Drugs, Poisons and Controlled Substances Amendment (Supply by Midwives) Bill 2012

Written on the 29 March 2012

I am pleased to rise to speak on the Drugs, Poisons and Controlled Substances Amendment (Supply by Midwives) Bill 2012, and I do so for a number of reasons. First, this legislation, as already mentioned by Mr Jennings, will bring us into line with other states and territories. Further, as a former midwife I have had firsthand experience in the administration of many routine drugs and medications in midwifery practice. I believe that anything that enhances midwifery practice is not only good for midwives but also good for the women and babies they are caring for.

 



I will return to my experience a little later in my contribution, but first I will comment on a couple of points raised by Mr Jennings and Ms Hartland in their contributions. I am pleased that they are both not opposing the bill.

 


I acknowledge the role of former governments that have participated in putting together the national framework. That was an important initiative to undertake. Mr Jennings made mention of some Koori communities with very high birth rates, which was definitely the case in my experience. Also in my experience of working in the area of diabetes in pregnancy, which is a high-risk pregnancy area, as members would know, there is also a greater risk of Koori women developing diabetes and having greater adverse outcomes in relation to their pregnancies and births. Those are two very important issues that will continue to need to be monitored.

 


In relation to the aspect of funding, which was raised by both Mr Jennings and Ms Hartland, Mr Jennings made the point that there needs to be significant investment made in health, and he called on the government to do so.
 

 

Ms Hartland also made reference to maternity services in the west and particularly those increased birthing rates over the past five years, which indicates a lack of planning under the previous government to cater for the growth that has occurred out in those regions especially. Now it is up to the Baillieu government to pick up the pieces and assist in that task of delivering appropriate health services.

 


She also made mention of the health planning and resourcing as a priority. I am pleased to say that in last year's budget the Baillieu government put $13.06 billion into the health budget.
 

 

The previous budget, in 2010-11, under the former Labor government was $12.341 billion, so there is a significant increase of 5.9 per cent in the health budget -- the greatest spend in the state of Victoria in the health budget that has been undertaken. That increase in the health budget compares with an increase of 1.6 per cent in the population, so I see that as a significant investment at the outset and as something that cannot be ignored by the Victorian public. Certainly the Minister for Health and other members of the government should be acknowledged for their hard work in relation to the health budget because this is a very expensive and demanding area of government and one that needs to be closely monitored, which is exactly what we are undertaking.

 


But getting back to the bill, as Mr Jennings highlighted this is a relatively straightforward bill. Its purpose is to provide for suitably qualified registered midwives, whose registration has been endorsed by the Nursing and Midwifery Board of Australia, to possess, use, sell and supply a number of drugs used in the course of midwifery practice. In accordance with the Drugs, Poisons and Controlled Substances Act 1981 the midwives will be authorised to use those drugs specified on a list approved by the minister. The bill also empowers the minister to specify at which health services and in which clinical circumstances the drugs may be used.
 

 

Clause 5 of the bill inserts into the principal act section 13(1)(bc), which adds registered midwives to the list of health professionals authorised by section 13 to obtain, to have in his or her possession and to use, sell or supply scheduled substances. The new section provides that a registered midwife, whose registration is endorsed by the Australian nursing and midwifery board, may obtain, have in their possession and use, sell or supply those drugs, as other allied health professionals have been able to do.
 

 

This bill will, under a strong regulatory framework, further enhance the authority of midwives to have greater prescribing rights and be able to provide a greater range of services, thereby improving access to maternity care for all Victorian women and their families.
 

 

It will give greater flexibility to those eligible midwives, greater choice to those women they are caring for during their antenatal and intrapartum periods and the best possible outcomes for the women themselves and their babies in their antenatal, intrapartum and six-week postnatal periods.
 

 

This issue, as was highlighted, arose from a federal government election commitment to develop a plan to promote the national coordination of maternity services. In doing so the National Maternity Services Plan 2010, of which I have an extract, states that it:
 

 

...recognises the importance of maternity services within the health system and provides a strategic national framework to guide policy and program development across Australia over the next five years.
 

 

The ...plan has been developed within the context of broader changes to Australia's health and hospital systems. On 13 February 2011 all Australian governments signed a heads of agreement on national health reform and committed to signing a full national health reform agreement by 1 July 2011.
 

