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Home > Ministers > The Hon Nicola Roxon MP - Minister for Health and Ageing > Media Hub > Press Conference - Health Minister’s meeting, health and hospital reform, homebirths, swine flu, IVF

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PDF printable version of Press Conference-Health Minister’s meeting, health and hospital reform, homebirths, swine flu, IVF (PDF 39 KB)

04 September 2009

E & OE

Nicola Roxon: Thank you for coming. Obviously we've had a very constructive meeting of Health Ministers today and I'm joined by both Paul Lucas, the Minister from Queensland and John Hill the Minister from South Australia.

I can report a number of very difficult and important issues have been dealt with today at the Health Ministers meeting, including a fruitful discussion of the Health and Hospitals Reform Commission report and the recently released Prevention Taskforce and Primary Care report.

It's very important from the Commonwealth's perspective that the states and territories are engaged in this process. Indeed they have a very high stake in this debate and the future shape of our health system, as those who run health systems health systems successfully around the country.

So that was a useful discussion and, of course, there will be a more formal process as part of the special COAG meeting that the Prime Minister has announced will be at the end of this year.

We also have discussed the H1N1 influenza situation. We had a presentation from Professor Jim Bishop, the chief medical officer, about the latest trends for swine flu. We've had discussions about the implementation plans that are well advanced in all of the states and territories.

You would be aware that the Commonwealth has received, under its contract with CSL, the first two million doses of the vaccine. They have been pre-deployed by CSL to each of the jurisdictions and we have agreed, as jurisdictions today, that it is desirable, of course, for us to commence the vaccination program as soon as possible after the TGA has approved the vaccine for use.

We have today received more data from CSL, so that will be assessed by the chief medical officer and, of course, separately the TGA of the regulator who will be assessing that information as it continues to be provided to them by CSL as the results of the human trials continue to be provided.

We have made a significant decision, and what I regard as a very important breakthrough in the national registration and accreditation program, and that is a resolution of the home birthing issue. Many of you will be aware that there were concerns as a result of the state's and commonwealth signing onto the registration of accreditation for 10 professions which, of course, are about lifting standards and ensuring that people are both registered, accredited and to be registered are insured.

This presented a particular problem for home birthing midwives, where there is no insurance product available, and where the commonwealth's budget package was not intended to cover those arrangements.

The states, territories and commonwealth have agreed today to a two year exemption for home birthing midwives who are acting, of course, outside the state hospital system. But there will be a number of conditions and requirements attached to that exemption, which include that a home birthing midwife must disclose to a mother who is interested in having a homebirth, that they will not be insured for that procedure and make sure that people are able to make an informed choice about undertaking a homebirth.

We will ask homebirthing midwives to report each homebirth. There currently is not good data across the country of how many homebirths occur. There are not requirements for independent midwives currently to notify state and territory authorities or hospitals. And we will require participation in quality and safety frameworks, for example, reporting the results of home birthing and incidences that are related to it.

We want this work to be done in a collaborative way. A peer review process in place. And Victoria, who have chaired the national registration and accreditation process will oversee that consultation process.

We will ask the National Nursing and Midwifery Board to provide advice on protocols for home birthing outside the publicly funded an auspice(*) to services. And, of course, I need to note that those privately practising midwives, some of whom currently provide home birthing services - but do it as part of their employment, either with the state, or a privately practising obstetrician - wouldn't be affected by these changes, as their insurance is already able to be covered through their employment status. Clearly this arrangement will not apply in jurisdictions where there is not any current lawful home birthing occurring.

This is, I think, a very important breakthrough. I have made clear that I was concerned that as an unintended consequence of the national registration and accreditation process, that home birthing might be driven underground, that that would not be a good outcome. Similarly, there are, I think, are important protections that many in the community believe should be in place if home birthing is to occur.

This two year exemption allows plenty more time for those protocols to be established and worked on. But in order for this exemption to be provided, there are some sensible but modest additional requirements that the states and territories and the commonwealth have agreed home birthing midwives will need to be compliant with and participate in, for that exemption to come into effect.

Finally, I might just give you - I've obviously flagged that we had a discussion about the swine flu arrangements. I should just give you an update on the figures.

Currently there are 375 people across Australia still in hospital with the H1N1 flu. Seventy-one of those people are in intensive care. Sadly, the number of people who have died and tested positive to H1N1 flu is now at 161 people. Of course we pass on the condolences to families who have been affected by this disease.

It does, I think, remind us when we're discussing the importance of the roll-out of a vaccine, that this is still a disease that is affecting people. We are starting to see some drop-off in the presentation, the numbers in our hospitals, but as you can tell 375 still in hospital and 71 in ICU is obviously still a large number.

And Professor Bishop reported to the group today that there has been reports from overseas of the flu continuing beyond the winter season in the northern hemisphere. So, of course, we are very conscious that whilst we're probably coming out of the normal flu season, we just don't yet know how many influenza - swine flu cases - will continue into these coming months. And, of course, part of the reason why as soon as the vaccine has been shown to be safe and effective and approved by the TGA, we will be making all of our collective efforts focused on providing that vaccine as early as possible to the vulnerable in the community.

