Response to Strengthening the National Registration and Accreditation Scheme for Health Professions

NRAS Review Implementation Project Secretariat
Health & Human Services Regulation and Reform Branch
Department of Health & Human Services
GPO Box 4057
MELBOURNE  VIC 3001

 

Re: COAG Health Council “Strengthening the National Registration and Accreditation Scheme for Health Professions to better protect the public. Two proposed amendments to the Health Practitioners Regulation National Law. It has been stipulated that this is subject to community consultation.”, undated Consultation Paper. Submissions due by 15 Dec 2019 to NRASConsultation@dhhs.vic.gov.au

“Health Ministers have agreed in principle that the National Law in all jurisdictions should now explicitly state that the guiding principle for administering the Act is that public protection and confidence in the National Scheme is paramount.” [underlining added]

ADF Response:

The ADF maintains that if the exact wording of the phrase “confidence in the National Scheme is paramount” is used as a guiding principle in the legislation [health practitioner’s National Law], it may result in the limiting of the right of all registered health practitioners to raise issues of concern and/or relevant criticism of the National Registration and Accreditation Scheme (NRAS).  The ADF has made recommendations at the conclusion of this submission to rectify this.

Explanation:

  1. The ADF maintains that settled legislation should not be disturbed unless there is a compelling case. Constant changes to legislation do not bode well for confidence in the legislation itself, and the organisation promoting the change.
  2. As is stated in the COAG Health Council Consultation Paper,1 public safety is already paramount in the current “Guiding Principles of the National Scheme”:

Section 3. Objectives and Guiding Principles. 2. The objectives of the National Registration and Accreditation Scheme are a) to provide for the protection of the public by ensuring that only health practitioners who are suitably trained and qualified to practise in a confident and ethical manner are registered. Page 15, Appendix 1.

 

What is the justification used for the proposed change?

  • to remove any cause for doubt among regulatory decision makers that public protection is to be considered a paramount principle guiding decisions that they make to apply the law and administer the National Scheme.” Page 8

ADF Response

  1. No evidence is presented in the Consultation paper that there is any doubt among regulatory decision makers that public protection is to be considered a paramount principle.
  2. There are many ways to remove doubts, if they exist, that do not require changes to legislation.

 

  • Legislative consistency

ADF Response

  1. The fact that we have separate legislation in each state is one of the strengths of the Scheme. It works against blind uniformity for uniformity’s sake and allows each state and territory government and each Health Minister to adapt legislation, if required, to its particular circumstances in accordance with the state or territory government’s legislative jurisdictional mandate.
  2. Individual state and territory governments can always change the National Law in their state if they have the will to do so. There is no evidence in the document that individual states or territories have had problems with their existing legislation, i.e. specific case examples.

 

  • “to improve public understanding of the importance of public health and safety to the National Scheme. Recent research carried out by AHPRA and National Boards to measure levels of stakeholder understanding about their work and to test perceptions of confidence and trust, found there is confusion about their regulatory role among practitioners and the public. The broader community are more likely to associate AHPRA as being ‘for practitioners’ (40%) as opposed to being ‘for the public’ (30%). While practitioners are more likely to associate AHPRA with being ‘for the public’ (38%) as opposed to being ‘for practitioners’ (30%). For National Boards, 36% of practitioners surveyed view their Board as being ‘for practitioner’s while 23% associate their Boards as being ‘for the public’. Among the broader community, 29% view the Boards as being ‘for practitioners’ while 23% see the Boards as being ‘for the public’.” Page 9

ADF Response

  1. Essentially AHPRA/NRAS is admitting that it is trying to solve a public relations problem. It wants changes to legislation to improve its image. The ADF believes that this points to a deeper problem within AHPRA/NRAS, notably that it seems to be more worried about its own perceived image than focusing on the important job it has been given.
  2. The reality is that AHPRA’s prime function is as a registration agency. It has no effective day to day control over the 700,000 health professionals (including 110,000 medical practitioners) it registers, other than overseeing compliance with registration standards and associated regulations. The State Medical Boards (not the Medical Board of Australia) undertake the face-to-face administration of professional regulations and standards. These state boards have been rebranded as being the National Board’s representatives in each state and territory, e.g. The NSW Board of the Medical Board of Australia. This in itself adds to the confusion of the public. It’s hard to see what was wrong with the former state and territory Medical Board titles.
  3. The ADF maintains that AHPRA/NRAS’s important public protection objectives are met by performing its registration and administrative role to the highest possible standards of administrative efficiency, procedural fairness and natural justice, in accordance with administrative law. It implements procedures outlined in legislation that are designed to protect the public from unqualified and unsatisfactory practitioners being given a licence to practise. This is an important administrative and technical role that does not require a major public profile. If the scheme is working efficiently, it should be virtually unnoticed.
  4. There are inherent dangers with open-ended broad objectives like “the welfare of the community” and “the safety of the public”. These broad objects may be seen by the public and those registered by AHPRA as too broad and meaningless or be used to justify actions that could be considered contrary to due process. More specific objectives are appreciated and understood as being real and implementable.

 

Summary & conclusions

The current phrase “confidence in the National Scheme is paramount” opens a door for potential abuse of process and negative consequences against those registrants, or others who have legitimate grievances with the administration of the Scheme. The airing of their grievances could be classed as “undermining confidence in the Scheme”, when in fact they are exercising their rights to administrative fairness, free speech and justice under the principles of established administrative law.

 

Recommendation

  1. That the existing wording in the National Law remain, as a clear compelling case has not been made for change.
  2. That if there is any change to the wording it should be as follows “the guiding principle of the Scheme is the protection of the public through efficient registration and complaints administration of all registered health professionals”.

 

Stephen Milgate AM
CEO ADF
10/12/19

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