 

As I mentioned, it was a five-year plan. The plan goes on to state:
 

 

Maternity care will be woman-centred, reflecting the needs of each woman within a safe and sustainable quality system. All Australian women will have access to high-quality, evidence-based, culturally competent maternity care in a range of settings close to where they live. Provision of such maternity care will contribute to closing the gap between the health outcomes of Aboriginal and Torres Strait Islander people and non-Indigenous Australians. Appropriately trained and qualified maternity health professionals will be available to provide continuous maternity care to all women.

 

Victoria, together with other states and territories, has undertaken this action to amend the relevant drugs and poisons legislation that will enable appropriate prescribing rights for midwives to facilitate access to the pharmaceutical benefits scheme, or PBS, to allow subsidies for women. Of course giving PBS authority to midwives is an authority to claim a rebate to certain PBS medications as listed. Authority to prescribe is granted through respective state and territory drugs and poisons legislation. The explanatory memorandum points out that clause 9(1) empower the Governor in Council to make regulations for or with respect to the prescribing of the scheduled poisons that a registered midwife is authorised to obtain and have in his or her possession and to use, sell or supply.
 

 

The explanatory memorandum goes on to say that clause 9(2) amends other regulation-making powers in section 132 relating to the scheduled poisons that a registered midwife is authorised to obtain and have in his or her possession and to use, sell or supply. That is pretty straightforward at the outset. What midwives can prescribe is restricted to a list of scheduled medicines which has been approved by the minister, and they are fairly routine medicines -- things like narcotic analgesics; antiemetics; non-steroidal anti-inflammatory agents; penicillins, which are quite routine in midwifery practice; anti-fungal agents, which again are quite routine for the neonate; oxytocic agents of course, in the intrapartum period; vaccines postpartum; and various analgesics.
 

 

There is an available list. It is not an exhaustive list, obviously, of medications, but it gives a midwife ability to practise and enhance the care of the woman she is looking after.
 

 

I say it is not exhaustive because there are many other drugs that are used in maternity care and practices, from my experience working at the Royal Women's Hospital. Mr Jennings made reference to the Royal Women's Hospital and the funding that the former Labor government gave to relocate the hospital. That issue was going on for quite some time. In fact when I was there from 1990 to 2000 it was an ongoing discussion, and I am delighted to see the new Royal Women's Hospital. Even though I had a significant amount of time in the old location, certainly the advancements at the Royal Women's Hospital are state of the art and give great care to Victorian women.
 

 

During my time at the Royal Women's Hospital I specialised in the high-risk area of diabetes in pregnancy.
 

 

I worked with a highly specialised team of health professionals, including obstetricians, endocrinologists, ophthalmologists and dieticians, and we all worked together to enable the best possible outcomes for both the mother and baby during those periods of pre-pregnancy, pregnancy and the postnatal periods.
 

 

Often I was monitoring and adjusting insulin levels, working closely with endocrinologists, obstetricians and in some cases country Victorian GPs to enable those best possible outcomes; but I undertook specific further tertiary education and obtained a further tertiary qualification to be able to do so. It was not the standard list of drugs that we are talking about in this instance.
 

 

If the act is not amended to provide for endorsed midwives to obtain, possess, use or supply scheduled medicines, Victoria will not be able to participate fully in the National Maternity Services Plan 2010, especially with respect to the provision of more maternity services for rural and remote communities, and I think that is terribly important. Without prescribing authority Victorian midwives would not be able to effectively utilise the Medicare benefits scheme items that would facilitate access to a greater range of collaborative care models, which is also equally important.
 

 

In conclusion, this legislation has been widely supported by a range of stakeholders. It gives greater flexibility to midwives and women during their pregnancy and their six-week postnatal period. Women will be able to receive a PBS rebate for medicines prescribed as part of a private midwifery practice and otherwise.
 

 

The bill brings Victoria into line with other Australian states and territories. Importantly, it enables those women who live in rural and remote areas to have greater access to a range of midwifery services, as I have already said. It further enhances health services to Victorian women and their families, and again I am pleased that the opposition parties are not opposing this bill. I commend the bill to the house.

 

 

[The ACTING PRESIDENT (Mr Ramsay)] -- Order! Thank you, Ms Crozier. I recognise your considerable experience and knowledge in this area.

 

 


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