Workforce Plan for the Health Workforce of the ACT 2012-2017
Discussion Document
1
Contents
1. Request for feedback ......................................................................... 3
2. Executive Summary ........................................................................... 4
3. Introduction ........................................................................................ 6
4. Health workforce demographics ......................................................... 7
5. National Workforce Issues.................................................................. 14
6. Additional issues impacting the ACT region ....................................... 18
7. ACT Government Health Directorate staff and program feedback ...... 20
8. Recruitment & retention ...................................................................... 22
9. Feedback from other Health Services in the ACT ............................... 26
10. High Risk Professions ........................................................................ 31
11. Informal carers and self-carers ........................................................... 33
12. What’s already happening to meet the health workforce challenge? .. 34
13. Key Strategies for further exploration ................................................. 44
14. Glossary ............................................................................................. 48
15. Bibliography ....................................................................................... 50
Attachment 1: List of Submissions received to assist preparation of the
Discussion Paper ..................................................................................... 56
Attachment 2: Achievements & Initiatives related to 2005-2010 ............... 57
Workforce Plan ......................................................................................... 57
Attachment 3: Health Directorate workforce distribution by ...................... 59
classification June 2011 ........................................................................... 59
Attachment 4: Health Directorate workforce distribution by age range ...... 60
Attachment 5: Related ACT Government Health Directorate Service
Plans and strategies ................................................................................. 61
2
1. Request for feedback
This discussion paper collates key national and local workforce issues and
considers strategies that may help to resolve or improve these issues.
The paper will be used to inform the development of the Workforce Plan for
the Health Workforce of the ACT for the period 2012-2017.
It is noted that some of the suggested strategies may already be occurring in some
sectors. The new workforce plan will incorporate additional current and projected
health workforce data.
The Workforce Planning team would like to thank all the clinicians, and service
managers who have provided input from across ACT Government organisations;
non Government organisations; aged care facilities; general practice; unions;
professional associations; tertiary institutions and private providers. A full list of
contributors is provided in Attachment 1.
The team would also like to apologise for the delay in releasing this discussion
document and advise that this relates to a significant increase in the Workforce
Policy and Planning workload following the commencement of other National health
workforce initiatives.
The new Workforce Plan has an expected release date of end July 2012.
Contact Details for Feedback
Please send feedback to WorkForcePlan@act.gov.au by 17 July 2012.
3
2. Executive Summary
In 2005 the ACT Health Workforce Plan 2005-2010 set the direction for building a
sustainable ACT Health workforce. Its purpose was to ensure that high quality health
and community care services continued to be delivered to the people of the ACT
and the surrounding region to the year 2010. It also aimed to provide long term
workforce planning guidance under four key objectives, including:
 workforce profile;
 responsive workforce;
 education and training partnerships; and
 effective linkages.
This Plan has contributed to a large number of successful initiatives (See
Attachment 2) and provided a good foundation for the next plan; however, a new
health workforce plan is now required to guide broader sustainability of our local
health care system.
The main focus of the new Plan will be on health professionals and health support
workers employed within ACT Government Health Directorate (Health Directorate).
However, the ACT public health sector is part of a complex interrelated health
system and so many of the strategies identified will also be relevant to other health
sectors in the ACT.
The Australian population is ageing and the health workforce is ageing faster than
the general working population. By 2050 there will be only 2.7 people of working age
to support each Australian aged 65 years and over (compared to 5 working age
people per aged person in 20101). Competition for labour is increasing for both
undergraduate and graduate entry professions, and within the international and
Australian health care labour market. The ACT’s high workforce participation rate
means that skilled health workers often need to be sourced outside the Territory.
Demand for health services is increasing due to our ageing population and an
increase in complexity of needs related to multiple chronic disease prevalence. It is
reported that increased service demand is impacting on services to less urgent client
groups and that clinicians are spending increasing time on essential administrative
duties impacting on the number of services they can provide.
Increasing numbers of people are providing informal care to family members or
friends, with around 2.9 million Australians providing 1.3 billion hours of informal
care in 2010.2
It is reported that lack of integration/collaboration between health services is leading
to inefficient practices such as duplications, gaps, multiple referrals and
inconsistencies in services delivered.
A gradual change in workforce skill-mix has led to a significant increase in the
proportion of vocational trained workers employed in the residential aged care sector
1
2
Commonwealth of Australia: Intergenerational Report: Australia to 2050:future challenges 2010
Access Economics: Caring Places- Planning for aged care and dementia 2010-2050
4
while the proportion of registered nurses (RN’s) to enrolled nurses (EN’s) in the
acute sector is higher than the national average.
To address these and many other health workforce issues in the ACT, there needs
to be a sustainable increase in productivity combined with a focus on improving the
health of the population to reduce the long term demand for health services through
prevention and early intervention measures.
A number of national initiatives are already underway to help meet current and
future workforce challenges and improve and sustain health services. Local
initiatives include a substantial redevelopment of health facilities in the ACT, part
time nursing graduate positions, GP workforce initiatives, role extension, new
support positions and innovative service changes.
Workforce planning and retention strategies must be cost effective, resilient,
proactive, ethical, equitable, accountable and appropriate and provide the right
service to the right person at the right time and in the right place. Consumer and
population needs must provide the main driving force for workforce change.
Proposed strategies to deal with these workforce pressures include:
 increased collaboration between organisations;
 service redesign;
 lifting the workforce participation rate;
 increasing client self care options;
 improving care of the health workforce to reduce absenteeism; and
 a greater emphasis on succession planning and retention.
The ACT is collaborating with the national workforce reform program to meet the
health workforce needs into the future so the proposed strategies have been based
on a combination of the local input provided to this paper, the findings from the
literature and national workforce reform strategies. Strategies have been aligned
under the five domains for action provided in the National Health Workforce
Innovation and Reform Strategic Framework for Action 2011-2015.
The aim is that these strategies will also assist other ACT based health services in
identifying potential workforce planning activities.
5
3. Introduction
In 2005, the ACT Health Workforce Plan3 set the direction for building a sustainable
ACT Health workforce. Its purpose was to ensure that high quality health and
community care services continued to be delivered to the people of the ACT and the
surrounding region to the year 2010. It also aimed to provide long term workforce
planning guidance under four key objectives: workforce profile, responsive
workforce, education and training partnerships and effective linkages.
The ACT Health Workforce Plan 2005-2010 has contributed to a large number of
successful initiatives (See Attachment 2) and provided a good foundation for the
next plan. However, a new health workforce plan is now required to guide broader
sustainability of our local health care system.
The ACT public health sector is part of a complex interrelated health system, so
while the main focus of the new Plan will be on health professionals and health
support workers in ACT Government Health Directorate (Health Directorate formerly known as ACT Health), this discussion document also highlights issues
experienced by other health providers across the ACT and it is expected that many
of the strategies identified could be applied across health sectors.
This document will be used to steer the direction of the new plan.
Greater competition for workers will be accompanied by a rising demand for health
services related to an increase in total population, our ageing population and an
increase in chronic diseases such as Type II Diabetes. For example, by 2014, in
addition to current service levels, it is projected that 1500 extra ACT residents will
require home and community care services and 200 more will require community
aged care packages.4 The increasing prevalence of chronic conditions is driving the
need to move a greater proportion of health workers into primary health care and is
influencing the role of health workers.
Without significant changes in the way health care is delivered into the future, rising
demand, combined with reduced workforce supply presents a real risk to
maintaining a sustainable health system and a multi-faceted and coordinated
approach will be needed. The health sector needs to find ways to increase
productivity in a sustainable way but there is also a need to focus on improving the
health of the population to reduce the long term demand for health services through
prevention and early intervention measures.
Discussion Points:
1. Are there other issues that you believe are facing the health workforce
that are not covered above?
3
ACT Health: ACT Health Workforce Plan 2005-2010
4
Access Economics: Caring Places- Planning for aged care and dementia 2010-2050
6
4. Health workforce demographics
National
By 2050, there will be only 2.7 people of working age to support each Australian
aged 65 years and over (compared to 5 working age people per aged person in
2010).5
Approximately 3.6 percent of the employed Australian workforce works in the health
sector. By 2018, there are forecast to be 409,300 Australians employed in the health
care occupations with an average growth of 1.7 percent per annum.6
Between 1985 and 2005, the average age of workers in health services rose by 5.5
years; almost double the average of 2.8 years for all industries.7
In 2008, 20.6% of male and 14.6% of female health workers were aged 55 years or
older and approximately one-third of health workers reported being born outside
Australia. In 2008, 35% of nurses were aged 50 or older.8
75.7% of the Australian health workforce is female and 50% of females employed in
health work less than 35 hours per week, compared with one-fifth of males. 9
ACT Government Health Directorate Workforce
The 5898 employees of Health Directorate make up approximately 27.5% of ACT
Public Service employees.10 The average worker is 42.2 years old, and is female,
has worked for Health Directorate for 7 years, and works full time in a permanent
position.11 The average Health Directorate staff member takes 11 days of personal
leave per annum as compared to an average of 9.6 days taken across the ACT
Government (see Attachment 3).
Almost 30% of the Health Directorate workforce are aged 50 or older and 15.6% are
aged over 55 (see Attachment 4). The average retirement age in Health Directorate
is 61 for males and 59 for females and 7.4% of employees permanently separate
from Health Directorate each year.10
15.4% of Health Directorate employees have a first language other than English,
0.6% identify as Aboriginal or Torres Strait Islander and 1.8% have a disability.10.
For the purposes of this document Health Directorate workers have been grouped
into 8 classifications (ordered by number of employees): Nurses, Administration,
Allied Health (including Dental), Medical Officers, Support services, Technical,
Miscellaneous professionals and Executives.
5
Commonwealth of Australia: Intergenerational Report: Australia to 2050:future challenges 2010
NHWT: Health Workforce in Australia and factors for current shortages 2009
7 Parliament of Australia; Australia’s Ageing Workforce 2005
8 AIHW: Nursing & Midwifery workforce 2008
9 AIHW: Health and community services labour force 2006 (Published 2009)
10 ACT Government: ACT Public Service Workforce Profile 2009-2010
11 ACT Government Health Directorate Workforce reporting data derived from Chris 21, June 2011
(attachment 4)
6
7
Medical Workforce
The medical workforce includes medical officers, post graduate fellows, registrars,
specialists and senior specialists. In ACT Government Health Directorate, there are
720 Doctors filling 621 full time equivalent resident positions. 57% are male. Doctors
have the youngest average age of any classification (39 years). Only 15% work part
time and only 30% are permanent employees. The average length of tenure for
doctors in the Health Directorate is 4 years.12
There was a 10% increase in medical practitioners in Australia between 2001 and
2006.13 The demographics of junior doctors have changed significantly over the last
20 years. This has been influenced by increasing feminisation, a move to graduate
entry and the entry of Generation Y Doctors to the workforce. In a 2007 Australian
Medical Association (AMA) work-life flexibility survey, 85% of respondents indicated
that they would need some form of flexible working and training arrangement over
the following 10 years and it was noted that hospitals with the most family and
employee friendly arrangements will increasingly become employers of choice.14
The ACT Government Health Directorate reports increasing requests from doctors
for part time employment and 5% of resident medical officers and registrars are
currently working part time.
In 2010, the ANU Medical school had 355 Medical students spread across 4 years15
and by 2014, graduating doctor numbers will have increased by 132% compared to
2006.16 The increase in medical student intake requires increasing numbers of
clinical placements and these placements require supervision.
Discussion Points:
1. Are there other matters relating to the medical workforce that you
believe could account for these figures?
Nursing & Midwifery Workforce
The nursing and midwifery workforce includes enrolled nurses, registered nurses,
registered midwives and nurse practitioners. The nursing and midwifery workforce is
the largest group of employees in the ACT Government Health Directorate,
comprising 40% of the Health Directorate workforce with 2363 individuals covering
full time equivalent 2009 positions. This group has the highest percentage of female
employees with 90% being female. They also have the highest percentage of part
time workers with 44% working part time and the highest number of workers in
permanent positions (86%). The average length of tenure for nurses and midwives
in the ACT Government Health Directorate is 7.77 years. 8.8% of the nursing and
12
ACT Government Health Directorate Workforce reporting data derived from Chris 21, June 2011
(attachment 4)
13 AIHW Health Workforce: accessed 10/05/2011
14 AMA: Work-Life flexibility Survey report of findings 2007
15 Medical Deans Australia & New Zealand: 2010 Medical Students Statistics
16 Medical Deans Australia & New Zealand: Media Release: Keep Medical Student Numbers on hold
13th April 2010
8
midwifery workforce permanently separate from ACT Government services each
year.17
The ACT has a higher ratio of RN’s to EN’s than the national average. In 2007 the
national ratio of RNs to ENs was 4.26:1 while the ACT ratio was 5.25:1. Victoria and
South Australia have ratios of 3.16:1 which suggests that there is potential to employ
higher percentages of diploma level ENs in the ACT workforce and use nursing
workforce skills more cost effectively.18
The University of Canberra has approximately 340 Bachelor of Nursing students and
80 Bachelor of Midwifery students enrolled across three years.19 Registered nurses
are also trained at the Australian Catholic University and enrolled nurses are trained
at Canberra Institute of Technology.
Between 1991 and 2008 the number of Australian nursing workers declined from
1415 to 1115 per 10,000 population. Employment of personal carers and nursing
assistants grew by around six per cent per annum and the ratio of registered nurses
to enrolled nurses also grew. There was a 16.3% increase in registered nurses and
0.5% decrease in enrolled nurses between 2001 and 2006.20
By 2008, for every RN under 35 years of age there were two RNs over the age of
50, part time work had increased in popularity, there was an increasing trend to
specialisation in nursing, 5% of nurses had qualified overseas and over 9% of
registered and 10.5% of enrolled nurses were not employed as nurses and were not
seeking work as nurses. This does not include nurses who had let their registration
or enrolment lapse and moved into alternative occupations.21
Discussion Points:
Are there other matters relating to the nursing & midwifery workforce that you
believe could account for these figures?
Allied Health Workforce (Health Professionals)
The Health Directorate defines a 'health professional' as one who diagnoses and/or
treats physical and mental illnesses and conditions, and recommends, administers,
dispenses and develops medications or treatments to promote, restore or manage
good health. Included in this definition are science and engineering professionals
who perform analytical, conceptual and practical tasks in the health environment.22
In order to ensure that all health professional groups are represented at an
executive level, the Allied Health Adviser in the Health Directorate provides
advocacy for any health professional group under the allied health banner that is
employed by the Health Directorate and does not fall into a medical or nursing
17
ACT Government Health Directorate Workforce reporting data derived from Chris 21, June 2011
(attachment 4)
18 AIHW: Nursing & midwifery workforce 2008
19 University of Canberra: Faculty of Health: Nursing and Midwifery (Accessed 09/05/2011)
20 AIHW Health Workforce: accessed 10/05/2011
