2012 Review of the Health Practitioners Competence Assurance Act 2003
August 2012
A Discussion Document
Citation: Ministry of Health. 2012. 2012 Review of the Health Practitioners Competence Assurance Act 2003: A discussion document. Wellington: Ministry of Health.
Published in August 2012 by the
Ministry of Health
PO Box 5013, Wellington 6145, New Zealand
ISBN 978-0-478-39380-4 (online)
HP 5539
This document is available at
Contents
Executive summary
How to have your say
Introduction
The Health Practitioners Competence Assurance Act 2003
Purpose of the review of the HPCA Act
Principles to guide the review
Process and timing
1Future focus
Overview
Workforce development and the purpose of HPCA Act
Health practitioners working in teams
Scopes of practice
Information contained in scopes of practice
Increasing workforce flexibility
Principles for developing or reviewing scopes of practice
Mobility of the health and disability workforce
Improving the pastoral care of health practitioners
2Consumer focus
Overview
Public understanding of HPCA Act
Public involvement in decision-making
Transparency of information and processes
3Safety focus
Overview
How the HPCA Act works within the health system
Discussion
4Cost effectiveness focus
Overview
Risk framework underpinning the HPCA Act
Regulatory options to manage consumer risk
Could we improve the cost effectiveness of the HPCA Act?
Current system
Balancing the cost of public protection with access to services
Importance of data collection systems to inform sector intelligence and planning
Increasing standardisation across professional groups
Size of RA boards
Improving employers’ ability to manage cost impacts
Other issues
Summary of questions in the Health Practitioners Competence Assurance Act 2003 Review public discussion document
Future focus
Consumer focus
Safety focus
Cost effectiveness focus
Abbreviations
Appendices
Appendix 1:Summary of responsible authorities and the professions they regulate
Appendix 2:International environmental scan
Appendix 3:Additional information on the Acts that interface with the Health Practitioners Competence Assurance Act 2003
Appendix 4:Models of occupational regulation
List of Tables
Table 1:Principles to guide the review
Table 2:Summary of stages and timeline for the 2012 review of the Health Practitioners Competence Assurance Act 2003
Table A1:Professions regulated under the Health Practitioners Competence Assurance Act 2003
Table A2:Summary of legislation and its interface with the HPCA Act
List of Figures
Figure A1:Comparison of initiatives across a sample of international jurisdictions
Figure A2:Functional elements of regulatory options
Executive summary
This public discussion document is the start of the 2012 review of the Health Practitioners Competence Assurance Act 2003 (abbreviated here to HPCA Act). It will assess the impact of the HPCA Act on the public, health care service providers and health professionals, and will determine if the HPCA Act is continuing to meet the requirements of a rapidly changing health sector.
The main purpose of the HPCA Act is to protect the health and safety of the public, but the HPCA Act must balance several competing priorities in order to fulfil its function. The review will look at how HPCA Act is functioning within the wider health system and how it (or the broader regulatory environment) could be improved. International trends in health occupational regulation point to a strengthening of consumer protection, standardisation of legislation and the design of institutions, and improving the performance of regulatory authorities.
There are four principles against which the HPCA Act will be assessed, each of which relates to a specific focus.
Future focus
To sustain our health service New Zealand needs to be able to attract and retain a workforce that delivers services within a lower growth funding path, in the context of an ageing workforce and significant numbers leaving for overseas in any one year. Our current services are mainly configured around historical patterns of population demand and traditional models of care that are labour intensive and expensive to sustain.
To meet these challenges we need to move away from a focus on hospital services and admissions and towards better, sooner, more convenient service delivery through the integration of primary care with other parts of the health service. The core safety function of HPCA Act needs to be balanced against ensuring that its indirect (but strong) influence on the shape of the workforce matches the needs of a changing sector.
In line with usual regulatory governance structures, responsible authorities (RAs) are set up to work independently, and yet the requirements they place on health practitioners shape how they practise in order to remain within their professional and legal requirements. This document looks at how RAs can ensure their requirements for health practitioners keep pace with what the sector needs in an environment that is undergoing transformational change.
Although regulation is generally managed along professional boundaries, these boundaries are increasingly shifting and becoming less distinct in complex clinical environments. Consumer care and the protection of consumer safety are increasingly dependent on how multidisciplinary teams and clinical networks operate.
The key value underpinning the HPCA Act is the accountability of individual health practitioners for their own clinical practice and application of professional judgement in their clinical practice. The challenge is to ensure this key value operates effectively in a changing environment.
Consumer focus
The views of consumers and the public generally will be an important input into this review, particularly views on how confidence in the safety of health and disability services can be maintained and enhanced and whether consumers have access to the necessary information to make good decisions about health practitioners. A consumer focus requires transparency of information and processes, and appropriate representation in the regulatory processes.