So I'm happy to answer any questions. I think Minister Hill is also very pleased that there was an agreement reached today that the new workforce agency will be based in Adelaide. The South Australian Government has put forward some investment to make that particularly easy for that decision to be made. And I'm sure the South Australian Government would welcome that and we congratulate them for that decision having been made.

So I'm happy to answer any questions.

Question: Minister, do you have any sense…

Question:: Minister, why not begin the…

Nicola Roxon: Hang on, here first sorry.

Question: Minister, do you have any sense of the timeframe that the TGA might take in terms of proving the efficacy of the vaccine? And also do you have a priority list on who will get the vaccines first?

Nicola Roxon: We certainly have a priority list. We've made that available in the past. We can provide that to you again of those who are most vulnerable, who will be prioritised. They include those with chronic diseases, pregnant women and also our health workforce who are coming in regular contact with numbers of people who have swine flu and, of course, would easily be able to a conduit to pass it on to others.

Nicola Roxon: We are very conscious that the TGA is a regulatory body; they need to go through their proper procedures. It's not up to me, as a minister, to try to set a timeline for that. They have been running what's called a rolling application process so that information can be assessed as it comes in; they don't sit and wait until all the information's there and then start the process.

So, of course, we understand that it would be quicker than usual. But that really is a matter for the TGA, not for me as the health minister.

Question: Minister, why not provide indemnity for home birth midwives in the legislation you're introducing next week in the regulations with that legislation? Why do home birth midwives miss out on indemnity cover that other midwives providing birthing services provide with.

And also under that legislation next week, why would home birth midwives miss out on access to Medicare provider numbers and also to the PBS?

Nicola Roxon: Well, there's a very clear answer to that and that is because we've undertaken a maternity services review process which did not recommend that public funding should be provided for home birthing. And we stick by that advice provided from the maternity services review by the chief nursing and midwifery officer Rosemary Bryant.

That was what was committed to in - and announced in our budget package. Nevertheless, despite recommendations that public funding should not be provided, I did not want to be in the position, and my state and territory colleagues have agreed with this, that we make a practice which is not currently unlawful in most of the country, unlawful.

So this arrangement agreed to today ensures that home birthing, midwives can lawfully continue to provide their services in jurisdictions where that's allowed. They will continue to be uninsured as they currently are.

We will be collecting more data on home birthing and we have a process to be able to work further on protocols that would either bring more home birthing services into our public system or potentially open the way in the future for an insurance product to be extended to cover them.

Question: Minister, are you considering changing the IVF…

[Over speaking by journalists]

Nicola Roxon: I am sorry, I didn't hear…

Question: At the end of the two-year exemption, Minister, how does the change, what do you anticipated in happening at that point to midwives?

Nicola Roxon: Well, we will have a fully operational nursing and midwifery board in place as part of the changes that are established as a result of registration and accreditation.

We have agreed, as part of this process, to work further on the appropriate protocols that should be in place for home birthing midwives to work cooperatively with hospitals and with obstetricians.

That work will continue during the two-year period. I think we've just made a very important decision which ensures that mothers who choose to have home births that are properly informed and make that decision, can continue to do so. And we're talking about a two-year exemption that runs from the middle of next year. So it's nearly three years where there is time for other avenues to be explored.

We have made no secret of the fact that we will continue to explore options in the future for indemnity products but we are not prepared to do that now.

Question: Minister, are you considering changing the budget cuts to the IVF rebates et cetera?

Nicola Roxon: No we're not. As we've made clear, right from the beginning, we are committed to finding significant savings in this area where there is clear evidence that IVF and a large number of IVF professionals have been charging exorbitant fees for families that are desperate to have their services and often unable or unwilling to try to negotiate around price.

We have been having consultations right from the beginning with those specialists about the restructuring of the fee arrangement.

Those meetings have been progressing very constructively, but there remains no change to the overall budget saved. There remains no change to patients.

I think, what we are starting to see is some constructive engagement from the industry who understands these changes will need to be made and who are working with us and the department on the detailed restructuring of the item numbers of which there are a large number because of the complex arrangements and variables if you are undergoing an IVF process.

So I think it's good news that there are constructive discussions that are progressing well but certainly the government remains committed to those budget saves and are happy to work with the industry and indeed with consumer organisations to make sure that within that commitment the EBS items are structured in the most productive way.

Question: Can you guarantee that patients won't end up having to pay more out of pocket as a result of these changes?

Nicola Roxon: What we've always perfectly clear is that if patients, a typical patient, is charged the average fee of around $6000 for a typical cycle of care that they won't be worse off under these arrangements.
Now of course, as I've made clear, if IVF practitioners hike up their fees or aren't prepared to charge people what is an average within an industry, then there will continue to be out of pocket expenses as people currently experience.

