pa | HE AUSTRALIAN
ORTHOTIC PROSTHETIC
ASSOCIATION
_
Orthotics and Prosthetics in Australia
Orthotist/prosthetists assess the physical and functional limitations of people resulting from disease, illness, trauma and disability, including limb amputation, diabetes, arthritis and neuromuscular conditions, such as stroke. Orthotic and prosthetic services may involve the provision of orthoses and prostheses to restore function, prevent deterioration, and improve quality of life. Orthotist/prosthetists are commonly employed in Australian hospitals, private clinics, research institutions as well as rural and remote regions, working independently and as part of multidisciplinary healthcare teams to support the Australian community.
Orthotist/prosthetists are tertiary qualified allied health
professionals. An Australian Qualification Framework
level 7 is required to practice as an orthotist/prosthetist in Australia, consistent with education standards for other allied health professions. Orthotic/prosthetic students complete training alongside physiotherapy, podiatry and occupational therapy students.
The Australian Orthotic Prosthetic Association (AOPA) is
the peak professional body for orthotist/prosthetists in Australia, with certified practitioners comprising 89% of the practicing profession. AOPA is responsible for regulating the profession and is a founding member of
the National Alliance of Self Regulating Health
Professions (NASRHP) in partnership with other professional organisations, including Speech Pathology
Australia, the Australian Association of Social Workers
and Exercise and Sports Science Australia. AOPA is recognised by the Commonwealth Government as the assessing authority responsible for conducting migration skill assessments for orthotist/prosthetists.
Contact
The Australian Orthotic Prosthetic Association
P.O. Box 1132 Hartwell, Victoria 3124
(03) 9816 4620 | www.aopa.org.au
Leigh Clarke – Chief Executive Officer
Executive summary
AOPA would like to the thank the Joint Standing • Only 14% of the orthotist/prosthetist workforce are Committee (JSC) on the National Disability Insurance located in regional and remote areas of Australia. Scheme (NDIS) for the opportunity to provide comment Difficulty accessing mentoring and continual on the NDIS National Workforce Plan 2021-2025 (the professional development as well as professional Workforce Plan)1. AOPA welcomes the opportunity to isolation, likely contribute to this low prevalence of support the work of the JSC through strengthening the practitioners,
NDIS workforce and improving access to clinical • The NDIS provider travel policy is aservices for NDIS participants. Commonwealth Government policy that negatively
affects remuneration of orthotic/prosthetic clinicalThis submission addresses the following JSC inquiries: services. This policy is: difficult to implement,
administratively and financially burdensome, and a a. The current size and composition of the NDIS barrier to the provision of sustainable clinical workforce and projections at full scheme, services,
b. Challenges in attracting and retaining the NDIS • Effective workforce development relies on State, workforce, particularly in regional and remote Territory and Commonwealth Governments communities, applying a coordinated, strategic and nationally
c. The role of Commonwealth Government policy consistent workforce strategy,
in influencing the remuneration, conditions, • An underdeveloped orthotic/prosthetic private working environment (including Workplace sector drives participants to public health services. Health and Safety), career mobility and training Conflicts arise as health services are triaged ahead needs of the NDIS workforce, of disability services,
d. The role of State, Territory, Commonwealth • Building a complimentary workforce, including Governments in providing and implementing a technicians and allied health assistants, will coordinated strategic workforce development increase capacity of the existing plan for the NDIS workforce), orthotic/prosthetic workforce.
e. The interaction of NDIS workforce needs with Examples in this submission consist of real-life reported employment in adjacent sectors including examples, as well as fictitious scenarios. Effort has been health and aged care, made to ensure all examples are accurate.
g. Other matters. AOPA is grateful for the opportunity to provide this By way of summary: additional context describing the orthotist/prosthetist workforce and other workforce issues relating to the
- The orthotic/prosthetic workforce is small and has JSC Terms of Reference. We are available for further poor geographic dispersion. Workforce comment and look forward to assisting the JSC to projections indicate that the orthotic/prosthetic implement initiatives that will help grow the NDIS workforce cannot support the needs of the NDIS workforce. at full scheme,
1 Australian Government. 2021. National NDIS Workforce Plan 2021-
3 AOPA | Submission to the Joint Standing Committee on the NDIS: NDIS Workforce 2021
a) The current size and composition of the NDIS workforce and projections at full scheme
The orthotic/prosthetic workforce is small and has poor geographic dispersion. Workforce projections suggest that the orthotic/prosthetic workforce cannot support the needs of NDIS participants at full scheme
The size and composition of the orthotic/prosthetic workforce
AOPA certified orthotist/prosthetists represent approximately 89%2 of the total number of orthotist/prosthetists working in Australia.
