PHI reform update

The Honourable Greg Hunt, MP (the federal Minister for Health)’s recent decision has effectively banned Private Health Insurers (PHIs) from covering Naturopathy and Western Herbal Medicine, despite a high level of evidence of their efficacy and valued use in chronic conditions. The Naturopaths and Herbalists Association of Australia (NHAA) is opposed to this decision. In our opinion, these new rules do not help patients, save virtually no money, create new risks to the public, deny care that is effective, and potentially encourage care that is ineffective and/or unsafe.

Most of the issues with the new rules stem from their prohibitive nature, so, whilst the purpose was to remove public subsidies for these services, the new rules actually prohibit their provision as part of a private health insurance plan under any circumstances. What has not been made clear in the new rules is why removal of public subsidies from these therapies requires that their supply be prohibited in complying policies.

Removal of Naturopathy and Western Herbal Medicine from private health insurance refundable status is of particular concern to the NHAA, primarily due to the anticipated impact on public safety.  In the absence of statutory regulation (such as under AHPRA), Naturopathy and Western Herbal Medicine currently operate in a self-regulated environment. A key safety lever in the current self-regulatory model, is the need for practitioners to join a professional association to access PHI provider numbers in order to allow patients to claim private insurer rebates on the services rendered.  In the face of inaction on the part of various governments to regulate Naturopathy and Western Herbal Medicine, the private health insurers have assumed the pseudo-regulatory role in this area by requiring practitioners be members of a professional association, to maintain current first aid training, and meet continued professional development requirements, which has acted as a steadying influence on the profession.  This allows professional associations such as the NHAA to enforce standards of public safety. For instance: ‘registered’ practitioner listings, codes of conduct, education standards and educational accreditation, monitoring of compliance with first aid certification, overseeing member professional development and continuing education activities, and ensuring practicing members hold appropriate levels of professional indemnity and public liability insurance. 

Removal from private health insurance refundable status in relation to naturopaths (and western herbal medicine practitioners) removes the ‘pseudo-regulatory’ function currently operating in the public interest and is likely to facilitate underqualified and non-compliant persons to practice Naturopathy or Western Herbal Medicine with no professional checks or balances. There are already high-profile cases of misconduct by people claiming to be Naturopaths while not meeting even the most basic requirements set by some of the other representative bodies.  Had there been statutory registration, cases like this would have been clearly described in the press as ‘fake Naturopaths’ in similar terms to those used for other fake medical practitioners. The NHAA is concerned the regulatory vacuum resulting from removal of PHI for Naturopaths (and western herbal medicine practitioners) will enable people with little or no qualifications in the discipline to misrepresent themselves and anticipate more harm to the community and to the standing of the profession. 

The Minister purports to use the “Review of the Australian Government Rebate on Private Health Insurance for Natural Therapies”^[1] as the justification for preventing PHI’s from providing rebates for Naturopathy and Western Herbal Medicine. The limitations of that review (eg., restricted to systematic reviews from 2008 onwards, missing an important review from 2007), as well as the large number of randomised controlled trials undertaken in the years since that review, make that reliance questionable. Not only was the report limited to published systematic reviews, but evidence has grown considerably since then: e.g. in 2013 there were six randomised controlled trials (RCT) comprising a total 692 patients for "whole practice" Naturopathy, however, there are now 31 RCTs comprising a total 9798 patients.  Even then the review found that there was evidence to suggest that whole-system naturopathic practice is effective in improving patient health for a range of chronic health conditions, including anxiety, multiple sclerosis, cardiovascular disease and musculoskeletal conditions. Of the studies which were included their positive outcomes were dismissed as not relevant to the Australian context due to the unregulated nature of the workforce. 

For western herbal medicine the review noted that while there is a large body of research on the effects of individual herbal agents and remedies, the study of the real-life practice and outcomes of western herbal medicine as a health service was separate to this research and as there were no studies of the real-life practice and outcomes of individualised western herbal medicine as a health practice they could not reach any conclusions as to its effectiveness or potential harms.

Had Naturopathy already been registered as a profession then it would not have been subject to the review in the first place. Naturopathy and Western Herbal Medicine have previously been assessed against the requirements for registration and found to meet the requirements.[2] It is the NHAA’s position that the lack of statutory regulation of naturopaths and western herbal medicine practitioners under the National Scheme (through AHPRA, as the agency that supports the National Boards to implement the National Scheme) is the key difference, to naturopaths and western herbal medicine practitioners’ adverse treatment under the policy change (that removes the government rebate to private health insurers in relation to a broad range of natural therapies). Registration under the National Scheme would address this issue and the NHAA has been, and will continue to, work to facilitate this.

