‘Significant disillusionment’: New spotlight on regulation failings

Experts tasked with simplifying health regulations have criticised a ‘lack of clarity’ and coordination as they prepare final reform recommendations for Australia’s health ministers.
 
The latest report from the ‘Complexity Review’, an independent analysis set in motion last year to look into the National Registration and Accreditation Scheme, was published this week.
 
Former New South Wales Health Care Complaints Commissioner Sue Dawson, who was appointed to lead the investigation, set out more detailed policy suggestions in the 122-page document, which follows a first consultation paper.
 
It includes some forthright criticisms.
 
‘At the heart of complexity of the National Scheme is a lack of clarity and no shared agreement about what is most necessary and important in health professions regulation, at any point in time and over time,’ it states.
 
‘There is not an overarching framework for the regulation of health professions.’
 
It also says health workers for the different professions under the National Scheme ‘are regulated in isolation from the broader health workforce’.
 
‘There is significant disillusionment with the manner in which these registered professions are regulated and an expectation that the National Scheme be more effective, responsive and fair in instances where expected standards of conduct and performance are not met,’ the paper suggested.
 
As well as a lack of strategic direction and regulation done in isolation, the report describes the current system as ‘not operating on contemporary regulatory stewardship’, while complaints handling is labelled a ‘significant weakness’.
 
‘Fragmented responsibilities and untimely and confusing complaints outcomes erode confidence and trust in health regulation,’ the review found.
 
It also highlighted a growing focus on the regulation of non-registered practitioners, including sonographers, private ultrasound clinics, cosmetic injectables and massage therapists.
 
It called for a more adaptable, co-ordinated approach to deal with emerging challenges that include telehealth, artificial intelligence and workforce pressures.
 
In a response issued immediately following the paper’s publication, the Australian Health Practitioner Regulation Agency (AHPRA) said it supports the review’s recommendations in principle, describing many as being ‘in lock step’ with its own reform agenda.
 
The regulator’s chief executive Justin Untersteiner also acknowledged that complaints ‘can take too long to resolve’.
 
‘Reforming our complaints handling process is a priority,’ he said.
 
AHPRA said it is reviewing all existing notifications older than 12 months and ‘ensuring there are clear completion strategies for each case’. 
 
It also said a health complaints navigator service – a measure suggested by officials involved in the Complexity Review – will be established to ensure people making complaints have their concerns directed in the right way.
 
‘I want AHPRA to be a listening, learning and responsive regulator,’ Mr Untersteiner said.
 
‘The time is right to take the National Scheme forward to meet the evolving needs of contemporary regulation.’
 
He said he looked forward to implementing the final recommendations put before health ministers.
 
According to the Complexity Review, reform of existing complaints handling and notification processes will need ‘a significant uplift’ in the relationship between AHPRA and the separate state and territory-based Health Complaint Entities (HCEs).
 
It called for ministers to agree a ‘unified national approach to health complaints’ with an immediate focus on improved management of high-risk matters.
 
In a previous phase of the review, the RACGP strongly advocated for changes to the notifications process, noting various issues.
 
‘These include timeframes for cases to be resolved, reputational damage and a lack of support provided to doctors,’ the college stated in its submission.
 
‘The impact of vexatious notifications on practitioners should not be underestimated, even if these are eventually dismissed.’
 
The RACGP backed the National Health Practitioner Ombudsman’s call to improve the management of vexatious complaints, a move also endorsed by officials working on the Complexity Review.
 
Last year, AHPRA said it would change its processes following an Ombudsman review that found health professionals needed better protection from groundless notifications and committed to implementing all 17 of the Ombudsman’s recommendations.
 
RACGP President Dr Michael Wright said there remains a need for reform of complex regulations.
 
‘We know that many GPs want to see improvements in the complaints processes, particularly regarding more transparency about processes and timelines,’ he told newsGP. 
 
‘Our members are keen to reduce stress and delays in the system.
 
‘This is the latest consultation in a series of reviews. We will look at these latest details and continue to advocate for clear regulation that ensures patient safety while also minimising the impact on our members.’
 
The recent paper is a last step before final recommendations are due to be presented to federal and state health ministers in July.
 
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