Towards a more effective and efficient health workforce system

1. Towards a more effective and efficient health workforce system Robert Fitzgerald AM Commissioner

2. Presentation outline • What the Commission’s study was about • Context for the study • How we approached our task • Recommendations • The COAG process

3. The Commission’s Terms of Reference • A forward looking review – a decade plus • Future demand and supply of health workers • Sustainable delivery of quality health care • Workforce efficiency and effectiveness • In the contexts of: demographic change, technological advances, rising health costs • In tandem with a broader CoAG exercise

4. Context • System already under pressure • Expenditure on health care and health workforce services growing rapidly – 9.7% of GDP now. 16% by 2045? • Workforce shortages • For particular professions (especially within current arrangements) and in rural/remote and special needs • These pressures will intensify • Demand will continue to grow and change • Expectations, technology, ageing • Workforce supply will tighten

5. Boundaries to the study • Broader health and education settings a ‘given’ • Though these settings significantly constrain the degree of improvement possible • Quantum of funding for health care and for health workers also a ‘broader issue’ • But is critical for outcomes • Funding, including as a proportion of GDP, will inevitably continue to increase

6. The Commission’s contribution • Workforce reforms to be assessed by their contribution to broader health goals • Access to high quality, safe, efficient, effective and financially sustainable health care services • Workforce reform objective: bring about arrangements which • Produce the most efficient workforce at any point in time • Produce a workforce that most effectively meets the health goals • Respond in a timely manner to changing needs of the system

7. Broad approaches • Reduce underlying demand • ‘wellness’ and preventative strategies • Increase education and training places for particular professions • With adequate clinical training places • Retention and re-entry programs • Correcting the original motivators for departure • Improve productivity, effectiveness and responsiveness of the available workforce • Amend institutional,, regulatory and funding arrangements, by • Removing impediments to ‘self-adjustment’ • Creating pro-active procedures – explicit pathways for change

8. What currently impedes adjustment? • Demonstrated adjustment capacity in current system • But, some systemic features impede change: • Fragmented roles and responsibilities • Ineffective coordination across the various components • Multiple and inflexible regulatory practices • Distortionary funding mechanisms and incentives • Entrenched custom and practice • Extraordinary complexity of the health care system

9. Where does the NHWSF fit? • Strategic Framework gives reasonable high level expression to the desired outcomes. • Has now been endorsed by COAG • Brings Education, Central Agencies into its purview

10. Reform strategies • Workplace change and job innovation • Health education and training • Accreditation and professional registration • Funding and payment arrangements • Quantitative projections of future workforce requirements • Many linkages between these components • All cogs in the health care system must move together • Also, need to address special need areas • Proper recognition in broader institutions and processes • Specific additional policies required

11. Workplace change and job innovation • Support local innovations • Establish health workforce improvement agency • Advisory • Objectively evaluate those of potential national significance • Facilitate and drive change through various regulatory processes

12. Health education and training • Various options to improve coordination across education and training • More active roles for Federal and State and Territory Health Departments in purchasing university places • Advisory Council – create national focus for current bi/multi lateral debates, better mesh course coverage and content with the needs of service providers

13. Education and training (clinical) • Lack of clinical training capacity a critical issue • Need to make better use of available capacity • Efficiencies from competition in delivery • While noting impact in small markets • But ultimately need to harness more capacity • Greater transparency of payments for clinical training • Involvement of private sector • High level task force

14. Accreditation and Registration • Overarching national accreditation board • Integrate current profession based accreditation • Delegate to appropriate existing entities • National registration board • Professional panels • National standards for each profession

15. Funding and payment arrangements • Aspects of MBS distort workforce outcomes: • Less efficient provision of healthcare service • Adverse influence on career choice • Relative Value Study – difficulty of achieving change • Independent assessor on requests to access the MBS • Under control/direction, or independent practitioners? • Example: practice nurses, nurse practitioners • Team based chronic/other care – who leads? • Need to streamline ‘fiscal gate-keeping’ mechanisms

16. Quantitative workforce projections • A tool to help policy formulation, not central control • Can be better focussed • Focus on major professional streams • Abolish AMWAC, AHWAC committees • Scenario analysis, including productivity • … and made more relevant • Embedding projection outcomes in institutional decision-making

17. Special needs • Specific attention to rural and remote and Indigenous issues • System-wide changes will be of benefit also to other special needs groups • Integration of special needs in the broader institutions and processes • However, time constraints prevented us from looking at additional requirements in all of the specific areas

18. Other matters • After hours GP services adjacent to hospitals • Distortions in mix of service use inevitable • Better cross-program evaluation a high priority • Data issues • Good data important for policy formulation • But data collection not costless • Ongoing productivity stream of research

19. Council Of Australian Governments COAG Communiqué of 10 February 2006 • Supports the key directions of the Productivity Commission’s Report • Endorsed the NHWSF • Given the significance of the recommendations of the Report • Asked Senior Officials to undertake further work on the recommendations and related issues • Report to COAG by mid 2006 • Include number and distribution of training places, the organisation of clinical education and training, accreditation and registration

20. www.pc.gov.au