DHBs, private sector bodies, professional organisations, education and training providers, professional colleges, and health clinicians and practitioners are all powerful contributors to the shape of the health and disability workforce. HWNZ’s strategic and tactical planning function is carried out in the context of partnerships with, and data and workforce intelligence from, these agencies.
As a small organisation, HWNZ provides leadership, support and coordination in the sector, but the implementation of strategic responses is often led by a stakeholder group. For example, we are working in partnership with Careerforce on the Health and Disability Kaiāwhina Worker Workforce Action Plan 2014 for the development of the non-regulated workforce, see the Developing the Non-regulated (kaiāwhina) workforce section (page 22).
HWNZ also works with other organisations that lead projects in areas of common interest. For example, we are seeking to have a high degree of influence in the scope of training offered and funded at undergraduate level through a proactive relationship with the Tertiary Education Commission (TEC). HWNZ and the TEC have a common interest in ensuring that the supply of graduates is geared to match the career opportunities for each workforce group.
In our work with the sector, we are guided by an engagement philosophy that reflects our leadership role and the need for a ‘whole of health workforce’ perspective across plans for the future. These guiding principles are set out in full at www.health.govt.nz.
Building a sustainable workforce
During the past five years, HWNZ has focused on a number of key areas that together contribute to building a sustainable workforce. They include:
developing workforce intelligence (through Workforce Service Forecasts and data collections)
demonstrating innovative roles
recruitment, retention and distribution initiatives
managing the medical and nursing pipelines
developing the non-regulated (kaiāwhina) workforce
increasing the number of targeted training opportunities
removing barriers to innovation
Developing workforce intelligence
New Zealand is a small player in a global market that is highly susceptible to economic and workforce ebbs and flows. We face a number of unknowns when we try to forecast workforce demand. For example, we cannot predict with any certainty the impact that technological change will have on the shape and size of future workforces.
It is certain that an ageing and growing population, together with medical advances, will result in an unprecedented demand for health and disability services in years to come. The emerging prevalence of chronic conditions will put pressure on primary health care systems as patients seek treatment closer to home.
Traditional workforce forecasting will not serve us well when we plan for a workforce to meet this demand. Experience shows that it is unhelpful to try to estimate the number of health practitioners the system will need because precise calculations are invariably wrong. When projections base demand on existing workforce models, they predict a health care system that is increasingly unaffordable and difficult to sustain.
In light of this, HWNZ has taken an alternative approach to forecasting that moves away from traditional numerical forecasting and instead emphasises pressure points and trends. We take into account the impact of a number of events in modelling trends, including: retirement patterns, recruitment rates, international labour market trends, service demands and the popularity of some training programmes compared with others. Reliable data is important, but so is intelligence about the events that are likely to impact on workforce supply and demand.
The Workforce Service Forecasts represent an outcome-focused approach to workforce planning. This approach involves scenario-building for the effective delivery of service aggregates (such as mental health, aged care and eye health) rather than profession-by-profession methodology of traditional forecasting. The former is a methodology that accommodates uncertainty and encourages innovation.
Over the past five years, HWNZ has commissioned groups of clinicians and other experts to undertake Workforce Service Forecasts across particular service areas.
Summaries of the individual Forecasts can be found in Appendix 1, and the full reports are available at www.health.govt.nz.
A number of common themes emerge from the 13 Forecasts published to date. These findings, together with information collected from a variety of sources (including workforce data sets) provide a rich source of intelligence upon which we predict future workforce trends.
The Forecasts consider the workforce that New Zealand will require in 2020. They use a ‘whole of system’ approach that takes into account the needs of people, the service configurations that can best meet these needs, and the workforce we require to deliver the services. The Forecasts generated a number of key themes including:
developing new roles and extending existing roles to make the best use of the workforce
focusing on prevention, rehabilitation and self-care to shift resources from hospitals to communities
developing regional clinical networks to make the best use of existing skills and resources.
Several Forecasts noted that traditional approaches to service delivery can be costly and inefficient. They frequently require highly trained clinicians to complete tasks that can safely be left to other health professionals. As an example, the Musculoskeletal Workforce Service Forecast reviews a traditional referral pathway that sends a patient from a GP to a neurologist, a rheumatologist, an orthopaedic surgeon and/or a specialised pain clinic.
The Forecast suggests an alternative pathway involving a range of health practitioners who screen out patients suitable for conservative treatments. This frees up specialists to manage the relatively small proportion of cases requiring surgery or other specialised services. This type of approach can be supported by long-distance, virtual diagnostic techniques, a useful means for specialist engagement.
Another theme is the contribution that information technology systems can make to medicine in terms of efficiency. As one example, if patients can digitally monitor their own vital signs and stream this data on their mobile phones to their health professionals, they will not need to see health professionals face to face so often.
The Forecasts support the idea of bringing services to people rather than people to services. This home and community-based approach is particularly important for older people. With the support of informal carers and the kaiāwhina workforce, it is possible to avoid unnecessary disruptions to a person’s ordinary routines.
Another theme for workforce planning for the future is that demographically appropriate services are desirable not only for older people but also for young people, and for Māori, Pacific and Asian/Indian populations.
The Forecasts suggest New Zealand needs an integrated workforce that can prevent and delay loss of function, and rehabilitate and support individual patients and people with disabilities in their homes.
The Mental Health and Addictions Workforce Service Forecast points to the importance of agencies working together to influence patient pathways, including by monitoring the passage of at-risk individuals through the education, health and justice systems. A recent report published by the Ministry of Health, Rising to the Challenge,7 supports the findings of the Forecast.
Workforce maldistribution favouring larger centres is considered, for example, in the Anaesthesia Forecast, which suggests more cross-boundary movement of staff and patients and a less siloed approach to health care delivery by DHBs.
The Forecasts’ conclusions in terms of education and training are as follows.
General practice is a key to the delivery of health care in the community – New Zealand will need more GPs in future, and they will need to provide more specialised care.
An adequate and well-trained practice nurse workforce is also vital.
New Zealand needs a workforce that is responsive to the needs of key populations, including Māori, Pacific people, older people, youth and people with disabilities. Accordingly, the workforce requires more Māori and Pacific health practitioners, more geriatricians, more gerontology nurses, and more support workers and carers working in primary care and across aged and disability care and residential facilities.
General scopes of practice help to future-proof the workforce; for example, a generic role such as rehabilitation practitioner is more effective than specific roles such as physiotherapist, occupational therapist and speech therapist.
We know enough about the growing prevalence of some diseases to plan for particular specialist health practitioners; for example, New Zealand will need more diabetes nurses in the future.
There needs to be a greater emphasis on keeping people well – an integrated workforce can help to prevent or delay the onset of disease.
Innovative approaches are required to streamline training of the specialist allied health workforce.
The non-regulated support worker and carer workforce is key to the delivery of health care in primary settings. This workforce needs appropriate training and career development opportunities.