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House of Assembly - Fifty-First Parliament, Third Session (51-3)
2009-07-16 Daily Xml
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NATIONAL HEALTH REGULATION SCHEME

Ms CHAPMAN (Bragg) (11:31): I move:

That this house—

(a) notes that the federal government is planning a national health regulation scheme for 10 different and varied health professions—chiropractors, dentists, medical practitioners, nurses and midwives, optometrists, osteopaths, pharmacists, physiotherapists, podiatrists and psychologists;

(b) notes that the proposed scheme has raised many concerns in all of these health professional areas and in health consumer forums, and will provide a bureaucratic and expansive regime, the cost of which will inevitably be passed on to South Australians visiting these professionals;

(c) notes that while the proposed scheme purports to 'provide greater safeguards to the public', many key stakeholders, such as the Australian Medical Association, the Australian Society of Anaesthetists and the Australian Association of Surgeons, believe that patient safety and standards will actually be compromised if the states press ahead with uniform legislation;

(d) requests the Minister for Health to make a statement detailing South Australia's position on a national health regulation scheme as a matter of urgency, including what consultation has occurred with local representatives of the 10 professions involved, and with consumer and other interest groups; and

(e) declares that this house will never agree to any national scheme which has the effect of centralising more power in Canberra and which undermines the current operation of South Australia's registration bodies comprising local profession representatives and input from members of the South Australian community.

It is with pleasure that I move this motion today. It is quite long, and it is detailed for the benefit of members. Essentially, it is to raise significant questions about the federal government's plan to introduce a national health regulation scheme to cover regulatory arrangements, largely in respect of registration and accreditation, for health professionals: chiropractors, dentists, medical practitioners, nurses, midwives, optometrists, osteopaths, pharmacists, physiotherapists, podiatrists and psychologists.

It raises concerns about the health professional areas and their stakeholder representatives as to the question of whether the proposed scheme claiming to provide greater safeguards to the public will, in fact, compromise patient safety and the standards that are applied. That is the major concern that underpins this.

It is fair to say that in this motion we are calling for the Minister for Health here in South Australia to make a statement detailing what the South Australian government's position is on this matter and what consultation has occurred and to declare to this house that we, as members of the opposition, will never agree to a national scheme which has the effect of centralising more power in Canberra without any direct benefit for South Australians, and which, indeed, has potentially negative impacts, without proper consultation and recognition—not just asking and calling for the submissions of stakeholders but actually to listen to what they have to say and the concerns they raise.

The history of this matter is that it started with the Council of Australian Governments (COAG), when the federal, state and territory governments get together and make decisions about what would be in the interests of all Australians. One would like to think that a number of the COAG agreements that come from these meetings take into account the diversity across the country and introduce new policy or legislation that is for the benefit of all Australians.

On the face of it, that is meritorious but, back in March 2008, the COAG signed an intergovernmental agreement to establish a single national registration and accreditation scheme; to get this going, they introduced legislation in the Queensland parliament. The Queensland health minister introduced the Health Practitioner Regulation (Administrative Arrangements) National Law Bill in 2008, following on from that agreement. It was strongly opposed by the opposition in Queensland.

The Hon. Mark McArdle MP, the member for Caloundra, spoke passionately on the bill and rightly pointed out the extraordinary alarm that was being voiced across his jurisdiction in Queensland and, indeed, national bodies about this legislation. So, before proceeding on to implement this legislation in other states, and at a national level, the COAG reconvened, thankfully, and started to review this matter.

I must say that I find it rather churlish of COAG to attempt to introduce legislation to start this type of action in Queensland, in the full knowledge that it does not have a Legislative Council. There is no house of review in Queensland so, of course, this legislation will be shoved through—all the more reason, of course, why we must protect, recognise, have high regard for and fight for upper houses in this country. This is exactly the type of abuse that can occur—using the Queensland parliament as a means to shove something through.

