agenda
for CHANGE
2014
the community services and Health industry
skills council has prepared this environmental scan
to highlight industry intelligence about existing
and emerging trends in the community services
and health industry, especially with regard to
workforce development.
as the industry skills council for this industry,
our role is to lead, advise and assist on workforce
development and develop the national work-based
qualifications that are integral to ensure quality
care and support for all australians.
this environmental scan has been produced
with the assistance of funding provided by the
commonwealth government through the
department of industry.
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Community Services and
Health Industry Skills Council
provides the direction for
workforce development
for Australia’s Community
Services and Health industry.
We drive this development by:
» providing advice and intelligence » developing skills » supporting growth » working in collaboration. Advice
We ensure that industry
information and other research we gather is shared with governments and government agencies, employers, unions, trainers, workers and potential workers so that decisions affecting our industries support the development and growth of our workforce and reflect client needs.
Skills
We have developed 160
qualifications, 1,198 competencies and 80 skill sets that form the national Vocational Education and Training (VET) standards for community services and health. These standards support a broad range of job roles carried out by 800,000 plus workers in Australia, and form the Community Services Training Package and the Health Training Package. Our training packages are used to ensure consistency and quality in training, and support workforce develop.
Workforce Growth And Development
We influence workforce development using a four- level strategy:
» national/industry: developing information and workforce predictions on policy and reform implications
» state/sector/region:
developing models to operate in specific locations that connect agencies working in the same sector to strengthen the service outcomes
» enterprise: showcasing and supporting best-practice models for service delivery through workforce planning and training including growing foundation skills
» individual: helping existing and potential workers access career advice and pathway information.
Collaboration
We maintain a two-way relationship with government advisory bodies, unions, peak bodies, associations, state and territory advisory boards and training providers to bridge the information gap on issues and activities impacting our workforce.
CS&HISC is one of 11 nationally recognised industry skills councils funded by the Australian Government. It is a not-for-profit company limited by guarantee and governed by an independent and industry-led Board of Directors.
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contEntS
LIST OF TABLESTable 1: Ten fastest growing
health and community service specific occupations (by change in 000s, 2006-11) 09 Table 2: Language spoken
at home by ANZSIC
industry subdivision 20 Table 3: Potential new and
emerging roles identified by the Community Services and Health industry 37
LIST OF FIGURES
Figure 1: Projected
employment growth by
industry, Nov 2012-Nov 2017 11 Figure 2: Projected growth
(‘000s) in selected health and community service specific occupational groups,
Nov 2012-Nov 2017 11 Figure 3: Community
Services and Health Training Package enrolments (‘000s),
2008-2012 25
Figure 4: Health enrolments
(‘000s) in Higher Education and VET sectors, 2008-2012 26
Figure 5: Course enrolments
in Victoria, Community Services and Health Training Packages, by level of qualification 27 Figure 6a: Community Services
Training Package enrolments by students’ age, 2008-2012 28 Figure 6b: Health Training
Package enrolments by
students’ age, 2008-2012 28 Figure 7: Community
Services and Health Training Package enrolments (2012) and resident population by area of remoteness (ARIA+) 29
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Overview 08Strong and Growing Demand 09
Implications for Industry 12
The Policy Environment 12
Changes to VET Funding 13
Recruiting, Retaining and Distributing Staff 14 Data to Drive Accountability and Transparency 15
Key Points 15
02. Identified Workforce Development Needs
16
Overview 18 Key Skills for a Changing Industry 18 Skilling Across Aligned Sectors 20 Workforce Strategies: Growth and Retention 20
Focus on CALD Workers 20
Attracting Younger Workers 21
Retention of More Mature Workers 21 Workforce Development to Improve Access 21
03. Current Impact of Training Packages
22
Overview 24
Training Package Uptake 24
Impact of VET Reforms 26
Student Profile 26
Qualifications and Vocational Outcomes 30 Industry Views on Current Training 30 Broader Impact of Training Packages 31
04. Future Directions of Training Packages
32
Overview 34
New and Emerging Roles 35
Improved Pathways 36 Streamed Qualifications 37 Speed to Market 38 End Notes 39 References 40 Appendices 42 Abbreviations 102
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KEY
InSIGHtS
the Community Services and Health industry continues to be
Australia’s largest and fastest growing employer. In the context
of this growth there are a number of challenges that industry
and governments will have to work together to address.
Industry stakeholders have told us that care and support services are facing the following challenges:
a. Strong and changing service demand: Population ageing is increasing service demand and the adoption of consumer-directed funding models will transform the way services are delivered.
b. Uncertainty in the policy environment: The scope and scale of changes in service demand are rapidly shifting. The workforce implications of key service reforms such as the National Disability Insurance Scheme (NDIS) have yet to be fully understood or realised. Also, developments in the Vocational Education and Training (VET) sector have implications for our capacity to train the future workforce required to meet increased service demand.
c. Need for better data: Difficulties accessing relevant and high-quality training and workforce data makes workforce planning for the Community Services and Health industry challenging, particularly with changing service demand and a shifting policy landscape.
d. Gaps in supply: With increased demand for workers current workforce shortages will increase without effective and coordinated strategies to supply sufficient and appropriately skilled workers.
e. Difficulty recruiting and retaining staff: In addition to gaps in supply, the low wages and poorer employment conditions for some roles are known to create real barriers to recruitment and retention. Other reported barriers to recruitment and retention include: low awareness of
opportunities; an ageing workforce; an unwillingness to work in certain geographical areas; and for some roles, negative perceptions about the work.
f. Threats to training capacity: The future capacity to train the required number of appropriately skilled workers may be inhibited by: difficulties obtaining appropriate work placements for VET students; conflicting training priorities between the state and national levels; and a growing disconnect between the VET and higher education (HE) systems. The Community Services and Health industry must deal with these ongoing challenges in the context of finite public resources. While this is challenging, the current uncertainties create opportunities to redefine the shape of our industry to better plan for a more sustainable future.
