Australia: reforming regulation
Anne-Louise Carlton, from the Victorian Department of Health and Human Services, paid a visit to the Authority to talk through regulatory reform in Australia.
Australia introduced its first piece of regulatory legislation in 1837 (the regulation of medical practitioners in Tasmania) which pre-dated the UK by 21 years.
Powers to regulate or register were situated within each Australian state and territory rather than in the Commonwealth and, similar to the situation in the UK, there was also a history of piecemeal changes over 170 years. By 2005, this all resulted in a system so complicated and confusing that it was no longer fit for purpose.
However recognising that something is not working is the easy part, working out how to fix it, is much more difficult. Fortunately for Anne-Louise, who had been working towards reforming health regulation since the mid-1990s, by 2005, a mix of social, economic and political pressures provided the push needed to go ahead, including:
- ageing populations and long-term health conditions and co-morbidities
- risk of pandemics
- new health technologies
- increasing costs
- public outcry over regulatory failures
- continuing measures to increase competition and reduce regulatory burden
- increasing difficulties with workforce shortages particularly in rural and remote areas and the need for health professionals to be able to work across state borders
- increased expectations for transparency, accountability and sharing of regulatory decision-making.
A 2005 Productivity Commission report detailed some of the problems and noted that a less fragmented and better co-ordinated system was needed.
Proposals were put forward to replace the existing system. A raft of State and Territory-based arrangements had to be unpicked (more than 95 health profession boards, 75 different Acts of Parliament, 38 regulatory organisations and over 1.5 million data items from 94 sources) all to be replaced by:
- one national scheme
- 14 health profession boards
- nationally consistent legislation (largely)
- one national organisation – the Australian Health Practitioner Regulation Agency (AHPRA)
- a single national online register (with five main registration types).
The objectives of the new National Law were designed to promote the protection of the public; encourage workforce mobility within Australia; encourage high quality education and training; provide a rigorous and responsive assessment of overseas trained practitioners; enable a flexible, responsive and sustainable health workforce; and enable innovation in education and training.
The new national regulatory organisation (AHPRA) would replace the 38 regulatory organisations and work with the 14 National Health Practitioner Boards to:
- set professional standards – entry into the profession
- register practitioners – compliance with standards (annual renewal)
- maintain national registers
- manage notifications – address concerns about ‘fitness to practice’ (health, conduct, performance)
- accreditation – set standards for educational pathways to registration
- enforcement – prosecute for offences.
The remit of the national statutory regulator is complemented by a statutory Code of conduct and negative licensing scheme pioneered by New South Wales, and currently being rolled out nationally. This scheme applies to all unregulated health and care workers, and effectively allows for the most serious transgressors to be removed from the workforce.
Anne-Louise says of her experience of bringing about such radical regulatory reform:
'It was very rocky in the first few years, but the potential of the National Scheme is now being realised. A single national register and a single administration provides the levers needed to drive workforce and system reform, to better protect the public.'
A diagramme of effective health professional regulation from Anne-Louise's presentation: