WESTERN AUSTRALIA by chenmeixiu

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									    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

Western Australian Allied Health
Taskforce on Workforce Issues 2002
           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 Taskforce Findings.............................................................................................42
           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 Taskforce Findings.............................................................................................48
           3.4.2.1         Salary and Conditions ..............................................................................48
           3.4.2.2         Career Structure .......................................................................................50

Western Australian Allied Health
Taskforce on Workforce Issues 2002
           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 Taskforce Findings.............................................................................................56
           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 Taskforce Findings.............................................................................................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


Western Australian Allied Health
Taskforce on Workforce Issues 2002
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


Western Australian Allied Health
Taskforce on Workforce Issues 2002
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 participation
                                         Partnerships within and across sectors
                                                     Collaboration
                                                     Coordination
                                                     Transparency
                                                    Accountability
                                                        Equity
                                                    Communication




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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.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                       -3-
                       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.




Western Australian Allied Health
Taskforce on Workforce Issues 2002                       -4-
       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.




Western Australian Allied Health
Taskforce on Workforce Issues 2002                         -5-
       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.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                      -6-
                       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.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                         -7-
       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.




Western Australian Allied Health
Taskforce on Workforce Issues 2002                      -8-
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




Western Australian Allied Health
Taskforce on Workforce Issues 2002        -9-
                                     SECTION ONE

                       Allied Health Taskforce on Workforce Issues




Western Australian Allied Health
Taskforce on Workforce Issues 2002          - 10 -
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.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                      - 11 -
           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.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                                     - 12 -
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.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                     - 13 -
     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.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                     - 14 -
     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.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                        - 15 -
           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:



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                    - 16 -
                 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
   professional therapists: Local and national perspectives. Perth: Institute for the Service Professions Edith Cowan University & Therapy
   Focus Inc.
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.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                                     - 17 -
                 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.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                                     - 18 -
                   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.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                                     - 19 -
                                             SECTION TWO

                                     Allied Health Workforce Profile




Western Australian Allied Health
Taskforce on Workforce Issues 2002                  - 20 -
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)
                                                                                     AH* FTE
                                      Profession                         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


Western Australian Allied Health
Taskforce on Workforce Issues 2002                              - 21 -
     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)
                                                          FTE Vacancy              FTE                  FTE Vacancy
                            Profession                     March 2002             Vacancy              (AHPEG report)
                                                              (%)                March 2002               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.

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



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                    - 22 -
           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
                                            (Organisational Survey, AHTWI, 2002)
                                                                            Employed
                                                Profession                  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.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                               - 23 -
           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)

                   Speech Pathology

                          Social Work

                               Podiatry

                        Physiotherapy

           Orthotics and Prosthetics

                            Orthoptics

               Occupational Therapy

               Nutrition and Dietetics

                   Clinical Pschology

                             Audiology

         Not specific to a profession

                                          0           5           10              15           20            25       30
                                                                  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.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                 - 24 -
                                                              Table 4
                                     Percentage of Respondents from a Professional Background
                                                   (Questionnaire, AHTWI, 2002).
                                                                               Percentage
                                           Professional Background
                                                                                  (%)
                                      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
                                              (Organisational Survey, AHTWI, 2002)
                                                                             Percentage
                                                      Sector
                                                                                (%)
                                        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%).



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                - 25 -
     2.1.3.5           Age by Sector
                                                             Table 6
                               Percentage of Allied Health Professionals in Different Sectors by Age
                                                  (Questionnaire, AHTWI, 2002)
                                                                                                  Disability
                                     Metropolitan                          Non Government
                                                       Rural Health                               Services
              Age range                Health                               Organisations
                                                                                                 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
                                             (Organisational Survey, AHTWI, 2002)
                                                                                Percentage
                                                    Profession
                                                                                    (%)
                                      Audiology                                      0.77
                                      Clinical Psychology                          10.82
                                      Nutrition and Dietetics                        4.52
                                      Occupational Therapy                         24.22
                                      Orthoptics                                     0.17
                                      Orthotics and Prosthetics                      0.96
                                      Physiotherapy                                23.35
                                      Podiatry                                       2.07
                                      Social Work                                  24.19
                                      Speech Pathology                               8.92

     2.2.1.2           Rural Distribution by Profession
           Physiotherapy has the highest level of representation of the allied health professions
           in rural areas.




