1. Major reports with a focus on health workforce

Health care and health system reports

Health care is a labour intensive service industry and the size, distribution and effectiveness of the health workforce plays a considerable role in ensuring access to adequate and quality health care. For this reason many reports about health care and health care systems focus much of their discussion on the supply of health workers. This section presents the findings of a number of Australian and international reports that highlight the extent of the problem and provide a range of suggested solutions.

The Blame Game: Report on the Inquiry into Health Funding

House of Representatives Standing Committee on Health and Ageing 2006

In response to increasing calls to address the shift in blame for problems in the health care system, the House of Representatives Standing Committee on Health and Ageing conducted an enquiry into how the Australian Government could take a leading role in improving the efficient and effective delivery of high quality health care to Australians.

The Committee released its report in 2006 and included in its findings seven workforce-specific recommendations:

• the Department of Health and Ageing to take a lead role in coordinating recruitment processes for overseas trained health professionals
• implementation of a strategy for Australia to be self sufficient by 2021 in producing health professional graduates
• allowance in current university funding structures to allow for supplementary funding from the Department of Health and Ageing toward academic appointment and clinical training for health workforce students
• purchasing agreements between the Commonwealth Government and public health care providers for clinical training places
• expanded opportunities for private sector training arrangements
• funding arrangements reflect any changes to skill mix and role substitution and
• changes to the Fringe Benefits Tax Assessment Act 1986 to resolve inequities between public sector health employees and those in other settings.

The World Health Report 2006: Working Together for Health

World Health Organisation 2006

The World Health Report 2006 - Working together for health examines and reports on the extent of global health workforce shortages. It proposes a number of solutions which can be applied over the next ten years to help countries improve their supply of health workers with the support of global partners.

The study does not suggest that Australia is one of the countries throughout the world with a critical shortage, however it comments on the finding that each country suffers from maldistribution of its workforce with urban concentration and rural deficits.

The range of issues facing Australia, including an ageing population, a shift towards chronic and degenerative diseases, increasing demand for services and a more technically advanced workforce, are common across most of the developed world.

The output of the study is a framework for action and proposed strategies related to various points across the 'working lifespan'; entry, workforce performance and exits.

Producing enough skilled workers (entry or preparing the workforce) is seen as requiring active planning and management of the supply chain by building strong training institutions, strengthening professional regulation and invigorating recruitment capabilities.

Workforce performance is best tackled through supportive supervision, decent pay, adequate infrastructure and access to education and training.

Finally, the report outlines the importance of managing attrition and migration through the introduction or enhancement of flexible working arrangements, occupational health and safety processes and incentives to retain older workers.

To achieve these goals, it is suggested that national strategies will require strong leadership and stakeholder engagement and are more likely to be successful if they focus on three priority areas: acting now; anticipating the future; and acquiring critical capabilities. Combining this with global solidarity will be necessary to achieve structural improvements of the workforce across all countries. Top of page

Health Workforce

Australia's Health Workforce

Productivity Commission 2005

The best known study that has looked at issues affecting the whole health workforce is the Productivity Commission's (PC) research report entitled 'Australia's Health Workforce'.

This report was commissioned by the Council of Australian Governments (COAG) in 2005, and reviews a range of workforce issues including: factors affecting the future supply of, and demand for, health workers; the efficiency and effectiveness with which the available workforce is deployed; and what reforms to health workforce arrangements might be undertaken to improve access across the community to quality and safe health care.

The PC called for public input into the study and received 374 submissions from a range of stakeholders including government departments, professional and industrial organisations, regulatory bodies, service providers, universities, special needs groups and individuals. To support the submission process, the PC also held discussions and roundtables with approximately 90 organisations and individuals across all jurisdictions in metropolitan, rural, regional and remote locations.

In releasing its findings, the PC makes specific reference to the unique problems experienced by rural and remote Australia. These include limited access to primary, specialist and emergency care services for patients with associated impacts on health outcomes and increased travel and financial costs and disruption to family and work life in order to receive specialist services.

