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STANDING COMMITTEE ON COMMUNITY AFFAIRS
07/05/2009
National registration and accreditation scheme for doctors and other health care workers

CHAIR —Good morning. I welcome witnesses from the Australian Physiotherapy Association and the Australian Physiotherapy Council. We have your submission, which was No. 62, so it was one of the earlier ones. Would any of you like to make an opening statement and then we will go to questions?

Mr Maher —I will give an initial opening statement from the Australian Physiotherapy Association and Margaret will also give one from the council. Thank you very much for the opportunity to appear before the committee. The Australian Physiotherapy Association or the APA is the peak body representing the interests of Australian physiotherapists and their patients. The APA is a national organisation with state and territory branches and specialty subgroups. The organisation has approximately 12,000 members representing approximately 70 per cent of registered physiotherapists in Australia, some 70 staff and over 300 members in volunteer positions on committees and working parties. It is governed by a board of directors elected by representatives of all stakeholder groups within the association. The APA vision is that all Australians will have access to quality physiotherapy when and where required to optimise health and wellbeing. The Australian Physiotherapy Association is very supportive of the current process to develop a national registration and accreditation scheme for physiotherapists and other health professionals.

The Australian Physiotherapy Association and the Australian Physiotherapy Council have worked closely together to provide submissions to the implementation team that reflect the consensus position of the physiotherapy profession. Our comments have been based on input from the eight physiotherapy registration boards, the universities that offer entry level physiotherapy education programs and the professional association, the APA. It is our understanding that we are the only one of the 10 professions affected by the new scheme that has consistently presented a consensus position to the implementation project team. The APA notes the clear responsiveness to comments provided in submissions and at meetings with the national registration accreditation and implementation project team and thank them for that.

The timelines for consideration of the consultation papers during this stage of implementation have been challenging for the professions that are involved and we wish to acknowledge the extraordinary efforts of the project team, particularly Dr Louise Morauta and Mr Chris Robinson, in ensuring that time imperatives did not compromise consultation with all stakeholders. Physiotherapy has appreciated the many opportunities to participate in meetings and to engage with members of the implementation team at various forums. Physiotherapy firmly believes this new national registration and accreditation scheme will lead to a consistent approach to the registration of all health professionals Australia-wide and we welcome it wholeheartedly. This is vital for continued health consumer protection and will also remove unnecessary duplication and cost between states, thereby allowing health professionals who wish to practice in more than one state or territory to register only once. The need to register as a health professional in multiple jurisdictions from our perspective is a redundant and wasteful practice that certainly is well past its use-by date.

National registration also provides an opportunity to combine in a national scheme the best parts of current regulatory practice from around Australia. This potential was demonstrated in March when health ministers decided to include in the national registration and accreditation scheme criminal history checks, based on Queensland legislation, and mandatory reporting based on New South Wales requirements—both of which, we believe, reflect best practice in these areas.

The Australian Physiotherapy Association does, however, have some concerns, which we have articulated in our submissions to the implementation team. We agree in principle with accreditation being part of the new scheme. However, we would support changes to ensure that the scheme does not interfere with the independence of accreditation. It is inappropriate for governments to be involved in the accreditation process of approving professional standards. We are also concerned that the ability of national board members to perform their statutory duties may be compromised by the national agency controlling the resources which will be funded by the registration fee being paid by health professionals.

The success of the new scheme requires that all health professionals covered by the scheme be effectively consulted. With 10 professions covered by the new scheme, there are certainly a variety of viewpoints. And I think it would be incorrect for senators to assume that the views of the largest or most vocal are necessarily shared by all other professions. We are committed to working with COAG to support the process they have put in place for the new scheme.

Finally, as an aside, the inquiry title refers to a ‘scheme for doctors and other health workers’. From our perspective, I think it is worthwhile noting that there are presently over half a million registered health professionals whose practice will be covered by the initial implementation of the National Registration Accreditation Scheme. This includes registrations of practitioners who register in more than one jurisdiction, so the total number of professionals will be somewhat smaller. However, of these registrations, only 94,000 are doctors and the vast majority will be nurses and other health professionals. Thank you for the opportunity to make that opening statement.

CHAIR —Thank you.

