Policy Area 1: RURAL ALLIED HEALTH POLICY, LEADERSHIP AND QUALITY AND SAFETY
1.1 Appointment of a Commonwealth Chief Allied Health Officer
SARRAH strongly supports the appointment of a Commonwealth Chief Allied Health Officer (CAHO), and considers that a key result area for the position is to improve rural allied health distribution, access and quality.
1.2 Rural Allied Health College
SARRAH supports the establishment of a rural college of allied health as an innovation with great potential to strengthen the rural allied health workforce. Further consultations within the sector are required to gain a shared understanding of the potential benefits of a college. For example, a college would need to draw a clear distinction between its focus on allied health rural generalism, as opposed to other areas of clinical interest in the allied health sector, to avoid perceptions of duplication of purpose by existing professional associations.
Policy Area 2: OPPORTUNITIES FOR RURAL ORIGIN AND INDIGENOUS STUDENTS
2.1 Introduction of Rural Origin Selection Quotas
There is limited evidence to support the efficacy of quotas for students of rural origin. SARRAH advocates for a range of options to be considered, including support for universities to deliver allied health programs by flexible delivery options (eg a combination of online modules and blocks of face-to-face study) to enable program delivery close to home, and scholarship programs linked to reducing HECS debts for graduates electing to work in rural areas.
2.2 Opportunities for rural origin Aboriginal and Torres Strait Islander people
SARRAH advocates for building the status and viability of the ATSIHP workforce to deliver a range of clinical services. Aboriginal Health Workers (AHWs) and ATSIHPs could constitute critical career entry points for younger Aboriginal people to gain access to a career in the health sector. In addition, a combination of locally available study options with appropriately supported entry pathways, combined with local placements and part-time work in the relevant industry (possibly as an AHA or similar) will facilitate growth in the ATSIHP workforce.
Policy Area 3: STRUCTURED RURAL TRAINING AND CAREER PATHWAYS (MMM2 – 7)
3.1 Increasing Opportunities for Home Grown Training (End to end and Immersion Training Opportunities)
SARRAH provided the following suggestions:
· Targeted funding to UDRHs to provide training beyond student placement programs.
· Support to develop an articulation pathway for allied health assistants to progress to a science degree and entry-level masters to an allied health program. For this to be effective there is a need to resolve industry role recognition for workers holding a Diploma in Allied Health Assistance or a Bachelor Rehabilitation Science. The Commonwealth could consider incentivising employers to develop care coordination roles in primary care, aged care, disability sectors that utilise these qualifications.
· Remuneration for clinical education that takes place in the private sector.
· Fast-track activity-based funding of teaching and training in public hospital settings recognising allied health contribution.
· Invest in greater support for new graduate rural training places and quality supervision in the workplace. Work closely with the education sector to achieve a good outcome.
· Review the findings of the UDRH/RHMT evaluation being undertaken in 2019/2020.
Feedback received by SARRAH in relation to the Rural Health Multidisciplinary Training (RHMT) Program has been generally positive. The RHMT has provided nearly four years of new financial support to rural and remote nursing and allied health student placement capacity building. The University Departments of Rural Health (UDRHs) have facilitated an increased number of allied health student training placements and is building supervision capacity in the rural and remote allied health workforce. The allied health academic and professional staff networks that this funding stream has facilitated will further strengthen the capacity of the workforce in the communities in which the UDRH’s operate.
3.2 Career pathways in rural allied health (MMM4 – 7)
SARRAH supports the expansion of the established Allied Health Rural Generalist Pathway (AHRGP) as one strategy to improve recruitment and retention of allied health professionals in rural and remote locations and raises the following points:
· There are currently 62 AHRGP trainees spread across five jurisdictions.
· Consultations regarding the AHRGP have occurred with multiple groups including the membership of the Australian Allied Health Leadership Forum (AAHLF).
· Evidence from Queensland on the 2014-2018 training cohorts indicates that the employment destination of the trainees at 6 months after separation from the temporary training roles used in the trial is 71% in Queensland Health regional, rural and remote services.
· The model’s applicability in other sectors such as primary health care, disability and aged care, will be explored by SARRAH in collaboration with the Project Governance Group over the next two years .
Policy Area 4: SUSTAINABLE JOBS AND VIABLE RURAL MARKETS
4.1 Integrated Allied Health Hubs
SARRAH supports the concept of Integrated Allied Health Hubs serving regional catchment areas as a means to facilitate consortium arrangements for effective pooling of funding and capacity-building. Factors to consider:
· The interface between sectors – streamline funding and governance frameworks of health, aged care, disability, primary health care, private income streams to create seamless transition of clients who may be eligible to access services under multiple funding streams.
· Need transparent management of service priorities so that the right clients are prioritised.
· Ensure allied health leadership is embedded within the operational structure of an IAHH to enable appropriate workforce design and development, relationship building and data collection.
· Co-design with local services so as not to “squeeze out” existing private sector clinics.
· Flexible procurement arrangements would assist consortia to negotiate effective agreements that allow pooling of funds to occur.
· Attractive recruitment packages for prospective hub employees, including relocation assistance, competitive salaries, guaranteed professional support and training allowances.
· Infrastructure to support data collection and the framework and data sets to evaluate these hubs is essential.
4.2 Viable Rural Markets
SARRAH supports the concept of appropriate remuneration for the complexity of work in rural and remote locations. All three options listed at point 3 on page 39 should be considered, with special attention given to unintended consequences arising from funders’ definitions of complexity.
a. rural loading on fees for allied health services (e.g. on Medicare payments).
b. a bulk billing incentive.
c. a GPRIP-like incentive.
Access to existing services can be improved immediately by:
· Removing cap for MBS items accessed under Better Access, CDM and Medicare Follow-up.
· Incentive payments to existing practices in the form of loading and/or incentive programs similar to those available to GPs.
· Allowing flexibility to enable NDIS clients who are not self-managed to utilise local service providers who may not be registered with NDIS.
Policy Area 5: TELEHEALTH ALLIED HEALTH SERVICES
SARRAH strongly supports Commonwealth initiatives that enable rural allied health professionals to delivery services by a range of modalities including telehealth. We also agree that telehealth is an important adjunct to allied health service delivery, but does not wholly replace face-to-face consultations with clients. Factors to consider:
· ensure local providers delivering services by mixed modalities are prioritised for rural and remote communities over business models offering telehealth-only services.
· Private health insurers should provide rebates for allied health services delivered via telehealth as a standard model of service delivery, noting the limited benefits to PHI for people living in rural and remote Australia.