CHAPTER 1
INTRODUCTION
TERMS OF REFERENCE
1.1
On 19 March 2009 the Senate referred the design of the proposed national
registration and accreditation scheme for doctors and other health workers
(NRAS/the Scheme) to the Senate Community Affairs Committee(the Committee) for
inquiry and report by 18 June 2009[1].
The reporting date for the inquiry was subsequently extended to 6 August 2009.
1.2
The terms of reference for the inquiry asked the Committee to consider
the design of NRAS including:
-
the impact of the Scheme on state and territory health services;
-
the impact of the Scheme on patient care and safety;
-
the effect of the Scheme on standards of training and
qualification of relevant health professionals;
-
how the scheme will affect complaints management and disciplinary
processes within particular professional streams;
-
the appropriate role, if any, in the Scheme for state and
territory registration boards; and
-
alternative models for implementation of the Scheme.
CONDUCT OF THE INQUIRY
1.3
The inquiry was advertised in the Australian and on the
Committee's website. The Committee invited submissions from Commonwealth and
state and territory governments and interested organisations and individuals.
1.4
The Committee received 141 public submissions. A list of individuals and
organisations that made submissions or provided other information authorised
for publication by the Committee is at Appendix 1.
1.5
The Committee also relied on information made available through the
website of the National Registration and Accreditation Implementation Project
(NRAIP), which has conducted a national consultation process as part of the
implementation of the NRAS. Information on the NRAIP consultation, including
consultation papers, stakeholder submissions and draft NRAS legislation, can be
found at http://www.nhwt.gov.au/natreg.asp. A chronology of the NRAIP process
is included at Appendix 3.
1.6
The inquiry focused on the exposure draft of the main piece of
legislation implementing the NRAS, the Health Practitioner Regulation National
Law—generally referred to as 'Bill B'—which was released on 12 June 2009. The
Committee approached the inquiry as an opportunity to complement or 'add value'
to the NRAIP consultations on the exposure draft. As such, the report does not
aim to provide an exhaustive analysis of all the issues raised in evidence and
submissions, but rather seeks to identify the major issues and concerns of the
regulated professions. The timing of the report was intended to ensure that it
could feed in to the NRAIP's final recommendations on Bill B to the Australian
Health Workforce Ministerial Council (AHWMC/the Ministerial Council).
1.7
The conduct of the inquiry was therefore guided by the availability of
the exposure draft of Bill B and by the timing of the national consultative
processes. The Committee had originally planned to conduct up to five hearings
for the inquiry; however, this was reduced to three hearings to allow the
Committee's report to contribute to the feedback on the exposure draft.
1.8
The Committee held three public hearings in Canberra on 7 May, 13 July
and 14 July. Witnesses who appeared at these hearings are listed at Appendix 2.
1.9
The Committee extends its thanks to Dr Louise Morauta, Project Director
of NRAIP. The evidence and information provided by Dr Morauta's concerning the
detail of the NRAS, as well as consultative and implementation processes for
the Scheme, were of great assistance to the Committee.
BACKGROUND
1.10
The introduction of the NRAS arises from the 'Intergovernmental
Agreement for a National Registration and Accreditation Scheme for the Health
Professions' (the Intergovernmental Agreement). The genesis of the Intergovernmental
Agreement was a 2005 Productivity Commission report which examined 'issues
impacting on the health workforce, including the supply of, and demand for,
health workforce professionals'; and proposed 'solutions to ensure the
continued delivery of quality healthcare over the next 10 years'. The Commission's
report recommended the establishment of a single national registration and
accreditation scheme to enable the Australian health workforce to deal with
shortages and associated pressures; to increase its flexibility,
responsiveness, sustainability and mobility; and to reduce red tape.[2]
1.11
On 14 July 2006 the Council of Australian Governments (COAG) subsequently
agreed to establish the NRAS, beginning with the health professions then
registered in all jurisdictions.
1.12
On 26 March 2008 COAG agreed to the introduction of the NRAS by 1 July
2010. The COAG communiqué announcing the agreement called the Scheme a 'major
step towards improving Australia's health system' and outlined a number of
perceived benefits:
The new arrangement will help health professionals move
around the country more easily, reduce red tape, provide greater safeguards for
the public and promote a more flexible, responsible and sustainable health
workforce.[3]
THE NRAS SCHEME
Legislative framework
1.13
The legislative framework for the implementation of the NRAS is governed
by the fact that the power of regulating health professions resides with the
states, which prevents the Commonwealth from enacting the Scheme through a
single piece of Commonwealth legislation. Accordingly, the Scheme is to be
enacted through the various state and territory legislatures. The enacting legislation
will be passed in Queensland first and then adopted by the other states and
territories.
