HEALTH WORKFORCE AUSTRALIA BILL 2009
THE INQUIRY
1.1
On 14 May 2009 the Senate, on the recommendation of the Selection of
Bills Committee (Report No.5 of 2009), referred the provisions of the Health
Workforce Australia Bill 2009 to the Community Affairs Committee for inquiry
and report by 15 June 2009.
1.2
The Committee received 23 submissions relating to the Bill and these are
listed at Appendix 1. The Committee considered the Bill at a public hearing in
Canberra on 11 June 2009. Details of the public hearing are referred
to in Appendix 2. The submissions and Hansard transcript of evidence may be
accessed through the Committee’s website at https://www.aph.gov.au/senate_ca.
BACKGROUND
1.3
In January 2006 the Productivity Commission released a report entitled Australia's
Health Workforce. The report noted the complexity of Australia’s health
workforce arrangements and the involvement of numerous bodies at all levels in
health workforce education and training and concluded that a more sustainable
and responsive health workforce for Australia was needed. One of the
recommendations was that more effective governance arrangements for
institutional and regulatory structures for the health workforce should be
established nationally.
1.4
On 29 November 2008, COAG agreed to a package of reform to the health
and hospital system. One component of the subsequent National Partnership Agreement
on Health and Hospital reflected the earlier Productivity Commission's recommendations
and involved the creation of 'a National Health Workforce Agency to establish
more effective, streamlined and integrated clinical training arrangements and
to support workforce reform initiatives. Its responsibilities will include
funding, planning and coordinating clinical training across all health
disciplines; supporting health workforce research and planning; funding
simulation training; and progressing new workforce models and reforms.'
1.5
The National Health Workforce Taskforce (NHWT) was established as part
of the COAG package to develop strategies to meet the National Health Workforce
Strategic Framework. The NHWT has undertaken a considerable level of
consultation, including comment being sought on two discussion papers: Health
Education and Training, Clinical Training – governance and organisation and
Clinical placements across Australia: capturing data and understanding
demand and capacity. Most of those who provided submissions indicated that
they had contributed to consultation in various forums, including the formal
consultative process conducted by the NHWT and in providing feedback on the
discussion papers. The authority to be established by this Bill will then
subsume the current activities and responsibilities of the NHWT.
THE BILL
1.6
The Health Workforce Australia Bill 2009 (the Bill) establishes Health
Workforce Australia (HWA) as a statutory authority under the Commonwealth
Authorities and Companies Act 1997. HWA will be responsible for implementing a
majority of the health workforce initiatives agreed to by COAG in November 2008.
1.7
The Bill specifies the functions, governance and structure of Health
Workforce Australia, enables health ministers to provide directions to HWA and
requires HWA to report to health ministers. Health Workforce Australia will be
responsible for:
- funding, planning and coordinating undergraduate clinical
training across all health disciplines;
- supporting clinical training supervision;
- supporting health workforce research and planning, including
through a national workforce planning statistical resource;
- funding simulation training; and
- providing advice to health ministers on relevant national
workforce issues.
1.8
The Bill provides that the HWA has such other functions as may be
conferred upon it by regulations. The Minister may also make a legislative
instrument specifying the kinds of students who are eligible to receive
payments for undertaking clinical training and the kinds of clinical training
that would be eligible. Such a legislative instrument may specify kinds of
clinical training by reference to specified courses in which clinical training
is provided or specified persons providing clinical training.
1.9
The Bill provides a legislative basis for HWA's operations and
governance arrangements that reflect the shared funding and policy interest of
all jurisdictions. HWA will be governed by a Board comprising a nominee from
each state and territory and an independent chair and may also include up to
three other members selected by health ministers. A chief executive officer
will be responsible for the day-to-day administration of Health Workforce
Australia, and expert committees and consultants will be engaged to assist with
functions as required.
