Ensuring right health workforce in time of change

I had the honour of taking up the Health Ministry nearly two years ago. My first priority was to get out on the ground and meet the people who make up Australia’s health workforce. I wanted to understand what makes up ‘a day in the life’ of someone working in the system – in hospitals, in aged care facilities, in general practices. I also wanted to understand what their concerns with government policies were and how we could improve them. Since then, I’ve developed a deep respect for the people who work tirelessly to ensure ours remains one of the best health systems in the world. Australia’s health outcomes compare favourably with those of similarly developed countries. In no small part, these outcomes are due to the expertise and commitment of the health workforce.

But we know the system isn’t perfect. It is well acknowledged that people living outside the major cities can face barriers to accessing the same range of health services as those in urban areas. Many of the arrangements under which the workforce operates are under considerable pressure, as are health workers themselves. Looking ahead, growing demand and tightening labour supply will add to the pressures on Australia’s health system and its workforce.

It’s no secret that there are shortages of health professionals in some outer metropolitan, rural and remote areas, and especially in Indigenous communities. Areas of special need such as mental health, aged care and disability services can also suffer significant shortages in the face of growing demand. And demand side pressures are expected to intensify.

With developing technology, growing community expectations and population ageing, the demand for health services will increase while the labour market will tighten.

A future health workforce that is flexible and responsive to changing requirements for health service delivery is essential to ensure Australia maintains its high standards of health care, and to ensure that all communities have appropriate access to the care they need.

In March 2005, the Productivity Commission began an inquiry into health workforce issues. The study looked at a range of areas – institutional, regulatory and other factors across the health and education sectors affecting the supply of health workforce professionals, the structure and distribution of the health workforce, and factors affecting the demand for services.

In the ten years since the Health Workforce Report 2005 was released there has been significant reform in health workforce policy settings. Governments have been working together to address the recommendations from the report to create a safe and sustainable health workforce that will support Australia well into the future.

As recommended by the Productivity Commission, Australia’s National Registration and Accreditation Scheme (NRAS) came into effect in 2010. NRAS provides national consistency in regulation for 14 health professions. The 14 national boards are working collaboratively to achieve greater consistency across professional standards and to ensure client directed care and interdisciplinary team work is a key component for all professional competencies.

These arrangements have resulted in a considerable reduction in red tape. Complementary legislation, enacted in each state and territory, allows for national mobility for these health professions. In recognition that some healthcare workers are not included in NRAS, health ministers have endorsed a National Code of Conduct that provides an enforceable, minimum set of standards for service delivery

Achieving national registration arrangements for health professions was transformational. It has given us a national system that ensures quality and safety, no matter where patients live. It gives us consistency. It gives the public, as well as health professionals, assurance that all health professionals are held to consistent national standards.

In addition, we are building a highly skilled and engaged workforce. Australia has very well-educated health professionals coming through both the higher education and VET systems. To make the most of these skills, it is increasingly important that health professionals have work where they can apply their skills and knowledge fully.

These kinds of roles, where health professionals have a broader and advanced scope, are continuing to emerge. The nurse practitioner role is a good example where a nurse can work autonomously and is able to prescribe scheduled medicines within their scope of practice. Taking note of international developments, my department will be leading work in this area.

Along with key nursing and midwifery stakeholders, we will explore the potential for prescribing rights to be extended to appropriately qualified registered nurses as a way of increasing access in underserviced communities.

Supporting professional roles with VET trained assistant workers is also an area where access to services can be improved. The development of a qualification for allied health assistants (AHAs) in the 2007 Community Services and Health Industry Skills training package provided impetus for new roles for AHAs across Australia, particularly in rural and remote communities where they are most needed. AHA’s provide more routine and monitoring health services, freeing allied health professionals to provide higher-level services required in more complex assessment and interventions. These roles are becoming an important part of improving consumer access to services.