While the exact proportion of orthotic/prosthetic practitioners that contribute to the NDIS workforce is not known, AOPA estimate that the vast majority likely provide orthotic/prosthetic services to NDIS participants. Therefore, the characteristics of the AOPA certified orthotist/prosthetist workforce presented Figure 1. Number of orthotist/prosthetists per 100 000 herein can be considered to be a fair reflection of the population characteristics of the NDIS orthotic/prosthetic workforce. The orthotic/prosthetic workforce is also geographically unevenly dispersed. 46% of the workforce is In 20193, the national orthotic/prosthetic workforce concentrated in Victoria where there are 2.85 comprised of 410 certified practitioners, with a practitioners per 100 000 population3 (Figure 1). Victoria practitioner prevalence of 1.62 orthotist/prosthetists per (2.85) and Tasmania (2.43) have the highest practitioner 100 000 population. There is only one published prevalence whilst New South Wales (0.99) and the recommendation for orthotist/prosthetist practitioner Northern Territory (0.81) have the lowest practitioner prevalence – which recommends 3.0 orthotists per 100 prevalence3. Only 14% of practitioners work outside of 000 population4. The Australian national average major cities (NB: this includes all of Tasmania and the practitioner prevalence (Figure 1) is therefore just over Northern Territory), which results in a practitioner half of the international recommendation. prevalence of 0.84 practitioners per 100 000 population; nearly half that of metropolitan areas. Geographical
2 Australian Bureau of Statistics (2016). 2016 Census of Population and 4 National Health Service (2005). Scottish Orthotic Services Review.
Housing, Customised Data report. ABS: Canberra, March 2020 Edinburgh: National Health Service
3 Ridgewell et.al. (2021) The changing demographics of the orthotist/prosthetist workforce in Australia: 2007, 2012 and 2019. Human Resources for Health 19 (34).
4 AOPA | Submission to the Joint Standing Committee on the NDIS: NDIS Workforce 2021
dispersion relating to regional/remote areas will be Orthotic/prosthetic workforce projections discussed further in section B) challenges in attracting and retaining the NDIS workforce, particularly in The orthotic/prosthetic workforce has grown steadily regional and remote communities. over time. For example, over the past ten years, the number of AOPA certified practitioners has increased at The Australian orthotic/prosthetic workforce has a steady rate of approximately 7% per year. While this become significantly younger over time. For example, growth has outpaced population growth and has mean practitioner age has reduced from 42 years to 38 therefore translated into more practitioners per 100 000 years in 2019 (p=0.008)3. In 2007, nearly half (44%) of the population, current practitioner prevalence in Australia Australian workforce was aged under 40 years; in 2019 remains below international recommendations. It is this proportion increased to nearly two thirds (63%)3. In likely that without targeted initiatives to increase or 2007, 17% of the workforce were aged 55 or older, expand the existing workforce, this shortage of dropping to 12% in 20193. orthotist/prosthetists in Australia, is likely to continue.
Since 2007, the Australian orthotic/prosthetic workforce has become significantly feminised (p<0.05)3 with the proportion of female orthotist/prosthetists increasing from 30% in 2007 to 49% in 2019 (Figure 2).
