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The Illusion of Peer Review

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My exchange with the Professional Services Review (PSR) during the December 2025 Senate Estimates only deepened my concerns regarding the integrity of their review process. It is becoming increasingly clear that their ‘peer review’ is a mere box-ticking exercise, dominated by lawyers rather than the medical peers the legislation intended.

I questioned why lawyers, rather than the doctors themselves, are drafting the reports. While the PSR claims lawyers only “put together” the doctors’ views to ensure procedural fairness, it appears to me that the heavy lifting, sometimes over 150 hours of drafting, is done by legal staff, while committee members may spend as little as seven to 10 hours reviewing the final product.

I raised the issue that there is no legal requirement for committee members to share the same subspecialty as the GP under review. A GP in a niche field like aerospace medicine could be judged by practitioners with zero experience in that specific group.

I questioned Professor Dr Dio and Ms. Weichert on the lack of basic legal protections, such as the absence of a presiding judge, the inability to cross-examine the committee on their views of “general body” standards, and the lack of a formal merits review.

Several questions were taken on notice, specifically around providing detailed log of hours spent by both staff and committee members on reports over the last three years. We need to see if the time spent by doctors actually justifies calling this a “peer-reviewed” outcome.

— Senate Estimates | February 2026

Transcript

Senator ROBERTS: At the December 2025 Senate estimates, Professor Dr Dio, you indicated that lawyers prepare their reports from the review scheme but that the committee members review the reports. In what way does the PSR monitor the performance of the committee—including if the committee has read the entire report and the material presented to it before signing it off? 

Prof. Di Dio: The committee diligently reads the draft reports and the final reports, and we have staff who liaise with the committee at various stages after draft reports and final reports have been sent to them. So should for any reason a committee member not do their duty and read in the draft report, the legal officer in charge of giving service to that committee would firstly of course remind the committee members to review the report, and if they do not, they would then come to me. But that’s a theoretical possibility, because I cannot recall that happening.  

Senator ROBERTS: The PSR committee process is supposed to be a peer review process performed by doctors. Why then don’t the doctors write their own reports? If administrative support is needed, why are lawyers drafting their reports instead of administrative or secretarial staff, which would come at a lower cost to the department?  

Prof. Di Dio: Because the reports are incredibly important. We are passionate about according natural justice and procedural fairness to all practitioners under review. It is my view that the best way to do that is to have the best qualified, quality people writing those reports. Reports of this nature would be best written by people who are very good at supporting doctors in providing their reports.  

Senator ROBERTS: ‘Best qualified’ to me would seem to be the doctors—and then trimmed up or modified by the lawyers.  

Ms Weichert: The lawyers are writing up what the doctors have formed a view about as part of that committee process, as part of the hearing process, the concerns they have put to a person under review and the things that have come back—the lawyers are just putting it together. They are the doctors’ concerns or the medical practitioners’ concerns. It is they who sign off on the report, who approve the report. They are the peer review committee members’ views.  

Senator ROBERTS: If it can be shown that a lawyer spends over 150 hours drafting a report, but a committee member only spends seven to 10 hours reviewing the material and reading the report, is this truly considered by the PSR to be a legitimate peer review?  

Ms Weichert: That’s not taking into account any of the time that was spent in the hearing, in questioning and the time that the committee members have turned the matter throughout the process.  

Prof. Di Dio: A hearing might take eight days; it might take 50 or 60 hours. The prehearing reading might take many, many hours. The contemplation of what happened during the committee hearing might take the committee members many, many hours to turn their mind to it.  

Senator ROBERTS: Over the past three years, as an average, what percentage of the total services reviewed has the committee found the services provided by doctors to be inappropriate?  

Prof. Di Dio: I will have to take that on notice.  

Senator ROBERTS: This question is about general practitioners. The Royal Australian College of General Practitioners recognises 37 specific interest groups as subspecialities. If a GP is under review by the committee, is it correct that there is no legal requirement for the committee members to share the same subspecialty? For example, if a GP practices solely in aerospace medicine, there’s no legal requirement for the committee to have any experience in aerospace medicine, because they all fall within the category of general practitioners. Why is there no subspeciality matching?  

Prof. Di Dio: The subspecialty matching is that members of the committee are general practitioners. But the PSR strives to find general practitioners who have experience in those matters. I can assure you that for some practitioners who are in craft groups that are exotic, as you say, like me—I have particular special interests—we try to match those as much as we can. But, under the law, a general practitioner can review a fellow general practitioner.  

