I endorse the words of the member for Lyons in his contribution this morning. This Health Legislation Amendment (Removal of Requirement for a Collaborative Arrangement) Bill 2024 is a very important bill, a timely bill, and one that gives me great personal excitement to see coming through the House.

So I rise today in support of this bill. I do so with the confidence that comes from having worked alongside nurse practitioners and endorsed midwives for many years, both clinically and in a research capacity. And I do so as someone who led a rural cohort of nurses studying for their Masters Degree in Advanced Practice Nurse Practitioner 15 years ago. These nurses went on to deliver desperately needed specialised care across aged care, critical care, emergency departments, mental health, palliative care, drug and alcohol services and diabetes. The educational program they undertake is rigorous, difficult and comprehensive. Added to that, these nurses come with extensive clinical experience leading into that masters degree preparation.

My first-ever published peer-reviewed journal article was about enablers and barriers to establishing a nurse practitioner model of care. My professional collaborations with local GPs and physicians during that time saw some fantastic teamwork, which has endured to this very day. I truly thank nurse practitioners and endorsed midwives for the extraordinary service and leadership they’ve given over such a long period of time, while being hamstrung by this particular collaborative agreement legislation that we’re about to change. I thank the supportive general practitioners and medical practitioners who stepped up 15 years ago and who have championed and supported nurse practitioners and midwives over so many years. Our health service in Wangaratta produced Victoria’s first-ever gerontic nurse practitioner, and many have followed since then. It wasn’t easy; there were many barriers to getting this model of care off the ground. But, as they say, time honours the brave, and it kind of feels a bit special to be talking about this today. In addition to what I know about this, there has now been 20 years of Australian research accompanying this model of care. It has shown conclusively that nurse practitioners and endorsed midwives provide safe, satisfying and effective care.

I want to speak briefly about my confidence too in the endorsed midwives. Prior to coming to this place, I worked clinically as a midwife for many years, including in caseload midwifery group practice, where, together with my team, we provided continuity of midwifery care for countless numbers of rural women. The evidence for this model of care is now overwhelming, from right across the world, that it reduces preterm and early birth, reduces the use of non-medical-required Caesarean sections and leads to great satisfaction—not just for women but for men too. It’s important work, and I’ve been very proud to be part of it.

The report Woman-centred care: strategic directions for Australian maternity services clearly showed that women want greater access to continuity of midwifery care and, in accessing that care, they need access to midwives who can provide that care under Medicare and prescribe under the PBS. Most critically, women from First Nations settings want to access continuity of midwifery care alongside the principles of closing the gap through birthing on country. It’s an absolutely critical campaign that we need to get behind in closing the gap for women and babies from First Nations communities.

The challenges facing our health system are enormous. We need only to look at the data to see that. The most recent ABS National Health Survey data from 2022 showed: 81.4 per cent of people in Australia had at least one long-term health condition; 49.9 per cent, so one in two people, had at least one chronic condition; mental and behavioural conditions sat at 26 per cent; back problems sat at 16 per cent; and arthritis, at 14.5 per cent, was the most common of the common chronic conditions. Many people with chronic conditions often have more than one condition, something we call multimorbidity. Then there are the almost one in three people living in areas of most disadvantage who have two or more chronic conditions compared to one in eight of those living in areas of least disadvantage. So the more disadvantaged you are the greater chance you have of chronic, long-term and multimorbidity conditions.

Added to this is the seemingly intractable problem reported by the Australian Institute of Health and Welfare time and time again that the number of employed full-time equivalent clinicians working in registered health professions decreases with increasing remoteness—a trend we’ve seen year on year. There are more registered clinical full-time equivalent health professionals in major cities than in all regional and remote areas of Australia combined. The single biggest group of health professionals, though, who are in rural and remote Australia are nurses and midwives. Right now, amongst these nurses and midwives are endorsed midwives and nurse practitioners who can only work to their full scope of practice if they have a collaborative agreement with a doctor. Patients cannot access their care and receive MBS and PBS rebates unless this collaborative agreement is in place. Nowhere is this more problematic than in rural, remote and regional Australia, where the needs are so great and where there is the greatest acute shortage of general practitioners and medical practitioners.

The Australian Rural Health Alliance commissioned work showing each person in rural Australia is missing out on nearly $850 per head per year of healthcare access, which equates to a total annual rural health spending deficit of $6.5 billion. The burden of disease in remote areas is 1.4 times that of major cities. So, in short, there is more work than the current system can handle, and the people who are most likely to miss out are the people who need care the most.

Nurse pensioners and endorsed midwives can contribute to bridging that gap, but right now we have built in redundancy to the capacity of our health workforce. Nowhere is this more evident than in rural Australia. This bill will help address that. The bill before us is sensible and timely because it enables two critical groups of highly trained and trusted health professionals—nurse practitioners and endorsed midwives—to put their considerable expertise to these health challenges without the handbrakes and hurdles that patients currently face in accessing their care. Currently these nurse practitioners and midwives are required to enter into a legislated so-called collaborative arrangement with a doctor to be able to prescribe under the PBS and to provide services funded for a Medicare rebate. They are the only health professions that have legislated collaborative agreements to enable them to access the MBS and PBS. If they can’t find a medical practitioner to enter into this agreement, they cannot give their patients access to the MBS and PBS. The passing of this legislation will bring nurse practitioners and endorsed midwives into line with all other healthcare professions.

