A National Registration and Accreditation Scheme for Health professions.
The proposed National Registration and Accreditation Scheme will bring about significant changes to the regulation of the health work force. On 26 March 2008, the Council of Australian Governments (COAG) endorsed an Intergovernmental Agreement to establish the Scheme by 1 July 2010.
While there is still much detail to be formulated and negotiated, the key objective is to have an Australia-wide registration and accreditation scheme for:
- Chiropractors.
- Dentists, dental hygienists, dental prosthesists and dental therapists
- Medical practitioners.
- Nurses and midwives.
- Optometrists.
- Osteopaths.
- Pharmacists.
- Physiotherapists.
- Psychologists.
Other health professions may join the proposed Scheme provided that in the majority of States and Territories the profession supports joining, and the protection of public health and safety would benefit from national regulation.
The core objectives of the current State and Territory registration schemes include protection of the public in upholding standards of the profession. The corresponding proposed national objective is to:
- Provide for the protection of the public by ensuring that only practitioners who are suitably trained and qualified to practise in a competent and ethical manner are registered.
Whether this subtle change in the objective corresponds to a change in the manner in which health professions are regulated is yet to be seen.
However, the national scheme will have other broader objectives:
- Facilitating workplace mobility across Australia and reduce red tape for practitioners.
- Facilitating the provision of high quality education and training and rigorous and responsive assessment of overseas-trained practitioners.
- Having regard to public interest in promoting access to health services.
- Having regard to the need to enable the continuous development of a flexible, responsive and sustainable Australian health workforce and enable innovation in education and service delivery.
These objectives reflect the current social and political climate.
There have been a number of well publicised matters concerning overseas trained doctors. The proposed Scheme will assist health professionals who are registered in more than one State or Territory.
The Intergovernmental Agreement1 does not give detail on how a national registration and accreditation scheme will promote 'access to health services' and enable 'development...in the health work force and enable innovation and education and service delivery'. Such ambitious objectives suggest a significant change to the manner in which the health professions are regulated.
Unlike the current schemes, under the new Scheme government will have a more direct and fundamental role. There will be less health professional representation on some of the bodies that oversee the proposed Scheme.
The Australian Health Workforce Ministerial Council will be established to oversee the Scheme. Membership of the Ministerial Council will be Commonwealth, State and Territory Health Ministers. The responsibilities of the Ministerial Council will include:
- Providing policy direction.
- Proposing legislative amendments to the Scheme.
- Appointing members to the Australian Health Workforce Advisory Council and to the Boards
- Requesting the Boards to review legislation, practice, competency and accreditation standards, and once reviewed, approving them.
The Ministerial Council will be supported by the Australian Health Workforce Advisory Council. The Advisory Council will advise the Ministerial Council of its responsibilities under the Scheme. The Advisory Council will be chaired by an 'independent and eminent' person who is not a current or recent health practitioner. Assisting the chair will be six other members, of whom three should have health or education expertise.
The national agency, which will be governed by an agency management committee, will administer the Scheme. Among other things, it will act in accordance with policy directions from the Ministerial Council. With the Boards, it will develop and administer procedures for the operation of the registration and accreditation functions.
The national agency is to establish a national office. That office is to establish 'a presence ('one-stop-shop') in each State and Territory'. While it is to provide support for the national agency committee and the Boards, it appears the national office will take on many of the Boards' current functions such as maintaining the register of health practitioners.
The Boards (once reconstituted under the new legislation) will generally be comprised in the same manner; there will be a majority of health professionals and at least two community members. The Boards will 'deliver' many of their present functions, such as registering health professionals, investigating complaints, conducting disciplinary hearings and assessing and accrediting overseas trained practitioners.
Some aspects of the present schemes will be adopted for handling complaints, prosecuting those complaints, dealing with registration issues, and dealing with impaired practitioners. Disciplinary matters which may lead to the suspension or cancellation of the registration of a practitioner will be referred to an external entity. The form of that entity will be determined by each State and Territory but presumably it will be an administrative tribunal or a tribunal within the present court structure. Less serious matters will be dealt with by the Boards.
Health assessment programmes for impaired practitioners will continue to be overseen by the Boards.
There will be a right to seek an 'internal merits review' of any decision made on a matter pertaining to 'registration, conditions upon registration, complaints investigation and management, and management of impaired practitioners'. If the practitioner or 'notifier' is not satisfied with that decision, then the matter will be referred to an external entity such as a court or tribunal. Under the current schemes, some of these matters may only be reviewed by a court or tribunal.
Queensland has been given the responsibility of drafting and 'hosting' the legislation to establish the Scheme. It will in turn be adopted by all other States and Territories, except Western Australia who will enact their own 'substantially similar' legislation. Each State and Territory will repeal their current health profession registration legislation. Ancillary legislation such as that which regulates the handling and administration of scheduled drugs and poisons will continue to be administered by each State and Territory.
Although the Scheme has been delayed by two years from its original commencement date, it will still be an accomplishment to have it established by 1 July 2010.
Footnotes
1. The Intergovernmental Agreement is available on the COAG website - www.coag.gov.au
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