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.