BILLS DIGEST NO. 77, 2013–14              2 June 2014

Health Workforce Australia (Abolition) Bill 2014

Dr Rhonda Jolly
Social Policy Section 

Date introduced: 15 May 2014

House: House of Representatives

Portfolio: Health

Commencement: Sections 1 to 3 on Royal Assent; Schedule1, Part 1, the day after Royal Assent; Schedule 1, Parts 2 and 3, a day to be fixed by Proclamation, which must be within six months of the day after Royal Assent.

Links: The links to the Bill, its Explanatory Memorandum and second reading speech can be found on the Bill’s home page, or through http://www.aph.gov.au/Parliamentary_Business/Bills_Legislation

When Bills have been passed and have received Royal Assent, they become Acts, which can be found at the ComLaw website at http://www.comlaw.gov.au/.

The Bills Digest at a glance

Purpose of the Bill

The purpose of the Health Workforce Australia (Abolition) Bill (the Bill) is to:

·         Abolish the body Health Workforce Australia (HWA).

·         Move the functions and programmes of HWA to the Commonwealth Department of Health.

·         Provide for the transfer of HWA assets, liabilities, interests in land, records and instruments (including contracts, undertakings, deeds or agreements) which have been made by HWA or to which HWA is a party.

Structure of the Bill

The Bill consists of one Schedule divided into three parts:

·         Part 1 contains amendments to the Health Workforce Australia Act 2009 (HWA Act) that will introduce interim arrangements that facilitate the ‘winding up’ of HWA.[1] The provisions include: removal of the requirement for HWA to act in accordance with the directions of the Australian Health Ministers’ Conference; termination of current HWA Board appointments; and allocation of the Board’s current functions to the Minister. The amendments in Part 1 would commence the day after Royal Assent.

·         Part 2 repeals the HWA Act in its entirety, with a commencement date to be within six months after the day of Royal Assent.

·         Part 3 provides for transitional provisions relating to the transfer of assets and liabilities to the Commonwealth on the date the HWA Act is repealed (the commencement time). It states that anything done by HWA before the commencement time is taken, after the commencement time, to have been done by the Commonwealth. It includes provision for the transfer of records or documents in the possession of HWA to the Department of Health. It also clarifies that the transitional arrangement do not provide for the transfer of HWA appointments, engagements or employment to Commonwealth appointments, engagements or employment.

Background

·         In 2008 the Council of Australian Governments (COAG) agreed to a National Partnership Agreement on Hospital and Health Workforce Reform (NPA). HWA was set up under the NPA to establish more effective, streamlined and integrated clinical training arrangements to support workforce reform initiatives, to support health workforce research and planning and to further new workforce models and reforms.

Stakeholder concerns

·         Stakeholders are concerned that valuable work undertaken by HWA will be discontinued or compromised by its absorption in to the Department of Health.

Key issues

·         The key issue or question this Bill raises is whether it is in the best interests of Australia’s health workforce as a whole, in the best interests of individual health workforces, or in the best interests of patients, to abolish HWA.

·         There appear to be two main, inter-related criticisms concerning retaining the agency as a separate entity: one is that it is seen as an additional and wasteful bureaucracy. The second is that there is ‘confusion’ about where the division between the roles of the Department of Health and HWA lies.

•         Some suggestions have been made which would allow HWA to remain an independent research body. One of these is that HWA relinquishes its program delivery work and continues only as an independent body tasked with gathering information about the health workforce and looking at ways of dealing with long-standing problems, such as distribution and productivity.

Background

In late 2005, a Productivity Commission (the Commission or PC) report on Australia’s health workforce noted the complexity of arrangements under which numerous bodies were involved at all levels in health workforce education and training.[2] The Commission considered that while Australia needed to develop a more sustainable and responsive health workforce, these arrangements hindered effective policy formulation and prevented changes which might better respond to changing care demands.

The Commission recommended that a new, effective, national process was established to ensure health workforce decision making processes were objective and transparent, informed by appropriate expert advice and that they reflected the public interest.[3]

Partly in response to the Commission’s findings, in 2008 the Council of Australian Governments (COAG), which had commissioned the PC’s research, agreed to provide funding of over $3.0 billion to a National Partnership Agreement on Hospital and Health Workforce Reform (NPA).[4] The Federal Government directly committed $1.38 billion to the package and the states and territories were to provide $540.0 million.[5]

The NPA partnership was intended to improve efficiency and capacity in public hospitals through four reform components, one of which involved the creation of a national health workforce agency. COAG intended that the agency would establish more effective, streamlined and integrated clinical training arrangements to support workforce reform initiatives. The agency’s responsibilities were to include:

•       funding, planning and coordinating clinical training across all health disciplines

•       funding simulation training

•       supporting health workforce research and planning and

•       progressing new workforce models and reforms.[6]

Senate inquiry and passage of legislation

In May 2009 the Federal Government introduced the Health Workforce Australia Bill 2009 (HWA Bill) to establish the new agency.[7] In comments made on the HWA Bill to a Senate Community Affairs Committee inquiry stakeholders were initially concerned about a number of aspects of the legislation.[8] These included concerns about:

•       the composition of the board of the proposed body; it was argued that there would be insufficient representation by health educators and professionals

•       the potential allowed in the HWA Bill for HWA to intrude into, fetter or influence the accreditation and training functions of the health professions and

•       the lack of a clear definition of clinical training in the HWA Bill and that it did not specify the types of courses considered eligible for funding by the agency, as this was to be determined by the Minister for Health through regulation. It was considered that this had the potential to have a negative effect on education and training standards.