Ms Grant —I would like to present, as much as anything, to help the committee get their heads around what the councils do and what accreditation is about.

CHAIR —Good luck!

Ms Grant —We will see how we go. Mr Maher has provided a very detailed description of what the Physiotherapy Association is about. The Physiotherapy Council is an independent national body which, interestingly, was established in the 1990s by the Australian Health Ministers Advisory Council, AHMAC. Our mission is to lead the national agenda to ensure high standards of physiotherapy for the Australian community. In striving towards that mission, our role is to act in the public interest by advising, investigating, accrediting and, in the end, making recommendations related to registrations, standards of education, competency and practice of the physiotherapy profession. Sometimes we are described a bit as a toothless tiger because we do not have authority over other, but we have a key role, which I will go on to explain.

Naturally, to achieve this role we have to have a close and very functional working relationship between regulators, the registration boards, the professional body and the educators. So our membership is one of 10 entities. We do not have individual members; we have organisations. They are the eight registration boards, the association itself, which is one of our entity members, and the Council of Physiotherapy Deans Australia and New Zealand. So we bring together those different arms. We are established as a company limited by guarantee and we are governed by a 10-member board of directors, where each of those 10 entities nominates one director to the board of directors.

We do a lot of things to achieve our mission, but those that are relevant to this particular inquiry and to the scheme are accreditation of education programs which lead to registration and assessment of overseas qualified practitioners to make recommendations to the department of migration—about those practitioners’ suitability to migrate under a skilled visa category—and to the registration boards about those practitioners’ suitability to practise physiotherapy safely and effectively in the Australian healthcare environment. Our organisation has been assigned that first three years of the accreditation function in the new scheme.

So, as noted by the president of the APA, the APA and the council have worked very closely on achieving consensus. In fact, physiotherapy, as Mr Maher noted, is one of the few professions that has consistently provided consensus opinions. I had to think: why is that—are we just simple or is it something about what we do? I realised that the thing is that physiotherapy has had national registration as part of its strategic goal for over five years and it has had a national registration function for over 10 years. So this is familiar territory. We are used to reaching consensus. The council itself crosses all areas that are involved in this scheme, and that is why we have been able to present those combined views. It is not that the council represents the profession. The council represents the public interest in ensuring standards of education and practice.

I will confine the last part of my statement to look at the potential impact of the scheme on standards of training and qualification of relevant health professionals. It will pertain to physio. Late in 2008, as you would be aware, there was a raft of consultation papers. The one on accreditation said:

The accreditation function is an integral part of the registration function. The purpose of accreditation of education and training courses is to ensure that graduates have the required skills, knowledge and competence to practise safely and meet registration requirements.

We would argue that accreditation is an integral part of regulation. It is interrelated to registration, but it is not integral to that registration function. That is one of the fundamental flaws and misunderstandings in the current scheme that has the potential to undermine the standards of education and consequently the standards of practice.

I will briefly try to explain what we do. A university decides to run a physiotherapy program. There is nothing to stop them starting to take students and run that program. They will have graduates who graduate with a physiotherapy qualification. Who decides whether or not those graduates should be registered? The registration board makes that decision on the basis of a recommendation from the council. The way the council does that is that the university, at the outset, provides a plan about how it is going to educate its students. The council looks at that plan and, during the delivery of education, looks at what is happening with that program. In the end, in order for a program to gain full accreditation from the council, the employers of those graduates and those graduates themselves must indicate that they are able to practise in the workplace under certain standards. The council makes the recommendation to the registration board that that program has met the standards required for practice and the registration board makes a decision to approve that program and add it to its list. They are very much interrelated but separate.

The accreditation itself is undertaken by panels which have members of the profession, members of registration boards and members of educators. It will soon have members of the community involved as well. It is an independent function but it does not operate in an unruly, independent way. There is a tenuous link to registration and, in the end, it is for the registration board to decide. What we would argue is that it is not for the minister to tell universities indirectly how to run their education of health professionals; it is for the government to regulate who can practice through registration. That is currently achieved very effectively. We would argue that the current model has a flaw in the way it creates a nexus between government and accreditation.

Finally, it is recognised internationally that such a nexus should not exist. The World Health Organisation and World Federation of Medical Education guidelines for accreditation states:

The legal framework must secure the autonomy of the accreditation system and ensure the independence of its quality assessment from government, the medical schools and the profession.

