Allied Health Growth: What We Do Not Measure We Cannot Manage Daniela Solomon1, Nicholas Graves1* and Judith Catherwood2

Solomon et al. Human Resources for Health (2015) 13:32 DOI 10.1186/s12960-015-0027-1 COMMENTARY Open Access Allied health growth: what we do not measure we cannot manage Daniela Solomon1, Nicholas Graves1* and Judith Catherwood2 Abstract Background: Data describing the Australian allied health workforce is inadequate and so insufficient for workforce planning. National health policy reform requires that health-care models take into account future workforce requirements, the distribution and work contexts of existing practitioners, training needs, workforce roles and scope of practice. Good information on this workforce is essential for managing services as demands increase, accountability of practitioners, measurement of outcomes and benchmarking against other jurisdictions. A comprehensive data set is essential to underpin policy and planning to meet future health workforce needs. Discussion: Some data on allied health professions is managed by the Australian Health Practitioner Regulation Agency; however, there is limited information regarding several core allied health professions. A global registration and accreditation scheme recognizing all allied health professions might provide safeguards and credibility for professionals and their clients. Summary: Arguments are presented about inconsistencies and voids in the available information about allied health services. Remedying these information deficits is essential to underpin policy and planning for future health workforce needs. We make the case for a comprehensive national data set based on a broad and inclusive sampling process across the allied health population. Keywords: Allied health, Registration, Service provision Background provider accountability and hence patient safety [3]. In The National Registration and Accreditation Scheme February 2011, the Australian Health Ministers Advisory (NRAS) for Health Professionals was introduced in Council (AHMAC) released a consultation paper recom- 2010. Ten professions previously registered in every state mending deferring consideration of inclusion of any add- and territory joined the scheme upon commencement, itional professions [4]; some 20 proposals from health and four subsequently, with representative national professions seeking inclusion in the NRAS have been boards overseen by The Australian Health Practitioners adjourned, despite having addressed the 6 benchmarking Regulation Agency (AHPRA) [1]. Consequently, many criteria underscoring the public benefit of improved established allied health professions have been excluded practitioner regulation as set out by the Intergovern- from the scheme: dietetics, speech pathology, audiology, mental Agreement for the NRAS [5]. Thus, less than a exercise physiology, orthotists/prosthetists, social work quarter of 50+ health professions as defined by the Health and sonography. This is despite the Productivity Commis- Professionals and Support Services Award 2010 are repre- sion recommending at the outset of consultations that sented [3]. registration should occur at as broad a level as possible, consistent with maintaining quality and safety [2]. Over Main text 50 000 practitioners remain outside of the framework of Current registration Public trust is predicated on the expectation that a formal * Correspondence: [email protected] regulation structure exists which provides recognition of 1 Institute of Health Biomedical Innovation (IHBI), School of Public Health and qualifications, minimum entry standards, assurance of Social Work, Queensland University of Technology, 60 Musk Ave. Kelvin Grove, Brisbane 4059, Australia practice standards, a code of conduct and ethics and an Full list of author information is available at the end of the article avenue for complaints as argued by the National Alliance © 2015 Solomon et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Solomon et al. Human Resources for Health (2015) 13:32 Page 2 of 6 of Self-Regulating Health Professions (NASRHP) [3]. A social workers belong to their professional association at a recent survey demonstrated that the general public believe time when social workers are playing a critical role in the they have far greater protection against inappropriate and management of mental health disorders [6]. Although a poor practice with respect to allied health practitioners self-regulatory system currently exists within the Austra- than they do [6]. The more than 6 million visits to lian Association of Social Work (AASW) for managing AHPRA’s website and its online register of practitioners in ethics complaints, only members can be investigated addition to the 310 000 customer service phone calls in through this process, with the most severe penalty pro- the first half of 2011 suggest a requirement for a mini- vided under this system being exclusion from eligibility mum level of transparency. The role of AHPRA as public for membership, enabling practise as a counsellor or ther- safeguard has been emphasized in an analysis of post- apist. The problems associated with loopholes whereby registration data by Lin and Gillick [7]. practitioners switching professional titles can evade the Professional indemnity insurance is not mandatory for regulatory net have been well-documented [7]. Published several non-AHPRA allied health professions (Table 1). statistics for the widely accessed Medicare-subsidized Representative bodies for these professions provide an Enhanced Primary Care and Chronic Disease Manage- important regulatory role; however, association member- ment (CDM) schemes show dieticians among the highest ship varies from state to state and between disciplines, allied health service providers for each year [10], yet dieti- with estimates of 60% for speech pathologists to 80% of cians have no requirements to be registered in any state or dieticians [8]. Accreditation programmes are entirely territory and, thus, no legally enforceable set of probity, voluntary. For self- or unregulated professions, few of the qualification and practice standards and no measure of components of professional accountability are mandatory certainty of competence and ethical practice for the mem- or enforceable [8]. Where clinical practice guidelines exist, bers of the public. Registration of speech pathologists in adherence to these professionally defined standards is Queensland was in fact recently discontinued by the only inconsistent [8]. There is no legislated registration for dis- state government formerly requiring it, despite the grow- ciplines such as social work even though there are an esti- ing need for speech pathology intervention [11]. mated 22 000 [9] social workers employed in a diverse range of settings, with some of the most disadvantaged Workforce data—getting ahead of the curve and vulnerable members of the community utilizing their There is currently no comprehensive national source of services. Social work remains the largest unregistered allied health workforce data. This has implications for health profession, providing services often in rural and re- current and future health workforce planning and policy mote locations where they are the sole provider of essen- development for the health sector, as robust, reliable and tial counselling and therapy to communities increasingly timely data are essential to successful health workforce burdened by mental health issues, yet less than 40% of planning [12]. This has been acknowledged in the US Table 1 Allied health professions (non-AHPRA) membership and coverage Audiology Dietetics Orthotics/ Speech Sonography Social work prosthetics pathology Current publicly List of clinics and public Yes, including Yes Yes No Yes, including list accessible national and private services expelled/ of conditional and register of registered by region suspended ineligible members practitioners members (ethics breach) Practitioners 98% 80% 75% 60% 70% 40% represented (approx.%) Accreditation status No Yes Yes Yes No Yes available Professional Mandatory for practitioners Not mandatory Not mandatory PI, Not Not mandatory. Not mandatory. PI indemnity in private practice and PL and products mandatory PI and PL provided and PL provided contract or sessional work liability recommended to ASA members to AASW members or if employed by DVA, by AOPA only only WorkCover, etc. Complaintsa Referred to Referred to Ethics Complaints senior advisor disciplinary Management professional committee Process issues AASW, Australian Association of Social Workers; DVA, Department of Veteran Affairs; PI, Private Insurance; PL, Public Liability; AOPA, Australian Orthotic Prosthetic Association; ASA, Australian Sonographers Association. aOnly applies to members of professional organizations. Complaints about non-members directed to the relevant state government service. Solomon et al. Human Resources for Health (2015) 13:32 Page 3 of 6 where minimum data sets are being developed at a indigenous communities. From 2001 to 2006, service national level through the Health Resources and Services provision in nuclear medicine grew by 11.8%, but the Administration National Centre for Health

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