For health workers, the PC's findings indicate concerns with the disparity of remuneration levels; professional demands; less flexibility in working hours; professional, geographical and social isolation; lack of access to education and training; limited career opportunities; and minimal, if any, locum relief.

On a positive note, the report suggests that there appears to be greater capacity for role redesign and workforce innovation in rural areas, which should be further enhanced with the proposed changes to national registration and accreditation processes.

The PC report acknowledges the range of measures introduced by governments and other organisations to enhance workforce supply in rural and remote areas in recent times and anticipates that these will go some way to addressing the issues. However, with respect to rural and remote service provision, the report highlights the need to consider all health disciplines when developing rural workforce policy and proposes changes to current funding mechanisms to facilitate greater use of the multidisciplinary team including block funding packages of care, targeted incentives for better uptake of technology, and a stronger focus on regionally based education and training. Top of page

Healthy Horizons: A Framework for Improving the Health of Rural, Regional and Remote Australians 2003 - 2007

National Rural Health Alliance/National Rural Health Policy Subcommittee 2002

This project by the National Rural Health Policy Subcommittee and the National Rural Health Alliance was undertaken at the request of the Australian Health Ministers' Conference (AHMC).

The Framework aims to act as a blueprint for the delivery of health and the coordination of effort across Australian and state and territory governments towards improving health outcomes in rural and remote Australia.

The report states that in many cases, rural, regional and remote Australians experience levels of injury, disease and overall health outcomes that are substantially worse than for the general population.

The Framework sets seven goals and associated principles including one directly targeting maintenance of a skilled and responsive health workforce. It calls for:

• continued action toward more flexible practice through the removal of legal and professional barriers
• a review of costs associated with clinical training
• targeted strategies to encourage health professionals from Aboriginal and Torres Strait Islander backgrounds
• increased cultural awareness training in health education courses
• workforce analysis of supply and demand for allied health workers in rural and remote areas
• continued effort to address symptoms of professional isolation and lack of peer support for health professionals through increased educational opportunities
• action to resolve professional indemnity issues and
• increased access and financial support to training opportunities in rural and regional centres. Top of page

Medical Workforce

The General Practice Workforce in Australia: Supply and Requirements to 2013

Australian Medical Workforce Advisory Committee Report 2005

This report provides a range of information on the general practice workforce in Australia including numbers, characteristics and roles of current general practitioners (GPs), their caseloads and practice arrangements and how general practice services are financed. It also contains sections on overseas-trained doctors and other primary care providers and a chapter on training arrangements for general practice. Of particular note it includes information about the specific issues faced by rural and remote practitioners.

Findings indicate that in 2002 there were 22,000 GPs in Australia with 80% of those vocationally registered. Females represent 37 % of the workforce. Distribution closely followed population trends with over 70% of GPs working in city practices. The average age of a GP is 48.6 and males are working on average 13.6% more hours per week than females. Hours worked by rural GPs increased progressively with rurality and remoteness.

In addition to identifying barriers to recruitment and retention, including lack of support structure, professional isolation, decreased levels of remuneration and increased demand and limited social infrastructure, GPs commented on the inadequacy of activity level data stating that data on the work that rural GPs perform outside the Medicare system, such as providing services to country hospitals, was not captured. Perceived inconsistencies and inequities in incentives schemes based upon the Rural, Remote and Metropolitan Areas classification (RRMA) were also raised as an issue.

The report concluded that demand for GP services would continue to increase within an environment of an ageing GP population and decreasing hours worked. It recommended an increase in training numbers to meet workforce entrant requirements by 2013 from the current 700 per annum to between 1,105 and 1,200 per annum based on a number of scenarios, continued use of overseas trained doctors and the development of strategies to increase workforce participation and new models of care delivery. Top of page

Expanding settings for medical specialist training

Report of the Medical Specialist Training Taskforce 2006

Considerable research has been undertaken since 2001 to better understand the range of challenges with providing adequate quality clinical training for medical specialist including the work of Professor Peter Phelan and an Australian Health Ministers' Advisory Council (AHMAC) working party on the matter, the Medical Specialist Training Taskforce (MSTT) and more recently the Medical Specialist Training Steering Committee (MSTSC).

