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Shaping the future of health

Tim Barnwell, APAM
WA Branch Councillor
1 August 2016


There have been profound changes to the funding of health in WA over the last few years—and this is set to continue. Right now, there’s a system-wide imperative to reduce the cost of health, given it’s clear the system cannot be sustained at its current cost and the rate at which these costs are growing.

Health funding remains a hot political issue between the federal and state governments, and it seems neither wants to hold sole responsibility for one of the largest budgetary expenses. The impact on the WA public health sector is seen in the form of wide-ranging cuts that focus on the biggest single cost in health: wages.

Health wages are expensive because the system requires highly trained staff to deliver clinical services. Training takes time: 12 years for a surgical consultant or seven postgraduate years for an advanced scope physiotherapist. The public system has traditionally been a training ground for clinical specialties including neurorehabilitation, cardiorespiratory, burns, women’s health, spinal rehabilitation and paediatrics—and that’s just to mention a few.

Experienced physiotherapists in these areas add significant value to patient outcomes and, at a service level, may be essential for service accreditation (in the case of intensive care units) or may directly manage complex recovery (eg, burns, spinal and neurological rehabilitation). While the time taken to train these physiotherapists is significant, the service they provide is vital.


While there have been ongoing and significant cuts to the public physiotherapy workforce in WA, this year it’s occurring at unprecedented levels, affecting the workforce in most of the tertiary and secondary hospitals in Perth. Some hospital services have been gutted.

Let’s digest what is happening. The public health system is reducing the cost of physiotherapy services by decreasing the number and type of physiotherapists employed within its ranks. But the demand for service remains. 

I don’t want to describe this demand as patients benefiting from physiotherapy because this does not describe strongly enough how essential physiotherapists are in the health system. The expertise of a physiotherapist and their engagement with the patient can be critical to good outcomes. This has never been truer than in 2016, where survival from accidents and disease leaves patients facing years of life with ongoing pain and impairment. This is a global trend and physiotherapists have become vital in helping these patients recover, sometimes over years.

Public health has traditionally been the area of the health system where many patients, particularly those who lack the resources to engage private services, have accessed physiotherapy. The reality is that many patients will no longer be able to access our services this way and won’t receive effective treatment of many impairments in the first instance. The impact on the wider system will be a simple issue possibly magnifying over time due to linked co-morbidities, ultimately increasing health costs. The current political narrative speaks only of direct health costs, ignoring the value of early comprehensive intervention.

For our colleagues in the public system, this is a stressful time, marked by a lack of compassion and explanation. It is not clear if final staffing levels will be arrived at by a calculation of clinical need (ie, what services public health is prepared to fund) or by fiscal expediency.
Questions remain about where and how patients will access services in the future. Theoretically, the funding for such services still exists, but it has moved into the primary healthcare arena with the Primary Health Networks (PHNs) and the Health Care Home program. Yet the services have not transitioned. A quick environmental mapping exercise shows reduced public services, many private practices and some NGOs all providing niche services. To quote one colleague, there has not been a ‘respectful transitioning of services’. The system is in disarray in WA; I fear it may be so in other states, too.

As we approach the March 2017 state election, health funding is back on the agenda. Now is the time to act. We can safely predict that the public health workforce is going to be ‘leaner’, so we need to define what services are best delivered in hospital to ensure excellence in patient care is maintained. This represents an opportunity for physiotherapists, with their expertise and specialist focus, to demonstrate value that cannot be matched by the delivery of other services.

An example is advanced scope physiotherapists triaging and treating patients on orthopaedic waitlists. The financial value of this service has been unequivocally demonstrated. There are a number of areas where physiotherapists could replace the most costly clinicians in delivering service.

Services are going to have to be established in partnership with the PHNs, presenting a tremendous opportunity to retain the talent spilled from the public system. Private practitioners also have a chance to explore delivering service beyond the traditional musculoskeletal model. Universities will have to engage in this area too, because a loss of clinicians in public health will also result in a reduction in already scarce student placements.

The whole system is changing and as a profession we need to be ready to change with it, as well as advocate for our profession and educate on the breadth of our scope.

It is time to fight as a profession for our patients and to seize the opportunities that are presented in these changes.

 

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