Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus

Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus i

Contents Introduction... 1 What is an Aboriginal and Torres Strait Islander Health Worker?... 2 How are Aboriginal and Torres Strait Islander Health Workers trained?... 3 Associations... 4 Regulatory and accreditation bodies... 4 What is known about this workforce?... 5 National Health Workforce Dataset: Aboriginal and Torres Strait Islander Health Practitioners... 14 Workforce inflows... 19 How can workforce activity be measured?... 24 What issues have stakeholders identified for the Aboriginal and Torres Strait Islander Health Worker workforce?... 25 HWA s assessment of this workforce... 28 How do Aboriginal and Torres Strait Islander Health Workers compare with other health occupations?... 34 How do Aboriginal and Torres Strait Islander Health Practitioners compare with other health occupations?... 40 What does the analysis show?... 43 Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus i

Health Workforce Australia This work is Copyright. It may be reproduced in whole or part for study or training purposes. Subject to an acknowledgement of the source, reproduction for purposes other than those indicated above, or not in accordance with the provisions of the Copyright Act 1968, requires the written permission of Health Workforce Australia (HWA). Enquiries concerning this report and its reproduction should be directed to: Health Workforce Division Department of Health GPO Box 9848 Canberra ACT 2601 Health.workforce@health.gov.au Suggested citation: Health Workforce Australia 2014: Australia s Health Workforce Series Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus ii

Introduction About HWA Health Workforce Australia (HWA) is a Commonwealth statutory authority established to build a sustainable health workforce that meets Australia s healthcare needs. HWA leads the implementation of national and large scale reform, working in collaboration with health and higher education sectors to address the critical priorities of planning, training and reforming Australia s health workforce. Australia s health system is facing significant challenges, including an ageing population and an ageing health workforce; changing burden of disease, in particular a growing level of chronic disease; and increased demand for health services with higher numbers of people requiring complex and long-term care. To achieve HWA's goal of building a sustainable health workforce that meets Australia's health care needs, health workforce planning is essential and in health workforce planning, understanding the number and characteristics of the existing health workforce is the essential first step. Australia s Health Workforce Series is designed to focus on describing particular professions, settings and issues of interest to aid workforce planning. This issue of Australia s Health Workforce Series examines Aboriginal and Torres Strait Islander Health Workers / Practitioners, bringing together available information to describe the Aboriginal and Torres Strait Islander Health Worker / Practitioner workforce, including number and characteristics, potential data sources to measure workforce activity, and an analysis based on information presented. This publication is divided into four main parts: 1. What is an Aboriginal and Torres Strait Islander Health Worker / Practitioner a brief overview of the roles and training pathways, and descriptions of the key regulatory bodies and peak associations. 2. What we know about the Aboriginal and Torres Strait Islander Health Worker / Practitioner workforce presentation of data from different sources, describing the number and characteristics of the workforce, inflows into the workforce, and potential data sources that could be used to measure workforce activity. 3. What issues are expected to impact supply and/or demand for Aboriginal and Torres Strait Islander Health Workers / Practitioners a summary of issues obtained through stakeholder consultation. 4. HWA s assessment of the workforce which includes an assessment of existing workforce position (whether workforce supply matches demand for services or not); presentation of a set of workforce dynamics indicators, used to highlight aspects of the current workforce that may be of concern into the future; and a comparison of the Aboriginal and Torres Strait Islander Health Worker / Practitioner workforce s key characteristics with other health workforces. Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 1

What is an Aboriginal and Torres Strait Islander Health Worker? The Aboriginal and Torres Strait Islander Health Worker workforce evolved from a need to provide culturally safe clinical and primary health services to Aboriginal and Torres Strait Islander people whose health needs were not being met by mainstream services. Aboriginal and Torres Strait Islander Health Workers are able to respond to local health needs and contexts and perform different tasks depending on the services needed. This is reflected in the wide degree of variation that exists in Aboriginal and Torres Strait Islander Health Worker roles, definitions, scopes of practice, education standards and career pathways. 1 Commonly, Aboriginal and Torres Strait Islander Health Workers:! provide culturally safe health care to Aboriginal and Torres Strait Islander people, such as advocating for Aboriginal and Torres Strait Islander clients to explain their cultural needs to other health professionals, and educating or advising other health professionals on the delivery of culturally safe health care! perform a comprehensive primary health care role, for example, clinical assessment, monitoring and intervention activities, and health promotion 2, 3, 4! adapt the roles they perform in response to local health needs and contexts. Aboriginal and Torres Strait Islander Health Workers are employed by a number of different service providers, including Aboriginal Community Controlled Health Organisations, Aboriginal Medical Services, hospitals, state and territory governments, and GP clinics. Recognising the complexity of the Aboriginal and Torres Strait Islander Health Worker workforce, and the barriers this creates for professional recognition, education and career pathways, one of the recommendations made in the HWA report Growing Our Future: the Aboriginal and Torres Strait Islander Health Worker Project Final Report was to endorse the national definition of an Aboriginal and Torres Strait Islander Health Worker as a person who:! identifies as an Aboriginal and/or Torres Strait Islander and is recognised by their community as such, and! is the holder of the minimum (or higher) qualification in Aboriginal and Torres Strait Islander primary health care, and! has a culturally safe and holistic approach to health care. 5 Currently the minimum qualification in Aboriginal and Torres Strait Islander primary health care is recognised as a Certificate III in Aboriginal and/or Torres Strait Islander Primary Health care. 1 Health Workforce Australia, 2011, Growing Our Future: the Aboriginal and Torres Strait Islander Health Worker Project Final Report 2 Ibid. 3 National Aboriginal and Torres Strait Islander Health Worker Association, www.natsihwa.org.au, Accessed 2 July 2013 4 Australian Indigenous Health Infonet, http://www.healthinfonet.ecu.edu.au/health-infrastructure/health-workers/health-workersworkforce/workforce-development, Accessed 2 July 2013 5 Ibid. Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 2

