Options for Regulation of Unregistered Health Practitioners

1. Options for Regulation of Unregistered Health Practitioners Consultation Forum

2. Background • Government reports have identified concerns about public protection with services provided by unregistered health practitioners • NSW established a regulatory scheme for unregistered health practitioners in 2007 & the South Australian Parliament has passed legislation • In Feb 2010 Australian Health Workforce Ministerial Council agreed to a national consultation regarding regulation of unregistered health practitioners

3. Who has an interest? • Unregistered health practitioners, professional associations and union and industry bodies • Registered health practitioners who practise outside the typical scope of practice of their profession • Consumers of health services provided by the above two groups • Education providers • Service providing agencies

4. Aim of National Consultation To consider : • If there is a need for strengthened regulatory protection for consumers who use the services of unregistered health practitioners? • If there is a need for further protection, how should it be structured and administered?

5. Context • Establishment of the National Registration and Accreditation Scheme • COAG agreement for a ‘Seamless National Economy’ • COAG ‘Best Practice Regulation’ requirements

6. Current regulatory arrangements • Laws governing registered health practitioners (Health Practitioner Regulation National Law Act) protect the public by: • probity checking all new entrants to these professions • powers to deal with impaired, incompetent or unethical practitioners • No similar protections for unregistered health practitioners

7. Current regulatory arrangements • Health complaints regulation • arrangements vary between States and Territories • all have powers to receive, investigate, and conciliate or resolve complaints from consumers about health service providers • more extensive powers in NSW & (shortly) in South Australia

8. Current Regulation • Consumer Protection Regulation • Australian Consumer Law 1 Jan 2011 • Unconscionable conduct • Misleading or deceptive conduct • False or misleading representations • Power to grant injunctions and issue notices/orders • Range of other regulatory protections: • public health risks • therapeutic goods regulation • drugs and poisons regulation • radiation equipment and use

9. Current Regulation • NSW regulation of unregistered health practitioners • ‘negative licensing’ regulatory model • Code of Conduct provides the basis for effective enforcement of standards of conduct and practice • communicates these standards to practitioners and consumers • provides mechanism for investigation and prosecution

10. Risk to the Public • Vast majority of health practitioners are competent and caring • A small number practise in a way that presents risks to the public • Many examples of unprofessional conduct: • lack of qualifications to support safe practice • failure to observe proper infection control • failure to refer on appropriately • making unsubstantiated claims about the benefits of a treatment

11. Risks to the Public • sexual or improper relationship with a client • financial exploitation • placing the public at risk due to physical or mental impairment • practising under the influence of alcohol or unlawful drugs • advising or encourage patients to cease conventional treatments • breaching the privacy of a patient • misuse of herbal medicines or pharmaceutical drugs

12. Options • Option 1: No Change • Option 2: Strengthen self-regulation – voluntary code of practice • Option 3: Strengthen health complaints mechanisms – statutory code of conduct

13. Option 1: No Change • Rely on existing regulatory and non-regulatory mechanisms • Professions able to make a case to governments for statutory registration at any time • Statutory code of conduct in some States and not in others

14. Possible costs Failure to deal effectively and timely with unethical practitioners Harm to consumers as a result. Consequences of Inconsistency between States. Possible benefits No new regulatory costs States can regulate as they wish Possible extension of statutory registration to other health practitioners Option 1

15. Option 2: Voluntary Code of Practice • Code/s may be tailored to each profession or occupation • Cooperative development of a national code of practice • Professional associations responsible for monitoring observance of code of practice and reporting on complaints and outcomes

16. Possible costs Lack of consensus in some professions may make implementation difficult Voluntary and therefore non-binding on rogue or bogus practitioners May be ineffective in protecting the public in some cases Possible benefits Flexible standards that are able to be adapted if need arises Professional associations able to take the lead in educating members and enforcing standards Provides guidance and education to practitioners and consumers on standards of practice Option 2

17. Option 3: Statutory Code of Conduct • Nationally consistent and enforceable statutory code of conduct for all unregistered health practitioners • Provides complaints mechanism for dealing with breaches of professional and ethical standards in health care whether the practitioner is registered or not • Minimal government intervention – only when breaches occur

18. Possible costs Requires new or amending legislation Need for new regulator or existing regulator to take on additional functions. Costs associated with investigation and prosecution of breaches of the Code of Conduct Possible benefits Enforceable standards regardless of registration status Less costly to the community than registration of all practitioners Nationally consistent standards Strengthened public protection and early intervention Option 3

19. Option 3 Two possible administrative mechanisms: • A single national administered by existing State and Territory complaints entities • A single national scheme administered by a new national complaints entity

20. Questions • Do you think there is a problem? • Do you think there is a need for further protection for consumers? • What do you think of the three options? • Do you have a preferred option?

21. Questions – cont’d • How important is national uniformity? • Should there be a single national Code of Conduct? • If you prefer option three, how should a scheme be administered – by existing State & Territory health complaints entities or a new national health complaints entity?

22. Questions – cont’d • Do you have any other comments about the proposals?

23. Further information • Contact: • Glenys Sleeman Tel: 03 9096 1160 Glenys.Sleeman@health.vic.gov.au OR • Anne-Louise Carlton Tel: 03 9096 7610 Anne-Louise.Carlton@health.vic.gov.au OR • Naomi Hebson Tel: 07 3234 0862 Naomi_Hebson@health.qld.gov.au