At the same time, stakeholders were genuinely pleased that a body would be established to provide more support for clinical education. In addition, they were very positive about the agency’s research function. The opportunity for HWA to engage in innovative research was seen as important to the development of new clinical education models and innovative models of care. As Professor Ian Wronski, Chair of the Australian Council of Pro-Vice-Chancellors and Deans of Health Sciences, stated:

… health systems research generally has been not as strong as it should be in Australia. In many ways, [the Australian Institute of Health and Welfare] mostly plays a collections role around measuring trends, and that will continue to be very important in understanding what is happening. In addition, universities and others are engaged in research around new models and evaluation. It is not as strong as it should be in Australia. It is striking, when you are trying to find data and trying to understand trends, that there are huge gaps in understanding...Understanding how the cohorts of health professions behave, how the health professions are redefining their role as the health system changes, the behaviour of different population groups in accessing health professional education, are all going to be important in providing a relevant future workforce, as well as recruiting students from populations or subpopulations that do not normally get access to education systems in the proportions we would wish.[9]

Most likely in response to the concerns expressed by stakeholders about the potential for the new agency to interfere in accreditation processes, the Government accepted one amendment to the Bill before its final passage through the Parliament on 24 June 2009. The amendment required that the functions of HWA were not to include responsibility for accreditation of clinical education and training and that regulations made under the Act were not to confer on HWA responsibility for accreditation of clinical education and training.[10]

While the Government did not directly address the issue of the lack of representation of professionals on the HWA Board, the appointment of its members has reflected a balanced approach to ensuring that both the interests of the states and territories, and those of the health professions are represented. Hence, while in 2012–13, the Chair of the Board was lawyer, James McGinty, its state and territory representatives included nurse, Professor Mary Chiarella, medical academic, Dr Peggy Brown, nutrition and dietetics specialist, Professor Sandra Capra, Professor John Horvath, who had acted as the Australian Government Chief Medical Officer from 2003 to 2009 and Dr Felicity Jeffries, an expert in rural recruitment and workforce issues.[11]

Work of the HWA

The HWA’s first Chief Executive Officer commenced his appointment in January 2010 and the HWA Board was appointed in February 2010 with the brief to work directly with the Australian Health Ministers’ Conference (AHMC) and the health and higher education sectors on:

•       authoritative, evidence-based health workforce planning, policy advice and analysis of future supply and demand scenarios affecting Australia’s health care system

•       capacity building and targeted reform in clinical training to ensure that Australia is able to maintain and grow the clinical training requirements of the nation’s health professionals—to be achieved through programs of funding, development and reform in both the health and higher education sectors

•       innovation and reform of Australia’s health workforce to encourage an inter-professional approach to service delivery, flexibility in deployment of scarce health professional resources and development of new health workforce models to respond to demand for health care

•       international recruitment and retention programs for health professionals and

•       general advice on a range of health workforce policy, planning and strategic matters for federal and state Health Ministers, the health sector and the higher education sector.[12]

During 2009–10 the agency prepared an interim program of work for approval by AHMC. In 2010–11 with new clinical training funding announced by the Prime Minister Julia Gillard and Health Minister Nicola Roxon of $425.0 million, HWA provided funding to 83 agencies for 470 projects.[13] Other projects commenced included the allocation of $94.0 million to support an expansion of Simulated Learning Environments, $32.0 million to create Integrated Regional Clinical Training Networks and $28.0 million for the Clinical Supervision Support program.[14]

In terms of research, the agency undertook a national consultation process on the development of a strategic framework to set out key focuses for health workforce innovation to 2015 and worked towards developing a national training plan for medical practitioners, nurses and midwives.[15]

In 2011–12, Health Ministers endorsed the HWA’s strategic framework, the National Health Workforce Innovation and Reform Strategic Framework for Action 2011–15.[16] The framework sets broad parameters for the health and higher education system. Amongst other work, the agency commissioned a range of projects under the Clinical Training Funding program and provided more funding to simulated-learning projects. It published a number of research reports examining Aboriginal and Torres Strait Islander health workers, competency-based training, physician assistants and oral health practitioners and produced the first in its series of Health Workforce 2025 papers, Health Workforce 2025—Doctors, Nurses and Midwives.[17] It also:

… delivered the first part of a comprehensive program of reforms looking at extending the role of paramedics, expanding the range of health professionals that can prescribe, training nurses to deliver endoscopy services and utilising physiotherapists and nurses more fully in emergency departments.[18]

