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National registration and accreditation scheme for doctors and other health care workers

CHAIR (Senator Moore) —Our committee is commencing its inquiry into the national registration and accreditation scheme for doctors and other health professionals. I welcome Dr Louise Morauta from the National Registration and Accreditation Implementation Project. Do you have any comments to make on the capacity in which you appear?

Dr Morauta —The National Registration and Accreditation Implementation Project is part of the Australian Health Ministers’ Advisory Council processes.

CHAIR —You are well versed in information on parliamentary privilege and the protection of witnesses. I remind senators that Dr Morauta can be asked to outline the role and activities of the implementation project, the progress to date with implementation, what has actually happened, what the next stages are, what will be included, timing to complete full implementation and issues that may still be under consideration. However, as a public sector worker, Dr Morauta is not able to answer questions on policy, and she is also experienced enough to know when senators cross the line with such questions. Dr Morauta, I invite you to make an opening statement.

Dr Morauta —I was not quite sure where to go with this, so I prepared a chronology of events in the implementation project to give you some factual background. I really do not know how familiar senators are with the project, so I will make these statements very quickly and then let you ask questions in areas you are not sure about. First of all the legislative structure for the implementation has three tiers and they have been called bills A, B and C; otherwise they get very longwinded. The first piece of legislation was to set up the administrative arrangements, and that piece of legislation was passed in the Queensland parliament at the end of last year. The second piece of legislation is a national bill that contains the full detail of implementation arrangements. It will supersede the first act and the plan is it will be passed in one parliament and then adopted by all the other state and territory parliaments to make it applicable in all states and territories.

This is all driven from the fact that the powers we are talking about here, of regulating health professions, lie with the states and territories, not with the Commonwealth, so you have to have this kind of legislative structure. The final tier of legislation is that not only do the state and territory parliaments have to adopt the national law but they also have to adjust or amend their own laws as a consequence of that, so they might have to repeal parts of their own law and adjust parts of their own law. Those have been called bill C and they are the adjustment to make the journey from the national to the state and territory complete. It is very much a legislative and parliamentary process in state and territory parliaments.

The second thing about the implementation process is that when COAG signed the IGA they gave an implementation date of 1 July 2010. That has meant that governments have designed an implementation process where a lot of things happen in parallel. It is not like you pass the legislation and then you get the operational bits going; you work on the operational side in parallel with developing the legislation in order to reach that end date, so there is a process with a lot of things happening at once. There are also a lot of players in that scheme—but I think I should probably stop there. That is an overview of the implementation arrangements and the committee will obviously want to ask me questions about different aspects of this.

CHAIR —Thank you.

Senator HUMPHRIES —Thank you for coming to give us an overview so we can understand where the whole scheme is going before we hear witnesses today. I want to understand a few things about the way this will work. Bill A, you say, was passed last year by the Queensland parliament. Bill B is yet to be introduced into the Queensland parliament. I have heard that will be happening in June. Is that your understanding?

Dr Morauta —I could not really comment on the exact timing of bill B—it is a matter for ministers. Bill B has to be as a result of a consensus among ministers of what it has in it. When that will happen, I could not speculate.

Senator HUMPHRIES —I see. So the ministers have not yet met to approve the content of bill B?

Dr Morauta —No, they have not, but they are considering what the actual process would be. Ministers would give guidance on key issues, and when those are resolved the guidance then enables the bill to be drafted for them to inspect. It then goes out as an exposure draft. That is the process.

Senator HUMPHRIES —Do we know when ministers are due to be meeting? I assume that is going to be at a health ministers forum of some sort.

Dr Morauta —I think they will be having a meeting very shortly. From there on, it is whatever process they decide on at that meeting.

Senator HUMPHRIES —The reason I ask is because this inquiry is designed to explore issues that have been raised by various professions and other stakeholders. They have concerns about elements of this, and we will hear that over the course of today. If we were to recommend some modifications or changes to the scheme—and our reporting date is approximately the end of June—it would be nice to think that if we had any constructive suggestions to make they would be taken on board before bill B were passed and cemented into place.

Dr Morauta —We are not at the stage where we have a final draft of the exposure draft yet, and an exposure draft process to which ministers have committed themselves would obviously take a period of time, so I really think that it would be possible for whatever this committee said to feed into that before you got to the final. After you have done an exposure draft you get a series of submissions and comments; then there is a process of reflecting on those. So I think that that process which ministers have committed to would occur in that sequence.

Senator HUMPHRIES —It does sound very much as if the legislation could not be passed through the Queensland parliament before the spring session, whenever that is in Queensland.

Dr Morauta —I cannot really comment on the detail of the process with ministers.

CHAIR —Perhaps we could make a note to the Queensland minister to get that kind of basic sequential information for you.

Senator HUMPHRIES —I just want to make sure that we are not wasting our time by making suggestions here only to be told, ‘Sorry, it’s too late; the bill has been drafted and introduced, and it is about to be passed.’ That is something I am trying to avoid, but it sounds to me as if that will not be a problem. You say that the legislation that states and territories already have to affect the registration and regulation of professions will as part of this process be repealed in place of the adoption by reference of the legislation that was passed through the Queensland parliament. I am aware that some states have legislation covering occupations different from those covered by other states; I think, for example, that in ACT we have a registration scheme for dental prosthesists which does not occur in other jurisdictions. Will all of the occupations which are currently regulated by all of the states be covered in this process or will only a certain number of them be covered?

