Health Practioner Regulation National Law (WA) Bill 2010 Pharmacy Bill 2010
Cognate Debate — Motion
On motion by Hon Simon O’Brien (Minister for Transport), resolved —
That leave be granted for the Health Practitioner Regulation National Law (WA) Bill 2010 and the Pharmacy Bill 2010 to be dealt with cognately.
Second Reading — Cognate Debate
HON ALISON XAMON (East Metropolitan) [12.58 pm]: I will make some comments about these bills, but particularly about the Health Practitioner Regulation National Law (WA) Bill 2010. I share the concerns laid out by my colleague, Hon Giz Watson, and also some of the concerns expressed by other members and the Standing Committee on Uniform Legislation and Statutes Review. I am particularly concerned about the mandatory provisions outlined in the national law bill, as well as those on spent convictions. We will obviously have an opportunity to talk about those in greater detail during the committee stage. As has already been said by others in this place, there are concerns about this Parliament losing the ability to scrutinise and disallow regulations made under this legislation. I will also make some comments about the implications of this bill for specialist psychologists in Western Australia, which I am very concerned about. As Hon Giz Watson pointed out, there was considerable discussion within the Greens (WA) about whether we could proceed with support for the bill as a whole. I would certainly have liked the repercussions for specialist psychologists to be removed from the bill, but we recognise that many of the aims of the bill are positive. As such, we will be supporting the bill, although I certainly hope that we can get some clarification and commitments from the minister.
Sitting suspended from 1.00 to 2.00 pm
Hon ALISON XAMON: Before the lunch break I was outlining my broad concerns about the Health Practitioner Regulation National Law (WA) Bill 2010. I am looking forward to being part of the further debate about that bill when we go into committee. I want to speak in particular about my concerns regarding the implications this bill will have for specialist psychologists in Western Australia. As I have indicated, those concerns are so great that it would have been my preference to excise the provisions for specialist psychologists to allay my very deep concerns about them. However, I am aware that that is very difficult to do, which is why, on the whole, the Greens (WA) will support this legislation. I certainly hope that when the minister replies to the second reading debate, he puts on the record some of the undertakings that I believe have been given by the Minister for Health in relation to specialist psychologists. I will go into that in more detail as I go.
Generally, the purpose of the bill is to create a single national registration and accreditation scheme for the health professions. The national scheme will cover the registration and accreditation of health professionals and ensure consistency in the areas of complaints, conduct and health performance, and also privacy and information sharing. I note that the national scheme prescribes offences for unregistered practitioners of the regulated professions. If this legislation is passed, the state-based system will be replaced with a new national scheme. As my colleague Hon Giz Watson said, the Greens (WA) are broadly supportive of this attempt. However, there is a level of uncertainty around the proposed national scheme. As noted on page 5 of the fifty-second report of the Standing Committee on Uniform Legislation and Statutes Review into the Health Practitioner Regulation National Law (WA) Bill 2010, the bill contains only the skeletal legislative framework of the national scheme,and a significant amount of detail is yet to be determined, which concerns me. I am concerned also that we have not had the opportunity to appropriately scrutinise the national scheme and its associated legislation. Paragraph 1.27 on page 5 of the committee’s report states —
State Ministers and departments need to justify to the Committee and ultimately Parliament why such a national scheme is necessary and why it is in the best interests of the Western Australian public to enact the legislation implementing or giving effect to the national scheme.
In effect, that has not been done. I note also the concerns of the committee about the restrictive time frame that was available to it to thoroughly examine the implications of this quite comprehensive legislation. I would like to join the chorus of support for the Standing Committee on Uniform Legislation and Statutes Review and for all the members on that committee for the excellent job they have done on this bill, despite the short time frame. I echo the congratulations for Hon Adele Farina for the excellent work that she continues to do while chairing this committee.