There was such public outrage about this at professional levels that the government pulled that process through COAG, convened again this year and has now introduced for public consultation a health practitioner regulation national law. An exposure draft was published last week. The Australian Health Workforce Ministerial Council announced that the ministers were releasing the draft legislation for the scheme for health professionals.

It has some new aspects to it. I do not know—perhaps they were unintended; perhaps they were deliberate—but they have not had a lot of oxygen by way of announcement by any government, federal or state. However, again, there has been outrage in the community, and I will come to that in a moment. There appear to be, on the face of it, attempts to sneak through hidden agendas with this type of legislation; causing the very concerns which a number of my colleagues in opposition around the country have raised and which, at the national level, the stakeholders have raised.

One of the aspects of this bill is to have a national registration scheme. At present, each of these disciplines of health professionals has a board: we have a Medical Board, a Nurses Board, a Chiropractors Board, etc. These play an important role in identifying and ensuring that the people who purport to and seek to practice, apart from being registered (which is a legal requirement), have certain standards of academic training, experience and refresher qualifications when they have been absent on leave, etc. Those standards play an important role.

Part of this new scheme was to introduce a system whereby there would be a national registration scheme. Presumably, one could go into this, identify if Nurse X was registered in any state in Australia, and there would be access to that record. Universally, across the country, the relevant professional bodies said, 'No problem with that. We have the information technology and we have the capacity to be able to provide this sort of service. We do that at a national level in a number of other professions and for other purposes. It is a good idea.' Everyone agrees with that: that is the easy bit.

But here is the hard bit: the hard bit is the concern raised repeatedly by medical associations and other disciplines, including colleges of the medical professions, nurses and chiropractors, etc., that the proposed scheme would be vulnerable to political interference. How is that so? The reason that they claim this would occur is that, unless you keep the standards of academic training and qualification independent of politicians, you run the risk of actually diminishing and devaluing the training requirements and quality standards for the purposes of undertaking a particular profession.

The danger is that if a department is motivated by the imposition of a requirement by a treasurer, for example, to cut costs or to have some efficiency savings (or other ways they gloss up getting rid of people these days), then the one thing to do is to reduce the cost of training professionals. One way of doing that is to reduce the number of years people might have to train or undertake a tertiary qualification or perform practical work. The danger is that you diminish the quality and standard of the professional involved. This is the core of the concern.

It appears that in more recent COAGs there was an acceptance that this was a concern of the professions, and they then looked to how they might address that and how they might remove potential political interference from that. They have introduced a scheme of panels that, from my reading of the draft bill, are still potentially under the influence of political interference by the appointment of people on these panels.

What happens? The health minister is under pressure; the Treasurer is saying, 'Cut costs; not got enough money.' One way, of course, is for them to say to their department, 'Okay; we're going to diminish the necessary standards. That will reduce the cost. We can provide a service to more people more cheaply but, the danger is, more dangerously.' Therefore, those concerns have been echoed again around the country, and they remain a major aspect of concern.

Why the federal Labor Party and the state administrations whose government benches are currently occupied by Labor members want to go down this line ought to be obvious to members of the parliament; that is, they want to provide a cheaper service and get the same service done cheaply. That will compromise the health standards, potentially, for patients. That is the dangerous outcome for patients.

Another aspect that I want to raise today is something that has become even clearer since I gave notice of moving this motion: what else is the government trying to push through? I noted in the draft when I was provided with this a couple weeks ago that the obligation of professionals has also increased. We actually already have laws that require that, if someone, for example, a doctor, is holding themselves out to be professionally qualified and registered and they have obligations in respect of their capacity to remain registered and therefore have the right to practice, they must also have professional indemnity insurance.

Medical specialists, of course, are in this category, as you would expect. Obstetricians, for example, have a very high insurance premium because of the extraordinarily large common-law payments that are made when children are born with some disability that has been found in the courts to have resulted in some way from the negligence of a practitioner. They are very high and, of course, if a baby is born with significant incapacity as a result of a finding such as this, it may need medical treatment and support for life, so these are multi-million-dollar payouts.

