Speech Pathology Australia. Options for regulation of unregistered health practitioners

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1 Speech Pathology Australia Response to: Consultation paper: Options for regulation of unregistered health practitioners (February 2011) Australian Health Ministers Advisory Council Response date: Response from Speech Pathology Australia Page 1 of 11

2 Submission from Speech Pathology Australia Summary Position Speech Pathology Australia has a strong commitment to quality health services and supports the government s intention of ensuring the protection of the public and the minimisation of the risk of harm from incompetent and poor practice and professional misconduct. The current National Registration and Accreditation Scheme (NRAS) that includes some professions and excludes others is not an effective or equitable system of practice regulation. Health Professions that are well established, and for which education and training is delivered through accredited tertiary-level training courses, should be included in the Scheme. Statutory registration provides the greatest level of public protection. Speech Pathology Australia believes there is a strong public interest in the profession of speech pathology being included in the NRAS and is continuing to work towards professional registration for speech pathologists. Speech Pathology Australia currently has strong self-regulation mechanisms, linked to membership, that ensure that speech pathologists have the appropriate qualifications and practice competencies; that they practise within the Association s code of ethics and scope of practice; and that their practice is recent and current. Members of Speech Pathology Australia can be accredited as Certified Practising Speech Pathologists which attests to their maintenance of continuing professional development. Speech Pathology Australia is currently working on strengthening and extending these regulatory mechanisms to be in line with the mandatory standards of AHPRA, with the view of transitioning into the National Registration and Accreditation Scheme in the future. Current and extending mechanism that naturally align with registration are outlined in Appendix 1. The Government through a national framework should recognise the robust self-regulatory mechanisms of those professions who can demonstrate they have these in place. The Government should strengthen self-regulation of all practising speech pathologists through mandating membership with their accredited professional body. This will ensure accountability in terms of ethical and competent practice of all practising speech pathologists. Complementing the self-regulatory functions of professional bodies, a safety-net universal statutory code of conduct and body to exercise investigations and prohibitions (mirrored on AHPRA) should apply to those health practitioners who are not members of a recognised self-regulating professional body. In summary, a national professional regulation framework should be developed that applies to registered, regulated and non-registered/regulated health practitioners, and is inclusive of the following components: NRAS, and state-based registration boards (ie in Queensland) regulation through accredited self-regulating peak bodies, and a statutory Code of Conduct outlining minimum acceptable standards of practice and a responsive national complaints mechanism (option 3), with capacity to limit or prohibit practice for non-compliant practitioners, to apply to those not falling under registration or recognised regulation schemes. Response from Speech Pathology Australia Page 2 of 11

3 Background to Speech Pathology Australia Speech Pathology Australia (SPA) is the national peak body for the speech pathology profession in Australia with 4,500 members. The first Australian speech pathology clinic was established in 1931 and a professional association for Australian speech pathologists (now Speech Pathology Australia) was formed in For nearly 60 years the Association has established and governed the evolving ethical and clinical standards of the profession. Speech Pathology Australia is recognised by the Department of Education, Employment and Workplace Relations, as the professional body representing speech pathologists in Australia. As such, it is acknowledged as both an accreditation authority for university speech pathology degree programs and a skills assessing authority for those who have overseas qualifications. The contemporary role and focus of the speech pathology profession is both well defined and readily understood by those within the profession and their other professional partners. This role is consistently reflected in documents produced by Speech Pathology Australia, including the Code of Ethics (2010), Competency Based Occupational Standards CBOS (2001, revised in 2011), Scope of Practice (2001), Competency Assessment in Speech Pathology COMPASS (2006) and Parameters of Practice (2007). It is also reflected in the educational qualifications undertaken by speech pathologists, the process of accrediting university degrees, and the focus of continuing professional development programs. Speech Pathology Australia has a commitment to ensuring high standards of ethical conduct and clinical practice of its members and advancing the profession with respect to providing evidencebased and efficacious services to maximise the health and educational outcomes of those with communication and swallowing difficulties. Speech Pathology Australia believes it demonstrates a commitment to maintaining professional standards and accountability for the profession through the setting of competency standards, the provision of comprehensive professional development and self-regulation (certification) programs and by formalised processes for the hearing of complaints and disciplinary procedures as governed by the Code of Ethics. (For further details refer to Appendix 1). (continue over for responses against Quick response questions) Response from Speech Pathology Australia Page 3 of 11

