SUMMARY OF SUBMISSIONS ON THE 2012 REVIEW OF THE HEALTH
PRACTITIONERS COMPETENCY ASSURANCE ACT 2003.
INTRODUCTION
A total of 145 public submissions were received on the document entitled “2012
Review of the Health Practitioners Competence Assurance Act 2003” which was
published in August 2012. The submissions came from a broad range of
stakeholders, including Responsible Authorities, professional associations, health
practitioner educators, health practitioners themselves, health service deliverers,
government organisations, community organisations and consumers, as follows:
Respondent Group
Number of
submissions
Respondent Group
Number
of
submissions
Responsible Authorities
16
Community
groups
who
engage with health service
consumers
4
Professional Associations
34
Health care providers (nonDHB)
5
Educators
professionals
health
28
Individual consumers
5
Groups of, or individual health
professionals1
35
Unions
2
Health sector employers
2
Government organisations
5
International regulators
1
Law Society
1
Unknown status
7
Total
145
of
Appendix 1 of this summary contains the names of 140 submitters. The other five
submitters requested that their names not be listed in the published summary of
submissions.
The submissions have been summarised under 25 topics in 5 sections. The first 4
sections reflect the structure of the discussion document: ie Future Focus, Consumer
Focus, Safety Focus and Cost Focus. The fifth section is a subset of the original
Cost Focus section and is concerned with issues about the structure of the
regulatory system.
1
These submitters included self-employed practitioners, and practitioners employed by DHBs and by
other providers.
1
The summary cannot reflect all comments or the nuances of each submission on any
particular topic. It reflects the views most commonly expressed and from time to time
reflects a single submission where the point made was striking or the perspective of
the submitter seemed particularly valuable.
FUTURE FOCUS
The first discussion document suggested that the Act needs to balance its core
function of protecting the safety of the public with its ability to influence the shape of
the workforce and meet the needs of a changing sector. It suggested that the Act
needs to support the development of a flexible and sustainable workforce and
specifically that professional regulation needs to support the integration of care and
the development of new service models.
The first discussion document also raised the following specific issues capable of
making a contribution to the development of a sustainable workforce and the delivery
of integrated care:
•
scopes of practice
•
the development of communication and team work skills
•
pastoral care for practitioners
•
the mobility of the health and disability workforce
•
the standardisation of codes across health professions
•
the promotion of education and training that has a wider focus and/or which is
common across professions.
Workforce development
There were three strong themes in the response of submitters to this issue. Firstly,
submissions tended to consider that the HPCA Act is not the predominant barrier to
better integrated healthcare, increased flexibility and greater teamwork. Using the
HPCA Act as a lever to increase integration, team work and workforce flexibility was
therefore seen as likely to be minimally effective. Secondly, it was widely considered
that some aspects of the current HPCA Act and the way in which Responsible
Authorities are implementing it, already facilitate a flexible workforce. Thirdly, some
submitters held strong opinions that the HPCA Act should not attempt to address any
goals other than public safety because public safety would be likely to be
compromised.
It was notable that many submitters were not clear about, or were concerned about
the implications of using the terms “integrated care” and “flexible workforce”. In the
case of “flexible workforce”, there was concern expressed that the consultation
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document reflected intentions that professionals would need to become highly
generic workers and that there would be undesirable outcomes such as a lack of indepth expertise, an absence of leadership in specialised areas and worsening
recruitment and retention problems.
Education and training with a broader non-clinical focus
The consultation document discussed how integration of health care could be
fostered by:
•
registered practitioners having knowledge and skills in team work and
communication
•
shared education across professions in both initial and continuing education
There was widespread agreement that knowledge and skills in team work and
communication would contribute to better integrated care. Many submissions gave
instances of training in team work skills already occurring both at undergraduate and
post graduate levels.
However, there was a lack of consensus about the role of Responsible Authorities in
promoting those skills. Some submissions considered that such skills are not clinical
skills, and therefore are not the business of Responsible Authorities.
There was some scepticism about the appropriateness of the Act directly addressing
the need for a wider focus on the education of health professionals.
The submission of the Health and Disability Commissioner pointed out that: “care
integration is an important factor in quality service provisions and quality and safety
are becoming increasingly dependent on how multidisciplinary teams and clinical
networks operate. Failure or inadequacy in care integration is a recurring theme in
complaints…. which often result in consumers receiving a poor standard of care.”