I raise this issue because it is not as though it is unique to have in this exposure draft the obligation of professional indemnity insurance as a prerequisite to being able to be registered under this new national scheme because, for many professions, it is already there. It is built into the cost of operating their practices; it is built into the cost of public administrators providing the services of medical and other health professionals in hospitals and health services operated by government. That, of course, is very significant, as we know, within the state budgets around the country that have the principal responsibility for employing such health professionals in many of the public hospitals that are networked across the state and, of course, in other jurisdictions in the country.

What it raises, though, as many members, I am sure, would now be aware, is the great concern of midwives across the state and across the country. It is proposed that there be a large rally against these regulations because of the imposition that this bill, if it becomes law, will place on midwives by requiring them to have professional indemnity insurance. What I say is this: it is of concern to me that if there is a backdoor way of excluding midwives from actually being able to carry out their practice, particularly in home births, which is the service they provide, then we are going to exclude an area of choice for women.

Just this last week I read that some male midwife made some great statement about how women have to endure the pain of childbirth to bond with their children. I have never heard such utter rot. However, what is important is that women do have a choice about where they have their baby, how they have their baby and which professional people they have with them. That is a personal choice of women.

It seems to me that it is scandalous that, at this level, there will be a requirement for insurance, which will put these people out of business and unable to offer a professional service. I have said it many times but I place on the record again that I have children, and I elected to have them in a hospital. If I had any more (actually, if I had any more I would slash my wrists) I would make sure that it was in a hospital. That is my personal choice, and I think it is important for women to have that personal choice.

What is important here, though, is that women should not be denied the opportunity to have a home birth with a midwife in attendance if that is their choice. What is important here is the government is saying that it needs to provide protection when, for example, a midwife does not elect to work in a triage situation with other general practitioners or specialists in attendance in relation to difficult or multiple births. There are some who do that and, again, that may be a dangerous practice. However, home births can be safe provided midwives understand when they are getting into trouble and understand the importance of having links with a hospital, other specialists and general practitioners in order to be able to get help when it is required. That is the key. What is important is that the Australian Labor Party go back and make sure that it looks at the question of informing the client—

The DEPUTY SPEAKER: Order! The member's time has expired.

Ms CHAPMAN: Inform the client of insurance, not require it.

The DEPUTY SPEAKER: Order! The member's time has expired.

Ms SIMMONS (Morialta) (11:47): I rise to oppose this motion and to give a brief explanation to the house of the government's position. On 26 March 2008, which happened to be my daughter Katie's 25th birthday, the Council of Australian Governments signed an intergovernmental agreement to establish a national registration and accreditation scheme for health practitioners.

The development of a national registration and accreditation scheme arises from the Productivity Commission report into Australia's health workforce commissioned by the Council of Australian Governments in 2004 to develop a more sustainable and responsive health workforce while maintaining a commitment to high quality and safe health outcomes.

Currently, registration and accreditation of health practitioners is the responsibility of each individual state and territory government, with more than 80 registration boards in operation across Australia. Requirements for registration and the professions required to be registered to practise vary across jurisdictions. Introducing a national scheme for registration and accreditation of health practitioners will provide improved safeguards for the public by allowing data on health practitioners to be shared, including criminal history, practice restrictions or clinical history. This will help avoid unfortunate situations that have occurred in the past where a board in one state or territory has registered a practitioner unaware that he or she has been subject to investigation or sanctions in another jurisdiction.

Having recently been part of the Social Development Committee Inquiry into Bogus, Unregistered and Deregistered Health Practitioners, during which we heard diabolical and damning evidence, I realise just how important this situation can be. I remind the member for Bragg that the member for Hammond and the Hon. Stephen Wade in another place were equally horrified by the evidence that we heard in that committee.

This scheme will also provide benefits to health practitioners, who will need to be registered only once in order to practise in more than one Australian jurisdiction, which means that they can go across borders and see patients quite easily across those borders.

