Contents Part 1 Cross-professional mandatory standards...2 Future considerations...4 Part 2 Profession-specific responses...5 Dental standards...

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1 Contents Part 1 Cross-professional mandatory standards...2 Future considerations...4 Part 2 Profession-specific responses...5 Dental standards...5 CPD and recency of practice...5 Scope of practice standard...5 Medical standards...6 CPD and recency of practice...6 Nursing and midwifery standards...6 CPD and recency of practice...6 S98 endorsement for approved area of practice...6 Optometry standards...6 CPD and recency of practice...6 Pharmacy standards...7 CPD...7 Recency of practice...7 Physiotherapy standards...7 CPD...7 Recency of practice...7 Specialisation...7 Podiatry standards...7 CPD and recency of practice...7 Specialisation...7 Psychology standards...7 CPD...7 Recency of practice...7 Specialist registration...8 Practice protections...8 Qualification requirements for general registration...8 Appendix 1: Provisions for endorsement of mental health nurses...10 Table 1: Existing provisions for the recognition of mental health nurses by jurisdiction

2 Part 1 Cross-professional mandatory standards The HSU asserts that the standards for professional indemnity insurance, English language and the criminal history checks ought to be common across all professions. In Part 1 we quote the relevant sections of the Practitioner Regulation National Law Act 2009 QLD (the Act) in black and our response appears in purple. 38 National board must develop registration standards (1) A National Board must develop and recommend to the Ministerial Council one or more registration standards about the following matters for the health profession for which the Board is established (a) requirements for professional indemnity insurance arrangements for registered health practitioners registered in the profession; The Act does not restrict the type of professional indemnity insurance policy that is to cover health professionals. The protection of the public is ensured if registrants have a policy that: indemnifies the registrant against liability at law arising from any claim during the policy period resulting from an alleged breach of professional duty and/or from professional malpractice covers the practitioner s scope of practice and does not exclude any procedures that the practitioner performs has a limit of liability that could reasonably be expected to cover a successful claim (refer Nurses Board Discussion Paper) Individual and group policies (i.e. those provided by a union or other association or an employer) must be acceptable by each board provided they meet the above conditions. We note that the draft standard prepared by the Physiotherapy Board of Australia (Section 2.3 of the board s consultation paper) is closely aligned with the Union s requirements. We seek to add to the reference to association in Point 4 a statement that group policies must meet all other requirements. With that addition we urge other boards to adopt the Physiotherapy Board s wellcomposed draft. The proposal of the Pharmacy Board of Australia is not acceptable, specifically Requirement 2, which states: The PII policy must be in the name of the pharmacist and must not expire during the general registration period. Any restriction on the type of policy is anticompetitive and possibly a breach of competition policy. Group policies that meet the other requirements adequately protect the public. It is completely unnecessary for a policy to be in the name of the individual, so the HSU is strongly opposed to Requirement 2, which must be replaced with the provision outlined above. The proposals of the Psychology, Podiatry, Medical, Optometry and Dental boards must be amended to include reference to union or association in the requirements related to group policies. (b) matters about the criminal history of applicants for registration in the profession, and registered health practitioners and students registered by the Board, including the matters 2

3 to be considered in deciding whether an individual s criminal history is relevant to the practice of the profession; There is a limited number of offences that would cause concern that the health and safety of the public could be at risk if a practitioner who committed those offences were registered. In general, criminal history is only to be considered relevant where the offence committed is relevant to the practice of the profession in question. In particular, an offence is relevant if commission of the offence casts doubt on the individual s capacity to practice or is suggestive that their character is unsuitable for a trusted health professional. The principles of natural justice must be applied so only recorded convictions should be considered. Charges and spent convictions are not relevant and must not be a consideration in any circumstances. The union does not propose to list offences that ought or ought not be considered but as an industrial organisation we must insist that offences related to industrial action and protest must be excluded from consideration. Offences arising from political or humanitarian actions should also be excluded from consideration. It is vital that board members making registration decisions are NOT provided with information pertaining to spent convictions or charges that did not result in a plea or finding of guilty. Board employees must be tasked with vetting any history obtained to ensure that only relevant matters are put to board members. (d) requirements about the English language skills necessary for an applicant for registration in the profession to be suitable for registration in the profession; In most professions and jurisdictions the requirements for potential registrants who have not taken their secondary or tertiary education at English speaking institutions is a score of at least 7 in all domains of the IELTS test or equivalent. HSU members are concerned that this score is inadequate. At present some professionals trained overseas struggle with verbal communication with patients, particularly where colloquialisms are used and in busy settings where professionals do not have time to reflect on what they are told. We note that the majority of boards consultation papers recommend retention of the existing requirement and that the Pharmacy Board questions whether a score of 7.5 (or equivalent) may be more appropriate. On balance the HSU considers that remaining at a score of 7 is adequate at present. However, the union notes that consumers are concerned about the English language skills of professionals trained overseas and urges boards to actively monitor community satisfaction and professional performance, particularly in the listening and speaking domains. 3