Figure 2. Proportion of male and female orthotist/prosthetists
5 AOPA | Submission to the Joint Standing Committee on the NDIS: NDIS Workforce 2021
b) Challenges in attracting and retaining the NDIS workforce, particularly in regional and remote communities
Poor access to mentoring and professional development coupled with professional isolation likely contribute to the low prevalence of orthotist/prosthetists in regional and remote Australia. Low orthotist/prosthetist prevalence in and remote areas must travel to metropolitan areas to regional and remote areas access orthotic/prosthetic services, while those who do not or cannot travel, experience substantial delays given Only 14% of the orthotic/prosthetic workforce are they must wait for a satellite or outreach service. located in regional and remote areas of Australia, including all of Tasmania and the Northern Territory, equating to 0.84 orthotist/prosthetists per 100 0003. This Example: Molly needs to travel 8 hours for is less than half the number of practitioners per 100 000 service population located in metropolitan areas of Australia (i.e., 1.92) 3, and only one third of the international recommendation of 3.0 orthotists per 100, 000 Molly is an NDIS participant and needs a population 4. The proportion of the orthotic/prosthetic new pair of ankle foot orthoses with workforce in regional and remote areas is similar to modified footwear to help her walk at many other allied health disciplines experienceing school, at her part-time job and around the workforce shortages, including occupational therapists5 community. Unfortunately, Molly lives 8 physiotherapists6 and podiatrists7. hours away from her nearest orthotist. This means Molly’s mother needs to take two With barriers such as lack of mentorship possibilities, days off work to drive Molly to her difficulty accessing professional development and appointment and back. As it is such a long professional isolation, AOPA suggest that low numbers trip, Molly and her mother also must stay of practitioners in regional and remote areas is unlikely overnight for this appointment. Molly and to substantially change in the future. her mother will need to make this trip again for a fitting appointment in 4 weeks’ time, Low orthotist/prosthetist prevalence in regional and and again in another 2 weeks for a review. remote areas make it difficult for NDIS participants to access orthotic/prosthetic services. For example, AOPA believe that the majority of participants living in regional
5 Department of Health. Occupational therapists. 2017 Factsheet. 7 Department of Health. Podiatrists. 2017 Factsheet. Canberra: Canberra: Australian Government Department of Health; 2017 Australian Government Department of Health; 2017. 6 Department of Health. Physiotherapists. 2017 Factsheet. Canberra:
Australian Government Department of Health; 2017
6 AOPA | Submission to the Joint Standing Committee on the NDIS: NDIS Workforce 2021
Barriers to recruiting and retaining • Take more time from work to travel to the CPD practitioners in regional and remote activity, settings • Pay additional transportation and accommodation costs.There are barriers inhibiting recruitment and retention of orthotist/prosthetists in regional and remote settings. Given there are so few practitioners providing services For example, it is particularly difficult to obtain into regional/remote areas of Australia, practitioners mentorship with a skilled and experienced practitioner often work in isolation or in services with few in regional and remote areas, given the low practitioner practitioners. It is often not possible for more than one prevalence and the small numbers of experienced practitioner to be absent from work at the same time. orthotist/prosthetists in the workforce overall. This is particularly problematic for very small allied Furthermore, experienced practitioners accepting health professions such as orthotist/prosthetists, who multiple requests for mentorship from junior also have access to fewer relevant CPD activities each practitioners have increased risk of burnout given the year, compared to many of their larger allied health balance required to manage a high clinical load and counterparts. allocate sufficient time to mentoring activities. Lack of mentorship opportunities is disadvantageous to junior practitioners given the practical and context-specific Example: Harry’s difficulty upskilling knowledge and support that could be provide through these professional relationships. Harry is an orthotist based in Whyalla. He is hoping to attend the
AOPA National Congress held in Example: John can't keep up Melbourne this year. Harry has
looked over the program and is John is an experienced certified excited to note a number of orthotist/prosthetist working in rural presentations and workshops are Queensland. He has over 45 years’ relevant to the services he provides experience across several major Unfortunately, as the congress is in clinical areas. John is looking Melbourne, Harry is unable to forward to reducing his clinical hours attend as he cannot cover the costs to part time, so he is able to spend of flights and accommodation, and more time with his grandchildren. the two days off work. John now mentors three junior practitioners, however the strain of mentoring whilst trying to reduce to Lack of mentorship opportunities and difficulty part time work means John is having accessing CPD can lead to professional isolation and less time to keep up with his own increased risk of intent to leave the profession. Given clinical load. This stress causes John opportunities to connect and network with professional to make plans to retire earlier than counterparts are so limited, practitioners in he had anticipated. regional/remote areas must either forgo opportunities or take them on at a greater cost compared with their metropolitan counterparts. A key barrier to orthotist/prosthetists working in a regional/remote area is difficulty accessing continuing Workforce Plan proposal professional development (CPD). Although practitioners can take part in web-based CPD such as live and pre- The Workforce Plan proposes an initiative to combat recorded webinars, the majority of profession-specific some of the difficulties facing regional/remote CPD activities such as national conferences and practitioners: “Enable allied health professionals in rural workshops are located in metropolitan areas. This and remote areas to access professional support via means practitioners in regional/remote areas are not telehealth” (Priority Action 3; initiative 15)1. only required to take time off work to attend the CPD activity, but they must: AOPA welcomes this initiative given it offers valuable support to practitioners working in regional/remote
7 AOPA | Submission to the Joint Standing Committee on the NDIS: NDIS Workforce 2021
areas of Australia. For example, since 2015, AOPA has offered high-quality and relevant webinars to our national membership, with feedback suggesting these webinars are highly valued by our regional/remote practitioners, given they offer support and resources that would otherwise be inaccessible.
