The absence of health services and workforce is the ‘ultimate risk’ to patient safety, according to the final report from the independent review of complexity in health registration and accreditation.
AHPRA and the national boards have been put on notice by a new report which found “more is required” to create a National Registration and Accreditation Scheme that responds effectively and proportionately to risks.
While it advocates for long-awaited reforms to the notification process, the report also delivers a verdict on the access-or-safety debate.
The final report from the Independent Review of Complexity in the National Registration and Accreditation Scheme for health practitioners was released by the Department of Health, Disability and Ageing on Friday.
Led by former NSW Health Care Complaints Commissioner Sue Dawson, the review team noted “significant disillusionment” with the fragmented regulation of health professionals and “dissatisfaction” with complaint-handling among both patients and practitioners.
The findings were in line with those laid out in the review’s second consultation paper in May and included recommendations to establish a complaints navigator service and to improve vexatious complaint management.
There will also be a move toward unified national complaints handling, wherein consumers can make a complaint about any practitioner or organisation in one place, with AHPRA’s investigative and disciplinary role reserved for “more serious” alleged breaches.
In making this last recommendation, the reviewers specifically cited the “deteriorating timeliness” of AHPRA investigations as evidence that the regulator did not have the capacity to deliver the number of investigations with which it was currently tasked.
The average number of days to complete an investigation increased by 52% between 2018 and 2023, with one in four investigations open for more than two years.
“The reasons for prolonged investigation timeframes are not apparent or not convincing,” the report said.
“Procedural fairness and humanity is at the heart of this matter, in the context of the significant personal and economic impact on practitioners.”
AHPRA has welcomed the report, noting that it is already conducting an “end-to-end” review of the notification system.
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“Australia’s health system is facing challenges including workforce shortages, questions around patient access and affordability, and the impact of new technologies and new business models,” AHPRA CEO Justin Untersteiner said.
“Our ongoing reform program will ensure that Ahpra continues to evolve, becoming a regulator that is more proactive and adaptable – and with public safety still our number one priority.”
The question of how to balance the need for greater service provision with public safety was another issue that the review sought to unpick, citing a lack of clarity about what was most important in health professions regulation.
“The seven objectives of the Health Practitioner Regulation National Law (the National Law) are clear,” the report said.
“They set out equal goals across public health and safety, training standards and qualifications (including for overseas practitioners), workforce mobility, cultural safety, public access to health services, and workforce development and innovation.
“There are also guiding principles, which were added to the National Law in 2022. The paramount principles are protection of the public and public confidence in the safety of services.”
Policy debate thus far, the review said, has assumed that increased consideration of workforce supply must come at the expense of standards.
AHPRA’s 2024 introduction of a fast-track registration process for internationally trained medical specialists, for example, faced pushback from the medical colleges for potentially undermining patient safety.
The Dawson review rejected the idea of a binary outcome.
“The Review highlights that it cannot be a case of one or the other,” the final report said.
“The interdependency is the key.
“Public safety is the paramount principle and applies equally to all objectives of the Scheme.
“Expressed otherwise, maintaining health service access and workforce supply and development (pursuant to objectives (e) and (f) of the National Law) is central to public health and safety – the absence of services and/or workers being the ultimate risk.”
The action associated with this finding was to confirm the existing Health Workforce Taskforce as an ongoing advisory committee to the health ministers, with the explicit role of “aligning workforce planning and health practitioner regulation”.