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Health Professionals Workforce Plan Taskforce
Technical Paper
NSW MINISTRY OF HEALTH
73 Miller Street
NORTH SYDNEY NSW 2060
Tel. (02) 9391 9000
Fax. (02) 9391 9101
TTY. (02) 9391 9900
www.health.nsw.gov.au
Produced by:
Health Professionals Workforce Plan Taskforce
This work is copyright. It may be reproduced in whole or in part for study
training purposes subject to the inclusion of an acknowledgement of the source.
It may not be reproduced for commercial usage or sale. Reproduction for
purposes other than those indicated above requires written permission from
the NSW Health.
© NSW Ministry of Health 2011
SHPN (WDI) 110201
ISBN 978-1-74187-617-8
October 2011
Health Professionals Workforce Plan Technical Paper NSW HEALTH PAGE 1
Technical Paper
The Technical Paper of the Health Professionals Workforce
Plan Taskforce is a summary of the data and research that
informed the development of the Health Professionals
Workforce Plan Discussion Paper. It is not intended to be
read as a stand-alone document, but is provided for those
who wish to view the data or information related to various
sections of the Health Professionals Workforce Plan
Discussion Paper. Some sections include additional
information to that included in the similar section in the
Discussion Paper. As a technical resource for the Discussion
Paper some data is presented here without analysis or
discussion.
Workforce Trends1
Nursing
Registered Nurses
The size of the Registered Nursing workforce (public and
private), relative to the population, has not changed
dramatically over the period 2005 to 2009. However, the
distribution of Registered Nurses as a FTE to the
population differs by geographic location. The highest FTE
ratio to population is in very remote areas, and in NSW there
was a sharp increase between 2005 and 2007 in the ratio of
Registered Nurses to the population in remote and very
remote regions.
Major city Inner regional Outer regional Remote Very remote Total
2005 NSW 809.8 803.1 626.3 565.3 831.5 819.2
2007 NSW 828.9 818.3 633.5 613.3 1038.6 846.6
2009 NSW 837.1 830.1 604.2 660.7 1038.4 843.9
2005 Aust 839.6 797.2 781.6 761.9 886.7 854.9
2007 Aust 865.3 858.0 769.6 804.4 872.3 891.0
2009 Aust 842.3 900.7 843.4 943.7 1037.4 905.9
0.0
200.0
400.0
600.0
800.0
1000.0
1200.0
FTE
rati
o p
er 1
00,0
00 p
op
.
FTE (38hpw) Registered Nurses per 100,000 population NSW and Aust comparison
30.0
31.0
32.0
33.0
34.0
35.0
36.0
37.0
38.0
39.0
40.0
Major city Inner regional
Outer regional
Remote Very remote Total
NSW 2005 NSW 2007 NSW 2009 Aus 2005 Aus 2007 Aus 2009
Av. hrs worked per week, RN workforce NSW and Aus 2005-07-09
The Outer Regional location is the only geographic area that
has seen a decline in the ratio of registered nurses to the
population over the time period, albeit a very small
decrease. The ratio of Registered Nurses to the population
for NSW in 2009 in Outer Regional locations is the lowest
ratio across the state and is also significantly lower to the
Outer Regional FTE ratio across Australia.
The average hours worked per Registered Nurse differs
depending on location. Registered Nurses who indicate their
main job is in a remote or very remote geographic location
work longer average hours than their counterparts in major
cities and inner and outer regional areas. The average hours
for NSW compared to the Australian average are higher in
every geographic location other than outer regional. The
greatest increase in average hours worked in NSW between
2005, 2007 and 2009 has been in very remote locations.
1 See section on Australian Standard Geographical Classifi cations for defi nition of regions.
PAGE 2 NSW HEALTH Health Professionals Workforce Plan Technical Paper
Enrolled Nurses
In both NSW and Australia there has been an increase in the
number of Enrolled Nurses as a proportion of the population
between 2005, 2007 and 2009. The ratio of Enrolled Nurses
to the population differs between regional areas, and shows
a different pattern of distribution to Registered Nurses. The
distribution for Enrolled Nurses shows a greater ratio the
further one moves from a major city location. Additionally
whereas the comparison between NSW and Australia shows
a greater proportion across Australia of Registered Nurses
working in outer regional and remote areas compared to
NSW, for Enrolled Nurses NSW has a higher proportion of
Enrolled Nurses to the population in all regions, but
markedly higher in remote and very remote regions.
The average hours worked for Enrolled Nurses mirrors the
pattern for Registered Nurses in regards to average hours
worked by location, and the greater average hours in NSW
compared to Australia. Similar to Registered Nurses, Enrolled
Nurses who indicate their main job is in a remote or very
remote geographic location work longer average hours than
their counterparts in major cities and inner and outer
regional areas. The average hours for NSW compared to the
Australian average are higher in every geographic location.
One major difference between the average hours worked
for Registered Nurses and Enrolled Nurses is that whereas
Registered Nurses have increased their hours in remote and
very remote regions the average hours for Enrolled Nurses in
these locations has fallen sharply between 2007 and 2009.
Medical Practitioners
The ratio of medical practitioners to 100,000 of population
is based on folllowing data from the Australian Institute of
Health and Welfare2, of which the NSW data is provided via
the Medical Labour Force profile. As such the information
relates to the entire registered workforce, public, private and
non-Government Organisation (NGO).
Across all geographic regions in NSW there was a decrease
in the ratio of medical practitioners to the population in
2007. For NSW, only in the remote/very remote category has
the ratio of medical practitioners to the population exceeded
the 2005 levels.
The NSW Head Count (HC) to population ratio is similar to
the Australian ratio for the major city and inner regional
areas, although there has been a greater increase in ratio
across Australia in major cities compared to NSW between
2007 and 2009. For outer regional and remote/very remote
the Head Count ratio to population is higher across Australia
compared to NSW.
0.0
100.0
200.0
300.0
400.0
500.0
Major city
Inner regional
Outer regional
Remote Very remote
Total
FTE nurses per 100,000 pop. Australia, (38hr week), 2005-07-09
FTE
ratio
per
100
,000
pop
.
NSW 2005 NSW 2007 NSW 2009 Aus 2005 Aus 2007 Aus 2009
Major city
Inner regional
Outer regional
Remote Very remote
Total
Av hours EN workforce NSW and Aust 2005-07-09
NSW 2005 NSW 2007 NSW 2009 Aus 2005 Aus 2007 Aus 2009
30.0
31.0
32.0
33.0
34.0
35.0
36.0
37.0
38.0
39.0
Health Professionals Workforce Plan Technical Paper NSW HEALTH PAGE 3
Medical practitioners HC per 100,000 population by location NSW 2005-2007-2009
FTE
rati
o p
er 1
00,0
00 p
op
.
Major city Inner regional Outer regional Remote / Very Remote
2005 NSW 364 205 128 88
2007 NSW 322 191 109 81
2009 NSW 343 202 119 115
2005 Aust 346 186 153 219
2007 Aust 348 193 161 203
2009 Aust 372 212 188 216
0
50
100
150
200
250
300
350
400
2 Sources: AIHW Medical Labour Force Surveys, 2005,2007 2009; unpublished ABS estimated resident population data.
PAGE 4 NSW HEALTH Health Professionals Workforce Plan Technical Paper
Allied Health
The previous sections on Nursing and Medical Practitioner
trends had data drawn from the Labour Force Profile data
gathered via state and national registration bodies. As
national registration for Allied Health professionals has only
recently commenced the same data sets are not readily
available. The latest available data showing the workforce in
NSW is from the 2006 Census as reported in the Australian
Institute of Health and Welfare3, and is represented in the
graph below.
