health professionals workforce plan taskforcenorth sydney nsw 2060 tel. (02) 9391 9000 fax. (02)...

Health Professionals Workforce Plan Taskforce

Technical Paper

NSW MINISTRY OF HEALTH

73 Miller Street

NORTH SYDNEY NSW 2060

Tel. (02) 9391 9000

Fax. (02) 9391 9101

TTY. (02) 9391 9900

www.health.nsw.gov.au

Produced by:

Health Professionals Workforce Plan Taskforce

This work is copyright. It may be reproduced in whole or in part for study

training purposes subject to the inclusion of an acknowledgement of the source.

It may not be reproduced for commercial usage or sale. Reproduction for

purposes other than those indicated above requires written permission from

the NSW Health.

© NSW Ministry of Health 2011

SHPN (WDI) 110201

ISBN 978-1-74187-617-8

October 2011

Health Professionals Workforce Plan Technical Paper NSW HEALTH PAGE 1

Technical Paper

The Technical Paper of the Health Professionals Workforce

Plan Taskforce is a summary of the data and research that

informed the development of the Health Professionals

Workforce Plan Discussion Paper. It is not intended to be

read as a stand-alone document, but is provided for those

who wish to view the data or information related to various

sections of the Health Professionals Workforce Plan

Discussion Paper. Some sections include additional

information to that included in the similar section in the

Discussion Paper. As a technical resource for the Discussion

Paper some data is presented here without analysis or

discussion.

Workforce Trends1

Nursing

Registered Nurses

The size of the Registered Nursing workforce (public and

private), relative to the population, has not changed

dramatically over the period 2005 to 2009. However, the

distribution of Registered Nurses as a FTE to the

population differs by geographic location. The highest FTE

ratio to population is in very remote areas, and in NSW there

was a sharp increase between 2005 and 2007 in the ratio of

Registered Nurses to the population in remote and very

remote regions.

Major city Inner regional Outer regional Remote Very remote Total

2005 NSW 809.8 803.1 626.3 565.3 831.5 819.2

2007 NSW 828.9 818.3 633.5 613.3 1038.6 846.6

2009 NSW 837.1 830.1 604.2 660.7 1038.4 843.9

2005 Aust 839.6 797.2 781.6 761.9 886.7 854.9

2007 Aust 865.3 858.0 769.6 804.4 872.3 891.0

2009 Aust 842.3 900.7 843.4 943.7 1037.4 905.9

0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

FTE

rati

o p

er 1

00,0

00 p

op

.

FTE (38hpw) Registered Nurses per 100,000 population NSW and Aust comparison

30.0

31.0

32.0

33.0

34.0

35.0

36.0

37.0

38.0

39.0

40.0

Major city Inner regional

Outer regional

Remote Very remote Total

NSW 2005 NSW 2007 NSW 2009 Aus 2005 Aus 2007 Aus 2009

Av. hrs worked per week, RN workforce NSW and Aus 2005-07-09

The Outer Regional location is the only geographic area that

has seen a decline in the ratio of registered nurses to the

population over the time period, albeit a very small

decrease. The ratio of Registered Nurses to the population

for NSW in 2009 in Outer Regional locations is the lowest

ratio across the state and is also significantly lower to the

Outer Regional FTE ratio across Australia.

The average hours worked per Registered Nurse differs

depending on location. Registered Nurses who indicate their

main job is in a remote or very remote geographic location

work longer average hours than their counterparts in major

cities and inner and outer regional areas. The average hours

for NSW compared to the Australian average are higher in

every geographic location other than outer regional. The

greatest increase in average hours worked in NSW between

2005, 2007 and 2009 has been in very remote locations.

1 See section on Australian Standard Geographical Classifi cations for defi nition of regions.

NSW HEALTH Health Professionals Workforce Plan Technical Paper

Enrolled Nurses

In both NSW and Australia there has been an increase in the

number of Enrolled Nurses as a proportion of the population

between 2005, 2007 and 2009. The ratio of Enrolled Nurses

to the population differs between regional areas, and shows

a different pattern of distribution to Registered Nurses. The

distribution for Enrolled Nurses shows a greater ratio the

further one moves from a major city location. Additionally

whereas the comparison between NSW and Australia shows

a greater proportion across Australia of Registered Nurses

working in outer regional and remote areas compared to

NSW, for Enrolled Nurses NSW has a higher proportion of

Enrolled Nurses to the population in all regions, but

markedly higher in remote and very remote regions.

The average hours worked for Enrolled Nurses mirrors the

pattern for Registered Nurses in regards to average hours

worked by location, and the greater average hours in NSW

compared to Australia. Similar to Registered Nurses, Enrolled

Nurses who indicate their main job is in a remote or very

remote geographic location work longer average hours than

their counterparts in major cities and inner and outer

regional areas. The average hours for NSW compared to the

Australian average are higher in every geographic location.

One major difference between the average hours worked

for Registered Nurses and Enrolled Nurses is that whereas

Registered Nurses have increased their hours in remote and

very remote regions the average hours for Enrolled Nurses in

these locations has fallen sharply between 2007 and 2009.

Medical Practitioners

The ratio of medical practitioners to 100,000 of population

is based on folllowing data from the Australian Institute of

Health and Welfare2, of which the NSW data is provided via

the Medical Labour Force profile. As such the information

relates to the entire registered workforce, public, private and

non-Government Organisation (NGO).

Across all geographic regions in NSW there was a decrease

in the ratio of medical practitioners to the population in

2007. For NSW, only in the remote/very remote category has

the ratio of medical practitioners to the population exceeded

the 2005 levels.

The NSW Head Count (HC) to population ratio is similar to

the Australian ratio for the major city and inner regional

areas, although there has been a greater increase in ratio

across Australia in major cities compared to NSW between

2007 and 2009. For outer regional and remote/very remote

the Head Count ratio to population is higher across Australia

compared to NSW.

0.0

100.0

200.0

300.0

400.0

500.0

Major city

Inner regional

Outer regional

Remote Very remote

Total

FTE nurses per 100,000 pop. Australia, (38hr week), 2005-07-09

FTE

ratio

per

100

,000

pop

.


Major city

Inner regional

Outer regional

Remote Very remote

Total

Av hours EN workforce NSW and Aust 2005-07-09


30.0

31.0

32.0

33.0

34.0

35.0

36.0

37.0

38.0

39.0


Medical practitioners HC per 100,000 population by location NSW 2005-2007-2009

FTE

rati

o p

er 1

00,0

00 p

op

.

