COAG Health Council

meeting as the Australian Health Workforce Ministerial Council

Communique

7 August 2015

The Independent Review of the National Registration and Accreditation

Scheme for Health Professions

Australian Health Ministers met in Darwin today as the Australian Health Workforce

Ministerial Council. Health Ministers considered the Final Report on the Independent Review

of the National Registration and Accreditation Scheme for health professions (the NRAS

Review) and are pleased to publicly release the Final Report.

Health Ministers note that the establishment of the National Registration and Accreditation

Scheme for health professions (the National Scheme) was a unique and important endeavour

that involved enactment of near identical legislation by each State and Territory Parliament,

thereby replacing the separate jurisdictional registration of health practitioners in 14 health

professions with a single National Scheme.

Health Ministers accept that the National Scheme has been embedded within the Australian

health system in a relatively short time. Health Ministers agree with the assessment by the

Independent Reviewer that while some changes are needed to improve the National Scheme,

it remains acknowledged as amongst the most significant and effective reforms of health

profession regulation in Australia and internationally.

Ministers acknowledge the significant achievements highlighted by the NRAS Review:

a. Ensuring that the community can have confidence that health professionals

providing treatment and care in Australia meet a national standard based on safe

practice.

b. Consolidating 74 Acts of Parliament and 97 separate health profession boards into a

single national legislation that covers the structure and functions for the regulation of

14 health professions comprising of over 619,500 health professionals.

c. Increasing the mobility for health professionals working in Australia by removing

the necessity for them to be separately registered in each jurisdiction.

d. Improving protection to the health system by ensuring that any health practitioner

who has been found to have committed misconduct can no longer practise

undetected in other states or territories.

e. Enabling significant improvements to health workforce information and planning

due to the availability of accurate data on each of the 14 professions operating within

it.

The NRAS Review was conducted by Mr Kim Snowball, a former senior public servant and

the former Director General of WA Health. The NRAS Review comprised an extensive

consultation process which included over 230 written submissions and the involvement of

more than 1000 individuals in consultation forums held in each capital city. This level of

Complaints mechanism administered under the Health Practitioner Regulation National Law

Submission 105 - Attachment 2

consultation has allowed the consumers, practitioners, health and education providers,

professional associations, National Boards and other stakeholders to raise their concerns

directly with the Independent Reviewer. Health Ministers acknowledge the work of Mr

Snowball and the project team in ensuring a comprehensive review process.

Health Ministers considered the recommendations arising from the NRAS Review noting that

the majority of amendments are designed to enable the National Scheme to fulfil the

objectives as set out by Health Ministers at the time of its establishment. The response of

Health Ministers to the recommendations (set out in detail in Attachment 1) have been

categorised as:

1. Improving Consumer Responsiveness

2. Consolidation of National Boards

3. Accreditation Functions

4. Governance Arrangements

5. Entry into the National Scheme

Improving Consumer Responsiveness

Health Ministers have agreed to the immediate implementation of key recommendations to

improve complaints and notification systems, and strengthen community participation in

National Board governance to ensure that the National Scheme is responsive to consumers.

Health Ministers note that the ability of the National Scheme to fulfil its objectives is

compromised without an effective process to manage complaints and notifications. Health

Ministers request the Australian Health Practitioner Regulation Agency (AHPRA) to provide

a progress report by December 2015.

Consolidation of National Boards

Health Ministers have deferred all decisions relating to the consolidation of the nine low

regulatory National Boards and have asked the Australian Health Ministers’ Advisory

Council (AHMAC) to provide additional advice. AHMAC has invited National Boards,

AHPRA and Professional Associations as part of a targeted consultation to propose

alternative approaches to ensure the sustainability of the National Scheme and enable a

streamlined approach to governance functions which also encourages cross pollination of

ideas and best practice approaches across National Boards.

