In 1990, seismic improvements in the regulation and accountability of health professionals in NSW resulted from the Report of the Royal Commission into Deep Sleep Therapy. But these gains are now at risk under plans being developed for national registration and accreditation of health professionals.

In a move that has not attracted the scrutiny that it deserves, a sub-committee reporting to Australian health ministers has recommended that health professional boards should self-manage complaints and investigations.

In NSW this would be a return to the system before the deep sleep inquiry and no one wants that. Not the consumers of NSW — The Public Interest Advocacy Centre and other consumer groups have made submissions opposing any watering down of the NSW system for complaint management — and not the health professions, who have seen the benefits of separating complaint management.

The Health Care Complaints Commission (HCCC) in NSW was established as an independent statutory body responsible to Parliament as a result of the deep sleep inquiry. The NSW Medical Practice Act was also extensively revised.

The Brett Walker Inquiry into Campbelltown and Camden Hospitals in 2004 confirmed the role and functions of the HCCC and extended its powers. Further recent amendments to the NSW Medical Practice Act require doctors to report certain types of misconduct to the Medical Board. These helpful changes make the NSW regulatory system the strongest in the country.

Early this year the Council of Australian Governments (COAG) agreed to build a single national registration and accreditation system for health professions including medical practitioners. This is necessary and will lessen the likelihood of unprofessional clinicians moving around undetected and make it easier for health professionals to practise across borders. But standardisation should not be at the expense of existing and effective models of complaint handling. The lowest common denominator should not drive reform — the higher standards should prevail.

A medical board, even with the best will in the world, is not appropriate to carry sole responsibility for complaints. Public trust requires complaints to be investigated by a skilful and accountable organisation such as an independent HCCC.

The perception that doctors will look after doctors is real, in part stemming from the tendency of doctors to identify with colleagues rather than patients. We would not accept police investigating police.

Most health registration boards are in various stages of transition from a “club type” organisation to being more open and transparent.

With colleagues in Queensland, Victoria and South Australia, I am currently researching struck-off doctors to ascertain if there are any common characteristics that might influence medical school selection. The only state where one can go to a website and obtain the names and the decisions on all the doctors is NSW.

There is also no requirement on doctors outside NSW to report unethical or unsafe practitioners.

Unfortunately many boards are the product of the competing interests of their colleges, associations, defense organisations and government. If we were designing for good regulation, we would start with patient expectations of health professionals — appropriate knowledge, skill and behaviour — and provide the infrastructure that best achieves these outcomes.

NSW, with some pain, has a sound infrastructure for managing complaints and investigations. We should be looking to implement the strengths of the NSW system nationally, rather than putting our hard-won gains at risk.

Merrilyn Walton is Associate Professor of Medical Education and Director of Patient Safety at the University of Sydney, and was the Commissioner of the NSW Health Care Complaints Commission from 1993-2000