NURSING AND MIDWIFERY PRACTICE BILL

Second Reading

Adjourned debate on second reading.

(Continued from 11 November 2008. Page 578.)

The Hon. G.E. GAGO (Minister for State/Local Government Relations, Minister for the Status of Women, Minister for Consumer Affairs, Minister for Government Enterprises, Minister Assisting the Minister for Transport, Infrastructure and Energy) (15:55): In summing up, I thank all honourable members for their contributions. Questions were asked in the other place regarding refresher and re-entry courses for nurses and midwives. An assessment is made by the board to ascertain whether registration can be approved, or whether the person will need to undertake an approved re-entry program. The assessment includes the length of time that a person will need to undertake an approved re-entry program. The assessment includes the length of time that a person has been away from the practice of nursing or midwifery; the breadth and depth of nursing or midwifery experience that the person has acquired following initial registration; the person's continuing professional development in nursing or midwifery; and any nursing or midwifery related activities undertaken during the period of absence.

The board approved re-entry program can be undertaken as a short continuing education course of a minimum of 14 weeks' duration. That includes a theoretical component and clinical experience placement to demonstrate that the ANMC national competency standards are achieved. Alternatively, the board approved re-entry program can be accessed as a pathway through the bachelor of nursing or midwifery whereby a person receives recognition of prior learning for previous education and experience and completes the outstanding units of study, including a clinical experience placement, to demonstrate national competency standards.

Commonly, this results in the person completing a minimum of two semesters of full time study of the three year or six semester bachelor of nursing or midwifery course. The person is not only eligible to reregister with the board but also may have the added benefit of upgrading their existing nursing or midwifery qualification to a bachelor degree. The Royal Adelaide Hospital and the Flinders Medical Centre provide state-wide nursing and midwifery refresher and re-entry programs on behalf of SA Health. Refresher and re-entry program funding is provided for the theoretical component of the program, which allows students to access courses free of charge, along with a scholarship grant, to assist them with their financial needs related to their education.

These programs commenced in 2001 and to date 67 programs have been conducted, with 802 participants having finished these programs, being 581 re-entry and 221 refresher participants. There was a total of 12 refresher and re-entry programs for 2007-08 with a total of 82 participants: 30 in the Royal Adelaide Hospital, and 52 at the Flinders Medical Centre. Of these 12 programs, I am pleased to inform the Hon. Sandra Kanck that there were two programs for midwives conducted jointly by the Flinders Medical Centre and the Women's and Children's Hospital, with 11 participants in each program. The funding that has been allocated to date by the government is $6.7 million. The Hon. Michelle Lensink sought information on the national registration and accreditation scheme for health professionals currently being developed as a result of the COAG agreement. The bill recently introduced into the Queensland parliament is the first of three bills that will establish the national registration and accreditation scheme.

A further bill will be passed by the Queensland parliament in late 2009 and, following that, a bill will be introduced into the South Australian parliament to adopt the Queensland act. At that time changes will be made to South Australian health professional registration bills to enable the national scheme to be implemented. The national scheme is expected to take effect from 1 July 2010, and it is intended that the scheme will cover all aspects of regulating the registered health professions, including accreditation, registration and disciplinary matters. Information on the development of the national scheme is available on www.nhwt.gov.au/natreg.asp.

In regard to proposed amendments to the Controlled Substances Act 1984 relating to the management of drugs of dependence in residential aged care facilities, I am advised that a number of consultations have occurred and that amendments to the Controlled Substances (Poisons) Regulation 1996 are currently being drafted.

The Hon. Michelle Lensink sought to know the total quantum of expenditure on nursing and midwifery agencies throughout the health system in South Australia. I am advised that SA Health is investigating and developing a statewide strategy for the management and utilisation of agency nurses and midwives and that the cost of agency nurses and midwives for 2007-08 was approximately 7 per cent of the total cost of employing nurses and midwives in the public sector.

I am pleased to be able to provide the following information in response to issues and questions raised by the Hon. Sandra Kanck during her speech on Tuesday 28 October. In response to a request from the Hon. Sandra Kanck, I can inform the chamber that the caesarean rate in South Australia in 2007 was 32.3 per cent, which is slightly lower than in 2006, which was 32.9 per cent. The rates were 28.4 per cent for all public hospitals, both metro and country, and 43.7 per cent for metro private hospitals. The caesarean section rates in the five metropolitan private hospitals ranged from 35.1 per cent to 54.8 per cent. The pregnancy outcome unit does not collect statistics on the person or category of health professional that is in charge of the birth, so it is not possible to provide a breakdown in figures based on whether the birthing was at the hands of a midwife or an obstetrician.

Private independent practising midwives have been seeking professional indemnity insurance cover through either federal or state government arrangements because it is either not available in the private sector or, if it is, the cost of the insurance is prohibitive. The provision of services by private independent practising midwives is separate from the services provided by the public health system. States and territories provide professional indemnity insurance for health professionals, including midwives, who are employed within the public health system.

Generally, the states and territories do not extend public cover to private sector health care providers. The current government has raised this issue with the federal government seeking possible alternatives in light of the unavailability of affordable professional indemnity insurance coverage for private independent practising midwives. I can also inform the council that the state government has paid $140,457.35, I think it is, in the year to date for 2008-09 for the GP Obstetrician Indemnity Scheme. The aim of this scheme is to support rural and remote doctors to remain in and to provide a service to country hospitals.