Accreditation Functions

Health Ministers are concerned about the significant issues relating to the high cost, lack of

scrutiny, duplication and the prescriptive approach to accreditation functions highlighted in

the Final Report. While the recommendations will go some way to improve Australia’s

accreditation arrangements, Health Ministers believe that more substantive reform of

accreditation functions is required to address the issues raised. Health Ministers have asked

AHMAC to commission further advice and undertake a comprehensive review of

accreditation functions. The terms of reference for this review will include comparative

analysis of the Australian and United Kingdom systems as well as further consideration of the

2005 Productivity Commission Australia’s Health Workforce report findings to specifically

address the concerns related to cost, governance and duplication highlighted during the

Complaints mechanism administered under the Health Practitioner Regulation National Law

Submission 105 - Attachment 2

NRAS Review. This review is to be undertaken within 12 months and advice provided to

Health Ministers by December 2016.

Governance Arrangements

Health Ministers do not support the establishment of a Professional Standards Advisory

Council. Health Ministers accept that improvements to governance, reporting and reform

arrangements are necessary to improve the transparency and accountability of the National

Scheme. However, these improvements will be achieved through existing structures

including the Agency Management Committee (which provides governance and oversight to

the operations of AHPRA) and AHMAC.

Entry into the National Scheme

Health Ministers note that the NRAS Review has identified a lack of clarity with regard to the

purpose and scope of the National Scheme and have agreed to issue a communique to clarify

the intent of the National Scheme and propose a process for unregistered professions to raise

concerns regarding government policy, funding and programs where absence of registration

is the sole factor for exclusion.

Of the 33 recommendations proposed, Health Ministers accept 9 recommendations

, accept in

principle 11 recommendations

, do not accept 6 recommendations

, and defer decisions on 7

recommendations

pending further advice.

The Final Report can be accessed here

http://www.coaghealthcouncil.gov.au/Publications/Reports

Please forward all enquires in relation to the Final Report of the Independent Review of the

National Registration and Accreditation Scheme for health professions to

[email protected]

Recommendations 8(a), 9, 21, 24, 25, 26, 28, 32 and 33 are accepted.

Recommendations 14, 15, 16,17,18,19, 20, 22, 23, 27 and 29 are accepted in principle pending further advice

from AHMAC.

Recommendations 1, 10,11,12,13 and 31 are not accepted.

Recommendations 2, 3, 4, 5, 6, 7 and 30 are deferred pending further advice on alternative approaches.

Complaints mechanism administered under the Health Practitioner Regulation National Law

Submission 105 - Attachment 2

Attachment 1

Australian Health Workforce Ministerial Council Response to the

Recommendations from the Independent Review of the National Registration

and Accreditation Scheme for health professions

AHWMC Response

Responsiveness to Consumers

Recommendation 9

Measures to be taken within the National

Registration and Accreditation Scheme (the

National Scheme) to ensure the following

principles are met within the design and

operation of the complaints and notifications.

Accepted

Ministers ask the Australian Health Practitioner

Regulation Authority (AHPRA) to action this

recommendation as a matter of immediate

priority and provide a progress report by

December 2015.

Recommendation 10

The Health Practitioner Regulation National

Law 2009 (the National Law) to be amended

to reflect the same mandatory notification

exemptions for treating practitioners

established in the Western Australian law.

Not accepted at this time – to be considered

pending further research

The NRAS Review has concluded that data is

inconclusive and has advised of research

commissioned by National Boards and AHPRA

on a preferred approach to managing

mandatory notifications.

Ministers will consider a national approach to

mandatory notifications upon receipt of

additional advice.

Recommendation 26

That the Health Practitioner Regulation

National Law 2009 be amended to enable the

Australian Health Workforce Ministerial

Council to appoint either a practitioner

member or a community member of a

National Board as Chairperson.

Accepted

Complaints mechanism administered under the Health Practitioner Regulation National Law

Submission 105 - Attachment 2

AHWMC Response

Recommendation 28

That the Australian Health Practitioner

Regulation Agency conduct specific

education and training programs for

investigators. These should be designed in

consultation with National Boards, Tribunals

and Panel members to develop more

consistent and appropriate investigative

standards and approaches, consistent with the

requirements of the Health Practitioner

Regulation National Law 2009, including the

primacy of public safety over other

considerations within the matters.

Accepted

Ministers request AHPRA to provide a

progress report by December 2015.

Recommendation 29

That the Health Practitioner Regulation

National Law 2009 prohibition order powers

be amended to provide the means for

Tribunals to prohibit the person from

providing any type of health service, to

establish an offence for breaching a

prohibition order and to provide for mutual

recognition of prohibition orders issues by

jurisdictions.