Aboriginal and Torres Strait Islander Health Practitioners Aboriginal and Torres Strait Islander Health Practitioners are the registered component of the Aboriginal and Torres Strait Islander Health Worker workforce. From 2012, under the National Registration and Accreditation Scheme (NRAS), practitioners who use the title Aboriginal and Torres Strait Islander Health Practitioner, Aboriginal Health Practitioner, or Torres Strait Islander Health Practitioner are required to be registered. Other Aboriginal and Torres Strait Islander Health Workers, not required to use these titles, or not required to be registered by their employer, can use the title Aboriginal and Torres Strait Islander Health Worker and do not need to be registered. In the Northern Territory, all Aboriginal and Torres Strait Islander Health Workers have been required to be registered since 1985. Upon the introduction of NRAS in 2012, all people registered under the Northern Territory Aboriginal Health Worker Registration Board were automatically registered as Aboriginal and Torres Strait Islander Health Practitioners. How are Aboriginal and Torres Strait Islander Health Workers trained? Training and qualification requirements for Aboriginal and Torres Strait Islander Health Workers vary among jurisdictions and employers, however the minimum qualification is generally recognised to be a Certificate III in Aboriginal and/or Torres Strait Islander Primary Health Care 6. Qualifications in Aboriginal and/or Torres Strait Islander Primary Health Care may be able to be obtained as part of a traineeship or apprenticeship, and commonly require a combination of workplace training and training through a Registered Training Organisation. 7 To be eligible to register as an Aboriginal and Torres Strait Islander Health Practitioner, a person must hold a Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care Practice, or equivalent (as determined by the Aboriginal and Torres Strait Islander Health Practice Board of Australia). Applicants who do not hold the Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care Practice may be eligible for registration under grandparenting arrangements, which are in place until 30 June 2015 and allow practitioners to register based on work experience and other qualifications. 8 6 Health Workforce Australia 2011. Growing Our Future: Final Report of the Aboriginal and Torres Strait Islander Health Worker Project. http://www.hwa.gov.au/sites/default/files/growing-our-future%20final-report-2011.pdf 7 National Aboriginal and Torres Strait Islander Health Worker Association, http://www.natsihwa.org.au/education-training/how-tobecome-a-health-worker/, Accessed 4 September 2013 8 Aboriginal and Torres Strait Islander Health Practice Board of Australia, Grandparenting Provisions Registration Standard, http://www.atsihealthpracticeboard.gov.au/documents/default.aspx?record=wd12%2f7072&dbid=ap&chksum=onbda9k2ootm2xy Bkwc5uA%3d%3dm accessed 19 May 2014 Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 3

Associations National Aboriginal and Torres Strait Islander Health Worker Association (NATSIHWA). NATSIHWA is the professional association for Aboriginal and Torres Strait Islander Health Workers in Australia. NATSIHWA was established in 2009 and advocates exclusively for the interests of Aboriginal and Torres Strait Islander Health Workers and their clients, and aims to achieve recognition of the vital and valued role that Aboriginal and Torres Strait Islander Health Workers play in providing professional, effective and culturally respectful health services to Aboriginal and Torres Strait Islander people. National Aboriginal Community Controlled Health Organisation (NACCHO). NACCHO is the peak body representing over 150 Aboriginal Community Controlled Health Services (ACCHSs) and community controlled Aboriginal Medical Services across Australia. It represents Aboriginal community controlled health organisations at a national level, advocating for culturally respectful and needs based approaches to improving health and wellbeing outcomes through ACCHSs across the country. Regulatory and accreditation bodies Aboriginal and Torres Strait Islander Health Practice Board of Australia (the Board). The functions of the Board include developing standards, codes and guidelines for Aboriginal and Torres Strait Islander health practice; approving accreditation standards and accrediting courses of study; registering Aboriginal and Torres Strait Islander Health Practitioners and students; and handling notifications, complaints, investigations and disciplinary hearings. Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 4

