Ahpra CEO Justin Untersteiner - Signposting 2031: the next phase in health practitioner regulation

25 Mar 2026

Ahpra's CEO, Justin Untersteiner, delivered the closing keynote speech on Wednesday 25 March at the Nursing and Midwifery Board of Australia National Conference held in Melbourne.

Hello and thank you for having me along – it’s a pleasure to provide the closing address at what I hear has been an extremely positive and productive few days.

I’d like to acknowledge the Wurundjeri Woi-wurrung and Bunurong/Boon Wurrung peoples of the Eastern Kulin Nation, as the Traditional Owners of the lands and waterways that surround us. I pay my respects to Elders past and present, and Aboriginal and Torres Strait Islanders of other communities, with us today.

Reflecting momentarily on the chosen theme for this conference: care, courage, and community – it’s easy to draw parallels to generations of First Nations Australians. These are characteristics that ring true across a history of dispossession, colonisation and exclusion. I want to express my deep gratitude for tens-of-thousands-of-years of Aboriginal and Torres Strait Islander custodianship, and commend their resilience and unbroken connection to culture, spirit, and Country.

As CEO of Ahpra, I’m about to reach my first anniversary. After a year in the job, I can no longer claim to be ‘the new kid’. I have hundreds of stakeholders, including many in this room, to thank for helping me get across our intricate and interesting National Scheme, and for sharing your insights and experiences to inform our new directions.

Completing a full annual cycle at Ahpra means I’ve seen the system in action. Any grace period or leniency that might come with joining a well-established organisation, is now behind me. It’s time to convert input and options into actions.

With that in mind, today I’d like to introduce you to our brand-new National Scheme Strategy – to show you what the coming five years will look like in health practitioner regulation, to the best of our knowledge. 

I will caveat this by making two points: 1) we don’t have a crystal ball, and 2) we will always be a listening and learning organisation. It’s paramount to our success that we remain relevant and responsive and never lose sight of the people we’re here to protect.

Reflecting on 2025

To that end, I want to start with some quick reflections on the past year.

Coming in, 2025 was about listening to stakeholders and signaling change. We didn’t stand still:

• We rolled out a major system change impacting almost a million practitioners. Despite a bumpy start with the nursing and midwifery renewals, we learned lessons quickly and successfully registered close to a million practitioners. By the end of the year we were registering practitioners in record times.

• We made inroads around our handling of concerns, closing the highest number of notifications in the history of the scheme, taking our open and aged notifications down to the second lowest numbers in six years. We also made the system safer for practitioners subject to notifications after delivering actions under our Minimising Practitioner Harm program.

• We took strong and early action on harms by ramping up activity around concerning cosmetic procedures, medicinal cannabis over-prescribing, and inappropriate access to superannuation, to raise awareness and build community confidence.

• And we continued to drive changes to create a safer scheme for Aboriginal and Torres Strait Islander people, including through our anti-racism policy.

• We delivered major changes to better support international practitioners, with the launch of a series of expedited pathways which have seen over 2000 practitioners enter our health system in record times – more on this shortly.

• We also responded to the release of the complexity review – a report that painted a sobering but constructive picture of the Scheme, and one we embraced as an opportunity to demonstrate early action on key issues. Consistent with Dawson’s recommendations, NMBA is preparing to transition from State and Territory Boards to a national committee for regulatory matters. This is a significant undertaking, but one that will create meaningful streamlining across regulatory governance while maintaining the balance between jurisdictional insight, and practitioner and community voice so essential to fair, high-quality decision-making.

While we’ve continued to deliver, it’s also been a time of significant change within our organisation – not just a new CEO but several other new faces on the leadership team.

We made structural changes to elevate our focus on Health Workforce, sharpen the emphasis on Health Regulation, and lift our Corporate Affairs and Regulatory Governance capability.

We know this is just the beginning, but it sets strong foundations for delivering our new National Scheme Strategy.

National Scheme Strategy 2031

On joining Ahpra last year, the sense of pride in purpose from our staff and leadership was palpable. And this was reflected by stakeholders across the Scheme – we exist to protect the public and practitioners. Our mission was – and remains – crystal clear.

But what seemed to be missing was a sharp, shared articulation of where we are headed – a vision to guide our priorities. In a diverse and disparate system, progress is bound to be hampered if we work at cross-purposes. 

