The psychology profession is perhaps only just beginning to steady itself after the enormous impact of the national registration scheme since July 2010, but more significant change for the psychology workforce and its education and training is on the way. A second major development associated with health workforce reform is gaining momentum through the work of Health Workforce Australia (HWA), an entity that was established in 2009 by the Council of Australian Governments (COAG). This COAG initiative is intended to work across the health and education sectors to address the challenges of providing a skilled and flexible health workforce to meet the growing health needs of Australia’s ageing population.
HWA’s National Health Workforce Innovation and Reform Strategic Framework for Action 2011–2015 has recently been released and there is no doubt that HWA has a significant mandate for change, that the scope of its reform agenda is very large, and that there are major implications for the psychology workforce. Although many of us may be feeling overwhelmed by the pace of change in the external operating environment for psychology, it is imperative that the psychology profession is across the detail of the proposed HWA changes to enable rigorous advocacy for appropriate arrangements for psychologists in the HWA reform processes.
The APS is a member of the HWA Standing Advisory Committee for Health Professions and I and other senior staff have recently attended a number of meetings as the proposed HWA reforms gather pace. This article aims to provide APS members with general information about the HWA’s broad reform agenda and the trends that will have an impact on the psychology workforce. Over the coming months members will be provided with further details of the particular HWA plans that will have a significant impact on the psychology profession, as well as implications for psychology education and training.
About Health Workforce Australia
HWA is a Commonwealth statutory authority that was set up by COAG to enable a national, coordinated approach to workforce planning and reform. HWA is effectively an arm of government as it reports to the Australian Health Ministers’ Conference, which is comprised of the nine health ministers in each State and Territory plus the Commonwealth. COAG has already instigated a more coordinated national approach with the national registration scheme for the health professions run by the Australian Health Practitioner Regulation Agency (AHPRA) and its national boards for each health profession, and HWA’s separate role is to integrate health workforce planning and reform with complementary reforms to education and training. Together with the national registration scheme, HWA’s mandate provides Australian governments with far-reaching policy levers to shape the health workforce to meet the needs of Australia’s growing and ageing population in more cost-effective ways, given the rapidly increasing health expenditure.
Australia is spending more and more on health care, with the total cost of spending on health rising faster than economic growth, yet the health needs of the community are still not being adequately addressed. These health needs will continue to increase with an ageing population. At the same time, the health workforce is also ageing and workforce participation rates are falling. This scenario is presenting a major challenge to health workforce policy makers and forms the basis of HWA’s charter. The major focus of many of the HWA reforms is on the medical and nursing workforce, and it appears that solutions that are formulated for these groups are then being applied to other segments of the health workforce. Currently, allied health providers make up 18 per cent of the Australian health workforce, with psychologists comprising the largest component of this segment.
The Strategic Framework for Action 2011–2015
The recently released Strategic Framework for Action 2011–2015 outlines HWA’s national call for action in workforce reform across the health and education sectors. It notes that addressing health workforce needs does not only equate to producing more workers; it identifies that the sustainability of the health sector requires “re-balancing” of many aspects of the current system, involving reconfiguring the health workforce and the education and training programs that prepare that workforce. It outlines a required “paradigm shift” which involves basing policy decisions on consumer and community need rather than “working forward from the base of existing professions and their interests and skills, demarcations and responsibilities”. This statement succinctly presents HWA’s intentions in relation to strongly influencing the future direction of the health professions. The HWA Strategic Framework states that re-balancing the system can be achieved by improving the health workforce’s competencies, skills mix and productivity. HWA’s role is to develop policy and deliver programs across four main areas.
- Health workforce information, analysis and planning
- Clinical training reform
- Innovation and reform of the health workforce
- Recruitment and retention of international health professionals
Health workforce information, analysis and planning
HWA is developing a National Statistical Resource to create a comprehensive data source for health workforce planning. HWA is working with AHPRA and the Australian Institute of Health and Welfare to develop this Statistical Resource, which will include data from the Australian Bureau of Statistics, the Department of Education, Employment and Workplace Relations, and the Department of Immigration and Citizenship.
