Act and Code Review – Supporting better and equitable
resolution for all communities
Background paper to support discussion
Disclaimer: This working paper is to get feedback and help develop thinking in the
early stages of policy development for the Act and Code review. It does not
necessarily represent the views of HDC.
Context
Purpose and scope of review
The Health and Disability Commissioner (HDC) has a statutory requirement to
regularly review the Health and Disability Commissioner Act 1994 (the Act) Act and
the Health and Disability Services Consumers’ Code of Rights (the Code) and make
recommendations to the Minister of Health.
These reviews are an opportunity to make sure the Act and Code are effective in
protecting and promoting the rights of al people using health and disability services.
The issues we are giving focus to in this review are:
1. Supporting better and equitable complaints resolution for al communities
2. Making the Act and Code effective for, and responsive to Māori
3. Making the Act and Code work better for tāngata whaikaha | disabled people
4. Considering the options for a right of appeal for HDC decisions.
We are not considering options to expand the scope of HDC or additional Codes for
any matter.
Purpose and approach
We are holding this workshop with key stakeholders to understand what is working
well, and what could be improved across the spectrum of complaints resolution.
and/or the Privacy Act 2020
While our focus in this review is on legislative change to support improvement, we
recognise that culture and practice change are vital contributors to improving
outcomes. We wil be capturing feedback for non-legislative improvements to be
considered by our quality improvement and leadership teams and to be shared with
relevant agencies.
Information released under the Official Information Act 1982
While this workshop wil have a particular focus on the right to appeal HDC decisions
(
pages 10-14), we also invite any feedback on the fol owing:
The principles of complaints resolution
1
The right to complain (Right 10)
Advocacy services
HDC processes
Your insights wil help shape a public consultation document seeking feedback on
how we can improve the Act and Code, which we are planning to release in March
next year and be open for submissions through to July. We wil report to the Minister
of Health with our findings and recommendations in December 2024.
Principles of complaints resolution
The Act requires complaints resolution to be fair, simple, speedy and efficient, and
provides a range of resolution pathways to best balance those principles depending
on the context.
Fair means that resolution should fol ow the principles of natural justice,
including to be impartial and fair to both parties, transparent and consistent.
In the context of upholding consumer rights, fair also means ensuring
equitable access to complaint resolution that considers the inherent power
and resource imbalance between providers and consumers, appropriate
accountability of health and disability providers, and action needed for system
learning and improvement.
Simple means the process for making and resolving a complaint should be
accessible and easy to understand and issues should be resolved at the
lowest appropriate level across the complaints system.
Speedy means timely resolution that avoids undue delays and reflects the
urgency of the situation.
Efficient means limited resources are al ocated in a fair and effective way and
people’s time and energy are respected.
‘Fair, simple, speedy and efficient’ balances two diverse aims. On the one hand,
facilitating resolution of suitable complaints directly with the service provider. On the
other, ensuring quality services for the public, and proper accountability of providers
by providing for an independent investigation of complaints by the HDC, and for legal
and/or the Privacy Act 2020
proceedings in the most serious cases.
The HDC is charged with ensuring that the purpose of the Act is met in its entirety
and that this balance of interests is appropriately managed.
There has been an increased focus, in recent years, on the need for complaints
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resolution processes to enhance people's mana and to be more people-centred and
trauma-informed. People have also highlighted the importance of equitable and
cultural y responsive approaches to complaints.
2
Including a requirement to enhance people’s mana as a principle of complaint
resolution has been suggested as a way to incorporate the essence of resolution
from a te ao Māori perspective and encourage the use of hohou te rongo (dispute
resolution from a te ao Māori perspective) and restorative practices where
appropriate. An example of a requirement in legislation to enhance people’s mana is
the Substance Addiction (Compulsory Assessment and Treatment) Act 2017, which
includes as a purpose of the Act to “protect and enhance [the person receiving
compulsory treatment’s] mana and dignity…”. The implementation of this legislation
was supported by guidance and training in relation to providing mana enhancing
care.
Consideration of the use of kupu Māori (Māori words) in the Act and Code to facilitate
interpretation and application from a te ao Māori perspective, as wel as the
protections needed to ensure the ongoing integrity of interpretation and application of
those kupu is explored further in the issue of Giving practical effect to Te Tiriti o
Waitangi in the Act and Code.
Questions:
Are the four principles for complaints resolution “fair, simple, speedy and
efficient” stil fit for purpose? Why / Why not?
Should a requirement to ‘uphold mana’ be included as a principle for
complaints resolution? Why / why not?
Are there any other principles we should consider? Why?
Right to complain (Right 10)
Right 10 provides for the right to complain. It sets out that every consumer has the
right to complain and that every provider must facilitate the fair, simple, speedy and
efficient resolution of complaints. Appendix 1 sets out Right 10 in ful .
Barriers to making complaints
We have heard that there may be barriers to making a complaint because of an
ongoing relationship the consumer may have with a provider, and concern that
and/or the Privacy Act 2020
making a complaint might negatively affect that relationship. This is particularly the
case where people are reliant on the care provided for example, disabled or older
people in residential facilities, people who are reliant on home carer support
(including where the carer may also be a family member), and those who require
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strictly control ed medications such as for opioid substitution treatment.
One option to support people to feel safe to complain is to include a non-retaliation
clause in Right 10. Currently Right 10 does not explicitly protect consumers from
retaliation from providers and this may be a barrier for some consumers to make a
complaint. However, the right to complain (Right 10) continues to apply after a
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complaint has been made, and the Code provides for other rights that would protect
against retaliation where a complaint has been made, including the right to be treated
with respect (Right 1), to freedom from discrimination and coercion (Right 2), and to
services of an appropriate standard (Right 4). An example of a non-retaliation clause
in legislation is the Protected Disclosures (Protection of Whistleblowers) Act 2022.
This Act prevents a person (A) from treating, or threatening to treat, another person
(B) less favourably because of a protected disclosure (see section 22 No
victimisation).
Questions:
Do you think Right 10 should explicitly provide for protection against
retaliation?
What other changes could be made to remove barriers and support people
to feel safe to complain?
Barriers to simple, timely responses from providers
We have heard from both people making complaints and providers that the
processes and timeframes for providers to respond to complaints set out in Right 10
are overly prescriptive and confusing. The provisions in Right 10 do not have
flexibility to al ow for a range of complexity. This can result in multiple extensions to
the set timeframes. Feedback so far indicates that while people like having some
timeframes in the Code, principle-based direction within Right 10 could enable more
clarity and responsiveness.
