Australia’s health ministers are expected to meet this month and are scheduled to receive a report recommending which regulatory option for audiologists should go ahead.
Registration under Ahpra (the Australian Health Practitioner Regulation Agency) is among seven options health ministers have put on the table as they consult on the future of audiology regulation.
A final paper recommending preferred options was due to be presented to health ministers on 27 July 2024 at their meeting but has been delayed. A Queensland Government spokesperson said on 27 July that the Audiology Regulatory Impact Statement (RIS) final report being prepared by Deloitte which was investigating options was still being finalised.
Meanwhile, the health ministers postponed their meeting.
Shortlisted options include the current model of self-regulation, national registration of the audiology profession through Ahpra’s National Registration and Accreditation Scheme (NRAS) and more targeted regulation of practitioners offering certain services.
Two accrediting bodies – Audiology Australia and the Australian College of Audiology incorporating the Hearing Aid Audiology Society of Australia (AcAud inc HAASA) – are aligned and want self-regulation for audiologists and audiometrists through mandatory membership via a practitioner professional body.
A third professional association, Independent Audiologists Australia, and peak consumer voice Deafness Forum Australia, believe mandatory registration of audiologists and audiometrists under Ahpra is best for the industry and the public.
Meanwhile, NASRHP (the National Alliance of Self-Regulating Health Professionals) wants an uplift of its regulatory powers in legislation to strengthen its provision of independent oversight to self-regulating professions.
Read their arguments and preferences below:
STRONGER SELF-REGULATION THE PATH FORWARD SAYS AUDIOLOGY AUSTRALIA
Audiology Australia (AudA) believes the most effective way to achieve professional regulation is through mandatory membership of all audiologists and audiometrists to a practitionerprofessional body (PPB).
It believes this should be supported through regulation changes to strengthen the powers of the National Alliance of Self-Regulating Health Professions (NASRHP), of which it is a member, to increase title protection and further strengthen independent oversight of quality and complaints, as well as mandatory certifications through Audiology Australia for areas of audiology that pose additional risk.
AudA said strengthening NASRHP’s powers could ensure safety and quality standards across self-regulating professions, leading towards advancing professionalism and safeguarding of health services.
“NASRHP oversees standards across 60,000 allied health professionals. It provides independent oversight of evidence-based minimum practice standards for health professions which meet requirements of membership. These align with Ahpra registration and standards, and both provide nationally consistent oversight of quality, including compliance with a code of conduct and consumer safety,” AudA CEO Ms Leanne Emerson said.
“‘Both regulatory systems work effectively to address scope-of-practice, competency standards, practitioner certification requirements and CPD, plus notifications or complaints. Neither provide industrial or business advice or a mandate on how an organisation or health service should conduct its operations. These gaps are important to consider.”’
AudA said the goal should be a regulatory environment that optimised delivery of high quality audiological services while promoting innovation and accessibility but there were options not included in the current consultation process that could comprehensively address this.
The organisation said it welcomed the opportunity to strengthen the profession and support professional regulation but there were positives and negatives to each model being considered. While regulation may support title protection and provide a clear pathway to address concerns and complaints about practising audiologists, AudA said it wouldn’t address a range of other issues that contributed to broader systemic failures in settings identified in the recent Queensland and South Australian inquiries. Equally, there was a risk that registration could result in restrictions to the current scope-of-practice for audiologists and audiometrists.
Findings from the inquiries suggested there was no evidence that regulatory models being considered would have changed outcomes for those affected or would offer protection against future issues, AudA said. Instead, the findings pointed to wider systemic failings across the health sector as contributing factors.
“It concerns us that this review may divert attention away from addressing the wider issues that have occurred across two public health systems,” Emerson added.
‘’Audiology Australia is not against the profession achieving registration and we continue to raise the issue with government whose response is that as a low-risk profession it doesn’t meet the criteria for registration.
“Some consequences come with registration that may not serve our members and advantages that regulation may offer including title protection, increased profile and improved access to referral and prescribing rights can be achieved outside the Ahpra model.”
