Strategic Workforce Development Unit

4 March 2010

Alison Sutherland

Strategic Workforce Development Unit

Ministry of Health

P.O. Box 5013

WELLINGTON

Dear Alison

Herewith is the New Zealand Tertiary Council for Physical Activity, Sport and Exercise’s (TCPASE) submission to the Ministry of Health’s (MoH) document ‘How Do We Determine if Statutory Regulation is the Most Appropriate Way to Regulate Health Professions’.

TCPASE is a formally constituted body representing tertiary institutions which offer New Zealand recognized and registered bachelor degrees in the areas of Physical Activity, Sport and Exercise.[1] TCPASE is concerned with knowledge and the dissemination of knowledge about the bio-physical and socio-cultural aspects of physical activity, physical education, physical education pedagogy, sport, exercise, work, health, well-being and recreation.

This submission represents the views of member institutions which offer training in physical activity, health and wellness. These institutions typically train graduates to work in these fields, and are working together, and through allied organizations such as Sport and Exercise Science New Zealand (SESNZ), to professionalize Physical Activity Consultants, Health and Wellness Consultants, and Clinical Exercise Physiologists. Ultimately, these institutions are working toward the registration of these new professions under the Health Professionals Competency Assurance Act (HPCAA) whereby the MoH will regulate and oversee their practices (in addition to, and independently of, their respective professional bodies / associations).

TCPASE supports the principle of applying statutory regulations to all health professions. In this submission we address the questions in Section 13 ‘Seeking Your Views’.

1. Are the principles for regulation set out in section 9 of this document appropriate? If not, why not?

While the proposed overriding principles seem appropriate, the real test of these principles will come with their implementation. To this end, the MoH should provide more detailed descriptions of how it will apply these principles.

2. Are the criteria set out in section 10 appropriate? If not, why not?

The proposed second level principles seem appropriate.

3. Are there any other criteria you think should be added to section 10?

No.

4. Do you agree that to establish a ‘risk of harm’ the profession must be involved in at least two of the following activities:

·  invasive procedures

·  clinical intervention with the potential for harm

·  making decisions or exercising judgement which can substantially impact on patient health or welfare, including situations where individuals work autonomously, i.e. unsupervised by other health professionals?

Potentially a profession involved in one of these activities could place the public at risk. Interventions, irrespective of whether they are invasive, are not necessarily cumulative in their outcomes, and an intervention that meets only one of these criteria could pose significant risk. Some non-invasive procedures applied by Physical Activity, Health and Wellness Consultants can increase risk, for example, those which elevate physiological responses. The three criteria do not explicitly cover such activities.

5. Should a profession be required to meet all of criteria 1–5 to establish that the health services pose a risk of harm to the public? If not, what are the minimum criteria a profession should meet?

No. The sole consideration should be the potential risk or harm to the public. We take this position on the grounds that while criteria 2 and 4 include clauses that apply to an existing registered profession, the assumption seems to be that there is no need to register another ‘like’ profession under the HPCAA for regulation when registration/accreditation procedures are in place which provide for a level of self regulation. However, this does not remove the possibility of two similar professions co-existing and a situation where the MoH recognizes both but regulates only one. What will happen if members of the unregulated profession cannot join the regulated profession? In our view the risks do not disappear. Unless the MoH issues clear guidelines with respect to members of unregulated professions, then the minimum criterion should be the first (i.e. the potential of risk or harm).

6. Do the proposed criteria provide sufficient guidance on what factors will be taken into account in establishing whether it is ‘otherwise in the public interest’ to regulate a profession?

We believe the individual points should be clearer. We suspect that Points 1 and 4 of Criteria 6 would apply to nearly any profession, as people are expected to be able to work alone, and anyone requiring a health service could be considered a vulnerable person who puts their trust in a health professional.

7. Should applicants be given the detailed guidelines outlined in section 11?

Yes. The profession/organisation should receive all the information needed to make informed decisions and supply all the necessary documentation in making an application. The time and resources needed to make a submission warrants full disclosure of detailed guidelines.

8. Should any other matters be included in the guidelines outlined in section 11?

Not that we can immediately identify. However, we raise the question, what happens to a ‘similar profession’ where a registered profession is identified as ‘representing a significant proportion of the profession’? The risks in the similar profession may be the same as in the registered profession but the former does not face the same level of regulation. Will the MoH compel the registered profession to expand its membership to include other ‘similar professions’ on this basis?

9. Should any other information be added to the application form to guide applicants?

The critical issue here is the quality of the application and to this end, some guidelines as to length of submission (e.g. fixed text boxes for each section), or even a template/example of the sort of information required, would allow comparison across potential new applicants.

10. If the revised criteria are confirmed, do you have any comments about the timing for introducing the new criteria? In particular, do you have any comments about how introducing the proposed changes might impact on the new professions that currently have applications with the Ministry?

A decision on the final form of the new criteria should be introduced as soon as possible so as not to delay the process further for applicants. We believe that professions with existing applications should reapply under the new guidelines. Now that the criteria are likely to be revised, this would now not only allow the existing applicants to reapply under these new criteria, but would allow other professions that didn’t apply to do so because they didn’t fit under the old criteria. In our field this would be the group of professionals working as Physical Activity Consultants, Health and Wellness Consultants, and Clinical Exercise Physiologists. Any timeframe should reflect the possibility of other professions wanting to submit an application.

11. Do you have any other comments?

We feel that there needs to be scope in the HPCA for the addition of new professions that are hitherto not well known but which will be integral to the health sector in the future. This would give the new professions credibility within the health sector (acknowledging the comments on page 6 final paragraph, where the main driver would be around risk to the public).

We recognise that the Ministry of Health is looking to minimise and if necessary reduce the number of regulated professions. In view of this we believe that there should be an ‘alternative route/pathway’ for recognition by the MoH if the application for a profession is either unsuccessful or where some level of self-regulation is warranted. This is important particularly given the recognition ACC gives regulated professions. It should be made clearer that not being regulated under the HPCA act does not affect the profession (or individuals within the profession) from applying for ACC status, nor does it diminish the validity of that profession.

There should be a clearly defined timeline for assessing applications in order to prevent existing professions from obstructing genuine applications from new professions seeking to establish themselves.

Members of TCPASE are more than happy to discuss further any aspect of this submission and we look forward to seeing the final report in the not too distant future.

Yours sincerely

Professor Doug Booth

Chair of the Tertiary Council for Physical Activity, Sports and Exercise

c/- University of Otago

P.O. Box 56

Dunedin

New Zealand

Email:

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[1] Current members include Auckland University of Technology (School of Sport and Recreation), Christchurch Polytechnic Institute of Technology (Physical Activity, Wellness and Sports Science), Eastern Institute of Technology (Sport and Recreation), Lincoln University (Department of Social Sciences, Parks, Recreation, Tourism and Sport), Massey University (Exercise and Sport Science, Palmerston North), Massey University (Exercise and Sport Science, Wellington), Southern Institute of Technology (School of Health, Exercise and Recreation), Unitec (Department of Sport) , Universal College of Learning (Exercise and Sport Science), University of Auckland (Health and Physical Education), University of Auckland (Sport and Exercise Science), University of Canterbury (School of Sciences and Physical Education), University of Otago (School of Physical Education), University of Waikato (Department of Sport and Leisure Studies),Victoria University of Wellington (Health and Physical Education), Waikato Institute of Technology (School of Sport and Exercise Science).