Peter Dutton (Dickson, Liberal Party, Shadow Minister for Health and Ageing) Share this | Hansard source

The Health Practitioner Regulation (Consequential Amendments) Bill 2010 before us today signals the final stages of what has been a long and complex process. This bill provides consequential amendments to what is a significant reform, being the National Registration and Accreditation Scheme. It is important that we consider the wider ramifications of the Registration and Accreditation Scheme that underpins this legislation before I comment on the specifics of the bill. There has been strong in-principle support for a nationally consistent registration scheme for health professionals. Different registration and accreditation requirements between jurisdictions has, in the past, hampered workforce mobility and made it difficult to monitor the small number of practitioners who have been under scrutiny or are facing disciplinary action in a given jurisdiction.

The guiding principles of the scheme are stated as, firstly, 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; secondly, to facilitate workforce mobility across Australia and reduce red tape for practitioners; thirdly, to facilitate the provision of high-quality education and training and rigorous and responsive assessment of overseas trained practitioners; thirdly, to have regard to the public interest in promoting access to health services; and, finally, to have regard for the need to enable the continuous development of a flexible, responsive and sustainable Australian health workforce and enable innovation in education and service delivery.

The process commenced when the Productivity Commission recommendations came down in January 2006 for a single national registration board and a single national accreditation scheme. The previous coalition government acted on the recommendations by reaching an agreement at COAG in 2006 for the establishment of a national registration scheme. In April 2007, COAG agreed on a single National Registration and Accreditation Scheme to commence in July 2008. The health workforce underpins our health and hospital system. Health workforce issues have been prominent in political debate and in the media recently. I think it is important that we take the opportunity to revisit some of the facts. The coalition, whilst in government, delivered nine new medical schools, including in regional areas. There was a 50 per cent increase in medical school places between 2003 and 2007. Additional funding was provided in 2006 for some 605 additional medical school places being phased in from 2007 to 2011. The coalition government also provided 3,700 additional nursing places between 2005 and 2007 alone. It was the coalition that commenced funding for practice nurses through the Nursing in General Practice Initiative and later with additional MBS rebates. The coalition clearly is committed to improving the quality of Australia’s health workforce, despite this government’s best efforts to rewrite history.

Following the election of the Rudd government, the national registration scheme stalled and implementation has been delayed until July 2010. One of the primary reasons for developing a single national scheme for registration and accreditation was to reduce bureaucratic red tape across the jurisdictions. Unfortunately it seems, like in many policy areas of this government, there has been strong bureaucratic influence and interference with the establishment and proposed functions of the boards. Concerns still exist regarding the exertion of power by the ministerial council over national boards and, in particular, accreditation standards. The national law provides that the ministerial council may give directions to a national board for a proposed accreditation standard, or a proposed amendment of an accreditation standard.

The only caveat originally on the ministerial council providing accreditation directives was that the proposed standard or amendment would have a substantive and negative impact on the recruitment or supply of health practitioners. This understandably stirred up considerable concern amongst health professionals and patient groups. On the face of it, this provided health ministers with the authority to interfere with accreditation standards on the basis of workforce supply—should they be faced with a shortage, the concern was that they would be able to take shortcuts and lower the bar to increase workforce numbers. This provision did little for confidence in the safety and quality of health care in our country. It was only after the first Senate Community Affairs Legislation Committee inquiry that a requirement was included for the ministerial council to give consideration to the potential impact of the council’s direction on the quality and safety of health care.

In fact, the committee explicitly recommended that the ministerial council consider the recommendations proposed by the Australian Medical Association in relation to this issue. The AMA recommendations included: defining ‘substantive and negative impact’; requiring the ministerial council to apply a public interest test that considers, amongst other things, the potential impact on the quality and safety of patient care; requiring the ministerial council to consult with the relevant learned medical college and faculties on best practice; requiring that ministerial council decisions to issue policy direction to national boards be unanimous; providing greater transparency of policy directives by providing justification and evidence for the decisions and publishing those decisions; and including specific provisions for review of directives.

Despite the committee’s and the AMA’s recommendations, the ministerial council has provided only a very limited response. A provision has been included for the council to first give consideration to the potential impact of the council’s direction on the quality and safety of health care. This falls well short of the calls of many stakeholders. Many stakeholders maintain there is a need at the very least for a public interest test for directives on accreditation standards. Without such, it is claimed that there will not be sufficient safeguards to protect patients under the current national law.

