Dear Joy, Jan et al
I think that everything would change very rapidly (as it did in NZ and
Ontario) if there were a system that enabled midwives to have guarranteed
health service per capita funding for being 'Lead Maternity Carers' (NZ
term). I would favour some national maternity payment (if as Carol suggests
we're going to have to wait as long as it would take to get a sorry out of
Johnnie Howard to get provider numbers!) as in NZ and Ontario.
A system where self employed midwives contract with individual health
services on an annual basis is a vulnerable system. In the SE London
Midwifery group practice the annual negotiations were a nightmare - each
year they tried to stop our funding, as in Newcastle, not because they
disapproved of our service (on the contrary), but because it was a
convenient, discreet pool of money that could get axed - because ultimately
it wasn't mainstream enough.
The midwives are now 'The Albany Midwives' in new community premises
sub-contracted to a hospital (Kings) working as part of the mainstream
services on offer, alongside other midwifery group practices formed by
employed midwives. I believe they have just negotiated the next 3 year
contract for per capita payments for an agreed number of women. This model
works well for this group of self employed midwives and it's a managers
dream - no oncosts, overtime, penalties, sickness/maternity cover to worry
about. However - it is not being replicated anywhere else in the UK as far
as I know. It seems it's too big a leap to go self employed and negotiate
sub contracts/contracts.
So I end up thinking that here it has to be some radical overall national
payment as in NZ to give many midwives the incentive to switch from
employed to self-employed status. The New Zealanders describe this
opportunity as being crucial to the development of 'autonomy' in terms of
how midwives see themselves as practitioners and how they are able to
engage in woman-centred practice. I believe we need to be making a clear
proposal to Canberra for a committee to explore and develop a national
maternity payment so that women can access free midwifery care (caseload
practice). We should think BIG on this issue - a 10 year Vision - and
'seize the moment' in light of the Senate Inquiry.
This might open up a debate - is true autonomy ever going to be possible
within models where midwives are employed? I wonder what people out there
think? Would Australian midwives embrace self employment if they could be
guarranteed per capita government funding?
Cheers
Nicky
Nicky Leap, Senior Research Fellow, Midwifery
The Flinders University of South Australia, GPO Box 2100, Adelaide, SA 5001
Tel: (08) 8201 3442 Fax: (08) 8201 3410
Home: 'Cennednyss', Summertown, SA 5141 Tel/Fax: (08) 8390 1069
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