Review of Australian Government Health Workforce Programs

9.4 Stakeholder support

Page last updated: 24 May 2013

Health education and training organisations, along with health profession representative bodies, are the Commonwealth’s key stakeholders in developing a highly qualified and appropriately skilled workforce to meet the health needs of all Australians. Each year, the Commonwealth provides funding to a number of these bodies to support their constituent members in providing the Commonwealth with advice to inform policy development and program design and implementation.

To this end, the Commonwealth provides funding to support these representative bodies to canvass their members’ views and build cross-profession commitment through a variety of activities including conferences, forums, committee meetings, secretariat and professional training.

Summarised below, these arrangements provide a mechanism for the Commonwealth to gain valuable insight into current and emerging health workforce issues which impact on health care service delivery to Australian communities. The summaries are based on information gathered by the review team during the analysis of specific programs.

Box 9.3: Summary of funded activities

National Prevocational Education and Training Forum

Amount: $241,417 ($60,000 pa) over 2012-13 to 2015-16

Fund holder: State and territory prevocational training councils

Fund: Health Workforce Fund

Activities: National Prevocational Education and Training Forum – annual meeting to discuss junior doctor education and training. Includes attendance of 16 junior doctors from rural areas.

This is a high profile event attracting international speakers and delegates from the fields of medical education and accreditation as well as workforce planners.

The forum provides the Commonwealth with valuable insight into new and innovative medical training models which can be used to inform the development of medical workforce policy and programs. The forum also provides opportunity for the Commonwealth to canvass views and reinforce the importance of National Health Reform.

Whilst there has been no formal evaluation of the benefits of this funding to the Commonwealth, a report is prepared describing key issues, outcomes, details of presentations and workshops, along with the results of a participant survey.

The Medical Training Review Panel (MTRP)

Amount: $1,080,000 ($270,000 pa) from 2012-13 to 2015-16

Fund Holder: Department of Health and Ageing

Fund: Health Workforce Fund

Activities: Two MTRP meetings each year, production of an Annual Report (as required by the Health Insurance Act 1973).

Under section 3GC of the Health Insurance Act 1973, the MTRP is required to examine the demand for and supply of medical training opportunities and to monitor the effect of the Medicare provider number arrangements. These arrangements generally require medical practitioners to complete a recognised postgraduate training program, in either general practice or another specialty, before they are eligible to provide services that attract Medicare benefits.

The MTRP comprises representatives of 35 organisations, including the Commonwealth and jurisdictions, medical education providers and medical professional associations, as well as medical student bodies. Commonwealth funding enables the MTRP to meet twice a year face-to-face.

The MTRP Annual Report provides information on university, junior doctor and medical specialist training positions, students and trainees, examinations and graduates. Information is also included on medical practitioners who have trained overseas either seeking to work in Australia or currently located in the country. This report has become a key tool in the monitoring and future planning of medical education and training and is highly regarded by governments, health care service providers and the medical education sector.

The MTRP was reviewed in 2010. The key findings were that the MTRP continue on the basis that it provides a valuable contribution to health workforce planning for the Commonwealth, jurisdictions and health care service providers as well as the education sector. It was recommended that the MTRP should be formally aligned with HWA.202 This has occurred, with HWA assuming responsibility for production of the MTRP Annual Report, in consultation with the Department.

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Medical Deans of Australia and New Zealand (MDANZ) Standing Committee Meeting and Medical Education Conference (MedEd)

Amount: $27,900 pa for standing committee meetings
$10,000 every two years for the MedEd conference

Fund holder: Medical Deans of Australia and New Zealand

Fund: Health Workforce Fund

Activities: Standing committee meetings and the MedEd conference

MDANZ comprises the 20 Australian and New Zealand university medical schools. The objective of this funding support is to enhance the Department’s stakeholder relationship and provide a platform for MDANZ to inform thinking on current and emerging medical workforce education issues, including implications for National Health Reform.

