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Why aren’t paramedics registered?

Ruth Townsend writes in this post below that if  you completed a first aid course last weekend then you could call yourself a paramedic.

She asks how the Australian Health Workforce Ministerial Council can justify its decision last month to defer the inclusion of paramedics on the Australian Health Practitioner register, a move that has major implications for clinical standards, patient safety and workforce needs.

***

Ruth Townsend writes:

On October 10, the  Australian Health Workforce Ministerial Council made a decision to defer the inclusion of paramedics on the Australian Health Practitioner register until sometime next year.

Despite the fact that the Council is aware that paramedics do perform 11 of the 13 risk factors that assist in evaluating the risk a profession might pose to the public, including the administration of anesthetics and the delivery of babies, paramedics remain unregistered under the National Health Practitioner Regulation Scheme.

The failure to include paramedics on the national register makes a mockery of that entire system.

The Australian Health Practitioner Regulation Agency (AHPRA), the administrative body created for the purpose of overseeing the registration of 14 different groups of health practitoners – including podiatrists –  commenced in 2010  in part as a response to a number of  high profile cases concerning healthcare quality and patient safety at a number of hospitals including Bundaberg in Queensland, King Edward Memorial in Western Australia and Canberra Hospital in the ACT.

The public were alerted to all three cases as a result of whistleblowers. The lack of transparency and oversight of the actions of a few were deemed to be a cause of concern for the many and resulted in the introduction of the Health Practitioner Regulation National Law Act that authorised the establishment of AHPRA.

AHPRA, and the National Law Act, not only allows for the tracking of sanctioned health practitioners across jurisdictions,  it facilitates the rigorous assessment of overseas-trained health practitioners and the maintenance of a flexible, responsive and sustainable health workforce.

It also authorises the registration of thousands of health practitioners and enables members of the public to check if their doctor or nurse is registered, and  requires accreditation of and sets national standards for educational courses for the health professions.

It also allows for the establishment of disciplinary bodies – like the Medical Board of Australia – to oversee the professional behaviour of members of a respective profession and to take action against those members who do not meet the required professional standards.

The power of these Boards extends to striking poorly performing members from the register. The primary principle informing the establishment of the national register, the educational standard and the disciplinary processes is one of maintaining clinical competency and thus patient safety.

Current regulation of paramedics fails to take account of the growth of the private sector in the provision of ambulance/paramedic services and fails to provide for the fact that persons performing these roles are found in a variety of workplaces and are performing increasingly high risk, high level intervention.

There are approximately 13,000 full time salaried paramedics in Australia and a further 5,000 volunteers working primarily in public, state-based ambulance services but the numbers in the private sector are growing.

The numbers are not dissimilar in the UK, where approximately 19,000 paramedics are employed, however there, paramedics are registered. The UK has a similar health practitioner regulatory agency – the Health Care and Professions Council (HCPC) – with a similar objective – to keep patients safe.

In 2012-2013, 262 cases alleging breach of a paramedic’s ‘fitness to practice’ were investigated by the HCPC: 22 were suspended from the register, 15 were struck off.

The most common complaints made against paramedics were clinical competency matters ranging from failing to provide adequate care to poor communication with colleagues. A number of  paramedics were cautioned from engaging in inappropriate behaviour ‘towards a service user’.

Given the number of paramedics in Australia and knowing the number and type of interventions they perform suggests that it is likely that a very small percentage of Australian paramedics would also be engaging in these behaviours.

If paramedics were registered under the National Scheme it would not only authorise action to be taken against those paramedics who were not upholding nationally agreed professional standards, but also allow the public and employers a transparent and easy route to check if paramedics are (a) registered and (b) if there are any sanctions on that registration. At the moment that task is either not easy or not possible.

In fact, so lacking in regulation is this particular group that not even their title is protected. Anyone can call themselves a paramedic. If you completed a first aid course last weekend then you could call yourself a paramedic. There are no national guidelines on education standards and there are differences between private and public providers of ‘paramedic’ services with some providing traditional ambulance services, that is transport services, and others providing high level intensive pre-hospital care. There is no way of telling from the title which type of response to expect.