What is known about this workforce? In this section, information is presented from a range of sources to describe the existing number and characteristics of the Aboriginal and Torres Strait Islander Health Worker and Aboriginal and Torres Strait Islander Health Practitioner workforces. Data sources and limitations Australian Bureau of Statistics (ABS) Census of Population and Housing (the Census). The Census is a descriptive count of everyone who is in Australia on one night, and of their dwellings. Its objective is to accurately measure the number and key characteristics of people who are in Australia on census night, and of the dwellings in which they live. Information in the Census is self-reported, meaning information is dependent on individuals understanding and interpretation of the questions asked. For example, when reporting occupation, a person may self-report as working in a particular occupation, but not necessarily be appropriately qualified/meet registration standards (where a registrable profession). However, the Census is able to provide a picture of the changing size and characteristics of the reported Aboriginal and Torres Strait Islander Health Worker workforce over time, which is not currently available through other data sources. National Health Workforce Dataset (NHWDS). The NHWDS combines data from the NRAS with Aboriginal and Torres Strait Islander Health Practitioner workforce survey data collected at the time of annual registration renewal. The survey is administered through the national registration body, the Australian Health Practitioner Regulation Agency (AHPRA), on behalf of HWA. The Aboriginal and Torres Strait Islander Health Practitioner NHWDS was collected for the first time in 2012, with an overall survey response rate of 44.2 per cent. Due to the lack of time series information, the NHWDS only shows the current characteristics of the Aboriginal and Torres Strait Islander Health Practitioner workforce. National Centre for Vocational Education Research (NCVER). NCVER conduct the vocational education and training (VET) provider collection (also known as the Students and Courses collection). This is an administrative collection of information on students, the courses they undertake and their achievement in the VET sector. This information is sourced from student enrolment records and it is an annual national collection. The VET collection does not obtain information from all private VET registered training organisations, so complete coverage of those providing training, and consequently complete information on those obtaining qualifications, is not available. Department of Education (DE). DE conduct the Higher Education Statistics Collection, which provides a range of information on the provision of higher education in all Australian universities. Information on higher education course commencements and completions by field of education is presented in this publication. Cautions to note with the DE data: The accuracy of coding courses to field of education is the responsibility of each university, and is subject to the knowledge of those allocating the codes. Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 5

Information includes combined courses where the course has been allocated to two fields of education. Combined courses are courses designed to lead to a single combined award or to meet the requirements of more than one award. ABS Census of Population and Housing In the Census, the Australian and New Zealand Standard Classification of Occupations (ANZSCO) is used to publish occupation statistics. In ANZSCO, an Aboriginal and Torres Strait Islander Health Worker is defined as someone who liaises with patients, clients, visitors to hospitals and other medical facilities and staff at health clinics, and works as a team member to arrange, coordinate and provide health care delivery in Aboriginal and Torres Strait Islander community health clinics. It should be noted that information is presented for people who self-reported in the Census as an Aboriginal and Torres Strait Islander, and as employed as an Aboriginal and Torres Strait Islander Health Worker (regardless of level and field of education). This includes those people working for an employer or conducting their own business, including those with their own incorporated company as well as sole traders, partnerships and contractors. It should also be noted that the ABS randomly adjusts cells to avoid the release of confidential data, so there can be slight discrepancies in totals when comparing Census tables. Age and gender From 1996 to 2011 the Aboriginal and Torres Strait Islander Health Worker workforce almost doubled (an increase of 584 people or 87 per cent). In each of the selected years there was a higher number of females than males, and between 1996 and 2011 the number of females increased at a greater rate than males almost doubling (93 per cent) compared with an increase of 72 per cent for males (Table 1). This increase in female participation is consistent with increases in female participation across other health occupations. Table 1: Number of employed Aboriginal and Torres Strait Islander Health Workers by gender, 1996 to 2011 1996 2001 2006 2011 % increase 1996 to 2011 Males 202 264 285 348 72.3 Females 470 584 681 908 93.2 Persons 672 848 966 1256 86.9 % female 69.9 68.9 70.5 72.3.. Source: ABS Census of Population and Housing, 1996 to 2011 Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 6

In 2011 the average age of Aboriginal and Torres Strait Islander Health Workers was approximately 41 years. Male Aboriginal and Torres Strait Islander Health Workers have a younger age profile than females, with a lower average age and a lower percentage aged 55 years and over (Table 2). Table 2: Employed Aboriginal and Torres Strait Islander Health Workers, age profile by gender, 2011 Average age Per cent aged 55 and over Males 38.9 10.3 Females 41.7 14.0 Persons 40.9 13.0 Source: ABS Census of Population and Housing, 2011 Figures 1 and 2 show a detailed age and gender breakdown of employed Aboriginal and Torres Strait Islander Health Workers in 2006 and 2011. The increase in the workforce between the two years, particularly growth in the number of females aged 35-44 years, can clearly be seen. This growth in females aged 35-44 years may reflect a mature entry pathway, with people choosing to enter the profession later in life. Figure 1: Number of employed Aboriginal and Torres Strait Islander Health Workers by age and gender, 2006 Figure 2: Number of employed Aboriginal and Torres Strait Islander Health Workers by age and gender, 2011 Age(yrs) Males Females 65+ 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 <25 200 150 100 50 0 50 100 150 200 Number Age(yrs) Males Females 65+ 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 <25 200 150 100 50 0 50 100 150 200 Number Source: ABS Census of Population and Housing, 2006 Source: ABS Census of Population and Housing, 2011 Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 7