The legal framework must authorize the accrediting body to set standards ...

Such a process has served the physiotherapy profession well for over a decade. What is being picked up in the scheme is exactly what we have been doing for a decade—perhaps not what other professions have been doing for the last decade. We would argue that the independence must be maintained to ensure that the public do not receive substandard care.

Senator HUMPHRIES —Picking up your last point, you quoted the international standard for accreditation. Where was that from?

Ms Grant —It is from the World Health Organisation, World Federation of Medical Education Guidelines for Accreditation of Basic Medical Education. It is a 2005 document. That particular quote comes from section 2 on page 4 of that document. If you would like, we could email a copy of it to you, Senator Humphries.

Senator HUMPHRIES —Please. That would be good, thank you.

CHAIR —If you email it to the secretariat then the whole committee will have it.

Ms Grant —Certainly.

Senator HUMPHRIES —You say that it requires that the accreditation process be independent of government, medical schools and the professions. Who is left if you take all those stakeholders out? I suppose it is independent of any one of those bodies. It is meant to be independent of the control of any one of those bodies.

Ms Grant —No. I think that is where the misunderstanding is coming in. It is ensuring the independence of the quality assessment from those things. Those agencies are necessarily involved. As I said, the current model has the registration boards, the statutory bodies, the universities—obviously not someone from the university involved but someone from another university—and the professional associations on the panel. They are involved in the actual operation of how it works but the quality assessment and the way that that occurs are not determined by government—

Senator HUMPHRIES —Or medical schools or professions individually?

Ms Grant —No.

Senator HUMPHRIES —All those bodies are involved, but none have the final say in what happens.

Ms Grant —That is correct.

Senator HUMPHRIES —It is a collective exercise. You say that the registration boards are involved in that at the moment.

Ms Grant —Yes.

Senator HUMPHRIES —They are merely involved rather than the determining body of those assessment standards for accreditation.

Ms Grant —It is a subtle difference. The registration board does not credit the programs. The registration board approves the qualification to add to its list of approved qualifications—and how that is done varies in every state at the moment—but it does so on the basis of a recommendation from the accreditation council.

CHAIR —So who is the delegate in that? The way I hear that is that the investigation and the recommendations are from the council but the delegate still, the one who puts it into the system, is the registration board. Am I getting that wrong?

Ms Grant —That is correct. So if the registration board has reason to have concern about the recommendation coming from the council, it could ask for further information. In the end a registration board makes its own decisions, but it makes those decisions on the basis of a recommendation from the council.

Prof. Wright —Currently the same recommendation is provided to all the registration boards across Australia.

CHAIR —Right. So—and I know it is an old one—the recommendation would be that the University of Queensland is an accredited institution for a physiotherapist to operate anywhere in the country?

Ms Grant —Yes. Essentially, the University of Queensland has been awarded full accreditation by the council and it has demonstrated through its employers and graduates that its graduates do indeed meet the required standard for practice.

Senator HUMPHRIES —Are you saying that the new arrangement proposed in the national registration accreditation scheme is or is not consistent with what the WHO suggested should be the model for accreditation?

Ms Grant —It is not consistent in that the accrediting body may set its standards but the final approval of those standards is by the ministerial council. The ministerial council can also give directions. I know I am playing the devil’s advocate—and even six months ago I used to say to people that you are chasing rabbits down holes—but in the current workforce environment there is a real danger of the standards not being approved by the ministerial council and of the ministerial council giving a direction to make changes to those standards in order for them to be approved.

On day one in year 1 a physiotherapist who registers can set up a sole practice and treat members of the community with no other health profession having seen them and no need to have anyone with them. For physio in particular, any reduction in education standards has the potential to have a direct impact on the community because there is no postgraduate requirement pre registration.