21 DEST: The Nursing Workforce 2010, AIHW: Nursing & midwifery workforce 2008
22 ACT Health Directorate: Allied Health Salary Information Accessed 10/05/2011
9
category. There are approximately 30 health professions who meet this criterion in
the Health Directorate.
955 allied health professionals fill 837 full time equivalent positions in the Health
Directorate, 28% work part time and 83% fill permanent positions. The average
length of tenure for allied health professionals in the Health Directorate is 7.06
years.23 Allied health is increasing in size faster than nursing and medicine in
Australia, with a 22% increase in allied health workers between 2001 and 2006.24
Allied health is comprised of a diverse group of small professions, but as a group
they comprise 16.19% of the Health Directorate workforce (the second largest
clinical workforce). 9.1% of the health professional workforce permanently separate
from ACT Government services each year.25
Only a few of the allied health professions are trained in the ACT, these are
physiotherapy, clinical psychology, pharmacy, dietetics, social work, pathology, and
occupational therapy. Allied health assistants are trained at the Canberra Institute of
Technology (CIT) crossing the professions of Physiotherapy, Occupational Therapy,
Speech Pathology, Nutrition and Podiatry.
Discussion Points:
Are there other matters relating to the allied health workforce that you believe
could account for these figures?
Administrative Workforce
Administration is the second largest group of employees in the Health Directorate;
this classification includes administrative service officers, senior officers, information
technology officers, public affairs officers, clinical coders, dental receptionists,
graduate administrative assistants and cadets. 1179 workers fill 1086 full time
equivalent positions. 80% are female, and 17% work part time. The average length
of tenure for the administrative workforce in Health Directorate is 7.2 years.26
Support Services Workforce
Support Services includes officers servicing stores, kitchens, sterilisation services
and other essential facilities. There are 442 employees in the Health Directorate
filling 397 full time equivalent positions, 58% are male. Support services have the
lowest number of temporary employees (7.47%). The average length of tenure for
support service workers in Health Directorate is 7.16 years.26
Technical Workforce
The technical classification includes technical officers in the Health Directorate,
assistants in nursing and health care assistants. There are 202 employees filling
159 full time equivalent positions, 73% are female, 24% work part time. There are
23
ACT Government Health Directorate Workforce reporting data derived from Chris 21, June 2011
(attachment 4)
24 AIHW Health Workforce: accessed 10/05/2011
25 ACT Government: ACT Public Service Workforce Profile 2009-2010
26 ACT Government Health Directorate Workforce reporting data derived from Chris 21, June 2011
(attachment 4)
10
more casual technical officer employees than in any other classification (26%). The
average length of tenure for the technical workforce in the Health Directorate is 5.5
years.26
In 2008, the US Bureau of Labor Statistics developed a list of the ‘30 fastest growing
occupations’ as forecast to 2018. This includes eight occupations that relate to
health assistants or health aides, with a 30-50% increase forecast in these positions
by 2018.27
1500 people were in training in community services and health Industry courses in
the ACT in September 2010.28
Executive Workforce
The executive workforce in the Health Directorate includes 20 full time employees,
60% are female. This workforce has the highest average age of 49 years and the
highest number of contract employees (70%). The average length of tenure for an
executive in the Health Directorate is 11.5 years.29
Miscellaneous Professional Workforce
The miscellaneous professional workforce in the Health Directorate includes 17
professionals working in research, information technology and teaching positions.
76% are female, 29% work part time and 59% are temporary employees. The
average length of tenure for a member of this workforce in the Health Directorate is
7.6 years.29
Other Health Services Workforces in the ACT
General Practitioners (GPs)
The number of ACT GPs has remained static since 2007 at around 67 GPs per
100,000 people. This compares with 90 GP’s per 100,000 people in other urban
areas of Australia.30 The average Canberra GP is in the 50-54 year age-range.
ACT GPs are increasingly working part time and taking on multiple roles across
different sectors e.g. hospital or university roles.31 However, it is suggested that
ACT GPs working part time are able to cope better with complex care and
psychiatric issues if they are not dealing with them every day. They may also have
27
United States Department of Labor: Bureau of Labor Statistics News Release: The 30 fastestgrowing occupations, 2008-18
28 Community Services and Health Industry Skills Council: Environmental Scan 2010
29 ACT Government Health Directorate Workforce reporting data derived from Chris 21, June 2011
(attachment 4)
30 Productivity Commission: Report on Government Services 2010
31 ACT GP Taskforce: General Practice and Sustainable Primary Health Care — the way forward:
Final Report, 2009
11
better links with other parts of the health system if they are working across different
areas.32
Specialists
The only data identified around average specialist supply in Australia is for
surgeons. In 2009, there were 68 active surgeons in the ACT, with10% aged under
40, 26.5% aged 40-44, 34% aged 45-54 and 29% aged 55 years or older. There
were 1.5 surgeons per 1000 population which conforms to the national average,
however per head of population, the ACT had fewer general surgeons and urologists
than the national average. ACT based surgeons were more likely to be taking part in
medico-legal work and less likely to be taking part in research and pro-bono work.33
33% of ACT patients feel that they wait longer than acceptable for a specialist
appointment, compared to 21.2 % of patients nationally.34 However, it is unclear
whether this relates to a longer than average wait time or a lower tolerance to long
wait times in the ACT population.
Community Services
In 2009, there were 197 Community Service outlets in the ACT with an estimated
1282 people working in disability services, 181 in child protection and 776 in the
general community services sector. This data includes both Government and nongovernment services,35 however there are other community services sectors in the
ACT that are not included in this profile.
Residential Aged Care Sector (RAC)
The RAC resident population is increasingly ageing and developing more complex
needs. This change in demographics has been accompanied by a change in skill
mix of the RAC workforce. Between 2003 and 2007, the proportion of registered
nurses (RNs) fell from 21% to 17% and ENs fell from 14% to 12.5%. Allied health
workers also fell from 7.6% to 6.6% while personal carers rose from 57% to 64% of
staff36. There are 23 Aged Care facilities in the ACT.
Private Practitioner Sector (other than Medical sector)
There is no publicly available data around the sole or small practice private
practitioner workforce in the ACT. However a survey of the 2010 ACT Yellow pages
identified approximately 50 pharmacies, 23 occupational therapy businesses, 42
physiotherapy businesses, 13 podiatry businesses, 127 dental businesses, 36
clinical psychology businesses, and 11 rehabilitation businesses. There were also
small numbers of private practitioner businesses offering pathology, medical
imaging, speech pathology and audiology services. Disciplines not employed within
the Health Directorate were not included in the search.
Dwan, Kathryn, Douglas, Kirsty, Forrest, Laura and Res, Sonia: Part time GP’s: scourge or saviour
of general practice?: Poster
33 Royal Australasian College of Surgeons: Australian Capital Territory Surgeons 2009 Census
34 COAG Reform Council: National healthcare Agreement Performance Report for 2009-10 2011
35 National Institute of Labour Studies: Who works in Community Services? 2010
36 Access Economics:Nurses in RAC 2009
32
12
Private Hospital Sector
There is no publicly available data specifically around the private hospital workforce
in the ACT37 but there are 328 beds across three private hospitals in the ACT.38
Non Government Organisations (NGOs)
The NGO sector is growing strongly showing an average annual growth of 7.7 per
cent between 1999 and 2007.39
Commonwealth sector
The Commonwealth has a number of key agencies based in the ACT that employ
health professionals. The Department of Health and Ageing had 5061 employees in
2009-10, the Australian Institute of Health and Welfare (AIHW) had 352 employees
and the National Health and Medical Research Council (NHMRC) had 257
employees.40 Only a small proportion of these employees are health professionals.
Additional health professionals are also employed in Defence, however there is no
accessible data available which identifies the proportion of Defence employees
working in health services.
Informal Carers
It was estimated that around 2.9 million Australians would provide 1.3 billion hours of
informal care in 2010.41 While data around informal carers is sparse, there were at
least 2300 primary carers in the ACT in 2003, the majority of whom were females in
the 35-54 year age range.42
37
ABS: Private Hospitals Australia 4390, 2011
AIHW: Australian Hospital Statistics 2009-10
2 Access Economics: Caring Places- Planning for aged care and dementia 2010-2050
39 Productivity Commission Research Report: Contribution of the Not for Profit Sector 2010
40 Australian Government: State of the Service report 2009-10
41 Access Economics: Caring Places- Planning for aged care and dementia 2010-2050
42 ABS: 4430.0 - Disability, Ageing and Carers, Australia: Summary of Findings - State Tables for
Australian Capital Territory 2003
38
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5. National Workforce Issues
The issues outlined below have been identified as impacting on the health workforce
nationally.
Competing demands for labour
Competition for labour is increasing for both undergraduate and graduate entry
professions, and within the international and Australian health care labour market.43
Where health professions in shortage are employed in both the ACT public and
private sectors there is intense competition for this workforce between sectors.
Issues have been raised by the private sector regarding their investment in training
staff that then leave to work in the public system. The ACT Government may be
competitively advantaged to attract staff due to its ability to offer public service
conditions such as salary packaging and by the wide variety of work it can offer.
However, since Commonwealth Government departments and New South Wales
(NSW) Health services are also competing for the health professional workforce in
the ACT, each service needs to maximise the advantages of their sector in order to
attract and retain their workforce.
Discussion Points:
1. Are there other competing demands that you think should be
considered in this section?
2. Are there other aspects of the ACT that you believe make this a
competitive market for attracting labour?
Ageing workforce
The Australian workforce pool is projected to decrease as a proportion of the total
population over the next decade, driven by the ageing demographics of the
workforce.44 In 2008, 18% of the Australian health workforce was aged 55 years and
over (compared with 13% in 2003). While many health workers are replaced by new
entrants, there is concern that the rate of workforce replacement is not keeping up
with the increased demand for health-care services as a result of the ageing
population.45 It is, however, possible that the changing age distribution will have less
of an impact than expected as workforce participation rates are increasing, partly
due to changes in policy such as superannuation rules and an increase in workforce
participation by women.46
43
NHWT: Health Workforce in Australia and factors for current shortages 2009
ABS: 4430.0 - Disability, Ageing and Carers, Australia: Summary of Findings - State Tables for
Australian Capital Territory 2003
45 AIHW: Australia’s Health 2010
46 Segal & Bolton: Issues facing the future health care workforce: the importance of demand
modelling, Australia and New Zealand Health Policy, 2009
44
14
Changing workforce intentions and availability
There appears to be a move towards decreasing the hours for some categories of
the health workforce and there is also an increasing trend towards part-time
employment.47
Reliance on international medical graduates
Australia is currently heavily reliant upon international medical graduates to
supplement shortages in medical practitioners. Ongoing global health workforce
shortages mean this is an unsustainable model and cannot be considered a solution
to manage workforce shortages in the long term.47 There are indications that
Australia may be moving into a situation where international medical graduates are
oversupplied in Australia.
Professional rivalries
Inter-professional boundaries and tensions may impact on the morale of individual
practitioners and this could lead to individuals leaving the workforce or changing
their role in the workforce.
Lack of integration/collaboration between sectors
Lack of collaboration between organisations, departments and individual
practitioners can lead to issues with efficiency and quality such as duplications,
gaps, multiple referrals and inconsistencies in service delivery. A number of barriers
make collaboration difficult to achieve including, differences in administrative
boundaries, laws, rules and regulations, budgets and financial streams, IT systems
and databases, professional and organisational cultures, values and interests and
commitment of the individuals and organisations involved.48 Collaboration is raised
as an issue across the ACT in relation to both inter-agency and interdepartmental
integration. Cooperation between the public and private sector in the ACT is
considered in workforce planning due to the close proximity of service facilities and
finite resources available.49
Workforce specialisation
The health workforce has become increasingly diversified and specialised, due to
professionalisation, scientific and technological developments, credentialing and
changing models of care and identified needs. As increasing sub-specialities are
developed, there can be protection of roles by controlling entry criteria, registration,
industrial action, and political influence. The more control a group has, the more
likely it is to influence the supply of its service within the health workforce.50
47
NHWT: Health Workforce in Australia and factors for current shortages 2009
Axelsson & Axelsson: Integration and collaboration in public health- a conceptual framework 2006
49 ACT Health Directorate Critical Care Services Plan 2007-2011 (internal document)
50 NHWT: Health Workforce in Australia and factors for current shortages 2009
48
15
This can contribute to workforce shortages by, creating demand for new sub
specialties that may be in short supply, reducing flexible work practices so that
multiple practitioners are required to undertake functions that may previously have
been undertaken by a single practitioner, preventing care being provided by a single
multi-skilled practitioner, restricting supply of the specialist practitioner through
constraining education and training capacity and increasing inter-professional
boundaries and tensions which impact on the morale of individual practitioners
leading to individuals leaving or changing their role in the workforce.51
Absenteeism and ill health
AIHW states that in a survey of working-age people, 96% report at least one of the
following risk factors: smoking, risky alcohol consumption, obesity, physical
inactivity, low fruit or low vegetable consumption, high blood pressure, or high blood
cholesterol. 75% of the respondents report multiple risk factors.
The authors found that people with three or more risk factors had significantly
greater odds of not being in the labour force compared with those without risk
factors and that absentee rates were significantly greater for males and females (4.0
times and 2.5 times as high, respectively) among those with at least one risk factor
and at least one chronic disease, compared with those with no risk factors or chronic
disease. In addition, the net annual loss due to absenteeism associated with these
risk factors was more than that for chronic disease (112,000 and 57,000 full-time
person-years, respectively).52
Job strain has been found to double a workers future risk of depression and
depression is estimated to cost more than $8000 per affected person per annum in
lost productive time and job turnover/employee replacement. Recommendations to
combat workplace depression include investment in ‘mentally healthy workplace’
studies, and a need for new workplace health promotion approaches to target job
stress.53
A recent Cochrane review found that interventions which increase employee control
by offering worker-orientated flexibility (specifically self-scheduling and
partial/gradual retirement) are likely to be associated with health improvements
including improvements in physical health, mental health and general health. In
contrast, interventions that were motivated or dictated by organisational interests,
such as fixed-term contract and involuntary part-time employment, found equivocal
or negative health effects.54
Initiatives such as increasing the number of child care facilities co-located with
health workplaces, offering extended hours of child or elder care and offering more
flexible working hours to support existing part time workers to increase their hours,
may also increase options for people to extend workforce participation.
51
NHWT: Health Workforce in Australia and factors for current shortages 2009
AIHW: Risk factors and participation in work 2010
53 Victoria Health: Estimating the economic benefits of eliminating job strain as a risk factor for
depression 2010
54 Pabayo et al: Flexible working conditions and their effects on employee health and wellbeing
(Cochrane Review) 2010
52
16
Classification
In the next five to ten years it is anticipated that new classifications will be required
as additional health professions become recognised and accepted, new professions
emerge or strengthen and others undergo role redevelopment, redesign or
extension.
It is noted that industrial relations, law and practice can impact negatively as well as
positively on workforce reform.55 Changing classification is a slow process that
impacts on the introduction of new or extended roles. In the Health Directorate,
industrial agreements usually cover a three year period, which makes it difficult to
introduce changes to classifications in a timely manner impacting on the introduction
of new roles.
Classification has been raised as an issue within the Health Directorate, with some
respondents believing that their positions are under classified for the level of work
that they perform and some indicating that classifications are inconsistently applied
across programs.
Following a review of the classification structure in the ACT Public Service, Chief
Minister and Cabinet Directorate is currently looking at options to create a new
