Introduction by Croakey: When the 2021-22 Federal Budget was handed down earlier this month the national peak body for allied health professionals cautiously welcomed funding committed to key areas where allied health is crucial, including aged care, primary care, mental health and support for people with cognitive disability.
Almost 200,000 allied health professionals practise in Australia, providing diagnostic, technical, therapeutic and direct health services. The diverse workforce includes physiotherapists, art and music therapists, dietitians, podiatrists, optometrists, psychologists and occupational therapists.
Allied Health Professions Australia was pleased to see funding in the Budget for allied health professional training and staffing in rural and remote areas, and for case conferencing for patients with chronic conditions.
But the organisation’s Policy and Advocacy Manager Chris Atmore says, in the article below, that a detailed analysis shows there are slim pickings in the Budget for allied health, particularly in aged care, and a lost opportunity for a more holistic approach to health.
Chris Atmore writes:
Significant inquiries in recent years, including the Royal Commission into Aged Care Quality and Safety, have repeatedly emphasised the need for decision-makers to take a holistic view of the health needs of Australians.
This approach encourages genuine integration and collaboration with tangible support for multidisciplinary health service provision, takes into account the social determinants of health, and emphasises preventative health and primary care as best practice for the person and cost-effective for governments.
It was, therefore, encouraging to see in the Budget the allocation of $500,000 to explore the drivers of higher hospitalisation rates for people living in residential aged care as part of the Government’s commitment to building a better evidence base for health provision in aged care. That project will examine models that incentivise the use of multidisciplinary teams – including allied health professionals – to reduce avoidable emergency presentations and hospital admissions.
But overall this emphasis on the interconnected facets of health and the associated need for ‘joined up’ health provision was rare in this Budget.
We regard allied health as a litmus test for whether a government is genuinely committed to a holistic health system. The Budget’s approach to allied health is perhaps best illustrated by examining aged care spending, following the damning findings of the Royal Commission.
While many of the aged care Budget items have been positively received by the health sector, it is instructive to compare the Budget to the Federal Government’s Response to the Royal Commission’s recommendations. Allied health was a significant aspect of the Royal Commission’s investigations and was explicitly addressed in several recommendations.
Home care for the elderly
The Royal Commission concluded that people in aged care have limited access to services from allied health professionals, including in-home care. In 2018-19 only two per cent of Home Care Package funding was spent on allied health. Of the 29 per cent of people who did receive allied health and therapy services, more than half received fewer than five allied health services (that is, individual sessions) per year.
The Commissioners said reablement and rehabilitation should be a central focus of aged care. Recommendation 36 said care at home should include a level of allied health care appropriate to each person’s needs, and that the eligibility process should identify any care that an elderly person needs to restore their physical and mental health to the highest level possible (and maintain it at that level for as long as possible) to maximise their independence and autonomy.
Assigned funding and an entitlement to allied health care based on assessed need was also recommended as part of a new care at home category, with coordination and monitoring by the elderly person’s home care provider (Recommendation 118).
The Federal Government accepted Recommendation 36 and said it would finalise design of the new home support program, including considering assessment mechanisms for allied health services.
Recommendation 118 was accepted in principle, with funding options and levels associated with the design process to “consider the types of services that will be funded by the Government and the appropriate level of Government support, noting the Government already funds allied health services under existing in-home care programs”.
The Government’s response also commits to provide funding to expand allied health services in the Commonwealth Home Support Program from 2021-22.
The Budget does not provide any greater level of financial detail other than the commitment of $7.5 billion towards supporting senior Australians who choose to remain in their home, including a ‘Home Care – Future design and funding’ measure of $10.8 million.
Residential aged care
The Royal Commission also found that allied health care as a fundamental component of residential aged care was seriously inadequate.
A study commissioned by the Commission found that the average amount of allied health care received by an Australian aged care resident was eight minutes a day. In particular, there is a lack of support from aged care providers for people to maintain and improve their mobility — including limited access to allied health professionals critical to promoting mobility, such as physiotherapists and exercise physiologists.
Lack of funding was found to be an important cause of the gap in allied health provision and the Commissioners recommended that allied health “should become an intrinsic part of residential care”.
To ensure that residential aged care includes a level of allied health care appropriate to each person’s needs, Commissioner Pagone recommended that providers be required to have arrangements with allied health professionals to provide services (Recommendation 38).
In contrast, Commissioner Briggs recommended that providers employ at least an oral health practitioner, a mental health practitioner, a podiatrist, a physiotherapist, an occupational therapist, a pharmacist, a speech pathologist, a dietitian, an exercise physiologist, and a music or art therapist, and have arrangements with optometrists and audiologists to provide services as required.