Major city Inner regional Outer regional Remote / Very Remote

2005 NSW 364 205 128 88

2007 NSW 322 191 109 81

2009 NSW 343 202 119 115

2005 Aust 346 186 153 219

2007 Aust 348 193 161 203

2009 Aust 372 212 188 216

0

50

100

150

200

250

300

350

400

2 Sources: AIHW Medical Labour Force Surveys, 2005,2007 2009; unpublished ABS estimated resident population data.


Allied Health

The previous sections on Nursing and Medical Practitioner

trends had data drawn from the Labour Force Profile data

gathered via state and national registration bodies. As

national registration for Allied Health professionals has only

recently commenced the same data sets are not readily

available. The latest available data showing the workforce in

NSW is from the 2006 Census as reported in the Australian

Institute of Health and Welfare3, and is represented in the

graph below.

The largest classification for Allied Health in NSW is retail

pharmacy, followed by physiotherapists, social workers and

clinical psychologists. The groups with the oldest age profile

are educational and organisational psychologists and

orthotists/prosthetists.

Many Allied Health professionals operate as private

businesses and are based within major cities, with low

numbers working in regional and remote areas.

Whilst the hours per week for NSW via the Labour Force

Profile aren’t available, data is available for the average

hours by classification in NSW Health Local Health Districts

(May 2011, sourced from Staff State Profile (unaudited State

HIE)). Nuclear Medicine Technologists, orthotists/prothetists,

radiographers and radiologists have the highest average

hours within the Allied Health classifications. Podiatrists, Art

and Music Therapists, Audiologists and Genetics Counsellors

have the lowest average hours.

3 Source: AIHW (2009): Health and community labour force 2006, additional material (includes all industries)

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Male Female average age

Allied health and other clinical categories by gender, NSW workforce, 2006


Whilst the information on hours worked is not available by

ASGC-RA the hours by LHD, sourced from the Staff State

Profile (unaudited State HIE) for May 2011, shows that the

LHDs with the greatest proportion of outer regional and

remote areas work less average hours than the inner

regional and major cities. This pattern is very different to

that shown by the Nursing profession.

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

Average Hours by Classification - NSW LHDs at May 2011

Av Weekly Hours Average Allied Health LHDs

25.00

26.00

27.00

28.00

29.00

30.00

31.00

32.00

Average Weekly Hours Allied Health by LHD - May 2011


Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA)

ASGC-RA is a geographic classification system that was

developed in 2001 by the Australian Bureau of Statistics

(ABS) as a statistical geography structure which allows

quantitative comparisons between ‘city’ and ‘country’

Australia. The purpose of the structure is to classify data

from census Collection Districts (CDs) into broad

geographical categories, called Remoteness Areas (RAs). The

RA categories are defined in terms of ‘remoteness’ - the

physical distance of a location from the nearest Urban

Centre (access to goods and services) based on population

size.

The following map4 shows the ASGC-RA rating for each of

the non Sydney LHDs.

4 LHD boundaries are highlighted in red. Only rural LHDs are labelled Local Health District Boundaries - Statewide and Rural Health Services and Capital Planning Branch, NSW Health. Australian Bureau of Statistics: Australian Standard Geographical Classifi cation (ASGC) Remoteness Structure (RA) Digital Boundaries, Australia, 2006


NSW Health System in Context

Health Service Delivery

The schematic shows the health care settings that the

discussions around health service delivery will be grouped.

The use of the term “health care settings” is not intended to

represent “bricks and mortar” but rather services provided

addressing particular needs of patients.

Primary and Preventative

Health

Primary health care refers to

universally accessible, generalist

services, including general

practice, and early childhood

nursing services that address the

health needs of individuals,

families and communities across the life cycle.

Comprehensive primary health care includes early

intervention and health promotion, treatment, rehabilitation

and ongoing care. For most people, these services are the

first point of contact with the health care system. In the

main, private practitioners provide the majority of primary

health care services.6

The World Health Report found that countries at similar

stages of economic development with health care systems

organised around the principles of primary health care

produce better health outcomes for their populations.7

Countries more oriented to primary care have residents in

better health at lower cost. In the United States health is

better in regions that have more primary care physicians,

whereas several aspects of health are worse in areas with

the greatest supply of specialists.8

Primary health care is the part of the health system which

Australians use the most. Over four out of five Australians

will see a GP or other primary care health professional at

least once a year. Primary health care is delivered in the

community, outside of hospitals. It covers a wide range of

providers such as general practitioners, practice nurses,

psychologists, physiotherapists, community health workers

and pharmacists.9

Critical to good chronic care is prevention. Many of the

same risk factors – obesity, poor nutrition, alcohol abuse,

inadequate exercise, smoking- that cause one chronic

disease are also associated with multiple chronic diseases.10

In NSW Health the Public Health Division seeks to improve

the health and well-being of people in New South Wales

through approaches which focus on whole populations.

The focus is to work with communities and organisations to

create circumstances that promote and protect health, and

prevent injury, ill health, and disease. Actions centre on:

■ monitoring health and implement services to improve life

expectancy and the quality of life■ implementing disease and injury prevention measures

Over four out of five Australians will

see a GP or other primary care health

professional at least once a year.

6 NSW Department of Health, 2006. Integrated Primary and Community Health Policy 2007–2012. Sydney: NSW Department of Health [online] http://www.health.nsw.gov.au/policies/pd/2006/pdf/PD2006_106.pdf Accessed 29 August 2011

7 World Health Organisation (2008) Primary Health Care. Now More than Ever. [online} http://www.who.int/whr/2008/whr08_en.pdf Accessed 29 August 20118 Starfi eld, B. (2008) Refocusing the system. New England Journal of Medicine. Vol. 359, No. 20, p. 2087-2091 [online] http://www.nejm.org/doi/full/10.1056/NEJMp0805763 Accessed 13 November

20109 Commonwealth of Australia (2011) Improving Primary Health Care for All Australians. [online] http://www.yourhealth.gov.au/internet/yourHealth/publishing.nsf/Content/improving-primary-health-

care-for-all-australians-toc/$FILE/Improving%20Primary%20Health%20Care%20for%20all%20Australians.pdf Accessed 29 August 201110 Anderson, G (2011) For 50 Years OECD Countries Have Continually Adapted To Changing Burdens Of Disease; The Latest Challenge Is People With Multiple Chronic Conditions. [online] http://www.