Senator ROBERTS: Is it correct that the legislation allows just three committee members to decide what is unacceptable to the general body of general practitioners? In deciding what the general body of general practitioners find unacceptable, do the committee members have to have any regard to any external resources or consideration of other doctors? Do the lawyers draft that part of the report as well, about what the general body of doctors think?  

Prof. Di Dio: One of the things that we train committee members to do, to absolutely and scrupulously give fairness to the practitioners under review, is try as much as possible to ask one question at a time to avoid the risk of the practitioner missing the opportunity to respond to any and all of the questions put to them. I’d be very grateful if you could ask me the first couple, and I’ll go through them with you systematically. 

Senator ROBERTS: Is it correct that the legislation allows just three committee members to decide what is unacceptable to the general body of practitioners?  

Prof. Di Dio: Yes. Ms Weichert: It’s at least three. There are certain circumstances where there could be additional committee members appointed, but it is usually three.  

Senator ROBERTS: In deciding what the general body of general practitioners find unacceptable, do the committee members have to have any regard to any external resources or consideration of other doctors?  

Prof. Di Dio: The committee members have to have regard to all of the evidence before them so that they can—  

Senator ROBERTS: All of the evidence before them?  

Prof. Di Dio: Yes. The committee members welcome from the practitioner any materials that they wish to submit as further evidence either before, during or after the hearing.  

Senator ROBERTS: While PSR committees are intended to operate as expert peer-review bodies, concerns include the absence of a presiding judge, the lack of merits review, the inability to cross-examine the committee on what they believe to be the views of the general bodies, the downweighting of significant evidence, limited engagement with defence submissions and a lack of transparency. Why do PSR procedures deny these basic elements of procedural fairness and justice, and how does the PSR contend that the peer-review function is being properly exercised in their absence?  

Prof. Di Dio: Could you ask the six points one at a time, and I’ll gladly respond to them.  

Senator ROBERTS: They’re intended to operate as expert peer review bodies. Concerns include the absence of a presiding judge.  

Prof. Di Dio: The process is a peer-review process. So, if somebody is trying to find out whether I’ve engaged in inappropriate practice, then the best placed people to do that are my peers, not a judge.  

Ms Weichert: And, ultimately, we are applying the scheme as it is set out in the Health Insurance Act, so that provides for a committee—  

Senator ROBERTS: That may be the problem. The lack of merits review?  

Prof. Di Dio: Under the act, there is no formal merits review; however, we try as much as we can to build fairness into this process by having multiple opportunities to respond and make submissions—multiple opportunities.  

Senator ROBERTS: The inability to cross-examine the committee on what they believe to be the views of the general bodies?  

Prof. Di Dio: The committee is there to ask questions and find out if the practitioner under review has engaged in inappropriate practice. It’s not the committee that is under review.  

Ms Weichert: But the person under review can put forward their information when they’re answering the questions and the information that they would like the committee to consider, and that will occur as part of the process.  

Senator ROBERTS: The downweighting of significant evidence?  

Prof. Di Dio: What do you mean by that?  

Senator ROBERTS: As I said, ‘the downweighting of significant evidence’—  

Prof. Di Dio: I don’t understand what you mean.  

Senator ROBERTS: with significant evidence being put cursorily or downgraded.  

Prof. Di Dio: What significant evidence? Who has reviewed something cursorily or downgraded it? I don’t understand.  

Senator ROBERTS: If there is significant evidence put before the committee, it’s downgraded in terms of the verdict.  

Prof. Di Dio: I don’t understand what you mean by that.  

Senator ROBERTS: Okay. Limited engagement with— 

Prof. Di Dio: I would gladly take that on notice if it’s clarified for me. I just don’t quite understand. I’m not in any way being disrespectful.  

Senator ROBERTS: Okay. I can’t understand how you can’t see that, because the words seem to be selfexplanatory.  

Prof. Di Dio: Are you suggesting that, during a committee process, a practitioner under review gives significant evidence and the committee then downgrades or chooses to ignore it?  

Senator ROBERTS: Yes.  

Prof. Di Dio: I’m not aware of that occurring.  

Senator ROBERTS: Limited engagement with defence submissions and a lack of transparency?  

Prof. Di Dio: ‘Limited engagement with defence submissions’—again, practitioners under review can make submissions. Those submissions are welcome, and they are reviewed.  

Senator ROBERTS: Okay. Next question—  

CHAIR: Senator Roberts, can I interrupt you for one quick second. There are media in the room, and I need to give a short statement. The media have requested permission to film and take photos of proceedings, and the committee has agreed to this. I remind the media that this permission can be revoked at any time. The media must follow the direction of secretariat staff. If a witness objects to filming, the committee will consider this request. The media are also reminded that they are not able to take images of senators’ or witnesses’ documents or of the audience. Media activity may not occur during suspensions or after the adjournment of proceedings. Copies of resolution 3, concerning the broadcasting of committee proceedings, are available from the secretariat. My apologies, Senator Roberts.  