Hours worked Aboriginal and Torres Strait Islander Health Workers worked an average of 36.4 hours per week in 2011, a slight increase from 34.2 hours per week in 2006. In 2006, the average weekly hours worked by female Aboriginal and Torres Strait Islander Health Workers was 1.5 hours less than the average worked by males. However, by 2011 average hours worked by females had increased, and was 0.7 hours higher than the average weekly hours worked by males (Figure 3). Figure 3: Employed Aboriginal and Torres Strait Islander Health Workers, average weekly hours worked, 2006 and 2011 Average weekly hours worked 40 35 30 25 20 15 10 35.3 35.9 36.6 36.4 33.8 34.2 2006 2011 5 0 Males Females Persons Source: ABS Census of Population and Housing, 2006 and 2011 Figure 4 shows that in 2011, average weekly hours worked by male Aboriginal and Torres Strait Islander Health Workers varied across age cohorts, ranging from 30 hours (below 25 years) to 43 hours (35 44 years). Across most age cohorts, average weekly hours worked by female Aboriginal and Torres Strait Islander Health Workers remained between 33 and 38 hours per week (Figure 5). Note that for both males and females, there is a very small number of individuals in the 65 years and older age cohorts, so hours worked for this age cohort should be interpreted with caution. Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 8

Figure 4: Employed male Aboriginal and Torres Strait Islander Health Workers by age and average hours worked, 2011 Figure 5: Employed female Aboriginal and Torres Strait Islander Health Workers by age and average hours worked, 2011 Average weekly ours worked 50 45 40 35 30 25 20 15 10 5 0 < 25 25-34 35-44 45-54 55-64 65 + Age group Average weekly ours worked 50 45 40 35 30 25 20 15 10 5 0 < 25 25-34 35-44 45-54 55-64 65 + Age group Source: ABS Census of Population and Housing, 2011 Source: ABS Census of Population and Housing, 2011 Education Table 3 shows the highest level of education of Aboriginal and Torres Strait Islander Health Workers. In both 2006 and 2011 approximately half of the workforce (45 per cent in 2006 and 56 per cent in 2011) were qualified to certificate, diploma, or advanced diploma level. This reflects the training pathway for Aboriginal and Torres Strait Islander Health Workers, which tends to be at the vocational education and training level (and is at this level for Aboriginal and Torres Strait Islander Health Practitioners, who are required to have a Certificate IV qualification). A minority of the workforce were educated to bachelor degree level or higher a total of 79 Aboriginal and Torres Strait Islander Health Workers (8 per cent) in 2006 and 89 (7 per cent) in 2011. Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 9

Table 3: Number of employed Aboriginal and Torres Strait Islander Health Workers by highest level of education, 2006 and 2011 Highest level of education 2006 2011 % increase Postgraduate degree 4 4 0.0 Graduate diploma and graduate certificate 4 11 175.0 Bachelor degree 71 74 4.2 Diploma and advanced diploma 148 225 52.0 Certificate 290 473 63.1 Not applicable (a) 353 373 5.7 Not stated/inadequately described 96 96 0.0 Total 966 1,256 30.0 (a) Includes persons with no post- school qualification and persons still studying for a first post-school qualification Source: ABS Census of Population and Housing 2006 and 2011 Sector and industry of employment In 2011, approximately two-thirds of all employed Aboriginal and Torres Strait Islander Health Workers (800 or 64 per cent) worked in the private sector, which includes non-profit organisations and non-government organisations such as Aboriginal Community Controlled Health Services. In terms of industry, most (1,111 or 88 per cent) Aboriginal and Torres Strait Islander Health Workers were employed in the Health Care and Social Assistance industry. Within this, approximately one-third (30 per cent or 337) worked in hospitals. As Census data is self-reported, this may include people employed in hospital settings as Aboriginal Liaison Officers who identified their occupation as an Aboriginal and Torres Strait Islander Health Worker in the Census (Table 4). Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 10

Table 4: Number of employed Aboriginal and Torres Strait Islander Health Workers, by sector and industry, 2011 Industry State and Territory government Other government (a) Private sector Total (b) Health Care and Social Assistance 367 5 739 1,111 Hospitals (except Psychiatric Hospitals) 318 0 19 337 Medical Services 37 0 152 189 Allied Health Services 3 0 74 77 Other health care and social assistance industries 9 5 494 508 Public Administration and Safety 43 31 0 74 Other industries 3 0 57 60 Total (c) 413 36 800 1,256 (a) Total number employed by the Commonwealth government and local governments (b) Includes sector not stated (c) Includes industry not stated Source: ABS Population of Census and Housing, 2011 Distribution Information from the Census on the distribution of the Aboriginal and Torres Strait Islander Health Worker workforce is based on place of usual residence, not place of work. State and Territory In 2006 and 2011, the highest numbers of Aboriginal and Torres Strait Islander Health Workers were located in Queensland (233 in 2006 and 305 in 2011). Despite the higher numbers in Queensland, South Australia had the highest number of Aboriginal and Torres Strait Islander Health Workers per 100,000 Aboriginal and Torres Strait Islander population in 2011 (469.9), and the Northern Territory had the highest number per 100,000 Aboriginal and Torres Strait Islander population in 2006 (421.2). Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 11