In its 2012–13 annual report HWA noted that its policy proposals in response to the issues documented in Health Workforce 2025 had been approved by AHMC. These proposals included: included improving coordination of medical training by working with trainees, employers, educators and governments through a new National Medical Training Advisory Network; analysing state and territory health workforce industrial arrangements to identify barriers and enablers to workforce reform; investigating the implications of increasing self-sufficiency in the medical workforce; streamlining clinical training funding through the development of nationally consistent approaches to clinical training placements in the public, non-government and private sectors and focusing work on the retention and productivity of nurses.[19]

Other projects included the funding of rural workforce agencies in each state and territory to recruit nurses and allied health professionals to rural and remote Australia, continued work on the Health Professionals Prescribing Pathway (HPPP) project to produce a nationally consistent approach to prescribing by health professionals other than medical practitioners and publication of the National Cancer Workforce Strategic Framework which considered a course of action to address challenges facing health professionals working in the area of cancer treatment and care.[20]

Indeed, at the conclusion of the NPA in June 2013, HWA proclaimed it had delivered ‘against all of the requirements outlined in the agreement for health workforce reform’.[21]

See further information on selected HWA projects in Appendix A.

Mason Review of health workforce programs

In April 2013, a review of health workforce programs, chaired by Jennifer Mason, former Director-General of the New South Wales Departments of Human Services and Community Services, reported to the Federal Government.[22]

The Mason Review made a number of observations about HWA. First, that existence of the agency provided an opportunity to expand:

… complementary activity in workforce that draws on the best available evidence, state and territory arrangements and improved workforce planning. Much of this reform activity is likely to take place in areas likely to be highly contested, either between states and territories (due to their differing service platforms – for example the rural generalist model which exists in QLD but not in all other states at this time) or by professional and industrial organisations where new professions or scopes of practice are proposed (such as nurse endoscopists).[23]

A second observation was that tensions existed between the Department of Health and Ageing (now known as the Department of Health, that is, the DoH) and HWA. This was in part due to the fact that the HWA legislation set up the agency as an independent body responsible for the delivery of projects under the NPA and other items as directed by Health Ministers—but the jurisdictions were not funding the agency directly. DoH’s role was to provide advice to the Australian Government and to fund specific health workforce programs. Given these circumstances, Mason considered it understandable that the Federal Government would want more involvement in the activities of HWA. In Mason’s words:

The expenditure of Commonwealth funds is involved, and the delivery of Commonwealth policy outcomes is to an extent contingent upon appropriate targeting of these funds.[24]

However, as it stood, there was no legislative or other basis for the Federal Government to seek to direct HWA in its operations as its operational accountability was to its board.[25]

In addition, Mason’s research had led her to conclude that the existing arrangement had led to ‘uncertainty from the perspective of stakeholders’ about the roles and responsibilities of HWA and the DoH and that this needed to be resolved.[26]

Having made these points, Mason iterated what had been stressed often in relation to health workforce planning, and one which needs to be assessed in considering this Bill:

The real question for future consideration will be whether the current structural arrangements facilitate or impede the delivery of good policy and operational outcomes in ensuring that Australia has a health workforce which is well qualified, capable and flexible to meet the needs of Australian communities.[27]

Mason’s answer to the question was to suggest three broad options for HWA’s ongoing operation which could be considered in the context of a review of the NPA. These were:

•       HWA operations remained the same. Mason commented on this option that it was problematic given the requirement to report to all Health Ministers had resulted in a cumbersome process requiring HWA to report to a variety of ‘masters’. This is despite HWA being fully funded from the Commonwealth

•       HWA took over the management of selected DoH programs. In Mason’s view there were pros and cons to this option—if HWA took over certain programs continuity could be ensured and duplication reduced. At the same time, the federal minister would lose ‘flexibility to utilise funding to meet arising priorities’ and

•       HWA became a data and policy agency, with a brief to fund innovative or pilot programs; it ceased to manage mature programs. In relation to this option, Mason commented:

HWA’s programs could be managed by the Department which would enable HWA to focus on its data analysis and policy development work. This would enable HWA to be more innovative and bold in its approach to workforce reform, having more time to focus on the emerging issues. This is the aspect of HWA’s work which has been most highly valued and validated by stakeholders in the course of this review, and it would justify investment of time and resources.[28]

Under this option HWA would retain a budget for innovation and reform; to support innovative ‘pilot’ approaches which may be, if successful, applied more broadly through DoH program funding. Mason considered that ‘in this option, the best approach would be to remove HWA’s program delivery as there could potentially be conflicts with HWA setting the policy and then setting funding priorities without having a transparent, open process’.[29]

National Commission of Audit

In its report released in May 2014 the National Commission of Audit argued that there are too many government bodies in Australia and that this situation ‘leads to duplication and overlap, unnecessary complexity, a lack of accountability, the potential for uncoordinated advice and avoidable costs’.[30] In examining the potential for rationalisation of bodies and agencies, some of the principles on which the NCoA based its recommendations were:

•       portfolio departments should undertake policy work, while agencies should deliver programmes and services

•       as far as practicable, bodies should be incorporated into a portfolio department and

•       the need for independence alone does not justify the establishment of a new operational body.