The largest classification for Allied Health in NSW is retail
pharmacy, followed by physiotherapists, social workers and
clinical psychologists. The groups with the oldest age profile
are educational and organisational psychologists and
orthotists/prosthetists.
Many Allied Health professionals operate as private
businesses and are based within major cities, with low
numbers working in regional and remote areas.
Whilst the hours per week for NSW via the Labour Force
Profile aren’t available, data is available for the average
hours by classification in NSW Health Local Health Districts
(May 2011, sourced from Staff State Profile (unaudited State
HIE)). Nuclear Medicine Technologists, orthotists/prothetists,
radiographers and radiologists have the highest average
hours within the Allied Health classifications. Podiatrists, Art
and Music Therapists, Audiologists and Genetics Counsellors
have the lowest average hours.
3 Source: AIHW (2009): Health and community labour force 2006, additional material (includes all industries)
0
10
20
30
40
50
60
0
1,000
2,000
3,000
4,000
5,000
6,000
Den
tist
Den
tal A
ssis
tant
Den
tal H
ygie
nist
Den
tal P
rost
hetis
t
Den
tal S
peci
alis
t
Den
tal T
echn
icia
n
Den
tal T
hera
pist
Med
ical
Dia
gnos
tic R
adio
grap
her
Med
ical
Rad
iatio
n Th
erap
ist
Nuc
lear
Med
icin
e Te
chno
logi
st
Sono
grap
her
Hos
pita
l Ph
arm
acis
t
Indu
stri
al P
harm
acis
t
Reta
il Ph
arm
acis
t
Aud
iolo
gist
Clin
ical
Psy
chol
ogis
t
Chi
ropr
acto
r
Die
titia
n
Educ
atio
nal
Psyc
holo
gist
Occ
upat
iona
l The
rapi
st
Opt
omet
rist
Org
anis
atio
nal
Psyc
holo
gist
Ort
hopt
ist
Ort
hotis
t or
Pro
sthe
tist
Ost
eopa
th
Phys
ioth
erap
ist
Podi
atri
st
Psyc
holo
gist
s, n
ec
Psyc
hoth
erap
ist
Soci
al W
orke
r
Spee
ch P
atho
logi
st
Ther
apy
Aid
e
Hea
dco
un
t al
l in
du
stri
es
Category (ANZCO)
Male Female average age
Allied health and other clinical categories by gender, NSW workforce, 2006
Health Professionals Workforce Plan Technical Paper NSW HEALTH PAGE 5
Whilst the information on hours worked is not available by
ASGC-RA the hours by LHD, sourced from the Staff State
Profile (unaudited State HIE) for May 2011, shows that the
LHDs with the greatest proportion of outer regional and
remote areas work less average hours than the inner
regional and major cities. This pattern is very different to
that shown by the Nursing profession.
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
Average Hours by Classification - NSW LHDs at May 2011
Av Weekly Hours Average Allied Health LHDs
25.00
26.00
27.00
28.00
29.00
30.00
31.00
32.00
Average Weekly Hours Allied Health by LHD - May 2011
PAGE 6 NSW HEALTH Health Professionals Workforce Plan Technical Paper
Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA)
ASGC-RA is a geographic classification system that was
developed in 2001 by the Australian Bureau of Statistics
(ABS) as a statistical geography structure which allows
quantitative comparisons between ‘city’ and ‘country’
Australia. The purpose of the structure is to classify data
from census Collection Districts (CDs) into broad
geographical categories, called Remoteness Areas (RAs). The
RA categories are defined in terms of ‘remoteness’ - the
physical distance of a location from the nearest Urban
Centre (access to goods and services) based on population
size.
The following map4 shows the ASGC-RA rating for each of
the non Sydney LHDs.
4 LHD boundaries are highlighted in red. Only rural LHDs are labelled Local Health District Boundaries - Statewide and Rural Health Services and Capital Planning Branch, NSW Health. Australian Bureau of Statistics: Australian Standard Geographical Classifi cation (ASGC) Remoteness Structure (RA) Digital Boundaries, Australia, 2006
Health Professionals Workforce Plan Technical Paper NSW HEALTH PAGE 7
NSW Health System in Context
Health Service Delivery
The schematic shows the health care settings that the
discussions around health service delivery will be grouped.
The use of the term “health care settings” is not intended to
represent “bricks and mortar” but rather services provided
addressing particular needs of patients.
Primary and Preventative
Health
Primary health care refers to
universally accessible, generalist
services, including general
practice, and early childhood
nursing services that address the
health needs of individuals,
families and communities across the life cycle.
Comprehensive primary health care includes early
intervention and health promotion, treatment, rehabilitation
and ongoing care. For most people, these services are the
first point of contact with the health care system. In the
main, private practitioners provide the majority of primary
health care services.6
The World Health Report found that countries at similar
stages of economic development with health care systems
organised around the principles of primary health care
produce better health outcomes for their populations.7
Countries more oriented to primary care have residents in
better health at lower cost. In the United States health is
better in regions that have more primary care physicians,
whereas several aspects of health are worse in areas with
the greatest supply of specialists.8
Primary health care is the part of the health system which
Australians use the most. Over four out of five Australians
will see a GP or other primary care health professional at
least once a year. Primary health care is delivered in the
community, outside of hospitals. It covers a wide range of
providers such as general practitioners, practice nurses,
psychologists, physiotherapists, community health workers
and pharmacists.9
Critical to good chronic care is prevention. Many of the
same risk factors – obesity, poor nutrition, alcohol abuse,
inadequate exercise, smoking- that cause one chronic
disease are also associated with multiple chronic diseases.10
In NSW Health the Public Health Division seeks to improve
the health and well-being of people in New South Wales
through approaches which focus on whole populations.
The focus is to work with communities and organisations to
create circumstances that promote and protect health, and
prevent injury, ill health, and disease. Actions centre on:
■ monitoring health and implement services to improve life
expectancy and the quality of life■ implementing disease and injury prevention measures
Over four out of five Australians will
see a GP or other primary care health
professional at least once a year.