A new
national health and
community services workforce
development plan will improve our
focus on meeting the needs of
those requiring care and support.
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Agenda for Change Addressing the challenges identified by industry will require a national health and community services workforce development plan. A national workforce development plan will assist the health, community services and education sectors to become more focused on meeting the needs of those requiring care and support. The latest intelligence points to an agenda for change for our industry and tells us that this new workforce development plan must address the following: 1. Sustainability through
improved workforce planning: Australia needs a sustainable approach to workforce development that addresses workforce supply to avoid future shortages.
This will require a whole of workforce approach to workforce planning; greater inter-agency collaboration; and industry engagement in the development and implementation of policy that acknowledges the fundamental issues affecting the health and community services workforce.
2. Develop skills for changing service needs: Changes in service delivery must be supported by appropriate training and workforce development. Consumer-directed funding; clients with multiple needs; client-centred care and support; and providing services in a person’s home all demand a broad skills base. It is therefore more important than ever that qualifications and training deliver the full range of skills required for care and support roles, including new and emerging roles. 3. Promote strong partnerships
between training providers and workplaces: Training and service providers share the responsibility for ensuring that training produces graduates with the appropriate skills for the job. Strong partnerships between training and service providers are essential and therefore any challenges to these partnerships should be addressed.
4. Ensure transparency and accountability: The systems and processes for workforce planning should be transparent, with clear lines of accountability supported by effective industry engagement. In particular, our
industry needs a data system that supports inter-agency data sharing with industry and has clear accountabilities for collecting and reporting relevant data. New data and better use of existing data are needed to ensure that current and future workforce development activities can be better evaluated.
5. Support enhanced workforce productivity: Expansion of services in an increasingly constrained fiscal environment requires a much greater emphasis on workforce productivity. Service providers will need to be supported to innovate and evaluate new ways of working in a more productive way.
6. Support recruitment and retention: Recruitment and retention strategies are needed to address concerns about pay and conditions. Service providers also need support to identify and recruit for the personal attributes as well as the taught knowledge and skills required for work in the health and community services.
01.
lAtESt
IntEllIGEncE
latest intelligence confirms a
continued increase in demand for
health and community services.
It also suggests a shifting policy
landscape is contributing to
uncertainty around the workforce
required to meet future demand.
projECtED
GroWtH IN
popUlAtIoN
AGED 65
AND ovEr
INformAl CArErS
HAvE tHEIr oWN
trAINING NEEDS
million
80 2.6
CoNtINUES to
bE AUStrAlIA’S
fastest
growing
EmploYEr
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With further increases in employment
growth projected, the need for workforce
sustainability will require continued
attention to innovation and improvements
in productivity.
Overview
Industry intelligence and the latest workforce data show that increased service
demand has been accompanied by an increase in the size of the workforce. In the
context of this growth, health and community service providers continue to report
difficulties recruiting and retaining sufficient numbers of appropriately skilled staff.
Workforce projections suggest that our workforce will continue to grow.
However, there is a lack of clarity around the scope and scale of changes in
service demand and of the consequent implications for education, training
and workforce development.
This is, in part, because the workforce implications of key service reforms such
as the National Disability Insurance Scheme (NDIS) have yet to be fully understood
or realised. Adding to this uncertainty are changes in VET funding at the state/
territory level. These changes are contributing to concerns about Australia’s
future capacity to train the number and quality of workers required.
The industry is still under pressure to deliver services to an ageing and expanding
population in a tight fiscal climate. Reconciling these competing pressures can only
be achieved through an increase in productivity. Service providers will need to be
supported to innovate and evaluate new ways of working in a more productive way.
Workforce planning for the care and support industry lacks strategic engagement
and coordination across governments and industry. It has traditionally focused on the
degree qualified professions, despite growth in the numbers of VET qualified workers.
To avoid future shortages, Australia needs a health and community services
workforce plan that considers the development of the whole workforce, is supported
by high quality data and involves effective inter-agency collaboration and industry
engagement. Greater stability with a clear vision for overall policy settings will
be necessary to achieve a sustainable workforce development strategy so that
Australia’s community services and health workforce can deliver on its potential.
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STRONG AND
GROWING DEmAND
Increases in demand for care and support services are being driven both by demographic factors and service reform. Increasing demand for support services as a result of population ageing has been identified as a significant force currently reshaping the Australian Community Services and Health industry (AIHW 2013).
Both internationally and in Australia, health and community services have been moving consistently towards home-based and individualised models of support across the industry, particularly in disability, aged care and mental health. The move to individualised, consumer-directed funding models will continue to impact on the nature of care and support
services being delivered and associated numbers of workers required. For example, full national rollout of the NDIS is expected to require the disability workforce to double in size (Treasury 2013, p17). At the same time, the age structure of the paid care and support workforce means many workers are expected to retire in the next decade (NDS Victoria 2013).
tAblE 1:
tEn FAStESt GrowInG HEAltH And communIty SErvIcE SpEcIFIc occupAtIonS
(by cHAnGE In 000, 2006-11)
Occupation
(ANZSCO 6 digit level) 2006 2011 Growth (000s) Percentage growth
Aged or Disabled Carer 77,414 108,216 30.8 39.8% Child Care Worker 59,472 80,512 21.0 35.4% Other Registered Nurses
(not further defined)
45,115 61,675 16.6 36.7% Teachers’ Aide 34,314 48,221 13.9 40.5% Occupational Health
and Safety Adviser
6,842 15,279 8.4 123.3% Registered Nurse (Critical
Care and Emergency)
9,915 16,584 6.7 67.3% Community Worker 17,875 24,242 6.4 35.6% Personal Care Assistant 21,957 28,041 6.1 27.7% Welfare Worker 11,267 17,191 5.9 52.6% Registered Nurse (Perioperative) 10,010 15,852 5.8 58.4%
Source: ABS Census of Population and Housing, 2006 and 2011 – customised data request for CS&HISC using the most detailed ANZSCO occupational classification (six-digit level). Please refer to end note i.
