The latest paper from the team tasked with simplifying health practitioner regulation has described “significant disillusionment” with the current system.
A review set to identify areas of unproductive and unnecessary complexity in the national registration and accreditation scheme has decried its “lack of clarity” about what is necessary and important in health practitioner regulation “at any point in time and over time”.
The second consultation paper from the review, which was originally meant to produce a final report by the end of 2024, was released earlier this week.
Led by former NSW Health Care Complaints Commissioner Sue Dawson, the independent review team distilled the complexity problems down to four key factors.
Namely, these are: an absence of clear strategic direction which manifests in perceived unresponsiveness and ineffectiveness; registered practitioners being regulated in isolation from the broader health workforce, leading to an insufficient ability to “recalibrate” the scheme; outdated regulatory stewardship principles which lead to inefficiency and poor accountability; and confusing complaint outcomes eroding public trust in health regulation.
It also noted “significant disillusionment” with the manner in which the 15 registered health professions are regulated and an expectation that the national scheme be more effective, responsive and fair in instances where expected standards of conduct are not met.
In line with the four key problem factors, the reviewers have proposed four reforms.
These include applying a regulatory stewardship model to set direction, context and accountability for the national scheme, establishing an integrated health professions regulation framework, realigning the functions and structures within the national scheme and progressing implementation of a unified national approach to health complaints.
“The difficulty of working across 15 National Boards to pursue important and necessary change and innovation was commonly characterised as one of the most significant and unrelenting challenges of the National Scheme,” the second consultation paper read.
“There was particular concern about the difficulty of meeting the requirement to secure agreement from all 15 National Boards in relation to Scheme-wide issues such as responding to new models of care, harmonising registration standards, and cross profession decision making.”
While the team considered the possibility of merging the national boards, it ultimately proposed reassigning the functions of the boards and AHPRA instead.
The report recommended national boards have a stronger policy, monitoring and strategy focus, with all notification-related decision making going to AHPRA.
“The significant concern across professions was that any such [amalgamation] initiative would unacceptably erode the foundations of profession based decision making, which continues to be regarded as an integral design feature of the National Scheme,” the reviewers wrote.
Reviewers also discussed practitioner concerns that AHPRA was overly bureaucratic and “too wedded to existing operational practices”, making it insensitive to impacts on individual registrants.
“It would be hard to overstate the breadth and depth of dissatisfaction with the current complaint handling and notification processes,” they said.
“These processes are not meeting the basic expectations of health practitioner regulation in Australia.
“This is an equally acute concern for practitioners, consumers and policy makers.”
The key finding was essentially that AHPRA’s current processes don’t make anyone happy.
According to the paper, patients largely believe they “can and should” make any type of health complaint to AHPRA and are frustrated to learn that the regulator only progresses notifications that represent a potentially significant breach of standards.
Meanwhile, it said, practitioners find the process “protracted and stressful”, even if more than 85% of notifications ultimately result in AHPRA not having jurisdiction or taking no further action.
“It is also concerning and confusing for complainants and practitioners that AHPRA does not have powers that allow a notification to be dealt with by conciliation, mediation or other less formal restorative means,” the review paper read.
The final report is now due before July 2025.
