AI Implementation in Hospitals

'AI Implementation in Hospitals: Legislation, Policy, Guidelines and Principles, and Evidence about Quality and Safety' (Australian Commission on Safety and Quality in Health Care, 2024) comments 

 To harness the enormous benefits of Artificial Intelligence (AI) in healthcare, implementation and use must be done safely and responsibly. The Commission engaged Macquarie University and the University of Wollongong to undertake a literature review and environmental scan to identify principles that enable the safe and responsible implementation of AI in healthcare. It presents evidence from the contemporary published literature about AI implemented in acute care as well as current, published legislation, policies, guidelines, and principles for AI implementation in healthcare. ... 

The purpose of this report is to provide a review of the recent literature and undertake an environmental scan to identify principles that enable the safe and responsible implementation of AI in healthcare. It presents evidence from the contemporary published literature about AI implemented in acute care as well as current, published legislation, policies, guidelines, and principles for AI implementation in healthcare. The findings will be considered by the Australian Commission on Safety and Quality in Health Care (ACSQHC) for future development of resources to assist healthcare organisations in evaluating and implementing AI. 

Policy scan and principles for safe and responsible AI in healthcare 

Chapters 2 and 3 report the findings from an environmental scan of international (USA, UK, New Zealand, Canada, Singapore), intergovernmental (WHO, OECD and EU) and national legislation and policy to gain insight about principles (e.g. guidelines, governing ideas, and strategies) for implementation of AI in acute care. The review covers both cross-sectoral legislation and policy that is relevant in healthcare, as well as healthcare-specific legislation and policy. 

Key findings from the environmental scan of national and international legislation and policy are:

• Governance of AI in healthcare is not limited to new AI-specific laws, but also involves primary legislation and policy (e.g. privacy laws, human and consumer rights law, and data protection laws). 

• Similar to Australia, national ethics frameworks are common in the reviewed countries and influence policy formulation. These frameworks are designed to support healthcare organisations in those jurisdictions by guiding the implementation of AI in their practice. The US Department of Health and Human Services drew on a national ethics framework to develop a playbook to guide health departments in embedding ethical principles in AI development, acquisition, and deployment (1). Internationally, governance approaches include establishing dedicated regulatory and oversight authorities (including healthcare-specific bodies), requiring risk-based or impact assessments, provisions to increase transparency or prohibit discrimination, regulatory sandboxing, as well as formal tools or checklists. 

• Australia’s National Ethics Framework is commonly used to frame Australian policy. The Australian Government has commenced development of a national risk-based approach to cross-sectoral AI regulation (2), based on four principles: i/ balanced and proportionate (achieved via risk-based assessment); ii/ collaborative and transparent (achieved via public engagement and expert involvement); iii/ consistent with international requirements; iv/ putting community first. This national approach will shape the future of AI governance and implementation in health services; in some jurisdictions, such as NSW, good progress has been made on developing state-based governance frameworks, including in health (see Section 3.3.1 page 49-50). The NSW Government’s AI Ethics Principles are embedded in the NSW AI Assurance Framework, which applies to uses of AI in the NSW health system. 

• Current developments in Australian governance and regulation of AI in healthcare include governance via existing cross-sectoral approaches (e.g. privacy and consumer law), regulation of software as a medical device, and specific health governance proposals from research and health organisations. The most significant developments in the healthcare sector are policy initiatives by the Australian Alliance for Artificial Intelligence in Healthcare (AAAiH) (73), The Royal Australian and New Zealand College of Radiologists (3), and the Australian Medical Association (4).

 Legislative and policy environment

• The AAAiH National Policy Roadmap Process has recommended, by consensus, that Australia establish an independent National AI in Healthcare Council to oversee AI governance in health. This Council should be established urgently. Its work should be shaped by the National AI Ethics Principles and the recommendations made by consensus in the National Policy Roadmap process. One of the key issues to address is practical guidance on clarifying consent and transparency requirements. The Roadmap also recommended that the Council engage individual professional bodies to develop profession-specific codes of conduct, and oversee accreditation regarding minimum AI safety and quality standards of practice covering cybersecurity threats, patient data storage and use, and best practice for deployment, governance and maintenance of AI. Such accreditation could fall under the remit of the ACSQHC’s accreditation scheme. 

• AAAiH’s recommendation for a risk-based safety framework also called for the improvement of national post-market safety monitoring so that cases of AI-related patient risk and harm are rapidly detected, reported and communicated. 

• Both the AAAiH and the Medical Technology Association of Australia (MTAA) recommended development of a formal data governance framework as well as mechanisms to provide industry with ethical and consent-based access to clinical data to support AI development and leverage existing national biomedical data repositories. 

• The Australian legislative and policy environment for AI is rapidly changing: upcoming developments include changes in cross-sectoral legislation (e.g. privacy law) and an intended national risk-based approach to AI legislation 

. • Review of Australian guidance documents showed that detailed legal analysis of privacy requirements with respect to AI implementation in healthcare (see 3.3.4 Privacy and confidentiality), and detailed legal analysis of accountability and liability in AI use (see 3.3.7 Accountability and liability), may be warranted, as these are not as well resolved in Australia as in some other jurisdictions. This could potentially support legal reform. 

Key issues for health organisations and clinicians 

• Ensure high quality, local, practice-relevant evidence of AI system performance before implementation. 

• Significant training and support for clinicians and other health workers is required during the implementation and integration of AI systems into existing clinical information systems or digital health solutions (e.g., electronic medical records, EMR). Training includes skill development to use the AI system, but also includes training in ethical and liability considerations, cybersecurity, and capacity to inform patients about the use of AI in their care (see Chapter 6, section 6.10 for details). 

• Ensure AI implementation, and organisational policy, complies with existing legislation (e.g. data privacy, consumer law, and cybersecurity policy) and relevant AI ethics frameworks. 

• AI governance should build on existing governance processes in healthcare organisations e.g. for patient safety, digital health and research ethics. This is necessary to ensure safe and responsible use of AI, as well as clarify lines of individual and organisation responsibility over AI-assisted clinical and administrative decision-making that comply with existing liability rules. 

• Strengthen engagement with consumers, communities, and stakeholders in healthcare AI implementation to ensure trustworthiness, and to shape implementation and use of consumer- or patient-facing AI. An example of policy-orientated community engagement is illustrated by a national Australian citizens’ jury convened to deliberate about AI implementation in healthcare. See Box 2 in Chapter 3, section 3.3.2 for the jury’s recommendations.   

• Implementation of AI in health services should ensure appropriate Aboriginal and Torres Strait Islander governance, by connecting AI governance processes in health systems to existing Aboriginal and Torres Strait Islander governance structures. Implementation should be in line with principles of Indigenous Data Sovereignty. 