Senator HUMPHRIES —We have been assured that in the new national process the ministerial council sets the standards but it cannot direct the boards, whom must originate the standards, as to how or what the standards should contain or details of the proposal. The best they can do is accept or reject what the boards put to them. This is meant to assure everyone that the process is one of approval by ministers but not of control or manipulation by ministers. I asked the question: what happens if the people on the board and the ministerial council cannot agree? I suppose that somehow something gets resolved, but we are assured that there is a measure of independence and that the real power for determining the standards really lies with the boards. Is the element that you are saying is inconsistent with the WHO guidelines the idea that it is the ministers who make the final decision? If it was clear in the guidelines that in fact the board is really in the driving seat, even though it is the ministers who tick the box at the end of the day, would that make a difference to the way that the WHO would view the accreditation process?

Ms Grant —The problem at the moment is that the use of the word ‘standards’ within the legislation covers accreditation standards, education standards, practice standards and continuing professional development standards, each of which is discrete. There is no denying that the ministerial council has a place in the standards for practice, because it is involved in regulation of the practice in order to protect the community. But it does not have a place in regulating education standards, because that is indirectly telling a university how it should be teaching. I would argue that in any profession to have government stepping into the profession and telling it how it should be teaching people in the profession is a step too far. There is no doubt that the ministers should be involved in regulation of who can practise these 10 professions in order to protect the community, but that can be done through robust processes that currently exist, without the arm of government extending into the university education of professionals.

As Patrick mentioned, this inquiry’s reference to a scheme of ‘doctors and other health workers’ is not really accurate, because these are professions. That is a key point that is made in the early part of the physiotherapy submission. Some people said it was a bit too academic for the committee but I did not think it was, so I left it in there. The hallmarks of a profession are that it defines its body of knowledge and its standards. In the end, where it has an interaction with the community, the government traditionally comes in and regulates that interface. But it is inappropriate for a government to step over that line into a professional arena and start to tell a profession how it should educate itself. The interface is between the graduate coming out and whether or not that graduate should be licensed or registered. The interface is not back at the education of that person.

If you think about other professions—architecture, law, engineering—there are similar set-ups in all of those professions. For example, the Standing Committee of Attorneys-General has been very involved with the Law Council of Australia in the national legal services market and the national model bill that is being put through by the law profession in all states except South Australia, but again that is at an arm’s length. The Standing Committee of Attorneys-General, which is analogous to the Health Ministers’ Advisory Council, would not go and tell a university exactly how it should be running a law degree.

It would appear from the fact that this has come from an inquiry into Australia’s health workforce, as well as the fact that there is other work going on by Health Workforce Australia, that some of the imperatives for this are to address health workforce issues. If the government wants to step in and change the way health workers are educated, that is fine. But these are health professions that have been around for a very long time. The danger is that in the end Australian graduates of these health professions will not be globally accepted anymore because the standards of education will not meet the international requirements such as those that I have cited.

Senator HUMPHRIES —What consequence does that have? Does that mean that an Australian accredited physiotherapist under this new arrangement would not be able to move to Britain or Canada and get accreditation because of the way that the accreditation has worked here?

Prof. Wright —Australian physiotherapists have provided leadership in physiotherapy internationally and would be very well respected and accepted in other countries. There has been a capacity for graduates to go and work in other locations. A number of the major countries now have their own licensing examination processes, but Australian graduates have been very successful in completing those processes and being able to practise in other countries. The concern would be that, if there is a dilution in the education standards for physiotherapy graduates, our capacity to provide that international leadership in physiotherapy would be diminished, and I think that would then reflect back onto the quality and standard of physiotherapy practice here in Australia.

Mr Maher —I think the flow-on effect of that last point that Tony made is very important, because if you lower the standards there is the potential for impact on the way we operate now and the standard at which we operate. I guess it is just reinforcing that Australian physiotherapy is very much respected internationally and it has a very high standard in both its clinical practice and its research capacity. We think we display leadership in various of those areas both nationally and internationally, and there is a potential to lose that.

Senator HUMPHRIES —I think it is axiomatic that we would agree that lowering standards is an undesirable outcome and we would not want to see that happen. The question we are trying to ask ourselves is to what extent this process will lead to that occurring. The argument from Dr Morauta, the advocate for the scheme, is that as far as registration is concerned they are simply elevating to a national board what was previously done by state based boards for the purposes of registration. The process is not very different there to what was operating before. With accreditation there seems to be a difference. It had been my impression that essentially accreditation was handled by the state based boards, but you have disabused me of that. It is clear that in fact there was a different process there and that accreditation is now being drawn into the national registration scheme as well.