However, this initiative alone is unlikely to make a substantial difference to practitioner recruitment and retention. For this initiative to appropriately support an orthotic/prosthetic workforce that is stretched thin and becoming progressively younger, professional support (i.e., mentoring) offered via telehealth could be offered in a group setting. This would capitalise on the knowledge and expertise of the experienced practitioner and would reduce travel barriers associated with geographic dispersion. Practitioners working in regional/remote areas would feel more connected to their profession and colleagues.
AOPA is looking forward to learning more about this initiative and is available to advise on how orthotist/prosthetists in regional and remote areas could access professional support such as group mentoring, via telehealth.
8 AOPA | Submission to the Joint Standing Committee on the NDIS: NDIS Workforce 2021
c) The role of Commonwealth Government policy in influencing the remuneration, conditions, working environment (including Workplace Health and Safety), career mobility and training needs of the NDIS workforce
The NDIS provider travel policy is a Commonwealth Government policy that negatively affects remuneration of orthotic/prosthetic clinical services. This policy is: difficult to implement, administratively and financially burdensome, and a barrier to the provision of sustainable clinical services. Current policy is not fit for purpose • Ensure each participant has provider travel in their plan,
The NDIS provider travel policy is intended to promote • Obtain consent from each participant to invoicepractitioner and service dispersion across Australia. provider travel,Unfortunately, the NDIS provider travel policies are
difficult to implement and present significant • Negotiate provider travel hourly rates with each administrative and financial burden which means they participant,
hinder access to services for NDIS participants. These • Negotiate how provider travel will be apportioneddifficulties can be considered under the following between participants (when a provider travels topoints: provide services to multiple participants).
• Administrative burden If a participant does not have provider travel in their
plan, the participant must instigate a plan review. This • Financial burden process can take months and disturbs current service
-
NDIA classifications do not reflect bookings. If one participant chooses not to pay the orthotic/prosthetic workforce provider for travel time, or wants to negotiate a different rate, the provider may have to re-negotiate with allAdministrative burden other participants. Out-reach services and clinics take substantial time to coordinate, which is compounded byThere are numerous administrative steps involved in these administrative tasks.invoicing provider travel time to the NDIS. Because funding for provider travel is accessed through a Financial burdenparticipant’s individual plan, these administrative steps
must be completed prior to service provision, and for Each administrative step attracts a financialevery participant. consequence. It takes hours to organise the necessities
for clinics and out-reach services (e.g., staffing, location,To provide services requiring provider travel, rent, equipment and inventory). Adding to this, the timeorthotic/prosthetic providers are required to: required to individually contact participants, including
confirmation and/or re-negotiation of appointments.
AOPA | Submission to the Joint Standing Committee on the NDIS: NDIS Workforce 2021 9
This administrative time translates directly into administrative costs.
The current NDIS provider travel policy requires individual participant negotiation, and as a consequence, is financially burdensome. AOPA is aware
of numerous service providers who rely on state-based funding to deliver clinics and out-reach services, which is not a long-term or sustainable solution for the delivery of services t NDIS participants in regional and remote areas. Example one below is one such example.
Example One: When multiple participants are seen in a Port Lincoln Clinic
These clinical services are provided in Port Lincoln, South Australia. According to the geographic classification system defined by the Modified Monash Model Six, Port Lincoln is an MM6 area. Because Port Lincoln is an MM6 area, the service provider cannot invoice any more than $271.59 per hour, for provider travel.
The Port Lincoln clinic is a 3-hour (one-way), drive from the provider’s regular place of business. On average, the
provider will see four NDIS participants per Port Lincoln clinic (and four Community Health Patients). The clinic
operates once a month, with two orthotist/prosthetists attending each clinic.
The provider can invoice each NDIS participant for the percentage of travel related to NDIS participant services at the
clinic. In this example, this is 50%, given NDIS participants represent 50% of the clinic caseload. The provider can
invoice each NDIS participant the proportion of provider travel time that is attributable to their service (25%), as long
as:
e Each participant has provider travel listed in their plan
- Each participant has agreed to the provider invoicing for travel time e Eachparticipant has agreed the provider can apportion their travel time across all NDIS participants.