Accepted in principle – further advice

requested

Ministers request AHMAC to seek legal advice

on a process to enable the recognition of

prohibition orders across jurisdictions.

Amalgamation of National Boards

Recommendation 2

The Health Practitioner Regulation National

Law 2009 be amended to provide the

Australian Health Ministerial Council (the

Ministerial Council) with the power to

consolidate National Boards. This will enable

the establishment of the Health Professions

Australia Board

Deferred

Ministers have asked AHMAC to provide

further advice by December 2015 following

targeted consultations with National Boards,

AHPRA and Professional Associations

Recommendation 3

The Australian Health Practitioner Regulation

Agency, in conjunction with the National

Boards of Aboriginal and Torres Strait

Islander health practice; Chinese medicine;

chiropractic; medical radiation practice;

occupational therapy; optometry; osteopathy;

podiatry and physiotherapy, to develop an

implementation plan for the merger of these

nine low-regulatory-workload professions

into the Health Professions Australia Board

and submit to the Australian Health

Workforce Ministerial Council for approval

Deferred

Ministers have asked AHMAC to provide

further advice by December 2015 following

targeted consultations with National Boards,

AHPRA and Professional Associations

Complaints mechanism administered under the Health Practitioner Regulation National Law

Submission 105 - Attachment 2

AHWMC Response

Recommendation 4

Once approved by the Australian Health

Workforce Ministerial Council, the Health

Professions Australia Board will be required

to plan the consolidation of functions

including formation of a consolidated fee

structure, registration processes, consolidated

accreditation and notification management

within the first 12 months

Deferred

Ministers have asked AHMAC to provide

further advice by December 2015 following

targeted consultations with National Boards,

AHPRA and Professional Associations

Recommendation 5

Each of the nine health professions to be

represented on the HPAB, together with three

community members

Deferred

Recommendation 6

The consolidation of the regulatory functions

to be completed in a manner that ensures

effective and ongoing professional input from

the nine professions into standard setting,

accreditation and notification management

activities

Deferred

Recommendation 7

Any savings generated by the consolidation

of the nine boards and their associated

functions to be returned to registrants in the

form of reduced fees, to the effect that no

professional group will be financially worse

off from the consolidation.

Deferred

Recommendation 30

That the regulation of Aboriginal and Torres

Strait Islander Health Practitioners be

continued by a merger into the Health

Professions Australia Board, with continued

involvement of Aboriginal and Torres Strait

Islander Health Practitioners on issues

covering that profession.

Deferred

Complaints mechanism administered under the Health Practitioner Regulation National Law

Submission 105 - Attachment 2

AHWMC Response

Recommendation 31

The Health Professions Australia Board

establish a committee involving Aboriginal

and Torres Strait Islander health leaders to

assist the National Scheme to better respond

to Aboriginal and Torres Strait Islander

health and cultural issues.

Not Accepted

Ministers agree that existing mechanisms

across all National Boards and AHPRA should

continue to be used and strengthened as

necessary.

Ministers also request AHPRA to include

within its annual report advice from all

fourteen National Boards on how ATSI health

and cultural issues are being addressed.

Accreditation Functions

Recommendation 14

Through the contractual arrangements

between Australian Health Practitioner

Regulation Agency and the Accreditation

Authorities, no fee increases levied on either

National Boards or higher education

institutions beyond the Consumer Price Index

rate will be allowed without the express

approval of the relevant National Board

Accepted in Principle – to be considered

pending further work

The NRAS Review has highlighted significant

concerns with the cost, transparency and

accountability of Accreditation Authorities and

has recommended measures to address these

including a review of the current accreditation

process against the United Kingdom approach.

Ministers request AHMAC to commission a

comprehensive review of the accreditation

processes within the National Scheme.

Recommendation 15

Through contractual arrangements between

the Australian Health Practitioner Regulation

Agency and Accreditation Authorities,

standardised accreditation protocols and fee

structures must be established within 12

months so that common accreditation

processes can be adopted between all

regulated health professions. These should be

focused on education outcomes relevant to

the outcomes of the National Registration and

Accreditation Scheme not prescriptive

education inputs

Recommendation 16

The standardised accreditation protocols

should be the subject of consultation with

higher education policy makers and providers

to streamline accreditation processes and

avoid duplication with existing university

accreditation processes. This consultation

should be sponsored by the Australian Health

Practitioner Regulation Agency

Recommendation 17

Amend the Health Practitioner Regulation

National Law 2009 to provide that the

National Health Practitioner Ombudsman has

jurisdiction over accreditation functions

Complaints mechanism administered under the Health Practitioner Regulation National Law

Submission 105 - Attachment 2

AHWMC Response

within the National Registration and

Accreditation Scheme.

