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Legal and Constitutional Affairs References Committee
20/04/2016
National registration system for paramedics

GOUGH, Associate Professor Stephen, Director, Paramedic Education Programs Accreditation Scheme, and Chair, National Ambulance Education Committee, Council of Ambulance Authorities

[11:04]

CHAIR: I now welcome Associate Professor Stephen Gough from the Council of Ambulance Authorities. The committee has received a submission from the Council of Ambulance Authorities as submission No. 7. We thank you for coming here and talking with us today. Before we commence, do you wish to make any additions or amendments to your organisation's submission?

Prof. Gough : No.

CHAIR: I now invite you to make a brief opening statement before we go to questions.

Prof. Gough : Representing the employer, the Council of Ambulance Authorities is the peak body established by its members. The members comprise the Ambulance Service of New South Wales, Ambulance Tasmania, Ambulance Victoria, ACT Ambulance Service, Queensland Ambulance Service, SA Ambulance Service, St John NT, St John Ambulance Western Australia, St John New Zealand and the Wellington Free Ambulance.

The CAA exists to help advance ambulance services so that they are able to further develop superior prehospital care and the operations of services to provide services to communities across Australasia, in particular Australia. The majority of paramedics in Australia that we consider to operate at the emergency prehospital care level are employed by ambulance services that are members of the CAA. It is the view of the CAA that it is logical, important and in the interest of public safety that paramedics should be included in the national registration and accreditation scheme alongside other registered health professionals who work in the health system across Australia.

Primarily, the registration of paramedics provides a number of important benefits to our patients, the communities we serve and the wider paramedic profession. Those benefits include, but are not limited to having a national registry of paramedics, for the reasons that have been mentioned by other witnesses previously; the protection of the title of paramedic, which would ensure that persons who portray themselves to be paramedics would meet the standards that a paramedic should be qualified to, meet the expectations of the community and protect that title against misuse or misrepresentation; the mandatory accreditation of paramedic entry to practice education programs—whilst the CAA provides an accreditation process currently across approximately 18 higher education sector universities in Australia and New Zealand providing entry to practice programs, it is not mandatory to be part of those programs; the regulation of the standard of persons and their fitness to practice, particularly around areas of impairment in professional practice, and the code of conduct that would apply. The application of the health professional code of conduct would ensure that paramedics are included in the same obligations as other professionals under AHPRA, in particular those applicable to nurses and doctors.

Importantly, national registration of paramedics will provide strengthened, consistent and increased accountability and transparency for those practicing in the profession and will ensure that the public can continue to have high levels of confidence in the qualifications, skill and level of care provided by highly trained paramedic professionals. In summary, the community of Australia should be able to have confidence that, in an emergency, the person providing care to them and who is purporting to be a paramedic meets the standards of the profession to which they belong, and it should be akin to those in nursing and medicine.

CHAIR: Thank you, Mr Gough. There is a bit of a theme going through today's hearing with regard to the qualifications of a paramedic. Is this an issue right across the country?

Prof. Gough : There is a standardisation of qualifications for paramedics across Australia and indeed in New Zealand. However, there is no mandate that upholds those minimum qualifications. The process of regulation and registration would provide the opportunity for those standards to be reviewed, particularly with a governing board, and for those standards to form the baseline of qualifications and standards for practice in Australia.

CHAIR: In your submission you talk about other countries and what they do. Do those countries deal with that issue?

Prof. Gough : Yes, they do. Mr Acker reflected on the Canadian experience and also reflected on the Health and Care Professions Council. The Health and Care Professions Council, or its predecessor, has probably been operating for 14 years and had a couple of iterations of the standards that apply to those health professions that are regulated by that organisation. Those standards reflect the baseline requirements for practice in those professions, which also includes paramedicine.

CHAIR: And in your submission you refer to 'further "downstream" benefits across the broader systems of health care' that would result from national registration of paramedics. Can you explain some of these potential benefits in more detail for us?

Prof. Gough : I will give some insight. Perhaps it is easiest to draw a picture around where most of the emergency paramedics are currently employed—that is with the major employer groups that I have mentioned previously, which are members of the CAA. However, notwithstanding that, the areas of practice outside the mainstream ambulance services are increasing. There is also a push to expand the role of various health practitioners into other areas and, really, to allow that to occur and involve paramedics. That is supported—or would be supported—by having paramedicine as a registered profession.

That would mean, particularly in rural and remote areas and outside the normal mainstream of ambulance practice with the traditional ambulance services, that health employers and health services potentially could employ paramedics for a range of other roles outside what has been provided traditionally by mainstream and ambulance services.