1.10
Health Workforce Australia is to commence management of undergraduate
clinical training from 1 January next year. The bill is required to establish
Health Workforce Australia by July 2009 to ensure it is operational within the
time frames agreed to in the COAG national partnership agreement.[1]
1.11
The Explanatory Memorandum notes that the Commonwealth will provide $125
million over four years for the establishment and operation of HWA. A further
$1.2 billion in combined Commonwealth and States and Territory funding will be
administered through HWA over four years for the majority of initiatives under
the COAG health workforce package.
ISSUES
1.12
Comments on the establishment of Health Workforce Australia and its
potential to ensure high quality and a sufficient number of clinical training
places for the rapidly increasing number of medical students, and students in
other health professions were generally favourable, ranging from strongly
supported to warmly welcomed, though the Australian Doctors' Fund maintained
that HWA would 'for the first time allow for the direct intervention of an
unelected bureaucracy into Australian healthcare standards'.[2]
However, the common view was that the national focus was welcomed as a
mechanism to engage the multiple jurisdictions, protect against unilateral
departures from a consistent approach, and lead to better planning with the
ultimate result of better access to and the provision of more appropriate and
improved health care for the public.
1.13
While generally supportive, many submissions indicated that it was
difficult to provide detailed comment on the Bill. It is essentially a
structural Bill, technical in nature and basically providing the legislative
framework required to establish the HWA and form the basis of its ongoing
operations. Many considered that a number of key elements were not described,
or not satisfactorily described, in the Bill. Most concerns focussed on the
functions, powers and responsibilities of the HWA. As the AMA, one of a number
of groups that a made a similar comment, stated:
these [functions] are broad in nature and provide very little
real insight into the activities of the HWA or its impact on health workforce education
and training. Much of what the HWA will be able to do is yet to be revealed as
a legislative instrument(s) will need to be put in place to support the
operation of the Bill once it becomes law.[3]
1.14
The Committee Chair drew attention during the hearing to the
longstanding concern of the committee[4]
about legislation that is referred to the committee without the supporting
regulations and then expecting senators to make decisions based on unknowns. As
noted in the above comments one of the key issues numerous witnesses raised
about the legislation was the lack of detail on certain aspects which would be
included in regulations.
Funding, planning and coordinating
clinical training
Funding
1.15
The Medical Deans noted that there are no specific requirements on how
the HWA actually enters into the provision of this financial support,
commenting that it is 'essential that the Bill require the Agency to consult
and cooperate with both education and health providers on the provision of
financial support and, importantly enter into agreements with such providers'.[5]
1.16
The explicit funding for clinical placements will be important in
enabling students of all socio-economic backgrounds to participate in high
quality and varied clinical training. Undertaking a clinical placement by a student
is not a cost free exercise, especially if undertaken outside their usual place
of study. The Optometrists Association Australia noted that at the moment, there
are limited clinical placement scholarships for ‘allied’ health professions in
rural and remote Australia. Currently a range of ‘allied’ health professions
compete for a limited number of clinical placement scholarships funded by the
Australian Government and there is a case to increase capacity in this
scholarship program ahead of more explicit funding by the new Health Workforce
Australia Agency.