oecd.org/document/17/0,3746,en_2649_37407_48127569_1_1_1_37407,00.html

Primary and Preventative Health

Facility Based Sub Acute/Rehab/Aged

In Hospital/Acute

Out of Hospital Care

Primary and Preventative Health


■ promoting and educating people about healthier life

styles■ protecting health through disease prevention services

and legislation■ ensuring the quality use of medicines, the safe use of

poisons, and safe, high quality care in private health

facilities.11

An example of the success of preventative health measures

is the decline in daily smoking. The proportion of daily

smokers among adults has shown a marked decline over the

past two decades in most OECD countries. Australia has

achieved remarkable progress in reducing tobacco

consumption, cutting by half the percentage of adults who

smoke daily (from 35.4% in 1983 to 16.6% in 2007). Much

of this decline in Australia can be attributed to policies

aimed at reducing tobacco consumption through public

awareness campaigns, advertising bans and increased

taxation.12 In NSW smoking rates have shown a dramatic

decline in daily smoking over the last decade.13

10

12

14

16

18

20

22

24

26

28

1997

1998

2002

2003

2004

2005

2006

2007

2008

2009

2010

Males Females Persons

Smoking Rates - NSW 1997-2010

Perc

enta

ge

Dai

ly S

mo

kers


NSW Health is committed to the

delivery of “the right care, to the

right person, at the right time

and in the right place”. This

commitment is demonstrated

through increasing the type and number of services that are

delivered out of the hospital environment 14

For many patients admission to a hospital ward can be

avoided, and for others, the time spent in hospital can be

reduced through using Out-of-Hospital care. NSW Health

delivers much of its care outside of hospitals through

community health services, outpatient clinics, day therapy

dialysis and palliative care. Services included in the Out-of-

Hospital Care program are:

■ Hospital Care at Home including Hospital in the Home

and Community Acute Post Acute Care Services■ ComPacks ■ Advance Care Planning


11 http://www.health.nsw.gov.au/publichealth/index.asp12 OECD (2011). OECD Health Data 2011 How Does Australia Compare [online] http://www.oecd.org/dataoecd/46/38/48295801.pdf Accessed 25 August 201113 Centre for Epidemiology and Research. Health Statistics New South Wales. Sydney: NSW Department of Health. Available at: www.healthstats.doh.health.nsw.gov.au. Accessed 29 August 201114 http://www.health.nsw.gov.au/performance/macca.asp


Out of Hospital Care 15

Strategies/Projects Outcomes

Hospital in the Home - Services are able to deliver care in

the home environment as they are staffed by or have

access to experienced multidisciplinary teams. Services

provided include: medical, nursing and allied health care.

In 2008/09 40,495 patients were treated by Hospital in the

Home /CAPAC services program. This increased to over

54,000 in 2009/2010.

Advance Care Planning. Advance Care Planning describes

the process in which a person plans ahead for health care

related decisions in the event they do not have the capacity

to make those decisions or communicate for themselves.

This process involves the person talking to family, friends

and health care professionals about their values and

concerns relating to health care.

Advance Care Planning outcomes have been measured

through the audit of medical records for people transferred

to EDs from Residential Aged Care Facilities. Transfer

documentation was examined for the documentation of

key Advance Care Planning elements –the “Person

Responsible” i.e. the substitute decision maker and the

presence of an Advance Care Plan. There was an increase

of the person responsible being identified from 16 to 23%

and the presence of an Advance Care Plan from 10% to

26% between 2009 and 2010.

ComPacks. Provide patients returning home from hospital

with case management and access to community services

for a period of up to 6 weeks. The services range from

house cleaning and assistance with bathing to assistance

with shopping, meal preparation and transport. The case

manager is a non-clinical person (i.e. not a nurse, doctor or

allied health professional) who helps organise non-clinical

community services.

Bed days for the over 75yr + patients show a 10%

reduction on the predicted rise.

Community health refers to a range of community based

prevention, early intervention, assessment, treatment, health

maintenance and continuing care services delivered by a

variety of providers. The NSW public health system provides

the majority of community health services, including;

■ Aboriginal health services — health workers who

provide consultation and support to other health

professionals who may undertake early detection, health

promotion and community development work within

their local communities. In addition, they provide an

important link between their Aboriginal communities

and mainstream health services.■ Allied health services — providers delivering a range

of services in community settings eg physiotherapists,

psychologists, occupational therapists, podiatrists, social

workers, optometrists and speech pathologists.

■ Child and family health and youth health

services — services provided by Local Health Districts

and delivered in community settings such as early

childhood clinics, community health centres, local council

buildings and in the home.■ Community health nursing services — generalist

community health nurses providing a range of services

across the continuum of care meeting a range of health

needs for clients anywhere in the community from

community health centres, primary health clinics, schools

and universities and client’s homes. Community nurses

usually work in multidisciplinary teams that ensure the

client receives the full range of health care, often

focused toward social conditions, illness/ disease

prevention or early intervention to prevent exacerbations

of chronic illness and unnecessary hospital admission

15 NSW Health document , Redesign Achievements 2009/2010 (unpublished)


■ Community mental health services — provide care

for people with acute problems and people in crisis.

Each service includes after-hours contact as well as long-

term care. They also provide programs to promote

mental health and prevent mental health problems■ Multicultural health services — statewide

multicultural health services provide health care, health

promotion and community development to communities

requiring specialised health care needs. Multicultural

health workers are specifically designated to provide

clinical services, undertake early detection, health

promotion and community development within their

local culturally and linguistically diverse (CALD)

communities.16

In 2008, the New South Wales Population Health Survey

estimated that 8.0 per cent of adults attended a community

health centre on 1 or more occasions in the last 12 months.

A significantly lower proportion of males (6.0 per cent) than

females (10.0 per cent) attended a community health centre

in the last 12 months. Since 2002, there has been a

significant increase in the proportion of adults who attended

a community health centre in the last 12 months (6.9 per

cent to 8.0 per cent). The increase has been significant in

rural health areas.17

Palliative Care services provide coordinated medical,

nursing and allied health care, delivered wherever possible in

the environment of the person’s choice. Palliative care

involves the provision of physical, psychological and

emotional support for patients and their families and carers.

It aims to respect the dignity, needs and wishes of the

person dying, with particular attention to the needs of

different cultural and religious groups. 18

In NSW Health palliative care services include services

provided in public hospitals, community-based and home

settings. 190 public hospitals provide palliative care services

in NSW. The former Area Health Services advised that in

2009/10 key palliative care services delivered included:

■ Public hospital separations 10,421■ Public hospital bed days 115,044 ■ Centre-based occasions of service 327,099■ Home based occasions of service 145,516

In Hospital-Acute Care

Acute care is generally considered

to be short-term medical

treatment, usually in a hospital. It

can include, for example, patients

admitted for an acute illness or

injury, recovering from surgery, acute episodes of chronic

conditions or maternity care.

An episode of acute care for an admitted patient is one in

which the principal clinical intent is to do one or more of the

following:

■ manage labour (obstetric),■ cure illness or provide definitive treatment of injury, ■ perform surgery,■ relieve symptoms of illness or injury (excluding palliative

care),■ reduce severity of illness or injury, ■ protect against exacerbation and/or complication of an

illness and/or injury which could threaten life or normal

functions, ■ perform diagnostic or therapeutic procedures.19

Admission to hospital is generally through an Emergency

Department, or through a referral from a specialist as a

“booked admission”.