We’ve also heard that provider complaint processes can be hard to find and fol ow
and have wide variation national y. While providers display the Code of Rights
poster, which includes processes for complaining to the advocacy service and HDC,
they often do not display information about their own complaints processes. This
encourages people to bypass the provider to complain directly to HDC, even where
the provider may be best placed to resolve the issue.
We note some complaints bodies in New Zealand such as the Privacy Commissioner
and health complaint resolution bodies overseas have a requirement for an attempt
at resolution directly with the provider before coming to them. While such a
and/or the Privacy Act 2020
requirement would encourage early resolution, it could also create a barrier to people
making complaints, and therefore reduce access to justice, as well as the opportunity
for public health and safety concerns to be transparently and adequately considered.
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Questions:
What is your experience of how wel provider complaint processes (as set
out in the Code) are working?
What options should we consider to improve provider complaint processes?
Should the complaint processes for providers in Right 10 be less
prescriptive and more principle-based? What could that look like?
Should people be required to attempt resolution with the provider (with or
without the support of advocacy services) before lodging a complaint with
the HDC? If yes, in what circumstances and what safeguards should be
considered?
Advocacy services
The Act provides for HDC to appoint an independent Director of Advocacy, who
oversees and contracts independent advocacy services to assist in the early
resolution of complaints at source, and to assist in redressing the inherent power and
knowledge imbalance between consumers and providers, as wel as helping to
restore relationships. The Act also provides for HDC to make guidelines to direct how
advocacy services should operate. The role of advocacy services set out in the Act
includes to promote the Code and resolution options for complaints; to help
consumers with informed consent; and to help consumers make complaints and to
seek resolution with providers.
We want to hear from you what opportunities there are to strengthen the role of the
advocacy service to better meet the needs of people and communities and support a
seamless interface between an independent advocacy service that empowers people
making complaints, and the HDC which resolves complaints independently from
people and providers.
The provisions relating to advocacy services are set out in Appendix 2. The Act sets
out the functions of advocates, al ows for a range of advocacy models to be
contracted, and for HDC to prepare guidance for how advocacy services should
operate. Currently HDC contracts a single national provider to provide advocacy
and/or the Privacy Act 2020
services across the country. In the 2022/23 year, 27 advocates dealt with 2857
complaints and over 21,000 enquiries. Due to funding constraints, the number of
advocates is fewer than when the service was first established.
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Currently there are also no specialist advocates to meet the needs of Māori, tāngata
whaikaha | disabled consumers and others (although there have been dedicated
advocates in the past e.g. Deaf advocates).
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We also note that the functions of advocates in the Act includes providing assistance
to health consumers to ensure informed consent (section 30(d)). To the best of our
knowledge the advocacy service has never undertaken this function.
Despite these constraints, both people accessing advocacy services and providers
report satisfaction with the advocacy service and they have high resolution rates.
Questions:
What is your experience of how wel the advocacy service is working for
people and providers to resolve complaints?
What does an advocacy service need to look like to uphold the rights of al
people, including to meet the needs of Māori, tāngata whaikaha | disabled
people and others?
Options for strengthening advocacy services
Most of the options for strengthening the advocacy service are operational (including
contract models for advocacy services, number and skil s of advocates), however,
legislative provisions in the Act which could support a strengthened advocacy service
include to:
Clarify that the responsibility of the Director of Advocacy to the HDC includes
promoting the purpose of the Act to support alignment towards shared goals
(section 24(1) states the responsibilities are for the “efficient, effective, and
economical management of the Director of Advocacy”).
Expand on what should be included in advocacy guidelines in section 28,
including to provide for processes that specifical y meet the needs of whānau
Māori and disabled consumers and their whānau | family and those who
support them.
Include a requirement to consult with Māori on the preparation of advocacy
guidelines.
Feedback provided in this review wil contribute to any future consideration of
changes to the advocacy guidelines and advocacy service contracts.
Questions:
and/or the Privacy Act 2020
What do you think are the most important changes that could be made to
strengthen advocacy services? Why?
What, if any, changes should be made to the Act to strengthen advocacy
services? Why?
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HDC decision-making processes
The Act sets out the processes HDC must fol ow and the options HDC has for
complaint resolution (see Appendix 3). HDC has a range of option to address the
breadth of issues complained about. Complaints can range from relatively minor
issues such as food quality or minor miscommunications through to more serious
and urgent issues that may raise risk of harm, public health and safety or
professional conduct concerns.
On receiving a complaint, HDC must undertake a preliminary assessment to decide
on the most appropriate complaint resolution pathway. Depending on the nature of
the complaint the preliminary assessment may involve gathering and assessing
information from different sources before making a decision. This can include: asking
the provider to respond to the complaint and the concerns raised; seeking
independent clinical advice about the standard of care; and asking the complainant
and provider to comment on any information gathered. The HDC wil also consider
the provider’s history of complaints and may seek information from other agencies
such as the Ministry of Health or the Accident Compensation Corporation.
Fol owing preliminary assessment there are different resolution pathways. HDC can:
Refer the complaint to the Advocacy Service, or to the provider for direct
resolution between the parties. Resolution between parties is one our most
common resolution methods and can be particularly useful where there is an
on-going relationship between provider and consumer that needs to be
maintained or in cases where the resolution outcome can be directly met by
the provider at the point of service (e.g. booking an appointment). Currently
HDC contracts a single national provider to provide advocacy services across
the country. Both the Advocacy Service and providers are required to report
back to HDC on the outcome of these referrals, so HDC can ensure that
people’s concerns have been addressed appropriately.
Refer the complaint to other agencies where the issues raised are more
appropriately dealt with by that agency – for example, issues related to a
registered provider’s fitness to practice are often more appropriately dealt with
by their regulatory authority who can assess and, if necessary, restrict their
ability to practice (which HDC cannot do).
and/or the Privacy Act 2020
Call a hui/mediation involving the parties in the complaint. This resolution
pathway has historical y been used infrequently. However, HDC recently
established a smal cultural team led by a Director Māori who provides cultural
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oversight of complaints and the option of hui ā-whānau. Hui ā-whānau brings
a te ao Māori approach to complaints resolution, and assists whānau in feeling
heard, validates their lived experience, provides a space for whānau to
determine what resolution is for them, as wel as improves the cultural
response of providers.