Whilst there has been no formal evaluation of the impact of this funding, MDANZ provides a summary of proceedings and conference outcomes and recommendations, along with feedback from attendees.

Participant feedback indicates that the conference is important in bringing together key stakeholders and contributors to medical education and training to review and establish strategic objectives, and provide an opportunity to consider practical initiatives to address medical education and medical workforce issues.

Confederation of Postgraduate Medical Education Councils (CPMEC)

Amount: $1,138,762 from 2011-12 to 2013-14

Fund holder: Confederation of Postgraduate Medical Education Councils

Fund: Health Workforce Fund

Activities: CPMEC core operations – advice to the Commonwealth, attending conferences etc, review and dissemination of the Australian Curriculum Framework for Junior Doctors, development of national intern standards, assessment of junior doctor training positions.

CPMEC is the peak body for state and territory postgraduate medical education councils and works closely with MDANZ, medical specialist colleges and the Australian Medical Council, as well as private and public health care providers. The funding provided to CPMEC supports the Commonwealth’s aim of increasing health workforce capacity and improving the quality of medical education and training through national consistency and innovation in training junior doctors.

Whilst there has been no formal evaluation or review of funding to CPMEC, regular reports are provided on the progress of funded activities. Regular liaison with CPMEC has facilitated the development of Commonwealth medical education policy and programs.

Coalition of National Nursing Organisations (CoNNO)

Amount: $49,995 from July 2012 to June 2013

Fund holder: Australian Nursing Federation

Fund: Health Workforce Fund

Activities: Meeting organisation, secretariat, travel to meetings for member organisations.

CoNNO has over 50 national nursing organisations as members. The role of CoNNO is to advance the nursing profession through key activity areas such as: being a forum for discussion and consultation on professional matters; facilitating communication between members and other stakeholders; and influencing and contributing to public discussion on health policy.

The Australian Nursing Federation is a union for registered and, enrolled nurses, midwives, and assistants in nursing doing nursing work in every state and territory throughout Australia. The ANF Federal Officealso represents Australian nursing internationally through links with other national and international nursing organisations, professional associations and the International Labour Organisations.

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National Rural Health Students’ Network (NRHSN)

Amount: $3,291,464 from 2010-11 to 2012-13
$260,000 in 2011-12 for the National Undergraduate Rural Health Conference

Fund holder: Rural Health Workforce Australia

Fund: Health System Capacity Development Fund
Health Workforce Fund (conference only)

Activities: Support for Rural Health Clubs, conference attendance, “uncommitted pool of extra funding for club activities”, rural high school visits, alumni database.

The NRHSN is the peak body representing 29 Rural Health Clubs at universities across the country, and their 9,000 health student members. NRHSN is supported in their activities by RHWA, with students voluntarily organising and participating in programs such as the rural high school visits, as well as providing advice to the Commonwealth on policies and programs from the perspective of health students.

The NRHSN has strong links to programs under the Rural Health Multidisciplinary Training (RHMT) program, which includes the Rural Clinical Training and Support (RCTS), University Departments of Rural Health (UDRH), Dental Training Expanding Rural Placements (DTERP), and the John Flynn Placement Program (JFPP) initiatives. A requirement of the Rural Australia Medical Undergraduate Scholarship (RAMUS) scheme is that recipients must hold Rural Health Club membership. The NRHSN promotes rural health careers through the Rural High School Visits and Indigenous Festivals, conference attendance and promotional items.

The 2005 evaluation of the National Rural Health Network (now the NRHSN) by Urbis Keys Young and the 2008 Rural Health Audit indicated the value of this funding support in promoting and supporting rural education and training.203 204

However, the review has identified a minor issue involving potential duplication with Commonwealth funding provided to GP Student Networks through General Practice Registrars Australia (GPRA) and funding support to rural health clubs through the NRHSN. There may be some potential to rationalise and streamline funding arrangements so that it is delivered by one agency, thereby reducing duplication and administration costs.