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The population aged 65 and over is projected to increase from 3.2 million in 2012 to between 5.7 million and 5.8 million in 2031 (ABS 2012). This will place pressure on aged care services as well as “a wide range of acute and sub-acute health services” (Department of Health, Victoria: submission to EScan 2014). This demographic shift means that increasing service demand in the care and support industry is expected to endure despite the state of the economy, and is likely to have
a greater impact than economic or cyclical factors.
The increased demand for services has been accompanied by increases in the numbers of workers. Table 1 presents 2006 and 2011 Census data that confirm the strong growth in a number of occupations, most notably ‘Aged or Disabled Carers’ (aged care workers and disability support workers), an expansion that has been supported by strong growth in demand for both aged care and disability services. Similarly, in response to increased demand for child care services there has
been a substantial increase in the number of child care workers. Despite these increases however, current workforce shortages have been reported in a number of areas including aged care and child care (DEEWR 2013a).
Alongside the paid carer workforce, there are also substantial numbers of unpaid or ‘informal’ carers. The National Carer Strategy recognised that the 2.6 million unpaid or informal carers in Australia have their own training needs (Department of Families, Housing, Community Services and Indigenous Affairs 2011). However, changing family structures may mean a declining proportion of Australians requiring care will be able to rely on informal carers in the future (Productivity Commission 2011a, p56). Any decline in the number of informal carers will need to be addressed by additional paid workers or incentives (financial or training) to support informal carers.
Government projections show that Health Care and Social Assistance will continue to be the fastest growing industry in actual terms between November 2012 and November 2017 (Figure 1).
Figure 2 shows the 10 occupational groups, specific to health and community services, that are predicted to have the highest actual growth between November 2012 and November 2017 (Department of Employment, 2013). These latest projections place greater emphasis on the future role of VET-trained occupations than previously projected; for example, the number of Aged and Disabled Carers is expected to increase by around 31,300 (or 27.7%). This is greater than the increase projected previously (see occupational projections to November 2016, DEEWR, 2012) and is the largest projected increase of all health and community service specific occupations. There is now only a modest increase (an additional 10,200 or 4.2%) of Registered Nurses projected from 2012 to 2017.
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fIGUrE 2:
projEctEd GrowtH (‘000) In SElEctEd HEAltH And communIty SErvIcE
SpEcIFIc occupAtIonAl GroupS, nov 2012–nov 2017
Source: Occupational Projections to November 2017, Department of Employment (2013)
31.3 15.5 0 5 10 15 20 25 30 35 C ounsellors Ps ychologis ts Dental As sis tants Social W ork ers Medical Technicians W elf ar e Support W ork ers R egis ter ed Nurses Gener alis t Medical Pr actitioners Child Car ers A ged and Disabled Car ers Pr oject ed change ('000s ), No v 20 12 - No v 20 17 10.6 10.2 5.9 5.3 5.2 4.3 3.9 3.4
fIGUrE 1:
projEctEd EmploymEnt GrowtH by InduStry, nov 2012–nov 2017
Source: Industry Projections to November 2017, Department of Employment (2013)
-50 0 50 100 150 200
Agriculture, Forestry and Fishing Electricity, Gas, Water and Waste Services Information Media and Telecommunications Rental, Hiring and Real Estate Services Mining Manufacturing Wholesale Trade Financial and Insurance Services Arts and Recreation Services Administrative and Support Services Other Services Transport, Postal and Warehousing Public Administration and Safety Professional, Scientific and Technical Services Education and Training Accommodation and Food Services Construction Retail Trade Health Care and Social Assistance
Projected change in employment (‘000) 177.8 109.1 100.2 66.8 64.5 62.8 43.2 41.6 38.5 26.1 21.8 16.1 15.5 14.2 11.5 11.1 9.6 3.3 -13.5
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Implications for Industry
Increases in government expenditure are being driven by population ageing, and are expected to continue partly as a consequence of new technologies and the demand for higher quality services (Productivity Commission, 2013). Australia will need a larger workforce to support the NDIS and to accommodate a $6.9 billion growth in demand for mental health services (Productivity Commission, 2011b).
With further increases in
employment growth projected, the need for workforce sustainability will require continued attention to innovation and improvements in productivity. There is a compelling need for more sustainable and productive approaches to delivering services, especially in areas such as aged care, disability and mental health. Innovation in service delivery must be supported by workforce development that focuses on equipping staff with the skills, knowledge and experience required for the jobs to be performed in the future. These innovations are likely to lead to changes to individual roles; and working conditions will need
to support the recruitment and retention of sufficient workers with the required skills. Currently there is a great deal of emphasis within the care and support industry on measuring resource inputs but relatively little on the actual outcomes. However, it is difficult to draw conclusions about productivity when performance metrics are not clearly articulated.
Measuring productivity in the Community Services and Health industry appears to have been put in the ‘too hard basket’. The Community Services and Health Industry Skills Council (CS&HISC) believes it is time to make a start on generating productivity metrics. Growth in the demand for
appropriately skilled workers requires an increase in the numbers of future workers being trained. This will increase the pressure on service providers to deliver work placements for VET and university students. Issues relating to the sustainable provision of work placements are increasingly being considered (Perlin 2011; Scott and Oliver 2013; Stewart and Owens 2013) and require further attention in the VET sector.
Organisations will require a high level of leadership and management skill to ensure that industry successfully makes the transition to new policy and funding parameters. Service providers also have the challenge of implementing new ways of working while
ensuring that working conditions attract more and diverse workers. In light of recent changes to the nature of the Aged Care Workforce Compact (Crowe 2013), concerns about workforce shortages being exacerbated by low wages are particularly pertinent.
THE POLICY
ENvIRONmENT
There is a high degree of uncertainty in the current policy environment that health and community services workforce operates within. The full implications of key current health and community service policies are not yet known, resulting in uncertainty about about the workforce required.
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“Under a full National
Disability Insurance
Scheme, the disability
workforce figures are
expected to double,
however what that
workforce [will] look like
is difficult to gauge”
(Community Services Directorate, ACT: submission to EScan 2014).