Between January and March 2011 patients admitted for

acute care or maternity and birth comprised 97% of all

admitted episodes in NSW hospitals. Most of these episodes

were overnight admissions (56%) and this percentage has

not changed over the previous two years. Patients stayed a

total of 1,294,785 bed days during the quarter. On average,

patients stayed 3.4 days in hospital. There were 17,886

babies born, up 3% from the same quarter one year ago. 20

The reasons for admission to hospital from Emergency

Department for the period January to March 2011 by

Diagnosis Related Groups (DRGs) shows the highest volume

of reasons for admissions was for chest pain, digestive

disorders, cellulitis, gastroenteritis, and kidney and urinary

tract infections. 21

16 NSW Department of Health, 2006. Integrated Primary and Community Health Policy 2007–2012. Sydney: NSW Department of Health [online] http://www.health.nsw.gov.au/policies/pd/2006/pdf/PD2006_106.pdf Accessed 29 August 2011

17 New South Wales Population Health Survey 2008 (HOIST). Centre for Epidemiology and Research, NSW Department of Health.18 NSW Health (2010) NSW Palliative Care Strategic Framework 2010-2013 [online] http://www.health.nsw.gov.au/policies/pd/2010/PD2010_003.html 19 http://www.bhi.nsw.gov.au/glossary20 Bureau of Health Information (2011) 21 NSW Health (2011) Ministerial Taskforce on Emergency Care (MTEC) Emergency Department Reports unpublished data

In Hospital/Acute


Facility Based Sub Acute /

Rehab/Aged

Subacute care treats individuals of

low and moderate acuity. Such care

is provided after, or instead of, acute

hospitalisation for purposes such as

evaluation and treatment of active or

unstable medical conditions, to offer

frequent recurrent monitoring of a patient’s clinical course,

and to provide moderately complex or risky treatment

requiring significant skill, judgment, or monitoring. Care sites

other than hospitals can often meet the needs of individuals

whose conditions are of moderate or low acuity.23

Subacute care is given for a limited time (several days to

several months) until a specific goal is accomplished, such as

stabilising a condition or completing a predetermined

treatment course. The care requires the coordinated services

of physicians, nurses, and other relevant professional

disciplines to assess and manage these conditions and

perform the necessary procedures. Although subacute and

long-term nursing home care can overlap somewhat, they

have different emphases. Subacute care is short-term care

related to recent illness or injury that must accommodate

underlying functional impairments and chronic conditions

that affect short- and intermediate-term recovery.24

Subacute care, within this framework, encompasses periods

of care that may be offered in and outside of acute hospital

environments, but which focus primarily on aspects of care

other than typical acute care requirements. As such, services

like rehabilitation and a large proportion of hospital based

aged care fall within this definition. Similarly, wards or sites

that offer primarily subacute care may be described as

subacute care facilities.25

22 Centre for Epidemiology and Research. Health Statistics New South Wales. Sydney: NSW Department of Health. Available at: www.healthstats.doh.health.nsw.gov.au. Accessed 28 July 2011.23 Levenson S 2000. “The future of subacute care.” Clinics in Geriatric Medicine 16(4): 683-70024 Levenson S 2000. “The future of subacute care.” Clinics in Geriatric Medicine 16(4): 683-700 25 Gray, L. (2002) Subacute care and rehabilitation. “Australian Health Review” 25 (5) 140-144

Hospitalisations by cause - rate per 100,000 of population 1998/99 - 2009/10

0.0 500.0 1000.0 1500.0 2000.0 2500.0 3000.0 3500.0 4000.0 4500.0 5000.0

Malignant neoplasms

Other neoplasms

Blood & immune diseases

Endocrine diseases

Mental disorders

Nervous & sense disorders

Cardiovascular diseases

Respiratory diseases

Digestive system diseases

Skin diseases

Musculoskeletal diseases

Genitourinary diseases

Maternal, neon. & congenital

Symptoms & abnormal findings

Injury & poisoning

Dialysis

Other factors infl. health

Other

Rate 09-10

Rate 98-99

Infectious diseases

Facility Based Sub Acute/Rehab/Aged

The graph below shows the rate of hospitalisation by cause

for the periods 1998-1999 and 2009-2010.22 It can be seen

than the rate of many causes of hospitalisation has remained

relatively similar for the 10 year period. There have been falls

in hospitalisations caused by cardiovascular disease,

respiratory diseases, digestive system diseases, genitourinary

diseases and maternal and neonatal. Increases can be seen

for endocrine, mental disorders, nervous and sense

disorders, injury and poisoning and dialysis – the largest area

of growth of causes for hospitalisations in the 10 year

period.


Rehabilitation

Rehabilitation care in NSW is defined as the provision of care

that aims to:

■ restore functional ability for a person who has

experienced an illness or injury■ enable regaining function and self-sufficiency to the level

prior to that illness or injury within the constraints of the

medical prognosis for improvement■ develop functional ability to compensate for deficits that

cannot be medically reversed.26

The setting in which rehabilitation takes place is principally

defined by the patient‘s changing needs over time and the

availability of rehabilitation services in particular areas. The

rehabilitation patient journey is not a linear process and

pathways are individually determined based on:

■ the patient‘s level of functional impairment (including

ability to function safely in a given environment); ■ medical acuity and prognosis; and ■ access to rehabilitation services.

An inpatient rehabilitation journey most often commences

with an acute presentation related to acute illness (eg

stroke), trauma (eg fracture), elective surgery (eg joint

replacement) or significant functional debilitation (eg

decreased mobility due to chronic disease or ageing). This

journey continues through to transfer of care to an alternate

setting or discharge from rehabilitation either with or

without further support services.27

With a strong focus on restoring function after an acute

hospitalisation older people are the largest users of

rehabilitation services. This patient population tends to take

longer to recover, especially after hospitalisation, and

requires an enhanced focus on continuity of care and

follow-up in the community to avoid further decline.28

In terms of bed days the highest volume of patient activity

for the period 2009/10 was attributed to stroke,

representing 25%, fractures representing 19% and other

disabling impairments representing 18% of all inpatient

public rehabilitation bed days.

The following co-morbidities were most frequent:

■ Cardiac related diagnoses (including ischemic heart

disease and atrial fibrillation and cardiac failure); (19% of

admissions). ■ Arthritis and osteoporosis (12% of admissions) ■ Other chronic and complex care conditions including

chronic obstructive pulmonary disease, renal failure,

asthma (5% of admissions). ■ Diabetes (5% of admissions). 30

A review of Local Health District Sub Acute plans reveals

some common themes in regards to current service delivery,

including:

■ The focus within facility based services is largely on

rehabilitation services followed by palliative care.