Our commitments have always been around a typical cycle of care, costing around $6000 per patient. There are a vast range of variables in this area where some people, with particular needs, may have an unusual mix of services that need to be provided and I simply couldn't detail each and every one of those for you.

Question: Could you remind us what your primary objection was in the maternity services review to home birthing?

Nicola Roxon:Well, look, there were a range different issues which were discussed and I think it needs to be put in context that the changes that were recommended by the maternity services review and have been adopted by the Government and introduced in the budget, are a significant expansion of public funding for midwifery services and for ensuring those general midwifery services.

The report made clear that there wasn't a consensus around the appropriateness of extending those benefits to home birthing midwives.

It noted that it was an area that the public certainly had divided views on; there were lots of submissions received by home birthing parents and midwives to that review.

Question: [Inaudible question]

Nicola Roxon: Look, I don't want to put words in the mouth of the chief nursing and midwifery officer. There were a range of issues that were explored. Some of them are about the pace of change, some of them were about safety considerations, others are about where you put public funding. What I've been very conscience to do is these are some of the most important changes to Commonwealth funded midwifery services for decades. The unfortunate coincidence with registration and accreditation having an impact that potentially would have made home birthing unlawful meant that the two were being mixed together.

Today, we have ensured that that separation continues, that registration and accreditation for the ten health professions that have been identified of course will go ahead; that there will be an exemption that will allow for more data to be collected, more work to be done with home birthing midwives.

Of course there might be potential in the future when proper data is gathered for there to be more changes but they won't be part of this maternity service budget package.

We have however ensured that women can make the choice if they're properly informed to still have a midwife attend to a home birth.

Question: Minister, the Greens are calling for consistency in state and territory abortion laws, do you have any intention of looking at that?

Nicola Roxon: No, look, that wasn't on the agenda today and hasn't been discussed.

Question: Minister, do you think you'll be addressing the mother of all rallies outside Parliament on Monday?

Nicola Roxon: No, I won't be attending the rally on Monday. I am sure that there'll be a lot of women at the rally who'll be very pleased with the decision that was made today by the Commonwealth and the State and Territory ministers.

I do know it has been causing anxiety for many women including those who are currently pregnant and want to make sure that they have the choice of home birthing in the future.

I think this is a sensible way forward and I look forward to continuing to work with those groups about opportunities in the future, but we do need to ensure that we put the care and needs of patients and mothers first. We want them to be properly informed about their choices, we do want midwifes who are providing these services to tell us the number of home births they're providing, participate in this quality framework and I think it is a win-win situation for everyone.

Question: Can I just ask one question on the swine flu too?

Nicola Roxon: Yes.

Question: You were saying earlier about the timing of the TGA's approval, are you still looking for a September start-up or is October now more likely?

Nicola Roxon: Look, I am still hopeful that we will be able to commence the vaccination program in September but I don't control the TGA regulatory process and it is appropriate for that process to be undertaken first.
What you have today is an absolute determination from the Commonwealth and from the States and Territories to do everything we can to be ready to vaccinate our community, particularly those who are vulnerable in the community as quickly as possible.

We want to make sure that if there continues a tale in this illness past the winter, if vulnerable people continue to be hospitalised that we're doing all we can to protect those individuals and also increase immunity across the entire population which of course helps stop the spread of the disease when it inevitably will return next winter as well.

Question: Are you planning…

Nicola Roxon: Okay, last two, one here and one here and then we're going to have to head off.

Question: Have the states asked for extra cash to help them with the caseload with the swine flu?

Nicola Roxon: Oh, look, I mean, it's - of course usual for the States and Territories to ask for extra funding for all sorts of things that we discuss. Treasurers are actually discussing these matters, they have been raised of course in the course of discussions today. But as health ministers, I think we have a very clear focus which is to make sure we are ready to deliver the vaccination to the vulnerable in the community and to the health workforce as quickly as possible and I am sure those other issues will continue to be worked on but I am sure will be worked out.

Question: You've distributed 2 million doses are you planning to buy more?

Nicola Roxon: Yes, we've got a contract with CSL for the provision of 21 million doses, that will be provided progressively over the coming months into January.

We are receiving instalments of those from CSL, I think, on a fortnightly and monthly basis, according to a particular program. And of course we want to make sure that we can use those vaccines as soon as they are shown to be safe and effective, for our health workforce and for the vulnerable in the community and that's why as part of our contract we've ensured that they can be delivered directly to CSL's holding facilities, as I understand it, in each of the States and Territories.

Question: Does that mean everyone in the country will be vaccinated or are you just; it's still those vulnerable groups?

Nicola Roxon: We will be prioritising those vulnerable groups. One of the pieces of data that we're waiting on is the efficacy from the human trials and I've made clear before, we ordered two two, 21 million doses on the basis that we would potentially need two doses per person.

So that would mean about half of the population could be vaccinated. If, as of course we would be hopeful, one dose is effective then it means we have sufficient to vaccinate the entire population.

Ends