allied health taskforce on workforce issues · director general, disability services commission and...

WESTERN AUSTRALIAN

ALLIED HEALTH TASKFORCE ON WORKFORCE ISSUES

Initial Report

June 2002

Acknowledgments It gives me great pleasure to submit this Initial Report on behalf of the Allied Health Taskforce on Workforce Issues. The Members of the Taskforce firstly acknowledge the initial support and enthusiasm of the Hon Sheila McHale and the Hon Bob Kucera for this project. Secondly, appreciation is expressed to Mr Mike Daube, Director General, Department of Health, Dr Ruth Shean, Director General, Disability Services Commission and members of the Allied Health Professionals’ Employers Group who committed financial and in-kind support for the Allied Health Taskforce on Workforce Issues project. The Taskforce is especially thankful for the time and effort of all allied health professionals, stakeholders and consumers who completed questionnaires, submissions or attended focus groups. A number of consumers of allied health services gave their time to attend the Taskforce consumer focus groups which were organised with the assistance of the Health Consumers’ Council. The Taskforce has greatly appreciated the involvement of Ms Moira Butler, Administrative Assistant, Women’s and Children’s Health Service, for her administrative support, and Dr Ann Larson and Ms Rhonda Owens, Combined Universities Centre for Rural Health for their invaluable assistance with the analysis of the questionnaire and survey results. Thank you to all the people who kept the Taskforce informed of other activities, articles and web sites, particularly Ms Cheryl Hamill, Librarian, Fremantle Health Service. The time and contribution of Taskforce members whose participation and commitment helped form the recommendations were greatly appreciated. Finally, thank you to Kendra Bell, Senior Project Officer, whose project leadership and management significantly shaped the content of the final report. Thank you to everyone. Angie Paskevicius Chairperson Allied Health Taskforce on Workforce Issues

Western Australian Allied Health Taskforce on Workforce Issues 2002

Contents

Acknowledgments

Executive Summary and Recommendations ........................................................................1

Members of the Taskforce .....................................................................................................9

Section One - Allied Health Taskforce on Workforce Issues.........................................10

1.1 Introduction ..........................................................................................................11

1.1.1 Background........................................................................................................11

1.1.2 Terms of Reference............................................................................................12

1.1.3 Objectives ..........................................................................................................13

1.1.4 Scope ..........................................................................................................13

1.2 Methodology ..........................................................................................................13

1.3 Analytical Strategy...................................................................................................16

1.3.1 Allied Health Vision ..........................................................................................16

1.3.2 Service Performance ..........................................................................................17

1.3.3 Workforce Systems............................................................................................17

1.3.4 Education and Support.......................................................................................18

1.3.5 Resourcing .........................................................................................................18

Section Two - Allied Health Workforce Profile ..............................................................20

2.1 Workforce Characteristics .......................................................................................21

2.1.1 Organisational Context ......................................................................................21

2.1.2 Allied Health Professions in the WA Workforce ..............................................21

2.1.2.1 Allied Health Professions ........................................................................21

2.1.2.2 Leave Relief .............................................................................................22

2.1.2.3 Vacancies .................................................................................................22

2.1.2.4 Turnover...................................................................................................22

2.1.2.5 Appointments...........................................................................................23

2.1.2.6 Hours of Employment..............................................................................23

2.1.2.7 Funding Sources.......................................................................................23

2.1.2.8 Support Staff ............................................................................................24

2.1.3 AHTWI Questionnaire.......................................................................................24

2.1.3.1 Professional Background .........................................................................24

2.1.3.2 Work Sector .............................................................................................25

2.1.3.3 Employment Status ..................................................................................25


2.1.3.4 Age and Gender .......................................................................................25

2.1.3.5 Age by Sector...........................................................................................26

2.2 Workforce Distribution................................................................................................26

2.2.1 State Health Employment Sector .......................................................................26

2.2.1.1 Metropolitan Distribution by Profession .................................................26

2.2.1.2 Rural Distribution by Profession .............................................................26

2.2.2 Disability Employment Sector...........................................................................27

2.2.2.1 Disability Services Commission Distribution..........................................27

2.2.2.2 Disability Funded Non-Government Organisations Distribution ............27

2.2.3 Population Ratios ...............................................................................................28

2.2.3.1 Number of Allied Health Professionals per 100,000 ...............................28

2.2.3.2 Projected Population Growth...................................................................28

2.3 Workforce Supply....................................................................................................29

2.3.1 AHTWI University Survey ................................................................................29

2.3.1.2 Undergraduate Training ...........................................................................29

2.3.1.3 Postgraduate Training and Continuing Professional Development .........30

Section Three - Recommendations Towards a Strategic Workforce Plan ...................32

3.1 Introduction ..........................................................................................................33

3.2 Allied Health Vision ...............................................................................................34

3.2.1 Recommendations to Enhance Allied Health Vision.........................................35

3.2.2 Taskforce Findings.............................................................................................36

3.2.2.1 Community and Industry Awareness.......................................................36

3.2.2.2 Allied Health Unity..................................................................................37

3.2.2.3 Allied Health Representation...................................................................38

3.3 Service Performance ...............................................................................................40

3.3.1 Recommendations to Enhance Service Performance ........................................41


3.3.2.1 Support for Service Provision..................................................................42

3.3.2.2 Meeting Community Needs .....................................................................43

3.3.2.3 Service Delivery Quality..........................................................................44

3.4 Workforce Systems..................................................................................................46

3.4.1 Recommendations to Enhance Workforce Systems ..........................................47


3.4.2.1 Salary and Conditions ..............................................................................48

3.4.2.2 Career Structure .......................................................................................50


3.4.2.3 Workforce Planning Mechanisms............................................................51

3.5 Education and Support.............................................................................................54

3.5.1 Recommendations to Enhance Education and Support .....................................55


3.5.2.1 Education and Support Needs..................................................................56

3.5.2.2 Provision of Education and Support ........................................................58

3.5.2.3 Research Needs........................................................................................60

3.6 Resourcing ..........................................................................................................62

3.6.1 Recommendations to Enhance Resourcing........................................................63


3.6.2.1 Current Funding of Allied Health Services .............................................63

3.6.2.2 Funding of Best Practice Services ...........................................................65

Section Four - Implementation Plan for the Allied Health Strategic Workforce Plan ........................................67

4.1 Plans for Implementation Development ..................................................................68

4.2 Next Steps – Implementation Preparation Phase July – December, 2002..............68

4.2.1 Cross Sector Developments ...............................................................................68

4.2.2 Health Sector Developments..............................................................................69

4.2.3 Disability Sector Developments ........................................................................69

4.2.4 Hospital Salaried Officers Association..............................................................69

4.3 Additional Implementation Recommendations .......................................................70

4.3.1 Allied Health Professionals Employer Developments.......................................70

4.3.2 Allied Health Professionals Developments .......................................................70

Section Five - Bibliography ...............................................................................................71

Section Six - Appendices....................................................................................................76

APPENDIX A Submissions and Literature Submission Proforma Submission Sources Submission Summary Literature Summary

APPENDIX B Questionnaire APPENDIX C Surveys and Groups

Consumer Focus Groups Summary Organisation Survey Organisation Data Summary University Survey Working Groups Participants Working Groups Strategies and Activities


Executive Summary The Allied Health Taskforce on Workforce Issues (AHTWI) was established to develop a strategic workforce plan for Western Australian allied health professionals (AHPs). For the first time it brought together information regarding 1,544 allied health professionals (full time equivalents) working in both the health and disability sectors in recognition of the need for a collaborative and strategic approach to workforce issues. Allied health professionals are recognised as an essential component of health and disability services contributing extensively to the missions and objectives of Western Australian health and disability sectors. They comprise almost 6% and almost 7% of the workforce of DoH and DSC respectively and almost 20% of NGOs. However, shortages of AHPs and the lack of a coordinated and strategic approach to workforce planning have been long term issues resulting in high community and economic costs. This project was funded by the Disability Services Commission (DSC), the Department of Health (DoH) and the Allied Health Professionals Employers’ Group (AHPEG). The project objectives were to develop a strategic workforce plan for the allied health professions in the health and disability sectors, and to make recommendations for immediate action, implementation and further investigation. The Taskforce undertook a high level of consultation and involvement with members of ten allied health professions, consumers and stakeholders to meet its objectives. The project was designed to analyse workforce issues within five strategic themes: allied health vision, service performance, workforce systems, education and support and resourcing. Each of the terms of reference was addressed within one or more of these five key themes. The findings of the AHTWI organisational survey confirm the concerns expressed in the AHPEG position paper of May, 2001, with the most startling finding that the number of vacancies has more than doubled since that review. The lack of a coordinated and strategic approach to workforce planning and an inadequate supply of well trained AHPs to meet current and projected population growth requirements were confirmed as continuous major contributing factors to the increasing shortage. The organisational survey results, literature review and sixty submissions further confirmed many of the findings of previous studies about the characteristics, distribution, funding and support arrangements of the Western Australian allied health workforce. AHTWI received responses to the workforce questionnaire from more than half of the identified allied health workforce. The reasons cited by respondents for leaving positions in the recent three years were to develop different skills, lack of management and supervision support structure, high workload demand and working conditions and hours. The literature related to the general workforce and these findings regarding AHPs in WA are congruent. The work of the Taskforce was limited by the short timeframe for the project, which was compounded by the delay in receiving the data from some of the contributing agencies and subsequent delay in the analysis of the data. The limited response to the widely distributed questionnaire to the university sector meant that supply issues of undergraduate AHPs were unable to be fully explored. The additional limitation of the poor data integrity provided by


some organisations, reducing its usefulness and applicability, diminished the ability to provide a more extensive profile of the allied health workforce. Given the evidence of substantial confirmation of previous findings, the startling finding of the doubling of vacancies since the 2001 paper and the limitations with the data, it is imperative that a further three months’ implementation preparation phase be funded immediately. This will provide an opportunity to consider the full evidence and to allow the Taskforce members to address the requirements and costing of implementation. The Taskforce findings demonstrate the complex nature of recruitment and retention for allied health professionals and reinforce the consistent nature of many issues across both the health and disability sectors. As a result, the initial report has been prepared detailing the recommendations, strategies and an implementation phase to specify requirements to address the findings of the AHTWI.

GOVERNING PRINCIPLES The Allied Health Taskforce on Workforce Issues, established as a partnership between health and disability, aimed to foster an approach based on a set of governing principles to guide and underpin all future workforce planning and service development. In keeping with this approach, all recommendations and strategies contained in this Report should be addressed in a manner which meets each of the following governing principles: active community and stakeholder participation; partnerships within and across sectors; collaboration; coordination; transparency; accountability; equity; communication.

Active community and stakeholder participationPartnerships within and across sectors

CollaborationCoordinationTransparencyAccountability

EquityCommunication

Western Australian Allied Health Taskforce on Workforce Issues 2002 - 2 -

RECOMMENDATIONS Overarching Recommendation

Recommendation One

The AHTWI strongly recommends an overarching initial course of action that the DoH and DSC immediately fund a three months’ implementation preparation phase to address the requirements and costings to implement all recommendations.

Additional recommendations are grouped according to five strategic themes: Recommendations to Enhance the Allied Health Vision

Recommendation Two

That the following vision be adopted by DoH, DSC and the NGO disability sector for AHPs in WA:

All Western Australians have access to high quality allied health services.

Allied health services are provided by a workforce that is dynamic, collaborative, qualified, skilled and recognised for their contribution to the well being of the community.

Recommendation Three

There is effective integration within DoH, DSC and the NGO disability sector of allied health at policy, strategic and operational levels.

Strategies

Define the concept of “allied health” and promote to industry and the community.

Identify and implement models for allied health representation at all levels within and across the health and disability sectors.

Increase lobbying for the allied health sector.

Recommendation Four

There is unity of allied health professions supported by the establishment by DoH and DSC of a peak representative body.

Strategies

Establish a peak association for all allied health professions through a facilitated process with current representative groups and professional associations.


Communicate and promote the characteristics and values of allied health professionals that support increased unity.

Recommendation Five

There is effective marketing of allied health services by DoH, DSC and the NGO disability sector.

Strategies

Investigate marketing strategies to improve industry and consumer perception and understanding of the contribution of allied health to the well being of the community.

Develop one voice and a consistent message for allied health.

Recommendations to Enhance Service Performance

Recommendation Six

There is an effective mix of support systems for allied health services within DoH, DSC and the NGO disability sector.

Strategies

Determine core professional activities and non-core professional activities performed by allied health professionals in each sector and identify their cost and impact.

Identify existing support systems for allied health and opportunities to utilise supports more equitably and efficiently.

Develop guidelines for management structures that best support the needs of allied health professionals.

Develop professional supervision guidelines that best support allied health professionals.

Recommendation Seven

Allied health services within DoH, DSC and the NGO disability sector are flexible and meet the needs of the local community.

Strategies

Establish consistent service delivery core business statements at all levels.

Develop formal processes and structures to support secondments and rotation of allied health professionals within organisations, between organisations and across sectors.

Assist allied health professionals to develop skills that will increase their capacity to adapt to changing needs and circumstances.


Recommendation Eight

Allied health services within DoH, DSC and the NGO disability sector are delivered consistent with best practice principles.

Strategies

Identify and develop best practice principles for service delivery across a range of settings and service delivery models.

Recognise the benefits of developing speciality skills and support workforce access to speciality resources.

Investigate the most effective means of ensuring allied health professionals maintain appropriate standards of practice.

Recommendations to Enhance Workforce Systems

Recommendation Nine

There is relative parity of salary and conditions within DoH and DSC and across the health and disability sectors.

Strategies

Identify mechanisms to ensure relative parity of salary and employment conditions across sectors for the allied health workforce.

Explore how key employment conditions for allied health can be developed eg right of private practice, professional development.

Investigate options to reduce barriers to work flexibly across services and across sectors (eg secondments, rotation between services).

Improve the allied health workforce awareness and understanding of their terms and conditions of employment.

Recommendation Ten

Allied health professionals within DoH, DSC and the NGO disability sector have access to a multifaceted career structure.

Strategies

Establish competency based career progression including;

Improved recognition of professional supervision.

Improved progression through classification structure.

Recognition for qualifications / sole practitioners.

Identify and facilitate the development of a range of career development opportunities at senior and base grade levels for both clinical, management and research streams.


Recommendation Eleven

There is ongoing allied health workforce planning by DoH, DSC and the NGO disability sector.

Strategies

Develop systems and processes that will support the workforce planning needs of allied health professions including undergraduate, practising professionals and professionals not currently in the workforce.

Establish a national minimum data set of core workforce data to be used for workforce planning across industry and within agencies.

Seek acknowledgment of the essential nature of allied health workforce planning by executive and government across health and disability sectors to ensure inclusion in their strategic planning.

Increase participation of allied health undergraduate students from diverse backgrounds (eg Aboriginal or Torres Strait Islander / rural).

Identify and implement strategies to recruit and retain identified target groups (eg rural, experienced, speciality).

Explore opportunities for pooling recruitment strategies and procedures across services and sectors.