Geriatric Evaluation and Management (GEM) is

considered the third priority and psycho geriatric services

is based on availability of funding.■ The development of Rapid Response outreach services. ■ An increased need for community based mental health

programs for older people.■ Significant growth in activity which some areas recording

over 100% growth in inpatient separations.

26 NSW Health (2011) Rehabilitation Redesign Project [online] http://www.archi.net.au/documents/resources/models/rehab_redesign/rehabilitation-moc.pdf 27 NSW Health (2011) Rehabilitation Redesign Project [online] http://www.archi.net.au/documents/resources/models/rehab_redesign/rehabilitation-moc.pdf 28 NSW Health (2011) Rehabilitation Redesign Project [online] http://www.archi.net.au/documents/resources/models/rehab_redesign/rehabilitation-moc.pdf29 NSW Health (2011) Rehabilitation Redesign Project[online] http://www.archi.net.au/documents/resources/models/rehab_redesign/rehabilitation-moc.pdf30 NSW Health (2011) Rehabilitation Redesign Project [online] http://www.archi.net.au/documents/resources/models/rehab_redesign/rehabilitation-moc.pdf

Rehabilitation patient age profile in NSW over three years 29

(Source: HIE data, Demand and Performance Evaluation Branch NSW Health, Nov 2010)


NSW Health Workforce

The following workforce graphs31 show the FTE for each

occupational group as an FTE and as an FTE per 100,000 of

population. This approach is useful to enable comparison to

reporting FTE data without any context to relative size

though it is not necessarily indicative of service delivery in a

particular LHD.

Medical

For the medical workforce the ratios in metropolitan

locations are fairly similar except for Sydney LHD. The higher

ratio to the population for Sydney LHD may be a factor of

referrals, particularly to Royal Prince Alfred, from outside

their geographic area. The FTE of medical workforce to

population for outer metropolitan LHDs is comparable to

and slightly higher than, the metropolitan Sydney LHDs. In

regard to the rural and regional LHDs, other than Southern

and Murrumbidgee LHDs the FTE ratio would not appear to

be significantly different, however in the main the rural and

regional LHDs are more geographically dispersed and have a

larger number of facilities. Southern LHD has the lowest FTE

of medical workforce to population. This ratio is further

complicated by the situation where 88% of the medical

workforce is comprised of Agency Doctors and Visiting

Medical Officers (VMOs).

Nursing

For the nursing workforce, other than Sydney LHD, the ratio

of nursing FTE to the population rises the further one moves

from the metropolitan areas, that is the FTE per population

is higher in the outer metropolitan LHDs than the Sydney

metropolitan, and the rural and regional are higher than the

inner and outer metropolitan LHDs, again excepting

Southern LHD. This may be a factor of a greater role

undertaken by Nursing Workforce in outer metropolitan and

rural and regional areas, and of changes in skills mix.

Allied Health

The ratio of the Allied Health workforce to the population is

slightly higher in the outer metropolitan LHDs (Illawarra-

Shoalhaven and Central Coast) and the Northern area LHDs

(Hunter New-England, Mid North Coast and Northern NSW).

The southern and western rural LHDs and the Sydney

metropolitan LHDs would seem to have a very similar profile

of Allied Health workforce (excepting Sydney LHD which has

the highest ratio to population overall). However, the FTE

ratio comparing Sydney to Rural needs to take into account

the greater distances a patient may have to travel to access

those services.

Oral Health

The profile for Oral Health does not follow a pattern based

on location. In the main the provision of Oral Health services

is mainly private the NSW Health profile reflects where there

is a concentration of Oral Health Services across LHDs, for

example, Sydney Dental Clinic in Sydney LHD and Westmead

Dental school in Western Sydney LHD.

31 The data for the workforce graphs is sourced from the Staff State Profi le (unaudited State HIE) for June 2011. VMO FTE has been calculated as a combination of fee for service payments and sessional hours.


Sydney

South

Easte

rn Sy

dney

South

Wes

tern

Sydney

Wes

tern

Sydney

Norther

n Sydney

Illawar

ra Sh

oalhav

en

Nepea

n Blu

e Mounta

ins

Centra

l Coas

t

Hunter N

ew En

gland

Mid

North

Coas

t

Norther

n NSW

South

ern N

SW

Murru

mbid

gee

Wes

tern

NSW

Far W

est

Sydney

South

Easte

rn Sy

dney

South

Wes

tern

Sydney

Wes

tern

Sydney

Norther

n Sydney

Illawar

ra Sh

oalhav

en

Nepea

n Blu

e Mounta

ins

Centra

l Coas

t

Hunter N

ew En

gland

Mid

North

Coas

t

Norther

n NSW

South

ern N

SW

Murru

mbid

gee

Wes

tern

NSW

Far W

est

Sydney

South

Easte

rn Sy

dney

South

Wes

tern

Sydney

Wes

tern

Sydney

Norther

n Sydney

Illawar

ra Sh

oalhav

en

Nepea

n Blu

e Mounta

ins

Centra

l Coas

t

Hunter N

ew En

gland

Mid

North

Coas

t

Norther

n NSW

South

ern N

SW

Murru

mbid

gee

Wes

tern

NSW

Far W

est

Sydney

South

Easte

rn Sy

dney

South

Wes

tern

Sydney

Wes

tern

Sydney

Norther

n Sydney

Illawar

ra Sh

oalhav

en

Nepea

n Blu

e Mounta

ins

Centra

l Coas

t

Hunter N

ew En

gland

Mid

North

Coas

t

Norther

n NSW

South

ern N

SW

Murru

mbid

gee

Wes

tern

NSW

Far W

est

020406080100120140160180200

0

200

400

600

800

1000

1200

1400

FTE

Medical Workforce (inc VMO) by LHD

0100200300400500600700800

0

1000

2000

3000

4000

5000

6000

Nursing Workforce by LHD

020406080100120140160

0100200300400500600700800900

1000

0

10

20

30

40

50

60

0

50

100

150

200

250

300

350

Oral Health Workforce by LHD

FTE

per

100

,000

of

po

pu

lati

on

FTE

FTE

FTE

FTE

per

100

,000

of

po

pu

lati

on

FTE

per

100

,000

of

po

pu

lati

on

FTE

per

100

,000

of

po

pu

lati

onAllied Health Workforce by LHD

Another factor to take into account in looking at the

workforce by LHD or geographic region is the relative make

up of the profession to determine whether there are any

issues in regards to the relative experience of staff.

