Registration of health practitioners is currently the responsibility of each individual State and Territory government. Requirements for registration vary somewhat across jurisdictions and the professions required to be registered to practise also differ. As a result, there are more than 80 health practitioner registration boards in operation across Australia. For psychologists there are currently eight Psychologist Registration Boards.
In 2005, the Commonwealth Government asked the Productivity Commission to undertake a study to examine issues impacting on the health workforce and to make recommendations to ensure the continued delivery of quality healthcare over the next 10 years. The Productivity Commission's report, Australia's Health Workforce, was delivered in January 2006 and recommended, among other things, the establishment of a single national registration board for health professionals, as well as a single national accreditation board for health professions' education and training. The Productivity Commission proposed that the introduction of a national scheme for registration and accreditation of health practitioners would provide improved safeguards for the public, deliver improved administrative efficiency and consistency by moving from the current fragmented jurisdictional system to one national scheme, and promote a more flexible, responsive and sustainable health workforce.
At the meeting of the Council of Australian Governments (COAG) in July 2006, agreement was reached to establish a national registration scheme for health professionals, beginning with the nine professional groups registered in all jurisdictions - psychology, medicine, nursing and midwifery, pharmacy, physiotherapy, osteopathy, chiropractic care, optometry, and dental care (dentists, dental hygienists, dental prosthetists and dental therapists). COAG further agreed to establish a separate, national accreditation scheme for health professions' education and training in order to simplify and improve the consistency of current arrangements. The nine health professions covered by the proposed schemes vigorously resisted the proposal of a single national board across the professions, and through an ongoing extensive consultation process this initial proposal was modified. In April 2007, the COAG communiqué announced a proposal for a single consolidated national registration and accreditation scheme incorporating a new national profession-specific board for each of the nine professions. The details of the model and structure of the new scheme were finalised at the COAG meeting in March 2008 with the release of an Intergovernmental Agreement (IGA).
The structure of the national registration and accreditation scheme for health professionals is depicted in Figure 1.
The Ministerial Council will oversee the scheme and be comprised of the Commonwealth Health Minister and the Minister responsible for health in each State and Territory. It will be responsible for approving legislation to be put before governments and parliaments, providing policy direction, appointing members of the National profession-specific Boards and the Agency Management Committee, and giving final approval of registration and accreditation standards. The Ministerial Council will have no role in individual registration and accreditation decisions.
The Advisory Council, with a membership appointed by the Ministerial Council, will provide independent advice to the Ministerial Council on matters related to the scheme.
The National Agency will be responsible for the administration of the national scheme in accordance with the legislation and policy directions issued by the Ministerial Council, and will be governed by the Agency Management Committee. The National Agency will provide support to the National profession-specific Boards and their committees and will be responsible for maintaining the national registers. It will be required to agree on the fees for each profession with the National Boards and will set the business rules for the development of professional standards by the National Boards (but not the professional content). A national office for the Agency will be established, with local offices in each jurisdiction to follow.
The National profession-specific Boards will be responsible for both the registration and accreditation functions for each of the ten health professions initially covered by the scheme (podiatry is now also to be included in the scheme, along with the nine professions stated previously). Each National Board will oversee the development of standards for registration and accreditation for its profession, and will oversee practitioner registration and course accreditation. The National Boards will establish national and local committees as required to enable delivery of each Board's functions.
To ensure a smooth transition to the new scheme, the IGA provides for a number of transitional arrangements, as follows:
The IGA requires that the national registration and accreditation scheme is to be put in place through legislation passed in every State and Territory Parliament on a timetable that allows the scheme to commence on 1 July 2010. To meet this deadline, a staged approach to commencement has been adopted.
The implementation of the national scheme relies on a national law that is given effect by an Act of a host jurisdiction, which in this case is Queensland. The introduction of national scheme legislation in a State or Territory Parliament for adoption by other participating States and Territories is a standard approach to implementing national schemes in areas such as health, where Constitutional powers rest with the States and Territories and not the Commonwealth.
The first stage of legislation (Bill A), which enables the establishment of the structural elements of the national registration and accreditation scheme, was passed by the Queensland Parliament in November 2008. This legislation will enable the National Agency and the National Boards to be established along with most of their functions during 2009.
The second stage of legislation (Bill B) will be introduced in the Queensland Parliament in August this year and will determine the details of the scheme and how it will function, including arrangements for registration, course accreditation, handling of complaints and disciplinary procedures, and the privacy regime for the use of information about individual health practitioners.