As such the NCoA recommended that five of the 22 bodies and agencies within the Health Portfolio were consolidated into the DoH. These included General Practice Education and Training Ltd and HWA, which the NCoA considered could be ‘brought together as a clinical training unit’.[31] This recommendation appeared to dismiss HWA’s research function.

In discussing research and data collection, however, the NCoA was of the view that a new independent Health Productivity and Performance Commission should be formed to take over the role of a number of bodies that collected and reported health data. It envisaged that the new body:

… could coordinate, report and drive performance across the health care system. This would include identifying innovative options to increase efficiency across the sector and publicly reporting health performance statistics and outcomes. Corporate functions would be supplied by the Department of Health.

The commission would be formed through a merger of the Australian Commission on Safety and Quality in Health Care, the Australian Institute of Health and Welfare, the Australian National Health Performance Authority, components of the Australian National Preventative Health Agency, the Private Health Insurance Administration Council, the Independent Hospital Pricing Authority, the National Health Funding Body and the National Mental Health Commission.[32]

From the perspective of rationalisation and creating a central repository of health information, from which the Government can ensure that the work of agencies aligns with Government objectives, this suggestion is sensible. But from another perspective, it could be argued that policy areas such as health are so complex that expertise in one health sector does not necessarily transfer to another sector. Hence, rationalisation may not produce the most effective outcomes, regardless of whether an agency is policy development or program driven. Similarly, the fact Government can ensure that agency work aligns with its objectives, may not necessarily ensure that advice is given which will produce long-term health workforce outcomes which make the best use of human and other resources.

Committee consideration

Senate Community Affairs Legislation Committee

The Bill has been referred to the Senate Community Affairs Legislation Committee for inquiry. Submissions to the committee are due by 6 June and a report is due 14 July 2014. Details of the inquiry are at the inquiry webpage.[33]

Policy position of non-government parties/independents

Following confirmation at Senate Estimates in November 2013 that HWA was experiencing a ‘funding freeze’ which had affected its support for clinical placement funding, Labor’s Shadow Parliamentary Secretary for Health, Amanda Rishworth, has constantly criticised Government treatment of the agency.[34] Rishworth accused the Prime Minister of not taking health workforce planning seriously, and demanded that the Government ‘come clean’ on its plan to abolish the agency.[35]

In December 2013, the Shadow Parliamentary Secretary for Health moved a motion in the House of Representatives calling on the Abbott Government to make HWA funding to support clinical training placements immediately available to HWA. Shadow Parliamentary Secretary Rishworth argued that Labor established HWA ‘to drive a long-term vision and plan for our health workforce’. [36] She continued:

Health Workforce Australia is an important organisation. It was established through COAG to ensure the government had an agency that was committed to building capacity, boosting productivity and improving the distribution of our health workforce. The agency works in collaboration with a number of key stakeholders and has direct links with states and territories, which are the biggest employers in our health system. Importantly, it has links on the boards of universities that train our medical workforce which focus on providing leadership, advice, research and funding to address the challenges of building a sustainable health workforce for our future.

Australia needs Health Workforce Australia. It has proven that it can respond and plan for our future health workforce needs. For example, when the former Labor government increased bowel screening, many Australians required an endoscopy; however, the capacity in the workforce for endoscopy nursing was not there. Health Workforce Australia responded through the Expanded Scopes of Practice program and made funding available to support nurses to extend their skills as well as respond to the growing demand for these services. This is an example of Health Workforce Australia responding flexibly and quickly to the needs of the community to ensure that important preventative measures occur.

Programs such as the Clinical Training Funding program delivered by Health Workforce Australia have had a significant impact. Indeed, the number of clinical placement days in 2012 increased by 50 per cent, compared to 2010. The funding contributed to a huge increase in placement days in rural and remote Australia, an area which so desperately needs more health professionals.

The Clinical Training Funding program was expanding the clinical training capacity of the health workforce in Australia and promoting the growth in clinical training placement days in 25 different health professions to address workforce shortages—a great example of how essential this funding was to supporting growth in training and addressing health workforce issues. But this funding to support clinical placements is now frozen thanks to this government's commission of cuts. If this is not unfrozen, it will lead to students not being able to access the clinical placements they need and to existing health professionals not having the facilities to expand their clinical skills. This threatens all the great work that has been done by Health Workforce Australia over the last few years to help build capacity in our training places and to improve productivity in our health workforce.[37]

Rishworth has maintained her stance on the Government’s approach to HWA. Her latest comment followed the Budget when she iterated the view that absorbing the agency into the DoH would ‘undermine efforts to plan to ensure that we have enough doctors, nurses and other healthcare workers into the future’.[38]