Western Australian Allied Health
Taskforce on Workforce Issues 2002                                - 26 -
           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
                                               (Organisational Survey, AHTWI, 2002)
                                                                               Percentage
                                                  Profession
                                                                                  (%)
                                      Audiology                                     0.80
                                      Clinical Psychology                           3.05
                                      Nutrition and Dietetics                       9.74
                                      Occupational Therapy                         20.81
                                      Orthoptics                                    0.05
                                      Orthotics and Prosthetics                     0.00
                                      Physiotherapy                                28.33
                                      Podiatry                                      2.87
                                      Social Work                                  16.85
                                      Speech Pathology                             17.50



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.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                                 - 27 -
           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
                                             (Organisational Survey, AHTWI, 2002)
                                                                      Ratio per         Ratio per
                                         Profession                    100,000           100,000
                                                                     Metropolitan         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




Western Australian Allied Health
Taskforce on Workforce Issues 2002                                - 28 -
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.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                    - 29 -
         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.




Western Australian Allied Health
Taskforce on Workforce Issues 2002                      - 30 -
         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.




Western Australian Allied Health
Taskforce on Workforce Issues 2002                    - 31 -
                                          SECTION THREE

                                     Recommendations Towards a
                                       Strategic Workforce Plan




Western Australian Allied Health
Taskforce on Workforce Issues 2002                - 32 -
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.




Western Australian Allied Health
Taskforce on Workforce Issues 2002                      - 33 -
         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

                                                                               (Meeting the Challenge: p 3, 2000)36




                                                  Active community and stakeholder participation
                                                      Partnerships within and across sectors
                                                                  Collaboration
                                                                  Coordination
                                                                  Transparency
                                                                 Accountability
                                                                     Equity
                                                                 Communication




36
     Department of Health. (2000). Meeting the challenge: A strategy for the allied health professions. London: Department of Health.



Western Australian Allied Health
Taskforce on Workforce 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.




Western Australian Allied Health
Taskforce on Workforce Issues 2002                   - 35 -
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.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                                       - 36 -
                                                             Figure 2
                                      Professional’s Rating of the Profile of their Professions
                                              (Organisational Survey, AHTWI, 2002)

                                           60


                                           50


                                           40


                                           30
                     Percentage (%)
                                           20


                                           10


                                            0
                                                    e x c e l le n t       good                  poor     v e ry p o o r


                                                                       P r o file o f P r o fe s s io n




           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
                                                 (Organisational Survey, AHTWI, 2002)

                                      70


                                      60


                                      50


                                      40


                  Percentage (%)      30


                                      20


                                      10

                                       0
                                                  excellent                good                   poor      very poor


                                                                           Profile of Allied Health




           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.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                                   - 37 -
           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.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                    - 38 -
           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.”
                                                                                                       (Submissions, AHTWI, 2002)


           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.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                   - 39 -
         3.3 Service Performance                                                          (Marshall & Craft: p10, 2000)
                                                                                                                            59




                             “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.”
                                                                                                                      59
                                                                                   (Marshall & Craft: p10, 2000)




                                                 Active community and stakeholder participation
                                                     Partnerships within and across sectors
                                                                 Collaboration
                                                                 Coordination
                                                                 Transparency
                                                                Accountability
                                                                    Equity
                                                                Communication




59
     Marshall, J., & Craft, K. (2000). New Vision for Community Health Services for the Future report. Perth: Health Department of Western
     Australia.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                                      - 40 -
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.




Western Australian Allied Health
Taskforce on Workforce Issues 2002                   - 41 -
3.3.2          Taskforce Findings

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




Western Australian Allied Health
Taskforce on Workforce Issues 2002                                     - 42 -
     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.
     Brisbane: Queensland Government Queensland Health.
70
   Country Services Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department
     of Health, Western Australia.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                   - 43 -
           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 . . .”
                                                                                                          (Submissions, AHTWI, 2002)



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




Western Australian Allied Health
Taskforce on Workforce Issues 2002                                     - 44 -
             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.”
                                                                                                          (Submissions, AHTWI, 2002)




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



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                      - 45 -
         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              79
                                                                               (McRee: p3, 2002)
                             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.”
                                                                                                                                 79
                                                                                                             (McRee: p3, 2002)




                                               Active community and stakeholder participation
                                                   Partnerships within and across sectors
                                                               Collaboration
                                                               Coordination
                                                               Transparency
                                                              Accountability
                                                                  Equity
                                                              Communication




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



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                      - 46 -
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.