The Commissioner also pointed out that Right 4(5) of the Code of Health and
Disability Services Consumers’ Rights gives consumers a right to co-operation
among providers to ensure quality and continuity of service.
There was a lack of consensus about whether teamwork skills should be part of
under-graduate or post-graduate education. Some submitters thought that it was
more appropriate for employers and the Ministry of Health than Responsible
Authorities to be concerned with post-graduate education in teamwork skills.
There was a concern that common learning might become a “one size fits all”
approach that will not support public safety. There was little evidence in the
submissions of shared education across professions occurring currently.
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Scopes of practice
Recommendation 3 of the 2007-09 review recommended that Responsible
Authorities “improve the processes relating to scopes of practice, including
developing a set of principles and guidelines, regular review, a central web-based
location for notifying new consultations and processes to allow any interested party
to propose new or amended scopes.”
The discussion document set out six principles for the development and review of
scopes of practice that arose from the 2007-09 review:
defining scopes to protect public health and safety rather than responding to
professional preferences
defining broad scopes to enable as much workforce flexibility as is compatible
with protecting public safety
setting qualifications that are the minimum requirements for public safety
allowing for movement between scopes by, for example, recognising the
relevance of prior learning
consulting widely and openly without predetermined positions, and carefully
evaluating and responding to submissions
basing decisions on the best available evidence, including from other
professions, especially where scopes of practice overlap.
There was diverse opinion about the role of scopes of practice in creating workforce
flexibility and it was evident that there are diverse approaches to the development of
scopes of practice and a range of beliefs about what constitutes good practice.
Many submissions recognised that the use of broad scopes of practice is an effective
means of achieving greater flexibility in the workforce and many submissions pointed
to examples of innovative and effective scopes of practice.
On the other hand, a number of submissions point out that there is a high variability
in Responsible Authority approaches to developing scopes of practice , with some
taking an approach that emphasises limiting harm and others focusing on optimising
public benefit. The submissions did not indicate a common understanding of the
risks and benefits of broader and narrower scopes of practice. The potential benefit
of overlapping scopes of practice was not always recognised.
There was discussion also in the submissions about who the audience for scopes of
practice is intended to be. Concern was expressed about the difficulties of writing
scopes in ways that are useful both to professionals and employers, and to
consumers and the public at the same time. Some proposed that Responsible
Authorities should provide “plain English” versions of scopes of practice for the
general public.
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Standardising Codes of Ethics/Conduct/Practice
The discussion document asked whether there was scope to better address the
standardisation of codes of conduct and ethics.
While there were some submitters who were concerned about a potential loss of
uniqueness of each profession if there were standardisation of codes of ethics and
codes of practice, the majority of submissions agreed that there was sense in at
least a degree of standardisation. It is clear that there is already some degree of
commonality in the codes of separate professions through the sharing of documents.
Three models of standardisation emerged from the submissions:
(i)
a single code (covering the current purposes of codes of ethics, conduct and
practice) which is applicable to all regulated professions. Some submitters
pointed to the success of the Health and Disability Code of Rights as
evidence that a single code can be applicable to all health care providers.
(ii)
a single base code, which is applicable to all regulated professions, but to
which individual professions could add
(iii)
the provision of principles for developing codes, with guidance to allow for the
development of relevant profession-specific approaches.
Pastoral care
The discussion document asked whether Responsible Authorities could have a
mandated role in health professionals’ pastoral care.
The term “pastoral care” was not closely defined in the first discussion document and
some submitters questioned its meaning and intention. Many submissions noted the
way in which Responsible Authorities will support rehabilitation, and others noted
requirements for practitioners of some professions to access professional
supervision as a matter of course.
The gap which the first discussion document was attempting to address was the lack
of intentional provision of a system of proactive pastoral care to which practitioners
could refer themselves or be referred to on a “without fear of prejudice” basis. Such
provision could be similar in nature to the rehabilitation practices of Responsible
Authorities with practitioners who have come to their notice. Accessing it, however,
would be self-directed rather than directed as the result of findings by a Responsible
Authority. Such pastoral care could support practitioners to continue or resume
practice rather than leave their profession because of issues they or others consider
might lead them to compromise public safety.
Almost all submissions addressing the issue rejected the notion that Responsible
Authorities should be involved with such proactive pastoral care. The main reason
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for rejecting the notion was that it could compromise the focus of Responsible
Authorities on public safety by also having a focus on the well-being of individual
practitioners. A secondary reason was the issue of costs.