The national scheme will commence on 1 July 2010, and it will initially cover 10 health professions: medicine, nursing and midwifery, pharmacy, physiotherapy, psychology, optometry, osteopathology, chiropractic, podiatry and dental. Aboriginal and Torres Strait Islander clinical health workers, Chinese medicine practitioners and medical radiation practitioners will join the scheme from 1 July 2012.

The implementation of the national scheme has been undertaken in three legislative stages. The first stage, the passage of the Health Practitioner Regulation (Administrative Arrangements) National Law Act 2008 by the Queensland parliament in November 2008, as the member for Bragg indicated, established governance and legal structures to facilitate the development and implementation of the scheme.

The second stage of the draft bill, the Health Practitioner Regulation National Law, was released for consultation on 12 June this year. This bill covers the operational arrangements of the national scheme, such as the registration and accreditation arrangements, arrangements for the handling of complaints and dealing with performance, health and conduct matters, and arrangements for information sharing and privacy protection.

The third stage is the adoption of the national law by all jurisdictions in their respective parliaments. This third bill will also provide the opportunity for jurisdictions to preserve those arrangements from their current health practitioner legislation that are not covered by the national law, such as the licensing of pharmacy premises in South Australia.

The development of the national scheme has been the subject of extensive consultation with regulatory bodies, practitioners, professional associations, consumers and other key stakeholders, both nationally and locally in South Australia. On 29 June 2009, over 96 people from registration boards, professional associations, educational institutions and consumer bodies attended a stakeholder forum held in South Australia to discuss the draft bill. A number of people from South Australia also attended a national forum in Canberra a week earlier to discuss the draft legislation. The Department of Health has held information forums with registrars and members of registration boards to discuss each of the papers and the legislation released as part of the consultation process.

Officers from the department have also met with representatives from registration boards and professional associations prior to ministerial council meetings to seek their views on policy directions. The department also convenes a meeting each month with registration boards to advise them of the progress of the implementation of the national scheme and to discuss the transition issues. The department is also in the process of establishing a newsletter to distribute to registration boards, to advise board members of the recent developments in the implementation of the national scheme.

The Minister for Health (Hon. John Hill) has also met with a number of professional associations, including the Australian Medical Association and Australian Nursing Federation, to seek their views on various aspects of the national scheme. He also met with registration boards to discuss the national scheme.

It has been difficult trying to get agreement across nine different governments and 10 different professions. There is general support among stakeholders in jurisdictions for what the national law sets out to do, although some areas require clarity. I would like to emphasise that most of these areas involve how the legislation is drafted, not the policy direction that is proposed.

The proposed national scheme will continue 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. Again, given the findings of the recent bipartisan inquiry, this government believes that this is really important.

The new scheme will also include provisions to prohibit practitioners who are deregistered from applying for registration for a specified time, from using a specified title or providing a specified health service. This gives effect to one of the recommendations from the Social Development Committee's report on bogus, unregistered and deregistered health practitioners, which calls for amendments to legislation to ensure that deregistered health practitioners are unable to re-establish themselves under a different title and/or continue to practise in unregulated areas of health care.

Under the national laws, South Australia will have at least one member on each of the profession-specific national boards. These national boards may establish a committee in each state and territory to handle registrations and complaints in a way that provides an effective and timely response to the health practitioners and consumers in that jurisdiction. These committees or state boards would ensure that there is a local presence.

Health ministers will continue to be responsible for the appointment of members of these committees, and the Minister for Health (Hon. John Hill) will propose that the current practice of appointing members from the relevant professions (as well as community members) to represent the public interest continues. The Council of Australian Governments committed $19.8 million to support the implementation of the national scheme.

The income raised from the registrant fees across Australia will pay for the scheme, as currently occurs with the registration boards in South Australia. The national boards for each profession will be responsible for the setting of the registrant fees. It is a legislative requirement that these fees are reasonable and give due regard to the efficient and effective operation of the national scheme.

