A different approach

Last week the ACM released an e-bulletin on the 'lay of the land' regarding the National Health (Collaborative arrangements for midwives) Determination 2010.  Needless to say, many members weren't happy with the College, their advice or their approach. What many may not know is that ACM Queensland also released an e-bulletin, outlining some alternative approaches for their members to consider. Unfortunately this has not been widely circulated outside of Queensland as the National Office didn't seem to think it reflected the views of all it's members. In addition to the infomation presented below, please note that 'The Determination' was presented to the House of Representatives on Tuesday 28th September, 2010 and now sits 'tabled' with the Senate where there are a 12 sitting days remaining in which a motion to disallow can be made.  Please find a the ACMQ e-bulletin below for your information.

E Bulletin from ACMQ Executive Regarding the Medicare Determination:

The distribution last Wednesday of an e bulletin from the ACM national office concerning the Medicare determination has caused considerable confusion amongst members in Queensland and we believe does not present all of the options available to us.

ACMQ Executive acknowledges that the ACM National President and Board members are working hard on this issue and making some difficult decisions representing the colleges view at a national level. This E bulletin to members is in no way meant to be divisive or to detract from the work undertaken at national level. However, ACM national has concentrated on one option in the e-bulletin and we seek to provide an alternative for consideration by members.

In agreement with ACM national ACMQ Executive unreservedly supports Medicare for midwives, but the determination needs to be changed.

ACM Queensland Executive continues to have a bottom line position that we will not accept a “collaborative arrangement” with a medical practitioner that requires a signed agreement or provides an opportunity for a doctor to veto a midwives ability to access Medicare funding.

ACMQ Executive does not endorse the ‘keep silent, don’t rock the boat it’s too high risk’ position proposed by ACM national.

ACMQ does not promote putting Medicare at risk.

However, this legislation and the determination process is complex and significant issues were not presented in the ACM e-bulletin distributed on Wednesday 22nd Sept these include:

• A motion to disallow the determination does not mean that the determination is disallowed. It means that the determination is then debated in parliament and THEN is voted on. To disallow would require support from the Coalition and Greens or independents (Senate) and the Coalition and independents (House of Representatives) – this is extremely unlikely.
• There is no mechanism to vote to “allow” a determination. The determination has already been signed off by the Governor General and will be tabled within the first 6 sitting days of the next parliament. It stays on the ‘table’ for 15 days after it is tabled. It is not (never) voted on unless a motion to disallow it is introduced and only THEN is it possible for the determination to be debated and voted on.
• The determination is currently in law. It remains in law (legislation) unless a motion to disallow is presented.
• The legislation is therefore in place for Medicare for midwives to commence on 1 November.

ACMQ Executive believes that by using fear-based tactics the minister’s advisors have created panic that Medicare will not start and thereby hope to prevent midwives lobbying to change the determination. It is the opinion of the ACMQ Executive that pressure from the government on ACM National to cease lobbying to alter the medical veto over midwifery practice is a deliberate strategy to stop pressure to change the wording of the determination.
The Minister has the ability to change the determination any time. She clearly does not want to do so (and is possibly under pressure not to do so by the medical lobby) and will not do so unless midwives lobby.

We agree that if the determination is VOTED on and the VOTE upholds the motion to disallow, it will have a dramatic impact on Medicare for midwives. However, a motion to disallow is NOT a VOTE. Lobbying is NOT a vote. A motion to disallow can be removed at any time, leaving the determination functioning and Medicare for midwives functioning.

ACMQ Executive offers the alternative position that we do not change our lobbying strategy. Members continue to ask for the wording in the determination to be altered. We recognise that in the immediate term it is unlikely that this will cause the Minister to change the wording. However early next year, with more evidence, it may become more obvious that there is a real difficulty in the currently worded determination.


ACMQ Executive is of the opinion that the strongest strategy is to indicate that we do not accept the current wording allowing a medical veto and that we stick together on this.


We accept that we may be required to change this strategy next year, when a final opportunity for a motion to disallow can occur. We also accept that if a motion to disallow occurs, we may need to change our strategy but we do not believe that now is the time to make this decision. Several of our partner organisations have reported from discussions with a range of MP’s and Senators (Coalition, Greens, and independents) that, while difficulties with the determination are acknowledged, no MP’s have indicated that they intend to take any action at this point to disallow the determination. They have all indicated that they will be watching the determination carefully over the next few months.