Recommendations to Enhance Education and Support

Recommendation Twelve

There is ongoing evaluation by DoH, DSC and the NGO disability sector of the education and support requirements of the allied health workforce and the health and disability industry.

Strategies

Establish a mechanism that integrates current allied health educational representative bodies to identify and evaluate the education and support needs of the industry and the workforce from undergraduate through all levels of development.

Recommendation Thirteen

There is effective provision of education and support by DoH, DSC and the NGO disability sector for allied health professionals.

Strategies

Establish a coordinated and cross-sectoral approach to the provision of professional development and postgraduate studies by universities, professional associations and the disability and health sectors.

Establish mechanisms that allow recognition, monitoring and communication of industry needs and university plans at an allied health level as well as at discipline level.


Establish joint appointments/ partnerships models between industry and universities in the education of student allied health professionals.

Investigate and implement strategies to address barriers to professional development and postgraduate studies for allied health professionals.

Facilitate interaction between and across university departments and professional development providers to develop generic or multidisciplinary units where appropriate.

Develop best practice guidelines for the clinical placement and supervision of students within the disability and health sectors.

Recommendation Fourteen

There are resources available from DoH and DSC for allied health research.

Strategies

Fund mechanisms that:

Increase leadership in allied health research;

Increase research opportunities for allied health;

Disseminate information about research activity;

Disseminate information about research opportunities (funding etc);

Develop coordinated research agendas;

Conduct systematic reviews and develops practise guidelines;

Increase the base of evidence for allied health services; and

Investigate cost-benefit analysis of allied health services.

Develop university and industry research partnerships.

Increase the level of employers funding and support for allied health research.

Recommendations to Enhance Resourcing

Recommendation Fifteen

There is a framework defined by DoH and DSC for the allocation of current and future funding for allied health services.

Strategies

Establish mechanisms that provide managers of allied health staff with a defined budget allocation for service provision, and reporting mechanisms to ensure expenditure on designated programs/staff.

Establish mechanisms to provide service continuity and sustainability (eg. provision of leave relief funding).

Establish mechanisms to facilitate collaborative approaches to funding of service delivery across sectors.


Recommendation Sixteen

There are resources allocated by DoH and DSC for best practice allied health services based on agreed models of resource allocation within the health and disability sectors.

Strategies

Develop models of resource allocation to deliver best practice allied health services within the health and disability sectors that establish minimum standards for facilities, resources, travel, speciality access, and staff support needs within consumer profiles.

Call for executive level long-term business planning of allied health services across all sectors to establish service delivery guidelines.

Determine the level of funding required to meet consumer and community profiles within different service delivery models to the planned level of service provision.

Facilitate opportunities for the allied health private sector to supplement service delivery.


Members of the Taskforce

Angie Paskevicius (Chairperson) Allied Health Professionals Employers’ Group

Virginia Bower / Dan Hill Health Professionals’ Forum Hospital Salaried Offices Association

Ron Chalmers Country Services, Disability Services Commission

Joan Cole / Kathy Briffa University representative for Western Australian Higher Education Council

Maxine Drake / Andrea Callaghan Health Consumers' Council

Mario Gallo Council of Disability Services Commission Funded Agencies

Joan Loud Combined Universities Centre for Rural Health and Services for Australian Rural and Remote Health Inc.

Trish Robustellini Combined Allied Health Professions Association

Sue Rowell Metropolitan Allied Health Council

Suzanne Spitz Country Services, Department of Health

Liz Ward / Neil Purdy Health Workforce and Reform, Department of Health

Kendra Bell Senior Project Officer


SECTION ONE

Allied Health Taskforce on Workforce Issues


1.1 Introduction In November 2001 the Allied Health Taskforce on Workforce Issues (AHTWI) was established to develop a strategic workforce plan for Western Australian allied health professionals (AHPs) that for the first time brought together AHPs working in both the health and disability sectors. This cross-sectoral partnership established the future direction for allied health, by seeking opportunities to join together in pursuit of improving the health and well being of the Western Australian community. This report outlines the key issues and analysis in support of the recommendations of the AHTWI. Recommendations made by the Taskforce were determined after extensive consultation with the allied health workforce and stakeholders in Western Australia (WA) through:

Consumer focus groups;

Submissions made to the Taskforce addressing the Terms of Reference;

A questionnaire to practising and non-practising AHPs within the scope of the Taskforce;

An organisational survey detailing the workforce and service provision of AHPs across the health and disability sectors;

A survey of university schools involved in undergraduate and postgraduate training of allied health professions; and

Review of recent literature, relevant reports and workforce surveys such as the Metropolitan Allied Health Council Survey1 and the Services for Australian Rural and Remote Allied Health Survey2.

Working groups of allied health and human resource professionals considered the information obtained and formulated key recommendations for immediate action, implementation and further investigation. The Taskforce’s high level of consultation and involvement of the allied health workforce, consumers and stakeholders, has established a supportive environment for consideration and implementation of the recommendations.

1.1.1 Background

Allied health services have been recognised as an essential component of health and disability services, contributing extensively to the mission statements and objectives of Western Australian health and disability organisations. Services provided by AHPs have an impact at primary, secondary, tertiary and rehabilitation levels across the sectors. In October 2000 the Allied Health Professionals Employers’ Group (AHPEG) formed as a result of employers across a range of agencies becoming increasingly concerned about the shortage of AHPs and the lack of a strategic and coordinated approach to

1 Metropolitan Allied Health Council. (1998). Metropolitan Allied Health Survey Report. Perth: Metropolitan Allied Health Council. 2 Services for Australian rural and remote allied health inc. (1999). SARRAH inc, Survey questionnaire. Canberra: SARRAH Inc.


workforce planning in WA. This group recognised that the Western Australian situation was a long-term issue that could only be resolved through collaboration between all key stakeholders.

A position paper titled “The Critical Impact of Allied Health Shortages on Western Australians” 3 was released by AHPEG in May 2001. The position paper detailed the high community and economic cost of the shortage of AHPs and made a single recommendation to “establish an across-government taskforce to develop a strategic workforce plan for the allied professions in the health and disability sectors in Western Australia”4. Allied Health Professionals’ Employers Group began lobbying key decision makers in government for support of this recommendation. This lobbying was successful when the Chief Executive Officer, Disability Services Commission (DSC), and the then Acting Commissioner of Health agreed to fund the project with equal contributions from their respective organisations and from non-government disability representatives of AHPEG. In November 2001 the inaugural meeting of the AHTWI was held and the project proposal endorsed. Taskforce membership included representatives from key stakeholder groups in WA.

1.1.2 Terms of Reference

The Allied Health Taskforce project identified eight key areas for investigation of the allied health workforce. The terms of reference closely followed those outlined in the recent Director General’s Allied Health Recruitment and Retention Taskforce Report by Queensland Health.5

Determine the current status of the allied health workforce in the disability and health sectors in WA.

Identify recruitment and retention issues and strategies.

Identify current models of service delivery and barriers to effective service provision.

Identify resource utilisation and workload management approaches and issues.

Review undergraduate and postgraduate education, training and development needs.

Investigate flexible employment practices.

Identify best practice principles for allied health and workforce planning and management of allied health.

Identify strategies for increasing community awareness of AHPs, their roles and contribution to the community.

3 Allied Health Professionals Employers' Group. (2001). The critical impact of allied health shortages on Western Australians. Perth: Allied

Health Professionals Employers' Group,. 4 Ibid. 5 Queensland Health. (2000a). Director General's Allied Health Recruitment and Retention Taskforce. Brisbane: Queensland Health.


1.1.3 Objectives

The Allied Health Taskforce proposed to meet and report on the following objectives:

Develop a strategic workforce plan for the allied health professions in the health and disability sectors in WA that addresses the Terms of Reference.

Make recommendations for immediate action, implementation and further investigation.

1.1.4 Scope

The Taskforce investigated allied health professions that worked across both health and disability sectors, and that were not currently under any other form of workforce investigation. Again the scope of the project followed that of the Queensland Health report6. Although not all AHPs were included in the project brief, the recommendations developed should have application across all allied health professions. Allied health professions included in the scope of this report are:

Audiology Clinical Psychology Nutrition and Dietetics Occupational Therapy Orthoptics Orthotics and Prosthetics Physiotherapy Podiatry Social Work Speech Pathology

1.2 Methodology A Senior Project Officer was appointed to assist the Taskforce to undertake its methodology. The methodology detailed in the initial project proposal was followed and extended over the course of the project as additional activities were identified. The major project strategies are described in the following section.

1. Call for submissions

A call for submissions was advertised in The West Australian and through extensive email distribution. A briefing session was held to assist the preparation of the submissions by individuals or organisations. Sixty submissions were received. Submissions were analysed for consistent themes and issues, and a summary document developed. Appendix A contains the submission proforma, the submission sources and the submissions summary.

6 Ibid.


2. Literature Review

A comprehensive literature review was undertaken by the project officer with the assistance of health service librarian staff. Literature summaries were compiled to inform the Taskforce and the working groups and are included in Appendix A.

3. Workforce Questionnaire

An AHP questionnaire was devised based on the Queensland Health questionnaire7 and various other recent questionnaires8 9. The questionnaire aimed to gather details about the current workforce status and the views of AHPs no longer working in their profession. The questionnaire was distributed via email and placed on the Taskforce website.10 Reminder memos were sent out to allied health managers for circulation prior to the release of the questionnaire and two weeks prior to its closing date. A total of 785 questionnaires were returned representing 51% of the current workforce. An additional 48 were returned from non-working AHPs, resulting in a total of 833. The sample from non-working professionals was too small for individual analysis (0.7%), but was included within the overall data analysis. Appendix B contains the questionnaire form and a summary of the data analysis.

4. Focus Groups

Consumers were invited to focus groups to identify their perspectives on allied health services and workforce issues. Two focus groups were held in the Perth metropolitan area and one in a rural location, Geraldton. Consumers represented individuals or groups who have contact with AHPs in either the health or disability sectors, from both paediatric and adult services. The groups’ statements were then collated as a summary document contained in Appendix C.

5. Organisational Survey

As insufficient workforce data were available for detailed workforce planning, an organisational survey was distributed via the Chief Executive Officer or General Manager of each state health and disability service within WA. This survey was based on organisational surveys from WA11 12, Queensland13, South Australia14 and New South Wales15. Taskforce members followed up non-returned surveys in order to obtain a 100% response rate detailing the allied health workforce status in WA as at the 15th March 2002. This information is included in Appendix C.

7 Ibid. 8 Saggers, S., Wildy, H., Gray, J., Paskevicius, A., Tilley, F., & Ciccarelli, P. (2001). Benchmarking recruitment and retention among

professional therapists: Local and national perspectives. Perth: Institute for the Service Professions Edith Cowan University & Therapy Focus Inc.

9 Services for Australian rural and remote allied health inc. (1999). SARRAH inc, Survey questionnaire. Canberra: SARRAH Inc. 10 www.alliedhealth.health.gov.au 11 Allied Health Professionals Employers' Group. (2001). The critical impact of allied health shortages on Western Australians. Perth:

Allied Health Professionals Employers' Group,. 12 Metropolitan Allied Health Council. (1998). Metropolitan Allied Health Survey Report. Perth: Metropolitan Allied Health Council. 13 Queensland Health. (2000a). Director General's Allied Health Recruitment and Retention Taskforce. Brisbane: Queensland Health. 14 Golding, S. (2000). Report on the South Australian Rural Allied Health Workforce. Summary Report. Adelaide: Department of Human

Service: South Australia. 15 Taylor, C., & Bradd, T. (2001). Allied Health Workplace structures in NSW: Mapping the current Status. Paper presented at the 2001

Speech Pathology Australia National Conference.


6. University Survey

A survey was distributed to each of the Heads of Schools of universities involved in training AHPs in WA. Five surveys were returned. Data provided were collated into a summary of the available training programs and entry quotas for allied health professions within the scope of the Taskforce. Appendix C contains the survey form.

7. Working Groups

The final phase of the project involved five working groups who assisted the Taskforce to develop recommendations and suggest implementation strategies for the report. Each of the five groups was allocated one of the following strategic themes within the analytical structure of the project:

Vision of allied health and community awareness;

Service performance;

Workforce systems;

Education and support; and

Resourcing.

Each group was constituted to ensure members represented a particular area of relevance to the theme under analysis, as well as having a mix of representatives from as many allied health professions as possible. Each group also contained representatives from the four primary organisations involved in the Taskforce: metropolitan health, rural health, non-government organisations (NGOs) and DSC. Metropolitan and rural health services were separated in recognition of their acknowledged differences and the need to ensure specific consideration of rural and remote needs. Appendix C contains a list of working group participants.

The working groups developed a range of strategies and activities that informed the Taskforce recommendations. Key strategies for each recommendation have been reported, with additional strategies and activities from the working group provided in Appendix C to support future planning.

8. Communication and Reporting

The Taskforce project implemented a number of communication and reporting strategies to ensure the success of the above strategies, and to inform all stakeholders of the progress of the project. A website was established (www.alliedhealth.wa.gov.au) which detailed the project plan and provided updates in the form of monthly newsletters. These newsletters were also distributed to representative groups and key stakeholders.

Reporting meetings were conducted at regular intervals with the Department of Health (DoH) and DSC as key funders of the project. The Chair of the Taskforce was also the Chair of AHPEG and reported back to that group as the third funder of the project.


http://www.alliedhealth.wa.gov.au/

A meeting to report to the Ministers of Health and Disability Services was held mid-way through the project. Numerous other briefing sessions or reporting meetings were held with a range of stakeholders and interested parties.

1.3 Analytical Strategy The AHTWI was formed to develop a strategic workforce plan for AHPs.16 Strategic workforce planning was considered in its broadest sense, not only addressing issues of recruitment and retention but investigating all elements of the workforce that contribute to successful allied health service provision for the benefit of the Western Australian community. The terms of reference addressed the work environment, the people involved, the stakeholders contributing to workforce development, and the processes in place that might address workforce issues in WA.

The interactions of both negative and positive influences on the allied health workforce were considered. The strategic workforce plan endeavours to address current and future workforce issues in the pursuit of having “the right person, doing the right thing, in the right way, in the right place, at the right time and with the right result” for the Western Australian community. The project was designed to analyse workforce issues within five key themes, being allied health vision, service performance, workforce systems, education and support and resourcing. Each of the terms of reference is addressed within one or more of these five strategic themes. Focusing at a thematic level minimised overlap between terms of reference due to the complex interplay of elements under investigation. Each of the five themes also interact and impact on each another. It is expected that recommendations in each section will contribute to and complement each other. The compound effect of endorsing recommendations in all sections is expected to have a considerable impact on the current and future allied health workforce status of WA. Each of the five themes is outlined in more detail in the following section.

1.3.1 Allied Health Vision

Vision is identified by contemporary management theory as a critical element in organisational improvement.17

Vision is a critical theme for strategic workforce planning due to the need to set a core purpose and expected values to help shape the development of an organisation and its workforce.18

Development of vision is seen as assisting in workforce planning in the alignment of the AHPs and the organisations employing them, so that the workforce and the employing bodies have similar expectations, values and beliefs19 20

16 Allied Health Professionals Employers' Group. (2001). The critical impact of allied health shortages on Western Australians. Perth:

Allied Health Professionals Employers' Group,. 17 Senge P. (1998). The fifth discipline. 18 DGL International. (2002). Vision and Purpose: With a "why" for what we do, we can deal with almost any "how". DGL International.

