Australian Health Practitioner Regulation Agency performance (12.03.2014)

Written on the 26 March 2014

Ms CROZIER (Southern Metropolitan) presented report, including appendices, extracts from proceedings and minority reports, together with transcripts of evidence.

Laid on table. Ordered that report be printed.

Ms CROZIER (Southern Metropolitan) -- I move:

That the Council take note of the report.

It is a pleasure to be able to rise and table this report of the inquiry into the performance of the Australian Health Practitioner Regulation Agency (AHPRA) on behalf of the Legal and Social Issues Legislation Committee. The reference given to the Legal and Social Issues Legislation Committee in October 2012 was to consider and report on the performance of the Australian Health Practitioner Regulation Agency, including its cost-effectiveness and regulatory efficacy, and the ability of the national scheme to protect the Victorian public. The performance of health practitioners is an important part of Victoria's health system, as is the need for the Victorian public to not be put at risk due to either the poor performance of a practitioner or their conduct.

It is reasonable that a government which has responsibility for the delivery of health services and resources should be concerned about poor performance or conduct within the health system that may impact the Victorian public.

Our health professionals and health services are highly regarded and do extraordinary work each and every day right across the state, but they too need to be protected, so it was somewhat disappointing that some non-government members of the committee did not think this inquiry was worthy, which was demonstrated by their lack of engagement and, quite frankly, their disrespect for some witnesses who came before the committee in its earlier stages.

Some members also expressed the view that as a three-year review by the Australian Health Workforce Ministerial Council is to be conducted, the Victorian Parliament did not need to assess what is happening within this state. That national review was to commence last July. However, to the best of my knowledge, it has not yet commenced, and we do not know how long that review will actually take or when it will commence. The protection of the Victorian public is at the centre of what this inquiry was about.

The committee received 55 submissions and heard from 20 different organisations and individuals who were particularly concerned about the conduct and overall responsibilities of AHPRA. I would like to thank the members of the public and representatives from those organisations for their willingness to participate in the inquiry, either by providing submissions and correspondence or by coming before the committee. The evidence received greatly assisted the committee in understanding the issues at hand. The committee also travelled to Queensland to further understand what led to the passing of legislation by the Queensland Parliament in recent times to reclaim responsibility for the complaints process within that state. Queensland, like New South Wales, is now a co-regulatory jurisdiction with respect to complaints, performance and disciplinary processes. Therefore there is no consistency in the national complaints process.

The committee heard numerous concerns from the Victorian public in relation to the complaints process, as indicated, including time delays, inadequate communication, confusion over the role of AHPRA, the boards and the Health Services Commission, the inadequate rights of notifiers and inadequate ministerial and parliamentary accountability and oversight. As one witness told the inquiry:

This system has no oversight, no transparency and no accountability. Three times AHPRA ignored my formal complaints. And three times the National Health Practitioner Ombudsman -- ostensibly charged with overseeing AHPRA -- also failed to respond. As a parliament we have the ability and responsibility to review issues such as those.

The evidence received clearly indicates that the process for managing health complaints is best managed at a local level rather than at a national level by AHPRA.

Another very important issue that was raised during the course of the inquiry was the status of the health programs supporting doctors, nurses and midwives.

Those programs are widely recognised across Australia as being comprehensive, and various witnesses suggested that they be maintained. The programs were originally established to support doctors, nurses, midwives and students with health problems such as drug and alcohol and mental health issues. Funding for the doctors program was at serious risk and there were concerns for its ongoing viability. However, at the final hearing the chair of the Medical Board of Australia reaffirmed the board's commitment to a future national health program specific to the needs of doctors.

Similarly, the Nursing and Midwifery Board of Australia announced in 2012 that it would not continue to fund the nursing and midwifery health program. However, during the inquiry it was noted that the national board would extend the funding of the nursing and midwifery health program to 30 June 2016. Clearly there remains uncertainty about the long-term future of these very important programs.

The findings and recommendations of the report therefore reflect the very important issues raised concerning the complaints system, the doctors and nurses and midwives programs and issues surrounding transparency, efficiency, cost effectiveness and reporting by AHPRA.

In conclusion, I thank firstly Mr O'Donohue, who chaired the inquiry for the first six months, and other members who participated in the inquiry. I also express my thanks to the staff of the committee, especially Richard Willis, Sarah Hyslop and Sean Marshall, for their assistance to the committee throughout the entire inquiry process.


