The Public Health Regulation 2022 (NSW) commenced on 1 September 2022. An important part of this regulation is the Codes of conduct for non-registered health practitioners and relevant health organisations (r 116 and Schedules 3 and 4).

The Public Health Act 2010 (NSW) and its regulation adopt definitions from the Health Care Complaints Act 1993 (NSW).  Under that Act, a ‘health practitioner’ is defined as ‘a natural person who provides a health service, whether or not the person is registered under the Health Practitioner Regulation National Law’ By definition a non-registered health practitioner is a person who provides a health service but they are not registered under the National law.

The term ‘health service’ includes ‘medical, hospital, nursing and midwifery services’ and ‘ambulance services’.  What is an ambulance service is not defined in this legislation, but it is defined in the Health Services Act 1997 (NSW).  In that Act ‘ambulance services’ means ‘means services relating to the work of rendering first aid to, and the transport of, sick and injured persons’.

Although the definition is not specifically ‘picked up’ by the Public Health Act or Regulation a court would be likely to look to it when deciding whether a person or organisation is bound by the relevant Code. The implication is that people who provide ‘services relating to the work of rendering first aid to, and the transport of, sick and injured persons’ eg patient transport officers, event health services providers etc are all ‘non-registered health practitioners’ and therefore bound by the Code of Conduct.

The Code of Conduct for Non-Registered Health Practitioners set out in Schedule 3 is not however onerous and does not require anything other than what one would expect from such a service.  It provides that a ‘health practitioner must provide health services in a safe and ethical way’.  To do that:

(a) a health practitioner must maintain the necessary competence in the practitioner’s field of practice,

(b) a health practitioner must practise in accordance with accepted professional standards,

(c) a health practitioner must not provide health care of a type that is outside the practitioner’s experience or training,

(d) a health practitioner must not provide services that the practitioner is not qualified to provide,

(e) a health practitioner must not use the possession of particular qualifications to mislead or deceive a client as to the practitioner’s competence in the practitioner’s field of practice or ability to provide treatment,

(f) a health practitioner must prescribe only treatments or appliances that serve the needs of the client,

(g) a health practitioner must recognise the limitations of the treatment the practitioner can provide and refer a client to other competent health practitioners in appropriate circumstances,

(h) a health practitioner must recommend to a client that additional opinions and services be sought, if appropriate,

(i) a health practitioner must assist a client to find other appropriate health care professionals, if required and practicable,

(j) a health practitioner must encourage a client to inform the client’s treating medical practitioner, if any, of the treatments the client is receiving,

(k) a health practitioner must have a sound understanding of adverse interactions between the therapies and treatments the practitioner provides or prescribes and other medications or treatments, whether prescribed or not, that the practitioner is aware a client is taking or receiving,

(l) a health practitioner must ensure appropriate first aid is available to deal with misadventure during a client consultation,

(m) a health practitioner must obtain appropriate emergency assistance, for example, from the Ambulance Service, if there is a serious misadventure during a client consultation.

The Code has further provisions dealing with health practitioners:

  • Diagnosed with an infectious medical condition;
  • Not to make claims to cure certain serious illnesses;
  • To adopt standard precautions for infection control;
  • And appropriate conduct in relation to treatment advice;
  • Not to practise under influence of alcohol or drugs;
  • Not to practise with certain physical or mental conditions;
  • Not to financially exploit clients;
  • To have clinical basis for treatments;
  • Not to misinform clients;
  • Not to engage in sexual or close relationship with clients;
  • To keep appropriate records;
  • To keep appropriate insurance; and
  • To ensure confidentiality and privacy of client health information.

The code of conduct for health organisations, set out in Schedule 4, contains similar obligations. Further it compels the organisation to take ‘take reasonable steps’ to ensure that employees, and any person who ‘provides health services under another arrangement with a relevant health organisation’ eg a volunteer or sub-contractor, complies with their obligations under Schedule 3.

The final clause of both Codes, observed more in the breach than the honouring, is the obligation to display the Code of Conduct and ‘a document in the approved form that contains information about how clients may make a complaint to the Health Care Complaints Commission’.   How many times are these displayed in first aid posts, on-site health centres and non-emergency patient transport ambulances?

You can see more about the Codes here – https://www.health.nsw.gov.au/phact/Pages/code-of-conduct.aspx

The Code was approved by the Council of Australian Governments in 2015 and is meant to service as a national code. Notwithstanding the national ambitions it has not yet been adopted in all jurisdictions. It applies in

  • New South Wales (Public Health Regulation 2022);
  • Victoria (Health Complaints Act 2016);
  • Queensland (Health Ombudsman Regulation 2014); and
  • South Australia (Health and Community Services Complaints Regulations 2019).

You can read the Final Report: A National Code of Conduct for health care workers (COAG, 17 April 2015) or the COAG Communique.

POSTSCRIPT

For further discussion on the Code see Mary Ward ‘Alternative health clinics that don’t comply with code of conduct face closure‘ Sydney Morning Herald (Online) September 23, 2022. She says, with respect to the Code that applies to organisations (set out in Schedule 4 to the Regulation):

The state’s health watchdog has been given the power to shut alternative health clinics, including naturopaths and chiropractors, for not complying with its code of conduct, as data shows an increasing number of complaints being made by patients.

Powers that came into effect this month expand the role of the Health Care Complaints Commission (HCCC) to allow it to issue a prohibition order against an entire clinic, rather than just an offending practitioner.

This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.