The total time to travel to and from the clinic is 6 hours. As the clinic is servicing 4 NDIS participants out of 8 clients,
only 50% (3 hours) of the travel time may be invoiced to the NDIS participants. The three hours of provider travel time comes to a total of $814.77. This figure is then apportioned across the 4 NDIS participants ($203.69 per participant).
® |f one of the participants doesn't have provider travel in their plan, or has depleted the funds from their plan,
the participant will need to undergo a plan review.
-
[f one participant wants to negotiate a different price (which they are entitled to) the provider must then apportion the travel time differently against the remaining NDIS participants.
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The administrative time spent obtaining consent, confirming provider travel funds in a participant’s plan and negotiating hourly rates, cannot be claimed.
[t is important to note that the service provider described in this example, is based in a state hospital department and
therefore has increased levels of administrative support that would not be available to smaller, private providers.
NDIA geographic classifications do not reflect orthotic/prosthetic workforce
As seen in example one, the NDIA use a geographic classification system called the Modified Monash Model (MMM). This classification system is intended to assist the NDIA in funding supports fairly across metropolitan, regional and remote areas of Australia. Essentially, participants in more remote areas of Australia receive additional funding to support the increased cost of provider travel.
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Unfortunately, funding provider travel using a geographical classification system based on population, does not take into account the nuances of provider travel based on workforce distribution.
For example; Launceston is classified as MM2 (Regional Centre) which offers two permanent orthotic/prosthetic service providers, with seven certified orthotist/prosthetists. In contrast, Rockhampton is also an MM2 location, but in contrast to Launceston, Rockhampton has no permanent orthotic/prosthetic service provider. Instead, participants living in Rockhampton receive orthotic/prosthetic services via
out-reach clinics offered by two orthotic/prosthetic This pricing project should capture provider travel service providers, who each offer one clinic twice per policies and opportunities to stimulate service provision month. Service providers travelling into Rockhampton into regional and remote areas. It could explore will need to charge provider travel time. Despite this alternative funding arrangements and ways to reduce being a 3-hour journey for some providers, they are the significant administrative and financial burden of the limited to billing a maximum of 30 minutes travel time at current provider travel policy. the regular support cost of $193.99. This means that service providers must absorb the cost of the additional This initiative has the potential to improve concentration travel time, creating a barrier to offer these services and of orthotic/prosthetic services in thin market areas, and reducing long-term sustainability. thereby enable participants to access their orthotic/prosthetic services with reduced barriers. This provider travel policy results in two participants, AOPA is available to provide further information and who live in the same MMM geographic classification (for assistance to the Australian Government as required. example Launceston or Rockhampton), and require the same funding supports, will not receive equitable access, given the participant in Rockhampton will experience increased service wait times.
The impact
Given provider travel costs are allocated based on a geographic classification that does not reflect the required provider travel, it is not surprising that orthotic/prosthetic providers travel into these areas only where alternative arrangements are in place (i.e., state funding received). For example, some private service providers report community-based funding is provided to support airfares and associated travel costs.
Current NDIA provider travel policy means it is difficult for providers to establish provider travel efficiently. Some providers must absorb the majority of the costs associated with provider travel - a practice that is highly unsustainable and problematic. Current provider travel policy has also resulted in some providers:
- reducing the number of outreach clinics,
- refusing to operate any outreach clinics,
- relying on state-based support to operate clinics. None of these outcomes are sustainable or enable participants to access services in a timely manner.
The workforce plan to reduce red tape
AOPA support the Workforce Plan’s 11th initiative to “continue to improve NDIS pricing approaches to ensure effective operation of the market, including in thin markets”. The plan proposes that the Australian Government run a “pricing project to consider approaches to improve pricing practices” and support “workforce development”.