Submitters often, however, acknowledged that professionals would benefit from
having occasional access to pastoral care and that patient safety would be
enhanced. Many submitters considered that there is sufficient access to pastoral
care already through professional associations, colleges and employers.
One Responsible Authority noted that it was considering sharing resources with
other Responsible Authorities to establish a health committee to provide “health and
fitness to practice” support. The committee would ensure the preservation of the
professional distance required for the Responsible Authorities to fulfil their statutory
obligations.
A number of submissions referred to known overseas models of pastoral care,
including the National Clinical Assessment Service in the UK, a non-statutory body
operating in several states in the US, and programmes for nurses, midwives and
medical practitioners in Victoria, Australia.
Some submissions suggested that a pastoral care service could be centrally funded
by government.
The mobility of the health and disability workforce
There were relatively few comments about this issue with comments falling into two
themes. Both appeared to be specific to a few professions only. One theme was to
urge Responsible Authorities to be flexible in the development and use of scopes of
practice that would facilitate the contribution of international academics, researchers
and post-graduate students to New Zealand professions, and the employment of
highly qualified but narrowly skilled overseas-trained practitioners. Some
Responsible Authorities appeared to be more flexible in this area than others.
The other theme concerned the operation of the Trans-Tasman Mutual Recognition
Arrangement. It appears that a small number of Responsible Authorities have issues
to work through with their Australian counterparts. A more general issue was the
inability of Responsible Authorities to apply any new conditions on the scope or
practice of a practitioner moving to New Zealand from Australia. This is of concern
particularly when overseas practitioners register in Australia before moving to New
Zealand.
CONSUMER FOCUS
The first discussion document considered a number of issues from the consumers’
perspective:
6
•
public knowledge of the Act
•
transparency of complaints processes
•
the balance of lay person and professionals on boards
•
the engagement of Responsible Authorities with the public
•
the potential use of consumer forums
Public knowledge of the Act
The discussion document asked whether it was considered that there was more
public knowledge of the Act now, since the recommendation in the 2007-09 review
that the Ministry of Health and the Responsible Authorities should do more to inform
the public about the Act.
The general view from submissions is that the lack of awareness by stakeholders,
the public and the professions about what the legislation provides for persists despite
the Ministry of Health and Responsible Authorities having taken some actions
subsequent to the 2007-09 review. Submitters often said it was unclear what use is
being made of the additional information that has been provided. Submitters also
often questioned what it is that the public want to know and need to know beyond
how to make a complaint.
Submitters considered the provision of information to the public to be a joint
responsibility of the Ministry of Health and Responsible Authorities. In particular,
there was a theme that the Ministry should be primarily responsible for public
knowledge about the Act while Responsible Authorities should be responsible for
public knowledge about their policies and practices.
One submitter noted that increasing knowledge about the Act is just one part of
improving health literacy in New Zealand and that perhaps knowledge of the Act
would be better dealt with in this wider context.
Transparency of complaints process
The discussion document noted that consumers are unable to review Responsible
Authority decisions or use the Official Information Act to access information about
decisions. It further noted that Responsible Authorities autonomously decide what
information to release to the public and that this can lead to inconsistency in what
information is released.
Submissions confirm that there is inconsistency about the reporting of outcomes and
many consider that current practices need to change to increase transparency.
Employers and some health professionals are concerned about the risks associated
7
with the lack of information provided, and complainants can be disconcerted by the
lack of feedback they get about outcomes.
There were also widespread concerns expressed about the preservation of natural
justice and of the privacy of both practitioners and complainants.
A number of submissions from Responsible Authorities suggested that the HPCA Act
could provide greater clarity about the information that should be provided for
complainants, the public in general, employers and fellow professionals.
Some submissions suggested that Responsible Authorities should be subject to the
Official Information Act. (Note however, that since Responsible Authorities are not
Crown entities, this is not appropriate.)
Public engagement in the decision-making of Responsible Authorities
The first discussion document noted that there is an international trend towards more
public engagement and that New Zealand’s practices in this regard have fallen
behind those of other countries, eg Australia, the United Kingdom, and Canada.
The 2012 discussion document asked the sector whether New Zealand should be
considering the introduction of consumer forums where the public can communicate
with Responsible Authorities on matters that concern them.