4 Comments against Quick Response Form Section 2 SCOPE If you are a professional association, can you provide an estimate of the number of unregistered health practitioners you believe to be practising in your profession or field. The scope of this work needs to take into account the differing levels of current regulatory frameworks across the professions listed as being applicable to this discussion. The professions listed on page 5 of the consultation paper are vastly different in terms of history, tertiary training, professional standards, evidence-based practice, inclusion in Medicare and national regulatory structure, and therefore should not be viewed similarly. This work needs to be informed by the nature of the profession, the presence or not of a strong professional identity and national peak body, existing regulatory functions and capacity to regulate the profession, and the history and extent of complaints and public concern. This consultation process should necessarily seek this information and data to inform final recommendations. Data on speech pathology profession Practising speech pathologists in Queensland have a formal registration scheme. However, registration is not established in other states or territories, and practising speech pathologists outside of Queensland, potentially fall outside a legislative framework to govern qualifications, standards and conduct. As outlined in the previous section, Speech Pathology Australia has put in place rigorous self-regulating mechanisms that are applied to those who have elected to be considered for membership and those who are members of Speech Pathology Australia. Workforce data available through the Queensland registration body, indicates that the number of speech pathologists registered in Queensland (as of June 2010) was 1,408. At this same time, there were approximately 732 SPA members from Queensland, which is equivalent to just 52% of those registered in Queensland overall. It could be assumed however that a higher membership level is likely in other states/territories without registration, particularly as in these jurisdictions membership of SPA is required for Medicare Provider status and other funding bodies eligibility criteria. Based on the profession s data in Queensland and extrapolating from this, the potential number of speech pathologists working in Australia (on per capita basis by state/territory) could be estimated at around 6500 clinicians. Given there are approximately 4,000 practising members of SPA, it is estimated that 2,500 (40%) are not members with a significant number (approximately 1,800) therefore not being regulated under either the Qld Board or SPA. Additionally the profession is growing at a fast rate with increased intake of students in existing programs and additional speech pathology courses now on offer or under development. In 2009, the profession was the second fastest growing profession registered by the 12 health practitioner registration Boards in Queensland. The number of speech pathologist registrations in Queensland has grown by 6% (averaged) annually since As the speech pathology profession currently falls outside the NRAS, the government should take measures to ensure that speech pathologists, whether practising in the public or private sector, should be members of the professional body, (Speech Pathology Australia,) which can ensure accountability in terms of qualifications and ethical and competent practice. Given the growth in the profession, and therefore the need to actively manage risk for the public, it is essential that speech pathology practitioners do not practice outside a regulated environment whether through registration and/or the professional body s internal regulating mechanisms. This can particularly occur where practitioners with overseas qualifications are employed without their qualifications and competencies being assessed by the recognised assessing authority. Response from Speech Pathology Australia Page 4 of 11

5 Section 4 THE PROBLEM Risks What do you think are the risks associated with the provision of health services by unregistered health practitioners? Speech Pathology profession Speech Pathology is a profession which potentially poses risks to public health and safety inherent in the profession s practices and services. By the nature of communication and swallowing disorders, speech pathologists work with people who are physically, socially and emotionally vulnerable. When clinical procedures are not carried out with due care and competence, and when complex invasive clinical instrumentation is not used appropriately, patients are at significant risk of physical harm and sometimes death. Additionally, the risk of considerable compromise to an individual achieving their developmental, educational, social and vocational potential is high when opportunities are lost due to poor practice in diagnosing and supporting an individual s communication needs. Details of the procedures of speech pathologists and their inherent risks are outlined within the profession s submission for inclusion in the National Registration and Accreditation scheme (The Speech Pathology Profession: A national approach for working in the public interest, October 2008). This submission contended that a range of the activities of the profession pose a significant risk of harm to the health and safety of the public if not conducted by qualified and competent speech pathologists. A number of areas in regard to the use of invasive clinical practices, emerging advanced and extended scope of practice, and incompetent practice were discussed with respect to risks to the public, wider community and speech pathologists. A number of areas of speech pathology practice are consistent with the conditions of risk as outlined in Appendix 8 of the Discussion paper. Additionally, it is common for speech pathologists to work in sole positions or without discipline specific management and supervision of clinical practice. Many workplaces lack the capacity to regulate and monitor professional standards of practice. It can be seen that there are substantial risks to the public associated with speech pathology remaining an unregistered profession (in all states except Queensland). Those practising speech pathology without appropriate competencies and evidence informed practice and those not adhering to the profession s code of ethics and clinical standards pose very real risks to the public. Complaints data Data about the speech pathology workforce in Australia is incomplete because statutory registration is only applied to speech pathologists working in Queensland. Speech Pathology Australia receives complaints from the public or other practitioners in regard to the competence and ethical behaviour of speech pathologists. While the Association only has the jurisdiction to investigate complaints concerning members, it does provide advice to the public regarding how they may have their concerns about non-member speech pathologists addressed through other jurisdictions. The Options consultation document shows a small number of formal complaints against speech pathologists through existing state-based Health complaint entities (NSW 2 over the last 5 years; Qld 3 over the last 10 years; nil in other states). The Speech Pathologists Board of Queensland has had 3 formal complaints in regards to professional practice over the last 14 months while they have also addressed a higher number of other concerns relating to currency of practice, requirements for further training and practising while not registered (Speech Pathologists Board of Queensland, Submission to this Consultation paper, ). Response from Speech Pathology Australia Page 5 of 11