• Transparency and consent are key issues for implementation of AI in health services. Governance of transparency and consent should draw on existing expertise and governance systems in healthcare organisations, including clinical ethics committees, research ethics committees, digital health committees, consumer governance committees and risk management structures. In developing approaches to transparency and consent, health organisations should note that: o Fundamental requirements for consent in clinical contexts—that a person must have capacity, consent voluntarily and specifically, and have sufficient information about their condition, options, and material risks and benefits—remain unchanged by the use of AI. o There is limited guidance available regarding requirements for consent to the use of AI as an element of clinical care. o Across the policy documents reviewed, there is strong agreement that there should be transparency about the fact that AI is being used. o Also consider transparency regarding training data, data bias, AI system performance and evaluation methods. o Risk-based assessment could require greater transparency for higher-risk applications. o As noted above, consent and transparency are potential areas of focus for a National Council on AI in Health. 

• Implement risk assessment frameworks to address the risk of bias, discrimination or unfairness in initial evaluation and ongoing monitoring of AI systems. See Appendix A for an example of an impact assessment tool. 

• Ensure use of existing patient safety and quality systems for monitoring AI incidents and safety events (including hazards and near miss events) as well as post-market safety monitoring so that cases of AI-related patient risk and harm are rapidly detected, reported and managed. 

Chapters 4 and 5 report findings from a scoping review of the literature to identify principles for safe and responsible implementation of AI at the health service level. The review covers 75 primary studies about AI systems deployed in acute care that were published in the peer-reviewed literature from 2021-2023 as well as nine studies reporting emerging safety problems associated with AI in healthcare. For healthcare organisations, safe and responsible AI in builds on best-practice approaches for digital health.

Key findings and principles are

AI in acute care settings 

Key finding 1: AI technologies are being applied in a wide variety of clinical areas, with studies identifying clear clinical use cases for their implementation. The most common clinical tasks supported by AI systems are diagnosis and procedures. All the AI systems identified in the literature search were based on traditional machine learning (ML) techniques and most were assistive requiring clinicians to confirm or approve AI provided information or decisions. Up until December 2023, no studies had evaluated the implementation of AI in hospital operations or the clinical use of foundation models or generative AI in routine patient care. 

Principle 1: Take a problem-driven approach to AI implementation, an AI system should address specific clinical needs. Confirm the specific clinical use case before implementation i.e. the types of patients and condition where the AI system is intended to improve care delivery and patient outcomes. 

Approach to AI implementation 

Key finding 2: The literature demonstrated multiple ways in which health services implemented AI systems such as to: i/ develop AI systems in-house; ii/ co-develop in partnership with technology companies; and iii/ purchase AI systems from commercial vendors (including AI systems subject to medical device regulation). Evidence of engagement with hospital ethics committees or clinical governance boards from a responsible use perspective was poorly reported in the studies reviewed.  

Principle 2: Deployment of AI systems that have been developed externally or internally, is a highly complex process and should be undertaken in partnership with key stakeholders including healthcare professionals and patients. Consultation should occur with those who have specialist skills traversing clinical safety, governance, ethics, IT system architecture legal and procurement, and include the specific healthcare professionals as well as patient representatives and/or patient liaison officers. 

Principle 3: When purchasing AI systems from commercial vendors, assess clinical applicability and feasibility of implementation in the care setting. Consider the system performance and whether the ML model will transport from its training and validation environment to the local clinical setting of interest. Consider feasibility of testing the AI using localised de-identified data sets or localised synthetic datasets to illicit utility and performance of the AI system in the local clinical area of interest, before conducting pilot implementation projects. AI system performance 

Key finding 3: AI system performance was usually assessed against a comparator (e.g. human or another device). Evaluation metrics such as sensitivity, specificity, positive predictive value, accuracy and F1 score were commonplace amongst the literature. 

Principle 4: Ensure AI is fit for clinical purposes by assessing evidence for system performance against a comparator. Evaluate performance in the local context of interest using localised de-identified datasets or synthetic datasets, before conducting pilot implementation projects to measure AI system performance and answer any evidence gaps in prior assessments. 

Key finding 4: Emerging evidence highlights the impact of distributional shift, stemming from disparities between the dataset on which AI systems are trained and deployment datasets. However, studies describing implementation lacked any reported quality assurance measures, such as post-deployment monitoring, auditing, or performance reviews. 

Principle 5: Monitor AI system performance in-situ post deployment, by means of electronic dashboards or other performance monitoring/auditing methods to rapidly detect and mitigate the effects of distributional shift. This should be underpinned by technical support as well as processes around planned and unplanned system downtime. 

Safety of AI in healthcare 

Key finding 5: Emerging evidence underscores safety concerns associated with AI systems and their impact on patient care. Although literature reporting on AI-related adverse events has been limited, evidence from the US FDA’s post-market safety monitoring emphasises the necessity of examining issues with AI systems beyond the known limitations of ML algorithms. Predominantly, issues with data acquisition were observed, while problems with use i.e. the misapplication of AI and its intended purposes were four times more likely to lead to patient harm that technical issues. 

Principle 6: A whole-of-system approach to safe AI implementation is needed. Ensure that AI systems are effectively integrated into IT infrastructure as they are highly reliant on data and integration with the IT infrastructure and other clinical information systems. Data quality and requirements for any accompanying changes to the EMR and other supporting clinical information systems need to be assessed to ensure data provided to the AI system is fit for purpose and its output is accurately displayed to users. 

Role of AI in clinical task, clinical workflow, usability, and safe use 

Key finding 6: AI systems in the literature were predominantly assistive or providing autonomous information meaning users were required to confirm or approve AI provided information or decisions, and still had overall autonomy over the task at hand. However, problems with the use of AI were more likely to harm patients compared to algorithm issues in safety events reported to the US FDA’s post- market safety monitoring. 

Principle 7: Ensure that users are aware of the intended use of AI systems (see Box 3). Training around the intended use and safe use of AI should be developed in consultation with the AI developer, clinical governance, patient safety and clinical leaders. The training should be maintained and updated throughout the life cycle of the AI system. 

Key finding 7: End user engagement to devise clinical workflows and training ahead of deployment were less well reported in the literature. When understanding interaction and adoption of AI systems into healthcare workflows, user experience data and user metrics uncovered facilitators and barriers.  

Principle 8: Integrate AI systems with clinical workflow. Devise clinical workflows for AI systems in a real- world care setting to ensure AI is seamlessly integrated into practice. Evaluate early to ensure AI fits local  requirements and address any issues. A pilot implementation can be used to test and refine integration with clinical workflow and supporting systems. 

Principle 9: Identify issues with system usability via user metrics and short, regular survey requests. Address these issues promptly by collaboration with the AI developer and clinicians using the system. 

Clinical utility and effects on decision-making 

Key finding 8: Decision change outcomes such as incorrect/correct decisions and the rate at which clinicians make decisions, their decision velocity, help to characterise effects of AI systems on clinical decision-making. Confidence, acceptability and trust in the AI system were important factors in decision change. 

Principle 10: Limitations of the AI system abilities must be made clear to all staff engaging with the AI system. This can be fostered by collaboration with the AI developer and strong engagement with clinicians in both pre-deployment and post deployment phases. AI incidents and safety events (including hazards and near miss events) should be easy to report and escalate. 

Principle 11: Before-and-after studies or historical cohort studies can be utilised to assess the clinical utility and safety of AI compared to a time period when AI was not implemented. 

