Strategic direction

We provide feedback or formal comments and suggestions for improvement to the entities involved in a complaint if we believe positive changes could be made at the system level. System-level improvements achieved in 2021–22 are demonstrated through the case studies in our annual report. They included Ahpra updating its service charter and Ahpra and the Boards strengthening their processes for identifying and managing conflicts of interest.

Ahpra’s service charter

Our office made suggestions for improvement, particularly during 2020–21 and 2021–22, about the importance of Ahpra outlining realistic expectations for notifiers and practitioners regarding communication and timeliness. We discussed with Ahpra the need to develop a more comprehensive service charter with detailed service standards. Our suggestions for improvement came from communication problems repeatedly raised by complainants. These included:

• a lack of transparency about the notifications or registration processes
• frustration with unanswered phone calls and written correspondence
• not receiving updates about a matter, particularly if it was delayed.

As outlined in our written answers to questions on notice to the Senate Community Affairs References Committee, service standards are beneficial from an organisational and complainant perspective:

From an organisational perspective, it would assist Ahpra to induct staff and ensure staff have a clear understanding of their role in communication.

From a complainant perspective, these standards also operate to set expectations about what level of communication they can look forward to, and therefore reduce unnecessary stress or anxiety associated with uncertainty.

In its report and recommendations, the committee agreed that our suggestion for a service charter should be ‘progressed as a priority’ and that the service charter should outline ‘when and how updates will be provided to parties during the notifications process’.

In April 2022 Ahpra published its updated service charter. The service charter identifies five high-level principles, and underpinning commitments, for engagement. The service commitments include some expected timeframes.

Our office welcomed the updated service charter, which demonstrates Ahpra’s commitment to communicate expectations more proactively. This is a significant improvement for the National Scheme.

We will continue to monitor issues in this area and make suggestions where appropriate about the importance of providing timely updates to those involved in the notifications process.

Ahpra and the Boards’ conflict of interest policies and procedures

Our office continued to closely monitor Ahpra’s processes for managing conflicts of interest in 2021–22. In the past our office made suggestions for improvement to Ahpra about the conflict of interest register that must be maintained by each Board. In 2020 we observed through our complaint handling work that it was sometimes difficult to respond to a complainant’s concerns about a conflict of interest or bias when there was limited documented information available in these registers to demonstrate:

• whether any consideration was given to a possible perception of a conflict of interest arising from a particular matter in circumstances where no conflict of interest was formally recorded
• discussion of whether any steps needed to be taken to manage a perceived conflict of interest
• if no action was taken to manage a conflict of interest, how this decision was reached.

We therefore identified an opportunity to improve the information recorded in each Board’s conflict of interest register. Ahpra subsequently undertook a review of its practices and procedures for recording conflicts of interest involving Board members, including both standing declarations of private interests and those conflicts that might arise from time to time in the context of individual regulatory matters under consideration. There were several positive outcomes of this review including:

• the introduction of a new procedure on recording declarations of private interests
• a revised form for completion about declarations of private interests and a new form for supplementary declarations
• a revised form for capturing all declarations made during a Board meeting
• a new guidance document to support consistent Board meeting management in relation to conflict-of-interest agenda items.

We were pleased to see these positive developments and will continue to monitor their implementation.

Through our complaint handling work, we also identified a policy gap in Ahpra’s management of differing independent opinion reports it receives when handling a notification. This includes how Ahpra identifies and examines conflicts of interest in independent opinions that have been sought and provided to Ahpra by the practitioner who is the subject of the notification. Ahpra agreed that this policy gap needs to be addressed, and our office will continue to work with Ahpra to ensure there is a robust policy and procedure for managing potential, perceived or actual conflicts of interest regarding reports provided by practitioners under investigation.

Ongoing monitoring of systemic issues

Our office continued to identify and monitor issues we were concerned may indicate systemic problems in the National Scheme in 2021–22. We monitored three issues closely by compiling relevant complaints data and information, together with concerns raised by stakeholders and in the media, in our case management system. The issues we closely monitored included:

• Ahpra’s delay in investigating a notification after immediate action had been taken against the practitioner
• Ahpra and the Boards’ application of the English Language Skills Registration Standard
• Ahpra and the Boards’ application of the framework for identifying and dealing with vexatious notifications.

This financial year we focused on further enhancing our early resolution processes to handle complaints more effectively and efficiently. Where appropriate, we have sought to rely on early resolution complaint mechanisms (such as making preliminary inquiries) and refined our criteria to progress complaints to an investigation. Of the 881 complaints made to the Ombudsman that were finalised in 2021–22, 89 per cent were closed without a formal investigation (590 complaints were finalised at the assessment stage, 106 at the early resolution transfer stage and 92 at the preliminary inquiry stage). We refocused our complaint handling mechanisms in this way to:

• provide Ahpra and the Boards with more opportunities to address issues prior to our office undertaking more resource-intensive investigations
• ensure complainants receive more timely responses, particularly in matters where our office’s involvement would likely be limited due to the circumstances of the matter
• focus our resources on addressing issues with broader system-wide effects where positive changes could have the greatest impact.

