Fiona Nash (NSW, National Party, Deputy Leader of the Nationals) Share this | Link to this | Hansard source

I present two government responses to committee reports as listed at item 14 on today's Order of Business. In accordance with the usual practice, I seek leave to have the documents incorporated in Hansard.

Leave granted.

The documents read as follows—

Australian Government response to the Senate Community Affairs References Committee report: Medical complaints process in Australia

October 2017

Introduction

The Australian Government welcomes the Senate Community Affairs References Committee (the Committee) report on the Medical complaints process in Australia. The Australian Government thanks the Committee members for their efforts in bringing to light the details surrounding workplace bullying and harassment in the medical profession, in particular the medical complaints process in Australia.

The bullying and harassment culture within the health sector must be taken very seriously. The community expects that the care they receive is safe and of high quality, and that the professionals delivering this care work within a respectful team environment.

All stakeholders in the health system must work together and demonstrate leadership to eliminate these negative behaviours.

Employers must ensure they provide a safe workplace, and negative behaviours and cultures must be addressed, in the first instance, in the workplace. In the health system, employers include the state and territory governments, who provide public health services, and providers in the private sector, mostly in private hospital settings. There are various pieces of state and territory legislation that specify employers' responsibilities, including work health and safety legislation. Commonwealth anti-discrimination legislation also protects against discriminatory practices or treatment in the workplace.

The educators of the health workforce, the higher education and vocational education sectors, and medical specialty colleges, also have an important role in growing students to work as part of a cohesive health workforce demonstrating positive behaviours. Teachers and clinical supervisors must model positive behaviours and ensure that there are clear processes in place so that students can be confident that any issues they experience will be fairly and transparently addressed, whether that be at the educational institution or in a health service.

Professional bodies also have a role in developing and setting professional expectations and generally providing guidance to their professions.

The Australian Health Practitioner Regulation Agency (AHPRA) and the national health profession boards (National Boards), as the national regulators of 14 professional groups, have the important role under the Health Practitioner Regulation National Law Act (the National Law) of ensuring that only those practitioners who are safe to practise are registered. Individual health practitioners must be held to account if their behaviour is such that patient safety is put at risk. If AHPRA is provided with a notification about a practitioner's behaviour that is impacting on patient safety, they are mandated to investigate this claim and decide whether any regulatory action is required in terms of the practitioner's registration to practise.

The National Law outlines the processes for handling a notification against a health practitioner and has a number of safeguards in place to support this process, including appeal rights for affected practitioners. The National Law also sets out the requirements for mandatory notifications for health professionals.

Response to the recommendations

The Australian Government has considered the six recommendations made in the report and provides the following responses. The Commonwealth Department of Health and the Department of Education and Training are the key portfolios with responsibilities relating to the recommendations.

Recommendation 1

The committee recommends that all parties with responsibility for addressing bullying and harassment in the medical profession, including governments, hospitals, specialty colleges and universities:

acknowledge that bullying and harassment remains prevalent within the profession, to the detriment of individual practitioners and patients alike;

recognise that working together and addressing these issues in a collaborative way is the only solution; and

commit to ongoing and sustained action and resources to eliminate these behaviours.

Australian Government response to recommendation 1:

The Australian Government supports this recommendation. The submissions and the inquiry hearings provided evidence of significant levels and types of bullying and harassment within health professions, especially in the medical profession. There must be zero tolerance of bullying and harassment in all health professions and systems must be in place to ensure that there are transparent mechanisms to provide avenues for victims to address issues without any fear of reprisal. To be effective, this requires collaborative work between governments, hospitals and health services, specialty colleges, professional associations and universities to prevent and address bullying and harassment in the workplace. Issues concerning bullying and harassment in the medical profession are under consideration and will continue to be addressed by all Health Ministers through the Council of Australian Governments (COAG) Health Council.

Recommendation 2

The committee recommends that all universities adopt a curriculum that incorporates compulsory education on bullying and harassment.

Recommendation 3

The committee recommends that all universities accept responsibility for their students while they are on placement and further adopt a procedure for dealing with complaints of bullying and harassment made by their students while on placement. This procedure should be clearly defined and a written copy provided to students prior to their placement commencing.

Australian Government response to recommendations 2 and 3:

The Australian Government supports recommendations 2 and 3 and notes that these are actions to be addressed by universities and organisations that provide clinical placements. The Australian Government has established a regulatory framework that requires providers to be responsible for the student experience both on and off campus. The requirement has been further strengthened by the revised Higher Education Standards Framework (the Standards) 2015 which came into effect from 1 January 2017. All registered higher education providers must comply with the Standards to remain registered with the Tertiary Education Quality and Standards Agency. The Standards require that "work-integrated learning, placements, other community-based learning and collaborative research training arrangements are quality assured, including assurance of the quality of supervision of student experiences" (Standard 5.4.1).