1.17
In order to expand clinical placements in rural and regional Australia, the
Optometrists argued that adequate funding is required to allow students to
participate (to cover costs of living in rural and regional Australia), and
build capacity of practitioners and local hospitals to host clinical
placements. There also needs to be sufficient attention to linking students to
local communities where they undertake their clinical training, to induct them
into rural life so that links are made outside the normal working day.[6]
1.18
Catholic Health Australia noted that one of the operational proposals
that is being considered is that regions be established to oversee the
operation or allocation of clinical placements to government hospitals, to
non-government hospitals, and to interrelate with the university and the training
system. It was expected that this would provide the opportunity for rural,
regional and underserved areas to be properly represented. Mr Martin Laverty,
CEO of Catholic Health Australia emphasised the importance of the
non-government sector and indicated that their facilities were well placed to
provide assistance with clinical placements:
Our country hospitals, our aged-care providers, are most
interested in creating and providing opportunities for nurse clinical
placements and medical clinical placements within country areas. That will only
be properly put in place if the balance of the allocation of clinical
placements between government and non-government service providers is properly
managed and the voice of aged care is very firmly represented at the board
table... This is an opportunity for a circuit-breaker, to say that there is a
strong network of hospitals and aged care run by the non-government sector in
Australia, which are in a position to access the opportunity that these new
clinical placements provide, and the only way we will ensure that is if the
governance arrangements of the establishment of Health Workforce Australia give
proper regard to aged care and country and regional needs.[7]
1.19
Coverage under the Bill as allied health professionals and issues with
the cost of funding clinical training were raised by the Osteopaths who advised
that:
Currently there is severe financial pressure on Osteopathic
faculties/schools and programs in Australian universities, arising from the
high cost of clinical (“hands-on”) training. Such training is not subsidised,
as in many other health and allied health professions, through access to public
health facilities. [It is provided on-campus].[8]
Accreditation and clinical training
1.20
The AMA provided useful background to the current system[9],
highlighting that Australia has a world-renowned system of medical education
and training. A robust and independent accreditation framework, overseen by the
Australian Medical Council (AMC)[10]
underpins this system. Explicit guidelines require that the accreditation of
medical education (including the component of medical education that takes place
during clinical training placements) should ensure that quality assessment is
independent of government, the medical schools and the profession, and that the
accrediting body (in this case the AMC) should be authorised to set standards
in respect of medical education and training, including clinical training.
1.21
Constant emphasis was made that the role of accrediting medical
education and training must continue to undertaken by the AMC and the HWA must
not seek to intrude into, to fetter or to influence the AMC's accreditation
functions in any way.
1.22
Within the current accreditation framework substantial diversity exists.
This encourages medical schools to develop courses that meet student and community
needs within a framework of social responsibility, innovation and academic
excellence. Diversity allows medical schools to build on their particular
advantages and it is seen as one of the strengths of medical education and
training in Australia.
1.23
Such diversity and flexibility in current arrangements are regarded as
fundamental. Many argued that the concept of reducing pre-professional clinical
training activities to 'one size fits all' and eliminating the current
divergent range of approaches to medical student clinical training must be
resisted.[11]
1.24
Clinical placements provide essential clinical and professional learning
opportunities to students by enabling them to gain experience in treating
patients and to mix with peers. Currently, the role of identifying appropriate
clinical placements is in the hands of universities, postgraduate medical
education councils, and medical colleges because they are in the best position to
ensure that clinical placements are of value and properly complement the
education and training programs that they deliver at undergraduate,
prevocational and vocational levels respectively.
1.25
Submissions acknowledged that the universities and health care providers
have collaborated very effectively in providing clinical education for medical
students. The parties have broad experience and knowledge and in many places
hard-won goodwill and support resulting from many years of negotiation. What
they do not have is adequate logistic and financial support. Their submissions
emphasised the concern that it would be counter-productive if this effective
system was dismantled. Universities Australia summed up the arguments put by
many:
If the HWA acts as a facilitator to provide funding, administrative
and higher-end strategic planning support for universities and health care
providers, it will assist in solving these problems [inadequate logistics and
financial support] now and prevent them becoming exacerbated over coming years
as increasing numbers of health students enter the system.
If, on the other hand, the HWA is established to be directly
involved in operational aspects of clinical education, with direct involvement
in the negotiation for and provision of clinical education places between universities
and health care providers, Universities Australia believes that it will not
substantially assist in alleviating current problems and, indeed, may add to
them through imposing a new level of bureaucracy that is not responsive to
local needs, or to changes in curricula and practice, and which may erode the
good relations that have built up between individual universities and health
care providers over decades.[12]
1.26
The message was clear: while the HWA should focus on leadership, best
practice and innovation in clinical education and training, and be involved in
the management of clinical placement through a planning and coordination role,
there is no role for the HWA in the central allocation of clinical training
places.