Some submissions considered that if there are consumer representatives among lay
members of a Responsible Authority board, this may constitute sufficient public
involvement in decision-making. Others considered that public involvement in
decision-making is better achieved by improved public consultation, engagement
and transparency of information processes.
A small number of submissions were sceptical about the need for consumer forums
for some of the following reasons:
•
lay people provide public perspectives
•
the Act is permissive of this activity
•
some Responsible Authorities consult the public already
•
there is no evidence of benefits, and
•
they are concerned about who bears the cost
A much larger group of submitters expressed interest in the concept of consumer
forums but wanted more clarity about who would run such forums and who would
pay for them before they supported their introduction. It was recognised that
consumer forums could increase the accountability of the Responsible Authorities
8
and improve the quality of health services and the operations of the Responsible
Authorities.
Those interested in the concept of consumer forums included a majority of the
Responsible Authorities, especially the larger ones though they too expressed
concerns about who would bear the costs. A further concern was the composition of
the consumer forums to prevent their being dominated by lobbyists, the aggrieved
and the “worried well”.
The Health and Disability Commissioner’s submission reported that in their
experience “the voice of consumers is an indispensable means of improving both
service provision and mechanisms for complaints resolution.” Their Consumer
Advisory Group also provides advice to the Medical Council of New Zealand on
matters concerning the Council’s polices and on consumer issues which arise in the
work of the Council.
The submissions indicated that many Responsible Authorities appear to rely on the
presence of lay people on boards to represent the views of consumers and potential
consumers.
It is clear that some Responsible Authorities do undertake consultations to shape
future regulation and to seek feedback from the public or a consumer perspective on
a specific impact of regulation.
Lay members of boards
The discussion document asked whether the current balance of lay to professional
members on Responsible Authority boards was appropriate.
On the whole, submitters considered that the current balance of lay to professional
members of boards is appropriate, with a few saying there should be more and
others cautioning against professional perspectives being swamped by those of lay
people.
It was evident that there is a lack of consensus about whether lay people are
expected to represent consumer interests or whether they are expected primarily to
contribute governance and decision-making skills, or both. The Medical Council of
New Zealand articulated this when they made the distinction between lay
representation, which brings in expertise to help with board functions but may not
necessarily result in “public involvement in decision-making”, and consumer
representation. The Nursing Council of New Zealand submission stated that lay
people primarily represent consumer interests rather than the interests of the
profession.
The Act is silent about the role and focus of lay members. Some submissions
suggested that it would be useful if the Act clarified these matters.
9
A number of submissions expressed concern that appointment processes need to be
more robust and transparent.
A number of submissions suggested that there should be an extension of a current
practice whereby there are lay people who are common to a number of Responsible
Authorities, thus increasing the expertise of lay persons and bringing a consistency
to their inputs to boards.
A number of submissions also called for representatives of Māori, Pacific, and other
cultures on Responsible Authority boards, and representatives of disabled persons.
SAFETY FOCUS
The first discussion document raised several issues related to safety:
•
the relationship of the HPCA Act to other pieces of legislation
•
whether the balance between legislation and other risk management systems
is appropriate to manage the risk of harm to the public
•
what level of risk needs to be regulated by statute
•
the benefits of risk profiling
•
the risks of sole practice
Submissions raised three additional issues
•
the risk of harm arising from unregulated professions
•
Section 7 infringements
•
Ensuring the safety of Māori and addressing the issue of population diversity
The first of the additional issues is covered in Section 5 of this document, Structure
of the Regulatory System. The two others are addressed in this section.
Ensuring the coherence of the HPCA Act and other legislation
Some submitters considered that the current diverse pieces of legislation fit well
together. A number of submitters suggested, however, that there is room for
operational improvement between parts of the system through better communication
channels. Some Responsible Authorities have taken initiatives to address this. The
Pharmacy Council, for example, noted that it has established Memoranda of
Understanding with both the Health and Disability Commissioner and Accident
Compensation Corporation.
10
A number of submitters considered there would be benefit if a specific initiative were
undertaken to identify and find solutions to gaps in legislation.
Using employer risk management systems
The discussion paper asked whether we could make better use of employer-based
risk management systems and reduce reliance on statutory regulation.
