Part 2: About the responsible authorities
2.1
The responsible authorities are charitable organisations registered under the Charities Act 2005. They do not usually receive government funding.7 As public organisations, they are subject to an audit under the Public Audit Act 2002. The responsible authorities are independent from professional practitioners’ associations and unions, who promote and advocate for the health professions.
2.2
All 18 responsible authorities function under the Health Practitioners Competence Assurance Act 2003 (the Act), which the Ministry administers. The purpose of the Act is to protect the health and safety of the public by providing ways to ensure that health practitioners are competent and fit to practise their professions.
2.3
The Act sets out the responsible authorities’ key responsibilities and functions. These include:
- authorising the registration of practitioners and considering applications for annual practising certificates (an annual practising certificate enables the practitioner to work in their health profession);
- ensuring that practitioners registered with them are practising within their scope of practice;
- setting the standards of clinical and cultural competence for practitioners;
- accrediting and monitoring educational institutions that offer relevant qualifications; and
- managing notifications about a practitioner’s competence and complaints about conduct.
2.4
The Act came fully into force in September 2004. It repealed 11 occupational statutes that previously governed 13 health professions.
2.5
In 2014, the Ministry carried out a review to identify potential improvements in public safety and health workforce development. The Act was amended in 2019 as a result. Amendments included new requirements, such as independent performance reviews of responsible authorities at least once every five years, the collection of workforce data, and new powers to act immediately and without notice to suspend a practitioner’s practising certificate if there were significant concerns about public health and safety.
2.6
Under the Act, the Minister of Health has responsibilities that include appointing members of each responsible authorities’ governance board, resolving disputes about scopes of practice, and regulating restricted activities for health practitioners.
Processing complaints and notifications about health practitioners
2.7
It is important that health consumers (people who use healthcare services) are able to raise concerns and make complaints about their healthcare experiences. This can lead to improvements in patient safety and the quality of care, and empower health consumers. Both the responsible authorities and the Health and Disability Commissioner (the Commissioner) play a significant role in the complaints and notification process (see paragraph 2.14 and Appendix 1).
2.8
The complexity of regulation administered by the responsible authorities is affected by the extent of possible harm, which varies depending on the health profession.
Role of the Health and Disability Commissioner
2.9
The Commissioner is responsible for promoting and protecting the rights of people using health and disability services, including assessing and resolving complaints that raise health consumer rights issues.
2.10
The Commissioner assesses complaints about the quality of care provided to people using health and disability services. In more serious cases, the Commissioner can carry out an investigation, which might result in a provider being found in breach of the Code of Health and Disability Services Consumers’ Rights (the Code).8
2.11
The complaints system is complex due to an overlap in roles between the responsible authorities and the Commissioner. Under the Act, responsible authorities must forward to the Commissioner any complaint alleging that the practice or conduct of a practitioner has adversely affected a health consumer. Similarly, the Commissioner must notify the responsible authority of any investigation that directly concerns a health practitioner.
Role of the responsible authorities
2.12
The responsible authorities ensure that health practitioners are fit to practise by conducting competence reviews and requiring practitioners to carry out recertification programmes. They might require an examination or test if there are concerns that a practitioner has a mental or physical condition that could affect their ability to work as a health practitioner. They also address and triage complaints and notifications about practitioners who do not meet standards set by the responsible authority and/or pose a risk of harm to the public.9
2.13
Complaints and notifications can be raised by practitioners’ peers and by members of the public. Responsible authorities also address cases that have been referred to them by the Commissioner, including cases that do not concern consumer rights, such as Accident Compensation Corporation fraud.
Types of complaints and notifications, and how they are addressed by the responsible authorities
2.14
Complaints and notifications fall into three main categories (some can involve multiple categories):
- Conduct complaints pare related to behaviour or not meeting ethical standards.
- Competence notifications relate to the skills and ability of health professionals to carry out their role.
- Health (fitness) notifications are related to the health practitioner’s own mental and/or physical health.
Conduct-related complaints and competence-related notifications
2.15
For both conduct-related complaints and competence-related notifications, section 70 of the Act prevents a responsible authority from taking disciplinary action while a complaint is being investigated by the Commissioner. While it awaits the outcome of the Commissioner’s investigation, the responsible authority might order interim suspension of a health practitioner’s practising certificate or place conditions on their practice. The Commissioner can refer a complaint to the responsible authority to investigate. The responsible authority must report back to the Commissioner on what action has been taken.
2.16
However, section 70 of the Act does not prevent responsible authorities from reviewing a practitioner’s competence while the Commissioner is carrying out an investigation. At any time, the responsible authority can initiate a competence review of a practitioner and then, if necessary, require them to complete a competence programme and/or place conditions on their practising certificate.
2.17
A responsible authority can also appoint a Professional Conduct Committee to investigate complaints about a practitioner’s conduct (other than matters under investigation by the Commissioner). For some complaints, the Professional Conduct Committee can refer cases to the Health Practitioners Disciplinary Tribunal.10 Outcomes of such cases can include fines, conditions, suspension of registration, or cancellation of the practitioner’s registration.
Health (fitness) notifications
2.18
Notifications can be sent to a responsible authority if a practitioner is believed to be unable to perform required functions due to mental or physical ill health. Depending on the case, the responsible authorities can require health practitioner examinations, suspend a practitioner’s registration, or set conditions of practice.