Ms MIKAKOS (Northern Metropolitan) -- I also speak on the Legal and Social Issues Legislation Committee final report on its inquiry into the performance of the Australian Health Practitioner Regulation Agency.

I point out at the outset that Mr Elasmar and I have provided a minority report at the conclusion of this report. I can see that Ms Hartland has also provided her own separate minority report. The reason we felt the need to do this is that whilst we had no difficulty with the first five chapters of the report in relation to both the evidence that was received and the findings and the recommendations, we had some very deep concerns in respect of the recommendations contained in chapter 6, particularly the final key recommendations in that chapter. I will indicate to the house shortly what those reservations were.

I make the point that members of the opposition participated in this inquiry with an open mind. We went to this inquiry with the understanding that there were to be further inquiries at a national level and that there would be opportunities for these issues to be explored in the near future, but we were prepared to see what would come out of this inquiry.

We took the view that there were many other issues affecting the -- --

The PRESIDENT -- Order! Thank you.


Mr O'BRIEN (Western Victoria) -- I too wish to join with other members in speaking on the Legal and Social Issues Legislation Committee report on the inquiry into the performance of the Australian Health Practitioner Regulation Agency (AHPRA). I endorse the words of the chair of the committee, Ms Crozier: this was an important inquiry. I note the significant number of submissions that were received and the weight of those submissions from many health practitioner bodies that have been affected by the issues that the inquiry dealt with.

In that regard the report contains some pretty fundamental recommendations, and in the time I have available I will proceed to the heart of those recommendations, particularly the point that the chair picked up -- namely, that the submissions and evidence the committee received were overwhelmingly of the view that there were significant problems in the structure of AHPRA. They raised the question that essentially has resulted in the majority report -- that these concerns are fundamental to AHPRA's structure, particularly in relation to the reporting and notification requirements.

For the reasons that have been given by the chair, and in line with the key recommendations in the report, it is the view of the majority of members of the committee that these matters are best dealt with in a co-regulatory model, with essentially a localised or state-based referral system such that which has been maintained in New South Wales and that which Queensland is heading to. This was a substantial and important inquiry.

I take this opportunity to agree with the final sentence of one of the minority reports which I have just read, which is that:

We also thank the deputy chair of the committee, Mr Matt Viney, for his participation in this inquiry and note that he was unable to participate in the final deliberations ... due to illness.
I commend Mr Viney on his participation and wish him all the best. I note that a number of other MPs participated in the inquiry at various times, including Mr Elsbury, Mrs Peulich, Mrs Millar, who joined the inquiry, Mrs Petrovich, who left the inquiry, as well as Mr O'Donohue, who first chaired the committee, and the secretariat and staff. I commend them all on their work.


Mr ELSBURY (Western Metropolitan) -- I take this opportunity to thank my parliamentary colleagues who have been members of the Legislative Council Legal and Social Issues Legislation Committee during the inquiry into the performance of the Australian Health Practitioner Regulation Agency. The chair, Georgie Crozier, and members, David O'Brien, Jenny Mikakos, Colleen Hartland, Amanda Millar, Nazih Elasmar, Edward O'Donohue, Inga Peulich, Matt Viney and our former colleague Donna Petrovich, and the committee staff, Richard Willis and Sarah Hyslop, all deserve rich recognition for their efforts in assembling this report. I start my speech in this manner because I acknowledge that my appointment to membership of this committee has been made only recently. However, I was a participating member of the committee, attending two of the hearings in Mrs Petrovich's stead following her departure and before Mrs Millar was able to assume her place in this chamber.

To say that the implementation of the Australian Health Practitioner Regulation Agency was poorly handled would, on the evidence I have seen and the testimony I have heard, be the most polite way to express the difficulties faced by practitioners and patients under this system. Both parties in the complaints process have expressed their disquiet at the length of time an investigation can take, as it can be more than 12 months before action is taken. Even then, participants in the process feel they have been provided with a minimal amount of information about the process, what the other party is saying or what the process actually is. This leads to confusion as to what is happening and how a conclusion is developed. Added to this, the stress that doctors can feel over that period is quite substantial as they do not know whether they are going to be able to continue in their profession, and patients have issues about recourse for their grievances.

The inquiry has resulted in 12 recommendations, which I strongly support and hope to see implemented.