6 The number of enquiries received by Speech Pathology Australia regarding professional and ethical matters has increased significantly with the number of formal complaints showing a small increase. The issues include matters of professional decision making, competence, scope of practice, transparency and communication with consumers, business practice integrity, and workplace or industrial concerns. Complaints reported to Speech Pathology Australia Year Queries and Complaints received Converted to Formal Complaint (ytd) 53 2 While the number of formal complaints regarding speech pathologists is relatively small the profession/association still considers this to be unacceptable as this reflects poorly on professional standards, behaviour and competence. It can be viewed that the profession is being regulated fairly well through its peak professional body and the registration board in Queensland, however this is not as satisfactory as would be the case if the profession was universally regulated under the framework of the NRAS. Section 5 THE OBJECTIVES OF GOVERNMENT ACTION What do you think should be the objectives of government action in this area? The mandate of the government is to protect from harm the health and safety of the public. National Registration has been put in place as of July 2010 as a means of ensuring that the standards, competence and behaviour of health professionals are determined and monitored with extensive powers bestowed to protect the public. These powers however do not extend to practitioners not covered under the National Scheme. Speech Pathology Australia supports the government s commitment to ensuring that there is adequate protection of the public and a regulatory framework with regard to health services delivered by practitioners not covered under the National Registration and Accreditation Scheme. However as will be discussed below, the current proposal falls short in comparison to NRAS in that all proposed options do not assure the public that the health practitioner they choose to see is appropriately qualified under the title they give, is competent and fit to practice, adheres to ethical standards and maintains appropriate professional development. The proposed framework for non-registered practitioners only applies to mechanisms once a complaint is made and therefore falls well short of the gold standard of professional regulation. Statutory registration provides the simplest, most transparent form of practice regulation for the public. The current fragmented approach, across professions, and across healthcare makes it very difficult for the public to identify and know what the processes are. Statutory registration also provides a more robust mechanism for articulating professional standards, and as such is a more proactive approach to practice regulation. Statutory registration also provides a mechanism for comprehensive data collection about the health care workforce. Response from Speech Pathology Australia Page 6 of 11