Dr Morauta —There are different tiers. If they are in every state and territory, those are the 10 that are in the scheme on 1 July 2010. There is a slight exception there—podiatry is not registered in the Northern Territory because there were not enough of them—but it is basically that if you are registered everywhere you are in the scheme from the beginning. Then there are a group of professions that are what we call partially regulated—regulated in some states and territories and not in others—and ministers are going through a process of considering whether those should come into the national scheme, perhaps at a later date, or not.

At the time they called for submissions, ministers made it clear that, if a profession was regulated in a particular state or territory and it was not coming into the national scheme, it would be entirely open to the minister in that state or territory to continue to regulate that profession there. In fact, there are quite a number of professions who are regulated only in some places and not others. I think there were seven or eight reviewed. So there is a provision for them to continue to be regulated state by state if that is what people want to do.

Senator HUMPHRIES —So it is quite possible that some state legislation may be preserved for those particular occupations?

Dr Morauta —If that is what the government wants to do, yes.

Senator HUMPHRIES —In most cases each occupation has its own board, so they would be able to retain that separately as a piece of freestanding legislation presumably?

Dr Morauta —Yes.

Senator HUMPHRIES —Some professions have legislation around them which regulate more than just the things that this national scheme seems to be interested in, like registration, accreditation, disciplinary arrangements and so on. For example, in the ACT our legislation regulates the ownership of pharmacies—who may own a pharmacy—and standards with respect to running a pharmacy, including what their dimensions need to be and security of drugs and things like that. Will that sort of legislation be preserved as a state preserve?

Dr Morauta —Yes. The intergovernmental agreement COAG signed made it clear that the regulation of pharmacy premises would remain with states and territories. So there has to be a splitting of the legislation, with the professional registration ceding to the national scheme—if that is how it is going to work. Then the regulation of premises—every state and territory have slightly different arrangements around that—would remain part of the state or territory legislation.

Senator HUMPHRIES —As I understand the arrangement, there will be national registration boards, or boards with responsibility for setting standards for registration of occupations, in each of the occupational groups which are to be covered by the national scheme. There will be a separate board for pharmacists and a separate one for doctors and so forth?

Dr Morauta —Yes.

Senator HUMPHRIES —Under current legislation in the states, these boards present reports to parliament in the states, they are appointed by the minister and there is a measure of professional independence in the way the decisions are made on individual applications, but they are responsible to the minister for the working of the board. With a national scheme, do we precisely replicate those arrangements? And, if so, to which minister does the board—for, say, pharmacists or chemists or doctors or whatever—report to?

Dr Morauta —In the act under which the first group of boards will be appointed, ministers appoint the members of the board.

Senator HUMPHRIES —All eight or nine ministers?

Dr Morauta —Yes, as a group. They are under the act—the Australian Health Workforce Ministerial Council—and they make the appointments to the boards, just as they already made the appointments to the agency management committee.

Senator HUMPHRIES —Is that eight or nine ministers making those appointments?

Dr Morauta —It is nine, because the Commonwealth minister is a party to the intergovernmental agreement, though not what is called a participating jurisdiction, in the sense that they have current regulatory powers in that area.

Senator HUMPHRIES —So they appoint by consensus or by majority vote? Has that been worked out yet?

Dr Morauta —I do not think the ministerial council has looked at that particular point.

Senator HUMPHRIES —So they are collectively responsible for the operation of the boards. Do the boards produce an annual report which is presented to the ministers and tabled in all of the parliaments? How will that work?

Dr Morauta —The current act requires that the agency compiles a report which includes reports from all the boards, and that is presented annually to the ministerial council and members are required to table that in their parliaments.

Senator HUMPHRIES —Right. So there will be a report to the National Registration Accreditation Scheme each year.

Dr Morauta —As a whole, yes.

Senator HUMPHRIES —Are there mechanisms or is there a design for the makeup of each of these boards at this stage? Will there be a certain number from each jurisdiction? Will there be a certain number of professionals and consumers? How will they be made up?

Dr Morauta —The act has gone some way on that but has left something for further resolution. The act has set down that there will be both community and practitioner members on every board. It is section 38. In the composition:

At least half, but not more than two-thirds, of the members of a National Board must be persons appointed as practitioner members—

that means they are registered in that profession, and—

At least 2 of the members of a National Board must be persons appointed as community members.

So a balance has been set in the composition of these boards, but the actual size of the board and composition within that framework is a matter that ministers can determine, and that particular determination has not yet occurred.

Senator HUMPHRIES —Right, and there is no state/territory representation notion in that.

Dr Morauta —No, not on the face of the legislation, but it could be something ministers took into account or said they were going to do.

Senator HUMPHRIES —So we might expect that boards for occupations with relatively small numbers would have small membership and there would be larger boards for larger—

Dr Morauta —That would be up to ministers to consider.

Senator HUMPHRIES —The concern that is being echoed in a number of comments that I have received is that the new structure is less directly accountable to a minister and a parliament. The process of professional autonomy is very much a feature of boards at the moment. It is a doctor setting standards for other doctors to enter the profession and practise in that profession, and the standards are maintained for the purposes of disciplinary proceedings against doctors who do not meet those standards. Because these arrangements are not directly accountable to a minister and a parliament, other notions might be introduced into that basic function, such as the need to address shortfalls in particular occupational groups, and the temptation might be to lower the standards in order to achieve a higher rate of inclusion and therefore cover shortfalls in the workforce. Is that a concern that people can legitimately hold about this arrangement?