Effects on care delivery and patient outcomes 

Key finding 9: Care process changes were not well described in the literature. However, clinical outcomes were ubiquitously reported as primary, secondary and exploratory outcomes, with many studies having a clinical outcome as the study primary endpoint. 

Principle 12: Ensure AI systems are suitably embedded i.e. their use and clinical utility in a particular context is established using formative evaluation methods during implementation before conducting clinical trials to assess impact on care delivery and patient outcomes. 

Conclusion 

The adoption of AI technologies in Australian healthcare is still in its early stages. By safely and responsibly implementing the current generation of AI, Australian health services can prepare for the future. This involves building on existing governance processes, strengthening engagement with consumers, utilising the available data infrastructure, and establishing robust processes for evaluating the performance, clinical utility, and usefulness of AI assistance based on current best practices for implementing digital health systems. Preparation is crucial as healthcare AI systems evolve from making recommendations to autonomously performing clinical tasks. Moreover, Australia has the opportunity to provide guidance to other countries seeking to use modern AI systems to improve care delivery and patient outcomes effectively and safely.

Phakes

Another article on phakes in Africa. 'Prevalence of substandard, falsified, unlicensed and unregistered medicine and its associated factors in Africa: a systematic review' by Biset Asrade Mekonnen, Muluabay Getie Yizengaw and Minichil Chanie Worku in (2024) 17(1) Journal of Pharmaceutical Policy and Practice comments 

Substandard, falsified, unlicensed, and unregistered medicines pose significant risks to public health in developed and developing countries. This systematic review provides an overview of the prevalence of substandard, falsified, unlicensed, and unregistered medicine and its associated factors in Africa. 

Articles published from April 2014 to March 2024 were searched in Google Scholar, Science Direct, PubMed, MEDLINE, and Embase. The search strategy focused on open-access articles published in peer-reviewed scientific journals and studies exclusively conducted in African countries. The quality of the studies was assessed according to the Medicine Quality Assessment Reporting Guidelines (MEDQUARG). This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). 

Of the 27 studies, 26 had good methodological quality after a quality assessment. Of the 7508 medicine samples, 1639 failed at least one quality test and were confirmed to be substandard/falsified medicines. The overall estimated prevalence of substandard/falsified medicines in Africa was 22.6% (1718/7592). The average prevalence of unregistered medicines was 34.6% (108/312). Antibiotics, antimalarial, and antihypertensive medicines accounted for 44.6% (712/1596), 15.6% (530/3530), 16.3% (249/1530), and 16.3% (249/1530), respectively. Approximately 60.7% (91/150) were antihelmintic and antiprotozoal medicines. Poor market regulatory permission, Free trade zones, poor registration, high demand, and poor importation standards contribute to the prevalence of these problems. 

Substandard, falsified, and unregistered medicines are highly prevalent in Africa, and attention has not been paid to the problem. Antibiotics, antimalarial, anthelmintic, and antiprotozoal are the most commonly reported substandard, falsified, and unregistered medicines. A consistent supply of high-quality products, enhancement of registration, market regulatory permission, and importation standards are essential to counter the problems in Africa. Preventing these problems is the primary duty of every responsible nation to save lives.

Power

'The Imperial Supreme Court' by Mark A Lemley in (2022) 136(1) Harvard Law Review 97 comments  

The past few years have marked the emergence of the imperial Supreme Court. Armed with a new, nearly bulletproof majority, conservative Justices on the Court have embarked on a radical restructuring of American law across a range of fields and disciplines. Unlike previous shifts in the Court, this one isn’t marked by debates over federal versus state power, or congressional versus judicial power, or judicial activism versus restraint. Nor is it marked by the triumph of one form of constitutional interpretation over another. On each of those axes, the Court’s recent opinions point in radically different directions. The Court has taken significant, simultaneous steps to restrict the power of Congress, the administrative state, the states, and the lower federal courts. And it has done so using a variety of (often contradictory) interpretative methodologies. The common denominator across multiple opinions in the last two years is that they concentrate power in one place: the Supreme Court. 

My goal in this essay is not to criticize these decisions on the merits, though there is much to criticize; lots of others will do that. Nor do I aim simply to make the legal realist point that the Justices will do what they want in the cases before them, though the last few Terms provide ample evidence for that claim too. Rather, my argument is that the Court has begun to implement the policy preferences of its conservative majority in a new and troubling way: by simultaneously stripping power from every political entity except the Supreme Court itself. The Court of late gets its way, not by giving power to an entity whose political predilections are aligned with the Justices’ own, but by undercutting the ability of any entity to do something the Justices don’t like. We are in the era of the imperial Supreme Court. 

In Part I, I show that the Court has not been favoring one branch of government over another, or favoring states over the federal government, or the rights of people over governments. Rather, it is withdrawing power from all of them at once. I also show that this result cannot be explained by any consistent judicial philosophy. The Court is happy to embrace conflicting philosophies to achieve the ends it wants in the case before it. In Part II, I suggest that the imperial Supreme Court is something new and dangerous and that we must consider more radical options to protect the American form of government.

Trustee Companies

The Productivity Commission 'Future Giving' report summarised in the preceding post considers questions about trustee companies. It states 

Administration of charitable trusts There are unique features of the administration of charitable trusts that could affect consumer choice and fee arrangements Donors can appoint trustees to oversee and manage charitable trusts. Trustees can include individuals, public trustees or a licensed trustee companies (trustee companies that hold an Australian financial services licence issued by the Australian Securities and Investments Commission (ASIC)). Licensed trustee companies are major providers of fund management services for charitable trusts, ancillary funds and other charities. Donors may also adopt co-trustee arrangements, where trustees include both a licensed trustee company and another trustee such as a family member of the donor. 

 

In 2012-13, the Corporations and Markets Advisory Committee (CAMAC) examined issues relating to licensed trustee companies in its report The Administration of Charitable Trusts (CAMAC report) (box 8.3). The CAMAC report’s recommendations have not been implemented and a number of submissions to this inquiry have advocated for their implementation. 

 

In September 2012, the Parliamentary Secretary to the Treasurer, the Hon. Bernie Ripoll MP, requested CAMAC examine various matters concerning fees and replacement of trustees for those charitable trusts that are administered by licensed trustee companies. The scope of the review did not extend to charitable trusts more generally or other charities. Among its recommendations were: 

• amendments to Chapter 5D of the Corporations Act to adopt ‘fair and reasonable’ requirement for all fees and costs charged by licensed trustee companies 

• a standardised approach to the disclosure of services and fee schedules to help donors compare prices 

• expansion of the jurisdiction of the court when dealing with allegations of excessive fees being charged to encompass all fees and costs charged to clients 

• enhanced juridical procedure, via legislation, for dispute resolution for charitable trusts administered by licensed trustee companies, including whether they should be replaced as a trustee 

• undertaking stewardship audits for a cross-section of charitable trusts administered by license trustee companies to increase information on the administration of charitable trusts, the findings of which could be used to inform any future regulatory change. 

 

There has been no government response to the CAMAC report. 

