Ahpra CEO Justin Untersteiner – National Scheme Combined Meeting speech

30 May 2025

Ahpra's CEO, Justin Untersteiner, delivered the following speech on Thursday 29 May 2025 at the National Scheme Combined Meeting. 

It is an incredible honour to stand before you today as the new CEO of the Australian Health Practitioner Regulation Agency. I am deeply humbled by the opportunity to lead an organisation that plays such a vital role in safeguarding the health and wellbeing of our communities. To be entrusted with this responsibility is both a privilege and a profound commitment – one that I embrace with great respect, energy, and purpose.

Australia’s health system is one of the most respected in the world, and at its heart lies a robust regulatory framework that ensures the public can have confidence in the care they receive. The work we do together – across professions, jurisdictions, and communities – underpins the safety, quality, and trust that Australians rightly expect from their healthcare system. I want to acknowledge the dedication, expertise, and integrity that each of you brings to this shared mission. It is through your efforts that we continue to uphold the standards that protect the public and support practitioners to deliver high quality care.

I have now spent 7 weeks listening very carefully.

I have met with many of you in this room, and for those I haven’t met, I hope to meet you soon.

I have also met with others across government, the professions, and the communities we serve. And there are still many more people for me to meet.

Early observations

I have spoken with a number of employees who have been with Ahpra from the beginning. They tell me about the days when our people had to race down to Officeworks to buy printers so they could print out registration forms. I hear about the shortage of computers and the need to share terminals to get work done.

I hear where we came from.

And now, fast forward 15 years, it is impressive to see how far we have come.

We are truly a national organisation that is well established as the National Health Regulator. We now have close to one million registered practitioners – that is a huge achievement. We have delivered world leading initiatives to improve cultural safety for Aboriginal and Torres Strait Islander People. We have delivered brand new technology to support the organisation, notifiers and practitioners.

Everyone who has been involved in this work should feel proud of what has been achieved.

Chance to reflect

However, being the first new CEO in 15 years also provides an opportunity – to stop, listen and reflect on how the National Scheme is performing.

It creates a chance to think about what the scheme needs to look like 10 years from now.

For this, I want to call out a few significant environmental factors which I think will influence and impact our future.

Political

We have just witnessed a historic election result with the Labor Government taking on a second term, but importantly with a resounding election win. We know that the Government has a high level of interest in health policy, this is unlikely to change. We should expect to see high expectations of what Ahpra and the scheme can deliver over the next three to six years.

Likewise, states and territories continue to be on high alert to the challenges in the health system and again will have high expectations of Ahpra and the scheme.

Geopolitical

We are seeing new and existing challenges play out overseas with the impacts being felt in Australia. Issues such as hate-backed policies, wars, and major economic shocks are playing out not just in other jurisdictions but are hitting our shores in Australia. The geopolitical challenges are also accelerating a loss of trust in institutions – an issue that has been on the rise already and certainly impacts Ahpra.

Technology

We are seeing new technologies impact health business models. Some of these are extremely positive, for instance telehealth. Telehealth provides greater and more flexible access to care across multiple professions – a service that I sense will only grow year on year.

Again – greater access is a good thing. However, like any major change it comes with risk. We have seen where telehealth models are misused and cause harm – for example, high and inappropriate prescribing of medicinal cannabis is a live case study of this risk.

Likewise, the use of A.I in healthcare. A.I can produce efficiencies, access to information and automation of low-risk activities – all of which are good. However, A.I can also introduce risks, such as information bias, privacy risk and misleading and inappropriate health advice.

A.I isn’t just a matter for healthcare providers, it is also something that Ahpra needs to consider in our own operations. It introduces opportunities and new risks.

The future model of healthcare

There is much evidence that suggests the current system for delivering healthcare is not sustainable nor delivering the care that is needed in some environments. The healthcare system is becoming unaffordable and will likely need to change if it is to meet the demands of the future. We should assume that healthcare models and service delivery will change, shifting how we regulate in Australia.

Community expectations

I believe the community expects more from us than ever. I believe the community expects that we are the first to identify new and emerging risks in the health system, such as risky business models, misconduct and other changes which are causing harm. And they would also expect that we lead changes or action to address these risks. They will not care about what the legislation does or doesn’t say, they won’t care about past barriers. They don’t care which regulator is responsible for which bit. They want us to lead the actions that are necessary to keep the public safe.

These are just a few examples of many changing environmental factors playing out right now, and as you can see these factors are likely to have a material impact on the health sector and consequently, how we are expected to regulate. I don’t think we can stand still.

We also have now seen the latest consultation report from the Dawson review. I find the publication of this report at this time, so early in my tenure, helpful as it allows me to see and hear a range of views about how the scheme, and how Ahpra is performing. We have welcomed the report and have given in-principle support to the recommendations. And there are many recommendations that we are already getting on with – because they make sense.

However, the report is also sobering – it paints a bleak picture of our performance in several areas. And a number of themes called out in this report are consistent with themes I have heard directly from those who I have been meeting with across the system.