Senator ROBERTS: Thank you, Chair. A former PSR director has been found liable in the Queensland court for misfeasance in public office for failing to perform her statutory duties. Given these matters raised, why should the PSR’s legislation, governance and current officeholders not be subject to a comprehensive independent review?  

Prof. Di Dio: We did have a comprehensive review in 2023 called the Philip review, which made findings. We have acted on all of those findings, including the appointment of associate directors to the scheme.  

Senator ROBERTS: The former director was found liable for making a decision without adequately considering submitted materials. Isn’t that exactly what’s still happening?  

Ms Weichert: We do not consider that to be happening.  

Senator ROBERTS: Okay. What percentage of the department’s budget is spent on the committee review process, and how many cases per year go through a committee process?  

Prof. Di Dio: I can’t tell you the exact amount— An incident having occurred in the committee room—  

Senator RUSTON: You might want to turn your device off, Malcolm; you’ll have Bridget McKenzie after you! Prof. Di Dio: It might save us all a bit of time!  

Senator ROBERTS: Only if it’s in super-rational mode—other than that, it’s just filled with garbage. Can you take that percentage on notice?  

Senator CAROL BROWN: It hallucinates from time to time. You have to be careful.  

Senator ROBERTS: Yes. I might just turn it off.  

Prof. Di Dio: I woke up this morning, and ChatGPT told me I was going to have a stress-free day, so I think it was hallucinating! Without notice, I can’t tell you exactly what percentage of the budget is spent on committee hearings, but we can take that on notice and give you an accurate reading.  

Senator ROBERTS: Thank you.  

Prof. Di Dio: The second part of your question was—  

Senator ROBERTS: How many cases per year go through a committee process? Prof. Di Dio: It changes from year to year, but we get approximately 100 to 120 cases per year referred from Medicare, which in turn represents about 30 per cent of the cases that Medicare reviews. Of those cases, a ballpark figure of approximately 10 per cent get no further action under section 91, about 80 per cent get an agreement with the director or the associate director under section 92 and about 10 per cent get referred to a committee. So maybe 10 practitioners get referred to a committee in a year. 

Senator ROBERTS: Thank you. I need to put on record that we’re not debating whether or not the PSR should be there. They are process which I now understand are legislated. That’s what the problem is for us and for doctors. It is very concerning. Take this as a question on notice. Please table a log of the hours spent on each of the draft and final reports by the PSR staff combined and each of the committee members for the last three years of PSR committee matters. It’s expected that this log will table around 60 rows for each of the cases it reviewed over that period.  

Prof. Di Dio: Thank you.  

Senator ROBERTS: Thank you very much for appearing. See you next time. 

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Avoiding the Next Robodebt

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I questioned the Minister regarding Schedule 1 of the Health Legislation Amendment (Miscellaneous Measures No. 1) Bill 2025, specifically the automation of Medicare Provider Numbers (MPNs).

My primary concern, as always, is ensuring that “automation” isn’t just a fancy word for another government digital disaster. We’ve seen the Robodebt fiasco, the Bureau of Meteorology website fiasco, Australia Post software fiasco and the Border Force Cargo management automation fiasco; my job is to make sure Australians aren’t the next victims of a “government stuff-up.”

I asked the Minister why legislation is needed for a process that is already using computers. She replied that this bill provides legislative support for existing practices and introduces safeguards, adding that computers will not be used to revoke or suspend provider numbers without a human request.

I asked if this automation of MPNs was a “Trojan horse” for Artificial Intelligence (AI). Despite the Explanatory Memorandum mentioning “computer programs” for non-discretionary decisions, the Minister stated on the record that there is no intention or requirement to use AI for allocating MPNs.

Finally, I sought clarification on changes to Commonwealth supported places. Under the new rules, medical students who withdraw from their degree, even late in their studies, will no longer be forced to repay the scholarship cost (though they remain liable for HECS). The Minister said that this is about “fairness” rather than recouping funds from students facing hardship.

I remain sceptical of any move toward “automated” government software, and I will be monitoring these automated systems very closely.

Transcript

Senator ROBERTS: Minister, schedule 1 of the bill automates the issuance of Medicare providers numbers, MPNs. ‘Automation’, I assume, means computer software. Computers are used now for the process. What is different about the process being proposed that it requires legislation to enact it?  