 

Although the focus of the CAMAC inquiry was on licensed trustee companies, some of the issues raised in relation to the administration of charitable trusts, including the oversight of fee arrangements and the ability to change trustees, could arise in contexts where an entity other than a licensed trustee company has been appointed a trustee of a charitable trust. For example, where an individual or a company has been appointed as the trustee of a charitable trust created through a will. To date there has been no broader review of the administration of charitable trusts, which goes beyond the role and practices of licensed trustee companies, to examine these issues more broadly and holistically. 

 

Competition in the licenced trustee sector 

 

High rates of market concentration increase the risk that competition will be muted. This can create situations where fees for services are higher or the quality of service is lower than would be the case if there were greater price competition. The Competition and Consumer Act 2010 (Cth) contains provisions which are enforceable by the regulator the Australian Competition and Consumer Commission (ACCC) in relation to mergers and acquisitions that have detrimental effects on competition and hence the potential to harm consumers. The long-term nature of these structures means that for funds held in perpetuity, there is sometimes limited ability to change trustee service providers once the donor is deceased. Where a licensed trustee company has been used, the licensed trustee company is essentially ‘locked in’, although the Supreme Court is able to remove a trustee in instances where they have not acted in accordance with their obligations. This is relatively rare and requires an application to be made to the Court, which can involve significant costs. 

 

Since the CAMAC report, the number of major licensed trustee companies has further consolidated to two major providers (Perpetual Limited and Equity Trustees), following the acquisition of the Trust Company Limited by Perpetual Limited in 2013 and the acquisition of both ANZ Trustees and Australian Executor Trustees by Equity Trustees in 2014 and 2022 respectively. In its Public Competition Assessment of the Trust Company Limited acquisition, the ACCC found there was unlikely to be ‘substantially lessening competition’ (ACCC 2013). Its reasoning included that in the market for private trust services, there was competition for trustee companies in the form of bank subsidiaries, other parties including solicitors, financial advisors and accountants and public trustees (noting their offer and focus differs). The licensed trustee companies that participated in this inquiry stated that these mergers contributed to efficiency gains, for example by building economies of scale for grant applications. 

 

Fees charged by licensed trustee companies for the administration of charitable trusts xx Fees charged for the administration of charitable trusts influence the level of funds available for distributing towards charitable purposes. If fees are higher, all else equal, this can reduce the amount of funds available. However, trustees also add value through their activities by ensuring that legal obligations are fulfilled, managing grant application processes and seeking to distribute funds effectively. This involves costs, which are met through fees. 

 

The Commission heard different views on how fees are charged by licensed trustee companies and whether there are sufficient mechanisms in place to protect the interests of donors and the broader community. Fees charged by licensed trustee companies must be paid from trust income (Corporations Act 2001 (Cth) (Corporations Act), s. 601TBE(3)(a)). Licensed trustee companies argued fees charged should be brought in line with other trust structures by allowing them to be taken from either capital or income, where it does not significantly affect the capital of the trust, under section 601TBE(2) of the Corporations Act. Although not specifically referring to licensed trustee companies, Seedling Giving  argued the commission-based approach to charging fees on funds under management creates a disincentive for funds to be distributed to charities. The Charitable Alliance also argued against allowing fees to be paid from capital on the basis that it would materially erode trust capital and would materially impact the ability of the trust to achieve the primary impact of the donor. 

 

A related question is how trustee and investment services are structured, which CAMAC identified as an area that would benefit from more clarity. When administering a charitable trust, a licensed trustee company may provide both trustee services and investment management services, with the assets of all administered charitable trusts placed in a ‘common fund’ that is invested to generate a return. There is a question as to whether these services need to be delivered together and it may be appropriate for a trustee to adopt an arms-length process to decide upon the provider of investment management services. This could be the investment management arm of the licensed trustee company, or it may be another company. It is unclear what arrangements are currently used in this regard and what steps are adopted so that that value for money is provided. 

 

A holistic examination of the oversight arrangements for charitable trusts 

 

The CAMAC report identified issues with the administration of charitable trusts by licensed trustee companies. In the draft report, the Commission sought further information about the administration of charitable trusts by licensed companies. This included information regarding competition issues that adversely affect donors and arrangements for switching providers or charging fees, particularly for funds held in perpetuity. A number of submissions addressed this information request and it was also the subject of evidence at the public hearings. Licensed trustee companies stated that they are focused on fulfilling the charitable purposes of the trusts they administer, as provided by the settlor of the trust, and are subject to adequate governance controls and extensive regulatory requirements . Perpetual commented that the market for trustee services ‘has likely never been more abundant’ . 

 

The Charitable Alliance stated that charitable trusts administered by licensed trustee companies are ‘materially compromised by governance issues’ and supported the implementation of the CAMAC report’s recommendations. Morgans also supported the implementation of those recommendations, with ANZTSR asking that the ACNC be resourced to conduct audits of charitable trusts for which licensed trustee companies are the sole trustee. 

 

Only one foundation provided a submission which commented on the fees charged to them by a licensed trustee company, which they considered ‘to be reasonable in the context of the considerable professional services to deliver to the purposes of the trust’. They did however suggest: … an informed discussion of this subject would be beneficial for Australia, but this could only be undertaken with full transparency over services provided and fees charged by all Trustees across the sector. While the Charitable Alliance presented a substantial amount of anonymised evidence and case studies which the Alliance argued provided evidence of unreasonable fee charging by licensed trustee companies . Since the CAMAC Review there have been significant changes to the market for trustee services, including consolidation of the licensed trustee sector, as well as major changes to the regulation of charities, including charitable trusts administered by the licensed trustee companies. The commencement of the ACNC in late 2012, just prior to the CAMAC report’s completion in May 2013, introduced new reporting requirements which increased the level of transparency applying to charities, including charitable trusts administered by licensed trustee companies. 

 

The CAMAC report only examined issue related to charitable trusts administered by licensed trustee companies. However, many of these issues, such as those concerning fees and the replacement of trustees, could arise more broadly in relation to charitable trusts, regardless of whether they are administered by a licensed trustee company or not. It would therefore be less than optimal to recommend changes which would apply only to one category of charitable trusts with a particular type of trustee. Rather, it is important to examine oversight arrangements for the administration of charitable trusts holistically, in order to achieve consistent outcomes for all charitable trusts. In addition, there are complex legal questions, involving the interplay of state and federal laws, derived both from statute as well as equity. Appropriate caution is therefore needed when considering changes, to avoid unintended consequences. 

 

The Commission recommended that the Australian Law Reform Commission undertake a review of charities law and regulation, which would include examining the roles and responsibilities of state and territory Attorneys-General and other relevant regulators, including in relation to oversight of charitable trusts (recommendation 7.2). Given that charitable trusts are generally regulated under state law, this review could conduct a holistic examination of relevant matters, including the adequacy of state laws in relation to regulating fees charged by all types of trustees of charitable trusts and whether the provisions about changing trustees are appropriate. As part of this, the review could consider the interaction of these laws with the regulation of licensed trustee companies by the Australian Government. 

