Croakey is closed for summer holidays and will resume publishing in the week of 13 January 2025. In the meantime, we are re-publishing some of our top articles from 2024.
This article was first published on Monday, June 24, 2024
The allied health workforce is an “untapped resource” that can help support important and necessary health reforms, according to speakers at an event recently convened by the Western Sydney Local Health District.
Professor Beverley Harden MBE, the Workforce Lead for NHS England’s Allied Health Professions and England’s Deputy Chief Allied Health Professions Officer, was a guest speaker at the event, Education Colloquium: Driving Population Health through New Models of Care Developing Advanced Clinical Practice Models.
This article is published by Croakey Professional Services as sponsored content.
Croakey Professional Services writes:
Rethinking the roles of allied health professions will be crucial if our health systems are to meet the challenges ahead, according to a recent forum of health sector leaders.
The group gathered on Dharug Country in western Sydney on 13 March to discuss ways that harnessing the full potential of allied health professionals could increase efficiency, assist with workforce retention and improve outcomes for patients.
The ageing population, rising tide of chronic diseases, and ongoing workforce shortages had created an urgent need to reimagine the delivery of health services, Jacqueline Dominish, Director of Health Professional Workforce at NSW Health, told the colloquium.
“We really need to think about how we can transform the system, focused on the patient and what’s best for them,” said Dominish, a former occupational therapist. “If we don’t do that now, we may not be able to cope in ten to fifteen years.”
Making better use of the allied health workforce could reduce waiting times and allow early preventive interventions that might avoid the need for more intrusive treatments later on, she said.
Western Sydney Local Health District convened the event, Education Colloquium: Driving Population Health through New Models of Care Developing Advanced Clinical Practice Models, to facilitate exchange of knowledge and health reform efforts.
Innovation
Dominish’s team is currently working on a variety of projects, including embedding paramedics and Aboriginal Health Practitioners in multidisciplinary teams, and enabling audiologists to proactively assess children for earlier conservative intervention or earlier escalation for surgical management while awaiting review for grommet surgery in specialist ENT clinics.
They are also planning a state-wide roll-out of the Rapid Assessment, Intervention, and Discharge-Emergency Department (RAID-ED) program, which sees primary contact transdisciplinary allied health teams providing initial patient assessments and treatment in emergency departments, immediately after triage, on a seven-day, extended hours basis. The teams typically include a social worker, occupational therapist and physiotherapist, with other professionals such as pharmacists and child life therapists included as needed.
The program was initially piloted by the Western Sydney Local Health District during the COVID pandemic as a strategy to keep people out of hospitals, where they were more likely to be exposed to the virus. It was soon found to have broader benefits.
“RAID-ED has proved very successful in terms of both the patient and clinician experience,” Dominish said.
“The doctors and nurses love it because it allows them to get on with what they need to do to attend to higher acuity patients, and it’s the best thing for vulnerable populations and those with multiple complex issues. You don’t want older people or people with disability or complex social issues in hospital if they don’t need to be: they have more falls, they get infections and they can become unnecessarily distressed and disorientated.”
The program had improved patient satisfaction, while also reducing admissions and the length of hospital stay for those patients who were seen by the RAID–ED team and admitted following a fall (by an average 1.6 days), which meant it had paid for itself, Dominish said.
The Western Sydney Local Health District had introduced other successful initiatives, according to Acting Director of Allied Health, Luke Taylor, a podiatrist. These included expanded roles for physiotherapists in musculoskeletal pathology, and for speech pathologists and nurse consultants post-tracheostomy.
The district, which employs 1,500 allied health workers across 22 disciplines, was looking at further opportunities for expanded roles, including for dietitians in post-gastrostomy device care, for speech pathologists in head and neck lymphoedema, and for physiotherapists in fracture clinics. Access to equipment prescribing and imaging was also under review.
“Some of the decisions around who can order imaging and under what circumstances are conscious and soundly based, but others may not be and we need to come back and have a look at them,” Taylor said.
Cultural lens
“Anything we do, whether it’s physiotherapy in the fracture clinic, or the RAID-ED program, absolutely anything we do needs to have a cultural lens,” said Belinda Cashman, a Wiradjuri woman and director of Aboriginal health strategy at the Western Sydney Local Health District.