In the interim, the NHAA will be working to have Naturopathy and Western Herbal Medicine removed from the “banned list”.  This is an administrative process, but it requires understanding of the issues by the Health Minister so that it becomes easier to make the change rather than to leave it as it is.  This requires a grass roots campaign with Naturopaths and their patients contacting their local member and the health minister to bring this to their attention and give them a reason to implement the change required.  The message needs to be succinct and to the point.  The NHAA will be keeping members updated with advice on practical action they can take to assist with the amendment process of the new PHI rules in the best interest of members and the public alike.

[1] Baggoley, C., (2015). “Review of the Australian Government Rebate on Natural Therapies for Private Health Insurance.” Australian Government Department of Health, Canberra.

[2] Lin, V., et al. (2005). "The practice and regulatory requirements of Naturopathy and Western Herbal Medicine " Melbourne: Department of Human Services.

AGM outcomes

AGM 2018 – it’s a wrap

The AGM was held last Monday, 22 October 2018. Thank you to the members who attended, sent in a Proxy and who sent in their apologies. Your ongoing support is greatly appreciated.

For those of you who were unable to attend please find below the President’s Report presented at the AGM, and also a copy of the draft minutes of the AGM 2018.

Prior to the election, a motion to simplify the election procedure was proposed and accepted by members in attendance.

The proposal was that where there are more nominees than positions available and an election is required, members only need to vote for their preferred candidates for those positions. Those candidates who receive the highest number of total votes will be elected to the NHAA Board. If there is a tie for the last elected Director position another single vote will be required.

2018-2020 NHAA Board of Directors

As a result of a ballot the elected candidates to fill the four (4) Executive Director positions are as follows;

• Tobey Pinder
• Shona Toranto
• Sally Mathrick
• Hannah Boyd

Congratulations! The above will join the 2018-2019 Board of Directors; Natalie Cook, David Casteleijn, Diana Bowman & Kathleen Murphy.

Thank you to all members who were nominated and to those members who nominated you. The strength of the NHAA is in its members and their commitment to the growth and future of the Association.

The Board (and subcommittees) are made up of passionate members who have a broad set of skills, knowledge and expertise. Board profiles and photos will be updated on our website in the next month.

If you have further questions about the 2018 AGM please contact Andrew Hamilton, Executive Officer, via This email address is being protected from spambots. You need JavaScript enabled to view it.

Documents

• President's Report
• DRAFT minutes

2018 Annual General Meeting - Mon 22 Oct

Information for Members

Upcoming Annual General Meeting

Our Board elections will take place at our Annual General Meeting (AGM) on Monday 22 October 2018 at 7.30pm (AEDT). The AGM will be conducted online via a webinar to allow more members to participate.

Daylight savings time impact

Please find below a break-up of the AGM time for each State as a reminder to login:

• NSW, ACT, VIC, TAS – 7.30pm
• SA – 7.00pm
• QLD – 6.30pm
• NT – 6.00pm
• WA – 4.30pm

* Webinar *

To join the webinar, please click on the following link:

https://events.redbackconferencing.com.au/23a246

Enter your email address and name in the boxes in the lower part of the screen and press the JOIN button immediately next to the boxes.

Proposed Constitutional Change to simplify the election procedure 

Following the challenges experienced in the exhaustive ballot election process at the 2017 Annual General Meeting, the NHAA Board is proposing to simplify the election process so it is easier for members to:

1. Understand; and
2. Elect their preferred nominee.

The NHAA Board is proposing that where there are more nominees than positions available and an election is required, members only need to vote for their preferred candidates for those positions. Those candidates who receive the highest number of total votes will be elected to the NHAA Board. If there is a tie for the last elected Director position another single vote will be required.

To implement this process requires a change to the current Constitution. The proposed clauses to be changed are outlined in the 2018 Annual General Meeting agenda.

Should the members approve the changes by attending the AGM at the time the meeting is held or by proxy, the election process will proceed via the new simplified format.

Should the members decide not to approve the change in the election process, the NHAA Board will proceed with the election process according to the current exhaustive ballot election process.

Below are the results of the call for nominations to be voted on at the AGM and the Proxy Form is attached for those members who wish to vote but cannot be present at the AGM.