7 Section 6 THE OPTIONS Do you think there is a case for further regulatory action by governments in this area? What do you think of the various options? The Consultation paper outlines 3 options: Option 1: No change Option 2: A voluntary code of practice for unregistered health practitioners Option 3: A national statutory code of conduct for unregistered health practitioners The options provided discuss a range of regulatory frameworks available to protect the public but need not be considered in isolation or exclusively. The National Registration and Accreditation Scheme currently provides for comprehensive regulation of the qualifications and standards of professions along with protection of title. In the same way, those professional bodies which have extensive self-regulatory mechanisms in place mirror these regulations for their members, and in so doing have been governing their profession for many years, albeit with less statutory powers. Option 3 in the discussion paper, provides baseline protection with respect to those practitioners who are not covered under the NRAS or regulating professional bodies and where the public complains about the practitioner s practice and failure to comply with a statutory code of conduct. Speech Pathology Australia contends that each system has merit and applicability to certain circumstances and professions and that the government needs to view these in the context of an overall regulatory framework for the country. A framework guiding professional standards, conduct and a complaint mechanism should apply across all health service providers and be applicable to both those registered and non-registered professions alike. The National Registration and Accreditation Scheme should be available for those professions that pose the greatest risk of harm to the public and should be extended over time beyond the current identified professions. To this end, the speech pathology profession will continue to pursue inclusion. Regardless of the profession s registration status, Speech Pathology Australia will maintain its well-placed role and recognition as the governing body for the speech pathology profession and continue its robust and rigorous mechanisms of regulation and promotion of high standards of ethical and quality practice. The government needs to recognise bodies, like Speech Pathology Australia, who have strong regulatory functions already in place and consider a framework which will provide for accreditation or certification of such associations who can demonstrate meeting the self-regulatory requirements. In this context Option 3 with a statutory code of conduct for all health service providers could apply to all and will be complementary to discipline specific standards and codes of ethics, working in tandem but not in substitution. The government should consider ways in which practitioners are required or encouraged to be members of their professional body where it is government accredited. However where such a body does not exist, or exists without sufficient regulating capacity, and where a practitioner is not a member, then the statutory code of conduct and its complaints mechanisms and prohibitions will apply. Do you think there should be a nationally uniform code of conduct for unregistered health practitioners or are different codes in each State and Territory acceptable? The statutory code of conduct should be national and uniform and have core components that are applicable across all health service providers including those included in NRAS. Response from Speech Pathology Australia Page 7 of 11

8 Do you have a preferred option for the legislative and administrative arrangements through which a code of conduct for unregistered health practitioners is administered and complaints about breaches of the code are investigated and prosecuted? A national health complaints authority should be established or the existing state entities be aligned with the same functions and powers. Powers should include investigating complaints and conducting hearings and should have provisions for appeals. Recommendations involving penalties and prohibitions should apply. The authority should have sufficient teeth to ensure a practitioner cannot practice any part or all health service if deemed appropriate. The authority must have the capacity to limit or prohibit practice for non-compliant practitioners. Where a practitioner is a member of an accredited professional association, the health complaints authority should first liaise with the association to determine what investigations/actions may have been undertaken or underway prior to determining whether separate actions is also required. The current framework of self-regulation however does not provide professional bodies with statutory powers under which an individual can be prohibited from practising. In cases of serious breach or misconduct, the national health complaints authority should exercise its full powers to prohibit the practice of the practitioner. Although Option 3 is not proposed to set minimum requirements for entry to a profession, with the professional body best placed to set professional standards and qualifications, consideration should also be given to mechanisms to protect the title of recognised professions for those not covered by NRAS. For example, while Speech Pathology Australia sets and assesses the entrylevel competencies required for those trained in Australia and overseas as a means of determining eligibility for practising membership status, any person (except when practising in Queensland) can call themselves a speech pathologist/therapist with no fear of legislative implications. In recent times there has been at least one occasion where an unqualified person purported to be a speech pathologist and was reported to the relevant Consumer Commission. A National Health complaints authority should be given the power to prosecute those who give themselves a title without the required recognised qualifications. This would necessarily include those who have not successfully completed a recognised course in Australia or had not had their overseas qualifications successfully assessed by a DEEWR recognised assessing authority. Consideration should also be given to establishing boundaries within which an unregistered/unregulated practitioner should operate with respect to scope of practice that is considered reasonable given the practitioner s training and qualifications. It is accepted that there needs to be a robust mechanism to deal with groups who do not have the same degree of tertiary qualifications; sets of professional standards or codes of conduct or ethics; internal self-regulation mechanisms for complaints; continuing professional development that aggregates points for certification. These groups differ substantially from the professions that fall under the NRAS and the National Alliance of Self-regulating Health Professionals with the latter including Speech Pathology Australia. An overarching framework should act as a safety-net in terms of minimum code/standards of practice that will protect the public and be applied to those providing health services defined in a broad sense. Financing of scheme (section 6.3.7) How do you think a regulatory scheme to investigate and prosecute breaches of a national statutory code of conduct for unregistered health practitioners should be funded? Costs apply to those practitioners who must register to practice (as under NRAS) and to those who elect to be members of their professional association. There should be no additional costs to practitioners of a government system of a statutory code of conduct and regulation. As the principle interest is protection of the public the cost of such a scheme should be borne by the government which has the mandate to provide for public health and safety. While there will be additional fees such as those required to conduct investigations, hearings, and legal representation, these administration costs would be outweighed by the strengthened capacity to provide public protection. Response from Speech Pathology Australia Page 8 of 11

