The University of Sydney’s 2019 Dean’s Future Health Forum, titled ‘Dare to disrupt: Solving wicked problems’ held earlier this month, focussed on ways to improve health and health care delivery using allied health services in Australia.
Professor Kathryn Refshauge opened the seventh forum, which was held in the ornate MacLaurin Hall in the university’s famous quadrangle, saying she hoped to find “provocative and magical” solutions to some of Australia’s intractable health sector problems.
Australian health system facing several problems
“We have one of the best health systems in the world. We have amongst the best clinicians, the best researchers, and the best educators. But… we know this is true predominantly for healthy white males in the central metro areas. We know that the further you deviate from that scenario, the further we move from excellence,” she said.
She noted that Australia is in the worst third of OECD countries for obesity, a known risk factor for many of the most “wicked” health problems Australian society faces.
“People living in rural Australia are hospitalised five times more frequently than people living in metro areas. We know that people with significant mental health disorders die up to 30 years earlier than the healthy population,” she said.
Prof Refshauge also pointed out that Indigenous Australians die more than 10 years younger than the white population.
“People still experience significant discrimination in our health system. There is racism, there is ageism, sexism, all the isms. There is discrimination against people with disability, different religions, ethnicities. So what are we doing with all this knowledge?” she asked.
Allied health professionals the key to keeping people well
She said that allied health professionals are key to keeping people well and out of hospital.
“Allied health professionals are more necessary than ever before,” she said, noting that a recent Harvard review suggested the world will need 300,000 more allied health professionals within the next decade.
Sydney University projections show that by 2022, Australia will need 6500 more physiotherapists. The Productivity Commission has predicted the NDIS workforce will need to more than double within a couple of years.
“How are we going to do that?” Prof Refshauge put to the audience.
Prof Reshauge said she was disappointed in both the recent budget and the budget reply, neither of which contained measures aimed at prevention.
“There is nothing for obesity, underpinning so much of our ill-health. Or the lack of physical activity or improved nutrition, or livable cities or socialising. In addition, there was no mention or particular inference about allied health in the budget,” she said.
Prof Refshauge said the forum is an opportunity to focus on solutions to some of these seemingly unsolvable problems.
What barriers restrict increases to the allied health workforce?
Amanda Larkin, Chief Executive of South Western Sydney, said allied health professionals are “core” to the delivery of health services in her district, but broadly speaking finding placements can be difficult.
“Over the years, we have played, I think, an important role in clinical placements for allied health units… I think they can come to the South West and get a rich level of experience in a diverse range of areas, right from the acute care services through to the community based services,” she said.
She said the level of support and direction their clinical placements receive is “critical”.
She also said the opportunity for allied health services to link with community health, with primary health networks is also important.
She would like to see NGOs out in the community collaborate to support clinical placements.
“What you hope is that people get into these placements and then develop their careers in these places,” she said.
Include people from disadvantaged communities in the decision making
Graeme Innes, the former Disability Discrimination Commissioner, said he would like to see people in rural and isolated areas, people with disabilities, and Aboriginal Australians more involved in health decision making.
“We need to start treating disadvantaged communities as members of our broader community, and in the same way as we treat everyone else. And we need to engage disadvantaged communities in the health process,” he said.
“The most likely way, I think, to get more positive outcomes in terms of health and allied health for these communities is to have the communities coming with you or being part of the process.”
He said people with disabilities “want to be included”, but “it takes the broader community to include us”.
“It takes the broader community to work with us rather than for us, or to tell us what to do,” he said.
Integrate GPs with allied health services
Jillian Skinner, former NSW health minister, said it was hard to get anyone to take notice when you talk about prevention, but health services, including GPs and allied health services need to be better integrated.
“I think [what is] most important going forward… is making sure everyone understands the value of allied health in the settings.”
“It’s about learning about dealing with your issues from a non-traditional approach. People say if you have a wonky hip, well, go and have it replaced. No, first of all, get a gait analysis, and etc. More of this should happen.
“It’s about getting the message out to people. Let people understand it. Let GPs understand it.”
Ms Skinner said some of the most successful projects she’s been involved in were in Western New South Wales, where GPs are involved with the allied health professionals, from physios to speech therapists, podiatrists, and exercise physiologists.
Funding allied health the same way we fund seeing a doctor
“The real tiger in the room is funding,” Ms Skinner said.
GPs are funded under Medicare, so how can we fund allied professionals in the same way, she asked?
Jacqueline Dominish, Director of Allied Health, said she has a passionate interest in diabetes-related foot disease in Aboriginal people.
She said any Aboriginal person at risk of developing diabetes should be able to see a podiatrist or dietician as many times as they want. But as things stand, you only get five sessions a year with an allied health professional, and even then they are not fully covered.
“If we don’t have those fully funded public services through the local health districts in Western Sydney – people need psychology, podiatry, all these other things – they can’t access them,” she said.
Ensuring allied health practitioners are taught a range of skills
Ed Johnson, co-founder of Umbo, said allied health students often aren’t taught the skills they need on the job, things like managerial responsibilities, building relationships, completing paperwork.
He described a pilot placement program in north-western NSW, from Dubbo through to Bourke and Brewarrina, that aimed to create a generalist experience for students.
Students were based in Aboriginal medical services, but they got out into the community and worked with schools, aged care facilities, and hospitals. They had several supervisors, and were sometimes given support online.
The government’s underspend on NDIS “unconscionable”
Mr Innes said the NDIS is under resourced, and yet there is “underspend” and people with a disability and their carers struggle to access the support they need through the NDIS.
“That underspend makes up a quarter of the projected surplus that the Commonwealth government is now claiming (to fund The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability),” Mr Innes said.
“That is just unconscionable,” he said.
“Until we recognise that… it is immoral… to claim a surplus when we have such a significant underspend in such an important area, then we are not going to be able to deliver,” he said.
Keeping young people with disabilities out of nursing homes
Mr Innes said young people with disabilities are often being forced to live in nursing homes.
“We are… pushing young people with significant disabilities out of hospitals and into nursing homes where they are living in communities that are way outside their age cohort. We have to stop doing that,” he said.
He said “smarter solutions” are required that will still move people with disabilities out of hospitals faster, but move them into the community with appropriate support.
“It is about changing our mindset and recognising that members of these disadvantaged groups are members of the community just like the rest,” he said.
Changing our mindset: older Australians as a source of wisdom
Mr Innes’s observation prompted Mr Ron Fuller, Moderator for the forum to ask, how we can ensure older Australian gain more respect in our society, and how can we ensure they receive more respectful care.
Prof Refshauge said she had a dream: she would like to see older people as a source of wisdom that society can harness.