Patient-centred care and health workforce change

There are very few areas in health policy which are not interconnected – reform in health often feels like a challenging game of cascading dominos. While policy-makers might be tempted to approach health with the objective of minimizing the chain reaction as much as possible, this strategy misses out on the significant benefits which come with holistic reform.

There is no better example of this than the relationship between the patient and the health workforce. Putting the patient at the centre means putting the workforce at the centre as well. It is nothing but short-sighted to expect reform in patient care while walking away from the changing needs of the workforce.

The reality is, as patient needs change – and they are changing significantly – our health workforce must keep pace.

Australia’s aging population, with trends of increasing levels of chronic disease, is driving conversations around new models of health care. As an example, the patient-centred health care home represents a significant opportunity to change the way we manage chronic conditions. But the potential to improve patient outcomes is severely limited if policy makers don’t put in place the broader framework needed to support the workforce in implementing this new model – and this has simply not been done.

Conversations around health policy, more often than not, end up focusing on expenditure. I am worried that it inadvertently lets the current Government off the hook at a time when they have vacated critical areas of health policy, including workforce planning.

Labor established Health Workforce Australia through legislation in May 2009, partly in response to the Productivity Commission inquiry that was established in 2006.  The premise of Health Workforce Australia was simple – if Australia is to have the best health system possible, (and indeed the most efficient health system possible) Australia could not continue to have such a haphazard approach to health workforce planning.

Health Workforce Australia was established by Labor to provide a national, long-term, coordinated approach to health workforce planning and reform to ensure that Australia’s health workforce can meet Australia’s health needs into the future.

At the heart of this is recognising that a sustainable and responsive health workforce won’t come out of simply crossing our fingers and hoping we fortuitously get there – it takes coordination and planning.

Some ten years on from the original Productivity Commission inquiry, I wish I could say that we were there. But with the Government’s abolition of Health Workforce Australia in 2014, it is more difficult than ever. While I see health care practitioners putting consumer-centred care at the heart of in training and practice, the current Government has shown a distinct lack of political will to support these efforts.

Before the Government abolished the agency, Health Workforce Australia funded close to 8,500 new quality clinical training places for students across 22 disciplines. Taking on the challenges of workforce distribution and responding to the identified needs of rural and remote communities across Australia, Health Workforce Australia’s efforts delivered an additional 446 nurses and allied health professionals in those areas. Health Workforce Australia had also commenced work on reform for the rural and remote health workforce and also for the Aboriginal and Torres Strait Islander health workforce, an area where there continues to be critical shortages.

Anyone who wants to see how Australia is tracking after this agency was abolished should look at the most recent workforce statistics from the Australian Institute of Health and Welfare, which showed a decline in the number of full-time equivalent (FTE) general practitioners in Remote, Very Remote and Outer Regional areas. This is not a trend we can allow to continue.

In the recent election Labor committed to establishing a permanent Australian Healthcare Reform Commission to be charged with driving progress towards a more integrated healthcare system across all levels of government.  Labor’s announcement recognised that we need a permanent body that has the capacity and the expertise to undertake substantial research and inquiry, implement and test models, make recommendations with respect to system wide changes, and oversee reform over the long-term, beyond the constraints of election cycles. Workforce issues would have been a key part of the Commission’s work.

Unfortunately, Labor won’t get the opportunity to establish the Commission, and we think there is a clear gap in how we embed continuous reform into our healthcare system – especially in relation to the capacity of our future workforce. While I genuinely feel that health care practitioners are paying increasing attention to consumer-centred care, they need the help of policy makers to see change at a scaleable level.

This will be a priority for Labor this term. Supporting our health workforce to be responsive and sustainable isn’t just a nice to do – it is critical if Australia is to have a chance at successfully reforming our health care system now and into the future.