Annual Report - Outcome 12 – Health Workforce Capacity

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Part 3: Management Arrangements

Part 4: Accountability Reporting

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Outcome Summary

Outcome 12 aims to support Australia’s health workforce through education and training programs for general practitioners, other medical specialists, nurses and allied health professionals. It also focuses on the effective distribution of the workforce to meet the health service needs of Indigenous Australians, and those living in remote, rural and outer metropolitan Australia. The Department worked to achieve this outcome by managing initiatives under the programs outlined below.

Programs Administered Under Outcome 12 (Program Objectives in 2008–09)

Program 12.1 – Rural Workforce

Increase the number of rural health professionals.
Ensure rural health professionals are well trained to practise in these areas.

Program 12.2 – Workforce

Increase the supply and retention of health professionals.
Influence the distribution of health professionals into areas of workforce shortage.

This chapter reports on the major activities undertaken by the Department during the year, addressing each of the key strategic directions and performance indicators published in the Outcome 12 chapters of the 2008–09 Health and Ageing Portfolio Budget Statements and 2008–09 Health and Ageing Portfolio Additional Estimates Statements. It also includes a table summarising the estimated and actual expenditure for this outcome.

The Health Workforce Division was responsible for Outcome 12 in 2008–09. The Primary and Ambulatory Care Division also contributed to this outcome.

Major Achievements for the Outcome:

Increased numbers of allied health students to undertake a clinical placement in a rural or remote community during their degrees, by establishing a new Allied Health Clinical Placement Scholarship Scheme (see Improved Supply of Health Professions in Rural, Regional and Outer Suburban Australia);
Provided a simpler and more flexible specialist training environment to improve training for health professionals by establishing a new Specialist Training Programs initiative (see Clinical Training Opportunities);
Improved the safety and quality of Australia’s health services by facilitating national agreement on, and developing draft legislation to implement a National Registration and Accreditation Scheme (see National Registration and Accreditation Scheme); and
Helped develop initiatives through the Council of Australian Governments’ National Partnership Agreement to increase the health workforce (see Key Fact for 2008–09: Council of Australian Governments’ Health Workforce Package).

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Challenges for the Outcome:

Lower than expected take-up of the Bringing Nurses Back into the Workforce Program (see Increasing the Number of Nurses Working in Hospitals and the Aged Care Sector); and
An inability to fill all approved specialist training posts for the 2009 academic year due to a lack of available registrars to fill positions (see Clinical Training Opportunities).

Key Strategic Directions for 2008–09 – Major Activities

Increasing the Number of Nurses Working in Hospitals and the Aged Care Sector

Addressing workforce shortages and making better use of the existing nursing workforce is critical to ensuring the current and future health needs of the population can be met. In 2008–09, the Department managed a range of initiatives to increase the number of nurses in the health workforce. These focused on: encouraging nurses to return to the workforce; supporting nurses from Indigenous backgrounds; and promoting nursing through a national scholarship scheme and the work of the Commonwealth Chief Nurse and Midwifery Officer.

Addressing Nurse Workforce Shortages

The Department implemented the national Bringing Nurses Back into the Workforce Program to encourage registered nurses, midwives and enrolled nurses who had been out of the Australian nursing workforce for 12 months or more, to return to the nursing profession. Those meeting the eligibility criteria could qualify for cash bonuses of up to $6,000.

While this initiative was expected to engage 1,000 nurses/midwives in the public and private sector in 2008, uptake was lower than anticipated, with only 366 nurses returning to work in 2008. In order to address this challenge, the Department reviewed the program, and subsequently expanded the eligibility criteria. The Department also developed a targeted national promotional campaign that was implemented in May 2009. Through this activity, participation is expected to increase and performance of the program is expected to improve in 2009–10. (Discussion relating to this initiative can also be found in the Outcome 4 Aged Care and Population Ageing chapter).

The Department also encouraged people to pursue a nursing career through the Nurse Practitioner Scholarship Scheme. Administered by the Royal College of Nursing Australia, the scheme had a particular emphasis on increasing the availability of nurse practitioners in rural and remote settings, and in areas of need such as aged care, mental health, women’s and men’s health, and drug and alcohol care. This year, 36 (20 full time equivalent) nurse practitioner scholarships were awarded, providing successful applicants with up to $15,000 over two years, to upgrade their skills.

