Turner-Benny Wakefield University of Auckland Chair of Allied - - PowerPoint PPT Presentation

Ms Petrina Turner-Benny

Chair of Allied Health Aotearoa New Zealand

11:00 - 11:55 WS #32: Mobilising Allied Health to Improve General Practice Output 12:05 - 13:00 WS #40: Mobilising Allied Health to Improve General Practice Output (Repeated)

Clare McCann

Clinical Lecturer University of Auckland

Georgia Wakefield

Dietitian

Mobilising Allied Health to Improve General Practice Outcomes Petrina Turner-Benny, Georgia Wakefield, Clare McCann

A Quick Overview

• Who/What is allied health and AHANZ?
• Where does allied health fit?
• Barriers and challenges to allied health integration
• Battling the obesity epidemic - a grassroots case study
• Connecting for integrated care
• Your turn (to tell us what you think)…

Who are Allied Health?

• I am someone who uses my expertise to meet your optical
• needs. Who am I?
• I am here to listen to and understand your emotional

and/or psychological problems, and to help you gain new understandings about yourself and to make positive changes in your life. Who am I?

• I am someone who enables an individual to repair and

rebalance, regardless of their pathology. Who am I?

Who are Allied Health?

• I can treat people who suffer from injuries and I can also

assist patients so they can be active without having

• pain. Who am I?
• Through the treatment I provide to a child, I am a predictor
• f their future adult health. Who am I?
• I am someone who will learn the lyrics and chords of an

ACDC song in order to engage with my client. That's part

• f my job. Who am I?

Who are Allied Health?

• I can see straight through you. Who am I?
• I am a primary health care provider with a particular

interest in the relationship between structure (primarily of the spine) and function (primarily of the nervous system) as that relationship may affect the restoration, preservation and promotion of health and well-being. Who am I?

• I am someone who helps people to maximise their

receptive communication. Who am I?

Allied Health, Scientific and Technical

More than 50 professions with specialised bodies of knowledge and skills, providing a range of services within health and disability, education, social services and justice settings. Their activities include: Prevention; Identification/Diagnosis; Rehabilitation/Habilitation; Promotion of Health/Wellbeing; Research; and Assessment/Evaluation; Treatment; Advocacy; Education; Leadership/Management.

Allied Health, Scientific and Technical

Allied health, scientific and technical professions work within the health and disability sector alongside medical, nursing and midwifery, and kaiawhina sectors. These professionals:

• Have tertiary (or equivalent) educational qualifications;
• Belong to a professional association;
• Abide by a Code of Ethics and Standards of Practice;
• Participate in professional development within a recognised system

for monitoring ongoing competency; and

• Many are registered under the HPCA Act 2003.

Allied Health Aotearoa New Zealand (AHANZ)

• Society of Allied Health Professional Associations.
• First established in 2001, as Allied Health Professional Associations’

Forum (AHPAF).

• Incorporated in 2013 with newly established Executive Committee

and formal Constitution.

• New associate membership categories in 2014.
• Connected voice of 28 allied health professional associations and four

strategic partners, representing up to 30,000 allied health professionals across NZ.

Allied Health Aotearoa New Zealand (AHANZ)

Our Strategic Goals:

• 1. To provide a supportive and effective forum for

allied health professional associations;

• 2. To promote the value of the allied health workforce;

and

• 3. To influence government and key stakeholders in

relevant policy development, implementation and evaluation.

Allied Health Aotearoa New Zealand (AHANZ)

Our Key Messages:

• 1. Allied health is crucial to improving patient health.
• 2. Allied health is fundamental to people living in the

community and remaining independent.

• 3. Care is not truly integrated unless it includes allied

health.

• 4. Allied health is key to the financial sustainability of
• ur health system.

Our 21st century patients need:

• Largely community-based care
• Multi-skilled health workers
• Responsive systems
• Readily accessible care
• Connected care
• Affordable care
• And appropriately qualified health professionals

and service providers

BUT….

• Our “let’s keep patients out of hospital” approach has not

worked.

• Our high-needs communities and populations still need!
• Community-based care is still the poor cousin of factory-

based care; underfunded, under-resourced, uncoordinated and disparate.

• The motivated, educated and knowledgeable get great care,

those who aren’t often don’t!

Definition of REALLY DUMB…….

Planning to care for tomorrow’s patients using a largely unchanged 19th century model of a hospital/medical-centric system that:

• Was designed primarily for communicable diseases
• In its day didn’t, and still isn’t, meeting the needs of the most

dependent members of our society!

• Has lost much of the community-based health support that

existed when it was designed!

• Is not utilising the rich spectrum of care capability and expertise

developed over the past 150 years.

