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Over the past decade there has been a signii cant movement towards interprofessional practice (IPP) and education within health care, as a key strategy to increase the effectiveness of health care delivery. Recent studies and systematic reviews have shown that IPP is well received by clinicians, can change their perceptions and attitudes, and is related to improvements in knowledge, skills and collaborative practice. There is a growing body of research showing the positive impact of IPP approaches on healthcare processes, patient satisfaction and clinical outcomes.
For people living with dementia and their carers, there will be many critical points across the trajectory of disease when they will seek – or be offered - advice, treatment, care and support. The organisation, delivery and quality of the health care they receive, and the important relationships that are formed in the process, can make the difference between a seamless healthcare journey that enhances overall quality of daily life or a fragmented, stressful series of encounters that makes the journey more dificult. Recent international and Australian initiatives in interprofessional dementia care have illustrated the potential benefits of this type of approach to the complex range of needs and issues that occur for people living with dementia and their carers.
Identify the challenges of applying evidence-based practice to health workplaces.
Discuss the role of interprofessional education in supporting the translation of evidence into practice within dementia care.
Describe the barriers and enablers of knowledge translation and evidence-based practice.
Key terms
evaluation
evidence-based practice (EBP)
interprofessional education (IPE)
knowledge translation (KT)
power
Introduction
The concept of evidence-based practice (EBP) has become the gold standard for health care as it envisions that new and innovative findings (ideas, treatments, technology and methods) will be incorporated into the education of health care teams and thus will lead to improvements in real-world practice with the application of current knowledge. It makes sense that we look to the research literature (peer reviewed and published studies), evaluate what we find, and use evidence in our planning and our ways of doing things. The Oxford Centre for Evidence-Based Medicine (Howick et al., 2011) has developed a hierarchy of likely best evidence with five levels of evidence from strongest to weakest: systematic reviews, randomised controlled trials, cohort studies, case series and clinical/mechanistic reasoning. They link the evidence to whether it is being used for diagnosis, prognosis, therapy and prevention, or economic decision analysis. Eccles and colleagues (1998) used three evidence categories to develop guidelines for the primary care management of dementia: They are:
I well-designed randomised controlled trials, meta-analyses or systematic reviews;
Review the collaborative skills required for interprofessional practice for people with dementia.
Consider how these skills are introduced into the working environment.
Discuss the factors that may affect staff resilience and the sustainability of good practice.
Key terms
capabilities
communication
dementia
interprofessional
interprofessional collaboration (IPC)
interprofessional teamwork
resilience
sustainability
teamwork
Introduction
In Chapter 1 , we looked at the competencies and capabilities that have been derived by various groups working in this area internationally. We noted that capability tools, to measure whether individuals in teams have these skills, continue to be developed and refined. In this chapter, we revisit these capabilities by asking how these could be introduced into an interprofessional team working with individuals who have dementia and how, with these skills, the team can become resilient to change and therefore can ensure an interprofessional culture that can be sustained by an organisation.
Interprofessional capabilities
There are a number of models and interprofessional capability tools that have been developed internationally. Interestingly, the same capabilities (with different emphases according to the country and the environment in which they have been developed) seem to be included in some way in these tools:
The judicial power of the Commonwealth shall be vested in a Federal Supreme Court, to be called the High Court of Australia, and in such other federal courts as the Parliament creates, and in such other courts as it invests with federal jurisdiction. The High Court shall consist of a Chief Justice, and so many other Justices, not less than two, as the Parliament prescribes.
Introduction
The previous chapters have covered the federal legislature and Executive. Chapter I of the Constitution vests the legislative power of the Commonwealth in the federal Parliament, to be constituted by the Queen and the two houses of Parliament. Chapter II of the Constitution vests the executive power of the Commonwealth in the Queen, to be exercised by the Governor-General as the Queen’s representative. Chapter III of the Constitution vests the judicial power of the Commonwealth in three categories of courts: the High Court of Australia; other federal courts that the Parliament creates; and such other courts that it invests with federal jurisdiction, principally the courts of the constituent States.