Dr Morauta —We are verging on the policy area, but I will talk about a couple of things in what you have said. The boards are accountable to ministers; it is just that they are accountable to multiple ministers. There is this very firm base in each state and territory parliament, so if the legislation is to be amended there needs to be a process with every parliament in Australia. The disconnection between parliaments and ministers is in terms of the nature of the relationship, but it is not the case that there is a complete disconnection. Obviously, in the main piece of legislation that is under preparation and under discussion now, there is a lot of work to be done about the exact relationship between ministers, the standards and what the boards are doing. There was a formula for that in the intergovernmental agreement, which had ministers approving the standards for both registration and accreditation. That formula in the IGA, to the extent that it is reflected anywhere at the moment, is in this act, but obviously the detail of how all of that will work is in the next bill.

Senator HUMPHRIES —To go back to the present arrangements, what is the equivalent for the approval of standards at the moment in state based registration? Who approves those?

Dr Morauta —In quite a lot of cases they are put in regulation and that is then subject to parliament. In other cases they are not; they are either approved separately by the minister or left with the board. It is a very different set of circumstances around the country. It is not a uniform picture at all.

Senator HUMPHRIES —So the standards will be set by the ministers. Presumably, each standard is a separate instrument, and if a standard is set which, say, a particular occupational group thinks is too low, it would have the capacity to lobby the various state governments or member state parliaments and say, ‘You should disallow this standard’, when it is presented in that parliament. Have I understood that correctly?

Dr Morauta —It is not clear yet whether it is a disallowable instrument or whether the legislation itself will contain enough to give the framework for the standards. Further work is being done on the nature of the instrument. But if I just go back, this legislation already makes it clear that standards have to come from the boards to ministers. Ministers cannot think up the standards. The boards have to recommend the standards and the ministers then have a choice of rejecting them or accepting them, but the standards have to be developed by the boards and put to ministers.

Senator HUMPHRIES —Accepted, rejected or amended by the ministers?

Dr Morauta —No, ministers cannot amend; they can only send them back for review.

Senator HUMPHRIES —You mentioned that there were practitioners and community representatives on the board. Are there also public servants on the board?

Dr Morauta —No.

CHAIR —Are they specifically excluded?

Dr Morauta —They would not be excluded from being a community member—

CHAIR —That is what I was thinking.

Dr Morauta —The act makes it clear that they are acting not in the interests of any group but in the interest of the community as a whole. You are right about that, Senator.

Senator HUMPHRIES —So the standards are developed by the board. The ministers approve the standards or send them back for more work. There is no mechanism to resolve a conflict between the minister and the board about standards?

Dr Morauta —I think at the end of the day the ministers rejecting a standard or asking for review would be the overarching point of play, but whether it would get to that stage or not in a conflict is not clear.

Senator HUMPHRIES —And it is not clear yet whether the standards, once made, will be disallowable instruments in each parliament?

Dr Morauta —No, the detail of that is being worked through with the Parliamentary Counsel’s Committee now.

Senator HUMPHRIES —But as amendments pass through to the overarching legislation they would need to be passed by each individual state and territory.

Dr Morauta —Yes. It is quite a complicated structure. For example, if anything is amended, all the ministers of all the jurisdictions in the IGA have to agree before the amendment goes off so you do not get a situation where somebody has an idea on his or her own and puts it in. The IGA says that they have to agree with what is going on. It is sort of underpinned by the IGA. We have a few things a bit like that around where there is an IGA, which is the mechanism by which ministers reach agreement before laws go through the system.

Senator HUMPHRIES —What do you understand to be the present position of Western Australia with respect to the scheme?

Dr Morauta —That is a matter for the minister for Western Australia, Senator. They were signatories to the IGA at the time it was signed. The position now is that they are formally in the IGA. I could not comment any further.

Senator HUMPHRIES —But you are aware that they have expressed some reservations about the scheme?

Dr Morauta —Yes.

Senator HUMPHRIES —So when particular occupations—and I am looking here, for example, at the osteopaths we are about to hear from—say:

There is no confidence within the professions that Ministers will not be tempted to interfere with draft standards for what they may regard as workforce planning reasons ...

is it possible to definitively answer that criticism? Do we know that the scheme is such that it will not allow ministers to impose a standard that gives them more workers in the field as opposed to workers with a high level of attainment of particular qualifications?

Dr Morauta —I think there is only a general statement we made. This is a legislative regulatory scheme, and that means that at the end of the day governments are accountable for the scheme. But the detail of how it will work is still to be resolved in bill B.

Senator HUMPHRIES —Okay. What are the administrative law arrangements around this process? Actually, I will back off there and ask another question first. I understand we are preserving state based committees as part of this exercise. Can you tell me what the state based committees will do?

Dr Morauta —In the intergovernmental agreement and in this act, it is not really anticipated that the national board would have their hands on all the registration processes and deal with individual matters. It is thought that very largely those would be dealt with as they are now, by state and territory committees of the national boards, and they would be serviced by a state or territory office of the agency.

Senator HUMPHRIES —Of the national registration scheme?