The Minister for Health established the safe conduct and respectful behaviour task force in late 2006 to identify and develop strategies to prevent and manage violence, aggression and bullying within health care settings. The task force is currently focusing on violence and aggression and is working with the University of South Australia to develop interventions, using a participative research design that builds on existing strategies to reduce violence, aggression and bullying directed at employees from people within the health system within the broader context of improving the psychosocial working environment.

This research will inform the current activities of the task force as follows: develop standardised documentation for the prevention and management of harmful behaviour in the form of SA Health violence and aggression policy guideline and resource kits, using a hazard management framework; develop an education and training framework, which will include a multifaceted approach, incorporating de-escalation techniques; and develop a public awareness campaign in conjunction with the Department of Health's Communications Division. The key message is that violence is not acceptable and that we value our employees. The respectful behaviour approach includes adopting a respectful behaviour framework, which promotes multi-systemic strategies to engage the workforce in desired behaviours and which is reflected in all levels of the organisation. It is anticipated that the task force will provide a final report, I think to the Minister for Health, including the actions and any further recommendations, by 30 December 2008.

In response to the final point raised by the Hon. Sandra Kanck, I can inform the council that educational requirements between enrolled nurses and registered nurses differ in that enrolled nurses are educated within the TAFE vocational sector in a task model and registered nurses are educated using evidence, research or academic inquiry and accountability of practice. Traditionally, the VET sector has not been seen as a high research academic provider within the same context as universities.

The Australian Nursing and Midwifery Council (ANMC) defines the enrolled nurse as an associate to a registered nurse and one who must demonstrate competence in the provision of patient-centred care, as specified by their licence to practise, educational preparation and context of care, whereas the registered nurse provides evidence-based nursing care. Again, I would like to thank all members of the council for their contribution to this important bill.

Bill read a second time.

Committee Stage

In committee.

Clauses 1 and 2 passed.

Clause 3.

The Hon. SANDRA KANCK: I move:

Page 6, line 11 (clause 3(1), definition of midwifery)—

After 'antenatally' insert:

, at the birth

I see this as being a tidying-up amendment. If members examine the bill itself it defines midwifery and then '(whether such treatment, care or advice is provided antenatally'—which means, obviously, before the birth—'or postnatally)'—which means after the birth, but there is a sort of middle point which is neither before the birth nor after the birth—which is at the birth of a child. I think that logically we need to include that crucial point.

The Hon. G.E. GAGO: In relation to this amendment to line 10—'(whether such treatment, care or advice is provided antenatally or postnatally)' you want to include 'at the birth'. We are happy to support that in principle, but you might want to reconsider the wording. The term recognised internationally and by the Australian College of Midwives is 'intrapartum', which means the first, second and third stages of labour.

The Hon. SANDRA KANCK: I am happy to accommodate that suggestion. I seek leave to amend my amendment.

Leave granted.

The Hon. SANDRA KANCK: I move:

Delete ', at the birth' and insert 'intrapartum'

Amendment to amendment carried; amendment as amended carried; clause as amended passed.

Clauses 4 to 27 passed.

Clause 28.

The Hon. SANDRA KANCK: I move:

Clause 28, page 20, after line 36—After subclause (1) insert—

(1a) The objective of the Board in approving and recognising qualifications and determining requirements under subsection (1) must be to ensure that a midwife is able to give total care to a woman and her baby during pregnancy, labour and postnatally up to at least 6 weeks.

This is essentially a philosophical perspective and reflects in some ways the international definitions of midwifery. We do not have an objective clause in this bill, but this is a more subtle way of having such a clause. It is stating what midwives want to see happen, and that is that a midwife should be able to give total care to a woman and her baby during pregnancy, labour and postnatally up till at least six weeks.

It is desirable; it is not saying that it has to be that way. However, by putting it in these terms, saying that it will be an objective of the board, it allows that philosophical position to be espoused without forcing anybody to do anything. I think it will make midwives feel more comfortable that this quasi-international definition is fitted into the legislation.

The Hon. G.E. GAGO: The government is opposed to this amendment. I understand the intention behind it but, unfortunately, putting that into words creates all sorts of potential problems for us, particularly around the terminology 'total care'. This amendment is actually not necessary for a start, because it is pretty much covered within the scope of the act in terms of your intention. We would need the definition of total care because we know that it is actually outside the scope of the role of a midwife to provide total care to a woman under any circumstance. For instance, a midwife will not take responsibility for repairing an appendix or such like. I know the intention, but the words make the scope of it much broader and bring in a range of unintended consequences that are outside the role, function and qualifications of a midwife.

The Hon. J.M.A. LENSINK: I do not think the Liberal Party can accept the amendment either, not for any philosophical reason but merely because on my reading potentially it could be challenged in a court. There is too much in there that is in the form of prescribing treatment. The minister referred to the word 'total' and said 'up to at least six weeks'; I find those sort of inclusions in a clause in a bill such as this objectionable for tying up the profession with potential legal problems. It might not arise for the vast majority of operations of midwives in their practice, but in some cases it could be quite detrimental to the profession as well as to individuals.

The Hon. SANDRA KANCK: Obviously the numbers are against me on this, but I make the observation that an objective hardly ties you in black and white to things, and I said that that is what it is. By simply saying that my objective is to achieve something does not mean that someone will take me to task because I did not achieve everything within the objective, as that is the whole idea of having an objective. I am disappointed it will not get up, but I can do the maths.

Amendment negatived; clause passed.

Remaining clauses (29 to 85), schedule and title passed.

Bill reported with amendments.

Bill read a third time and passed.