It would be my view—from over 35 years' experience in the sector in three states—that the emergence of professional practice in paramedicine would actually be appropriate. Paramedics are well placed to take on a broader range of roles within the health context.

CHAIR: Are there any alternatives to a national register? Have you heard of any or have you seen any?

Prof. Gough : There is a range of ways in which you can provide regulatory activity. Those have been examined through the processes of the Council of Australian Governments Health Council review of the need to introduce regulation into the paramedic sector. Having been on the periphery of that, state based regulation systems and negative licensing arrangements have been considered. But the agreed position is that there is benefit perceived in having the national register, where persons who are deemed to be paramedics are on a national register. The mainstream and ambulance employers know the history of that person when they are considering their employment. It allows for the transportability of the qualification between the states and territories and also, in effect, gives some ease to taking those qualifications overseas—someone may wish to work in the UK and register with the HCPC, or in North American ambulance services.

CHAIR: It is interesting about the paramedics being 'pinched', I guess, or 'poached' from here to the UK. Do they have to go through any extra training to become a paramedic over there?

Prof. Gough : I would say, with some prejudice, that it is probably a testimony to the quality of the paramedic graduates coming out of the Australian system. Because of staff shortages in places like the London Ambulance Service, they have been over here trying to recruit graduates from our higher education sector. They will have to go through an assessment when they go for entry into another country, the same as in the past—several years ago—when Queensland and some of the other states were recruiting from overseas because there were insufficient students graduating in the market to meet Australian needs.

I have to say that the London Ambulance Service is looking at taking about 300 paramedics a year out of Australia to meet its current shortfall. The way that they have been recruiting them and the way they have been targeting Australian and New Zealand graduate paramedics, again, highlights the quality of those graduates.

We have paramedic programs that are offered in the higher education sector in Australia and also in New Zealand that are amongst the most popular programs on offer at university at the moment. We are certainly not in a position where we have an undersupply of graduates coming through the system.

CHAIR: I assume there would be a lot of overseas students wanting to study here.

Prof. Gough : Most of the programs that are on offer in Australia and New Zealand are residential programs and require full-time studies.

CHAIR: Is there a consensus among your members about the need for a national registration system for paramedics?

Prof. Gough : Yes, there is. As stated in the submission, it is fully supported by the member jurisdictions.

CHAIR: Have you been involved in negotiations over implementation? Have COAG et cetera sussed you out and got your opinion?

Prof. Gough : The Council of Ambulance Authorities is currently working with the Department of Human Services in Victoria, amongst other key stakeholder groups, to look at the rollout of a four-stage project for placing paramedics under AHPRA, under NRAS. The target date that is anticipated for that to have effect is around September 2018.

CHAIR: Right. In your opinion, is this approach likely to be successful in Australia? Do you think it can be developed and be successful?

Prof. Gough : Looking generally at the sector I have worked in, and through my association with the higher education sector and experience of overseas models, I think, providing that all of the states and territories continue to provide their support to the process through the COAG Health Council, that it will be successful.

CHAIR: Will there be any limitations put on the paramedics?

Prof. Gough : Part of the registration process, which of course is a function of regulation, is to introduce grandparenting provisions. That is about drawing the line in the sand; it is about looking at current paramedics who are practising at the level that is required but may not necessarily have the qualification that is deemed the entry-to-practice qualification. They would receive registration on the basis of their current practice at level, and the people who are recruited to this sector going forward would need to meet the minimum qualification for entry.

Senator PERIS: Earlier we heard from Mr Samuel, who a number of times spoke about protecting the title 'paramedic'. It is almost like a badge of honour. How can we further protect that, with paramedics at the absolute coalface, having that badge of honour, knowing that it is not more than a first aid certificate holder in that role of paramedic? And what does that mean to doctors who at the other end are receiving these patients?

Prof. Gough : I think it is about establishing very clearly what we mean by 'paramedic'. That is one of the other difficulties that arise across the sector, because the word paramedic is used quite loosely both internally within the services and in the outside private sector. The minimum qualification that is being proposed in the submissions that I have looked at is to look to the undergraduate degree in paramedicine as being the minimum qualification. That would be the line in the sand. The current programs in Australia and New Zealand meet the requirement for entry to practice paramedicine.

Senator PERIS: So that is in New Zealand and—

Prof. Gough : Australia.

Senator PERIS: Okay.

Prof. Gough : People in the community, when someone turns up and says they are a paramedic, can be reasonably assured that the person has undertaken the requisite training and has the capabilities to deliver the services that you would expect from a paramedic. Notwithstanding that, it is not the case currently in Australia, where in effect any person with little or no qualification can go out and call themselves a paramedic. In fact, the terms 'ambulance officer' and 'ambulance service' are better protected in Australia than the definition of a practitioner as a paramedic is.