Dr Morauta —Of the national agency. That kind of arrangement, where there is a service organisation and multiple boards, is quite common in some jurisdictions, including in the ACT. If a complaint came in and an inquiry was to be made about the complaint, it would happen in the state or territory where the complaint arose. The possible exception to that is the very small professions. We have three professions in scheme with less than 5,000 registrants nationally, and often they have less than 50 registrants in a particular state or territory. There the board may look for more grouped up arrangements to make it more efficient and less onerous for the profession in a particular group. It is quite difficult when you have 20 registrants to get a whole committee and everything working in one place. But generally speaking in all of the major professions the expectation is there would be a committee of the national board in every state and territory. They would be doing very much the kinds of functions that occur now, and the national board would be responsible for drawing in the information from these to set the national standards. A state or territory committee might say: ‘This is coming up as a problem. We haven’t got this nailed. Let’s have a look at what we’re doing,’ and then go to the national board, which would look at it. But the national board could not be involved in the registration of individuals. There are 350,000 nurses and so on. It is a very big operation.

Senator HUMPHRIES —Do the committees in the states look at individual applications and process them?

Dr Morauta —Yes, but in the bigger professions a lot of the work is in the handling of complaints about performance, impairment and so on. In fact you find that the registration staff in things like medical boards is not usually as numerous as the staff working on other matters.

Senator HUMPHRIES —So those committees will operate very much like state based boards do at the moment, except that they will not be involved in the setting of the standards that the people they are dealing with have to meet—that will be done by the national body.

Dr Morauta —Yes, though undoubtedly in conjunction with them in terms of consultation and so on.

Senator HUMPHRIES —So the national boards will consult with the state based committees.

Dr Morauta —They would be mad if they did not, because these are the guys that are actually doing the work and know what it is like on the ground. I imagine it would be very much a cooperative effort, but the national board has the responsibility for putting it together as a proposal for ministers.

Senator HUMPHRIES —Does the legislation drafted so far stipulate the composition of the committees at the state level?

Dr Morauta —I cannot really comment on draft legislation which is not in the public domain.

Senator HUMPHRIES —Is there a draft yet on the table which sets out the composition?

Dr Morauta —No.

Senator HUMPHRIES —So there is no in principle agreement in the IGA about how the committees will be made up.

Dr Morauta —The IGA only makes three points about these committees:

(a) committee members will be drawn from a process approved by the Ministerial Council;

(b) committee members will be provided with appropriate statutory immunities … and

(c) the legislation will specify the minimum number of committee members and their composition that is required for statutory decision making.

So that is what is on the table. We have had consultations about how this might be done, and there have been revisions in that. At the moment there is no outcome from that discussion process.

Senator HUMPHRIES —But we expect to see that detail in bill B?

Dr Morauta —That would be the expectation based on the IGA, yes.

Senator HUMPHRIES —Lastly, with this process of the national boards and committees in each state, why are they called committees as opposed to boards?

Dr Morauta —Because the national things are called boards, so could they be called boards too, or not? The IGA decided that they could not.

Senator HUMPHRIES —Will there be any role for professional organisations in the formal operation of either the boards or the committees?

Dr Morauta —I think it is mainly in the process by which they are appointed. The national board process is set down in the legislation. There has to be a public advertisement—there was for the agency management committee—and the process is that either people can express an interest on their own behalf or they can be nominated by other people or by groups. So that would be the role in arriving at the practitioner members, and the community members would be that any organisation in the country would be able to nominate people that wish to.

Senator FURNER —Could you take us through the process of, in particular, the new objectives of NRAS in dealing with the high quality education, training and rigorous assessment of overseas trained practitioners. How will that evolve into a different standard of assessment from what we currently have? I take it that will be made up by a new composition of a board. Who would be on that particular board?

Dr Morauta —I am not sure that is an area where there is immediately a great deal of change anticipated.

Senator FURNER —Not for three years, I understand.

Dr Morauta —No, for the whole business of handling of overseas registrants. In most professions they are already handled at a national level so there is already a substantial national process, for example in medicine, that deals with these things at a national level. Most of the disjuncture between the present and the future comes where something is currently handled at the state level and it is done differently in different states and territories. But in this case the proposal is that the accreditation bodies who are doing this work now—or sometimes it is a board supervising the work directly—that work will continue to be done against the kind of national standards that are, by and large, already in place. That is the sort of expectation around that

Senator FURNER —So there will be a maintenance of the standard they currently have in each particular state?

Dr Morauta —I think that would be the basic expectation that people would have around that. I would not expect a big jolt in that area.

Senator FURNER —You have indicated that bill C deals with the adoption of state and federal laws. There are obviously different state laws across each jurisdiction. Is it a case of blending them in to one common law? Can you explain a bit further in detail how that will work?

Dr Morauta —The national law comes sailing along—it is sort of a package thing—and the state or territory parliament is asked to adopt that law. But in adopting it, there will be a lot of things in it that conflict with things in their current law. So they have to adjust their current laws at the same time as adopting it does not work. So they have to say, ‘Well, if we are going to have a national medical board and we are not going to have a state and territory medical board operating under state and territory legislation, then the state and territory legislation which sets up the medical board has to be repealed at the same time.’ Whatever happens in the state and territory has to be adjusted to make the national scheme work. So you adopt a national law and you repeal your local law.

Senator FURNER —In Queensland, for example, given that is a model they are starting with, will it be a case of Queensland’s laws being blended into the national laws as a model?

