A major revamp of health workforce planning and research infrastructure is necessary in AustraliaSep 9, 2021
How do we plan and deliver a healthcare workforce that is more responsive to population needs?
Will our education, regulation, funding and care provision systems be able to adapt to the expectations of Covid and post-Covid environments? In this article, we raise the importance of rejuvenated health workforce planning and research infrastructure in addressing the challenges of the Covid world.
Although Australia is considered to have a strong health workforce, healthcare is still largely funded, organised, and provided along professional lines. Medicare is named “medi” “care” for a reason. There is a serious lack of integration with “unconnected silos everywhere” across the community, primary, secondary, and tertiary sites of care. The big challenges lie in education, regulation, funding, and provision. And as Duckett has noted, “Change is required in many aspects of the health workforce, but especially in what they do, how they are paid and where they work.” Clearly, we need more sophisticated strategies aligned to meeting population and patient needs.
The Australian health workforce
Australia has more than 1 million people employed in the delivery of health and welfare services. Healthcare practitioners include doctors, nurses and midwives, dentists and allied health professionals such as physiotherapists, psychologists and pharmacists. Welfare practitioners broadly include residential care service workers, childcare and preschool education staff, and other social assistance and disability service workers.
In 2018, nurses and midwives comprised the largest group of health practitioners (n=334,000), followed by allied health professionals (n=133,400). We have about 100,000 medical practitioners and more than 20,000 dental practitioners.
Most significantly, between 2008 and 2018, the number of welfare practitioners increased by 72%. Welfare practitioners account for more than 550,000 workers. Aged care and disability support workers alone comprised nearly half of the welfare personnel. These are the growth industries: aged care and disability services.
Towards integrated solutions and new models of care
Simply speaking, an integrated workforce is one in which the different professional groups work together to address health challenges. And we are a long way from an integrated and efficient health workforce. As Menadue has often said, we have a 19th century workforce structure. The structure of the current healthcare workforce is characterised by health professional silos. The uneasy alliance, or truce, struck between doctors and nurses in the British Military Hospital in Scutari, in the Asian part of Istanbul during the Crimean War in the 1850s, provided the foundation for the modern industrial hospital and healthcare system.
Our special issue of the International Journal of Environmental Research and Public Health spells out that we require both healthcare and welfare practitioners working in a coordinated way to provide care and support to individuals in the current century. To achieve this, a strong culture of inter-professional collaboration and multidisciplinary teamwork is essential. It also means that people with the right skillsets are available, and able to address population and patient needs.
Expanding the skill mix of health and welfare practitioners or creating new groups of workers who can navigate through social, professional, and organisational boundaries is an essential aspect of integrated care. New models of care that focus on priority population groups such as Aboriginal and Torres Strait Islander people, and people from non-English speaking background communities, and people with chronic conditions are the need of the hour.
A greater focus towards prevention and primary care will reduce the burden on our paramedics, doctors, hospitals, and intensive care units. Nowhere is this more evident than in the need to vaccinate our population during the Covid pandemic from which so many who use a needle during everyday practice are excluded, e.g. dentists and nurses.
Healthcare workforce planning
Workforce 2030, the World Health Organization global strategy on human resources for health views health workforce planning as the backbone of health systems, fundamental to achieving universal health coverage and sustainable development goals. The philosophy behind health workforce planning is to ensure that the right number of health practitioners, with the right training and skill sets, are available at the right place and at the right time to meet population needs, at an acceptable cost and quality.
Healthcare workforce planning is a complex process. It requires trade-offs across multiple health practitioner objectives in education, regulation, and practice. We also need to account for numerous uncertainties in the future, such as crisis situations, emergencies, and pandemics.
We know from research conducted in the National Health Service in the United Kingdom that there is an increasing body of evidence that indicates if the health workforce were to be redesigned from the ground up – based on population needs – we would see a very different configuration of the health workforce. So, how one can we design and develop innovative health workforce solutions for the future to make the health workforce more responsive to population needs, and contemporary challenges?
Funding for health workforce planning and research in Australia is very poor!
Since the closure of Health Workforce Australia (in 2014), planning and research efforts have been sporadic and have lacked a common purpose. Over the last few years, several independent research and advocacy groups have emerged to conduct work on specific aspects of health workforce. Much of this effort is carried out by dedicated academic researchers, with small scale and insecure funding support. It is unclear to what extent these groups will be able to sustain themselves.
There is a growing global consensus identified in our own work that several models of integrated care require serious research-based exploration. In our view, the absence of a focussed centre or national organisation that can accommodate serious evidence-based and policy-relevant research work and translation is just not good enough.
A clear revamp of health workforce planning and research infrastructure is necessary in Australia.
A national task force that brings together research groups, stakeholders and planning efforts have to be established. Funding for health workforce planning and research should substantially improve. Then, hopefully, we will see systems of education, regulation, funding, and provision quickly adapt to the ongoing realities, and emerging challenges of the Covid world.