Tasmanian Department of Health and Human Service

Tasmanian Department of Health and Human Service Agency Health Professional Reference Group Allied Health Professional Workforce Planning Group Allied Health Professional Workforce Planning Project Speech Pathology Information

Contents 1 List of tables 3 2 List of figures 3 3 Preface 3 4 Overview 4 5 Description of the speech pathology profession 7 5.1 Description of occupations related to speech pathology 7 6 Workforce supply 7 6.1 Profile of the current speech pathology workforce 7 6.2 Projecting workforce supply of speech pathologists 15 7 Workforce demand 16 7.1 Current demand for speech pathologists 16 7.2 Projecting future demand for speech pathologists 18 8 Workforce planning issues for DHHS speech pathologists as identified through consultations 19 8.1 Organisational structures for speech pathology in DHHS 19 8.2 Recruitment 19 8.3 Staff workloads in DHHS 19 8.4 Future DHHS speech pathology client mix 20 8.5 Professional recognition of speech pathologists 20 8.6 Professional development to retain and strengthen a quality workforce 20 8.7 Staff satisfaction with DHHS employment 21 8.8 Links with the other service providers 21 8.9 Employment opportunities in the private sector 21 9 Annotated bibliography 22 2

1 List of tables Table 1: Breakdown of the numbers of DHHS speech pathologist FTE positions 10 at specific award levels Table 2: Staff satisfaction with professional practice parameters in DHHS 16 Table 3: Summary of information obtained from speech pathologists at the focus groups 21 2 List of figures Figure 1: Division and service structure of speech pathologists employed in 8 DHHS Figure 2: Speech pathology headcount per award classification cross DHHS 9 Figure 3: Speech pathology FTEs per award classification across DHHS 9 Figure 4: Speech pathology FTEs per award classification in HAS compared to 10 the regional populations in 2001 Figure 5: Speech pathology FTEs per award classification in the CPRH 11 compared to regional populations in 2001 Figure 6: Speech pathology workforce per age group and award classification 11 Figure 7: Speech pathology workforce per gender and award classification 12 3 Preface This Speech Pathology Information should be read in conjunction with the main Allied Health Professional Workforce Planning Project Discussion Paper. 3

4 Overview Speech pathologists are trained to assess, identify, diagnose, treat and work with people with a communication disability. Speech pathologists also work with people who have difficulties swallowing food and drink. Qualifications to enter the profession of speech pathology can be obtained through a number of courses recognised by Speech Pathology Australia, the professional organisation for speech pathologists: a four-year bachelor degree offered in all states of Australia except Tasmania, or a two-year masters level qualification that is undertaken after a bachelor qualification (preferably in health, behavioural sciences, biological sciences or linguistics). Speech pathologists were employed in services in the Hospitals and Ambulance Service, the Community, Population and Rural Health and the Children and Families Divisions in the DHHS. Some DHHS rehabilitation speech pathology services for adults and paediatrics are provided through contracts with private sector providers Calvary Health Care Tasmania Inc (adults and paediatrics) in the south and St Giles Incorporated (paediatrics) in the north. These positions are not included in the following analysis. As at 21 March 2002, there were 31 speech pathologists employed in 20.63 FTE positions in DHHS. It required 1.5 speech pathologists to fill one FTE position and this was one of the highest rates of DHHS allied health professions. This rate indicated that there was a high proportion of parttime staff or positions. Females comprised 96 per cent of the DHHS speech pathology workforce. The median age of the DHHS speech pathology workforce was 37 years, which was younger than the median age of 42 years for all DHHS allied health professions. In the years 2000 and 2001, an average of five speech pathologists left the DHHS per year and an average of 7.5 DHHS speech pathology positions were advertised each year. The average turnover rate for speech pathologists of 16 per cent, was considered to be a medium turnover rate when compared to all DHHS allied health professions in those two years. There were three DHHS speech pathology positions that were vacant for at least six months in 2001. One was in the Hospitals and Ambulance Service and two in Disability Services in the Community, Population and Rural Health Division in the north and south. 4