Senator McALLISTER (Minister for the National Disability Insurance Scheme): Thank you for your patience, Senator Roberts. I was just obtaining advice so I can advise you correctly. This new part of the act will ensure that the system can approve the use of a computer program for certain decisions relating to the allocation and management of Medicare provider numbers. It will not—and this, I think, will be important to you—enable the approval of the use of a computer program to make decisions about revoking a Medicare provider number or suspending a Medicare provider number where the suspension is not at the request of a health professional.  

It will also include safeguards around the use of computer programs to make decisions relating to Medicare provider numbers. Those safeguards include a requirement to notify a person where a computer program was used to make a decision about their Medicare provider number; a requirement to make it public when the use of a computer program to make decisions about Medicare provider numbers has been approved; a power to make substitute decisions where they are satisfied that a decision made by the operation of a computer program is incorrect; and a requirement to include information in the Services Australia annual report about the number and types of substituted decisions. 

Importantly, these things introduce safeguards, and they also, as is indicated in the explanatory memorandum, provide legislative support for an existing practice where some Medicare provider numbers have been allocated by use of a computer program, rather than by a human delegate.  

Senator ROBERTS: I think you anticipated one of my future questions, but, in the meantime, who decides if a person is qualified for a Medicare provider number, including the decision to give a Medicare provider number to a new arrival in the country? I’m asking this to see how this automation will impinge on the process of determining qualifications.  

Senator McALLISTER: May I clarify. I think what you’re asking is, ‘How would a new migrant to Australia have their qualifications recognised for the purpose of practising in an Australian context?’ Is that correct?  

Senator ROBERTS: That’s part of the question. The other part concerns any Australian who’s here right now; how would they be qualified?  

Senator McALLISTER: I’m terribly sorry. I might ask you to clarify further. You said that you’re asking about how a person who is here now would obtain a Medicare provider number. Do you mean an Australian citizen or another person? What are you trying to elicit from me?  

Senator ROBERTS: Anybody who’s qualified to get a Medicare provider number—how would you make sure they are qualified, and how would you make sure that we’re not excluding people?  

Senator McALLISTER: The advice I have is that the bill that’s before us doesn’t change any of the existing arrangements. Those arrangements, of course, include a series of processes to ensure that a person seeking to practise within the Medicare system is qualified.  

Senator ROBERTS: How extensive are the checks, and is there any hint of automation being more than just computer software? Is the bill intending to allow for the use of AI for automatic MPNs?  

Senator McALLISTER: No.  

Senator ROBERTS: So there’s no requirement for artificial intelligence to be used in allocating MPNs?  

Senator McALLISTER: The advice I have is no.  

Senator ROBERTS: I’ll quote from the explanatory memorandum:  

The Bill will enable the Chief Executive Medicare to approve the use of a computer program to make appropriate, non-discretionary decisions relating to the registration and claims process.  

Can I confirm you intend to use AI for that process? If so, what checks are in place to make sure the AI is fit for purpose?  

Senator McALLISTER: The advice I have in relation to AI is that there is no intention. We do not require AI to perform the functions that are set out in the bill. In relation to your earlier question about the process by which a person becomes eligible for obtaining a Medicare number, the Parliamentary Library’s Bills Digest in relation to this says:  

To be eligible to provide a Medicare service, health professionals must meet certain criteria. Practitioners eligible to have Medicare benefits payable for their services ‘at the place of practice as well as refer patients to other health professionals for Medicare eligible services, such as pathology and diagnostic imaging from the place of practice’, may apply online or in writing to Services Australia for a MPN for the locations where these services/referrals/requests will be provided.  

MPNs are used by health practitioners both ‘as a means of identifying themselves and their place of practice for the purposes of claiming Medicare benefits for eligible services, and as an identifier to support other Medicare-related programs …  

Senator ROBERTS: To clarify for constituents and to get some reassurance: you didn’t hesitate when you used the word ‘intention’ with regard to AI and then said there was no requirement. After the robodebt fiasco, the Bureau of Meteorology website fiasco, the Australia Post software fiasco and the Border Force cargo management automation, constituents have every right to point out that these stuff-ups keep happening because of the way in which new technology is rolled out. That’s a big concern. Now you’re giving the software decision-making powers, and it sounds like there are no plans to do that with due care. What security steps are being taken to reassure our constituents that the automations proposed in this bill don’t become yet another government stuff-up? I acknowledge that not all of the stuff-ups have occurred on your watch. 