Australian Medical Council (AMC)

Amount: $764,000 from Nov 2012 to June 2013

Fund holder: Australian Medical Council

Fund: Health Workforce Fund

Activities: The Department provides funding for the development and dissemination of a workplace based assessment (WBA) DVD training resource; national WBA workshop; implementation of an electronic records management system; secretariat support for the Forum of Health Professions Councils.

The AMC’s purpose is to ensure that standards of education, training and assessment of the medical profession promote and protect the health of the Australian community. The AMC is the nationally recognised medical accreditation body which forms part of the National Registration and Accreditation Scheme (NRAS) for health practitioners. It develops and implements accreditation standards as well as policies and procedures for undergraduate university medical courses, junior doctors and medical specialist training. The AMC also assesses the knowledge, skills and professional attributes of overseas medical practitioners seeking registration in Australia. It is in respect of this OTD function that the Commonwealth funding described here is provided.

The House of Representatives Standing Committee on Health and Ageing’s Lost in the Labyrinth report noted that the AMC’s WBA pathway provides an effective method of clinical assessment of overseas trained doctors (OTDs) and recommended increasing access to WBAs for OTDs.205 The Commonwealth is providing funding support to the AMC for this purpose. Together, the funded projects will facilitate expansion of the WBA pathway to enable more OTDs to undertake clinical assessment in a timely fashion, thereby building the capacity of the medical workforce to provide health care to all Australians.

The Forum of Health Professions Councils, convened by the AMC, allows for the exchange of information and expertise across the health professions which are a part of NRAS. The Commonwealth is funding the AMC to provide secretariat support to the Forum in developing a quality framework to underpin accreditation arrangements across the NRAS.

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General Practice Registrars Australia (GPRA)

Amount: $875,000 from Jul 2011 to Dec 2013

Fund holder: General Practice Registrars Australia

Fund: Health Workforce Fund

Activities: Administration and governance, including annual conference and online professional resources for GP registrars.

GPRA is the industrial body representing GP registrars (i.e. trainee general practitioners) and also provides professional support, promotes general practice as a career, and represents the interests of GP registrars with Government and other professional medical groups. GPRA works closely with GPET, the RACGP and ACRRM.

GPRA forms an important link between the Commonwealth and trainee general practitioners through meetings and regular reports. For example, GPRA was a key participant in the development of the GP Registrars Rural Incentive Payments Scheme, which has since been combined with GPRIP.

An evaluation of Commonwealth funding to GPRA will be undertaken in 2013. Given the mix of training, industrial and student support functions conducted by GPRA (much of which is funded through other sources), it would be timely for this review of the organisation’s funding and activities to determine whether other agencies could play a greater role in delivering some of the organisation’s functions, particularly in terms of possible overlaps in educational support provided by professional training organisations.

CRANAplus

Amount: $12.5 million over 2010-11 to 2012-13
$219,333 for 2012-13 for National Standards and Credentialing program

Fund holder: CRANAplus

Fund: Health Workforce Fund and Health System Capacity Development Fund (HSCDF)

Activities: Secretariat support (HSCDF); Centre for Remote Health Academic Program (HSCDF); First Line Emergency Care (FLEC) (HWF); Bush Support Service (HSCDF and HWF), National Standards and Credentialing program (HWF).

CRANAplus’ role is to educate, support and advocate for health professionals working in remote areas of Australia. Membership is open to all health professionals who work in remote areas, have a desire to do so or have a keen interest in the sector. CRANAplus aims to ensure that those who choose to work in remote areas are as prepared as they can be for the challenges they will face.

With this in mind, CRANAplus is funded by the Commonwealth to deliver a range of programs supporting all health professionals and their families in remote areas of Australia. The aim is to improve the recruitment and retention of appropriately qualified and highly skilled health practitioners in remote communities.

