Workforce needs pose an allied question

It’s clear that Australia needs an efficient health system with the right health workforce and the necessary funding mechanisms in place to allow that workforce to deliver care. Health dollars are scarcer than ever at a time when the country is experiencing a significant increase in chronic disease, a growing aging population, and increased demand for services for people with disabilities or mental health issues.

Allied health services are particularly suited to supporting the prevention and management of chronic and complex conditions—a wide range of research has shown that the specialised services and expertise provided by the allied health sector can reduce costs and improve health outcomes. Allied health practitioners also typically deliver services focused on wellness, independence, restorative care and improving functionality, approaches that align closely with the recommendations of several Productivity Commission investigations into the health sector.

However a range of barriers still prevent effective integration of allied health services into our health system. While Australia’s 175,000 allied health practitioners already provide an estimated two million treatments each year across a broad range of health issues, there is still significant unmet demand for services, particularly for at-risk populations. Public funding is a key factor as access to allied health services frequently depends on a consumer’s ability to pay privately. Allied health services in public hospitals and community health services funded by State and Territory Governments typically have long waiting lists. Medicare funded allied health services are currently only available in very limited circumstances such as GP-prescribed Chronic Disease Management plans which fund only five consultations per year across all allied health disciplines.

Dr Stephen Duckett’s recent Perils of Place report, released by the Grattan Institute, showed unnecessary hospitalisation rates over 50 percent higher than state averages over the last decade in Frankston and Broadmeadows in Victoria and Mount Isa and Palm Island in Queensland. These are all areas in which socioeconomic factors limit the ability of people to pay privately for the services they need. Current reforms such as the planned Health Care Homes add no additional funding for allied health services despite the evidence of savings and improved health outcomes through preventative care.

Yet the annual net positive financial impact of allied health interventions for diabetes and osteoarthritis has been conservatively estimated to be in excess of $147 million. For people with Type II diabetes, that translates to significantly better health outcomes and overall functionality though the prevention of long term complications including advanced eye and kidney disease and a reduction in the number of lower limb amputations. An increase in effective, flexible and equitable funding, based on best practice outcomes would support the delivery of allied health services and ensure access to services and drive growth where additional services are needed.

Australia’s allied health workforce continues to be poorly understood due to the absence of data about allied health services available to public health planners. The organisation tasked with collecting health workforce data, the Australian Institute of Health and Welfare only collects and provides data on those allied health professions registered with the Australian Health Practitioner Regulation Authority leaving out a range of key self-regulating professional groups such as audiologists, diabetes educators, perfusionists and several others. This significantly limits the ability of organisations such as the Primary Health Networks to identify service gaps and plan appropriate interventions to address need.

The demise of Health Workforce Australia has exacerbated this issue and left a gap in the interaction between the tertiary education sector and the existing allied health workforce. No attempt is currently made to regulate Australian universities in regards to the allied health courses they offer or to match the supply of graduates with the demand for allied health services. This leads to oversupply in some allied health professions whilst others are greatly in need of more graduates.

There is a significant need for the tertiary education sector to implement new models for the clinical education of the allied health workforce, but this is difficult without processes for input from the allied health sector.

The Productivity Commission in its 2015 report on health efficiency noted that in the absence of HWA, there was a role for the Australian Government ‘to promote and champion workforce reforms at the national level’….to achieve ‘nationally coordinated workforce policy activities’.

Closely related to this is a need to carefully examine the scopes of practice and associated regulations that govern the health sector in order to improve the efficiency of health service delivery. The Productivity Commission has noted that expanding roles, based on evaluations of past and current trials, and amending scopes of practice would lead to ‘greater workforce flexibility, potentially lower labour costs, better patient access and higher workforce satisfaction.’

These recommendations could be a crucial step towards addressing some of the issues that hamper recruitment and retention in the allied health sector. Issues such as professional isolation, lack of clinical supervision, lack of opportunities for professional education, career progression and transition to leadership roles have been found to limit levels of work satisfaction in the sector and result in low long term retention rates for some allied health professions. Victorian government data shows that allied health practitioners are not being utilised effectively with up to 17% of their time being spent on tasks that could be delegated to suitably trained and supervised allied health assistants.

There is significant scope for current health reforms to address these issues and help achieve a sustainable and high functioning healthcare system. The present review of the Medicare Benefits Schedule provides an opportunity to increase access to services and support workforce flexibility through the introduction of new publicly-funded roles in the primary care sector. State and Territory governments too have a role to play in allocating a larger proportion of primary health care funding for allied health services. By expanding the collection of data to include the entire allied health sector and by rebuilding links to the tertiary education sector, Australia will be better equipped to guide the development of the future allied health workforce. However, in the current fiscal environment and in the face of resistance from some parts of the health sector, it will be difficult to achieve the necessary changes. It is only through strong leadership at all levels of the health system and effective advocacy that we will achieve the necessary regulatory and funding changes.