Position of major interest groups

A Medial Observer article following the Budget quoted medical experts who condemned the proposal to merge General Practice Education and Training with Health Workforce Australia (HWA) and consolidate them into the health department.[39] In the view of the President of the Royal Australian College of General Practitioners, Liz Marles, ‘the move would risk destabilising general practice training’. Public Health Association chair, Michael Moore, labelled the plan short-sighted. Moore argued that the merged organisations would not have the same independence nor influence if they were combined with the health department. Professor Simon Willcock, who has sat on the boards of both organisations, also pointed to the good work HWA had done in developing databases and around workforce projections and lamented that it would be a shame to see all that work not continue.[40]

In commenting on the Budget Croakey blogger Jennifer Doggett’s opinion was that it was difficult to assess what effect mergers, abolition of agencies and rationalisation would have on the health sector as insufficient information had been given about what function and programs of the organisation would continue. Doggett was inclined to think that ‘[w]hile there may be some savings in administration of combining several organisations, there are also risks that some valuable and cost-effective activities being undertaken by these agencies will cease’.[41]

Prior to the 2013 Election it was reported that while the Australian Medical Association (AMA) was mostly supportive of coalition policies, it would oppose any cuts to the planning and analysis done by HWA. In October 2013 AMA President, Steve Hambleton, emphasised the value of HWA during a meeting with Health Minister, Peter Dutton.[42]

It is worth noting that the AMA continues to support the work done by, and the existence of HWA, despite its criticising some of the agency’s recommendations. For example, in response to an HWA recommendation for autonomous non-medical prescribing endorsed by Australia’s health ministers, the AMA President argued that autonomous prescribing led to ‘misadventure’.[43]

The Mason Review noted, but did not elaborate upon in detail, stakeholder concern about the extremely onerous compliance based contracting model used by HWA in delivering funding. At the same time, however, Mason noted that stakeholders praised the agency’s data and policy work and its innovative funding projects.[44]

In the context of the policy to absorb HWA into the DoH, it should be noted that in general there have been calls for overall reduction of the federal bureaucracy and/or for the privatisation, abolition or absorption of the various agencies set up under the previous Labor Government. One critic has argued that the agencies are ‘undertaking unnecessary, and sometimes damaging, work or undertaking work that should rightfully be done by the main government departments’.[45]

Another has contended that some Federal Government entities ‘could be abolished altogether on account of the distortionary economic impacts of policies or programs, or unnecessary roles, undertaken by such bodies’.[46]

Financial implications

The Explanatory Memorandum to the Bill argues that it will deliver savings to the Government ‘through reduced duplication of functions and administrative efficiencies’.[47] The 2014–15 budget papers predict savings from the abolition of HWA will be $142.0 million over five years (see the table below).[48] The budget papers state that these will result from administrative efficiencies due to transfer of the agency to DoH. There is no indication that the transferred funding will be additional to the DoH Budget after 2017–18. If it is not, this may affect the resources the DoH is able or willing, to allocate to the type of research and projects HWA was prepared to initiate and pursue.

Expense ($m)

2013–14

2014–15

2015–16

2016–17

2017–18

Department of Health

5.1

188.0

169.9

166.4

190.5

Health Workforce Australia

–

–211.5

–214.1

–216.8

–219.5

Total — Expense

5.1

–23.6

–44.2

–50.3

–29.0

Statement of Compatibility with Human Rights

As required under Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011 (Cth), the Government has assessed the Bill's compatibility with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of that Act. The Government considers that the Bill is compatible.[49]

Failure to pass

Should this Bill fail to pass in the Senate, there will be questions raised about what will happen to HWA, given that funding for the agency has been re-allocated in the 2014–15 Budget to DoH. According to the second reading speech for this Bill existing functions, commitments, and activities will continue, and ‘organisations currently funded by HWA can be assured that all current funding agreements will be met.’[50] However, no funding will be available to allow the agency to continue to function. So even if it is not abolished, its functions will still likely be transferred to the DoH.

An analogy can be found with the Climate Change Authority and the Clean Energy Finance Corporation which continue in existence as the Bills seeking their abolition have failed to pass the Senate. As the Shadow Minister, Mr Butler said in a media release on 17 March 2014:

The Clean Energy (Carbon Tax Repeal) Bills – totalling 11 bills - were introduced to the Senate on 2 December 2013. Labor and the Greens voted to separate the bills relating to the abolition of the Climate Change Authority and the Clean Energy Finance Corporation and be debated in their own right. Each bill was defeated in the Senate, meaning both the CCA and CEFC will continue their operations.[51]

There was no funding for the Climate Change Authority in the Budget, but until it is lawfully abolished, funding will have to continue for remuneration of appointees until terms of appointment expire.[52]

In the case of HWA, clearly the agency cannot continue without funding. Therefore, it may be possible for the DoH to provide funds from the appropriations for HWA to continue to operate. Given the Government’s resolve to provide efficiencies by abolishing HWA (and other agencies in the Health Portfolio), it appears unlikely that the DoH will provide funding to the agency; that it will remain in limbo until such time as this Bill can be passed by both Houses of the Parliament.

