Strengthening the Allied Health Assistant workforce through occupational co-regulation

The Allied Health Assistant National Association (AHANA) is the national peak body representing Allied Health Assistants (AHAs) in Australia.

There are currently around 25,000 AHAs in Australia, but they work under different state and territory awards, have no consistent training standards and work in a variety of roles. In other words, there is no standardisation of the workforce.

AHANA has established standards for Certified Practicing Allied Health Assistants that guarantee the qualifications and experience of those practitioners, as well as a range of other quality measures. This provides endorsement and quality assurance of AHAs that meet entry certain criteria for experience and training of the workforce.

AHAs are an important adjunct to allied health care and work under delegation from an allied health professional (such as physiotherapists, speech pathologists, podiatrists, dietitians) to deliver services to patients that are coordinated by an allied health professional, but do not need to be delivered by an allied health professional. Examples of the types of services performed are numerous and include providing basic footcare to older people; delivering falls prevention training; installing equipment to keep people safe at home; and running groups to provide communication support to people who have had a stroke and lost their ability to speak.

AHAs work with any type of patient or client, including older people, people with disabilities, children and people who have been discharged from hospital and require support.

Currently, allied health professionals who are a registered member of their association can access a provider number which gives them access to funding from certain bodies, such as NDIS, My Aged Care, Medicare, private health insurance, and state-based insurance services. However allied health assistants do not have access to similar funding models. This means that their services are not consistently employed by allied health professionals.

AHANA is seeking occupational ‘co-regulation’ which means that government and employers recognise AHANA as the body that sets the standards for Certified Practicing status as an allied health assistant. This will ensure that Certified Practicing Members of AHANA (or people who meet those standards) are recognised for their qualifications and skills by government funding bodies, and therefore may be eligible for funding from government sources, or receive preferential treatment by employers.

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Examples of occupational co-regulation in allied health in Australia:

?Funding programs such as Medicare, NDIS, DVA and the Commonwealth Home Support Program

Where practitioners hold certain classes of professional association membership, their patients can access rebates under specific government funding programs. For example, practising members of Speech Pathology Australia, Dietitians Australia (amongst other self-regulating professions) are eligible to become registered providers under Medicare, NDIS and Department of Veterans Affairs (which means they or their patients qualify for funding or rebates) and the services provided by Certified Practising Speech Pathologists are eligible for Commonwealth Home Support Program funding.

Assessing Authorities for immigration purposes

Some professional associations have been approved as ‘assessing authorities’ by the Australian Government Department of Home Affairs (Immigration and Citizenship). Assessing authorities are authorised to assess the skills, qualifications and/or work experience of prospective migrants who are applying for a visa to work in Australia and who believe they are qualified in an occupation on the skilled occupations list. The Australian Society of Medical Imaging and Radiation Therapy and the Australian Orthotic Prosthetic Association (AOPA) (and many others) carry out this function on behalf of government (see: https://immi.homeaffairs.gov.au/visas/working-in-australia/skills-assessment/assessing-authorities)

How might occupational co-regulation strengthen the allied health assistant workforce?

It is in the interests of governments to support professional association certification schemes where they have the capacity to improve the safety, quality and competence of the health workforce. Governments also have an interest in ensuring the most cost-effective use of limited health funding and can use these co-regulatory arrangements to promote the most efficient and effective division of labour in healthcare.

For instance, qualified allied health assistants working under the supervision of an allied health practitioner may be able to deliver a range of lower risk, or more routine tasks thereby enabling allied health professionals to see more patients and/or provide more complex and services or meet the needs of more complex clients. However, this relies on the availability a skilled and competent AHA workforce.

What is the role of AHANA in occupational co-regulation of allied health assistants?

AHANA assures the quality and safety of practising AHAs by ensuring that they:

·??????? meet minimum Board endorsed standards of entry, based on qualifications and experience;

·??????? adhere to a Board endorsed Code of Conduct;

·??????? meet minimum safety standards, such as police checks, working with children checks and other requirements that are relevant to their state or territory, and role;

·??????? are covered by appropriate professional indemnity insurance to practise;

·??????? maintain a minimum level of continuing professional development; ?

