Allied Health Assistants: A new wave of health workers
By Dr Sandra Mercer Moore - Australian Polity - Volume 2 (Number 1)
With rapid population ageing in Australia and its consequent need for health services, there is a widening gap between the availability of allied health workers such as physiotherapists, occupational therapists and speech pathologists and the demand for their services. Although this gap is evident across Australia, rural and regional communities have greater difficulty in accessing these services than in metropolitan areas. Currently many factors contribute to this gap including difficulties in recruitment and retention of allied health professionals, increasing demand for allied health service, increasing specialisation of allied health professionals, fluctuations in the uptake of careers in allied health and difficulties for some people to access careers in allied health.
The last decade began with the Baby Boomers ranging in age from the mid-thirties to early fifties and it concludes with some of the Boomers entering retirement and becoming pensioners. This is the start of the age wave hitting Australia. By the end of 2020 there will be more 65 year olds than one year olds. In 2020 life expectancy at birth will exceed 81 for a male and 86 for a female and almost one in five Australians will be aged over sixty. Over the next four decades while the total population will increase by just over half, the 65 and over population will more than double and the 85 and over population will triple. This ageing population will affect everything from the national accounts, to demands on health and housing, to the workforce. In 2020 the never-grow-old Baby Boomers will be in their sixties and seventies, and the oldest Gen Xers will be in their fifties – and themselves beginning to exit from the labour force.
Work Changes – From Increasing Demands to Career Development
While the last decade saw the growth of portfolio careers, work-life balance, and “sea-change” lifestyle jobs, this new decade is bringing back some new stability. With an ageing population will come an ageing workforce, mass retirements, a skills shortage, and a succession planning challenge. Over the next decade, forty per cent of today’s senior leaders will reach retirement age. Already the average age of an employed person in the education sector is 44, and in the health sector it is 45. Therefore, there will be a premium paid to employees who can gain experience in a career, climb the ranks within an organisation, and move into leadership positions.
While flexibility, job variety, collaborative leadership models, and work-life balance will remain part of employment, there will be a return to training, skills development, longer job tenure and stability.
What will the health service delivery look like in 2020?
Currently, seven per cent of the Australian workers are health care workers. If this amount remains constant, there will be a decrease in the ratio of health workers to the over 65 age group, more apparent in rural areas leading to poorer health outcomes. There has been a steady increase in the number of allied health professionals trained in Australia over the last ten years, but even so the attrition and turnover rate is high. To sustain and reframe the workforce, revitalise allied health especially in rural and regional areas, we need to look at issues of recruitment, retention, redevelopment of existing frameworks and the development of new pathways into and through allied health.
The Council of Australian Governments (‘COAG’) set the agenda for health reform when it endorsed the National Health Workforce Strategic Framework released in April 2004 by the Australia Health Ministers’ Conference (‘AHMAC’). With the release of the revised Health Training Package in March 2007, the opportunity and challenge of developing a trained and qualified assistant workforce became the focus of activity across the community and health sectors. This activity accelerated in July 2008 when COAG announced the Productivity Places Program allocating 50,000 additional vocational education and training places over three years for areas of national skills shortage in health professions. Complimentary to this reform is the development of advanced and extended scope of practice for health professionals.
The Community Services and Health Industry Skills Council (‘CS&HISC’) leads the provision of advice about skill needs in the community services and health industries in Australia and undertakes research to establish and maintain the national vocational education and training (‘VET’) qualifications and competency standards across these industries.
It is estimated that some 24 per cent of workers in the health and community services area have no formal qualifications. In addressing the workforce reform agenda in Australia two different approaches are being adopted to establish new roles. One is to establish occupational specific standards in allied health assistance using a shared competence methodology, which addresses the needs of both specialist and more generalist services in metropolitan, regional and remote locations. The second approach is the establishment of horizontal workforce pathways across a specific area of client need such as the establishment of competencies for workers involved in chronic disease self -management.
With more than eighty per cent of the community services industry and fifty per cent of the health industry workforce covered by VET qualifications in Australia, the role of the new framework and competency projects provides the opportunity for improved articulation of job roles across professional boundaries.
Emerging role of Allied Health Assistants
The Certificate IV in Allied Health Assistance covers workers who provide therapeutic and program related support to allied health professionals. The worker is required to conduct therapeutic and program related activities under the guidance of an allied health professional. Supervision may be direct, indirect or remote and must occur within organisational requirements. Competency units for the qualification are packaged into generalist and specialist streams. Specialist streams have been developed for physiotherapy, occupational therapy, podiatry, speech pathology, nutrition and dietetics and community rehabilitation. In developing competencies, CS&HISC worked with professional associations in the identified professional areas to identify both core competencies and additional elective competencies to provide the best possible training and skill development. Various state health departments in association with TAFEs also ran projects to develop consistency of allied health assistant roles to ensure that assistants are utilised to their fullest capacity, standardise the related educational qualifications and develop career pathways for assistants. In some instances particularly in rural and remote areas, the assistant may be providing physiotherapy based treatments, for example, with supervision delivered by video or teleconferencing with a physiotherapist or through another allied health professional on site.
In 2004, the Australian Physiotherapy Association began working with CS&HISC to develop competencies for a Certificate IV in Allied Health Assistance (Physiotherapy) so that a uniform standard of education for assistants could be developed across the nation. In 2007, following wide consultation with the profession, the Australian Physiotherapy Association voted to create a membership category for physiotherapy assistants, hoping that this membership category would also promote the development of a sustainable physiotherapy assistant workforce. In late 2009, the Australian Physiotherapy Association along with Esset Australia – a Registered Training Organization – made an application via CS&HISC to the Department of Education, Employment and Workplace Relations for funded training places for existing workers in the Federal Government’s Enterprise Based Productivity Places Program. Some fifty places were obtained for physiotherapy assistant training across Australia. Program delivery is by workshop, distance, online and on the job training where practical. Workshop attendance is essential for the mandatory physiotherapy elective units and assessment against competencies must be by a qualified physiotherapist. Student enrolment has come from remote areas such as Exmouth in Western Australia, Thursday Island in Queensland and some from the Northern Territory. It is hoped that by training and upskilling allied health assistants in rural and remote communities, increased workforce retention will occur and increased services will be provided.
Australians have a growing expectation that they will remain capable of functioning at a high physical level as they age. The development of categories of allied health assistants will ensure that there is a health sector workforce with the capacity to meet the ever increasing demand for health care services to match the physical and social needs of the population allowing senior Australians to enjoy a high quality of life and physical independence.