Western Australian Allied Health
Taskforce on Workforce Issues 2002                     - 47 -
             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           Taskforce Findings

       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.”
                                                                                                       (Submissions, AHTWI, 2002)


             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)
                                                Currently exists             Currently                AHP would
                       Type of Work             in organisation           accessed by AHP           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.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                                    - 48 -
           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)

                                       50



                                       40



                                       30

                    Percentage of
                    Respondents
                                       20
                         (%)

                                       10



                                        0
                                                       m o re             le s s         e q u iv a l e n t   d o n 't k n o w     n /a
                                        C o n t i n u i n g P r o fe s s io n a l D e v e l o p m e n t A c c e s s v e r s u s E n t i tl e m e n t




           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.”
                                                                                                                                                (Submissions, AHTWI, 2002)


           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.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                                                          - 49 -
        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.”
                                                                                                         (Submissions, AHTWI, 2002)


             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)
                                                                                        Percentage
                                                   Career Plans
                                                                                           (%)
                                      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.
      Brisbane: Queensland Government Queensland Health.
86
     Country Services Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department
      of Health, Western Australia.
87
     Queensland Health. (2000b). Director-General's Allied Health Recruitment and Retention Taskforce 1999-2000 Summary report.
      Brisbane: Queensland Government Queensland Health.
88
     Country Services Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department
      of Health, Western Australia.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                     - 50 -
     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
    professional therapists: Local and national perspectives. Perth: Institute for the Service Professions Edith Cowan University & Therapy
    Focus Inc.
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.




Western Australian Allied Health
Taskforce on Workforce Issues 2002                                    - 51 -
                                                              Figure 5
                             Allied Health Professional rating of Initial Orientation to Current Position
                                                   (Questionnaire, AHTWI, 2002)


                                       60



                                       50



                                       40



                                       30
                  Percentage of
                   Respondents
                                       20
                       (%)

                                       10


                                        0
                                               Very well              W ell              Poor            Very Poor            Not applicable


                                                   Rating of Initial Orientation to Current Position



             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
                                                    (Questionnaire, AHTWI, 2002)

                                       50



                                       40



                Percentage of          30
                Respondents
                     (%)
                                       20



                                       10



                                        0
                                                           yes                           no                       N o t a p p li c a b l e

                                                                 P r o v i s i o n o f E x i t I n t e r v ie w




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

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

             There are restrictions in accessing alternative sources of AHPs such as overseas
             professionals98 (Submissions, AHTWI, 2002; Working Groups, AHTWI, 2002). The
98
     Country Services Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department
      of Health, Western Australia.




Western Australian Allied Health
Taskforce on Workforce 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.”
                                                                                                         (Submissions, AHTWI, 2002)




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.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                                    - 53 -
         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 al; p17, 2001)
                                                                             (Saggers et
                             professional development program with consistency
                             and equity in access and application, and a substantial p16, 2001) 104
                                                                          (Saggers et al:
                             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”
                                                                                                                       104
                                                                                         (Saggers et al: p16, 2001)




                                               Active community and stakeholder participation
                                                   Partnerships within and across sectors
                                                               Collaboration
                                                               Coordination
                                                               Transparency
                                                              Accountability
                                                                  Equity
                                                              Communication




104
      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.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                       - 54 -
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).;

Western Australian Allied Health
Taskforce on Workforce Issues 2002                     - 55 -
                 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          Taskforce Findings

      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.




Western Australian Allied Health
Taskforce on Workforce Issues 2002                                     - 56 -
           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
                                                     (Questionnaire, AHTWI, 2002)

                                     40




                                     30




            Percentage of            20
            Respondents
                 (%)
                                     10



                                      0
                                          P o s t g r a d d ip lo m a                    M a ste rs          O th e r
                                                              P o st g ra d d e g re e                P hD


                                                        P o s t G r a d u a t e Q u a lific a t io n s


           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.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                                                       - 57 -
                                                        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.”
                                                                                                              (Submissions, AHTWI, 2002)


      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.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                     - 58 -
           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
                                                 (Questionnaire, AHTWI, 2002)

                                     40




                                     30




                 Percentage of       20
                 Respondents
                      (%)
                                     10



                                      0
                                              0 -2 0 h rs                   4 1 -6 0 h rs                   8 1 -1 0 0 h rs                   > 2 0 0 h rs
                                                            2 1 -4 0 h rs                   6 1 -8 0 h rs                 1 0 1 -2 0 0 h rs
                                     T o t a l H o u r s o f C o n tin 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



           The allied health workforce in WA has concerns about the structure and
           implementation of undergraduate practicums for a number of allied health disciplines
           (Submissions, AHTWI, 2002; Working Groups, AHTWI, 2002).130

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

128
    Country Services Department of Health. (2002). Rural and remote allied health workforce issues: a discussion paper. Perth: Department
    of Health, Western Australia.
129
    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.
130
    Health Department of Western Australia. (2000). Mental Health Reforms in Western Australia: a report of the government reform
    program. Perth: Health Department of Western Australia.
131
    McAllister, L., McEwen, E., Williams, V., & Frost, N. (1998). Rural attachments for students in the health professions: are they
    worthwhile? Australian Journal of Rural Health, 6, 194-201.



