AUSTRALIA’s governments in 2008 decided to establish the National Registration and Accreditation Scheme — an important and internationally recognised initiative in health practitioner regulation.
Initially uniting 10 (now 14) professions via legislation in eight jurisdictions, it was described as a “significant milestone in the reform of the Australian healthcare system” before it was introduced in 2010.
Initially, implementation of the scheme, which deals with registration, accreditation and complaints handling administered by the Australian Health Practitioner Regulation Agency (AHPRA), was not smooth. Much angst was caused by the complex process of transferring functions previously undertaken by state and territory regulatory boards to the national scheme structure.
These teething problems, particularly in registration, have been largely overcome, but concerns remain about complaints handling.
After 3 years of operation, the scheme is now subject to a mandatory independent review. It is an interesting time for a review as AHPRA in its short life has already been the subject of two reviews of its performance, one by the Senate and the other by a Victorian upper house committee.
Overcoming the previously fragmented approach to managing complaints about practitioners is a key benefit of the national scheme, as it provides consistency of approach, not only in terms of process, but also in terms of outcomes for consumers and practitioners alike.
However, the national scheme for complaints handling was not universally adopted around Australia. NSW opted out of this aspect of the scheme from the beginning, Queensland took itself out of the national complaints handling regime from July 2014, and in March 2014, the Victorian inquiry recommended that state consider doing the same.
The Queensland Health Minister Lawrence Springborg described the handling of complaints as “dysfunctional”, saying the new Health Ombudsman would provide better oversight and accountability.
The Victorian inquiry found that there were numerous problems with the existing complaints process in Victoria including confusion and inconsistencies, time delays and inadequate ministerial and parliamentary accountability and oversight.
So a key question for practitioners, consumers and regulators is whether the review of the national scheme, due to report to health ministers early this year , will recommend further fragmentation of a system that is beginning to find its feet and show improvements.
The consultation paper for the national scheme review noted that the recent developments in Queensland and comments in the Victorian upper house inquiry report are “a clear indication of serious concerns that the National Law notification system has not been operating effectively”.
One of the options canvassed in the consultation paper is that the Queensland model for complaints handling be adopted nationally. Under this model, there would be a single entry point for all complaints and notifications, and serious matters would be dealt with by an independent health complaints entity, with less serious matters referred to the national boards and the AHPRA. The aim is primarily to overcome the confusion faced by consumers about the management of complaints under the national scheme.
In Avant’s submission to the review, we noted our strong support for the national scheme. This is supported by the results of an unpublished survey that Avant undertook in April 2014 which revealed that 70% of doctors surveyed preferred a standard national complaints-handling system to state-based systems.
We do not support further jurisdictions opting out of the national scheme for complaints-handling, and believe that improvements can be made to address concerns to prevent this happening.
Now is not the time for further fragmentation. Academic research is currently underway looking at complaints handling systems and models of professional regulation in Australia. As the results of this research are not yet known, it is premature to consider any significant changes to complaints and notifications handling in the national scheme.
Instead, we should concentrate on fixing issues with the current arrangements rather than risking more organisational chaos. This will be better for all involved in the national scheme — the AHPRA and national boards, practitioners and consumers, and, most importantly, it will lead to greater public confidence in our health regulatory system.
Ms Georgie Haysom is the head of advocacy at Avant.