 

The Commission also notes that there are existing regulators who have roles monitoring various aspects of licensed trustee companies. Licensed trustee companies are governed by the Corporations Act and have regulatory obligations to ASIC and to the ACNC (as mentioned above). In addition, should evidence of any issues emerge that are a direct result of market concentration in the trustee company market in future, the ACCC is able to investigate.

Philanthropy

The Productivity Commission's report Future foundations for giving recommends major changes to the Australian charitable trusts regime. The Commission comments 

 Philanthropy contributes to a better society by providing money, time, skills, assets or lending a voice to people and communities who would otherwise have lower quality outcomes or have less access to goods and services. • Many Australians give money, other assets or their time. Over $13 billion was donated to charities in Australia in 2021 and 6 million people volunteered in 2022. • Philanthropy, particularly volunteering, can help build social capital by contributing to social networks, building trust within communities, and diffusing knowledge and innovations through communities. • Philanthropy can also provide untied, flexible or long-term funding for more innovative and riskier projects compared to what government funding can offer. 

Philanthropy in Australia is increasing and government policies are supporting this growth. The Productivity Commission’s recommendations reinforce the foundations for philanthropy in Australia, so that the benefits of giving can continue to be realised into the future. 

The deductible gift recipient (DGR) system is not fit for purpose and should be reformed. • The arrangements that determine which entities can access DGR status are poorly designed, overly complex and have no coherent policy rationale. • All Australian taxpayers co-invest in charities through the DGR system, so reform is needed to simplify the DGR system and direct support to where there is likely to be the greatest net benefits to the community from subsidised philanthropy. If adopted, the Commission’s recommendations would mean that more charities overall would be able to access tax-deductible donations. 

An independent organisation should be established to strengthen relationships between Aboriginal and Torres Strait Islander organisations and philanthropic networks. • Provisionally called ‘Indigenous Philanthropy Connections’, it should be led and controlled by Aboriginal and Torres Strait Islander people and be funded by an endowment provided by the Australian Government. Reforms are needed to enhance the regulatory framework for charities and to support high levels of public trust and confidence in charities now and into the future. • Establishing a National Charity Regulators Forum comprised of Australian, state and territory charity regulators would formalise the regulatory architecture to embed coordination and cooperation. 

The Commission has designed policy principles to inform the minimum distribution that ancillary funds are required to make each year to charities for the benefit of the wider community. • Guided by these principles, the Australian Government should set the minimum distribution rate for ancillary funds between 5% and 8%, following further consultation with the philanthropic and charitable sectors. 

The Australian Government should create more value for the public from the data collected about charities and giving, including by publishing aggregate information on corporate giving and by requiring listed companies to be more transparent to stakeholders about their giving. 

Philanthropy literally means ‘the love of humanity’. Each day, millions of Australians express this sentiment in practical ways, seeking to improve the wellbeing and resilience of their communities by contributing to causes they care about. People and organisations give for many reasons. Some are highly personal, such as those associated with a loved one or with their family experiences. Religious traditions and values provide an important source of motivation for many people and shape the ethos of many Australian charities. Other motivations can be broader, such as wanting to ‘give back’ to the community by helping those in need. Access to philanthropic networks and information also shape decisions to give. 

Whatever our reasons for giving, Australians give generously. Over $13 billion was donated to charities in Australia in 2021 and 6 million people volunteered in 2022. In real terms, the Productivity Commission expects giving to increase by $6.4 billion or 48% by 2030 (box 1). This once-in-a-generation inquiry comes at a key point in time. While the Australian Government has a goal to double giving by 2030, some of the most important policy settings that would underpin such an increase are not fit for purpose. This report therefore focuses on reforms to build firmer foundations for philanthropy in Australia, so that the benefits of giving can continue to be realised into the future. 

The reforms proposed in this report focus on four main areas: improving the system that determines which charities have access to tax-deductible donations; improving access to philanthropic networks for Aboriginal and Torres Strait Islander people; enhancing the regulatory framework for charities and ancillary funds; and improving public information on charities and donations. 

Policy choices come with trade-offs. Subsidising philanthropy through tax deductions can encourage giving, but it also means the Government collects less revenue through income tax, which could otherwise be used to fund core government services or fund charities directly. Regulation can provide benefits, but it can impose compliance burdens and require additional resources for regulators. The bottom line is: there is no free lunch. 

With this in mind, the Commission developed a framework to assess where there is a role for government to support philanthropy and where policy changes are needed. This assessment was based on the expected benefits and costs to the community of different forms of government involvement in philanthropy. 

The Commission drew on the perspectives of donors, charities, philanthropic foundations, researchers and governments to analyse policy options to support giving, including their effect on equity and efficiency. The Commission was informed and guided by the contributions of inquiry participants through 1,611 public submissions, 1,593 brief comments, over 120 consultations, 10 roundtables and 6 days of public hearings, as well as previous government reviews and the academic literature.

The report states

Charities are subject to oversight from multiple national, state and territory regulators, each with their own institutional arrangements, responsibilities, powers, priorities and resources. The Australian Charities and Not for profits Commission (ACNC) is the national charities regulator. However, regulatory oversight is not consolidated at the national level because the Australian Parliament does not have the constitutional power to generally legislate for charities or the full range of structures a charity can adopt. Two effects of this are: • charities found to have engaged in the same kind of misconduct can face different regulatory consequences • the full scope of the ACNC’s regulatory powers is limited to a small proportion of charities characterised as ‘federally regulated entities’ and charities that operate outside Australia. 

A referral of powers by state parliaments is likely to be the best approach to address the constitutional limitations of the ACNC, but that would involve significant implementation challenges and costs. Variation across jurisdictions may still occur if some states decline to refer a matter to the Australian Parliament. 

Given this, the Commission proposed a suite of recommendations that build on the existing collaborative approach to charities regulation that would strengthen the ACNC’s information gathering powers and are proportionate to current and foreseeable risks. The Commission’s recommendations include enabling the ACNC to: • require a charity to provide information necessary to form an opinion on whether it is a ‘federally regulated entity’ • require a charity undergoing revocation of its ACNC registration to evidence the distribution of its net assets to an eligible entity, unless the ACNC Commissioner waives that requirement • have standing so it can seek orders in the Supreme Courts of all jurisdictions, where necessary, to protect charitable assets. 

There are also technical issues in charities law that require further examination. In consultation with the Standing Council of Attorneys-General, the Australian Attorney-General should refer an inquiry to the Australian Law Reform Commission to examine: • the scope and coverage of Australian, state and territory charities laws focused on opportunities to simplify and harmonise laws across jurisdictions • the roles and responsibilities of state and territory Attorneys-General and other relevant regulators in relation to the oversight of charities, including charitable trusts. 

As the behaviour of donors and charities evolves, a referral of powers may need further consideration by governments, should it become apparent that the current sharing of responsibilities for charities regulation is not sufficient. 

A sound regulatory framework will only promote trust and confidence in the charitable sector if the ACNC exercises its powers when the need arises. ACNC data suggests that it has made limited use of its formal enforcement powers. The Commission was not asked to assess the effectiveness of the ACNC as a regulator and acknowledges there are several explanations for why the ACNC may not have used its formal enforcement powers more routinely. As the ACNC progresses through its second decade of operation, it may have greater ability to assume a more assertive enforcement and compliance posture, where necessary, to support trust and confidence in the charitable sector. 