Submissions were close to unanimous in stating that a regulatory system is essential
over and above employer risk management systems, no matter how good employer
risk management systems are. The reasons were various, including:
•
employers face particular conflicts of interest that Responsible Authorities do
not
•
regulation ensures a high degree of national consistency within professions
•
many health professions are self-employed or employed in small practices
which may not have formal systems of risk management
Risk profiling
The discussion document asked whether, in the case of practitioners that might be
considered to be high risk, it would be useful for a risk-profiling approach to be
applied by Responsible Authorities.
Risk profiling of health practitioners by Responsible Authorities was supported by
many submitters. It is evident that some Responsible Authorities have practices that
address the risks of certain groups of professionals.
Others thought there were considerable risks to individuals in risk profiling such as
the risk of stigmatising certain groups of practitioners and of overly aggressive
monitoring.
Section 7 infringements
The issue of Section 7 infringements was not raised in the discussion document, but
it was raised by a number of submitters. Section 7 of the Act states that an
unqualified person must not claim to be a health practitioner and that a person who
does so commits an offence punishable on summary conviction by a fine not
exceeding $10,000.
There were a number of submissions stating that a greater than necessary risk of
harm exists because the Ministry of Health does not meet its obligations under
Section 7 of the Act in that either the Ministry does not provide robust public
11
education about the Act and or in that it does not use its powers to prosecute
unregistered people using the title of a registered health practitioner.
(It should be noted that the Ministry follows up all complaints and has an
enforcement strategy in place. Most matters are successfully dealt with through
obtaining compliance by the individuals concerned, while prosecutions are taken in
appropriate cases having regard to evidential sufficiency and the public interest
(including regard to the Crown Prosecution Guidelines).
Ensuring the safety of Māori and addressing the issue of population diversity
It was of concern to a number of submitters that the first discussion document failed
to address the omission of any reference in the Act to Te Tiriti o Waitangi.
Submissions acknowledge that the Act requires Responsible Authorities to set
standards of cultural competence for professionals. However, they consider that
there are issues for Māori professionals which Responsible Authorities are not
addressing such as alternative qualification pathways and scopes of practice that
relate to Māori health and that the lack of responsiveness to these issues means
opportunities to positively influence Maori health outcomes are missed.
Similarly, it was of concern to some submitters that nothing in the Act or in the
discussion document acknowledges the increased diversity of populations served by
health providers and the implications for the work of Responsible Authorities.
COST FOCUS
In taking a cost perspective, the first discussion document raised the following
issues:
•
whether there is a need in the Act for a definition of harm/serious harm to
guide the policies of Responsible Authorities and/or to establish which
professionals should be regulated under the Act
•
balancing the cost of public protection with access to services
•
data collection
Defining harm / serious harm
The Act makes reference to the terms harm and serious harm, but the terms are not
defined in the Act. The discussion document gave as an example of a definition of
harm/serious harm, the Medical Council of New Zealand’ s working definition.
Among many submitters, there did not appear to be an understanding of the
advantages of defining risk of harm/serious harm in the Act.
12
Some considered that it should be left to individual Responsible Authorities to define
risk of harm but more often submitters accepted the merit of a common statement.
There is some opinion that while the Medical Council definition of harm/serious harm
is a good start, it is not broad enough to encompass psychological, social and
emotional harm as well as physical harm.
Responsible Authorities’ consideration of costs implications of their decisions
The first discussion document points out that, when prescribing qualifications,
Responsible Authorities are required by the Act to be guided by the principle that
“the qualifications may not impose undue costs on health practitioners or on the
public.”
The document asked for feedback on whether the requirement to balance the costs
and benefits of regulation need to be strengthened in the Act.
Most Responsible Authorities in their submissions considered that they are very cost
conscious. Most other submitters seem concerned about additional costs that the
outcome of this review might oblige Responsible Authorities to carry (and pass on),
rather than about their current costs. It is not clear that submitters were conscious of
broader costs beyond those than those that fall directly on practitioners.
The first discussion document also asked “should Responsible Authorities be
required to consult more broadly with relevant stakeholders?” Professional
associations and practitioners were very much in favour of being consulted more by
Responsible Authorities.
Data Management
The 2009 review recommendations included a recommendation “that, as part of
workforce planning, the Ministry of Health work with responsible authorities and other
stakeholders to improve the collection, collation, analysis and dissemination of
comprehensive, accurate, comparable, timely and non-identifiable information about
the registered health practitioner workforce.”