Retrieved 30/5/02, 2002, from the World Wide Web: www.dgl.com.au/resources/vision.htm 19 Ibid. Retrieved, from the World Wide Web:


Elements of vision considered by the Allied Health Taskforce included:

community and industry awareness of allied health services;

the extent of representation of AHPs within all levels of the industry; and

the allied health culture of the Western Australian workforce.

1.3.2 Service Performance

The workforce’s ability to meet the needs of the Western Australian community can be explored by investigating issues associated with service performance in relation to:

the capacity to provide the best service performance possible; and

the reciprocal impact on workforce retention when quality services are not able to be provided.

The consumers of health services deserve optimal service performance to meet their many and varied needs. 21 22

When AHPs are unable to provide a quality service or one that meets their expectations of what is needed, they consider leaving either the workplace or the profession.23 24

Service performance in relation to how the service is managed and planned has a strong influence on retention25

Elements of service performance considered by the Taskforce included:

best practice in management of allied health;

best practice in service delivery models;

barriers in the current system impeding service performance; and

the skills and specialisation of the workforce in providing services needed by the community.

1.3.3 Workforce Systems

Strategic human resource management relies on access to adequate information and systems to use that information for planning.26

20 Bowman, P., Tweeddale, M., & Kuys, S. (2001). The development of a strategic workforce plan for Queensland health's allied health

services. Paper presented at the 4th National Allied Health Conference, Perth. 21 Allies in Health: Briefing paper for the Minister for Health and Ageing. (2001). Melbourne: Health Professions Council of Australia LTD. 22 Smith, G., McCavanagh, D., Williams, T., & Lipscombe, P. (1996). Making a Commitment: The Mental Health Plan for Western

Australia. Perth: Health Department of Western Australia. 23 Salsberg, E. S. (2001). The evolving health care system: challenges for allied health professions. Centre for Health Workforce Studies at

the University at Albany (USA). Retrieved, 2002, from the World Wide Web: 24 Saggers, S., Wildy, H., Gray, J., Paskevicius, A., Tilley, F., & Ciccarelli, P. (2001). Benchmarking recruitment and retention among


25 Extract from: Achieving employee retention, customer satisfaction, productivity and profitability: summarised results from questioning over one million employees and managers over 25 years. The Gallup Organisation. Retrieved 18/12/00, 2000, from the World Wide Web: www.greenleaf.org.au/Extract.htm

26 Golding, S. (2000). Report on the South Australian Rural Allied Health Workforce. Summary Report. Adelaide: Department of Human Service: South Australia.


Investigating the current organisational systems across health and disability will determine areas needing development to improve the status of the allied health workforce.

Planning requires analysis of the workforce composition, to understand the possible needs, trends and motivation of the workforce under consideration.27 28

Elements of information and systems considered within this theme were:

composition, distribution, profile, mobility of the workforce;

human resource management processes and conditions; and

information to support current and future workplace planning.

1.3.4 Education and Support

Allied health professionals acknowledge that a professional’s career is a learning journey of new skills, new insights and new methodology.29

The distance of the Western Australian community as well as its geographical distance from other major centres creates inherent difficulties and issues in establishing and maintaining work practices that are best practice or competency based.30

Education and support mechanisms need to be of an extremely high quality to support quality outcomes in the form of “doing the right thing, in the right way” for the community.31

Elements of education and support considered within this theme were:

undergraduate to post graduate education;

professional development; and

research opportunities.

1.3.5 Resourcing

One of the most critical elements of investigation was the means by which services, education and research for allied health are resourced.

With the increasing reductions in available health dollars32, AHPs acknowledge the need to demonstrate their worth to society and long term cost benefit of their services.33

27 Steggall, V. (2000). Staying connected. Australian Human Resources Institute. Retrieved 8/5/02, 2002, from the World Wide Web:

www.ahri.com.au 28 Smith, C. S., & Crowley, S. (1995). Labor force planning issues for allied health in Australia. Journal Allied Health, 24(4), 249-265. 29 Public Health Workforce Development Working Group. (2002). Factors in public health workforce development investment decisions:

Basis for a work plan. National Public Health Partnership. Retrieved 7/3/02, 2002, from the World Wide Web: 30 Millstead, J., McCahon, J., & Shoebridge, A. (1994). An assessment of the need for a support centre for allied health professionals in

rural and remote Australia. Perth: Centre for Evaluative Research for Independent Living. 31 Bannigan, K. (2000). To Serve Better: Addressing poor performance in occupational therapy. British Journal of Occupational Therapy,

63(11), 523-528. 32 Podger, A., & Hagan, P. (1999). Reforming the Australian Health Care System: The role of government. Canberra: Department of Health

and Aged Care Occasional Papers Series. 33 Allies in Health: Briefing paper for the Minister for Health and Ageing. (2001). Melbourne: Health Professions Council of Australia LTD.


It is essential to consider new ways to access, enhance or collaborate on new and innovative funding opportunities for the benefit of the Western Australian community.34

Investigating and establishing mechanisms to support these challenges will ensure that there is improved capacity to:

resource the needs of the workforce in terms of elements impacting on retention (eg salary, workload pressures); and

access professional development and education.

Elements of resourcing considered included:

resource utilisation;

access and distribution to resources; and

requirements for service provision.

34 Podger, A., & Hagan, P. (1999). Reforming the Australian Health Care System: The role of government. Canberra: Department of Health

and Aged Care Occasional Papers Series.


SECTION TWO

Allied Health Workforce Profile


2.1 Workforce Characteristics The Allied Health Taskforce gathered a substantial amount of information on the Western Australian allied health workforce. These data informed the development of the Taskforce recommendations. They will also assist with the future implementation of the strategic workforce plan by individual agencies and stakeholders. The data in the section provide a broad snapshot of information only. More detailed analysis is possible from the data provided in Appendices B and C.

2.1.1 Organisational Context

The state health sector consists of 1,311.45 full time equivalent (FTE) employee AHPs, with 1,047.55 FTE in the metropolitan area and 254.80 FTE in the rural sector.

Allied health professionals represent 5.99% of the health employment sector.

The disability sector consists of 251.29 FTE AHPs, with 97.9 FTE in DSC and 153.39 FTE in disability funded NGOs. The NGOs included in the workforce analysis are Cerebral Palsy Association of Western Australia, Therapy Focus Inc., Rocky Bay Inc, the Association of the Blind, the Autism Association of Western Australia and the Multiple Sclerosis Society.

Allied health professionals represent 6.85% of the DSC total organisation.

Allied health professionals represent 19.48% of the disability funded NGOs’ employees.

2.1.2 Allied Health Professions in the WA Workforce

2.1.2.1 Allied Health Professions

Table 1 outlines the number of FTE for each allied health profession employed in the health and disability sectors.

Table 1 Allied Health Professions by Full Time Equivalent

(Organisational Survey, AHTWI, 2002)

Profession FTE* AH* FTE (% of total)

Audiology 11.00 0.71 Clinical Psychology 159.81 10.35 Nutrition and Dietetics 72.48 4.69 Occupational Therapy 373.25 24.17 Orthoptics 3.61 0.23 Orthotics and Prosthetics 10.00 0.65 Physiotherapy 368.66 23.88 Podiatry 29.53 1.91 Social Work 310.17 20.09 Speech Pathology 205.48 13.32 Total 1,543.99 100.00

* FTE = Full Time Equivalent * AH = Allied Health


2.1.2.2 Leave Relief

Leave relief was inconsistently reported by organisations. It was not clear if the majority of organisations had not completed the leave relief section of the organisational survey or if no leave relief was available for AHPs in these organisations.

Eight organisations indicated leave relief was available for AHPs.

Three organisations reported leave relief for all the AHPs they employed.

The remaining five organisations reported that leave relief was specific to professions with Physiotherapy the predominate recipient (in four of the five services).

Occupational Therapy had leave relief in two of the five services. Audiology, Podiatry and Social Work had access to leave relief in only one service each.

2.1.2.3 Vacancies

The number of vacancies has more than doubled since the time of the AHPEG Report (2001)35 although the AHPEG report indicated the full extent of vacancies may not have been captured at that time.

Anecdotally variations in vacancies of AHPs tend to be seasonal, however, these figures demonstrate the opposite of expected variations.

Table 2 Allied Health Vacancies

(Organisational Survey AHTWI, 2002)

Profession FTE Vacancy March 2002

(%)

FTE Vacancy

March 2002

FTE Vacancy (AHPEG report)

Dec 2000 Audiology 9.09 1.00 0.80 Clinical Psychology 7.53 14.40 2.20 Nutrition and Dietetics 12.14 8.80 0.00 Occupational Therapy 4.53 16.92 6.10 Orthoptics 0.00 0.00 0.00 Orthotics and Prosthetics 20.00 2.00 1.00 Physiotherapy 5.21 19.21 7.80 Podiatry 4.06 1.20 1.00 Social Work 4.51 14.00 3.50 Speech Pathology 5.52 11.35 13.70 Total 5.99 85.88 36.10

2.1.2.4 Turnover

The AHTWI Organisational Survey (2002) asked organisations to provide turnover rates for each of the AHPs. There was wide variation in the response to this question. A large number of organisations failed to include this information in their survey. As a result, the data collected were unable to be analysed with accuracy.

35Allied Health Professionals Employers' Group. (2001). The critical impact of allied health shortages on Western Australians. Perth: Allied

Health Professionals Employers' Group.


Turnover is critical workforce planning information that needs to be collected on an ongoing basis for AHPs. For this to be recorded accurately, a common understanding of how turnover is measured is required, as well as a consistent mechanism to collect the information.

2.1.2.5 Appointments

Most organisations reported a mix of permanent appointments and fixed term contracts for the AHPs they employed.

The Disability Services Commission, the Cystic Fibrosis Association and four rural health services had only permanent employees at the time of the survey.

2.1.2.6 Hours of Employment

The proportion of full-time employees to part-time employees varied depending on the profession, ranging from 100% full time employment of Orthotists / Prosthetists to 42.89% full-time employment of Podiatrists.

Table 3 Percentage of Professions Employed Full Time


Profession Employed Full-time

(%) Audiology 50.20 Clinical Psychology 67.15 Nutrition and Dietetics 71.85 Occupational Therapy 71.36 Orthoptics 52.91 Orthotics and Prosthetics 100.00 Physiotherapy 70.86 Podiatry 42.89 Social Work 73.30 Speech Pathology 75.22

2.1.2.7 Funding Sources

The AHPs employed in the state health and disability sectors are predominantly funded by recurrent state funding.

Organisations reported that additional funding for AHPs they employed came from recurrent commonwealth funds, non-recurrent state funds, non-recurrent common-wealth funds, self funding and grants.

Recurrent commonwealth funding was reported in a number of different organisations for the allied health professions of Clinical Psychology, Nutrition and Dietetics, Occupational Therapy, Physiotherapy, Podiatry, Social Work and Speech Pathology.

Non-recurrent state funding is currently used to employ Clinical Psychologists, Occupational Therapists, Physiotherapists, Podiatrists, Social Workers and Speech Pathologists.


Physiotherapy, Podiatry and Nutrition and Dietetics access non-recurrent commonwealth funding.

Some Nutrition and Dietetics, Physiotherapy and Social Work positions within state health and disability organisations were funded by grants.

Seven of the ten professions had some positions that were supported by self-generated funding in a small number of organisations.

2.1.2.8 Support Staff

There are 205.99 FTE clerical and therapy assistant staff supporting allied health services in the health and disability sectors. This comprises 76.94 FTE clerical staff and 129.05 FTE therapy assistants.

Occupational Therapy had the highest number of support staff (26.19%), followed by Physiotherapy (22.55%).

Orthoptics (0.08%) and Audiology (0.83%) had the lowest access to support staff.

Figure 1 Percentage of Support Staff by Profession (Organisational Survey, AHTWI, 2002)

0 5 10 15 20 25 30

Not specific to a profession

Audiology

Clinical Pschology

Nutrition and Dietetics

Occupational Therapy

Orthoptics

Orthotics and Prosthetics

Physiotherapy

Podiatry

Social Work

Speech Pathology

Percentage of Support Staff (%)

2.1.3 AHTWI Questionnaire

The following information was provided from the results of the AHTWI Questionnaire (2002) that was completed by 51% of the allied health workforce.

2.1.3.1 Professional Background

The AHPs responding to the Allied Health Taskforce Questionnaire represented all professions within the scope of the Taskforce project.


Table 4 Percentage of Respondents from a Professional Background

(Questionnaire, AHTWI, 2002).

Professional Background Percentage (%)

Audiology 1.3 Clinical Psychology 8.2 Nutrition and Dietetics 10.1 Occupational Therapy 25.1 Orthoptics 0.5 Orthotics and Prosthetics 0.4 Physiotherapy 20.2 Podiatry 2.6 Social Work 12.8 Speech Pathology 18.4

2.1.3.2 Work Sector

Respondents to the Questionnaire (AHTWI, 2002) came from all employment sectors.

Table 5 Percentage of Respondents Employed by each Sector


Sector Percentage (%)

Metropolitan health 52.0 Rural Health 20.0 Non-Government Organisations 8.9 Disability Services Commission 6.5 Private 6.5 University / Research 1.1 Other 1.1

2.1.3.3 Employment Status

The majority of respondents were AHPs employed as clinicians, either part-time or full-time in the workforce (74.8%). This increased to 78.6% with the inclusion of AHPs who were part time in both allied health and non-allied health employment.

Almost 13% (12.8%) of respondents were managers of AHPs with a clinical caseload, while only 2.4% were managers who did not have a clinical caseload.

A small number of AHPs either not working or not working in allied health roles completed the questionnaire (5.7%), but the actual size of this population is not known.

2.1.3.4 Age and Gender

Almost 90% (88.1%) of respondents were female while 11.8% were male.

Most AHPs were aged between 25-29 years (22.1% of sample), followed by 30-34 years (17.5%). There was then a drop in AHPs aged between 35-39 (10.6%), with the third highest number in the age bracket between 40-44 years (13.0%).


2.1.3.5 Age by Sector Table 6

Percentage of Allied Health Professionals in Different Sectors by Age (Questionnaire, AHTWI, 2002)

Age range Metropolitan

Health (%)

Rural Health

(%)

Non Government Organisations

(%)

Disability Services

Commission (%)

20-24 7.4 16.2 16.2 13.0 25-29 21.5 26.3 25.7 20.4 30-34 16.9 18.0 14.9 20.4 35-39 11.1 11.4 13.5 9.3 40-44 13.4 12.6 10.8 7.4 45-49 9.9 6.6 9.5 13.0 50-54 9.5 3.6 2.7 9.3 55+ 8.3 4.8 5.4 7.4

2.2 Workforce Distribution

2.2.1 State Health Employment Sector

The DoH employs 80.92% of its AHPs in the metropolitan area and 19.16% in rural and remote areas of WA (Organisational Survey, AHTWI, 2002).