The AIHW (2001) indicated that in 1996, Tasmania had 13.6 speech pathologists per 100,000 population This rate was for those employed in the public and private sectors and was similar to the national average at that time of 13.2 speech pathologists per 100,000 population. In late 2001, the speech pathology labour market varied across the Australia and there were shortages if the local university had small numbers of speech pathology graduates. There were shortages of experienced speech pathologists in some rural areas and specialities. In Tasmania, the labour market was in shortage mainly due to there being no training facility in Tasmania, competition with the mainland for staff and the small size of the profession leading to perceptions about lack of career prospects. Tasmania has been seen as a place of short-term employment by speech pathologists who wish to gain or broaden their experience and then move on. The major national drivers for speech pathology services are: population growth the ageing of the population (and the incidence of conditions such as stroke) advances in medical technology government policy on health services community awareness of the services provided by speech pathologists. Future work prospects for speech pathologists across Australia are good. Representatives of the Tasmanian branch of Speech Pathology Australia, stated that there were a number of speech pathology service gaps in DHHS, especially in aged care services, early intervention (in the north and north west), adolescents and funding for communication devices. There are a number of workforce planning issues specific to the DHHS speech pathology workforce that were identified through consultations: There appeared to be few professional linkages in terms of professional supervision, mentoring and the provision of professional development for speech pathologists across the Divisions and services of the DHHS. There was no career pathway outside the Hospitals and Ambulance Service Division. There are difficulties recruiting experienced speech pathologists. Research indicated that a large percentage of speech pathologists are specialised within their field. There is also a high proportion of parttime positions. These two factors make it difficult to fill permanent and temporary vacancies. Staff comments in the DHHS staff survey indicated, due to minimal staffing levels, speech pathologists were not able to use the full range and depth of their skills for patient care. 5

Representatives of Speech Pathology Australia stated that there was little, and in many cases, no clerical support for speech pathologists and this impacted on clinical service delivery and levels of staff satisfaction. Representatives of Speech Pathology Australia stated that there is low awareness of the capabilities of speech pathologists within the health system and the community. The demographics of the Tasmanian population are predicted to alter in the next 10 to 20 years, in that it is expected that the size of the Tasmanian population will decline, there will be a larger proportion of the population who are over 65 years of age and the numbers of population under 14 years of age will decrease (ABS 2000). These changing demographics could impact strongly on the type of work available for speech pathologists in DHHS. Representatives from Speech Pathology Australia stated that there are opportunities within DHHS to obtain a variety of work experiences and to be employed in positions with high levels of responsibility. These attributes should be taken advantage of when recruiting speech pathologists to the DHHS. Representatives of Speech Pathology Australia stated that the professional organisation does provide professional development for members but that it is expensive, as it is difficult to access appropriate speakers in Tasmania. Speech pathology services for paediatric clients in Tasmania are fragmented. Many organisations provide services but each has limitations in terms of their scope of service and levels of resourcing, so that confusion is created for clients, and depending on where the client is located in the state, their eligibility for specific services varies. The private sector speech pathology service in Tasmania is very small and there is little capacity to provide services that the DHHS is unable to provide. 6

5 Description of the speech pathology profession A speech pathologist has been trained to assess, identify, diagnose, treat and work with people with a communication disability. The training encompasses all aspects of communication including speech, using and understanding language, voice, fluency, hearing, writing, reading, signs, symbols and gestures. Speech pathologists also work with people who have difficulties swallowing food and drink. Speech pathologists work in primary schools, high schools, colleges and special schools, nursing homes, public hospitals, community and mental health services, rehabilitation services, kindergartens, private practice, specialist organisations providing services for people with disabilities and as teachers and researchers. Registration is not required in Australia. 5.1 Description of occupations related to speech pathology 5.1.1 Speech pathology assistants Speech pathology assistants (also known as therapy assistants or aides) perform the following tasks under the supervision of a speech pathologist: assist in the provision of therapy to clients once a speech pathologist has assessed and devised a suitable program; assist and train clients in the use of electronic and non-electronic alternative communication systems; and help make or prepare equipment to use with clients. Therapy assistants work under the direction of professional staff and are not qualified to diagnose conditions or prescribe treatment. 5.1.2 Audiologists Audiologists assess hearing and determine the nature of hearing disorders. They are responsible for the non-medical management and rehabilitation of hearing loss and associated disorders of communication. (Commonwealth Department of Education, Science and Training 2002) 6 Workforce supply 6.1 Profile of the current speech pathology workforce 6.1.1 Demographics of the speech pathology workforce 6.1.1.1 Human Resource Services Information System data Data on the DHHS speech pathology workforce from the DHHS Human Resource Services Information System (as at 21 March 2002) has been displayed graphically. The information displayed in these graphs represents all speech pathology positions within DHHS regardless of whether these were filled or vacant at the time of the analysis. 7