The 2012 consultation document provided an opportunity to further explore
stakeholder views about how registration processes and APC processes can provide
a single point of data capture.
The issue drew little comment other than that it was not currently a function of
Responsible Authorities to provide such information to the Ministry and that it is
unclear how the need to do so could be enforced. (Note that section 123 of the
HPCA Act allows for the Minister to ask for statistical information.)
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STRUCTURE OF THE REGULATORY SYSTEM
In the first discussion document, there was a set of issues discussed under the Cost
focus, which, in this document, are brought together as a subset of cost issues that
are relevant to the structure of the health professional regulatory system.
These issues were:
•
the establishment of a shared secretariat for Responsible Authorities
•
the size of Responsible Authority boards
•
regulatory options to manage consumer risks
Submissions raised further issues:
•
amalgamation of Responsible Authorities
•
regulation of the regulators
•
transparency of appointment processes to Responsible Authority boards
•
elected members of Responsible Authority boards
•
appointment procedures and lengths of term
The establishment of a shared secretariat for Responsible Authorities
There was considerable acceptance of, and at times positive support for, the
development of a single secretariat in that it would support closer collaboration
between Responsible Authorities and reduce costs. The support was not unanimous,
however.
Amalgamation of Responsible Authorities
The 2009 report on the 2007-09 review of the HPCA Act recommended that the
Minister have the power to amalgamate two or more Responsible Authorities. This
issue was not raised in the 2012 discussion document but there were many
submissions on the subject.
Many submissions acknowledged the benefits of some rationalisation of Responsible
Authorities. In summary, submitters tended:
•
not to support a single Responsible Authority, most often because of concern
about loss of identity and unique culture of professions, and about the
medicalisation of professions
•
not to support the amalgamation of effective Responsible Authorities with
large numbers of professionals
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•
•
to see benefits of amalgamating smaller Responsible Authorities whose
professions have a high degree of alignment or lower risk of harm, such as
o
costs being reduced
o
wider stakeholder involvement
o
increased interprofessional understanding
to be concerned about power imbalances on amalgamated boards.
Size of Responsible Authority boards
The Act allows that the Minister may appoint up to 14 members for each authority.
Current numbers are less than that. The discussion document asked for views about
the ideal size of boards.
The range that most submitters thought appropriate was 6-12. Many said that the
actual size of the board depends on what they do, the size of the group they regulate
and the level of risk associated with the profession they regulate. The size may also
depend on the number of health professions that a board regulates. Professions who
share a Responsible Authority were particularly keen that the board be big enough to
represent all professions appropriately.
Regulatory options to manage consumer risk
The 2012 discussion document asked the question “Is the Act clear about the level
of risk that needs to be regulated by statute? If not, what would help to improve the
match between level of risk and level of regulation?”
The 2012 discussion document noted that “there is no recognition of a continuum of
risk to the public across the various health professions.” The document stated that
“given this continuum, risks could be better managed if there were a larger menu of
regulatory options available. This said, there are many health professionals who are
not regulated but where the risks associated with practice overlap with those of the
regulated workforce.”
There have been a range of responses, all of the following having significant support:
•
that the Act is clear enough, and appropriate criteria have been established. If
there is a problem, it is in the application of the criteria
•
that the Act is not clear about the level of risk that needs to be regulated
•
that the current criteria set too low a threshold for regulation
•
that the definition of risk should be broad and encompass emotional, mental,
physical and social risk
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•
that being included as a regulated health profession might give some groups
a legitimacy and credence that they otherwise would not have
•
that some non-regulated professions expose consumers to more risk of harm
than some of the professions currently regulated under the Act
•
that the current system of some regulated and some unregulated professions
is confusing to the public and may limit the choices they make about
appropriate health care
•
that the current system disadvantages non-regulated groups in that District
Health Boards and Accident Compensation Corporation, as part of their own
risk management practices, are unwilling to employ, fund or contract
unregistered practitioners even when the practitioners have highly developed
skills and are able to offer services at least equivalent to those of registered
practitioners in some scopes of practice
•
that there should be a multi-tiered system of regulation
•
that there should be a mechanism to review the continued need for any
profession to be regulated under the Act
•
that there should be a registration category for students.
