THE HON NICOLA ROXON MP MINISTER FOR HEALTH AND AGEING, SPEECH FOR OPENING ADDRESS TO AUSTRALIAN COLLEGE OF NURSE PRACTITIONERS CONFERENCE, MARQUE HOTEL, CANBERRA, 1 NOVEMBER 2010

Good morning, I would like to begin by acknowledging the Ngunnawal and Ngambri People, the traditional custodians of the land on which we are meeting, and pay my respect to their elders, both past and present.

I would like to also acknowledge the President of the Australian College of Nurse Practitioners, Ms Helen Gosby, the Assistant Secretary of the ANF, Ms Yvonne Chaperon and members of my Department.

I would like to begin by thanking you for asking me to speak to you on such an important day.

Today is a momentous day.

For the first time, nurse practitioners are able to access relevant new items under the Medicare Benefits Schedule and to prescribe certain medicines under the Pharmaceutical Benefits Scheme.

This will pave the way for the role of Nurse Practitioners to be properly supported in our health system. Most importantly, it will enable many more members of the community to benefit from your expertise and experience.

Patients will win as they will have greater choice of expert health care practitioners  - less waiting to see their general practitioner and less travelling to see medical specialists. Patients will be the recipients of your expertise and expanded role.

It is a breakthrough day in the development of the nursing profession and their patients in Australia.

I know that we have many of the pioneers of the Nurse Practitioner movement in this room today and I know many of you have spent years fighting for these changes, unsure if you'd see them eventuate in your lifetimes.

How many collective hours of meetings, writing submissions and lobbying have you spent making the case for the changes that come into effect today?

Many thousands I suspect.

It's a been a long journey and there have been many battles along the way. It is my privilege to be the Health Minister in the Gillard Government bringing about this change.

The growth and development of the Nurse Practitioner is a testament to your belief, your expertise and your experience. You started as nurses developing your expertise in critical areas of need. You went back to university and gained additional qualifications in your areas of specialty. In 2000 the first nurse practitioner was registered in NSW. We now have over 400 nurse practitioners working in areas as diverse as emergency medicine, mental health, child health and diabetes management. But we know the lions share of you currently work in our public hospital system. Today marks an opportunity for you to move outside these walls.

The Government is proud to support you and I am pleased to be here today to celebrate this day with you.

I see today that you have a distinguished list of expert speakers who will provide you with all the technical information you require, so I will concentrate on why we've taken these steps, what it can mean for nurse practitioners and how it fits into the Government's broader health reform agenda.

We know that nurse practitioners study and work hard to get their Nurse Practitioner qualifications - the educational requirements are rigorous and the bar is set very high.

For some time nurse practitioners have been working side by side with doctors and allied health care professionals ensuring patients see the right person with the right skills - but to date this has largely occurred in hospital settings in acute care, and particularly in emergency medicine.

But there is a big and, as yet, untapped opportunity for more health care services to be delivered by you as well trained health care professionals - and for you to have a greater reach into the community. 

That is, well trained nurse practitioners now, with access to MBS items and prescribing through the PBS, have the chance to move further into community and ambulatory care settings to work collaboratively with general practitioners and specialists to deliver front line patient services - in ways you haven't really been able to do to date.

For example:

• assisting patients in managing their diabetes or hypertension or asthma close to where they live,
• writing scripts for elderly patients in aged care and not putting them in ambulances to wait long hours in emergency departments
• helping better manage people with mental health problems in the community and out of hospitals
• looking after patients in rural areas as their first line health care provider

We want to use these changes to put the right practitioner with the right skills in the right place - where the public need them.

Here in the ACT, we have the first nurse-led walk in clinic co located at Canberra Hospital. Nurse Practitioners are doing their thing there - showing to the world their skills and abilities.

In last year's Budget the Government committed $59.7 million over four years to enable nurse practitioners to access relevant new items under the Medicare Benefits Schedule and to prescribe certain medicines under the Pharmaceutical Benefits Scheme. In addition we invested $66.6 M for expanding Medicare and PBS support for eligible midwives with an additional $25 M for access to Professional Indemnity Insurance for these midwives - another vital win for highly qualified health care professionals, for too long undervalued.

As you know, the measure will be limited to eligible nurse practitioners, working within their authorised scope of practice and level of competence and prescribing within what is allowable under their relevant state or territory legislation.

As I said earlier, this breakthrough initiative has a number of aims - to support an expanded role for nurse practitioners in non-acute settings, including the areas of primary care, aged care and rural and remote Australia.

It utilises the considerable skills of nurse practitioners, especially in multidisciplinary teams working collaboratively with doctors, greatly improving the capacity of Australia's health workforce as well as increasing access to primary care.