2.2.1.1 Metropolitan Distribution by Profession

Occupational Therapy, Physiotherapy and Social Work have relatively similar levels as the largest of the allied health professions in the metropolitan area.

Table 7 Percentage of each Allied Health Profession in Metropolitan Health


Profession Percentage (%)


2.2.1.2 Rural Distribution by Profession

Physiotherapy has the highest level of representation of the allied health professions in rural areas.


Speech Pathology and Nutrition and Dietetics are more strongly represented comparative to the other allied health professions in rural areas than in metropolitan areas.

Table 8 Percentage of each Allied Health Profession in Rural Health


Profession Percentage (%)


2.2.2 Disability Employment Sector

The disability services sector employs 251.29 FTE AHPs with 61% employed in a disability funded NGO and 39% in DSC (Organisational Survey, AHTWI, 2002).

2.2.2.1 Disability Services Commission Distribution

Clinical Psychologists have the highest representation of the allied health professions at DSC (29.5%) followed by Speech Pathologists (21.4%) (Organisational Survey, AHTWI, 2002).

Occupational Therapy (19%) and Physiotherapy (15.32%) have similar levels of employment, with Social Work slightly lower (11.23%) (Organisational Survey, AHTWI, 2002).

The remaining allied health professions employed by DSC consist of Audiology, Nutrition and Dietetics and Podiatry, with 1% representation each (Organisational Survey, AHTWI, 2002).

2.2.2.2 Disability Funded Non-Government Organisations Distribution

Occupational Therapy has the highest representation of the allied health professions in the disability funded NGO sector (33.98%) followed by Speech Pathology (31.76%) and Physiotherapy (26.92%) (Organisational Survey, AHTWI, 2002).

In disability funded NGOs 4.1% of AHPs are Clinical Psychologists and Social Workers (Organisational Survey, AHTWI, 2002).

Orthoptics (1.1%) is represented more highly in disability funded NGOs than in any other sector.


Nutrition and Dietetics (0.03%) are the only other allied health profession employed in the NGOs (Organisational Survey, AHTWI, 2002).

2.2.3 Population Ratios

Population ratios have been provided to allow some degree of comparison across areas, however the Taskforce cautions interpretation at this level as it is not indicative of levels of need or health status in the different areas reported.

2.2.3.1 Number of Allied Health Professionals per 100,000

These ratios have been developed for AHPs in the health sector only. The majority of AHPs in disability services are based in the metropolitan area and their inclusion would increase the ratio for metropolitan populations. However, the disability sector provides services and support to rural areas which were not able to be specified in the Organisational Survey (AHTWI, 2002).

Table 9 Number of Allied Health Professionals per 100,000 in the Health Sector


Profession Ratio per 100,000

Metropolitan

Ratio per 100,000 Rural

Audiology 0.58 0.19 Clinical Psychology 8.66 1.50 Nutrition and Dietetics 3.36 5.19 Occupational Therapy 18.03 11.24 Orthoptics 0.13 0.02 Orthotics and Prosthetics 0.72 0.00 Physiotherapy 17.38 14.78 Podiatry 1.54 1.41 Social Work 18.01 8.49 Speech Pathology 6.64 9.31 Total 74.4 52.94

2.2.3.2 Projected Population Growth

The Western Australian population is expected to increase by 15.6% by 2006.

Table 10 Expected Growth in WA Population 1996-2006

(Health Information Centre, DoH, 2002)

Year Population 1996 1,759,781 2001 1,896,228 2006 2,033,430


2.3 Workforce Supply ♦ The Taskforce questionnaire (AHTWI, 2002) found that the majority of AHPs were

trained in WA (77.2%). Workforce supply for WA relies to a degree on the number of graduate places and the attrition rates during undergraduate training.

♦ Two allied health professions do not have a training school in WA, orthoptics and orthotics. Workforce supply for these professions relies on Eastern State training or overseas graduates.

♦ Overseas graduates make up a small proportion of the workforce with the highest percentage from the United Kingdom (4.8%), followed by South Africa (1.9%), with minimal numbers from Asia and other European countries (0.5% each) and the USA (0.2%) (Questionnaire, AHTWI, 2002).

2.3.1 AHTWI University Survey

A survey was widely distributed to all Western Australian University schools that train allied health professions within the scope of this project.

Five surveys from undergraduate schools were returned and one additional survey was returned from a school involved in postgraduate training of AHPs. Returned surveys are summarised in the following section.

2.3.1.2 Undergraduate Training

Clinical Psychology – Edith Cowan University Six Master of Psychology (Clinical) places per year.

Ratio of 10 : 1 local versus overseas enrolments, with 70% female.

Occupational Therapy – Curtin University Three undergraduate programs:

• Bachelor of Science (Occupational Therapy) – 75 places; • Bachelor of Science (Occupational Therapy) and Bachelor of Business

Administration (double degree) – 16 places; and • Bachelor of Science (Occupational Therapy) and Bachelor of Education (Early

childhood education / primary education) (double degree) – 22 places.

Master of Occupational Therapy (Graduate entry) – 22 places offered in 2002.

Reported to have a higher number of applicants than places with 60% school leavers. Ninety five percent of entrants are local, with 91% female.

Ten percent of students withdraw from a course, on average.

The school is currently lobbying for an increased quota, with increased demand for places from high quality applicants.


Physiotherapy – Curtin University One hundred places for a Bachelor of Science (Physiotherapy).

Graduate entry Master of Physiotherapy offers approximately 20 places.

No difficulty filling places each year with an average of 90% school leavers and an equal gender spilt.

Approximately 80% of students are Australian with 20% from overseas.

Podiatry – Curtin University Bachelor of Science (Podiatry) offers 30 places and a Bachelor of Science

(Honours) Podiatry has one to two places per year.

Sixty percent of places are filled by school leavers, with 98% being Australian.

Seventy percent of students are female.

There is generally a 30% attrition rate in the first year.

Social Work - University of Western Australia Fifty-five positions for a Bachelor of Social Work, with 200 applicants reported

for the undergraduate course in 2002.

Majority of entrants reported to be mature age.

There are a minimal number of overseas students (three of current 175 students).

The attrition rate is minimal.

Ninety percent of students are female.

Speech Pathology – Curtin University Forty-eight places for Bachelor of Science (Human Communication Science).

Ninety percent of students are school leavers with two overseas students to every 20 local students.

The attrition rate reported is two students per year.

99.5% of enrolments are female.

A two year Master by coursework degree is available, with an intake of ten students a year with one overseas enrolment on average.

There is 100% female enrolment in the Master by coursework currently.

2.3.1.3 Postgraduate Training and Continuing Professional

Development

Clinical Psychology – Edith Cowan University Six Doctor of Psychology places per year.


Occupational Therapy – Curtin University Currently offer a Higher Degree (Research) Doctor of Philosophy and Masters by

Research, as well as Masters of Clinical Science and Graduate Certificate in Mental Health. Higher Degree Research Masters places are restricted but all other post graduate courses are open.

Eighty percent of students are Australian students with 20% from overseas.

Seventy five percent of students are female.

Currently developing a Professional and Continuing Education Program (PACE).

Physiotherapy – Curtin University Fifteen Graduate Certificates in Physiotherapy, 35 positions for Professional

Masters, seven for Masters by Research and PhD positions are available.

There are 25 overseas students to ten local students on average for these places with an equal gender mix.

Currently planning further postgraduate programs for 2003.

Podiatry – Curtin University A Graduate Certificate and a Professional Masters offered by distance education

with more then 30 places in each. Positions are difficult to fill due to the high cost.

Ninety percent of students are local with an equal gender split.

Professional development courses are offered on a six monthly basis.

Social Work – University of Western Australia Thirty five students are enrolled in postgraduate courses such as Masters

Preliminary/ Advanced Diploma in Social Work / Master in Social Work / Master of Arts Social Work and PhD. There are plans to introduce a professional doctorate.

Ninety five percent of postgraduate students are female.

Collaborating with professional association for a winter school as part of Continuing Professional Development for the state.


SECTION THREE

Recommendations Towards a Strategic Workforce Plan


3.1 Introduction The project was designed to analyse workforce issues within five strategic themes: allied health vision, service performance, workforce systems, education and support and resourcing. Each of these themes is discussed in more detail in the following section. Key recommendations are presented for each of the themes. It is imperative, however, to establish the overarching course of action endorsed by the Taskforce to immediately fund a three months’ implementation preparation phase to address the requirements and costings to implement all recommendations.

3.1.1 Overarching Recommendation

Recommendation One

The AHTWI strongly recommends an overarching initial course of action that the DoH and DSC immediately fund a three months’ implementation preparation phase to address the requirements and costings to implement all recommendations.

Strategies

Details of the plans for the implementation development are set out in Section Four.


(Meeting the Challenge: p 3, 2000)36

3.2 Allied Health Vision

“Meeting the Challenge sets out how we want to see the role of the allied health professions developed and supported, building on real accounts of the work they do. It is about ensuring that the work which these professions do is acknowledged, valued and supported and that innovative practice becomes the norm, to the benefit of the (community).”

(Meeting the Challenge: p 3, 2000)36



EquityCommunication

Western AustraTaskforce on W

36 Department alth.
of Health. (2000). Meeting the challenge: A strategy for the allied health professions. London: Department of He
lian Allied Health orkforce Issues 2002 - 34 -

3.2.1 Recommendations to Enhance Allied Health Vision

Recommendation Two

That the following vision be adopted by DoH, DSC and the NGO disability sector for AHPs in WA:

All Western Australians have access to high quality allied health services.

Allied health services are provided by a workforce that is dynamic, collaborative, qualified, skilled and recognised for their contribution to the well being of the community.

Recommendation Three

There is effective integration within DoH, DSC and the NGO disability sector of allied health at policy, strategic and operational levels.

Strategies

Define the concept of “allied health” and promote to industry and the community.

Identify and implement models for allied health representation at all levels within and across the health and disability sectors.

Increase lobbying for the allied health sector.

Recommendation Four

There is unity of allied health professions supported by the establishment by DoH and DSC of a peak representative body.

Strategies

Establish a peak association for all allied health professions through a facilitated process with current representative groups and professional associations.

Communicate and promote the characteristics and values of allied health professionals that support increased unity.

Recommendation Five

There is effective marketing of allied health services by DoH, DSC and the NGO disability sector.

Strategies

Investigate marketing strategies to improve industry and consumer perception and understanding of the contribution of allied health to the well being of the community.

Develop one voice and a consistent message for allied health.


3.2.2 Taskforce Findings

3.2.2.1 Community and Industry Awareness

Boyce (1998) identified that the Allied Health professions hold an “invisible position” in Australia.37

There is a limited understanding by the industry of the benefits and impacts of allied health professions on both an individual basis and as a collective.38

The Health Professions Council of Australia (2001) reported that the Commonwealth government tend to ignore the highly developed skills of AHPs and fails to capitalise on the capacity of the allied health workforce. 39

The benefits and long term cost saving of timely allied health intervention has been well demonstrated.40 41

There is emerging evidence that investment in allied health services results in cost savings for the government.42 43

Significant health improvements are possible through increased resourcing in key strategic areas.44 45

The challenge for allied health is to continue to demonstrate and communicate the cost-benefit of increasing allied health funding.

There is a belief that as a collective group allied health are not well recognised.46

Community profile ratings by the allied health workforce varied dependant on the profession (Questionnaire, AHTWI, 2002).

37 Boyce, R. (1998). The allied health professions. In M. Clinton & D. Scheiwe (Eds.), Management in the Australian Health Care Industry.

(Second ed.). Melbourne: Addison Wesley Longman Australia. 38 Allied Health Professionals Employers' Group. (2001). The critical impact of allied health shortages on Western Australians. Perth:

Allied Health Professionals Employers' Group,. 39 Allies in Health: Briefing paper for the Minister for Health and Ageing. (2001). Melbourne: Health Professions Council of Australia LTD. 40 Allied Health Professionals Employers' Group. (2001). The critical impact of allied health shortages on Western Australians. Perth:

Allied Health Professionals Employers' Group,. 41 Allies in Health: Briefing paper for the Minister for Health and Ageing. (2001). Melbourne: Health Professions Council of Australia LTD. 42 Ibid. 43 The representatives of nutrition and dietetics services group. (1998). Dietetic and nutrition services in the Perth metropolitan area 1998 to

2020: A descriptive resource paper for use in Health Service Planning in response to the HDWA Health 2020 discussion paper. Perth: Dietitians Association of Australia (WA Branch).

44 Cranny, C., & Associates. (2000). Mid North Coast Area Health Service: Clinical Service Strategy for Acute Care.: Mid North Coast Area Health Service.

45 Podger, A., & Hagan, P. (1999). Reforming the Australian Health Care System: The role of government. Canberra: Department of Health and Aged Care Occasional Papers Series.

46 Commonwealth Department of Health and Family Services. (1996). Developing a framework for Ambulatory Care: a report of five technical workshops., Allied Health Workforce Planning: Extracts from various Commonwealth and State Documents. Brisbane: Queensland Health, Health Workforce Planning and Analysis Unit.


Figure 2 Professional’s Rating of the Profile of their Professions


P ro f ile o f P ro fe s s io n

v e ry p o o rp o o rg o o de x c e l le n t

6 0

5 0

4 0

3 0

2 0

1 0

0

Percentage (%)

Sixty three percent of AHPs surveyed by the Taskforce believed allied health had a

good or excellent profile (Questionnaire, AHTWI, 2002).

Figure 3 Professional’s Rating of the Profile of Allied Health


Profile of Allied Health

very poorpoorgoodexcellent

70

60

50

40

30

20

10

0

Percentage (%)

Most consumers in the focus groups indicated a better understanding of specific

professions than of the term allied health (Consumer Focus Groups, AHTWI, 2002).

Allied health professionals believe marketing to increase understanding of allied health needs to target the community (72.4%), General Practitioners (48.6%), the media (43.0%) and the state government (41.8%) (Questionnaire, AHTWI, 2002).

3.2.2.2 Allied Health Unity

Allied health professionals struggle with the definition of what constitutes allied health, which contributes to a fear of active promotion of allied health.47 48

There is no agreed list of allied health professions and no agreed definition of what constitutes allied health.49

47 Boyce, R. (1998). The allied health professions. In M. Clinton & D. Scheiwe (Eds.), Management in the Australian Health Care Industry.

(Second ed.). Melbourne: Addison Wesley Longman Australia. 48 Mcleod, B., & Stevenson, K."Allied Health" the third profession - the threat of homogenization. Paper presented at the Conference

proceedings. 49 Allies in Health: Briefing paper for the Minister for Health and Ageing. (2001). Melbourne: Health Professions Council of Australia LTD.


Some AHPs indicated a lack of trust in the ability of other AHPs to represent their views or needs adequately50 (Submissions, AHTWI, 2002; Working Groups, AHTWI, 2002).

Consumers in WA had a varied understanding of the term allied health. Some expressed no exposure to the term while others had some understanding of the mix of professions that consider themselves allied health (Consumer Focus Group, AHTWI 2002).