Senator McALLISTER: This bill puts in place safeguards to ensure that, to the extent that a computer is utilised, the circumstances in which a computer is being used are made very explicit. It also puts some constraints around the kinds of decisions that may be taken by a computer in the context of this process—that is, the process of obtaining a Medicare provider number. I read to you earlier some of those safeguards, which are set out in the explanatory memorandum. As I indicated to you, the advice I have is that this process, which involves the use of a computer for certain purposes that are quite tightly defined and constrained, does not require the use of AI.  

Senator ROBERTS: This final question has a lengthy preamble. Item 3124ZH1 removes the requirement for students who do not complete their degree to repay the Commonwealth supported place cost. Students can currently withdraw from the program without consequence up to the HECS census date in their second year of study. If the student withdraws after that date, they incur a debt to the Commonwealth equal to the full cost of their Commonwealth supported place up to the date of withdrawal in addition to any HECS or HELP liability. The proposed amendment, as I understand it, seeks to extend the existing grace period from the HECS census date in the second year of study to the award of the medical degree. Can you please explain that provision? It sounds like they can pull out right at the end of their degree and not have to pay back the cost. Is that right?  

Senator McALLISTER: Senator, you’re correct that at the moment a person who withdraws from their degree doesn’t need to pay the cost of the scholarship back if they withdraw prior to the census date you alluded to. I believe that they do remain liable for the HECS costs incurred by them in the pursuit of their studies up to that point. You are also correct that a purpose of this bill is to extend the period during which a person may withdraw without incurring a debt associated with their receipt of Commonwealth payments.  

Senator ROBERTS: Sorry, that was my second-last question; I’ve got another one now. What is the rationale behind extending the withdrawal date so they won’t have to pay it back?  

Senator McALLISTER: Earlier in the debate I read out an email from a person who has incurred a debt in precisely these circumstances, and they spoke about the hardship they had experienced as a consequence of that. This person made the point that the purpose of the bonded nature of this program is to ensure that people who do qualify as medical professionals fulfil their obligation to work in an area that is underserved by medical practitioners. The purpose is not in itself to recoup funds from students, and we simply seek to make the system fairer. 

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Doctors Concerned Over Report Process

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Doctors have raised with me their concerns about a lack of accountability and a lack of basic understanding that is evident in reports prepared by the Professional Services Review Scheme (PSRS).

During the December 2025 Senate Estimates session, I asked Professor De Dio of the PSRS about the process for drafting Committee Reports. He explained that the reports are written by Committee members with significant assistance from staff lawyers. The lawyers contribute by reviewing the reports and helping with drafts, ensuring the content reflects the concerns of the Committee members.

Professor De Dio noted that the reports are the result of collaborative work, with lawyers playing an important role in production. A draft report is prepared based on the questions asked and the input of members, after which the Committee reviews the draft. He confirmed that this process is standard practice.

My question regarding who signs off on the reports was taken on notice.

– Senate Estimates | December 2025

Transcript

Senator ROBERTS: This is to the Professional Services Review. Who actually writes the draft and final reports on doctors—PSR lawyers or committee members?

Prof. Di Dio: They are the reports of the committee members, and they are assisted in the drafting of those reports by the PSR’s staff.

Senator ROBERTS: Are they lawyers or staff?

Prof. Di Dio: Usually they are lawyers, yes.

Senator ROBERTS: To what extent is legal assistance involved in the authorship of such reports?

Prof. Di Dio: Sorry?

Senator ROBERTS: To what extent is legal assistance involved in authorship of such reports?

Prof. Di Dio: The committee are assisted by the legal practitioners who form part of the support team at the PSR to a significant extent, but, ultimately, the report is their own. They review the report and ensure that the
report contains their views, their opinions and their assessment as to what the outcome should be.

Senator ROBERTS: How much of a final report is written by lawyers and how much by doctors? I know it would vary.

Prof. Di Dio: It varies very much. I can only reiterate that the report is the report of the committee.

Senator ROBERTS: Which parts are written by lawyers?

Prof. Di Dio: I can’t make it clearer. The report is the committee’s report. Legal officers assist with the drafting but the report reflects, at a very granular level, what the concerns of the committee are in both a generic
sense and in the sense of individual services being reviewed.

Senator ROBERTS: The committee members presumably need to collaborate and co-operate if they’re to produce a final report together. What form does this take? Is it emails, phone calls, zoom meetings, face-to-face
meetings?

Prof. Di Dio: It’s something that occurs in a variety of ways. They also have shared access to technology such as SharePoint and other—

Senator ROBERTS: So they might pass the written report around amongst themselves, modifying it, reading it.

Prof. Di Dio: There are a variety of different ways in which they do it. It is their report.