4 Future considerations The HSU has many members who work as assistants to most of the professions covered under the Act. We note that, across Australia, assistants are being pressured by employers to take on extended duties, often without appropriate support or training. Members are often vulnerable and find it difficult to resist pressure from employers, even though they do not feel comfortable taking on additional roles. Professional members are regularly placed in an awkward position in that their professional ethics and indemnity insurance do not allow for the supervision of assistants in roles for which they have not been trained. The HSU regularly receives requests to help assistant and professional members to resist pressure to work out of scope and/or at a level above which they are remunerated. To the best of the union s ability we are assisting in the protection of the public in this regard. However, it is likely that some form of regulation of assistant workforces will be necessary in future. The HSU calls on boards to establish mechanisms to collect information on the quality and safety of services that patients are receiving from the assistant workforce. Information will not be easy to collect without a major research project and it may be anecdotal in nature. However, as pressure on the scope of practice is escalating, we believe this information is important to ensure that boards are able to protect the public in future. Once collected, these data should be analysed (by profession) to determine whether regulation of the assistant workforce is necessary to protect the public. The union is willing to discuss with boards ways in which we may be able to assist with data collection and to collaborate on applications for funds to carry out this vital study. 4

5 Part 2 Profession-specific responses Dental standards CPD and recency of practice The HSU supports the recommendation of the national body for Dental Therapists and Oral Therapists, the Australian Dental and Oral Therapists Association (ADOHTA), in relation to continuing professional development requirements. ADOHTA has recommended the following. ADOHTA recommends that CPD in cardiopulmonary resuscitation (CPR) and infection control are an annual requirement. The 80 % clinical or scientific content may be difficult to achieve if a narrow definition of scientific is taken to mean only biological or clinical science. The ADOHTA recommends the inclusion of behavioural and social sciences to ensure practitioners are encouraged to develop skills in all areas relevant to safe provision or oral health care. The requirement of 60 hours CPD over three years is excessive and unachievable particularly for rural and remote registrants. ADOHTA recommends a re-evaluation of the feasibility of this time requirement. It will be necessary to ensure that approval is given for CPD activities via means other than face to face didactic events: Electronic platforms, review of journals and research to name a few. The HSU supports a non-practicing period of five years before recency of practice requirements are triggered. Scope of practice standard Dental Therapists (DTs) and Oral Therapists (OHTs) are independent practitioners who are not required to work under the supervision of a dentist. As currently drafted Section 3.1 of the standards infers that DTs and OHTs must work under supervision. This is a substantial departure for existing standards and must be amended. Requirement 6 is totally unacceptable to the HSU and the statement that dentists are clinical team leaders in Requirement 3 is also opposed by the union. Each of the professions is autonomous and each has its own scope of practice. The scope of practice of dentists is more extensive than the scope of the other professions but that does not mean that the other professions require supervision in all circumstances or that dentists are team leaders in all circumstances. In most jurisdictions DTs work as independent practitioners without supervision and can set up their own private practice with a referral relationship with a dentist. This has been in place for many years but would be disallowed under the proposal of the Dental Board. In all Australian states where there are school dental services (community services), DTs and OHTs are employed as independent practitioners. This arrangement delivers quality services where they are needed and any change would substantially reduce the capacity of the dental workforce. Requirements 3 and 6 must be amended to ensure that existing practice arrangements can continue. Failure to amend these provisions will lead to a substantial reduction in the dental workforce and have a deleterious impact on our members who currently practice independently. 5