There was significant advocacy from non-regulated professions for the benefits of
extending regulation to other professions. Some non-regulated groups recognised
that their profession did not pose sufficient risk to warrant statutory regulation. They
advocated, nevertheless, for a system to offer formal recognition for health
professions not regulated under the Act. They argued, that because their services
contribute to patient well-being and because members of the public seek out their
services (rather than being referred to them), a system that encompassesa wider
range of services/professions would be likely to lead to better integrated care and
better team work.
Regulation of the regulators
A number of submissions raised the issue of “who regulates the regulators”, though
this was not an issue raised in the 2012 consultation document. The issue arose out
of submitters’ recognition that some Responsible Authorities perform better than
others and out of frustration on the part of some practitioners with what they consider
to be inappropriate policies and processes in the Responsible Authority that
regulates them.
A few submitters had an interest in New Zealand having a body similar to the Council
for Health Care Regulators Excellence (CHRE) in the United Kingdom. Given the
costs this would add to New Zealand’s regulatory system, this is not being
considered by government.
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Some submitters considered that there should be more active use of the reporting
and audit provisions in the Act. Some submitters considered that there should be
regular auditing of Responsible Authorities.
Many supported the introduction of clear and appropriate performance measures for
Responsible Authorities and monitoring against these. This is consistent with
recommendation 12 of the 2007-2009 review that the Ministry of Health arrange for a
set of indicators to be developed to measure the effectiveness of the Act and to
measure the performance of Responsible Authorities.
Elected professionals
A very small number of submitters to the 2012 Review raised the issue of elected
professionals on Responsible Authority boards even though the issue was not raised
in the 2012 discussion document. The wish to have elected members appears to
arise out of a perception that the Responsible Authorities, as self-regulators, are not
sufficiently accountable to the professions they regulate.
In the 2007-2009 review report, it was recommended that section 120(4) of the Act,
which gives the power to have some members of Responsible Authorities elected,
remain unchanged and the question of whether to allow elections continue to be
considered on a case-by-case basis.
Some submissions to the 2012 review recommended that the basis for such
decisions should be made more transparent by the development of set of criteria to
increase the transparency of decisions about allowing elected professionals to be
members of Responsible Authorities.
Appointment procedures and lengths of term
This is a subject area that is additional to matters discussed in the first discussion
document. The matter was raised within the Ministry of Health.
It was proposed that the Chairs and Deputies of the Health Practitioners Disciplinary
Tribunal (HPDT) should have, as there is for Responsible Authority members, a rollover provision, as set out in s121(2)(c) of the Act. This would ensure the HPDT is
sufficiently staffed at all times, and remove unnecessary time constraints associated
with appointing Chairs and Deputies.
It was also proposed that appointments to the Responsible Authority boards, and
Chairs or Deputy Chairs for the HPDT be made by letter from the Minister, with the
appointments subsequently published in the Gazette to speed up the process of
appointments.
In addition, it was proposed that the Act be amended such that someone who is
qualified to register as a health professional but who has not practised for, say 10
17
years, and whose current occupation does not create a conflict of interest should be
able to be appointed to a Responsible Authority board.
It was also proposed that a solution be found for occasions where tribunals cannot
be formed, because of health practitioner members being unavailable or having
conflicts of interest (eg, they know the subject of the case). In these situations it has
been necessary to go through an entire appointment process to get a suitable
member to hear a single case, delaying the hearing for quite some time.
Two possible solutions were proposed:
(i)
allow the appointment of 'temporary members' to hear single cases, when a
tribunal could not otherwise be formed, and develop a shorter process for the
temporary appointment.
(ii)
allow an HPDT member from another appropriate profession to sit on a
tribunal. This option would allow tribunals to be formed more quickly, but it
would reduce the peer perspective of tribunals.