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HDC continues to explore the broader application of hui ā-whānau and
mediation in complaints resolution and how we can use this function to greater
effect and embed its use more ful y within our processes.
Take no further action on a complaint where the preliminary assessment
indicates that a formal investigation is not warranted. The HDC has wide
discretion to take no further action on a complaint. For example no further
action may be taken where the care was appropriate, or where matters are
being addressed through other appropriate processes. This pathway can be
accompanied by educational comments or recommendations to improve the
quality of care or facilitate resolution of the complaint.
Conduct a formal investigation which can result in the provider being found
in breach of the Code, as well as recommendations. Under the Act, the
Commissioner may also undertake an investigation on her own initiative, in
the absence of a complaint, into any aspect of care that, on the face of it,
appears to breach consumer rights.
Refer a provider to the Director of Proceedings (DP) where the
Commissioner has determined the Code has been breached. The DP can
prosecute when providers are referred to them by the HDC and there is public
interest in doing so.
When undertaking an assessment of a person’s care, the HDC engages in a quasi-
judicial but inquisitorial process. The HDC assesses every side of the argument,
weighs up evidence, reaches conclusions on the facts, applies the law (the Code),
and makes an impartial decision.
Significantly increasing complaint numbers is having an impact on the time it takes
for the HDC to assess and resolve complaints. This can have a negative impact on
consumers and providers and lessen the impact of our recommendations and the
interventions of other agencies we may refer to.
We are hearing that:
the way complaint resolution pathways are described in the Act, particularly in
relation to ‘no further action’ and investigations, can be confusing
and/or the Privacy Act 2020
our complaint processes can be hard to understand and follow
our processes are too paper-based and often do not enhance people’s mana
or address the outcomes people are seeking from laying a complaint.
Research suggests there are a range of outcomes people are seeking when they
Information released under the Official Information Act 1982
make a complaint. People want to: be heard; understand what happened and why;
receive an apology; improve services and prevent what happened to them happening
to others; seek restoration; and hold people and providers accountable.1
1 Jo Manning [2018 NZLR] 618.
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There are cal s for our complaints resolution processes to be more transparent and
people-centred to improve people’s experience and facilitate equitable and cultural y
responsive approaches that include a focus on preserving and restoring relationships
where appropriate alongside considerations of public safety, accountability, and
service improvement.
We want to hear how wel the complaint resolution pathways are working and what
could be changed to support better and equitable resolution for all communities.
Question
What is your experience of how wel HDC’s complaints resolution processes
support better and equitable resolution for al communities?
Options for supporting better and equitable resolution for al communities
Legislative options to support better and equitable resolution for al communities
include:
Reviewing the wording of the complaint resolution pathway to take ‘no action’
or ‘no further action’ to better reflect the process and outcome of the decision.
Expanding the application of a ‘mediation conference’ in section 61 of the Act
and broadening the wording to reflect a wider application. The term ‘mediation’
in the Act is also broader than the ordinary usage of the term and it may be
helpful to use different language such as ‘facilitated resolution’ or
‘conciliation’2 and explicitly recognise and provide for tikanga led resolution
practices such as hohou te rongo and hui ā-whānau.
HDC can also undertake operational changes to support better and equitable
resolution for al communities. Improvements we have recently put in place include:
strengthening our cultural responsiveness through the establishment of our
Director Māori role and supporting his team to provide cultural oversight of
complaints and cultural advice as a routine part of the triage of complaints,
and to provide a hui-ā-whānau option for Māori whānau who make complaints.
introducing a new multidisciplinary triage system with senior resource to
review new complaints. This has allowed for better and earlier identification of
and/or the Privacy Act 2020
systemic issues and more strategic use of HDC’s levers, including better
communication of emerging concerns with external parties.
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2 Processes of ‘conciliation’ feature in legislation for several comparable Australian agencies including,
for example, the State of Victoria’s Health Complaints Commissioner (HCC), and the Northern
Territory’s Health and Community Services Complaints Commission. While definitions of conciliation,
and the conciliation process vary slightly between jurisdictions and agencies, the process is typical y
flexible, designed to suit the circumstances in each matter, and al ows the consumer and provider the
opportunity to identify the issues in dispute, develop options, consider alternatives and endeavour to
reach an agreement and resolution. The HCC also allows conciliation for the whole, or part of the
complaint.
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a renewed focus on supporting early resolution between the parties. Where
appropriate, we support people and providers to try to resolve complaints
together first before intervening as we know that general y, this is the most
effective and timely way to resolve concerns.
introducing complainant and provider experience surveys to measure the
impacts of change on the people we engage with and to prioritise our
improvement work.
introducing clinical navigators to help talk people through our findings, and
explain why sometimes when bad things have happened, it doesn’t mean their
rights have been breached.
Question:
What legislative and non-legislative changes do you think are most
important to support better and equitable complaints resolution for all
communities? What impact (positive and negative) do you think these
changes would have?
Options for a right of appeal of HDC decisions
The Legislative Design Advisory Committee (LDAC) advises that where an agency
such as the HDC makes a decision affecting a person’s rights or interests,
“that
person should general y be able to have the decision reviewed in some way. The
ability to review or appeal a decision helps to ensure that those decisions are in
accordance with the law. Also, the prospect of scrutiny encourages first-instance
decision makers to produce decisions of the highest possible quality.”3
The pathways for review of HDC decisions if a person who complains or a provider
who is complained about is unsatisfied with the outcome are as fol ows:
Ask the HDC to review the decision. The decision to review a closed file is at
the discretion of the HDC. Recent processes have been put in place to make
the HDC’s consideration of review more transparent;
Lodge a complaint with the Ombudsman. The Ombudsman’s review wil focus
on procedural fairness (whether the decision was reasonable and made in
accordance with the law). While the Ombudsman is not legal y precluded from
looking into the substantial fairness or reasons for the decision, the
and/or the Privacy Act 2020
Ombudsman would not substitute a fresh decision or remake findings of fact
or law. However, they can make recommendations to the HDC for
reconsideration of the matter; and/or
Seek judicial review in the High Court. Similar to an Ombudsman review, in a
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judicial review a judge wil look at whether the way the decision was made
was in accordance with the law. The judge won’t usual y decide whether the
decision was the ‘right’ decision.
