Ac­tion time for roles re­form

The launch this week of a new health work­force in­sti­tute will keep up the pres­sure for new mod­els of health worker. Health ed­i­tor Adam Cress­well re­ports

The Weekend Australian - Travel - - Health -

LA­BOR’S elec­tion vic­tory has dra­mat­i­cally changed the out­look for Aus­tralia’s health sys­tem. State and fed­eral bu­reau­cra­cies, pro­fes­sion or­gan­i­sa­tions and pres­sure groups land­scape are sud­denly elec­tri­fied by the need to de­velop or mon­i­tor pro­pos­als for im­ple­ment­ing the new Gov­ern­ment’s plans — rang­ing from re­duc­ing wait­ing lists, im­prov­ing pre­ven­tive care, de­vot­ing more re­sources to hard-pressed GPs and fix­ing the lack of ac­cess to med­i­cal ser­vices in the bush.

Un­der­neath th­ese head­line-grab­bing is­sues, a raft of other cur­rents are flow­ing. One of them con­cerns the health work­force, which is creak­ing at the seams, and will con­tinue to do so for many years be­cause the length of train­ing means that re­cent in­creases in univer­sity train­ing places will in some cases not flow through to more doc­tors, nurses and oth­ers un­til 2015 at the ear­li­est.

Last year the Lib­eral Gov­ern­ment dis­ap­pointed ad­vo­cates for re­form by shelv­ing rad­i­cal Pro­duc­tiv­ity Com­mis­sion pro­pos­als to cre­ate new types of health worker, al­low nurses and oth­ers to per­form tasks cur­rently the exclusive do­main of doc­tors, and ad­just train­ing pro­grams to pro­duce health work­ers suited to more spe­cific roles.

But the change of gov­ern­ment has raised hopes that some of th­ese pro­pos­als may get an­other air­ing in the cor­ri­dors of power. A new think-tank and re­search in­sti­tute an­nounced this week aims to en­sure th­ese ideas are voiced with suf­fi­cient deci­bels for min­is­ters sit up and take no­tice.

The Aus­tralian Health Work­force In­sti­tute, an­nounced this week as a joint ini­tia­tive of the Univer­si­ties of Melbourne and Queens­land, is openly es­pous­ing many of the ideas backed in the Pro­duc­tiv­ity Com­mis­sion re­port, in­clud­ing the ex­pan­sion of new types of health worker — such as US-style physi­cian as­sis­tants.

It also backs ex­tend­ing the roles of ex­ist­ing work­ers such as nurses and al­lied health work­ers, such as phys­io­ther­a­pists; al­low­ing them to work more ef­fi­ciently through bet­ter use of in­for­ma­tion tech­nol­ogy such as shared records and bet­ter use of pre­ven­tive care, al­ready a de­clared pri­or­ity for the fed­eral Gov­ern­ment.

The AHIW also aims to con­duct re­search to find out what short­ages ex­ist in var­i­ous health and med­i­cal dis­ci­plines, and whether th­ese are likely to im­prove or worsen over com­ing years. As the Pro­duc­tiv­ity Com­mis­sion re­port last year noted, es­ti­mat­ing even cur­rent short­ages is not straight­for­ward; pro­ject­ing fu­ture needs is even more pre­car­i­ous.

The Gov­ern­ment’s of­fi­cial sup­pli­ers of work­force data re­gard­ing doc­tors, the Aus­tralian Med­i­cal Work­force Ad­vi­sory Com­mit­tee, knows this only too well. Al­though in the elec­tion cam­paign the Lib­eral Gov­ern­ment took flak for hav­ing mis­judged the med­i­cal work­force needs in the 1990s, when train­ing places were cut, the pre­vi­ous La­bor Gov­ern- ment took a sim­i­lar approach. The poli­cies were backed by data pro­vided by AMWAC, which — to the con­ster­na­tion of the med­i­cal pro­fes­sion — in­sisted there was an over­sup­ply, par­tic­u­larly of GPs.

‘‘ We need to have some­thing that’s in­de­pen­dent (to com­pile work­force data) — some­thing that’s go­ing to en­sure that the work­force num­bers are col­lected cor­rectly,’’ says Peter Brooks, ex­ec­u­tive dean of the Univer­sity of Queens­land’s fac­ulty of health sci­ences and in­terim di­rec­tor of the new in­sti­tute.

A long-stand­ing ad­vo­cate of health work­force re­form, Brooks says that as bad as it al­ready is, the ex­ist­ing short­age of doc­tors and nurses world­wide is just go­ing to get worse — and that AHWI will be much more ac­tivist than AMWAC, in that the new in­sti­tute will also con­duct re­search and ad­vo­cate for spe­cific pro­pos­als.

‘‘ AMWAC, you would have to say, has been there for a while, and was there when we were told we had too many doc­tors in this coun­try,’’ Brooks says. ‘‘ AMWAC is not go­ing to do too much re­search — it’s go­ing to col­lect the data but it’s not re­ally go­ing to query the data. If the oph­thal­mol­o­gists say ‘ we need an­other 1000 oph­thal­mol­o­gists’, we re­ally need some­one to ask how many we would need if we cre­ated physi­cian as­sis­tants, or if we found a new way to cure cataracts.

‘‘ AMWAC is not go­ing to do what this in­sti­tute will do, which is look at the health sys­tem — look at the sort of health sys­tem we will have in 2020.’’

It’s prob­a­bly not un­fair to spec­u­late that AMWAC’s num­bers ended up be­ing wildly out be­cause it failed to spot, or at least give ad­e­quate weight to, emerg­ing de­mo­graphic fac­tors. Th­ese in­clude the in­creas­ing fem­i­ni­sa­tion of the work­force (as women tend to work shorter hours than men, and go on ma­ter­nity leave), fewer hours be­ing worked by men, the age­ing of the med­i­cal work­force, in­creas­ing sub-spe­cial­i­sa­tion and a trend for qual­i­fied pro­fes­sion­als not to prac­tise.

But as its name im­plies, the AHWI will be look­ing at the en­tire health work­force, not just doc­tors, and many of the above points ap­ply to nurses as well. The nurs­ing work­force is also strain­ing, and faces a de­mo­graphic time-bomb be­cause so many nurses are 10-15 years away from re­tire­ment.

Many thou­sands are also no longer work­ing as nurses.

Brooks is can­did about the AHIW’s in­ter­est in de­vel­op­ing new mod­els of health worker, and that it will ‘‘ pick up a num­ber of is­sues that were raised by the Pro­duc­tiv­ity Com­mis­sion’’. ‘‘ My view is that the Pro­duc­tiv­ity Com­mis­sion re­port was ac­tu­ally a very good Con­tin­ued inside — Page 13

Pic­ture: David Sproule

Role play­ers: Pro­fes­sor Peter Brooks with stu­dents, from left, An­drea Diaz (nurs­ing), Ali Alshami (phys­io­ther­apy) and Michael Bon­ning, Aus­tralian Med­i­cal Stu­dents As­so­ci­a­tion pres­i­dent

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