Dr Morauta —No, the proposed model is—whether they do or not is a matter for the parliament—that there will be a national law that each parliament adopts, and that whole national law then becomes a law of that parliament. I may not be technically and legally spot-on here but this is the process as I understand it. At the same time as they adopt that law—that is one thing—they also need to adjust their own laws. And there will be all kinds of things like the pharmacy regulation one that Senator Humphries raised where if you have got regulation of pharmacy premises you need to have an arrangement to do that now that you do not have a pharmacy board that is under state and territory legislation. So there will be a lot of consequential legislation.

Senator FURNER —Can you see any disadvantages to particular states as a result of that adoption?

Dr Morauta —What kinds of disadvantages?

Senator FURNER —I am just asking generally. Would it be a case of there being a relinquishing of particular laws or would there be normal maintenance?

Dr Morauta —It is such that the parliament in that state would have to form the view that it would be an advantage to the people in that state to do this. There are advantages to national registration which are quite clearly set out. If that were the way the parliament went it would adopt the national legislation and withdraw its own in that space.

Senator BOYCE —Dr Morauta, you mentioned earlier that seven or eight professions that were registered in some states were partly covered. Could you tell us what they are? I know it would be possible to pull it together out of the submissions—

CHAIR —We have been having some difficulty getting a lot of basic information about who is covered and who is not. We have got the major ones that are covered. In the first part of your evidence you gave some data about the ones that had small numbers and the ones that were registered in some states and not others. We have not been able to get a schematic that actually pulls all of that together.

Dr Morauta —I am not dead certain I can hit all of those, but I will just give you my idea. I could give you a table which showed where these seven or eight were. Off the top of my head there is Chinese medicine, Aboriginal and Torres Strait Islander health workers, occupational therapists, radiation technologists—and I am really going to get in a mess if I do not find them all! There is a group of things like that. I will take it on notice and give you a table that says, ‘These are the ones that are registered in some states and territories—

Senator BOYCE —Which states they are registered in—

Dr Morauta —Yes, the state along the top and who it is down the side.

Senator BOYCE —That would be wonderful.

CHAIR —I think you said there were five that had less than 5,000. Do you have any data on those?

Dr Morauta —Yes, it was three. I will give you a table which has the number of registrants by states and territories.

Senator BOYCE —Yes. That would be a useful overview of who is who. The next question I had related to future professions. As you said, it is still open to states to maintain perhaps a registration and accreditation system for these current organisations if they are not accepted as national organisations. What would happen in terms of perhaps an occupation we have not yet thought of—a new health profession? How would that come into a national system?

Dr Morauta —There is a process for that that has been set down by health ministers before. It is in the back of the IGA. A profession can put itself forward. There are quite a number of professions that are not registered anywhere that are already seeing the national registration scheme and saying, ‘We really want to be in there.’ There is a process by which they can make a submission to ministers, and ministers can assess them—

Senator BOYCE —The ministerial council.

Dr Morauta —The ministerial council. A set of criteria is applied. If ministers decided to include them in the national scheme, then the legislation would have to be amended to include them.

Senator BOYCE —Is there within the legislation presently an impetus to prefer national over state, by which I mean we could end up right back, in 50 years time, where we are now, with a piecemeal registration and accreditation scheme, if there is not a particular push for this to be national in preference to being state based?

Dr Morauta —I think it is hard to really judge. If there were a national scheme, if something completely new came along, I think it is most likely—this is just speculation—that the profession would address itself first to the national scheme and see if it could be approved there. So there might be more of a tendency to look at it nationally. But you can imagine in the future cases where a particular jurisdiction wants to try something or innovate and they might do that on a local basis in the first instance. I think it is difficult to say. The professions themselves appear to really be interested in national registration as a goal for themselves.

Senator BOYCE —You have given us this chronology, which is fabulous. I presume, Dr Morauta, that you or your staff have had time to look at most of the submissions that have been presented. Is there anything of note in difference between submissions made to this inquiry and the sorts of things that were being said by the relevant professions at the forums that were held in each state?

Dr Morauta —At the moment the forums were held early in the process, then we went out with these consultation papers and then everybody came back on those.

Senator BOYCE —Sorry, I probably should have phrased that a bit better.

Dr Morauta —I have not really looked at all your submissions. I had a look on the weekend, but the secretariat told me that you have received a very large number recently and I have not had a chance to look at those. The ones I looked at did not surprise me in terms of the kind of feedback we had had. They were consistent in terms of themes and so on. Possibly people are getting a bit clearer about the major issues. We were consulting on a lot of technical stuff too. How do you design the minutiae of the registration legislation so that our submissions cover a lot of detail? I think people look at your terms of reference; they look more at the wider issues you have got there. There is a little bit of difference in the angle that people are taking.

Senator BOYCE —One of the issues that I think has come up in quite a few of the submissions that have come to us is a concern about having registration and accreditation happening within the same body.

Dr Morauta —Yes. It was a pretty consistent theme in the submissions that came to us too.

Senator BOYCE —Would you have any further comment on that then, Dr Morauta?

Dr Morauta —Obviously what is important is that there is analysis of these submissions and that ministers consider these issues—and they obviously are considering them—and when they have resolved them they will tell us what they have resolved. Until then, I cannot comment.

Senator BOYCE —So you would not see that as a finished discussion?

