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New models of nursing care will provide solutions to the ageing population

25 Aug 2023

A joint press release from Mem­bers of the Nurs­ing Lead­ers of Aus­tralia, rep­re­sent­ing Aus­tralian Nurs­ing Peak Organ­i­sa­tions, fol­low­ing the release of the Inter­gen­er­a­tional Report.

The Inter­gen­er­a­tional Report, released yes­ter­day, pre­dicts that Australia’s pop­u­la­tion is expect­ed to climb to 39.8 mil­lion by 2060 – 61, a mil­lion more than the pre­vi­ous pro­jec­tions for 38.8 mil­lion released in 2021, and pass 40 mil­lion by 2063. Addi­tion­al­ly, Aus­tralians are expect­ed to live longer with life expectan­cies fore­cast to rise to 87 years for men and 89.5 years for women by 2062 – 63

The num­ber of peo­ple over 65 is set to dou­ble, and the num­ber of Aus­tralians over 85 will triple, accord­ing to the report. It is expect­ed Aus­tralians will remain health­i­er to an old­er age, and have few­er chil­dren, which is expect­ed to bring long-term eco­nom­ic chal­lenges as more peo­ple rely on gov­ern­ment-fund­ed ser­vices for longer. 

This coali­tion of peak nurs­ing organ­i­sa­tions, rep­re­sent­ing over 400,000 nurs­es states that these pre­dic­tions call for inno­v­a­tive mod­els of care, to sup­port this health­i­er age­ing pop­u­la­tion. These new mod­els will increase health lit­er­a­cy and enable peo­ple to age in place, and sup­port and teach peo­ple skills to self-care to keep well and healthy, thus min­imis­ing the impact on acute health services. 

Nurs­es already form the sin­gle largest group of health pro­fes­sion­als work­ing in pri­ma­ry health care in Aus­tralia, but cur­rent­ly are under-utilised and under-fund­ed to work to full scope of prac­tice. How­ev­er, there is strong evi­dence sig­nif­i­cant­ly inter­na­tion­al­ly and also in Aus­tralia to 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.

Mod­els such as the Buurt­zorg mod­el of care, devel­oped by a social enter­prise in the Nether­lands in 2006, involve small teams of nurs­ing staff pro­vid­ing a range of per­son­al, social and clin­i­cal care to peo­ple in their own homes in a par­tic­u­lar neighbourhood.

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 to be 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 health care. The peak nurs­ing organ­i­sa­tions are keen to con­tin­ue their pre­lim­i­nary work with the Labor Gov­ern­ment to progress inno­v­a­tive mod­els of pri­ma­ry health care and funding.

Rep­re­sen­ta­tives from the Nurs­ing Peaks have just attend­ed the North­ern Ter­ri­to­ry First Nations Pri­ma­ry Care Health Work­force Sum­mit in Alice Springs this week, where the work­force is in dire straits. Nation­al­ly in rur­al and remote areas there seem lit­tle relief in sight to improve work­force num­bers. Sad­ly, we have recent­ly seen five nurse prac­ti­tion­ers sacked in Doomadgee in favour of employ­ing doc­tors. The sit­u­a­tion there had moved beyond seri­ous. Those doc­tors nev­er arrived, leav­ing the pre­dom­i­nant­ly First Nations com­mu­ni­ty exposed with no pri­ma­ry health care ser­vices. The Nurs­ing Peaks are ques­tion­ing whether our Gov­ern­ment will allow this to continue.

Karen Booth, Pres­i­dent of Aus­tralian Pri­ma­ry Health Care Nurs­es Asso­ci­a­tion (APNA) says… The pop­u­la­tion is grow­ing whilst GP num­bers are drop­ping, and health care is becom­ing hard­er to access. We need to for­ward focus and think smart about how we can main­tain health ser­vices in pri­ma­ry care and keep peo­ple health and well. We need inno­va­tion in the types and mod­els of care that use all the skills of our high­ly trained health care 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. Reg­is­tered Nurse pre­scrib­ing would aug­ment team care by giv­ing patients imme­di­ate access to their reg­u­lar med­ica­tions, most impor­tant­ly when they can’t access the doc­tor. Many peo­ple will seek health care, but they don’t always need med­ical care, so we need to look at how we meet their health needs and con­serve doc­tor care for those more acute prob­lems. We wel­come to new Scope of Prac­tice Review. We need to think big pic­ture and bet­ter utilise the skills of allied health pro­fes­sion­als, phar­ma­cists and com­mu­ni­ty based para­medics to meet imme­di­ate non life-threat­en­ing health needs and keep peo­ple out of hospital.”

Leanne Boase, CEO of Aus­tralian Col­lege of Nurse Prac­ti­tion­ers (ACNP) says… The ACNP is ready to work on the upcom­ing scope of prac­tice review, ensur­ing a for­ward focus on access to qual­i­ty health care. Nurs­es rep­re­sent the major­i­ty of the health work­force, are under­utilised in Aus­tralia, and need to be high­ly val­ued and sup­port­ed as skilled health care pro­fes­sion­als now and into the future. 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 health care will only increase. It makes no sense to con­tin­ue to under­utilise our great­est resources in health care.”

Annie But­ler, Nation­al Sec­re­tary Aus­tralian Nurs­ing and Mid­wifery Fed­er­a­tion (ANMF) says… 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 full utilised. 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.”

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.

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