One of the recommendations of the review of the National Registration and Accreditation Scheme back in 2015, was that a separate review be conducted into the current accreditation processes of our health workforce.
After ten months of national consultation, including more than 110 written submissions, the draft report of the Accreditation Systems Review was released on 4 September and is open for comment until 29 September 2017.
The post below is an “analysis of issues and recommendations” in the draft report from health policy expert, Dr Lesley Russell.
She argues that change is indeed needed if we want a health workforce that serves the ever-changing needs of the community moving forward.
And the clock is ticking on those responses…
Dr Lesley Russell writes:
The draft report from the Independent Review of Accreditation Systems within the National Registration and Accreditation Scheme for health professions, entitled Australia’s Health Workforce: strengthening the education foundation, was released for comment on September 4.
A wide-ranging review
The review was commissioned by the COAG Australian Health Ministers’ Advisory Council and undertaken by Professor Michael Woods (UTS Professor of Health Economics). Comments on the thirty-six recommendations made in this 180-page report are due by September 29.
The scope of this report is very broad, and it will potentially impact all the healthcare professions that are required to be registered under the National Registration and Accreditation Scheme (NRAS). It may also impact some other professions such as social workers, yet the timeframe allowed for recommendations is very tight: just four weeks.
The big ticket items
I am not an expert in health workforce, education and training, but my reading of the report highlights some areas that require considerable debate and discussion, so I have taken the liberty of highlighting these in the hope that this will help drive responses and feedback to the Independent Reviewer. I have not had the time to read the submissions to the review, which are available here.
There are several reasons why all stakeholders in the Australian healthcare system should pay close attention to the recommended findings of this report. These include:
Education and training and registration are inextricably linked and are integral to the quality and safety of healthcare services
The draft report makes a good case for increasing the links between registration, and education and training. The health professions demand continual learning, and skills must constantly be refined and assessed at the same time as remaining mindful of patients’ wellbeing and quality of life. There should be a discussion about what “work ready” means for these professionals.
Those who fail to deliver quality or safe care need re-education and retraining and, in some cases, limits on their ability to practice. There are too many examples where appropriate and timely interventions to address substandard practices have not occurred.
The accreditation system needs to address the evolving health and healthcare needs of the community
The key issues in health today – prevention, chronic illnesses, mental health problems, dementia and aged care, disadvantage based on social status, geography and race – require more than access to healthcare services if they are to be solved.
The report makes an excellent case that the composition, and education and training, of the health and healthcare workforce must change to reflect this.
For example, health workforce education and training needs to reflect the current emphasis on multi-disciplinary teams and patient-centred care, rather than disease-specific approaches. It should also encompass the need integrate with social services.
A particular requirement is to ensure the better integration of physical and mental health: these should not be the domains of two separate types of workforce.
If the accreditation system is to address the needs of the community (and more specifically of patients) then community members must be involved in the system. The report asks for recommendations about where this involvement would add value.
Efforts need to be made to ensure effectiveness and efficiencies in the accreditation system
There are currently fourteen accreditation authorities recognised by the Australian Health Practitioner Regulation Agency (AHPRA) and more than twenty other entities with some element of involvement. Education and training also takes place in university departments, community centres and hospitals.
There are certainly opportunities to make this system more effective and efficient and to ensure better integration. A key recommendation of the report – and one which will surely be controversial – is for the establishment of a Health Education Accreditation Board within AHPRA to deliver these outcomes.
The Board would oversee accreditation committees and approve accreditation standards. It would not mean AHPRA taking over education and training.
More clarity and transparency is needed around issues like the assessment processes used by accrediting bodies to ensure work readiness, compliance with Australian standards and requirements, and fees charged
For decades the medical specialist colleges have functioned as “closed shops” with little transparency about assessments and the fees charged for accreditation. It is likely that this is also true for other professional bodies. The report calls for greater clarity and transparency around costs and how these relate to expenditures.
There is also a recommendation for a more consistent national approach to the assessment of overseas-trained healthcare professionals, including that their supervision requirements should be more aligned with the requirements imposed on Australian-trained practitioners.
The need to align workforce reforms with other reforms taking place in the healthcare system
The report makes the case that workforce reforms should be aligned with broader healthcare and social care policies in a formal manner.
It recommends that the COAG Health Council should have oversight of a policy review process to identify workforce directions and reforms. This might be taken as criticism of the fact that workforce policies and reforms previously conducted by the now defunct, Health Workforce Australia, have been subsumed by the Department of Health and, as such, are no longer visible.
Improving the system
There will predictably be outrage at the recommendations in this draft report from many of the organisations that represent the healthcare workforce, and specifically from the Specialist Medical Colleges. However it is clear, with growing reports of discrimination, bullying, sexual harassment, improper handling of complaints, and unfair assessments of overseas-trained professionals, plus concerns about the mental health of those who work in healthcare, that the status quo cannot continue.
The onus now is to move forward with developing an improved accreditation and registration system – one which is properly resourced to do the work assigned to it. This new system must be seen as benefitting all stakeholders – that means it is there to serve the needs of the community and patients as well as healthcare professionals.
Dr Lesley Russell is an Adjunct Associate Professor at the Menzies Centre for Health Policy at the University of Sydney. On twitter @LRussellWolpe