During 2009–10, the Department will consolidate a number of nursing scholarship and support programs to improve potential applicants’ access. This will see consistency in program design and more efficient delivery arrangements.
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Indigenous Australian Nurses

The Department helped address the under representation of Indigenous people in the nursing profession through the development of targeted recruitment, mentoring and support arrangements. This involved working with the Congress for Aboriginal and Torres Strait Islander Nurses in its role of mentoring, supporting and encouraging Indigenous nursing students working in the field. The Department also collaborated with the states and territories, private sector representative organisations and peak nursing bodies to attract Indigenous nurses. (Discussion relating to other workforce support measures targeting Aboriginal and Torres Strait Islander people can be found in the Outcome 8 Indigenous Health chapter).

National Promotion of Nursing

In 2008–09, the Department helped promote nursing nationally, by supporting the activities of the Commonwealth Chief Nurse and Midwifery Officer. The Government established the Commonwealth Chief Nurse and Midwifery Officer in March 2008, as part of the National Health and Hospitals Reform Plan to improve health and hospital services. The role of the Officer includes: building and strengthening the nursing profession as a career of choice; playing a key role in developing a strategic and collaborative approach to national nursing policy across all jurisdictions; and providing advice on key Government commitments.

During the year, the Department assisted the Commonwealth Chief Nurse and Midwifery Officer to develop policies that underpinned nursing and midwifery initiatives announced in the 2009 Budget by providing support and project/program management services. The Department also supported her in a review of maternity services (discussed in the Outcome 3 Access to Medical Services and Outcome 5 Primary Care chapters).

The Department promoted nursing as a career by funding organisations to advertise scholarship and other nursing support programs through media such as print and digital advertising. This contributed to a fully subscribed nursing scholarship program in 2008–09. In addition, the Department funded nursing expos and key conferences that included representatives from remote areas.

Funding for the above activities was sourced from Program 12.2 – Workforce.

Improved Supply of Health Professionals in Rural, Regional and Outer Suburban Australia

Increasing the number of qualified health professionals in rural areas contributes to improving the provision of quality primary and allied health services in these communities. In 2008–09, the Department worked to achieve this by supporting rural clinical placement scholarships, bonded medical places and the placement of overseas trained doctors. The Department also sought to improve access to medical services by investing in training infrastructure, and supporting the rural specialist obstetrician workforce.
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Allied Health Rural Clinical Placement Scholarships

A major achievement for the Department was the implementation of the new Allied Health Clinical Placement Scholarship Scheme. Developed in response to evidence that allied health students who experience a positive clinical placement in a rural or remote region are more likely to practise in those areas after graduation, the scheme provides funding for travel, accommodation and living expenses. It also funds supervisor and community contact allowances. While implementing the scheme, the Department consulted with Services for Australian Rural and Remote Allied Health, as the scheme administrator, and an advisory group with representatives from health professional groups, State and Territory Governments and academia.

In the scheme’s first round of operation, the Department saw 289 applications made, and offered scholarships to 89 allied health students to undertake a clinical placement in a rural or remote community during their degree. In the second round, 589 applications were received and 66 scholarships were offered. It is likely that more scholarships will be offered through these rounds as details and costs of placements are finalised. These scholarships will continue next year as part of the consolidated Nursing and Allied Health Training and Supply initiative announced in the 2009–10 Budget.

Bonded Medical Places and Medical Rural Bonded Schemes Scholarship

The Department aims to help increase the supply of doctors by funding medical school places in universities through the Bonded Medical Places Scheme. This year, the Department provided funding for 636 places, which brought the total number since the scheme’s inception in 2004 to 2,447.

The Department also administered the Medical Rural Bonded Scholarship Scheme, which provides over $23,000 a year to students who commit to working for six continuous years in a rural or remote area after completing their medical training as a specialist. In 2008–09, the Department supported 96 new students under the scheme. At the end of this year, there were 883 participants. The Department expects that a number of doctors supported by the scheme will commence their return of service obligation in rural and remote areas in 2010–11.

Overseas Trained Doctors

Communities in rural, remote and some outer metropolitan areas have difficulty in accessing Medicare funded services compared with inner metropolitan regions, due to a lack of doctors and specialists. In 2008–09, the Department worked to improve access by supporting the placement of 159 overseas trained general practitioners and 32 specialists in areas recognised as districts of workforce shortage. The Department achieved this by contracting recruitment agencies and meeting the associated recruitment costs for employers and doctors through the International Recruitment Strategy. Of this number, 107 (56 per cent) were placed in Rural, Remote and Metropolitan Area classification 3–7 locations.¹

The Department also provided 4,200 overseas trained general practitioners and specialists with an exemption to Section 19AB of the Health Insurance Act 1973, allowing them to provide services which attract Medicare benefits to over 2,000 communities in 2008–09. This brought the total of overseas trained doctors with a Section 19AB exemption to 5,900.