Figure 1 shows the speech pathology service structure across the three DHHS Divisions. Speech pathologists were employed in: the Royal Hobart, Launceston General and North West Regional Hospitals in the Hospitals and Ambulance Service Division. Community Rehabilitation and Allied Health Services in Primary Health and Disability Services in Community Support; in the Community, Population and Rural Health Division. Some of the positions occupied by speech pathologists in Disability Services were generic Professional Officer positions and could be occupied by another allied health profession at another time. the Family Child and Youth Health Service in the Children and Families Division. The 31 speech pathologists in DHHS were employed in a mix of full time and part time positions (20.63 FTEs). It required 1.5 speech pathologists to fill 1 FTE position. This rate was one of the highest for allied health professions, indicating a larger number of part-time positions or staff. Some DHHS rehabilitation speech pathology services for adults and paediatrics are provided through contracts with private sector providers, Calvary Health Care Tasmania Inc (adults and paediatrics) in the south and St Giles Incorporated (paediatrics) in the north. These positions are not included in the following analysis. Figure 1: Division and service structure of speech pathologists employed in DHHS (headcount in brackets) Speech pathologists (31) 20.63 FTE HAS (15) 10.5 FTE CPRH (14) * 8.83 FTE CF (2) 1.3 FTE RHH (6) 4.5 FTE LGH (6) ** 3.00 FTE NWRH (3) 3 FTE CRAHS (7) 3.83 FTE DS (7) *** 5 FTE FC&YH (2) 1.3 FTE Source: DHHS Human Resource Services Information System 21 March 2002 (filled and vacant positions) * Since 21 March 2002, there has been additional speech pathology services funded through the HACC program, so that CRAHS in the Community, Population and Rural Health Division has a total of 4.02 FTE speech pathology positions (at September 2002). ** Since 21 March 2002, there has been additional speech pathology services funded through the local councils and the Commonwealth Government for Scottsdale (0.1 FTE) and Campbelltown (0.05 FTE). *** The speech pathologists in Disability Services are employed in Professional Officer positions, which may be occupied by another allied health profession when next vacated. 8

Figure 2 shows the Divisions and regions where the 31 speech pathologists were employed, as well as their award classifications. Figure 2: Speech pathology headcount per award classification cross DHHS 10 9 8 Number of employees 7 6 5 4 3 2 Level 4 Level 3 Level 2 Level 1 1 0 HAS South CPRH South HAS North CPRH North CF North HAS NorthWest CPRH NorthWest CF NorthWest Region and Division Source: DHHS Human Resource Services Information System 21 March 2002 Figure 3 displays the 20.63 FTEs speech pathology positions per region and Division. Figure 3: Speech pathology FTEs per award classification across DHHS FTEs 10 9 8 7 6 5 4 3 2 1 0 Level 4 Level 3 Level 2 Level 1 HAS South CPRH South HAS North CPRH North CF North Region and Division HAS NorthWest CPRH NorthWest CF NorthWest Source: DHHS Human Resource Services Information System 21 March 2002 (filled and vacant positions) 9

Table 1 shows the numbers of DHHS speech pathologists at the various award levels. Table 1: Breakdown of the numbers of DHHS speech pathologist FTE positions at specific award levels Award levels PF1 PF2 PF3 PF4 DHHS total FTE speech pathologist 5.50 11.13 1.0 3.0 20.63 positions FTEs FTEs FTEs FTEs FTEs Source: DHHS Human Resource Services Information System 21 March 2002 (filled and vacant positions) Figure 4 displays the number of FTE speech pathologists employed in the Hospitals and Ambulance Service Division along with the populations of the three regions of Tasmania. Figure 4: Speech pathology FTEs per award classification in HAS compared to the regional populations in 2001 35 250000 30 200000 FTEs 25 20 15 10 150000 100000 Population Level 4 Level 3 Level 2 Level 1 Population 5 50000 0 RHH LGH NWRH Region 0 Source: DHHS Human Resource Services Information System 21 March 2002 (filled and vacant positions) and ABS 2001 census 10

