Ahpra CEO Justin Untersteiner - National Scheme: Future Reform Directions

24 Jun 2025

Ahpra's CEO, Justin Untersteiner, delivered the following speech on Monday 23 June 2025 to the Australian Medical Association's Colleges, Associations and Societies (CAS) meeting held in Canberra.

Before I begin, I would like to acknowledge the Traditional Custodians of the land we are meeting on – the Ngunnawal Peoples – for their continuing connection to land, sea, community and culture.

We pay our respects to their Elders past and present.

It is an 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 an important role safeguarding the health and wellbeing of our communities. 

While I am new to health, I have more than 20 years’ experience in regulation and compliance, helping to uphold the standards that professionals – like you – take extraordinary pride in, and that consumers, everywhere, rely on. 

My professional career has also included leading change and transformation programs and bringing in new approaches to address emerging issues and changing expectations.

As many of you would know, I am only the second CEO of Ahpra in its 15-year history and that provides a unique 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, and how the professions might look, and practice in the future.

At its core, I want Ahpra to be a listening, learning and responsive regulator.

I have now been with Ahpra for a little over two months and I have spent much of that time listening very carefully, not only to our committed staff but also key stakeholders such as yourselves. I recently met with health ministers, and will continue to engage with the sector.

I am reminded as I meet with many across the professions and the communities that we serve that we live in a time of dramatic change. 

Geopolitical challenges are accelerating a loss of trust in institutions – an issue that has been on the rise in recent times and certainly impacts Ahpra and other authorities.

We are also seeing dramatic change in the Australian health system, in addition to the ongoing issue of supply and demand and questions around patient access and affordability.

We are seeing new technologies impact health business models. Some of these are very positive, telehealth for example, that provides greater and more flexible access to care across multiple professions.

But like any major change, it also comes with risk. 

We have seen where telehealth models are misused and cause harm – high and inappropriate prescribing of medicinal cannabis is a live case study of that 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. 

We have seen an explosion in the popularity of cosmetic procedures, and the challenges of regulating industries that blur the line between consumer demand and patient need. 

We should assume that healthcare models and service delivery will change, and that will shift how we regulate the professions in the future. 

The community also 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 us to lead changes or action to address these risks. They want us to lead the actions that are necessary to keep the public safe. 

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

Notifications system

But most of our efforts up until this point have been focused on responding to harm that has already taken place – via a notification.

We must embrace new ways of regulating for the betterment of both practitioners and patients. 

We have started to trial some new ways of working in the Rapid Regulatory Response Unit - with a focus on prevention rather than response - but this needs to be expanded across all ways that we work and how we regulate. 

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 – for their benefit.

We need a holistic review and major transformation of our notification system. That I have heard clearly over the past two months.

For there to be trust in our system, our notification system must do four things well:

• It must be timely and efficient

• It must be transparent with strong and clear communication

• It must demonstrate high levels of procedural fairness

• And it must be empathetic and accessible. 

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

We need to pick the whole system up and rethink it.

We need to better understand the experience of anyone interacting with our scheme. This is an important priority.

Workforce

There is also 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 will need to change – to continue to change and continue to adapt - if it is to meet the demands of the future.

There continues to be real workforce challenges in the health sector here in Australia – as there are in many different jurisdictions around the world. Patients with little access to Australia’s otherwise well-regarded health system, or who are being served by tireless practitioners who deserve more support. 

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. 

We are on track to implement the Kruk Review recommendations, and, following policy decisions made by governments, we are now seeing skilled overseas practitioners enter the Australian system via our new expedited pathway. But much more needs to be done and we must continue to work together with governments, colleges, accreditation bodies and other partners to address these challenges and seize any opportunities to do things better.

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

Dawson review

And finally, we have now seen the latest consultation report from the Dawson review, and I would like to thank Sue Dawson and her hard-working team for their comprehensive work.

The publishing of this report so early in my tenure is very helpful as it allows me to see and hear a range of views about how the Scheme, and how Ahpra are performing. 

We support 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. 

The report is also sobering – it paints a bleak picture of our performance in several areas. 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 health system.

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

I look forward to Sue finalising her recommendations to health ministers and their decision on priorities for implementation.

Conclusion

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.

Australia’s health system is one of the most respected in the world. It can only maintain that reputation through a robust regulatory system 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 Australia’s rightly expect from their healthcare system.

We have a responsibility to undertake this important mission together. 

I would like to thank you for the important work you do everyday that makes our health system so well respected and I look forward to working with you in the future.