The Department will continue these initiatives in 2009–10, to ensure communities in districts of workforce shortage can attract and retain medical practitioners. Top of page

Figure 2.3.12.1: Number of Overseas Trained Doctors Recruited and Working under the International Recruitment Strategy

Source: Department of Health and Ageing (with data obtained from Recruiters of Overseas Trained Doctors) [2009].

Enhancing Clinical Training Facilities

Investing in clinical teaching facilities is an important way of developing the future health workforce and promoting high quality training for medical students. In 2008–09, the Department supported improvements to clinical training facilities at the Sunshine Hospital in Melbourne and four project sites at the Flinders Medical Centre in Adelaide. The Department worked with fund-holding organisations to secure long-term access to land for these facilities, which subsequently enabled the commencement of construction work.

In addition, the Department established a project to construct clinical training facilities at the Greenslopes Hospital in Brisbane, where students will have the opportunity to experience work in the private hospital sector. As part of this, the Department negotiated a new training partnership between the University of Queensland and Ramsay Health Care, and ensured that the new facility will support training in Queensland over the long-term.

Obstetrician Care for Rural Women

Through the Specialist Obstetrician Locum Scheme, the Department provides rural specialist obstetricians with locum support, so that they can provide quality maternity services for rural women. This in turn ensures that rural women can access a range of birthing services and receive appropriate care in the antenatal and postnatal periods.

In 2008–09, the Department funded the Royal Australian and New Zealand College of Obstetricians and Gynaecologists to deliver the scheme and to ensure that connections were in place to link locum and rural obstetricians. The brokerage service managed by the college and locum subsidies funded under the program were critical to the delivery of 81 specialist locum placements and 16 general obstetrician placements in locations across all states and the Northern Territory.

Funding for the above activities was sourced from Programs 12.1 – Rural Workforce and 12.2 – Workforce.
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Clinical Training Opportunities

The Department moved to increase the number of medical trainees and improve the quality of training in the medical workforce by collaborating with the states and territories, and the private sector, to develop initiatives that expose medical trainees to an expanded range of settings, and support rural health through undergraduate training.

Medical Training

There is growing recognition of the need for trainees in many medical specialities to undertake training in a range of clinical settings, to augment what they learn in traditional teaching hospitals. This year, the Department implemented the Expanded Specialist Training Program to provide registrars with the opportunity to develop their skills in various expanded settings, such as private hospitals, clinics, day surgeries and Aboriginal medical services. As at 30 June 2009, the Department had supported 193 expanded specialist training positions under this program.

While this was good news, there was difficulty in filling all approved specialist training posts for the 2009 academic year, due to some expanded settings not being able to achieve accreditation in time and other settings not being able to secure registrars. The Department will address this challenge in 2009–10, by developing ways to better match accredited expanded specialist training settings with specialist college training positions.

A major achievement for the Department in 2008–09 was the development of a more sophisticated and coordinated approach to medical specialist training. The Department established a Specialist Training Programs initiative, which consolidates the range of Australian Government-funded specialist training programs into a single program. The single program offers the flexibility lacking in the previous years, and fosters greater stakeholder collaboration in matching accredited training positions with appropriate registrars.

Supporting Rural Health through Training of Health Undergraduates

The Department supported rural undergraduate health training by managing initiatives such as the Rural Clinical School and University Departments of Rural Health programs, and funding the development of rural training for new medical schools at Deakin University (Victoria), Notre Dame University (New South Wales), and the University of Western Sydney (New South Wales).

The Department also expanded the John Flynn Placement Program to provide more opportunities for medical students to work in rural communities, under the guidance of a medical mentor and local host. Students are placed in the same community for a minimum of two full weeks per year, normally over a four year period, which enables them to develop a strong bond with local people, and in turn encourages students to choose a rural career post graduation.

The Department aims to progressively increase the number of placements under the program from 600 in 2008, to 1,200 in 2012. In 2009, the Department funded an additional 150 placements, bringing the total to 750. In addition, the Department appointed an agency to manage the program’s administrative processes, and increase collaboration between professional groups to maximise the number of placement opportunities available to students. The Department will work with the agency in 2009–10, to ensure that the growth in the number of participants is sustainable, particularly in relation to the availability of rural doctor mentors.

Funding for the above activities was sourced from Program 12.1 – Rural Workforce.
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Figure 2.3.12.2: John Flynn Placement Program Expansion 2006 to 2012

Source: Department of Health and Ageing program data.