• Is largely continuing to ignore the causative factors

The NZ Health Strategy

NZ Health Strategy: Future Directions All New Zealanders live well, stay well, get well in a system that is people-powered, provides services closer to home, is designed for value and high performance and works as one team in a smart system.

The NZ Health Strategy

FROM TO Treatment Prevention and support for independence; Focus on the individual Wider focus on family and whanau; Service-centred delivery People-centred services; Competition Trust, cohesion and collaboration; Fragmented health sector silos Integrated social responses.

Take Charge: Managing Six Transformations in Health Care Delivery, Issel et al, Nursing Economics

FROM TO

“MY” Patient My Customer Illness Wellness Cost reduction Total healthcare cost management Professional autonomy Professional interdependence Fragmented care Continuity of care and information Passive patient Quality conscious consumer This paper was published in 1996 !!!

Understanding the Need – What the Ministry Has Said

The NZ Health Strategy

The NZ Health Strategy

Investment approach: Investment in long-term financial benefits (education, employment, alcohol/drug dependency, family violence, mental health) and non-financial benefits. Provide a strong incentive to focus on the long-term impacts and value alongside immediate short-term goals.

Closer to Home

• Well-designed and integrated pathways
• Services as close to home as possible
• Identify, prevent and slow deterioration of early health problems
• Well co-ordinated care for complex needs
• Right services in the right location
• Equitable
• Cost-effective
• Fully utilise health professional skills and training
• Address common risk behaviours

One team

• United approach and best use of skills – medical, nursing, allied

health, Kaiawhina, researchers

• Link health with related pressure points in housing, education and

employment

• Join up organisations with common interest / investment
• Invest in capability and capacity of workforce.

NZ Health Strategy

Some of the strengths:

• Developed in context with a funded universal health

system and a committed and highly trained workforce;

• Health services with a strong focus on primary care

and a widely supported focus on wellness; and

• Strong Government desire for health and social

services to work better together.

NZ Health Strategy

Some of the challenges:

• Aging population - more health and social services

needed for people to remain healthy and independent;

• Rise in obesity, with resultant social and long-term

health impacts;

• Does not effectively address our high-needs

population, creating further inequity.

NZ Health Strategy

Some of the challenges:

• No leadership within the Ministry of Health
• The Roadmap of Actions supporting the strategy are

not actions, they are intents

• Fragmented IT solutions with lots of reinvention
• Current model of service provision is unsustainable,

but appetite is limited to change the funding model.

Challenges to Better Integration

Funding: Resourcing the integrated care laid out in the Health Strategy will require:

• DHBs funding of services when they change setting

(not a short-term cost-cutting exercise); and

• Investment from general practice in workforce and

facilities in order to provide services in a new way.

Challenges to Better Integration

Funding: Current integrated service close to patients’ homes is geographically localised. The ability to shift services seen as dependent on:

• Relative investment of resources in such services; and
• Workforce development required to provide

increasingly complex and interdisciplinary range of services.

Challenges to Better Integration

Ministry of Health perceptions of allied health:

• No strategic leadership allied health advisory

position

• Chief Medical Officer, Chief Nurse ????
• MOH tend to consult with pharmacy profession

as the representative of the allied health sector.

Challenges to Better Integration

Professional Challenges

• Predominantly female professions
• Professions working largely in isolation, so they have

been made invisible or absent

• It has often been difficult for GPs and colleagues to

refer to or understand what different professions can

• ffer
• Public do not always know they can self-refer.

Challenges to Better Integration

General Practitioners’ Perceptions of Allied Health

• Confusion around the professions under the HPCA Act

where some professions are not included.

• A perception amongst GPs that many allied health

professionals sell ‘snake oil’.

Challenges to Better Integration

General Practitioners’ Perceptions of Allied Health

• “I generally do not refer to alternative practices. preferring

evidence-based modalities. Would prefer more rigorous

• versight of some modalities.”
• “I only refer to people who are adequately qualified in

verifiable professions and who take responsibility for their

• work. I do not refer to 'alternative' or quack people.”
• “Non-regulated health ‘professionals’ are called quacks,

aren't they?”

Challenges to Better Integration

GP perceptions of allied health: In response to being asked what prevents GPs making more referrals to an allied health professional as part of the patient’s care plan or for support in managing their long-term condition:

• 46% said Lack of awareness of local services available
• 79% said Cost of services to patient
• 14% said Nothing

General Practice Sustainability Report

Some key recommendations from 10 regional forums held around the country:

• Targeting high needs;
• Workforce sustainability; and
• Shifting services.

