Transcript Board meeting 2010 - Federation of Chiropractic Licensing

National Registration – ‘Reform
extraordinary in its vision and scale’
Dr Paul Fisher, Chiropractor
Dr Phillip Donato OAM, Chiropractor
Executive Officer,
Chiropractic Board of Australia
Chair,
Chiropractic Board of Australia
1
Outline...
• What did we have
• What was wanted
• What did we get –
NRAS
• What have we learned?
•
What was extraordinary
BACKGROUND
Did you know...
5
Did you know...
6
Australia today...
• We share our land with its indigenous people and
we acknowledge their ownership and custody of this
land.
• Total population 23.5 M, urban 89%, 6 per sqkm
• 25% resident population born overseas
–
–
–
–
–
–
UK 23%
NZ10%
China 6%
Italy 5%
Vietnam 4%
India 3%
• Median Age 37
Health Care in Australia...
Australian Health Expenditure
• 9.1% GDP ( US 15.2%)
• 70% paid by Government, balance by Private and third party payers
Health Insurance – mixed system
•
•
Medicare – universal health insurance – Medical fees (partly covered) ,
public hospitals, some Chiropractic Care
Private health insurance – private hospitals and ancillary benefits
Workforce
•
One in 44 Australians – or one of every 20 working Australians - is a
registered health practitioner.
CHIROPRACTIC REGULATION
History of chiropractic
regulation…
•
1905 until 1960 Chiropractic - self regulated profession
• Chiropractic first regulated by own statute in Western
Australia in 1964
• Eventually all states and territories enacted laws to
regulate the practice of chiropractic
• Significant variation in the style of legislation
Prior to June 2010...
• Legislation in each state and territory regulating
chiropractors ( 8 sets of laws)
• Chiropractic Registration Boards in each state and
territory (8 separate Boards)
• 1992 Commonwealth Mutual Recognition Act
- to facilitate movement of registered professionals
between jurisdictions ( same as Australia- New
Zealand recognition model)
• Single Accreditation Council (CCEA Inc)
• Similar for all other regulated Health Professions
An environment of change...
• Increasing community involvement
– Board membership – 1/4 to 1/3 lay members
– Consultation re standards, guides
• Increased public access to information
– About registrants, Board processes and outcomes
• Separation of powers – more serious matters
heard in judicial tribunals
• Increasing transparency and accountability
• More oversight and scrutiny
The visions...
The professions
– National registration – driver’s licence model
– National standards and consistency
– Reduced fees
The community
– More information and transparency
– More consistent regulation and accountability
Governments
– More workforce flexibility, mobility and capacity
NATIONAL REGISTRATION AND
ACCREDITATION SCHEME
(NRAS)
(The combined vision)
The new scheme – NRAS...
National registration and accreditation scheme
(NRAS) for
1. The regulation of health practitioners
2. The registration of students undertaking clinical
training in a health profession
3. Nationally consistent accreditation processes
Genesis...
• Concerns about health workforce shortages
• Concerns about workforce inflexibility and location
• Concerns about consistency of standards
• General need for reform
• 2006 - Productivity Commission
- Australia’s Health Workforce – ‘Super Board’
• 2008 – COAG
- Agreed to develop a single National Registration and Accreditation
Scheme for 10 professions
COAG...
Council of Australian Governments
• Peak intergovernmental forum
• Prime Minister & State Premiers and Territory Chief
Ministers
• To initiate, develop, monitor implementation of policy
reforms of national significance which require
cooperative action by Australian governments e.g.
health, education, energy
• Aims to deliver ‘seamless national economy’
Development...
• July 06 - COAG announced NRAS – start July 08 “to
facilitate workforce mobility; improve safety and quality;
reduce red tape; simplify and improve consistency”
• Mar 08 - COAG Intergovernmental Agreement
single scheme, national agency, profession specific
national boards, offices in each state/territory
• National Law Model – legislation enacted in one
jurisdiction and then mirror imaged across states.
THE NATIONAL LAW
Legislation...