6 Medical standards CPD and recency of practice The HSU supports the proposed requirements. Nursing and midwifery standards CPD and recency of practice The HSU supports these requirements. S98 endorsement for approved area of practice The Act provides for the endorsement of nurses and midwives as nurse practitioners and midwife practitioners only. Many states and territories currently have a number of other endorsements or recognise postgraduate qualifications in particular areas of practice, one of those being mental health. There are variations between states and territories in current regulatory standards, endorsement and mandatory minimum qualification standards for other areas of practice, with five states currently regulating practice. Appendix 1 details the existing provisions. The HSU submits that mental health nurses must be endorsed to ensure the protection of the public and of the nurses delivering services to patients with severe mental illness. Mental health services are complex and nurses working in the field require postgraduate qualifications. The qualifications ensure that patients receive the care they require and that nurses are equipped to respond to difficult or violent patients. We further contend that there are significant workforce drivers for the endorsement of mental health nurses. In particular we note the increasing demand for health professional services and the proliferation of government mental health programs requiring mental health nurses. Without endorsement, there is limited incentive for nurses to take the additional qualifications required to deliver services at the requisite standard. The union therefore calls on the board to apply under Section 15 for approval of mental health nursing as an area of practice for the purposes of endorsement. Endorsement would enable the board to approve education standards and education providers, determine the minimum requirements for endorsement and approve competency standards for mental health nurses. Such approval is essential to ensure that the health and safety of the public are protected. Optometry standards CPD and recency of practice The HSU supports the proposed requirements. 6

7 Pharmacy standards CPD The HSU notes that the draft standard broadly reflects the numerical CPD points/credits requirements in the majority of the ENRICH handbooks but that the requirements are less defined than in the relevant handbooks. We consider that the standards will evolve over time and thus support the draft CPD standard. Recency of practice The HSU supports this provision but contends that it could be improved by requiring the applicant to undergo an interview with members or delegates of the board to investigate the requirements and evidence necessary to register the applicant. Physiotherapy standards CPD The HSU supports the draft standard. Recency of practice The HSU supports this requirement. Specialisation The HSU supports recognition of the clinical specialties accredited by the College of Physiotherapy under Division 2 of Part 7 of the Act. The board s proposal is thus acceptable to the HSU. However, the union notes that there will be industrial ramifications associated with recognition and reserves the right to make claims accordingly. Podiatry standards CPD and recency of practice The HSU supports the CPD requirements and argues that the recency of practice provisions should not be triggered by a five-year non-practicing period. Specialisation The HSU supports recognition of podiatric surgeons as specialists in Division 2 of Part 7 of the Act. Psychology standards CPD The HSU supports the board s proposal. Recency of practice The HSU does not understand why the term remedial action (Requirement 2(b)) has been chosen. It has a punitive tone to it and the union does not support its use. However, the union does support the proposal that psychologists who have not practised for five years or more will not be eligible for automatic registration and may be required to undertake supervised practice and additional CPD. 7