Consumers were of the opinion that marketing of the term allied health needed to occur. They emphasised the importance of a specific condition or client need being described in terms of the “package” of services required. This would give broader community exposure to the range of professions. (Consumer Focus Groups, AHTWI, 2002).

Government policy makers and executive level officials expect allied health to take a collective position. Allied health professionals need to influence how this occurs rather than resisting it.51

The challenge is to develop a culture of allied health that recognises and capitalises on the inherent differences in the core skills of AHPs.52

Submission Snapshot

“The general community perception of the collective group calling itself ‘Allied Health’ is poor . . . There is a need to first define the term ‘Allied Health’ within the professions before a successful public campaign can be implemented. The exclusion of certain professions from this taskforce is symptomatic of how this lack of identity is precipitated.”

(Submissions, AHTWI, 2002)

3.2.2.3 Allied Health Representation

There is a concern that allied health issues are rarely raised due to the lack of representation in major decision making forums (Submissions, AHTWI, 2002). Plant (2001) describes this as marginalisation of the “professions allied to medicine”.53

There is support in the literature for the current lack of focus for allied health policies within the commonwealth and other “decision-making forums”.54

There is a lack of planning and funding of additional allied health needs when new services are initiated. This lack of insight by planning bodies frequently causes considerable pressure on the workforce to take on new duties or greater caseloads. (Submissions, AHTWI, 2002).

50 Mcleod, B., & Stevenson, K."Allied Health" the third profession - the threat of homogenization. Paper presented at the Conference

proceedings. 51 Boyce, R. (1996). Management and organisation of Rural Allied Health Services. Brisbane: Graduate School of Management: University

of Queensland. 52 Mcleod, B., & Stevenson, K."Allied Health" the third profession - the threat of homogenization. Paper presented at the Conference

proceedings. 53 Plant, R. D., & Lossing-Rangecroft, C. (2001). Regional research and development networks supporting professions allied to medicine.

British Journal of Clinical Governance, 6(3), 190-196. 54 Allies in Health: Briefing paper for the Minister for Health and Ageing. (2001). Melbourne: Health Professions Council of Australia LTD.


Allied health involvement has been called for in the planning of Western Australian speciality services as well as new services. 55

Submission Snapshot “AH professionals are frequently overlooked for management appointments . . . This is a cultural problem inherent in the health system, which will require a significant effort on the part of AH professionals in order to effect change”

“(There is) non-inclusion or late inclusion (of AHPs) in workplace change initiatives such as clinical governance framework development, clinical reform and strategic planning of health services.”


Allied health professionals are a relatively small component of the health or disability

sectors. Each individual discipline is a minor component of the broader organisational structure (Organisational Survey, AHTWI, 2002).

Smaller allied health professions have fewer opportunities to be included in current decision-making structures. This is also evident in rural settings or some smaller organisations56 (Submissions, AHTWI, 2002).

There is variation in the models of how AHPs are managed within WA, which creates inconsistency in how AHPs are represented and at what level they have representation.57

An allied health policy and planning position was called for in 1991 within the central Western Australian Health Department to ensure representation following a restructure and removal of allied health “principals and deputy principal” positions.58 No such position has been developed.

55 Metropolitan Allied Health Council. (1998). Metropolitan Allied Health Survey Report. Perth: Metropolitan Allied Health Council. 56 Queensland Health. (2000b). Director-General's Allied Health Recruitment and Retention Taskforce 1999-2000 Summary report.

Brisbane: Queensland Government Queensland Health. 57 Country Services Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department

of Health, Western Australia. 58 Joint Working Group. (1991). Report of the joint working group of health department and union representatives. Perth: Health

Department of Western Australia.


0) 59

WesteTaskfo

59 Ma

Aus

(Marshall & Craft: p10, 200

3.3 Service Performance

“It’s about making it possible for the people in this state to have the skills and capacity to influence their own health and the health of their communities. It’s also about ensuring equity of access for equal need to primary care, preventative, treatment and ongoing management health services addressing not just cost barriers, but cultural and other barriers, and targeting certain disadvantaged groups with high needs.”

(Marshall & Craft: p10, 2000) 59



EquityCommunication

rn Australian Allied Health rce on Workforce Issues 2002 - 40 -

rshall, J., & Craft, K. (2000). New Vision for Community Health Services for the Future report. Perth: Health Department of Western tralia.

3.3.1 Recommendations to Enhance Service Performance Recommendation Six

There is an effective mix of support systems for allied health services within DoH, DSC and the NGO disability sector.

Strategies

Determine core professional activities and non-core professional activities performed by allied health professionals in each sector and identify their cost and impact.

Identify existing support systems for allied health and opportunities to utilise supports more equitably and efficiently.

Develop guidelines for management structures that best support the needs of allied health professionals.

Develop professional supervision guidelines that best support allied health professionals.

Recommendation Seven

Allied health services within DoH, DSC and the NGO disability sector are flexible and meet the needs of the local community.

Strategies

Establish consistent service delivery core business statements at all levels.

Develop formal processes and structures to support secondments and rotation of allied health professionals within organisations, between organisations and across sectors.

Assist allied health professionals to develop skills that will increase their capacity to adapt to changing needs and circumstances.

Recommendation Eight

Allied health services within DoH, DSC and the NGO disability sector are delivered consistent with best practice principles.

Strategies

Identify and develop best practice principles for service delivery across a range of settings and service delivery models.

Recognise the benefits of developing speciality skills and support workforce access to speciality resources.

Investigate the most effective means of ensuring allied health professionals maintain appropriate standards of practice.



3.3.2.1 Support for Service Provision

Limited or ineffective support systems that include management support, supervision, technology access, and administrative assistance impact on AHPs’ perception that they can fulfil their job requirements.60 61

Salsberg (2001) describes the need for job re-design such as improved support and reduced paperwork as key elements of improving the “supply” of a limited resource.62

Health professions such as medicine, faced with a limited supply of qualified staff, have sought mechanisms to increase productivity through job-reallocation of “non-profession specific” duties.63

Submission Snapshot “Clinical time is sacrificed spending time on administrative duties such as scheduling appointments, filing, typing up consultation letters and answering phones.”

(Submission Snapshot, AHTWI, 2002)

Lack of management support or lack of supervision structures was the second most

cited reason given by AHP across the state for leaving their last position in the last three years (Questionnaire, AHTWI, 2002).

An employee’s relationship with their immediate manager is the most likely reason for people leaving their position and also impacts on the productivity of the individual.64

Ninety nine percent of metropolitan health AHPs indicated a desire for access to appropriate supervision.65

Rural retention is affected by access to locum relief, mentorship, advisor support and the opportunity to participate in collegial projects.66

Access to locum services impacts on service continuity for rural areas during AHPs periods of leave.67

60 Services for Australian rural and remote allied health inc. (1999). SARRAH inc, Survey questionnaire. Canberra: SARRAH Inc. 61 Saggers, S., Wildy, H., Gray, J., Paskevicius, A., Tilley, F., & Ciccarelli, P. (2001). Benchmarking recruitment and retention among


62 Salsberg, E. S. (2001). The evolving health care system: challenges for allied health professions. Centre for Health Workforce Studies at the University at Albany (USA). Retrieved, 2002, from the World Wide Web:

63 BMA Health Policy and Economic Research Unit. (2002). The future healthcare workforce discussion paper 9. British Medical Association. Retrieved 21/3/02, 2002, from the World Wide Web:

64 Extract from: Achieving employee retention, customer satisfaction, productivity and profitability: summarised results from questioning over one million employees and managers over 25 years. The Gallup Organisation. Retrieved 18/12/00, 2000, from the World Wide Web: www.greenleaf.org.au/Extract.htm

65 Metropolitan Allied Health Council. (1998). Metropolitan Allied Health Survey Report. Perth: Metropolitan Allied Health Council. 66 Hodgson, L., & Hornsby, D. (1996). Allied Health Service delivery in the bush. Paper presented at the Inaugural Conference of the New

Zealand Speech-Language Therapists and the Australian Association of Speech and Hearing., Auckland, New Zealand. 67 Country Services Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department

of Health, Western Australia.


3.3.2.2 Meeting Community Needs

Currently most organisations provide services to a diverse and large range of populations across all levels of care (Organisational Survey, AHTWI, 2002).

The disability sector and some health services target well defined populations. The bulk of the health sector has a broad range of services and populations with limited access criteria other than assigned geographic boundaries. This is particularly so for rural health services.68

There appears to be a lack of consistency across the health sector in the type of access criteria or populations receiving prioritised services. Services frequently cite the lack of funding as a primary reason for precluding certain groups from accessing the allied health service (Organisational Survey, AHTWI, 2002).

Queensland Health (2000) found that health services had developed considerable autonomy in setting service access criteria due to a lack of policy direction, contributing to inconsistency across regions.69

The Organisational Survey (AHTWI, 2002) indicates that the above finding exists in WA with a wide variation in the number and type of access criteria applied by health services. Criteria applied may be discipline specific or patient/client age specific. Some services reported that where private services were available, no access to a public service was possible (Organisational Survey, AHTWI, 2002).

Geographical boundaries differed in some cases for different types for services from the same site (ie mental health and primary health care services). In some cases, a townsite in a rural area may not fall under the geographical area of a service but if consumers from that area drove to the service they could access the AHPs. Application of this criterion varied between regions (Organisational Survey, AHTWI, 2002).

The Western Australian allied health workforce indicated their first reason for leaving their last workplace was the desire to develop different skills (Questionnaire, AHTWI 2002).

All sectors raised concerns about the need for AHPs with the range of skills required to meet the needs of their community (Submissions, AHTWI, 2002). With the small size of the workforce both within and across sectors, there is restricted capacity to develop skills and specialisations to address the full range of social, physical and emotional issues.

Multidisciplinary teams are recognised as a best practice method in meeting the needs of populations with complex needs. However there are differences between the staffing mix of services and agencies, with recognition that some do not have the range of staff needed to provide a holistic service to the population targeted.70

68 Ibid. 69 Queensland Health. (2000b). Director-General's Allied Health Recruitment and Retention Taskforce 1999-2000 Summary report.




Current services need to be designed to be culturally appropriate to reduce inequity of access for Aboriginal and Torres Strait Islander communities,71 with a particular focus on establishing partnerships to allow for community leadership.72

Submission Snapshot “(There is) limited availability of staff with skills and expertise in specialist areas eg disability. Staff (are) requested to do work they do not have skills for.”

“(The) medical model in most health services – (is) outdated and needs to be replaced with biopsychosocial model which implies multidisciplinary treatment. DOH has done little to change its mode of service delivery . . .”


3.3.2.3 Service Delivery Quality

Recruitment and retention are affected by the AHPs’ feelings about the quality and extent of the service they are able to provide to the community.73

Australian studies have found that the allied health workforce’s capacity to provide efficient and effective services to the community is restricted.74

Workload demand was cited as the third top reason by AHPs for leaving their last position in the last three years (Questionnaire, AHTWI, 2002).

High workloads, lack of coordination and poor planning were frequently given as reasons that services did not meet the needs of the community (Submissions, AHTWI, 2002).

A study into “burn-out” in speech pathologists found it was related to caseload size, job satisfaction and effectiveness.75

Reviews of service provision in WA have highlighted the need for increased coordination across agencies to improve the current situation of less than optimum service provision to clients.76

Formal agreements are required to prevent variation in the implementation of partnership models and to reduce the current issue of partnerships relying on the goodwill of the manager.77

71 Ibid. 72 National Rural Health Alliance. (2002). Action on rural health: RHEA input to review of National Rural Health Strategy. National Rural

Health Alliance. Retrieved 7/3/02, 2002, from the World Wide Web: 73 Saggers, S., Wildy, H., Gray, J., Paskevicius, A., Tilley, F., & Ciccarelli, P. (2001). Benchmarking recruitment and retention among


74 Bowman, P., Tweeddale, M., & Kuys, S. (2001). The development of a strategic workforce plan for Queensland health's allied health services. Paper presented at the 4th National Allied Health Conference, Perth.

75 Potter, R. (1995). The incidence of professional burnout among Canadian Speech-Language Pathologists. Journal of Speech-Language Pathology and Audiology, 19(3), 181-186.

76 Dawson, S. (1998). Meeting the needs of families who have children with long term physical disabilities. Bunbury: Bunbury Health Service and Disability Services Commission.

77 Disability Services Commission Country Services Directorate. (2001). Statewide Analysis of Therapy Service for People with Disabilities Living in Country Areas. Perth: Disability Services Commission.


Nursing professionals state that innovation in health service models will improve access to services, improve health outcomes, reduce costs and improve working conditions in rural and remote areas.78

Submissions Snapshot “(Current) waiting lists and workload pressures do not allow (the) amount of therapy that is required. (It) addresses (the) short term problem of waiting lists but encourages a long-term problem of cases staying on caseload.”

“(There is) fragmented service provision for families with complex needs across agencies not communicating with each other.”

“Decisions in health funding and management are made in isolation therefore agencies change access criteria without considering impact on other agencies/ communities.”

“(There is) constant pressure for rapid discharge with less time to attend to all treatment requirements.”

“(There is) pressure to decrease length of stay without considering impact on AH needs.”


78 Alliance, N. R. H. (2002b). Action on nursing in rural and remote areas: draft issues paper. National Rural Health Alliance. Retrieved

8/5/02, 2002, from the World Wide Web: www.ruralhealth.org.au/nursingissues220402.htm


(McRee: p3, 2002) 79

3.4 Workforce Systems

“We need to break down the intellectual and institutional barriers that prevent us from collecting crucial data. Breaking down these barriers requires us to eliminate profession-specific tunnel vision and to begin assuming that the health system planners, administrators, educators, researchers, and government personnel are interested in the research we do about health care workers in our various silos. In every sector of the health care workforce, there are professional groups and researchers collecting data that could be helpful in systematising workforce planning, but they do not seem to be talking to each other.”

(McRee: p3, 2002)79



EquityCommunication


79 Marshall, J., & Craft, K. (2000). New Vision for Community Health Services for the Future report. Perth: Health Department of Western

Australia.

3.4.1 Recommendations to Enhance Workforce Systems Recommendation Nine

There is relative parity of salary and conditions within DoH and DSC and across the health and disability sectors.

Strategies

Identify mechanisms to ensure relative parity of salary and employment conditions across sectors for the allied health workforce.

Explore how key employment conditions for allied health can be developed eg right of private practice, professional development.

Investigate options to reduce barriers to work flexibly across services and across sectors (eg secondments, rotation between services).

Improve the allied health workforce awareness and understanding of their terms and conditions of employment.

Recommendation Ten

Allied health professionals within DoH, DSC and the NGO disability sector have access to a multifaceted career structure.

Strategies

Establish competency based career progression including;

Improved recognition of professional supervision.

Improved progression through classification structure.

Recognition for qualifications / sole practitioners.

Identify and facilitate the development of a range of career development opportunities at senior and base grade levels for both clinical, management and research streams.

Recommendation Eleven

There is ongoing allied health workforce planning by DoH, DSC and the NGO disability sector.

Strategies

Develop systems and processes that will support the workforce planning needs of allied health professions including undergraduate, practising professionals and professionals not currently in the workforce.

Establish a national minimum data set of core workforce data to be used for workforce planning across industry and within agencies.