Figure 5 displays the number of FTE speech pathologists employed in the Community, Population and Rural Health Division, along with the three regions of Tasmania. It must be noted that he information displayed in Figure 5 is distorted as: public sector rehabilitation speech pathology services are contracted out to the private sector in the south (adults and children) and north (children) of Tasmania and the private sector data was not included in this document some positions in Mental Health services were generic and could be occupied by another AHP at another time. Figure 5: Speech pathology FTEs per award classification in the CPRH compared to regional populations in 2001 35 250000 FTEs 30 25 20 15 10 5 0 5.83 1 2 South North North W est 200000 150000 100000 50000 0 Population Level 4 Level 3 Level 2 Level 1 Population Region Source: DHHS Human Resource Services Information System 21 March 2002 (filled and vacant positions) and ABS 2001 census The age distribution of the DHHS speech pathology workforce peaked in the 30 to 39 years age group, as shown in Figure 6. This is an older workforce when compared to the Australian speech pathology workforce (analysed in 1996) which peaked in the 25 to 34 years age group (AIHW 1997). However, with the passage of six years, the Australian speech pathology workforce may also now peak in the 30 to 39 years age group. Figure 6: Speech pathology workforce per age group and award classification Number of employees 8 7 6 5 4 3 2 1 0 20-24 25-29 30-39 40-49 Age group 50-59 60+ Data unavailable Level 4 Level 3 Level 2 Level 1 Source: DHHS Human Resource Services Information System 21 March 2002 (filled and vacant positions) 11

The average age of the DHHS speech pathology workforce was 38.2 years, which was younger than the average age of 40.3 years for all DHHS allied health professions. The median age of the DHHS speech pathology workforce was 37 years, which was younger than the median age of 42 years for all DHHS allied health professions. Figure 7 displays the gender mix information of the DHHS speech pathology service. Ninety six per cent of the DHHS speech pathology workforce was female. The AIHW indicated that 95 per cent of the Tasmanian speech pathology workforce were female in 1996. This was similar to the national rate for speech pathology where 96 per cent were female. Figure 7: Speech pathology workforce per gender and award classification 30 Number of employees 25 20 15 10 5 Level 4 Level 3 Level 2 Level 1 0 Female Male Data unavailable Gender Source: DHHS Human Resource Services Information System 21 March 2002 (filled and vacant positions) 6.1.1.2 DHHS staff survey data There were 31 speech pathologists employed by the DHHS and 25 completed a survey form; resulting in an 81 per cent response rate. This was considered to be a valid sample and analysis was undertaken and used in this document where possible. 6.1.1.3 AIHW data Because registration of speech pathologists is not mandatory in Tasmania, it is difficult to obtain accurate data on the numbers of speech pathologists. The ABS census data for 1996, stated that there were 63 persons classified as speech pathologists in Tasmania. 6.1.1.4 Other data Walker and Barns in their research in 2001 located 75 speech pathologists living in Tasmania. This was an increase of approximately 12 speech pathologists since 1996, as described by the AIHW data above. 12

In the Walker and Barns research, Tasmanian speech pathologists were asked to plot their career patterns, in terms of location of employment, over 20 years. The researchers found, of the 42 speech pathologists who responded, that: approximately 40 per cent had been employed outside Hobart (but in Tasmania) immediately post graduation, but this percentage decreased to approximately 10 per cent by five years post graduation (i.e. many interstate trained speech pathologists return to the mainland) approximately 20 per cent had been employed in Hobart for the first six years post graduation and then the rates diminished so that approximately eight per cent of respondents were employed in Hobart until 20 years post graduation (i.e. many interstate trained speech pathologists return to the mainland) approximately 10 per cent had been employed overseas until ten years post graduation, when the rate diminished to zero (i.e. speech pathologists frequently work overseas, but most return to Australian employment by 10 years post graduation). 6.1.2 Vacancies The DHHS Human Resources Service identified three speech pathology positions that were vacant for six months in the period from 1 July 2001 to 1 January 2002. These positions were: one PF1 (0.63 FTE) position at the Launceston General Hospital one PF2 (1.00 FTE) position in Disability Services in the south one PF2 (1.00 FTE) position in Disability Services in the north. 6.1.3 Types of work and client groups Eighty-four per cent of the DHHS staff survey respondents indicated that they were working as a clinician, twelve per cent were working as a clinical manager and four per cent were working as a teacher/educator. Speech pathologists who responded to the DHHS staff survey indicated that they were primarily working in the following fields of activity: 7 (28 per cent) in developmental disability 2 (8 per cent) in children and family services 2 (8 per cent) in community paediatrics 1 (4 per cent) in hospital paediatrics 2 (8 per cent) in community health 3 (12 per cent) mixed medical and surgical 2 (8 per cent) in neurology 2 (8 per cent) in neurosurgery 2 (8 per cent) in rehabilitation 2 (8 per cent) in management. This information correlates with the Speech Pathology Australia Labour Force Survey information collected in 2000 (Lambier 2002) where the majority of speech pathologists in Australia indicated that their most 13