We needed a high-level, long-term plan of action, designed to achieve specific goals in variable conditions. We needed a strategy. To set the scene, we know without question that the next few years will bring uncertainty. Consequences of rapid change can be unpredictable and unintended – solving one set of problems and creating another. That’s the nature of the era we live in.

But there are known knowns. For example:

• A growing and ageing population will increase demand on health services 

• Barriers to access, cost and time pressures are seeing people self-serve health advice, circumventing expertise for immediacy.

• The rise of technology and general distrust in institutions also feeds this. AI, telehealth, robotics, and social media facilitate new business models and offer enormous benefits but need careful oversight.

Our strategy is a plan for what we know, recognising the key to success will be in our ability to identify emerging trends, foresee challenges, explore options and respond swiftly.

To be meaningful, our future directions had to be identified with input from the people responsible for delivering them, across the National Scheme.

Consultation was extensive and unsurprisingly, only confirmed what I’d been hearing in my initial meet and greets with stakeholders. The themes were resounding.

Firstly, effective harm prevention. This goes right to our core purpose – making sure peoples’ experiences of the health and regulatory systems are safe and free from preventable harm.

That means:

• Responsive regulation to prevent future harm

• Identifying emerging risks and intervening early, and

• Making sure our own processes don’t cultivate harm.

We’ve started an end-to-end review of our notifications system, to ensure we are taking a human-centric approach, protecting it from potential manipulation or weaponization, and meeting the expectations of those involved, around transparency, timeliness and fairness.

The second theme is a Culturally safe health system for Aboriginal and Torres Strait Islander Peoples – these communities and individuals must be able to access health services and work in a health system that is free from bias, discrimination and racism.

We’ve made some good progress in this area, but there’s so much more to do, including:

• elevating Aboriginal and Torres Strait Islander voices to inform regulatory processes and systems – including to ensure a safe notifications process

• lifelong training and capability building for practitioners, and strengthening accreditation of cultural safety, and

• embedding self-determination, indigenous data sovereignty and governance principles into our ways of working.

Strong and productive strategic partnerships are key to our success in this space - work like the NMBA is doing in partnership with the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives. We’ll continue working closely with Aboriginal and Torres Strait Islander Health Health Leaders, to produce and implement the next iteration of the Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy – expected to be released in coming months.

And our third strategic theme is sustainable health workforce – ensuring all communities have access to health practitioners equipped to meet their needs now and in future.

As you certainly appreciate, managing workforce is complex. There are many factors and many actors. We play a distinct but significant role that can’t be underestimated.

Here I see opportunities for:

• a deep review of accreditation models. Standards that support quality education and training as well as access to services

• regulation that supports innovative delivery models and promotes quality, high value care

• improved pathways to registration, and

• scope of practice and registration endorsements that meet service delivery needs. Endorsements like designated registered nurse prescribing that improve community access to medicines without compromising public safety.

Since the staged commencement of improved international pathways to registration from October 2024, more than 2,000 Internationally Qualified Health Practitioners have been registered.

• At the end of February 2026:

• 1,399 internationally qualified registered nurses have been registered through the NMBA’s new pathways for comparable jurisdictions – pathways that are now being explored in non-comparable, high-volume jurisdictions.

• plus 535 specialist international medical graduates have been registered through the MBA’s new pathway

• and 129 internationally qualified occupational therapists.

• We’re now preparing further new pathways for Specialist International Medical Graduates.

• I’m interested in how we can make training options more financially viable for oversees practitioners – bridging the chasm for nurses seeking to work in Australia, with more cost-effective, geographically accessible facilities.

There’s a long ‘to-do’ list under each of these broad banners: Harm prevention, cultural safety and sustainable workforce – some commitments are already in progress, others are still taking shape.

But it’s broader than this. There are six strategic attributes that don’t just enable us to deliver on those key themes, they will guide the way we do business.

These are:

Embed Scheme stewardship: Building trust in the National Scheme to apply robust governance and collaborative leadership, and deliver effective, sustainable, future-focused regulation.

Focus on the user experience: Ensuring interactions with the Scheme are timely, transparent, straight forward and empathetic.

