Author: Professor Gregory Kolt

Professor Kolt is an executive member of the Australian Council of Deans of Health Sciences (ACDHS), and is the Dean of the School of Health Sciences at Western Sydney University. The ACDHS is a peak national body representing Australian universities providing undergraduate study in clinical allied health sciences.

Demand for healthcare professionals post-COVID is increasing rapidly, driven by an ageing population, increased needs in disability and community care, mental health challenges, and higher levels of chronic disease.

This follows international trends with the World Health Organization predicting a worldwide workforce shortfall by 2030 of around 18 million healthcare workers. In Australia, healthcare and social assistance will be a key driver of employment over the next five years.

Nowhere is this more apparent than in the field of allied health. These professions represent around 25 per cent of the healthcare workforce and include diverse clinical services like occupational therapy, physiotherapy, dietetics, speech therapy, psychology and podiatry.

Standing alongside medical practitioners, nurses, and dentists, they provide critical care in the community that results in positive health outcomes.

Building a strong pipeline of qualified allied health professionals who can hit the ground running in emerging areas of need will be a priority. That means increasing the number and diversity of student clinical training placements both inside and outside of public hospitals.

This kind of workforce planning now requires a much broader approach and can present a challenge for providers, clinical supervisors, and universities.

Yet there are very clear areas where allied health provision is so desperately needed right now and we must upskill for this need.

For example, the Royal Commission inquiry into Aged Care Quality and Safety heard that most aged care residents in Australia do not receive the kind of access to allied health services that would enable better quality of life.

In fact, a University of Wollongong research paper presented to the Royal Commission in 2020 found that only 2 per cent of Australian residents in aged care facilities currently receive the internationally benchmarked allied healthcare recommendation.

Unfortunately, failings like these rarely hit the headlines. The discussion is focused around securing better access to doctors and nurses, and less around how we can enhance wellness and encourage rehabilitation and better independence in the community setting -- and prevent costly hospital admissions.

Allied health needs more student training placements

This kind of continued ‘invisibility’ of the value of allied health professions in healthcare debates has ramifications for future workforce capacity.

As more students choose to study allied health -- with a 22.7 per cent increase recorded between 2013 and 2018 -- universities are left with the task of trying to rapidly increase clinical training placements with partners across more than 20 allied health specialities to cater for increased demand and the need for relevant experience in emerging areas in community settings. We must find a way to unlock greater clinical placement capacity.

The answer increasingly lies in moving beyond traditional hospital-based placements and incentivising private healthcare providers in urban and regional areas to play a bigger role in the clinical training of allied health students.

Training placements in private aged care facilities and disability care have been limited to date, but this may present an opportunity for change.

COVID-19 adding to the problem

Another major problem is that COVID-19 has made the situation worse.

Due to the restrictions of 2020, many allied health students are still struggling to complete their clinical training requirements, leaving universities struggling to fill the backlog.

The Australian Council of Deans of Health Sciences (ACDHS) conducted a survey in May 2020 which found an average of 49 per cent of students had experienced disruptions to placements due to the pandemic with oral health, audiology, paramedicine, exercise physiology, and medical radiology some of the worst affected.

Universities are stretched to capacity, working to cover the clinical experience needed for those finishing their studies while also trying to ramp up new clinical training placements for the increasing number of students entering allied health programs.

The health and education sectors have been calling for an allied health workforce strategy to be undertaken by the Commonwealth to determine demand and supply needs. The shortage in allied health data is long-standing and has been highlighted in the past.

This includes in major national policy development and review processes, national monitoring reports, implementation and status reports on major initiatives (e.g. the NDIS) and in the current Aged Care Royal Commission.

We need to look at compiling important data sooner rather than later given the urgent health needs now faced by our community in the wake of the pandemic, and the identified needs in the aged and disability sectors.

Incentives will be needed

Driving sector partnerships and encouraging additional clinical training placements without additional funding or placement incentives is also a barrier.

Subsidies for allied health training similar to ‘Practice Incentive Payments’ offered to GPs who help to train medical students could encourage more private providers to participate in the placement programs.

There have been other suggestions too. A recent pre-Budget report by Universities Australia in 2021 argued for more government assistance in the form of emergency short-term funding to help universities develop a new framework for clinical placement procurement (including in allied health) and to foster stronger industry collaborations, as well as incentivising more private healthcare providers to work with tertiary education institutions.

Value of student placements

Convincing new partners of the value of student placements is not always easy. Some potential partners still view students as an impost, largely due to fee-for-service environments, lack of suitable supervisors, and new COVID-19 regulations.

Rather than being a burden, a long-term study from the Faculty of Medicine and Health Sciences at Stellenbosch University in South Africa demonstrated that clinical training placements actively benefit health services.

The study showed students can help address workflow gaps, improve quality of patient care, and create a better learning culture by helping clinicians to stay informed of the latest evidence-based approaches to healthcare delivery. They also improve client perceptions of services.

Wider placement programs could also extend to graduates being more willing to accept job placements in areas of unmet need, including in rural and regional areas where allied health professionals are in short supply.

Filling this skills shortage would be an effective cost-saving strategy too, given studies show preventable hospitalisation rates in very remote areas in 2018-2019 were 2.5 times as high as major cities (AIHW, Rural and Remote Health, 2019).

New collaborations with health

Successful health industry/university training programs have already been established by several ACDHS members around Australia.

For example, the University of South Australia is currently delivering a student-led $780,000 pilot program to improve the health of people in disadvantaged suburbs, run in conjunction with supervisors at local health facilities and councils.

Other universities have found new ways to provide more on-the-job experience in areas of clinical need. The University of Queensland recently opened a new Rural Health Clinical Training Facility 700km from Brisbane with students able to work with the local community and allied health providers.

As the important role of allied health is better understood and we move toward an interdisciplinary model of care, building new partnerships with public and private providers should become easier.

Aside from future workforce benefits, additional student clinical training placements in a range of allied health settings will help to establish a stronger innovation culture and will allow more transference of cutting-edge research. This will be to the benefit of the entire healthcare sector.

However, we can only achieve these goals with continued and expanded support from, and collaboration with, partners beyond the university walls.