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National Registration and Accreditation Scheme

On 26 March 2008, the Council of Australian Governments signed an Intergovernmental Agreement to implement a National Registration and Accreditation Scheme for health professions by 1 July 2010. The scheme will initially cover ten health professions: chiropracty, dental (including the profession of a dentist, dental therapist, dental hygienist, dental prosthetist and oral health therapist), medicine, nursing and midwifery, optometry, osteopathy, pharmacy, physiotherapy, podiatry and psychology. On 8 May 2009, the Australian Health Workforce Ministerial Council agreed that from 1 July 2012, an additional three professions would be included in the scheme, namely Aboriginal and Torres Strait Islander health practitioners, Chinese medicine practitioners and medical radiation practitioners.

A major achievement for the Department in 2008–09 was the key role it played in the implementation of the scheme by maintaining collaborative arrangements with the National Registration and Accreditation Implementation Project team, and State and Territory Governments. The Department provided policy advice and options for consideration by government and managed relationships with key stakeholders. This work facilitated agreement on the first piece of legislation for the scheme: the Health Practitioner Regulation (Administrative Arrangements) National Law Act 2008, which received Royal Assent in Queensland in November 2008, and facilitated agreement on key issues for the development of the second stage of legislation for the scheme, the Health Practitioner Regulation National Law 2009. The Australian Health Workforce Ministerial Council released the exposure draft for this second stage of legislation for public consultation. The Department will continue to contribute to the whole-of-government decision-making process in 2009–10, and develop consequential amendments to existing Commonwealth legislation, with the expectation that the National Registration and Accreditation Scheme will be implemented on 1 July 2010.

Funding for the above activities was sourced from Program 12.2 – Workforce.

Key Fact for 2008–09: Contribution to the Council of Australian Governments’ Health Workforce Package

On 29 November 2008, the Council of Australian Governments agreed to invest in a National Partnership Agreement on Hospitals and Health Workforce Reform, to assist training and planning of Australia’s health workforce. In 2008–09, the Department worked closely with the states and territories, and the National Health Workforce Taskforce, to develop a workforce package. The main elements of the package were:

the establishment of a national health workforce agency – Health Workforce Australia (to be established in 2009–10);
a clinical training subsidy for providers of pre-professional registration clinical training;
an increased use of simulated learning environments in clinical training;
expanded supervision capacity for clinical training to meet the demands of an increased number of students;
a national approach to the international recruitment of health professionals; and
a national health workforce statistical resource.

The Department also drafted legislation to establish Health Workforce Australia, which was passed by Parliament in July 2009.

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Performance Information for Outcome 12 Administered Programs

Program 12.1 – Rural Workforce
Indicator:	Increased number of nurses re-entering the nursing workforce.
Reference Point/Target:	Up to 1,000 in 2008–09.
Result: Indicator not met.
The target of 1,000 nurses returning to work under the Bringing Nurses Back into the Workforce Program related to the 2008 calendar year. As at 30 June 2009, only 366 nurses returned to the workforce under this initiative. It is expected that this number will continue to change as nurses who have returned to the workforce in 2008 access the program.
Indicator:	Students from metropolitan, rural and remote backgrounds supported to undertake clinical placements in rural and/or remote communities during their allied health degree.
Reference Point/Target:	Up to 100 scholarships to be awarded by mid-2009.
Note: This performance indicator was amended in the 2008–09 Health and Ageing Portfolio Additional Estimates Statements, to clarify that this initiative is specifically for allied health students.
Result: Indicator exceeded.
A total of 155 scholarships were awarded to allied health students from metropolitan, rural and remote backgrounds.

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Program 12.2 – Workforce
Indicator:	Increased support of training for health professionals in expanded settings across undergraduate, general practice, and other medical specialist disciplines.
Reference Point/Target:	Up to 150 specialist training positions to be funded in expanded settings by April 2009. Up to 3 new rural clinical schools established in 2008–09. An additional 150 John Flynn Placement Program positions filled for the 2009 academic year.
Result: Indicator exceeded.
The Department funded 193 specialist training positions in expanded settings during the first half of the 2009 academic year. This compares with 98 funded positions in 2007–08. In 2008–09, the Department negotiated the establishment of three new rural clinical schools at Deakin University (Victoria), the University of Notre Dame Australia (New South Wales) and the University of Western Sydney (New South Wales). From 2009–10, these universities will receive full funding to deliver rural training at sites including Bathurst, Lismore, and Wagga Wagga in New South Wales; and Ballarat, Warnambool and smaller locations throughout south-west Victoria. An additional 150 John Flynn Placement Program positions were filled in the 2009 academic year, increasing the total number of new places offered to 300 for the year.
Indicator:	Increased number of suitably qualified overseas trained doctors in outer metropolitan, rural and remote districts of workforce shortage.
Reference Point/Target:	Approximately 5,000 placements located in areas of workforce shortage by mid 2009.
Result: Indicator met.
In 2008–09, 3,906 overseas trained doctors were placed in districts of workforce shortage. This result exceeded the target by 18%, and compares with 3,207 in 2007–08.
Indicator:	Increased support for rural obstetricians and general practice proceduralist placements.
Reference Point/Target:	At least 80 obstetrician and general practice proceduralist placements will be supported in rural areas.
Result: Indicator exceeded.
A total 97 placements in rural areas were supported through the Specialist Obstetrician Locum Scheme in 2008–09 (exceeding the target by 21.3%). This number included 81 specialist locum placements and 16 general obstetrician placements, and compares with a total of 74 in 2007–08.