The quality and development of FLEC courses delivered by CRANAplus is overseen by Flinders University, which also seeks to develop greater health research capacity in remote health issues. The FLEC courses provide health professionals with additional skills specific to remote communities where other health services may not be immediately available. The Bush Support Service is a telephone counselling and workshop facility assisting health practitioners and their families who are involved in rebuilding communities following a national and/or international crisis.

There is strong stakeholder support for CRANAplus and an external evaluation of the FLEC courses found they have high participation rates and are well regarded, relevant and highly effective in upskilling the remote health workforce.206 207 However, despite a requirement in the current funding agreement to seek alternate funding sources for the FLEC programs, CRANAplus has indicated that continued Commonwealth funding is their preferred model.

CRANAplus has expressed concerns about the different timing of funding payments and reporting for the HWF and HSCDF. This may represent an opportunity to rationalise the siloed approach to funding within DoHA (as discussed in the grants management reform section above).

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Services for Australian Rural and Remote Allied Health (SARRAH)

Amount: $1,062,611 over 2010-11 to 2012-13
$225,500 for 2012-13 (additional communication activities)

Fund holder: Services for Australian Rural and Remote Allied Health

Fund: Health System Capacity Development Fund and Health Workforce Fund (2012-13 communication activities only)

Activities: 2010-11 to 2012-13 – secretariat.
2012-13 – employment of a communications officer, engagement with Medicare Locals and HWA, SARRAH Board meeting, corporate governance training for allied health practitioners.

SARRAH advocates for, develops and provides services to allied health professionals in rural and remote areas. SARRAH assists in providing the Commonwealth with advice on workforce policies and programs, promotes rural and remote career choices and pathways and supports allied health students and practitioners outside of metropolitan areas. SARRAH administers the allied health component of the Nursing and Allied Health Scholarship and Support Scheme (NAHSSS), funded through the HWF (Refer to Chapter 3).

In consultations undertaken as part of this review, SARRAH voiced concerns about the amount of Commonwealth funding for their core business and secretariat functions. SARRAH believe that they receive less funding than other rural stakeholders and that the level is insufficient to adequately support the rural and remote allied health workforce. SARRAH states this issue is amplified by the requirement to participate in National Health Reform initiatives such as Medicare Locals and HWA. SARRAH advises that it is running at a financial deficit and requires additional funding to continue current activities.

It is difficult to test the merit of these arguments without further analysis of SARRAH’s detailed financial position, which is outside the scope of this review. Given the historical nature of many of the funding allocations to organisations like SARRAH, the only way to test these funding arguments may be to move towards competitive processes.

SARRAH’s outcomes and impact on the rural health workforce have not been evaluated. It is recommended that consideration be given to opportunities for savings through collaboration with other organisations, including delivery of scholarship programs by other agencies, and evaluation based on independently-gathered and assessed quantitative data rather than anecdotal material.

Aboriginal and Torres Strait Islander Health Workforce Training Package

Amount: $50.9 million from 2012-13 to 2015-16

Fund holder: Various – see Chapter 5

Fund: Health Workforce Fund

Activities: Functional and organisational activities of Indigenous Australian workforce and training organisations and networks under the Training Package. The table below outlines funded activities.

Building Aboriginal and Torres Strait Islander health workforce capacity is a key requirement to achieving Closing the Gap. The Training Package supports Aboriginal and Torres Strait Islander health professional bodies to support Indigenous Australian health practitioners, promote health as a career option to Aboriginal and Torres Strait Islander students, and seek to improve awareness and understanding of Indigenous health issues across the non-Indigenous health workforce.

The Aboriginal and Torres Strait Islander health workforce and the Training Package are further discussed in detail in Chapter 5 of this report.

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Departmental funding overlaps

The HWF is a Commonwealth initiative administered by the Department and designed to support activities that will improve the capacity, quality and mix of the health workforce to meet the requirements of health services including through training, registration, accreditation and distribution strategies.

