Models for a cross agency rural Allied Health workforce Richard Cheney, Delys Brady, Graeme Kershaw, Linda Cutler, Jenny Preece

1 Aims  To propose sustainable models for an integrated, cross agency rural Allied Health workforce which meets local health needs and issues irrespective of which agency has specified criteria to service these needs.  Develop an implementation Toolkit to: –assist and guide choices (by agencies) to develop cross agency service arrangements. –Enable agencies to tailor cross agency service arrangements to local conditions and contexts

2 Nature & Extent of the Problem  The key drivers to establish cross agency employment arrangements and partnerships are: –Fragmented funding –Lack of Allied Health positions –Need for better coordination –More comprehensive interagency approaches Specifically in the Western NSW LHD : –A young female workforce (81%) –A large ‘sleeper workforce’, –Allied Health services offered in a restricted format –Agencies duplicating Allied Health services to some communities, whilst leaving service gaps.

3 Strategic importance  Allied Health service delivery in rural NSW is challenged by a number of professional, structural and resource factors: –Workforce shortages and heavy reliance on outreach models. –Inequitable distribution of Allied Health. –Higher cost of delivering services and maintaining the workforce with limited viability to Allied Health private practice.

4 Planning & development  Initial submissions in 2008  Consultant, workshops, literature, environmental scan. (May 2010)  Industry scoping interviews  Model development  Stakeholder consultation for model testing  Development of Toolkit and marketing strategy (Dec 2010)  Toolkit on CETI website

5 Implementation Toolkit –Assembles findings and learnings from organisations across Australia that have sought to develop cross agency service arrangements –Draws on research, theory and policy to develop tools –Identifies 5 models, of increasing complexity for an integrated, cross agency rural Allied Health workforce. –Is a “how to” document – a starting point to guide and assist agencies with hyperlinks to examples of - MoU’s, service agreements...

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7 Sustaining Change To assist agencies assess their readiness, capacity to develop and sustain the cross agency arrangement, the Toolkit outlines –10 Foundational Principles to design a service model –Environmental scan to identify potential partners and needs of the region of interest – Checklist of Enabling factors required to determine the most applicable option.

8 1 Technically competent staff 2 Recruitment & Retention of staff 3 Integrated systems of care across the care continuum and across agencies 4 Equitable access to health services 5 Build health literacy and self management capability 6 Community participation in health service development, delivery, monitoring and evaluation 7 The service model and practitioners are culturally secure to promote access to and utilisation of services 8 Evaluation of services to ensure effective delivery responsive to expressed community need 9 Inclusion of the principles of community development in service delivery 10 Delivery of services through multi-professional primary health care teams 10 Foundational principles

9 Resource coordination YesNoMaybe There is willingness and commitment from at least one other agency, or unit within another agency to share and coordinate resources There is commitment by key agencies to joint service planning and delivery in the region of interest Agencies and practitioners have agreed on common drivers for a new way of working together There is an agreed approach to assessing the technical competency of staff Agencies are committed to sharing information Staff of partnering agencies are prepared to work in a cross agency service arrangement OR Resources are available to support change management At least 1 partner can accommodate flexible employment arrangements There is administrative capacity to track service provision by agency, practitioner and funding stream to comply with reporting requirements OR this capacity can be developed Funders have flexible policies to encourage and foster a partnership approach to service delivery Enabling Factors Level 1 Network

10 Resource blending, coordination and supply YesNoMaybe Funding or resources within agencies can be combined to create more attractive positions Agencies have policy flexibility to support cross agency employment Agencies agree on employment arrangements for new positions Agencies are willing to work toward an integrated system of care Agencies agree on, or are willing to work toward agreement on data to be collected to monitor and evaluate service delivery Funding bodies to consider streamlined reporting Enabling Factors Level 2 Network

11 Use this slide for additional for diagrams, tables, graphs or photos

12 Lessons Learned  Partnerships offer challenges: –Developing a shared understanding of the needs of each agency and their client group –Differing organisational cultures and way of working –Ensuring accountability back to management and funding bodies –Salary and entitlement parity –Establishing and maintaining sound clinical governance –Clinical supervision and line management –Operational issues such as activity and clinical information sharing, professional indemnity, travel.

13 Future Scope  The Toolkit is: –Transferable: Specialist Nursing roles and Medicine –Marketable: LHD’s, Divisions of GPs, Rural Drs Network, NSW Health, local Government, national organisations, Commonwealth Department of Health and Ageing –Electronic: CETI, tracking the use of the document and providing regular updates.