This audit assessed the effectiveness of the Department of Health’s administration of the Medical Specialist Training Program.
Audit objective and criteria
The audit focused on key aspects of Health’s administration of the STP since the consolidation of funding programs in 2009, and the achievement of key program targets and objectives. To assess the department’s grants administration, the ANAO focused on the fourth annual grant funding round (the 2014 round) which was completed in December 2013 and funded training positions from the beginning of 2014.
Australian Government programs providing support for medical specialist training were consolidated in 2009 as the Specialist Training Program (STP), and in March 2010 the then Government announced additional funding of $144.5 million over four years to increase the number of specialist training positions funded under the STP from around 360 to 900 by 2014. The funding increase was intended to help address a forecast shortage of specialists in Australia by tapping into the private sector and other non-traditional training settings. The STP is a grants program, with four annual competitive funding rounds conducted since its expansion in 2010. While the Department of Health (Health) has overall responsibility for STP administration, the department receives advice from state health services and specialist medical colleges as part of the grants assessment process, and disburses grants through the colleges.
Health has made substantial progress towards achieving the key STP targets and objectives, adopting a generally sound administrative approach which has improved over time. The STP training targets established in March 2010 have largely been met, with college reports indicating that some 93 per cent of training positions have been filled, and some 89 per cent of funded training positions have been located in non-traditional settings. However, in the 2014 grant funding round Health adopted an internal review and rescoring procedure which was not documented, and the department did not strictly adhere to the published selection criteria; an approach which affected the transparency and to an extent the equity of the assessment process when viewed in terms of the application form and other explanatory material that informed applicants’ expectations about how grants would be selected.
The ANAO’s analysis of specialist medical college reports provided to Health indicates that, on a full-time equivalent (FTE) basis, around 833 training positions were filled as at 30 June 2014, representing some 93 per cent of the target of 900 training positions announced in March 2010. Further, college reporting indicates that the STP has been successful in utilising non-traditional settings to expand the number of specialist training opportunities. The most recent (July 2014) reporting indicates that 800 (89 per cent) of the training positions are in ‘expanded’ (non-traditional) settings, with 369 (41 per cent) in regional or rural areas.
The 2014 funding round, which was completed in December 2013 with a view to funding training positions from early 2014, increased the number of funded training positions from 750 to 900. The first stage of the assessment process for the 2014 round was soundly-based and benefited from third-party assessment of applications by state health services and colleges. However, Health decided not to fund some highly-rated applications recommended by the state health services and colleges as it sought to obtain a relatively even distribution of the new training positions against the population. In adopting this approach, which also featured in the previous (2013) funding round, the department effectively applied a selection criterion that was not documented in the application form or other explanatory material made available to applicants. Although the program’s funding priorities, which underpinned the assessment criteria, were reviewed between rounds, Health did not take the opportunity to incorporate a reference to the approach adopted on population distribution in the 2014 round application form or explanatory material. Nevertheless, when considered in the context of the program’s intended outcomes (which include achieving a better geographical distribution of specialist services) the department’s approach in relation to this matter was not unreasonable.
Further, the department advised the ANAO that it also adopted an internal review and rescoring procedure in the 2014 round, to address differences in assessment scores from the state health services and colleges; another departure from documented processes. Health’s approach was also inconsistent with information provided to applicants that the department would ‘collate’ assessment results received from state health services and the colleges, and advice to the Health Minister in March 2013 that the department’s selection of applicants was ‘essentially administrative’ as individual assessments were based on recommendations received from the state health services and colleges.
The ANAO has made one recommendation aimed at improving the transparency and equity of Health’s grants administration by: reviewing program guidelines and assessment criteria to incorporate lessons learned from funding rounds; and providing operational guidance to staff on moderation or other quality control processes to be applied to assessments by third-party advisers.