CHAPTER 1

CHAPTER 1

INTRODUCTION

TERMS OF REFERENCE

1.1        On 19 March 2009 the Senate referred the design of the proposed national registration and accreditation scheme for doctors and other health workers (NRAS/the Scheme) to the Senate Community Affairs Committee(the Committee) for inquiry and report by 18 June 2009[1]. The reporting date for the inquiry was subsequently extended to 6 August 2009.

1.2        The terms of reference for the inquiry asked the Committee to consider the design of NRAS including:

CONDUCT OF THE INQUIRY

1.3        The inquiry was advertised in the Australian and on the Committee's website. The Committee invited submissions from Commonwealth and state and territory governments and interested organisations and individuals.

1.4        The Committee received 141 public submissions. A list of individuals and organisations that made submissions or provided other information authorised for publication by the Committee is at Appendix 1.

1.5        The Committee also relied on information made available through the website of the National Registration and Accreditation Implementation Project (NRAIP), which has conducted a national consultation process as part of the implementation of the NRAS. Information on the NRAIP consultation, including consultation papers, stakeholder submissions and draft NRAS legislation, can be found at http://www.nhwt.gov.au/natreg.asp. A chronology of the NRAIP process is included at Appendix 3.

1.6        The inquiry focused on the exposure draft of the main piece of legislation implementing the NRAS, the Health Practitioner Regulation National Law—generally referred to as 'Bill B'—which was released on 12 June 2009. The Committee approached the inquiry as an opportunity to complement or 'add value' to the NRAIP consultations on the exposure draft. As such, the report does not aim to provide an exhaustive analysis of all the issues raised in evidence and submissions, but rather seeks to identify the major issues and concerns of the regulated professions. The timing of the report was intended to ensure that it could feed in to the NRAIP's final recommendations on Bill B to the Australian Health Workforce Ministerial Council (AHWMC/the Ministerial Council).

1.7        The conduct of the inquiry was therefore guided by the availability of the exposure draft of Bill B and by the timing of the national consultative processes. The Committee had originally planned to conduct up to five hearings for the inquiry; however, this was reduced to three hearings to allow the Committee's report to contribute to the feedback on the exposure draft.

1.8        The Committee held three public hearings in Canberra on 7 May, 13 July and 14 July. Witnesses who appeared at these hearings are listed at Appendix 2.

1.9        The Committee extends its thanks to Dr Louise Morauta, Project Director of NRAIP. The evidence and information provided by Dr Morauta's concerning the detail of the NRAS, as well as consultative and implementation processes for the Scheme, were of great assistance to the Committee.

BACKGROUND

1.10      The introduction of the NRAS arises from the 'Intergovernmental Agreement for a National Registration and Accreditation Scheme for the Health Professions' (the Intergovernmental Agreement). The genesis of the Intergovernmental Agreement was a 2005 Productivity Commission report which examined 'issues impacting on the health workforce, including the supply of, and demand for, health workforce professionals'; and proposed 'solutions to ensure the continued delivery of quality healthcare over the next 10 years'. The Commission's report recommended the establishment of a single national registration and accreditation scheme to enable the Australian health workforce to deal with shortages and associated pressures; to increase its flexibility, responsiveness, sustainability and mobility; and to reduce red tape.[2]

1.11      On 14 July 2006 the Council of Australian Governments (COAG) subsequently agreed to establish the NRAS, beginning with the health professions then registered in all jurisdictions.

1.12      On 26 March 2008 COAG agreed to the introduction of the NRAS by 1 July 2010. The COAG communiqué announcing the agreement called the Scheme a 'major step towards improving Australia's health system' and outlined a number of perceived benefits:

The new arrangement will help health professionals move around the country more easily, reduce red tape, provide greater safeguards for the public and promote a more flexible, responsible and sustainable health workforce.[3]

THE NRAS SCHEME

Legislative framework

1.13      The legislative framework for the implementation of the NRAS is governed by the fact that the power of regulating health professions resides with the states, which prevents the Commonwealth from enacting the Scheme through a single piece of Commonwealth legislation. Accordingly, the Scheme is to be enacted through the various state and territory legislatures. The enacting legislation will be passed in Queensland first and then adopted by the other states and territories.

1.14      The legislative structure to implement the Scheme involves three bills, for convenience referred to as Bills A, B and C:

1.15      Bill A, which set up the interim administrative arrangements for the Scheme, was passed by the Queensland parliament on 13 November 2008, and took effect upon receiving Royal Assent on 25 November 2008.

1.16      Bill B, which supersedes Bill A, contains the full detail of the implementation arrangements for the NRAS. This includes:

Scope of NRAS

1.17      The AHWMC communiqué of 14 July 2006 confined the first tranche of national registration to the ten health professions registered in all jurisdictions,[4] with other health professions to be added over time The professions to be regulated from the inception of the Scheme are:

1.18      The AHWMC communiqué of 8 May 2009 advised that from 1 July 2012 a further three professions will be regulated under NRAS. These are:

Objectives and guiding principles of NRAS

1.19      The Intergovernmental Agreement set out the following objectives to be enshrined in the NRAS legislation:

1.20      The Intergovernmental Agreement set out the following principles to be enshrined in the NRAS legislation:

  1. it should operate in a transparent, accountable, efficient, effective and fair manner;

  2. it should ensure that fees and charges are reasonable; and

  3. it should recognise that restrictions on the practice of a profession should only occur where the benefits of the restriction to the community as a whole outweigh the costs.[7]

1.21      The object of the NRAS is set out in clause 3 of Bill B:

The object of this Law is to protect the public by:

  1. establishing a national scheme for the regulation of health practitioners that ensures health practitioners registered under this Law are suitably qualified and competent, and maintain appropriate standards of practice, and

  2. establishing a national scheme for the registration of students undertaking programs of study that provide a qualification for registration in a health profession, to ensure the public is not placed at risk by the students in the course of undertaking the programs of study.

1.22      The objectives and guiding principles of the NRAS are set out in clause 4 of Bill B:

  1. The objectives of the national registration and accreditation scheme are as follows:

    1. to provide for the protection of the public by ensuring that only health practitioners who are suitably trained and qualified to practise in a competent and ethical manner are registered,

    2. to facilitate workforce mobility across Australia by reducing the administrative burden for health practitioners wishing to move between participating jurisdictions or to practise in more than one participating jurisdiction,

    3. to facilitate the provision of high quality education and training of health practitioners,

    4. to facilitate the rigorous and responsive assessment of overseas-trained health practitioners,

    5. to facilitate access to services provided by health practitioners in accordance with the public interest,

    6. to enable the continuous development of a flexible, responsive and sustainable Australian health workforce and to enable innovation in the education of, and service delivery by, health practitioners.

  2. The guiding principles of the national registration and accreditation scheme are as follows:

    1. the scheme is to operate in a transparent, accountable, efficient, effective and fair way,

    2. fees required to be paid under the scheme are to be reasonable having regard to the efficient and effective operation of the scheme,

    3. restrictions on the practice of a health profession are to be imposed under the scheme only if it is necessary to ensure health services are provided safely and are of an appropriate quality.

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