Elevate community voices: Being confident that people of all backgrounds, in any circumstances have an avenue for input, and can access health services that support them.

That we work in partnership: We are seen as a responsive, credible, and trusted partner in the health system, leading and connecting others.

Optimise data and insights: decision makers across the Scheme and sector can rely on the data we capture, interpret and report. 

And, Empower and engage staff, board and committee members: Our people are capable, curious and adaptive, with the regulatory skills and tools they need to deliver the right outcomes.

I hope you agree these all sound about right – that they’re priorities you can get behind… but how will we know if it’s working? How can we be sure we’re putting our effort in the right places, for the right results? Well, we have to be better at measuring our progress and our impact.

Measuring effectiveness is key to building trust and confidence in the Scheme – the commitment is clear, but it’s the outcomes we’ll be judged on.

We want to measure our impact at the highest level – to ensure the work we’re doing is affecting the health system in the way we intend to. So, we’ll be looking at the big things: like trust and confidence, public safety, and the experience of those who work in, and interact with, the regulatory system.

This Strategy is intentionally ambitious and it’s fair to say there’s a lot of work for Ahpra here. But we’re not doing this in isolation – we simply wouldn’t succeed. This is a Strategy for the entire Scheme, requiring the explicit support, participation and leadership of every one of us. I graciously ask that you use this as a guide, champion it with others, and do everything in your remit to bring it to fruition.

Listening and learning 

With our new Strategy in play, there’s a lot of optimism in the air. But I’ll touch on how we manage scrutiny and criticism of the Scheme – particularly in light of the recent media focus on practitioner behaviour and our processes. We will never be immune to this.

Of course, I can’t discuss specific allegations or investigations, but I can say, after talking with leaders across the health sector, we are all deeply concerned about the experiences and events brought forward, and united in our resolve to improve.

In a complex and interconnected system, such issues can be concealed and cumulative – a series of failures and missteps across the wider health system – surfacing in governance, risk management, and decision-making processes.

As we look deeper, what’s become evident is that some knew of the seriousness of the situation, but chose not to speak up. In my short time as CEO of Ahpra, I have seen too many instances of this. I understand the reasons and appreciate there is no quick fix for these issues – which ultimately go to culture.

But what I can tell you is that we all have a responsibility to lean into this systemic issue. We must ensure practitioners understand their role and feel safe to fulfill their obligations. All practitioners – along with employers and regulators – play a critical role in patient safety, and calling out concerns is paramount to keeping the system safe.

This will be an ongoing conversation between the colleges, ourselves, governments, and the private and public system – but I’ve always said, I intend for Ahpra to be a listening and learning organisation. While we should do everything in our power to avoid them, these situations present an opportunity to demonstrate our responsiveness. I want to understand if and where we can improve, and to be transparent. If we have lessons to learn, we will learn them – we’ll be accountable and make the necessary changes.

Summary

As I sum up, it seems like a good time to circle back to the conference theme: care, courage and community. These three C’s influence a fourth one: culture.

We see the ramifications of poor culture play out in workplace settings across the health system. It’s not conducive to success. We need to think carefully about the small actions we take every day that set the tone and uphold the values.

The new National Scheme Strategy outlines what we will deliver and why. Undoubtably, how we will implement this must be guided by:

• Care for those we’re here to protect and represent,

• Courage to tackle the bigger issues, face into complexity, and make the change we need to see, and

• Community voices at the fore. We can’t do this to others, we must do it with them.

Across Ahpra and the wider Scheme, the right culture will be key to realising our aspirations.

Acknowledging the outgoing NMBA Chair

I’m aware that she sadly couldn’t be with us in Melbourne this week - but before I close - I want to make special mention of Veronica Casey who concludes her time as NMBA chair later this year.

Veronica has been instrumental in setting a positive culture of shared values, beliefs and behaviours for the NMBA.

On behalf of Ahpra, I want to express our deep gratitude to Veronica for her service, leadership and unwavering dedication to the Board, Scheme and profession.

Close

Thanks again for having me today.

For all the complexity, ambiguity and difficulty that we will inevitably face – across the Scheme as we deliver the new Strategy, and individually in our day jobs – I hope you get a sense of the tremendous optimism I have, for what we can achieve. Success is energising and extremely satisfying. I want us all to enjoy a share of that over the coming five years.