Public health workforce neglect

It won’t come as a surprise to many to learn that there is a crisis in the sciences, allied health and pharmacist workforces in Victoria.

All the research points to one thing – there is a crisis in the medical scientists workforce with not nearly enough scientists available to fulfil the required work; or to deal with the continued growth and demand on pathology services. There are not enough psychologists, pharmacists, audiologists, dietitians, medical physicists and the list goes on. Without these workforces being adequately staffed Victorians are not going to get the world-class healthcare they should expect. It’s not possible to get more work out of people who are already over-worked and burned out from extreme workloads; coupled with the failure to recognise the need to employ more people.

This research supports the most recent research by RMIT University in the Bartram report, which confirms the research the Union has been independently doing since 2011; and again confirms the results from our 2019 survey.

The Department’s own commissioned independent workforce report (published in Feb 2019) on Medical Laboratory Science found understaffing of pathology laboratories is a widespread issue with “frequent reports of increased overtime, high levels of stress, fatigue and burnout” for scientists. The DHHS is maintaining a dogmatic refusal to engage genuinely with the MSAV to discuss the report – it is being buried!

For dietitians the research highlights key areas of concern included inadequate resourcing to meet the increasing prevalence of obesity and diabetes; and the lack of funding and changes in funding models resulting in dietitians not providing services to all of those who would benefit from seeing them. A recurrent theme in the research of the dietetics workforce was an absence of career development opportunities and difficulty in securing permanent employment. Career pathways are not clear and a lack of post-graduate training pathways and opportunities were highlighted. Despite working in a clinical role, 30% of dietitians had no clinical supervisor and highlighted the need for early career graduates to be supported. No one working as a dietitian will be surprised by the research outcomes or the work done by the Union which have highlighted these very concerns over a number of years.

For audiologists the concerns are very similar to dietitians. There are poor opportunities for career progression and senior roles are scarce and career pathways are not clear and a lack of publicly-funded services in the community, particularly in regional areas and Indigenous communities. There is a need to better support audiologists in coping with reforms arising from government inquiries into the industry, changing funding arrangements (particularly the introduction of the NDIS), and the possibility of tighter regulatory arrangements. And the research noted there was a strong recurrent theme in the need to provide more opportunities for career progression and recognition.

There is a lack of appropriately funded and graded positions within the community to meet the needs of clients and there are not enough psychologists working across the public health sector. The VPA has been doing significant work around workforce issues especially around ensuring there is a large enough workforce to deal with the growing demand for mental health care, and the results of this research shows the VPA has been successful. Research does indicate that there is a need for clearer career development pathways including continuing professional development opportunities, mentorship and opportunities to undertake research were identified. It has also been revealed that there is the need to review the impact of privatisation and fee-for-service payments on the workforce, the understanding of supervision, peer consultation and mentoring. This is not surprising given how frequently the VPA has to intervene and ensure that members have access to supervision. It’s also extremely frustrating and disappointing that health services fail to understand the value and significance that supervision, peer consultation and mentoring provides psychologists in delivering world-class mental health care.

What all of this research says, and again reinforced by the results from the 2019 No Pay? No Way! Survey, is that there has been massive neglect of the scientific, allied health and pharmacist workforces to the detriment of patients and the people working across these services. Successive Governments of both persuasions have wilfully neglected vital aspects of Victoria’s health care system by failing to properly fund our workforces.

The sheer impact of this neglect can be seen in the comments members left in the most recent No Pay? No Way! Survey including:

“Extra work is done to complete patient care-related tasks. And this is often done by cutting breaks short, or having meals at the desk while working. Of course it feels uncomfortable to say no if tasks are urgent and timely completion benefits patient outcome. Due to short staffing, my preferred leave was not able to be given and this caused turmoil in my family life.”

“Sometimes management tells us we must leave on time but gives us an impossibly large work load to complete it within time. This means that we get in trouble for staying back but also we cannot leave our work unfinished so we lose either way. We are given time in lieu given they approve/agree that the over time was warranted but cannot use it anyway due to understaffing.”

“The workload is too high for even regular hours. Overtime is regularly organised for the weekend but we are still falling behind and patient reports are going out at around double the recommended time. Understaffed.”

“Unrealistic expectations from management with regard to completion of workload. Management has no idea how long duties take to be performed even when done as quickly as possible as there are situations where testing can take longer depending on the requested tests. Managements statistical figures are erroneous showing a lack of understanding of maths at the most basic level with regard to manual testing of samples.”

“Management are aware work out of hours (afternoon and weekend) has increased by 35% in last couple of years but do not intend to staff adequately – because the government has no money”

“hospital decided to implement 0930 discharges. Problem is the prescriptions for identified patients are written late in the day and when the pharmacist says it can’t be completed before 0930 the next day, they are threatened with the phrase “well I’ll tell the nursing co-ordinator then.”

“Often unpaid work is not requested however implied. For example, unreasonable deadlines are set and it is the expectation that these are met. Even though it is physically impossible to complete all of the operations work and then meet the additional deadlines. So Management are not directly requesting for the work to be done as unpaid overtime however there is no time provided during work hours to complete this.”

The Union will continue to determinedly advocate for increasing workforces across all allied health disciplines and we certainly make no apologies for it. To us there is no other choice if we truly want a world-class healthcare system then we must have the people; and we have to put an end to this ongoing reliance on people who are overworked, stressed and burned out.

Paul Elliott

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