11 AOPA | Submission to the Joint Standing Committee on the NDIS: NDIS Workforce 2021
d) The role of State, Territory, Commonwealth Governments in providing and implementing a coordinated strategic workforce development plan for the NDIS workforce
Effective workforce development relies on State, Territory and Commonwealth Governments applying a coordinated, strategic and nationally consistent workforce strategy State/territory equipment funding policies Similar market-growth issues occur in other inhibit growth of private sector states/territories. For example, the Queensland Artificial
Limb Service (QALS) and Western Australian Limb
There are a range of equipment scheme funding Service for Amputees (WALSA) only recognise service policies currently in place across the various states and providers who are contracted suppliers. Becoming a territories of Australia. These policies are intended to contracted supplier is administratively burdensome. It govern and regulate equipment scheme services and also prevents new providers entering the market easily. providers within each specific state/territory. As a result, workforce growth is inhibited in these states, These funding policies are not nationally consistent - and other states with similar funding policies. each has different requirements for service providers Practitioners are attracted to open private practice in within each jurisdiction. This disjointed approach to other states with less restrictive policies, thus funding orthoses and prostheses inhibits growth of the practitioner prevalence decreases and access to orthotic/prosthetic workforce, particularly in the private services is made more difficult. sector. An under-developed private sector forces For example, ENABLE NSW is a state-based equipment NDIS participants to the public sector scheme that has contracts with private service providers for the provision of state-funded prosthetic services With a small and unevenly dispersed orthotic/prosthetic funded by ENABLE NSW. Service providers must workforce, the lack of private practice providers in many compete for contracts, and if awarded a contract, they states steers NDIS participants to access must re-apply every five years. Given service providers orthotic/prosthetic services in the public sector. Where cannot rely on successful contract applications, it is the public sector is unable to meet this outpatient difficult to forecast future service needs or for new disability service demand, long waiting lists are service providers to enter the market. emerging. This is typically because public sector services are required to prioritise inpatient health In addition to this, private service providers in NSW are services over outpatient disability services. allocated to various amputee clinics in each Local Health District (LHD). For example, one private service Waitlists are highly problematic for people requiring provider is allocated an amputee clinic in one LHD but orthoses and prostheses. Orthoses and prostheses are cannot provide services in another LHD. This makes it vital assistive technology that enable people to safely difficult for service providers who wish to expand into ambulate, administer self-care tasks and activities of other LHD and in turn, is a barrier to market growth. daily living, and participate in school, work and social
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life. When waitlisted, a person may be denied access to this vital assistive technology and may be therefore unable to participate in home, school or work life. They may also face an increased risk of falls, injury or an escalation in care needs.
Workforce growth
Workforce growth in the private sector depends on the removal of barriers currently inhibiting private practice set-up. This includes the reviewing of contractual arrangements with state-based equipment schemes to make it easier for new service providers to enter the market. States and territories need to uniformly remove these barriers to encourage workforce growth across the sector.
13 AOPA | Submission to the Joint Standing Committee on the NDIS: NDIS Workforce 2021
e) The interaction of NDIS workforce needs with employment in adjacent sectors including health and aged care
An underdeveloped private sector drives participants to public health services. Conflicts arise as health services prioritise inpatient services over out-patient disability services. The conflict between health and disability workforce and under-developed private sector in many states, NDIS participants are often driven to the public Orthotist/prosthetists work across a range of sectors sector to access orthotic/prosthetic services. including health, aged care, and disability. With a small and unevenly dispersed profession, As the public sector must prioritise health services, orthotist/prosthetists must provide services across all disability caseloads are often waitlisted and sectors to meet market demand. downgraded in their priority. This conflict often results in NDIS participants needing to wait longer to receive Given the low numbers of orthotist/prosthetists in their service. This is particularly problematic in regional regional and remote areas, and in several and remote areas where there are low workforce state/territories, a number of public orthotic/prosthetic numbers and even fewer private practices. providers are also NDIS providers. Given the small
Example: Health and disability services in a regional areas
Angela lives in regional area. She uses an ankle foot orthosis (AFO) to ambulate at home and in the community. There are no private providers for Angela to access in her region, therefore she attends the local hospital orthotic/prosthetic department for outpatient services.
Angela has a scheduled review appointment to see her orthotist. She made this appointment after she noticed a small crack in her AFO. On the day of the appointment her orthotist is running late as they have been called into surgery to fit a post-operative orthosis and has also been required to attend the emergency department to fit a cervical orthosis to someone who has a spinal fracture.
Angela is unable to wait any longer than an hour. She has had to reschedule her orthotic appointment for the following week. Two days later, as Angela is walking down the steps at her front door, her AFO develops a large crack in her AFO at the ankle. Angela falls down two steps. She has injured herself and is unable to use her AFO as it is unsafe.
