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2011
THE
LEGISLATIVE ASSEMBLY FOR THE
AUSTRALIAN CAPITAL
TERRITORY
HEALTH AMENDMENT BILL
2011
EXPLANATORY
STATEMENT
Presented by
Katy Gallagher MLA
Minister for Health
EXPLANATORY STATEMENT
The proposed Health Amendment Bill 2011 will provide for the following two
unrelated matters:
a. amendments to Part 4 and Part 5 of the Health Act 1993 (the Health Act) which governs how approved clinical privileges committees and quality assurance committees exercise their powers and perform their functions; and
b. amendments to establish a legislative basis for a Local Hospital Network
(LHN) for the ACT.
Amendments to Part 4 and Part 5 of the Health
Act
The object of the amendments to Parts 4 and 5 of the Health
Act is to better articulate the intention of the legislation. The amendments
seek to improve the efficiency, effectiveness, and quality of health services in
the ACT. The amendments do not propose policy changes or any new direction of
the government in regards to the governance of quality assurance committees and
clinical privilege committees.
Part 4 of the Health Act
specifically governs the assessment and evaluation of quality assurance
activities conducted by health service providers. Part 5 governs the review of
clinical privileges for doctors and dentists, that is, the rights of a doctor or
dentist to treat patients, or carry out other procedures, at a health facility,
or to use the equipment, or other facilities, at a health facility.
The
amendments to Part 4 and 5 of the Health Act are required to remove the
ambiguity regarding the obligations of confidentiality imposed under the current
legislation in relation to information obtained by quality assurance committees
and clinical privileges committees. The ambiguities in the legislation have
resulted in complex administrative arrangements being required in order to meet
the statutory obligations to protect the safety of members of the public
fully.
Amendments to establish a Local Hospital Network for the ACT
(ACT LHN)
The objectives of these amendments are to set out a
definition of the ACT LHN, its governance arrangements within ACT Health and to
establish an ACT LHN Council including the process of appointment and its
generic composition.
The National Health and Hospitals Network
Agreement, (the Agreement) provides for Local Hospital Networks, which are
to be comprised of a single or group of hospitals and other health services that
are geographically or functionally linked. The ACT LHN will be a networked
system holding service contracts with ACT Health, will report to the Deputy
Chief Executive of ACT Health who has responsibility for clinical operations of
ACT Health, and will be comprised of:
a. the Canberra Hospital;
b. Calvary Hospital in relation to public patient activity;
c. the Queen Elizabeth II Family Centre; and
d. Clare Holland House.
The amendments provide for the membership of the ACT LHN Council which
are aligned with the requirements of the Agreement but reflect local capacity
and expertise including the need to ensure some local community knowledge and
understanding. The amendments proposed will provide for the generic composition
of the ACT LHN Council and will be based on a transparent process of
appointment.
The amendments make clear that the ACT LHN Council is not
intended to comprise representatives of particular groups or interests in the
health system, or indeed the community, but will be comprised of members with
an appropriate mix of skills and expertise including:
a. health management experience;
b. clinical expertise (external to the LHN wherever practical);
c. cross-membership with local Primary Health Care Organisations (now called Medicare Locals);
d. academic, teaching and research experience
e. financial management, commerce and industry experience;
f. public consultation experience; and
g. consumer/carer experience.
The amendments also provide that the ACT LHN Council must provide an
annual report to the Minister and must include in that report the consultation
undertaken by the ACT LHN Council with the community about any issues affecting
the satisfactory delivery of health services and the overall performance of the
ACT LHN
DETAIL
This clause is a technical clause and sets out the name of the proposed
Act as the Health Amendment Act 2011.
This clause is a technical clause setting out when commencement of the Act
will occur. It is intended that commencement of the Act other than sections 4
and 5 will occur on day after its notification. Sections 4 and 5 will commence
on 1 July 2011.
This clause identifies the Act to be amended, namely the Health Act
1993.
This clause inserts a new section, which defines for the purposes of the Act
what is the local hospital network for the ACT.
This clause inserts a new part 3A. Division 3A.1 provides for the
establishment of the Local Hospital Network Council (section 13), its functions
(section 14), its reporting requirements (section 15), its membership (section
16, 17, 18, 19, 19A and 19B). Division 3A.2 (sections 19C, 19D and 19E)
provides for the proceedings of the Council including the time and place of
meetings, governing procedures and the disclosure of interests of council
members. Division 3A.3 provides for a review of the operation of part 3A as
soon as practicable after the end of its first year of
operation.
Clause 6 New section 27A
This clause inserts a
new section 27A which provides that the Minister may not approve a term of a
quality assurance committee (QAC) for longer than 3 years.
Clause
7 New sections 38A and 38B
The clause inserts two new sections. The
first (section 38A) allows a QAC to provide an extraordinary report to the Chief
Executive of Health where the QAC becomes aware of something that is
sufficiently serious to require urgent action to prevent or limit any adverse
effect it might have on the health service. The second ( section 38B) allows a
QAC to provide an interim report to the Chief Executive of Health before it
completes an assessment or evaluation.
Clause 8 Sections 43 to
46
This clause substitutes sections 43, 44, 45 and 46. The main
difference being the inclusion of the word ‘may’ and the removal of
the words ‘must not’ that has led to varied interpretations of when
information may be shared with identified entities. The amendment now provides
that QACs may give protected information to the Coroner’s Court, other
QACs, the relevant Health Board and the Minister where the QAC is satisfied that
giving the information would be likely to facilitate the improvement of health
services in the ACT. As the Health Services Commissioner (HSC) is entitled to
receive any information provided to the Health Boards provision has been made to
allow the HSC to receive this information at the same time.