The Standards also require that "when a course of study, parts of a course of study, or research training are delivered through arrangements with another party(ies), whether in Australia or overseas, the registered higher education provider remains accountable for the course of study and verifies continuing compliance of the course with the standards in the Higher Education Standards Framework that relate to the specific arrangement" (Standard 5.4.2).

Recommendation 4

The committee recommends that all hospitals review their codes of conduct to ensure that they contain a provision that specifically states that bullying and harassment in the workplace is strictly not tolerated towards hospital staff, students and volunteers.

Australian Government response to recommendation 4:

The Australian Government supports recommendation 4, noting that as the employers, this responsibility sits with state and territory health departments and private hospitals.

Recommendation 5

The committee recommends that all specialist training colleges publicly release an annual report detailing how many complaints of bullying and harassment their members and trainees have been subject to and how many sanctions the college has imposed as a result of those complaints.

Australian Government response to recommendation 5:

The Australian Government notes recommendation 5. This recommendation is a matter for specialist training colleges to consider. Through the COAG Health Council, Health Ministers will continue to receive updates from AHPRA and the Medical Board of Australia on their work to improve transparency of vocational training pathways.

Recommendation 6

The committee recommends that a new inquiry be established with terms of reference to address the following matters:

the implementation of the current complaints system under the National Law, including the role of AHPRA and the National Boards;

whether the existing regulatory framework, established by the National Law, contains adequate provision for addressing medical complaints;

the roles of AHPRA, the National Boards and professional organisations—such as the various Colleges—in addressing concerns within the medical profession with the complaints process;

the adequacy of the relationships between those bodies responsible for handling complaints;

whether amendments to the National Law in relation to the complaints handling process are required; and

other improvements that could assist in a fairer, quicker and more effective medical complaints process.

Australian Government response to recommendation 6:

The Australian Government does not support recommendation 6.

The Scheme has undergone a number of reviews including an Independent Review of the Scheme (the NRAS Review) completed by Mr Kim Snowball in December 2014. In addition, reviews in Queensland (Parliamentary Committee inquiry into the functioning of the Office of the Health Ombudsman), and Victoria (Duckett review) have been undertaken.

The Government believes that a further inquiry is not warranted at this time. Work is currently underway as a result of these reviews, in collaboration with jurisdictions and AHPRA, to make improvements to the Scheme, especially in relation to notifications and complaints processes. This work is expected to address the issues raised in Recommendation 6.

Australian Government response to the Legal and Constitutional Affairs References Committee report: Establishment of a national registration system for Australian paramedics to improve and ensure patient and community safety

October 2017

Recommendations and Australian Government responses

Recommendation 1

The Committee recommends that the paramedic profession be nationally registered and accredited throughout Australia, and that such a scheme give consideration to 'grandparenting' arrangements for current paramedics, while ensuring that they meet the agreed professional standards.

Recommendation 2

The Committee recommends the establishment of a paramedics board, operating in conjunction with the National Registration and Accreditation Scheme (NRAS) and administered by the Australian Health Practitioner Regulation Agency (AHPRA).

Australian Government response to recommendations 1 and 2:

On 7 October 2016, all Health Ministers agreed to proceed with amendments to the Health Practitioner Regulation National Law Act (the National Law) that will bring into effect the regulation of paramedics into the NRAS. The Health Practitioner Regulation National Law and Other Legislation Amendment Bill 2017 (the Bill) was introduced into the Queensland Parliament on 13 June 2017 and includes provisions to incorporate paramedics into the National Law. The Bill includes provisions for grandparenting arrangements for current paramedics and will establish the Paramedicine Board of Australia.

Recommendation 3

The Committee recommends that all Australian states and territories participate in a national registration and accreditation system for paramedics.

Australian Government response to recommendation 3:

National consistency was a key principle underpinning the establishment of the NRAS. The Government is of the view that maintaining this consistency is critical to the ongoing success of the NRAS and continued achievement of positive outcomes, such as those described by Health Ministers in their Communique of 7 August 20151. The Government welcomes the decision by all Health Ministers at their meeting of 7 October 2016 to participate in the registration of paramedics under the NRAS.