This bill will amend the National Health Act 1953 and the Health Insurance Act 1973 to remove the legislated requirement for a collaborative arrangement in order for an eligible midwife or eligible nurse practitioner to prescribe under PBS and provide services under Medicare. It’s so critical, so important and so timely. This bill recognises that nurse practitioners and midwives are autonomous professionals who deliver high-quality care to patients within their scope of practice.

Importantly, given my introductory remarks, this bill will remove barriers to health care for Australians, particularly in rural and remote Australia. It will support more a effective use of the existing health workforce, which was recommended by the Strengthening Medicare Taskforce report and the Nurse Practitioner Workforce Plan.

An independent review of collaborative arrangements was commissioned by the Department of Health and Aged Care, and this included an analysis of Australian and international literature and extensive stakeholder consultation on the efficacy and appropriateness of collaborative arrangements. The findings of the independent review supported the need for clinical collaboration between all health professionals. It’s a no-brainer; of course you need to collaborate. However, it found that the current legislative requirements for these collaborative arrangements can create unnecessary barriers to care. There has been pushback from some professional groups who say this is not a good thing. However, again, if you look at the international research, local research and independent review you will see that there is indeed no evidence, not a scrap, to say that there is any danger, problem or reason why we would not get rid of these collaborative arrangements.

The skills and experience of nurse practitioners have been leveraged across the world for over 50 years, with the role formally legislated in Australia in 1998. I remember very well when Nicola Roxon, the then minister for health, was at the forefront of introducing nurse practitioner legislation to this House. The only problem at the time was that there was pushback from some professional groups, and the collaborative arrangement was inserted into the legislation. So here we are now, ready to wind it back.

The ability for nurse practitioners to work autonomously and collaboratively within a multidisciplinary health team, and their ability to undertake advanced clinical care, indicates they are well positioned to provide flexible and affordable health services to Australian communities, and we need them so desperately. Compared to the international experience, though, in Australia the roles of our nurse practitioners and endorsed midwives have been substantially underutilised, and this bill is going to help fix that. In her second reading speech, the minister said:

Removing the legislative requirement for collaborative arrangements will not impede clinical collaboration or the delivery of care. These health professionals are already regulated by the professional standards for practice and quality and safety guidelines issued by the Nursing and Midwifery Board of Australia, which require collaboration with other health professionals. This is an actionable standard under the Health Practitioner Regulation National Law Act as in force in each state and territory.

In other words, the collaborative agreement is an add-on to what is already there under national law. It’s simply not necessary. I’m really pleased to have read in the press that the coalition also supports this legislation, so this truly is a bipartisan reform, and that’s really pleasing.

Let me conclude by using the words of two nurse practitioners from my home town of Wangaratta. Both of them are pioneers and outstanding clinicians, and they’ve had their shoulder to the wheel for longer than I care to remember. The first experience is that of an endorsed gerontic nurse practitioner—in fact the very first one to be trained and registered in Victoria. He’s now had more than 15 years in the role. In 2020 he was called to the very first COVID-19 outbreak in Melbourne, at an aged-care facility. These are his words:

Everyone working together to achieve the best we could for our community, society and residents.

From my medical colleagues, there was no prejudice towards me about being an NP and my qualification. Collaborative arrangements were not mentioned. There was nothing but respect from the doctors for my clinical input and decision making. There was no thought of having to supervise my work. It was simply a team who had mutual respect for each other and striving for the best outcomes for the residents. I have never seen a more streamlined and unfragmented model before.

I dare say that the outcome would not have been the same if I had been hamstrung/restricted by doctors insisting on the full scope of CA’s.

At this time, although the normal GPs did not come into the facility, I made every effort to communicate and collaborate with the GPs about their residents. They very much appreciated this. It reinforced to me that collaboration is about communication and the rules around current CA’s were superfluous and a barrier.

A second nurse practitioner also caring for older people said:

I’ve been a Nurse Practitioner, caring for the older person, for the past 13 years in a regional/rural setting. I work in an in-reach program which endeavors to support Residential Aged care Facilities (RACF) to provide acute care outside of hospitals as much as possible. Older people don’t always do well in the hospital system away from the familiarity of their home, family and carers. We are able to attend to such things as infections, chronic disease, pain and falls to name a few. We are also able to provide palliative care with symptom support for the person dying and emotional support for their family. This is, of course, happening in complete cooperation with their GPs. My medical colleagues in General Practice are increasingly stretched and it is only through our continued relationships and communication that we are able to achieve responsive health care for our most complex and frail community members. Please bear in mind that there are a growing number of older people in RACFs who are not able to secure the services of a GP…

And therefore no collaborative agreement can be reached, so they have no access to a nurse practitioner either.

Nurse practitioners have a unique insight into the care of people across our community. In closing, this legislation is important and necessary, and the time has come for it to be passed. I want to thank Assistant Minister Kearney for all the work she has done on this; it’s substantial, important and right, and I look forward to further work around the health professional scope of practice. I commend this bill to the House with great joy.

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