Facilitating the movement of health professionals around Australia is a good goal, but I am not sure whether that is enough to justify rushing legislation through Parliament without giving it adequate scrutiny or understanding as to how it will be enacted in practice or what effect it will have. The Health Practitioner Regulation National Law (WA) Bill 2010 grants wide powers to a ministerial council and associated national boards. These powers will replace the detail contained in the current state legislation. On page 21 of the committee’s report it is noted that the effect of the bill is the transfer from a legislative framework to a more administrative framework.
They are just some of my general concerns about this bill. Again, I echo the comments made by Hon Giz Watson regarding the lack of Western Australian parliamentary oversight of the national scheme as well as the lack of legislative detail. I believe that the passage of this legislation, without amendment, will result in the loss of transparency and accountability. In that regard, it is hard to see how the Western Australian public will benefit.
I refer now specifically to the concerns that psychologists have raised with me. I am sure that I am not the only member in this place who has been approached by psychologists with their concerns. Psychology is one of the 14 professions that will join the national scheme and it is one of the 10 professions that will join the scheme from 1 July this year. A number of concerns and objections to the regulation of psychologists under this scheme have been raised with me. As I said, I am sure that they have been raised with many other members. I understand that they were raised also with the Standing Committee on Uniform Legislation and Statutes Review. Psychologists are rightfully very passionate about their profession and concerned about the implications this legislation will have on their profession. I commend them for that and for speaking out and being so ardent about wishing to defend the integrity of their profession. On that note, I am not convinced that their concerns have been adequately addressed. That is one of the reasons I have such serious concerns about supporting those provisions within this legislation.
The first concern expressed to me by psychologists relates to the loss of the “specialist” title. Western Australia has had a specialist scheme for many years. This has been enshrined within our state legislation. Disappointingly, the national scheme does not recognise the rigour and high standards of our WA scheme. It does not seek to bring the rest of Australia up to our level; instead, it grants the national board the power to recognise and endorse areas of practice in psychology. Although the legislation allows for recognition of specialist medical practitioners and specialist dentists, it does not allow the same for specialist psychologists. I am not convinced that an endorsement of specialist psychologists is adequate. It certainly does not go towards meeting the concerns of that profession. The recognition of a specialist title sends a clear message to the public that those psychologists with specialist title have undergone significant further training and experience in their chosen field of specialisation. I firmly believe that this should not be undermined. If we are going to do that, I believe it will be detrimental to both the psychology profession and those psychologists who have worked so hard to get that specialist title. A fair amount of additional training is involved to become a specialist. I also think it will be detrimental to the general public seeking mental health services and who hope to get a particular level of expertise from a psychologist. Endorsement is not the same as specialist recognition. Endorsement will lie solely within the power of the national boards. It is an administrative rather than a legislative process. It is a reduced level of recognition and a reduced level of protection for consumers of psychological services. It is basically going backwards for WA. We are letting our Western Australian specialist psychologists down by going down this path. I do not understand why the national scheme will have both specialist recognition of medical practitioners and dentists and endorsement of areas of practice for psychologists. It has yet to be explained to me why we have two different processes for these professions. It has yet to be explained to me why we cannot look at specialist recognition of our psychologists in the same way. It does seem a strange way to proceed. This needs to be addressed. As recommended by the Standing Committee on Uniform Legislation and Statutes Review, the minister needs to provide this place with a better understanding of these issues.
I understand, from speaking to specialist psychologists who have met with the Minister for Health and who have been lobbying on this area for quite some time, that there has been a suggestion that these bad decisions can be reversed at some point in the future. I really hope that is the case. I hope that the recognition of specialist title for psychologists will be included in the national scheme. I certainly hope that the Greens (WA) are not the only party in WA to believe that when our standards are better than that of other states, we should be working towards bringing those states in line with us, with our improved standards, rather than reducing our own standards to the lowest common denominator. We should not be looking to drag down our professional standards in this industry or, I would argue, in any other industry. If we are not prepared to protect our own standards, we really should not be going into a scheme that will reduce standards. I hope that the minister is fighting very hard for psychologists and also for members of the WA public who want to acquire the services of a specialist psychologist in the future. I understand undertakings have been made by the Minister for Health to advocate for specialist psychologists in the Council of Australian Governments meetings. I hope that is the case, but I really have no guarantee. I am hoping that the minister can give us some more information in his reply.