6 NSW Department of Health, 2006. Integrated Primary and Community Health Policy 2007–2012. Sydney: NSW Department of Health [online] http://www.health.nsw.gov.au/policies/pd/2006/pdf/PD2006_106.pdf Accessed 29 August 2011
7 World Health Organisation (2008) Primary Health Care. Now More than Ever. [online} http://www.who.int/whr/2008/whr08_en.pdf Accessed 29 August 20118 Starfi eld, B. (2008) Refocusing the system. New England Journal of Medicine. Vol. 359, No. 20, p. 2087-2091 [online] http://www.nejm.org/doi/full/10.1056/NEJMp0805763 Accessed 13 November
20109 Commonwealth of Australia (2011) Improving Primary Health Care for All Australians. [online] http://www.yourhealth.gov.au/internet/yourHealth/publishing.nsf/Content/improving-primary-health-
care-for-all-australians-toc/$FILE/Improving%20Primary%20Health%20Care%20for%20all%20Australians.pdf Accessed 29 August 201110 Anderson, G (2011) For 50 Years OECD Countries Have Continually Adapted To Changing Burdens Of Disease; The Latest Challenge Is People With Multiple Chronic Conditions. [online] http://www.
oecd.org/document/17/0,3746,en_2649_37407_48127569_1_1_1_37407,00.html
Primary and Preventative Health
Facility Based Sub Acute/Rehab/Aged
In Hospital/Acute
Out of Hospital Care
Primary and Preventative Health
PAGE 8 NSW HEALTH Health Professionals Workforce Plan Technical Paper
■ promoting and educating people about healthier life
styles■ protecting health through disease prevention services
and legislation■ ensuring the quality use of medicines, the safe use of
poisons, and safe, high quality care in private health
facilities.11
An example of the success of preventative health measures
is the decline in daily smoking. The proportion of daily
smokers among adults has shown a marked decline over the
past two decades in most OECD countries. Australia has
achieved remarkable progress in reducing tobacco
consumption, cutting by half the percentage of adults who
smoke daily (from 35.4% in 1983 to 16.6% in 2007). Much
of this decline in Australia can be attributed to policies
aimed at reducing tobacco consumption through public
awareness campaigns, advertising bans and increased
taxation.12 In NSW smoking rates have shown a dramatic
decline in daily smoking over the last decade.13
10
12
14
16
18
20
22
24
26
28
1997
1998
2002
2003
2004
2005
2006
2007
2008
2009
2010
Males Females Persons
Smoking Rates - NSW 1997-2010
Perc
enta
ge
Dai
ly S
mo
kers
Out of Hospital Care
NSW Health is committed to the
delivery of “the right care, to the
right person, at the right time
and in the right place”. This
commitment is demonstrated
through increasing the type and number of services that are
delivered out of the hospital environment 14
For many patients admission to a hospital ward can be
avoided, and for others, the time spent in hospital can be
reduced through using Out-of-Hospital care. NSW Health
delivers much of its care outside of hospitals through
community health services, outpatient clinics, day therapy
dialysis and palliative care. Services included in the Out-of-
Hospital Care program are:
■ Hospital Care at Home including Hospital in the Home
and Community Acute Post Acute Care Services■ ComPacks ■ Advance Care Planning
Out of Hospital Care
11 http://www.health.nsw.gov.au/publichealth/index.asp12 OECD (2011). OECD Health Data 2011 How Does Australia Compare [online] http://www.oecd.org/dataoecd/46/38/48295801.pdf Accessed 25 August 201113 Centre for Epidemiology and Research. Health Statistics New South Wales. Sydney: NSW Department of Health. Available at: www.healthstats.doh.health.nsw.gov.au. Accessed 29 August 201114 http://www.health.nsw.gov.au/performance/macca.asp
Health Professionals Workforce Plan Technical Paper NSW HEALTH PAGE 9
Out of Hospital Care 15
Strategies/Projects Outcomes
Hospital in the Home - Services are able to deliver care in
the home environment as they are staffed by or have
access to experienced multidisciplinary teams. Services
provided include: medical, nursing and allied health care.
In 2008/09 40,495 patients were treated by Hospital in the
Home /CAPAC services program. This increased to over
54,000 in 2009/2010.
Advance Care Planning. Advance Care Planning describes
the process in which a person plans ahead for health care
related decisions in the event they do not have the capacity
to make those decisions or communicate for themselves.
This process involves the person talking to family, friends
and health care professionals about their values and
concerns relating to health care.
Advance Care Planning outcomes have been measured
through the audit of medical records for people transferred
to EDs from Residential Aged Care Facilities. Transfer
documentation was examined for the documentation of
key Advance Care Planning elements –the “Person
Responsible” i.e. the substitute decision maker and the
presence of an Advance Care Plan. There was an increase
of the person responsible being identified from 16 to 23%
and the presence of an Advance Care Plan from 10% to
26% between 2009 and 2010.
ComPacks. Provide patients returning home from hospital
with case management and access to community services
for a period of up to 6 weeks. The services range from
house cleaning and assistance with bathing to assistance
with shopping, meal preparation and transport. The case
manager is a non-clinical person (i.e. not a nurse, doctor or
allied health professional) who helps organise non-clinical
community services.
Bed days for the over 75yr + patients show a 10%
reduction on the predicted rise.
Community health refers to a range of community based
prevention, early intervention, assessment, treatment, health
maintenance and continuing care services delivered by a
variety of providers. The NSW public health system provides
the majority of community health services, including;
■ Aboriginal health services — health workers who
provide consultation and support to other health
professionals who may undertake early detection, health
promotion and community development work within
their local communities. In addition, they provide an
important link between their Aboriginal communities
and mainstream health services.■ Allied health services — providers delivering a range
of services in community settings eg physiotherapists,
psychologists, occupational therapists, podiatrists, social
workers, optometrists and speech pathologists.
■ Child and family health and youth health
services — services provided by Local Health Districts
and delivered in community settings such as early
childhood clinics, community health centres, local council
buildings and in the home.■ Community health nursing services — generalist
community health nurses providing a range of services
across the continuum of care meeting a range of health
needs for clients anywhere in the community from
community health centres, primary health clinics, schools
and universities and client’s homes. Community nurses
usually work in multidisciplinary teams that ensure the
client receives the full range of health care, often
focused toward social conditions, illness/ disease
prevention or early intervention to prevent exacerbations
of chronic illness and unnecessary hospital admission
15 NSW Health document , Redesign Achievements 2009/2010 (unpublished)
PAGE 10 NSW HEALTH Health Professionals Workforce Plan Technical Paper
■ Community mental health services — provide care
for people with acute problems and people in crisis.
Each service includes after-hours contact as well as long-
term care. They also provide programs to promote
mental health and prevent mental health problems■ Multicultural health services — statewide
multicultural health services provide health care, health
promotion and community development to communities
requiring specialised health care needs. Multicultural
health workers are specifically designated to provide
clinical services, undertake early detection, health
promotion and community development within their
local culturally and linguistically diverse (CALD)
communities.16
In 2008, the New South Wales Population Health Survey
estimated that 8.0 per cent of adults attended a community
health centre on 1 or more occasions in the last 12 months.
A significantly lower proportion of males (6.0 per cent) than
females (10.0 per cent) attended a community health centre
in the last 12 months. Since 2002, there has been a
significant increase in the proportion of adults who attended
a community health centre in the last 12 months (6.9 per
cent to 8.0 per cent). The increase has been significant in
rural health areas.17
Palliative Care services provide coordinated medical,
nursing and allied health care, delivered wherever possible in
the environment of the person’s choice. Palliative care
involves the provision of physical, psychological and
emotional support for patients and their families and carers.
It aims to respect the dignity, needs and wishes of the
person dying, with particular attention to the needs of
different cultural and religious groups. 18
In NSW Health palliative care services include services
provided in public hospitals, community-based and home
settings. 190 public hospitals provide palliative care services
in NSW. The former Area Health Services advised that in
2009/10 key palliative care services delivered included:
■ Public hospital separations 10,421■ Public hospital bed days 115,044 ■ Centre-based occasions of service 327,099■ Home based occasions of service 145,516
In Hospital-Acute Care
Acute care is generally considered
to be short-term medical
treatment, usually in a hospital. It
can include, for example, patients
admitted for an acute illness or
injury, recovering from surgery, acute episodes of chronic
conditions or maternity care.
