In conversation with AHPA CEO Bronwyn Morris-Donovan

For our Allied Health Issue, Hospital + Healthcare speaks with the leader of Allied Health Professions Australia, Bronwyn Morris-Donovan. Among the many reforms she is championing are equal treatment and funding for the allied health sector.

When Bronwyn Morris-Donovan calls for the better treatment of allied health, she feels it, quite literally, to her core.

Living with a chronic back condition — the management of which falls beyond the scope of allied health professionals — Morris-Donovan knows the importance of this multidisciplinary care stream, first-hand.

That, and a lifetime of working through the industry ranks, have lit a fire within her — the heat from which she channels into her advocacy work.

Among the many reforms she is championing are equal treatment and funding for the allied health sector.

Stark disparities

“Allied health is the primary handler of Australia’s most prevalent and chronic conditions, like diabetes, which affects one in 20 people and accounts for 11% of deaths. And yet, when you compare the allied health sector with [the] medical there are stark inequities,” she told Hospital + Healthcare.

“For example, the Chief Allied Health Officer is a part-time role — and therefore not equivalent to the Chief Nursing and Midwifery Officer.

“Then, in residential aged care facilities, you have mandatory minimum nursing minutes, but no such thing for allied health. This is despite more than half of aged care residents living with multiple chronic conditions.”

Private health insurance also tends to undervalue allied health, categorising it as an ancillary service — despite its significant role in managing chronic disease.

Medicare, too, is more judicious in rebating allied health services, subsidising just five allied health services per calendar year under the MBS Chronic Condition Management item.

“In diabetes management, the majority of patients’ care is managed from outside the hospital setting and requires a multidisciplinary team of allied health professions — such as a credentialed diabetes educator, a dietician, a podiatrist, an exercise physiologist. A single discipline approach would reduce health outcomes for people with this condition,” Morris-Donovan said.

The situation looks unlikely to change soon, with the government recently announcing it will invest $8 billion into general practitioner (GP) bulk billing incentives, matched by the Coalition, with no equivalent funding for allied health.

Meanwhile, the sector has been impacted by reforms to the National Disability Insurance Scheme (NDIS), which has not seen changes to its allied health fee indexation in the last five years.

“It’s a complex scheme, and it’s becoming a very difficult scheme for allied health professionals to work in,” Morris-Donovan said.

NDIS aside, the sector as a whole is becoming more treacherous for workers, having incurred widespread job losses as a result of funding inequities.

Ironically, these losses have come at a time when the sector is facing a talent shortage, to the tune of 25,000 workers.

“We have allied health professionals who were in what they understood to be secure jobs — as occupational therapists and speech pathologists in residential aged care facilities — having their employment pulled away from them because of the funding constraints.

“Decades ago, GP consultations were probably sufficient for most of your health concerns. But now the population has this really high burden of chronic and increasingly complex conditions. When you consider the level of unmet need we have for these professionals — and how much more is forecast for the future — it is alarming many are being driven out of their roles.”

Cultural change is needed

At the crux of these inequities are misconceptions, under-estimations and, at times, wilful ignorance around the value that allied health brings, Morris-Donovan argued.

“The sector is grossly under-valued. Across the health sector and the community, we highly value nursing and general practice, and rarely question its worth. In contrast, we spend a lot of time questioning the value allied health brings — often looking at it as a luxury, rather than a necessity.

“As advocates, much of our time is spent demonstrating that, yes, you really do need all of these health professions to work together to bring about the best health outcomes for the consumer; that a single-discipline model isn’t going to cut it.”

With the sector now boasting a substantial evidence base to verify its impact on patient outcomes, Morris-Donovan has concluded that it is largely culture perpetuating the inequity.

“It has become so normalised to have an under-funded allied health sector,” she said.

For meaningful change, Morris-Donovan calls for proportional funding mechanisms to enable genuine multidisciplinary team care, and access to direct in-scope referrals between allied health professionals and specialists.

At a minimum, she would like to see increased recognition of allied health in government spheres.

“We spend our precious advocacy resources trying to get a seat at the table, when we want to spend these resources developing quality submissions.

“And yes, we are often given that seat — but if you’ve got 25 professions under the allied health umbrella, one seat is not enough.

“It is progress, but we can’t stop there.”

*Amy Sarcevic is a freelance science and technical writer who regularly writes for Hospital + Healthcare. She has an academic background in psychology.

Image caption: Allied Health Professions Australia (AHPA) CEO & Company Secretary Bronwyn Morris-Donovan.