Royal commission required into health services administration and regulation

Reform of the regulation and administration of health services in Australia is long overdue, writes Dr Don Kane and Dr John Stokes.

THE Australian Health Practitioner Regulation Agency (AHPRA) has identifiable problems and needs input by an external panel of experienced clinicians – that is, health professionals who currently provide health services or are experienced retired health professionals who have practical experience in health service delivery – for them to be resolved.

Health professionals who have worked solely in administration do not see and experience the front line problems. It would be best for AHPRA's chief executive officer to have extensive clinical experience, with knowledge that has been acquired in the health working environment. At the very least, the CEO of AHPRA should have a senior clinician available at all times for meaningful advice about the nature of many notifications.

The current AHPRA personnel should not be involved in the restructure; they have no practical perspective or insight into what is wrong with the AHPRA processes when it comes to clinical matters. Changing the name to Australian Health Professionals Registration Agency is not a satisfactory solution and, without understanding the direction or navigating the problems that physicians can help identify, is akin to changing the deck chairs on the Titanic.

The genesis for many of the problems with AHPRA will not be fixed by another inquiry unless it has the powers of a royal commission. The reason is that there is a hidden misuse of AHPRA complaints in the guise of mandatory notification, such as those said to be “in the public interest”, which we know can be done dishonestly by some colleagues or administrators. These notifications drive the dysfunction within AHPRA. We believe many of these notifications are motivated by personal and/or commercial reasons rather than clinical concerns.

It is astounding that some notifiers of high intelligence and intellect, who may be held in high regard by an unsuspecting public, indulge in activity that is venal. This is why a royal commission is essential — so that perpetrators are held to account by AHPRA and in a judicial environment where they can be exposed by interrogation on oath in public.

The situation and problems with AHPRA are similar to the problems that led to a Royal Commission into the activity of unions. Health professionals who have acted dishonestly should not escape similar exposure and action. The fact is there has been enormous personal injustice to the victims and their families, including some incidents of loss of life, plus depletion of health services for the Australian public.

#ENOUGH this must stop now Bullying and collateral damage: The case of Dr Emery https://t.co/i46F4ZWhUJ @IndependentAus
— hannah dahlen (@hannahdahlen) June 23, 2016

Recent media exposure on ABC Lateline and Channel 9 A Current Affair have highlighted one case and its impact on the surgeon and his family plus the community.

The solutions are:

1. A royal commission into the misuse of AHPRA by health professionals and adminstrators within health services in Australia.

2. Change to AHPRA to be responsible solely for registration of health professionals and the record of registrants.

3. A body such as a Commission to

i. oversee AHPRA; and

ii. undertake the examination of notifications and complaints about health practitioners so that

a) they are assessed methodically so as to provide due process, natural justice and the presumption of innocence for the subject of a notification or complaint; and

b) no action is taken before the full facts are revealed.

iii. Ensure that any review of work practice of a health professional is undertaken by a genuine peer review agreed to by the commission and the subject of notification or complaint.

The Health Professionals Australia Reform Association (HPARA) conference is to be held in Melbourne at the Radisson on Flagstaff Hotel on Friday 7 April 2017. Click HERE for the conference program and more details.