In addition, the new federal government is yet to announce its program of reform for community services, health and tertiary education and the National Commission of Audit recommendations may lead to changes that will also take time to be fully realised.
Some of this uncertainty relates to concerns about possible reductions in funding. However, the latest available data on government and private expenditure (up to the 2012-13 fiscal year for community services and 2011-12 for health) show that expenditure continues to increase, both in real terms and as a proportion of the national revenue base (see Appendices C1 and C2). The increase in government expenditure has occurred across all reported community services and health sectors, with the exception of spending on private hospitals (Productivity Commission 2014). A slowing of federal government expenditure is expected for the period ahead. The most significant policy developments include the implementation of aged care reforms and the roll-out of the NDIS (please refer to end note ii). These reforms focus on increased consumer choice and control and require the industry to build workforce capacity and skills.
For example, it is anticipated that full roll-out of the NDIS will require the formal disability workforce to double in size (Treasury 2013, p17). There are concerns that this service expansion and reform will exacerbate existing workforce shortages and that the higher wages paid in the disability sector will divert staff away from aged care. In addition, feedback from the NDIS demonstration sites indicates that the average cost of the NDIS per person is 15 per cent higher than what was originally budgeted (Wilson 2014). This level of overspend is unsustainable if replicated in the national roll out. Changes in regulation are also impacting on the care and support workforce. It is anticipated that the national regulation of Aboriginal and Torres Strait Islander health practitioners will improve the recognition and effectiveness of this role across Australia. In child care, reforms under the National Quality Framework (NQF) are already impacting the child care and early childhood development workforce. For example, new quality standards mean that from 2014 every long day care, family day care, preschool, and outside school hours service is expected to maintain a specific ratio of Certificate III, Diploma and Degree qualified staff based on the number of children and their ages. This requirement is driving the need to train and recruit new workers as well as up-skill existing workers. The overwhelming industry-held view is that the changing policy environment will alter the scope and shape of the care and support workforce, with some pointing to an increased role for VET-qualified workers.
“Growing a sustainable
workforce will require
a greater mix of skills
for new and emerging
roles and an increased
utilisation of
vEt-qualified workers”
(Department of Health, Victoria: submission to EScan 2014).
Health and community service providers are looking to policy makers for guidance on how to respond to the implementation of consumer-directed models of funding.
Changes to vET Funding
Industry also expressed concern that the VET system may not be able to supply the number of appropriately skilled workers required to respond to changes in service demand and delivery. Reforms in VET funding are being implemented across a number of jurisdictions and aim to focus the provision of VET subsidies on areas of greatest public benefit and industry need.
However, where these reforms result in an increase in fees, there is concern that even with fee support any increase in fees adds to the risk that certain groups will perceive training to be unaffordable; a perception that could lead to a reduction of enrolments. The longer term implications of this could be significant, with a decrease in overall student numbers that may impact national efforts to supply the future required workforce. This is a particular concern for qualifications leading to occupations for which there is strong demand and for Diploma and Advanced Diploma qualifications, which support the development of much needed leadership and management capability.
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Assessing the impact of the current changes in funding is complicated as each state and territory has its own list of priorities with different methodologies for determining which qualifications are to be considered a priority. While some differences between jurisdictions are to be expected, there needs to be national oversight of state training priorities and incentives to support the development of Australia’s future health and community services workforce. The impact of previous changes to VET funding on enrolments is discussed in section three of this report.
RECRUITING, RETAINING
AND DISTRIBUTING STAFF
Difficulties recruiting and retaining staff continue to be reported across our industry. Some difficulties are national and relate to demographic changes, increased service demand and changes in national policy and regulation. For example:
» in child care, current and persistent shortages of appropriately qualified child centre managers and child care workers have been reported (DEEWR 2013a)
» in aged care, the most recent census and survey of the aged care sector showed difficulties recruiting and retaining staff (Aged Care Workforce final
report, king et al 2012). More
recent evidence indicates that while vacancies are relatively easy to fill it is harder to recruit for roles providing in home care, and providers across the sector continue to report difficulties retaining staff (DEEWR 2013b). The Aged
Care Workforce final report also
highlighted the need to define the social and emotional skills associated with direct care work, in order to support the recruitment of workers with the attributes required for direct care work (King et al 2012). There are indications that poor distribution of the workforce continues to create shortages in certain regions. Stakeholders reported difficulties recruiting suitably qualified workers in aged care, child care and other areas including clinical coding, allied health assistance and child protection. Reported difficulties also related to the need for workers with the skills required to respond to changes to service delivery. For example, the need for:
» support workers in aged care and disability with the skills to respond to co-morbidity
» qualified and experienced managers and leaders
» experienced mental health workers to manage and co-ordinate peer workers. Stakeholders also felt that some recruitment difficulties related to barriers in the system, such as misdistribution or inefficient training pathways, which restrict supply of workers into particular roles or to rural and remote areas. Examples highlighted by stakeholder submissions include:
» difficulty in regional areas recruiting Certificate III and Diploma qualified child care workers to meet the national quality standards
» incentives are encouraging private sector medical practices to recruit Aboriginal and Torres Strait Islander health workers, driving increasing demand for a limited supply.
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In the view of many stakeholders, low pay remains an important barrier to improving workforce retention. As a result of a decision by the Fair Work Commission in 2012, around 150,000 workers in social, disability and community services are due to receive pay increases of between 23 and 45 per cent.
However, to address the barrier of low pay fully, other initiatives may be required. Appendix C4 provides details of the workforce shortages, skill gaps and system constraints identified by stakeholders.
DATA TO DRIvE
ACCOUNTABILITY AND
TRANSPARENCY
Difficulties accessing relevant and high quality training and workforce data, in a time of change and uncertainty, makes health and community services workforce planning challenging (Goodger 2013). There are a number of agencies collecting data without transparent protocols for how that data is being shared and being made available to industry in a digestible format.