Seek acknowledgment of the essential nature of allied health workforce planning by executive and government across health and disability sectors to ensure inclusion in their strategic planning.


Increase participation of allied health undergraduate students from diverse backgrounds (eg Aboriginal or Torres Strait Islander / rural).

Identify and implement strategies to recruit and retain identified target groups (eg rural, experienced, speciality).

Explore opportunities for pooling recruitment strategies and procedures across services and sectors.


3.4.2.1 Salary and Conditions

Salary and working conditions are typically identified as one of the factors to be considered in improving the recruitment and retention of a workforce. AHPs are placing an increasing importance on salary.80 81

Salary differences exist in WA with the recent pay increases awarded to health employees creating lack of parity with AHPs in the disability sector (Submissions, AHTWI, 2002).

Submission Snapshot “(There is a) lack of wage parity across government agencies and (the) non-government sector.”

“Pay (is) not commensurate with qualifications or academic performance required to gain access to the professions undergraduate course.”


Overall both disability and health AHPs indicate that working conditions and work

flexibility are good (Submissions, AHTWI, 2002; Working Groups AHTWI, 2002).

Work conditions and hours were also given as the fifth top reason for AHPs leaving their last position (Questionnaire, AHTWI, 2002).

Allied health professionals reported varying access and interest in different types of flexible working conditions (Questionnaire, AHTWI, 2002).

Table 11 Existence of and Access to Flexible Working Conditions

(Questionnaire, AHTWI, 2002)

Type of Work Currently exists in organisation

(%)

Currently accessed by AHP

(%)

AHP would like to access it

(%) Flexi time 79.0 56.7 18.5 Hours suit family 56.9 28.7 19.4 Family friendly 30.7 10.8 15.2 Close child care 11.6 1.2 11.9 Part time work 59.7 22.9 13.3 Job share 31.2 6.5 16.4

80 Buchan, J., & O'May, F. (2000). International recruitment of physiotherapists: A report for the Chartered Society of Physiotherapy.

Edinburgh: Chartered Society of Physiotherapy. 81 Esdaile, S., Lokan, J., & Madill, H. (1997). A comparison of Australian and Canadian occupational therapy student' career choices.

Occupational Therapy International, 4(4), 249-270.


There appears to be a proportion of the workforce who do not understand their working conditions and options, or do not access their working condition entitlements (Questionnaires, AHTWI, 2002; Submissions, AHTWI, 2002).

A large proportion (38.2%) of AHPs reported not knowing their minimum continuing professional development entitlements (Questionnaire, AHTWI, 2002).

Figure 4 Allied Health Professional Access to

Continuing Professional Development Compared to Entitlement (Questionnaire, AHTWI, 2002)

C o n t in u in g P r o fe s s io n a l D e v e lo p m e n t A c c e s s v e r s u s E n t i t l e m e n tn /ad o n 't k n o we q u iv a le n tle s sm o r e

5 0

4 0

3 0

2 0

1 0

0

Percentage of Respondents

(%)

There is a degree of misinformation and assumptions made about salary and conditions in other sectors and organisations (Submissions, AHTWI, 2002).

Submission Snapshots “Potential applicants do not apply under HSOA (Hospital Salaried Officers Award) as they feel pay will be less than other awards – (they) do not understand tax-free salary packaging component.”


Fifty five percent of AHPs do not currently access salary packaging. Employees of

non-government agencies access salary packaging most frequently (89.2%), followed by metropolitan health employees (48.9%). Rural health (25.5%) and DSC employees (15.1%) accessed salary packaging the least (Questionnaire, AHTWI, 2002).

Australian AHPs are being actively recruited with offers of attractive salary and conditions by other countries with skills shortages such as the United Kingdom.82 83

Incentive packages are rarely available to attract AHPs to specific areas when recruitment efforts fail, for example for positions needing highly specialised and experienced staff or for rural and remote positions. Such schemes have been used to good effect for other professions such as General Practitioners 84 (Working Groups, AHTWI, 2002).

82 Buchan, J., & O'May, F. (2000). International recruitment of physiotherapists: A report for the Chartered Society of Physiotherapy.

Edinburgh: Chartered Society of Physiotherapy. 83 The West Australian (16/3/2002) Advertisement for Physiotherapists and Occupational Therapists, Guys and St Thomas Hospital NHS. 84 Allies in Health: Briefing paper for the Minister for Health and Ageing. (2001). Melbourne: Health Professions Council of Australia LTD.


3.4.2.2 Career Structure

Lack of career advancement opportunities or diverse career options have been cited as reasons for the loss of experienced AHPs (Submissions, AHTWI, 2002).85

Allied health professionals in WA indicated they seek positions that will either advance or change their career (Questionnaire, AHTWI, 2002).

Career pathways are particularly restricted in rural areas and for smaller professions.86 87

The allied health workforce needs improved career opportunities in management, clinical speciality, rural speciality and research88 (Submissions, AHTWI, 2002; Working Groups, AHTWI, 2002).

Submission Snapshot “(There is) extreme difficulty recruiting quality experienced staff to remote areas for long term/ permanent contracts.”

“(There is a) flat career structure with limited opportunities for clinical career advancement.”


The career plans of the current AHPs workforce for the next five years reflect a strong

desire to specialise clinically (45.1%) followed by remaining in their current role (35.3%) (Questionnaire, AHTWI, 2002).

Table 12

Five Year Career Plans for Allied Health Professionals Surveyed (Questionnaire, AHTWI, 2002)

Career Plans Percentage (%)

Clinical Specialisation 45.1 Research 12.4 Education and Training 13.4 Non allied health area 6.7 Policy development/ projects 7.7 Private 16.7 Stay in current role 35.3 Management 5.9 Other 20.8

Many AHPs feel there are opportunities to achieve their career aspirations with their

current organisation (52% of AHPs in NGOs, 48% of metropolitan health AHPs, 39% of rural health and 37% of AHPs in DSC) (Questionnaire, AHTWI, 2002).

85 Queensland Health. (2000b). Director-General's Allied Health Recruitment and Retention Taskforce 1999-2000 Summary report.


of Health, Western Australia. 87 Queensland Health. (2000b). Director-General's Allied Health Recruitment and Retention Taskforce 1999-2000 Summary report.




3.4.2.3 Workforce Planning Mechanisms

Workforce planning is necessary to anticipate the needs and changing dynamics of the workforce and minimise its impact on an organisation and the services it provides.89 90

The essential nature of the human service industry requires strong strategic planning to limit workforce changes impacting on the Western Australian community.91

Strategies to assist in recruitment and optimum retention of AHPs need to consider variables such as the age, gender, profession, service type and location of the employee.92 93

There is minimal workforce planning and preparation currently occurring for AHPs. There are few mechanisms to collect data and an inconsistency in recording data to support planning.94 95

Queensland Health (2000) reported that turnover was higher for AHPs than for any health employment group other than medical.96

In 2000 the Government Health Training Advisory Board recognised skill shortages for AHPs in WA 2000 indicating that there are currently no mechanisms in place to address these shortages.97

Almost seventy percent (66.7 %) of the Western Australian workforce reported that their orientation to their current workplace met their needs well or very well, while 27.6% rated their orientation as poor or very poor (Questionnaire, AHTWI, 2002).

89 New Zealand stocktake 90 NHS Executive. (2000, 4/10/00). Human Resources Performance Framework. National Health Service Executive. Retrieved 6/5/02, 2002,

from the World Wide Web: www.doh.gov.uk/hrstrategy/index.htm 91 Lomma, A. (1997). An occupational therapy workforce study of registered occupational therapists in Western Australia - 1996., Curtin

University of Technology, Perth. 92 Queensland Health. (2000b). Director-General's Allied Health Recruitment and Retention Taskforce 1999-2000 Summary report.

Brisbane: Queensland Government Queensland Health. 93 Saggers, S., Wildy, H., Gray, J., Paskevicius, A., Tilley, F., & Ciccarelli, P. (2001). Benchmarking recruitment and retention among


94 Metropolitan Allied Health Council. (1998). Metropolitan Allied Health Survey Report. Perth: Metropolitan Allied Health Council. 95 Lomma, A. (1997). An occupational therapy workforce study of registered occupational therapists in Western Australia - 1996., Curtin

University of Technology, Perth. 96 Queensland Health. (2000b). Director-General's Allied Health Recruitment and Retention Taskforce 1999-2000 Summary report.

Brisbane: Queensland Government Queensland Health. 97 Cruickshank, M. (2001). Government Health Training Advisory Board Industry Training Plan. Perth: Government Health Training

Advisory Board.


Figure 5 Allied Health Professional rating of Initial Orientation to Current Position


Rating of Initial Orientation to Current Position

Not applicableVery PoorPoorW ellVery well

60

50

40

30

20

10

0

Percentage ofRespondents

(%)

Forty five percent of the AHPs who left an organisation in the past three years had not

completed an exit interview. Metropolitan health services and NGOs had the largest proportion of non-completion of an exit interview, (Questionnaire, AHTWI, 2002).

Figure 6 Provision of an Exit Interview at Resignation


5 0

4 0

3 0

2 0

A

eh(

Crot

Tp

98 Country S

of Health

Western AustrTaskforce on W

Percentage ofRespondents

(%)

P r o v is io n o f E x i t In te r v ie w

N o t a p p lic a b len oy e s

1 0

0

lmost a quarter of the workforce (24.9%) were on contract or in temporary mployment (Questionnaire AHTWI, 2002). Nearly all professions and organisations ad at least two or more fixed term contract staff as of the 15th March 2002 Organisational Survey, AHTWI, 2002).

ontracts created uncertainty for AHPs, discontinuity of service provision and estricted long term planning. Contracted AHPs generally felt less committed to the rganisation and were likely to accept other permanent positions despite enjoying heir current position (Questionnaire, AHTWI, 2002; Submissions, AHTWI, 2002).

here are restrictions in accessing alternative sources of AHPs such as overseas rofessionals98 (Submissions, AHTWI, 2002; Working Groups, AHTWI, 2002). The

ervices Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department , Western Australia.

alian Allied Health orkforce Issues 2002 - 52 -

United Kingdom has improved the speed and ease of accessing overseas AHPs in recognition of the need to supplement their local resources.99

The Western Australian allied health workforce consists of 77.2% locally trained AHPs, with 12.4% from another Australian state and 7.4% from overseas (Questionnaires, AHTWI, 2002).

Rural recruitment and retention of health professionals, particularly those with experience, is a nationwide problem. There are many successful strategies emerging locally and in other states to address this issue. 100

There is a need for planned strategies to alter the diversity of students undertaking allied health studies (Working Groups, AHTWI, 2002).

Research indicates rural origin students are more likely to return to work in rural areas but are currently under-represented in health courses at a tertiary level.101 102

Only 0.8% of the Western Australian workforce indicated that they were of Aboriginal or Torres Strait Islander descent (Questionnaire, AHTWI, 2002). Research has found that organisations must address barriers of lack of knowledge, financial constraints and social issues to begin to change this under-representation.103

Submission Snapshot “(There is a) perceived lack of job security for staff on short-term contracts that are continuously extended.”

“(The) recruitment process is arduous, bureaucratic and disempowering – too many check points, restrictions on advertising and delays, no support for interstate/ overseas advertising, devolvement impacts on clinical time of AHP.”

“(There is) difficulty getting overseas therapists registered with slow turn around time, lengthy process and time consuming processes.”

“(The) time delay in recruiting results in potential staff accepting other positions prior to job being offered to them.”

“Organisations (are) imposing arbitrary restrictions in filling vacancies.”

“(Too much) time (is) taken to give approval to fill positions.”

“(There is) seasonal variation in recruitment – winter months when service demands increase more difficult to recruit.”

“(There is) lack of uniform collection of statistics and therefore inability to use data for benchmarking and human resource allocation.”


99 Department of Health. (2000). Meeting the challenge: A strategy for the allied health professions. London: Department of Health. 100 Country Services Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department

of Health, Western Australia. 101 Ibid. 102 Durey, A., & Larson, A. (2000). Promoting health careers to rural and remote young people - a statewide consultation. Geraldton:

Combined Universities Centre for Rural Health. 103 Ibid.


001)

) 104

104 SapF

WesteTaskfo

(Saggers et al; p17, 2

(Saggers et al: p16, 2001

3.5 Education and Support

“If the updating of skills and skill sets required to meet both policy and future directions are to be met, a professional development program with consistency and equity in access and application, and a substantial commitment to resource allocation by government and organisations is strongly indicated.”

(Saggers et al; p17, 2001) “a key intrinsic motivator and stimulator for professionals is the drive to continue to grow and develop as a skilled professional”

(Saggers et al: p16, 2001) 104



EquityCommunication

ggers, S., Wildy, H., Gray, J., Paskevicius, A., Tilley, F., & Ciccarelli, P. (2001). Benchmarking recruitment and retention among

rofessional therapists: Local and national perspectives. Perth: Institute for the Service Professions Edith Cowan University & Therapy ocus Inc.


3.5.1 Recommendations to Enhance Education and Support Recommendation Twelve

There is ongoing evaluation by DoH, DSC and the NGO disability sector of the education and support requirements of the allied health workforce and the health and disability industry.

Strategies

Establish a mechanism that integrates current allied health educational representative bodies to identify and evaluate the education and support needs of the industry and the workforce from undergraduate through all levels of development.

Recommendation Thirteen

There is effective provision of education and support DoH, DSC and the NGO disability sector for allied health professionals.

Strategies

Establish a coordinated and cross-sectoral approach to the provision of professional development and postgraduate studies by universities, professional associations and the disability and health sectors.

Establish mechanisms that allow recognition, monitoring and communication of industry needs and university plans at an allied health level as well as at discipline level.

Establish joint appointments/ partnerships models between industry and universities in the education of student allied health professionals.

Investigate and implement strategies to address barriers to professional development and postgraduate studies for allied health professionals.

Facilitate interaction between and across university departments and professional development providers to develop generic or multidisciplinary units where appropriate.

Develop best practice guidelines for the clinical placement and supervision of students within the disability and health sectors.

Recommendation Fourteen

There are resources available from DoH and DSC for allied health research.

Strategies

Fund mechanisms that:

Increase leadership in allied health research;

Increase research opportunities for allied health;

Disseminate information about research activity. ;

Disseminate information about research opportunities (funding etc).;


Develop coordinated research agendas;

Conduct systematic reviews and develops practise guidelines;

Increase the base of evidence for allied health services; and

Investigate cost-benefit analysis of allied health services.

Develop university and industry research partnerships.

Increase the level of employer funding and support for allied health research.


3.5.2.1 Education and Support Needs

Access to education and continuing professional development (CPD) has been identified as having a positive impact on recruitment and retention.105

Continuing Professional Development ensures that workforce skills are at a competent or enhanced level.106

The size and sparseness of the population of WA creates specific CPD needs. There is a resultant challenge to maintain competence across varying population groups. Despite these issues being recognised, they remain unaddressed.107 108

A lack of coordinated assessment of AHPs education and support needs results in fragmented planning and ad hoc CPD provision (Submissions, AHTWI, 2002; Working Groups, AHTWI, 2002).