Senator ROBERTS: What’s the justification for lawyers writing drafts and final reports when the act states that they must be prepared by the committee?

Prof. Di Dio: The committee is provided with support services by the agency in order to do their job. The report is their report.

Senator ROBERTS: Do lawyers ever draft a report or write the final report?

Prof. Di Dio: Lawyers have a role to play in the production of that report. The report is created after a committee has sat for however long it sits for. At that committee hearing, questions are asked by the members of
the committee, and the members of the committee present and clarify their findings with the practitioner under review. A process then occurs whereby a draft report is initiated, but that draft report is based upon an extensive review and analysis of what occurs at the committee and what the practitioners who are members of the committee do and say. So there is a role to be played by the PSR team in the preparation of the draft of that report, but the draft of that report is based upon a variety of pieces of data which are initiated by the members of that committee, whether it is what they said contemporaneously, what they asked, the contents of a transcript. It is the committee’s report.

Senator ROBERTS: So a lawyer may write the draft, but it will be after consultation with the committee?

Prof. Di Dio: That is what may occur, yes.

Senator ROBERTS: Are committee members paid for their work in writing the draft and final reports?

Prof. Di Dio: Sometimes. It depends on whether they request to be paid for their work.

Senator ROBERTS: What sort of role does a committee member have? What are they paid for and what are they not paid for?

Ms Weichert: Committee members are entitled to be paid under the Remuneration Tribunal determination for their input into the draft and final reports. It just depends on whether they submit their timesheet to us to process that pay. The Remuneration Tribunal determination is what sets out what they are entitled to be paid for.

Senator ROBERTS: Assuming that lawyers are not trained in clinical medicine, how can they know if what they are writing is a correct summary of the medical evidence canvassed in meetings? How do you make sure that it’s accurate medically?

Ms Weichert: The committee members do that.

Prof. Di Dio: That’s the whole purpose of the committee members; they conduct their committee meeting, and then they review a draft report at various stages, and they continue to review it.

Senator ROBERTS: How long has this practice been in existence?

Prof. Di Dio: What practice?

Senator ROBERTS: Drafting with lawyers.

Prof. Di Dio: I’m not sure. I suspect it’s been many years.

Senator ROBERTS: Thank you.

Mr Comley: Can I just comment. The practice Associate Professor Di Dio is talking about is absolutely common practice throughout probably all parts of public administration, where multidisciplinary teams with
different aspects will have a hand in the preparation of documents, but there is an authorised person or persons actually accountable for the output. In the same way, there are many products that are prepared for me, but,
fundamentally, if I sign them off, I take accountability for those judgements. Or any other area that occurs—when I think about other regulators, that’s very, very common practice. So what has been described is very common. Finally, that person or that body signing off takes accountability for it, but there are many people who actually prepare the raw materials that go into it.

Senator ROBERTS: Thank you, Mr Comley. What we’re concerned about is a number of doctors who have said there doesn’t seem to be any accountability, and quite often the reports are errant medically, and they haven’t been given a fair go. I’m just trying to find out who would sign off on the reports.

Mr Comley: I think it’s been made clear the people signing off on the report are the Professional Services Review board. They take accountability for it. They take responsibility for the report, but they are assisted by
other people in preparing the raw material before they say, finally, ‘Yes, we are comfortable with that output.’

Senator ROBERTS: Just as you sign some reports—I understand you need to have it legally vetted by a lawyer—who signs off on the report for the committee?

Prof. Di Dio: The committee.

Senator ROBERTS: The whole committee? Each of the committee members?

Prof. Di Dio: I believe so. I can take that on notice, but I believe it’s either the chair or whole committee.

Senator ROBERTS: Mr Comley, the reason for my question is we have had a lot of complaints about the PSR reports, and they appear to reflect, in some doctors’ eyes, a lack of understanding of what’s going on. We’re
concerned about accountability. Thank you for your comments.

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AHPRA’s Cultural Safety Strategy Draws Criticism

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I asked the representative of AHPRA about the directive that is written into the Cultural Safety Strategy which requires all registered health practitioners to acknowledge colonialism and systemic racism.

Their response? The policy was to denounce racism. I was critical of their policy, which is directing health practitioners what to think, say or do on political and cultural matters in a health setting.

This approach mirrors the strategy that was employed during the Voice Referendum, which was decisively rejected by the Australian public as being divisive.

Transcript

Senator ROBERTS: Thank you for appearing, Mr Fletcher. What’s going on with AHPRA? Since when did AHPRA take on a role to tell doctors that they must acknowledge Australian colonisation and systemic racism, which impacts on individual and community health, presumably? How? 