The specialist psychologist community in WA has called for the establishment of a statutory board in WA, specifically to oversee the registration of specialist psychologists and to monitor the continuing education and supervision of specialist psychologist registrars. I believe some misinformation has circulated that the psychologists wanted the current board and all its functions to be maintained. I understand this is not necessarily the case. They are advocating for the creation of a new, small state board to maintain the current standards in WA. If the national scheme does not offer our public an adequate level of guidance and protection, maybe we should consider our own scheme to do that. I acknowledge that this will certainly not be ideal as it creates a dual registration scheme; however, it may be that it can be done in an uncomplicated way until such time as the national scheme is brought up to our current standards, as has been promised to specialist psychologists. If we were to go down the path of this proposal, it would result in the creation of a three-tier system consisting of four year- trained psychologists and psychologists endorsed to practise in specific areas, both registered under the national scheme; and then WA specialist psychologists who would be registered by a WA specialists board. There may be some merit in considering this proposal. I put to members in this place that this is a proposal that has come from specialist psychologists themselves as a way to move forward, although of course our preference would be for the national scheme to protect and recognise specialist psychologists in the first place.
The second issue that has been raised with me by a group of psychologists over the past few months is the omission of health and community psychology within the different fields of psychology specialisation. I do not really understand why these two fields of psychology have not been included in the national scheme. I believe that the Department of Health, the Australian Psychological Society and the Psychology Board of Australia support the inclusion of health and community psychology. It seems odd to me that these areas have been excluded. Both specialties are significant branches of psychology. They are recognised internationally as well. They both include accredited specialist university courses. These courses have been developed over several decades.
I recently tabled in this place a petition on behalf of a group of community and health psychologists. I would like to quote from the petition. The petition stated, in part —
Both specialities —
By that they meant community and health psychology —
are recognised world-wide as having an increasingly vital role in advancing positive health and wellbeing as well as in ameliorating mental health problems, and will be essential in reducing the increasing acute costs of health care as indicated in the Healthy Future for All Australians report (2009).
I will briefly comment on some of the important contributions of these two specialties and point out some of the work these areas cover. Health psychologists are postgraduate-trained experts who focus on the understanding of the crucial psychological components of good physical health that are applied through clinical work and health promotion. Health psychologists play an important role, particularly in the management of chronic disease. Their competencies are in the diagnosis and treatment of the behaviours, beliefs and attitudes that negatively impact on the prevention and management of chronic disease, as well as in a range of related disorders such as anxiety, depression, grief and addiction. I hope members do not mind. I quoted that directly from my notes because I wanted to make sure that I got it quite precise. Health psychologists can play a really vital role in making broad improvements to public health through their work. In their work, they increase patient adherence to prescribed medicines, medical testing and also lifestyle changes.
Health psychologists provide direct services in acute care, community services and private practice, and they also consult with, and educate, other professional groups in health behaviour change, and assist with health policy programs. They provide cost-effective interventions that deliver better outcomes from surgery and rehabilitation. This results in decreased hospital admissions and also assists with the slowed progression of chronic illness.
Community psychologists work preventatively to improve health and wellbeing. The field of community psychology focuses on prevention and early intervention as a means to promote health in addition to treatment. Community psychologists, like other psychologists, are focused on facilitating change in behaviour and attitudes, and generating the means to effect that change. However, rather than focusing on an individual’s behaviour change, they work with psychological concepts such as a sense of community to address system level change through researching and also developing and implementing theory relating to legislative initiatives, environmental change and community-wide reform. These sorts of initiatives are very relevant to health promotion activities, and again they are involved with things such as facilitating exercise in the management of chronic disease, developing social support networks and supporting resilient communities. Community psychologists also play a key role in foregrounding prevention of family violence as being very crucial to women’s mental health and mental wellbeing. They use principles of equity and respect for diversity. Australian community psychologists have established strong links with Indigenous and other community groups that have typically lacked access to mainstream health services. They also make very important contributions to reducing levels of illicit drug and alcohol use, as well as youth tobacco use and suicide and road deaths. Following the recent Victorian bushfires, the contribution of community psychologists was absolutely enormous. They played a really important role—a vital role—within those communities, both in preparation for, and in response to, the community-wide tragedies.