Ms HARTLAND (Western Metropolitan) -- I wrote a minority report on this inquiry. My reasons were quite clear -- that is, I was very concerned about the fact that committee members did not know until part-way through the inquiry that there would be a three-year federal inquiry. I was very concerned that the minister had not bothered to tell committee members about that.

During the hearing of the evidence it was quite clear that in the first year there were major bedding-down problems with the process. Representatives of organisations were saying to us that after the initial period it became better with registration. Clearly there is a major problem with the Australian Health Practitioner Regulation Agency complaints process.

We heard a great deal of evidence about how patients in particular were not dealt with well in the process.

I would like to thank the staff who were involved in this inquiry. They did a sterling job. I would also like to congratulate the chair of the committee, because I believe that even when there was disagreement among members of the committee Ms Crozier chaired the committee in a fair and unbiased way, and I appreciate that.

One of my major problems with the inquiry is that so many attempts that have been made to send references to various legislation and reference committees have been knocked back by the government, yet this reference was going to be dealt with on a national basis -- and that is where it should have been dealt with.


Mr ELASMAR (Northern Metropolitan) -- I rise to speak on and support the minority report of the Legal and Social Issues Legislation Committee. It is a rare occasion when this house is presented with a minority report arising out of a parliamentary committee's inquiry. The importance of the disagreements between members of the committee and the inability of the committee to table a combined single report to this house has resulted in opposition members of the committee submitting this minority report.

While opposition members support nearly all the recommendations contained in the majority report, some fundamental problems have not been addressed properly either in the short term or indeed the long term. While I am addressing this matter, I would like to thank the former chair of the committee, Mr Ed O'Donohue, the current chair, Ms Crozier, and the deputy chair, Mr Viney, who unfortunately could not attend and participate in all the hearings because of his illness.

He has put a lot of time into this report, and I wish him all the best in his health improving.

The issue of the health practitioner complaints process is a major stumbling block. We believe it is imperative that complaints made by patients about medical professionals be dealt with as quickly as possible by the Australian Health Practitioner Regulation Agency. This regulatory body must be equipped within its framework to expedite and carry out its role in a timely and

effective way that safeguards users of the medical health system. As the majority report stands, it does not adequately protect the interests of anyone, either the patients or the medical professionals. It is critically important to get it right now and not some years down the track when all the wheels have fallen off.
I also thank the executive officer, Mr Richard Willis, and all the members of the committee.



Mrs MILLAR (Northern Victoria) -- I am pleased to make a statement in relation to the inquiry into the performance of the Australian Health Practitioners Regulation Agency (AHPRA), an inquiry which I was pleased to join after 21 August last year.

This was an important inquiry for all Victorians because it came in the wake of some serious concerns about, in particular, the way AHPRA -- which was formed in 2010 -- has handled the review of a number of complaints made about health practitioners in this state.

The inquiry examined in detail 55 submissions relating specifically to a number of these complaints. The submissions detailed lengthy delays, concerns about the rights of notifiers and information provided to employer organisations about the matters under review. These submissions detailed some very serious shortcomings in these reviews, which have eroded the trust and confidence of the Victorian public in that body. Once lost, that trust and confidence cannot reasonably be expected to ever be restored. However, in accordance with the terms of reference, the most important consideration for the committee was the question of whether the safety of the Victorian public was at any time compromised by AHPRA's handling of the complaint reviews.

The evidence before the committee indicated that this had indeed occurred over the period under consideration. This single factor has been significant in driving the committee's ultimate recommendations.

It is often said, and is certainly true, that there is nothing more critical than our health. Thus it is that when something goes wrong in the delivery of health services we expect -- and are entitled to expect -- these complaints will be reviewed with the highest degree of scrutiny and effectiveness. This was not found to be the case with every consideration under AHPRA, and this has led to the final recommendations made by the committee.

I note the very fine work done by Mr Richard Willis as senior committee secretary to this inquiry, Ms Sarah Hyslop and a significant number of other parliamentary staff and the Hansard reporters.

The talent, dedication and contribution made by the staff of this Parliament never ceases to amaze me, and I think that few Victorians fully understand the contributions made beyond those of us who sit in this place. The work done on parliamentary committees highlights that more than anything else. I thank my colleague Ms Georgie Crozier, who yet again excelled as a committee chair of great skill, patience, even-handedness and grace. I thank the other members of the committee from both . . .

The ACTING PRESIDENT (Mr Elasmar) -- Time!

Motion agreed to.

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