The final stage of legislation (Bills C) will involve State and Territory adoption Bills to enable the National Agency and National Boards to operate within each State/Territory and to repeal existing State Registration Acts. A Commonwealth Bill will amend Commonwealth legislation to recognise the national registration scheme.
Once this legislative program is completed, the National Boards will be empowered to regulate practitioners and accredit courses when the national scheme commences operation from 1 July 2010.
The Health Ministers' Advisory Council, through the National Registration and Accreditation Implementation Project (NRAIP) team, has held extensive and ongoing consultation regarding the scheme since it was first proposed in 2006. The APS has participated in the Professions Reference Group and the Forum of Australian Health Professions Accreditation Councils, attended numerous national forums and panel discussions, and provided formal submissions at every step of the consultation process thus far. Since the release of the IGA in 2008, the consultation process has focused on elements of Bills A and B. It is not anticipated that consultation will be required on Bills C involving the adoption of the previous Bills within each State and Territory.
Consultation was invited on the Bill that establishes the structure of the national scheme i.e., the creation of the Ministerial Council, National Agency, National profession-specific Boards and the Advisory Council.
In response to the consultation paper, the APS provided a submission which included a number of recommendations. The Bill was passed by the Queensland Parliament in November 2008. The APS supported the recommendation that the National Board for psychology be known as the ‘Psychology Board of Australia' and this has been specified in the new Act. The APS also proposed that the framing of the legislation should include the capacity to register practitioners in a way that acknowledges those registrants working in non-health sectors. A recommendation was put forward to empower the National Board to seek expertise and advice from non-health sectors with respect to practitioner standards and needs in non-health employment situations. However, the new Act does not address this issue.
A major concern raised by the APS in consultations is the cost of conducting the new scheme. The consultation papers indicate that it is anticipated that the scheme will be self-funding, that is, will operate with funds collected from only two groups of ‘users' of the system - practitioners requiring registration and universities seeking accreditation. The major cost to any current Psychologist Registration Board is handling complaints regarding practitioners and any subsequent litigation, rather than managing registrations. The APS believes it should be a government responsibility to fund the expenses associated with supporting the rights of community members to complain about health practitioners since it concerns protection of the public. The current system of funding Psychologist Registration Boards varies between States. Where attempts at ‘self-funding' have been made (e.g., Victoria), registration fees for psychologists are currently $365 per year. In contrast, where State governments bear the majority of costs and provide centralised complaint and legal processes (e.g., NSW, NT), the annual registration fees are $80 and $25 respectively. Registration fees in other States currently vary from $150 to $312. The APS has argued strongly that the Commonwealth Government should commit to substantial recurrent funding of the new registration and accreditation scheme, so that not all of the costs of conducting the scheme are passed on to the registrants. The new Act has not addressed this issue, nor has any indication of the costs associated with registration under the new scheme been provided to date, which is of major concern.
Extensive consultation has been invited on the Bill that specifies the arrangements for how the registration and accreditation functions will be conducted. The NHWT provided five consultation papers seeking input on the following proposed aspects of the legislation:
The APS has provided extensive submissions on each of these consultation papers as they have been progressively released since September 2008, and during this process has invited input from APS member groups and worked closely with the Council of Psychologists Registration Boards (CPRB) and the Australian Psychology Accreditation Council (APAC). The consultation process for this phase closed at the end of December 2008.
The NRAIP team will consider all feedback provided and develop the draft legislation for Bill B by March/April 2009. It has been stated that the guiding principles in developing the legislation and the scheme are that the safety of the public is paramount, that high quality health care must be protected and advanced, and that governments should be accountable and processes transparent. A further period of consultation will be available to comment on the draft of Bill B until June 2009. During this subsequent consultation period, the APS will obtain legal advice on the draft legislation and will seek further input to the process from APS Colleges, State Committees and appropriate Advisory and Reference Groups. The final amended Bill is expected to be introduced in the Queensland Parliament in August 2009.
It is not possible to report here on the details of all of the submissions tendered by the APS in response to aspects of Bill B, but the most important issues highlighted by the APS in regard to proposed arrangements for both the registration of psychologists and the accreditation of psychology education and training programs are presented separately in the following two articles. The full submissions tendered by the APS can be found on the APS website (www.psychology.org.au/about/submissions/#s1).
Further information on the national registration and accreditation scheme, including all consultation papers with proposed arrangements for the scheme, can be found on the Government website (www.nhwt.gov.au/natreg.asp).