August 31, 2011  |  Second Reading

Health Practitioner Regulation National Law (Victoria) Amendment Bill 2011

Thank you, Speaker. I am glad that I am still able to get up off my knees; they are still pretty bruised and sore. I am pleased to speak on the Health Practitioner Regulation National Law (Victoria) Amendment Bill 2011. Despite what some previous speakers have said, there is quite a history to this bill and the work in this area. Clearly the Labor Party is not choosing to oppose this bill.

I refer back to some earlier matters in relation to these issues. There was an Australian Health Ministers Advisory Council meeting in May 2007, when the member for Melbourne was the health minister.

I remember those days well, when I was working for her. A number of issues were dealt with at that forum in relation to workforce issues, including national registration.

The issues covered off at that time included the establishment of a task force to undertake project-based work so that we could advise on workforce innovation and reform. These were key matters under the Labor government that needed investment to try to build, to continue to improve and to increase the numbers of those who wanted to work in the health area, particularly in order to fill gaps where there were workforce shortages. This also required a national process of assessment of overseas-trained doctors so we could seek to encourage more overseas-trained doctors and make it easier for them to work, particularly in our regional centres and remote communities.

There was also a desire to pursue processes for better engagement with the education and training sectors on health workforce and supply. That required investment around a range of issues, including rural training centres aligned with a range of tertiary institutions in regional Victoria. That was in order to provide a place for people to pursue their workforce training as health practitioners but also to hopefully encourage people to stay in those country, rural and regional towns where they were able to get their tertiary training and get their on-the-job training in a range of hospitals and health services.

There was also discussion about the need for a substantial increase in commonwealth-funded medical training places and tertiary training places and for a commitment by states and territories to provide clinical training opportunities.

We saw a range of those centres in Gippsland, Ballarat, Bendigo and Geelong that were opened by the previous Labor government in consultation with the federal government to try to secure better training facilities in regional centres to improve the workforce.

National registration was amongst the issues involved in trying to improve the health practitioner workforce, which brings us to some of the matters that have been touched on in this bill. The registration issue goes back over many years of work that was largely about improving and increasing the workforce in health practitioner areas in regional and remote communities. The question was: how could we do that when we also wanted to bring in a number of overseas-trained medical practitioners and provide assistance for them to ensure that their registration needs could be met not only in Victoria but in many places where there were cross-border anomalies, such as Mildura, Albury-Wodonga, certainly around Echuca and potentially also in Swan Hill?

We would bring in overseas-trained or perhaps interstate-trained medical practitioners who needed an opportunity to maybe move between centres and different regional areas. In that case it was important to make sure that any national laws around their registration reflected the concerns and issues they were finding and to ensure that they were encouraged to work in these challenging areas. Part of that was providing not only the facilities to maintain their training and skills but also a way to ensure that they were able to meet their professional obligations around registration.

In relation to who is affected by the bill, it certainly allows practitioners such as chiropractors, dentists, doctors, nurses and midwives, optometrists, osteopaths, pharmacists, physiotherapists, podiatrists and psychologists to register once and practise anywhere. While these changes might not necessarily affect those who work in metropolitan centres, certainly for those who work in cross-border towns and cities these sorts of changes, as they are rolled out, will have a significant effect on their capacity to provide their skills and services in regional centres on our northern Victorian border. I note that the national boards are responsible for ensuring that only health practitioners who are suitably trained and qualified are able to practise and be registered.

I will pick up also on some matters that relate importantly to the community. Members of the community want to be able to ensure that they are still able to make complaints against practitioners where concerns are raised by them around their treatment or engagement with health practitioners.

National registration will ensure that there are dedicated telephone lines for members of the public wishing to make complaints, and there will also be offices in each state and territory through which complaints can be addressed. Those complaints will be passed to the relevant national board to be dealt with through the appropriate state or territory office.

Assistance will be provided to members of the public who need it to make a complaint, and I would hope there is appropriate advice provided to the community so that those pathways where concerns or complaints need to be addressed are clear to those who use the services of health practitioners. It is important that the community have confidence in those services under these new arrangements.

Some of the other questions the community raised include whether there is a fair representation of community members on the boards under the national scheme.

Clearly it is important that we have skilled practitioners — peers — who are able to assess the competency, qualifications and work of others in their fields. But it is also important, as we have found across many boards and statutory authorities, that we have members of the community — laypeople — who also have an opportunity to make a contribution.

The model of community representation on boards that exist in Victoria under the current Health Practitioner Regulation National Law (Victoria) Act 2009 has been mirrored in the national law. On a national board no more than two-thirds of the members can be practitioner members and at least two members must be appointed as community members, and that is about picking up on the concerns of the community and giving people confidence that they will have a say and they will have experts who can advocate for them where any concerns may arise.

Another question raised by the community was whether VCAT (Victorian Civil and Administrative Tribunal) and the Office of the Health Services Commissioner will continue to have a role in the complaints management process. That is another area that feeds into what I have talked about — that is, the community’s confidence in the way people can deal with their concerns and issues in the complex areas of the health portfolio. In terms of the model of complaints management, under the national law it is similar to the current structure under the Health Practitioner Regulation National Law (Victoria) Act 2009 in that the national boards have the same mechanism in place to deal with notifications made against health practitioners through either a health performance or professional standards panel, and that is also very important.

Of course serious matters in relation to a practitioner’s conduct will be referred to VCAT. The health services commissioner will continue to have a strong role and a relationship with the national boards, although it will be interesting to get some further feedback in the annual reports of the health services commissioner when these reforms are rolled out. We are, however, still looking at 1 July 2012 before that occurs, which allows time for practitioners to be informed of the new 28-day limit.

The other aspect that is important is the role the Victorian health minister has in the national scheme. The particular point in relation to that matter is that under the national scheme the ministerial council comprises the commonwealth health minister and the state and territory health ministers. The ministerial council is responsible for providing policy direction, approving registration standards and giving approvals in relation to specialist registration — it is approving areas of practice for purposes of endorsement — and the health minister also has a role in the publishing of directions and appointment of approvals to national, state and territory boards.

In relation to health practitioners, who clearly have a concern about a number of the aspects of how these reforms will apply under these national arrangements, one of the key areas they have sometimes talked about is the divisions of nursing that will be covered under national law. The Nursing and Midwifery Board of Australia will have two registers, and they relate to a register for nurses, including divisions of registered nurses — that is, Div 1s, as they are known — and also enrolled nurses, or Div 2s. There will also be a register for midwives.

We all know with the way federation works that the more we can work together and cut through the red tape, the better, but we need to make sure that the community has confidence that it still has the capacity to advocate in relation to its concerns on these matters. I commend the bill to the house.