Set up in November 2002, the MSTSC was asked to investigate issues relating to the implementation of the Taskforce's findings. In particular, it was asked to explore issues relating to education, costs and benefits and public hospital capacity.

Before the report was released, the Council of Australian Governments (COAG) announced a package of health workforce reforms that affected directly the work of the steering committee including a decision to establish a system of rotation for specialist trainees through an expanded range of settings and opportunities beyond traditional public teaching hospitals. This could include a range of public settings (including regional, rural and ambulatory settings), the private sector (hospitals and practices), community settings and non-clinical (for example, simulated learning) environments.

The report is being used as a resource to guide the expansion of medical training into a range of settings including rural and remote areas. Top of page

Nursing Workforce

National Nursing and Nursing Education Taskforce Final Report

National Nursing and Nursing Education Taskforce 2006

The National Nursing and Nursing Education Taskforce (N³ET) was established to implement 12 recommendations from the report of the National Review of Nursing Education, Our Duty of Care. N³ET was also requested to monitor implementation of a number of other recommendations.

In addition to Our Duty of Care, the Taskforce was also given responsibility for a number of the recommendations from three Australian Health Workforce Advisory Committee (AHWAC) nursing workforce reports: The Critical Care Workforce in Australia 2001-2011(2002); The Midwifery Workforce in Australia 2002-2012 (2002); The Australian Mental Health Nurse Supply, Recruitment and Retention (2003) and to consider a number of issues related to nursing specialisation.

The N³ET operated from 2004 until July 2006 during which it produced a significant number of publications and reports. The N³ET delivered a final report on its activities to Health Ministers in 2007. The findings of these reports are the subject of consideration by AHMAC through the Health Workforce Principal Committee.

While many of the outputs from the work of N³ET relate to strategies to recruit and retain the nursing workforce generally, a number of recommendations will have specific benefit for the rural and remote workforce, most notably continued support for specialist post graduate training, maximising education pathways and improved data collection processes. Top of page

Report on the Inquiry into Nursing - The patient profession: Time for action

Senate Community Affairs Committee 2002

In response to increasing calls for action to address nursing shortages, the Senate Community Affairs Committee was asked to undertake an inquiry into:

• the shortage of nurses in Australia and the impact that this is having on the delivery of health and aged care services and
• opportunities to improve current arrangements for the education and training of nurses, encompassing enrolled, registered and postgraduate nurses.

The Committee made 81 recommendations covering a broad range of areas including recruitment and retention, nurse education and training, nurse workforce planning data collection, and leadership in nursing.

Four recommendations were specifically directed towards the needs of nurses in rural and remote areas.

Recommendation 79: That the Commonwealth provide additional funds to universities to extend clinical education in rural and remote regional hospitals

Recommendation 80: That the Commonwealth increase the amount of funding of rural and remote nursing programs, including scholarship programs, in line with funding of medical programs

Recommendation 81: That the Commonwealth and States provide funding for nursing relief programs such as 'circuit nurse' programs in rural and remote Australia

Recommendation 82: That all rural and remote area health services with the assistance of State Government offer additional incentives to nursing staff through employment packages including accommodation assistance, additional recreation and professional development leave, and appointment and transfer expenses to encourage nurse recruitment. Top of page

Allied Health Workforce

The Australian Allied Health Workforce - An Overview of Workforce Planning Issues

Australian Health Workforce Advisory Committee 2006

Recognising the lack of data available for the allied health workforce, the Australian Health Ministers' Advisory Council (AHMAC) commissioned the Australian Health Workforce Advisory Committee to undertake a review of the allied health workforce and provide advice on potential areas for future action.

The Review identified a number of issues that could be undertaken:

• improvement in workforce data collection and national workforce planning activities
• improved pathways for Indigenous persons to encourage participation in the allied health workforce and
• improved coordination between health and education regarding university intakes and clinical practicum requirements.
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