1.27
Although a limited brokerage role was considered by some to be
appropriate, it was regarded as important that clinical training continues to
be managed at the local level to maximise the benefit available from
longstanding relationships established between health services and education
providers. As Professor Ian Wronski said: 'It is regional communities of
interest that really drive successful clinical placement programs and it is
based on trust and relationships'.[13]
1.28
The Department advised that it is anticipated that HWA will work with a
number of regional or local entities to support clinical training:
Subject to further agreement and consultation with
stakeholders, regional entities would broker and oversee relationships and
collaborations between education and clinical training providers with
benchmarking by HWA.
Regional entities are expected to match supply and demand for
placements and distribute them appropriately, including student support
activities where necessary. They would have a role in ensuring that performance
indicators are met. The entities would monitor service provider clinical
placement quality and safety. Regional entities will be directly accountable to
HWA for the local management of placements, ensuring that outcomes around
maximising capacity and efficiency are met. It is expected that most of the
regional entities would be partnerships with existing bodies such as Divisions
of General Practice, relevant universities and local health services. This new
role for these entities would be funded through HWA.[14]
1.29
There were also concerns that the HWA could move to impose uniform
clinical placement requirements within a discipline. The timing, placement
length and learning outcomes vary across and within professions. The role and
expertise of the professions in determining these requirements and maintaining
that position was emphasised by many submitters.
1.30
The Royal College of Nursing Australia drew attention to the particular
significance of the supervisory arrangements between education and health service
providers. The College noted that currently there are significant shortages of appropriately
prepared clinical facilitators who are essential for optimal student clinical
learning experiences.[15]
The vital link between investing in continuing professional development and
increasing the capacity to offer quality clinical placements may only be
maintained if the number of nurses or health professionals prepared to
contribute to collegial teaching and mentoring students are increased as the
number of students who would benefit from these new arrangements are similarly
increased in number.
1.31
Professors White and Hensley spoke from their perspectives of the
difficulties faced by universities in finding clinical placements that has
required collaboration with each other as well as area health services and the
development required in terms of the recruitment of clinical teachers, their
training and the review of curricula.[16]
Standards
1.32
The Bill does not provide a clear definition of clinical training and
nor does it specify the types of courses considered eligible for funding by the
HWA. Such crucial aspects of the Bill will be determined by the Minister for
Health and Ageing through regulation. The possible negative effect the HWA
could have upon standards for health education and training was raised by a
number of submitters. The AMA argued:
It is not hard to envisage that, with a budget under its
administration in excess of $1.2b, the HWA will be able to significantly impact
on the standards of medical education in Australia. There is an obvious
potential for the HWA, through funding arrangements, to impose de facto
standards for clinical training that are inconsistent with independently
accredited arrangements.[17]
1.33
The Australian Nursing and Midwifery Council (ANMC) also commented on
the impact of these aspects being determined by the Minister:
There is no apparent requirement to include consultation with
the National Boards of the health professions, Accrediting Bodies or
Professional Bodies. It is difficult to see how this would not impact on the
accreditation functions of the Professional Boards and Accrediting Bodies of
the health professions who are responsible for determining the standards and
criteria for accreditation of educational courses leading to professional
registration and practice. Given the capacity for this to impact the overall
standards of educational preparation of health professionals and ultimately of
the standard of care to the Australian community the ANMC is concerned that
there is no provision within the Bill to ensure a consultation process with
these bodies.[18]
1.34
The Department clarified the situation relating to setting standards:
HWA will not set standards around the actual clinical
training to be undertaken. Matters regarding training content, length of
placements, assessment and so forth are the responsibility of the accreditation
body for that profession and the universities. For example, universities
offering courses in medicine will still need to be accredited by the Australian
Medical Council (AMC) and will be responsible for ensuring that clinical
placements satisfy the AMC's guidelines. Post graduate medical education is out
of the scope of HWA.[19]
Workforce planning
1.35
The Medical Deans were concerned that there is no mention of workforce planning,
though it had been identified as a key function of the HWA in documentation
relating to the HWA's establishment. The Deans stressed that workforce planning