• Act A – The Health Practitioner Regulation
(Administrative Arrangements) National Law Act 2008
(Queensland)
• Act B – Health Practitioner Regulation National Law Act
2009 (Queensland) - Full provisions for operation of the
scheme to commence 1 July 2010
• Acts C – Adoption and Consequential Bills in each
jurisdiction – agreement to have in place by end 2010
Federation … in practice!
Jurisdiction
Queensland
New South Wales
Victoria
Legislation passed
Joined scheme
3 November 2009
1 July 2010
19 November 2009
1 July 2010
8 December 2009
1 July 2010
ACT
16 March 2010
1 July 2010
Northern Territory
17 March 2010
1 July 2010
Tasmania
17 June
2010
1 July 2010
South Australia
29 June
2010
1 July 2010
Western Australia
19 August 2010
18 October 2010
Before 1 July 2010
After 1 July 2010
• Eight States and
Territories
• > 85 health profession
boards
• 65 Acts of Parliament
• 85 sets of administration
infrastructure
• One national scheme
• 10 health profession
boards
• National Law model
• Local variation in 3
jurisdictions
• One administration
infrastructure
22
Health Professions involved...
July 2010
•
•
•
•
•
•
•
•
•
•
chiropractors
dental care (including dentists, dental
hygienists, dental prosthetists &
dental therapists),
medical practitioners
nurses and midwives
optometrists
osteopaths
pharmacists
physiotherapists
podiatrists
psychologists
July 2012
•
•
•
•
Aboriginal and Torres Strait
Islander health practitioners
Chinese medicine practitioners
medical radiation practitioners
occupational therapists
Future
•
?
Guiding principles...
• national scheme to operate in transparent,
accountable, efficient, effective and fair way
• registration fees to be reasonable (having regard to the
efficient and effective operation of the scheme)
• restrictions on practice to be imposed only if
necessary to ensure health services provided safely and
of appropriate quality
Objectives...
• Provide for protection of the public by ensuring that only
practitioners who are suitably trained and qualified to practice in a
competent and ethical manner are registered
• Facilitate workforce mobility across Australia
• Facilitate provision of high quality education and training of
health practitioners
• Facilitate rigorous and responsive assessment of overseas
practitioners
• Facilitate access to services in the public interest
• Enable continuous development of a flexible, responsive and
sustainable Australian health workforce and enable innovation in
education and service delivery
NRAS – what model of
regulation is it?
• National regulation under national law
• Protection of title, not practice (some exceptions)
• Role of government more explicit (Ministerial
Council)
• All jurisdictions, ten professions, one
administration(AHPRA)
Does NRAS address the concerns?
27
THE NATIONAL LAW
IN OPERATION
Government...
Via Australian Health Workforce Ministerial Council
• May give directions to Agency or Boards including
– about policies, administrative processes, procedures
– about accreditation standards only if proposed standard will
have substantive negative workforce effect and if first consider
potential impact of direction on quality and safety of healthcare
• Approve registration standards, specialties, endorsements
• Appoints National Boards, Agency Management Committee,
AHWAC
• May not give directions about particular person or qualification
or application, notification or proceeding or codes/guidelines
AHPRA...
• Australian Health Practitioner Regulation Agency
• Ensures all functions are carried out in line with the
objectives and guiding principles of the scheme
• Provides support and administrative services to National
Boards and committees, through a National office and
State/Territory offices
• Has own regulatory functions and responsibilities under
the National Law
• Establish annual Health Profession Agreements with
each National Board re registration fees and re services
AHPRA provides
• Employ staff, enter contracts, manage property etc
National Boards...
• Appointed by Ministerial Council
• At least half and not more than two thirds
practitioner members
• The chair is to be a practitioner member
• At least a third community members
• Members from each jurisdiction
– Initial membership drawn from existing state and
territory Boards
• Terms of appointment – 3 years
Role of National Boards...
• Set national registration standards, codes and guidelines
• Determining overarching policy
• Final approval of programs of study
• Oversee assessment overseas trained practitioners
• Oversee receipt and follow-up of notifications re health,
performance and conduct
• Maintain registers (with AHPRA)
• Set registration fees and develop Health Profession
Agreement with AHPRA
NRAS Structure...