The resulting Statistical Resource will bring together information from various work settings, student pathways, immigration and geographic deployment to provide a comprehensive and nationally comparable health workforce data source. Such a resource has not been previously available and will allow detailed health workforce analysis and planning, and will provide justification for the wide-ranging reforms.
Clinical training reform
In order to increase the health workforce capacity and skills development, HWA has identified that a major shift in health education and training is required. This will involve developing training curricula that are outcome and competency based to reflect the skills and competencies required to meet the needs of consumers and their communities. This represents a shift from time-based education, with completion of training primarily linked to the demonstration of competence.
HWA has also identified that national reform will entail a major shift towards common education platforms that will produce more health providers delivering general services in expanded settings. This increasing focus on ‘generalism’ and away from specialisation is to enable a more flexible health workforce with adaptable skills that can be built on as priorities change.
Training reforms will also involve inter-professional education and practice, where health professionals from different backgrounds learn with and from each other to improve collaborative team-based care. This will also enable flexible training and career pathways that are more cost-effective and which facilitate cross-over training between professions through greater recognition of prior learning and existing competencies.
Taken together, these training reforms represent major challenges for the current education and training of psychologists.
Innovation and reform of the health workforce
HWA’s focus in this area is to reform health workforce roles to improve productivity and support more effective, efficient and accessible service models that better address population health needs. At a national level this will involve the redesign of roles and service delivery across the health professions to ensure that all professions work to full capacity through expanded scopes of practice and a greater emphasis on generalist roles. This may see psychologists with expanded opportunities, such as prescribing rights following suitable training, but it also poses significant threats as other health professions gain expanded scope to possibly deliver psychological services.
The creation of assistant roles and a support workforce is another major HWA workforce reform that will free the higher skilled part of the workforce from activities requiring a lower level of skill. Models will be developed to determine where an assistant workforce would improve productivity and effectiveness, and enable existing health disciplines to work to their full scope of practice. There are plans to train the assistant health workforce within the Vocational Education and Training (VET) sector, which is of considerable concern given there are usually no prerequisite formal qualification entry requirements. Settings where HWA is considering this include mental health and primary health care, and plans for psychology assistants are proceeding.
Reforms in this area will also focus on increasing the rural and regional health workforce through support mechanisms.
Recruitment and retention of international health professionals
HWA is undertaking a national strategy for recruitment and retention of international health professionals to augment the Australian health workforce.
APS advocacy on HWA reforms
The broad strategic directions of HWA’s reforms for the Australian health workforce outlined above have major implications for the psychology profession and its education and training pathways. In particular, shared training pathways, moves towards generalist models of training and expanded scopes of practice could well see other segments of the health workforce providing a substitute psychology workforce to deliver psychological services in the context of psychologist shortages.
The APS is already immersed in significant advocacy to try to achieve the most appropriate outcomes for psychologists and the clients and communities they serve. As a member of the HWA Standing Advisory Committee for Health Professions, the APS has raised a number of concerns about various aspects of the HWA reforms and put forward proposals to try to influence inevitable developments to move in more appropriate directions. The strategic partnerships that the APS is already involved in – such as Allied Health Professions Australia, the Mental Health Professions Association and the National Primary Health Care Partnership – are being used to strengthen the voice of the health professions to uphold appropriate standards of practice as the workforce reforms gather pace. Alliances through the APS’ role in psychology education and training – such as the Australian Psychology Accreditation Council and the Head of Department and School of Psychology Association – will also enable stronger advocacy for appropriate training standards for psychologists in the reform process.
It is quite clear that major changes to the way psychologists are trained, deployed and distinguished from other health professionals are on the agenda. The APS is in a strong position to advocate and influence on behalf of the psychology profession, but significant changes are coming!
The National Health Workforce Innovation and Reform Strategic Framework for Action 2011–2015 can be downloaded from http://www.healthinfonet.ecu.edu.au/key-resources/bibliography/?lid=25652.