·??????? are subject to a complaints procedure where appropriate disciplinary action may be taken; and

·??????? have access to peer support through the association.

Strengthening AHANA’s certification program through stronger co-regulatory partnerships with government has many potential benefits – for employers, funders, the profession and, ultimately, those who rely the services of AHAs.

AHANA is already carrying out important quality assurance functions that aim to:

1.????? Enhance quality of care: The primary goal is to help ensure AHAs deliver high-quality care. Standards set by AHANA define what good AHA practice looks like and provide a benchmark that all practising AHAs are expected to meet.

2.????? Protect public safety: Certification by AHANA helps to ensure that AHAs have the appropriate skills and knowledge to carry out their roles safely. This is particularly important as AHAs often work with vulnerable populations, including people with disabilities, the elderly, and those recovering from illness or surgery.

3.????? Maintain professional ethics: AHANA aims to uphold professional ethics, helping to ensure that AHAs conduct themselves in a manner that is respectful, responsible, and in the best interests of their patients/clients.

4.????? Promote continuing professional development: AHANA membership provides a structured way to support ongoing learning and development, which is critical in a fast-evolving field like healthcare. By setting requirements for mandatory continuous professional development, AHANA membership (and certification of non-member AHAs who meet the same standards) helps ensure that AHAs keep their skills and knowledge up-to-date.

5.????? Ensure accountability: AHANA membership and certification of non-members ensures professional accountability by providing mechanisms for handling complaints and carrying out disciplinary actions when necessary. It can protect both the public and the occupation by dealing with individuals who fail to meet the established standards.

6.????? Instill public confidence: Certification of members and non-members should enhance public confidence in AHAs. Knowing that the occupation is governed by a set of clear standards and is under the oversight by external body representing the occupation can increase trust in the services provided by AHAs.

Using co-regulatory partnerships with government agencies to recognise, formalise and finance the important role of AHAs within an allied health delegated model of care has the potential, not only to strengthen the quality of the services provided by AHAs but also to:

·??????? support allied health professionals to delegate more work to AHAs within a formal framework that optimises the expertise of the allied health professional, while increasing their capacity to provide services, and

·??????? increase the capacity of resource-constrained allied health services, to better meet the health needs of the population.

If AHANA’s certification scheme were to be recognised under one or more government programs as the trusted source of advice on the question of who is a qualified AHA, AHAs who hold certain classes of Practicing Membership (and non-member AHAs who are assessed by AHANA as meeting the same certification standards) would likely be viewed more favourably by employers and funders when recruiting to increase the capacity of their allied health workforce.?

Next steps

Allied health assistants do not practise autonomously, instead they work under the delegation of an allied health professional. This means that co-regulatory arrangements would be expected to operate in a slightly different way to how they work with allied health professionals.

To reap the benefits of co-regulatory partnerships may require changes in healthcare financing. However, there are complex policy issues involved, particularly if changes are suggested to the way funding is allocated for allied health services under programs such as Medicare, Department of Veterans Affairs, the National Disability Insurance Scheme or the Commonwealth’s Private Health Insurance Rules.

While it is the role of governments to do this policy work, the first step is to open a dialogue with AHAs and allied health professionals, government and other stakeholders on the potential for AHANA’s certification program to improve the quality and quantity of allied health services.

Consultation process

AHANA’s consultation process will include the following:

·??????? Circulation of this discussion document to elicit feedback

·??????? A public webinar/discussion AHA on co-regulation held on 16 August 2023, at 3PM AEST. The recording is available here.

·??????? Written submissions will be sought via a web form on the AHANA website.

Following initial consultation, AHANA will seek to enter into discussions with government departments or funders about specific government funding programs, with a view to securing in-principle agreement to work together to design co-regulatory arrangements that recognise AHANA’s certification scheme as the basis for determining who is a qualified AHA.

Discussion questions

1.???? What are the advantages and disadvantages of seeking co-regulatory partnerships with governments – for the AHA profession, for AHANA, for the community?

2.???? What might be some of the risks of progressing such a strategy?

3.???? What funding programs might be included in this strategy?

4.???? What are the models of employment of AHAs that might be addressed in this strategy?