While national registers of health professionals exist and new registers are being developed, data collection on the care and support workforce needs to more inclusive of the broad range of care and support occupations, including those roles that are VET qualified.
The current Australian and New Zealand Standard Classification of Occupations (ANZSCO) system limits industry’s ability to classify and count the numbers of workers in certain roles, (please refer to end note iii). Where data is not available it is difficult to plan effectively, and ultimately reduces the likelihood of a coherent workforce development strategy for the Community Services and Health industry.
Stakeholders have highlighted the need for better data to assist in the development of the required workforce.
“there is no agreed
assessment for future
demand, and no
place to create this
agreement. the sector
needs to undertake
better and more
detailed demand
estimation, service
modelling and transition
planning in order to
meet future needs”
(EScan 2014 interview, peak body, Mental Health sector).
Effective and sustainable workforce planning demands a data system where accountabilities for collecting and reporting relevant data are clear and inter-agency data sharing is supported. New data and better use of existing data is needed to ensure that current and future workforce development activities can be better evaluated, both regionally and nationally.
Key Points
»
There is strong and growing demand for health and community services.
Occupations such as child care workers and support workers in aged care,
disability support and home and community care have experienced strong
growth and numbers are projected to continue to increase over the next
five years.
»
There is considerable uncertainty in the policy environment. What is certain
is that the industry will be subject to greater funding pressure. Workforce
innovations will be essential to meeting future demands for services.
»
Planning for the future and responding to changes in the policy settings
for health, community services and VET is made more difficult by the lack
of reliable, comparable and transparent training and workforce data.
02.
IdEntIFIEd
worKForcE
dEvElopmEnt
nEEdS
Strategies to attract new workers,
develop skills and retain existing
workers will need to respond to
increased demand for services,
a shifting policy context and
the changing needs of clients
and workers.
WorKErS
SpEAK ENGlISH
AS A SECoND
lANGUAGE
of DIrECt-CArE
WorKErS IN AGED
CArE WErE borN
ovErSEAS
in
%
1 5 32
rEmotE ArEAS
HAvE
poorer
access
to HEAltH
prACtItIoNErS
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KEY SKILLS FOR A
CHANGING INDUSTRY
New service delivery models being introduced throughout health and community services require a change in skill-mix and mindset. In disability, transition to a new market model of individualised funding, and the expected increase in home-based services will require changes in the skills sets and the approaches of both workers and organisations (NDS Victoria 2013, p4). The entire disability support workforce will need to effectively promote client choice and control (Cortis et al 2013).
More broadly, it is expected that consumer-directed funding models will require workers to have increased personal accountability and decision-making responsibilities, and the ability to collaborate with workers in other services.
In addition, workers will need to provide care and support within client-centred approach to service delivery and an understanding of the practice implications of a human rights based framework.
Strong leadership and
management skills will be
necessary to manage the
organisational, cultural
and financial implications
of consumer-directed services.
Overview
Changes in service demand and delivery must be
supported by appropriate training and workforce
development. As was the case in EScan 2013 there
is a need to develop skills for consumer-directed
care, enhance leadership and management
capability and to support skilling across sectors.
Current policy is advocating a move to individualised
(consumer-directed) funding models for care
and support services.
Strong leadership and management skills will be
necessary to manage the organisational, cultural
and financial implications of consumer-directed
services. Also the move to more consumer-directed,
home and community delivered services is likely
to lead to an increased demand for workers with
a broader base of skills and the further blurring
of boundaries between traditional sectors, (please
refer to end note iv).
To meet increased service demand the industry will
need to continue to develop and implement strategies
that attract new workers and retain existing workers.
To meet the demand for health and community
services in rural and remote areas innovative use
of new and existing roles will be required.
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“Staff need to become
more flexible and,
more broadly, better
trained. they need
to define their roles
as client-centric
rather than
service-centric. they need to
be encouraged and
supported to move
out of their silos into
ways of working which
transcend traditional
paradigms in favour
of addressing client
disadvantage in a
holistic manner”
(Department of Human Services, Victoria: submission to EScan 2014).As the move towards consumer-directed models of care gathers pace, industry will need strong support to develop comprehensive workforce
development plans that achieve Australian Government policy objectives. While industry remains largely supportive of the move to consumer-directed models, some stakeholders raised concerns about the resources service providers will need to investigate and strategically consider the workforce and business planning implications of these changes. As market pressures increase, many small providers will need to be supported to develop workforce plans, and larger providers should be supported to evaluate the effectiveness of their plans. High levels of leadership and entrepreneurial skills are required to shift organisations and workers to new service delivery models. Stakeholder feedback singled out the improvement of the management and leadership skills of middle level managers as being particularly crucial.
“Improving
management
and leadership
competencies is
[a priority], particularly
in relation to
developing middle
managers’ [ability
to]: lead practice
supervision and
support; effectively
manage risk;
encourage service
cultures that support
person-centred
practice; and drive the
implementation of new
workforce practice
and innovation”
(NSW Health: submission to EScan 2014).Under the Aged Care Workforce Innovation Project funded by the Department of Industry, CS&HISC is engaged in two initiatives that encourage an industry led approach to improving leadership and business management capacity in the aged care sector. More information about the Aged Care Workforce Innovation Network (WIN) and Aged Care Leadership development project is available on our website: www.cshisc.com.au.
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As the client-base becomes increasingly diverse, industry stakeholders also noted the need for culturally sensitive services. This involves employers providing working environments that are ‘culturally safe’ for workers and clients, as well as workforce development that equips workers with the required skills and cultural competencies.
SKILLING ACROSS
ALIGNED SECTORS
With the introduction of
individualised funding models, it is expected that service complexity will increase. Consumers may, for example, need to access disability, aged care and housing services simultaneously. This means that the industry will need to develop and maintain a workforce that is able to operate across a range of service contexts. An increase in at-home care will involve the management of chronic and complex conditions in the home and in the community. This will require more generalist roles with the ability to determine when and how to enlist specialist assistance. These workers will require a broad base of skills, drawing knowledge from different disciplines and across sectors in order to better support clients. Workers of the future will need to be able to apply their knowledge over a broad range of areas and
have the skills required to improve the functioning of multi-disciplinary teams. This is likely to be a particular requirement in rural and remote areas. Organisations will need to operate in ways which use specialist and generalist workers effectively and recognise the complimentary roles of both within a team.