Reporting on complaints and notifications
2.19
To be accountable to the public, the health system needs to be transparent. It also needs to show appropriate actions are taken to address concerns in a professional and timely manner.
2.20
The Commissioner reports on the total number of complaints received and resolved within specific time frames. Its 2022/23 annual report included measures that showed the total time taken to resolve complaints. They were reported against set targets, which were linked to strategic objectives. For example, the Commissioner reported that 66.5% of closed complaints in 2022/23 were closed within three months, against a target of 60%.
2.21
For 2022/23, the annual reports of the five authorities we looked at had dedicated sections on complaints and notifications, although the level and type of information varied. Not all of the five responsible authorities we looked at reported on complaint resolution timeliness, the nature of the complaint or notification, or on the source of the complaint (see Appendices 2 and 3).11
2.22
We consider that reporting on measures related to complaint resolution timeliness, similar to those of the Commissioner, would provide the public with information on whether the responsible authorities are acting to resolve issues in a timely manner.
2.23
In our view, the responsible authorities could usefully provide information about the timeliness of their complaints and notifications processes. They could include information about the number of open complaints and notifications and how long they have been pending at the start and end of a set time period. Responsible authorities could also include target time frames to close complaints and notifications and to provide an outcome to the complainant.
Responsible authorities’ role in workforce matters
2.24
Responsible authorities have a legal requirement under the Act to collect workforce data to assist the Ministry and others with workforce forecasting and planning.
2.25
The responsible authorities do not implement or lead policies to remove structural barriers or resolve workforce challenges, such as retention rates. That is the Ministry’s role, given its stewardship responsibilities for the health system.
2.26
Each of the five authorities we looked at collected in-depth data about their respective registered professions. This information provides the responsible authorities insight into workforce trends.
2.27
The five authorities we looked at collect data through two main methods. First, registration data is collected when a practitioner is added to each authority’s register. Registration information includes gender, ethnicity, and the current country or region where the practitioner is registered.
2.28
Secondly, workforce survey data is collected when practitioners renew their annual practising certificates. Workforce survey reports include information such as the number of hours worked each week, hours on call, ethnicity, and detailed employment information such as employer type and work type by subspecialty. However, the workforce surveys are voluntary and only record results from those that participate.
2.29
Appendix 4 sets out more information about the various workforce reports published by the five authorities we focused on. Trends in the total registered workforce, including proportions of complaints and notifications, are in Appendix 5.
Reporting on registration applications
2.30
Responsible authorities’ key functions include authorising the registration of practitioners and considering applications for annual practising certificates, which allow health practitioners to work in their profession.
2.31
To keep up with an increasing number of applications, some responsible authorities have reviewed and streamlined their registration processes.
2.32
For example, there was a significant increase in the nursing workforce from 2018/19 to 2022/23. In 2022/23, 74% of newly registered nurses were from overseas, 165% higher than in 2018/19. The Nursing Council increased the capacity of the team managing applications and carried out several initiatives to streamline the application process.
2.33
For 2022/23, the Physiotherapy Board reported a 62% increase in the number of overseas applications for registration. To improve the timeliness of its registration process, the Board implemented an “Express Pathway” for applications from selected countries.
2.34
As part of its 2022/23 service performance framework, the Medical Council reported on the time it takes to process applications for registration. It included information on the percentage of international medical graduate applications and general registration applications that it processed within its target time frames.
2.35
Similarly, the Nursing Council reported in its 2022/23 annual report on the median time taken to process registrations, both for those who were required to complete a competence assessment programme and those who were not.12 However, this data did not show trends in registration time frames nor progress against any targets.
2.36
We did not find publicly available information about registration timeliness for the Dental Council, the Pharmacy Council, or the Physiotherapy Board (see Appendix 4).
2.37
Because one of the responsible authorities’ core functions is registering practitioners and considering applications for annual practising certificates, the responsible authorities should, in our view, consider reporting on the timeliness of this function over time and against set targets.
| Recommendation 1 |
|---|
We recommend that responsible authorities improve their reporting by providing information on the target and actual timeliness of:
|
2.38
To ensure that reporting is consistent, the Ministry could set standard metrics for complaint and notification processes and registration processes in the responsible authorities’ annual reporting. This should include timeliness data and more context to explain trends that are unique to each of the responsible authorities.
| Recommendation 2 |
|---|
| We recommend that the Ministry of Health set standard measures and definitions for annual reporting to ensure that there is consistency in the information reported by all responsible authorities. |
7: In 2020, the Ministry of Health provided the Team Relief Fund to the Pharmacy Council to support over-stretched pharmacy teams.
8: The Code establishes the rights of health consumers and the obligations and duties of providers to comply with the Code. It is a regulation under the Health and Disability Commissioner Act.
9: Under the Act, this includes notifying the Director-General of Health, the Health and Disability Commissioner, the Accident Compensation Corporation, and the employer of the health practitioner.
10: The Health Practitioners Disciplinary Tribunal hears and determines charges brought against practitioners by a Professional Conduct Committee.
11: Sources of complaints about health practitioners can include members of the public, employers, or colleagues.
12: Competence assessment programmes are designed to ensure that nurses trained overseas and nurses returning to the profession have the required skills and knowledge to practise.