The largest change in the number of Aboriginal and Torres Strait Islander Health Workers between 2006 and 2011 occurred in Victoria, where the workforce more than doubled (an increase of 68 people or 142 per cent). In terms of workforce characteristics, most states and territories were similar: Approximately 70 per cent of Aboriginal and Torres Strait Islander Health Workers were female. Average age was similar, except in Tasmania (which was substantially lower than the national average 28.6 years compared with 41 years). Average hours worked ranged from a low of 33.2 in Tasmania to a high of 41.1 in Western Australia. Table 5: Selected characteristics of employed Aboriginal and Torres Strait Islander Health Workers by state and territory, 2006 and 2011 NSW Vic. Qld SA WA Tas. NT ACT Aust. (a) 2011 Number 274 116 305 143 200 23 195 0 1,256 No. per 100,000 Aboriginal and Torres Strait Islander population 158.7 305.3 195.7 469.9 287.1 117.2 343.4 0 229.0 Average age 40.3 39.4 41.3 41.2 42.8 28.6 41.6 0 41.0 % aged 55 and over 11.6 3.5 15.5 11.7 20.9 0.0 9.7 0 12.8 Average hours worked 36.3 31.6 38.5 39.0 41.4 33.2 35.1 0 36.5 % female 75.8 72.8 76.3 68.5 68.3 79.2 67.3 0 72.5 2006 Number 204 48 233 97 148 10 226 0 966 No. per 100,000 Aboriginal and Torres Strait Islander population % change in number 2006 to 2011 147.3 159.2 182.6 379.6 252.1 59.6 421.2 0.0 212.3 34.3 141.7 30.9 47.4 35.1 130.0-13.7 0 30.0 (a) Includes migratory and no usual residence. Source: ABS Census of Population and Housing, 2006 and 2011. Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 12

Remoteness area The remoteness area (RA) structure is a geographic classification system produced by the ABS and is used to present regional data. The RA categories are defined in terms of the physical distance of a location from the nearest urban centre (access to goods and services) based on population size. In both 2006 and 2011 the highest number of Aboriginal and Torres Strait Islander Health Workers were located in very remote areas a total of 316 (25 per cent) in 2011 and 319 (33 per cent) in 2006. The highest concentration of Aboriginal and Torres Strait Islander Health Workers per 100,000 Aboriginal and Torres Strait Islander population was also in very remote areas in 2011 and 2006 (Table 6). There is a discrepancy between the distribution of the Aboriginal and Torres Strait Islander Health Worker workforce and the distribution of the Aboriginal and Torres Strait Islander population. The 2011 Census showed approximately 35 per cent of Aboriginal and Torres Strait Islander people lived in major cities, with a further seven per cent and 14 per cent in remote and very remote areas respectively. However the rate of Aboriginal and Torres Strait Islander Health Workers was highest in remote and very remote areas, and lowest in major cities. This likely reflects health service delivery models, such as remote health clinics, and the accessibility of a wider range of health services in major cities. Table 6: Selected characteristics of employed Aboriginal and Torres Strait Islander Health Workers by remoteness area, 2006 and 2011 Major cities Inner regional Outer regional Remote Very remote Australia (a) 2011 Number 282 236 288 134 316 1,256 No. per 100,000 Aboriginal and Torres Strait Islander population 149.6 194.6 243.1 337.1 407.8 230.2 Average age 41.9 40.0 40.1 42.2 41.2 41.0 % aged 55 and over 16.8 11.1 13.5 16.5 10.2 13.3 Average hours worked 36.9 35.5 37.6 39.7 36.8 37.0 % female 75.5 70.8 76.7 67.2 68.7 72.5 2006 Number 157 144 192 154 319 966 No. per 100,000 Aboriginal and Torres Strait Islander population 106.6 145.0 194.6 390.8 464.0 213.0 % change in number 2006 to 2011 79.6 63.9 50.0-13.0-0.9 30.0 (a) Includes migratory and no usual residence. Source: ABS Census of Population and Housing, 2006 and 2011 Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 13

National Health Workforce Dataset: Aboriginal and Torres Strait Islander Health Practitioners Information on Aboriginal and Torres Strait Islander Health Practitioners, the registered component of the Aboriginal and Torres Strait Islander Health Worker workforce, is available from the NHWDS. As noted earlier, Aboriginal and Torres Strait Islander Health Workers who do not use the protected titles Aboriginal and Torres Strait Islander Health Practitioner, Aboriginal Health Practitioner or Torres Strait Islander Health Practitioner, are not required to be registered (unless required by their employer). Therefore the NHWDS does not provide a full picture of the Aboriginal and Torres Strait Islander Health Worker workforce, but can provide detailed information regarding Aboriginal and Torres Strait Islander Health Practitioners. The NHWDS for Aboriginal and Torres Strait Islander Health Practitioners was first collected in 2012. Information is collected from Aboriginal and Torres Strait Islander Health Practitioners at the time of their annual registration renewal (due in November). In this section, information focusses on describing the number and characteristics of employed Aboriginal and Torres Strait Islander Health Practitioners in 2012. Please note, in the NHWDS, the term employed means a practitioner who worked for a total of one hour or more in the week before the survey in a job or business (including own business) for pay, commission, payment in kind or profit, or who usually worked but was on leave for less than three months, or on strike or locked out, or rostered off. Labour force status In 2012 there were 265 registered Aboriginal and Torres Strait Islander Health Practitioners in Australia, with the majority (252 or 95 per cent) in the labour force. Of those in the labour force, most (233 or 93 per cent) were employed at the time of the survey (Figure 6). Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 14