Recommendation 18

A standing committee is needed within the

National Registration and Accreditation

Scheme involving the education sector,

National Boards, Accreditation Authorities

and representation from employers and

jurisdictions to:

a. discuss the means by which health

workforce reform and health service

access gaps can be best addressed in the

education and training of health

professionals

b. consider the evidence and value of

alternative innovations in the delivery of

health education and training. (An

example is that simulated learning is

accepted by some but not all accreditors)

c. share an understanding of workforce

distribution and projected workforce need.

d. ensure that education opportunities exist

for students to meet the minimum standard

of entry

Recommendation 19

The fee structures for the accreditation

functions associated with standard setting and

assessment of overseas-trained health

professionals and the accreditation of

university programs of study should be clear

and transparent as to which functions are

funded by the National Boards from

registrant fees and which are being met by the

higher education sector

Recommendation 20

The UK approach to accreditation should be

explored to examine whether the significant

cost difference between the UK and Australia

results in better education outcomes in

Australia. If this is the case, then the UK

approach to accreditation should be

considered for application

Complaints mechanism administered under the Health Practitioner Regulation National Law

Submission 105 - Attachment 2

Themes

AHWMC advice

Governance

Recommendation 1

The Australian Health Ministerial Council (the

Ministerial Council) to establish the

Professional Standards Advisory Council

(PSAC) for a period of three years to:

a. facilitate the implementation of accepted

recommendations of the Review

b. establish key performance standards,

including financial standards, to be

reported to Ministerial Council and

individual Health Ministers by National

Boards, Accrediting Authorities and the

Australian Health Practitioner Regulation

Agency (AHPRA) in delivering the

objectives of the Health Practitioner

Regulation National Law 2009 (the

National Law);

c. inform National Boards, AHPRA and

Accreditation Authorities on key health

workforce reform priorities and health

service

d. access gaps as identified by Australian

Health Ministers Advisory Council

(AHMAC) standing committee structure

and processes, and requiring action by

the regulators;

e. examine evidence on contested cross –

profession issues that arise from time to

time within or between professions;

f. undertake reviews or audits at the

direction of Ministerial Council where

safety Issues or concerns are raised

Page 19 of the Final Report notes that the

council will comprise of 7 members with at

least 2 from regulatory backgrounds, 2 with

health service experience, one legal, one

business and one consumer/community

representative.

Not accepted

Ministers accept that improvements to

governance, reporting and reform

arrangements are necessary to enhance the

transparency and accountability of the

National Scheme and agree that such

improvements can be achieved through

existing structures including the Agency

Management Committee which provides

governance and oversight to the operations

of AHPRA.

Recommendation 11

Make amendments to the Health Practitioner

Regulation National Law 2009 provision

preventing the use of testimonials on platforms

and sites that are managed or controlled by the

practitioner or business.

Not Accepted

Issues surrounding testimonials should

continue to be dealt with through National

Board guidelines.

Complaints mechanism administered under the Health Practitioner Regulation National Law

Submission 105 - Attachment 2

Themes

AHWMC advice

Recommendation 13

That the Australian Health Workforce

Ministerial Council charge the Australian

Health Ministers’ Advisory Council, its Health

Workforce Principal Committee and the

Commonwealth Department of Health (where

it carries previous functions of Health

Workforce Australia) with articulating the

health workforce priorities and health service

access gaps to the Professional Standards

Advisory Council (PSAC) for action by the

National Registration and Accreditation

Scheme.

Not accepted

Existing AHMAC and AHPRA structures

to be used.

Recommendation 21.