Dr Morauta —I think a lot of these discussions are not finished in the process of the implementation of this thing. Having done all this consultation, ministers then have the opportunity to look at what people have said and say, “Where they are all saying the same thing to us—‘What do we do about this? What do we do about that?’” we have to resolve that. That is really a job for politicians to resolve among themselves.

Senator BOYCE —Thank you.

Senator BILYK —Maybe you can clarify a few things for me. I have had a number of people in Tasmania approach me with concerns. In Tasmania, as I understand it, there are currently five or six health professional groups that are not that large so they have come together and got a contractor to do their work. I understand that under the new system there will not be any space, so to speak, for that contractor type situation. Can you clarify that for me?

Dr Morauta —The committees in the state and territory of those boards and the state manager for Tasmania will need to work out what the best arrangement is. We are having discussions at the moment about how we can have continuity of expertise and how we can integrate it. I think the basic test has to be what will work, what will make a safe transition. I think we have to be open to any arrangements which deliver a safe transition. Basically the long-term future of contractors operating separately from a state office is not contemplated, but in the transition there will be different arrangements. In several states and territories we have got the same situation for small professions. Sometimes a contractor is happy to move out but let the staff move across. There are different arrangements coming up. At the end of the day it is a pragmatic decision. What will make this a safe transition? I think the most important operational requirement is that we make this safe for the community. So we are not taking a dogmatic approach to that. The view is that we have a state manager and that we try to get, as soon as possible, an integrated service which is efficient for people in the states and territories. If you have a single IT system, for example, the backbone of the whole operational design is an IT system which lets somebody on a Tasmanian physiotherapy board look at physiotherapists across the country real-time. If somebody is doing something with somebody in Queensland, they will be able to see that on the system. That is more efficiently run from a single office.

Senator BILYK —I think there were some concerns that roles would be taken on by people with a medical or nursing background who might not necessarily have the in-depth knowledge. Certainly in the case of pharmacy, with the Pharmacy Board, often the issues are very technical and you really do need that background to be able to help resolve those issues.

Dr Morauta —There are different kinds of work in the office. I think the work around complaints, performance, impairment and all the other issues are often very profession specific. However, a lot of things—like front desk, corporate services, registration processes when they are more standardised, and IT support—are very generic. I think they are trying to get a mix over time of those things.

Senator BILYK —As I understand it, the optometrist boards in Tasmania, Victoria, South Australia and Western Australia come under that same sort of concern. That was put to me. Also, what will the mechanism be when the legislation that is outside the scope of the proposed national registration scheme happens? I am thinking specifically of Tasmania, where pharmacy premises legislation and existing pharmacy ownership legislation are currently part of the Pharmacists Registration Act. Once bill B is passed, they will be left hanging. Who will manage the parts of the act that are left hanging?

Dr Morauta —That is a decision for each state minister to make. Different states do the regulation of premises differently now. In Queensland, there is an independent authority, I think, and a secretariat in the department. There are different ways that this will be done, and that is up to the state minister to decide.

Senator BILYK —So that will be a cost picked up by the state government?

Dr Morauta —Mostly that the regulation of pharmacy premises is based on a registration fee process. They are largely self-funding activities now.

Senator BILYK —You have predicted my next question. Is it likely that these registrations will increase?

Dr Morauta —Sorry, the fees for?

Senator BILYK —The registration fees.

Dr Morauta —For the professionals?

Senator BILYK —Yes.

Dr Morauta —It is very difficult to say. The situation at the moment is that fees are very variable across the states and territories. Sometimes there is a ratio of four to one in what is being charged within a profession. The proposal has been that there will be a single fee for each profession for, say, renewal or category of registration. How that is developed is probably the biggest question, I think, given the big disparity in fees between states and territories now, because everybody will be getting the same service on the same basis.

Senator BILYK —So different states and territories have different fees?

Dr Morauta —They are very different now—really big differences.

Senator BILYK —Basically, I think, from the people who have approached me in Tasmania, there is support there for the national process. But there is also the feeling that maybe there are better processes for the smaller states and more regional areas to be more included. One comment that was put to me was that it was ‘like throwing the baby out with the bath water’. Can you comment on that sort of comment that has been put to me?

Dr Morauta —If we have been working in a way that gives that impression, I think it would be not our intention to have created that. For example, there is a transition manager in every state and territory funded by government, so Tasmania has a full transition manager, just like a big state like New South Wales does. I think that, if you talked about the balance of benefits for the smaller jurisdictions, the arrangements are very clear, because, at the moment, they find it very difficult to sustain complicated services. And I think in a national arrangement when they are—

Senator BILYK —I think that is why they have moved to a contract.

Dr Morauta —Yes, that is right. But that is purely locally.

Senator BILYK —It does seem to work particularly well—in Tasmania at least.

Dr Morauta —That is right. And that is the shared services model, which I think is the better model. But remember that in a small jurisdiction, if you have got a small number of registrants and they get a big court case—and that has happened in a couple of cases—small groups of registrants just have to take a great big hit in their fees to cover it, because it is only them in that place covering it. Whereas, if they are in a pool with all the other members of their profession across Australia, the risk to them financially is much less.

Senator BILYK —Now just to clarify for me: there is scope, isn’t there? My biggest concern is about losing this process—because we are a small state, a regional area as such—and losing the skills and knowledge that that contractor has developed over, I don’t know, 15 years I think it is that they have been working in that area. So there is scope for some sort of discussion to take place to help resolve those concerns that are happening in Tasmania, is that right?

