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The Allied Health Professional Associations' Forum is a group of allied health organisations who meet to collaborate and share ideas for improving the status of allied health in the health system.

The New Zealand professional health and disability workforce consists largely of three major groups: the medical professions, the nursing professions and the allied health professions.

ALLIED HEALTH PROFESSIONAL ASSOCIATIONS' FORUM

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VISION & STRATEGIC GOALS 2003 - 2008 

ALLIED HEALTH PROFESSIONAL ASSOCIATIONS' FORUM

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VISION

The Allied Health Professional Associations' Forum (AHPAF) is the recognised connected voice of Allied Health Professionals advancing their common interests. 

STRATEGIC GOALS 2003-2008 

1.      AHPAF is a supportive and effective forum for allied health professional associations. 

2.      AHPAF is recognised by Government and key stakeholders as a credible and influential participant in health policy development, implementation and evaluation. 

3.      AHPAF promotes a positive environment and role for allied health professionals in order to maintain and improve the health and wellbeing of all New Zealanders.

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STRATEGIC OBJECTIVES 2003-2008 

Strategic Goal 1

AHPAF is a supportive and effective forum for allied health professional associations.

Strategic Objectives

1.1    To operate as an effective forum. 1.2    To represent a committed membership including all eligible allied health professional associations.

Strategic Goal 2

AHPAF is recognised by Government and key stakeholders as a credible and influential participant in health policy development.

Strategic Objectives

2.1    Take an active approach and involvement in relevant legislation, policy, procedures and issues. 2.2    Develop effective working relationships with government and key stakeholders.

Strategic Goal 3

AHPAF promotes a positive environment and role for allied health professionals in order to maintain and improve the health and wellbeing of all New Zealanders.

Strategic Objectives

3.1             Promote the value of Allied Health Professional services in maintaining            and improving the health and wellbeing of all New Zealanders.

The allied health professions each have a distinct, specialised body of knowledge and skills, and actively work with people accessing health and disability services across a range of settings.

Allied health professionals are appropriately qualified as defined in s12 (2)(a-e) of the Health Practitioners Competence Assurance Act 2003, have a professional association, an appropriate code of ethics and standards of practice, and a recognised system for monitoring ongoing competence.                                                                  

In their practice, allied health professionals provide services and engage in activities which may include:

·        prevention

·        assessment / evaluation

·        identification / diagnosis

·        treatment

·        rehabilitation / habilitation

·        advocacy

·        promotion of health and wellbeing

·        education

·        research

  Position Paper for Pete Hodgson

1.      Allied Health Professionals

The New Zealand professional health and disability workforce consists largely of three major groups: the medical professions, the nursing professions and the allied health professions.  

New Zealand has at least 24,000 allied health professionals[1].  This reflects approximately 26% of the health practitioner workforce (See Appendix One).

The allied health professions each have a distinct, specialised body of knowledge and skills, and actively work with people accessing health and disability services across a range of settings. 

In their practice, allied health professionals provide services and engage in activities which may include:

• prevention

• assessment/evaluation

• identification/diagnosis

• treatment

• rehabilitation/habilitation

• promotion of health and well being

• education

• and research 

  Allied health professionals are appropriately qualified as defined in s12 (2)(a-e) of the Health Practitioners Competence Assurance Act 2003, have a professional association, an appropriate code of ethics and standards of practice, and a recognised system for monitoring ongoing competence.

  Best practice management of specific conditions is unachievable without the specific contribution of tertiary-trained (or equivalent), autonomous allied health professionals.

  2.      Allied Health Professional Associations’ Forum (AHPAF)

  AHPAF was formed in 2001 with the support of the then Minister of Health, Hon. Annette King, who agreed to support the development of the Forum, and attend regular meetings. It has a membership of 15 allied health professional associations with the Public Service Association holding associate membership status.   

  AHPAF has been working to gain greater representation of allied health at a policy level, but has struggled to be heard over the voices of the medical and nursing communities, both of which have effective representation within the Ministry of Health.  

  AHPAFs contribution; 

  AHPAF’s earliest, and possibly most effective contribution, was on the Health Practitioners’ Competence Assurance Bill. The Forum was involved, on its own and in concert with other health professional associations and unions, in lobbying the Ministry, the Minister and in presenting submissions to the Health Select Committee. 

  Since that time AHPAF has made a number of submissions on such topics as the Health Workforce and People with Chronic Conditions.  We have representation on external bodies for example, Rural Primary Healthcare Forum and the PHO Task Force.  