common field of activity was paediatric clinical practice, followed by adult clinical practice and then management/administration. 6.1.4 The education of speech pathologists 6.1.4.1 Entry-level qualifications to the speech pathology profession Qualifications to enter the profession of speech pathology can be obtained through a number of courses recognised by Speech Pathology Australia: a four-year bachelor degree offered in all states of Australia except Tasmania, or a two-year masters level qualification that is undertaken after a bachelor qualification (preferably in health, behavioural sciences, biological sciences or linguistics). Speech pathology services in the DHHS provide clinical placements for undergraduate speech pathologists from mainland universities. It is frequently difficult to provide suitable supervision for student placements, as Speech Pathology Australia recommends that speech pathologists have at least two years clinical experience before they undertake this role. 6.1.4.2 Re-entry into the profession Most positions open to speech pathologists require that the applicant has eligibility for membership of Speech Pathology Australia. Speech Pathology Australia has that requirement that speech pathologists, who have practiced for less than 1000 hours in the last five years, must undertake professional re-entry activities to gain eligibility for membership of the association. The re-entry activities consist of a specific CPD program and supervised clinical practice for a period that depends on the time the speech pathologist has been out of the workforce. Approximately one speech pathologist undergoes a professional re-entry program in Tasmania each year. 6.1.4.3 Postgraduate qualifications Post-graduate courses in speech pathology are offered at most of the institutions that offer undergraduate speech pathology courses. 6.1.4.4 Postgraduate qualifications of DHHS speech pathologists Seven of the 25 respondents (28 per cent) to the DHHS stated that they had postgraduate qualifications. These were graduate diploma, graduate certificate or masters level qualifications in clinical speech pathology or education. Four respondents indicated they were currently undertaking postgraduate courses; these were in similar areas to the above, plus a masters in business administration. 6.1.4.5 DHHS speech pathologists born outside Australia Six respondents to the DHHS staff survey stated that they were born outside Australia. All were Australian citizens and the place of education could not be ascertained from the data. Lambier (2002) found that the 14

largest groups of Speech Pathology Australia members who were born in another country came from the United Kingdom and South Africa. 6.2 Projecting workforce supply of speech pathologists Workforce supply is a balance between outgoing staff (retirees, those temporarily withdrawing from the workforce, emigrants or those who die or take up employment with other employers) and incoming staff (new graduates, immigrants, staff coming from other employment and staff increasing their hours of employment). 6.2.1 Outgoing DHHS staff information In the two years 2000 and 2001, there was an average of 5 permanent, temporary and casual speech pathologists who left the DHHS per year. Applying this average to the 21 March 2002 headcount, there was an average turnover rate of approximately 16 per cent of the DHHS speech pathology service. This was considered to be a medium turnover rate when compared to all other allied health professions. In order to ascertain the possible future numbers of outgoing speech pathologists, staff were asked a number of questions in the DHHS staff survey. Staff were asked: if the hours they worked were the hours they wanted to work if they anticipated a change in their work hours in the next three years and the reasons for this change if they were considering leaving the DHHS in the next six to twelve months, and if so, what were the reasons what were their levels of satisfaction for a number of professional practice parameters in the DHHS. Of the twenty-five speech pathology respondents, five indicated that they were not happy with the hours they worked. Three respondents indicated that they would like to reduce their hours of work. All of these respondents were working full-time plus between two to five hours per week of unpaid overtime. Two respondents who were working part-time indicated that they would like to increase their hours of work. Eight (thirty-two per cent) of the speech pathology respondents indicated that they anticipated an increase in hours over the next three years and cited 'family considerations' as the main reason. Five (twenty per cent) expected a decrease in hours over the next three years and these cited 'family considerations' (two respondents), 'lifestyle preference' (two respondents) and 'to build a practice' (one respondent). Nine (thirty-six per cent) of the 25 speech pathology respondents indicated that they were considering leaving the DHHS in the next three to six months and the reasons cited included 'travel', 'promotion', 'other employment' and 'family reasons'. If the predicted departures translate into actual departures, this would be a considerable turnover for the size of the workforce. 15