Dr Morauta —Absolutely. It is kind of an operational matter: how do we get safely into the new scheme? The new agency management committee put out a statement after its first meeting, saying its top priorities were staff and retaining skills, and obviously that goes into that area, as well.

Senator BILYK —Going back to a comment Senator Boyce had about future programs, I thought that even 10 years ago care plans really were not thought of. But I think with your answer to Senator Boyce you answered the concern I had there, so thank you.

Senator HUMPHRIES —To follow up those questions about regional arrangements, is it intended that each of the professional registration processes be internally self-funding? Is it intended that the fees paid by osteopaths, physiotherapists or whatever to their registration exercise cover the cost of registration within that occupational group?

Dr Morauta —Yes. The IGA says it will be self-funding. The main source in all lists of anything is renewal fees. They are the big financial driver. The proposal is that the fees received by the national board for a profession be pooled for a profession and they pay for the services that are provided.

Senator HUMPHRIES —So the amount that an osteopath pays to register in Western Australia will be the same that they pay in Tasmania?

Dr Morauta —Yes, that is the proposal. Given the work we have now done to see how very dispersed these fees are at the moment, exactly how the national boards get to that position would be something they would probably give consideration to.

Senator HUMPHRIES —There is no cross-subsidisation between occupational groups, though?

Dr Morauta —No. We got a very strong message about that in the first round of consultation—‘I am not paying for them’—and I think that there is a very strong sense that that is how it has to be.

Senator HUMPHRIES —I am sure you did. I have a couple of other questions from issues arising from other submissions that we are looking at today. Some of the groups we are hearing from are concerned about the time frame in which they have had to deal with these issues. Notwithstanding the quite thorough process you have been engaged in so far, they are concerned that we need longer than has been set down to finalise the details of this. The nurses and midwives, for example, say:

To develop a national approach will take a considerable amount of time, resources and preparation, none of which are built into the current implementation, consultation and transition schedule for the national scheme.

Do you think that is a fair comment? Will we be ready by 1 July 2010?

Dr Morauta —I think we can be ready in an operational sense. That is the public service bit of it—will we get an IT system up, will we have the staffing sorted and so on? I think the answer on that side is yes. The answer in terms of the parliament and the legislation is not my hands. That will be for ministers and parliaments to decide.

Senator HUMPHRIES —Do you think stakeholders, with their engagement with this and their capacity to be involved through consultation with setting mechanisms up, will have the time to do this properly?

Dr Morauta —The sector has been under a lot of pressure because the timetables for doing these different jobs have been quite short. They have responded as well as they could—and actually much more fulsomely than I thought they would be able to. They have done very well. But there will be an exposure draft process. Ministers have called for another set of forums around the country, so there are going to be forums on the exposure draft in every state and territory. There will be technical briefings for the boards, because we think that they will provide the best input on the technicalities of the legislation at the lower level. There will again be a submission process for people to submit before the bill is sorted. Beyond that the national boards move into a process where they gather information for standards and other things. They will be running the consultations with the professions on other issues. We are still more than 12 months out. It is a stretch, but from an operational side I do not think it is impossible to do. I think it is possible.

Senator HUMPHRIES —On the question of independence, there are several mechanisms to achieve that suggested in some of the submissions. I think the nurses and midwives go the furthest when they suggest:

… the National Nursing and Midwifery Board should be established as a statutory authority with perpetual succession, a common seal, the capacity to sue and be sued in its corporate name, the power to enter into contracts, acquire, hold, deal with and dispose of property, conduct general banking, and make financial investments.

Is that a reasonable way of giving it independence from interference by government?

Dr Morauta —I cannot really make a policy comment. That is not what it is in the IGA or in the first act.

Senator HUMPHRIES —Okay.

Dr Morauta —I might just explain how that nexus is drawn out in the first act. An issue, in coming to the first act, was how the boards would control their own resources. I think that, at the bottom of it, was what people were concerned about there. And what was put in—which was not there in the original thinking and you do not find it in the IGA—was a thing called a health profession agreement. This sets out the budget—the fees and the services—that the agency has to provide to each board, and the board has to be happy with it. If the board is not happy, it goes to ministers and says, ‘We are not happy with this. The agency is trying to give us less than we want,’ or, ‘The agency is making us pay for more than we want.’ That can then go to ministerial council for resolution. In the act that is there now that issue has been addressed by this mechanism of the health profession agreement which the agency and the board have to reach. But if they do not reach agreement with it, the matter goes to ministers. So boards have an absolute right under this legislation to go to ministers and say, ‘They will not let us put up our fees,’ or, ‘They are forcing our fees up to pay for irrelevant bureaucracy,’ or whatever the thing is that the board thinks about it. So that issue was considered and dealt with in that way in that legislation. But what they are saying—that is not in the legislation. The agency has, if you like, all the corporate functions.

CHAIR —The issue that Senator Humphries has mentioned from the nurses—they did raise that in the consultative process.

Dr Morauta —Yes, they raised it right at the beginning—well, several professions did—because they were concerned that the result of having this agency might be that they would somehow be told that they could not have X or they could not have Y. The legislation has a very strong sense that the regulatory functions belong to the boards. They are not given to the agency, they belong to the boards. They are the regulators and they have to reach agreement with the agency on what resources and services they need to perform that function. If they are not satisfied with what the agency gives them, they will go to the ministers. That is the structure that is in there.