vocational stream and a single salary spine.56
55
National Health Workforce Innovation and Reform Strategic Framework for Action: National
Consultation: In draft
56 ACT Health Directorate: General Enterprise Agreement 2010-2011
17
6. Additional issues impacting the ACT region
Sustainability is identified in the Health Directorate Corporate Plan as a key
performance area,57 however sustaining the health workforce in the ACT is a
significant challenge compounded by a number of issues specific to the region.
In July 2010, the national workforce participation rate was 65.3% as compared to the
ACT rate of 72.9%. The national unemployment rate was 5.2% and the ACT rate
3.4%.58 The financial crisis has triggered a rise in the number of people employed in
community services and health across Australia,59 however the ACT has less
potential than most states and territories for increasing workforce participation levels
in the existing population and must look outside the territory boundaries for
additional skilled workers.
In the Commonwealth Public Service, 52% of ongoing Senior Executive Service
(SES) and Executive Level (EL) employees will be eligible for retirement in the next
10 years. 76.5% of all SES and 62.3% of all EL employees are employed in
Canberra so this could have a significant impact on the ACT.60
While the ACT has the most educated population in Australia, 32% of people in the
ACT still have a level of literacy below the accepted standard needed to work in a
knowledge-based economy.61 A lift in workforce participation in semi-skilled healthbased occupations would require increased provision of basic core skills training
such as adult language, literacy and numeracy as well as vocational skills.62
As of 2012, people who complete Year 12 studies in NSW but study at interstate
universities are no longer guaranteed medical intern placements in NSW hospitals.63
The ACT may be too small to be able to offer sufficient variety of placements to
deliver the breadth of experience required by an intern, so there is potential for this
decision to impact on student choice of university and potentially on the diversity of
the internships available to ANU graduates.
Lack of local new graduate supply and limited training facilities makes recruitment to
many allied health professions extremely difficult in the ACT.
57
ACT Health Directorate: Corporate Plan 2010-2012
ACT Government Labour Force- July 2010
59 Community Services & Health Industry Skills Council: Environmental Scan 2010
60 Australian Government: State of the Service report 2009-10
61 Australian Bureau of Statistics (2008), 2006 Adult literacy and life skills survey, Australia, 4228.0
62 HWA: National Health Workforce Innovation and Reform Strategic Framework for Action 20112015
63 NSW Health Priority List for Intern Allocation 2012
58
18
Commencements in vocational education courses grew in all states and territories
except the ACT between 2005 and 2010, the ACT maintained an average
commencement rate of 1200 students per quarter across all vocational training
courses.64 Corporate support services have a critical role in underpinning core
health services business and assisting delivery of services and maintaining a
reliable supply of vocational educated workers to deliver these services is vital.
Discussion Points:
1. Are there additional issues impacting the ACT Region that you feel
should be included here?
64
NCVER Australian vocational education and training statistics: Apprentices and trainees:
September quarter 2010
19
7. ACT Government Health Directorate staff
and program feedback
Submissions were sought to identify the key workforce issues of concern in the ACT
(see Attachment 1). A number of issues were raised by the Health Directorate staff
and divisions which are not noted as national key workforce issues. These are
outlined below.
Community based Nursing services
There was an 18% increase in occasions of community based nursing services
delivered between 2007-08 and 2010-11. One of the suggested reasons for this
increase is that community based clients are increasing in complexity. Since 2006,
routine personal care has been referred for delivery by non government
organisations, so only people with the most complex needs are seen by community
based nursing services. Community nursing services introduced a number of new
community based services such as weekend and specialist clinics in 2009-201065 in
an attempt to meet demand.
Allied Health services
Some allied health services report increased demand for their services which
impacts on the level of service provided to less urgent client groups which they feel
leads to reduced satisfaction, reduced clinical efficiency, an impact on provision of
clinical training to students and a reduction in time available for non client contact
activities such as leadership, policy development and development of new models of
care.
There are currently no national standards available around allied health acute
staffing ratios. Although some work is in progress66 lack of standards is reported as
impacting on acute areas and future service planning. There are local staffing
standards available to guide allied health in some services.67
Increasing student numbers and the commencement of new local health training
schools, e.g. the new occupational therapy school, are recognised as essential to
assist recruitment and develop sustainability of the allied health workforce.
However, it is noted that delivering supervision to increasing numbers of students is
a major challenge for the allied health workforce in the ACT and new training
programs need tutors and supervisors for clinical placements which may need to be
sourced from the existing workforce.
Medicine
65 2011
report Community Care Program Nursing Workload 2008-2011 (Unpublished)
Health Workforce Australia: Workload Measures for Allied Health Professionals accessed
16/06/2011
67 ACT Health Directorate: Operational Support: Standard Operating Procedure Acute Support Allied
Health - Caseload Allocation (internal document)
66
20
It is noted that improvements in rostering for junior doctors in 200868 has resulted in
safer working hours. However in March 2011 the Health Directorate had 15 vacant
junior doctor positions and junior doctors were working overtime to backfill these
vacant positions while the positions were being readvertised. This situation has now
improved and junior doctor recruitment for 2012 is now finalised with 100%
recruitment achieved.
Administrative services
Where administrative staff are not available, or are under classified for the tasks
required, clinicians are spending increasing time on essential administrative duties
and this inevitably impacts on the number of services provided by clinicians.
Career pathways
Limited clinical career structure is raised as an issue within some allied health
professions, where it is reported that there are very few clinical opportunities beyond
Health Professional (HP) 3 level. This means that clinicians need to move into a
management career path in order to advance. This is an issue usually documented
in rural areas,69 however the small size of the ACT means that there may be limited
opportunities for local promotion within discipline, especially in small professions.
Some professions, such as speech pathology have advised that there are
significantly better career opportunities available in NSW and this can impact on
retention.
Practice nurses and health promotion professionals currently have no formal career
path at all; health promotion is not classified as profession in its own right which
makes it very difficult to develop a career pathway.
It is reported that people employed in support services have limited opportunities for
skills education, development and articulation to higher studies.
68
ACT Health Directorate: Annual Report 2007-08
et al, A conceptual model for recruitment and retention: Allied health workforce
enhancement in Western Victoria, Australia: Rural & Remote Health (Online) 2005
69 Schoo
21
8. Recruitment & retention
It is noted that recruitment and retention of experienced staff is a particular issue in
the ACT, as the size of the ACT restricts career opportunities in some professions.
High house prices and inflexible hours in some sectors are also cited as contributing
to this issue. Locally trained new graduates are easy to attract, however they may
move on when they have gained 1-2 years of experience. Staff leaving for other
sectors are generally more experienced and are more difficult to replace.
New graduates trained interstate can be hard to attract to the ACT and this impacts
on professions without a local training school. New graduates are more likely to stay
working in their profession if they feel well supported so an investment in graduate
support programs is essential.
A survey of 246 new Canberran’s by the ‘Live in Canberra’ team70 indicates that
work and lifestyle are the main influences behind choosing to move to Canberra,
NSW was the most common state to immigrate from and the UK was the more
common overseas location. Most people attracted to Canberra have partners and
41% are families with children.
It is noted that compliance with the mailed request for provision of exit data in Health
Directorate is poor. Consistent provision of data detailing staff reasons for leaving is
invaluable for planning retention incentives. Other methods such as electronic
surveys may have a higher take-up rate. An incentive may also encourage greater
compliance.
Medical Specialists
Recruitment to specialist and some trainee positions in the ACT public sector has
been a particular issue in geriatric medicine, anaesthesia, plastic surgery,
emergency and palliative care, with positions staying vacant between three to 12
months and longer in some cases.
Executives and managers
Retention of executives and managers is raised as an important priority within the
Health Directorate. Volatility at this level is highly undesirable as it makes it difficult
to progress initiatives, or to maintain a secure, supported workforce.
70
Live in Canberra Program Welcome to Canberra Events Survey 2006-2010 (Unpublished)
22
Mature aged workers
Depending on the financial situation, Commonwealth Superannuation Scheme
(CSS) members may find that they have a significant financial incentive to retire at
54 years and 11 months and it is estimated that 40% of CSS members of that age
choose to retire. The CSS stopped taking new members in 1990 and there are now
only 275 CSS members in the Health Directorate (including 130 nurses) so they only
represent 4.6% of employees (5.5% of nurses). Special employment agreements
are available to help retain these experienced staff members by offering increased
superannuation payments to remove the gap between the standard pension (taken
after age 55) and the deferred pension (taken at 54 years, 11 months). This option
can be limited to selected employees but must be negotiated before the employee
starts to implement retirement plans. This strategy can also be used where an
employee prefers a ‘staged retirement’ moving to part time or lower level
employment. However the employee would need to be aware that superannuation
contributions would be based on their former (full time) salary and so would result in
a lower take home salary while employed. The employee benefits by gaining from
further growth of the salary that their final benefit is calculated on and by the
reduced pension discount because they retire at an older age.71
The Health Directorate General Enterprise Agreement72 allows the Director General
to approve additional remuneration benefits for eligible mature aged employees,
instead of employer superannuation where the employee has knowledge, skills and
experience that are essential for the agency to retain. This allows key staff members
to be offered position retention without financial disadvantage to the staff member.
Graduated retirement options may assist in retaining some executives and
managers beyond retirement age. Part time options for recently retired workers may
include retaining involvement in training and supervision.
In addition to the key workforce issues above, the issues outlined below were also of
concern to Health Directorate staff and divisions.
Small Professions
Small professional groups report feeling professionally isolated in the ACT and state
that this impacts on retention and professional credentialing for their groups. Local
peer support networks may be implausible due to low numbers. The smaller
professions, such as speech pathology and orthotics / prosthetics, are not trained in
the ACT so there is no home grown source of these professionals and it can often
be difficult to fill vacancies locally. Members of small professions seldom have the
benefit of backfill to allow them to take time to do research, develop new models of
care, and trial new clinical practices. This makes it difficult for these professions to
introduce changes that may benefit their service. There are difficulties with
succession planning in professions or specialties where there may only be one or
two practitioners and small professions may also need additional travel and interprofessional support in order to meet credentialing, up-skilling and quality
improvement requirements.
71
Australian Government: Management Advisory Committee: Report on Organisational Renewal,
2003
72 ACT Health Directorate: General Enterprise Agreement 2010-2011
23
Slow growth in Assistant Roles
While assistant roles are slowly increasing in number within Health Directorate,
limited resourcing is impacting on the creation of new roles.
Assistants in Nursing (AINs) are not currently classified as nurses despite being paid
and recognised under the Nursing Collective Agreement and, as non nurses, they sit
outside the nursing hours per bed day calculation of workload determination. This
means that AINs are unlikely to be employed as additions to current staffing levels.
As "nurse equivalents" they would be included in total nurse numbers creating
industrial concerns about lowering the skill mix. However, there are also concerns
that as scopes of practice have moved up the continuum, basic care activities such
as showering, toileting, feeding and routine pressure care are being increasingly
impacted.
A stage 2 pilot of assistants in nursing (AINs) occurred within the Health Directorate
in 2009/10, however these roles have not been continued following the trial.
Changing Technologies
New technologies are increasingly influencing workforce needs, requiring increased
need for technician resources. As monitoring and treatment services are
increasingly conducted remotely in the community it is expected that the Health
Directorate will need to set up home based equipment services and technicians will
be required to deliver these services. These technicians may not be used to working
with clients so some may require additional training.
Increasing use of IT in specialised areas may require targeted development of
specialist IT roles such as Laboratory IT support- where the support person has
basic training in pathology as well as IT skills. Staff will also need support to change
the way they do business.
Where changes in technology have reduced care complexity, there is a need to
explore reallocation of tasks to less skilled workforce members. Technology may
also improve the safety of some interventions making it more feasible to re-locate
affected tasks outside the tertiary hospital campus.
Despite the fact that 82% of ACT residents have home internet access73 a lack of
approved IT encryption currently prevents the use of email as a route of
communication with patients.
Proposed mobile health worker electronic record technologies are expected to save
significant time, enable additional services to be provided and enhance community
based worker safety by remotely identifying their location; however there are issues
around privacy that will need to be addressed to support these changes.
73
ABS: Household Use of Information Technology Australia 2008-09
24
It is noted that while new technologies can be significant time savers, they can also
lead to increased staffing requirements where new treatments are offered for
conditions that would previously have been untreatable or where treatment
outcomes are significantly improved by a new more labour intensive technology.
Discussion Points:
1. Are there other recruitment and retention issues facing the Health
workforce that you feel should be included?
2. What are your suggestions for improving recruitment and retention
throughout the Health Directorate?
25
9. Feedback from other Health Services in the ACT
Submissions were sought to identify the key workforce issues for health services in
the ACT other than Health Directorate. Please see Attachment 1 for a list of all the
submissions received.
Key issues shared across multiple external health services
Training, supervision & mentoring support
Supervision and mentoring requirements vary between professions, and there are a
range of support models for the provision of supervision in the Health Directorate.
Smaller health services in the ACT do not have sufficient numbers of health
employees to support significant training infrastructure which impacts on their ability
to provide appropriate training to staff.
While cross sectoral training is offered by the Health Directorate, this is delivered for
a fee to cover costs incurred by the Health Directorate. Health Directorate’s Staff
Development unit advise that there is no profit margin included in this fee, however
the fee is referred to as a barrier to training access for some services.
Lack of supervision and mentoring support is reported to be an issue across sectors,
particularly where people filling these roles are relatively isolated, such as practice
nurses.
Some training needs are reported as not currently being met in the NGO sector,
including disability awareness, mental health training and multicultural awareness
training. NGOs note that in some circumstances, employing people with lived
experience, such as people with experience of alcohol or drug dependence assists
them to deliver more relevant and meaningful services to clients, however there may
be barriers to their employment through normal selection procedures. These
workers may also face unusual difficulties in completing qualifications in order to
enter into the workforce and may require significant additional support such as
language support, longer timeframes to complete units, affordable child care, and
scholarship support.
Better support may also be required for health workers returning to the workforce in
the NGO sector. NGOs also report difficulty for workers in accessing supervision
and debriefing support to reduce the stress encountered whilst working in very
demanding environments.
Salary Inequity
Health Professionals working for the ACT Government Community Services and
Justice and Community Safety Directorates are not entitled to the same level of
salary packaging as those in ACT Government Health Directorate and this
potentially impacts on recruitment and retention of health professionals in these
agencies. This also impedes the ability for staff to rotate seamlessly across the
sectors.
26
Salary inequity has significantly impacted on the attraction of NGO staff and has
discouraged skills development through higher education, with employees leaving
the sector for better-paying jobs in the public sector.74