You suggested, Professor Wright, that the standing of Australian physiotherapy will open doors for physiotherapists from this country in other parts of the world, but technically is it likely that any other national registration process will begin to say to Australian physiotherapists: ‘No, your accreditation scheme does not comply with WHO guidelines and therefore we won’t accept your qualification to practise in Canada, Britain or wherever it might be’?

Prof. Wright —If we take the Canadian process as an example, in the Canadian process graduates or practitioners who want to practise in Canada need to provide evidence of the courses and programs that they have completed, and those are reviewed quite closely in terms of whether they would meet the Canadian standards. That is a first step—

Senator HUMPHRIES —And the Canadian standards are based on the WHO rules—would that be fair to say? What I am trying to get at is to what extent these—

Prof. Wright —The Canadian accreditation process is actually very similar to the Australian accreditation process.

Senator HUMPHRIES —The one we have now?

Prof. Wright —Yes. There is a body called ACCPAP, and the Canadian accreditation body has developed standards in a similar manner to the way that standards have been developed in Australia, which is again a collaborative process which involves input from registration boards, from universities, from the professional association and so on. So a fairly similar process has been followed in Canada to establish their standards and their accreditation process.

Senator HUMPHRIES —So if ours differs in the future and we have a scheme which is not based on that model but on a national board—

Prof. Wright —It comes down not so much to the model that is established but to the actual educational programs that result from that model and whether the educational programs will meet the standards that are established in other countries. Currently, graduates from accredited programs in Australia will normally have their qualifications accepted by the Canadian process and they will then be eligible for the Canadian examination process. The concern would be that, if there is a significant dilution in standards and in the quality of the educational program as a result, it may be the case that those courses would no longer be considered.

Senator HUMPHRIES —So what you are really raising with us is not so much the fact that what is proposed here varies from the WHO guidelines; that of itself will not disqualify any Australian physiotherapists from practising in other parts of the world. What you are concerned about is that with this exercise, because we depart from the WHO guidelines, our standards will start to slip because they are based more on priorities of governments to fix shortages in workforces rather than on maintaining the highest standard of outcome for the training and qualifications.

Ms Grant —It is probably more that those guidelines indicate international good practice and that we would be varying ourselves from that. In England, some years ago now, the programs were shortened from four years to three years. The World Confederation for Physical Therapy recommends a minimum of four years of study. The English graduates over time have had their standards lowered. They cannot now register in New Zealand without getting a year of clinical experience. In Australia they can apply for our assessment of overseas physiotherapists, which is something the council does which is quite separate from accreditation of education programs. Through that process, we have noticed that the English graduates that we are now seeing are trained to work in the National Health Service in the UK. The foundation of their education is not sufficient for them to be able to work in the Australian healthcare setting without significant additional education and experience. If that were to happen to Australian graduates going the other way, I think it would be a sad indictment.

Anecdotally, the Australian education of physiotherapists is recognised so highly that a key English sporting body which recently had a lead physiotherapy position made it clear to a number of Australian physios that they did not want an English physio in that job; they wanted an Australian physio. They wound up getting an Australian physio. That is because in England now—it is sad—outside the National Health Service the way that physiotherapists are able to work is not suited to other environments. It would be a tragedy for the Australian public to be in the same situation. In Australia, at least half of physios work in the private, not the public, setting anyway and I think it would be a sad indictment of the folly of one aspect of this scheme if, in 10 or 15 years time, the public did not have the same access to quality care that they currently do. Six months ago, I thought this was a little bit Chicken Little—‘The sky is falling!’—but it is a real and present danger in the current system if the ministerial council has the capacity to approve standards of accreditation and education and therefore has, on the flip side, the ability to not approve them, which Dr Morauta has confirmed to you will be the case.

Mr Maher —I will just add one more bit there. Margaret mentioned earlier that physiotherapists when they graduate are live, if you like. I can graduate one day, get registered and practise without supervision. If there is a lowering of standards, you would then need to look at what that means in terms of practice: does there need to be greater supervision? That would be detrimental to the health system because it would add, if you like, an extra layer to the education we are offering. So that is another possible consequence of a lowering of standards.