AudA said striking a balance between regulation and flexibility was essential to support patient safety, high professional standards and advancement of the audiology sector.
INDEPENDENT AUDIOLOGISTS AUSTRALIA SUPPORTS AHPRA REGISTRATION FOR AUDIOLOGISTS AND AUDIOMETRISTS
Independent Audiologists Australia (IAA) strongly believes in mandatory registration via the Australian Health Practitioner Regulation Agency (Ahpra) for audiologists and audiometrists, regardless of workplace, specialty or location as the only viable measure to provide consistent safeguards to patients at all stages of the lifespan – and to restore public confidence in audiology as a profession.
President Dr Tegan Keogh, PhD, said that for more than 15 years, IAA had lobbied and campaigned government for what it believes is an important step in quality assurance of the profession.
“IAA cares about safeguards for patients and the standing of audiologists in the community which is why we were the only professional body to submit a request for registration at the National Health Ministers Meeting,” Keogh said. “To our knowledge, no other professional body has made such a submission before.
“Regulation under Ahpra is not a new topic. In 2017 the parliamentary inquiry into hearing health recommended the Australian Government pursue registration of the hearing health sector under Ahpra. The events reported in 2023 in SA and Queensland have demonstrated the significant potential for life-altering risk to patients engaging with our sector and the shortcomings of self-regulation in managing this risk. Change is needed.
“IAA supports mandatory whole-of-sector registration as the gold standard for safeguarding public interests, ensuring quality of service provision, and upholding professional recognition.”
She said there were four reasons why IAA continued to advocate for registration; protection of title; quality and compliance; protections for the public; and health profession agreements with the National Boards.
Keogh noted that titles of Ahpra-registered health professions were protected by law. If someone used a proteted title to describe their professional role, others could expect this person was appropriately trained and qualified in that profession, registered, and met safe and professional standards of practice, she said. They would have a clearly defined scope-of-practice for this title linked to their educational level and enforceable by law.
“Under the National Law, Ahpra works to make sure registered health practitioners meet the standards of their profession and takes action if it determines there is a risk posed to the public,” she said. “It’s a criminal offence for someone who isn’t a registered health practitioner to use a protected or specialist title. This isn’t a function of NASRHP.”
Ahpra registration would mean legal protection of the title ‘audiologist’ and penalties for misuse including possible jail time. A national register of audiologists and audiometrists would allow the public to find accurate information about practitioners, and make informed choices about how they receive hearing and balance care, she added.
Ahpra advises the National Boards on registration standards, codes and guidelines for health practitioners. This ensures that only those with the necessary skills and qualifications to provide competent and ethical care are registered, Keogh said.
This would not restrict anyone from practising within their righful scope but would provide clear guidelines for the public about the expected scope for each profession and a transparent regulatory framework to allow audiologists to practise at the top of their scope, appropriate to their training. National Boards and Ahpra enforce the Health Practitioner Regulation National Law in each state and territory. By ensuring only suitably trained and qualified practitioners are registered, Ahpra upholds competent and ethical practice to protect public health and safety.
ACAUD INC HAASA CONFIDENT RIGOROUS SELF-REGULATION CAN BE ACHIEVED
The Australian College of Audiology incorporating the Hearing Aid Audiology Society of Australia (ACAud inc HAASA) said it remained committed to “robust self-regulation” and mandatory membership with a practitioner professional body (PPB.)
It believes this should be supported through regulation changes to strengthen the powers of the National Alliance of Self-Regulating Health Professions (NASRHP), of which it said it was in the process of becoming a member. The current structure of ACAud aligns with the requirements of NASRHP.
ACAud chair Ms Marguerite Rushworth emphasised that the primary objective should be the establishment of a regulatory framework designed to optimise the delivery of high quality audiological services. This framework should not only foster innovation within the field but also enhance accessibility for all individuals in need of these services.