Western Australian Allied Health
Taskforce on Workforce 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.”
                                                                                                        (Submissions, AHTWI, 2002)



      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
                                               (Organisational Survey, AHTWI, 2002)
                                                                                         Percentage
                                                      Service
                                                                                            (%)
                                     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.



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                    - 60 -
           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
                                                 (Questionnaire, AHTWI, 2002)

                                     60


                                     50


                                     40
                     Percentage of
                     Respondents     30
                          (%)
                                     20


                                     10


                                      0
                                                 yes                no              n o t su re   n o t a p p lic a b le

                                             R e s e a rc h O p p o rtu n itie s in C u rre n t W o rk p la c e




                                                       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.”
                                                                                                                           (Submissions, AHTWI, 2002)




Western Australian Allied Health
Taskforce on Workforce Issues 2002                                         - 61 -
       3.6 Resourcing
                                                                                                                         138
                                                                                                    (Podger: p6., 1999)

                            “Governments have a responsibility to spend well – to p12., 2001)139
                                                       (Health Professions Council of Australia:
                            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….”
                                                                                                                  138
                                                                                               (Podger: p6., 1999)


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




                                              Active community and stakeholder participation
                                                  Partnerships within and across sectors
                                                              Collaboration
                                                              Coordination
                                                              Transparency
                                                             Accountability
                                                                 Equity
                                                             Communication




138
    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.
139
    Allies in Health: Briefing paper for the Minister for Health and Ageing. (2001). Melbourne: Health Professions Council of Australia
     LTD.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                                  - 62 -
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 Taskforce Findings

        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:



Western Australian Allied Health
Taskforce on Workforce Issues 2002                                       - 63 -
           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
                                                (Questionnaire, AHTWI, 2002)


                                     40




                                     30




                                     20
                 Percentage of
                 Respondents
                      (%)            10




                                      0
                                             0        1 to < 5   5 to < 1 0   1 0 to < 1 5   1 5 to < 2 0   >= 20


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



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

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

           Alternative funding sources are available to supplement, improve or research current
           services, but there is inconsistent awareness and access to these funds (Submissions
           AHTWI, 2002).

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

           There are limitations on the private service capacity in WA due to private insurance
           company restrictions on provider numbers, limited rebates for consumers who choose
141
    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.
142
    Queensland Health. (2000b). Director-General's Allied Health Recruitment and Retention Taskforce 1999-2000 Summary report.
     Brisbane: Queensland Government Queensland Health.
143
    Metropolitan Allied Health Council. (1998). Metropolitan Allied Health Survey Report. Perth: Metropolitan Allied Health Council.
144
    Allies in Health: Briefing paper for the Minister for Health and Ageing. (2001). Melbourne: Health Professions Council of Australia
     LTD.
145
    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.




Western Australian Allied Health
Taskforce on Workforce 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.”
                                                                                                           (Submissions, AHTWI, 2002)



      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:




Western Australian Allied Health
Taskforce on Workforce Issues 2002                                      - 65 -
           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.


Western Australian Allied Health
Taskforce on Workforce Issues 2002                                     - 66 -
                                        SECTION FOUR

                                Implementation Plan for the
                          Allied Health Strategic Workforce Plan




                                     Active community and stakeholder participation
                                         Partnerships within and across sectors
                                                     Collaboration
                                                     Coordination
                                                     Transparency
                                                    Accountability
                                                        Equity
                                                    Communication




Western Australian Allied Health
Taskforce on Workforce Issues 2002                         - 67 -
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

                                     Cross Sector
                                     Developments
                                                                           HSOA Review of
                                      Allied Health                        Specified Callings
                                     Implementation                            and Other
                                       Taskforce                             Professionals
                                                                          Joint Working Party


                Health Sector                         Disability Sector
                Developments                           Developments

                Allied Health                          Allied Health
               Working Group                          Working Group



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.




Western Australian Allied Health
Taskforce on Workforce Issues 2002                    - 68 -
           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


Western Australian Allied Health
Taskforce on Workforce Issues 2002                 - 69 -
           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.




Western Australian Allied Health
Taskforce on Workforce Issues 2002                 - 70 -
                                     SECTION FIVE

                                     Bibliography




Western Australian Allied Health
Taskforce on Workforce Issues 2002         - 71 -
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
Alliance, N. R. H. (2002b). Action on nursing in rural and remote areas: draft issues paper.
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                                     SECTION SIX

                                     Appendices




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Taskforce on Workforce Issues 2002        - 76 -

								
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