Undertaking independent reviews of systemic issues is a critical way that our office strives for positive change in the regulation of Australia’s registered health practitioners. Important milestones this financial year included the Ombudsman and Commissioner:

• joining the expert panel of the independent review into the regulation of health practitioners in cosmetic surgery. Find out more about the review on Ahpra’s website.
• initiating an independent review into the implementation of Ahpra’s framework for identifying and dealing with vexatious notifications made about health practitioners. Find out more about the review.

In 2021–22 our office welcomed the opportunity to provide evidence and information to the Senate Community Affairs Reference Committee’s inquiry into the administration of registration and notifications by Ahpra and related entities under the National Law. The inquiry was referred to the committee by the Senate in March 2021 and considered several areas in Ahpra’s administration of registration and notification matters.

Find out more about the Senate Inquiry

In 2021–22 we welcomed the opportunity to provide comment on the Health Practitioner Regulation National Law and Other Legislation Amendment Bill 2022 as part of the targeted and public consultation processes. The Ombudsman and Commissioner generally expressed support for the reforms outlined in the Bill and welcomed ongoing legislative reforms necessary to ensure the National Scheme achieves its objectives and operates efficiently and effectively.

Our public submission summarised the Ombudsman and Commissioner’s ongoing concerns and recommendations for further consideration in relation to some reforms.

Find out more about the National Law updates

Our office made a submission to health ministers on the regulation impact statement about medical practitioners using the title ‘surgeon’. The Ombudsman and Commissioner reiterated her support for efforts to understand potential risks and harm associated with the current use of the informal title ‘cosmetic surgeon’.

Due to our office’s involvement in the independent cosmetic surgery review, we did not wish to pre-empt its findings in our submission. Instead, the Ombudsman and Commissioner provided a brief overview of our complaint handling work in relation to cosmetic surgery and the register of health practitioners.

Find out more about the regulation impact statement

Record management

In 2021–22 we began a new project to prepare for the creation of our office’s unique recordkeeping framework. We collect, use, store and disclose a range of personal and health information to provide services to the community and to carry out the office’s statutory functions. This requires recordkeeping practices and systems that ensure the creation, management and protection of accurate and reliable records. Creating, managing and protecting records:

• improves operational efficiency including reducing risks
• ensures transparency and accountability
• protects the interests of staff and stakeholders.

We are dedicated to ensuring information collected and stored by our office is appropriately protected and remains confidential in line with the requirements of the National Law and our legislative framework.

In April 2022 our office began a joint project with the department to map how our records are stored. Historically, as our office’s host jurisdiction, the department has provided recordkeeping and archiving services for the office. This mapping project will assist us to determine the best approach to the ongoing management of our records.

A comprehensive staff intranet

Another important development in 2021–22 was the creation of our staff intranet to improve team communication as we embrace hybrid working. The intranet has been designed to:

• increase connection between individual staff and team units across our office
• ensure staff can easily access important information related to their employment and relevant areas of work
• enhance recordkeeping through document version control
• facilitate improved understanding about staff responsibilities and guidelines, particularly given our unique hosting arrangements with the department.

Wellbeing group

In 2021–22 the Wellbeing Working Group continued to focus on creating opportunities to enhance our team’s wellbeing and support greater connection between staff.

Our work can raise many sensitive issues, and it is important that staff feel equipped to manage these matters while staying safe and well. As a result, the office implemented additional compulsory training for staff on dealing with vicarious trauma and providing mental health first aid.

Diversity and Inclusion Working Group

The Diversity and Inclusion Working Group was created to improve cultural awareness and safety within our office and to support our engagement with the Australian community. In 2021–22 the Diversity and Inclusion Working Group focused on improving cultural awareness and confidence within our team, particularly about cultural safety. The group:

• introduced cultural awareness training provided by the Victorian Aboriginal Child Care Agency as part of the staff induction process
• introduced Acknowledgements of Country where appropriate, including adding an Acknowledgement of Country to our website and email signatures, putting up a physical sign in our office reception, and ensuring a verbal Acknowledgment of Country is provided in team meetings
• facilitated some staff to attend the Australian Reconciliation Convention to learn and recommit to the next steps in our reconciliation journey. Staff attended a range of sessions that focused on the convention’s theme of moving from safe to brave.

Our independent review of relevant accreditation processes in the National Scheme was a significant focus this financial year. The Ombudsman and Commissioner initiated the review in December 2020 to consider the quality of the existing complaint and appeal processes of entities performing accreditation functions within the National Scheme.

Find out more about the accreditation processes review

In 2021–22 we focused on providing staff training and improved communications about our privacy-related functions through collaboration with Ahpra and its staff. In response, the office saw an increase in the number of complaints and notifiable data breaches we received including:

• 13 privacy complaints to the Commissioner (up from 3 in 2020–21)
• eight confirmed eligible data breach notifications received from Ahpra (up from 1 in 2020–21).

Find out more about privacy complaints to the Commissioner