An episode of acute care for an admitted patient is one in
which the principal clinical intent is to do one or more of the
following:
■ manage labour (obstetric),■ cure illness or provide definitive treatment of injury, ■ perform surgery,■ relieve symptoms of illness or injury (excluding palliative
care),■ reduce severity of illness or injury, ■ protect against exacerbation and/or complication of an
illness and/or injury which could threaten life or normal
functions, ■ perform diagnostic or therapeutic procedures.19
Admission to hospital is generally through an Emergency
Department, or through a referral from a specialist as a
“booked admission”.
Between January and March 2011 patients admitted for
acute care or maternity and birth comprised 97% of all
admitted episodes in NSW hospitals. Most of these episodes
were overnight admissions (56%) and this percentage has
not changed over the previous two years. Patients stayed a
total of 1,294,785 bed days during the quarter. On average,
patients stayed 3.4 days in hospital. There were 17,886
babies born, up 3% from the same quarter one year ago. 20
The reasons for admission to hospital from Emergency
Department for the period January to March 2011 by
Diagnosis Related Groups (DRGs) shows the highest volume
of reasons for admissions was for chest pain, digestive
disorders, cellulitis, gastroenteritis, and kidney and urinary
tract infections. 21
16 NSW Department of Health, 2006. Integrated Primary and Community Health Policy 2007–2012. Sydney: NSW Department of Health [online] http://www.health.nsw.gov.au/policies/pd/2006/pdf/PD2006_106.pdf Accessed 29 August 2011
17 New South Wales Population Health Survey 2008 (HOIST). Centre for Epidemiology and Research, NSW Department of Health.18 NSW Health (2010) NSW Palliative Care Strategic Framework 2010-2013 [online] http://www.health.nsw.gov.au/policies/pd/2010/PD2010_003.html 19 http://www.bhi.nsw.gov.au/glossary20 Bureau of Health Information (2011) 21 NSW Health (2011) Ministerial Taskforce on Emergency Care (MTEC) Emergency Department Reports unpublished data
In Hospital/Acute
Health Professionals Workforce Plan Technical Paper NSW HEALTH PAGE 11
Facility Based Sub Acute /
Rehab/Aged
Subacute care treats individuals of
low and moderate acuity. Such care
is provided after, or instead of, acute
hospitalisation for purposes such as
evaluation and treatment of active or
unstable medical conditions, to offer
frequent recurrent monitoring of a patient’s clinical course,
and to provide moderately complex or risky treatment
requiring significant skill, judgment, or monitoring. Care sites
other than hospitals can often meet the needs of individuals
whose conditions are of moderate or low acuity.23
Subacute care is given for a limited time (several days to
several months) until a specific goal is accomplished, such as
stabilising a condition or completing a predetermined
treatment course. The care requires the coordinated services
of physicians, nurses, and other relevant professional
disciplines to assess and manage these conditions and
perform the necessary procedures. Although subacute and
long-term nursing home care can overlap somewhat, they
have different emphases. Subacute care is short-term care
related to recent illness or injury that must accommodate
underlying functional impairments and chronic conditions
that affect short- and intermediate-term recovery.24
Subacute care, within this framework, encompasses periods
of care that may be offered in and outside of acute hospital
environments, but which focus primarily on aspects of care
other than typical acute care requirements. As such, services
like rehabilitation and a large proportion of hospital based
aged care fall within this definition. Similarly, wards or sites
that offer primarily subacute care may be described as
subacute care facilities.25
22 Centre for Epidemiology and Research. Health Statistics New South Wales. Sydney: NSW Department of Health. Available at: www.healthstats.doh.health.nsw.gov.au. Accessed 28 July 2011.23 Levenson S 2000. “The future of subacute care.” Clinics in Geriatric Medicine 16(4): 683-70024 Levenson S 2000. “The future of subacute care.” Clinics in Geriatric Medicine 16(4): 683-700 25 Gray, L. (2002) Subacute care and rehabilitation. “Australian Health Review” 25 (5) 140-144
Hospitalisations by cause - rate per 100,000 of population 1998/99 - 2009/10
0.0 500.0 1000.0 1500.0 2000.0 2500.0 3000.0 3500.0 4000.0 4500.0 5000.0
Malignant neoplasms
Other neoplasms
Blood & immune diseases
Endocrine diseases
Mental disorders
Nervous & sense disorders
Cardiovascular diseases
Respiratory diseases
Digestive system diseases
Skin diseases
Musculoskeletal diseases
Genitourinary diseases
Maternal, neon. & congenital
Symptoms & abnormal findings
Injury & poisoning
Dialysis
Other factors infl. health
Other
Rate 09-10
Rate 98-99
Infectious diseases
Facility Based Sub Acute/Rehab/Aged
The graph below shows the rate of hospitalisation by cause
for the periods 1998-1999 and 2009-2010.22 It can be seen
than the rate of many causes of hospitalisation has remained
relatively similar for the 10 year period. There have been falls
in hospitalisations caused by cardiovascular disease,
respiratory diseases, digestive system diseases, genitourinary
diseases and maternal and neonatal. Increases can be seen
for endocrine, mental disorders, nervous and sense
disorders, injury and poisoning and dialysis – the largest area
of growth of causes for hospitalisations in the 10 year
period.
PAGE 12 NSW HEALTH Health Professionals Workforce Plan Technical Paper
Rehabilitation
Rehabilitation care in NSW is defined as the provision of care
that aims to:
■ restore functional ability for a person who has
experienced an illness or injury■ enable regaining function and self-sufficiency to the level
prior to that illness or injury within the constraints of the
medical prognosis for improvement■ develop functional ability to compensate for deficits that
cannot be medically reversed.26
The setting in which rehabilitation takes place is principally
defined by the patient‘s changing needs over time and the
availability of rehabilitation services in particular areas. The
rehabilitation patient journey is not a linear process and
pathways are individually determined based on:
■ the patient‘s level of functional impairment (including
ability to function safely in a given environment); ■ medical acuity and prognosis; and ■ access to rehabilitation services.
An inpatient rehabilitation journey most often commences
with an acute presentation related to acute illness (eg
stroke), trauma (eg fracture), elective surgery (eg joint
replacement) or significant functional debilitation (eg
decreased mobility due to chronic disease or ageing). This
journey continues through to transfer of care to an alternate
setting or discharge from rehabilitation either with or
without further support services.27
With a strong focus on restoring function after an acute
hospitalisation older people are the largest users of
rehabilitation services. This patient population tends to take
longer to recover, especially after hospitalisation, and
requires an enhanced focus on continuity of care and
follow-up in the community to avoid further decline.28
In terms of bed days the highest volume of patient activity
for the period 2009/10 was attributed to stroke,
representing 25%, fractures representing 19% and other
disabling impairments representing 18% of all inpatient
public rehabilitation bed days.