is an essential component of the health reform agenda if Australia is to successfully
manage the development of its health workforce for the future and especially for
meeting the burgeoning needs of outer-metropolitan, regional and rural areas to
ensure all Australians have access to quality health care. The Medical Deans
believed that 'the omission of the key function of planning in the legislation
is serious and will severely limit the Agency’s value to health workforce
reform'.[20]
1.36
The Australian Medical Council (AMC) also noted that while the
explanatory notes made reference to a planning function this had not been included
in the list of functions in section 5 of the Bill. The AMC commented that as
the HWA is a health workforce authority, so it is meant to cross over a number
of areas related to health workforce planning and development, not just
clinical placement and, as such, the AMC 'would like a little bit more
clarification on the relationships with existing or proposed bodies which have
similar mandates'.[21]
1.37
The SA Health & Community Services Skills Board considered that it
was critical that the roles of existing bodies should be taken into account and
stated that:
The large number of stakeholders involved at all levels of
health workforce planning and strategy makes this a complex environment and is
an ongoing issue that requires continuing facilitation. It is important that
the creation of the HWA does not further complicate matters by replicating
existing arrangements but is instead able to draw together the stakeholders in
a manner that is productive and progresses the reform process.[22]
1.38
In relation to workforce planning, the Department advised that:
The establishment of HWA will also allow for a national
approach to workforce planning. Historically, data on the health workforce has
been sporadic and unreliable, often relying on voluntary surveys. HWA will work
with the National Registration and Accreditation Scheme (scheduled to commence
in July 2010), Medicare Australia and other sources to build a statistical
database holding detailed de-identified information on Australia's health workforce.
The availability of quality data will assist HWA in the
analysis of current workforce distribution, quantify shortages and provide for
a tool to support policy development and workforce planning.[23]
Possible future expansion
1.39
It was argued by some that the Bill enabled future expansion to occur.
While the current focus of the Bill is on undergraduate or pre-professional
entry clinical training, it was possible that at some subsequent time the HWA's
activities could be extended to encompass also medical specialist vocational training.
The AMA described this as extension 'by stealth' and was concerned that should
the role of the HWA be so expanded 'then its capacity to interfere with medical
workforce training will be strengthened even further'.[24]
1.40
Should such an expansion eventuate, some groups, such as the Committee
of Presidents of Medical Colleges, argued that adequate consultation and
cooperation with the Specialist Medical Colleges and the profession generally
would be essential to ensure that any measures introduced did not impinge
negatively on the existing clinical training processes.[25]
Simulation training
1.41
The expanded use of simulation training was supported by a number of
submitters. The Committee of Presidents of Medical Colleges (CPMC) welcomed the
focus on simulated clinical educational activities which it considered are
'currently somewhat underutilised in medical education'. The CPMC outlined the
operation of simulation training, adding that the HWA needed to consider how
best to ensure that rural and urban trainees have access to similar
opportunities:
Simulation usually targets the development of specific skills
and it will be of value to consider in which areas of training simulation
provides the most benefit. At present, simulated learning opportunities in the
field of technical competence generally provide basic support and tend to be
limited to the early phases of the learning process. However, several
disciplines are more advanced in their use of high fidelity simulation, which involves
large capital investment and high ongoing support costs.[26]
1.42
The Australian and New Zealand College of Anaesthetists (ANZCA) does
offer such an advanced course and argued that there was a need for the
development of a more coordinated national approach to simulation training with
consistent standards. The ANZCA referred to the simulation course offered to
its trainees and suggested that the course could be readily modified for
broader use.[27]
1.43
However, submitters did note that while simulation is an excellent
adjunct to in-situ clinical learning, it cannot on its own be a substitute for
the many elements required for adequate medical training and in particular, the
necessity for exposure to the clinical environment.[28]
1.44
The Department noted that the COAG health workforce package has provided
funding for greater use of simulated learning environments (SLEs) to support
clinical training. The department explained the role envisaged for HWA:
HWA will identify the most appropriate settings for SLEs in
consultation with the states and territories and stakeholders. This will
include determining the size and location of training centres, with priority
being given to rural and regional settings. HWA will also fund the
establishment of mobile SLE units which will support training and professional
development in areas which traditionally have limited access to facilities.