“With ever-increasing
demands for health care
it is essential to make
the best use of every
health practitioner
available. this means
that all health
professionals should
be working within their
competencies to their
full scope of practice”
(National Rural Health Alliance: submission to EScan 2014).Workers’ skills and qualifications should be matched to the job they are required to do. As such, new revised qualifications will need to reflect the broader range of knowledge and skills required of roles redesigned in response to changes in service and funding
models. In addition, there is a need for new qualifications that better support flexible career and training pathways. The development of streamed qualifications that recognise the common skills for care and support work would assist horizontal mobility across sectoral boundaries, contribute to more flexible organisations and provide greater employability for workers. This will require articulation of the core skills for care and support roles and will facilitate a more sustainable and flexible workforce.
WORKFORCE
STRATEGIES: GROWTH
AND RETENTION
Industry stakeholders highlighted a number of current strategies to support the supply of the future health and community services workforce. These most commonly involved active recruitment of migrant and younger workers, and retention of more mature workers.
Focus on CALD Workers
Industry intelligence indicates an increasing number of workers in the care and support industry are from Cultural and Linguistically Diverse (CALD) backgrounds. ABS data from the 2011 Census indicate that around one in five workers in the ‘Health Care and Social Assistance industry’ speak
tAblE 2:
lAnGuAGE SpoKEn At HomE by AnZSIc InduStry SubdIvISIon
Language spoken at home
Total workers N (‘000) N (‘000)English Language other than English N (‘000) Language other than English %
Social Assistance Services 262 217 45 17.2 Residential Care Services 184.8 143.2 41.6 22.5
Hospitals 361 293.6 67.4 18.7
Medical and other Healthcare services 312.8 255.7 57.1 18.3 Total Health Care and Social Assistance 1167.6 947.1 220.5 18.9 Source: ABS 2011 Census of Population and Housing
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a language other than English at home, with the largest proportion of non-English speakers working in the residential care services sector (Table 2).
Data reported in the 2012 Aged Care Workforce Census suggests an even higher proportion of Personal Care Assistants and Community Care Workers working in aged care speak a language other than English. It identified that in 2012 the proportion of the direct care workforce born overseas was 28% in community outlets and had increased from 25% in 2003 to 35% in residential care facilities (King et al 2012).
This diversity was seen as largely positive for the industry. However, cultural and linguistic diversity has significant implications for training and workforce development. Overseas workers need to be provided with additional support to develop the cultural competency, English language literacy and related communication skills they need to do an effective job. CS&HISC is engaged in a range of activities aimed at supporting the development of Foundation Skills across the workforce. Beyond training and support provided in Australia, broader strategies that embrace the internationalisation of skills agenda have yet to be fully explored by the care and support industry. However, offshore VET delivery in the fields of health and human welfare studies and services experienced rapid growth over the period 2007-2011 (NCVER 2013a).
Attracting Younger Workers
The community services and health workforce in particular, is ageing. Stakeholders raised the following strategies to increase attraction of younger workers to the industry:
» encouraging organisations to undertake succession planning so that younger workers can identify a clear career path
» marketing to overcome the ‘non-glamorous’ image of the sector
» stronger articulation arrangements between VET and universities.
Retention of More Mature Workers
Strategies to retain mature workers involve a better understanding of the requirements of older workers, particularly around job design, working hours and ongoing training. Stakeholders reported that the introduction of new minimum qualification requirements, in family day care for example, have added to the challenge of retaining mature workers as some are reluctant to embark on a new qualification.
WORKFORCE
DEvELOPmENT TO
ImPROvE ACCESS
The challenges faced by health professionals and health services in remote communities continue to be significant. For example, Australians living in remote areas have significantly less access (between 45% and 67%) to medical practitioners, putting pressure on all health workers (HWA 2013a). A major concern is the limited choice and control consumers in these areas experience due to the difficulty recruiting and retaining staff. Addressing these concerns requires practitioners in remote areas to have a more flexible and collaborative approach to service delivery.
“practitioners and
health systems will
need to be more
flexible, less ‘siloed’
and to recognise the
roles and contributions
of the client/patient
themselves and the
people in the
patient’s life”
(National Rural Health Alliance: submission to EScan 2014).
Difficulties accessing care are exacerbated by the fact that health outcomes for people living outside metropolitan areas continue to be worse than for their city counterparts, particularly for Aboriginal and Torres Strait Islander people. Reducing the gap in life
expectancy between Indigenous and non-Indigenous Australians continues to be a challenge for the care and support industry. Improving Indigenous representation in the health and community services workforce and improving the cultural awareness of all workers are key to addressing this on-going challenge and responding to the National Indigenous Reform Agreement,
Closing the Gap (COAG 2012).
The proportion of Indigenous students enrolled on different Training Packages is described in section three and in Appendix D2. The Growing our Future report (HWA 2011) identified strategies to strengthen and develop the Aboriginal and Torres Strait Islander Health Worker workforce to better respond to the needs of the Aboriginal and Torres Strait Islander population. Since the report:
» Aboriginal and Torres Strait Islander Health Practitioner role is a recognised health profession and is subject to registration
» CS&HISC has completed the review and update of the Aboriginal and Torres Strait Islander Health Workers qualifications in the HLT Health Training Package
» HWA has initiated a number of projects to support some of the 27 recommendations identified in the Growing our
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recent data shows that publicly
funded enrolments in the
Community Services and Health
training packages have increased
and that service providers are
generally satisfied with the
quality and relevance of
formal vocational training.
