The Budget: where's the money going for allied health?

The 6th of October saw the 2020–21 Federal Budget, delivered by Treasurer Josh Frydenburg, touted as “An Economic Recovery Plan” for Australia following the devastating effects of COVID-19 on the Australian economy. So, where was health and disability investment focused, and what does this mean for rural and remote health and disability services for the coming budget cycle?

There is continued investment in the Stronger Rural Health Strategy — $550 million in this budget — which gives us hope that there is an acknowledgement of the importance of providing equitable health services outside of the capital cities. At the same time, there exists an alarming lack of funding for allied health initiatives within the package, with nurses and doctors again seeing the overwhelming majority of the funds coming their way.

In the context of an ageing population, higher rates of chronic disease and larger populations of First Nations Australians in rural and remote areas, allied health is absolutely essential to ensure that our health services in the bush are able to provide adequate support to their communities.

Focusing on nursing and medicine without the inclusion of allied health is more reactive than preventative, and preventative health care is the only realistic way to support an ageing, diverse and geographically disparate population in rural and remote Australia. Allied health prevents illness/injury, gets people out of hospital quicker, keeps people out of hospital and increases community participation, which can help to keep our bush communities alive.

Effective support for rural allied health

There is growing demand in the regions for timely and high-quality allied health services, but we need a significantly greater amount of investment in workforce innovation, recruitment and retention in the bush to be able to support the demand. The Commonwealth’s Workforce Incentive Program provides funding for GPs to attract allied health professionals to be employed, but the overwhelming majority of allied health professionals do not work under a GP, and many consumers pursue allied health services independently of general practice — our services are broader and more complex than this.

On the face of it, it doesn’t seem to be a robust enough plan and incentive to get allied health professionals into the bush, or include strategies for professional support and career progression to encourage people to stay. The realities of allied health practice in rural and remote practice see the workforce often servicing a diverse caseload through a variety of funding sources which can often lead to barriers in supporting certain client groups when there is confusion or disagreement over federal and state responsibilities for allied health service provision.

In addition, there are often few or no allied health professionals in regional areas for GPs to refer to, even in areas close to metropolitan centres, let alone our more remote communities like Thursday Island or Birdsville.

There is continued oversight of rural health by the National Rural Health Commissioner. The expansion of the role into a more holistic and multidisciplinary approach to rural health care gives the recently appointed Commissioner the opportunity to implement the recommendations provided on the back of the previous Commissioner’s extensive investigation into allied health services reported upon earlier this year.

Addressing the NDIS underspend

Allied health professionals and consumers were not just looking at the investment in the Health Department, but also in the National Disability Insurance Scheme (NDIS). In the last budget we saw a $4.6 billion underspend in the NDIS.

One of the key reasons for this underspend is low access to supports including allied health services in rural and remote Australia. People are struggling to navigate the NDIS, unable to access allied health services or not able to see their allied health professional frequently enough to spend the money allocated to them. Knowledge of the roles and scope of practice of the allied health disciplines is also lacking somewhat in rural areas and amongst NDIS planners, so people are going without essential allied health services.

The Commonwealth has committed another $3.9 billion to the NDIS in line with expected growth this year, but will need to continue to refine policy measures to ensure an increased rate of plan utilisation and increased availability of allied health services to those in need. Again, this speaks to issues of workforce recruitment and retention to some degree at least. One of the ways forward here is to renew the NDIS Rural and Remote Strategy which was due to be renewed in 2020, but is yet to be addressed. With a comprehensive rural and remote strategy and associated policy initiatives, it may become more realistic not to expect continued underspending in subsequent budget cycles, as well as low plan utilisation rates associated with limited allied health access in the bush.

On the surface, this appears to be a sound budget for allied health in both the health and disability sectors, with significant spending on rural and remote health, as well as the NDIS, but there is more work to do in acknowledging and sufficiently supporting our rural allied health services into the future.