Senator HUMPHRIES —Will the agency be a public service organisation, to be populated by public servants employed by the ministers collectively?

Dr Morauta —No, the agency sets its own terms and conditions, so they are not public servants of a jurisdiction or anything like that. The agency is the employer.

Senator HUMPHRIES —So it is a statutory body of some sort?

Dr Morauta —Yes.

CHAIR —As a statutory body, where would they fit in the Senate estimates process? Would that come under the Health and Ageing portfolio? Would they be accountable to a Senate estimates process?

Dr Morauta —I do not think I know the answer to that.

CHAIR —I was just thinking that we have the Institute of Family Studies and those things, but—

Dr Morauta —No, they are set up under Commonwealth legislation.

CHAIR —Yes, this is set up under COAG legislation. We will follow that one up. It just struck me in terms of the body of power—but it is possibly self-interest!

Senator BOYCE —But disinterested self-interest!

Dr Morauta —I certainly cannot give an answer myself but I can ask the Parliamentary Counsel’s Committee what their view is on that.

CHAIR —Thank you.

Senator HUMPHRIES —I understand that the Commonwealth is putting some money into this scheme in order to help the process of negotiation and consultation and so on to get to this stage. But the Commonwealth does not have an ongoing common funding obligation to this scheme.

Dr Morauta —All jurisdictions have put money into the pot for the implementation, not just the Commonwealth.

Senator HUMPHRIES —No, I realise that but—

Dr Morauta —And ongoing, of course, the idea is that it is self funding. I would guess that because the annual report is tabled in all the parliaments, if you follow the annual report that would tend to mean that it could logically appear in every parliament.

CHAIR —Yes, in every jurisdiction.

Dr Morauta  —But I really do not know the answer. There is a group of entirely legal ladies and gentlemen who deal with this sort of thing on the Parliamentary Counsel’s Committee, and I think I would have to defer to their views on that and ask them.

Senator BILYK —What is the timeframe for it to become self funding?

Dr Morauta —I think the IGA anticipates that that will be pretty well from the beginning.

Senator BILYK —So, basically, the states will be paying and the local people will be paying to prop up the national—

Dr Morauta —No.

Senator BILYK —That does imply an increase in fees.

Dr Morauta —‘Self-funding’ does not mean that; it means that the professions are paying.

Senator BILYK —Sorry, that is what I meant. I used the wrong word. But that does imply that fees will probably increase. Things will probably work from the lower denominator upwards to increase fees to help cover that, won’t they?

Dr Morauta —I think it is difficult to say what the effect on the overall cost of the scheme will be. There may not be much of an increase, because there are a lot of efficiencies in it. But what I have already drawn your attention to is this very big disparity of fees between jurisdictions within a profession. If you go to a single fee, you are going to get in a situation where some people go up and some people go down—and these differences are very big.

Senator BILYK —There is an access and equity issue there if you are in a smaller state and you are not making as much income as other professions can make in bigger states with bigger access.

Dr Morauta —I think I have a table which shows the fees differently—by jurisdiction.

Senator BILYK —Could you table that for us.

Dr Morauta —It may not be dead accurate, but I will give you the source of it.

CHAIR —We really like tables. If you have any tables, we would like them.

Senator HUMPHRIES —I would assume that the fees would be quite large in jurisdictions where there is a very small number of professionals. I think I was told that there are three podiatrists in the Northern Territory, so I assume that their fees would be quite large.

Dr Morauta —They do not actually register podiatrists in the Northern Territory at the moment. They are registered somewhere else. But there was one small profession which had a couple of bad cases and it started paying $800 a year to cover its cases. Actually, the smallest jurisdictions are not usually the cheapest to be in.

Senator BILYK —I have seen the fees for Tasmania. I think the highest fee in general is in the five hundreds.

Dr Morauta —We have some around the eight hundreds and the six hundreds. There are some jurisdictions which overall have a pattern of lower fees. It is not to do with the professions; it is to do with the way governments’ own operations intersect with the boards. So that gives you a different perspective. It is actually quite a difficult public policy issue—how to get from this wide variety to a standard fee. By the time people get into the scheme, they are getting a standard service. So how you move from one to the other is a big issue. Let me see what I have got on that. It may not be dead accurate but it will give you a picture of it.

Senator BILYK —Thank you.

Senator HUMPHRIES —I have two more questions. Are we going to register medical students?

Dr Morauta —The registration of students is one of the issues that is quite variable between jurisdictions, and ministers are currently considering it.

Senator HUMPHRIES —Once we have heard the evidence today and elsewhere, it might be useful to hear from you again. I hope we might be able to entice you back to talk to the committee again.

Dr Morauta —On the factual things, I really did not know what people needed today. If you need tables just contact me and we can help you with that.

CHAIR —We have now got your website details and I have been told that the document you have put at the end of today’s paper is very useful. I have looked at other things, but I have not looked at that document. Anything you think would be useful for us, we want to have.

Dr Morauta —I think it is more about other issues that arise. I can see how the three tables I have offered to provide you today fit in to give you an overview. That is not on the website. It is just background material that we have collected to help us think through things.

CHAIR —Thank you very much. We deeply appreciate your time and I am sure that we will be speaking to you again.

[10.04 am]