Senator PERIS: We heard earlier about various models. In your opinion, what is the best model for Australia? There is the model in the UK but also the one in the United States through the National Registry of Emergency Medical Technicians. Is that something that we should consider?

Prof. Gough : My commentary on the United States would be limited. They have so many providers over there and so many issues that they have to deal with in delivering health services in a for-profit environment in a lot of cases. I would be more able to look at the UK or North America—in particular, the UK. A lot of the arrangements that we have around AHPRA and the NRAS are reflective of consistent content with the HCPC arrangements which apply in the UK.

Senator PERIS: I want to ask about time lines. If this were to happen with a magic wand, what is the time frame that we could be looking at?

Prof. Gough : There are discussions on a four-stage project that are currently being worked on by the various Australian states and territories through the COAG Health Council. From the policy changes that are required and which are being led by the Victorian Department of Human Services, the legislative changes that are required that are being led by Queensland Health where the parent health practitioner national law resides and with the establishment of the machinery around a paramedic board, it is likely that it will come into effect around September 2018.

CHAIR: It appears to me that everybody wants this to happen. People have wanted it to happen for well over a decade. Why hasn't this happened?

Prof. Gough : There has been some variation in agreement between states and territories. Not everyone has thought it is a need. There has been some variation between what people have generally accepted as being a baseline qualification, whether it is a diploma in the VET sector or a higher education degree from a university. Those things have moved forward significantly in the last three to five years. There is general acceptance around the basic qualification. The majority of the major ambulance employers have moved to almost exclusively employing from the higher education sector graduates with an undergraduate entry-to-practice degree.

I also think there has been a recognition in states and territories, particularly within the health sector, of the significant changes that have occurred in ambulance practice in the last 10 years. If I reflect back 20 or 25 years, there was very little invasive therapy and very few invasive techniques provided by ambulance officers then. Paramedicine today is quite different. It involves a lot of critical thinking and critical reasoning. A lot of judgement is required in very short time frames and there is a high level of invasive procedures and techniques required to deliver competent paramedic practice in the current environment.

CHAIR: Does that mean that if qualified paramedics want to go to another state to work they have to undergo retraining?

Prof. Gough : That is the case. They would have to go through a full process of recognition of prior learning. Their qualification would probably get them to the front door, but then there would be a whole series of assessments required to make sure they have the competencies and capabilities required for practice.

CHAIR: If there was a national register, they could go on to that register and find out exactly what—

Prof. Gough : It would certainly fast-track the process. Moreover, it would eliminate the high level of risk we currently have with people who fly under the radar, moving between states and territories. There are those who do that. It would mean being able to see in the state and territory ambulance services whether a person is currently registered and whether they have restrictions or have had impairment issues previously et cetera in determining their suitability for employment.

Senator PERIS: You said that 2018 is the likely date of implementation. Is there any issue in the interim with imposing mandatory qualifications across jurisdictions?

Prof. Gough : I think that would have to be an agreed position. Usually the mandatory qualifications under the AHPRA-NRAS arrangement are determined by the board responsible for the profession. It is my understanding that you would not do that in advance of the appointment of the board and determining those mandatory qualifications. There can be an agreed position in general between the major Australian and New Zealand employers. But, again, that is not mandatory. There is no obligation.

CHAIR: Is it pretty easy to go from, say, Australia to New Zealand to take up work?

Prof. Gough : Because of the trans-Tasman agreement between Australia and New Zealand, a lot of people move reasonably easily between health practices in New Zealand to Australia and vice versa.

CHAIR: Would you say that it is easier than going from state to state?

Prof. Gough : I think, in the absence of a national registry, it would probably be the same level of difficulty. I can also say that it is within my knowledge that New Zealand is going through the process, at the moment, of looking at the national registration of their paramedics for the same reason that it has been looked at closely within Australia.

Senator PERIS: As we know, in Western Australia and the Northern Territory there is no ambulance legislation. Before any of this happens in 2018, is that something that the states and territory—

Prof. Gough : The services in the Northern Territory and Western Australia are delivered under a provider agreement contract arrangement with the department of health in the territory and the state. The way in which standards are controlled in that environment is that the specification for service delivery is associated with the contract, so how well that prescription is provided in that specification will determine those levels of service. Having said that, if you take that in the context of the previous discussion about national standards, in the presence of national standards that would occur with regulation registration. They would automatically have to form part of those contracts.

CHAIR: Thank you, Professor, for your time.

Proceed ings suspended from 11:26 to 11 : 47