The role, powers and functions of the ACNC would be expanded if these recommendations were adopted. The reforms the Commission is proposing to strengthen the ACNC are more likely to be successful if the ACNC is able – and resourced – to adopt a more assertive regulatory posture, while retaining its emphasis on supporting charities to meet their obligations through education and guidance.

The Commission's Findings and Recommendations are - 

Chapter 3: Philanthropy in Australia 

Finding 3.1 Rising income and wealth are the major reasons behind rising tax-deductible donations 

Tax-deductible donations by individuals made directly to charities have increased in value, but fewer people are making such donations. From 2000-01 to 2020-21, tax-deductible donations tripled (in real terms) despite the number of taxpayers increasing by only 38%. The available evidence indicates that this coincided with individuals’ financial capacity to donate increasing. 

The Australian Government also made policy changes that provided additional or more flexible financial incentives to give, which likely also played a role in increasing giving. Giving into private and public ancillary funds has grown in value (from $692 million in 2011-12 to $2.4 billion in 2020-21). The relative importance of private ancillary funds has also grown from 15% to 27% of individual giving. 

Finding 3.2 Volunteering is widespread in Australia, but the formal volunteering rate has declined 

In 2022, about one in four people in Australia (about 6 million people) volunteered for an organisation. Nearly twice as many people volunteered informally (that is, assisting people other than family members, outside of the context of an organisation or group). However, the formal volunteering rate fell from 36% in 2010 to 25% in 2020. Data indicates that by 2022, the volunteering rate had recovered slightly to 26.7% following the COVID-19 pandemic. xx These figures likely understate total volunteering given official data sources use language and definitions that may result in underreporting of such giving because of different cultural meanings of volunteering.   

Finding 3.3 People give or do not give for a range of personal reasons 

People give for a range of complex and multifaceted reasons that can change over time. Specific events can also prompt people to give. Common patterns of giving behaviour include: • people affected by natural disasters are likely to donate more to help others in their own community • some people with high net worth use giving vehicles (such as ancillary funds or trusts) to connect with family through giving, to leave a legacy or to teach skills to the next generation • many businesses use high-visibility giving, including pro bono work, to bolster their corporate reputation, and to attract and retain employees and customers. xx People choose not to give for a variety of reasons. A lack of financial resources is one of the main reasons people do not donate money and common reasons people do not volunteer are work and family commitments. A lack of trust in how charities will use donations and financial constraints on volunteering are also common reasons people choose not to give. 

Chapter 4: How governments can incentivise giving 

Finding 4.1 People respond to incentives, with those on a higher income more likely to give 

Modelling undertaken by the Commission indicates that people give more than they otherwise would because of the personal income tax deduction for donating to entities with deductible gift recipient status. The modelling draws on Australian taxpayer panel data and is the first time panel data has been used in Australia to estimate how people respond to personal income tax deductions for donations. The Commission used two models to estimate the price elasticity of giving – which is how people change their giving behaviour in response to changes in tax incentives for giving – and the income elasticity of giving, which is how people change giving behaviours in response to changes in their own income. The Commission’s estimates fall within the following ranges for: • price elasticity of giving in Australia: from -1.67 to -0.48, meaning a 1% increase in the tax deduction for giving is associated with a 0.48% to 1.67% increase in giving • the income elasticity of giving in Australia: from 0.86 to 1.17, meaning a 1% increase in income is associated with a 0.86% to 1.17% increase in giving. However, these estimates are only one factor to consider when evaluating the effectiveness of tax incentives to give. The share of taxpayers claiming a deduction for giving increases with income. Most of the tax benefits from giving that accrue to people in the lowest taxable income decile go to people who had high incomes before claiming any tax deductions. 

Recommendation 4.1 Remove the $2 threshold for tax-deductible donations 

The Australian Government should amend the Income Tax Assessment Act 1997 (Cth) to remove the $2 threshold for tax-deductible donations to entities with deductible gift recipient status. 

Finding 4.2 A personal income tax deduction is likely to be an effective way to encourage giving 

Tax incentives can be designed to target the total amount donated, increase the number of people participating in giving or to encourage particular types of giving, such as money, physical assets or time. The current design of the personal income tax deduction is likely to be the most cost-effective way for the Australian Government to encourage giving. A flat tax credit would likely incentivise more people to give, but the total amount given overall would likely fall if people who have a high income faced a higher price of giving than they currently do. Adjustments to a tax credit to account for the likely fall in overall giving, including a hybrid approach – a tax deduction for some income cohorts and a tax credit for others – would add complexity and the effect on total donations would be uncertain. Whether a tax deduction or tax credit would encourage more people to volunteer is highly uncertain, but they would likely increase tax integrity risks and compliance costs given volunteer work and expenses are often undocumented or informal. Government grants to support volunteering where there is a clearly identified need would likely generate greater net benefits to the community than tax incentives for volunteering, if properly targeted and evaluated. 

Chapter 5: An assessment of the deductible gift recipient system 

Finding 5.1 The deductible gift recipient (DGR) system is poorly designed, overly complex and has no coherent policy rationale 

The DGR system is not fit for purpose as a mechanism for determining which entities should be eligible to receive indirect government support through tax-deductible donations. There is no coherent policy rationale for why certain entities are eligible for DGR status and others miss out. The complexity of the system continues to increase as new DGR endorsement categories are added in a piecemeal manner. The DGR system creates inefficient, inconsistent and unfair outcomes for donors, charities and the community. It needs reform. 

Chapter 6: Reforming the deductible gift recipient system 

Recommendation 6.1 A simpler, refocused deductible gift recipient (DGR) system that creates fairer and more consistent outcomes for donors, charities and the community 

The Australian Government should amend the Income Tax Assessment Act 1997 (Cth) to reform the DGR system to focus it on activities with greater community-wide benefits. The scope of the reformed system should be based on the following principles. • There is a rationale for Australian Government support because the activity has net community-wide benefits and would otherwise be undersupplied. • There are net benefits from providing Australian Government support for the activity through subsidising philanthropy. • There is unlikely to be a close nexus between donors and beneficiaries, such as the material risk of substitution between fees and donations. In applying these principles, the Australian Government should: • extend eligibility for DGR status to most classes of charitable activities, drawing on the charity subtype classification in the Australian Charities and Not-for-profits Commission Act 2012 (Cth) to classify which charitable activities are eligible for DGR status and which are not • expressly exclude the following classes of charitable activities or subtypes: – primary, secondary, religious and informal education activities, with an exception for activities that have a specific equity objective (such as activities undertaken by a public benevolent institution) – the activities of early childhood education and care and aged care (other than activities undertaken by a public benevolent institution) – all activities in the subtype of advancing religion – activities in the other analogous purposes subtype that are for the purpose of promoting industry or a purpose analogous to an exclusion in another subtype – activities in the law subtype that further another excluded subtype • only grant DGR status to government entities where they are analogous to a charity and undertake activities that would be eligible for DGR status if undertaken by a charity • continue to limit the scope of the DGR system to registered charities and equivalent government entities • only use the specific listing mechanism in exceptional circumstances. When it is used, the Australian Government should increase the transparency of applications, how these are assessed, and the decision-making process to maintain confidence in the broader DGR system. 

