Allied Health Workshop February 2019

On 13 February 2019, the Ministry of Health hosted an open workshop for representatives from the Allied Health, Scientific and Technical (Allied Health) sector, attended by 60 people. We noted opportunity for further engagement as there were many allied health professions not represented.

We are creating an allied health stakeholder database; if you would like to be added to this list, please email info@healthworkforce.govt.nz.

The workshop comprised two sessions: the first focusing on data and the second on future engagement between the Ministry’s Health Workforce Directorate and the Allied Health sector.

The following content is a summary of notes taken during discussions that took place at the workshop; verbatim notes of participant’s comments can be found in the appendices. If you would like to contribute or comment, please do email your feedback to info@healthworkforce.govt.nz.

Regarding the data, Emmanuel Jo and his team will be following up and has also provided comments, but it’s also an opportunity for others to share and work together, which we would like to encourage.

Next steps for engagement, there is an interim health workforce committee that are currently considering and advising the Ministry and Minster on health workforce governance, and in the next month this committee will be considering the role and purpose of the advisory groups and other engagement mechanisms. We will be providing them this feedback, and any further feedback you provide us so they and the Ministry can consider your views especially how the Ministry can better engage with the Allied Health Scientific and Technical sector.

We also want to encourage the Allied Health sector to work together to address common issues, this was a theme that emerged and we encourage you to reach out to each other to progress common issues.


Session One: Data

The first session focused on Allied Health data, specifically how we can work together in strengthening this data to support evidence of the workforce in this sector.

Emmanuel Jo (Manager, Health Workforce Analytics) shared current examples of modelling for medical, nursing, mental health and maternity services. They went on to outline how these could be expanded for modelling allied health professions.

Participants suggested considering the following opportunities for future modelling:

  • What is the unmet need, where is it located, and how can it be addressed? Emmanuel advises that utilisation data is needed.
  • Patient outcomes; access to health records for enhanced patient outcomes and holistic care. Emmanuel advises that it would be preferable to incorporate patient outcomes but more details would be needed. First, utilisation data would be needed, in order to measure the outcome.
  • Shift to community (private professionals as well). Emmanuel advises that facility data would be essential.
  • Generalist/specialist – how do they work together in a wider workforce model, especially in Allied Health. Emmanuel advises that guidance is needed in how to capture this.
  • Prescribing – integration within the health sector for non-medical prescribers and non-nursing. Emmanuel advises that we can do this now.
  • Types of models
    • Demand/needs based modelling: Emmanuel advises this has already been started.
    • Scenario modelling – closer to home and specifically the impact of earlier interventions on allied health, nursing and kaiawhina workforces. For example, if one service is increased, what is the impact on other workforces? Emmanuel advises that a modelling workshop is needed to confirm how to do this.
  • First contact point. Emmanuel advises that help is needed from other agencies, such as ACC.
  • Collect and analyse data on: (Emmanuel advises that the Health Practitioners Competence Assurance Act 2003 (HPCAA) will help us to do this)
    • Intersectoral data (eg health, social, justice, education and sharing data).
    • Linkage to disability statistic (eg uptake of the Ministry’s subsidy for hearing aids). Emmanuel advises that we need to check with the Disability Directorate.
    • Accessibility for rural populations, in particular for people with disabilities.
    • Ethnic data of workforce, in particular Māori and Pacific.
    • Qualitative data to help inform the quantitative data to avoid assumptions.
    • Demographic of wider workforce. Emmanuel advises that this has already been started.
  • Broader Visibility:
    • Data captured by other Professional Associations: numbers in training, unregistestered, non DHB.
    • Ensuring evidence base available for planning, policy, etc.
    • Emmanuel advises that we need more data (eg, registration data, work hours).
    • A ‘findings sheet’ summary to be distributed, highlighting trends and showing what ‘story’ the data tells.
    • Emmanuel advises that we need more data for the Allied Health workforce.
  • Equity:
    • Access/equity for Māori and Pacific to postgrad studies (including funding via Health Workforce), and working to top of scope.
    • Iwi, Hapū organisation data (kaupapa Māori organisations).
    • Measurement of data that helps to inform treaty relationship, level of engagement and obligations..
    • Whānau Ora workforce (navigators, cultural advisors, rongoā practitioners etc).

For further details of the discussion that took place during Session One, please see Appendix One.