Safety focus
The core function of the HPCA Act is to provide a mechanism to regulate occupational groups to ensure the safety of the public. However, other legislative mechanisms are also concerned with public safety, so it is necessary to consider how the HPCA Act contributes to the overall system of government regulation, and whether the role of professional regulation in safeguarding the public is supported and complemented by the responsibilities of employing organisations.
It is therefore necessary to consider whether there is an appropriate balance between the safety concerns of employers and the requirements of government regulation. For example, if employers already have all the systems in place for groups of health professionals to keep the public safe from harm, what additional value does statutory regulation have in this situation?
Cost effectiveness focus
Safety in health and disability services is a critical element, but it comes at a cost. The more that professions are regulated, the greater the potential for regulation to affect the volume and cost of services available to meet the needs of the public. It is therefore necessary to consider the trade-offs required and whether the balance is appropriate.
As part of this discussion there are considerations around which professions need to be regulated, whether a graduated risk-based regulatory regime should be considered, whether there are efficiencies that can be gained by reviewing the regulatory processes, and how the collection of data can contribute to risk management efforts.
Scope of the review
The review will assess how:
- the HPCA Act supports the delivery of the workforce required, both now and in the future
- pastoral care for the health and welfare of health professionals, to support the sustainability of the workforce, can be improved
- a robust data collection system to inform sector intelligence and planning can be developed
- the HPCA Act can work effectively within the wider health environment, and whether the purpose of the HPCA Act remains fit for purpose
- the health occupational regulatory settings can be improved
- the HPCA Act can provide optimal levels and types of regulation for the next five to ten years
- the operational functioning of the HPCA Act can be improved.
The review builds on the work already completed by the Ministry in conjunction with the sector. This includes not only an operational review of the HPCA Act (2007–2009) but also a 2010 public consultation, How Do We Determine if Statutory Regulation is the Most Appropriate Way to Regulate Health Professions?
How to have your say
You are invited to submit feedback on the information set out in this document. In particular, it would be helpful to receive your responses to all or any of the specific questions included at the end of each section and gathered together at the end.
You can download and email the submission form to:
or post your submission to:
HPCA Submissions
Health Workforce New Zealand
National Health Board, Ministry of Health
PO Box 5013
WELLINGTON 6145
You can also download this document and other information including dates and venues for the regional public meetings from
The closing date for submissions is Friday 26 October 2012.
2012 Review of the Health Practitioners Competence Assurance Act 20031
Introduction
The Health Practitioners Competence Assurance Act 2003
The purpose of the HPCA Act is to protect the health and safety of the public. Responsible authorities (RAs) fulfil that purpose by ensuring that all health practitioners registered with them are competent in the practice of their respective professions.
To achieve its purpose, the HPCA Act allows a high level of self-regulation for health practitioners to maintain competence within prescribed scopes of practice. It also provides for an independent disciplinary tribunal to hear disciplinary complaints against health practitioners.
Under the HPCA Act, every health practitioner who practises in a regulated profession must be registered with the relevant RA. They cannot perform activities that are part of their profession but that fall outside the scope of practice for which they are registered. A health practitioner can perform activities that are within another scope of practice provided they do not hold themselves out to be registered in that other profession.
There are currently 16 RAs responsible for implementing the HPCA Act for the 22professions covered by it (see Appendix 1 for a list of RAs and the professions they are responsible for). Each RA has a governance board or council, with some members appointed by the Minister and approximately a third being laypeople.
The RAs develop scopes of practice with associated qualifications. They regulate their professions through registration, issuing practising certificates, carrying out competence reviews and recertification processes, investigating complaints about practitioners and considering concerns about their health.
The RAs’ functions also include:
- recognition and accreditation of training and education programmes for entry to professional programmes and for the ongoing competence of health practitioners
- setting standards of clinical competence, cultural competence and ethical conduct
- promoting education and training in the profession.
International trends in the regulation of health professionals show that, overall, there is a pattern of increasing intervention, with three main trends:
- Strengthening consumer protection: This occurs throughindependent consumer complaints agencies, independent prosecutions, reviews of disciplinary hearings and the introduction of continuing competency requirements
- Standardising legislation and the design of institutions: Standardisation of legislation has been achieved in New Zealand and other jurisdictions, such as Ontario and the Netherlands. Australia has implemented standardised legislation and institutional arrangements through a single regulatory agency at a national level. In the UK there has been a gradual process of standardisation due to the way these institutions have evolved and expanded over more than 100 years.
- Improving the performance of the RAs in relation to traditional functions: This includes the management of registers and, more recently, the accreditation of training, or inter-professional collaboration and teamwork. These latest developments focus on the implications of regulators’ attempts to progress policies rather than managing RAs’ processes.
