Introduction by Croakey: Health leaders with key roles in developing the National Allied Health Workforce Strategy and national scope of practice reforms spoke at the 15th National Conference for Rural and Remote Allied Health in Victoria last week.
They shared personal and professional insights about the role of rural health professionals and imperatives for reform, reports Marie McInerney for the Croakey Conference News Service.
Marie McInerney writes:
Professor Jenny May, the newly appointed National Rural Health Commissioner, says her 40-year career in rural medicine, medical education, and rural health advocacy underscores the importance of evidence about what helps to build a rural and remote workforce.
According to May, her career is the product of “a couple of predictive factors that increase the likelihood of health clinicians working in rural and remote areas” – very positive rural exposure early in training, longer immersion and marrying someone from the bush, which she dubbed “rural spousal origin”.
May, who took up the Commissioner role last month, told delegates at last week’s 15th National Conference for Rural and Remote Allied Health that her career began, alongside her GP husband Dr Peter May, as a GP at the Tamworth Base Hospital in 1985.
She then moved to the mining town of Tom Price in Western Australia and later to the remote First Nations community of Bella Coola in Canada.
These postings followed medical training that equipped her cohort for generalist practice and a wide scope of practice and provided genuine exposure to what integrated multidisciplinary care can look like, as well as lessons in providing care in proximate resource-poor areas, she said.
“And I think that points to some of the things that have changed and some of the challenges that we’ve got in terms of our health workforce going forward,” she said, ahead of an address focused on rural health workforce issues, including generalism and the looming role of artificial intelligence (AI).
May said that, alongside workforce maldistribution and thin markets, the rural and remote allied health sector is navigating changes in availability and access to services and workforce wrought by the expansion of the NDIS, and where services have to “beg, borrow and steal” staff from other sectors.
That meant generalism is “incredibly important” for the health workforce as a whole, and the more so “the more remote we go”, she said. (See a thread on X/Twitter of her presentation).
#SARRAH2024
Apologising for not being able to attend #SARRAH2024 in person, May delivered a video address from Darwin, where she was to speak at the Rural Medicine Australia conference, hosted by the Australian College of Rural and Remote Medicine (ACRRM) and Rural Doctors Association of Australia (RDAA), and where her predecessor Adjunct Professor Ruth Stewart was honoured with a 2024 ACRRM Life Fellowship.
More than 3,000 kilometres south, the two-day #SARRAH2024 event, hosted by Services for Australian Rural and Remote Allied Health (SARRAH) in Mildura on the lands of the Latji Latji and Barkindji peoples, attracted more than 250 allied health delegates from across the country.
As well as May, keynote speakers included new Chief Allied Health Officer Anita Hobson-Powell, Assistant Rural and Regional Health Minister Emma McBride, in a brief video presentation, and Shadow Assistant Regional Health Minister Dr Anne Webster, the local Nationals MP who has her eye on McBride’s job next year.
Each will play significant roles in critical policy pieces that are underway, including the National Allied Health Workforce Strategy (due next year) and the Unleashing the Potential of our Health Workforce – Scope of Practice Review (with the final report from Professor Mark Cormack now submitted to the Health Department, Croakey was told).
As SARRAH CEO Cath Maloney put it: “The conference couldn’t have been better timed to capture evidence-based measures to support and grow a rural and remote allied health workforce within the strategy.”
Upstream work
While not focused specifically on allied health, May’s address touched on the unique role health professions play in rural and remote areas.
This included broader roles than their metropolitan counterparts in prevention and population health outcomes that saw the development of higher levels of clinical responsibility and additional specific community roles “as we get more rural”.
Most clinicians in rural and remote areas “work upstream…not only in the prevention space, but more generally looking at population health outcomes and how we support risk reduction and a better way of ensuring better health”, she said.
Prior to her appointment as Commissioner, while continuing to work as a GP in Tamworth, May had worked for the past 20 years in the University of Newcastle’s Department of Health (UDRH), overseeing rural training and research and specialising in workforce issues.
She told #SARRAH2024 she sees three key needs for rural and remote allied health professionals:
- to know that there are rural career trajectories and all multiple career trajectories that work into integrated multidisciplinary care
- to have secure and predictable funding streams that rural and remote allied health can rely on
- to know that the care they provide is supporting First Nations and rural communities to be healthier.