Session Two: Engagement

The second session included a discussion on future engagement with the Ministry and the Allied Health sector. There was an update from Helen Wood (the Ministry’s Acting Deputy Director-General, Health Workforce) and Ray Lind (Chair, Interim Health Workforce Advisory Group) who outlined the approach for the future direction of Health Workforce.

During the session, we explored how the Allied Health sector can work more efficiently and engage together. With a focus on engagement, participants discussed what could we all do more of, and what could we do less of.

(For those unable to attend, a more substantive update on these developments was sent via the Ministry and the Health Workforce Advisory Group separately.)

What could we (including the wider sector, allied health organisations and the Ministry) do MORE of?

Key themes were identified from the significant feedback that was obtained through this session. These themes were:

  • building more in the way of future models of care that could test how workforces could be utilised to meet service need
  • improved representation or involvement with Allied Health Scientific and Technical professions (over 50) and the Ministry
  • ensuring future work is done with a patient focus and/or using co-design principles
  • an equity perspective needs to be woven through all work
  • ensure appropriate governance is in place for any work undertaken
  • as much as possible to undertake work from a whole of sector view
  • ensure future models are explicitly aligned to patient need e.g. a seven day or extended hour service
  • tighten Ministry processes (eg, timeliness, feeding back).

What could we (including the wider sector, allied health organisations and the ministry) do LESS of?

Key themes identified were:

  • being a black hole for information and initiatives to disappear into
  • current models of care and funding streams being perpetuated without examining options
  • being unfocused with use of time and resources
  • being influenced politically as opposed to maintaining political neutrality
  • continually reinventing the wheel.

Next steps

This summary, the appendix, and any other feedback that you provide, will be provided to the Interim Health Workforce Committee and the Ministry’s Health Workforce Directorate. They are considering how they can better engage with the sector, which will include the role and purpose of the advisory groups. They will be considering this in May and will also be influenced by the updated Health Workforce Governance Terms of reference.

For further details of the discussion that took place during Session Two, please see Appendix Two.

Appendix One

This appendix contains verbatim notes of participant’s comments during the discussions that took place during Session One. These comments should be considered in the context of the discussions described in the main document (pages one to two).

Potential sources of data for the Ministry’s Health Workforce team to explore:

Groups and organisations

  • NZ Association of Optometrists
    • Likely can reveal other variables such as geographic location, age, work location and public or co-private (98% in private!). Emmanuel would like to meet with this group regarding possible data and model sharing.
  • Emergency services – (NATO)
  • Aotearoa New Zealand Association for Social Workers, and Social Workers Registration Board
    • Emmanuel advises that Health Workforce has commenced engaging with MSD on data sharing; hopefully the data will be available to the Ministry soon.
  • Inter-professional practise and its impact on scopes of those practices.
  • HISO standard for Allied Health. Emmanuel supports this.
  • ACC – Sports injuries. Emmanuel confirms that we need to talk to ACC.
  • Mental health:
    • Counselling services delivered outside core health, via school based services for example. Emmanuel would like to meet with this group regarding possible data and model sharing.
    • PHO mental health data (if not already on PRIMHD). Emmanuel would like to meet with this group regarding possible data and model sharing.
    • Psychotherapists – numbers who work in different areas – ACC, PHO and private – NOIS, gender, demographics. Emmanuel would like to meet with this group regarding possible data and model sharing.
    • Private psychologist practice. Emmanuel has highlighted the Psychologists Workforce Survey.
  • Sterile technicians:
    • Ageing workforce.
    • Required to model future needs for training of staff.
    • Only identified recently as allied health professionals.
  • University/Institutes
    • Emmanuel advises that we have just signed MOU with two medical schools, and it needs to expand to other professions.
    • Numbers entering training compared to exit rates.
    • Attrition rates.
    • Postgrad training funding through Health Workforce. Emmanuel advises that the CTA database requires improvement.
    • Post registration education and training.
    • Impact of student workforce – back to apprenticeship model of education/training.
    • Potential workforce entry data, new graduates, mix diversity – match with population or expected. Human resources information.
    • DHB contracts – who is contracted.
    • NZQA involvement and development of micro–credentialing.
  • NZ Speech Therapists Association – membership info to capture SLT workforce numbers. Emmanuel would like to meet with this group regarding possible data and model sharing.
  • Audiology:
    • MOH – subsidy and fully funded, hearing aid funding.
    • ACC data of NIHL, Link to population stats.
    • Hearing aid funding linkage access to population statistics – age, location, deprivation.
  • TEC data.
  • ARC primary care data and core data.
  • Clinical Physiology Registration Board. Emmanuel would like to meet with this group regarding possible data and model sharing.
  • DHB employed workforce data held by TAS on behalf of the DHBs. Emmanuel advises that the DHB employed workforce data is available at an aggregated level, via dynamic dashboards on the Workforce Visualisation Tool managed by TAS.  TAS and the MoH continually work to improve data sharing opportunities to inform health workforce planning and development.
  • Private and self-regulated:
    • The “private” workforce for private hospitals and private providers. Emmanuel advises that the amended HPCAA will help us to identify where people work and so highlight staff shortages.
    • Private sector demand data. Emmanuel advises that utilisation data is needed.
    • All self-regulating professions – increase visibility and value by collecting data. Emmanuel advises that we would need to contact each self-regulating body to obtain this data.
    • Better use and involvement of NGO’s – workforce.
    • Tele-health and its impact.