9 Other comments Do you have any other comments to make about these proposals? Terminology There needs to be careful consideration of the terminology used in the context of health professions. This paper makes a distinction between the health professions who come under NRAS and the health practitioners who are un-registered. This nomenclature potentially raises different public perceptions which while not intentional is undermining of those health professions outside the NRAS. For those professions with strong regulating frameworks in place, the term un-registered has a further potential negative connotation. All health professionals should be dealt with equitably. As discussed, a national framework of regulation across those registered, regulated and those un-regulated should apply which should be communicated to the public in a way that does not give undue differing assurances and negative implications to the public. CONTACT DETAILS: Name: Speech Pathology Australia Address: Level 2, Bank Place Melbourne 3000 Phone: We are a: Professional Association / National Peak Body Would you like to be informed of the outcome of the consultation? Yes References: Code of Conduct (2010). The Speech Pathology Association of Australia Limited, Melbourne. Competency Based Occupational Standards (2001). The Speech Pathology Association of Australia Limited, Melbourne. Principles of Practice (2001). The Speech Pathology Association of Australia Limited, Melbourne. Scope of Practice (2003). The Speech Pathology Association of Australia Limited, Melbourne. Parameters of Practice (2007). The Speech Pathology Association of Australia Limited, Melbourne. The Speech Pathology Profession: A national approach for working in the public interest, (2008). Joint Submission from Speech Pathology Australia and The Speech Pathologists Board of Queensland. Retrieved: _Info_Nov_08.pdf Response from Speech Pathology Australia Page 9 of 11

10 Appendix 1 Existing and Extending Regulatory Framework for Speech Pathology Australia (applying to members of Speech Pathology Australia) Current Regulatory framework and mechanisms: Code of Ethics Members must commit to abiding with the Code of Ethics (2010) which guides their professional and ethical conduct. SPA monitors observance of the Code of Ethics and provides education and resources to inform expectations of ethical practice Complaints handling mechanism and disciplinary procedures A formal complaints management process is in place for members of SPA, involving formal investigations and hearings through the Association s Ethics Board. Censure and sanctions can result where the person is found to be in breach of the Code of Ethics. Serious breaches of the Code may lead to removal of current and future eligibility for membership, with public notification of this decision. This can have strong consequences as a requirement for most public employment is eligibility for practising membership with SPA. Practising membership of SPA is a requirement as a Medicare and Private Health Fund Provider (with the exception of those practising in Queensland where registration applies as the eligibility criteria). Professional Standards - Eligibility for practising membership of Speech Pathology Australia - Competency Based Occupational Standards (CBOS) determine the competencies required of entry level practitioners and is integral to the functions of: o Assessment of students undertaking clinical practicum o Assessment of overseas applicants o University speech pathology program accreditation - Recency of practice Policies dictate that eligibility for practising membership status requires a minimum of 1,000 hours of speech pathology practice in the previous 5 years - Re-entry to the profession A formal re-entry program is required for those wishing to return to practising membership but cannot demonstrate recency of practice Association Practice and Standards Documents A range of core Association documents guide the scope of practice and clinical standards of the profession including: Principles of Practice (2001) Scope of Practice (2003) Parameters of Practice (2007) Clinical Guidelines and Position Statements (various for different areas of practice) Professional Self-regulation program Certified Practising Speech Pathologist The Association s Professional Self-Regulation (PSR) program is a formal practitioner certification program. Successfully meeting the requirements of PSR leads to the status of Certified Practising Speech Pathologist (CPSP). The program is based on recognition of members professional development and ongoing learning. CPSP status is increasingly becoming the criteria for third party funding and rebate eligibility. Response from Speech Pathology Australia Page 10 of 11

11 Extending mechanisms To mirror the mandatory standards of AHPRA, the following extensions of self-regulation are being progressed: Mandatory CPD Currently CPD is voluntary however making this mandatory is currently under discussion. Criminal and Identity Checks Legal advice is being obtained with respect to building in Police checks to the eligibility for membership of Speech Pathology Australia. Extension of Professional Self-regulation program (PSR) In addition to mandatory CPD being under consideration which would extend to mandatory PSR participation for practising membership, discussion is underway regarding extension of the PSR program participation to non-members (on a user-pays basis). Response from Speech Pathology Australia Page 11 of 11

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