Expectations of Commissioner
May said these aligned broadly with the statement of expectations given to her last month by McBride.
This statement says the Commissioner will:
1. Contribute to Strengthening Medicare through developing and promoting innovative, integrated and multidisciplinary approaches.
This includes advising on the Government’s responses to key primary healthcare reviews and on opportunities to address inequities in access to healthcare in rural and regional settings, from a geographic and socioeconomic perspective.
2. Contribute to primary care, rural workforce, and training reforms.
3. Support First Nations peoples’ health and wellbeing.
This includes working in partnership with First Nations people, peak bodies, and other stakeholders to support First Nations peoples to receive culturally safe care, and supporting the increase of attraction, retention and career development for First Nations people in the health workforce.
4. Support urgent and emerging priorities.
This includes assisting with the design and implementation of response strategies on disaster and recovery advice for rural, remote and very remote communities in consultation with the National Emergency Management Agency.
May said the statement demonstrated that three things mattered “enormously” for her office: equity, generalism and place.
She highlighted the need for a shift from metropolitan to rural and remote influences on training and models of care, and said the recent Ngayubah Gadan Consensus Statement – Rural and Remote Multidisciplinary Health Teams would be a guiding document.
May made clear the stakes are high: “Increasingly and concerningly, we see people needing to move to metropolitan areas in order to get the care they need.”
Watch her address in full here.
Not fair, reasonable or just
National Party MP Dr Anne Webster, the Shadow Assistant Minister for Rural and Regional Health and local MP for the Mildura region, made it clear to #SARRAH2024 delegates that she wants to stay in the regional health portfolio if the Coalition wins next year’s federal election.
She said a regional health summit that she ran 18 months ago in Mildura had informed nine policies for regional health that have been costed and are now “sitting in the lap of the powers that be on my side of government to review and look at what we will be bringing to the election”.
“I am personally very excited about those policies, because I think they will shift the dial,” she said, later declining a Croakey request for more details.
“We cannot keep being the poor cousin of our urban counterparts,” she said.
“It is not fair, it is not reasonable, it is not just. And, you know, we do a cracking job out of the country, and I think we are, frankly, far more sensible, rational, pragmatic than those who live in the cities that get caught up in a whole bunch of stuff that we don’t need to know about because we’re doing our job.”
To address significant allied health workforce shortages in rural and remote areas, Webster indicated she would move to increase the number of Commonwealth Supported Places (CSP) in rural universities to stop the drain of health students away from rural and remote communities.
“Once kids from this region go down there to do their studies, it’s ‘see you later’. Very few come back and that is typical across Australia. We can do better than that,” she said.
Webster congratulated some tertiary institutions, such as Charles Sturt University, for beginning to host allied health studies in regions but said that for others it remains “a no go” area.
“So we need to be talking across government at all levels, especially state and federal and all of the sectors and universities, and currently even our secondary school systems, to ensure that we are bringing up a workforce that understands how wonderful these jobs are, how rewarding these jobs are, and to build the allied health workforce.”
Webster referred to research commissioned by the Nursing and Midwifery Board of Australia, which found Australia’s midwifery workforce is in crisis and that widespread local staffing shortfalls, particularly in rural and regional areas, would be “catastrophic” if the already high rates of workforce attrition increase above expectations.
The Shadow Assistant Minister homed in on a Herald Sun report of the research, showing that only one in five midwives are working full-time.
“It doesn’t matter whether it’s doctors, nurses, allied health…we’re graduating the same numbers, but people are working less hours,” she said, highlighting the career of her husband Dr Philip Webster as a case in point.
Set to retire this month after being a local GP in Mildura for nearly five decades, he had worked 90 hours a week in the early days of their marriage, she said. She would cross a field between the ‘picker’s shack’ in which they lived, where medical interns were accommodated, to see him in the Emergency Department in the middle of the night, “to say ‘g’day’”.
“That’s how we did it back then it was, it was an adventure. Do I want to do it again? Probably not, now that I know life can actually be better than that, but the fact is that we think about work and life and managing our communities and our life in our communities differently now.”
