Australia, Canada, New Zealand and the UK are all lowering health training standards. Why?

After my last video on psychology training reform in Australia, something interesting happened. Clinicians in New Zealand, Canada and the UK got in touch, all describing almost exactly the same thing: broader pathways, expanded scopes, assistant roles, and the language of “top of scope”.

In my experience there are no coincidences. When regulators in several countries do the same thing, for the same reasons, at the same time, something deeper is going on. So I went digging, and it turned out to be a whole-of-healthcare story.

First, what I’m not saying

I’m not against nurse practitioners, psychology assistants, better training pathways or cultural safety. Many of these reforms are overdue, and the waitlists, shortages and training bottlenecks are real.

But, as anyone in government will tell you, you never let a good crisis go to waste.

Where the language comes from

Much of the language in these documents echoes the UK and right-touch regulation. The idea is that a profession should be regulated just enough: proportionate, agile and responsive to the level of risk. It emerged in the UK in the austerity years after the 2008 financial crisis.

One of the most influential figures is Harry Cayton, a former head of the UK Professional Standards Authority. My reading of that body of work is that it challenges the role of professions as gatekeepers, and pushes regulators to think less like guardians of quality and more like managers of labour markets.

That is an economic rationalist agenda, given the fig leaf of two genuinely good ideas: cultural safety and health equity. High standards of training get reframed as systemic barriers.

Some of the critique has merit: guild behaviour and elitism exist (I say that as the first in my family to go to university). But the biggest barrier to entry was built by governments unwilling to fund placements. Only people who are already wealthy can afford six months to two years of unpaid placement.

How good ideas go bad

Once an idea leaves the think tank and meets a cash-strapped health system, it mutates. Agility becomes shortcuts. Flexibility becomes thinner training. Modernisation becomes a cheaper workforce.

The pattern is the same across health. In mental health it is psychology assistants and shorter pathways; in medicine, pharmacist prescribing and nurse practitioner procedures. For all of us there is someone less trained who can do some of our work safely, a lot of it only a little bit unsafely, and some of it not at all. None of the people in these roles are the problem. This is a systems problem.

The model on offer: lower standards to just safe enough, then build a large, less-trained workforce with a handful of fully trained people at the top carrying all the risk. The UK has already shown us what happens next. The best clinicians vote with their feet. They cut hours, burn out, go private or go overseas.

A false choice

Culturally safe care for First Nations, Māori and Indigenous Canadian communities is not a slogan. What makes me uncomfortable is governments talking as if we must choose between culturally safe care and expert care. That is a false choice created by budgets. We are wealthy countries. We can afford scholarships, rural pathways, community-led training and retention incentives, but only if we value them.

And ask who will still get the highly trained experts. People with money will. Everyone else gets triage first, apps first, assistants first, and eventually a senior clinician off on stress leave from supervising everyone else. That isn’t universal excellence. It’s tiered access in modern language.

Consultation theatre

The process upsets me most. Eight weeks, hundreds of pages, a preferred option already written, and stakeholders nudged into fighting over scraps, while the real question, how much we will invest in quality care, slips out the back. A serious country would pilot reforms, publish retention and patient outcome data, and ask the UK openly what worked and what failed.

If you work in health in any of these countries, tell us what you’re seeing on the ground. If policy models can cross oceans, evidence should too. I’m not against reform. I’m against fake reform, and the illusion of consultation when the answer was printed before the first question was asked.

I track these reforms, country by country, at Protect Health.