Nursing

The following graph shows the distribution of Nursing

classifications within each LHD, that is, the proportion of

each classification within all nursing employees within each

LHD. Murrumbidgee, Western NSW and the Far West LHDs

Sydney

South

Easte

rn Sy

dney

South

Wes

tern

Sydney

Wes

tern

Sydney

Norther

n Sydney

Illawar

ra Sh

oalhav

en

Nepea

n Blu

e Mounta

ins

Centra

l Coas

t

Hunter N

ew En

gland

Mid

North

Coas

t

Norther

n NSW

South

ern N

SW

Murru

mbid

gee

Wes

tern

NSW

Far W

est

Nurse-Midwife manager

Clin Nurse-Midwife Consultant

Clin Nurse-Midwife Specialist

Nurse Practitioner

Clin Nurse-Midwife Educator

Nurse-Midwife Educator

Nurse-Midwife Unit Manager

Registered Midwife

Registered Nurses (5-8)

Registered Nurses (1-4)

Enrolled Nurse

Assistant in Nursing

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Nursing Classifications as Proportion of Nursing Workforce - by LHD


have the greater proportion of Assistant in Nursing and

Enrolled Nurse classifications. However, they also have a

greater proportion of Nurse Manager positions, so there is a

greater reliance on both junior and senior staff in the rural/

remote LHDs.

Medical

The following graph shows the distribution of Medical

Practitioner classifications within each LHD, that is the

proportion of each classification within all Medical

Practitioners within each LHD. The graph highlights the

greater reliance on short-term contracted doctors in the

rural and remote LHDs, especially in Southern NSW and the

Far West LHDs. Central Coast LHD has the largest proportion

of Junior Medical Officers (Intern and RMO). Mid North

Coast LHD has the largest proportion of Career Medical

Officers. Care needs to be taken in interpretation of

proportion of junior doctors due to the rotational nature of

their appointments during their pre-vocational and

vocational training.

Sydn

ey

Sout

h Ea

stern

Sydn

ey

Sout

h W

este

rn Sy

dney

Wes

tern

Sydn

ey

North

ern

Sydn

ey

Illawar

ra Sh

oalha

ven

Nepea

n Blu

e Mou

ntain

s

Centra

l Coa

st

Hunte

r New

Engla

nd

Mid

North

Coa

st

North

ern

NSW

Sout

hern

NSW

Mur

rum

bidge

e

Wes

tern

NSW

Far W

est

Agency Doctor

VMO

Clinical Academic

Staff Specialists

Career Medical Officers

Registrar

RMO3-4

RMO1-2

Intern

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Medical Classifications as Proportion of Medical Workforce - by LHD


Allied Health

The following graph shows the distribution of Allied Health

Professionals within each LHD. Care needs to be taken with

analysis of this information as there is a greater proportion

on Allied Health staff temporarily appointed to Health

Reform Transitional Organisations, who will not be reflected

in this graph. An example of this would be the level of

radiographers in South Eastern Sydney and Illawarra-

Shoalhaven LHDs, as medical imaging staff are employed in

a business unit that sits under the Health Reform Transitional

Organisation and are therefore not reflected in the number

of employees in each LHD.

Sydney

South

Easte

rn Sy

dney

South

Wes

tern

Sydney

Wes

tern

Sydney

Norther

n Sydney

Illawar

ra Sh

oalhav

en

Nepea

n Blu

e Mounta

ins

Centra

l Coas

t

Hunter N

ew En

gland

Mid

North

Coas

t

Norther

n NSW

South

ern N

SW

Murru

mbid

gee

Wes

tern

NSW

Far W

est

Other

Nuclear Medicine Technologists

Counsellor

Podiatrist

Radiation Therapist

Dietitian

Radiographer

Psychologist

Clinical Psychologist

Speech Pathologist

Pharmacist

Occupational Therapist

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Allied Health Classifications as Proportion of Allied Health Workforce by LHD

Physiotherapist

Social Worker


Future projections

Population

The NSW Department of Planning has released New South

Wales Statistical Local Area Population Projections, 2006-

2036. They project that the NSW population will grow by

22.3% between 2008 and 2028, increasing from 7.015

million to 8.578m, an increase of 1.563m. The strongest

population growth will occur in the following Statistical

Local Areas (SLAs): Western Sydney, parts of central Sydney,

regional areas on or near the coast, the Sydney-Canberra

corridor and some regional centres (Central and South

Coast).32 At the same time, many SLAs with small

populations usually located in more remote parts of the

State (under 5,000 people) are projected to decline in

population.

The projected population growth by Local Health District

(LHD)33 shows the population increase by each of the LHDs

in NSW. Consistent with the projections from the NSW

Department of Planning by SLA the biggest growth for LHDs

is in South Western and Western Sydney, Southern NSW

and the Mid-North Coast. The areas of lowest and even

negative growth are Far West NSW, Western NSW and

Murrumbidgee.

The Age Profile for the projected population by 2028 shows

that each LHD will be potentially dealing with different

burdens of health care based on the demographics of its

population. Mid North Coast, Illawarra Shoalhaven and

Northern NSW will be dealing with a larger proportion of

older residents, whilst South Western Sydney, Western

Sydney and Nepean Blue Mountains will have a

proportionally younger aged community. Sydney and South

Eastern Sydney LHDs will have the largest proportion of

working age population, whilst Mid North Coast,

Murrumbidgee and Central Coast LHDs will have the

smallest proportion of working age population.

Sydney

South

Easte

rn Sy

dney

South

Wes

tern

Sydney

Wes

tern

Sydney

Norther

n Sydney

Illawar

ra Sh

oalhav

en

Nepea

n Blu

e Mounta

ins

Centra

l Coas

t

Hunter N

ew En

gland

Mid

North

Coas

t

Norther

n NSW

South

ern N

SW

Murru

mbid

gee

Wes

tern

NSW

Far W

est

-30%-20%-10%0%10%20%30%40%50%

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

FTE

per

100

,000

of

po

pu

lati

on

FTE

per

100

,000

of

po

pu

lati

on

NSW Pop by LHD 2008 and Projection to 2028

2008 2028* % Change NSW Average Change

32 Population NSW Bulletin April 201033 Centre for Epidemiology and Research. Health Statistics New South Wales. Sydney: NSW Department of Health. Available at: www.healthstats.doh.health.nsw.gov.au. Accessed 4 Aug 2011

Sydney

South

Easte

rn Sy

dney

South

Wes

tern

Sydney

Wes

tern

Sydney

Norther

n Sydney

Illawar

ra Sh

oalhav

en

Nepea

n Blu

e Mounta

ins

Centra

l Coas

t

Hunter N

ew En

gland

Mid

North

Coas

t

Norther

n NSW

South

ern N

SW

Murru

mbid

gee

Wes

tern

NSW

Far W

est

70+

45-69

25-44

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Age Profile by LHD - 2028 Projected Population