1.14
The legislative structure to implement the Scheme involves three bills,
for convenience referred to as Bills A, B and C:
-
Health Practitioner Regulation (Administrative Arrangements)
National Law Act 2008 (Bill A);
-
Health Practitioner Regulation National Law 2009 (Bill B); and
-
each state and territory will introduce adopting or corresponding
legislation (Bill C) into their parliaments to fully implement the national
scheme; the Commonwealth will also make consequential amendments to
Commonwealth laws to support the implementation of the national scheme.
1.15
Bill A, which set up the interim administrative arrangements for the
Scheme, was passed by the Queensland parliament on 13 November 2008, and took
effect upon receiving Royal Assent on 25 November 2008.
1.16
Bill B, which supersedes Bill A, contains the full detail of the
implementation arrangements for the NRAS. This includes:
-
defining the role and powers of the Ministerial Council;
-
establishing and defining the role, powers and governance
arrangements of the Australian Health Practitioner Regulation Agency (the
National Agency);
-
establishing and defining the role, powers and governance
arrangements of the National Boards of the regulated professions;
-
defining the authorities and processes for the accreditation of
regulated health professions;
-
defining the requirements for registration of health
practitioners and students;
-
proscribing offences for unregistered practitioners of the
regulated professions (practice protections);
-
establishing processes for managing complaints, performance
assessment and professional standards; and
-
establishing powers and processes for the conduct of
investigations.
Scope of NRAS
1.17
The AHWMC communiqué of 14 July 2006 confined the first tranche of
national registration to the ten health professions registered in all jurisdictions,[4]
with other health professions to be added over time The professions to be
regulated from the inception of the Scheme are:
1.18
The AHWMC communiqué of 8 May 2009 advised that from 1 July 2012 a
further three professions will be regulated under NRAS. These are:
Objectives and guiding principles of
NRAS
1.19
The Intergovernmental Agreement set out the following objectives to be
enshrined in the NRAS legislation:
-
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;
-
to facilitate workforce mobility across Australia and reduce red
tape for practitioners;
-
to facilitate the provision of high quality education and
training and rigorous and responsive assessment of overseas-trained
practitioners;
-
to have regard to the public interest in promoting access to
health services; and
-
to have 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.[6]
1.20
The Intergovernmental Agreement set out the following principles to be
enshrined in the NRAS legislation:
-
it should operate in a transparent, accountable, efficient, effective
and fair manner;
-
it should ensure that fees and charges are reasonable; and
-
it should recognise that restrictions on the practice of a profession
should only occur where the benefits of the restriction to the community as a
whole outweigh the costs.[7]
1.21
The object of the NRAS is set out in clause 3 of Bill B:
The object of this Law is to protect the public by:
-
establishing a national scheme for the regulation of
health practitioners that ensures health practitioners registered under this
Law are suitably qualified and competent, and maintain appropriate standards of
practice, and
-
establishing a national scheme for the registration
of students undertaking programs of study that provide a qualification for
registration in a health profession, to ensure the public is not placed at risk
by the students in the course of undertaking the programs of study.
1.22
The objectives and guiding principles of the NRAS are set out in clause
4 of Bill B:
-
The objectives of the
national registration and accreditation scheme are as follows:
-
to provide for the protection of the public by
ensuring that only health practitioners who are suitably trained and qualified
to practise in a competent and ethical manner are registered,
-
to facilitate workforce mobility across Australia by
reducing the administrative burden for health practitioners wishing to move between
participating jurisdictions or to practise in more than one participating
jurisdiction,
-
to facilitate the provision of high quality
education and training of health practitioners,
-
to facilitate the rigorous and responsive assessment
of overseas-trained health practitioners,
-
to facilitate access to services provided by health
practitioners in accordance with the public interest,
-
to enable the continuous development of a flexible,
responsive and sustainable Australian health workforce and to enable innovation
in the education of, and service delivery by, health practitioners.
-
The guiding principles
of the national registration and accreditation scheme are as follows:
-
the scheme is to
operate in a transparent, accountable, efficient, effective and fair way,
-
fees required to be
paid under the scheme are to be reasonable having regard to the efficient and
effective operation of the scheme,
-
restrictions on
the practice of a health profession are to be imposed under the scheme only if
it is necessary to ensure health services are provided safely and are of an
appropriate quality.
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