Mathias Cormann (WA, Liberal Party, Shadow Parliamentary Secretary for Health Administration) Share this | Link to this | Hansard source

The opposition will not oppose the Health Workforce Australia Bill 2009, subject to the Senate agreeing to an amendment that we have circulated in the chamber. Essentially, while there is broad support in the health community for the establishment of Health Workforce Australia, there is serious concern about the lack of quality of this piece of legislation. It does not contain any detail—and, as we all know, the devil very often is in the detail. It is not based on a sufficient degree of consultation—yet again, here is the issue of a lack of consultation. There is a serious concern that, in the way the legislation is currently drafted, it is unclear as to whether its purpose is for Health Workforce Australia to cut across the roles and responsibilities of professional colleges and other organisations responsible for the accreditation of clinical education and training for health professionals. There are no supporting regulations in place yet. There is a deliberate lack of involvement by the government of medical and health professionals in the proposed governance of Health Workforce Australia.

Even government senators share many of those concerns. There is a very insightful report by the Senate Community Affairs Legislation Committee, and I commend in particular the comments made by Senators Boyce and Adams. They are very, very insightful comments indeed. Even in the chair’s draft of the report, a number of concerns are raised, and I draw them to the attention of the Senate. The report said:

… many still expressed some concerns relating to the Bill, especially the composition of the Board and committees that would ensure that the views of a broad cross-section of stakeholders are heard; and the possibility for the HWA—

Health Workforce Australia—

to interfere with independently accredited education and training standards.

Incidentally, the opposition will move an amendment to deal with that second issue to remove doubt and make absolutely sure that that is not going to happen as a result of this bill.

The chair of the committee, in her report, put the proposition that if the consultations offered by the department were undertaken then there would be no real issue with proceeding with the legislation. But that is a big ‘if’. It is really saying: ‘Trust us; we’re from the government. We’re going to fix this in consultations.’ Why was it not fixed before this legislation came to the Senate? Why are we presented with a piece of legislation that does not have any of the detail and about which there is significant concern out there in the health community and then just told: ‘Take us on trust. All of the things that are wrong with this bill we’re going to fix afterwards.’ To be honest, I do not think that is good enough. The government ought to seriously reflect on whether that is an appropriate way of going about it.

In the amendment that we will be moving in the committee stage, we will ask for the Senate to agree with the proposition that it needs to be made absolutely clear that the functions of Health Workforce Australia do not include responsibility for accreditation of clinical education and training; for example, accreditation of individual health professional courses; and that the regulations—when they come; the regulations that have not been provided yet—must not confer on Health Workforce Australia responsibility for accreditation of clinical education and training.

From the opposition’s point of view, it is absolutely essential that we include that particular provision in the bill that is passed by the Senate to ensure that there is no doubt as to what our intentions are in passing this legislation. We would be very concerned if a very obscure piece of legislation without much detail could then be used as a vehicle to do things that we never envisaged would happen when we were debating the legislation.

I draw your attention to the evidence provided during the inquiry, for example by Ms Magarry of Universities Australia, who noted:

Our concern is that the bill does not currently provide any substantive detail on the powers and responsibilities of Health Workforce Australia …

Professor White of the Clinical Placements Advisory Group of Universities Australia said:

… it is the lack of clarity in the bill, the lack of information and detail in the bill, that is of concern in relation to governance but also in relation to the structure and the way in which the organisation will interact with clinical placements per se.

The Australian Medical Council said:

We are not sure what the relationship will be between the bodies that currently fulfil a function related to clinical training and something like Health Workforce Australia.

I am quoting quite extensively from the minority report of Senators Boyce and Adams, a very high quality report, which said:

This uncertainty made many of the professional organisations concerned that, because of its relative size and dominance by Government representatives, HWA would seek to replace the sector’s existing and highly respected clinical training and accreditation standards. ...

This clearly is a move towards centralisation, with the inherent risk of a one-size-fits-all approach. When you move towards centralisation from where there currently is a very diversified approach there is a serious risk that important issues will fall between the cracks. I do not think the government has seriously thought through all of these issues. We hope that the chair of the community affairs committee is justified in her confidence and the quality of consultation after the legislation has been considered by parliament is going to be better than the quality of consultation that took place before this legislation was considered by parliament.

As a general point, I think it is absolutely incredible that anybody would believe that, once this legislation is passed and the government is off the hook as far as support from parliament is concerned, the government will be more engaging and constructive in its approach to consultation than it has been while still seeking the support of the parliament. With those few remarks, I flag that the opposition will be moving an amendment and that our support is contingent on this amendment being passed by the Senate today.

Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

The Australian Greens believe that an effective healthcare system is dependent upon a skilled and well-resourced workforce. We believe in health funding that supports preventive care and health promotion, multidisciplinary teams and networks, and co-located services. We have championed the need for increases in student places, be they in the medical, dental or nursing schools. We have also called for allied health courses, to address the shortage of health professionals, and commensurate funding for staffing. We believe it is important that we see improvements in facilities to ensure high-quality teaching and mentorship programs. We are also keen to see matters addressed around the planning for Australia’s health workforce and we are concerned that this has been hampered by little or no coordination or leadership, which has created a desperate shortage of appropriately skilled and qualified health practitioners.

