National health practitioner regulation reform

1. National health practitioner regulation reform Peter Carver Executive Director National Health Workforce Taskforce 10 December 2007

2. National health practitioner regulation reform • Prime Minister requests Productivity Commission to review health workforce • Council of Australian Governments (CoAG) requests CoAG senior officials to report on improving the supply, responsiveness and flexibility of the health workforce. • Productivity Commission Report 19 January 2006 • 21 recommendations for reform • Focused on significant structural reform of governance, education and training and funding structures • Emphasis on multidisciplinary approaches

3. National health practitioner regulation reform CoAG response • Clarity achieved on differences between Commonwealth and States but many common areas of agreement • Reform areas focused on promoting workforce flexibility, innovation and multidisciplinary approaches • National agreement on annual planning health education numbers through MCEETYA • Minor expansion of access to MBS • Reforming where medical specialist training takes place • Funding and structures to progress reform and innovation (National Taskforce) • National schemes for registration and health professional course accreditation

4. Australian Health Ministers Conference Australian Health Ministers’ Advisory Council Health Workforce Principal Committee Other Principal Committees National Health Workforce Taskforce Aboriginal & Torres Strait Islander Health Workforce Working Group Mental Health Workforce Advisory Committee Practitioner Regulation Subcommittee National health practitioner regulation reform National health practitioner regulation reform Australian Health Ministers Council Committee Structure

5. Innovaton & Reform Research & Workforce Planning HWPC support National health practitioner regulation reform National health practitioner regulation reform National Health Workforce Taskforce • Primary vehicle for driving reform • Established for four years • Budget of approximately $34M over 4 years (all sources)

6. National scheme for registration and accreditation • Australian Constitution does not give power to the Commonwealth for health professional registration and accreditation • Queensland Government will pass primary legislation • Referencing legislation will be passed by other states and territories • Scheme will be covered by an Intergovernmental Agreement • Identifies objectives, governance arrangements, scope, legislative arrangements and financial arrangements • Once signed, health ministers to take responsibility for implementation • Scheme will cover doctors, nurses, dentists, pharmacists, physiotherapists, psychologists, chiropractors, optometrists and osteopaths in the first instance • Upon signing of IGA all partially registered professions will be reviewed to determine whether they should be included in the new scheme as soon as possible (if not immediately) upon national scheme commencement

7. National scheme for registration and accreditation What must a national system be? • Its overriding interest should be the safety and quality of the care that patients receive from health professionals • It must be grounded in a solid legal framework • It must sustain the confidence of both the public and the professions through demonstrable impartiality and both real and perceived independence • It should sustain, improve and assure professional standards as well as identify and address poor practice or bad behaviour • It should not create unnecessary burdens, but be proportionate to the risk it addresses and the benefit it brings • It must be sufficiently flexible to work effectively for the different and evolving health needs and healthcare approaches across Australia

8. National scheme for registration and accreditation What things must a national system do? • Create uniform national standards on which to base professional registration and course accreditation • Provide a consistent approach across Australia to protection of the public • Provide greater public scrutiny and consumer participation in practitioner regulation • Have regard to the public interest in promoting access to health services • Facilitate cross-profession approaches to health workforce issues • Remove impediments to more efficient workforce deployment (both geographically and clinically)

9. National scheme for registration and accreditation What things must a national system do? • Promote common codes and guidelines for practice • Facilitate the provision of high quality education and training • Promote interdisciplinary and multidisciplinary education and training and articulation between VET and higher education and training • Improve appropriateness and consistency of accreditation across professions and rigorous and responsive assessment of overseas-trained practitioners • Reduce administrative and compliance costsand reduce red tape for practitioners

10. National scheme for registration and accreditation What will a national system look like? • Final framework of the Scheme yet to be finalised with the signing of an IGA • National and state based consultation have been undertaken • 155 submissions from stakeholders • Consultations will be ongoing • The “knowns” (and the “unknowns”) • A national Scheme to be overseen by Australian Health Ministers setting policy directions • Ensuring regulation, standards and guidelines remain flexible and responsive to consumer and health system needs • Not intervening in individual decisions of the boards regarding practitioners • A national Scheme that will be self funding but with establishment costs funded by governments

11. National scheme for registration and accreditation • The “knowns” (and the “unknowns”) • A single national agency supporting profession specific boards • A single grant of registration allowing practice across Australia • A state and territory presence to handle enquiries, registrationapplications and complaints linked to existing state and territoryreview mechanisms with determinations to have national effect • Profession specific boards made up of practitioners, consumers and others appointed on the basis of skills and experience andnot representing any particular interest group • Existing board members to be offered the opportunity to continue to participate through the state and territory presences

12. National scheme for registration and accreditation • The “knowns” (and the “unknowns”) • Accreditation of health education requirements for registration provided with a legal framework as part of the registration function. Decisions relating to qualification assessment and course approval will continue to be independent in this framework • Existing accreditation bodies, providing they meet certain public interest standards, will be delegated the accreditation role for up to 3 years whilst the profession resolves how best to make this role work in the new national Scheme • That there are many “unknowns” that will require resolution in consultation with stakeholders • Resolving the unknowns provides the opportunity to draw on good systems across Australia and around the world to build the best in a national Scheme

13. National scheme for registration and accreditation • The “knowns” (and the “unknowns”) • Provides the opportunity to resolve issues currently not well dealt with and link into other national initiatives, eg: • Certifying continuing professional competence/revalidation • Long debate about whether the health professionals should demonstrate objectively currency with professional and clinical developments • Trust alone no longer sufficient guarantee of fitness to practise. Public expect health professionals to be revalidated as part of annual registration and many believe that this already takes place • Registration, recruitment screening, revalidation, accreditation, credentialling and clinical privileging often traverse same space. National approaches to safety and quality accreditation are under consideration • A national Scheme provides the opportunity to better align these process, consider overlaps and provide a more integrated approach to practitioner and system quality

14. National scheme for registration and accreditation When will it happen? • CoAG initially agreed to implementation of the national Scheme by July 2008 • Final framework of the Scheme yet to be finalised with the signing of an IGA thus this date appears ambitious • Once the IGA is signed a revised work program and timetable will be developed for approval by AHMC • A staged approach will enable the development and passage of legislation in parliaments across Australia and a smooth administrative transition • This approach will allow further consultation with stakeholders to progressively resolve the complex policy, technical and logistical issues as they arise

15. National health practitioner regulation reform Peter Carver Executive Director National Health Workforce Taskforce 10 December 2007