Optimising the allied health professions for better, more sustainable integrated care

As noted in the the report 'Hidden in plain sight - Optimising the allied health professions for better, more sustainable integrated care, the NZIER report to Allied Health Aotearoa New Zealand (23 June 2021) the allied health workforce will be integral to improving the delivery of health services in Aotearoa New Zealand. 

Allied health practitioners represent a ready-workforce able to support a shift to more effective and more pro-active prevention, person-centred care, and collaborative, interdisciplinary team-based approaches that are most appropriate for people with complex health issues including long-term conditions.
With experience working in multi-disciplinary teams and across the secondary and primary care sectors, many allied health practitioners are also uniquely experienced in supporting patient transitions between settings of care, a critical strength that can support greater coordination and continuity in patient journeys.

On the demand side, the growing burden of disease, particularly non-communicable disease including musculoskeletal conditions, demands more GP time and contributes to both increased referrals to specialists and greater acute demand in tier 2 settings. An ageing population reinforces this trend.

Instead of an increased utilisation of allied health professions and increased provision of training places in the context of a growing and ageing general population and ageing GP profession, and increased demand for services and increasing burden of musculoskeletal and complex multi-morbidity presentations, there is actually a decrease in the total number of training places and a decrease in the ratio of practitioners to population. 

The solutions are to have extended scope first contact practitioners to improve referral flows with triage processes that could include osteopaths, physiotherapists, and nurse practitioners

Lack of shared patient records make it difficult for GPs to refer confidently to allied health practitioners who work outside DHB and PHO settings. IT platforms and systems need to be funded arcoss the health and diability sector not just with in the former DHB sector "silo".

Education and workforce planning 
The lack of an education framework for allied health professions makes movement across occupational domains, whilst recognising existing knowledge, skills and capabilities, and building on those or adding new competencies difficult or impossible. 

Ministry lack of awareness of Allied Health profession capabilities 

The Ministry seems to have a blind spot with regard to the capabilities of allied health professions that are outside of the DHB funding model and even some that straddle DHB and community settings. This was highlighted in the lockdowns. Whilst physiotherapists, osteopaths and chiropractors were classified as essential health workers in Australia and the UK, in NZ they were not and required to stay home. In the UK, osteopaths were utilised as community vaccinators with some practices vaccinating tens of thousands of their community, whilst in NZ they were ineligible to undertake the provisional vaccinator training despite a 5 year, clinical based programme delievered at Masters level encompassing immunology pathology and physiology and high level clinical examination and patient assessment and history taking skills. 

Without immediate action to implement innovative health care delivery models, population health and care accessibility will continue to deteriorate  in New Zealand. Allied health will play an important role in meeting the health care needs of New Zealanders.