Peter Brooks, Executive Dean, Health Sciences, at the University of Queensland and Interim Director of the Australian Health Workforce Institute at the University of Melbourne, has responded to the National Health and Hospitals Reform Commission report:
Australia is, like the rest of the globe, facing significant challenges recruiting health workers from a diminishing source.
The health workforce provides the underpinning for any health system and shortages in this skilled resource are producing some of the problems with timely delivery of services such as emergency care and routine surgery around the country.
The reasons for the workforce shortages are well described and include such issues as the increase in chronic disease, the ageing population , changes in work practices amongst the health professionals, and feminisation of the workforce, amongst other things.
The NHHRC report recognises this as one of the key elements that need reform and makes some useful recommendations. on the “skills , expertise and distribution” of the required workforce.
We do need to understand that the doctor, nurse and other health professional shortage seen in Australia is a reflection of the global shortage – estimated by the World Health Organisation to be in excess of 4.3 million in the decade 2006-2016.
Taking health workers from countries who may need them more than we do may not be helpful although it has to be acknowledged that these workers may repatriate significant funds back to their country of origin (estimated to be in excess of US $11 billion for India alone ) and some countries such as India and the Phillipines have an overt policy of training health workers for ‘export ‘.
Some of the recommendations in the Interim Report will assist in easing the workforce challenge. Extending the roles of existing health professionals (particularly nurses and allied health professionals including pharmacists) so that they can assist doctors deliver services as part of ‘team ‘care is very sensible.
Given the increasing demands on the system though, we do need to recruit new workers to be engaged in health. Creating new types of health professionals such as physician assistants who work in a delegated model of care always reporting to a doctor , or health facilitators – who might guide the unsuspecting public through our complex health system also need to be considered.
The Physician Assistants (PAs), of whom there are some 65,000 in the US and who are now being introduced to the UK , Canada and a number of countries in Europe, are interesting as the clear experience in the US is that this profession recruits a different type of person and thus will increase the number of health professionals in toto – exactly what has to occur if we are going to create a sustainable health system.
Other points made in the Interim report relate to issues such as improving efficiency within the system using information technology (particularly the use of linked electronic health information and telemedicine). Reports that nurses and doctors spend up to 30 % of their time on administivia/ paper work may well be an underestimate – let’s get these professionals back to patient care and streamline some of these “system” issues.
The other key element of the report that will impact on workforce in the future is the issue of educating patients about their own health and how to maintain it. The emphasis on improving health literacy and aligning the Health and Education systems to create a National Health Curriculum is to be applauded because in the long term this will really make a difference.
Some of these suggestions such as role extension remain controversial but they should and are being implemented, with nurses and allied health professionals having increasing access to the MBS.
As always, the devil will be in the detail and how the Interim Report is “shaped” over this discussion period. Of fundamental importance will be how health will be funded and the 3 models suggested by the Commission are worthy of significant thought and debate.
Let us hope that occurs over the next few months and that the Minister is able to bring about real reform in an area desperate for a new vision.
So well done Commissioners; now it is for us all to work with this document to refine it and assist in implementing some of the findings.