Health workforce

Australia is experiencing workforce shortages across a number of health professions despite a significant and growing reliance on overseas trained health workers. The shortages are even more acute in rural and remote areas and in certain special needs sectors.

With developing technology, growing community expectations and population ageing, the demand for health workforce services will increase while the labour market will tighten. New models of care will also be required.

Expenditure on health care is already 9.7 per cent of GDP and is increasing. Even so, there will be a need to train more health workers. There will also be benefits in improving the retention and re-entry to the workforce of qualified health workers.

It is critical to increase the efficiency and effectiveness of the available health workforce, and to improve its distribution.

The Commission's objectives are, therefore, to develop a more sustainable and responsive health workforce, while maintaining a commitment to high quality and safe health outcomes. It has proposed a set of national workforce structures designed to:

• support local innovations, and objectively evaluate, facilitate and drive those of national significance through an advisory health workforce improvement agency;
• promote more responsive health education and training arrangements through: the creation of an independent advisory council; and a high-level taskforce to achieve greater transparency (and appropriate contestability) of funding for clinical training;
• integrate the current profession-based accreditation of health education and training through an over-arching national accreditation board that could, initially at least, delegate functions to appropriate existing entities, based on their capacity to contribute to the objectives of the new accreditation regime;
• provide for national registration standards for health professions and for the creation of a national registration board with supporting professional panels; and
• improve funding-related incentives for workforce change through: the transparent assessment by an independent committee of proposals to extend MBS coverage beyond the medical profession; the introduction of (discounted) MBS rebates for a wider range of delegated services; and addressing distortions in rebate relativities.

Those living in outer metropolitan, rural and remote areas and in Indigenous communities, and others with special needs, would benefit from these system-wide initiatives.

• Integration of these groups into mainstream health workforce frameworks will further improve outcomes, but targeted initiatives will also be required.
• There is a need for better evaluation of various approaches to service delivery in these areas and across the health system more generally.

Changes are needed if Australia's health workforce is to become more efficient and effective, according to a research report released by the Productivity Commission.

In releasing the report, Commissioner Mike Woods said: 'Lasting gains can only be achieved if the current fragmented delivery of services is overcome and if professional and regulatory rigidities and other barriers to innovation are removed'.

'Workforce shortages and the increasing demands of an ageing community are placing mounting pressures on Australia's health care system. Improving preventative health care, increasing the number of training places and retaining more of those currently employed are all important strategies, but they don't go far enough,' Mr Woods said.

The Commission recommends an integrated set of national actions which will result in a more sustainable and responsive health workforce. The proposed workforce arrangements are designed to:

• drive reform to scopes of practice, and job design more broadly, while maintaining safety and quality;
• deliver a more coordinated and responsive education and training regime for health workers;
• accredit the courses and institutions and register health professionals in nationally consolidated and coherent frameworks; and;
• provide the financial incentives to support access to safe and high quality care in a manner that promotes innovation in health workplaces.

Mr Woods said: 'The Commission's proposals will help ensure that safe, quality care is delivered by well trained health workers with the right skills and in the most cost-effective fashion. Demand for health care is growing and our responses need to be financially sustainable. The proposals will benefit all Australians, including those living in outer metropolitan, rural and remote areas, and others with special needs where workforce shortages are particularly evident.'

The Council of Australian Governments is expected to consider the Commission's report, along with a review of other health care issues by its Senior Officials, in the early part of this year.

Preliminaries
Cover, Copyright, Foreword, Terms of reference, Foreword, Contents, Abbreviations, Key points, Overview, Recommendations

1 About the study
1.1 Scope and focus of the study
1.2 The Commission's approach

2 Context for policy development
2.1 Key workforce trends
2.2 Current workforce issues
2.3 Emerging challenges
2.4 What inhibits workforce change?

3 Objectives and strategies
3.1 Objectives for an efficient and effective workforce
3.2 Strategies for achieving improved health workforce outcomes

4 Workforce innovation
4.1 The institutional and regulatory framework affecting workforce deployment
4.2 Recent developments in Australia and overseas
4.3 An active approach to workforce innovation
4.4 Establishing a health workforce improvement agency

5 Health workforce education and training
5.1 Objectives of education and training
5.2 How does the current system work?
5.3 How well is the system performing?
5.4 How could the system be improved?

6 Accreditation
6.1 Existing accreditation arrangements
6.2 Issues and proposals
6.3 The case for a single national accreditation regime
6.4 Implementing a national accreditation board
6.5 Assessment of overseas trained professionals

7 Registration
7.1 Current roles of registration boards
7.2 Issues and proposals
7.3 Adoption of national registration standards
7.4 The case for a single consolidated national registration board
7.5 Implementation of a single board
7.6 Extension of registration

8 Payment mechanisms for health care services
8.1 A pervasive influence on the health workforce
8.2 The MBS and the health workforce
8.3 What are the key workforce-related concerns?
8.4 What should be done to address these problems?

9 Workforce planning — projecting future workforce needs
9.1 The role of workforce planning
9.2 Methodological issues
9.3 Data and research issues
9.4 Institutional arrangements

10 Rural and remote issues
10.1 Features of health care provision in rural and remote Australia
10.2 Underlying causes of workforce maldistribution
10.3 The context for future policy
10.4 What further changes are required?

11 Addressing special needs
11.1 General approach
11.2 Indigenous health workforce issues
11.3 Other key special needs areas

12 After hours GP services and other matters
12.1 After hours GP services
12.2 E-Health
12.3 The influence of policies in other areas

13 Our proposals in practice
13.1 Processes influencing workforce deployment
13.2 How the proposals would work
13.3 The benefits would be considerable
13.4 Facilitating the reform process
13.5 Facilitating effective evaluation

A Inquiry processes and consultation

B An overview of the current health workforce

C Measuring health sector productivity

References