Figure 6: Registered Aboriginal and Torres Strait Islander Health Practitioners by labour force status, 2012 Registered Aboriginal and Torres Strait Islander health practitioners 265 In Aboriginal and Torres Strait Islander health practitioner labour force in Australia 252 (95.1%) Not in Aboriginal and Torres Strait Islander health practitioner labour force in Australia 13 (4.9%) Currently employed in Aboriginal and Torres Strait Islander health practice 233 (92.5%) On extended leave 15 (6.0%) Looking for work in Aboriginal and Torres Strait Islander health practice 4 (1.6%) Employed elsewhere and not looking for work as an Aboriginal and Torres Strait Islander health practitioner 3 (23.1%) Clinician 163 (70.0%) Not employed and not looking for work as an Aboriginal and Torres Strait Islander health practitioner 10 (76.9%) Other 71 (30.0%) Source: NHWDS: Allied Health Practitioners 2012 Characteristics In 2012 there were 233 registered Aboriginal and Torres Strait Islander Health Practitioners employed in Aboriginal and Torres Strait Islander Health Practice in Australia (Table 7). Over two-thirds of the workforce (70 per cent) worked as clinicians, that is, practitioners who spend the majority of their time undertaking activities related to the diagnosis, care, and treatment, including recommending preventative action, of patients or clients. The Aboriginal and Torres Strait Islander Health Practitioner workforce is predominately female (72 per cent). The average age is 44.4 years, and almost one in five (19 per cent) are aged 55 years or older. Aboriginal and Torres Strait Islander Health Practitioners work an average of 40.5 hours per week. Clinicians have higher average weekly working hours than those in non-clinical roles, a difference of 4.2 hours per week (Table 7). Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 15

Table 7: Employed Aboriginal and Torres Strait Islander Health Practitioners, selected characteristics, 2012 Number % female Average age % aged over 55 Average weekly hours worked FTE (a) Clinicians 163 70.7 44.2 19.6 41.8 179 Non-clinicians 71 n.p. 44.8 n.p. 37.6 70 Total 233 71.9 44.4 18.8 40.5 248 (a) FTE calculated on a 38 hour week n.p. Not publishable Source: NHWDS: Allied Health Practitioners 2012 Distribution Information from the NHWDS on the distribution of the Aboriginal and Torres Strait Islander Health Practitioner workforce is based on survey respondents reported location of main job. State and territory Table 8 shows the distribution of employed Aboriginal and Torres Strait Islander Health Practitioners by state and territory. Almost all are employed in the Northern Territory. When Aboriginal and Torres Strait Islander Health Practitioners joined the NRAS from July 2012, all of the practitioners who had been registered with the Northern Territory Aboriginal Health Workers Board were automatically transitioned to registration under the national Aboriginal and Torres Strait Islander Health Practice Board of Australia. This automatic registration likely accounts for the far higher number of registered Aboriginal and Torres Strait Islander Health Practitioners in the Northern Territory. Table 8: Selected characteristics of employed Aboriginal and Torres Strait Islander Health Practitioners by state and territory, 2012 NSW Vic. Qld SA WA Tas. NT ACT Aust. Number 11 3 10 2 9 0 194 4 233 Average age 49.7 n.p. 46.4 n.p. 45.3 0 44.1 43.7 44.4 Average weekly hours worked 39.1 n.p. 38.1 n.p. 45.3 0 40.5 42.6 40.5 (a) Care should be taken when interpreting the figures for all regions besides the Northern Territory, due to the relatively small number of employed Aboriginal and Torres Strait Islander Health Practitioners who reported their usual residence was in these regions. n.p. Not publishable Source: NHWDS: Allied Health Practitioners 2012 Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 16

Remoteness area Table 9 shows the distribution of employed Aboriginal and Torres Strait Islander Health Practitioners by remoteness area. As with the state and territory distribution in Table 8, the automatic registration of Northern Territory based Aboriginal and Torres Strait Islander Health Practitioners in July 2012 likely accounts for the higher percentage of Aboriginal and Torres Strait Islander Health Practitioners located in outer regional, remote, and very remote areas, as the Northern Territory is only classified to these areas. Aboriginal and Torres Strait Islander Health Practitioners located in remote and very remote areas had a younger average age than the national average. Table 9: Selected characteristics of employed Aboriginal and Torres Strait Islander Health Practitioners by remoteness area, 2012 Major cities (a) Inner regional (a) Outer regional Remote/ Very remote Australia Number 7 9 73 142 233 Average age 46.3 42.8 46.6 43.4 44.4 Average weekly hours worked 43.3 39.4 37.7 42.0 40.5 (a) Care should be taken when interpreting the figures for Major cities and Inner regional areas due to the relatively small number of employed Aboriginal and Torres Strait Islander Health Practitioners who reported their usual residence was in these regions. Source: NHWDS: Allied Health Practitioners 2012 Sector and setting The number of Aboriginal and Torres Strait Islander Health Practitioners undertaking clinical work in 2012 was approximately evenly distributed between the public and private sectors (Table 10). Table 10: Employed Aboriginal and Torres Strait Islander Health Practitioners by sector, 2012 Public Private (a) Number 103 106 Clinical FTE number (b) 81 95 (a) In the NHWDS, non-profit organisations and non-government organisations including Aboriginal Community Controlled Health Services are reported as private. (b) FTE calculated on a 38 hour week Source: NHWDS: Allied Health Practitioners 2012 Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 17