Quorum

To ensure that we have a quorum can you please email This email address is being protected from spambots. You need JavaScript enabled to view it. to confirm your attendance.

Nomination Results

2018-2020 NHAA Board of Directors

Five nominations were received to fill four Executive Director positions. The nominations received are as follows:

• Executive Director - Tobey Pinder

[Board Nomination Form, Candidate Profile Information]

• Executive Director - Shona Taranto

[Board Nomination Form, Candidate Profile Information]

• Executive Director - Sally Mathrick

[Board Nomination Form, Candidate Profile Information]

• Executive Director - Hannah Boyd

[Board Nomination Form, Candidate Profile Information]

• Executive Director - Dominique LivKamal

[Board Nomination Form, Candidate Profile Information]

Members will be asked to elect four Executive Director positions from these five nominations. Information about each candidate’s career and reasons for nominating are provided above.

The remainder of the Board of Directors for 2018-2019 will be made up as follows:

• Executive Director - Natalie Cook
• Executive Director - Diana Bowman
• Executive Director - David Casteleijn
• Executive Director - Kathleen Murphy

Appointment of Proxy (optional)

All full, fellow and honorary life members of the Naturopaths and Herbalists Association of Australia Pty Ltd are entitled to vote. Such members may appoint a proxy to attend the meeting in their place but such proxy must be a full member or fellow or honorary life member of the Association.

Appointment of Proxy form

To appoint a proxy the signed and completed form (attached) must be received by the Secretary by 7.30pm Saturday, 20 October 2018 via:

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Documents

Poisons Standard Scheduling of Herbs that contain Arbutin

Original release 18 June 2018, UPDATED 24 June 2018

Has there been a recent change to the Scheduling of arbutin and arbutin-containing herbs?

No. The change occurred in 2010. There is a TGA administrative follow-through on previous Scheduling decisions about the chemical substance hydroquinone and related substances found in certain herbs. Arbutin is included as a cross-reference to hydroquinone in the Appendices to the Poisons Standard and is affected by this follow-up. Therefore, the TGA is correct in communicating there is ‘no change’ in the Scheduling of arbutin-containing herbs per se. What has changed, is the TGA’s follow through and further analysis on arbutin-containing herbs, such as Arctostaphylosuva-ursi folium (bearberry leaf) and Turnera diffusa folium (damiana leaf), and how they are to be captured by this rescheduling...

Please click here to read the full resource document.

Naturopaths call for government regulation in the name of public safety

Australia’s oldest complementary medicine association, the NHAA, has renewed its bid for government regulation for the Naturopathic and Herbal Medicine professions.

The Naturopaths and Herbalists Association of Australia (NHAA) has long been, and continues to be, strongly in favour of regulation of the profession of naturopathy and herbal medicine through statutory registration. “The public must have confidence that when someone calls themselves a naturopath or herbal medicine practitioner” said Natalie Cook, President of the NHAA, “the education and licensing requirements exist which not only protect the public but maintain the integrity of our ethical practitioners.”

“This same level of protection is something we take for granted in many health professions like doctors and dentists, but also Chinese Medicine Practitioners. Now naturopaths and herbal medicine practitioners are renewing their call for the same type of government controlled checks and balances through statutory regulation.” Currently the professional associations take on the role of not only providing member support and services, but also that of quasi regulators. There are however many associations with differing standards and requirements and Australia’s most respected practitioners are calling for a national licencing board. Ms Cook said, “The NHAA already ensures its standards are in line with those set by the Australian Health Practitioner Regulation Agency (AHPRA) as one of many actions we hope will allow this to happen sooner than later.”

What we have seen this week, is that the current system is clearly not enough and we are calling on the Federal Health Minister to open pathways for new professions to apply to be regulated under the National Registration and Accreditation Scheme. The professions of Naturopathy and herbal medicine have been assessed against the requirements by previous government reviews, have been found to meet the requirements and yet remain unregistered. Naturopaths in Australia are required to complete a 4 year degree with a strong foundation in biological sciences to meet requirements for practice. However, “When someone with no recognised training in naturopathy is able to claim to be a naturopath and then be found to cause harm in doing so, the whole profession is unfairly tarnished”. The NHAA has been setting standards for the industry since 1920. Protection of title and compulsory registration of practitioners will help ensure these high standards are maintained.

Natalie Cook
NHAA President