The decision by the AHWMC has resulted in the Victorian government announcing that it will consider going it alone and establishing its own paramedic board. It would be the first of its kind in the country.

It should be noted that the draft legislation looks to open the way for competition from private emergency paramedic health services (not just transport services) and to authorise billing privileges for individual paramedics which suggests that paramedics will be able to work autonomously, thus making the establishment of a comprehensive regulation scheme for paramedics all the more critical.

Other jurisdictions have also taken independent steps to attempt to regulate paramedic practice with both South Australia and Tasmania attempting to protect the title and set minimum educational standards. There are some questions as to whether these approaches will achieve the desired outcome of providing improved clinical standards, patient safety and workforce needs and it begs the question of why this approach would be taken when there is a national scheme already established to meet this same end.

Ruth Townsend has worked as both a health and legal practitioner. She was formerly a lecturer in health law, ethics and human rights in the Australian National University College of Law and School of Medicine. She is currently completing a PhD at the ANU on the regulation of paramedics in Australia. She was the co-editor and co-author of the textbook ‘Applied Paramedic Law and Ethics’.

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Comments 3

  1. Tsiry Diton says:

    >a response to a number of high profile cases concerning healthcare quality and patient safety at a number of hospitals

    Were paramedics at the centre of the problems? If not, why this article?

  2. Raymond Bange says:

    Ruth raises this as an important issue in the public interest. Healthcare needs appropriate regulation to ensure public safety as witness the 14 professions currently registered under AHPRA. It’s simply inexplicable that paramedics are not nationally registered.

    I can assure readers that my personal research over many years and work as a consultant to the profession has revealed a number of cases in the public domain including Coronial reports. Together with overseas’ experiences, these are more than sufficient to justify the objectives nominally sought by the Victorian legislation to ensure competency and independent assessment of fitness-to-practice. What is particularly disconcerting is that the overall size of the problem is difficult to determine because of the lack of regulatory transparency – that must change in the public interest!

    Beyond the legal imperatives, healthcare regulation should not be determined as a state issue but be considered as a national matter. Practitioner standards and competencies should not be determined by lines on a map. AHPRA already provides the solution through an established national framework reached as a result of past experience and COAG decisions.

    To prevent misuse of the title and possible misrepresentation of the skills and expertise of the person claiming to be a paramedic (with potentially fatal consequences), a nationally consistent framework of registration is by far the most appropriate mechanism that captures all practice settings across all jurisdictions. This option was the overwhelming choice arising from a comprehensive national consultation process over several years.

    Paramedics perform clinical interventions that carry significant risk and indeed more so than many currently registered health professions. The consultation process highlighted these factors and the lack of data on paramedic services offered by many providers including public and private ambulance services.

    To better understand some of the issues that support registration as the preferred regulatory option you may like to visit the Facebook page on the topic hosted by the Paramedics Australasia professional body available here https://www.facebook.com/ParaRegAU

    My strong view is that Victoria should devote its resources to moving forward with the national registration scheme rather than further fragmenting the healthcare regulatory landscape and increasing the compliance costs that will affect every provider or paramedic operating across different jurisdictions. That separate legislative move will likely stifle innovation and reduce the equity of access to healthcare able to be provided through various forms of community paramedic practice.

  3. Russ Hunter says:

    Anyone know how much of this comes down to ‘politics’ (read: Govt’s ability to screw down Ambo wages and conditions).

    I believe that the (state?) govt refuses to acknowledge Ambos as professionals (which they clearly are) as this would strengthen Ambos’ case to be paid better (as they should be, and are already interstate). Ambo’s are leaving interstate or to regional areas in droves while their management (who come across as government cronies) seem happy to see them churn over despite the likely impact on standards of care and the wellbeing of paramedics.

    Qualifeid Ambos should be treated and paid as professionals and, yes, they should be regulated by AHPRA. It seems like a no-brainer if you want a high quality service which benefits everybody.

    Or the powers that be can keep screwing Ambos and all of us over to save a few bucks.

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