3 https://www.ldac.org.nz/assets/documents/Chapter-28-Creating-a-system-of-appeal-review-and-
complaint-2020-06-25.pdf, page 130
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Additional y, where a matter has been investigated by the HDC and results in a
breach decision, then:
the HDC can refer the matter to the Director of Proceedings for prosecution in
the Health Practitioners Disciplinary Tribunal (HPDT) and/or the Human
Rights Review Tribunal (HRRT).
o The HPDT hears and makes decisions on disciplinary proceedings
brought against registered health practitioners. Disciplinary
proceedings against a health practitioner can only be brought before
the HPDT by either the Director of Proceedings or a Professional
Conduct Committee.
o The HRRT hears claims relating to breaches of the Code as wel as
breaches of the Human Rights Act 1993 and the Privacy Act 2020. The
HRRT considers the matter afresh and has the power to award
damages, including punitive damages, but not compensatory damages
where they are barred by the Accident Compensation Corporation Act
2001;
if the HDC does not refer the matter to the Director of Proceedings, where
there has been a breach finding the complainant can take the matter
themselves to the HRRT.
A recent petition to the Health Select Committee has argued that there are limited
options for substantive review (considering the matter afresh or whether the ‘right’
decision was made) of HDC decisions. The petitioner was of the view that
introducing a right of appeal would “provide assurance that HDC decisions are fair
and transparent. It would also lead to improvements in the protection of consumers’
rights, the identification of patterns of harm, and standards of care.”4
We want to hear from you whether a right of appeal of HDC decisions is needed to
strengthen the promotion and protection of the rights of people accessing health and
disability services, and if so, what that right of appeal should look like.
The LDAC advises that
“the value of an appeal must be balanced in the particular
circumstances against a consideration of the potential costs, implications of delay,
significance of the subject matter, competence and expertise of the decision-maker
and/or the Privacy Act 2020
in the first instance, and the need for finality. However, concerns about cost and
delay should usual y be dealt with by limiting the right of appeal, rather than denying
it altogether.”5
Information released under the Official Information Act 1982
4 Petition of Renate Schutte: A right to appeal decisions made by the Health and Disability
Commissioner (selectcommittees.parliament.nz)
5 https://www.ldac.org.nz/assets/documents/Chapter-28-Creating-a-system-of-appeal-review-and-
complaint-2020-06-25.pdf, page 131
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Questions:
Do you think the current pathways to chal enge an HDC decision are
adequate? Why? / Why not?
Options
Legislative options to chal enge HDC decisions include:
Introducing a right to appeal HDC decisions to the Courts of general
jurisdiction (District Court, High Court, Court of Appeal, Supreme Court) and /
or
Introducing a statutory requirement for internal review process; and / or
A lowering of threshold for access to the Human Rights Review Tribunal
(HRRT) – currently a complaint must be investigated and the provider found
in breach for access to the HRRT by a complainant.
There are also a number of non-legislative actions that HDC has taken to address
some of the concerns raised by the petition, and in relation to a recent review by the
Ombudsman, which are set out below. We also want to hear from you whether you
think our internal processes for reviewing HDC decisions are adequate and how they
can be improved.
Introducing a right to appeal HDC decisions to the Courts of general jurisdiction
The LDAC guidance suggests that where there is a specialist statutory office holder
such as the HDC empowered to investigate complaints relating to a particular field,
they “
should be relied on rather than creating new jurisdictions, unless there are
good reasons not to… [including] that the body lacks the necessary powers,
independence, or governance arrangements to properly address the issues.”
Questions:
What reasons, if any, do you think would support a right of appeal to the
Courts of general jurisdiction?
and/or the Privacy Act 2020
Introducing a statutory requirement for internal HDC review processes
Currently the HDC has discretion to undertake internal reviews of decisions if
requested. An option to chal enge HDC decisions would be to include a statutory
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requirement for HDC to review decisions if requested, and publicise this requirement.
This right could be similar to the provision in the Health Care Complaints
Commission Act 1993 (NSW) which requires that “The Commission must review a
decision made under section 39 [action taken after an investigation] if asked to do so
by the complainant” (section 41(3)).
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The threshold for accessing HRRT
The HRRT is a special jurisdiction tribunal that can hear claims relating to breaches
of the Human Rights Act 1993, the Privacy Act 2020 and our Act. Unlike the HDC,
the HRRT wil usual y hold public hearings, and can award damages for losses
suffered, including injury to feelings, humiliation and loss of dignity. The HRRT’s
decision may be appealed to the High Court.
To access the HRRT under our Act, the HDC must have both investigated the
complaint and made a breach decision. This is a higher threshold than the Privacy
Act and Human Rights Act. For access to the HRRT:
the Human Rights Act only requires that a complaint is first made to the
Human Rights Commission and the Commission closes that complaint.
the Privacy Act requires that the Privacy Commissioner must first have
investigated the complaint. The Privacy Commissioner does not have to
conclude that there was substance to the complaint (that is, that ‘interference
with the privacy of the individual has occurred’).
This is in contrast to our Act where a person can only bring proceedings if the HDC,
having found a breach of the Code on the part of the person to whom that section
applies, has not referred the person to the Director of Proceedings under section
45(2)(f); or the Director of Proceedings declines or fails to take proceedings.
The petitioners submitted that the threshold for access to the HRRT to appeal HDC
decisions should be lowered to al ow a complainant access to the HRRT at their own
initiative without the HDC having determined there was a breach of the Code.
Questions:
Do you think the threshold for a complainant to access the Human Rights
Review Tribunal should be lowered? Why?
If yes, what threshold do you consider to be most appropriate (eg fol owing
the closure of a complaint, fol owing an investigation regardless of whether
a breach has been found)?
How might a lower threshold affect the fair, simple, speedy and efficient
and/or the Privacy Act 2020
resolution of complaints, including any considerations of equitable access
to justice?
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Non-legislative changes to strengthen transparency and review of HDC decisions
Over the last few years, the HDC has made changes to strengthen the transparency
of our decision-making and review processes. These include changes fol owing
recommendations from the Ombudsman as a result of complaints about our
processes. We have:
Reviewed and improved our ‘closed file review’ / internal review process.
Reviewed the preliminary assessment process to determine the most
appropriate resolution pathway to ensure that steps taken do not become
overly protracted. As part of this, we have reviewed and clarified decision-
making guidance around the interplay between taking no further action and
notifying an investigation. This guidance can be found here.