The creation of the federal judicature by Chapter III of the Constitution was intended to give effect to two primary objectives. Firstly, from the 1840s there had been various suggestions, from the Colonial Office in the United Kingdom and the colonies, regarding the creation of a court of appeal for Australasia that would replace the Privy Council as the ultimate court of appeal from the superior courts of the colonies. When the delegates to the Constitutional Conventions met to discuss the terms of the proposed federal compact, the creation of a general court of appeal, and its relationship to the Privy Council, naturally fell for consideration. Secondly, the establishment of an effective federal system would not be complete without the creation of a judicial arm of government. As Alfred Deakin said at the 1890 Australasian Federation Conference preceding the Constitutional Conventions of the 1890s, ‘[w]hat we shall require will be, not simply some Federal Court of Appeal to hear cases after they have been dealt with in the courts of the colony, but a Federal Judiciary, with Federal Courts in all the colonies’. It was essential and vital that the federal tier of government possess each of the ‘three great arms of state’.
This book, by four leading constitutional law academics, presents a critical perspective on the development of constitutional law in Australia as an historical and legal narrative. It is a well-known saying, sometimes attributed to Arnold Toynbee, that history is ‘just one damned thing after another’. Inadequately presented, constitutional law can seem to the harried student to be just one damned case after another. In this text the authors give an account of Australian constitutional law informed by a large vision of their subject and accompanied by measured critical observations of its development, reflected in decisions of the High Court, over the 115 years since the Constitution came into force. Their presentation is more in the nature of a conversation with the reader, than legal analysis of a long stream of decisions.
The book demonstrates the dynamic character of constitutional law. The text of the Constitution is definitive but necessarily open textured as befits a document designed for an unknown future. Woven into any comprehensive treatment of constitutional law must be the strands of history and of political and social change and the interactions between major institutions that shape and are shaped by the Constitution over many decades. So much appears from the opening quotation from Andrew Inglis Clark:
The constitutional law of a country may be defi ned as that portion of its fundamental law which prescribes or determines the structural character of the various governmental organs included in its total political organisation, their relations inter se , and the particular powers and functions of each of them.
The executive power of the Commonwealth … extends to the execution and maintenance of this Constitution, and of the laws of the Commonwealth.
Introduction
Section 61 of the Constitution declares that the ‘executive power of the Commonwealth’ is ‘vested in the Queen’ and that it ‘extends to the execution and maintenance’ of the ‘Constitution’ and the ‘laws of the Commonwealth’. The executive power of the Commonwealth is thus composed of several elements. Its exact content and ambit is one of the most pressing and complex issues in Australian constitutional law.
By declaring that the executive power is vested in the Queen, the framers of the Constitution understood that, subject to the Constitution, this incorporated the various powers customarily exercised by British monarchs as recognised by the common law. Andrew Inglis Clark put it this way:
[T]he supreme depositary of the executive authority in the Commonwealth is the King, and he possesses and may exercise within the Commonwealth all the prerogative rights and powers which are inherent in the … Crown. … [T]he Crown possesses prerogative rights and powers which have their source in the common law, and it is therefore evident that a portion of the common law attaches to the Constitution of the Commonwealth.
William Harrison Moore further maintained, without apparent qualification, that:
[w]here a power or duty committed to ‘the Commonwealth’ is of such a kind as is according to common law exerciseable by the Executive, the Commonwealth Executive is empowered to take such action as the common law allows.
The executive power of the Commonwealth extends to the ‘execution’ of the Constitution. This reinforces the primacy of the Constitution as the ultimate source of Commonwealth governmental authority within the federation. That the power also extends to the execution of Commonwealth laws reflects the principle, noted in Chapter 2, that the Constitution accords a certain normative priority to the role of the Parliament in legislating and holding the Executive Government to account, a role that is fundamental to responsible government and important in establishing the rule of law. This feature of the executive power also reflects the federal nature of the Constitution, for in this respect the power is limited to the execution of Commonwealth laws the subject matter of which is limited by ss 51 and 52 and 122.
The Constitution of each State of the Commonwealth shall, subject to this Constitution, continue as at the establishment of the Commonwealth, or as at the admission or establishment of the State, as the case may be, until altered in accordance with the Constitution of the State.