Both commissioners recommended a blended funding model accompanied by strict monitoring and reporting of the level of allied health services actually delivered, including via the collection and review of data.
The Government’s response to Recommendation 38 is to accept it in principle, while tying more specific outcomes to the design of the Australian National Aged Classification (AN-ACC) model. The response does not explicitly prefer one commissioner’s proposal over the other’s, but simply refers to “measures to support increased access to allied health care appropriate to each person’s needs”, including training and virtual access to primary care and allied health professionals in residential aged care facilities.
The Government has also accepted the monitoring and reporting proposals, but without referring expressly to allied health care professionals.
The diversity of allied health
Commissioner Briggs’ proposal in Recommendation 38 is one of the few instances in the final report of the Royal Commission – or indeed in Federal Government policy – where diverse allied health professions are delineated. Commissioner Briggs’ stance reflects an understanding that we need a multidimensional network of care to ensure the health and wellbeing of older Australians (and indeed, all Australians), instead of atomised individual providers and policies.
Far more commonly, however, policies and strategies refer to primary care and aged care health services and leave it unclear as to whether allied health is included. At best, “allied health” is used by policymakers as shorthand for a bundle of services as if everyone knows what these are.
This can mean that “allied health” is taken to encompass only commonly used services like physiotherapy, occupational therapy and speech pathology. These are critical aspects of allied health provision – particularly in aged care – but so are psychology, social work, podiatry, optometry and orthoptics, audiology and exercise physiology.
Many older people also benefit from the services of rehabilitation counsellors, osteopaths, orthotists and prosthetists, music and art therapists, medical imagery and radiation specialists, and chiropractors.
Both the Budget and the Government’s response to the Royal Commission leave allied health professions unclear about how the holistic health needs of older people in residential aged care are to be funded from the $7.3 billion allocated to ‘Residential Aged Care Services and Sustainability – Reforming residential care funding to drive better care and a viable system’.
Will funding for allied health professionals who provide direct care be part of the $3.9 billion aimed at increasing the amount of frontline care delivered to residents of aged care and respite services? Should allied health care be included in the soon-to-be-mandated 200 average care minutes per day, and if not, how will there be accountable reporting?
Workforce planning and beyond
When we turn to planning for the allied health workforce, Royal Commission Recommendation 75 proposed the establishment of an Aged Care Workforce Planning Division within the Australian Department of Health.
The division would develop workforce strategies for the aged care sector by obtaining up-to-date data about the workforce via a census, and conducting long-term modelling on the supply and demand of health professionals, including allied health professionals. It would also consult with education and training providers to ensure an appropriate distribution — particularly in regional, rural and remote Australia — of health professionals to meet the needs of the aged care sector.
The Government has accepted this recommendation, which is to be further considered by the Aged Care Workforce Industry Council. The Budget provides line items for registered nurses and personal care workers, and allocates $23.6 million to build a better data and evidence base for workforce and other planning, but there is almost no accounting or a specific dollar value allocated to allied health workforce planning for the aged care sector, let alone for training and service provision.
The allocation of $700,000 for a gap analysis of allied health data is welcomed. We need comprehensive data that identifies where and how older people are missing out on the allied health care they need. But that must be followed by effective provision of the services according to how and where they are needed.
Unfortunately, since the release of the Budget and the Government response to the Royal Commission, it appears that the Government does not accept that allied health services are a fundamental and intrinsic component of aged care. Enhancement to MBS items or other external measures will not address the needs identified by the Royal Commission.
For the Government to excise allied health from aged care costings demonstrates again a disturbing lack of understanding of the way allied health operates and the value it provides to the ablement and quality of life of older Australians. Professor Kathy Eager, the architect of the he AN-ACC residential aged care assessment tool, said allied health was the “real loser” in the Budget.
Former Royal Commissioner Briggs has also commented on the Budget’s inadequate provision for effective allied health services in residential care.
“I hope that you will not give up on the provision of effective allied health services in residential care. Older people deserve the opportunity to retain and maintain their health for as long as possible rather than be written off,” Ms Briggs told the Aged and Community Services Australia National Online Summit on May 19.
Allied Health Professions Australia now looks ahead to being involved in the National Aged Care Advisory Council and in the design and implementation of all relevant aged care strategies.
More broadly, we will be working closely with the Federal Government and the Department of Health to comprehensively clarify the allied health impacts of the Budget measures, and to ensure that the allied health sector is fully involved in their implementation.
Dr Chris Atmore is Manager, Policy and Advocacy at Allied Health Professions Australia.
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