Questions:
What changes would you like to see to HDC’s internal review processes?
What other legislative and non-legislative options should we consider to
make our processes more transparent and bring an appropriate level of
chal enge to HDC decisions?
and/or the Privacy Act 2020
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Appendix 1
Right 10: Right to complain
(i) independent advocates provided
1) Every consumer has the right to
under the Health and Disability
complain about a provider in any form
Commissioner Act 1994; and
appropriate to the consumer.
(i ) the Health and Disability
(2) Every consumer may make a
Commissioner; and
complaint to—
(c) the consumer's complaint and the
(a) the individual or individuals who
actions of the provider regarding that
provided the services complained of;
complaint are documented; and
and
(d) the consumer receives al
(b) any person authorised to receive
information held by the provider that is
complaints about that provider; and
or may be relevant to the complaint.
(c) any other appropriate person,
(7) Within 10 working days of giving
including—
written acknowledgement of a complaint,
the provider must,—
(i) an independent advocate
provided under the Health and
(a) decide whether the provider—
Disability Commissioner Act 1994;
(i) accepts that the complaint is
and
justified; or
(i ) the Health and Disability
(i ) does not accept that the
Commissioner.
complaint is justified; or
(3) Every provider must facilitate the fair,
(b) if it decides that more time is
simple, speedy, and efficient resolution of
needed to investigate the complaint,—
complaints.
(i) determine how much additional
(4) Every provider must inform a
time is needed; and
consumer about progress on the
(i ) if that additional time is more than
consumer's complaint at intervals of not
20 working days, inform the
more than 1 month.
consumer of that determination and
(5) Every provider must comply with al
of the reasons for it.
the other relevant rights in this Code when
(8) As soon as practicable after a provider
dealing with complaints.
decides whether or not it accepts that a
(6) Every provider, unless an employee of
complaint is justified, the provider must
a provider, must have a complaints
inform the consumer of—
procedure that ensures that—
(a) the reasons for the decision; and
(a) the complaint is acknowledged in
and/or the Privacy Act 2020
(b) any actions the provider proposes to
writing within 5 working days of receipt,
take; and
unless it has been resolved to the
(c) any appeal procedure the provider
satisfaction of the consumer within that
has in place.
period; and
Information released under the Official Information Act 1982
(b) the consumer is informed of any
relevant internal and external
complaints procedures, including the
availability of—
15
Appendix 2
Part 3 of the Act – Health and Disability
(1) Subject to this Act, the Director of
Services Consumer Advocacy Service
Advocacy shal from time to time, in the
name and on behalf of the Crown,—
24 Director of Health and Disability
(a) negotiate and enter into advocacy
Services Consumer Advocacy
services agreements containing such
(1) For the purposes of this Act, the
terms and conditions as may be
Commissioner shal from time to time
agreed; and
designate one of its employees as the
(b) monitor the performance of each
Director of Health and Disability Services
advocacy services agreement.
Consumer Advocacy.
(2) Every advocacy services agreement
(2) In exercising or performing the powers,
shal impose on the person that agrees to
duties, and functions of the Director of
provide, or arrange for the provision of,
Advocacy under this Act, the person for
advocacy services pursuant to the
the time being designated under
agreement the duty to ensure that any
subsection (1) shal not be responsible to
guidelines for the time being in force
the Commissioner but shal act
pursuant to section 28 are fol owed in the
independently.
provision of those services.
(3) Nothing in subsection (2) limits the
(3) Nothing in this section limits—
responsibility of the Director of Advocacy
to the Commissioner for the efficient,
(a) any other enactment; or
effective, and economical management of
(b) any powers that the Minister or the
the activities of the Director of Advocacy.
Crown has under any enactment or rule
25 Functions of Director of Advocacy
of law.
The functions of the Director of Advocacy
28 Guidelines for operation of
are as fol ows:
advocacy services
(a) to administer advocacy services
(1) The Commissioner may from time to
agreements:
time, and shal if directed to do so by the
Minister, issue guidelines relating to the
(b) to promote, by education and
operation of advocacy services.
publicity, advocacy services:
(2) Without limiting subsection (1), any
(c) to oversee the training of advocates:
guidelines issued pursuant to subsection
(d) to monitor the operation of
(1) shal include provisions relating to the
advocacy services, and to report to the
procedures to be fol owed by advocates in
Minister from time to time on the results
carrying out their functions, including any
of that monitoring.
special procedures to be fol owed when
and/or the Privacy Act 2020
26 Advocacy services to operate
advocates are dealing with any particular
independently
persons or classes of persons.
Subject to this Act, advocacy services
(3) The Commissioner may from time to
shal operate independently of the
time, and shal if directed to do so by the
Information released under the Official Information Act 1982
Commissioner, the Ministry, purchasers,
Minister, issue an amendment or
health care providers, and disability
revocation of any guidelines issued
services providers.
pursuant to this section.
27 Purchase of consumer advocacy
(4) The Commissioner may not issue any
services
guidelines, or any amendment to or
revocation of those guidelines, under this
16
section unless the Minister has approved
(c) having regard to the needs, values,
the proposed guidelines or the proposed
and beliefs of different cultural,
amendment or revocation.
religious, social, and ethnic groups, to
(5) The fol owing are secondary legislation
provide information and assistance to
(
see Part 3 of the Legislation Act 2019 for
health consumers, disability services
publication requirements):
consumers, and members of the public
(a) the guidelines:
for the purposes of—
(b) an amendment to or revocation of
(i) promoting awareness of the rights
those guidelines.
of health consumers and of disability
services consumers:
29 Consultation on preparation of
guidelines
(i ) promoting awareness of the
procedures available for the
Without limiting section 14(2), the
resolution of complaints involving a
Commissioner shal , before issuing any
possible breach of the Code:
guidelines or amendments to guidelines
pursuant to subsection (1) or subsection
(d) to provide to health consumers or,
(3) of section 28, consult with, and invite
where applicable, persons entitled to
representations from, such persons,
consent on a health consumer’s behalf
bodies, organisations, and agencies,
such assistance as may be necessary
including representatives of health
to ensure—
consumers, disability services consumers,
(i) that the health consumer’s or, as
health care providers, and disability
the case may be, that person’s
services providers, as the Commissioner
consent to the carrying out of health
considers necessary to ensure that a wide
care procedures is obtained; and
range of views is available to the
Commissioner to assist in the preparation
(i ) that that consent is informed
of those guidelines or amendments.