Data that would strengthen models

  • Capture of minimum data - are requirements being met?
  • Community’s reasons for accessing particular services/providers/therapies over others, for example, do integrated health care hubs meet needs/improve outcomes?
  • Travel distance to care multiplied by number of appointments required per patient. Emmanuel advises that utilisation data is needed.
  • What happens if you change the scope of the practitioners to elevate a different scope?
  • DNA rake related to ethnicity to ophthalmology service.
  • Develop generic policy around data collection that RA’s can implement/use for private information. Emmanuel advises that a protocol for RAs is being developed.
  • Trend care – patient acuity system (data to include how allied health professionals spend their time, clinical and non-clinical, and the ties of patients (DRGs) that Allied Health have contact with). Emmanuel advises we need to have better understanding in trend care.
  • Allied Health demand data
  • Service level focus, rather than profession specific. Emmanuel supports this.
  • The consumer experience (effect of waiting times etc)
  • Missing bodies at the table – Education etc
  • Appropriateness of referrals, in and out of DHBs
  • Potential for Allied Health to assist in gathering the data, and in addressing issues
  • Atlas of healthcare

Appendix Two: Session Two: Engagement

This appendix contains verbatim notes of participant’s comments during the discussions that took place during Session Two. These comments should be considered in the context of the discussions described in the main document (page three).

What could we (including the wider sector, allied health organisations and the Ministry) do MORE of?

