Health Minister's speech to Parliament (Vic)
HEALTH PROFESSIONS REGISTRATION BILL
Second reading
Ms PIKE (Minister for Health) -- I move:
That this bill be now read a second time.
Page 61
The services provided by Victoria's health professionals are fundamental to the delivery of high-quality health care to all Victorians. Victoria's regulatory arrangements for the health professions date back to 1862 when the first Medical Practitioners Act was passed. Since then successive health professions have achieved statutory regulation. Today there are 12 Victorian acts of Parliament and associated regulations that regulate separately the professions of medicine, nursing, dental care, chiropractic, osteopathy, optometry, podiatry, physiotherapy, pharmacy, psychology, medical radiation technology and, most recently, Chinese medicine.
The bill presented to Parliament today reflects the extensive research and consultation with professional bodies, the registration boards and consumers. Indeed, in unveiling these reforms, it is important to formally acknowledge the important role played by registration board members and their staff, highly committed people who are dedicated to their task of protecting the public.
All health practitioners have an obligation to act professionally and to provide quality services to the public. However, statutory registration boards play an important role in protecting the public and affording Victorians the confidence that our registered health professionals are well qualified to do the difficult jobs they do. Registration boards not only set standards for entry to the profession, they also protect the public by investigating complaints from consumers about unprofessional conduct by individual practitioners, and they apply sanctions to those practitioners if necessary.
The current Victorian legislative model for the health professions was established following an extensive review in the late 1980s, with the passage of the Nurses Act in 1993 and the Medical Practice Act in 1994. Since that time, as the various existing acts have been reviewed and updated, they have adopted the common legislative framework, and a new act has been passed to regulate the profession of Chinese medicine.
Following 10 years of operation of the Victorian legislative model, it was considered timely to examine its effectiveness, to ensure it equips our registration boards to protect the public and address emerging challenges.
Since the review was commenced in 2002, there has been extensive consultation with professional bodies, consumer groups and other regulatory authorities. In October 2003 a discussion paper titled 'Regulation of the health professions in Victoria' was released. The paper canvassed a number of proposals for structural reform, as well as detailing many issues that had arisen with the current scheme and proposed some reforms to the model provisions.
In response to the discussion paper, over 120 submissions were received from individuals, professional bodies and registration boards.
A number of studies were commissioned to provide further input to the review, including a study of the experiences and views of those who have made complaints to registration boards. In April of this year, a further options paper was released, narrowing down the structural reform proposals and inviting further comments. Public forums were held and submissions were again received and taken into consideration in developing final proposals for reform.
There are a number of important principles that have guided the review.
The first is accountability. Registration boards must be accountable to the Victorian community in carrying out their statutory functions.
Second, transparency. The decision-making processes of registration boards should be open, clear and understandable for both the consumers and the professions.
Third, fairness. Registration boards should maintain an acceptable balance between protecting the rights and interests of patients and those of the practitioners.
Fourth, effectiveness. The regulatory system should be effective in protecting the public from harm and supporting and fostering equity of access and the provision of high-quality care.
Fifth, efficiency. The resources expended and the administrative burden imposed by the regulatory system must be justified in terms of the benefits to the Victorian community.
Sixth, flexibility. The regulatory system should be well equipped to respond to emerging challenges in a timely manner, as the health care system evolves and the roles and functions of health professionals change.
And finally, consistency. As far as possible there should be consistency across Australian states and territories in the regulatory arrangements for the health professions.
This bill recognises and retains the strongest elements of the existing scheme, but also introduces a number of important reforms to ensure it is sufficiently flexible and fair to meet evolving service needs.
First, it repeals 11 registration acts that regulate the health professions, including relevant provisions within the Health Act 1958 and replaces them with a single act. Under the current scheme, with 12 separate acts, it is a resource-intensive task to keep all the acts up to date, and there is considerable lead time between when a reform is introduced in one act and when it is applied to the remaining 11 acts. This bill provides an overarching regulatory framework for all the registered health professions, while ensuring the unique regulatory requirements for each of the professions are met. The bill provides for the existing registration boards to continue in operation but under a single regulatory framework, with a consistent set of powers for each board.