This will help improve access to clinical training for an increasing number of health
students in coming years.[29]
Research
1.45
The HWA will also be given a research function and the power to collect,
analyse and publish data that will inform the evaluation and development of
policies in relation to the health workforce. Professor Jill White from
Universities Australia was strongly supportive of the research function:
One of the arms of this new body is in relation to
innovations research and I know that our council—and, I would believe, the
others—believe that it is as important an arm as the clinical funding arm.
Being able to engage in research into new and innovative models of care as well
as clinical education models, models that would give greater primary health
care access, new maternity service models, is really important. They are all
models that link into both care delivery and better educational models for
clinical education, so I think that the innovations research arm is absolutely
fundamental to Health Workforce Australia.[30]
1.46
Although this data collection and research role was strongly supported,
a note of caution was made that the HWA's role would not overlap or usurp the
work performed by the Australian Institute of Health and Welfare (AIHW).
Catholic Health Australia was one group who expressed this need for caution:
Whilst Health Workforce Australia needs to take on a policy,
a research function, I would hope very much that that does not necessarily mean
that we are somehow rearranging the responsibilities that the Institute has at
the moment, and that it can retain the independence and the premier position
that it has as the provider of reliable and independent data on health
workforce and other issues affecting the Australian community.[31]
1.47
The Department explained how it was expected that the data collection
and use would be undertaken.
The National Registration and Accreditation Scheme will be developing
a very good set of workforce data, which is updated on a regular basis, for all
the registered professions for the first time ever. We are currently discussing
with the AIHW about the data from the National Registration and Accreditation
Scheme being sent to the AIHW and deidentified. The AIHW would then basically
be the holder of that data, because they have legislative provisions in place
around secrecy and privacy, which are very stringent and well respected within
the sector. They would then produce a series of reports, similar to those that
they already produce...
The other thing they will do is send that deidentified data
to Health Workforce Australia, who will then be able to use it for planning for
demand and supply purposes, which is not a role that the AIHW currently has. So
the AIHW will be in the middle of the train of data, will be the custodian of
that data, and will continue to provide to stakeholders and to governments the
standard reports that they do now.[32]
Representation on the Board and
stakeholder input
1.48
There was much criticism the proposed governance structure did not
reflect the interests of the broad range of stakeholders, with considerable
concern expressed over the composition of the Board being heavily weighted to
State and Territory representation[33]
without representatives from the health professions or education sector
specifically included. There needed to be a more equitable balance of
representation from the educational institutions, the health professions, the
primary health care sector, the private health care industry and the broader
community sector. Groups from each of these sectors were strong advocates of
their cause in having dedicated places on the Board.[34]
1.49
The importance for such a balance of representation was described by
Professor Ian Wronski:
What people bring is a perspective of the world from their
own profession that is very useful in understanding how to take a system
forward, and so we need some balance of disciplinary dimension to the sort of
decision making that HWA is going to make...What is important to be established
through the board process is the representation of views of the world from
across the health professions, as well as from universities and from the
disciplinary areas that are important in making these sorts of decisions. Also,
if we are going to expand clinical placements, the great untapped areas are the
private sectors and the NGO sectors, and yet they seem to have been excluded,
so I think there is some rethinking to do about that.[35]
1.50
The Bill does provide for the establishment of committees to provide
advice or assistance to the HWA in the performance of its functions. However,
the membership of such a committee may be by Board members, non-members or a
combination of both. The Optometrists Association Australia picked up on this
aspect commenting that:
If profession-specific issues are being examined by the
Health Workforce Agency, we would expect that any committee established to
advise the new agency would include appropriate representatives from the
relevant profession, including relevant registration and accreditation boards.[36]
1.51
The Department considered that the establishment of expert committees 'will
be crucial in ensuring HWA can provide quality advice to the Board and Health
Ministers'. The Department emphasised that the committees will draw upon
relevant health, education and other experts as required and that they will
also provide an opportunity for stakeholders to be fully engaged in the policy
development and workforce planning tasks required to ensure an effective and
sustainable health workforce in the longer term.[37]
1.52
While the work of the committees was regarded as important, it was
representation on the Board that was more keenly desired. Professor White
commented:
Committees are an absolutely necessary part of doing the
business, but they are not a substitute for having the appropriate voices at
the key table. I would not see them as a substitute; I would see them as an
important adjunct to the work of the board. But it is fundamental that
medicine, nursing and midwifery, and allied health are represented at that
board level; and the vice-chancellors, I would believe, as well.[38]
1.53
It was broadly argued that there is no guarantee that the medical
profession or the other health professions, nor the education sector, will have
any meaningful input into the work of the HWA. Stakeholder input is regarded as
essential to inform its activities in relation to all of its functions
including the funding of clinical training, workforce planning and health
workforce reforms.