  • Future focus - National workforce planning, strategy, and training models that support future ways of working.
  • Future proofing.
  • Patient focus – increase health literacy in patients.
  • Focus on people we serve: when include in engagement (eg HDC – impact).
  • Increased/Strengthened public/private partnership.
  • Engage with non-Ministry agencies and organisations (iwi, hapu, kaupapa Māori organisations, Ministry of Education, Department of Corrections, Whanau Ora etc).
  • Needs led services with 7 day services.
  • Workforce modelling post this session.
  • Recognition of differences and setting minimum standards within DHBs and Allied Health services.
  • Recognition of differences among DHBs.
  • The governance group to more strongly represent Allied Heath, Scientific and Technical than the Advisory Group.
  • Understanding the workforce.
  • Social work to link regulatory and MoH Health Workforce – not only MSD.
  • Timely responses.
  • Co-design.
  • Real partnership.
  • Get in early – curious and enquiring, choose priorities.
  • Put effort into doing a few things well.
  • Give back info.
  • Listing – conversation, collaboration.
  • Evidence.
  • Variety in ways of engagement, to avoid a ‘one size fits all’ approach.
  • Thinking about what’s possible (eg internationally outside of constraints).
  • Exchange/rotate staff between Ministry and sector.
  • Sharing workforce scalability.
  • Actively avoid risks identified through data and engagement.
  • Co-ordination of workforce mental health trauma training, Ministry and ACC etc.
  • Review health and social services for prisoners.
  • Structured interface engagement.
  • Change meeting and leadership:
    • Expertise.
  • Interdisciplinary:
    • Not whole of health.
    • How will things become a priority if they are unknown.
  • Ensuring ‘action’ and follow up:
    • On reports regarding problems in workforces.
    • Follow through on earlier initiatives (eg workforce service reviews).
    • Check points on strategic delivery – accountability.
    • Registration board requirements, regularly review training requirements.
  • Allied Health scopes of practice:
    • Support for development of scopes of practice.
    • Enabling Allied Health to work more at the top of scope through use and understanding of the full scope, along with identifying barriers to this.
    • Ensuring available and capability and resource to support action.
    • Oversight of wider AHST workforces eg. NGOs.
  • Education:
    • Ministry of Health to lead where tertiary/secondary services should be based.
    • Ensure students get skills essential in demand training while studying or on graduation.
    • Centralised ways of doing recruitment drives across New Zealand marketing.
    • Preregistration education linkage to supply and demand.
    • Accept and support role of DHBs in incubating future health workforce.
    • Funding for post registration education.
    • Roll out trainings (such as the Otago Medical School CBT training) to allied health professionals who are not employed by DHBs.
    • Relationship/partnership leading to engagement “partnership agreements”. Engagement leading what workforces are trained in.
    • Orienting people into the sector.
  • Funding:
    • Review of cost funding models.
    • Funding for community based models.
    • Flexibility in using funding to meet local and regional needs.
    • Support for intervention to include early intervention/prevention.
    • Funding for regulating authorities to provide data.
  • Communication points:
    • Work together so we don’t double up the work.
    • To broadly inform and communicate regularly – a greater spread of info (eg, a shareholder newsletter, ROI feedback) to include up to date info workforce, strategy, current innovations, research, collected data etc.
    • Transparency re how funding for health workforce works.
    • More transparency.
    • Use the same language with common definitions/language/terminology, stop phrases such as ‘silo’, ‘scopes’.
    • Interagency/cross sector work – increased conversation and collaboration.
    • Clear pathways for engagement (eg points of contact in the Ministry, a clear communication strategy for stakeholders).
    • Structures for accessing health-care/prohibitive costs.
    • Closer working relationship between association and regulator.
    • Collective agreed overall goals, priorities and strategic direction.
    • Transparency around how the groups work and feedback and who to.
    • Engage with Allied Health.
    • Clearer quicker decision making.
    • Information to allow stakeholders to socialise with their members befits and what you are doing.
    • Socialising our members/registrants/teams/staff etc.
    • Communication around data collection:
      • Clear about purpose.
      • Co-ordinated collection (eg templates for full workforce).
      • Tell the story around the data – manage the story.
      • To be agile and responsive to data collection, with faster analysis and reporting on.
      • Consumer/whanau based model.
      • Discussions and support around data protection and security.
    • Information for frontline people:
      • How they can input/feedback into the design.
      • Social media.
      • Sharing of success stories.
      • Information for the public on allied health professionals and their roles/scope.
      • Information on models of care.
      • Information on shift of care to primary and how this changes the workforce.
      • Preventative.
      • Self-management – If priorities not clear, serving to big picture.
      • Incentivising right behaviours.
  • Equity/Representation:
    • Prioritising equity and Māori representation.
    • Prioritise treaty relationship engagement and various organisations that represent Māori voice.
    • Develop the workforce to be more representative of the communities we serve. Eg. increase Māori/Pasifika workforce.
    • Engage with Nga Pou Mana.
    • Equable outcomes, tertiary institute, employees Professional Associations/Responsible Authorities.

What could we (including the wider sector, allied health organisations and the ministry) do LESS of?

  • Legislation being an enabler (example of pharmacy technicians and problems recognition of overseas medicines legislation).
  • Less restructuring.
  • Barriers (less partisan approach).
  • Black hole.
  • Modelling:
    • Less of organising service via medical models, enabling new ways of working and for new workforces.
    • Less of process and or outcomes move more to population/people outcomes.
  • Funding:
    • Stop silo approach/funding.
    • Even spread of funding between DHBs, community, primary.
    • Funding barriers.
    • Discontinuation of status quo around funding.
  • Greater respect for people’s time:
    • Too many narrowed down priorities - long term and short term.
    • Short notice meetings.
    • Short timeframes – more realistic timeframes.
  • Move away from political influence:
    • Political appointments.
    • Political interference.
    • Institutional structures self-serving.
    • Imbalance of power.
  • Value all workforces equally:
    • Duplication due to not knowing what been done before.
    • Loss of knowledge and continuity.
    • Decisions without involving the people/professions involved/impacted.
    • Patch protection hierarchy.
    • Talking and taking without giving back (eg data).

 

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