CHAIR —Senator Humphries, could I ask a question on that. I have heard all the arguments and I have read the submission. Why do you think any minister would want to destroy the profession? It has been constantly, very diplomatically, placed in your evidence—that is, the protection of witnesses and all that stuff. Why do you truly believe that there would be a push on—which is the underlying statement through your evidence, whilst you have very diplomatically not said it overtly—from any minister or group of ministers in the health system to deliberately lower the standards of any profession if the focus of all this grouping and all the rhetoric we have read is about protecting the best health of Australian communities? That is the language that is permeating it all, but in your evidence there seems, from your perspective, to be a direct, very clear threat that the first thing ministers would do is lower the standards. I am very keen, if you are prepared to do so, for you to say why.

Mr Kruger —It is around the workforce pressures. I will give you an example. Here in the ACT there is a school of physiotherapy. Getting graduates to work in the ACT prior to the school coming about was very difficult. So a school was started up at Canberra university.

CHAIR —How long has that been going?

Mr Kruger —About four years. They have just graduated.

CHAIR —So that first bunch has just come out?

Mr Kruger —Yes. They are now starting to have some graduates. There is political pressure, if you like, from the ACT government to ensure that graduates from those universities get through. Say the Australian Physiotherapy Council finds that that course is not sufficient—that they do not have enough clinical experience; they are doing only four weeks instead of 12 weeks—do not think that is enough to graduate a physiotherapist and therefore we will not accredit the course. If the health ministers could actually interfere in the accreditation standards you could have a situation where they keep knocking back the standard, saying, ‘Twelve weeks is too much; you have to have four weeks.’ And we would see that as actually not sufficient to graduate a work-ready physiotherapist.

CHAIR —Have you had any indication from any government that that would be what they want to do? That is the kind of stuff we need to know.

Ms Grant —Keeping in mind that there is privilege here, through the newly formed Health Workforce Australia, which has come out of the National Health Workforce Taskforce, there are several programs focused on clinical education—or clinical training, as they refer to it—and Tony has also been to some of the forums that have been run there. Because physiotherapy does not specify hours, it is a bit of an enigma, and there has been a suggestion that in order for the central agency that is going to be involved in clinical education to do its job, whatever it is going to be doing, the accreditation standards may need to change.

CHAIR —That has been in the discussion.

Ms Grant —That is why I am saying this. Six months ago I was probably where you are at, Senator Moore. I could not really see that a minister would ever want to do this. But as soon as it is talked about in a parallel discussion—

CHAIR —In an open discussion, yes.

Ms Grant —The fact that under the model it would be possible, as Jonathan stated, for a minister to say, ‘We won’t accept that because you need to say how many hours of clinical education you need,’ and, ‘No, that is too much; we think you only need this much’—and in another arena we have had it stated that the accreditation standards may need to change—makes me think it is not just ‘the sky is falling’.

CHAIR —That is really valuable because it actually brings the generalist concern down to a specific concern, and that is what we need to struggle with.

Mr Maher —In a general sense going forward, if you look at the demographics we are all aware of, which are that the workforce is going down and aged care is going up, physiotherapy has a massive role to play in aged care. There is going to be a workforce issue.

CHAIR —And we are already short of you.

Mr Maher —Yes, that is correct, and it is only going to get worse. We do need to look at how we work and how we work differently—different models and all those sorts of things—but the bottom line is that if there is an easy way of alleviating the workforce by dropping a four-year course to a three-year course it is going to be attractive somewhere along the line.

CHAIR —Thank you. Senator Humphries, I am sorry I interrupted you.

Senator HUMPHRIES —I have other questions, but probably other senators want to ask some as well.

Senator BOYCE —There is a flip side to that as well that you might like to comment on. The view is sometimes put that health professions use those accreditation standards as a way of restricting supply into the market. That is the argument that would be put in response to what you have just said. You might like to address that question.

Mr Maher —Margaret might like to talk about some specifics here, but over the last 10 years the number of universities that have physiotherapy courses and the number of graduates of physiotherapy has increased dramatically. The current mechanism of accreditation has not provided any restriction on the actual number of universities providing courses or the number of graduates. So in terms of the setting of standards, I would say that for physiotherapy that has not been a restriction in the marketplace for providing more physiotherapists.