consent:
30 Functions of advocates
(e) to promote, by education and
publicity, an understanding of, and
An advocate shal have the fol owing
compliance with, the principle that,
functions:
except where any enactment or any
(a) to act as an advocate for health
provision of the Code otherwise
consumers and disability services
provides, no health care procedure
consumers:
shal be carried out without informed
(b) to use his or her best endeavours to
consent:
ensure that—
(f) in respect of health care providers
(i) health consumers on or in respect
and disability services providers in the
of whom any health care procedure
area that the advocate serves,—
and/or the Privacy Act 2020
is carried out, or is proposed to be
(i) to provide information on the
carried out, by a health care
rights of health consumers and
provider; and
disability services consumers:
(i ) disability services consumers to
(i ) to promote awareness of
whom disability services are
Information released under the Official Information Act 1982
advocacy services:
provided, or are proposed to be
provided, by a disability services
(i i) to provide advice on the
provider—
establishment and maintenance of
procedures for providing proper
are made aware of the provisions of the
information to health consumers in
Code:
17
relation to health care procedures
consumers, or in relation to health
and for the obtaining of consent to
consumers or disability services
such health care procedures:
consumers general y) that, in the
(iv) to provide advice on the
advocate’s opinion, should be drawn to
establishment and maintenance of
the attention of the Commissioner:
procedures to ensure the protection
(l) to exercise and perform such other
of the rights of health consumers and
functions, powers, and duties as are
of disability services consumers,
conferred or imposed on advocates by
including monitoring procedures and
or under this Act or any other
complaints procedures:
enactment.
(g) to receive complaints al eging that
any action of any health care provider
or disability services provider is or
appears to be in breach of the Code:
(h) in respect of a complaint of the kind
referred to in paragraph (g), to
represent or assist the person al eged
to be aggrieved for the purposes of
endeavouring to resolve the complaint
by agreement between the parties
concerned:
(i) to provide assistance to persons who
wish—
(i) to pursue a complaint of the kind
referred to in paragraph (g) through
any formal or informal procedures
(including proceedings before an
authority) that exist for resolving that
complaint:
(i ) to make a representation to the
Commissioner or any other body or
person in respect of any matter that
is or appears to be in breach of the
Code:
(j) to report regularly to the Director of
Advocacy on the operation of advocacy
and/or the Privacy Act 2020
services in the area served by the
advocate:
(k) to report to the Commissioner from
time to time on any matter relating to
the rights of health consumers or
Information released under the Official Information Act 1982
disability services consumers or both
(whether in relation to a particular
health consumer or disability services
consumer, or a group of health
consumers or disability services
18
Appendix 3
treated as if it had been made to the
Commissioner.
Part 4 of the Act – Complaints and
33 Preliminary assessment
investigations sections 31 – 46
(1) As soon as reasonably practicable
after receiving a complaint, the
Receipt of complaints
Commissioner must make a preliminary
assessment of the complaint to decide—
31 General right to make complaints
(a) whether to take 1 or more of the
(1) Any person may complain oral y or in
fol owing courses of action:
writing to an advocate or to the
Commissioner al eging that any action of
(i) to refer the complaint to an
a health care provider or a disability
agency or person in accordance
services provider is or appears to be in
with section 34 or section 36:
breach of the Code.
(i ) to refer the complaint to an
(2) Any person may complain oral y or in
advocate:
writing to an advocate or to the
(i i) to cal a conference,
Commissioner about any action of a
under section 61, of the parties
health practitioner that was taken at any
concerned:
time before 1 July 1996, if it is alleged or it
(iv) to investigate the complaint
appears that the action—
himself or herself; or
(a) affected a health consumer; and
(b) whether to take no action on the
(b) was, at the time that it was taken, a
complaint.
ground for bringing disciplinary
(2) The Commissioner must promptly
proceedings against the health
notify the complainant and the health care
practitioner under a former health
provider or the disability services provider
registration enactment; but
to whom the complaint relates of the
(c) was not referred to the body that,
Commissioner’s preliminary assessment.
under that enactment, had jurisdiction
(3) This section does not preclude the
to consider it.
Commissioner from revising a preliminary
(3) If a complaint is made under this
assessment and from subsequently
section to an advocate and the advocate
exercising 1 or more of his or her other
is unable to resolve the complaint, the
powers in relation to the complaint
advocate must—
concerned.
(a) refer the complaint to the
(4) If the Commissioner revises a
Commissioner; and
preliminary assessment, the
(b) inform the parties concerned of that
Commissioner must promptly notify the
and/or the Privacy Act 2020
referral and the reasons for it.
fol owing persons and agencies of the
revised assessment:
32 Complaints referred to
Commissioner
(a) the complainant:
For the purposes of this Part, a complaint
(b) the health care provider or the
Information released under the Official Information Act 1982
that is referred to the Commissioner
disability services provider to whom the
under section 31(3) of this Act or section
complaint relates:
64(1) of the Health Practitioners
(c) any agency or any person to whom
Competence Assurance Act 2003 must be
the complaint has, in accordance
19
with section 34 or section 36, been
(3) After referring a complaint, in whole or
referred:
in part, to an agency or person mentioned
(d) any advocate to whom the
in subsection (1), the Commissioner must
complaint has been referred.
notify the complainant and the health care
provider or the disability services provider
Referral of complaints to agencies,
to whom the complaint relates of the
persons, statutory officers, or advocates
action that has been taken.
34 Referral of complaint to agencies or
(4) The Commissioner may refer a
persons involved in health or disability
complaint, in whole or in part, to more
sector
than 1 agency or person mentioned in
(1) At any time after completing a
subsection (1), as long as each referral is
preliminary assessment of a complaint,
authorised by a paragraph of that
the Commissioner may refer the
subsection.
complaint, in whole or in part,—
(5) A reference of a complaint under
(a) to the appropriate authority if it
subsection (1) does not preclude the
appears from the complaint that the
Commissioner from taking action on the
competence of a health practitioner or
complaint himself or herself.
his or her fitness to practise or the
35 Agencies or persons to keep
appropriateness of his or her conduct
Commissioner informed about referred
may be in doubt; or
complaints
(b) to the Accident Compensation
Each agency or person to whom a
Corporation if it appears from the
complaint is referred under section
complaint that the aggrieved person
34 must—
may be entitled to cover under
the Accident Compensation Act 2001;
(a) promptly acknowledge receipt of the
or
complaint; and
(c) to the Director-General of Health if it
(b) promptly advise the Commissioner
appears from the complaint that failures
of any significant step taken in its
or inadequacies in the systems or
consideration or examination of the
practices of the health care provider or
complaint; and
the disability services provider
(c) promptly advise the Commissioner
concerned may harm the health or
of the outcome of its consideration or
safety of members of the public; or
examination of the complaint.