Table 2 provides information on staff levels of satisfaction with the various professional practice parameters. Table 2: Staff satisfaction with professional practice parameters in DHHS Criteria measured Per cent of respondents who were satisfied or very satisfied Opportunity to use your abilities 80% Sufficient work to maintain competence 80% Hours of work 84% Amount of work 72% Overall satisfaction 84% Source: DHHS staff survey October 2002 Other information relevant to future outgoing DHHS speech pathology staff was that there were six speech pathologists aged 55 years and over. 6.2.2 Incoming staff 6.2.2.1 National incoming information At the end of 2002, there will be approximately 332 speech pathologists completing undergraduate courses at universities across Australia. The approximate numbers will be in New South Wales (120), Victoria (68), Queensland (70), South Australia (29) and Western Australia (45). 6.2.2.2 DHHS incoming information In the two years 2000 and 2001, there were 15 full time, temporary and casual DHHS speech pathology positions advertised. It is not known if these advertisements were successful. The rate of advertised DHHS speech pathology positions was higher than the rate of terminations of employment by DHHS speech pathologists and this indicated that a number of speech pathologists must have reduced their hours or new positions were established. The advertised positions were: 6 x PF1 level positions (40 per cent) 7 x PF2 level positions (47 per cent) 2 x PF4 level positions (13 per cent). 7 Workforce demand 7.1 Current demand for speech pathologists 7.1.1 Current national demand for speech pathologists Unpublished research by the Commonwealth Department of Employment and Workplace Relations found that in late 2001, in: New South Wales, the strong growth in demand for speech pathologists over the 1980s and early 1990s had slowed due to constraints in public sector funding. The labour market for experienced speech pathologists was in balance and it was predicted that it was likely to remain so, although some recruitment difficulties may persist in less popular locations or specialisations. 16

Victoria, the labour market for speech pathologists was in balance overall with some shortages of experienced speech pathologists (five years plus experience) in some regions, and specialties. There were sufficient new graduates to fill the available positions. Despite the general balance between available positions and applicants, there was considerable unmet need for speech pathology services, which was reflected in lengthy waiting lists for services. The Victorian government has recently initiated measures to review services and the level of funding for speech pathology services. Queensland, the labour market for speech pathologists was in shortage, with significant difficulties recruiting speech pathologists to both metropolitan and rural areas. Acute shortages were experienced in rural and remote and speciality areas. South Australia, demand appeared to be in line with supply. Western Australia, the overall labour market for speech pathologists was in shortage with this being chronic in country areas. Despite the increased demand for speech pathology services, the level of funding for additional speech pathology training positions had not increased dramatically. The level of attrition of speech pathology students has been high. Tasmania, the labour market was in shortage mainly due to there being no training facility in Tasmania, competition with the mainland for staff and the small size of the profession leading to perceptions about lack of career prospects. Tasmania was seen as a place of short-term employment by speech pathologists who wish to gain or broaden their experience and then move on. 7.1.2 Perceived DHHS speech pathology service gaps Representatives of the Tasmanian branch of Speech Pathology Australia stated that they were a number of speech pathology service gaps in DHHS, especially in aged care services, early intervention (in the north and north west), adolescents and funding for communication devices. 7.1.3 Patterns of usage 7.1.3.1 Profession to population ratios The AIHW (2001) indicated that Tasmania had 13.6 speech pathologists per 100,000 population in 1996. This was similar to the national average of 13.2 speech pathologists per 100,000 population. However, as these figures include public and private sector employed speech pathologists it is difficult to examine figures for the public sector only. In Tasmania, if it can be assumed that the ABS census data for 1996 that records that 63 persons stated they were employed as speech pathologists; and 31 speech pathologists are employed in DHHS (in 2002), then approximately half the speech pathologists in Tasmania are employed in the public sector. Some speech pathologists are employed in both the public and private sectors. It is not known how this ratio compares with public to private sector ratios in others states or territories of Australia. 17

