensuring that nurses and midwives are fit to practice and continue to observe high standards of professionalism. In recognising the importance of midwifery and the position it occupies in the health system the bill will play an important role in encouraging midwives back into professional practice—which can only be a good thing.
The amendments that the bill will make to the existing complaints and disciplinary system and with respect to the reporting of criminal convictions, findings and certain serious criminal charges will ensure that the disciplinary and reporting systems continue to operate in an efficient and effective manner that recognises the professionalism of nurses, midwives and the public interest. I turn to some of the issues that were referred to earlier in debate. I refer, first, to competence and continuing education. The whole scheme of the Act provides a robust system for ensuring that nurses are competent and fit to practice. While there are no specific requirements for continuing professional education in the current bill, the issue remains on the agenda and will be the subject of ongoing consultation with the nursing profession. A number of honourable members referred to consultation. I am advised that the New South Wales Midwives Association was extensively consulted during the drafting of this bill.
I refer next to midwife practitioners and nurse practitioners. New section 20 of the bill will provide an entitlement for a registered midwife to apply for authorisation as a midwife practitioner. That parallels a similar entitlement for registered nurses who attain an advanced degree and skill in their profession to become a nurse practitioner. I am advised that it will not entitle a person who does not have appropriate qualifications to become a nurse practitioner. I believe that that addresses most of the issues that were raised during debate. I thank all honourable members for their contributions and I commend the bill to the House.
Motion agreed to.
Bill read a second time.
In Committee
Clauses 1 to 4 agreed to.
Ms SYLVIA HALE [8.48 p.m.], by leave: I move Greens amendments Nos 1 and 2 in globo:
No. 1 Page 7, schedule 1 [26], line 11. Omit "16 members". Insert instead "17 members".
No. 2 Page 7, schedule 1 [26]. Insert after line 33:
(f) 1 is to be a registered midwife nominated by the New South Wales Midwives' Association, and
No-one would contest the fact that society undervalues nurses and midwives. Their lot is one of poorly paid and long hours, to which should be added the difficulty that many midwives encounter in obtaining professional indemnity insurance. Midwives in particular work under extraordinary conditions, caring for not one patient but two as they bring a new life into this world. In rural hospitals midwives often deliver babies without a doctor being present. In remote and Aboriginal communities they routinely deliver babies on their own. In birthing centres and at home births midwives often perform their duties with only the mother and her partner present.
The trend for natural births and less medical intervention in the birth process is a trend that should be supported. If there are no complications, giving birth can be a wonderful and a natural event. However, it is a potentially difficult process for all concerned. It is essential that the midwifery profession be adequately acknowledged, supported and represented. It is all the more puzzling, therefore, that the Government has been so deaf to calls for appropriate midwife representation on the Nurses and Midwives Board, whose function it is to promote and maintain professional standards of both nurses and midwives, to promote the education of nurses and midwives, and to advise the Minister on registration and practice standards for nurses and midwives.
The proposed restructure of the board increases the total number of positions to 16, but only one of these is designated specifically for a midwife. Seven positions are designated for registered or enrolled nurses and three are designated for community representatives. A further four positions may be filled by either nurses or midwives but in each case the pool from which the positions must be drawn consists overwhelmingly of nurses. In light of this it is far more likely that nurses rather than midwives will be nominated to the board. The almost certain result will be one midwife on a 16-member Nurses and Midwives Board—representation that is undeniably inadequate. At least two nominated positions on the board should be reserved exclusively for midwives.
The Greens amendments acknowledge all the professional bodies nominating representatives, although we question the need for nine from a total of 16 members to be ministerial appointments. The Greens amendments propose to increase the total number of board members from 16 to 17 by adding an additional position that would be filled by a nominee of the New South Wales Midwives Association. While the bill appears at first blush to offer midwives adequate representation on the board, in practice they will probably be limited to a single position. I urge all honourable members to support the New South Wales Midwives Association in its calls for representation on the board that is both adequate and guaranteed.
The Hon. CARMEL TEBBUTT (Minister for Community Services, Minister for Ageing, Minister for Disability Services, and Minister for Youth) [8.51 p.m.]: The Government does not support the Greens amendments. The board is already significant in size and representation and a further nomination from the New South Wales Midwives Association is not warranted.
Amendments negatived.
Schedule 1 agreed to.
Schedule 2 agreed to.
Title agreed to.
Bill reported from Committee without amendment and passed through remaining stages.
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