Mr Fletcher: I’m not entirely sure what you are referring to there. What’s the particular the document or piece that you’re referring to?  

Senator ROBERTS: The Aboriginal and Torres Strait Islander Health Strategy Group.  

Mr Fletcher: We have had now for a number of years an Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy. The oversight or guidance for that is led by a strategy group that brings together Aboriginal staff within AHPRA—Aboriginal and Torres Strait Islander board members as well as the national health Aboriginal group. It also reflects that, in our legislation, we have both objects and guiding principles that relate to the promotion of cultural safety for Aboriginal and Torres Strait Islander peoples and the elimination of racism. This is a core part of our guiding principles and objects, and that strategy group, and the unit that we have within, AHPRA leads that work and implements that work.  

Senator ROBERTS: That lines up pretty much with what I was about to go on with. This is a national strategy called ‘cultural safety’, as you said, that’s based on totally unproven propositions of a political persuasion. Is this driven by the same elites, academics and vested-interest holders who pushed for the failed referendum on the Voice?  

Mr Fletcher: I don’t accept the premise of your question. The health and cultural safety strategy is about how we intend to address cultural safety and the elimination of racism for Aboriginal and Torres Strait Islander peoples across all of our work as a regulatory scheme.  

Senator ROBERTS: My question was: is this driven by the same elites, academics and vested interest holders who pushed for the failed referendum on the Voice?  

Mr Fletcher: I don’t know who you’re referring to there.  

Senator ROBERTS: I can answer the question—it is.  

CHAIR: Senator, you don’t need to answer the questions; just ask them, please.  

Senator ROBERTS: Wasn’t that referendum soundly defeated, Mr Fletcher? That referendum result showed that Australians rejected outright propositions that would ultimately divide Australians based on race. You’re asking doctors to treat people differently.  

Mr Fletcher: I can only repeat what I’ve said. In our legislation we have, in our objects and guiding principles, a requirement to promote cultural safety for First Nations people and to address the elimination of racism. So what we’re doing is looking at how we can implement that across all of the work we do as a regulatory scheme.  

Senator ROBERTS: I have it here in front of me on, page 2 from your website—’Definition of cultural safety for the national scheme,’ it goes on. Then it says, ‘Cultural safety definition,’ and ‘principles,’ and then it says, ‘definition,’ and then it says, ‘how to’. These are the instructions: 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.  

CHAIR: What’s the question, Senator Roberts?  

Senator ROBERTS: I’m getting to the question now. The referendum was soundly defeated. How much is AHPRA spending to enforce this untrue fiction that is of no benefit in closing the gap?  

Senator McCarthy: Point of order, Chair.  

CHAIR: Yes.  

Senator McCarthy: The referendum was only about one question: to have a Voice or not to have a Voice to the parliament. That is totally not within the standing orders, in terms of the questions that Senator Roberts is putting to Mr Fletcher. I just point it out, Chair.  

Senator ROBERTS: I’ll rephrase the question.  

CHAIR: Thank you, Minister. Before you do rephrase it—I have been listening carefully. Senator Roberts, you know there’s a very broad scope here, but you do need to ask questions within the scope of what Mr Fletcher is here to present on, which is the operations and expenditure of his agency. I also remind you that AHPRA attends voluntarily to our committee.  

Senator ROBERTS: And they push directives on and force doctors and nurses—  

CHAIR: Just come to the question, please, Senator. 

Senator McCarthy: Point of order. 

CHAIR: Senator Roberts, please come to the question.  

Senator ROBERTS: How much is AHPRA spending to enforce this what I call ‘untrue fiction’ that is of no benefit in closing the gap?  

CHAIR: Can I just clarify for Mr Fletcher that you are referring to a certain guideline? I don’t have it in front of me. Perhaps you could table it.  

Senator ROBERTS: Sure.  

CHAIR: Mr Fletcher, it’s open to you, if you feel able to answer that question, if you understand the relevance of that question to your agency.  

Senator ROBERTS: It’s as Mr Fletcher said: the national strategy called cultural safety.  

CHAIR: Mr Fletcher?  

Mr Fletcher: There are probably two comments that I’d make to the question. One is that there was a lot of work done in the development of that health and cultural safety strategy to work with stakeholders around an agreed definition of cultural safety. The second comment that I would make is that we do have a health strategy unit within AHPRA that leads our work on the implementation of that strategy, and that is staffed by Aboriginal and Torres Strait Islander people.  

Senator ROBERTS: How much is AHPRA spending to enforce this strategy, as you call it, that is of no benefit to closing the gap? How much?  