1.54
In the absence of strong stakeholder input, concern was expressed that the
proposed governance structure means that there is a very real danger that the
HWA will be dominated by the considerations of state/territory health departments
that are focused on service delivery in public hospitals. Training is likely to
become a secondary consideration. As the AMA stressed:
The HWA needs to be open and transparent in all areas of its
activity. Stakeholder involvement will be fundamental to its success or
otherwise.[39]
1.55
The Department explained the different functions of the Board and
committees and the approach taken to their memberships:
The
governance board is exactly that, it is a governance board, so it is there to
be a management board for the agency, to ensure that the agency carries out its
functions appropriately. There is always the issue, as you would know, that
everybody would like to be a part of this, but really we need to have a board
that is workable, and trying to have everybody represented on the board is just
not going to work. As I say, it has a different purpose, and that is to make
sure that the agency runs effectively.
Allowed for
in the legislation are a number of expert committees that will look at
particular aspects of the work of the agency, and we would see that as
providing an avenue for more representation from organisations to put their
views into the workings of the agency through a committee structure rather than
through the board structure...
We thought that the appropriate way to get input from key
stakeholders was through the expert committee structure rather than on the
board itself... there are many stakeholders that want to be involved in this, and
we welcome that involvement, but actually trying to find positions on the board
for everybody would mean that we would have an unworkable and unwieldy board
structure. We think the way to do this is as expressed in the legislation - through
expert committees.[40]
1.56
The Department also advised that the provision that enables committees
to be established was intended to be flexible enough so that there would be
'some standing committees on the issues that are particularly relevant to the
agency, for example you might have a standing committee on the clinical
training subsidy'.[41]
1.57
To have some standing committees would provide greater certainty as to
their importance and assurance to the stakeholders who become members of any
standing committees. Universities Australia's recommendation that a Clinical
Education Advisory Committee be established to report to the Board on health
and education issues and comprise experts that would enable a balanced
representation of stakeholder groups[42],
could be an example of a committee that would fit the standing committee
concept as envisaged by the Department.
CONCLUSION
1.58
The evolution of these reforms within the health workforce system has
been undertaken over a number of years. Generally the form and direction that
is being taken that would deliver significant national benefit is supported by
stakeholders across the system.
1.59
The Committee notes that all major submitters to this inquiry have been
involved in the discussion and other processes in the development of this
legislation, primarily through the National Health Workforce Taskforce. However
many still expressed some concerns relating to the Bill, especially the
composition of the Board and committees that would ensure that the views of a
broad cross-section of stakeholders are heard; and the possibility for the HWA
to interfere with independently accredited education and training standards.
1.60
The Committee further notes that the Department advised in their
submission and oral evidence that further consultations are being undertaken by
both Departmental officers and the Taskforce.
A number of operational parameters such as eligible courses,
the delivery model and level of funding per student are still under discussion
with stakeholders to ensure the most effective solution for clinical training.[43]
1.61
The Committee considers that if these consultations are undertaken with
a genuine desire to resolve the remaining concerns, that are primarily related
to implementation issues and filling-in detail that is likely to be provided by
the Regulations, then the timetable envisaged for the introduction of this
reform through the passage of this Bill should not be delayed.
Recommendation
1.62 The Committee recommends that the Health Workforce Australia Bill 2009
be passed.
Senator Claire Moore
Chair
June 2009
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