New models of nursing care would provide solutions to ageing population, peaks argue

Intergenerational report

Australia’s population is forecast to pass 40 million by 2063, with the number of people aged over 65 set to double, while the number of Australians over 85 will triple, the government’s 2023 Intergenerational Report, released yesterday, has revealed.

By 2062-63, the life expectancy of Australians is predicted to rise to 87 years for men, and 89.5 years for women, the report states. It is also anticipated that Australians will remain healthier to an older age, and have fewer children, which is likely to bring long-term economic challenges as more people rely on government-funded services for longer.

The country’s coalition of peak nursing organisations, including the Australian Nursing and Midwifery Federation (ANMF), representing over 400,000 nurses, have argued the report’s outlook calls for innovative models of care to support the looming healthier ageing population.

The new models would increase health literacy and enable people to age in place, and support and teach people skills to self-care to keep well and healthy, therefore minimising the impact on acute health services, the peaks say.

According to the nursing peaks, nurses already form the single largest group of health professionals working in primary healthcare across Australia, yet, are currently under-utilised and under-funded to work to their full scope of practice.

“The ANMF welcomes the Federal Government’s scope of practice review, Unleashing the Potential of our Health Workforce, a recommendation of the Strengthening Medicare Taskforce, which must achieve its aim – to ensure all health professionals are fully utilised,” ANMF Federal Secretary Annie Butler said.

ANMF Federal Secretary Annie Butler. Photograph by Chris Hopkins

“The Review will determine how health practitioners can be supported to work to the full extent of their skills and training, which will lead to greater satisfaction for those practitioners and, most importantly, better health outcomes for our communities.”

Ms Butler said nurses and midwives, who comprise the majority of the healthcare workforce, have the capacity, expertise, and education to vastly improve health equity and access for people living in all areas of Australia. The review needs to recognise this and that nurse and midwife-led models of care are effective, feasible, appropriate, and cost-efficient.

“The Review also needs to address the barriers that currently prevent nurses and midwives from working to their full scope and identify the policy and funding measures needed to ensure nurses and midwives, and all health practitioners, are utilised most effectively. Government must then implement these measures to guarantee a future healthy Australia,” she added.

Strong evidence, both internationally and in Australia, demonstrate the efficacy of nurses working in partnership with consumers to maximise their independence and to enable them to live healthy and productive lives in the community, the peaks argue. These models include the Buurtzorg model of care, developed by a social enterprise in the Netherlands in 2006, where small teams of nursing staff provide a range of personal, social and clinical care to people in their own homes in a particular neighbourhood.

Here, the emphasis is on one or two staff working with each individual and their informal carers to access all the resources available in their social networks and neighbourhood to support them to be more independent. The nursing teams have a flat management structure, working in ‘non-hierarchical self-managed’ teams. This means they make all the clinical and operational decisions themselves.

Such models are proven both cost and health effective in a number of European countries, in the UK and in Canada, but to succeed in Australia would require a restructuring of funding models for primary healthcare, the peaks say.

Now, the peak nursing organisations want to continue their preliminary work with the Labor Government to advance innovative models of primary healthcare and funding.

Just this week, many representatives from the nursing peaks attended the Northern Territory First Nations Primary Care Health Workforce Summit in Alice Springs, where “the workforce is in dire straits”. Nationally, in rural and remote areas, they suggest there is little relief in sight to improve workforce numbers. Meanwhile, in Doomadgee, in Queensland, five nurse practitioners were recently sacked in favour of employing doctors.

“The population is growing whilst GP numbers are dropping, and healthcare is becoming harder to access,” President of the Australian Primary Health Care Nurses Association (APNA), explained.

“We need to forward focus and think smart about how we can maintain health services in primary care and keep people healthy and well. We need innovation in the types and models of care that use all the skills of our highly trained healthcare teams.

“There are already very successful models of care using nurses and nurse practitioners to run preventive health clinics and clinics for people with chronic health issues keeping them on track with their health and out of hospital.”

Ms Booth said registered nurse prescribing would augment team care by giving patients immediate access to their regular medications, especially when they cannot access a doctor.

CEO of the Australian College of Nurse Practitioners (ACNP), Leanne Boase, said the college looked forward to working on the upcoming scope of practice review to ensure a focus on access to quality healthcare.

“Nurses represent the majority of the health workforce, are under-utilised in Australia, and need to be highly valued and supported as skilled healthcare professionals now and into the future,” Ms Boase said.

“As part of that health workforce, nurse practitioners and registered nurses working in advanced practice roles must be fully enabled to work, utilising all of their knowledge, expertise and skills to improve health outcomes.

“Existing barriers to practice must be removed in the interests of better health, and as highlighted in the Intergenerational report, our demand for healthcare will only increase. It makes no sense to continue to under-utilise our greatest resources in healthcare.”

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