(d) to the health care provider or the
36 Referrals of complaints to certain
disability services provider to whom a
statutory officers
complaint relates if the complaint does
(1) If, at any time after completing a
not raise questions about the health or
preliminary assessment of a complaint,
and/or the Privacy Act 2020
safety of members of the public and
the Commissioner considers that the
can, in the Commissioner’s opinion, be
complaint relates, in whole or in part, to a
appropriately resolved by the provider.
matter that is more properly within the
(2) At any time before or after referring a
scope of the functions of one of the
Information released under the Official Information Act 1982
complaint, in whole or in part, to an
statutory officers specified in subsection
agency or person mentioned in subsection
(4), the Commissioner must promptly
(1), the Commissioner may consult with
consult with that officer in order to
that agency or person as to the most
determine the appropriate means of
appropriate means of dealing with the
dealing with the complaint.
complaint.
20
(2) As soon as reasonably practicable
(a) the terms of any agreement reached
after consulting with the officer concerned,
between the parties concerned; and
the Commissioner must determine
(b) if agreement is not reached on al
whether the complaint should be dealt
matters, those matters on which
with, in whole or in part, under this Act.
agreement is reached and those
(3) If the Commissioner determines that
matters on which no agreement is
the complaint should be dealt with, in
reached; and
whole or in part, by one of the officers
(c) any other matters that the advocate
specified in subsection (4), the
thinks fit.
Commissioner must promptly—
(4) A copy of every report made under
(a) refer the complaint or, as the case
subsection (2)(b) must, on request, be
requires, the appropriate part of the
made available by the Commissioner to
complaint to that officer; and
each of the parties concerned.
(b) notify the complainant and the
Decision to take no action
health care provider or the disability
38Commissioner may decide to take no
services provider to whom the
action or no further action on
complaint relates of the action that has
complaint
been taken.
(1) At any time after completing a
(4) The statutory officers referred to in
preliminary assessment of a complaint
subsection (1) are—
(whether or not the Commissioner is
(a) the Chief Commissioner under
investigating, or continuing to investigate,
the Human Rights Act 1993:
the complaint himself or herself), the
(b) the Chief Ombudsman:
Commissioner may, at his or her
(c) the Privacy Commissioner.
discretion, decide to take no action or, as
the case may require, no further action on
37 Commissioner may refer complaint
the complaint if the Commissioner
to advocate
considers that, having regard to al the
(1) At any time after completing a
circumstances of the case, any action or
preliminary assessment of a complaint
further action is unnecessary or
(whether or not the Commissioner is
inappropriate.
investigating, or continuing to investigate,
(2) The Commissioner’s consideration
the complaint himself or herself), the
under subsection (1) may, in particular,
Commissioner may refer the complaint to
take into account any of the fol owing
an advocate for the purpose of resolving
matters:
the matter by agreement between the
parties concerned.
(a) the length of time that has elapsed
between the date when the subject
(2) On a referral of a complaint, under
and/or the Privacy Act 2020
matter of the complaint arose and the
subsection (1), the advocate must—
date when the complaint was made:
(a) use his or her best endeavours to
(b) whether the subject matter of the
resolve the complaint by agreement
complaint is trivial:
between the parties concerned; and
Information released under the Official Information Act 1982
(c) whether the complaint is frivolous or
(b) report the results of those
vexatious or is not made in good faith:
endeavours to the Commissioner.
(d) whether the person al eged to be
(3) Every report made under subsection
aggrieved does not want any action
(2)(b) must record—
21
taken or, as the case may be,
of the public, the Commissioner must
continued:
promptly notify the Director-General of
(e) whether there is in al the
Health of that belief and the reasons for it.
circumstances an adequate remedy or
(3) If, during or after an investigation, the
right of appeal, other than the right to
Commissioner is of the opinion that there
petition the House of Representatives
is evidence of a significant breach of duty
or to make a complaint to an
or misconduct on the part of a health care
Ombudsman, that it would be
provider or disability services provider or
reasonable for the person al eged to be
an officer or employee or member of a
aggrieved to exercise.
health care provider or disability services
(3) Subsection (2) does not detract from
provider, the Commissioner must promptly
the generality of subsection (1).
refer the matter to the appropriate person
or agency.
(4) In any case where the Commissioner
decides to take no action, or no further
Investigations by Commissioner
action, on a complaint, the Commissioner
40 Commissioner may investigate
must inform the fol owing persons and
breaches
agencies of that decision and the reasons
(1) The Commissioner may decide to
for it:
investigate any action of a health care
(a) the complainant:
provider or a disability services provider if
(b) the health care provider or the
the action is, or appears to the
disability services provider to whom the
Commissioner to be, in breach of the
complaint relates:
Code.
(c) any agency or any person to whom
(2) The Commissioner may investigate
the complaint has, in accordance
any action of a health practitioner that was
with section 34 or section 36, been
taken at any time before 1 July 1996, if it
referred:
appears that the action affected a health
consumer and was, at the time that it was
(d) any advocate to whom the
taken, a ground for bringing disciplinary
complaint has been referred.
proceedings against the health
Commissioner required to share certain
practitioner under a former health
information
registration enactment.
39 Commissioner to inform agencies of
(3) The Commissioner may investigate an
certain risks
action under this section either on
(1) Whenever the Commissioner has
complaint or on the Commissioner’s own
reason to believe that the practice of a
initiative.
health practitioner may pose a risk of
41Complainant and provider to be
harm to the public, the Commissioner
and/or the Privacy Act 2020
notified of investigation
must promptly notify the appropriate
(1) Before proceeding to investigate a
authority of that belief and the reasons for
matter under this Part, the
it.
