Introduction by Croakey: As previously reported at Croakey, the Australian Health Practitioner Regulation Agency (Ahpra) in March launched a “badly needed” five year Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy, with a goal to achieve a health system free of racism.
The need for it was reinforced later that month, in the midst of the pandemic, when the Australian Indigenous Doctors’ Association (AIDA) called out racist comments that denied Aboriginal and Torres Strait Islander people’s access to culturally safe healthcare seeking testing for COVID-19.
In the article below, Ahpra CEO Martin Fletcher and the Aboriginal and Torres Strait Islander Health Strategy Group’s co chair, Karl Briscoe, CEO of the National Aboriginal and Torres Strait Islander Health Worker Association, discuss how the strategy came about, what it commits to, and the need for safer working conditions for the Indigenous health workforce and strengthened scope of practice, particularly amid the coronavirus pandemic.
As part of that, Aboriginal and Torres Strait Islander Health Practitioners were last week added to the pandemic response sub-register, which enables Ahpra and National Boards to fast track the return to the workforce of qualified and experienced health practitioners, joining over 35,000 doctors, nurses, midwives, pharmacists, diagnostic radiographers, physiotherapists and psychologists already on the pandemic response sub-register.
Martin Fletcher and Karl Briscoe write:
It is a fundamental right that everyone has the right to access health care that is free from racism and the harm that it causes notably the impacts on the health and wellbeing of vulnerable populations. The current Black Lives Matter movement has clearly highlighted that racism is a public health issue.
We recently released a statement, No place for racism in healthcare. This statement called out racist behaviour in the context of the COVID-19 pandemic and made clear there is no place for racism when treating patients.
One of the challenges is that most health professionals do not see themselves as racist. They can take great offence when these words are used, possibly without even considering that perhaps they may be unwittingly contributing to the problem. Yet the health outcomes gap tells the true story – we all have work to do to improve the health outcomes for Aboriginal and Torres Strait Islander Peoples.
All health practitioners and parts of the health and education system must do their part to address racism in healthcare. We were heartened by the support we received from organisations and individuals on our statement.
So how should a practitioner regulatory scheme play its part in ensuring culturally safe health care and addressing the gap in health outcomes for Aboriginal and Torres Strait Islander Peoples?
Two years ago, we posed this question to Aboriginal and Torres Strait Islander health experts. The beginnings of an answer, they said, was to establish a genuine partnership through which Aboriginal and Torres Strait Islander people are not only providing advice but are equal partners in shared governance and decision making.
And so, the National Registration and Accreditation Scheme Aboriginal and Torres Strait Islander Health Strategy Group was born.
A major focus of the work of the Strategy Group is to equip all entities within the National Scheme – National Boards, NSW Councils, Ahpra and accreditation authorities – with the knowledge, awareness and tools to enable culturally safe health care.
We are proud of our early work in developing a national definition of cultural safety for our scheme, which was led by Aboriginal and Torres Strait Islander health experts. The definition reads:
Cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities.
Culturally safe practice is the ongoing critical reflection of health practitioner knowledge, skills, attitudes, practising behaviours and power differentials in delivering safe, accessible and responsive healthcare free of racism.
To ensure culturally safe and respectful practice, health practitioners must:
- Acknowledge colonisation and systemic racism, social, cultural, behavioural and economic factors which impact individual and community health;
- Acknowledge and address individual racism, their own biases, assumptions, stereotypes and prejudices and provide care that is holistic, free of bias and racism;
- Recognise the importance of self-determined decision-making, partnership and collaboration in healthcare which is driven by the individual, family and community;
- Foster a safe working environment through leadership to support the rights and dignity of Aboriginal and Torres Strait Islander people and colleagues.
This definition is one of the many strategic actions committed to within the National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020 – 2025, which was developed by the Aboriginal and Torres Strait Islander Health Strategy Group. The Strategy focuses on achieving patient safety for Aboriginal and Torres Islander Peoples as the norm and the inextricably linked elements of clinical and cultural safety.
To counteract unconscious bias and to help ‘unlearn’ the filtered history many of us were taught at school, we have partnered with two Indigenous-led organisations, PricewaterhouseCoopers Indigenous Consulting and the First People’s Health Unit at Griffith University to develop a solid, pedagogically sound and evidence-based cultural safety training program. Over time, every person working at Ahpra and on a National Board or committee will attend this in-depth training, because we must ensure that our work as a regulator is culturally safe.
However, the implementation of cultural safety is as much about individual practice as it is about changing systemic and institutional responses, whether that be practice standards, policy or legislation.
The National Boards that Ahpra works with to regulate Australia’s registered health practitioners set the national standards that all registered health practitioners must meet to become and remain registered.
The Boards have been integrating cultural safety requirements to these standards, meaning that the community can be clear about what they can expect from their practitioner. It also means that if a practitioner fails to meet this obligation, a Board may take regulatory action.
Strengthening the Indigenous health workforce
In supporting Aboriginal and Torres Strait Islander communities, the current COVID-19 pandemic has also highlighted the opportunities to better use our culturally safe and clinically qualified Aboriginal and Torres Strait Islander Health Practitioner workforce. They are one of 16 nationally regulated professions within the National Scheme.
The Aboriginal and Torres Strait Islander Health Practitioner workforce has lived experience in and a deep understanding of the communities they serve, possessing cultural, intellectual, social and linguistic knowledge and skills that set the workforce apart from other health professions.
These skills underpin community reach and engagement capability, coupled with comprehensive foundations in primary health care, give Aboriginal and Torres Strait Islander Health Practitioners a unique ability and perspectives as health care professionals, cultural brokers and health system navigators.
More needs to be done to enable this workforce to play its part fully. For example, as has been highlighted in an earlier piece at Croakey variances in the Drugs and Poisons Acts of each jurisdiction significantly limits what Aboriginal and Torres Strait Islander Health Practitioners are authorised to do.
To address this, a review of drugs and poisons legislation across Australia could ensure Aboriginal and Torres Strait Islander Health Practitioners share the same basic rights to supply and administer medications in their communities.
We continue to engage with the community and sector to increase the numbers of Aboriginal and Torres Strait Islander Peoples on the Agency Management Committee and National Boards.
Work has commenced to develop a monitoring and reporting framework for notifications and during the pandemic we’ve managed to successfully complete the pilot for the Moong-moong-gak cultural safety training.
Furthermore, responding to COVID-19, we established a surge workforce for the Aboriginal and Torres Strait Islander Health Practice profession to be most responsive to the healthcare needs of Aboriginal and Torres Strait Islander community members.’
Ensuring access to culturally safe healthcare is a priority for Ahpra and the important role of the Aboriginal and Torres Strait Islander Health Practice profession is a foundation for improving health outcomes and ensuring culturally safe health care.