Ministerial Council
Advisory Council
Accreditation
Authorities
National Boards
Agency
Management
Committee
National
Committees
Support
National Office
State/ Territory/
Regional
Boards
Support
State and Territory
Offices
Contract
Key features of the National
Law...
• Broad consultation
• Categories of registration
• Registration standards
• Mandatory Reporting of notifiable conduct
• Voluntary notifications
• Student registration
Key elements of the National Law
(continued)...
Funding
• National registration fee for each profession
• Entire scheme self-funded from registration fees
• No cross profession subsidisation
Accreditation
• Initial appointment by Ministerial Council
Registration Types...
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•
•
•
•
•
•
•
General Registration
Specialist Registration
Provisional Registration
Limited Registration – Public Interest
Limited Registration – Teaching and Research
Limited Registration – Supervised Practice
Student Registration
Area of Practice Endorsements
36
Registration Standards...
•
•
•
•
•
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Criminal history
English language proficiency
Recency of practice
Mandatory continuing professional development
Mandatory professional indemnity insurance
Limited Registration
37
Notifications...
• The National Law provides for both Voluntary and Mandatory
notifications about practitioners and students.
• Mandatory notifications - practitioners and employers must
report a registrant who they reasonably believe has engaged
in notifiable conduct (some exceptions)
• Not limited to notifications in same profession
• Notifiable conduct defined as
– practising while intoxicated by drugs or alcohol
– engaging in sexual misconduct in connection with professional
practice
– placing the public at risk of substantial harm through
impairment or poor professional practice.
THE NATIONAL REGISTER OF
HEALTH PRACTITIONERS
Registration data...
Profession
Chiropractor
Dental Practitioner
Medical Practitioner
Midwife
Nurse
Nurse and Midwife
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
No PPP*
Total
53
1,409
24
669
351
44
1,103
454
180
4,287
330
5,611
120
3,536
1,568
320
4,124
2,070
558
18,237
1,706
27,641
881 16,774
6,877
2,031
21,271
8,234
2,517
87,932
16
320
309
7
631
168
90
1,780
78,866 2,839 54,625 26,881
7,543
76,725
28,295
9,463
289,463
4,226
10
229
713
14,285
573
7,641
2,627
726
10,375
3,223
353
40,516
Optometrist
69
1,496
29
902
209
80
1,100
335
195
4,415
Osteopath
32
394
2
132
19
37
683
53
100
1,452
Pharmacist
398
8,057
173
4,915
1,828
600
6,271
2,792
679
25,713
Physiotherapist
418
6,522
131
4,102
1,824
378
5,419
2,606
784
22,184
45
892
12
568
342
80
1,076
341
32
3,388
766
9,884
200
4,997
1,408
501
7,583
2,970
366
28,675
155,377 4,994 99,090 44,243 12,347
136,361
51,541
15,317
528,042
Podiatrist
Psychologist
Total
8,772
40
Physiotherapist
4.20%
Registrations for all NRAS Professions
Chiropractor
Psychologist 0.81%
Pharmacist
4.87%
Podiatrist
0.64%
Osteopath
0.27%
Optometrist
0.84%
Nurse and
Midwife
7.67%
5.43%
Dental Practitioner
3.45%
Chiropractor
Medical Practitioner
16.65%
Dental Practitioner
Medical Practitioner
Midwife
0.34%
Midwife
Nurse
Nurse and Midwife
Optometrist
Osteopath
Pharmacist
Physiotherapist
Podiatrist
Nurse
54.82%
Psychologist
41
Chiropractic data...