Key issues and provisions

Schedule 1 to this Bill consists of three parts.

Part 1 of the Schedule contains amendments to the HWA Act that will introduce interim arrangements that facilitate the ‘winding up’ of HWA. Amongst other things, the provisions provide for:

•       removal of the requirement for HWA to act in accordance with the directions of the Australian Health Ministers Conference (item 2)

•       termination of current HWA Board appointments (item 18) and

•       the appointment by the Minister of a person to act as the CEO for a period of more than 12 months (items 3 and 4)

In essence items 3 to 15 have the effect of allocating to the Minister the functions currently undertaken by the HWA Board. Item 16 gives the Minister the power to delegate any of his or her functions or powers as described under Part 4 of the HWA Act to the Secretary of the DoH or an Senior Executive Service (SES), (or acting SES) officer of the DoH.

Part 2 of the Schedule, repeals the HWA Act in its entirety (item 19).

Part 3 of the Schedule relates to transitional matters. Division 2 relates to the transfer of assets and liabilities. Items 21 and 22 state that all assets and liabilities of HWA become assets and liabilities of the Commonwealth on the date the HWA Act is repealed (the ‘commencement time’).[53]

Division 3 relates to the transfer of other matters. Item 25 states that anything done by HWA before the commencement time is taken, after the commencement time, to have been done by the Commonwealth. Item 27 sets out that any records or documents in the possession of HWA immediately before commencement time will transfer to the Department of Health. Item 26 provides for Commonwealth to be substituted for HWA in any unresolved court or tribunal proceedings. Item 28 provides that ongoing Commonwealth Ombudsman investigations into the actions of HWA will continue as if the Department had taken the relevant action.

Division 4 relates to annual reporting requirements and requires the Secretary of the DoH to prepare a final annual report for HWA and present it to the Minister, who will be required to table the report in Parliament. The report is to include financial statements of the agency.

Division 5 relates to staffing matters. The effect of item 33 is to clarify that nothing in the transitional arrangements in Part 3 provides for the transfer of HWA appointments, engagements or employment to the Commonwealth.

Division 6 deals with miscellaneous matters.

Concluding comments

The key issue or question this Bill raises is whether it is in the best interests of Australia’s health workforce as a whole, in the best interests of individual health workforces, or in the best interests of patients, to abolish HWA.

There is little dispute that HWA has done valuable work in the short time it has been in existence, and there does not appear to be suggestions that the type of work it carries out should not continue. It appears there are two main, inter-related criticisms concerning retaining the agency as a separate entity: one is that it is seen as an additional and wasteful bureaucracy. The second is that there is ‘confusion’ about where the division between the roles of the DoH and HWA lies. However, as the Mason report notes, there are solutions to these problems which may not involve the abolition of the agency.

Mason’s suggestion that HWA continues to be an independent body tasked with not only gathering information about the health workforce, but also looking at ways of dealing with long-standing problems, such as distribution and productivity is a worthwhile one. This would clearly delineate the roles of the DoH and the agency into those of program delivery and research. The solution would require legislative adjustment which redefines the role of HWA, and compromises such as those pertaining to governance arrangements. It would ensure, however, that valuable, independent information and advice is available to inform the development of long-term health workforce outcomes. It remains to be seen if the DoH has the capacity or will to undertake research which is premised wholly on finding workable, far-sighted solutions to health workforce problems.

Appendix A: selected current Health Workforce Australia projects

This appendix provides examples of current HWA projects which have been designed to meet three of the agencies strategic objectives—improving distribution, building capacity and boosting the productivity of Australia’s health workforce.[54]

Improve distribution

Geographic Distribution: Medical Workforce project

The mal-distribution of the medical workforce has been a challenge for many years, and while a significant number of incentive programs have been offered to encourage medical practitioners to work in rural and remote areas, a more effective and coordinated approach is needed. The geographic distribution project is being designed to examine the impact of incentive programs currently offered, consider what has worked in the past and what impact programs have across different career stages.

The aim of the project is to provide health ministers with a list of policy options for effective investment decisions.

Rural Health Professionals Program

The Rural Health Professionals Program aims to attract, recruit, and retain nursing and allied health professionals from Australian metropolitan and approved overseas locations to work in rural and remote Australia. Support is also available for candidates in regional areas who are relocating to more rural or remote locations of employment. Recruits are provided with retention supports, for up to two years, to assist them to remain practicing in rural and remote communities.

Positions with Aboriginal Medical Services and Aboriginal and Aboriginal Community Controlled Health Services across all regions are also targeted as eligible positions under the program. Qualified recent Australian graduates, within the last 12 months, may be eligible. Funding has been provided to the state and territory Rural Workforce Agencies to deliver the program, which commenced in January 2012.