The following co-morbidities were most frequent:
■ Cardiac related diagnoses (including ischemic heart
disease and atrial fibrillation and cardiac failure); (19% of
admissions). ■ Arthritis and osteoporosis (12% of admissions) ■ Other chronic and complex care conditions including
chronic obstructive pulmonary disease, renal failure,
asthma (5% of admissions). ■ Diabetes (5% of admissions). 30
A review of Local Health District Sub Acute plans reveals
some common themes in regards to current service delivery,
including:
■ The focus within facility based services is largely on
rehabilitation services followed by palliative care.
Geriatric Evaluation and Management (GEM) is
considered the third priority and psycho geriatric services
is based on availability of funding.■ The development of Rapid Response outreach services. ■ An increased need for community based mental health
programs for older people.■ Significant growth in activity which some areas recording
over 100% growth in inpatient separations.
26 NSW Health (2011) Rehabilitation Redesign Project [online] http://www.archi.net.au/documents/resources/models/rehab_redesign/rehabilitation-moc.pdf 27 NSW Health (2011) Rehabilitation Redesign Project [online] http://www.archi.net.au/documents/resources/models/rehab_redesign/rehabilitation-moc.pdf 28 NSW Health (2011) Rehabilitation Redesign Project [online] http://www.archi.net.au/documents/resources/models/rehab_redesign/rehabilitation-moc.pdf29 NSW Health (2011) Rehabilitation Redesign Project[online] http://www.archi.net.au/documents/resources/models/rehab_redesign/rehabilitation-moc.pdf30 NSW Health (2011) Rehabilitation Redesign Project [online] http://www.archi.net.au/documents/resources/models/rehab_redesign/rehabilitation-moc.pdf
Rehabilitation patient age profile in NSW over three years 29
(Source: HIE data, Demand and Performance Evaluation Branch NSW Health, Nov 2010)
Health Professionals Workforce Plan Technical Paper NSW HEALTH PAGE 13
NSW Health Workforce
The following workforce graphs31 show the FTE for each
occupational group as an FTE and as an FTE per 100,000 of
population. This approach is useful to enable comparison to
reporting FTE data without any context to relative size
though it is not necessarily indicative of service delivery in a
particular LHD.
Medical
For the medical workforce the ratios in metropolitan
locations are fairly similar except for Sydney LHD. The higher
ratio to the population for Sydney LHD may be a factor of
referrals, particularly to Royal Prince Alfred, from outside
their geographic area. The FTE of medical workforce to
population for outer metropolitan LHDs is comparable to
and slightly higher than, the metropolitan Sydney LHDs. In
regard to the rural and regional LHDs, other than Southern
and Murrumbidgee LHDs the FTE ratio would not appear to
be significantly different, however in the main the rural and
regional LHDs are more geographically dispersed and have a
larger number of facilities. Southern LHD has the lowest FTE
of medical workforce to population. This ratio is further
complicated by the situation where 88% of the medical
workforce is comprised of Agency Doctors and Visiting
Medical Officers (VMOs).
Nursing
For the nursing workforce, other than Sydney LHD, the ratio
of nursing FTE to the population rises the further one moves
from the metropolitan areas, that is the FTE per population
is higher in the outer metropolitan LHDs than the Sydney
metropolitan, and the rural and regional are higher than the
inner and outer metropolitan LHDs, again excepting
Southern LHD. This may be a factor of a greater role
undertaken by Nursing Workforce in outer metropolitan and
rural and regional areas, and of changes in skills mix.
Allied Health
The ratio of the Allied Health workforce to the population is
slightly higher in the outer metropolitan LHDs (Illawarra-
Shoalhaven and Central Coast) and the Northern area LHDs
(Hunter New-England, Mid North Coast and Northern NSW).
The southern and western rural LHDs and the Sydney
metropolitan LHDs would seem to have a very similar profile
of Allied Health workforce (excepting Sydney LHD which has
the highest ratio to population overall). However, the FTE
ratio comparing Sydney to Rural needs to take into account
the greater distances a patient may have to travel to access
those services.
Oral Health
The profile for Oral Health does not follow a pattern based
on location. In the main the provision of Oral Health services
is mainly private the NSW Health profile reflects where there
is a concentration of Oral Health Services across LHDs, for
example, Sydney Dental Clinic in Sydney LHD and Westmead
Dental school in Western Sydney LHD.
31 The data for the workforce graphs is sourced from the Staff State Profi le (unaudited State HIE) for June 2011. VMO FTE has been calculated as a combination of fee for service payments and sessional hours.
PAGE 14 NSW HEALTH Health Professionals Workforce Plan Technical Paper
Sydney
South
Easte
rn Sy
dney
South
Wes
tern
Sydney
Wes
tern
Sydney
Norther
n Sydney
Illawar
ra Sh
oalhav
en
Nepea
n Blu
e Mounta
ins
Centra
l Coas
t
Hunter N
ew En
gland
Mid
North
Coas
t
Norther
n NSW
South
ern N
SW
Murru
mbid
gee
Wes
tern
NSW
Far W
est
Sydney
South
Easte
rn Sy
dney
South
Wes
tern
Sydney
Wes
tern
Sydney
Norther
n Sydney
Illawar
ra Sh
oalhav
en
Nepea
n Blu
e Mounta
ins
Centra
l Coas
t
Hunter N
ew En
gland
Mid
North
Coas
t
Norther
n NSW
South
ern N
SW
Murru
mbid
gee
Wes
tern
NSW
Far W
est
Sydney
South
Easte
rn Sy
dney
South
Wes
tern
Sydney
Wes
tern
Sydney
Norther
n Sydney
Illawar
ra Sh
oalhav
en
Nepea
n Blu
e Mounta
ins
Centra
l Coas
t
Hunter N
ew En
gland
Mid
North
Coas
t
Norther
n NSW
South
ern N
SW
Murru
mbid
gee
Wes
tern
NSW
Far W
est
Sydney
South
Easte
rn Sy
dney
South
Wes
tern
Sydney
Wes
tern
Sydney
Norther
n Sydney
Illawar
ra Sh
oalhav
en
Nepea
n Blu
e Mounta
ins
Centra
l Coas
t
Hunter N
ew En
gland
Mid
North
Coas
t
Norther
n NSW
South
ern N
SW
Murru
mbid
gee
Wes
tern
NSW
Far W
est
020406080100120140160180200
0
200
400
600
800
1000
1200
1400
FTE
Medical Workforce (inc VMO) by LHD
0100200300400500600700800
0
1000
2000
3000
4000
5000
6000
Nursing Workforce by LHD
020406080100120140160
0100200300400500600700800900
1000
0
10
20
30
40
50
60
0
50
100
150
200
250
300
350
Oral Health Workforce by LHD
FTE
per
100
,000
of
po
pu
lati
on
FTE
FTE
FTE
FTE
per
100
,000
of
po
pu
lati
on
FTE
per
100
,000
of
po
pu
lati
on
FTE
per
100
,000
of
po
pu
lati
onAllied Health Workforce by LHD
Another factor to take into account in looking at the
workforce by LHD or geographic region is the relative make
up of the profession to determine whether there are any
issues in regards to the relative experience of staff.