Mr Fletcher: Again, I don’t accept the premise of your question, but if you’re asking—we have a range of activities to implement that strategy across our work as a regulatory scheme. I don’t have the figure in front of me of exactly what we’re spending on that, but if you want me to, for example, give you an idea of how much we’re spending in relation to work of the health strategy unit, I can take that on notice. 

Senator ROBERTS: Thank you, Mr Fletcher. What is AHPRA prepared to do to enforce such an edict?  

Mr Fletcher: I can give you examples of some of the work that we’re doing. For example, we’re doing work in the area of continuing professional development, looking at what might be some of the elements of continuing professional development for registered health practitioners around questions of cultural safety and elimination of racism for Aboriginal and Torres Strait Islander peoples. We do a lot of outreach with Aboriginal and Torres Strait Islander health practitioners in relation to their registration processes because we have a goal to increase the participation of Aboriginal and Torres Strait Islander people across all of the regulated professions. We also have a specific board for Aboriginal and Torres Strait Islander health practitioners who are providing a lot of first-line services, particularly in rural and remote areas across Australia, for Aboriginal and Torres Strait Islander communities and peoples. We support the work of that board also.  

Senator ROBERTS: What would you do if a doctor or a nurse said that they are not prepared to acknowledge systemic racism or other factors? What would you do, because you have told them they must do it?  

Mr Fletcher: We would have a concern if there were any examples of racism in the way that the practitioner was treating an Aboriginal and Torres Strait Islander person—  

Senator ROBERTS: I didn’t say that—  

Mr Fletcher: and that would be looked at in the context of our process for dealing with notifications.  

Senator ROBERTS: Racism is abhorrent. I didn’t mention that. I just said that they refused to acknowledge systemic racism. I didn’t say if the doctor or nurse were racist. I asked: what would you do if they refuse to acknowledge systemic racism because they haven’t seen it or don’t believe that it exists?  

Mr Fletcher: As I said, the concern that would come to our attention, typically, would be if a concern were being raised that a health practitioner had acted in a racist way against an Aboriginal or Torres Strait Islander person. We would look at that as a notification in the way that we would look at any concern being expressed to us about a registered practitioner, with reference to the relevant code of conduct for that health profession.  

Senator ROBERTS: Are you saying that only racists need to acknowledge it? I’m talking here about a doctor who is not a racist, who doesn’t believe there’s systemic racism, who doesn’t want to acknowledge colonisation, and he or she refuses to acknowledge that. You’re telling doctors what to think.  

CHAIR: Senator, I am listening to you very carefully. I am finding it difficult to make the link between the question you are asking and the operations and expenditure of AHPRA. I’ll allow Mr Fletcher an opportunity to respond, but I remind you that, although the scope is very broad, it does have to go to the operations and expenditure of the agency which you are questioning. Mr Fletcher, do you wish to respond?  

Mr Fletcher: I think I’ve made the comments that I wanted to make. 

Senator ROBERTS: With due respect, Chair, I talked about what it would cost, what they were prepared to do to enforce this—  

CHAIR: And I didn’t rule that out of order.  

Senator ROBERTS: and then I asked what they would do to enforce such an edict. That’s the question I want answered now.  

CHAIR: There was a lot of preamble, which, to me, bordered very much on matters of opinions, Senator Roberts. I haven’t ruled you out of order, but I’m asking you to keep your comments to the operations and expenditure of AHPRA and give Mr Fletcher some flexibility in the way that he answers that, given where I believe it sits on the spectrum of opinion and operations and expenditure. Senator, you have one more question, then it’s time to rotate the call.  

Senator ROBERTS: Will this direction extend to 750,000 health practitioners and allied health professionals in Australia?  

Mr Fletcher: The commitment to the elimination of racism and cultural safety for Aboriginal and Torres Strait Islander people is in our legislation and applies to all of the regulated health professionals.  

Senator ROBERTS: Will this directive extend to the 750,000 health practitioners?  

Mr Fletcher: Senator, I think you’re referring to a strategy rather than a directive, and the strategy is looking at all of the regulated health professions in Australia.  

CHAIR: Thank you, Senator Roberts—  

Senator ROBERTS: It says health practitioners must—  

CHAIR: I will be passing the call now, Senator Roberts, to the opposition. I’m just confirming that’s Senator Rennick. Just before you do—yes, Minister?  

Senator McCarthy: Chair, if I may, in terms of some of the commentary by Senator Roberts, I would like to point out that within Closing the Gap, the concerns around cultural safety for health practitioners, certainly First Nations health practitioners, is a very real issue. I commend Mr Fletcher and AHPRA for the work that they’re doing in this space to support them. 
 
 

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