Thursday, 13 May 2010
Health Practitioner Regulation (Consequential Amendments) Bill 2010
I rise to speak on the Health Practitioner Regulation (Consequential Amendments) Bill 2010. This bill is the final stage of what has been a long and much debated process, particularly for the professionals covered by the legislation. The bill amends the Health Insurance Act to streamline the recognition of health professions under the National Registration and Accreditation Scheme for the Health Professions. The national registration and accreditation scheme is a significant reform commenced by the coalition government. There has been strong in-principle support for a nationally consistent registration and accreditation scheme for health professions. Jurisdictional differences for registration and accreditation requirements have hampered workforce mobility and made it difficult to monitor the small number of practitioners who have been under scrutiny or facing disciplinary action in a given jurisdiction.
The guiding principles of the scheme are stated as:
- 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.
The process commenced with the Productivity Commission recommendations in January 2006 for a single national registration board and a single national accreditation scheme. The coalition government acted on the recommendations by reaching a COAG agreement in 2006 to establish a national registration scheme. In April 2007, COAG agreed on a single national registration and accreditation scheme to start in July 2008.
The health workforce underpins our health and hospital system. Health workforce issues are prominent in political debate and in the media. The coalition has a strong record and commitment to improving the quality of Australia’s health workforce, despite this government’s best efforts to rewrite history. The coalition government delivered nine new medical schools, including in regional areas such as at the University of Wollongong, which I was very pleased to support. 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. It was the coalition government that introduced funding for practice nurses through the Nursing in General Practice Initiative and later with additional MBS rebates.
Following the election of the Rudd government, the national registration and accreditation scheme stalled. The implementation has been delayed by two years and the start date is now July 2010. A key motivation for a single national scheme for registration and accreditation was to reduce bureaucratic red tape across the jurisdictions. Regretfully, it seems there has been bureaucratic influence and interference with the establishment and proposed functions of the boards.
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. A provision has been included for the council to first give consideration to the potential impact of its direction on the quality and safety of health care. A number of professions, including physiotherapy and psychology, have experienced delays with or expressed frustration at the process for specialisation recognition under the registration scheme. Clearly, the process has not been without difficulty and there remain some issues to be resolved before implementation in July.
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 coalition will not oppose the bill.
I rise to speak on the Health Practitioner Regulation (Consequential Amendments) Bill 2010. The Australian Greens understand that reaching this agreement on a national system for the registration and accreditation of the 10 health professions that are currently included has been a long and complicated process. We believe that reducing bureaucracy and making cost savings are very good for our health system where that is practical and where it produces good outcomes. We also support the concept of national registration. However, we do have some concerns that, in some instances, there seems to have been a lowering of the standards of accreditation in order to generate this one-size-fits-all solution.
I will talk about a specific example from my home state of Western Australia. The standards of the Australian Psychological Society for their colleges and entrance into their colleges are quite different from those in Western Australia, where we have a much more focused approach on specialist registration standards. We believe that we have higher standards than those of the Australian Psychological Society. In the last few years since we have fortunately been able to access some of these services under Medicare, the society has allowed more people with no postgraduate training into their specialist colleges, something which the WA board has not allowed. This is why WA has the lowest level of membership of the Australian Psychological Society. WA’s psychologists have not needed membership of their specialist colleges to be identified as specialists. We have that already in WA. The WA registration board has performed this function—we believe a lot better.
The most important issue for WA is that the new system will have only the undergraduate level of training—four years of university training and supervision—registered to practise in all areas of psychology. They believe—and the Greens are concerned about this—that this level of training is significantly below international training standards. International training standards require, at the very least, masters-level training—two years full-time intensive postgraduate training and two years supervision. All up, that is at least eight years. WA has been the only state, and still is, which has registered this postgraduate training and two years on-the-job supervision, and hence has been the only state to meet international training standards. This level of registration in WA will be lost under this new scheme. It has caused a significant amount of concern in Western Australia, and I am sure that my fellow Western Australian senators have received emails and letters about this as well—not to mention meetings around this issue.
The endorsement process, which on the surface looks like the postgraduate registration, is highly inadequate—especially for WA. Firstly, although people with these postgraduate qualifications can be endorsed to practise in a specialist area under the national scheme, the specialist areas of practice are not protected at all. This is because a registered generalist with only undergraduate training—no clinical, diagnostic or ethics training—can go out and practise in all specialist areas. They just need to refrain from indicating that they are endorsed.
Secondly, the endorsement procedure is very flexible. This means that if the Psychology Board of Australia, for example, under pressure from government or others felt they needed to change the level of training for endorsement definition—for example, reduce it—then this could be readily done. It makes it much more difficult to ensure that we are maintaining standards. Endorsement is also confusing to the public, who look for specialists, not for ‘endorsed’ psychologists. This is of concern to the psychologists and their level of training, which ensures that the public know what they are getting and that it is the best. It is also actually confusing for the public, particularly in Western Australia, where they are very used to the specialist title approach that we take there.
We are concerned about the potential deskilling of the workforce over time. If an undergraduate can practise in all speciality areas but just not say that they are endorsed, why would they spend the extra time and significant cost to do postgraduate training if this is not going to be accredited and registered properly? We believe that the way forward is for WA to retain specialist title registration and the recognition that affords, which gives much better protection to the public and the community. I understand that this issue has been raised on a number of occasions and that it has not been properly dealt with through the whole accreditation process. There continues to be a great deal of anxiety in Western Australia around this particular issue.
The other issue about the national registration scheme that continues to concern me is around midwives and the linking of midwives with the requirement for indemnity insurance. I do appreciate that there has been legislation passed through this chamber which provides indemnity insurance for midwives. Of course, at the moment we have got that intermediate situation where we all know that indemnity insurance does not extend to midwives providing homebirths but all registered midwives have to have indemnity insurance. At the moment we have a two-year exemption where midwives do not have to have the indemnity insurance for providing homebirths. That situation is ongoing, yet needs to be resolved. The Greens will be watching this very carefully.
As I have said, the Greens have supported this process. We do have some ongoing and specific concerns, particularly around the issue of specialist psychologists and their titles in Western Australia. We believe that needs to be resolved in such a manner that Western Australia can retain its specialist titles. We encourage the government to engage with the Western Australian government and the Australian Psychological Society process in Western Australia to ensure that these psychologists and their specialist titles and training are preserved. This is not just about psychologists wanting to have specialist titles for the prestige. This is an important issue for the community. It is an important issue about standards and maintaining those standards in Western Australia. Western Australians feel really strongly that we should not have to lower our standards, which are good standards, to the eastern states’ standards. In fact, we believe that the eastern states’ standards should be raised to those of Western Australia because they are a much better approach and they meet international standards.
I thank the senators for their contributions in summing up the debate. This is very important legislation for us. It actually heralds landmark changes for Australian health practitioners. It is, as Senator Fierravanti-Wells said, a piece of work that COAG initiated in 2004 and it is very important for us to ensure that this bill takes effect from 1 July. I commend the bill to the Senate.
Question agreed to.
Bill read a second time.