Commissioner—
(2) Whenever the Commissioner has
Information released under the Official Information Act 1982
(a) must, by written notice, inform the
reason to believe that failures or
complainant (if any), the health care
inadequacies in the systems or practices
provider or the disability services
of a health care provider or a disability
provider to whom the investigation
services provider are harming or are likely
relates, and any person al eged to be
to harm the health or safety of members
aggrieved (if not the complainant) of the
22
Commissioner’s intention to make the
(i i) that the matter is not to be
investigation; and
referred to the Director of
(b) must, by written notice, inform the
Proceedings under section 45(2)(f);
health care provider or the disability
or
services provider to whom the
(b) the Director of Proceedings notifies
investigation relates of—
the authority of his or her decision
(i) the details of the complaint (if any)
under section 49 not to institute
or, as the case may be, the subject
disciplinary proceedings in relation to
matter of the investigation; and
the matter.
(i ) the right of that person to submit
(3) This section does not prevent any
to the Commissioner, within 15
action under the Health Practitioners
working days of the date of the
Competence Assurance Act 2003—
notice, a written response in relation
(a) under any of sections 36 to 42, 45
to the complaint or, as the case may
to 51, or 69 of that Act; or
be, the subject matter of the
(b) in bringing and completing
investigation.
disciplinary proceedings initiated by a
(2) The Commissioner may, at his or her
charge laid by the Director of
discretion, extend the deadline of 15
Proceedings.
working days set by a notice given under
43 Information about result of
subsection (1)(b), and may do so before
investigation
or after the deadline.
(1) As soon as reasonably practicable
42 On notification of investigation
after the Commissioner completes an
authority not to take disciplinary action
investigation, the Commissioner must
until further notice
advise the persons specified in subsection
(1) In any case where, after deciding to
(2)—
investigate the action of a health care
(a) of the results of the investigation;
provider or a disability services provider, it
and
appears to the Commissioner that the
(b) of any further action that the
investigation directly concerns a health
Commissioner proposes to take or that
practitioner, the Commissioner must
the Commissioner proposes to take no
promptly give notice of the investigation to
further action.
the appropriate authority.
(2) The persons referred to in subsection
(2) Once the authority has received the
(1) are—
notice, no disciplinary action under
the Health Practitioners Competence
(a) any complainant whose complaint
Assurance Act 2003 may be taken in
led to the investigation:
and/or the Privacy Act 2020
relation to any subject matter of the
(b) any person al eged to be aggrieved
investigation until—
(if not the complainant):
(a) the Commissioner notifies the
(c) the health care provider or the
authority—
disability services provider whose
Information released under the Official Information Act 1982
(i) that the matter is not to be
action was the subject of the
investigated, or investigated further,
investigation:
under this Act; or
(d) if the investigation directly concerns
(i ) that the complaint or matter has
a health practitioner, the appropriate
been resolved; or
authority.
23
44 Consultation required before matter
consumer and was, at the time that it
referred to Director of Proceedings
was taken, a ground for bringing
(1) The Commissioner may not,
disciplinary proceedings against the
under section 45(2)(f), refer 1 or more
health practitioner under a former
health care providers or disability services
health registration enactment.
providers to the Director of Proceedings
(2) If this section applies, the
for a decision as to whether proceedings
Commissioner may do all or any of the
should be instituted or action taken in
fol owing:
respect of a person unless the
(a) report the Commissioner’s opinion,
Commissioner has given that person an
with reasons, to any health care
opportunity to comment on that proposed
provider or disability services provider
referral.
whose action was the subject matter of
(2) The Commissioner must have regard
the investigation, and may make any
to any relevant factors of the kind
recommendations as the Commissioner
specified in subsection (3) when the
thinks fit:
Commissioner considers whether or not to
(b) report the Commissioner’s opinion,
refer, under section 45(2)(f), 1 or more
with reasons, together with any
health care providers or disability services
recommendations that the
providers to the Director of Proceedings
Commissioner thinks fit, to all or any of
for a decision as to whether proceedings
the fol owing:
should be instituted or any action taken.
(i) any authority or professional body:
(3) The kinds of factors referred to in
(i ) the Accident Compensation
subsection (2) are—
Corporation:
(a) the wishes of the complainant (if
(i i) any other person that the
any) and the aggrieved person (if not
Commissioner considers
the complainant) in relation to the
appropriate:
matter; and
(c) make any report to the Minister that
(b) any comments made under
the Commissioner thinks fit:
subsection (1) in relation to the matter;
and
(d) make a complaint to any authority in
respect of any person:
(c) the need to ensure that appropriate
proceedings are instituted in any case
(e) if any person wishes to make such a
where the public interest (whether for
complaint, assist that person to do so:
reasons of public health or public safety
(f) refer 1 or more health care providers
or for any other reason) so requires.
or disability services providers to the
45 Procedure after investigation
Director of Proceedings for the purpose
of deciding whethe
and/or the Privacy Act 2020r any 1 or more of
(1) This section applies if, after making an
the fol owing actions should be taken in
investigation under this Part, the
relation to those providers:
Commissioner is of the opinion that any
action that was the subject matter of the
(i) any of the actions contemplated
investigation—
by section 47:
Information released under the Official Information Act 1982
(a) was in breach of the Code; or
(i ) the institution of proceedings
under section 50:
(b) in the case of an action of a health
practitioner that was taken at a time
(i i) the institution of disciplinary
before 1 July 1996, affected a health
proceedings.
24
(3) On referring 1 or more health care
providers or disability services providers
to the Director of Proceedings under
subsection (2)(f), the Commissioner must
advise the Director of Proceedings of any
relevant factors of the kind specified
in section 44(3).
(4) Subsection (2)(f)(i ) does not apply if
this section applies because of subsection
(1)(b).
46 Implementation of
recommendations of Commissioner
(1) Where, in accordance with section
45(2)(a) or (b), the Commissioner makes
any recommendation to any person, the
Commissioner may request that person to
notify the Commissioner, within a
specified time, of the steps (if any) that the
person proposes to take to give effect to
that recommendation.
(2) If, within a reasonable time after a
recommendation is made, no action is
taken which seems to the Commissioner
to be adequate and appropriate, the
Commissioner—
(a) shal , after considering the
comments (if any) of the person
concerned, inform the complainant (if
any) of the Commissioner’s
recommendations and may make such
comments on the matter as the
Commissioner thinks fit; and
(b) may, where the Commissioner
considers it appropriate, transmit to the
Minister such report on the matter as
the Commissioner thinks fit.
and/or the Privacy Act 2020
Information released under the Official Information Act 1982
25