Another significant recommendation from the Productivity Commission’s report was to improve national workforce planning. Understanding the make-up of the existing health workforce was the first step. With information provided by health professionals as part of the NRAS registration process, we have, for the first time, an accurate national data source. We are using this information to predict future supply and demand and better understand distributional issues in rural and remote communities.

We are also working with the states and territories and major health professional bodies to better understand our workforce. The Australian Government has been producing and sharing information and evidence associated with different reform approaches to allow better informed workforce planning across Australia. This work provides a platform for government and non-government health organisations to make informed policy decisions.

This work has already given us valuable insight into future workforce needs. Prior to this data being available, there was a concern that increased medical places were required because of a perceived looming undersupply of doctors.

Current evidence shows that Australia is moving towards an oversupply of medical practitioners, indicating a likely oversupply of 7,000 by 2030.

With data projections continuing to indicate issues of maldistribution of doctors, especially in rural and remote communities, the Department of Health can ensure that policy initiatives are aimed to address these issues.

To promote evidence-based policy development in response to workforce planning reports, the Australian Government has established advisory bodies for both the medical and for the nursing and midwifery professions.

The National Medical Training Advisory Network was established in February 2014 as the expert medical advisory body to governments on how to improve the coordination of medical training nationally. The network advises health ministers on issues relating to the planning, distribution and coordination of medical training and plans across the training pipeline.

The National Nursing and Midwifery Education Advisory Network provides high level strategic advice to health ministers on evidence-based approaches to the planning and coordination of education, employment and immigration for nurses and midwives in Australia. This network also provides advice to enable all nurses – registered and enrolled- and midwives to work to their full scope of practice, improve productivity, and models of care to deliver the best outcomes for consumers.

Another important initiative to address appropriate distribution of Australia’s health workforce was the establishment of a National Rural Health Commissioner. The Commissioner will work with rural, regional and remote communities, the health sector, universities, specialist training colleges and across all levels of government to improve rural health policies and champion the cause of rural practice. One of the first tasks for the Commissioner will be develop and define a National Rural Generalist Pathway and report to Government on a pathway to reform.

In addition to this, we are working with community organisations to provide better care to consumers in Australia’s Indigenous communities. We know Aboriginal and Torres Strait Islander peoples are more likely to understand, respect and use services that are provided in a culturally appropriate way. Accordingly, the principle of culturally appropriate service provision is central to policies that guide prioritisation, target setting and monitoring of progress against growing and developing the capacity of the Aboriginal and Torres Strait Islander health workforce.

Government-funded Aboriginal and Torres Strait Islander health professional organisations play a key role in promoting culturally safe health care for Aboriginal and Torres Strait Islander peoples. This has been achieved through developing and delivering training programs for non-Indigenous health professionals and promoting the importance of including Aboriginal and Torres Strait Islander health professionals as part of a health care team.

Ensuring health professionals develop cultural capabilities before graduating will contribute to improving the accessibility and quality of health services available to Aboriginal and Torres Strait Islander peoples. The recently-released Aboriginal and Torres Strait Islander Health Curriculum Framework will better equip health professionals and medical students to address the cultural needs and sensitivities of Aboriginal and Torres Strait Islander peoples. It provides a model for higher education providers to successfully implement Aboriginal and Torres Strait Islander health curricula, which could also be applied widely across tertiary learning contexts.

We still have work to do, but our reform program continues to refine policy settings, strengthening our workforce policies to give us more sustainable, more effective, more innovative health system into the future. The by-product of this will be confident, skilled and mobile health professionals, and enhanced safety and quality for consumers.

Sustainable. Consumer-centred. People-centred. That’s what I want for our health system.

The commitment, care and professionalism of all those who contribute to our health system is crucial to this success. Getting our workforce mix right will help to ensure we can achieve this goal together.

I understand the importance of getting health service policy and delivery right for all Australians. This requires constant collaboration by governments, professional stakeholders and the community to ensure we get the best health outcomes for all Australians.