18
APPENDIX 1: LIST OF SUBMITTERS
NAME OF INDIVIDUAL SUBMITTER
Anonymous
Andrew Judd
Willem Aalderink
Mary Kensington
Robert and Linda Barlow
Gary Lees
Sarah Brenchley
Ruth Martis
Belinda Buckley
Beverley Rayna
Katharine Clarkson and Deborah Ashworth
R M Ridley-Smith
Vanessa Cumming
Morgan Rothwell
Veronique Dihn
Alan P Saks
Trish Du Villier
Peggy Savage
Jeremy Dryden
Aidan Tabor
Kathy Fray
Anne Tacon
Gregory Fyfe
Keith Tudor
Gillian Gonthier
Ravi Vas Vohora
Ben Gray and Eileen McKinlay
Yvette Walton
Peter Grimmer
Adam White
5 individual submitters who did not wish their names to
appear on this list
Rob Hallinan
Paul Nicholas Hey
NAME OF GROUP OR ORGANISATION MAKING SUBMISSION
Ambulance New Zealand
Asian Health Support Services, Waitemata DHB and Northern DHB Support Agency
Association of Dispensing Opticians NZ
Association of Professionals and Executive Employees, New Zealand Resident Doctors' Association , and Medical
Laboratory Workers' Union
Association of Salaried Medical Specialists
Auckland District Law Society - Mental Health and Disability Law Committee
Australia and New Zealand College of Anaesthetists
Australian Health Practitioner Regulation Agency
Bicultural Committee of NZ Psychotherapists
College of Nurses Aotearoa Inc
Combined Counselling Associations of Aotearoa/NZ
Commerce Commission
Council of Deans of Nursing and Midwifery, Australia and NZ
Council of Medical Colleges
Counties Manukau DHB Allied Health Directorate
Dental Council
Department of Occupational Science and Therapy, AUT University
DHB Directors of Nursing
DHB HR Managers
Dietitians Board
Dietitians Canterbury DHB
Dietitians NZ
Dunedin Community Law Centre
East Health Trust PHO
Enrolled Nurse Section NZNO
Faculty of Dentistry - Otago University
Family Planning
19
Federation of Women's Health Councils Aotearoa
Heads of Schools and Departments of Psychology at NZ Universities
Health and Disability Commissioner
Health Care Development -Midcentral DHB
HRC - Disability Commissioner
Luxottica Retail NZ
Medical Council of NZ
Medical Sciences Council of NZ
Midland Public Health Medicine Specialist's Peer Group
Midwifery Council
Natural Health Council
Naturopaths of NZ
Neonatal Nurses College of Aotearoa NNCA/NZNO
NZ Acupuncture Standards Authority Inc, NZ Chinese Medicine and Acupuncture Society Inc, NZ Institute of
Acupuncture
NZ Association of Psychotherapists
NZ Association of Medical Herbalists
NZ Association of Child and Adolescent Psychotherapists
New Zealand Association of Occupational Therapists
NZ Association of Optometrists Inc
NZ Association of Psychotherapists
NZ Board of Dialysis Practice
NZ Chiropractic Board
NZ Chiropractors' Association
NZ College of Chiropractic
NZ College of Mental Health Nurses Inc
NZ College of Midwives
NZ College of Midwives - Wellington Region
NZCTU
NZ Dental and Oral Health Therapists Association
NZ Health Practitioners Disciplinary Tribunal
NZ Health Professionals Alliance Inc
New Zealand Medical Association
NZ Medical Radiation Technologists
NZ Nurses Organisation
New Zealand Orthopaedic Association
NZ Psychological Society
NZ Psychologists Board
Nz Register of Acupuncturists Inc
NZ Sterile Services Association
Nga Ao e Rua
Nursing and Midwifery Leadership team, Southern DHB
Nursing Council of NZ
Nurse Education in the Tertiary Sector
Nursing Studies - Otago University
Nutrition Services Auckland DHB
Occupational Therapy Board of NZ
Optometrists and Dispensing Opticians Board
Osteopathic Council of NZ
Osteopathic Society of NZ
Palmerston North Women's Health Collective
Paramedics Australasia New Zealand
Paramedicine and Emergency Management, AUT
20
Pharmac
Pharmaceutical Society of NZ Ltd
Pharmacy Council of NZ
Physiotherapy Board
Physiotherapy New Zealand
Plunket
Podiatrists Board
Podiatry NZ
Professional Heads, Capital and Coast DHB
PSA
Psychotherapists Board
Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Royal Australasian College of Physicians
Royal Australian and NZ College of Psychiatrists
Royal Australasian College of Surgeons
Royal Australian and NZ College of Radiologists
Royal NZ College of GPs
School of Nursing, Eastern Institute of Technology
School of Nursing SIT
School of Pharmacy - Otago University
School of Physiotherapy - Otago University
Senior Nurses and Midwives, Bay of Plenty DHB
Senior Nursing Team, Emergency Department, Canterbury DHB
Southern Cross Hospitals Ltd
South Pacific College of Natural Medicine
Speech Language Therapy, Auckland DHB
Tairawhiti DHB
Wellpark College of Natural Therapies
Women's Health Action
21