Prof. Wright —I think we should also come back to what we said initially about the collaborative process in terms of setting and establishing the standards. It has had input from the registration boards as well as the profession, the association and so on. It is not a process where the professional association, for example, is setting the standards and having capacity to use those standards in some restrictive way. The input from the boards is very much around establishing standards such that graduates are able to practise appropriately, effectively and safely for the benefit of the public.

Mr Kruger —On that point, clinical education is an evolving arena. When I was going through physiotherapy you do 20 weeks of clinical practice. That has changed. We are looking at alternate models of educating people—using computerised skills, tools et cetera. There is movement there; it is not set in stone within the accreditation standards. We would definitely be open from a workforce perspective looking at alternate models of education broadly—clinical and otherwise.

Senator BILYK —Just following on from that, you mentioned the increase of physiotherapists in recent years. Have you got some numbers for us?

Ms Grant —Having authored a chapter on the physiotherapy workforce in a book that has been published this year, I am certainly happy to provide that to the committee. The physiotherapy profession has gone from seven programs in 1997, when our accreditation started, to more than 20 programs that will be offered in Australia in 2010. Our accreditation system has been so flexible that we have been able to accommodate that. It is not a prescriptive model. I will not go any further down the line. The current workforce projections are that there will be in excess or around 3,000 physiotherapy graduates per year in the next five years.

Senator BILYK —Each year?

Ms Grant —I will get this on the record: because physiotherapy is a largely female occupation and there is a lack of re-entry programs, there is a sleeping workforce out there. Part of the answer to workforce is not more programs or more overseas graduates; it is supporting women who have left practice to raise a family to come back to practice. It costs less and it will be more effective.

Senator BILYK —It is similar to what we do witnesses.

Ms Grant —Yes.

Senator BILYK —Just going back to the time frames of the training, obviously everyone at this table wants to make sure that the highest level of competence that can be achieved is achieved. Correct me if I am wrong, because I do not know about the physiotherapy course, but we have moved over the last few years towards a competency based training regime. As you have mentioned yourself, there are varying ways of doing the training. Maybe part of that might be being prescriptive that you want to have a four-year course. Are there ways of streaming people? You mentioned the UK system—I gathered you were not that keen on people just being streamed into one area. But, for example, in areas like aged-care, wouldn’t that be a possibility?

Ms Grant —It is a good question. When I say four years , that is what the World Confederation for Physical Therapy has in its guidelines. The physiotherapy accreditation standards require a university to demonstrate that its program is of a sufficient length to produce quality graduates. There are certainly some indicators there. At the moment we have four-year bachelor degrees, two-year graduate entry masters degrees and a six-semester graduate entry doctoral program. The profession embraces diversity and innovation, so we would wholeheartedly support all of the things that you have suggested.

In terms of competency based training, a physiotherapist needs to know some things and needs to be able to do some things. The area that is not covered by competency based training is what is called clinical competence, and that is the capacity to problem-solve and bring those skills and that knowledge together with a particular patient in a particular setting. If, for workforce reasons, there are clients in aged care that require a particular physiotherapy programs, there is now a certificate for an allied health assistant. A physiotherapist would assess a patient and provide the program to be delivered by somebody who has undertaken a competency based training program in the VET sector. They deliver that; they do not make decisions around that person’s care beyond the scope of their competence. There is a place for competency based training in the health sector, but what we are trying to say is, ‘Don’t pull the professions down into health worker status. They are health professionals.’ Yes, the health workforce needs more people to provide care, but the way to achieve that is not by a system that allows ministers to go back into the education of health professions and change it.

Senator BILYK —Great. Thank you. I did not want it to be taken in any way that I would support the reduction in the overall outcome, but just whether there were varying ways they might be able to be achieved. If so, have you put those views to people?

Ms Grant —Absolutely. Our system, if anything, is the most innovative and flexible there is—to the frustration of some universities, who would rather be told how long the piece of this string we require is.

Senator BILYK —Sure. That is great. Thank you.

CHAIR —We have run out of time. I know that some of the members of the committee do have further questions. We will get those to you on notice. Certainly if there is anything that you come up with that you think we should know, please let us know. We are awaiting the exposure draft of bill B, which I think many people are waiting on. When that happens, you may well have further comment to make at that time. Thank you very much.

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