We are at an important moment in time for both the scheme and for Ahpra.

The question isn’t whether Ahpra and the scheme should reform, the question is what does reform look like and when do we get there.

We must write the next chapter of health regulation, and we must start today.

There are four themes emerging for me as I consider the environment, as I read the Dawson report, and as I listen to the broader feedback from the many stakeholders I have spoken with.

Regulatory posture

A friend of mine, Delia Rickard, who among other notable roles was a Deputy Chair at the ACCC, recently completed a review of the Online Safety Act at the request of the Federal Government.

In her report she talks about the importance of building fences along the top of the cliff, rather than bringing more ambulances to the bottom.

As a contemporary regulator, we should be the first to identify the dangerous cliffs, and we should be preventing harm in any way we can. Where appropriate, we should be building fences and installing flashing lights and warning signs. We should be seen as leaders in the prevention of harm.

Public safety is, and must remain, our number one priority.

Most of our efforts up until this point are focused on responding to harm that has already taken place – we do this via a notification.

We have started to trial some new ways of working in the rapid response unit but have only dipped a toe in the water. We need to be thinking about our regulatory strategy, frameworks, principles, capability needs including technology and tools, and resource allocation. There is a chance to be innovative and brave in how we lead this work.

I would like Ahpra to be seen as a leader in harm prevention. I want the professions and the community to have confidence in the work we are doing to improve the system.

Experience

When I talk about experience, I mean the experience for a practitioner registering in our system, for a consumer making a notification, and for practitioners who have a notification made against them. I mean the experience for a student in medical school, for an international graduate looking to practise in Australia, or for existing practitioners who are engaging in the accreditation system.

We need to better understand the experience of anyone interacting with our scheme.

But not all is equal, and there is an immediate priority – a need for a holistic review and major transformation of our notification system.

For there to be trust in our system, our notification system must be timely and efficient, it must be transparent with strong and clear communication, and it must demonstrate high levels of procedural fairness. It should also be empathetic and accessible.

I am not convinced that the current notifications end-to-end system is achieving these important outcomes, and as a result it is leading to a loss of confidence and a loss of trust in the scheme.

I have been told that our system, which is designed to protect people, is at times causing harm.

I don’t believe we can afford to make small tweaks; I think we need to pick the whole system up and rethink it.

There is enough evidence out there either through community and practitioner feedback, or in our own data that tells us the system isn’t working as it should.

This is an important priority.

The right workforce in the right place

We are all aware that there continues to be real workforce challenges in the health sector here in Australia – as there are in many different jurisdictions around the world.

This becomes even more bleak when you consider regional and remote communities, and harder again when you look at the number of Aboriginal and Torres Strait Islander practitioners registered in our system.

This is not an issue solely for Ahpra to solve, however we play a critical leadership role in enabling workforce solutions through our registration and accreditation systems.

There is a perception that we have moved too slowly, and at times made decisions that appear to be made in isolation without a deep enough understanding about flow-on consequence and risks.

Yes, we are on track to implement the Kruk Review recommendations, and yes, I am very excited that we are seeing skilled overseas practitioners enter the Australian system now via our new expedited pathway. But much more needs to be done and we must work together with the governments, colleges, accreditation bodies and other partners to address this issue.

We need to accelerate accreditation reform, and we must work across the system to improve workforce outcomes in the health sector.

Community voice and cultural safety

As I have said, the work that Ahpra has led to improve cultural safety for Aboriginal and Torres Strait Islander people, and to eliminate racism in the healthcare system, is incredible and world leading. But we know there is still more to do. There is much evidence that tells us racism remains too common in the health sector and that culturally safe practice is not yet imbedded system wide. We should ask the question about whether we are the regulator that protects all members of the community.

And as I have already noted, there is more work required to support an increase in the number of Aboriginal and Torres Strait Islander practitioners registered in our system.

We also have an opportunity to lift the community voice in our system. The Community Advisory Committee is a critical component of our system, and I thank the members of the committee for their hard work. But I feel like too much load has been placed on this one committee. There is an opportunity to lift diverse community voices into different parts of our regulatory system. This will require us to have deeper roots in the different communities that we serve, to allow these voices to be heard. We must create a voice for those who feel like they don’t have one.

A modern and contemporary regulator understands the lived experiences, the challenges and impacts of the health system on diverse members of the community.

Conclusion

These four themes; regulatory posture; experience; workforce; and community voice and cultural safety – are the themes that I hear time and time again. And I want to continue to test these themes with the many stakeholders in our system. We will soon be developing the next 5-year National Scheme strategy, and I look forward to engaging with you as this work progresses.

This is an exciting time to be part of the scheme, one where we all have an opportunity to be part of building the next chapter in the Australian regulatory system. At its core, I want Ahpra to be a listening, learning and responsive regulator. Thank you for listening to me today and I look forward to partnering with you into the future.