“We need to be bringing more Aboriginal people into allied health careers – there are programs doing that now – and other staff needed to be prepared to interact in a culturally appropriate manner,” Cashman said.
It was also important to ensure adequate data about First Nations peoples’ health: “People are talking about using Artificial Intelligence in healthcare but, if the data isn’t complete, it won’t deliver good outcomes for us.”
First Nations people had had good reason to be suspicious of the health system in the past, so it was vital to earn their trust when making changes, Cashman said.
“People who have experienced systemic racism and sub-standard care need to be convinced they’re being offered the same level of care as everybody else,” she added.
Career pathways: the UK experience
“We are limited by our imagination more than anything else,” guest speaker Professor Beverley Harden told the gathering.
England’s Deputy Chief Allied Health Professions Officer, Harden has long advocated for transformation of the health system to better serve populations. The United Kingdom, like other countries, was facing a “perfect storm” of significant waiting lists, increased health inequity, workforce shortages and poor retention, along with models of care that did not always deliver what patients needed, she said.
Allied health was the biggest untapped resource in the system, offering potential solutions for current and future problems, including the ageing population, Harden said. However, existing models of care meant workers were often unable to exercise the full scope of practice they had been trained for and there was little opportunity for career advancement.
Poor understanding of the allied health workforce by both colleagues and patients aggravated the problem and, with 15 distinct professions grouped under the title in the UK, it was hard for allied health to have a clear voice about its role and needs.
To address these issues, Harden helped establish the UK’s Centre for Advancing Practice, which brings together clinical and education experts from the various health professions to develop educational and career pathways leading to enhanced, advanced and consultant practice.
Providing proper levels of support and training across a career was the key to attracting, and retaining, a skilled workforce, Harden said.
“It’s a terrifying thing going from being a student to being out in the community with a tremendous workload,” Harden said.
“We have got to support people through that phase, and then we have to help them develop so they can use the full scope of practice they’ve been trained for. People are leaving because there’s no career path, they’re bored because they can’t exercise their full scope of practice.”
Breaking down silos
New models of care must always put the patient at the centre, asking first what they needed, then who was best placed to deliver it, said Dominish. To answer those questions, all sectors of the workforce needed a better understanding of what others did and were capable of doing, and of the shared skills between professions as well as the unique ones.
“We need curiosity, admiration and appreciative inquiry of professional colleagues rather than suspicion and scepticism,” she said. “We need to break down the silos.”
Care of the population was a team sport, Harden agreed. “I’m an incredibly proud physio with a huge shared skill set with other health professions, and a unique one. I’m not a doctor, I don’t want to be a doctor, and I’m not a threat to the medical workforce. This is not meant to be medical substitution. There’s plenty of work for all of us.”
We needed to change the narrative, she said. Rather than passing people on to allied health because ‘there was no doctor available’, the focus should be on the benefit to the patient from a particular profession’s skills and expertise.
Harden said strong governance and data collection were also essential to any successful change in models of care.
“You need to be able to evidence the impact and safety of what you do, and your accreditation and training has to be at the same level as colleagues from other professions who do the same work.”
Practitioners needed to ensure their imaging requests, for example, were just as rigorous as any other clinician’s and that they had the data to show it.
“And if you want to scale something across the system, you need to have data coming out of your ears.”
Agile and innovative
Secretary of NSW Health Susan Pearce AM, who began her career as a nurse, told the gathering that successful local initiatives could be rolled out statewide.
“The COVID-19 pandemic demonstrated how agile and innovative our workforce can be,” she said.
“We can make rapid changes which directly benefit our patients, particularly when local workforces have already tested the technology.”
Dominish added: “We’re at a point in time where we do really need to think about how we transform the system – and the opportunity is there to do that.
“This is not about us as health professionals, and it’s not about cutting costs, it’s about the patient. The patient has to be at the centre.”
Declaration
This article was commissioned and funded by the Western Sydney Local Health District, which had final say over the content and provided the photographs. It was written on behalf of Croakey Professional Services by Jane McCredie and edited by Dr Melissa Sweet.