These two areas of psychology—health and community psychology—are particularly focused on public health approaches, and have developed specialisations and international research standing that cannot be covered in any other area of specialist psychology. They make a major contribution to extending psychological care from traditional areas of service delivery, such as hospitals and clinics in major cities. They go out to schools, workplaces, sports settings and art precincts, and obviously they do a lot of work in rural and remote communities also. These are really critical for successful health promotion, illness prevention and early intervention.
There is a desperate need in our society for psychologists of all specialties and at all levels of engagement, including engagement with individuals, but also with marginalised groups, communities and those who work on health promotion and illness prevention across whole populations. I think that investment in the core areas of illness prevention and health promotion has been shown to be among the most cost-effective ways in which we can spend our health dollars.
Psychologists are very concerned that the failure to include in the national scheme community and health psychology in those recognised areas of specialisation would result in the discontinuation of postgraduate programs in these areas. Today I have tried to highlight how critical these areas are and what a loss it would be if we were to downgrade the value of these particular categories of specialist psychology to our society. It would be a huge loss, particularly at a time when we are so desperately in need of specialists with expertise in systemic change, disease prevention and health promotion. Therefore, I support the calls of the Australian Psychological Society, as well as the individual psychologists who have contacted me, regarding the importance of maintaining the diversity of their profession. Health and community psychology should be included in the national scheme.
I will also briefly put the case for Western Australia having its own state board of the Psychology Board of Australia. I understand that at the moment the proposal is for WA to have a regional board shared with South Australia. I do not think we should have to share a psychology board with another state. On this point, I certainly concur with the committee. South Australia and Western Australia do not have a shared background in the way that we regulate psychologists. WA has a unique disciplinary system, and it is operated through the State Administrative Tribunal. We are the only state that currently recognises specialists. Therefore, I think we need a board that is going to understand WA specifically. Having only three Western Australians on a regional board is unlikely to be enough, given that the current Psychologists Registration Board of Western Australia comprises eight members and meets every month.
In summary, the Greens support improvements to the quality and the safety of our healthcare system, obviously. We also support moves to facilitate the increased mobility and flexibility of our health workforce around Australia. It is common to now work in several different states. We recognise that for health professionals to be able to move freely around Australia to deliver health services is certainly a good thing. However, when we are considering legislation about health, the safety of the public should be the primary concern. That is why we certainly do not support any lowering of Western Australia’s standards for psychologists. Again, as I said, I also do not support legislation that reduces our ability to scrutinise and potentially disallow regulations. As I said before, I think that that will have the effect of reducing accountability and transparency. On that note, we support the amendments proposed by the committee to improve these deficiencies within the legislation.
Western Australia has a strong history of nation-leading high standards and regulation in the psychology profession. I can understand why WA psychologists do not want to lose that specialist title. I can understand why they want community and health psychology to be recognised under the national scheme. Again, I do not know why neither of these things has been reflected in the plans for the national scheme. I urge the minister to do his utmost to progress these issues and to ensure that good outcomes are achieved, not only for Western Australian psychologists, but also for the Western Australian consumers of the services of those psychologists. Therefore, I will be seeking an undertaking from the minister that that is what he will do. We certainly do not want this state to go backwards and be worse off under this national scheme. Considering that psychologists have taken these extra steps to do that additional training and to work so much harder, it is highly problematic that they will now effectively be penalised as a result of coming into the national scheme.
I commend the members of the psychology profession for their passion and for the diligence that they have demonstrated in engaging in this debate and campaigning on these issues. These are very important issues. I know that their voice has been heard. I hope that in hearing their message, the members of the ministerial council will do the right thing and make the necessary changes to the national scheme.