Nursing
The following graph shows the distribution of Nursing
classifications within each LHD, that is, the proportion of
each classification within all nursing employees within each
LHD. Murrumbidgee, Western NSW and the Far West LHDs
Sydney
South
Easte
rn Sy
dney
South
Wes
tern
Sydney
Wes
tern
Sydney
Norther
n Sydney
Illawar
ra Sh
oalhav
en
Nepea
n Blu
e Mounta
ins
Centra
l Coas
t
Hunter N
ew En
gland
Mid
North
Coas
t
Norther
n NSW
South
ern N
SW
Murru
mbid
gee
Wes
tern
NSW
Far W
est
Nurse-Midwife manager
Clin Nurse-Midwife Consultant
Clin Nurse-Midwife Specialist
Nurse Practitioner
Clin Nurse-Midwife Educator
Nurse-Midwife Educator
Nurse-Midwife Unit Manager
Registered Midwife
Registered Nurses (5-8)
Registered Nurses (1-4)
Enrolled Nurse
Assistant in Nursing
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Nursing Classifications as Proportion of Nursing Workforce - by LHD
Health Professionals Workforce Plan Technical Paper NSW HEALTH PAGE 15
have the greater proportion of Assistant in Nursing and
Enrolled Nurse classifications. However, they also have a
greater proportion of Nurse Manager positions, so there is a
greater reliance on both junior and senior staff in the rural/
remote LHDs.
Medical
The following graph shows the distribution of Medical
Practitioner classifications within each LHD, that is the
proportion of each classification within all Medical
Practitioners within each LHD. The graph highlights the
greater reliance on short-term contracted doctors in the
rural and remote LHDs, especially in Southern NSW and the
Far West LHDs. Central Coast LHD has the largest proportion
of Junior Medical Officers (Intern and RMO). Mid North
Coast LHD has the largest proportion of Career Medical
Officers. Care needs to be taken in interpretation of
proportion of junior doctors due to the rotational nature of
their appointments during their pre-vocational and
vocational training.
Sydn
ey
Sout
h Ea
stern
Sydn
ey
Sout
h W
este
rn Sy
dney
Wes
tern
Sydn
ey
North
ern
Sydn
ey
Illawar
ra Sh
oalha
ven
Nepea
n Blu
e Mou
ntain
s
Centra
l Coa
st
Hunte
r New
Engla
nd
Mid
North
Coa
st
North
ern
NSW
Sout
hern
NSW
Mur
rum
bidge
e
Wes
tern
NSW
Far W
est
Agency Doctor
VMO
Clinical Academic
Staff Specialists
Career Medical Officers
Registrar
RMO3-4
RMO1-2
Intern
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Medical Classifications as Proportion of Medical Workforce - by LHD
PAGE 16 NSW HEALTH Health Professionals Workforce Plan Technical Paper
Allied Health
The following graph shows the distribution of Allied Health
Professionals within each LHD. Care needs to be taken with
analysis of this information as there is a greater proportion
on Allied Health staff temporarily appointed to Health
Reform Transitional Organisations, who will not be reflected
in this graph. An example of this would be the level of
radiographers in South Eastern Sydney and Illawarra-
Shoalhaven LHDs, as medical imaging staff are employed in
a business unit that sits under the Health Reform Transitional
Organisation and are therefore not reflected in the number
of employees in each LHD.
Sydney
South
Easte
rn Sy
dney
South
Wes
tern
Sydney
Wes
tern
Sydney
Norther
n Sydney
Illawar
ra Sh
oalhav
en
Nepea
n Blu
e Mounta
ins
Centra
l Coas
t
Hunter N
ew En
gland
Mid
North
Coas
t
Norther
n NSW
South
ern N
SW
Murru
mbid
gee
Wes
tern
NSW
Far W
est
Other
Nuclear Medicine Technologists
Counsellor
Podiatrist
Radiation Therapist
Dietitian
Radiographer
Psychologist
Clinical Psychologist
Speech Pathologist
Pharmacist
Occupational Therapist
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Allied Health Classifications as Proportion of Allied Health Workforce by LHD
Physiotherapist
Social Worker
Health Professionals Workforce Plan Technical Paper NSW HEALTH PAGE 17
Future projections
Population
The NSW Department of Planning has released New South
Wales Statistical Local Area Population Projections, 2006-
2036. They project that the NSW population will grow by
22.3% between 2008 and 2028, increasing from 7.015
million to 8.578m, an increase of 1.563m. The strongest
population growth will occur in the following Statistical
Local Areas (SLAs): Western Sydney, parts of central Sydney,
regional areas on or near the coast, the Sydney-Canberra
corridor and some regional centres (Central and South
Coast).32 At the same time, many SLAs with small
populations usually located in more remote parts of the
State (under 5,000 people) are projected to decline in
population.
The projected population growth by Local Health District
(LHD)33 shows the population increase by each of the LHDs
in NSW. Consistent with the projections from the NSW
Department of Planning by SLA the biggest growth for LHDs
is in South Western and Western Sydney, Southern NSW
and the Mid-North Coast. The areas of lowest and even
negative growth are Far West NSW, Western NSW and
Murrumbidgee.
The Age Profile for the projected population by 2028 shows
that each LHD will be potentially dealing with different
burdens of health care based on the demographics of its
population. Mid North Coast, Illawarra Shoalhaven and
Northern NSW will be dealing with a larger proportion of
older residents, whilst South Western Sydney, Western
Sydney and Nepean Blue Mountains will have a
proportionally younger aged community. Sydney and South
Eastern Sydney LHDs will have the largest proportion of
working age population, whilst Mid North Coast,
Murrumbidgee and Central Coast LHDs will have the
smallest proportion of working age population.
Sydney
South
Easte
rn Sy
dney
South
Wes
tern
Sydney
Wes
tern
Sydney
Norther
n Sydney
Illawar
ra Sh
oalhav
en
Nepea
n Blu
e Mounta
ins
Centra
l Coas
t
Hunter N
ew En
gland
Mid
North
Coas
t
Norther
n NSW
South
ern N
SW
Murru
mbid
gee
Wes
tern
NSW
Far W
est
-30%-20%-10%0%10%20%30%40%50%
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
FTE
per
100
,000
of
po
pu
lati
on
FTE
per
100
,000
of
po
pu
lati
on
NSW Pop by LHD 2008 and Projection to 2028
2008 2028* % Change NSW Average Change
32 Population NSW Bulletin April 201033 Centre for Epidemiology and Research. Health Statistics New South Wales. Sydney: NSW Department of Health. Available at: www.healthstats.doh.health.nsw.gov.au. Accessed 4 Aug 2011
Sydney
South
Easte
rn Sy
dney
South
Wes
tern
Sydney
Wes
tern
Sydney
Norther
n Sydney
Illawar
ra Sh
oalhav
en
Nepea
n Blu
e Mounta
ins
Centra
l Coas
t
Hunter N
ew En
gland
Mid
North
Coas
t
Norther
n NSW
South
ern N
SW
Murru
mbid
gee
Wes
tern
NSW
Far W
est
70+
45-69
25-44
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Age Profile by LHD - 2028 Projected Population
15-24
0-14
10
6,4
66
26
5,5
57
14
7,6
35
23
2,5
20
16
5,5
51
79
,06
9
84
,41
3
72
,57
8
17
7,9
42
43
,06
1
60
,80
1
44
,42
0
46
,92
9
51
,38
6
4,4
13
85
,36
5 17
3,8
07
11
9,3
78
15
6,8
12
12
0,1
73
50
,53
9
55
,66
9
46
,17
1
11
1,3
34
23
,35
6
34
,88
1
24
,01
9
27
,45
6
29
,05
6
2,4
55
23
1,0
06
32
2,4
03
28
6,4
63
31
6,8
86
26
2,9
06
10
1,7
94 11
1,3
22
92
,23
3
22
3,3
96
47
,07
6
71
,28
8
53
,78
3
53
,35
7
59
,73
9
5,5
36
18
1,7
61
32
4,4
22
24
3,1
47
28
7,7
96
26
2,1
27
13
7,4
95 10
9,7
77
11
2,1
20
30
6,7
66
88
,20
8
11
5,9
50
83
,91
9
76
,98
8
85
,17
4
8,8
04
74
,43
2
13
5,8
01
11
8,4
50
10
9,1
46
13
0,7
59
80
,73
7
49
,49
6
66
,40
7
17
6,2
81
59
,24
1
71
,63
5
44
,49
1
45
,19
9
47
,76
6
4,9
87
PAGE 18 NSW HEALTH Health Professionals Workforce Plan Technical Paper
Whilst the data for the same period is not available for the
Aboriginal population, data for a similar period shows a
much different projected growth in age groups for the NSW
Aboriginal population. There is a larger projected growth for
the Aboriginal population than the average growth in NSW,
a much larger projected increase for younger age groups,
and a smaller growth for those aged over 70.