Recommendation 6.2 Supporting reforms to improve the deductible gift recipient (DGR) system 

To facilitate the implementation of reforms to the DGR system, and provide greater clarity to both charities and the Australian Charities and Not-for-profits Commission (ACNC), the Australian Government should: • amend the Australian Charities and Not-for-profits Commission Act 2012 (Cth) to require the ACNC to register new and existing charities with all applicable charitable subtypes where a charity has endorsement as a DGR or has indicated they will be seeking such endorsement. This should include any necessary amendments to enable the ACNC to compel the provision of necessary information to assess eligibility for subtype registration where that registration has not been applied for by an entity. Charities should continue to be able to seek review of subtype registration decisions through the Administrative Appeals Tribunal or its successor • develop a legislated definition of what constitutes a public benevolent institution to delineate its scope more clearly. 

Recommendation 6.3 Transition arrangements to support reform of the deductible gift recipient (DGR) system 

In implementing reforms to the DGR system, the Australian Government should also provide a transition period of five years, during which time entities with DGR status (largely, school building funds and entities that provide religious and ethics education in government schools) can maintain their existing DGR endorsements and receive tax-deductible donations. Subsequently, there should also be a further period in which these entities can use those donations for their intended purposes. The length of this period should be determined by balancing the potential constraints imposed on entities with the benefits of simplifying the DGR system over the longer term. In the context of the proposed withdrawal of DGR status for school building funds, the Australian Government should concurrently develop and put in place other funding mechanisms for primary and secondary school infrastructure outside the DGR system. 

Chapter 7: A sound regulatory framework 

Recommendation 7.1 A more transparent and consistent approach to regulating charities 

The Australian Government should amend the Australian Charities and Not-for-profits Commission Act 2012 (Cth) to remove the concept of ‘basic religious charity’ and associated exemptions, so all charities registered with the Australian Charities and Not-for-profits Commission are regulated in a consistent manner. This should include obligations to comply with principles based governance standards and reporting requirements proportionate to size. 

Recommendation 7.2 Strengthening the Australian Charities and Not-for-profits Commission 

The Australian Government should: • amend the Australian Charities and Not-for-profits Commission Act 2012 (Cth) (the Act) to enable the Commissioner of the Australian Charities and Not-for-profits Commission (ACNC) to require a charity to provide the information necessary to assess whether the charity is likely to be a ‘federally regulated entity’ • amend the Act to enable the Commissioner of the ACNC to require a charity undergoing revocation of its ACNC charity registration to evidence the intended or actual distribution of its net assets to an eligible entity unless that requirement is waived by the Commissioner • work with state and territory governments to ensure the Commissioner of the ACNC has the necessary enforcement powers to fulfil their role within the regulatory framework for charities. This should include implementing or reforming laws, where necessary, to confirm that the Commissioner of the ACNC has standing to make applications in a state or territory Supreme Court for orders regarding the administration of charities, including the protection of assets held in trust for charitable purposes, regardless of a charity’s structure. 

Recommendation 7.3 Review of charities law by the Australian Law Reform Commission 

The Australian Government should refer an inquiry to the Australian Law Reform Commission to examine: • the scope and coverage of Australian, state and territory charities laws focused on opportunities to simplify and harmonise laws across jurisdictions • the roles and responsibilities of state and territory Attorneys-General and other relevant regulators in relation to oversight of charities, including charitable trusts. 

Recommendation 7.4 Increasing certainty about Australian Charities and Not-for-profits Commission regulation 

The Australian Government should: • provide test case funding for the Australian Charities and Not-for-profits Commission (ACNC) to distribute to charities in specific circumstances for the purpose of developing the law • amend the Australian Charities and Not-for-profits Commission Act 2012 (Cth) to introduce a rulings scheme for the ACNC, modelled on part 5-5 of schedule 1 of the Taxation Administration Act 1953 (Cth), to support certainty in regulatory outcomes. 

Recommendation 7.5 Regulatory architecture to improve coordination and information sharing among regulators 

The Australian Government should: • establish a permanent National Charity Regulators Forum comprised of Australian, state and territory charity regulators • develop and agree to an intergovernmental agreement to, among other things: – give effect to the National Charity Regulators Forum and determine its terms of reference, how the chair is selected and the corresponding secretariat support, frequency of meetings, and any other operational matters – clarify roles, responsibilities and information sharing arrangements between the Australian Charities and Not for profits Commission, relevant Australian, state and territory regulators, and Attorneys General through the development of memorandums of understanding, including in relation to referrals, joint compliance approaches, appointments of a lead regulator, non-operating charities and processes to protect charity assets – progress charities law and regulation reform – identify any regulatory risks in the sector and collaborative approaches for managing, mitigating and responding to these risks, including the development of legislative or policy responses where needed. 

Recommendation 7.6 Review of nationally consistent fundraising regulation reforms 

The Council on Federal Financial Relations should: • continue to monitor the implementation of nationally consistent fundraising registration, reporting and conduct requirements by state and territory governments • commission an independent review of the outcomes of the fundraising harmonisation process and options to maintain regulatory consistency over time within 12 months of the tabling of this report in Parliament. This review and the response from the Council on Federal Financial Relations should be made public. 

Recommendation 7.7 Explicitly consider the effects on volunteers when designing policies and programs 

To support volunteering, Australian, state, territory and local governments should consider how changes to policies and programs would affect volunteers. This includes adopting measures that may mitigate any adverse effects on volunteer participation and identifying opportunities for volunteers as part of policy or program design. 

Chapter 8: Structured giving vehicles 

Recommendation 8.1 Improving the effectiveness and performance of ancillary funds for the whole community 

The Australian Government should amend the private ancillary fund and public ancillary fund guidelines to: • set the minimum distribution rate at between 5% and 8% for ancillary funds, based on: – the Government’s assessment of the trade-off between bringing forward the funds that are distributed to charities and a lower amount distributed in the future – available information – further consultation with the philanthropy and charitable sectors • require that ancillary funds develop a ‘distribution strategy’ outlining how they will support eligible entities to further their charitable purpose. The Australian Government should also: • change the name of ancillary funds to Private and Public Giving Funds to make their philanthropic purpose clearer • provide a five-year period of notice before any new minimum distribution rate applies to allow existing ancillary funds to make any necessary changes to their investment strategies • conduct a periodic review of the minimum distribution rate every 10 to 15 years to decide whether the rate should be adjusted • conduct and publish a survey of charities on their preferred minimum distribution rate for ancillary funds and how money is distributed to charities each time the minimum distribution rate is reviewed. 

Recommendation 8.2 Enabling distributions of funds to be smoothed over three years 

The Australian Government should increase the flexibility of the regulatory regime by amending the private ancillary fund and public ancillary fund guidelines to enable smoothing of the distribution rate over a period of up to three years, with integrity measures to ensure the resulting distributions are at least equal to (or higher than) the amount that would have otherwise been payable under existing rules. 