Queensland Health (2000) identified that despite health’s investment in education and training of undergraduates it had little ability to influence the content of their courses.109 Cruikshank (2001) identified a similar lack of opportunity for industry input for both undergraduate and postgraduate training in WA.110

There is a need for improved preparation and training of WA undergraduates to meet industry needs (Submissions, AHTWI, 2002).111 112 Recent graduates feel competent in their clinical skills but lack caseload management, multidisciplinary training and primary health care knowledge.113

105 Millstead, J., McCahon, J., & Shoebridge, A. (1994). An assessment of the need for a support centre for allied health professionals in

rural and remote Australia. Perth: Centre for Evaluative Research for Independent Living. 106 Country Services Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department

of Health, Western Australia. 107 Millstead, J., McCahon, J., & Shoebridge, A. (1994). An assessment of the need for a support centre for allied health professionals in

rural and remote Australia. Perth: Centre for Evaluative Research for Independent Living. 108 Duckworth, M., Matthews, C., Summers, J., & Wojnar-Horton, S. (2002). Occupational Therapy Paediatric Services in WA: A

demographic survey of staffing patterns and service delivery. Perth: The Occupational Therapists' Registration Board of WA. 109 Queensland Health. (2000b). Director-General's Allied Health Recruitment and Retention Taskforce 1999-2000 Summary report.

Brisbane: Queensland Government Queensland Health. 110 Cruickshank, M. (2001). Government Health Training Advisory Board Industry Training Plan. Perth: Government Health Training

Advisory Board. 111 Ibid. 112 Lilley, S. H., Clay, M., Greer, A., Harris, J., & Cummings, H. D. (1998). Interdisciplinary rural health training for health professional

students: strategies for curriculum design. Journal Allied Health, 27(4), 208-212. 113 Loud, J. (2001). Recent graduate preparedness for rural employment. Paper presented at the 6th National Rural Health Conference,

Canberra.


Refresher courses are required to assist health professionals who are not currently working to return to the workforce.114

There is a reducing rate of post graduate study by AHPs.115 Only 9.4% of AHPs surveyed are undertaking post graduate studies (Questionnaire, AHTWI, 2002).

Many Western Australian AHPs (43.1%) had a post graduate qualification, with post graduate diplomas most common (37.3%). Clinical Psychologists made up 18% of this group as they must complete a Masters degree in order to practise. (Questionnaire, AHTWI, 2002)

Figure 7 Percentage of Respondents with Post Graduate Qualifications


P o s t G ra d u a te Q u a lif ic a t io n s

O th e rP h D

M a s te rsP o s t g ra d d e g re e

P o s t g ra d d ip lo m a

4 0

3 0

2 0

1 0

0


(%)

There is inequity in the range and type of post graduate studies available from

different professions (University Survey, AHTWI, 2002).

There is an identified need for integrated multi-disciplinary education and generic CPD to support workforce and industry requirements.116 117

There is a need to enhance the workforce’s adaptive capacity to meet changing industry and community needs.118

Smith (1995)119 identified that new skills are needed by all AHPs including increased management skills, understanding of the heath care systems in place, knowledge of the changes in disease patterns and the increased need for a preventative focus.

114 Cruickshank, M. (2001). Government Health Training Advisory Board Industry Training Plan. Perth: Government Health Training

Advisory Board. 115 Physiotherapy Labour Force. (2000). Canberra: Australian Institute of Health and Welfare. 116 Commonwealth Department of Health and Family Services. (1996). Developing a framework for Ambulatory Care: a report of five

technical workshops., Allied Health Workforce Planning: Extracts from various Commonwealth and State Documents. Brisbane: Queensland Health, Health Workforce Planning and Analysis Unit.

117 Country Services Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department of Health, Western Australia.

118 Public Health Workforce Development Working Group. (2002). Factors in public health workforce development investment decisions: Basis for a work plan. National Public Health Partnership. Retrieved 7/3/02, 2002, from the World Wide Web:

119 Smith, C. S., & Crowley, S. (1995). Labor force planning issues for allied health in Australia. Journal Allied Health, 24(4), 249-265.


Submission Snapshot

“Universities (are) asked to include more content at entry level but never to remove information – (this) results in inability to cover content requests.”

“(There is) inconsistency between undergraduate curriculum and requirement of AHPs delivering service.”

“(There is a) gap between theoretical teaching at university and clinical need.”

“(There are) limited opportunities for lateral attainment of postgraduate qualifications.”

“(There is) no (industry) position responsible for organising / coordinating AH professional development activities to maintain and promote standards.”


3.5.2.2 Provision of Education and Support

Retention of AHPs can be positively influenced by access to library resources, study leave and training opportunities, as well as skill recognition.120

It is vital to maximise the limited education and support resources that currently exist to ensure that the range of skills and knowledge required by the industry can be met (Submissions, AHTWI, 2002; Working Groups, AHTWI, 2002).

Allied health CPD in the United Kingdom was found to be informal, uni-disciplinary, unaccredited and not linked to organisational needs.121

Partnerships are essential to improve provision of education and support with collaboration needed between health providers and professional associations.122 This has been highlighted as a particular need for rural and remote AHPs preparation and ongoing performance requirements.123 124

Health and university partnerships have the potential for reciprocal benefits with the potential for income generation by CPD provision by universities and access to the research capacity of universities by organisations.125

Salsberg (2001) states the need for government to recognise and commit to the essential premise of life long learning by health professionals.126

Professional development budgetary funding is required to ensure every AHP can meet the workforce standards that are required.127 Budgets that can assist in a planned

120 Hodgson, L., & Hornsby, D. (1996). Allied Health Service delivery in the bush. Paper presented at the Inaugural Conference of the New

Zealand Speech-Language Therapists and the Australian Association of Speech and Hearing., Auckland, New Zealand. 121 Department of Health. (2000). Meeting the challenge: A strategy for the allied health professions. London: Department of Health. 122 Salsberg, E. S. (2001). The evolving health care system: challenges for allied health professions. Centre for Health Workforce Studies at

the University at Albany (USA). Retrieved, 2002, from the World Wide Web: 123 Millstead, J., McCahon, J., & Shoebridge, A. (1994). An assessment of the need for a support centre for allied health professionals in

rural and remote Australia. Perth: Centre for Evaluative Research for Independent Living, National Rural Health Alliance. (2002). Action on rural health: RHEA input to review of National Rural Health Strategy. National Rural Health Alliance. Retrieved 7/3/02, 2002, from the World Wide Web:

124 Country Services Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department of Health, Western Australia.

125 Boyce, R., & Mickan, S. (2001). Partnerships between hospitals and universities: Finding a model to actively manage allied health education, training and research. Paper presented at the 4th National Allied Health Conference, Perth.

126 Salsberg, E. S. (2001). The evolving health care system: challenges for allied health professions. Centre for Health Workforce Studies at the University at Albany (USA). Retrieved, 2002, from the World Wide Web:

127 Commonwealth Department of Health and Family Services. (1996). Developing a framework for Ambulatory Care: a report of five technical workshops., Allied Health Workforce Planning: Extracts from various Commonwealth and State Documents. Brisbane: Queensland Health, Health Workforce Planning and Analysis Unit.


approach to professional development are essential, especially for rural areas faced with high costs and reduced access to suitable professional development opportunities.128

More than half (52%) of Western Australian occupational therapists identified that they needed a mentor to offer them additional support and development and 70% indicated the need for improved computer skills to take advantage of technology available.129

Networking is a common support AHPs access to maintain and develop their skills. More than half of AHPs (58.2%) reported that lack of time was the biggest barrier to networking. Other identified barriers were a lack of opportunity (19.8%) and not knowing who or where to access networks (11%).

Technological advancements offer considerable benefit in the provision of education and support but require careful planning and evaluation to ensure the best use of the options available (Submissions, AHTWI, 2002; Working Groups, AHTWI, 2002).

Over a third of AHPs (37%) accessed similar amounts of CPD in 2001 as they had in the past. The majority had received less than a week of CPD. Only 10% of AHPs reported that they had received more CPD than their award entitlements. Almost a quarter (22%) reported receiving less CPD than they were entitled to (Questionnaire, AHTWI, 2002).

Figure 8 Amount of Continuing Professional Development Accessed in 2001


4 0

3 0

2 0

Thim(S

Thint

128 Country Se

of Health, W129 Duckworth

demograph130 Health Dep

program. P131 McAllister,

worthwhile

Western AustraliTaskforce on Wo


(%)

T o t a l H o u r s o f C o n t in u in g P r o fe s s io n a l D e v e lo p m e n t a c c e s s e d in 2 0 0 1

> 2 0 0 h r s1 0 1 - 2 0 0 h r s

8 1 - 1 0 0 h r s6 1 - 8 0 h r s

4 1 - 6 0 h r s2 1 - 4 0 h r s

0 - 2 0 h r s

1 0

0

e allied health workforce in WA has concerns about the structure and plementation of undergraduate practicums for a number of allied health disciplines ubmissions, AHTWI, 2002; Working Groups, AHTWI, 2002).130

e industry can benefit from increased undergraduate rural placements that promote erest in working in rural and remote areas.131

rvices Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department

estern Australia. , M., Matthews, C., Summers, J., & Wojnar-Horton, S. (2002). Occupational Therapy Paediatric Services in WA: A ic survey of staffing patterns and service delivery. Perth: The Occupational Therapists' Registration Board of WA. artment of Western Australia. (2000). Mental Health Reforms in Western Australia: a report of the government reform erth: Health Department of Western Australia. L., McEwen, E., Williams, V., & Frost, N. (1998). Rural attachments for students in the health professions: are they ? Australian Journal of Rural Health, 6, 194-201.

an Allied Health rkforce Issues 2002 - 59 -

Submission Snapshot “(The) extreme isolation of WA makes interstate travel prohibitive and restricts access.”

“(There is) excellent internal PD available in different organisations, but limited access across organisations.”

“The current 16 hours a year (for PD) (HSOA EBA) makes a mockery of the contribution allied health professionals make to health care delivery.”

“Clinical Psych in WA had 10 full days paid study leave a year 10 years ago – now deleted from JDF.”

“Health service employers offer minimal support for staff wishing to pursue educational development to allow them to develop new services.”


3.5.2.3 Research Needs

Evidence-based practice and outcomes research are current industry requirements (Submissions, AHTWI, 2002).132 133

Allied health services must address the need for evidence-based research (Submissions, AHTWI, 2002).

A collective approach to research has been cited as essential to increase research outcomes and produce powerful research at the policy end of service provision.134

Less than 1% of resources were dedicated to research in a survey of Western Australian metropolitan health services.135

There is inconsistency in the extent and range of research being undertaken by AHPs in WA (Working Groups, AHTWI, 2002).136

There are identified gaps in the capacity of the allied health workforce to perform research and a need for leadership and planning of research directions (Submissions, AHTWI, 2002).137

Rural health had the least number of services involved in research in the Organisational Survey (AHTWI, 2002).

Table 13 Percentage of Services involved in Allied Health Research


Service Percentage (%)

Metropolitan health 55 Rural health 23 Non-government organisation 60 Disability Services Commission 100

132 Wooldridge, M. (2000). Ministers agree: health and medical research - a top priority. Minister for Health and Aged Care Media Release.

Retrieved 7/3/02, 2002, from the World Wide Web: www.partners.health.gov.au/mediarel/yr2000/mw/mwhmc2003.htm 133 McWilliam, C., Desai, K., & Greig, B. (1997). Bridging Town and Gown: Building research partnerhsips between community-based

professionals, providers and academia. Journal of Professional Nursing, 13(5), 307-315. 134 Stanley, F. (2001). Towards a national partnership for developmental health and wellbeing. Family Matters, 58. 135 Metropolitan Allied Health Council. (1998). Metropolitan Allied Health Survey Report. Perth: Metropolitan Allied Health Council. 136 Metropolitan Allied Health Council. (2000). Specifications for the implementation of recommendation 3 (Establishment of Chairs of

Allied Health) of the Metropolitan Allied Health Survey Report. Perth: MAHC. 137 Metropolitan Allied Health Council. (1998). Metropolitan Allied Health Survey Report. Perth: Metropolitan Allied Health Council.


Just over half of AHPs (52.6%) in WA reported having the opportunity to perform research in their workplace.

Allied health professionals in NGOs reported the highest capacity to perform research (80%), followed by metropolitan health (57%) and DSC (51%).

Rural health AHPs indicated restricted capacity, with 34% indicating they had opportunity and 31% not sure if there was opportunity for research. (Questionnaire, AHTWI, 2002)

Figure 9 Research Opportunities in Current Workplace


R e s e a rc h O p p o rtu n it ie s in C u rre n t W o rk p la cen o t a p p l ic a b len o t s u ren oy e s

6 0

5 0

4 0

3 0

2 0

1 0

0


(%)

Submission Snapshot “(There is a) need for treatment efficacy research to ensure best treatments are being offered.

“(There is a) lack of evidenced based practice.”

“(There is a) need for research into using technologies to support delivery of allied health services in the most efficient and effective way.”

“Staff working within some of the current models in the community, are not trained in the skills that they require to do the job. Evidence based practice and best practice are espoused but then inadequate training doesn’t allow for this to occur.”



)138

1)139

138 Po

an139 Al

L

WesteTaskfo

(Podger: p6., 1999

(Health Professions Council of Australia: p12., 200

3.6 Resourcing

“Governments have a responsibility to spend well – to get ‘value for money’ whenever they devote public resources to health. This means allocating scarce resources so as to obtain the most improvement in health….”

(Podger: p6., 1999)138 “Funds available for allied health services have been greatly reduced – in some cases, up to 25% over the past five years. At the same time, demands on allied health services have increased as a result of the growing emphasis on speedy throughput of patients, and the growing complexity of medical interventions….”

(Health Professions Council of Australia: p12., 2001)139



EquityCommunication

dger, A., & Hagan, P. (1999). Reforming the Australian Health Care System: The role of government. Canberra: Department of Health d Aged Care Occasional Papers Series. lies in Health: Briefing paper for the Minister for Health and Ageing. (2001). Melbourne: Health Professions Council of Australia TD.


3.6.1 Recommendations to Enhance Resourcing

Recommendation Fifteen

There is a framework defined by DoH and DSC for the allocation of current and future funding for allied health services.

Strategies

Establish mechanisms that provide managers of allied health staff with a defined budget allocation for service provision, and reporting mechanisms to ensure expenditure on designated programs/staff.

Establish mechanisms to provide service continuity and sustainability (eg. provision of leave relief funding).

Establish mechanisms to facilitate collaborative approaches to funding of service delivery across sectors.

Recommendation Sixteen:

There are resources allocated by DoH and DSC for best practice allied health services based on agreed models of resource allocation within the health and disability sectors.

Strategies

Develop models of resource allocation to deliver best practice allied health services within the health and disability sectors that establish minimum standards for facilities, resources, travel, speciality access, and staff support needs within consumer profiles.

Call for executive level long-term business planning of allied health services across all sectors to establish service delivery guidelines.

Determine the level of funding required to meet consumer and community profiles within different service delivery models to the planned level of service provision.

Facilitate opportunities for the allied health private sector to supplement service delivery.


