Securing a healthy system

The commission's approach would mean that the Federal Government would negotiate an agreed number of university positions, state by state, for all health professional training. The distribution of these places, university by university within each state or territory, would remain a responsibility of DEST. Each agreement would be for three years (which seems bizarrely short, in the circumstances).

This would not preclude closer relations between DEST and the Department of Health and Ageing (although the commission is pessimistic about this happening).

The other, lesser, impediment is the resistance of professions to change. This gums up debate about the relation of specialist to generalist education, the mix of roles and tasks among healthcare professionals and the duration of courses.

To address this, the commission proposes the formation, by the Australian Health Ministers' Conference, of an Advisory Health Workforce Education and Training Council. This would advise on opportunities to improve workforce education and training opportunities, including changes to curriculum and accreditation requirements.

AHWETC would represent a significant shift in the control of university health sciences courses in two respects. First, it would offer a more negotiated, responsive solution to the numbers problem (a plus for health service providers, such as the states). Second, it implies greater control over course content and outcomes (for some universities this would not be a plus, but it could open up a new dialogue between educators and service providers and funders).

Both the proposed federal-state/territory university place negotiations and the AHWETC engage the many interests vested in the education and training of our health workforce. They each seek a more discursive and inclusive approach to health service workforce development. This is urgently needed.

If we accept these two proposals, do we see an agenda for action? Yes and no.

We are left with an urgent need for more doctors, nurses and several other categories of health professionals. This should be the first topic for debate at the AHWETC. Strategies are needed so that services can be delivered in unconventional ways, for example by working across the divisions of the health service professions.

AHWTEC should consider the responses of the British Government to the recommendations of the Wanless Report (2002). That report called for radical change in the health workforce, including a rethinking of the roles and responsibilities of different health professionals. This notion that the patient and their needs should be at the centre of workforce discussion contrasts sharply with recent responses to the Productivity Commission Report. Professional bodies such as the Australian Medical Association show no acceptance of expanded healthcare roles for other professions, such as pharmacists, nurses and physiotherapists.

Australia should embark on an examination of what the future healthcare needs of the nation will be and what skills, structural arrangements and health service financing would best serve our needs. The health workforce and their educators cannot be expected to solve all these challenges. Health and health care are everyone's concern and health is an intensely political matter. Sudden decision-making is usually inappropriate. Wide discussion, frustrating to those obsessed with efficiency, is essential. Real political leadership would be timely and welcome.