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g) Any other matters Building a complimentary workforce, including technicians and allied health assistants will increase capacity of the existing orthotic/prosthetic workforce. Orthotic/prosthetic technicians in Australia. However, technicians are not employed across all orthotic/prosthetic service providers, which One strategy to combat a small workforce size and suggests potential for meaningful workforce growth of geographical dispersion, is to strengthen the this complimentary workforce. complimentary workforce which in turn increases the capacity of the existing workforce by allowing How the workforce plan can support practitioners to work at top of scope. technician training
A key complimentary workforce for the The Workforce Plan is able to support orthotic/prosthetic profession is the orthotic/prosthetic orthotic/prosthetic technician training through initiative technician workforce. While orthotist/prosthetists are 14: “explore options to support allied health trained and qualified to assess, prescribe, design, professionals to work alongside allied health assistants manufacture, fit and review orthoses and prostheses, and support workers to increase capacity to respond to orthotic/prosthetic technicians have expertise in the participants’ needs”. While this initiative explicitly lists manufacture of orthoses and prostheses. allied health assistants and support workers, AOPA strongly recommend that orthotic/prosthetic technicians The technician workforce is an integral part of the be included in this initiative. orthotic/prosthetic workforce. With technicians providing expertise and skills in manufacturing and Currently, orthotic/prosthetic technicians have no formal repairing orthoses and prostheses, practitioners have training pathway. Technicians must learn on-the-job and increased capacity to be able to work at the top of the apply for positions using transferable skills sets. A lack scope, consult with more clients and provide more of formal training means no formal professional identity clinical services, which effectively expands the existing - one reason that it is difficult to retaining workforce. orthotic/prosthetic technicians.
For example, a practitioner is attending a busy The Workforce Plan offers an opportunity to formalise rehabilitation clinic, with several clients requiring training and develop a career pipeline for refurbishments to their orthoses. The practitioner orthotic/prosthetic technicians. This would also assesses the first client and notices an orthotic knee contribute to helping secure a formal identity to a joint on a knee ankle foot orthosis is showing signs of workforce that currently has no representation or formal malfunction. After assessing the need for a new orthotic training. Furthermore, with formal training, an knee joint, the practitioner takes the orthosis to the opportunity presents itself for further career progression technician in the workshop. The technician replaces the when training courses can articulate from a technician knee joint according to the practitioner’s specifications. qualification to practitioner. Whilst the technician completes this, the practitioner is able to consult with their next client. Technicians are a vital part of the orthotic/prosthetic profession and must be considered when implementing AOPA estimates there are 200 technicians employed by the Workforce Plan. public and private orthotic/prosthetic service providers
AOPA | Submission to the Joint Standing Committee on the NDIS: NDIS Workforce 2021 15
Allied health assistants How the workforce plan can support an orthotic/prosthetic allied health assistant Allied health assistants are a complimentary workforce workforce that could be utilised to increase the capacity of the existing orthotist/prosthetist workforce, by allowing Initiative 14 of the Workforce Plan will support allied them to work top of scope. While the number of allied health assistant training and mobilisation within the health assistants employed within the orthotic/prosthetic profession. orthotic/prosthetic profession is not known, AOPA believe there are currently no allied health assistance AOPA is aware of the Victorian Government’s allied employed in the private orthotic/prosthetic sector. health workforce plan and training institutions like Skills Allied health assistants are generally employed by IQ, working to ensure competencies and training public health services and are understood to be to packages are fit for purpose. The Workforce Plan can utilised only occasionally in the public sector to support further promote disability training for allied health orthotic/prosthetic service provision. assistants.
Allied health assistants can increase a practitioner’s capacity by allowing them to work at top of scope. For example, a practitioner is attending a busy rehabilitation clinic, with several clients requiring casting and refurbishments to their orthoses. The practitioner assessed one client needing a new orthotic knee joint on their knee ankle foot orthosis (KAFO). The practitioner has instructed the allied health assistant to help the client put on their KAFO after the technician has replaced the knee joint. Whilst the allied health assistant helps the client put on their KAFO, the practitioner can commence casting another client. After the practitioner has completed casting, they return the first client and instruct the allied health assistant to prepare the casting room for the next client. The practitioner can now assess if the new orthotic knee joint is achieving its purpose.
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The Australian Orthotic Prosthetic Association
P.O. Box 1132 Hartwell, Victoria 3124
(03) 9816 4620 | www.aopa.org.au