ACMQ Executive would like to state that the position taken to a stakeholder meeting on Tuesday night (21 Sept) from our consumer partner organisation Maternity Coalition and Homebirth Australia was that they did not want to accept this determination. Childbirth Australia took the position that they did not want to impact Medicare.

ACMQ Executive believes continuing to lobby to change the determination before a motion to disallow can even be introduced, let alone voted on, does not carry the level of risk outlined by the ACM national e-bulletin.

Timeline for the Determination:

• Determination was signed off by Governor General on 16 July which means that the Medicare for Midwives legislation is ready to commence on 1 November.
• Parliamentary process requires that because the determination is only signed off by Governor General, it is tabled in parliament in first six sitting days of the new parliament (28, 29, 30 Sept 2010, 26, 27, 28 October 2010).
• On the day it is tabled a new timeline commences in which a motion to disallow can be introduced within 15 sitting days. Therefore, if the determination is tabled on 28 Sept (the first day of the new parliament) the last possible day on which a motion to disallow can be introduced is the first sitting day of 2011 which is late Feb or early March. There is nothing ACM can do to alter these timeline as it is a fixed parliamentary process.
• On 1 November Medicare for midwives will commence.
• This year (because of the parliamentary schedule), a motion to disallow could still be tabled in parliament up until 25 Nov, the last sitting day for the year. This requires support from a MP or Senator to introduce it and does not impact on Medicare at this point (just introducing a motion to disallow does not impact on the determination or Medicare for midwives).
• Next year a motion to disallow could still be introduced in parliament on the first sitting day of the new parliamentary year or later if the determination was tabled after 28 Sept 2010.
• Once a motion to disallow is introduced a debate on relative strengths of determination can occur in the Senate (or House of Representatives). If this is after the summer break, evidence of non-collaboration could also be tabled at this time.
• This applies maximum political pressure.
• After the debate occurs, a vote to uphold or reject the motion to disallow will occur. The motion can be withdrawn up until the moment when a vote will occur. To disallow the determination a majority of Senators will have to vote to disallow. This would require Coalition and Greens both voting to disallow. In the House of Representative it would require the Coalition to vote to disallow and the independents to break their agreement with the government and vote with the Coalition – EXTREEMLY UNLIKELY.
• IF disallowed the Minister can refuse to reintroduce a rewritten determination making Medicare unworkable. However, as this timeline indicates, a discussion about this possibility is extremely premature and prevents continued political pressure. A discussion to allow or disallow and lobbying around this should occur IF a motion to disallow is introduced – this is the point in time where we decide what action we want MPs or Senators to take.

ACMQ Executive maintains the line that the determination is unacceptable, that we continue to lobby that it is unacceptable and that we demand a meeting with the Minister (not only her advisors). We are of the belief that the Ministers deputy chief of staff, who met with the ACM National President last week (who is an obstetrician - Dr Judy Searle), presents a potential barrier for clear information being supplied to, or obtained from, the Minister.

All midwives who experience difficulty accessing Medicare due to an inability to obtain a signed medical agreement have the opportunity to keep the pressure on by notifying ACM national, ACMQ and the Minister’s office of the practical difficulties created by the determination.

If it turns out that the determination is working well and women have no difficulty accessing Medicare funded midwifery care this will soon become apparent. If this is the situation then any motion to disallow can be withdrawn as stated earlier.

ACMQ’s position involves lobbying to change the determination and buying time to see if the determination will or won’t work.

ACMQ Executive holds the view that a frank and fulsome communication between all members is required to ensure that a representative view can be tabled if the situation occurs that the determination will be voted on in the Senate/House of Representatives.

Before sending this communication we have considered all aspects of this complicated situation in detail. Thank you for considering this alternative option, it is now completely up to you as a member to decide if you would like to write to/contact your MP, the Minister, Jenny Gamble as our National Delegate and ACM National to lobby for the wording of the determination to be changed.

ACMQ Executive will continue to apply pressure and lobby to get the determination changed.

This e-bulletin is supported unanimously by the ACMQ Executive:
Hazel Brittain - President
Jodi Bunn – Executive Member
Jenny Gamble – National Delegate
Richard Hayes - Treasurer
Bec Jenkinson - Consumer
Marie McAuliffe – Executive Member
Mandy Ostrenski – Executive Member
Sue Rath – Executive Member
Mary Sidebotham – Vice President
Barb Soong – Executive Member
Teresa Walsh - Secretary
Kellie Wilton - Student