3.6.2.1 Current Funding of Allied Health Services

Increased funding and improved use of resources for allied health services is required to address many of the recruitment and retention issues currently faced in WA.140

There are difficulties associated with accessing funds to meet standard workforce requirements of providing leave relief 141 and supporting access to CPD (Submissions, AHTW, 2002).

140 National Rural Health Alliance - 2001 Election charter. (2001b). Resources for nursing, allied health, dentistry and pharmacy. National

Rural Health Alliance. Retrieved, 2002, from the World Wide Web:


The majority of AHPs (81.1%) performed unpaid overtime with a mean of five hours and a median of four hours a fortnight (n=562) in order to provide current services (Questionnaire AHTWI, 2002).

Only one third of Queensland Health AHPs (32%) performing unpaid overtime worked more than four hours a fortnight compared to 45.4% of those AHPs in WA.142

Figure 10 Hours of Unpaid Overtime Per Fortnight


4 0

3 0

2 0

1 0

Li

pro

ThMMall

AlseAH

A reqinc

Thco

141 Metropolita

Allied Hea142 Queensland

Brisbane: Q143 Metropolita144 Allies in H

LTD. 145 Podger, A.,

and Aged C

Western AustraliTaskforce on Wo


(%)

U n p a id O v e r t im e p e r F o r tn ig h t (h o u rs )

> = 2 01 5 to < 2 01 0 to < 1 55 to < 1 01 to < 500

mited expenditure on resources and facilities has reduced the capacity of AHPs to vide quality and efficient services (Submissions, AHTWI, 2002).143

e Federal government reports an increased expenditure on allied health under the ore Allied Health Services (MAHS) funding arrangements. In reality, only 22% of AHS funding is spent on allied health services with the majority of funding being ocated to nursing and generic mental health positions.144

ternative funding sources are available to supplement, improve or research current rvices, but there is inconsistent awareness and access to these funds (Submissions

TWI, 2002).

full range of complementary and supportive private allied health services is uired to provide consumer choice, reduce pressure on the public systems and rease the effectiveness of service provision. 145

ere are limitations on the private service capacity in WA due to private insurance mpany restrictions on provider numbers, limited rebates for consumers who choose n Allied Health Council. (2000). Specifications for the implementation of recommendation 3 (Establishment of Chairs of

lth) of the Metropolitan Allied Health Survey Report. Perth: MAHC. Health. (2000b). Director-General's Allied Health Recruitment and Retention Taskforce 1999-2000 Summary report. ueensland Government Queensland Health.

n Allied Health Council. (1998). Metropolitan Allied Health Survey Report. Perth: Metropolitan Allied Health Council. ealth: Briefing paper for the Minister for Health and Ageing. (2001). Melbourne: Health Professions Council of Australia

& Hagan, P. (1999). Reforming the Australian Health Care System: The role of government. Canberra: Department of Health are Occasional Papers Series.

an Allied Health rkforce Issues 2002 - 64 -

to access private allied health services and gaps in skills for populations needing highly specialised intervention (Submissions, AHTWI, 2002)146.

Submissions Snapshot “(There is a ) lack of funds to enhance and improve services and purchase equipment and capital works. This stems from a lack of recognition from the executive level that allied health is an important component of the health care system. Current funding models are designed to provide money on an inequitable basis. Priority is frequently given to medical and nursing services over allied health services.”

“(A) lack of leave relief means departments may be constantly down a staff member due to need to cover each other.”

“(With) waiting list monies – too many submissions seem to end up going nowhere or without a clear response or take too much time for the approved monies to be transferred.”


3.6.2.2 Funding of Best Practice Services

A significant lack of resourcing has been identified with WA allied health services described as a bare minimum.147 148

Holmann (1993) noted that resourcing of community and child health services had not increased during the 1980’s relative to the population increase, and warned that if staff and expenditure did not keep pace with the population in the 1990’s, access to services would need to be restricted.149

There are a number of population groups currently unable to access allied health services or receiving limited services that do not meet their need. Populations identified include Aboriginal or Torres Strait Islander communities, school age children, adolescents, older people, culturally diverse or complex families, people with complex disorders, people with disabilities, pre-admission assessments for surgical cases, follow up after inpatient interventions, and people in geographically distant sites (Submissions, AHTWI, 2002; Organisational Survey, AHTWI, 2002).

Dietetics and audiology were reported as services with considerably restricted capacity to meet needs (Submissions, AHTWI, 2002; Organisational Survey, AHTWI, 2002).150

There is an inequity in funding distribution across Australia (Submissions, AHTWI, 2002). Currently rural communities are known to receive $92 per person in Medicare funded services while metropolitan communities receive $145.151

146 Country Services Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department

of Health, Western Australia. 147 Holmann, D. (1993). Health Needs Analysis: North Metropolitan Regional Health Service. Perth: Health Department of Western

Australia. 148 Cranny, C., & Associates. (2000). Mid North Coast Area Health Service: Clinical Service Strategy for Acute Care.: Mid North Coast

Area Health Service. 149 Holmann, D. (1993). Health Needs Analysis: North Metropolitan Regional Health Service. Perth: Health Department of Western

Australia. 150 The representatives of nutrition and dietetics services group. (1998). Dietetic and nutrition services in the Perth metropolitan area 1998

to 2020: A descriptive resource paper for use in Health Service Planning in response to the HDWA Health 2020 discussion paper. Perth: Dietitians Association of Australia (WA Branch).

151 National Rural Health Alliance - 2001 Election charter. (2001a). 30% fair share for rural health. National Rural Health Alliance. Retrieved, 2002, from the World Wide Web:


Rural communities require access to some highly specialised allied health services only based in Perth. The Patient Assisted Travel Scheme (PATS) provides assistance for rural patients to attend specialist medical appointments but does not cover referral to allied health specialists. In a recent PATS review (2002) it was recommended that subject to funding becoming available, the scope of PATS should expand to include highly specialised allied health assessment and treatments.152

Improving equity requires more data that supports planning of allied health service provision, as well as the need for intersectorial collaboration of all fund providers.153 A number of workforce reports have identified the need to reorientate funds to areas of most significant need and the need for considerable workforce planning to achieve this.154

The need for multi-dimensional frameworks to drive appropriate levels of resourcing has been acknowledged by health and disability services and by specific health professions such as nursing.155 156 157

A range of frameworks will be required to address differences in service provision models and different requirements for metropolitan and rural providers.158

There is a particular need for funding models that do not disadvantage rural communities,159 including the need to cover costs associated with travel (Submissions, AHTWI, 2002) and to address the poorer health status of rural communities compared to metropolitan.160

Current costing framework developments such as the National Allied Health Service Weights Project target only inpatient or hospital related services.161

152 Patient Assisted Travel Scheme Review Report. (2002). Perth: Department of Health. 153 Review of Therapy Services. (1998). Sydney: Ageing & Disability Department. 154 Alliance, N. R. H. (2002a). Action on nursing in rural and remote areas vision and required conditions - a statement of desired outcomes

relating to nursing in rural and remote Australia. National Rural Health Alliance. Retrieved 8/5/02, 2002, from the World Wide Web: www.ruralhealth.org.au/nursingoutcomes220402.htm

155 National Rural Health Alliance - 2001 Election charter. (2001a). 30% fair share for rural health. National Rural Health Alliance. Retrieved, 2002, from the World Wide Web:

156 Heinzman, S. (2001, 18/12/01). Decision on nurses' load a win for all. The West Australian, pp. 12. 157 Dyson Consulting Group. (2001). Early childhood intervention funding: Stage One. Melbourne: Cerebral Palsy Association of Western

Australia. 158 Country Services Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department

of Health, Western Australia. 159 Golding, S. (2000). Report on the South Australian Rural Allied Health Workforce. Summary Report. Adelaide: Department of Human

Service: South Australia. 160 National Rural Health Alliance - 2001 Election charter. (2001a). 30% fair share for rural health. National Rural Health Alliance.

Retrieved, 2002, from the World Wide Web: 161 Itsiopoulos, C. (2001). National Allied Health Service Weight Project. Paper presented at the National Allied Health Casemix Committee,

Melbourne.


SECTION FOUR

Implementation Plan for the Allied Health Strategic Workforce Plan



EquityCommunication


4.1 Plans for Implementation Development The AHTWI strongly endorses an initial course of action to immediately fund a three months’ implementation preparation phase to address the requirements and costings to implement all recommendations. The AHTWI recommendations were developed with strong consultation and agreement from the allied health workforce. The short project timeframe and delays in receipt of data and analysis, demand that there be a preparation implementation phase before the development of an implementation plan and activities and structures that support AHPs. A consultation and development process is required to ensure the implementation activities meet the needs of the allied health workforce and that the workforce remains a key stakeholder in the process. It is proposed that the current Allied Health Taskforce becomes an Implementation Taskforce that oversees the full implementation of the recommendations and strategies over the next two years. The following suggestions are made by the AHTWI to progress the preparation phase of the report recommendations. It is anticipated that the implementation will be as collaborative and reflective as was the initial phase of the project.

4.2 Next Steps – Implementation Preparation Phase July – December, 2002

HSOA Review of Specified Callings

and Other Professionals

Joint Working Party

Disability Sector Developments

Allied Health

Working Group

Health Sector Developments

Allied Health

Working Group

Cross Sector Developments

Allied Health

ImplementationTaskforce

4.2.1 Cross Sector Developments

Meeting with the Director General of the DoH and the Chief Executive Officer of DSC to present the final report, discuss findings and seek endorsement of the recommendations.


Meeting with the Ministers for Health and Disability Services to present the final report, provide a briefing on major findings and seek endorsement of the recommendations.

Distribution by the Taskforce of the report to their constituents and other stakeholders.

Presentation of the report by the Taskforce to relevant groups and stakeholders to seek feedback on activities to assist the implementation of the recommendations.

Establishment of the Implementation Taskforce on Allied Health Workforce Issues following endorsement of recommendations.

Securement of funding and establishment of project officer position to assist the Taskforce in implementation development and costing of activities and structures.

Official launching of the AHTWI report by the Ministers at the Edith Cowan University symposium: Joined up services: allied health @ work.

Ongoing Implementation Taskforce meetings to determine what needs to be performed at a cross sector level and monitor health and disability sector developments.

4.2.2 Health Sector Developments

Formation of an Allied Health Working Group within the DoH structure. This working group is to commence the development of structures and activities, and funding requirements to implement the endorsed AHTWI recommendations in the health sector.

Involvement of relevant health Taskforce members on the Allied Health Working Group to provide a link between the implementation developments.

4.2.3 Disability Sector Developments

Formation of an Allied Health Working Group or similar mechanism with representation from DSC and NGOs. This working group to commence the development of structures, activities and funding requirements to implement the endorsed AHTWI recommendations in the disability sector.

Involvement of relevant disability Taskforce members on the Allied Health Working Group to provide a link between the implementation developments.

4.2.4 Hospital Salaried Officers Association

In accordance with the Hospital Salaried Officers Enterprise Agreement 2001, a Joint Working Party (JWP) has been established to review a number of workforce issues


affecting various professional classifications. The JWP is due to report in October 2002.

The Joint Working Party to ensure that relevant recommendations from the AHTWI are considered to assist in the review of specified callings and other professionals.

A Hospital Salaried Officers Association representative to remain on the Implementation Taskforce to ensure the processes of the Taskforce and JWP are complementary and have consistent outcomes.

4.3 Additional Implementation Recommendations

4.3.1 Allied Health Professionals Employer Developments

Provision of support to allied health staff to discuss the AHTWI recommendations and implementation requirements within their services.

Provision of workforce plans for AHPs in DoH, DSC and the NGO disability sector consistent with the findings and recommendations of AHTWI.

Maintenance of employers links with the Implementation Taskforce via AHPEG to provide feedback from a service level to inform future implementation planning of structures and activities.

4.3.2 Allied Health Professionals Developments

Determination of AHTWI recommendations of particular relevance. Seek opportunities for development of these recommendations in the local situation.

Lobbying actively in local area of influence for progress on recommendations.

Monitoring of the progress and activities of the Implementation Taskforce.

Seeking opportunities to be involved in activities that progress recommendations of interest.

Ensuring employers are aware of the Report and recommendations and maintain communication on the progress of the Implementation Taskforce.

Using the recommendations and AHTWI data to assist in local level service improvements and project proposals.


SECTION FIVE

Bibliography


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conditions - a statement of desired outcomes relating to nursing in rural and remote Australia. National Rural Health Alliance. Retrieved 8/5/02, 2002, from the World Wide Web: www.ruralhealth.org.au/nursingoutcomes220402.htm

Alliance, N. R. H. (2002b). Action on nursing in rural and remote areas: draft issues paper. National Rural Health Alliance. Retrieved 8/5/02, 2002, from the World Wide Web: www.ruralhealth.org.au/nursingissues220402.htm

Allied Health Professionals Employers' Group. (2001). The critical impact of allied health shortages on Western Australians. Perth: Allied Health Professionals Employers' Group,.

Allies in Health: Briefing paper for the Minister for Health and Ageing. (2001). Melbourne: Health Professions Council of Australia LTD.

Bannigan, K. (2000). To Serve Better: Addressing poor performance in occupational therapy. British Journal of Occupational Therapy, 63(11), 523-528.

BMA Health Policy and Economic Research Unit. (2002). The future healthcare workforce discussion paper 9. British Medical Association. Retrieved 21/3/02, 2002, from the World Wide Web:

Bowman, P., Tweeddale, M., & Kuys, S. (2001). The development of a strategic workforce plan for Queensland health's allied health services. Paper presented at the 4th National Allied Health Conference, Perth.

Boyce, R. (1996). Management and organisation of Rural Allied Health Services. Brisbane: Graduate School of Management: University of Queensland.

Boyce, R. (1998). The allied health professions. In M. Clinton & D. Scheiwe (Eds.), Management in the Australian Health Care Industry. (Second ed.). Melbourne: Addison Wesley Longman Australia.

Boyce, R., & Mickan, S. (2001). Partnerships between hospitals and universities: Finding a model to actively manage allied health education, training and research. Paper presented at the 4th National Allied Health Conference, Perth.

Buchan, J., & O'May, F. (2000). International recruitment of physiotherapists: A report for the Chartered Society of Physiotherapy. Edinburgh: Chartered Society of Physiotherapy.

Commonwealth Department of Health and Family Services. (1996). Developing a framework for Ambulatory Care: a report of five technical workshops., Allied Health Workforce Planning: Extracts from various Commonwealth and State Documents. Brisbane: Queensland Health, Health Workforce Planning and Analysis Unit.

Country Services Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department of Health, Western Australia.

Cranny, C., & Associates. (2000). Mid North Coast Area Health Service: Clinical Service Strategy for Acute Care.: Mid North Coast Area Health Service.

Cruickshank, M. (2001). Government Health Training Advisory Board Industry Training Plan. Perth: Government Health Training Advisory Board.

Dawson, S. (1998). Meeting the needs of families who have children with long term physical disabilities. Bunbury: Bunbury Health Service and Disability Services Commission.


http://www.ruralhealth.org.au/nursingoutcomes220402.htm

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SECTION SIX

Appendices