15-24

0-14

10

6,4

66

26

5,5

57

14

7,6

35

23

2,5

20

16

5,5

51

79

,06

9

84

,41

3

72

,57

8

17

7,9

42

43

,06

1

60

,80

1

44

,42

0

46

,92

9

51

,38

6

4,4

13

85

,36

5 17

3,8

07

11

9,3

78

15

6,8

12

12

0,1

73

50

,53

9

55

,66

9

46

,17

1

11

1,3

34

23

,35

6

34

,88

1

24

,01

9

27

,45

6

29

,05

6

2,4

55

23

1,0

06

32

2,4

03

28

6,4

63

31

6,8

86

26

2,9

06

10

1,7

94 11

1,3

22

92

,23

3

22

3,3

96

47

,07

6

71

,28

8

53

,78

3

53

,35

7

59

,73

9

5,5

36

18

1,7

61

32

4,4

22

24

3,1

47

28

7,7

96

26

2,1

27

13

7,4

95 10

9,7

77

11

2,1

20

30

6,7

66

88

,20

8

11

5,9

50

83

,91

9

76

,98

8

85

,17

4

8,8

04

74

,43

2

13

5,8

01

11

8,4

50

10

9,1

46

13

0,7

59

80

,73

7

49

,49

6

66

,40

7

17

6,2

81

59

,24

1

71

,63

5

44

,49

1

45

,19

9

47

,76

6

4,9

87


Whilst the data for the same period is not available for the

Aboriginal population, data for a similar period shows a

much different projected growth in age groups for the NSW

Aboriginal population. There is a larger projected growth for

the Aboriginal population than the average growth in NSW,

a much larger projected increase for younger age groups,

and a smaller growth for those aged over 70.

The projected growth in the population by age group shows

a greater growth in those aged 65 and over and smaller

growth in those of working age.

Projected Growth in Age NSW Aboriginal population 2006-2021

0-4

5-9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

All

Ag

es

80+

-40.0%

-30.0%

-20.0%

-10.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Percentage growth in age, NSW population, 2008 to 2028

20.5% 20.8%

15.9%

10.5%8.7% 9.7%

16.9%

10.7%14.9%

3.8%

11.0%

17.4%

27.2%

63.3%

76.2%80.5%

67.6%

92.5%

22.3%

0.0%

0-4

5-9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85+

All

ages

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

In looking at the relative size of the working age population

(20-64) to both younger and older age groups it can be

seen that the largest growth is in the over 65 age group.

45.7% of the projected growth of the population (0.714m)

will be in the age group of 65 years and older, with an

estimate growth of 74.1% (more than three times total

population growth).34

For the Aboriginal population the growth in the younger

age groups mitigates this effect. Whilst the age group over

65% has the largest growth the difference in growth

between the age groups is not as stark.

■ In the 12 months to December 2010, net overseas

migration (NOM) contributed to 58% of the State’s

population growth, while natural increase (births minus

deaths) contributed to 40% ■ At the same time there was a net loss due to interstate

migration of 11,200 persons to neighbouring States, the

largest net loss among States and Territories.35

0

1000000

2000000

3000000

4000000

5000000

6000000

Under 19 20-64 65+

Pop

ula

tio

n N

um

ber

Perc

enta

ge

Gro

wth

Growth in Age Groups NSW 2008-2028

0

20

40

60

80

2008 2028 % Growth

0

20000

40000

60000

80000

100000

120000

Under 19 20-64 65+

Pop

ula

tio

n N

um

ber

Perc

enta

ge

Gro

wth

Projected Growth in Age Groups - AboriginalPopulation NSW 2006-2021

2006 2021 % Growth

0%

60%

50%

40%

30%

20%

10%

34 Health Statistics NSW: Estimated residential population and projected population by age and sex, NSW, 2008 to 202835 Koleth, E. (2010) Population issues for Sydney and NSW: Policy frameworks and responses. Briefi ng Paper No. 5/2011 NSW parliamentary Library Research Service.

Source: Health Statistics NSW: Estimated residential population and projected population by age and sex, NSW, 2008 to 2028

Source: NSW Aboriginal Housing Offi ce (2008) Indicative New South Wales Indigenous Population Projections 2006 to 2021


Service Delivery

Acute

The inpatient projection model used by NSW Health, aIM

2010 (Acute Inpatient Model), has been developed to take

into account projected growth in inpatient activity based on

specialty groupings (SRGs – service reference groups). The

latest projections use 2009 as the base year, and project

inpatient activity to 2027. The specialties in the aIM data

have been mapped to medical specialist categories, which

are then weighted to estimated specialist numbers by

speciality. Growth rates were analysed for both separations

(number of patients) and case weighted technical units

(CWTU). The weighted total growth rate per annum used in

the baseline specialist modelling is 1.87% (CWTU).

The largest projected growth in is renal medicine,

endocrinology and ophthalmology – all specialities

associated with the increase in rates of diabetes. There is

also a projected growth in non subspeciality medicine. The

lowest growth areas are cardiothoracic surgery,

transplantation, gynaecology and obstetrics and drug and

alcohol.

Annual Percentage growth in inpatient activity, 2009-2027, NSW public & private hospitals

AveVarSep% AveVarCWTU%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

4.50%


The projected increases for the Acute Inpatient Model (aIM)

type of stay in NSW public hospitals indicates that there is a

larger annual increase in same day procedures (2.5%)

compared to the annual average increase in overnight

hospitalisations (1.9%).

There has been a small but steady decrease in average

length of stay in NSW public hospitals over the last decade.

This is partly due to an increase in the proportion of patients

treated on a same day basis (same day separations), and

partly a result of shorter length of stay for patients staying

more than one day (overnight average length of stay). The

graph below illustrates the two trends.

Overnight average length of stay for acute patients is

currently 5.1 days (NSW average), but there is considerable

variation between Local Health Districts. Some of this

variation is due to a different mix of patients treated at

different Local Health Districts.

0

500000

1000000

1500000

2000000

2500000

2009 2012 2017 2022 2027

aIM projected increases in overnight and same dayprocedures - NSW public hospitals

Overnight Same Day

Overnight Average Length of Stay and Percentage of Same Day Separations by Financial Year (acute separations only)

Ove

rnig

ht

ALO

S (d

ays)

% o

f Sa

me

Day

Sep

rati

on

s

5

4.9

5.3

5.2

5.1

5.4

5.5

5.6

42.5%

42.0%

44.0%

43.5%

43.0%

44.5%

45.0%

45.5%

Same Day Separations as % of All Acute Separations

Overnight Average Length of Stay (Days)

2005/06 2010/112009/102008/092006/07

Rehabilitation Palliative Care Psychogeriatric Maintenance

2009 111,679 10,120 656 7,715

2017 134,947 12,332 964 9,172

2022 155,335 13,861 1,131 10,102

Growth 2009-2017 21% 22% 47% 19%

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

Act

ive

Epis

od

es

Subacute Inpatient Projections (Demand) for NSW Public Hospitals

Workforce Projections

Modelling

The approach to demand modelling used within the models

below relates to the method of economic demand, and

incorporates the use of current and projected data for the

public health sector and private health sector (if modelling

whole of workforce). Demand modelling for the whole

workforce has been determined through an aggregation of

the demand estimates of staff categories within workforces

(weighted accordingly) and service demands. The service

demands have been determined from the current NSW

Acute Inpatient Model (aIM) projections project all acute

Diagnosis Related Groups (DRGs) or both public and private

hospitals from 2009 to 2027. Growth is estimated to

increase by 1.88% per annum over this period.


