Are Assistants a Solution to our Workforce
HWA workshop and panel discussion report
James Buchan and Karen Cook
• There is significant evidence that
assistants are a key part of the workforce.
• Some areas are using them more
extensively and effectively than others.
• HWA is currently doing some work on
assistant and support roles.
Session aims
• Share current initiatives and perspectives
on assistants and the support workforce.
• Draw out key issues, identify areas of
commonality, outline areas of difference
and cover what’s next for this workforce.
• Act as a consultation input for HWA’s work
on Assistants and Support roles.
Our expert panel
• Ms Deborah Law - Policy and Strategy Manager, HWA .
• Ms Ann- Maree Keenan - Executive Director, Ambulatory and
Nursing Services, Austin Health, Victoria
• Dr Saravana Kumar - Deputy Director, International Centre for Allied
Health Evidence, University of South Australia
• Mr Andrew Larpent - CEO, Southern Cross Care
• Mr Rod Cooke - CEO, Community Services and Health Industry
Skills Council
• Ms Lee Thomas - Federal Secretary, Australian Nursing and
Midwifery Federation
• Ms Tanya Lehmann - Principal Consultant Allied Health, Country
Health SA Local Health Network
Deborah Law, HWA
• Setting the scene; outlining HWA related work
on assistants/other work
• Always a core part of the broader health/care
• But only one facet in pursuit of availability/
sustainability/ affordability
• Multiplicity of roles, titles, uses,
training…deflected from national
attention/debate from most productive models
Deborah Law HWA
• Four main aspects:
1.Roles they undertake
2.Contributions they make
3.The way they work (substitution/ supplementation/
workforce of choice) to enable everyone to work to
full scope
4.Not an “unqualified” workforce (partic.aged care)
• = Active management of perceived and real barriers
• National guidance/ local governance
Ann Maree Keenan, Austin
• 900 bed tertiary hospital, 8000 staff
• Recognised need to use workforce to best
• 2008-9 feasibilty study- asked nurses what
would make work easier/ more rewarding
• Assistant introduced- Complementary role
• Outcomes-incl. +staff satisfaction; pathway to
other health careers
Ann Maree Keenan
Governance at organisational level
Leadership from nursing team
Education- grow your own- clear selection
• Role clarity- delegation, supervision
• Nurses satisfaction- basic care now being
attended to/ not managed previously
Saravana Kumar
• Allied Health Assistants
• Increasingly recognised as an important piece of
the puzzle, but not always well integrated
• Benefits: +patient satisfaction;+ access; AHPs
working to full scope
• Barriers; poor clarity about delegation +
supervision; role delineation ;turf protection
• ..little evidence of cost effectiveness, or how
AHP’s can be used when released
Saravana Kumar
• Why, despite the evidence are there
ongoing challenges in integration of
• Change management issues
• AHA roles, work settings, delegation and
supervision, skills of AHP in delegation
and supervision; role divisions
Andrew Larpent
• ?? Use of title of “assistants”?
• Need right type of worker for care requirementsmatching
• Silos between health/ aged care
• Some existing health professionals felt threatened by the
HWA , ACWR project
• Focused on the caring profession as the key deliverer,
not med/tech
• Referred to UK NHS Francis report
Andrew Larpent
• New models of care/ new roles- e.g PCA
in community dementia care
• New worker- STELLA- Specially Trained
End of Life Living Assistant
Rod Cooke
• Large component of an even larger
workforce, where 69% are informal carers
• Also questioned use of title “assistant”
• Different roles and titles
• Lack of other workers in some care
environments to provide supervision
Rod Cooke
• Demographic, funding and policy drivers to
increased use of assistants
• E.g +125,000 needed in disability care in
next few years
• Need for increased training and
development capacity
• ..a “partial answer” to shortages
Lee Thomas
• Current growing and essential part of the
nursing family
• Lack of national consistency [e.g compared to
plumbers, electricians]
• Changing nature of hospital based care- i.e.
Increased acuity- yet no nationally mandated
quals for AINs in acute care
• Huge variations in qualifications, titles, education
Lee Thomas
• Apply a single title to the role
• National regulation “the best way”- incl
prof practice framework and defined scope
of practice
• Emphasis on minimum level of knowledge;
protection of the public
• “Everyone is responsible”
Tanya Lehmann
• Focus on rural/remote- health disparities; geog.
distribution issues
• Small dispersed population; lower frequency of
need; smaller quantity of service- different
workforce models required
• (Local) assistants are needed in remote
communities- more generalists
• Issues of training, supervision and governance;
Tanya Lehmann
• Assistants as a solution:
• Small numbers= “little change can make a big
difference”; +job satis, patient satis, productivity
• Remote supervision can work; need to have role clarity;
distinguish between delegated and assigned tasks;
• Need to variation- one size does not fit all=cant overstandardise/ nationalise
• Risk management not regulation
• Focus for safety, quality
The questions
• What might need to be done in order to
better utilise assistant and support roles in
the workforce?
• What risks would
need to be managed?
The themes
Safety and quality
The contribution that assistants can make
Career development
Organisational readiness
Industry and regulatory
The results – Safety and Quality
• Appropriate competency based training
• Clearly defined roles and scope of practice,
including supervision, so the roles and
parameters are understood
• Clear rationale for implementing the role
• Focusing on growing your own and making sure
it is context specific for the community
• Need for regulation
The results – The Contribution that Assistants
can make
• Increased understanding of the role in health care teams
and the community
• Establishing a national framework which matches the
role against the education
• Articulation of a clear career pathway with early
exposure to assistant roles as a career option at school
• Need to establish the evidence for safe integration and
establishing the benchmark for the ratio between skilled
and unskilled workers
The results – Career Development
• Training and education needs to be based on agreed core
competencies which can be built on for different career paths
• Existing workforce is able to supervise and mentor assistants
• Importance of describing the scope of the assistant and the mapping
of core competencies, leading to specialisation of some kind, (eg
speech, OT, dental) or across professions and service delivery
• Professionals need to be trained to supervise and delegate
The results – Organisational Readiness
• Reform process has to be done together ie
workforce, clinical and education reform
• Focus of a good delegation supervision
framework rather than rigid scope of practice
• Upfront identification of patient need
• Broad communication about the changes
needed /management
The results – Industrial and regulatory
Clarity between industries – one size may not fit all
Generalist not specialist
National minimum training competency standards
Clear framework for risk management (indemnity etc)
Funding for upskilling
(Some) Identified Risks and Barriers
• How to evaluate the costs and
effectiveness of the role?
• Acceptance/ resistance from established
professionals/ supportive work
• Public awareness / support
• Cost saving as major perceived driver
(Some) Identified Risks and Barriers
• Achieving serious buy in and engagement
by management
• Government appetite for change?
• Overregulation-management
response?/assistant, potential assistant
In summary..
• Assistants are a key component in the
overall solution
• National guidance/local governance
• Active management of real and perceived
• Regulation issue remains unresolved
In summary
• Assistants are a key component in the
overall solution
• On oredr to be most eferive, there needs
to be a level of national standardisation
combined with local combined with l

View the presentation slides here