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Performance Information for Outcome 12 Departmental Outputs

Output Group 1 – Policy Advice
Indicator:	Quality, relevant and timely advice for Australian Government decision-making measured by ministerial satisfaction.
Reference Point/Target:	Ministerial satisfaction.
Result: Indicator met.
Ministers were satisfied with the quality, relevance and timeliness of advice provided for Australian Government decision-making.
Indicator:	Production of relevant and timely evidence-based policy research.
Reference Point/Target:	Relevant evidence-based policy research produced in a timely manner.
Result: Indicator met.
In 2008–09, the Department undertook research in a range of health workforce areas. For example, the Department engaged an organisation to conduct an evaluation of the Rural Clinical Schools and University Departments of Rural Health programs. The evaluation found that both programs were achieving their objectives and all centres satisfied their funding parameters. The evaluation was conducted in a timely manner, and all findings were evidence-based.

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Output Group 2 – Program Management
Indicator:	Administered budget predictions are met and actual expenses vary less than 0.5% from budgeted expenses measured by comparison of actual expenses against budget.
Reference Point/Target:	0.5% variance from budgeted expenses.
Result: Indicator not met.
The actual Administered expenses for Outcome 12 were 4.2% less than budgeted expenses. Funds were underspent due to actual expenditure being less than estimated for Programs 12.1 – Rural Workforce (0.9%) and 12.2 – Workforce (9.2%).
Indicator:	Stakeholders participate in program development through a range of avenues such as surveys, conferences and meetings, consultation mechanisms and submissions on departmental discussion papers.
Reference Point/Target:	Stakeholders participated in program development.
Result: Indicator met.
In 2008–09, the Department worked with stakeholders to develop health workforce related programs through extensive consultations and site visits carried out during the evaluation of the Rural Clinical Schools and University Departments of Rural Health programs. The Department collaborated with a wide variety of stakeholders, including the Consumers Health Forum of Australia to facilitate consumer engagement and input into the implementation of the National Registration and Accreditation Scheme. In addition, the Department worked with State and Territory Governments and private sector stakeholders in the implementation of the Bringing Nurses Back into the Workforce Program; and sought their input to the program’s interim review, which led to the expansion of eligibility criteria in December 2008.

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Outcome 12 – Financial Resources Summary

	(A) Budget Estimate 2008–09 $’000	(B) Actual 2008–09 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2009–10 $’000
Program 12.1: Rural Workforce
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	118,127	120,718	2,591	161,945
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	9,314	9,374	(60)	11,170
Revenues from other sources	166	240	74	175
Subtotal for Program 12.1	127,607	130,332	2,725	173,290
Program 12.2: Workforce
Administered Items
Annual Appropriation Bill 1 (Ordinary Annual Services)	74,234	63,585	(10,649)	249,849
Annual Appropriation Bill 2 (Other Services)	1,735	1,736	1	-
Departmental Outputs
Annual Appropriation Bill 1 (Ordinary Annual Services)	9,533	9,594	(61)	11,433
Revenues from other sources	170	246	76	179
Subtotal for Program 12.2	85,672	75,161	(10,511)	261,461
Total Resources for Outcome 12	213,279	205,493	(7,786)	434,751
Outcome 12 Resources by Departmental Output Group
Department of Health and Ageing
Output Group 1: Policy Advice	11,643	11,808	(165)	13,727
Output Group 2: Program Management	7,540	7,647	107	9,230
Total Departmental Resources	19,183	19,455	(272)	22,957
Average Staffing Level (Number)	142	141	(1)	165

1. Rural, Remote and Metropolitan Areas classifications: 3 – large rural centres; 4 – small rural centres; 5 other rural areas; 6 – remote centres; and 7– other remote centres.

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