Registered Nurses NSW Health Adjusted headcount vs. Status quo headcount

hea

dco

un

t

35,000

40,000

45,000

50,000

55,000

60,000

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

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Year (Balancing year 2026)

Status quo headcount Adjusted headcount

Nursing

NSW Health - Registered Nurse Workforce

This graph36 indicates the number of Registered Nurses

projected to be working in the NSW public health system

under two different scenarios. The status quo headcount

represents the scenario where there are no changes to the

current training level.

Even without change the projected increase in the size of

the Registered Nurse workforce between 2008 and 2028

shows a requirement for an extra 15,000 Registered Nurses.

The adjusted headcount represents the required headcount

based on projection of service needs to 2030. To achieve the

adjusted headcount there is a requirement to increase

training places for registered nurses of 239 students per

year.

The NSW Health Registered Nursing Modelling has identified

high losses in the nursing workforce in the years up to 40

years and around retirement age. Between these periods on

average there is more re-entry than losses in the registered

nursing workforce. This movement contributes to the factors

contributing to the need to train more graduates along with

the reduction in average hours worked. An increase in

retention is currently being experienced by NSW Health in

2010/11 compared to previous periods. This can be

attributed to external factors such as labour market shift due

to the Global Financial Crisis and loss of re-entry of the

workforce to other sectors other than NSW Health.

Enrolled Nurses

This graph37 indicates the number of Enrolled Nurses

projected to be working in the NSW public health system

under two different scenarios. The status quo headcount

represents the scenario where there are no changes to the

current training level. The adjusted headcount represents the

required headcount based on projection of service needs to

2030. To achieve the adjusted headcount there is a

requirement to increase training places for Enrolled Nurses

by 849 students per year.

The NSW Health Enrolled Nursing modelling has identified

high losses in the nursing workforce in the years up to 40

years and around retirement age. Between these periods on

average there is more re-entry than losses in the Enrolled

Nursing workforce. This movement contributes the factors

contributing to the need to train more Enrolled Nurses along

with the reduction in average hours worked. An increase in

retention is currently being experienced by NSW Health in

2010/11 compared to previous periods. This can be

attributed to external factors such as labour market shift due

to the Global Financial Crisis and loss of re-entry of the

workforce to other sectors other than NSW Health.

Enrolled Nurses NSW Health Adjusted headcount vs. Status quo headcount

hea

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36 2007 Nurses NSW Labour Force Profi le and unpublished NSW Health workforce projections37 2007 Nurses NSW Labour Force Profi le and unpublished NSW Health workforce projections


38 2009 Nurses NSW Labour Force Profi le and unpublished NSW Health workforce projections

Totalled Medical Workforce Adjusted headcount vs. Status quo headcount

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Medical

This graph38 indicates the number of Medical Practitioners

projected to be required in the total NSW health system

(public and private) under two different scenarios. The status

quo headcount represents the scenario where there are no

changes to the current training level.

The projected workforce growth required to meet service

needs projected to 2030 is 14,258, under current training

levels. The adjusted headcount required to meet service

needs is 14,664. This adjusted projected increase in the size

of the Medical workforce required between 2009 and 2030

shows a need for an extra 406 doctors. The adjusted

headcount represents the required headcount based on

projection of service needs to 2030. To achieve the adjusted

headcount there is a requirement to increase training places

for doctors of 38 students per year.

The Medical modelling for NSW has identified high losses in

the medical workforce in the initial years of training/work

and around retirement age. Between these period on

average there is more re-entry than losses in the medical

workforce. This movement contributes to the need to train

more graduates, together with the reduction in average

hours worked. An increase in retention is currently being

experienced by NSW Health in 2010/11 compared to

previous periods. This can be attributed to external factors

such as labour market shift due to the Global Financial Crisis

and increasing training being offered.

Allied Health

Initial workforce modelling has been undertaken on 13 of

the 26 professional groups within Allied Health employed by

NSW Health. This represents 97% of the June 2010 NSW

Allied Health Public Health workforce. The scenarios

discussed below are based on preliminary estimated demand

and further refinement may be required.

It is estimated that for Psychologists and Clinical

Psychologists NSW Health employs 30.3% of the total

NSW Psychology workforce. Assuming baseline growth of

1.8% it is estimated that NSW Health will need

approximately 6% additional headcount per year if the

current model of care persists.

For Physiotherapists NSW Health employs 28.4% of the

total estimated NSW Physiotherapy workforce. Initial growth

in estimates indicate that NSW Health will need an

additional 2.2% workforce headcount per year to meet

projected service requirements.

Occupational Therapists are predominately employed by

NSW Health and estimated at above 58% of the total

estimated NSW Occupational Therapist workforce. Initial

growth estimates indicate that NSW Health will need an

additional 0.5% growth in headcount per annum.

It is estimated that for Dieticians NSW Health employs 44%

of the total estimated NSW Dietician workforce. With

baseline growth of 1.8% it is estimated that NSW Health

will need approximately 2.4% additional headcount per

annum if the current model of care persists.

NSW Health employs approximately 52% of the total Social

Worker workforce in NSW. A range of scenarios estimate a

growth in headcount up to 1.4% per annum to meet

projected service requirements. Counsellors require a

headcount growth of approximately 3.4% per annum,

however the size of the NSW workforce for counsellors is

difficult to determine due to differential terminology of

classifications in use.

For Radiographers, Radiation Therapists and Nuclear

Medicine Technologists there is a range of additional

headcount growth required. Both Radiographers and

Radiation Therapists required less than 1% growth in

headcount per annum whereas Nuclear Medicine

Technologists require a growth of 2.1% per annum.


Modelling for Pharmacists and Speech Therapists did not

indicate any shortage in the initial workforce modelling.

However, the initial workforce modelling has not considered

initial shortages or meeting national guidelines on patient

care, so does not per se indicate that there is not a

shortage. Further investigation is required to quantify this.

NSW Health employs approximately 12% of the NSW

Pharmacy workforce and 52.7% of the NSW Speech

Therapist workforce.

SHPN (WDI 110201

health professionals workforce plan taskforcenorth sydney nsw 2060 tel. (02) 9391 9000 fax. (02)...

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