She said that while the current consultation process was a step in the right direction, it had failed to consider several alternative options that could more comprehensively and effectively address these critical goals. By incorporating these overlooked options, a more robust and inclusive regulatory environment could be achieved, ultimately benefitting both providers and recipients of audiological care, she added.
Rushworth said that if regulation was to be introduced, it was imperative that it included the entire sector – both audiologists and audiometrists.
“ACAud recognises the serious nature of the recent incidents in Queensland and South Australia and offers our deepest condolences to the families impacted,” she said.
“However, we believe that the current consultation might not address the root cause or prevent similar future incidents. It is important to note that the consultation paper seems to lack a complete understanding of the intricacies of our field, impacting the proposed measures’ potential effectiveness. Regulation would not have prevented the incidents from occurring and would not in the future.
“ACAud remains committed to robust self-regulation and working with peer organisations to strengthen the profession. The impact on the wider profession has not been considered.”
Rushworth said ACAud already enforced a comprehensive sector-wide Scope of Practice, Code of Conduct and Ethical Review Framework, along with the National Competency Standards, which collectively ensured the high standards of its members’ practise.
“Should regulation be introduced, it is imperative that it encompasses the entire sector, including both audiologists and audiometrists,” she said.
Rushworth said ACAud’s advocacy for mandatory membership with a practitioner professional body (PPB) underscored its belief in a unified approach to regulation.
“Given the size and specific risks associated with our sector, we are confident that it can be effectively managed through rigorous self-regulation,” she added.
“We are committed to collaborating with all stakeholders to ensure that any regulatory measures enhance the trust and quality of the hearing health care services we provide to the community.”
ALLIANCE OF SELF-REGULATING HEALTH PROFESSIONS SEEKS GREATER POWER
The National Alliance of Self-Regulating Health Professions (NASRHP) needs legislative backing for formal recognition, which will strengthen the body and enable better self-regulation of audiologists, the alliance believes.
Its former chair Ms Anita Hobson-Powell left the role three weeks ago and is now Commonwealth Chief Allied Health officer. When she was chair, she said the current Scope of Practice Review had initiated discussions about the “regulation” of the health professions space. But she said the review lacked the recognition that self-regulation could be divided into two categories.
“Firstly, there are those who truly self-regulate, with individual professional bodies deciding how they will regulate their profession,” she said. “Secondly, there are professions falling under the NASRHP, operating to meet external standards for self-regulation.
“Formal recognition of the NASRHP as the authoritative body entrusted to provide independent oversight to the self-regulating professions is needed and must be in legislation.
“NASRHP can ensure safety and quality standards across self-regulating professions, leading towards advancing professionalism and safeguarding of health services.”
Hobson-Powell added that to ensure comprehensive oversight and standardisation “a legislative requirement mandatorily requiring all self-regulating health professional bodies to submit their regulatory frameworks for independent validation by NASRHP needs to be established”.
“Legislative mandates should unequivocally designate NASRHP as the equivalent to the Australian Health Practitioner Regulation Agency (Ahpra), establishing parity and credibility within the regulatory landscape,” she said.
In 2017, the national alliance emerged as a beacon of integrity, administering a robust quality standards framework for organisations within self-regulated health professions not covered by the National Registration and Accreditation Scheme (NRAS), Hobson-Powell said.
The Australian Department of Health and Aged Care provided seed funding, underscoring the need for an independent entity to uphold standards in self-regulated professions, she said. But since then, the government had not capitalised on its investment.
“NASRHP is ready to fill the gaps in self-regulation, it just needs legislative recognition to have the additional impact required for self-regulating professions,” she said.
NASRHP’s quality assurance system oversees about 60,000 allied health professionals dedicated to autonomous service delivery. More than 23,000 operate under self-regulation without the benefit of NASRHP’s regulatory oversight, she said.
In 2018 the Council of Australian Governments (COAG) stated that NRAS primarily served to shield the public from potential harm rather than to confer prestige or validate individual professions. Despite this, she said federal and state laws often referenced the Health Practitioner Regulation Law, which excluded two-thirds of the allied health workforce.
