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

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

3. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 20 www.pc.gov.au