Build capacity

International Health Professionals Program

The International Health Professionals Program has implemented a range of projects that intend to:

•       support a streamlined approach to the attraction, placement and retention of international health professionals

•       evaluate the effectiveness of current measures and develop policy options to achieve improved distribution of health professionals to areas where they are most needed

•       reduce red tape for international health professionals and deliver more health professionals, more quickly and efficiently into practice and

•       reflect the principles of ethical recruitment and ethical integration of international health professionals into practice.

Integrated Regional Clinical Training Networks

The cornerstone of the clinical training system is the partnerships that exist between organisations and individuals from higher education and training providers and clinical training providers.

Integrated Regional Clinical Training Networks (IRCTNs) build capacity, increase productivity and improve distribution in the clinical training system by building partnerships between higher education and training providers, and clinical training providers.

HWA has provided funding to the states and territories for IRCTNs across Australia.

The functions of the Networks are to:

•       understand the number of clinical placements required by higher education and training providers, and their availability from clinical training providers

•       facilitate collaboration and cooperation between higher education and training providers, and clinical training providers

•       engage with IRCTN members and stakeholders to promote the IRCTNs, seek feedback on the IRCTNs’ activities in the region and obtain input into the IRCTNs’ planning processes

•       engage with and support the implementation, management and evaluation of HWA’s other clinical training reform initiatives, particularly the Clinical Supervision Support Program, Simulated Learning Environments program and the Local Innovations Fund and

•       facilitate engagement with IRCTN members and stakeholders on broader health workforce reform issues.

Boost productivity

Assistant and Support Roles Program

Using the full potential of assistant and support workers as an integral part of the health care workforce is a priority for Australian governments as well as non-government and private organisations.

HWA is analysing scopes of practice and models of care for assistant and support workers with a focus on workforce availability, affordability and sustainability in relation to how quality and safe care is organised, delivered and sustained.

Expanded Scopes of Practice Program

As medical practitioners are not always easily accessible for parts of the Australian community, particularly in regional, rural and remote areas, expanding the scope of health professionals within areas of high needs is one way of addressing this.

Health Workforce Australia’s Expanded Scopes of Practice Program is funding projects within health and ambulance services to help broaden the roles of health professionals.

The program includes undertaking the implementation phase of expanding the scope and uptake of new or redesigned roles of health workers and increasing recruitment within areas of high needs with the aim of improving productivity, retention, accessibility, efficiency and effectiveness of healthcare services.

This involves undertaking a number of targeted innovative health workforce reform initiatives with a specific focus on role redesign and expanding the scope of existing health workers in acute and primary care settings.

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[1].              Health Workforce Australia Act 2009, accessed 26 May 2014.

[2].              Productivity Commission (PC), Australia’s health workforce, Research report, PC, Canberra, 22 December 2005, accessed 21 May 2014.

[3].              Ibid.

[4].              Council of Australian Governments (COAG), National Partnership Agreement on Hospital and Health Workforce Reform, COAG, December 2009, accessed 23 May 2014.

[5].              The total funding of $3.042 billion consisted of $1.38 billion Commonwealth transfers to states and territories, $1.12 billion Commonwealth own purpose expenses and $540.0 million state and territory contributions. COAG, National Partnership Agreement on Health and Hospital Reform, op. cit. Note: as the Mason report (see detail at footnote 17) points out the states and territories have not provided funding directly to Health Workforce Australia (HWA). The Department has advised that these jurisdictions indicated subsequent to the 2008 COAG agreement that they would provide their contribution to HWA’s broad objectives through in-kind arrangements related to historical clinical training provided to undergraduate students through the public hospital system.

[6].              COAG, National Partnership Agreement on Hospital and Health Workforce Reform, op. cit., p.16.

[7].              Parliament of Australia, ‘Health Workforce Australia Bill 2009 homepage’, Australian Parliament website, accessed 31 May 2014.

[8].              Summary of information contained in submissions, evidence given to and the report of the Senate Community Affairs Legislation Committee, Inquiry into the Health Workforce Australia Bill 2009 [Provisions], The Senate, June 2009, accessed 22 May 2014.

[9].              I Wronski (Chair, Australian Council of Pro-Vice-Chancellors and Deans of Health Sciences), Evidence to the Senate Community Affairs Legislation Committee, Inquiry into the Health Workforce Australia Bill 2009, The Senate, Canberra, 11 June 2009, p. 8, accessed 30 May 2014.

[10].              Schedule of Amendments to the Health Workforce Australia Bill 2009, accessed 23 May 2014.

[11].              Health Workforce Australia (HWA), Annual report 2012–13, HWA, accessed 22 May 2014.

[12].              HWA, Annual report 2009–10, p. 2, accessed 22 May 2014. Note: the reporting requirements for approval of HWA major projects are that the Chief Executive Officer reports to the Board (consisting of a Chair, three independent members and nominees from all jurisdictions). Following approval of the Board, HWA then seeks approval from all health ministers.

[13].              J Gillard (Prime Minister) and N Roxon (Minister for Health), Training more doctors, nurses and health professionals, media release, 13 October 2010, accessed 23 May 2014 and HWA, Annual report 2010–11, p. 4, accessed 22 May 2014..