The National Boards and the Australian Health

Practitioner Regulation Agency (AHPRA) to

complete a review within 12 months of the 60

Committees supporting the National Boards,

the 20 State and Territory or Regional Boards,

and their 78 supporting committees to:

consolidate committee functions; remove

committees duplicating the AHPRA corporate

support role (for example, finance

committees); review and revise delegation

instruments to remove double handling of

operational matters; and report to Australian

Health Workforce Ministerial Council on the

outcomes

Accepted

Complaints mechanism administered under the Health Practitioner Regulation National Law

Submission 105 - Attachment 2

AHWMC Response

Recommendation 22.

Amend the Health Practitioner Regulation

National Law 2009 to require National Boards

to seek Australian Health Workforce

Ministerial Council approval for changes to

qualification standards for registration

purposes if the proposed standard could have a

substantive and adverse impact on the

recruitment or supply of health practitioners to

the workforce

Accepted in principle – pending further

advice.

Health Ministers request AHMAC to develop

guidance on when registration standards,

codes, guidelines and accreditation standards

should be referred to Ministers for approval.

Recommendation 23.

Amend the Health Practitioner Regulation

National Law 2009 to require National Boards

to seek Australian Health Workforce

Ministerial Council approval for any codes or

guidelines that might impose new competition

restrictions or regulatory burdens, to ensure

that these are in the broader public interest

Recommendation 24.

The performance of the Medical Board of

Australia and the Australian Health

Practitioner Regulation Agency, in the

implementation of changes to the International

Medical Graduate assessment process arising

out of the Lost in the Labyrinth report, form

part of the key performance standards to report

to the Australian Health Workforce Ministerial

Council

Accepted

Recommendation 25.

The Medical Board of Australia to evaluate

and report on the performance of

specialist colleges in applying standard

assessments of International Medical Graduate

applications and apply benchmarks for

timeframes for completion of assessments

Accepted

Recommendation 27.

That the Health Practitioner Regulation

National Law 2009 be amended to reflect and

recognise that nursing and midwifery are two

professions regulated by one National Board

Accepted in principle –pending further

work

Ministers note that there are inconsistencies in

the provisions of the National Law regarding

references to the nursing and midwifery

professions. Ministers request AHMAC to

provide policy recommendations on suitable

amendments to the National Law.

Complaints mechanism administered under the Health Practitioner Regulation National Law

Submission 105 - Attachment 2

AHWMC Response

Entry into the Scheme

Recommendation 8

The Australian Health Workforce Ministerial

Council to ensure that health professionals not

included in the National Scheme should not be

excluded or disadvantaged professionally by

either:

a. issuing a communiqué stating that the

National Registration and Accreditation

Scheme (the National Scheme) is for the

purpose of additional regulation of

specified professions only and is not to be

used for any other purpose

b. making amendments to the Health

Practitioner Regulation National Law 2009

(the National Law) to state that the

National Scheme is for the purpose of

additional regulation of specified

professions only and is not to be used for

any other purpose

c. establish a system of quality assurance for

voluntary registers of self-regulated

professions

Recommendation 8(a) is accepted

Recommendations 8 (b) and 8(c) are not

accepted.

Ministers agree to issue a communique which

will also clarify the process for raising

concerns about jurisdiction policy, funding or

programs which use the absence of

registration as the sole factor for exclusion.

Restriction of Practice

Recommendation 12.

The protection of the practice of birthing

services to be adopted nationally, consistent

with the South Australian amendment

Not accepted

Ministers agree that individual jurisdictions

may choose to adopt further regulatory and

non-regulatory measures to support safe

birthing practice in accordance with local

circumstances.

Implementation Process

Recommendation 32.

That the Health Practitioner Regulation

National Law 2009 be amended to reflect

provisions endorsed by the Australian Health

Workforce Ministerial Council in 2011

Accepted.

Complaints mechanism administered under the Health Practitioner Regulation National Law

Submission 105 - Attachment 2

AHWMC Response

Recommendation 33

That the amendments proposed by the National

Boards and the Australian Health Practitioner

Regulation Agency (AHPRA) be further

considered by the formation of a small working

group with representatives from AHPRA and

jurisdictions with suitable legal and policy

expertise to review the list of proposed

amendments to the Health Practitioner

National Law 2009 and make

recommendations to the Australian Health

Workforce Ministerial Council

Accepted.

Complaints mechanism administered under the Health Practitioner Regulation National Law

Submission 105 - Attachment 2