Given these circumstances, the Greens pay tribute to the hard work and dedication of all those who have participated and continue to participate in the delivery of health care in this country. Our healthcare workforce provide us with an excellent health service, under extremely difficult circumstances in many cases, and we believe they should be commended. In November 2008 the Council of Australian Governments signed off on what the government calls the ‘historic’ $1.6 billion health workforce package. With $1.1 billion of Commonwealth funding and $539.2 million from states and territories, it does in fact represent a substantial investment in the health workforce. This investment should improve health workforce capacity, efficiency and productivity. We hope it will do this by improving clinical training arrangements, increasing postgraduate training places for medical graduates, improving health workforce planning across Australia and enhancing training infrastructure, particularly in regional and rural areas.

A significant part of the COAG package is the establishment of Health Workforce Australia to produce more effective, streamlined and integrated clinical training arrangements and to support workforce planning and policy. The Health Workforce Australia Bill 2009 establishes Health Workforce Australia and implements the majority of the COAG health workforce initiatives. This bill specifies the functions, governance and structure of Health Workforce Australia. It is proposed that it will enable the health ministers to provide directions to Health Workforce Australia and should require Health Workforce Australia to report to the health ministers. We understand that Health Workforce Australia will be responsible for funding, planning and coordinating undergraduate clinical training across all health disciplines, and we expect it should also support clinical training supervision and health workforce research and planning—planning being a very important role. It should also provide funding for simulation training and provide advice to health ministers on relevant national workforce issues.

Under the governance of Health Workforce Australia we hope to see a greater capacity to ensure better value for money for these workforce initiatives and a more rapid and substantive progression of the necessary policy and planning initiatives. These are critical pathways to an improved health workforce and we welcome them. We think it is important in the process of establishing Health Workforce Australia that the role of existing health professions and educational institutions should be acknowledged. We have received assurances from the Minister for Health and Ageing that the invaluable knowledge of existing stakeholders will not be lost amid the expected broad changes to workforce planning structures and authority. We agree with the Australian Nursing Federation that ‘cutting out those who both professionally and industrially have the best interests of their professions and their consumers at the forefront of our minds’ would be a mistake. We note concerns raised by key stakeholders during the committee inquiry that this agency should not usurp the functions of accredited agencies or universities in relation to clinical training accreditation. Again we have received assurances from the minister that further clarification about the extent of the remit of Health Workforce Australia in accreditation will become evident when we get to see the draft of the regulations.

We want to see greater consistency around matters of data collection within the health system. We are all aware of the difficulties experienced in data collection. Historically, it has been a spasmodic and unreliable area of health management. We hope that Health Workforce Australia will create a new culture of timely and uniform information gathering. Every issue that is related to health that we talk about in this place has had problems with access to and collection of data, so this is particularly important. Health Workforce Australia provides a national focus to the provision of health care, and with this come significant changes to authority, hierarchies and power. We have received assurances from the minister that these definitions and the impact they have on engagement with existing stakeholders will again be clarified in the regulations. With the promise of $1.6 billion in funding, it is not hard to envisage that, as the AMA has stated, Health Workforce Australia ‘will be able to significantly impact on the standards of medical education in Australia.’ A comprehensive strategy to address workforce shortages has been much needed, and we hope that this will be just a part of a significant commitment to the delivery of health care in this country.

The issue in this legislation, as in many bits of legislation we see pass through this place, is that a lot of it is delivered through the regulations. It is imperative that those regulations be right. Of course, regulations are a disallowable instrument. I understand the regulations will be going to COAG. We will seek assurances from government, hopefully in the minister’s summing-up speech, that in fact stakeholders will get to be engaged and will be consulted in the generation and development of the regulations before it goes to COAG. I am sick of regulations coming into this place and us being told that we cannot alter them because they have already been to COAG. It is necessary for the government to ensure that stakeholders are consulted before the regulations go to COAG, because I do not want to see disallowable instruments come in here and be rejected. If the proper consultation does not happen, that is what will happen in this place. We seek assurance from government during this debate that there will be consultation with all stakeholders around those key regulations. Once those assurances have been given, the Greens will be supporting this legislation.

Sue Boyce (Queensland, Liberal Party) Share this | Link to this | Hansard source

The coalition takes the view on the Health Workforce Australia Bill 2009 that we have been assured by the minister, by the department and by all governmental witnesses that there is no intention whatsoever for the developing Health Workforce Australia to take over the accreditation roles of the various health professional and medical organisations in Australia. In our view, if that is the case then there is no reason why this cannot be spelt out very clearly in the bill. Our greatest concern is that, given the size of this organisation and given that the majority of its representatives will come from federal and state health departments, there is a strong likelihood that over time this organisation will not only want to look at the training and education that is necessary for health professionals but also start having views about what that actually should look like—what sort of training it would be and what sort of accreditation it would finally have. There will be a strong push for this organisation to start to set all the rules, to decide how long a course should be and to decide what constitutes a reasonable level of skills in profession after profession. The AMA, all of the universities, the deans of the medical colleges and numerous other groups have given us evidence about their very strong concerns about the centralising tendency that this legislation could ultimately lead to.

In our view, this is the most flawed aspect of this bill. We certainly need some national health workforce planing; the states have not proved capable of doing that. But to give over to those same states the power to decide what constitutes a reasonable level of education and training before people can practise as doctors, surgeons, nurses and many other health professionals is in our view a very poor way of attempting to cope with the very serious workforce issues in this area. I believe that we need the assurance of this amendment to go into the legislation so that we can confidently say to our health professionals that the current very high and respected standard of Australia’s health workforce will be maintained and will not be overrun by state health departments and state public hospitals seeking to cut corners and save money. This tendency is quite possible and certainly must be resisted.

Debate interrupted.