7.1.3.2 Staff workload assessments The DHHS staff survey asked speech pathologists if they considered their current workload was about right, too much or too little. Of the 25 speech pathology respondents: 16 (64 per cent) stated that their workload was about right 8 (32 per cent) stated that their workload was too much. 7.2 Projecting future demand for speech pathologists 7.2.1 General future national demand Information about the future demand for speech pathologists was available from the JobSearch web site of the Commonwealth Department of Employment and Workplace Relations (2002): "Job prospects for speech pathologists are good. Employment for speech pathologists to 2007-08 is expected to remain steady. Employment in this small occupation (4,100 in February 2002) grew strongly over the past ten years, but has declined over the past two years, although employment estimates fluctuate. There are recruitment difficulties for speech pathologists in regional areas of New South Wales and Victoria and more widespread shortages in Queensland, Western Australia and Tasmania. Speech pathologists have a low proportion of full-time jobs (48 per cent) and earnings are average - in the sixth decile. Unemployment for speech pathologists is low. Job turnover for speech pathologists is average. Vacancies arising from job changing (speech pathologists changing employers) are expected to provide 88 per cent of vacancies, compared with 12 per cent from job openings (speech pathologists leaving the occupation)". 7.2.2 National drivers for speech pathology services Unpublished research by the Commonwealth Department of Employment and Workplace Relations stated that demand for speech pathology services was driven by: population growth the ageing of the population (and the incidence of conditions such as stroke) advances in medical technology government policy on health services. As a large proportion of speech pathologists were employed within the public health sector, the demand is subject to the level of government funding provided for speech pathology services. That is, demand tends to grow in proportion to the level of service available. community awareness of the services provided by speech pathologists. Services are not well understood by the general public and this has an impact on the demand for services. 18

7.2.3 Perceived drivers of speech pathology services in DHHS The majority of speech pathology respondents to the DHHS staff survey perceived that the factors most likely to increase the size of the DHHS speech pathology workforce were: aging of the population changing patterns of health greater patient expectations requirements for safer procedural practice multi-disciplinary team provision the need for improved geographical distribution of the profession increasing specialisation growth in consumer demand. 8 Workforce planning issues for DHHS speech pathologists as identified through consultations 8.1 Organisational structures for speech pathology in DHHS There appeared to be few professional linkages in terms of professional supervision, mentoring and the provision of professional development for speech pathologists across the Divisions and services of the DHHS. There were no career pathways outside the Hospitals and Ambulance Service Division. 8.2 Recruitment Representatives of Speech Pathology Australia stated that there were difficulties recruiting experienced speech pathologists. Walker and Barns in their research of 2001 asked speech pathologists if they specialised in their field. Of the 57 speech pathologists who responded to the survey (n=75), 37 (65 per cent) stated that they specialised in their field. This extent of specialisation (although necessary for optimum client care) reduces an already small pool of speech pathologists and makes the filling of specialised positions and temporary vacancies with suitable staff, difficult. There were also a comparatively high number of part-time positions in the speech pathology workforce (it required 1.5 speech pathologists to fill one FTE). These two factors make it difficult to fill permanent and temporary vacancies. 8.3 Staff workloads in DHHS Staff comments in the DHHS staff survey indicated, due to minimal staffing levels, speech pathologists were not able to use the full range and depth of their skills for patient care. 19