Second, the bill establishes better separation of powers in the disciplinary processes of boards. The bill provides for the hearing of serious allegations of professional misconduct by the Victorian Civil and Administrative Tribunal, rather than within each board.
This reform separates the investigation and prosecution function undertaken by boards from that of hearing and determining such disciplinary matters.
With the transfer of this function to VCAT, the bill preserves the principle of peer review in disciplinary decision making while creating a structural framework to ensure procedural fairness. Panel hearings within VCAT that make final determinations concerning health practitioners will be constituted by at least three persons, of whom two must be practitioners from the same profession as the practitioner who is the subject of the disciplinary action.
Third, the bill addresses some of the concerns that consumers and others have raised about the transparency and fairness of complaints handling by registration boards. There is a new right for complainants to seek a review of a board's decision not to investigate a matter, or to take no further action following an investigation.
In such circumstances, a board will be required to establish an 'investigation review panel' comprising at least one practitioner, one lawyer and a nominee of the health services commissioner. The panel will have powers to reconsider the matter, and, if necessary, reopen the investigation and reach a different decision.
The bill also includes a range of reforms aimed at strengthening the transparency, accountability and flexibility of the complaints management and disciplinary processes:
Complainants will have the right to seek reasons for decisions, and there will be a statutory requirement for boards to provide periodic reports on the progress of investigations.
Boards will have more flexible powers to finalise less serious complaints through agreement with the practitioner and at times if this is constructive, by agreement between the practitioner, the complainant and the board.
The informal hearings that boards currently run will be replaced by 'health panels' to deal with practitioners who may be unwell or incapacitated, and 'professional standards panels' to deal with conduct or performance matters.
Panels will have the power to impose conditions on a practitioner's registration following a hearing, and the health panel will have the power to suspend a practitioner's registration without the need to go to a VCAT hearing.
Fourth, the bill establishes a limited requirement for boards to obtain the Minister for Health's approval of codes or guidelines that relate to qualifications for registration or the scope of practice of registered practitioners.
It is intended that these powers be used where such instruments have the potential to adversely impact on the work force and its capacity to deliver effective health services in times of changing demand. There are significant challenges facing the community in providing for the health needs of all Victorians. It is essential that the regulatory arrangements for the health professions not only support acceptable standards of training and practice, but also facilitate quality improvement and work force flexibility.
The bill also establishes a role for the boards in collecting information from registrants for work force planning purposes.
In doing so, however, the need to protect the privacy of individuals is recognised, and necessary safeguards will be put in place by each of the boards to ensure this.
Fifth, the bill establishes consistent registration categories across all regulated health professions, including a student registration category so that responsible boards may regulate students who are undertaking clinical training. The powers of the boards in relation to students are limited to instances where a student may be suffering ill health or has been charged with or found guilty of an indictable offence.
The bill makes provision for endorsement of the registration of nurses who have qualifications to practise in midwifery. There are also provisions that allow registration of those who have direct entry midwifery qualifications but not general nursing training. This approach to regulation of midwives is considered to be in the public interest, as it will facilitate greater flexibility in the development and deployment of the nursing and midwifery work force.
There is also provision for the Medical Practitioners Board and the Dental Practice Board to endorse the registration of suitably qualified practitioners in approved areas of specialty practise. It is expected that these boards will exercise such powers within a common national framework for recognition of specialities.
Sixth, the bill provides for suitably qualified podiatrists to be endorsed by the Podiatrists Registration Board to prescribe to their patients from a limited list of medicines.
Establishment of this scheme, coupled with other reforms to streamline the process for adding new drugs to the list approved for prescribing by optometrists and nurse practitioners will improve access to services for consumers and make the best use of the expertise available in our Victorian health work force.
Finally, the bill extends to all boards the reforms to board structure and membership that were adopted with the passage of the Pharmacy Practice Act. Boards are to be constituted with between 9 and 12 members, of whom at least half must be registered practitioners from the profession that the board regulates, 3 must be persons who are not practitioners registered by the board, and 1 must be a lawyer.