03.
currEnt ImpAct oF
trAInInG pAcKAGES
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ENrolmENtS
INCrEASED bY
INCrEASE IN
NUmbEr of
INDIGENoUS
StUDENtS
SINCE 2008
oUr StUDENtS
ArE AGED
25
and over
11.2
90
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Stakeholders voiced concerns about
the potential disruptive effect of
current vEt funding reforms and
their potential impact on future
training capacity and enrolments.
TRAINING
PACKAGE UPTAKE
As predicted in EScan 2013, publicly funded enrolments in the Community Services Training Package continue to grow, with 230,477 enrolments in 2012, an increase of 29,444 enrolments (14.5%) since 2011. Part of this growth is being driven by increased demand for care and support workers in Aged Care and Children’s Services. The 67,654 publicly funded enrolments in the Health Training Package in 2012 represent a marginal increase (844 or 1.3%) in enrolments since 2011. However, this follows the slight decline in enrolments between 2010 and 2011. Therefore this continues the pattern of no notable growth in Health enrolments since 2010. EScan 2013 highlighted a steady increase in the number of university enrolments in Health courses from 2007 in contrast with enrolments in the Health Training Package, which have plateaued since 2010. Last year it was suggested that this might point to students who may have previously undertaken a qualification in the VET sector choosing to enrol in a university course instead.
Overview
Publicly funded enrolments in the Community
Services (CHC) and Health (HLT) Training Packages
increased in 2012 relative to 2011. Older students
form a growing component of community services
and health enrolments. Indigenous students are also
a prominent group of community services and health
enrolments, including a substantial number enrolled
in higher level VET courses. It should be noted that
VET enrolment figures are available only up to 2012,
figures on course completions are subject to an
even longer lag, and all figures only relate to publicly
funded enrolments.
Stakeholders voiced concerns about the potential
disruptive effect of current VET funding reforms and
their potential impact on future training capacity and
enrolments. Recent survey data indicate that health
and community service employers are generally
satisfied with the quality and relevance of formal
vocational training. However, concerns remain about
the variability in quality of training and the supply
of VET work placements.
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31.3 15.5 10.6 10.2 5.9 5.3 5.2 4.3 3.9 3.4 HLT – Health CHC – Community Services Enr olments ('000)0
50 100 150 200 250 2012 2011 2010 2009 2008 35.6 124.7 139.6 167.9 201.2 230.5 59.6 69.3 66.8 67.7Source: NCVER VOCSTATS Students and Courses, accessed December 2013
fIGUrE 3:
communIty SErvIcES And HEAltH trAInInG pAcKAGE
EnrolmEntS (‘000), 2008-2012
While it is clear that the increase in university Health courses has continued into 2012 (Figure 4), it is likely that a number of factors are contributing to this trend.
For example, recent changes in the regulatory requirements for health professionals and the introduction of uncapped places in higher education in 2012. Further research is required to fully explore any
trends in the uptake of training and to consider whether the training being undertaken is the right match for the productive future workforce required.
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Impact of vET Reforms
As noted earlier in this report, major reforms to VET funding are being implemented in several jurisdictions. Feedback from industry suggests these changes are causing considerable uncertainty about the funding available. The main concern is that where these changes result in a fee increase for students there could be a decrease in enrolments and impact on the supply of new workers. Victoria’s demand-driven funding model has been fully implemented since 2011. The model favoured Certificate III and IV level qualifications by reducing the subsidies available for Diploma-level qualifications. Enrolment data for Victoria show that since the implementation
of the demand driven funding model enrolments have continued to increase for qualifications in the Health and Community Services training packages across all qualification levels with the exception of Certificate I or II (Figure 5).
New reforms in Victoria and similar reforms in the other jurisdictions are now looking to focus the provision of VET subsidies to target areas of greatest public benefit and industry need.
As these reforms are implemented it will be important to evaluate how these different training priorities are impacting on national as well as regional supply of health and community service workers.
Student Profile
Enrolment data shows there was a higher proportion of Indigenous students enrolled in the Health and Community Services Training Packages than the average across all Training Packages (see table D2 in the appendices). This difference was particularly pronounced for Certificates IV and below. While the total proportion of Indigenous students has remained relatively consistent, the number of Indigenous students enrolled in Community Services and Health qualifications has increased by over 90% since 2008. Both training packages remain important towards reaching the goal of increasing the number of Indigenous Australians with higher-level VET qualifications.
VET Health enrolments Higher education Health enrolments
Enr olments ('000) 0 50 100 150 200 2012 2011 2010 2009 2008 35.6 140.7 152.1 163.9 172.5 184.8 59.6 69.3 66.8 67.7
fIGUrE 4:
HEAltH EnrolmEntS (‘000) In HIGHEr EducAtIon And vEt SEctorS, 2008-2012
Sources: NCVER VOCSTATS Students and Courses, accessed December 2013; Department of Education, Higher Education Statistics – 2012 Student Data, accessed December 2013
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0 10000 20000 30000 40000 50000 60000 70000 Diploma or higher Cert III/IV Cert I/II 2012 2011 2010 2009 2008 0 10000 20000 30000 40000 50000 60000 70000 Diploma or higher Cert III/IV Cert I/II 2012 2011 2010 2009 2008 2,069 19,248 2,513 22,249 7,648 11,010 2,724 26,495 13,644 2,834 35,436 14,953 2,340 46,074 17,660 CHC C ourse Enr olments, V ict oria 0 5000 10000 15000 20000 25000 30000 Diploma or higher Cert III/IV Cert I/II 2012 2011 2010 2009 2008 2,921 9,046 7,581 11,556 1,089 1,539 9,317 11,232 4,169 7,111 12,764 6,966 751 17,337 9,095 HL T C ourse Enr olments, V ict oriafIGUrE 5:
courSE EnrolmEntS In vIctorIA, communIty SErvIcES And HEAltH trAInInG
pAcKAGES, by lEvEl oF quAlIFIcAtIon
Source: NCVER VOCSTATS Students and Courses, accessed December 2013 Note: A full breakdown of enrolments by state has been included in Appendix D9.
Source: NCVER VOCSTATS Students and Courses, accessed December 2013 Note: A full breakdown of enrolments by state has been included in Appendix D9.
