Introduction

Just as an individual may occupy many roles in relation to health care (patient, consumer, carer, health practitioner, taxpayer and citizen), likewise the organisation that is responsible for health practitioner regulation needs to be responsive to a series of different audiences. In terms of individuals, this includes patients for whom a safe outcome is sought and practitioners who are the subject of the regulatory oversight. Taking a wider view, the community expects the organisation to act in the interests of patients over the professions, and indeed other parties including governments. The governments that establish the legislative framework and regulatory agencies expect that the organisation will effectively undertake the tasks assigned to it, as just outlined, in such a manner that promotes confidence in the provision of health care – irrespective of how it is delivered or funded.

However, what happens when the same governments that are responsible for establishing a regulatory agency also become collectively accountable for that organisation when they only have the authority to act individually? How can governance arrangements be conceptualised in such circumstances? And what effect does this have on the relationships between the state, health professions and the public that they are responsible to? This chapter seeks to answer this set of questions in the context of the development of historic health workforce regulatory reform in Australia. In Australia the National Scheme for the Registration and Accreditation of the Health Professions led to the establishment of a new structure and creation – in effect a clean state – that drew on existing local thinking and expertise (Carlton, 2005; Healy and Braithwaite, 2006), as well as reforms pursued elsewhere (Rogers, 2004; Pacey et al, 2017). In 2016, the national scheme oversaw the regulation of 14 professional groups and in excess of 650,000 registered individuals, equating to almost 3% of the Australian population (Australian Health Practitioner Regulation Agency, 2016). In the intergovernmental agreement that blueprinted the national scheme in July 2010, a series of objectives was anchored around the protection of the public and wider health workforce governance concerns.

This chapter focuses on analysing the context in which these objectives were designed, within the wider context of the society, the state and professions.