The bill provides that the president and deputy president of a board will usually be practitioners from the profession.
This is in recognition of the important leadership role these office bearers carry out for their respective professions. Only in special circumstances, where it is necessary for the effective operation of a board, would these roles be filled by board members who are not practitioners.
The provisions do not specify detailed requirements as to the types of practitioner members who must be appointed to boards. However, the government is committed to ensuring that both the size and the membership of a board is reflective of the range of work roles of each profession and the settings in which practitioners work.
For example, on the Dental Practice Board and the Medical Radiation Practitioners Board there should be a presence of practitioners from each of the divisions of their respective registers.
On the Nurses Board there should be nurse members from rural and metropolitan work settings, from hospital and community settings, and from clinical, management and academic roles. There should be a presence of members from the different divisions, and those with expertise in psychiatric nursing, midwifery and aged care nursing.
Last year the government enacted a new Pharmacy Practice Act. This act contains important reforms relating to regulation of pharmacists, pharmacy businesses, pharmacy departments and depots. The bill replicates these provisions and allows the Pharmacy Board to continue its work. The provisions that regulate ownership of pharmacy businesses are continued and pharmacists should notice very few changes from their current regulatory scheme.
The bill establishes a new board, the Medical Radiation Practitioners Board of Victoria, to replace the Medical Radiation Technologists Board of Victoria.
The new board will be an independent statutory authority rather than an administrative unit of the Department of Human Services.
The bill will bring the administration of the registration scheme for the medical radiation profession into line with that of the other regulated health professions. The Medical Radiation Practitioners Board of Victoria will move to the same model as the other 11 boards.
This bill does not address the regulatory requirements for the range of health professions that do not have statutory registration boards. Further work is being undertaken to address the regulatory requirements for these health professions, in particular to explore the feasibility of systems of negative licensing to deal with unregistered practitioners who engage in serious misconduct.
Finally, I would particularly like to thank the interested consumers, professional bodies and registration boards and their staff, who have put in many hours of their time reviewing documents, attending forums, and assisting the Department of Human Services throughout the review. Their contribution has been invaluable.
Both consumers and the professions stand to benefit from a regulatory scheme that is fair, accountable, effective and efficient. It operates to protect both consumers and practitioners and provide the best possible regulatory environment to support the delivery of high quality health services. These reforms will ensure a proper balance is struck between the rights and interests of consumers and those of the practitioners who deliver health services.
I commend the bill to the house.
Debate adjourned on motion of Mrs SHARDEY (Caulfield).
Debate adjourned until Thursday, 10 November.
Mr Delahunty -- On a point of order, Acting Speaker, in relation to this very important Health Professions Registration Bill, I have just gone out to the papers office, and this is the last copy. There are other members out there trying to get copies, and no doubt there are other people vitally interested in this very important bill.
Mrs Shardey -- On the point of order, Acting Speaker, given that this information has now been made available to the house, I call upon the Minister for Health to give a commitment to the house that she will immediately make sure that further copies are made available.
The ACTING SPEAKER (Mr Ingram) -- Order! I have been informed that the circulation print should be available tomorrow. I am assuming that the usual number has been printed. I have been informed that there have been 50 copies made available.
Ms Pike interjected.
The ACTING SPEAKER (Mr Ingram) -- Order! I hope that addresses the concerns raised by members earlier; extra boxes of the prints have been made available.
Mr Walsh -- On a further point of order, Acting Speaker, as part of the process of second-reading speeches and the distribution of the print copies, could we set up a procedure in the Parliament whereby members of Parliament have priority for print copies, particularly when bills are second read on a Thursday? We find that the bills are second read, they are taken to the papers office and quite a few other industry participants and interested people go and get the copies. We find that we when we leave the chamber -- as happened with the water bill a number of weeks ago -- there is not enough copies left there, particularly for country members who are travelling home and may not be back until we sit again. Is it possible for the Parliament to explore a procedure whereby copies of the bills are put aside for members of Parliament?
The ACTING SPEAKER (Mr Ingram) -- Order! This is not necessarily an issue now. Copies of this bill are available. I am sure the Speaker will deal with that matter.
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