The projected growth in the population by age group shows
a greater growth in those aged 65 and over and smaller
growth in those of working age.
Projected Growth in Age NSW Aboriginal population 2006-2021
0-4
5-9
10-1
4
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
All
Ag
es
80+
-40.0%
-30.0%
-20.0%
-10.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Percentage growth in age, NSW population, 2008 to 2028
20.5% 20.8%
15.9%
10.5%8.7% 9.7%
16.9%
10.7%14.9%
3.8%
11.0%
17.4%
27.2%
63.3%
76.2%80.5%
67.6%
92.5%
22.3%
0.0%
0-4
5-9
10-1
4
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
80-8
4
85+
All
ages
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
In looking at the relative size of the working age population
(20-64) to both younger and older age groups it can be
seen that the largest growth is in the over 65 age group.
45.7% of the projected growth of the population (0.714m)
will be in the age group of 65 years and older, with an
estimate growth of 74.1% (more than three times total
population growth).34
For the Aboriginal population the growth in the younger
age groups mitigates this effect. Whilst the age group over
65% has the largest growth the difference in growth
between the age groups is not as stark.
■ In the 12 months to December 2010, net overseas
migration (NOM) contributed to 58% of the State’s
population growth, while natural increase (births minus
deaths) contributed to 40% ■ At the same time there was a net loss due to interstate
migration of 11,200 persons to neighbouring States, the
largest net loss among States and Territories.35
0
1000000
2000000
3000000
4000000
5000000
6000000
Under 19 20-64 65+
Pop
ula
tio
n N
um
ber
Perc
enta
ge
Gro
wth
Growth in Age Groups NSW 2008-2028
0
20
40
60
80
2008 2028 % Growth
0
20000
40000
60000
80000
100000
120000
Under 19 20-64 65+
Pop
ula
tio
n N
um
ber
Perc
enta
ge
Gro
wth
Projected Growth in Age Groups - AboriginalPopulation NSW 2006-2021
2006 2021 % Growth
0%
60%
50%
40%
30%
20%
10%
34 Health Statistics NSW: Estimated residential population and projected population by age and sex, NSW, 2008 to 202835 Koleth, E. (2010) Population issues for Sydney and NSW: Policy frameworks and responses. Briefi ng Paper No. 5/2011 NSW parliamentary Library Research Service.
Source: Health Statistics NSW: Estimated residential population and projected population by age and sex, NSW, 2008 to 2028
Source: NSW Aboriginal Housing Offi ce (2008) Indicative New South Wales Indigenous Population Projections 2006 to 2021
Health Professionals Workforce Plan Technical Paper NSW HEALTH PAGE 19
Service Delivery
Acute
The inpatient projection model used by NSW Health, aIM
2010 (Acute Inpatient Model), has been developed to take
into account projected growth in inpatient activity based on
specialty groupings (SRGs – service reference groups). The
latest projections use 2009 as the base year, and project
inpatient activity to 2027. The specialties in the aIM data
have been mapped to medical specialist categories, which
are then weighted to estimated specialist numbers by
speciality. Growth rates were analysed for both separations
(number of patients) and case weighted technical units
(CWTU). The weighted total growth rate per annum used in
the baseline specialist modelling is 1.87% (CWTU).
The largest projected growth in is renal medicine,
endocrinology and ophthalmology – all specialities
associated with the increase in rates of diabetes. There is
also a projected growth in non subspeciality medicine. The
lowest growth areas are cardiothoracic surgery,
transplantation, gynaecology and obstetrics and drug and
alcohol.
Annual Percentage growth in inpatient activity, 2009-2027, NSW public & private hospitals
AveVarSep% AveVarCWTU%
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
4.50%
PAGE 20 NSW HEALTH Health Professionals Workforce Plan Technical Paper
The projected increases for the Acute Inpatient Model (aIM)
type of stay in NSW public hospitals indicates that there is a
larger annual increase in same day procedures (2.5%)
compared to the annual average increase in overnight
hospitalisations (1.9%).
There has been a small but steady decrease in average
length of stay in NSW public hospitals over the last decade.
This is partly due to an increase in the proportion of patients
treated on a same day basis (same day separations), and
partly a result of shorter length of stay for patients staying
more than one day (overnight average length of stay). The
graph below illustrates the two trends.
Overnight average length of stay for acute patients is
currently 5.1 days (NSW average), but there is considerable
variation between Local Health Districts. Some of this
variation is due to a different mix of patients treated at
different Local Health Districts.
0
500000
1000000
1500000
2000000
2500000
2009 2012 2017 2022 2027
aIM projected increases in overnight and same dayprocedures - NSW public hospitals
Overnight Same Day
Overnight Average Length of Stay and Percentage of Same Day Separations by Financial Year (acute separations only)
Ove
rnig
ht
ALO
S (d
ays)
% o
f Sa
me
Day
Sep
rati
on
s
5
4.9
5.3
5.2
5.1
5.4
5.5
5.6
42.5%
42.0%
44.0%
43.5%
43.0%
44.5%
45.0%
45.5%
Same Day Separations as % of All Acute Separations
Overnight Average Length of Stay (Days)
2005/06 2010/112009/102008/092006/07
Rehabilitation Palliative Care Psychogeriatric Maintenance
2009 111,679 10,120 656 7,715
2017 134,947 12,332 964 9,172
2022 155,335 13,861 1,131 10,102
Growth 2009-2017 21% 22% 47% 19%
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
Act
ive
Epis
od
es
Subacute Inpatient Projections (Demand) for NSW Public Hospitals
Workforce Projections
Modelling
The approach to demand modelling used within the models
below relates to the method of economic demand, and
incorporates the use of current and projected data for the
public health sector and private health sector (if modelling
whole of workforce). Demand modelling for the whole
workforce has been determined through an aggregation of
the demand estimates of staff categories within workforces
(weighted accordingly) and service demands. The service
demands have been determined from the current NSW
Acute Inpatient Model (aIM) projections project all acute
Diagnosis Related Groups (DRGs) or both public and private
hospitals from 2009 to 2027. Growth is estimated to
increase by 1.88% per annum over this period.