Webster also talked about her experience in allied health, as a social worker and later founder of a charity that worked with young mothers, and of having a son with Asperger’s Syndrome, and the challenges the family faced in identifying and finding the right supports.
While not giving away Coalition solutions to the rural and remote workforce shortage, Webster hailed the work being done by former Rural Health Commissioner Paul Worley in South Australia, reported earlier here at Croakey and said other pilot models around Australia were also working well.
Watch our interview with Dr Anne Webster, pictured presenting below and see this summary on X/Twitter.
Strengths-based focus
New Chief Allied Health Officer Anita Hobson-Powell surprised some in the audience with a call for rural and remote allied health professionals to make sure they’re not sounding like a “broken record” of negativity, and instead demonstrate their value in a strengths-based way.
In her first address to SARRAH members, the former long-term CEO of Exercise and Sports Science Australia and exercise physiologist acknowledged that, despite its importance in the Australian healthcare system, allied health is “often relegated to the sidelines, we’re seen as the third cousin in the healthcare hierarchy”.
Allied health is less visible, less recognised and under-utilised versus nursing and medicine, she said.
However, she suggested it may need to consider its “branding, marketing and communications”.
“For many of the allied health professionals in this room today, I’m constantly hearing the messages that you would like to be considered and valued, just like your nursing and medical colleagues,” she said.
“The phrases of ‘don’t forget about us’, ‘what about us’, ‘we’ve been excluded again’, ‘we’re forgotten’ are constant messages across many rooms, many hallways, many consultations, many advocacy meetings and many workshops.”
Hobson-Powell said she understood their frustration, but wondered whether allied health’s stakeholders were “tuning out because they’re hearing the same old message”.
She challenged the sector instead to consider a strength-based approach to their feedback on plans, programs and problems that is “positively framed and not in the expected ‘broken record’ way”.
“Let’s not just demand recognition, but let’s demonstrate our value. How do we make them look good by including us,” she said, in a call that prompted some pushback from delegates.
Hobson-Powell also called on nursing, medical and allied health professionals to end professional turf wars, saying that was a message that she had heard “clear and strong” from government in recent weeks.
Turning to the Allied Health Workforce Strategy, Hobson-Powell said allied health demand is being driven by multiple factors, including increased focus on chronic disease management, healthy aging, the expansion of the NDIS, growing focus on multidisciplinary team care, interprofessional practice, working to full scopes of practice, telehealth, digital health, and advancing health technologies.
The strategy’s latest round of consultations have identified frustrations with funding models that do not value training, career progressions and the overall value to the healthcare system, costly and complex regulatory requirements, funding barriers to support training and working in rural, remote locations, and cultural norms and regulations restricting scope of practice, she said.Hobson-Powell said the workforce strategy will take a long-term view, looking not only at the immediate needs of the workforce, but also the trends and challenges that will shape healthcare delivery over the next decade, including the impact of technology advances, disease pattern changes and consumer shifts in expectations.
As well, over the next 12 months, her office will be developing a definition for allied health. “We cannot be stuck on an outdated list or definition that fails to reflect the current and future landscape,” she said.
Another big challenge is the need for comprehensive workforce data. “We actually don’t know how many allied health professionals there are out there, where they’re located, what sector they’re working in, how often they’re working, or even what the pipeline is from the education sector”.
In a later interview with Croakey, Hobson-Powell spoke about the importance of the allied health rural generalist pathway and expanded scope of practice, climate change and some of the innovative workforce approaches she was hearing about at #SARRAH2024.
Watch our interview with Hobson-Powell.
Multidisciplinary matters
In her video, Minister McBride, a registered pharmacist who is also Assistant Minister for Mental Health and Suicide Prevention, highlighted her previous work in acute adult mental health inpatient units on the New South Wales central coast and said “the benefits of comprehensive healthcare provided by multidisciplinary teams can’t be underestimated”.
“Especially as the Australian population ages, we know multidisciplinary teams working to their full capability can provide significant benefits to both patients and the healthcare system. It just makes sense.”
See the full conference program. Bookmark this link to follow ongoing coverage via the Croakey Conference News Service, and also follow this list on X/Twitter for ongoing news from #SARRAH2024 presenters and participants.