New Zealand’s introduction of the Health and Disability Commissioner (HDC) to uphold the rights of consumers is a key element in strengthening consumer protection.
Purpose of the review of the HPCA Act
This policy and operational review of the HPCA Act follows a review completed in 2009 by the Director-General of Health on the operation of HPCA Act. The Government has directed the Ministry of Health to carry out a further strategic review of the HPCA Act in 2012.
The purpose of the review is to examine the policy principles underpinning the HPCA Act and their impact on the public, health care service providers and health professionals to determine if these principles continue to support the requirements of a rapidly changing health sector.The review will look at how the HPCA Act:
- creates incentives for health practitioners to maintain safe clinical practice
- works in an increasingly complex environment, where interdependent multidisciplinary team work and clinical integration are critical components of care
- supports health priorities and the objectives of ensuring a sustainable, integrated, more convenient and patient-centred health system
- can mirror international trends towards more public engagement, improved transparency of complaints and complaint processes and transparency of information, with increased emphasis on protecting the public interest.
Principles to guide the review
Table 1 sets out the principles the Ministry of Health will use to guide the review. These principles are based on the Government’s statement on regulation, Better Regulation, Less Regulation, which sets out its commitment to introduce new regulation only when satisfied that it is required, reasonable and robust. The full statement can be found at
Table 1: Principles to guide the review
Focus / Principle1 / Future / A health occupational regulatory framework that supports workforce flexibility, working in multidisciplinary teams and clinically networked environments
2 / Consumer / Operation of the HPCA Act in a way that is accessible and transparent for consumers
3 / Safety / A systems perspective that balances individual accountability with team and organisational accountabilities for the management of consumer safety
4 / Cost effectiveness / The level of regulation is matched to the level of risk of harm to the public and ensures value for money is maintained
Process and timing
A staged approach will be taken for the Review. The stages and associated timelines are summarised in Table 2.
Table 2: Summary of stages and timeline for the 2012 review of the Health Practitioners Competence Assurance Act 2003
Public consultations / TimingPublic discussion on Discussion Document / 31 August–26 October 2012
Public discussion on draft findings and recommendations / March – April 2013
Final report released / End of July 2013
1Future focus
Overview
To sustain our health service New Zealand needs to be able to attract and retain a workforce that delivers services within a lower growth funding path in the context of an ageing workforce and where significant numbers leave for overseas in any one year. Our current services are configured around historical patterns of population demand and traditional models of care that are labour intensive and expensive to sustain.
To meet these challenges we need to shift away from a focus on hospital services and admissions to better, sooner, more convenient service delivery through the integration of primary care with other parts of the health service. Integrated care means better-coordinated health and social services and the development of care pathways designed and supported by the community, primary and secondary clinicians. It will deliver better-coordinated patient care across service providers and professions and enable us to manage within tight fiscal constraints.
Delivering integrated care will require a more flexible workforce, where health practitioners will increasingly be required to work in a range of new types of clinical settings, in turn requiring access to a broader range of knowledge, skills and technology. They will increasingly work within multidisciplinary teams and will be part of clinically networked systems. A wider, deeper base of commonality across health professions will be required.
Increasing integration of the health and disability system necessitates changes to education and training to ensure ongoing competency. It also means taking a wider focus that includes effective ways of working in teams, improved communication skills and support for consumers’ self-management.
Although regulation is generally managed along professional boundaries, those boundaries are increasingly shifting and becoming less distinct in increasingly complex clinical environments. Consumer care and the protection of consumer safety are increasingly dependent on how multidisciplinary teams and clinical networks operate. How well scopes of practice operate in the sector is also important, and in particular, how well they balance definition of practice with flexibility of clinical practice.
Part of ensuring we have a sustainable and fit-for-purpose workforce includes recruiting and retaining the health and disability workforce. New Zealand will continue to experience flows of health and disability workers into and out of New Zealand as health practitioners seek overseas experience, training opportunities and a different lifestyle. In the case of some professions, these factors are very relevant to the recruitment of overseas-trained practitioners. It is therefore important that we can attract and retain both New Zealand and overseas-trained health practitioners. Pastoral care also has an important role to play in retaining our health and disability workforce.
This section looks at how the HPCA Act can, via RAs, ensure that the requirements on health practitioners keep pace with what the sector needs in an environment that is undergoing change. We would like your views on how the HPCA Act can continue to keep the public safe from harm and support integrated care that will achieve the best outcomes for patients.
Workforce development and the purpose of HPCA Act
RAs have an independent role in keeping the public safe through ensuring the competence of health practitioners. The RAs also have an important influence on how the workforce evolves over time. They influence the shape of the workforce through how they set qualifications, scopes of practice, competence standards and ongoing professional development requirements, as well as educational and training accreditation standards.