  In addition, the Forum has developed a Memorandum of Understanding between its constituent associations, established a strategic plan, developed a definition of allied health (now widely used) and signed a Memorandum of Understanding with the Ministry of Health. It has also continued to meet regularly (every two months), invite guest speakers and act as a point of co-ordination and information sharing between associations. 

  Challenges for AHPAF: 

  There are a number of weaknesses concerning AHPAFs capacity and capability to maintain and grow its sphere of influence. 

  a. AHPAFs resources are limited 

  The ongoing ‘work’ and participation in sub-committees usually but not exclusively falls to those Associations’ representatives who are in the more fortunate position of having paid staff.  Representatives have time constraints on their ability to participate and contribute. 

  Financial resources too are limited– with membership subscriptions currently at $280 per member group, to ensure smaller groups can participate; the current annual budget is $3,120.00.  

  AHPAF believe it can support the Ministry of Health through research and contributions to policy development.  However to provide such functions AHPAF would require greater resources.  

  b. There is no effective representation of allied health professionals in the MOH 

  There is no Allied Health Advisor or Allied Health desk within the Ministry of Health.  In order to maximise the contribution of allied health professionals, and effectively utilise the contribution of medical and nursing professionals greater representation of allied health is required within MoH.

  
  

  Why was AHPAF established?

  One of the key drivers for establishment of AHPAF is improved recognition for allied health professionals and their work. At both a national level and within DHBs, there is often not enough recognition of the contribution the various allied health professions make to client health and wellbeing.  Many individual allied health groups are comparatively small in number compared to other health professions.  Working together results in a stronger voice for allied health, and each member association also benefits from the knowledge and skills shared within AHPAF.  

  To meet its objectives AHPAF is:

  §promoting the value of allied health professional services

  §developing effective working relationships with government and other key stakeholders

  §taking an active approach to be involved in development, implementation and monitoring of relevant health policies

  §making representations and submissions on issues of common interest to allied health professions 

  3. Value of Allied Health

  Allied health professions make a crucial contribution to New Zealand’s health care services; but their skills are frequently undervalued. Allied health professionals are highly skilled, tertiary trained autonomous professionals. An increasing number have post-graduate specialist qualifications and play a crucial role in research, management and health policy development. 

   

  Internationally, there is a growing recognition of the important role played by this group. Australian Allied Health Professionals are also lobbying for a stronger voice within their Ministry of Health, requesting a fully funded National Allied Health Office late last year.

   

  AHPAF believes Government remains overly focused on medical practitioners and on medical solutions to health problems. This adds to costs, reduces choice for consumers, and does not recognise that best practice often requires a multidisciplinary approach.

   

  There is agreement that New Zealand faces a critical shortage of allied health professionals, and that changes are urgently needed in many areas affecting the allied health workforce– notably on skills recognition, education and workforce development.

   

  There are many opportunities for AHPAF to enhance cross-discipline practice between allied health and other health professions, assisting to offset current medical and nursing workforce shortages.

   

  Two key health concerns are population ageing and the increasing numbers of people who are overweight or obese. In the interests of cost saving and best practice care, doctors and the Government need to recognise the significant role that allied health professionals can play in preventing and/or and managing these issues. There is an urgent need for comprehensive workforce studies of key health professions other than doctors and nurses in the light of the changing health services environment.

  A further example is that some allied health professionals are already employed in emergency departments of some hospitals. Their skills and contributions complement those of medical and nursing staff, and can be particularly helpful for ‘social'admissions where community support can be a more appropriate option than hospital admission. 

  Through greater collaboration between medical, nursing and allied health groups the whole system will benefit through greater productivity, improved outcomes and many cost reductions in other areas of government expenditure such as, those in education and aged care services. 

  
  

  Examples 

  a. Reducing the need for surgical services

  Effective deployment of allied health professionals can reduce the need for expensive surgery. For example, in Denmark a study[2] examined implementation of two non-surgical spine clinics. The purpose was to ensure uniform, fast, and competent evaluation of patients suffering from prolonged bouts of sciatica, with or without lower back pain. The clinics were staffed by: Rheumatologists, physiotherapists, Nurses, Social Workers and Occupational Therapists. 

   

  The patients were given a full assessment by the rheumatologist and physiotherapist, advice and exercise guidance, posture correction and reassurance. All staff were trained in communication skills based on cognitive behaviour therapy principles.

   

  The programme almost halved the number of lumbar disc operations over a four year period, significantly reducing overall costs to the system. 

   

  b. Reducing the need for educational support and long term state reliance

  As an example, a child suspected with a hearing loss is referred to ENT outpatient by their GP and is referred back to their GP as a result of long ENT waiting lists. Their case is given priority 5 (the lowest priority) and as a result the child’s hearing aid fitting is delayed at a time when prompt intervention was crucial to ensure good outcomes. 