Most Aboriginal and Torres Strait Islander Health Practitioners, both clinicians and non-clinicians, work in Aboriginal health services. Practitioners working in this setting accounted for almost two-thirds (63 per cent) of clinicians and over half (55 per cent) of the total Aboriginal and Torres Strait Islander Health Practitioner workforce. Table 11: Employed Aboriginal and Torres Strait Islander Health Practitioners, work setting of main job, 2012 Clinicians Total (a) Setting Number Average weekly hours worked Number Average weekly hours worked Aboriginal health service 102 42.1 127 40.9 Community health care service 31 42.4 33 42.2 Hospital 3 30.0 8 35.2 Educational services - - 7 40.4 Correctional services 7 53.7 7 53.7 Other government department or agency 11 36.4 24 38.8 Other - - 11 35.3 Unknown/not stated/inadequately described 10 37.4 18 37.6 Total 163 41.8 233 40.5 (a) Non-clinician roles include administrator, teacher, educator, and researcher. Source: NHWDS: Allied Health Practitioners 2012 Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 18

Workforce inflows Information on workforce inflows is an important component of workforce planning, to understand how many people are entering the workforce. Since the NRAS implementation, the primary stream to become a registered Aboriginal and Torres Strait Islander Health Practitioner is through the education system and the completion of an accredited program of study at the level of Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care Practice. Minimum training and qualification requirements for Aboriginal and Torres Strait Islander Health Workers vary among jurisdictions and employers, but the minimum qualification is generally recognised to be a Certificate III in Aboriginal and Torres Strait Islander Primary Health Care 9. Figure 7 shows the courses included in the Aboriginal and Torres Strait Islander Health Worker Qualification Framework. Figure 7: Community Services and Health Industry Skills Council Aboriginal and Torres Strait Islander Health Worker Qualification Framework, 2013 Source: Community Services and Health Industry Skills Council 9 Health Workforce Australia 2011. Growing Our Future: Final Report of the Aboriginal and Torres Strait Islander Health Worker Project. http://www.hwa.gov.au/sites/default/files/growing-our-future%20final-report-2011.pdf Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 19

In this section, student information is presented from three sources: 1. AHPRA, which provides information on people undertaking a Board approved program of study. 2. NCVER, which provides information on Indigenous students commencing and completing courses in the VET sector. 3. Department of Education, which provides information on Indigenous students undertaking courses in Indigenous Health. 10 It is not possible to reconcile information from the three sources, as they are each collected on a different basis, however the information provides an indication of student trends over time. Registered Aboriginal and Torres Strait Islander Health Practitioner students Under the national registration laws, education providers provide AHPRA the details of people undertaking a Board approved program of study. Student registration numbers are cumulative and reflect the number of students who have an active registration on 30 June 2013, based on the expected completion date supplied by the education provider. As at 30 June 2013 there were 69 registered Aboriginal and Torres Strait Islander Health Practitioner students 11. NCVER student numbers As noted earlier, minimum training and qualification requirements for Aboriginal and Torres Strait Islander Health Workers vary among jurisdictions and employers. Generally, training is at the VET level, and NCVER collect information on students, the courses they undertake and their achievement in the VET sector. However, the scope of the NCVER collection does not currently encompass all private Registered Training Organisations, so information on course commencements and completion numbers may be understated. The following tables show course commencements and completions by students who identified as Aboriginal and Torres Strait Islander, in VET courses which are considered to meet minimum training and qualification requirements: For Aboriginal and Torres Strait Islander Health Workers, the minimum qualification is recognised as a Certificate III in Aboriginal and/or Torres Strait Islander Primary Health Care. Above this minimum qualification, the Certificate IV in Aboriginal and Torres Strait Islander Primary Health Care is commonly held by Aboriginal and Torres Strait Islander Health Workers. For Aboriginal and Torres Strait Islander Health Practitioners, it is a registration requirement that the Certificate IV in Aboriginal and Torres Strait Islander Primary Health Care Practice, or equivalent, is held. 10 Where Indigenous and Indigenous Health are used, this reflects the terminology used in the source data. 11 AHPRA Annual Report 2012-13 Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 20