A Fair Work Australia Equal Remuneration Case for community services workers
recently found that there is not equal pay in the non Government sector for work of
equal or comparable value by comparison with state and local government
employment and that employees are generally remunerated at a level below that of
state and local government employees who perform similar work. Work is now
commencing to determine what changes will be introduced following this decision.75
The significant wage differential between residential aged care (RAC) nurses and
other nurses is resulting in shortages of adequately trained nursing staff and is
leading to problems with nurse retention and turnover rates.76 Low salaries in the
RAC industry make it increasingly difficult to attract workers.
A number of issues were raised which were specific to individual sectors and are
documented by sector below.
The ACT Government Sector (other than Health Directorate)
Slow growth in assistant roles
Disability ACT does not currently have assistant roles but believes that disability
assistants could be used to support health and nursing professionals in the disability
sector. Therapy ACT would also be interested in exploring the use of psychology
assistants to support families to implement interventions.
Non Government Organisations
Recruitment & Retention
NGOs are often subject to funding arrangements that do not guarantee recurrent or
ongoing funding. This limits their capacity to plan adequately for the future,
especially in terms of service provision and staffing. Due to funding uncertainty,
short term contracts are usually offered which impacts on recruitment and retention
as employees prefer the security of a longer contract. Average staff turnover across
Australian community sector agencies was equivalent to 29% in 2010.77 As a
comparison, Health Directorate has an average permanent staff turnover rate of
7.4%.
Staff turnover is expensive to an organisation, with resignation of a staff member
incurring significant expenses including separation, replacement, training, lost
74
Community Services & Health Industry Skills Council: Environmental Scan 2010
Fair Work Australia Decision- Equal Remuneration Case: Australian Municipal, Administrative,
Clerical and Services Union and others 2011
76 Access Economics: Nurses in RAC 2009
77 ACOSS: Australian Community Sector Survey Report 2010: Volume 1- National
75
27
productivity and lost business costs. Labour turnover costs may range from between
50 to 130 percent of an incumbent's annual salary.78
The Productivity Commission notes that NGOs are usually required to subsidise the
costs of services delivered on behalf of Government agencies and that this has led
to salaries being squeezed to the point where many NGOs find it difficult to attract or
retain experienced staff79 and this means that some NGO workforces are
increasingly weighted with inexperienced staff. NGOs note that, in some
circumstances this can lead to inexperienced clinicians being promoted beyond their
skill level.
Career pathways
NGO staff turnover is particularly impacted by lack of career paths. The small size of
many NGOs means there are few career opportunities, and, even where employees
undertake training, funding structures are often insufficiently flexible to
accommodate employees with higher level qualifications. The current absence of
career paths, and associated financial recognition linked to training, can reduce the
incentive for employees to invest in their own training. This, along with funding
constraints, means that many NGO employers are unable to sufficiently invest in
training their staff. In addition, staff training expenses are often not regarded by
funding bodies, or the public, as a necessary part of service delivery.80
Service demand / High workloads / burnout
The NGO sector reports that it is providing much of the basic community service
intervention and this work continues to grow.
Workplace flexibility
NGOs identify a need to increase the flexibility of their working hours to attract more
staff, including part time options.
Residential Aged Care Sector
The rate and number of residential aged care places in the ACT increased in
2009-1081. The demand for aged care workers is also expected to significantly
increase as a result of the increasing number of older Australians requiring care and
support and a decline in the relative availability of informal carers.
78
Council for Equal Opportunity in Employment (CEOE) survey cited by The Australian Governments
Equal Opportunity for Women in the Workplace Agency
79 Productivity Commission Research Report: Contribution of the Not for Profit Sector 2010
80 ABS: 4430.0 - Disability, Ageing and Carers, Australia: Summary of Findings - State Tables for
Australian Capital Territory 2003
81 COAG Reform Council: National healthcare Agreement Performance Report for 2009-10 2011
28
Staffing skill-mix
Nurses in RAC have to spend much of their time on non clinical activities and
supervision, rather than providing clinical care. This affects work satisfaction as well
as reducing the amount of direct care provided to RAC residents by nurses, and the
quality of overall care.82
Dependence on overseas residents to fill personal carer positions
In the ACT, increasing numbers of personal carers are international students or
spouses of international students. Poor English language skills and differing cultural
backgrounds can lead to communication difficulties with demented and frail
residents.
These workers are not entitled to government financial assistance with vocational
training and the cost of training in 2010 was $5,550 for a 6 month Certificate III in
Aged Care.83 This equated to almost 18% of the annual entry level FTE minimum
carer salary of $31,512.84
Regulation of personal carers
Due to low salaries and high rental costs, many personal carers are working in
multiple RAC locations and may be rostered for consecutive shifts in different
places. There is no registration of personal carers so regulation is difficult and there
is the potential for unsuitable people to remain in the industry by moving to an
alternative employer.
GP Access
The aged care sector reports acute issues with accessing GP services, with few
GPs able or willing to take on clients in the RAC sector as home visits are poorly
reimbursed and time consuming. Some RAC facilities have approached this problem
by arranging for a GP to hold a regular weekly clinic in the facility and see any
patients who require a consultation, however in order to take advantage of this
option, residents need to transfer to this GP. The remuneration for GPs taking on
this work is also impacted, as under the current remuneration structure GPs are paid
decreasing amounts for each additional patient seen in the duration of the visit.
A lack of consulting rooms and computer facilities is an issue for GPs when seeing
RAC clients.85 A few GPs have very large numbers of aged care patients and these
are predominantly older GPs so there will be a substantially negative impact when
one of them takes leave, retires or moves out of the ACT. After-hours and weekend
GP cover is also seen as a major issue in the RAC sector, although the Canberra
after-hours Locum Medical Service does provide cover.
82
Access Economics: Nurses in RAC 2009
CIT International Student Section- telephone advice 20/09/10
84 MA000018 - Aged Care Award 2010
85 ACT GP Taskforce: General Practice and Sustainable Primary Health Care — the way forward:
Final Report, 2009
83
29
Palliative care services
A palliative care nurse provides services to RAC facilities in the ACT, however it is
sometimes difficult to get urgent prescriptions written by GPs in a timely manner.
Clients requiring palliative care may be best served by remaining in a familiar
environment if their palliative care needs can be met there so there is the potential
for aged care palliative care nurse practitioners to work within or across RAC
facilities to improve this service. As of 1 November 2010, nurse practitioners can
access the Medicare Benefits Schedule and provide pharmaceutical benefits
scheme medicines in the community and this may assist in improving the timeliness
of medication changes to the aged requiring palliative care.
Medical Practitioners
In 2009 a GP Taskforce was set up in the ACT to investigate GP workforce issues.
The predominant challenges identified by the Taskforce were the GP workforce
shortage, and the provision of care to older residents.86
International Medical Graduates
The ACT Division of General Practice (ACTDGP) (now the ACT Medicare Local)
flags that access to training placements for International Medical Graduates (IMG)
can be difficult and note that the current GP training model is inefficient for IMGs.
GP practices that source a suitable IMG to work with them, have a six to nine month
time lag before the IMG can be approved to commence work. Extensive paperwork,
appropriate medical registration and an appropriate visa must be obtained for the
position offered. IMGs are then subject to Medicare provider number restrictions that
affect where they can work in Australia, with IMGs who take up permanent residency
or citizenship in Australia being unable to obtain a Medicare provider number for 10
years unless they work in a district of workforce shortage.87 Some outer metropolitan
parts of the ACT are currently included as districts of workforce shortage, however
this status has the potential to be revoked on review. In March 2012, the House of
Representatives Standing Committee on Health and Ageing tabled its report on the
inquiry into the registration processes and support available to overseas trained
doctors in Australia88. This report includes 45 recommendations to increase the
transparency of the National Scheme’s accreditation and registration processes for
IMGs, and to reduce the administrative burden on IMGs by improving efficiency.
The Medicare Local has stated that they would like to explore the potential for
medical and physician assistant roles but they are impacted by funding limitations.
ACT GP Taskforce: General Practice and Sustainable Primary Health Care — the way forward:
Final Report, 2009
87 Department of Health & Ageing: Doctor connect Website- Provider number restrictions 2007
88 Parliament of Australia- House of Representatives: Lost in the Labyrinth
Report on the inquiry into registration processes and support for overseas trained doctors 2012
86
30
10.
High Risk Professions
A number of health professions are cited as being at, or near, crisis level in terms of
a declining workforce numbers and in attracting people to train in these professions.
Nationally the health professions that are identified as being in shortage or having
recruitment difficulties are sonographers, optometrists, occupational therapists,
physiotherapists, podiatrists, audiologists, speech pathologists, midwives, registered
nurses, psychologists, medical laboratory scientists, social workers and welfare
workers.89
Within the ACT the professions being identified as requiring immediate intervention
are pathology (including medical laboratory scientists, cytologists venepuncturists,
and pathologists), biomedical engineers, specialty nurses (such as ICU and
emergency department nurses), medical physicists and radiation therapists.
The US Bureau of Labor Statistics lists Medical Scientists as the 6th fastest growing
occupation in the USA, with an expected increase of 40.4% between 2008 and
2018.90 A review is currently being undertaken of ACT Pathology medical laboratory
scientists.
A recent survey of the Australian pathology workforce91 indicates that, compared to
other states and territories, the ACT has the greatest proportion of permanent full
time workers (77.0%), the highest number of workers who regularly work for more
than 50 hours per week (15% compared to 8% nationally), the highest number
intending to reduce their hours (36.1% compared to 20.4%) and the highest number
of workers planning to leave the pathology workforce within the next three years
(50%) with many citing their intent to leave to improve work/life balance. 39% of
pathology workers in the ACT are aged over 50.
Both private and public sector pathology services agree that a variety of approaches
are required to increase the pathology workforce in health, including attracting more
students to take up clinical placements in health and improving the training through
increased industry involvement.
Medical physicists and biomedical engineers often require overseas recruitment to
fill positions.
Biomedical Engineering Technicians (BMETs), work under the guidance of
professional clinical engineers in clinical settings and with patients / clients and have
the technical skills, knowledge and experience to enable them to effectively maintain
clinical technology, taking electrical safety and patient safety into account. BMETs
are also equipped to manage and mitigate the risks associated with ‘hospital in the
home’.
89
DEEWR : Skill Shortage List, Australia 2011
Bureau of Labor Statistics: Fastest Growing occupations 2008-2018 (USA)
91 DOHA: Survey of the Pathology Workforce: 2011
90
31
Discussion Points:
1. Are there other factors that you think contribute to high risk
professions?
2. Do you have suggested mitigation strategies?
32
11.
Informal carers and self-carers
Where a client is receiving long term treatment and they, or their carer, are willing
and able to do so, they can be trained to deliver their own treatment, monitor
progress, react to changes and call for professional assistance when required.
There is an increasing move towards self management of health and self
management of chronic diseases, for example, the Diabetes Services Strategic
Plan92 includes the need to promote active self management approaches to assist
people in meeting their targets for control of blood glucose, lipid and blood pressure.
Clients are already delivering 12% of their own haemodialysis in Australia (21% in
NSW). 93
Benefits include better control over timing of treatments to fit around client’s work or
social events, reduced travel requirements and clients may have less adverse
incidents due to closer self monitoring.93
Clients and carers may require a high level of initial support, however there is
potential for a longer term reduction in professional intervention required for these
patients.
Informal carers are more likely to be unemployed or not participating in the paid
workforce than those who are not carers so the availability of informal care for aged
and disabled people is expected to be impacted by increasing workforce
participation.94 It is, however possible that the ageing population will create a larger
pool of informal carers of retired age.
Discussion Points:
1. How do you believe the balance between increased prevalence of self
managed care and decreased participation in the workforce (for
informal carers) can be achieved?
92
ACT Health Directorate: Diabetes Services Strategic Plan 2008-2012
Kidney Health Australia: Home Haemodialysis- A Treatment Option
94 ABS: 4430.0 - Disability, Ageing and Carers, Australia: Summary of Findings - State Tables for
Australian Capital Territory 2003
93
33
12.
What’s already happening to meet the health
workforce challenge?
National initiatives
A number of national initiatives are underway to help meet current and future
workforce challenges and improve and sustain health services:
National Health reform
A Heads of Agreement on National Health Reform was signed by all states and
territories in February 2011 and the full National Health Reform Agreement was
signed in August 2011.
The purpose of the health reform measures are to improve health outcomes and
ensure the sustainability of the health system. Under this agreement the states and
territories maintain management of public hospital services and have a lead role in
public health while the Commonwealth will increase its contribution to growth
funding for hospitals to 50% from 1 July 2017 and an independent national funding
body will administer hospital funding from 1 July 2012.95 The Commonwealth is
developing a national approach to employment structures as part of its health reform
package.96
Local Hospitals Networks (LHNs) have been established by all states and territories.
The ACT Government has implemented a single LHN for the ACT, initially confined
to the geographic borders of the ACT. This is a networked system that will hold
service contracts with the Health Directorate and is comprised of the Canberra
Hospital, Calvary Public Hospital, Clare Holland House (CHH) and the Queen
Elizabeth II Family Centre (QEII). The ACT and NSW Governments have both
agreed to undertake a further planning exercise to examine the feasibility of
developing a regional LHN model.97
Medicare Locals are new primary health care organisations that have been set up by
the Commonwealth to better integrate health care and improve the responsiveness
to the needs of the local community. The boundaries of the ACT Medicare Local and
the ACT LHN are aligned. The ACT Division of General Practice formed the ACT
Medicare Local as of 1 July 2011. The ACT Medicare Local is developing an
expanded range of services to the wider primary health care community in the ACT,
so that Canberran’s can access better coordinated and integrated primary health
services and preventive health programs.
The ACT Medicare Local aims to bring together primary health care professionals
and organisations to deliver quality services to the ACT population. General practice
will remain central to the ACT Medicare Local service delivery.
95
Heads of Agreement- National Health Reform 2011
COAG: National Partnership Agreement on Hospital & Health Workforce Reform 2009
97 ACT Government: A Local Hospital Network for the Australian Capital Territory 2011
96
34
Priority activities for the ACT Medicare local are to:
 Continue as a key partner in developing the ACT Primary Health Care
Strategic Plan 2011-14 in the context of COAG health reforms;
 Develop a dedicated GP portal enabling GPs to access relevant patient
clinical information;
 Expand on e-Health capacity including e-Discharge summaries and eReferrals and participate as a member of a consortium which has been
selected for the second wave of e-Health records, and is working on
furthering other e-Health projects;
 Promote good governance throughout the primary care sector;
 Work towards developing a highly sophisticated population health capacity
sourced through national data sets;
 Identify groups of people missing out on general practice and primary health
care or services that a local area needs and respond to those gaps by better
targeting services; and
 Work with Local Hospital Networks to assist with the transition of patients out
of hospital and if required, into aged care.98
Health Workforce Australia (HWA)
HWA is a key national agency, established in early 2010. HWA’s mandate is to
provide leadership in addressing the health workforce issues facing Australia. It is
aiming to ensure that we have a skilled, flexible and innovative health workforce that
meets the needs of the Australian community.
To achieve this, HWA is developing policy and delivering programs across four main
areas including research and data, workforce innovation, clinical training and
international recruitment. This focus aligns closely with the objectives of the first
Health Directorate Workforce Plan.
HWA is progressing a raft of initiatives including:







98
a National Health Workforce Data Set containing national supply and demand
data;
a profile of the supply and demand projections for the aged care and
Residential Aged Care (RAC) sector nursing workforce (RNs, ENs and AINs)
and the acute care nursing workforce;
a methodology to support mental health workforce planning for the nongovernment community mental health sector;
increasing supply and demand of health workforce professionals to meet both
anticipated future demand and to overcome any existing shortages;
initiatives to increase clinical training placements;
a review of supervision and simulated learning environments;
a map of health workforce competencies and a taxonomy for competency
based standards in health education and training;
ACT Medicare Local Website: Accessed 17/05/2012
35





evidence based options for competency based career frameworks for the
Australian health workforce;
alternative approaches to health workforce planning;
a review of major shifts in the aged care workforce to improve the future
supply and adaptability of the workforce for the care of older Australians;
options for data sources for measuring workload/productivity of the allied
health workforce; and
oversight of the National Health Workforce Planning and Research
Collaboration.99
Integrated Regional Clinical Training Networks have been set up in every state and
territory to support a collaborative focus on student placement and a forum to
explore additional opportunities for cross sectoral integration and collaboration
around clinical education and training for staff. These networks may support
initiatives such as inter-agency placements, rotations and expansion of shared staff
training in the region.
In November 2011, Health Workforce Australia published the National Health
Workforce Innovation and Reform Strategic Framework for Action 2011-2015.100
This provides a framework of the following five domains for action:
1. Health workforce reform for more effective, efficient and accessible service
delivery;
2. Health workforce capacity and skills development;
3. Leadership for the sustainability of the health system;
4. Health workforce planning; and
5. Health workforce policy, funding and regulation.
These domains will also provide the framework for the Workforce Plan for the Health
Workforce of the ACT 2011-2017.
E Health
The national e-health initiative will deliver personally controlled electronic health
records, and a national e-health records system and is expected to be implemented
by September 2012.101
E-health is expected to improve the quality and safety of health care by allowing
better flow of information between all parties involved in a healthcare event. It can
replace many of the current paper-based processes and improve access to relevant
information through enabling 24 hour a day 7 days a week access. It can also
overcome fragmentation and duplication of services, give individuals / carers better
management and control of their personal health outcomes and provide better
access to health care services in remote, rural and disadvantaged communities.
99
HWA Website http://www.hwa.gov.au/
HWA: National Health Workforce Innovation and Reform Strategic Framework for Action 20112015
101 E-Health website http://www.ehealthinfo.gov.au/
100
36
However, new technologies may also open up opportunities to offer additional
services of value to the community and additional workers are then needed to
deliver these new services.102
From a workforce perspective, e-Health can significantly improve health service
efficiency by reducing staff time spent accessing paper based records, reducing
duplication of services such as pathology tests, and speeding up the flow of
communication between health professionals providing services to a client.101
However significant training and management of change is required to support the
introduction of these initiatives.
Training incentives
Incentives to choose nursing degrees are being offered by the Commonwealth
Government, whereby nursing graduates who go on to work in the nursing
profession have their compulsory HECS HELP debt repayments significantly
reduced.103
Aged Care reform
The Commonwealth Government has announced that it will assume full funding and
policy responsibility for aged care and it has allocated more than $310 million over
four years for a combination of workforce programs, including additional nursing
places and scholarships, incentive payments for the aged care workforce to
undertake additional training and/or upgrade qualifications and the introduction of
the Aged Care Nurse Practitioner Program. In response to this funding
announcement the budget review notes that complementary strategies are also
required such as offering positive remuneration to draw practitioners to areas where
skills are most needed.104
The Productivity Commission released a report on ‘Caring for Older Australianss in
June 2011’ which recommended proposals to assist with workforce issues in the
aged care sector including, scheduling prices for aged care to enable fair and
competitive wages to be paid to the workforce, expanding accredited courses to
increase skills, expanding ‘teaching aged care services’ to promote the sector,
providing appropriate training for personal carers, medical, nursing, allied health
students and professionals and reviewing delivery and outcomes of aged care
related vocational education and training courses by registered training
organisations.105
Succession planning
While succession planning has traditionally focussed on executive and senior
management positions, it can also be extended to all levels of an organisation.
Organisations that have embraced succession planning have found that it helps
identify management talent and capabilities, establishes a broad base of leadership
ready to take on new challenges, and avoids the disruption that can result from ill102Australian
Health Workforce Advisory Committee and Australian Medical Workforce
Advisory Committee: Technology & Health Workforce Planning, 2005
103 Commonwealth of Australia: Transforming Australia’s Higher Education System 2009
104 Parliamentary Library: Budget Review 2010-11
105 Productivity Commission: Caring For Older Australians 2011
37
timed promotions and inadequately prepared managers. Succession planning also
addresses both sides of the recruitment and retention equation, drawing people to
the organisation and making it easier to fill senior positions from within.
Succession planning can be approached as replacement planning, in which
managers identify and help groom their replacements before moving on to another
position themselves. Leadership transition planning focuses on planning for the
transition of the top two or three positions in an organisation, and continuity or
leadership development planning takes a broader assessment of management
talent throughout the organisation without attempting to identify single individuals to
fill specific positions.106
Local Initiatives
The first Health Directorate Workforce Plan (2005-2010) has already initiated a large
number of successful initiatives (See Attachment 2).
Health Infrastructure Program: ‘investing in Canberra’s Health’
The ACT Government is currently overseeing a major redevelopment of health
facilities in the ACT. These initiatives will require a mix of additional staff, additional
skills and workforce redesign including new models of care.
The Health Infrastructure Program: Investing in Canberra’s Health is a
comprehensive range of services, including hospitals, community health, mental
health, cancer services, aged care and rehabilitation services. This includes
provision of home based and remote monitoring and use of technologies to support
mobile health workers. The implementation of new technologies is expected to lead
to safer treatment with improved quality of care for patients and better
communication and collaboration between clinicians and services. It is anticipated
that better organisation of workflow and significant time savings will result from the
introduction of mobile nurse call systems and laboratory service alert systems.107
Expanded facilities are necessary to meet the future needs of the ACT community.
New facilitates completed or underway at the Canberra Hospital (TCH) include an
Adult Mental Health Unit, a Mental Health Assessment Unit, a Adolescent and
Young Adult Mental Health Inpatient Unit, a new Neurosurgery Suite, a 16 bed
Surgical Assessment and Planning Unit and a new Women and Children's Hospital.
Future planned developments include a new acute services building which will
include an Emergency, ICU /High Dependency Unit (HDU) and acute inpatient
units, and a Centre for Health Teaching, Training and Research. The development
will also include the expansion of of diagnostic and treatment services which include
new Medical Imaging, expanded interventional suites and development of a digital
mammography system.
A sub-acute hospital is also planned to be built on the north side of Canberra.108
106
Rollins, G.: Succession planning: Laying the foundation for smooth transitions and effective
leaders in Healthcare Executive Vol 1(6),2003
107 The Nexus Consortium: ACTGHD: Digital Health Enterprise Technology Strategy and
Implementation Plan Version 1.2 2010
108 ACT Government Chief Minister: Media Release: New North Side Hospital, May 2011
38
Within the community, planning includes a new community health centre at
Gungahlin, redevelopment of the existing community health centres, potential for
Walk in Centres (WICs) in community health sites, expansion of two health centres
into enhanced community health centres including expanded clinical, diagnostic,
acute and post acute services, and an upgrade of Brian Hennessy House
Rehabilitation Centre.
The ACT is investing in new technology to support the Health Infrastructure Program
with planned integration of information and communication technologies and medical
equipment, including clinical systems, communication systems, clinical devices,
controls over the physical facilities, imaging services and information management.
This integration will extend across all services and will include home based and
remote monitoring and technologies to support mobile health workers.109 This ehealth program will further complement and connect with the computerisation of GP
services. The new technology is expected to enable secure and coordinated
information sharing and teamwork between the different parts of the health system,
resulting in improved quality of care and improved patient outcomes.110 Detailed
planning is currently underway for the integration of technology into future health
service delivery.
Part time Nursing Graduates
With increasing numbers of new nursing graduates, the Health Directorate is offering
new nursing graduates the option to work part time.
109
The Nexus Consortium: ACTGHD: Digital Health Enterprise Technology Strategy and
Implementation Plan Version 1.2 2010
110 ACT Government media release: Electronic Transfer of Prescriptions (ETP) way of the future 2010
39
GP Initiatives
The GP Taskforce recommendations have led to the commencement of the
following initiatives:






A GP Marketing Support Officer position has been established;
Education Infrastructure Support Grant payments are being offered to support
GPs teaching undergraduate medical students;
Scholarships are being offered to provide incentives to train in general
practice;
The GP Prevocational Placement Program supports junior doctors to
experience general practice as one of their medical rotations;
A GP Development Fund is providing one-off incentive payments to GP
practices for initiatives to attract staff, enhance practices and establish new
services;
A business-hours GP aged day service has commenced to assist GP
practices to provide care to people who cannot travel easily (such as
residents of aged care facilities) and reduce pressure on after-hours services
and ACT emergency departments.
Models of Care
Service growth offers opportunities to review and change work practices to use
existing staff more efficiently, develop new work flow practices, develop new roles,
extend existing roles and review skill mix requirements. The Health Directorate has
progressed a number of initiatives including role extension, support positions and
innovative service changes.
Role extension
Role extension is being increasingly explored and implemented to meet client
needs, reduce workforce pressures and improve clinical career structures. Nonphysician clinicians working as substitutes or supplementing physicians in specific
roles have been found to maintain, and sometimes improve the quality of care and
the outcomes for patients. Revision of roles appears to be acceptable to patients
and physicians.111
The Health Directorate has conducted several projects to trial, implement and
assess extended scope roles across the health sector, including nurse practitioners
who are registered nurses educated and authorised to function autonomously and
collaboratively in advanced and extended roles. This role includes assessment and
management of clients using nursing knowledge and skills and may include direct
referral of patients to other health care professionals, prescribing medications and
ordering diagnostic investigations.112 Following successful trials, the number of
nurse practitioners has grown in the ACT and the number is likely to continue to
expand.
111
Laurant et al: Revision of professional roles and quality improvement: a review of the evidence,
2010
112 Office of the Chief Nurse, Nursing & Midwifery, ACTGHD Nurse Practitioners in the Australian
Capital Territory: The Framework, 2008
40
Extended Scope of Practice (ESP) Physiotherapy trails are being conducted in the
Orthopaedic and Emergency departments at TCH.
In the orthopaedic trial, new referrals are triaged and referred to physiotherapy, a
multidisciplinary specialist clinic, or, where the problem has resolved or been treated
elsewhere, they are removed from the waiting list. The Orthopaedic ESP
physiotherapist provides independent caseload management and has undergone
training to order and interpret medical imaging, prescribe limited analgesia and inject
joints. Preliminary data is showing reduced waiting times for outpatient orthopaedic
appointments, improved access to appropriate care for patients and that these
extended scope interventions have been shown to be safe and effective and
accepted by patients and colleagues. The project has also proved cost-effective,
supporting better utilisation of consultant skills by ensuring that they only see clients
who are most likely to require their specialised services.113,114
In the emergency department trial, the ESP physiotherapist is managing
musculoskeletal injuries and simple fractures, interpreting x-rays, prescribing simple
analgesia and injecting local anaesthetics for relocation of small joint dislocations.
Preliminary data indicate that 94% of patients referred to the ESP physiotherapist
are treated and leave the ED within 4 hours and that the productivity of the ‘in scope’
physiotherapists working in ED is also enhanced.115
Support Positions
The number of allied health assistants in the Health Directorate is rising slowly and
most assistants now have formal qualifications. The literature is sparse, but there is
some evidence that allied health assistants have increased access to care for some
clients, reduced length of stay, led to faster improvement due to additional
rehabilitation input and increased the percentage of patients able to be discharged
straight home instead of being discharged to a high level care facility. Allied health
professionals have also been freed up to undertake a greater range of services and
to concentrate more on providing complex treatments to a greater range of
patients.116
In the Health Directorate, assistants are being used to run group sessions for groups
of people assessed as having the same needs. In one instance it was found that
changing to a class based intervention for post operative exercise needs for total
knee replacements (TKR) led to an overall 36% improvement in staffing efficiency
compared to standard practice in treating TKR and specifically led to a 79%
reduction in physiotherapist hours spent treating clients with TKRs117 and the
classes were well accepted by clients. This type of initiative has the potential for
113
Morris et al: Effectiveness of a physiotherapy-initiated telephone triage of orthopaedic waitlist
patients; Patient Related Outcome Measures 2011
114 Gilmore et al: Skills escalator in allied health: a time for reflection and refocus; Journal of
Healthcare Leadership 2011
115 Morris, J. PowerPoint presentation (unpublished) May 2012
116 ACT Health Directorate: Evaluation of the impact of up skilling ACTGHD Technical Officers
working in Speech Pathology, Physiotherapy and Occupational Therapy 2009
117 Quality Improvement Activity Report for 'Implementation of Circuit Class for Post Total Knee
Replacement (TKR) Patients referred to Continuing Care Physiotherapy' July 2009 (Unpublished)
41
expansion to other treatment groups and disciplines where appropriate and assists
in making better use of the skill mix available.
In 2011-12 Therapy ACT will be piloting a new model of service using therapy
assistants for students with disabilities in schools.118
Innovative service changes
A number of innovative service changes are occurring within the Health Directorate,
including:




The new WIC is staffed by nurses who provide free one-off advice and
treatment for people with minor illness and injury;
The ‘Care around the Clock’ project recently examined current services,
staffing and demand at the Canberra Hospital and analysed and proposed
services, systems and staffing across 24 hour service delivery. The findings
are being used to inform future improvement work and rolled into an overall
plan for the Canberra hospital campus;119 and
The Rapid Assessment of the Deteriorating Aged at Risk program (RADAR)
is a rapid response program to support older people in the community, when
they are becoming unwell and their own GP requires assistance with medical
management.120 In 2009-10 the RADAR service helped to potentially avoid
admission to hospital for 78% of all patients seen by the service. Patients that
did require admission were directly admitted to the Medical Assessment and
Planning Unit, or into the private hospital system under the care of a
geriatrician, thus avoiding admission to the Emergency Department. The
service has been expanded by the recruitment of an additional staff specialist
geriatrician, an additional RN and an occupational therapist. Access to the
service has also been broadened to include referrals from RAC facilities,
providing the GP has consented.121
As part of the ambulatory planning process, suitable Health Directorate
services currently based at a hospital will be gradually relocated into
community health centres. The aim is to provide tertiary level services on
hospital grounds and non tertiary/non-acute services in the community
setting.
Developing and supporting the consumer, carer and volunteer workforce
The mental health sector is building their consumer and carer workforce including
establishing a scholarship program for consumers to study certificate IV in mental
health and supporting consumers and carers to take on valued paid and volunteer
roles in all areas of planning, development, governance, management, delivery, and
evaluation of services across the mental health sector. It is anticipated that the
118
ACT Government Community Services Website 07/11/2011
ACT Health Directorate: Care Around the Clock project (Accessed 02/12/2011)
120 ACT Government (Health) RADAR Web Page 2011
121 ACT Health Directorate Annual Report 2009-10
119
42
consumer and carer workforce will offer additional support options not reliant on
specialist professionals.122
Where viable and appropriate, Health Directorate workers in the community can
provide education, support and training for carers who choose to provide care
including technical care.123
Chronic disease self-management (CDSM) is the active participation by people in
their own health care. A joint Health Directorate and Arthritis ACT program offers
training for people with chronic diseases on living a healthy life with long term
conditions.124
Volunteers enjoy an increased sense of belonging to their community, as well as
opportunities to use their skills, to make a difference to the organisation’s work, and
to learn and develop. Volunteers also find that volunteering assists them to find paid
employment. The available supply of suitable volunteers and limited organisational
capacity are the most common barriers to involving volunteers reported by
organisations. There is also a need to introduce new and different approaches to
promoting volunteering.125
Discussion Points:
1. Do you believe there is enough investment already underway to meet
the health workforce challenge?
2. Are there other areas of the workforce challenge that you believe needs
closer attention?
122
ACT Health Directorate Mental Health Services Plan 2009 - 2014
ACT Health Directorate Support & Training for Carers policy (internal document)
124 ACT Health Directorate: Chronic Conditions- Living a Healthy Life with long term conditions
accessed 17/06/2011
125 Volunteering Australia: National Survey of Volunteering Issues 2010: Preliminary Findings –
Summary
123
43
13.
Key Strategies for further exploration
Overarching principles
Workforce planning and retention strategies should be cost effective, resilient,
proactive, ethical, equitable, accountable and appropriate and support provision of
the right service to the right person at the right time and in the right place. Consumer
and population needs must provide the main driving force for workforce change.
The following overarching strategies are aligned under the domains provided in the
Health Workforce Australia National Health Workforce Innovation and Reform
Strategic Framework for Action 2011-2015. The ACT will be collaborating with the
national workforce reform program to meet the health workforce needs into the
future.
These strategies are recommended to provide a framework for workforce planning
and retention within the Health Directorate. The strategies are based on the local
input provided to inform preparation of this paper, the findings from the literature and
the national workforce reform strategies.
These strategies may also assist other health services based in the ACT in
workforce planning activities.
Workforce planning strategies
Domain 1: Health workforce reform for more effective, efficient and accessible
service delivery.
Objective: Reform health workforce roles to improve productivity and support more
effective, efficient and accessible service delivery models that better address
population health needs.
Strategies under Domain 1
 Introduce more efficient technologies;
 Develop strategies to meet service gaps;
 Increase use of volunteers and use volunteers more effectively;
 Provide time and support for planning and change management;
 Support inter-professional collaboration;
 Increase productivity and retention of the existing workforce;
 Support all health disciplines to work to their full or extended scope of
practice;
 Utilise the assistant and support workforce more efficiently;
 Collaborate with national initiatives to investigate models of workforce
reform, policy and funding options that are inclusive of private and NGO
providers;
44
 Collaborate with national initiatives to develop cross-discipline guidelines for
regulation of redesigned roles, expanded scopes of practice and
accreditation of supporting training programs.
Domain 2: Health workforce capacity and skills development.
Objective: Develop an adaptable health workforce equipped with the requisite
competencies and support to provide team-based and collaborative models of care.
Strategies under Domain 2
 Make better use of skills in the workplace;
 Empower consumers and expand client self-care options;
 Collaborate with national initiatives to increase education and training
options including inter-professional strategies, articulation across education
programs, increased re-entry points to training and career paths;
 Promote health careers and build programs in schools and workplaces;
 Work with tertiary institutions to ensure that education and training programs
prepare the workforce to deliver culturally appropriate and safe health care
in all settings;
 Facilitate the uptake of technologies that enhance workforce practice and
productivity with an emphasis on underserved communities and populations;
 Expand clinical training placements in underserved and non-traditional
settings.
Domain 3: Leadership for the sustainability of the health system.
Objective: Develop leadership capacity to support and lead health workforce
innovation and reform.
Strategies under Domain 3
 Make succession planning part of core business;
 Encourage continuity of leadership;
 Collaborate with the development of national health workforce leadership
competencies;
 Support the leadership capacity of the Aboriginal and Torres Strait Islander
workforce;
 Support, promote and sustain inter-professional practice and workplace
learning.
45
Domain 4: Health Workforce Planning.
Objective: Enhance workforce planning capacity, taking account of emerging health
workforce configuration, technology and competencies.
Strategies under Domain 4
 Develop targeted retention and attraction strategies for small and hard-to-find
professions;
 Drive workforce change based on consumer and population needs;
 Develop incentives for retired workers to return to part time employment;
 Improve the capacity and accessibility of workforce information among
managers and staff;
 Collaborate in the development of a national health workforce planning
approach and national health workforce tools;
 Contribute health workforce data to a National Statistical Resource.
Domain 5: Health workforce policy, funding and regulation.
Objective: Develop policy, regulation, funding and employment arrangements that
are supportive of health workforce reform.
Strategies under Domain 5
 Lift the workforce participation rate by encouraging and supporting more
people to enter, re-enter, extend working hours and remain in the workforce;
 Support the capacity of the tertiary education sector to deliver skills training;
 Develop a partnership approach to workforce development between
government, industry and private enterprise;
 Facilitate increased collaboration between organisations;
 Revise exit data collection methodology;
 Encourage and support bottom-up workforce change initiatives;
 Utilise the new Integrated Regional Clinical Training Network to improve
training opportunities;
 Make care of the health workforce part of core business;
 Work with HWA to identify system wide changes required to achieve a
balance between generalism and specialism;
 Identify policy, financial and non-financial mechanisms which enable the most
cost-effective, efficient deployment of the health professional workforce;
 Work with HWA to maximise retention of clinical training supervisors across
disciplines by addressing policy, regulatory and other mechanisms;
 Collaborate with national legislative and regulatory reforms to facilitate
appropriate mobility of the health workforce across professions and the
implementation of expanded scopes of practice;
46
 Collaborate with national legislative and regulatory reforms to address
legislative, regulatory, industrial and other barriers to minimise inefficiency
and duplication and to achieve greater workforce ability to respond to the
health needs of the community;
 Collaborate with national legislative and regulatory reforms to address
remuneration, payment arrangements and terms and conditions to support
workforce models that increase accessibility, improve workforce retention and
productivity and encourage inter-professional practice.
Discussion Points:
1. Do you agree with these strategies?
2. Are there other strategies that you believe should be considered?
47
14.
Glossary
AIN:
Assistant in Nursing
ACT:
Australian Capital Territory
ACTGHD:
ACT Government Health Directorate
AIHW:
Australian Institute of Health & Welfare
ACTDGP:
ACT Division of General Practice
CSS:
Commonwealth Superannuation Scheme
CCU:
Coronary Care Unit
EN:
Enrolled Nurse
EL:
Executive Level
ESP:
Extended Scope of Practice
FTE:
Full Time Equivalent
GP:
General Practitioner
HP:
Health Professional
HDU:
High Dependency unit
HWA:
Health Workforce Australia
ICU:
Intensive Care Unit
IMG:
International Medical Graduate
NHMRC:
National Health and Medical Research Council
NSW:
New South Wales
NGO:
Non Government Organisation
RAC:
Residential Aged Care
RADAR:
Rapid Assessment of the Deteriorating Aged at Risk
RN:
Registered Nurse
SES:
Senior Executive Service
48
TCH:
Canberra Hospital
TKR:
Total Knee Replacement
VET:
Vocational Education & Training
VMO:
Visiting Medical Officer
WIC:
Walk in Centre
49
15.
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Organisational Renewal, 2003
Australian Government: State of the Service report 2009-10
Australian Health Workforce Advisory Committee and Australian Medical Workforce
Advisory Committee: Technology & Health Workforce Planning, 2005 E-Health
website http://www.ehealthinfo.gov.au/
Axelsson & Axelsson: Integration and collaboration in public health/10.1002/hpm.8
framework 2006
Birrell: Centre for population and Urban Research, Monash University: Australia’s
New Health Crisis: Too Many Doctors
Bureau of Labor Statistics: Fastest Growing occupations 2008-2018 (USA)
Centre for Health Services Management / ACT Health Nursing Workload and
Staffing: Impact on Patients & Staff, 2009
COAG Reform Council: National healthcare Agreement Performance Report for
2009-10 2011
COAG: National Partnership Agreement on Hospital & Health Workforce Reform
2009
Commonwealth of Australia: Intergenerational Report: Australia to 2050: future
challenges 2010
Commonwealth of Australia: Transforming Australia’s Higher Education System
2009
Community Services & Health Industry Skills Council: Environmental Scan 2010
Council for Equal Opportunity in Employment (CEOE) survey cited by The Australian
Governments Equal Opportunity for Women in the Workplace Agency
DEEWR: Skill Shortage List, Australia 2011
Department of Health & Ageing: Doctor connect Website- Provider number
restrictions 2007
52
DOHA: Survey of the Pathology Workforce: 2011
Department of Immigration and Citizenship: Migration Occupations in Demand List
2010
DEST: The Nursing Workforce 2010
Dwan, Kathryn, Douglas, Kirsty, Forrest, Laura and Res, Sonia: Part time GP’s:
scourge or saviour of general practice?: Poster
E-Health website http://www.ehealthinfo.gov.au/
Fair Work Australia Decision- Equal Remuneration Case: Australian Municipal,
Administrative, Clerical and Services Union and others 2011
Gilmore et al: Skills escalator in allied health: a time for reflection and refocus;
Journal of Healthcare Leadership 2011
Heads of Agreement- National Health Reform 2011
Health Workforce Australia: Workload Measures for Allied Health Professionals
accessed 16/06/2011
HWA Website http://www.hwa.gov.au/
HWA: National Health Workforce Innovation and Reform Strategic Framework for
Action 2011-2015
Kidney Health Australia: Home Haemodialysis- A treatment Option
Laurant et al: Revision of professional roles and quality improvement: a review of the
evidence, 2010
Live in Canberra Program Welcome to Canberra Events Survey 2006-2010
(Unpublished)
MA000018 - Aged Care Award 2010
Medical Deans Australia & New Zealand: 2010 Medical Students Statistics
Medical Deans Australia & New Zealand: Media Release: Keep Medical Student
Numbers on hold 13th April 2010
Morris et al: Effectiveness of a physiotherapy-initiated telephone triage of
orthopaedic waitlist patients; Patient Related Outcome Measures 2011
National health Workforce Innovation and Reform Strategic Framework for Action:
National Consultation: In draft
53
National Institute of Labour Studies: Who works in Community Services? 2010
NCVER Australian vocational education and training statistics: Apprentices and
trainees: September quarter 2010
NHWT: Health Workforce in Australia and factors for current shortages 2009
NSW Health Priority List for Intern Allocation 2012
Office of the Chief Nurse, Nursing & Midwifery, ACT Health Nurse Practitioners in
the Australian Capital Territory: The Framework, 2008
Pabayo et al: Flexible working conditions and their effects on employee health and
wellbeing (Cochrane Review) 2010
Parliament of Australia; Australia’s Ageing Workforce 2005
Parliament of Australia- House of representatives: Lost in the Labyrinth Report on
the inquiry into the registration processes and support for overseas trained doctors
2012
Parliamentary Library: Budget Review 2010-11
Productivity Commission Research Report: Contribution of the Not for Profit Sector
2010
Productivity Commission: Report on Government Services 2010
Productivity Commissions: Caring For Older Australians 2011
Rankin et al: A review of service delivery and clinical outcomes at public maternity
units in the Australian Capital Territory, 2010
Rollins, G.: Succession planning: Laying the foundation for smooth transitions and
effective leaders in Healthcare Executive Vol 1(6), 2003
Royal Australasian College of Surgeons: Australian Capital Territory Surgeons 2009
Census
Schoo et al, A conceptual model for recruitment and retention: Allied health
workforce enhancement in Western Victoria, Australia: Rural & Remote Health
(Online) 2005
Segal & Bolton: Issues facing the future health care workforce: the importance of
demand modelling, Australia and New Zealand Health Policy, 2009
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Strategy, 2010
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54
and Implementation Plan Version 1.2. 2010
Twigg et al, The impact of the nursing hours per patient day (NHPPD) staffing
method on patient outcomes: A retrospective analysis of patient and staffing data,
International Journal of Nursing Studies: 2010 Aug 7. [Epub ahead of print]
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30 fastest-growing occupations, 2008-18
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factor for depression 2010
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Findings – Summary
Workforce Pressures Report May 2010 (Internal Health Directorate Document)
55
Attachment 1: List of Submissions received to assist preparation
of the Discussion Paper
Written Submissions
External
ACT Ambulance Service
ACT Council of Social Services (ACTCOSS)
ACT Division of General practice (ACTDGP)
Australian Health Promotion Association
(AHPA): ACT Branch
Australian Nurses Federation (ANF)
Australian Salaried Medical Officers
Federation (ASMOF)
Capital Pathology
Canberra institute of Technology (CIT)
Community & Public Sector union (CPSU)
Disability ACT
Healthcare Consumers Association (HCCA)
Mental health Community Coalition (MHCC)
Royal College of Pathologists of Australia
Speech Pathology Australia
Therapy ACT
Health Directorate
ACT Chief Nurse
Health Directorate Speech Pathology
ACT Lyphoedema Service
Calvary Public Hospital
Capital Region Cancer Service
Continuing Care Nutrition
Continuing Care Nursing
Information Management
Interprofessional Learning Coordinator
Patient Safety & Quality Unit
Staff Development Unit
TCH Pharmacy
TCH Psychology
TCH Social Work
Transitional Therapy & Care Service
Verbal Feedback
External
ACTCOSS
HCCA
Mental health Community Coalition (MHCC)
Morsehead RAC facility
Private Speech Pathologist
ACTGHD
Acute support
Aged care & Rehabilitation Service
Business & Infrastructure
Clare Holland House (Palliative Care)
Government Relations, Planning &
Development Unit
Women with Disabilities
Youth Coalition of the ACT
ACT & Southern Tablelands Regional
Committee & DONs meeting
56
Attachment 2: Achievements & Initiatives related to 2005-2010
Workforce Plan
The 2005-2010 Workforce Plan supported ACTGHD to:

Initiate a range of research projects on workforce redesign, extended job roles
and extended scopes of practice within the allied health, nursing and midwifery
disciplines

Establish Nurse Practitioner Roles

Establish Allied Health Assistant Roles

Introduce new workforce practice models for enrolled nurses

Introduce safe working-hours arrangements for the medical profession

Introduce more versatile roster hours for nurses

Conduct an Occupational therapy workforce review

Conduct a Radiation Therapy Workforce Review

Collaborate with the Canberra Institute of Technology (CIT) to develop and
implement Certificate IV programs for Occupational Therapy Assistants,
Physiotherapy Assistants and Speech Pathology Assistants (2006-07)

Explore Nutrition & Podiatry Allied Health Assistants roles and participate in
developing a Certificate IV course for these groups

Participate in the CIT Advisory Committee and Program Reference group to
develop new curricula for enrolled nurse training

Participate in establishing an accelerated program for articulation from EN to RN
at the Australian Catholic University (2006)

Work with local higher education institutions to better align courses with
workforce needs

Conduct a feasibility study for the establishment of a Skills Development Centre
including simulation environments

Use the Special Employment Arrangement provisions for hard-to-recruit
professions, offering scholarships to students who agreed to work in ACT Health
upon graduation

Collaborate with the University of Canberra initiative to provide access to Clinical
Educators to undertake a Graduate Certificate in Tertiary Education (2008)

Commence Prevocational General Practice Placements Program (2008)

Establish Health Day Out careers day (2007)

Pilot a Mentoring Program for Early Career Researchers in the Allied Health
Professions
57

Establish an accredited medical specialist training program in paediatric surgery
and partnerships with the private sector for vocational training programs in
Psychiatry, general surgery and community rehabilitation and aged care

Support building the Allied Health School at the University of Canberra

Commence a trial of extended scope physiotherapy roles (2010)

Enhance partnerships with the tertiary education sector

Develop a rigorous learning and development strategy

Review the Health Directorate orientation program (2008-09)

Develop the Capabiliti training management system (2007-08)

Review the performance management system learning and development
strategy, resulting in streamlined training activities (2007-08)

Fund scholarship support to nurses, & midwives and (from 2007) allied health
professionals

Introduce Apprenticeships & Traineeships for Allied Health Assistants

Introduce a Leadership & Management development program (2008-09)

Introduce team development exercises

Establish the Medical Appointments and Training Unit (2006)

Establish the Student Clinical Placement Unit (2008)

Develop and launch the Student Placements Online Database

Commence a Managers Orientation Program

Commence a Stepping Up Program (2008)

Establish the Inter-professional Learning Coordinator and Program (2005)

Commence a Graduate Midwife Program (2006)

Commence an EN Graduate Program (2006)

Revise the EN Professional Development Program (2009)

Commence the Clinical Development Nurse/Midwifery Program

Provide support and resources for Diploma and Certificate courses in Nursing
and Midwifery

Introduce refresher programs for registered nurses/midwives

Introduce an overseas-qualified nurse program

Introduce a Paediatric non-health professionals programs

Introduce the Positive Professional Development Scheme
58
Attachment 3: Health Directorate workforce distribution by
classification June 2011
Nurses
Admin
Medical
Officers
720
Support
Services
442
Technical
Executive
1179
Allied
Health
955
20
Miscellaneous
Professionals
17
Head count
2363
202
FTE
2009.18
1085.59
837.25
620.65
397.03
% Female
90%
80%
80%
43%
Average age
43
42
40
% Part time
44%
17%
% Permanent
85.99%
% Casual
TOTAL
5898
158.91
19
14.99
5142.6
42%
73%
60%
76%
76.55%
39
42
43
49
41
41.5
28%
15%
20%
24%
0%
29%
30%
82%
83.35%
30.14%
78.28%
62.37%
30%
41.1%
76.21%
5.5%
4.83%
2.61%
1.11%
14.25%
26.2%
0%
0%
5.6%
% Temporary
8.51%
13.31%
14.03%
68.75%
7.47%
11.38%
70%
58.82%
18.09%
% of total
workforce
Average
tenure (years)
40.06%
19.99%
16.19%
12.21%
7.49%
3.42%
0.34%
0.29%
100.00%
7.77
7.20
7.06
4.02
7.16
5.48
11.47
7.59
6.97
59
Attachment 4: Health Directorate workforce distribution by age range
ACTGHD Workforce distribution by age range as at 22/09/10
700
600
500
400
300
200
100
0
<20
20_24
25_29
30_34
35_39
40_44
Female
Age
Range
Female
Male
Grand
Total
45_49
50_54
55_59
60_64
65+
Male
<20
21
8
20_24
256
61
25_29
579
122
30_34
522
183
35_39
532
213
40_44
528
176
45_49
579
145
50_54
615
155
55_59
429
112
60_64
191
70
29
317
701
705
745
704
724
770
541
261
Grand
65+
Total
48
4300
19
1264
67
5564
60
Attachment 5: Related ACT Government Health Directorate Service
Plans and strategies
ACT Health Directorate Corporate Plan 2010-2012
Health Directorate Sustainability Strategy July 2010
Critical Care Services Plan 2007-2011 (Under review)
Digital Health Enterprise Technology Strategy and Implementation Plan Version 1.2
2010
Diabetes Services Strategic Plan 2008-2012
Mental Health Services Plan 2009-2014
Renal Health Services Plan 2010-2015
Towards a Healthier Australian Capital Territory: A Strategic Framework for the
Population Health Division 2010–2015
61