There is a continued commitment within the HWF to key priorities such as programs that increase training opportunities, assist retention and provide support to health practitioners. The stakeholder activities described earlier fall within the HWF’s key priorities, noting the emphasis on providing support to health practitioners and the development of the Aboriginal and Torres Strait Islander health workforce.

The flexibility of the HWF allows funding priorities to reflect current and emerging health workforce priorities. Funding allocations are made on an annual basis with funded organisations having an expectation of this continuing at the same or increased levels.

The HWF is not the only source of funding for professional organisations’ operating costs. As noted earlier in this chapter, the Health System Capacity Development Fund (HSCDF), managed by the Department’s Population Health Division, also supports specific projects which provide support to and represent constituent workforces, in particular those in rural and remote areas.

An example of a crossover in stakeholder funding support within the Department is that provided for delivery of rural and remote health system capacity development through the HSCDF. The HSCDF supports health consumers, students and community organisations (including those in regional and remote areas) to undertake policy development and deliver safe, high quality health care systems and services. The result is that some organisations are funded through both the HSCDF and the HWF for similar activities. There is potential to streamline the funding support to health workforce bodies funded through the HWF and HSCDF. This would decrease the administrative burden in applying for funding under separate funds and would also decrease the departmental resources required to manage the agreements.

Recommendations
Recommendation numberRecommendationAffected programsTimeframe
Recommendation 9.7To standardise funding arrangements for stakeholder support, the Department should consider future competitive targeted funding rounds. Stakeholder support should focus on the identified priorities for the Health Workforce Fund (HWF) and be based on current and emerging health workforce issues.Organisations including (but not limited to) CoNNO, CPMC, MDANZ , AMC, SARRAH, NRHSN and CRANAplus.Medium term – aligned with the expiry dates of current funding agreements.
Recommendation 9.8To reduce the burden of multiple application processes and reduce payment timing difficulties and reporting requirements, the Commonwealth should consider co-locating all funding for a similar purpose within one flexible fund – either the HWF or the Health System Capacity Development Fund. As aboveMedium term – aligned with flexible fund management and the timing of scheduled application processes.

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The Commonwealth has invested in stakeholder support funding over many years. These arrangements vary significantly between stakeholder organisations but most, if not all, follow a historical funding pattern. This has led to significant inconsistencies in the activities funded, including the amount provided for administration, secretariat and other “core business” activities.

The complexities include multiple applications to different Flexible Funds, and variations in funding periods along with reporting and payment timing. The resulting uncertainty for stakeholders and occasional failure to communicate effectively within the Department means a reduction in effective resource utilisation for both sides and less than optimal advice to the Commonwealth on health workforce policy and program matters – the prime purpose for which this funding is provided.

This review has highlighted the reliance of some organisations on Commonwealth funding and their reluctance to explore opportunities to build financial viability. However, this too is variable with some of the larger organisations having diversified their funding base and forged a role for themselves that spans the divide to self-sustainability.

There is no doubt that the advice provided to the Commonwealth by stakeholder organisations is critical to the development of sound health workforce policy and that the successful implementation of some initiatives would be in doubt without their support. However, the current funding arrangements should be revised to optimise the opportunities for all parties.

202 ARTD Consultants, Report on the 2010 Review of the Medicare Provider Number Legislation, Commonwealth of Australia, 2010.

203 Urbis Keys Young, National Rural Health Network Evaluation, 2005

204 Department of Health and Ageing, Audit of Health Workforce in Rural and Regional Australia, 2008

205 House of Representatives Standing Committee on Health and Ageing, Lost in the Labyrinth: Report on the inquiry into registration processes and support for overseas trained doctors, Commonwealth of Australia, 2012

206 R. Dunn, Evaluation of CRANAplus Remote Emergency Care Program, CRANAplus, 2012 (unpublished)

207 R. Dunn, Evaluation of CRANAplus Maternity Emergency Care Program, CRANAplus, 2012 (unpublished)