Sunday, February 22, 2009

Recommendations 17 and 18

Blog readers will have noticed the information on the Maternity Services Review, and the Report which was published yesterday.

If you are wondering why this is important, the big question that looms, and that there was a widespread hope for a lifeline through the recommendations of the review, is the future of independent midwifery in Australia. Next year, from 1 July 2010, new legislation will be enforced requiring all health professionals to demonstrate suitable indemnity insurance arrangements for their private practices, in order to be registered. Every health profession, EXCEPT midwifery, is able to buy indemnity. The Australian government provides special indemnity arrangements for obstetricians and procedural GPs so that they can afford insurance.

The recommendations of the review are a long way from structural reform that will in any way change the status quo. The last two recommendations, #s 17 and 18, are of interest to midwives who provide primary care through the birthing continuum.

Recommendation 17:
That, noting the potential issues to be resolved including the potential interaction with Private Health Insurance arrangements, the Australian Government gives consideration to arrangements, including MBS and PBS access, that could support an expanded role for appropriately qualified and skilled midwives, within collaborative team-based models.

Recommendation 18:

That, in the interim, while a risk profile for midwife professional indemnity insurance premiums is being developed, consideration be given to Commonwealth support to ensure that suitable professional indemnity insurance is available for appropriately qualified and skilled midwives operating in collaborative team-based models. Consideration would include both period and quantum of funding.

Recommendations 17 and 18 give me no indication that any self-employed midwife – even those in privately operated group practices – will have any future under these proposed reforms.

Although we (self employed/private/independent midwives) collaborate constantly, using the ACM Guidelines (and basic common sense and knowledge of a midwife’s scope of practice), it would be difficult to argue that we practise in “collaborative team-based models” that would satisfy our colleagues. I wonder where the evidence supporting whatever is meant by that phrase comes from.

It was clear from the RANZCOG responses to the review and statements to the press that ‘independent’ midwives are not acceptable, and I am not in the least surprised by the lack of support for the midwife’s right to be employed directly by the woman, or the woman’s right to employ her own midwife/ves.

So ...
Although there is talk in the recommendations of indemnity insurance, there is no commitment to providing it so that midwives can continue our private practices. The next 16 months, leading up to 1 July 2010, will provide interesting subject material for this blogger.


Joy Johnston said...

What does all this mean?
I can't find any hope for the future of independent midwifery in those recommendations. It's not about homebirth - that can be done through the system. It's about the right of a professional to hang up a shingle and do the work they are supposedly qualified to do. In shutting down the independent midwife the government will be restricting the whole profession, putting a group of highly committed professional midwives, with an excellent record, out of work, and restricting choice for women.

Sif said...

This is appalling!

In these times, when unemployment is on the rise, to shut out an entire industry (however, small it might be in the scheme of things) is just outrageous!

I can imagine though that independent midwifery barely makes it onto the Government radar when considering health care provision for women. The belief would be that the demand is too low to consider it properly, for support.