Introduction
On 1 January 1901, the colonies together formed ‘a Federal Commonwealth under the name of the Commonwealth of Australia’ based upon the continuance of the colonies in a new political form. Each constituent State maintained its colonial constitutional heritage – its Constitution and governmental structures – with the only qualifications to this being those in the Commonwealth Constitution necessitated by Australia’s federal union. Therefore, rather than being ‘subordinate’, the six States were accorded a hybrid ‘original’ and ‘continuing’ status.
Previous chapters have shown how the colonies were integral to the formation of the Commonwealth, how the States are integral to the representative character of the Commonwealth Parliament, and how the distribution of legislative, executive and judicial power under the Commonwealth Constitution presupposes the prior existence of the colonies as the fundamental constituents of the federation. Other vital aspects of the Constitution address the legal relationship between the Commonwealth and the States, and even the limits on legislative power that are contained in the Constitution are shaped fundamentally by its character as the constitution of a federal commonwealth. This chapter traces the Australian States’ constitutional ancestry. It explores what the ‘continuing’ constitutional status of the States and their constitutions means, including an analysis of the constitutional powers and limitations pursuant to which they function. The chapter also touches on the implications for the States of proposals for constitutional reform.
The executive power of the Commonwealth is vested in the Queen and is exercisable by the Governor-General as the Queen’s representative ….
A Governor-General appointed by the Queen shall be Her Majesty’s representative in the Commonwealth ….
The Governor-General may appoint offices to administer such departments of State of the Commonwealth as the Governor-General in Council may establish. Such officers shall hold office during the pleasure of the Governor-General. They shall be members of the Federal Executive Council and shall be the Queen’s Ministers of State for the Commonwealth.
Introduction
Section 61 of the Constitution proclaims that the executive power of the Commonwealth is ‘vested in the Queen’. Australia is a constitutional monarchy, and ‘the Crown’ is therefore at the apex of the Executive Government of the nation. As the preamble to the Constitution records, the people of the Australian colonies agreed to unite ‘under the Crown of the United Kingdom’. Provision was also made in the Constitution Act that references to the Queen would ‘extend to Her Majesty’s heirs and successors in the sovereignty of the United Kingdom’. The current reference to the Queen in the Constitution indicates that the present ruling monarch presides over the government of the Commonwealth in her capacity as Queen of Australia. The Queen’s ‘Royal style and title’ in Australia is ‘Elizabeth the Second, by the Grace of God Queen of Australia and Her other Realms and Territories, Head of the Commonwealth’. At her Coronation on 2 June 1953, the Queen swore an oath to govern the peoples of Australia and her other realms ‘according to their respective laws and customs’. This reference is significant, for it is apt to include the conventions of parliamentary responsible government as they operate in Australia.
This book is about the history, principles and interpretation of the Australian Constitution. It is based on the conviction that federalism is one of the Constitution’s most important organising principles. The Constitution itself refers to the Australian polity as a ‘federal commonwealth’, by which was meant that the Commonwealth of Australia was to be federal in its foundations, its institutions and its powers, and that its development into the future would be dependent upon its federal character and design. As to its foundation in 1901, the Australian Constitution is based upon the consent of the people of the six colonies that would become the constituent States of the federation. As to its institutions, the Commonwealth of Australia consists of a Parliament that represents the people of the States (in the Senate) and the people of the Commonwealth as a whole (in the House of Representatives), an Executive Government that is responsible to that Parliament, and a federal supreme court, called the High Court of Australia, that is responsible to ensure that the Parliament and the Executive Government function within the bounds of the Constitution. As to its powers, the Commonwealth Parliament is limited to making laws with respect to a list of specified matters, the executive powers of the Commonwealth are said to extend only to the maintenance and execution of the Constitution and of laws enacted by the Commonwealth Parliament, and the judicial power of the Commonwealth is again limited to specified matters. At the same time, the Constitutions, institutions and powers of the States are preserved and continued, subject only to certain overriding provisions of the Commonwealth Constitution, validly enacted Commonwealth laws, certain activities of the federal Executive, and decisions of the High Court of Australia on appeals from State courts.
The Parliament shall, subject to this Constitution, have power to make laws for the peace, order, and good government of the Commonwealth with respect to: … .