   

  The child could have been seen more quickly had they been referred directly to an audiology service. In this case, prompt diagnosis and early intervention would be much more likely to result in normal speech and language development.

   

  Where intervention is delayed, speech, language, psychosocial and educational issues are more likely to occur as is the need for educational and other types of support (e.g. speech language therapists, advisors on deaf children, teachers of the deaf – provided by the Ministry of Education, Group Special Education). Such barriers to effective learning can limit the individual throughout their life, causing an unnecessary drain on government resources, through increased unemployment and social support and reduced mental health. 

   

  Studies in the USA suggest that only 15% of all presenting cases of hearing loss are actually amenable to surgical intervention.  While all confirmed paediatric hearing loss cases should see an ENT Surgeon as part of their review, audiologists can be effectively used as gate-keepers for the hearing impaired.  This allows effective triaging and also for as early hearing aid fitting as is practicable

  4.  Current issues for allied health

  Issues facing allied health professionals include: 

  a.      Health workforce issues

  All the above factors have major implications to the future allied health workforce. This comes at a time when the value of the allied health workforce is being increasingly recognised as providing cost effective, non-invasive treatments.

   

  b.     The impact of registration under the Health Practitioners Competence Assurance Act 2003 (HPCA)

   

  Some allied Health Professions have been registered for many years, others are in the process of registration under the HPCA, and still others are yet to be included under this Act. 

   

  Registration results in significant increases in membership fees. This increase, coupled with the obligations of maintaining ongoing competence can cause difficulties with retention of allied health professionals, particularly those working part time.

   

  Health professionals are now required to demonstrate ongoing competence requirements set by the registration authorities. A large proportion of the allied health workforce is female who often take time out of the workforce for child rearing. Under the HPCA Act they may be required to complete a re-certification course before returning to the workforce. Unfortunately at this point in time no one has taken on the responsibility of providing these recertification courses. This could lead to serious shortages in the allied health workforce in the future.

   

   c.      Lack of funding for post graduate education - CTA funding

   

  The allied health workforce seldom has access to this funding. Post graduate education is mainly funded by the individual with occasional support from their employer or professional body by means of a scholarship grant.

   

  d.      Clinical Placements and Internships

   

  All members of the allied health work force struggle to find sufficient clinical placements for their students. This is exacerbated by an increasing number of students to meet a shortfall in supply, and a decrease in staff employed in hospitals able to teach and supervise the students. There is also a lack of adequate funding for these positions. 

   

  As an example, for many allied health professions, public hospitals provide the bulk of undergraduate clinical education. Private clinics rarely provide clinical education opportunities for students, but benefit when highly trained graduates leave the public system to seek higher incomes in the private sector. In some professions, this has increased pressure within the public sector, leading to longer waiting lists and, some believe, high staff turnover.  

  5.  Recommendations

  Allied Health professionals have a sense that government focuses almost exclusively on the medical and nursing professions in its policy development, health workforce research and planning. We believe that the Minister is missing out on key advice from a significant and sizable part of the health sector workforce, leading to missed opportunities to improve productivity and outcomes.  

  We ask that the Minister works with the Ministry to ensure the establishment of a Chief Advisor - Allied Health to ensure the voice of this sector is heard, and to improve the effectiveness of future health policy.

  Greater access to allied health services will strengthen preventative as well as remedial health care, and so will help limit overall health costs. To improve access, current and future allied health workforce shortages must be addressed, together with issues relating to clinical education, data collection, recruitment and retention.

   

  Providing a voice for this sector within the Ministry of Health is also crucial to ensure that this significant group of health professionals can contribute fully to implementing the Health Strategy. We also ask that consideration be given to supporting AHPAF to secure its role for the future thereby ensuring that the Ministry and the Minister is provided with a full and accurate picture from the health sector.   We would welcome further discussion on this topic.

   

  AHPAF would also like to extend an annual invitation to the Minister to the meet with AHPAF in Wellington.  

  Appendix One: Refer Allied Health Stock take – Excel spread sheet

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  [1] This stocktake of allied health professionals has been collated based on current APC numbers; and where figures are unavailable on a best guess or the MOH NZ Health Workforce – A Stocktake of Issues and Capacity 2001.  The total figure is only a conservative estimate and only includes what might be considered the well known and traditional allied health professional groups.

  [2] Rasmussen et al (2005) Rates of Lumbar Disc Surgery Before and After Implementation of Multidisciplinary Non-surgical Spine Clinics.