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fIGUrE 6A:
communIty SErvIcES trAInInG pAcKAGE EnrolmEntS by StudEntS’ AGE,
2008-2012
Source: NCVER VOCSTATS Students and Courses, accessed December 2013 Note: A full breakdown of enrolments by state has been included in Appendix D9.
50 and over 25 to 49 years 24 and under C ourse enr olments (% of t otal) 32.7 32.5 32.2 31.2 30.1 52.3 52.6 53.5 54.2 54.6 14.4 14.2 14.0 14.3 15.1 0 10 20 30 40 50 60 2012 2011 2010 2009 2008 32.7 52.3 14.4 32.5 52.6 14.2 32.2 53.5 14.0 31.2 54.2 14.3 30.1 54.6 15.1
fIGUrE 6b:
HEAltH trAInInG pAcKAGE EnrolmEntS by StudEntS’ AGE, 2008-2012
Source: NCVER VOCSTATS Students and Courses, accessed December 2013 Note: Percentages do not add to 100% because figure excludes Age not known
50 and over 25 to 49 years 24 and under C ourse enr olments (% of t otal) 0 10 20 30 40 50 60 2012 2011 2010 2009 2008 34.7 50.9 13.7 32.2 51.0 15.8 32.3 51.5 16.1 33.7 50.9 15.2 33.9 51.0 15.0
Enrolment data for 2012 indicates that 57% of enrolments across all industries were aged 25 years and over (NCVER, 2013a). A much higher proportion of enrolments were aged 25 and over in
Community Services (70%) and Health (66%). Figure 6 shows how the age profile of students enrolled in Health and Community Services Training Packages has shifted since 2008; with a slight decline
in the proportion of students aged 24 and under, and a comparable increase in the proportion aged 50 and above.
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fIGUrE 7:
communIty SErvIcES And HEAltH trAInInG pAcKAGE EnrolmEntS (2012) And
rESIdEnt populAtIon by ArEA oF rEmotEnESS (ArIA+)
Sources: NCVER VOCSTATS Students and Courses, accessed December 2013; ABS (2012) 3218.0 Regional Population Growth, figures estimates as at 30 June 2012
Note: Figure excludes “Other” (such as those living outside Australia, don’t know, and not collected)
Areas of remoteness are defined using the ABS’s extended version of the Accessibility/Remoteness Index of Australia (ARIA+).
Australian Population Health enrolments
Community Services enrolments
% of t otal 0 10 20 30 40 50 60 70 80
Remote/ Very remote Outer regional Inner regional Metropolitan 56.5 25.0 70.4 54.5 18.3 9.0 25.2 12.4 3.9 12.0 3.2 1.4
This trend towards older students in Community Services and Health qualifications may point to an increase in older workers entering the workforce as well as existing older workers accessing training. If this trend continues, service providers should consider adapting their recruitment strategies to target a broader age-range of candidates.
A comparison of Training Package enrolment data with general population data indicates that a relatively high number of Australians from regional and remote areas are enrolled in Health and Community Services qualifications (Figure 7).
This highlights the critical role played by VET in providing access to tertiary education and in providing a pool of appropriately trained workers for the care and support industry.
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Qualifications and vocational OutcomesIn 2012 as in previous years, the largest numbers of enrolments within the Community Services Training Package are in children’s services and aged care, with enrolments continuing to grow. There have also been sizable increases in enrolments in Certificate III. In Home and Community Care, Certificate IV in Mental Health and Certificate III in Education Support.
In the Health Training Package, nursing continues to have the largest number of enrolments. A decline in enrolments for certain qualifications has been offset by increases in other areas, most notably Certificate III in Health Services Assistance and Certificate IV in Allied Health Assistance. Appendix D8 lists all enrolments in HLT and CHC qualifications by sector. The 2013 Outcomes Survey indicates that 88.7% of 2012 Community Services and Health Training Package graduates were in employment or further education; a similar proportion to the average across training packages (NCVER 2013b).
INDUSTRY vIEWS ON
CURRENT TRAINING
Industry satisfaction with VET graduates remains relatively high (NCVER, 2013c). In CS&HISCs survey of industry, service provider-respondents who rated the relationship with their primary training provider the highest also indicated higher levels of satisfaction with the relevance and quality of formal vocational training. A recent Australian Skills
Quality Agency (ASQA) report on an audit of training in aged and community care services, indicated variation in the quality of training provided in the sector. Assessment was highlighted as a particular problem area, including insufficient assessment of skills in a workplace context (ASQA 2013). The report also highlighted wide variations in the provision of work placements and recommended more explicit requirements on work placement provision, and improvements to the existing training for trainers and assessors (i.e. Certificate IV in Training and Assessment).
Employers are generally
satisfied with the quality
and relevance of
training. However
concerns remain
about the supply of
vEt work placements.
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The National Skills Standards Council’s Standards for Training Packages have made it possible to address the need for more explicit guidance on work placements and workplace based assessment in the revised units of competency. Feedback from industry
stakeholders highlighted the critical role that a work placement plays in ensuring students’ develop the competencies required for the workplace as well as difficulties sourcing work placements. Around two thirds (67%) of survey respondents from health and community service providers indicated that it was difficult to obtain a work placement for their students.
Currently, while there is funding to support the provision of clinical placements in higher education, VET Community Services and Health work placements are un-funded. With increasing demand for services and an increase in the number of students requiring work placements, these difficulties are likely to get worse, particularly without a mechanism to better incentivise employers to participate in the delivery of quality work placements. There is also a need to better ensure the quality and job relevance of Community Services and Health work placements.
BROADER ImPACT OF
TRAINING PACKAGES
As with previous years, the overwhelming majority of respondents to the survey indicated that the competency standards outlined in the Community Services and Health Training Packages support training delivery, assessment and the development of existing staff. However, there are indications that they are also used to:
» redesign and reorient job roles (62%)
» recruit new staff (76%)
» assist in articulating
professional standards (74%).