8 The HSU supports the proposal for psychologists who have not practised for three to five years to provide evidence of CPD (excluding supervision) activities. Psychologists who have not practised in Australia for more than three years but who have practised and/or been registered in an equivalent jurisdiction overseas should be granted registration. Specialist registration The HSU supports specialist registration by the board, subject to the proviso that any changes that are proposed to the criteria for specialist registration are the subject to a process of consultation with all stakeholders, including industrial organisations/unions representing psychologists. The union supports legislative protection of specialist titles. We make the following points in relation to specialist recognition. The minimum qualification for a specialist title should be a professional doctorate in the speciality plus one year s approved supervised full-time equivalent practice as proposed The HSU supports the proposal regarding equivalence of a PhD with the caveat that all specialist coursework and placement at master s level have been completed plus CPD and an additional two years supervision Psychologists who are currently members of a specialist college of the Australian Psychological Society will be registered as specialists under the national board ( grandparenting ). We are unsure of what clinical geropsychology is and would like clarification and further information before commenting on that proposal. Practice protections The HSU notes with concern that psychological testing has not been included in Subdivision 2, Division 10 of Part 7 of the Act. Our psychologist members have consistently argued that psychological testing and the interpretation of results should only be undertaken by registered psychologists to protect the public from the administration and/or interpretation of psychological tests by persons who lack the necessary education and training and depth of knowledge. No-one other than a registered psychologist should be permitted to administer or interpret psychological tests. The HSU calls on the board to lobby for an appropriate amendment to the Act. We are sure that board members are cognisant of the dangers posed by unqualified persons administering and/or interpreting psychological tests and we do not propose to repeat the concerns here. However, we would be pleased to provide additional information on request. Qualification requirements for general registration The HSU supports the phasing out of the four-year university degree plus two-year internship over six years. That is, students enrolled in four-year undergraduate courses as at 1 July 2010 or enrolled in a fourth year equivalent diploma as a 1 July 2010 may continue with a two-year board-approved internship, but this is to cease for new enrolments from 1 January Further, we support the phasing out of the current arrangements immediately, except for students enrolled as at 1 July The base qualification for general registration ought to be a six-year Australian Psychology Accreditation Council accredited sequence of study with a minimum qualification of a master s degree. 8

9 A person with a PhD (as opposed to a professional doctorate) may be registered having completed a one-year internship and/or placements at master s level plus CPD. 9

10 Appendix 1: Provisions for endorsement of mental health nurses Table 1: Existing provisions for the recognition of mental health nurses by jurisdiction State Legislation Regulations Qualifications required Tas Section 31 of the Nursing Act 1995 provides for the authorisation to practise in restricted practice areas of which psychiatric nursing is identified. Vic Section 12 of the Professions Registration Act 2005 states that: A responsible board, from time to time, may recognise any qualification that the responsible board considers to be relevant to the provision of regulated health services in the health profession the board regulates in addition to those required for registration. SA The Nursing and Midwifery Practice Act 2008 states: 36 Endorsement (a) recognition in a particular area of nursing or midwifery prescribed by the regulations Nil Nil Nursing and Midwifery Practice Regulations 2009 identifies the following: 7 Prescribed areas of nursing or midwifery For the purposes of section 36(2)(a) of the Act, the area of mental health nursing is prescribed. The Nurses Board of Tasmania requires a registered nurse to have a postgraduate Diploma in Mental Nursing from an approved education provider. The Nurses Board of Victoria recognises the postgraduate Diploma in Mental Nursing as an additional qualification. The course must be approved by the NBV. The Nursing and Midwifery Board of South Australia requires a postgraduate Diploma in Mental health Nursing from an approved education provider. Qualification offered in the jurisdiction Postgraduate diploma in Mental Master of Nursing Mental Master of Nursing Mental Masters of Nursing Mental 10

11 State Legislation Regulations Qualifications required WA Western Australian Nurses and Midwives Act 2006 states: Registration as specialists (1) The Board is to register an applicant as a specialist in a branch of nursing prescribed by the regulations as a specialty. Nurses and Midwives Regulations 2007 identifies the following: Specialty prescribed For the purposes of section 31(1) of the Act, mental health nursing is prescribed as a specialty. NT Nil Nil Nil QLD Section 77 of the Nursing Act 1992 states: An individual may be authorised by the council to practise mental health nursing if the person has successfully completed a mental health nursing course accredited by the council or a comparable course outside Queensland that is based on similar competencies. Section 13 of the Nursing Regulation 2005 Application for authorisation to practise (1) A person may apply to the council to be authorised to practise midwifery, mental health nursing. ACT Nil Nil Nil NSW Nil Nil Nil The Nurses & Midwives Board of Western Australia requires a postgraduate Diploma in Mental Nursing. The Queensland Nursing Council requires a postgraduate Diploma in Mental Nursing. Qualification offered in the jurisdiction Master of Nursing Mental Master of Nursing Mental Master of Nursing Mental Master of Nursing Mental Master of Nursing Mental 11

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