|Competence Assurance Bill|
|Implemented in this survey?|
The Ministry of Health has reviewed the 2003 Health Practitioners Competence Assurance Act which provides mechanisms to ensure health practitioners are competent and fit to practice.The review found that, although the Act is operating largely as intended, there are a number of areas that could be improved. These include better communication about how the Act operates, improved administration by the Ministry of Health, and more efficient procedures for managing complaints.
The main aim of the Health Practitioners Competence Assurance Act (2003), which brought all regulated health professions under a single piece of legislation, is to ensure that health professionals are competent and fit to practice their professions (see Survey 2003 (1) for more details). The Act also aims to ensure higher and more consistent standards amongst health professionals and to provide a supportive environment in which health professionals can practise, maintain their competence throughout their careers, and learn from their experiences and the experiences of their colleagues. The Act includes a requirement that the legislation be reviewed after 3 years to consider whether any amendments are necessary or desirable. The purpose of this review was to examine whether the Act was operating well with respect to its underlying policy settings, rather than to review the overall impact of the Act on practitioner competence and public safety.
The Ministry of Health commenced its review in 2007. The review was undertaken in 4 phases: a survey of organisations and individual practitioners on the operation of the Act, a series of open workshops to develop proposals (April 2008), a second series of workshops to discuss preliminary findings and develop recommendations (September 2008), and a draft report for public consultation (January 2009). The final report was released in June 2009.
|Medienpräsenz||sehr gering||sehr hoch|
The recommendations made by this review call for marginal rather than fundamental changes to the legislation and to the organisations involved in setting the standards and in monitoring the competencies of health professionals. The structural impact of the recommendations is therefore likely to be rather marginal.
While many of the principles and processes that underlie these recommendations could apply equally in other health systems, the particular mix of rules and regulations, and of the agencies responsible for monitoring these, are peculiar to the New Zealand setting. The transferability of this policy is therefore described as "rather system-neutral."
|Implemented in this survey?|
One hundred and fourteen individuals and organisations responded to the reviewers' initial survey of the operation of the Act (Ministry of Health, 2008). The large majority of submissions came from (medical and non-medical) professional groups covered by the act but submitters also included payers (District Health Boards and the Accident Compensation Commission), regulatory authorities, service providers (especially NGOs), tertiary educators and individual health professionals.
Most groups considered that the Act has had a positive impact on standards of competence of registered health professionals. However, all submitters made recommendations for improvements in the legislation or in the way that the regulations are implemented and monitored.
A common criticism across many groups of stakeholders was that, while regulated practitioners cannot work outside of their scope of practice, unregistered practitioners are able to work in any scope of practice with impunity (Ministry of Health, 2009). It was suggested that, if the Act is truly to achieve its goal, then unregistered practitioners should not be able to undertake work that is within the scope of practice of regulated practitioners. Some stakeholders disapproved of the Ministry of Health's approach to enforcing the Act. There was also a strong view - especially amongst service providers - that scopes of practice are sometimes developed without proper consultation, and that descriptions about scopes of practice are often too technical, or do not accuately describe what practitioners actually do.
Some provider organisations (including the New Zealand Medical Association and the NZ Nursing Organisation) expressed concerns that, under this Act, all members of the regulatory authorities (such as the Medical and Nursing Councils) are appointed by the Minister of Health. There is therefore no provision for health professionals to directly elect members to these authorities. The NZ Medical Association also expressed concerns about the wide power that the legislation gives to the Minister to intervene in the decisions of the regulatory authorities.
Some of the regulatory authorities (such as the Nursing Council) felt that disciplinary procedures tend to be overly bureaucratic, lengthy and costly. Other stakeholders felt that qualifications were being driven by educators rather than by the needs of health practitioners, and that a strong focus on registration and recertification through university qualifications or other education courses is costly yet does not necessarily maintain or improve competence.
|Minister of Health||sehr unterstützend||stark dagegen|
|Ministry of Health||sehr unterstützend||stark dagegen|
|Provider associations||sehr unterstützend||stark dagegen|
|Regulatory authorities||sehr unterstützend||stark dagegen|
|Minister of Health||sehr groß||kein|
|Ministry of Health||sehr groß||kein|
|Provider associations||sehr groß||kein|
|Regulatory authorities||sehr groß||kein|
The reviewers found that, overall, the Act has operated as the Government intended (Ministry of Health, 2009). However they made a number of recommendations for improvement, including:
If accepted by the Minister, these recommendations will require 18 minor legislative changes plus some changes in the way that responsbile authorities work together.
The report of the review committee was tabled in Parliament on 4 June 2009 and the Ministry of Health subsequently developed a work programme for implementing the review's recommendations. Given that the recommendations concern operational matters only, there is no reason to believe that the recommendations will not be implemented in full.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
As noted above, this review concerned the operation of the Health Practitioners Competence Assurance Act rather than the impact of the Act on professional competencies. Changing operational aspects of the Act is unlikely to have any significant impact on the quality and equity of service provision. There could be some impact on the cost of some services if the review results in some streamlining of the regulatory processes.
|Competence Assurance Bill|
Process Stages: Gesetzgebung
Toni Ashton, CHSRP