Representatives of Speech Pathology Australia stated that there was little, and in many cases, no clerical support for speech pathologists and this impacted on clinical service delivery and levels of staff satisfaction. 8.4 Future DHHS speech pathology client mix The demographics of the Tasmanian population are predicted to alter in the next 10 to 20 years, in that it is expected that the size of the Tasmanian population will decline, there will be a larger proportion of the population who are over 65 years of age and the numbers of population under 14 years of age will decrease (ABS 2000). These changing demographics could impact strongly on the type of work available for speech pathologists in DHHS, but it is difficult to predict how. It is known that there will be an increased demand for speech pathology for older clients and these clients are serviced by the health system. There is an increasing realisation that speech pathologists have a role in improving literacy in children and as these services are provided through the education system, there could be a move of DHHS speech pathologists into this area of employment as well. 8.5 Professional recognition of speech pathologists Representatives of Speech Pathology Australia stated that there was low awareness of the capabilities of speech pathologists within the health system and the community. 8.6 Professional development to retain and strengthen a quality workforce 8.6.1 Professional association information Attendance at professional development activities is mandatory for membership of Speech Pathology Australia and a minimum number of hours must be accrued each year. The professional development hours maybe accrued in four areas: clinical practice, business management skills, teaching and education abilities and commitment to the association. Accredited activities include: independent study, teaching and presentations, association activities etc. Tasmanian representatives of Speech Pathology Australia stated that the professional organisation provides professional development for members but that it is expensive, as it is difficult to access appropriate speakers in Tasmania. 8.6.2 DHHS staff survey information Six respondents to the DHHS staff survey indicated that they were not offered regular CPD. These staff were all employed in the CPRH. Seventeen respondents to the survey indicated that they had applied to attend a conference in the last two years and eleven were successful in attending the conference. Of the eleven respondents who attended a 20

conference, nine received assistance from the DHHS and this assistance varied from 25 to 100 per cent funding. 8.7 Staff satisfaction with DHHS employment Information about staff satisfaction with DHHS employment was sought through focus groups. A total of three speech pathologists, one from the south and two from the north west attended the focus groups. A summary of the information obtained is provided in Table 3. Table 3: Positive attributes of employment in DHHS Variety of clients and work Team work Summary of information obtained from speech pathologists at the focus groups Aspirations Access to services for supervision and support Administrative support Negative attributes of employment in DHHS Staff shortages Limited CPD Communication between corporate and service delivery Lack of understanding by management of the role and contribution of speech pathologists Constraints Budget Regional variations Suggestion from the north west were to look to the Northern Territory rural health program for ideas for incentives for attracting and retaining staff in rural and remote areas. Source: DHHS focus group December 2001 Representatives from Speech Pathology Australia stated that there are opportunities within DHHS to obtain a variety of work experiences and to be employed in positions with high levels of responsibility. These attributes should be taken advantage of when recruiting speech pathologists to the DHHS. 8.8 Links with the other service providers Speech pathology services for paediatric clients in Tasmania are fragmented. Many organisations provide services but each has limitations in terms of their scope of service and levels of resourcing, so that confusion is created for clients, and depending on where the client is located in the state, their eligibility for specific services varies. 8.9 Employment opportunities in the private sector The private sector speech pathology service in Tasmania is very small and there is little capacity to provide services that the DHHS is unable to provide. The clients of most private speech pathology services are paediatrics in the zero to five years age group, nursing home residents and people with insurance claims. 21

There is little community awareness and understanding of speech pathology services. Even if clients have private health insurance, the capping of services and limited insurance fund rebates act as a deterrent to people accessing private services. 9 Annotated bibliography Australian Bureau of Statistics, 2000, Population Projections, Tasmania, 1999 to 2021, ABS Catalogue # 3222.6. Australian Institute of Health and Welfare, 2001, Health and community services labour force 1996, AIHW cat. no. HWL 19. Canberra: AIHW (National Health Labour Force Series no. 19). This publication was compiled from ABS Census of Population and Housing 1996 data. Commonwealth Department of Education, Science and Training, Good job guide, viewed 2 March 2002, <http://jobguide.thegoodguides.com.au/search.cfm>. This site provides general workforce information. Commonwealth Department of Employment and Workplace Relations, JobSearch web site, viewed 3 October 2002, http://jobsearch.gov.au/joboutlook/jobprospects.asp?ascocode=2386 Lambier J, 2002, Labour Force Survey, Speech Pathology Australia, < http://www.speechpathologyaustralia.org.au>. Speech Pathology Australia commissioned a national work force survey that was undertaken with association membership renewals for 2001. The response rate to the survey was 83 per cent (1996 of a total of 2410 renewing members). Not all speech pathologists belong to the professional association. Walker J and Barns J, 2001, Where are they going? - A project to retain experienced Allied Health Clinicians in rural areas, Final Report, University of Tasmania, Department of Rural Health. 22