Health Professionals Workforce Plan Technical Paper NSW HEALTH PAGE 21
Registered Nurses NSW Health Adjusted headcount vs. Status quo headcount
hea
dco
un
t
35,000
40,000
45,000
50,000
55,000
60,000
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
20
22
20
23
20
24
20
25
20
26
20
27
20
28
20
29
20
30
Year (Balancing year 2026)
Status quo headcount Adjusted headcount
Nursing
NSW Health - Registered Nurse Workforce
This graph36 indicates the number of Registered Nurses
projected to be working in the NSW public health system
under two different scenarios. The status quo headcount
represents the scenario where there are no changes to the
current training level.
Even without change the projected increase in the size of
the Registered Nurse workforce between 2008 and 2028
shows a requirement for an extra 15,000 Registered Nurses.
The adjusted headcount represents the required headcount
based on projection of service needs to 2030. To achieve the
adjusted headcount there is a requirement to increase
training places for registered nurses of 239 students per
year.
The NSW Health Registered Nursing Modelling has identified
high losses in the nursing workforce in the years up to 40
years and around retirement age. Between these periods on
average there is more re-entry than losses in the registered
nursing workforce. This movement contributes to the factors
contributing to the need to train more graduates along with
the reduction in average hours worked. An increase in
retention is currently being experienced by NSW Health in
2010/11 compared to previous periods. This can be
attributed to external factors such as labour market shift due
to the Global Financial Crisis and loss of re-entry of the
workforce to other sectors other than NSW Health.
Enrolled Nurses
This graph37 indicates the number of Enrolled Nurses
projected to be working in the NSW public health system
under two different scenarios. The status quo headcount
represents the scenario where there are no changes to the
current training level. The adjusted headcount represents the
required headcount based on projection of service needs to
2030. To achieve the adjusted headcount there is a
requirement to increase training places for Enrolled Nurses
by 849 students per year.
The NSW Health Enrolled Nursing modelling has identified
high losses in the nursing workforce in the years up to 40
years and around retirement age. Between these periods on
average there is more re-entry than losses in the Enrolled
Nursing workforce. This movement contributes the factors
contributing to the need to train more Enrolled Nurses along
with the reduction in average hours worked. An increase in
retention is currently being experienced by NSW Health in
2010/11 compared to previous periods. This can be
attributed to external factors such as labour market shift due
to the Global Financial Crisis and loss of re-entry of the
workforce to other sectors other than NSW Health.
Enrolled Nurses NSW Health Adjusted headcount vs. Status quo headcount
hea
dco
un
t
0
2,000
4,000
6,000
8,000
10,000
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
20
22
20
23
20
24
20
25
20
26
20
27
20
28
20
29
20
30
Year (Balancing year 2026)
Status quo headcount Adjusted headcount
36 2007 Nurses NSW Labour Force Profi le and unpublished NSW Health workforce projections37 2007 Nurses NSW Labour Force Profi le and unpublished NSW Health workforce projections
PAGE 22 NSW HEALTH Health Professionals Workforce Plan Technical Paper
38 2009 Nurses NSW Labour Force Profi le and unpublished NSW Health workforce projections
Totalled Medical Workforce Adjusted headcount vs. Status quo headcount
hea
dco
un
t
20,000
40,000
30,000
35,000
25,000
20
07
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
20
22
20
23
20
24
20
25
20
26
20
27
20
28
20
29
20
30
Year (Balancing year 2025)
Status quo headcount Adjusted headcount
Medical
This graph38 indicates the number of Medical Practitioners
projected to be required in the total NSW health system
(public and private) under two different scenarios. The status
quo headcount represents the scenario where there are no
changes to the current training level.
The projected workforce growth required to meet service
needs projected to 2030 is 14,258, under current training
levels. The adjusted headcount required to meet service
needs is 14,664. This adjusted projected increase in the size
of the Medical workforce required between 2009 and 2030
shows a need for an extra 406 doctors. The adjusted
headcount represents the required headcount based on
projection of service needs to 2030. To achieve the adjusted
headcount there is a requirement to increase training places
for doctors of 38 students per year.
The Medical modelling for NSW has identified high losses in
the medical workforce in the initial years of training/work
and around retirement age. Between these period on
average there is more re-entry than losses in the medical
workforce. This movement contributes to the need to train
more graduates, together with the reduction in average
hours worked. An increase in retention is currently being
experienced by NSW Health in 2010/11 compared to
previous periods. This can be attributed to external factors
such as labour market shift due to the Global Financial Crisis
and increasing training being offered.
Allied Health
Initial workforce modelling has been undertaken on 13 of
the 26 professional groups within Allied Health employed by
NSW Health. This represents 97% of the June 2010 NSW
Allied Health Public Health workforce. The scenarios
discussed below are based on preliminary estimated demand
and further refinement may be required.
It is estimated that for Psychologists and Clinical
Psychologists NSW Health employs 30.3% of the total
NSW Psychology workforce. Assuming baseline growth of
1.8% it is estimated that NSW Health will need
approximately 6% additional headcount per year if the
current model of care persists.
For Physiotherapists NSW Health employs 28.4% of the
total estimated NSW Physiotherapy workforce. Initial growth
in estimates indicate that NSW Health will need an
additional 2.2% workforce headcount per year to meet
projected service requirements.
Occupational Therapists are predominately employed by
NSW Health and estimated at above 58% of the total
estimated NSW Occupational Therapist workforce. Initial
growth estimates indicate that NSW Health will need an
additional 0.5% growth in headcount per annum.
It is estimated that for Dieticians NSW Health employs 44%
of the total estimated NSW Dietician workforce. With
baseline growth of 1.8% it is estimated that NSW Health
will need approximately 2.4% additional headcount per
annum if the current model of care persists.
NSW Health employs approximately 52% of the total Social
Worker workforce in NSW. A range of scenarios estimate a
growth in headcount up to 1.4% per annum to meet
projected service requirements. Counsellors require a
headcount growth of approximately 3.4% per annum,
however the size of the NSW workforce for counsellors is
difficult to determine due to differential terminology of
classifications in use.
For Radiographers, Radiation Therapists and Nuclear
Medicine Technologists there is a range of additional
headcount growth required. Both Radiographers and
Radiation Therapists required less than 1% growth in
headcount per annum whereas Nuclear Medicine
Technologists require a growth of 2.1% per annum.
Health Professionals Workforce Plan Technical Paper NSW HEALTH PAGE 23
Modelling for Pharmacists and Speech Therapists did not
indicate any shortage in the initial workforce modelling.
However, the initial workforce modelling has not considered
initial shortages or meeting national guidelines on patient
care, so does not per se indicate that there is not a
shortage. Further investigation is required to quantify this.
NSW Health employs approximately 12% of the NSW
Pharmacy workforce and 52.7% of the NSW Speech
Therapist workforce.
SHPN (WDI 110201