Course commencements Table 12 shows Aboriginal and Torres Strait Islander commencing enrolments in the selected VET courses increased by 76 per cent from 2008 (475 students) to 2012 (837 students). In each year, there were a higher number of commencements in the Certificate III in Aboriginal and/or Torres Strait Islander Primary Health Care than either of the Certificate IV level courses. However, the Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care Practice saw the largest percentage increase from 2008 to 2012, more than doubling (up by 178 per cent or 189 students). The percentage of female students remained relatively steady, at approximately three-quarters of all students in each of the selected years (Table 12). Table 12: Number of Aboriginal and Torres Strait Islander course commencements in selected VET courses, 2008 to 2012 2008 2009 2010 2011 2012 Certificate III in Aboriginal and/or Torres Strait Islander Primary Health Care 315 320 522 492 401 Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care (a) 54 83 120 191 141 Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care Practice (b) 106 99 151 324 295 Total 475 502 793 1007 837 % Female 72.8 71.5 72.5 72.4 76.2 (a) Prior to July 2013, this qualification was the Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health (Community Care) (b) Prior to July 2013, this qualification was the Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health (Practice) Source: National Centre for Vocational Education Research, VOCSTATS, 2008 to 2012 Course completions Table 13 shows Aboriginal and Torres Strait Islander students completing the selected VET courses between 2008 and 2011 (no data is available prior to 2008 as the health worker qualification framework that the selected VET courses are part of was first introduced in 2007). The number of course completions for each course increased sharply between 2008 and 2012. Notably, there was a large increase in students completing the Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care Practice between 2010 (36 students) and 2011 (141 students). This is the qualification required for registration as an Aboriginal and Torres Strait Islander Health Practitioner, and this result may reflect the inclusion of Aboriginal and Torres Strait Islander Health Practitioners in the NRAS, which took effect from July 2012 but was planned for in the Health Practitioner Regulation National Law Bill, which was passed in 2009. Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 21

Table 13: Number of Aboriginal and Torres Strait Islander course completions in VET courses, 2008 to 2011 2008 2009 2010 2011 Certificate III in Aboriginal and/or Torres Strait Islander Primary Health Care 33 134 129 173 Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care (a) 2 23 86 88 Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care Practice (b) 49 38 36 141 Total 84 195 251 402 % Female 79.8 75.9 72.9 73.9 (a) Prior to July 2013, this qualification was the Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health (Community Care) (b) Prior to July 2013, this qualification was the Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health (Practice) Source: National Centre for Vocational Education Research, VOCSTATS, 2008 to 2011 Department of Education student numbers The Department of Education conducts the Higher Education Statistics Collection, which provides a range of information on the provision of higher education in all Australian universities. DE information can be used to show the number of Indigenous student commencements and completions in higher education courses with an Indigenous health field of education. This field of education encompasses the study of the health of the Indigenous population within the broader context of socio-economic development of Aboriginal and Torres Strait Islander communities, with subjects including Indigenous health care delivery approaches, Indigenous caring and healing practices, Indigenous child health and Indigenous primary health care. Cautions to note with the DE data include: Information may include courses allocated to the Indigenous health field of study that do not lead to employment as an Aboriginal and Torres Strait Islander Health Worker. That is, it may include students in courses with a policy, research, or public health focus, rather than a primary health care focus. The accuracy of coding courses to field of education is the responsibility of each university, and is subject to the knowledge of those allocating the codes. Information includes combined courses where the course has been allocated to two fields of education. Combined courses are courses designed to lead to a single combined award or to meet the requirements of more than one award. Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 22

Student commencements Table 14 shows the number of Indigenous students commencing higher education courses in Indigenous health from 2008 to 2012. Across almost all years, most student commencements were at the Bachelor level. The same as the VET commencements, over half of all student commencements were female, ranging between 60 per cent and 72 per cent across the selected years. Table 14: Number of student commencements within the Indigenous health field of education, 2008 to 2012 2008 2009 2010 2011 2012 Bachelor 52 75 64 45 40 Postgraduate 46 28 40 49 37 Associate Degree 0 0 0 43 14 Advanced Diploma (AQF) 5 0 0 0 0 Diploma (AQF) 0 13 19 17 0 Enabling Courses 11 0 0 0 0 Total 114 116 123 154 91 % Female 71.7 70.7 64.2 71.4 60.4 Source: Department of Education Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 23

Student completions While the number of Indigenous student commencements was higher in Bachelor degrees, most completions were in postgraduate qualifications (Table 15). This suggests the students either changed courses, or did not finish their bachelor degree. Table 15: Number of student completions within the Indigenous Health field of education, 2008 to 2012 2008 2009 2010 2011 2012 Bachelor 16 28 11 29 18 Postgraduate 33 21 30 38 31 Associate Degree 0 0 0 0 11 Advanced Diploma (AQF) 6 5 0 0 5 Diploma (AQF) 5 0 11 11 18 Enabling Courses 0 0 0 0 0 Total 60 54 52 78 83 % Female 78.3 73.1 75.0 76.3 68.3 Source: Department of Education How can workforce activity be measured? There is limited information available to measure workforce activity for both Aboriginal and Torres Strait Islander Health Workers, and Aboriginal and Torres Strait Islander Health Practitioners. The only identified source of information available is from Medicare, as some services provided by eligible Aboriginal and Torres Strait Islander Health Workers are covered under the Medicare Benefits Scheme. Aboriginal and Torres Strait Islander people who have had a need for allied health services identified as a result of a health assessment are eligible for up to five individual services per year from allied health professionals, including from eligible Aboriginal and Torres Strait Islander Health Workers. Aboriginal and Torres Strait Islander patients with chronic or terminal medical conditions and complex care needs are also eligible for up to five individual services per year, including from eligible Aboriginal and Torres Strait Islander Health Workers. Medicare benefits are only claimable under the above circumstances if the Aboriginal and Torres Strait Islander Health Worker or Aboriginal and Torres Strait Islander Health Practitioner providing the service is registered with Medicare. Registration with Medicare is separate to registration with the Board, and Aboriginal and Torres Strait Islander Health Workers / Practitioners in focus 24