The National Registration and Accreditation Scheme for the health professionals has been agreed to by all jurisdictions and has been subject to extensive consultation nationally and within each jurisdiction. The scheme will ensure that practitioners continue to provide services in South Australia at the highest standards of competence and conduct while providing for nationally consistent standards and qualifications in registration and removing barriers that inhibit registered practitioners from more easily establishing practices in South Australia.

I recommend that all members read the bogus, unregistered and deregistered health practitioner report that was handed down in this place. I ask that the house oppose this motion.

Ms CHAPMAN (Bragg) (11:56): I conclude by thanking the one speaker from the government who raised the question of the bogus practitioners' action arising out of a committee report to this parliament. It is something which the government indicated it would deal with a couple of years ago. It sent it to a committee. We welcome that report, and we will, of course, look at the legislation that ultimately emanates from it, which, I hope, the government will hurry up and deal with. It is an area that needs to be looked at and, subject to receiving this draft bill, I look forward to supporting something to ensure that that gap is closed.

Quite frankly, that has nothing to do with the national registration scheme, which is to take control of the registration and accreditation—and introduce a whole lot of other aspects—of the professional standards that are applied to 10 areas of health professional in this country. I am disappointed that the government has not seen the merit in ensuring that it take some responsibility. We know that 26,000 people are employed in the health department in this state, many of whom, of course, are health professionals and the large majority of whom are nurses.

We have an ever-increasing number of midwives coming through our universities with specific qualifications, and the government needs to take a good look at this and not simply accept at the national level what the federal minister is proposing. The Hon. Nicola Roxon has the conduct of this matter now; and it is about time that the health ministers around the country take a good look at this and understand what this is really all about. We need to secure this properly to ensure the future safety of patients in South Australia and that proper administration is able to be undertaken without overlap, without bureaucracy and without control from Canberra.

We need an assurance that we have a capacity in this state to continue to determine our own destiny in the provision of public health services and ensure that those professionals who are employed in our private sector are also up to scratch. This COAG agreement is very important. It will crush the capacity for South Australia to act independently. Already we have had the issue of midwives exposed, and I understand there are some issues in relation to standards that might apply to other services across the country, including the Royal Flying Doctor Service.

These are issues that must be looked at, not rubberstamped by state Labor health ministers just because the Hon. Nicola Roxon says so from Canberra. That is not acceptable, it is not responsible and it is completely negligent for any government—particularly a health minister—to go down that line.

I indicate that, whilst I am concerned that a government representative has spoken against this, I will still be putting the motion and ask that the house consider its passing favourably and understand the consequences that will occur to this state and the health of over 1.5 million South Australians if this is not attended to. I commend the motion to the house.

The house divided on the motion:

AYES (10)
Chapman, V.A. (teller) Evans, I.F. Goldsworthy, M.R.
McFetridge, D. Pederick, A.S. Penfold, E.M.
Pengilly, M. Pisoni, D.G. Venning, I.H.
Williams, M.R.
NOES (25)
Atkinson, M.J. Bedford, F.E. Bignell, L.W.
Breuer, L.R. Brock, G.G. Caica, P.
Ciccarello, V. Conlon, P.F. Geraghty, R.K.
Hanna, K. Hill, J.D. Kenyon, T.R.
Key, S.W. Koutsantonis, A. Maywald, K.A.
O'Brien, M.F. Piccolo, T. Portolesi, G.
Rankine, J.M. Rann, M.D. Simmons, L.A. (teller)
Thompson, M.G. Weatherill, J.W. White, P.L.
Wright, M.J.
PAIRS (8)
Redmond, I.M. Lomax-Smith, J.D.
Griffiths, S.P. Stevens, L.
Hamilton-Smith, M.L.J. Foley, K.O.
Gunn, G.M. Fox, C.C.

Majority of 15 for the noes.

Motion thus negatived.

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