State
General
ACT
51
NSW
1368
NT
Non-practising
Total
2
53
40
1409
23
1
24
QLD
654
15
669
SA
340
11
351
TAS
44
VIC
1065
38
1103
WA
446
8
454
Not supplied
97
1
83
180
4088
2
198
4287
Total
Limited
1
44
42
Distribution of Chiropractors with General Registration
Not supplied
2.37%
ACT
1.25%
WA
10.91%
ACT
NSW
33.46%
NSW
NT
QLD
VIC
26.05%
SA
TAS
VIC
WA
TAS
1.08%
SA
8.32%
QLD
16.00%
NT
0.56%
Not supplied
43
Chiropractic data (cont.)
Sex
State
General
Female
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Not supplied
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Not supplied
NSW
VIC
WA
Not supplied
23
481
9
200
116
11
388
165
34
28
885
14
454
224
33
676
280
62
2
1
1
1
4088
Male
Not supplied
Total
Limited
1
Non-practising
Subtotal
Total
2
17
1
5
2
25
499
10
205
118
11
402
166
67
28
908
14
464
233
33
700
287
112
2
1
1
1
4287
1503
14
1
33
23
10
9
24
7
50
1
198
2779
5
4287
44
Current Registration data (cont.)
Age
20 - 25
26 - 30
31 - 35
36 - 40
41 - 45
46 - 50
51 - 55
56 - 60
61 - 65
66 - 70
71 - 75
76 - 80
81 - 85
86 +
Not supplied
Total
General
100
613
653
705
579
409
370
263
181
113
64
24
10
2
2
4088
Limited
Non-practising
1
25
38
27
19
23
19
11
14
8
10
4
1
198
Total
100
639
691
732
598
432
389
274
195
121
74
28
10
2
2
4287
45
Age Demographics…
Age Profile
800
700
600
500
400
Total
300
200
100
0
20 - 25 26 - 30 31 - 35 36 - 40 41 - 45 46 - 50 51 - 55 56 - 60 61 - 65 66 - 70 71 - 75 76 - 80 81 - 85
86 +
Not
supplied
46
WHAT HAS HAPPENED AND
WHAT HAVE WE LEARNED?
Differences practitioners notice...
•
•
•
•
•
Registration fees – $528 AUD
National registration
Requirements for CPD, Recency, PII
Mandatory reporting
New codes, guidelines and registration
standards
• Challenges in first few months
Differences the public notice...
• National Online Registers
• Consistent standards across jurisdictions
• Greater tranparency
49
Personal perspectives...
• Major and significant reform – right timing
• Turbulent and difficult gestation and infancy
• Extent of change process was underestimated
– New legislation
– New organisations in new offices
– New systems and process including IT system
• Many experience sense of loss of identity, culture,
history, status and felt disempowered
Significant benefits...
• National approach and consistency
• Will be springboard for reform and innovation
• Cross jurisdiction & cross profession learning and
collaboration
• Eventual cost efficiencies
• Greater resourcing through large agency
• More online ( paperless) functions
• More detailed data mapping
• Better engagement and communication
Significant challenges
• To rebuild relationships and confidence
• To get all the people and systems working
effectively together
52
Reflection...
•
•
•
•
•
•
•
Monumental first few years
Journey of extraordinary change
Realisation of a vision
Move towards regulatory excellence and reform
More robust systems
Stronger relationships
Extraordinary achievement
53
Issues for the
Chiropractic Board ...
• Advertising
• Ensuring proportionate and timely responses to
notifications
• Dealing with frivolous or vexatious - complainants
and practitioners
• Building and maintaining the confidence of the
public and the profession
…hopes for NRAS
• Respected by the profession, governments and the
community
• Focus on safety and quality of healthcare and
promote good practice
• Find the right balance between competing needs
and views e.g. workforce
• Agile, able to identify & address emerging issues
Transparent, accountable, efficient, effective, fair
regulation
References
•
•
Morauta, L 2011, Implementing a COAG Reform Using the National Law Model:
Australia's National Registration and Accreditation Scheme for Health
Practitioners. The Australian Journal of Public Administration, 70 (1) 75-83
Commonwealth of Australia, 2011. The administration of health practitioner
registration by the Australian Health Practitioner Regulation Agency (AHPRA).
Senate Finance and Public Administration Reference Committee. Canberra
Australia.
56
Any other issues?
Questions?
57