For the first time nurse practitioners will have the opportunity to develop innovative practice models that can be tailored to meet individual and local needs.

In the Government's view it made no sense that nurse practitioners could provide advanced level care, including undertaking health assessments, ordering tests, prescribing specific drugs and referring to specialists in public hospitals, but because of their lack of access to the MBS and PBS had severely limited roles outside the public hospital setting.

Most importantly, these changes will deliver real benefits for patients. There is growing evidence that patients enjoy better health outcomes when they receive coordinated, continuous, comprehensive care that is delivered by appropriately-trained health professionals. This evidence is part of the reason we have always supported collaboration - to improve the coordination of care, not fracture it further.

Patients of nurse practitioners will now have more choice in their primary health care provider and treatment options, while some of our most valuable and experienced nurses will gain the recognition and support they deserve.

It is a key part of the Government's reform agenda.

I am aware that a few of you have concerns about some aspects of how the arrangements will work. That's understandable - it is rare when such a big change occurs for it all to go smoothly immediately or for everyone to get everything they want.

Of course we are keen to keep working with you as the changes are implemented to make sure they do deliver the benefits for the community that we want them to.

It is vital that we recognise the big step forward this is and we all join in celebrating this important day.

I want to move now to the broader context in which our nurse practitioner reforms sit - because I know as health professionals you all care about the broader health reform process and what it means for our health system into the future.

I'm sure you're aware this is also a special day for maternity care in Australia. Eligible midwives will today also be able to deliver antenatal and postnatal care in the community as well as provide assistance with delivery in hospital - the mothers they care for will have access to MBS rebates and PBS medicines for the first time.

Midwives will be able to manage low risk births while working collaboratively with obstetricians, providing greater choice for women. Pregnant women may now choose midwives as their primary maternity care provider in the community knowing that there is medical care also available should that be required for them and their newborn baby.

With an even broader lens you will be aware that as a result of the COAG agreement with 7 of the 8 states and territories in April of this year, the Government is pursuing the biggest changes to the health system since the introduction of Medicare.

Our reforms are aimed at ensuring the system is better funded, better run, and more sustainable into the future:

• we will be funding a majority share of hospital costs - including a fixed (60 per cent) share of the efficient price of all hospital services;
• we are setting tough national standards and
• we will drive better care through improved national transparency, accountability, and quality standards.

One of the most important aspects of the structural changes that we are pursuing is that they will establish the right incentives in the system for the Commonwealth to invest properly in primary care and prevention long term - because we'll be picking up the majority of the tab for expensive hospital treatment if we don't get the front end right.

That's why we're investing heavily in prevention and primary care - to keep people healthy and out of hospitals, for example through:

• having nurse practitioners and midwives delivering front line services
• establishing more GP Super Clinics - another great setting for nurse practitioners - and investing in primary care infrastructure;
• investing in the after hours care;
• Medicare Locals to bring together and better coordinate primary health care services; and
• our world leading tobacco reforms.

We also want to modernise the health system, through:

• Electronic health records for all Australians - which will be critically important in assisting nurse practitioners to work collaboratively with doctors and other health professionals in ensuring information about their patients is accessible and up to date;
• Massively expanding tele-health through Medicare rebates for online consultations; and
• using the power of the NBN to improve health services delivery.

And of course - we know that we won't be able to pursue any of these reforms without the workforce to implement them. And that is where you and your many colleagues in the nursing and other health professions come in!

We know we have health workforce shortages in many parts of the country. That's why as well as the new options for nurse practitioners and midwives, we're investing more than ever before in:

• training more undergraduate doctors and nurses;
• supporting more clinical training for health professionals - including our recent announcement of $425M to expand clinical training capacity, of which 32% will go to nursing;
• Supporting health professionals to work in rural and remote areas - including our recent budget initiative to establish the first ever rural locum scheme for nurses.

And of course, we are pursuing reforms to make sure we make best use of the skills and expertise of all of our health professionals, which is what the reforms we are celebrating today are all about.

These investments will ensure our health workforce meets the needs of Australians today - and the ever-increasing demand for health services well into the future.     

So in conclusion.

Ladies and gentlemen, as I said earlier it is just a decade since the first nurse practitioner was registered in New South Wales, but you have come a long way in those 10 years. 

The sky didn't fall in as some predicted with the appointment of the first nurse practitioners. In fact, to the contrary, patients in some parts of the country have been benefiting from professional and compassionate care already

From now on nurse practitioners will be able to take their rightful place in the Australian health system. A place earned through your training, your experience and your determination to reach their highest potential in the profession you have chosen.

I congratulate you all and wish you well on this momentous day - a good day for your profession and a good day for patients in Australia.

Thank you.