A number of professions, including physiotherapy and psychology, have experienced delays or expressed frustration at the process for specialisation recognition under the registration scheme. Physiotherapists argue that specialisation is well established and recognised within the profession. It is claimed that specialist physiotherapists, like recognised specialists in other health professions, have extensive additional training and experience qualifying them to assess and treat complex and high-risk patients. This includes formal postgraduate qualifications and a rigorous external training and examination process. The argument is that removal of specialisation title recognition will make the referral process much more difficult for patients with specialised needs and will not be in the public interest. Clearly, the process has not been without difficulty and there remain a great number of issues to be resolved before implementation in July this year. The bill before us today amends the Health Insurance Act to streamline the recognition of health professions under the registration and accreditation scheme. The Health Insurance Act allows for the recognition of specialists, consultants and GPs for access to Medicare.

There are a number of issues which have been identified by stakeholders and are evident in the Senate committee inquiry which is due to conclude its findings. The bill specifies requirements for consultant physicians and specialists to qualify for Medicare purposes. In addition to requiring medical specialists and consultant physicians to be registered in their speciality and recognition of the speciality for the purposes of the Health Insurance Act, this bill specifies that medical practitioners and consultant physicians satisfy any other requirements prescribed by the regulation. The provision does not relate to general practitioners or other health professionals for Medicare eligibility. It is argued that specialists and consultant physicians would already be required to be registered and on the specialist register to be eligible for Medicare benefits, and there seems to be little justification for creating additional requirements.

The bill also provides consequential amendments to section 19 of the Health Insurance Act relating to Medicare benefit ineligibility for medical practitioners that are not authorised to render certain services under the practitioner’s registration. The Australian Medical Association and the Royal Australian College of GPs submit that there are a range of health professionals who are eligible for Medicare benefits. Accordingly, it is argued that the bill should be amended to extend the relevant sections to other health professions eligible for Medicare benefits.

Key nursing stakeholders have also raised some concerns regarding definitional amendments contained within the bill. Amongst other things, the bill removes the requirement that nursing care be given by or under the supervision of a registered nurse—it removes the word ‘registered’ from the definition. Whilst there can be different uses of the word ‘registered’ for nurses, it would seem appropriate that there remain clear lines of responsibility and accountability for nursing care.

The coalition understands the government is moving amendments to address a number of the issues discussed in relation to this bill. Whilst there have been extensive consultations throughout the national registration process, it does seem the government has again failed to do the groundwork for the basics on this consequential bill. It is becoming an unfortunate habit of the government to have to move amendments to their own bills because of oversights or lack of initial consultation. It is unfortunate, as I have pointed out, that the committee has recommendations which are pending, a report which is pending, but the government has not paid courtesy to that process or indeed to those people who have submitted evidence to that committee or indeed to the committee members. I hope that this process is able to provide to the government some lessons about the way in which they conduct their business and proceed with these amendments.

These are significant reforms and they impact not just on health professionals but of course on patients as well. The coalition, like the government and all Australians, wants to see a rigorous process put in place to make sure that the high standards that we have adopted for many decades in this country will remain long into the future. We want to make sure that health professionals right across the country in every profession increase their professional development and that we reduce the sorts of cases that we have seen operating in Queensland in recent times under what is a completely incompetent jurisdiction in the domain of the Queensland state government. We hope that the government will learn from this process. We hope that the government will have the ability to conduct these negotiations in a more consultative way into the future. There are unintended consequences. There is no question about that. Some of them have been ironed out and some will require amendment into the future. To be quite frank, it would seem rather unacceptable to have the Senate only with a day or so reporting potentially with further recommendations and the government not waiting to take those into consideration. Having spoken to a number of professionals in the health workforce around the country over the course of the last six or 12 months in relation to this issue, I have heard that they believe their views have not been heard. They have expressed their views strongly but they have not been heard by this government.

There is already a track record over the last couple of years of this government making lots of promises in relation to health but not having the capacity to deliver. Clearly, this is a government which promises a lot and has no problems in getting a headline but in the end just cannot deliver on the promises that it makes. Health is one of those areas and last night we have again seen that play out in the budget where the government has promised another 23 GP superclinics on top of the 36 already on offer. It has taken three years for this government to have two fully operational, yet that does not stop it from pretending that it is going to have another 23 rolling out some time, over the next couple of years or over the forward estimates, when I think it has proven to all Australians that it has a Prime Minister that does not have the capacity to deliver on his promises. Registration and accreditation is one such area where commitments have been made to the professions and again people have been let down. That is why there is a great level of frustration amongst clinicians and health professionals right across the board. I think there are certainly some lessons to be learnt from this and I hope that the government is able to take those away. As I have stated in my speech today, the coalition will not oppose the bill with the proposed amendments.

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