Chapter 4
Committee view and recommendations
4.1
The importance of establishing a national registration system for
Australian paramedics is supported throughout the profession and the Australian
health care system. Paramedics fulfill a complex role that requires them to
perform many tasks that are equivalent to those performed by doctors and nurses.
However, unlike doctors and nurses, paramedics often provide treatment in an
unregulated environment with limited support, such as at the scene of a car
accident. They are regularly required to make clinical decisions under pressure
that have serious consequences for patients' lives. Whilst their colleagues,
including doctors, nurses, and 12 other health professions have national
registration systems, paramedics do not.
4.2
The committee is persuaded by the overwhelming support for national
registration it heard from submitters and witnesses, and believes there is a
strong case for national registration. There are a range of benefits that would
result from taking this approach, extending from appropriate recognition of the
work that paramedics undertake, through to greater efficiency within the
Australian healthcare system.
Registration
4.3
The committee agrees that registration would recognise the importance of
the paramedic profession, particularly in comparison with the other health
professions that are currently registered. Some of these professions do not
appear to have the same level of complexity or involve situations of
life-and-death, of the sort faced by paramedics as part of their
responsibilities.
4.4
The committee heard from submitters and witnesses about the positive
outcomes that would result from national registration of paramedics, such as enhanced
safety for the public, who do not have a choice in who provides treatment. Paramedic
registration would also ensure suitable regulation of paramedics' qualifications,
professional standing and criminal history: matters which are currently
inconsistent and lack transparency across Australian jurisdictions.
4.5
The committee is particularly cognisant of the workforce mobility issues
that have been raised in relation to paramedics. National registration would
greatly enhance transferability of the paramedic workforce around Australia.
Importantly, it would enable employers to quickly assess applicant's
qualifications, skills and suitability for positions, and improve standards in
the paramedic profession. This issue is particularly pertinent for employers of
paramedics in rural Australia, where it can be difficult to recruit qualified
staff. The isolation of working in these locations often means that paramedics must
take on a higher level of autonomy in decision making and utilise a broader
range of clinical skills.
Professional standards
4.6
The committee recognises the concern expressed at the hearing, and in
submissions, regarding the current inconsistency of professional standards in
the paramedic profession. The committee is concerned that there is currently no
regulation of the title 'paramedic', nor any required qualifications or professional
skills in several Australian jurisdictions. There appears to be confusion in
the community about what or who is a paramedic, and what treatment they are qualified
to provide.
4.7
The committee accepts the position of witnesses and submitters that the lack
of codified and nationally consistent professional standards is potentially
dangerous given the type of treatment paramedics are called on to provide in an
emergency. The fact that incompetence or malpractice may be hard to detect in
paramedicine, given that paramedics work without direct supervision, further
highlights this issue. In this context, national accreditation and registration
of paramedics should include, but not be limited to, matters such as the scope
of paramedic skills and competencies, qualifications, continuing education, criminal
history checks, insurance, and limitations on the use of the title.
4.8
A consideration in establishing professional standards for paramedics is
the current diversity of qualifications in the paramedic workforce. Professional
recognition is important for students and recent graduates who have invested in
university degrees in paramedicine. However, it is also important to recognise
members of the current workforce who do not have a degree, but do have
significant clinical experience and have demonstrated their ability to operate
effectively. In this context, options to ensure that current paramedics are not
disadvantaged, such as 'grandparenting' should be considered.
Recommendation 1
4.9
The committee recommends that the paramedic profession be nationally
registered and accredited throughout Australia, and that such a scheme give
consideration to 'grandparenting' arrangements for current paramedics, while
ensuring that they meet the agreed professional standards.
Governance
4.10
The committee agrees that a paramedicine board should be established and
operate alongside the National Registration and Accreditation Scheme (NRAS),
and administered by the Australian Health Practitioner Regulation
Agency (AHPRA). The board should have responsibility for implementing national
registration for paramedics in Australia. This is the approach taken for the 14
health professions that are currently registered. The committee believes it is
appropriate that registration and accreditation of paramedics should be
integrated with the existing approach for these health professions.
4.11
A well governed national registration and accreditation system that
implements mandatory requirements for the profession will improve patient
safety and clinical standards. It will also increase community confidence in
paramedics as health care professionals and appropriately acknowledge the
skills and contribution that paramedics make to the Australian community.
4.12
A national registration system will be more comprehensive, consistent
and transparent than the current approach. It is also likely to improve
efficiency in the Australian healthcare system by establishing central
registration, and identifying shared professional competencies with other
health professions to identify opportunities to reduce duplication.
Recommendation 2
4.13
The committee recommends the establishment of a paramedic board,
operating in conjunction with the National Registration and Accreditation
Scheme (NRAS) and administered by the Australian Health Practitioner Regulation
Agency (AHPRA).
4.14
The committee is convinced that in order for national registration of
paramedics to be effective, it is vital that all states and territories
actively participate in the system. If this does not occur, there is a high
risk that the entire process will be undermined. Any state that does not
participate would create a gap in the system that may weaken its integrity and
provide the opportunity for unscrupulous individuals who do not meet the
national profession standards to manipulate the system.
4.15
The committee acknowledges the agreement made by the COAG Health Council
in November 2015 to work towards national registration for paramedics. The work
already being undertaken in Victoria and Queensland to establish the necessary
policy changes and establish a paramedic board is commendable. The committee
understands that this work is likely to result in the implementation of a
national system in mid-2018.
4.16
The committee supports the work undertaken towards establishing a
national registration system for paramedics, and reiterates the importance of
all states and territories participating in the system.
Recommendation 3
4.17
The committee recommends that all Australian states and
territories participate in a national registration and accreditation system for
paramedics.
Senator Glenn
Lazarus
Chair
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