Introduction
The formation of the Australian federation in 1901 presupposed the prior existence of the six colonies as independent, self-governing political communities. The federal union of those colonies involved the establishment of a federal government, to which particular powers were granted; but apart from those specific surrenders, the general principle was that the existing powers, privileges and territorial rights of the colonies would remain as they were prior to federation.As the Premier of New South Wales, Henry Parkes, put it in one of the principal resolutions adopted by the Federal Convention of 1891:
the powers and privileges and territorial rights of the several existing colonies shall remain intact, except in respect to such surrenders as may be agreed upon as necessary and incidental to the power and authority of the National Federal Government.
A year earlier, at the inter-colonial Conference held in Melbourne, it had similarly been resolved that any federation of the colonies would have to occur ‘on principles just to the several colonies’. Parkes’s resolution made it clear that it would be for the colonies themselves to determine what those principles would be, in line with the proposition that the federation must rest upon the agreement and consent of its constituent States. Each colony could thus be assured that its territorial rights would be secured and its legislative powers preserved. Charles Kingston, who would later become Premier of South Australia, put it this way:
[W]e are dealing with autonomous States, who have long enjoyed the blessing of self-government, and who should not be asked – and who, if asked, would not be likely to accede to the request – to sacrifice any of their existing powers other than those which it is absolutely necessary should be surrendered in the national interest.
The Parliament shall, subject to this Constitution, have power to make laws for the peace, order, and good government of the Commonwealth with respect to: … (xxxi) the acquisition of property on just terms from any State or person for any purpose in respect of which the Parliament has power to make laws.
On the imposition of uniform duties of customs, trade, commerce, and intercourse among the States, whether by means of internal carriage or ocean navigation, shall be absolutely free.
The Commonwealth shall not make any law for establishing any religion, or for imposing any religious observance, or for prohibiting the free exercise of any religion, and no religious test shall be required as a qualification for any office or public trust under the Commonwealth.
Introduction
As noted in Chapter 4, the Australian Constitution is primarily concerned with establishing the institutional foundations of a federal commonwealth. The demarcations and limitations on power imposed by the Constitution are therefore chiefly directed to federal considerations of one kind or another. The Constitution does not contain a general bill of rights because the prevailing view, at the time it was drafted, was that appropriately operating systems of representative and responsible government at a Commonwealth and State level would, on the whole, provide adequate protection for civil and political rights. This reflected the general view that had motivated the framers of the United States Constitution in 1787; that is, before pressure from Antifederalists compelled Federalist leaders such as James Madison to agree to the insertion of ten amendments to the Constitution which have since come to be known as the Bill of Rights. As Denis Galligan has explained:
On the [American] Federalists’ view, Constitutions provide the means to good government; they are not concerned to dictate the substantive ends that good government should achieve. This approach has significant implications for the Bill of Rights issue. It is important to remember that the Federalists did not originally intend to include a Bill of Rights in the American Constitution; indeed they argued vehemently against it.
The legislative power of the Commonwealth shall be vested in a Federal Parliament, which shall consist of the Queen, a Senate, and a House of Representatives, and which is hereinafter called ‘The Parliament’, or ‘The Parliament of the Commonwealth’.
Introduction
The Commonwealth Parliament is the first of the three principal institutions of government established by the Australian Constitution. Its pre-eminence in the Constitution is not accidental. It is mentioned first not only due to its inherent importance as an institution, but also on account of the normative priority of legislative power over the other powers of government, associated with the principle of the rule of law. Quick and Garran put it this way:
Legislation consists in the making of laws. It is contrasted with the Executive power, whose office is to enforce the law, and with the Judicial power which deals with the interpretation and application of the law in particular cases.
On this view, there can be no executive or judicial power without a pre-existing law to enforce, interpret and apply, and the usual source of this law is an exercise of legislative power by the Parliament. The Parliament is thus conceived as having a temporally prior role in making the law which it is the function of the Executive and the courts to administer. If read literally, this would mean that unless the Parliament legislates, the Executive Government and the Judiciary will simply have nothing to do. While an important principle is at stake here, Quick and Garran’s statement cannot be taken quite literally, because parliamentary statutes are not the only kind of law which has to be administered and applied. The relevant law is the whole body of constitutional, statutory and common law operating in Australia at a Commonwealth, State and Territory level.