Review of legislation on workforce competencies

• Abstract
• Characteristics of this policy
• Purpose and process analysis
• Expected outcome
• References

Abstract

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.

Recent developments

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. 

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Structural or Systemic Impact	marginal		fundamental
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral
current    previous

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."

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Initiators of idea/main actors

• Government: The review process is being undertaken to satisfy a legislative requirement.

• Providers

• Civil Society

Stakeholder positions

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.

Actors and positions

Government
Minister of Health	very supportive		strongly opposed
Ministry of Health	very supportive		strongly opposed
Providers
Provider associations	very supportive		strongly opposed
Civil Society
Regulatory authorities	very supportive		strongly opposed
current    previous

Actors and influence

Government
Minister of Health	very strong		none
Ministry of Health	very strong		none
Providers
Provider associations	very strong		none
Civil Society
Regulatory authorities	very strong		none
current    previous

Positions and Influences at a glance

Monitoring and evaluation

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:

1. More effective communication and engagment is required between the responsible authorities, the public, funders, practitioners, educators, employers, policy makers and other key stakeholders.
2. Increased collaboration between the authorities that are responsible for professional regulation (such as the Medical Council and the Nursing Council) could improve methods of functioning and reduce costs.
3. The Ministry of Health should increase and improve its role in administering the Act.
4. The process for considering when and where health services should be designated as health professions (i.e. so that the Act covers additional groups of practitioners) should be improved.
5. A number of technical changes to the legislation were recommended to improve the flexibility and efficiency with which complaints and matters concerning professional conduct are managed.
6. Regarding quality assurance actvities, overall the review found that the protections afforded by the Act are valuable and have encouraged quality assurance activities. However some operational aspects could be improved, including the simplification and reduction of reporting requirements.
7. The reviewers made a number of other recommendations, including that responsible authorites do not impose more restrictions on registering practitioners than are allowed under the Act.

If accepted by the Minister, these recommendations will require 18 minor legislative changes plus some changes in the way that responsbile authorities work together.

Expected outcome

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.   

Impact of this policy

Quality of Health Care Services	marginal		fundamental
Level of Equity	system less equitable		system more equitable
Cost Efficiency	very low		very high
current    previous

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.

References

Sources of Information

• Ministry of Health. Review of the Health Practitioners Competence Assurance Act. Report to the Minister of Health by the Director General of Health. Wellington: Ministry of Health, June 2009. www.moh.govt.nz/moh.nsf/indexmh/report-to-minister-on-the-review-of-hpca2003-jun09?Open
• Ministry of Health. Analysis of responses to Ministry of Health Survey Document - Review of the Health Practitioners Competence Assurance Act 2003: Identification of Issues and Proposed Solutions. Wellington: Ministry of Health, March 2008. www.moh.govt.nz/moh.nsf/indexmh/hpca-review-submissions-analysis-mar08?Open
• Ministry of Health. Review of the Health Practitioners Competence Assurance Act 2003: Identification of Issues and Proposed Solutions. Wellington: Ministry of Health. October 2007. www.moh.govt.nz/moh.nsf/indexmh/hpca-identification-issues-solutions-consultation-oct07?Open

Reform formerly reported in

Competence Assurance Bill Process Stages: Legislation

Author/s and/or contributors to this survey

Toni Ashton, CHSRP

Suggested citation for this online article

Ashton, Toni. "Review of legislation on workforce competencies". Health Policy Monitor, October 2009. Available at http://www.hpm.org/survey/nz/a14/5