General Practice Sustainability Report

Workforce Sustainability

• Investigate mechanisms for recognising and rewarding

practice accreditation and vocational registration

• Develop career pathways for medical, nursing and
• ther professionals within the interdisciplinary general

practice team.

General Practice Sustainability Report

Shifting Services

• Make it a priority to enhance coordination of General

Practice and include the following services under primary (or joint) governance: a. Community-based radiology and other diagnostic services; b. District and community nursing; c. Dietetics and nutrition advice; and d. Social workers and other allied health practitioners, e.g. physiotherapists.

General Practice Sustainability Report

Workforce Sustainability and Shifting Services

• Endorse the basic principles of the Health Care home

care and workforce models

• Encourage a greater emphasis on comprehensive and

well-coordinated care provided by a wider team.

Case Study – Kaiawhina Trial

• Systematic review of the dietetic workforce in primary

care.

• Hon Dr Jonathan Coleman announcement of

childhood obesity and diabetes as priorities.

• Ministry announcement of priority for high-needs

populations.

• Careerforce NZ development of a Health and

Wellbeing Level 4 qualification.

Case Study – Kaiawhina Trial

Key Questions:

• What are the key social issues facing high-needs clients?
• What key services are needed to address these?
• What does an affordable, integrated, sustainable and

client-centred community-based nutrition health service look like?

• What are the workforce requirements needed to support

this?

Case Study – Kaiawhina Trial

Barriers:

• Rhetoric within Government and NGO circles but a

lack of action

• A Multi-faceted and very complex problem
• A slowly improving but still severely lacking

understanding of allied health by GPs

• A need to work outside of health “silos”.

Case Study – Kaiawhina Trial

Things that could be influenced:

• Training more closely linked to employer needs
• A desire to make a difference
• Grassroots solutions that are directed by and for the

communities that need them

• Collaboration and communication between agencies.

Case Study – Kaiawhina Trial

Networking discussions:

• Mayor of Porirua
• MOH [Childhood Obesity Plan]
• Treasury [Health Funding team]
• University of Auckland and University of Otago
• National Heart Foundation
• Primary Care Dietitians in Porirua, Wellington and Hutt Valley
• Careerforce
• Porirua community leaders

Case Study – Kaiawhina Trial

Proposal:

• Upskill Kaiawhina to deliver nutrition messages whilst

supported by a qualified dietitian.

• To improve the numbers, status and profile of dietitians within

primary care.

• To trial a pilot programme in a high-needs area with:
• An engaged and willing population; and
• Strong links between community groups, schools, businesses and

local government.

Case Study – Kaiawhina Trial

Case Study – Kaiawhina Trial

• Collaborative working

relationships

• Support self-determination
• Recognise the purpose and

impact of own role

• Knowledge of models, tools and

strategies used to support holistic health and wellbeing

• Ethical and reflective practice
• Engage and recognise the

context in which individuals, families, and/or whanau live

• Acknowledge the history of

Maori as tangata whenua

• Contribute to a culture of safety
• Demonstrate leadership.

Case Study – Kaiawhina Trial

Community Wellbeing Strand

Graduates will also be able to: Support individuals, family and/or whanau to manage their own health and wellbeing. They may be employed as community health workers, whanau support workers, tamariki ora or field workers.

Case Study – Kaiawhina Trial

Porirua Kaiawhina Trial

• Stocktake of all nutrition and exercise programmes in the

region.

• Kaiawhina workforce enrolled in the Careerforce NZ

Qualification

• Coordination of activities within schools, churches,

community agencies and local businesses

• Business case.

Connecting for Integrated Care

Opportunity to connect, to learn and understand what

• ther health professionals do. Aims:
• Build local networks;
• Identify integrated projects/services;
• Provide information about professions and services;
• Explore opportunities for collaboration; and
• Raise the profile of allied health professionals.

Connecting for Integrated Care

• Successful pilot event in 2015
• Attendees from a range of professions:
• Physiotherapy, Acupuncture, Dietetics, Clinical Psychology,

Counselling, Podiatry, Music Therapy, Osteopathy, Chiropractors, Speech-Language Therapy, Orthoptics and Occupational Therapy.

• Look out for the next event coming to your area.

General Practitioners cannot do this by themselves. It’s time to do something different, together.

Your turn (to tell us what you think)…

What are the 3 most important things that would fundamentally change the way you proactively manage your patients? [e.g. Diagnostics, IT, access to allied health?]

Your turn (to tell us what you think)…

Where, within the primary care sector or

• n the continuum of care, should we be

focusing or putting our energy in order to initiate change?

Your turn (to tell us what you think)…

What are the factors that are motivators and demotivators to enable this to happen?

chair@alliedhealth.org.nz