Recommendation 8.3 Improving public information on ancillary funds 

The Australian Taxation Office should: • publish additional aggregate information on distributions by ancillary funds • collect and publish additional information on sub-funds within public ancillary funds • raise public awareness of information on ancillary funds, including by collaborating with the Australian Charities and Not-for-profits Commission to include additional information in the Australian Charities Report. 

Finding 8.1 There is no case for reducing superannuation taxes for bequests 

The current tax arrangements for superannuation treat a donation to a charity in the same way as a payment to any other non-dependant beneficiary. The tax system is not neutral in death and provides a larger tax benefit for the superannuation component of an estate. Adding further concessions at the time of death would be a relatively costly way for the Australian Government to incentivise philanthropic giving. 

Chapter 9: Public information about charities and giving 

Finding 9.1 Administrative expenses are not an accurate reflection of the performance of a charity 

An overemphasis, amongst donors and other stakeholders, on the amount of revenue that charities spend on administrative expenses can lead to incorrect conclusions about charity effectiveness and create perverse incentives for charities. For example, it can result in the underreporting of administrative costs or underinvesting in core capabilities and capacity, such as staff training, which undermines long-term capacity to further charitable purposes and benefit the community. Charities have incentives to provide information about effectiveness to donors and this information is shared in various ways. Introducing additional requirements, such as standardised effectiveness measures, would be impractical and may lead to significant unintended consequences. 

Recommendation 9.1 Enhance information published by the Australian Charities and Not-for-profits Commission 

The Australian Charities and Not-for-profits Commission (ACNC) should enhance the usefulness of the information it provides on charities and giving for donors and the public. The ACNC should: • present data on the ACNC charity register in ways that are more meaningful and accessible to donors and the public based on stakeholder consultation • publish the DGR status of charities on the ACNC charity register • raise public awareness of the ACNC charity register and other government sources of information on charities. 

Recommendation 9.2 Introduce enhanced disclosure and reporting of corporate giving 

The Australian Government should introduce a requirement for listed companies to publicly report itemised information on their donations of money, goods and time (volunteering) to entities with deductible gift recipient status. This would enhance accountability to shareholders, consumers, employees and other stakeholders within the community. The Australian Taxation Office (ATO) should amend the company tax return to require listed companies to report donations of money and assets to entities with deductible gift recipient status as a distinct line item in deductions, similar to what is required for individuals. The ATO should regularly publish aggregate information on corporate giving in Australia (for example, in the Australian Taxation Statistics) including, at a minimum, donations by company size, taxable status and industry. 

Recommendation 9.3 Improve data on charitable bequests 

To provide more information about giving through charitable bequests, including trends over time, the Australian Charities and Not-for-profits Commission should require registered charities to separately report income from bequests in their annual information statement and publicly report the aggregate data. 

Recommendation 9.4 Improve the usefulness of public information sources on volunteering 

The Australian Bureau of Statistics (ABS) should improve the usefulness of public information sources on volunteering. It should amend the questions on volunteering in the Census to capture: • whether respondents engaged in informal volunteering (in addition to whether they engaged in formal volunteering with an organisation) • the amount of time the respondent engaged in formal or informal volunteering (for example, hours each week). The ABS should also collect more detailed information on volunteering annually through a survey such as the General Social Survey. At minimum, the survey should collect information on whether respondents engage in formal and informal volunteering, and the time spent engaged in these activities. However, the ABS should strongly consider including additional questions to improve information on volunteering, in consultation with relevant stakeholders. Following engagement with communities, the ABS should develop methodologies that enable better measurement of volunteering by Aboriginal and Torres Strait Islander communities and culturally and linguistically diverse communities. 

Chapter 10: Increasing participation in giving 

Recommendation 10.1 Establish Indigenous Philanthropy Connections 

The Australian Government should establish an independent organisation, provisionally called Indigenous Philanthropy Connections, controlled by – and for the benefit of – Aboriginal and Torres Strait Islander people and communities. The goals of Indigenous Philanthropy Connections should be to strengthen the capacity of: • non-Indigenous philanthropic organisations to be more culturally safe and responsive to the needs of Aboriginal and Torres Strait Islander people and organisations • Aboriginal and Torres Strait Islander people and organisations to build relationships and partnerships with philanthropic and volunteering networks • Aboriginal and Torres Strait Islander communities by supporting the establishment and growth of new and existing Aboriginal and Torres Strait Islander philanthropic organisations. Indigenous Philanthropy Connections should: • have governance arrangements that support self-determination, including a board comprised by a majority of Aboriginal and Torres Strait Islander people • not replace or replicate existing Aboriginal and Torres Strait Islander philanthropic organisations • be funded by an endowment from the Australian Government that is large enough to guarantee that it is financially sustainable and independent, without need to seek further funding from either government or philanthropy. The Australian Government should also fund an independent evaluation of Indigenous Philanthropy Connections, to be conducted 10 years after its establishment. 

Finding 10.1 A government-funded public campaign could help broaden participation in giving, but there is insufficient evidence to conclude that such an intervention would be effective 

More evidence is needed, including through rigorous evaluations from Australia or overseas, to demonstrate that a government-funded campaign would be effective at increasing giving and yield net benefits to the community. Governments could maximise the chances of a successful public campaign (and opportunities for learning) by ensuring any public campaigns that involve public resources (whether it be a campaign run by a government agency or public funding of a sector-led campaign) adhere to sound program design, evaluation and transparency principles.

Cheating

'Chegg’s Growth, Response Rate, and Prevalence as a Cheating Tool: Insights From an Audit within an Australian Engineering School' by Edmund Pickering and Clancy Schuller in (2024) Journal of Academic Ethics comments 

Online tools are increasingly being used by students to cheat. File-sharing and homework-helper websites offer to aid students in their studies, but are vulnerable to misuse, and are increasingly reported as a major source of academic misconduct. Chegg.com is the largest such website. Despite this, there is little public information about the use of Chegg as a cheating tool. This is a critical omission, as for institutions to effectively tackle this threat, they must have a sophisticated understanding of their use. To address this gap, this work reports on a comprehensive audit of Chegg usage conducted within an Australian university engineering school. We provide a detailed analysis of the growth of Chegg, its use within an Australian university engineering school, and the wait time to receive solutions.

The authors state that over half of audited units had  assessment content found on Chegg. 

1180 solutions were found on Chegg which directly matched assessment content, with the largest unit having 394 matches identified. We reiterate that the uploading of these 1180 assessment items to Chegg constituted academic misconduct as these were efforts to subvert assessment.

They note that

Chegg is broadly used to cheat and 50% of questions asked on Chegg are answered within 1.5 h. This makes Chegg an appealing tool for academic misconduct in both assignment tasks and online exams. We further investigate the growth of Chegg and show its use is above pre-pandemic levels. This work provides valuable insights to educators and institutions looking to improve the integrity of their courses through assessment and policy development. Finally, to better understand and tackle this form of misconduct, we call on education institutions to be more transparent in reporting misconduct data and for homework-helper websites to improve defences against misuse.