what's happening in practice?
As you might recall from our November 2010 e-newsletter, the National Health (Collaborative arrangements for midwives) Determination 2010 was signed into law in mid July. The Determination defines the "collaborative arrangements" that midwives are required to demonstrate before a woman can receive Medicare rebates.
The Determination provides four options for collaborative arrangements. Each option requires the midwife to have some form of permission from a doctor.
The minimum form of permission requires a named doctor of a specific type to acknowledge "that the practitioner will be collaborating in the patient’s care", and that the named doctor has received copies of a hospital booking letter and a maternity care plan.
In theory, privately practising midwife can have a collaborative arrangement in place which could consist of an individual signed agreement with a doctor, a referral of a woman from a doctor, clinical privileging or an agreement signed by the medical director of a hospital.
HAS has always been concerned that these requirements will make it very difficult for women to access Medicare-funded care from midwives in private midwifery practice, when we are planning to birth at home, mainly because it is likely to be difficult to find private doctors who are willing to enter collaborative arrangements with them.
Now that the determination is in place, it appears that our fears were well founded - doctors and hospitals are refusing to collaborate with homebirth midwives and the result is effectively a 'right of veto' by doctors over both women's choice of care and of midwives' practice. However, it is important to note that the Determination only affects midwives seeking to access Medicare and midwives can -and are - choosing not to do this.
So what are the options for moving forward? You may recall that prior to the election, the Greens spokesperson for Health, Senator Rachel Siewert, committed that when the Senate next sat the Greens will move a motion to disallow the collaborative arrangements determination.
The Australian College of Midwives (ACM) met with the Minister's office recently to discuss the current state of play, and has proposed that changes be made to the wording of the determination which would resolve many of the outstanding issues including removing the words ‘named medical practitioner’ and removing the words ‘acknowledgement by a named medical practitioner’. The Minister has given no commitment to this proposal.
It is important to bear in mind that ACM represents midwives working in all settings – hospitals and in women's homes. As a consequence, the College has urged that the Determination should be left in place, and specific problems ironed out as they are identified.
ACM are concerned that disallowing the Determination (and lobbying to support a disallowance) is placing the whole maternity reform package at risk. The Government have said they will not reintroduce the determination if it is disallowed which means that no midwives in Australia will be able to access Medicare.
Homebirth Australia (HBA) have responded with the view that the Determination is completely unworkable and must be completely re-written. The full detail of HBA's position can be on the Homebirth Australia website.
It remains to be seen whether the Greens decide to proceed with their planned disallowance, in the face of differing views among midwives and homebirth consumers about the best strategy for moving forward.
HAS will keep members posted as things develop.