Rural health suffers as demand for allied health exceeds supply

It is usually the hip pocket that suffers when consumers are faced with limited access to a product or service. Yet in the distant corners of rural and remote Australia it is the health of communities who are in desperate need of allied health care who suffer. It isn’t only those communities either, state and federal health budgets are affected as they continue to provide more and more money to hospitals to manage chronic health conditions that could have otherwise been avoided if there were access to appropriate and timely health care in the bush.

For over twenty years Services for Australian Rural and Remote Allied Health (SARRAH) has worked hard to be the voice of people living in the bush to improve access to the allied health services they need. SARRAH is a national, multidisciplinary member association, supporting allied health professionals including but not limited to: audiologists, dieticians, exercise physiologists, occupational therapists, optometrists, oral health workers, pharmacists, physiotherapists, podiatrists, psychologists, social workers and speech pathologists.

Many reports are published about shortages of doctors and nurses, particularly in rural and remote Australia. There are not, however, a similar number of reports on allied health workforce shortages due to gaps in data despite allied health being the second largest group in the Australian health workforce. The nature, size, distribution and economic effectiveness of the allied health workforce have been the subject of on-going debate. Notwithstanding this, access to health services provided by allied health professionals are essential to maintaining quality of life for all Australians.

Since the 2005 Productivity Commission Report into the Australian Health Workforce, a combination of Medicare rebates, workforce incentives and other approaches have been introduced to address workforce shortages. However, whilst the vast majority of the policies and programs have been targeted to primary healthcare professions, allied health has not received the same equity in workforce support from government initiatives as compared to other health professions.

Addressing Diabetes-Related Foot Disease in Indigenous NSW, a report prepared by SARRAH in April 2016 notes that in 2013 there were only 4.4 podiatrists for every 100,000 people in rural and remote communities compared with 15.8 for every 100,000 people in major cities. This significant workforce shortage is replicated across a number of allied health professions. In mid-2016 the Heart Foundation released new Australian Heart Maps data which shows that people living in rural and remote areas are up to twice as likely to be admitted to hospital for a chronic heart condition as people living in a major city.

Hospital admissions for diabetes, heart disease or other health conditions such as stroke costs state and federal budgets many tens of millions of dollars each year and yet a lot of these costs could be significantly reduced by providing sufficient access to allied health care services. In 2015, SARRAH released a report titled: The Impact of Allied Health Professionals in improving outcomes and reducing the cost of treating diabetes, osteoarthritis and stroke. In this report, $175 million in annual savings to the healthcare system were identified for only eight allied health interventions specifically targeting diabetes, osteoarthritis and stroke.

The report provided a range of projects where savings to health budgets were possible including the Queensland Diabetic Foot Innovation Project (2011). The project utilised multidisciplinary teams in 2008-09 to support people at high risk of lower limb amputations through ongoing observation and early treatment.

The end result of this preventative allied health care project was a reduction of 64% in the number of amputations and an average hospital stay that was 24% shorter.

Another project conducted in Melbourne (2014) involved 45 patients on a waiting list for surgical intervention due to osteoarthritis who were evaluated by a physiotherapist after referral from a GP. As a result, 24 patients were appropriate for non-surgical management of their osteoarthritis. Of these patients, 22 were discharged from the surgical treatment waiting list for their osteoarthritis with no surgery required.

Whilst the evidence is starting to be compiled, the Federal Government is content with cutting a range of health programs that are targeted at improving access to a broad range of health services in rural and remote communities. In 2015 at a panel at the National Press Club of Australia SARRAH outlined the hidden harms of concealed health budget cuts. During the panel discussion it was highlighted that the Federal Government announced in its 2015-16 budget, cuts of nearly $800 million in funding to key health initiatives over four financial years.

These Federal Budget cuts impacted drug treatment and rehabilitation programs, and preventative health programs. The cuts also included a 34% reduction in 2015-16 to the allied health stream of the Nursing and Allied Health and Scholarship Support Scheme (NAHSSS).

These scholarships provide support for people who live, practice or intend to practice in rural and remote communities across Australia. The scholarships are split over five streams to provide support for undergraduate and postgraduate students, clinical placements, clinical psychology and continuing professional development. The cut to the NAHSSS resulted in 326 scholarship places being lost whilst demand for the scholarships outstripped supply by a factor of almost six to one. This reduction in scholarships will adversely impact the number of people looking to practice as allied health professionals in the bush at a time where there is a severe shortage in areas of need.

To work towards closing the allied health services gap, SARRAH is calling for greater funding of economic research, programs and incentives to get more allied health professionals out in the bush whilst properly supporting peak bodies that give a voice to people who otherwise do not have a voice. All levels of Government need to invest in allied health services to keep Australians healthy and reduce the impact on the healthcare budget

Whilst Governments’ continue to fall short in funding rural and remote allied health services, we will see service gaps increasing and the health of people residing in rural and remote Australia deteriorate.