Clause
9 Part 5 heading
This clause substitutes a new heading for part 5
namely ‘Reviewing scope of clinical practice’.
Clause
10 Definitions—pt 5
This clause removes the definitions of clinical privileges,
clinical privileges report and clinical privileges review notice
from section 50.
Clause 11 Section 50, definition of review and note
This
clause substitutes a new definition for review and includes the new
definitions of scope of clinical practice, scope of clinical practice
executive decision notice and scope of clinical practice report. It
also includes a new drafters note for the term scope of clinical practice
committee which is defined in the Act at section 51.
Clause
12 Section 51
This clause substitutes a new section to define what
is a scope of clinical practice committee.
Clause 13 Sections
54 to 74
The clause substitutes new sections for sections 54 to 74.
The amendments replace the term ‘clinical privileges’ with
‘scope of clinical practice’. This will align the language of the
Health Act with the National Standard for Credentialing and Defining
the Scope of Clinical Practice and the existing policies of other Australian
States on credentialing and defining the scope of clinical practice of doctors
and dentists. Two new provisions will then allow for clinical privileges
committees to: credential doctors and dentists; and also define a scope of
clinical practice for, and grant a scope of clinical practice to, doctors and
dentists.
A series of new provisions will allow for interim and emergency
recommendations to be made in relation to a complaint about the clinical
competency of a doctor or dentist. New provisions will allow for decision-makers
to: be notified of the interim and emergency recommendations; make a decision on
these recommendations; and then notify relevant parties of that decision
including the final decision arising from the full review process. Relevant
parties includes the Chief Executive of the health facility where the doctor or
dentist is working, the Medical Board of Australia or the Dental Board of
Australia, a health service outside of the ACT, but only if there is a specific
request from that health service or the other third parties for the
information.
New provisions will mandate the sharing of information about
decisions between the two decision-makers in the public health sector but only
in circumstances where the sharing of that information is likely to facilitate
the improvement of health services provided in the ACT or the safety of persons
who receive those health services. Where a decision is made to amend or withdraw
the scope of clinical practice of a doctor or dentist, a new provision will
allow decisions-makers to notify relevant persons responsible for the management
of affected areas of the decision so that they will be aware of and, as
appropriate, implement the decision.
New provisions will allow for the
sharing of information between clinical privileges committees and other clinical
privileges committees and also clinical privileges committees and quality
assurance committees, but only in circumstances where the disclosure of
information is likely to facilitate the improvement of health services provided
in the ACT or the safety of persons who receive those health
services.
New provisions will ensure complainants remain anonymous and
that their original written complaint is de-identified before it is provided to
any doctor or dentist against whom a complaint has been made or any other third
party to whom the original written complaint is required to be released
to.
Clause 14 Who is an information holder?
Section 122
(a) (ii), (iii) and (iv)
This clause substitutes new subparagraphs to
ensure consistency with the changes made in clause 13.
Clause
15 Section 122 (b), note, last dot point
This clause substitutes new
dot point to be consistent with changes made in clause 13.
Clause
16 What is sensitive information?
Section 124, definition of
sensitive information,
paragraph (a) (iv)
This clause
substitutes a new subparagraph to be consistent with the changes made in clause
13.
Clause 17 Review of decisions
Section 130
(a)
This clause substitutes a new subparagraph to be consistent with
the changes made in clause 13.
Clause 18 New section
189
This clause inserts a new section 189 that provides for the
protection of a doctor or dentist from liability in emergency situations. This
change was considered necessary to overcome the difficulties that might arise in
a health facility context of relying on the protection from liability provided
by the good Samaritans provision in section 4 of the Civil Law (Wrongs) Act
2002.
Clause 19 Disclosure of interests by committee
members
Section 190 (1), note 1
This clause substitutes a
new note 1 consequential on the changes made to section 19E and section 61
above.
Clause 20 New part 22
This clause inserts a new part
22 to provide for transitional provisions for the Health Amendment Act
2011. The new part covers definitions (section 255), approvals and expiry
dates of QACs (section 256), decisions regarding reviews not yet commenced
(section 257) and decisions regarding reviews already commenced (section 258).
They also cover admissibility of evidence (section 259) and the expiry date of
the new part (section 260) which is 1 year after the commencement
day.
Clause 21 Dictionary, new definition of chief executive
officer, Calvary
This clause inserts a new definition for
chief executive officer, Calvary to overcome the fact that this position
is not covered by the definition of chief executive as contained in the
Legislation Act 2001.
Clause 22 Dictionary
This
clause omits the definitions of clinical privileges, clinical
privileges committee, clinical privileges report and clinical privileges
review notice, which are no longer referred to in the
legislation.
Clause 23 Dictionary, new definition of
council
This clause inserts a new definition of
council, which means the Local Hospital Network Council as established
under section 13.
Clause 24 Dictionary, definition of
dentist
This clause substitutes a definition for
dentist consequent on the changes made to Part 5.
Clause
25 Dictionary, definition of doctor
This clause substitutes a
definition for doctor consequent on the changes made to Part
5.
Clause 26 Dictionary, definition of hospital
This
clause substitutes a definition for hospital consequent on the changes
made to Part 5.
Clause 27 Dictionary, new definition of local
hospital network
This clause inserts a new definition for
local hospital network as provided for in section 8.
Clause
28 Dictionary, definition of review
This clause substitutes a
definition for review consequent on the changes made to Part
5.
Clause 29 Dictionary, new definitions
This clause
inserts new definitions for scope of clinical practice, scope of
clinical practice committee, scope of clinical practice executive decision
notice and scope of clinical practice report. These are
consequential on the changes made to Part 5.