1 http://www.coaghealthcouncil.gov.au/Announcements/ArtMID/527/ArticleID/71/Reissued-Communique-Final-Report-of-the-Independent-Review-on-the-National-Accreditation-Scheme-for-health-professionals

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

In the limited amount of time that I suspect is left in this section, in respect of the government response to the Community Affairs References Committee report Medical complaints process in Australia, I move:

That the Senate take note of the document.

I chaired that inquiry. It was, I thought, an important inquiry. I will just remind the chamber that it related to, and brought to light a lot of detail surrounding, workplace bullying and harassment for the medical profession, and, in particular, the medical complaints process in Australia. That's what this was particularly focused on.

The committee heard about the bullying of some of our medical students that has been going on. We heard some quite poignant accounts of some of the bullying and harassment that some of the medical students have felt—in particular, female medical students—and we heard some pretty significant and compelling evidence of people's very awful experiences in our training facilities, unfortunately. We also heard how some of our Aboriginal and Torres Strait Islander medical students had felt bullied and harassed through their experiences. We also heard from medical practitioners who have been going through the Australian Health Practitioner Regulation Agency processes of medical complaints, and we heard, again, some pretty compelling evidence—certainly, people felt bullied and harassed through that process.

We made a number of recommendations, to which the government has responded. And, for once, I can stand in this place and say: the government has supported most of our recommendations. Our first recommendation was:

… that all parties with responsibility for addressing bullying and harassment in the medical profession, including governments, hospitals, speciality colleges and universities:

The government supports this recommendation, which is great. We also recommended that all universities adopt a curriculum that incorporates compulsory education on bullying and harassment.

Recommendation 3 was:

… that all universities accept responsibility for their students while they are on placement and further adopt a procedure for dealing with complaints of bullying and harassment made by their students while on placement. This procedure should be clearly defined and a written copy provided to students prior to their placement commencing.

The government supports both of those recommendations. They note that the actions are required by the university and organisations that provide the clinical placements. It is the same as with recommendation 1: they are saying it is the responsibility of those institutions, which is right, but it's good to have government behind those recommendations and reinforcing them with the institutions. But, as to this issue around having the universities accept responsibility for their students while on placement, it has been while these students have been on placement that some of this harassment and bullying has occurred, and they haven't really known who to complain to. The hospitals say they are not theirs, and the universities say, 'Well, you're on placement,' so it's very unclear how they can take action.

Our fourth recommendation was:

… that all hospitals review their codes of conduct to ensure that they contain a provision that specifically states that bullying and harassment in the workplace is strictly not tolerated towards hospital staff, students and volunteers.

We've heard a lot about this over the years in the media, where hospitals say they are taking action and other organisations, such as the specialty colleges, say they are going to take action. Unfortunately, the evidence we received shows that this is still happening. So this sort of recommendation is really important, and it's really important that it's taken on board by these organisations and that hospitals, in particular, review their codes of conduct. The government again supports this. I urge the government and the departments to take this up with the hospitals.

Recommendation 5 is:

… that all specialist training colleges publicly release an annual report detailing how many complaints of bullying and harassment their members and trainees have been subject to and how many sanctions the college has imposed as a result of those complaints.

This is actually really, really important as well. It's really important that these reports are published so that these institutions are transparent and accountable. I am hoping that, in the future, if all of these recommendations are implemented, we will see a decrease in this harassment.

Our sixth recommendation is the only recommendation that the government didn't support, and that is:

The committee recommends that a new inquiry be established with terms of reference to address the following matters:

During this inquiry, we got a number of submissions from health professionals and practitioners that did not specifically relate to the terms of reference, so we felt very strongly that we needed another inquiry. The government didn't support this recommendation. The Senate obviously agreed with us because, in fact, they did support our referral of this to an inquiry. So it's a pretty pointless response from the government, because we actually held the inquiry and we got some very compelling evidence around some issues that do need to be addressed that are in another committee report. So I am making the point here that whilst the government did not support us having another inquiry, as I have just outlined, the Senate did refer it to the committee. The committee has already reported and we found, as I said, some pretty significant issues and made some recommendations, which I hope the government does look favourably on.

I hope I will again be in this place speaking favourably about how the government has supported some of the committee's recommendations for improvement in the process because no system is perfect. This one certainly hasn't been. It has caused distress. There have been issues raised. There are a number of practitioners who feel strongly that they have been bullied and harassed through the process. So I urge the government to look on the committee's subsequent report to the inquiry the government didn't want us to do, which we did anyway. I encourage the government to look at those recommendations carefully and support those the same way they supported these. I urge the government to work with these institutions and encourage these institutions to take up the recommendations that we made in this report, which they support. I seek leave to continue my remarks later.

Leave granted; debate adjourned.