[14].              HWA, Annual Report 2010–11, op. cit., p. 4, accessed 22 May 2014.

[15].              Ibid., p. 5.

[16].              HWA, Annual report 2011–12, p. 9, accessed 22 May 2014.

[17].              HWA, Health workforce 2025: doctors, nurses and midwives: volume 1 and volume 2, March 2012; Health workforce 2025: medical specialists: volume 3, November 2012, accessed 23 May 2014.

[18].              HWA, Annual report 2011–12, op. cit.

[19].              HWA, Annual report 2012–13, op. cit., p. 10.

[20].              Ibid.

[21].              Ibid., p. 9.

[22].              J Mason, Review of Australian Government health workforce programs, Department of Health and Ageing, April 2013, accessed 23 May 2014.

[23].              Ibid., p. 326.

[24].              Ibid., pp. 327–328.

[25].              Ibid., p. 328.

[26].              Ibid., p.25.

[27].              Ibid., p. 328.

[28].              Ibid., p. 329.

[29].              Ibid., p. 330.

[30].              National Commission of Audit (NCoA), Towards responsible government: phase one, February 2014, p. xxvi, accessed 23 May 2014. The NCoA was announced by the Treasurer and the Minister for Finance on 22 October 2013. It was established as an independent body to review and report on the performance, functions and roles of the Commonwealth Government.

[31].              Ibid., p. 211.

[32].              Ibid., p. 210.

[33].              Senate Community Affairs Legislation Committee, Inquiry into the Health Workforce Australia (Abolition) Bill 2014, The Senate, Canberra, accessed 30 May 2014.

[34].              Senate Community Affairs Legislation Committee, Official Committee Hansard, 20 November 2013, p. 147, accessed 26 May 2014.

[35].              A Rishworth, (Shadow Parliamentary Secretary for Health), Abbott Government’s commission of cuts hits clinical placements, media release, 28 November 2013, accessed 26 May 2014.

[36].              A Rishworth, (Shadow Parliamentary Secretary for Health), ‘Private Members’ Business: Health Workforce Australia’, House of Representatives, Debates, 9 December 2013, p. 1882, accessed 26 May 2014.

[37].              Ibid., p. 1883.

[38].              A Rishworth (Shadow Parliamentary Secretary for Health), Worst fears confirmed as Commission of Audit targets Health Workforce Australia, media release, 4 May 2014, accessed 22 May 2014.

[39].              F Murphy, ‘Move to merge GPET and HWA not welcome by doctor groups’, Medical Observer, 16 May 2014, accessed 23 May 2014.

[40].              Ibid.

[41].              J Doggett, ‘Budget 2014: the good, the bad and the ugly (but mostly the ugly…)’, Croakey, 14 May 2014, accessed 23 May 2014.

[42].              A Corderoy and D Hurst, ‘Health groups face scalpel under $340m plan’, The Canberra Times, 23 August 2013, p. 5, accessed 26 May 2014 and A Rollins, ‘Hope on prescription bugbear following Dutton talks’, Australian Medical Association (AMA), 22 October 2013, accessed 26 May 2014.

[43].              B Kaye, ‘Doc outrage over non-med prescribing plan’, Medical Observer, 22 November 2013, accessed 26 May 2014.

[44].              Mason, Review of Australian Government health workforce programs, op. cit.

[45].              J Sloan, ‘Opinion: when in doubt, Tony, scrap useless bodies’, The Weekend Australian, 9 November 2013, accessed 26 May 2014.

[46].              J Novak, Razor cuts, not paper cuts: a framework for rightsizing Commonwealth Government employment, Institute of Public Affairs, October 2012, p. 31, accessed 26 May 2014.

[47].              Explanatory Memorandum, Health Workforce Australia (Abolition) Bill 2014, p. 1, accessed 21 May 2014.

[48].              Australian Government ‘Part 2: expense measures’, Budget measures: budget paper no. 2: 2014–15, accessed 21 May 2014.

[49].              The Statement of Compatibility with Human Rights can be found at page 2 of the Explanatory Memorandum to the Bill.

[50].              P Dutton ‘Second reading speech: Health Workforce Australia (Abolition) Bill 2014’, House of Representatives, Debates, 15 May, 2014, p. 4, accessed 26 May 2014.

[51].              M Butler (Shadow Minister for Environment, Climate Change and Water), Time comes for Abbott to step up on climate change, media release, 17 March 2014, accessed 26 May 2014.

[52].              Australian Government, ‘Part 1: agency resourcing’, Budget measures: budget paper no.4: 2014–15, accessed 26 May 2014.

[53].              Commencement time is defined as the commencement of Part 2 of Schedule 1 which is to be a date fixed by Proclamation that must be within six months of the day after Royal Assent (item 20). If a date is not proclaimed within that time, the Act will commence on the day after the end of six months after Royal Assent.

[54].              Source of information in this Appendix: ‘Current programs’, Health workforce Australia website, accessed 26 May 2014.