Workforce Assessment Report

Transcription

1 Strategic Workforce Services Workforce Assessment Report DHB Occupational Therapy (Whakaora Ngangahau) Workforce July 2017 Strategic Workforce Services Occupational Therapy Workforce Assessment July

2 Copyright C/- Central Region s Technical Advisory Services Limited (TAS) PO Box Wellington 6140 Phone Fax info@centraltas.co.nz Central Region s Technical Advisory Services Limited Copyright Statement The content of this document is protected by the Copyright Act The information provided on behalf of TAS may be reproduced without further permission, subject to the following conditions. You must reproduce the information accurately, using the most recent version. You must not use the material in a manner that is offensive, deceptive or misleading. You must acknowledge the source and copyright status of the material. Disclaimer While care has been used in the processing, analysing and extraction of information to ensure the accuracy of this report, TAS gives no warranty that the information supplied is free from error. TAS should not be liable for provision of any incorrect or incomplete information nor for any loss suffered through the use, directly or indirectly, of any information, product or service. Document History Date July 2017 Authors Sam Valentine, Sally McLean and Fazleen Rahiman Strategic Workforce Services Occupational Therapy Workforce Assessment July

3 Contents Executive Summary... 4 Recommendations Purpose... 7 Background / Context... 7 Occupational Therapy Defined... 7 Occupational Therapy Workforce covered within this Assessment... 7 Occupational Therapy Workforce Overview Current Status of the DHB Occupational Therapy... 9 Overall Assessment of the Occupational Therapy Workforce... 9 Summary of the Current Status of the DHB Employed Occupational Therapy Workforce: Key Issues Service Demand Supply Operational Flexibility Operational Capacity Operational Workforce Analysis Headcount Full Time Equivalent (FTE) Turnover Age Distribution Ethnicity (headcount) HWIP Technical Notes Non DHB Employed Workforce Information Occupational Therapist Board of New Zealand Annual Report Occupational Therapist Board of New Zealand Workforce Data Tertiary Education Commission: Education Counts Appendices Appendix A: Health Workforce Classification Scoring Matrix Appendix B: General Scope of the Occupational Therapist Strategic Workforce Services Occupational Therapy Workforce Assessment July

4 Executive Summary The Workforce Strategy Group commissioned this workforce assessment to identify the current state, key trends and emerging issues impacting on the Occupational Therapy (Whakaora Nganhahau) workforce. The drivers for the assessment were that: No workforce assessment has been done to date on the Occupational Therapy workforce which is one of the larger DHB Allied Health workforces; and The Occupational Therapy workforce is connected to the New Zealand Health Strategy goal: Closer to Home. The key findings of the assessment are outlined below. Service Demand Demand for this workforce is growing driven by an aging population presenting with complex conditions, co-morbidity and chronic illnesses. This contributes to increasing hospital admissions and surgical volumes with associated Occupational Therapy services required for rehabilitation. In response to increasing acuity of patients, Occupational Therapists are performing an increased role within acute medical wards with an associated decrease in orthopaedic wards. Occupational Therapists are increasingly delegating lower scope work in areas such as orthopaedics to Therapy Assistants. The scope of the Occupational Therapist within the hospital has also increased into new areas such as Emergency Departments, Intensive Care Units/High Dependency Units, medical admission, discharge and provide an increased role in transition planning. Shifts toward conservative management particularly in orthopaedics (i.e. delays or alternatives to surgery), decreasing length of stay and new models of care have all contributed to increasing demand, particularly for services delivered in the community. Demand is high year round with a tendency for peaks during winter months. The growth in demand is also accompanied by an increased requirement for services to be delivered outside of traditional working hours (i.e. the introduction of seven day services). Workforce Supply & Operational Capacity The supply of Occupational Therapists has increased 8% since 2010 which represents a nil growth in supply relative to resident population. However, DHBs expressed the view that increases in the DHB employed workforce have not kept up with associated trends in service demand. The workforce is female dominated and Maori, Pacific and Asian peoples are under-represented in the workforce. The workforce has a relatively young age profile which is projected to continue with increasing enrolments and completions of Occupational Therapists are forecast in coming years. DHBs report that the supply of graduates is sufficient (and increasing) but significant issues are occurring around the recruitment of Occupational Therapists with 3-7 years of experience. There are difficulties recruiting and retaining experienced Occupational Therapists which has led some DHBs to replace senior positions with junior staff. This extends to Occupational Therapists with specialist skills and experience to support the credentialed services such as wheelchair assessments and housing modifications. Some DHBs reported issues sourcing experienced generalists to fill Occupational Therapy roles in rural and regional centres. Many experienced Occupational Therapists throughout the DHBs are overseas qualified but this is particularly prevalent for outreach services. Occupational Therapists do not currently appear on the New Zealand Immigration essential skills lists. The number of visas granted each year to overseas trained Occupational Therapists is too low to justify inclusion on the list. Strategic Workforce Services Occupational Therapy Workforce Assessment July

5 Staff reflected that while professional development is available in most DHBs, Occupational Therapy lacked a clear career development pathway. Factors impacting retention include staff leaving to pursue overseas experiences, not returning after parental leave and competition from employers in the private sector, NGO s, PHO s or with ACC. Despite these factors the length of service continues to rise and the annual turnover rate reflects a relatively stable workforce. Operational Flexibility DHBs report increasing inter-disciplinary substitution particularly to undertake tasks traditionally performed by physiotherapists and nursing staff. This is particularly relevant as care is increasingly being delivered in community settings. Some substitution is also present at the lower scope of the Occupational Therapy practice to health/occupational Therapy/allied health assistants. Some DHBs reported difficulty matching the skill mix particularly in relation to providing credentialed staff to deliver a complete service in community settings. Workforce overview and demographics Headcount FTE Mean FTE Mean Age % Female Mean Length Service of Annual Turnover Rate 1, years 91.9% 6.5 years 15.3% Other Ethnicity Asian Māori Pacific 90.0% 5.9% 3.0% 1.2% Workforce growing at approximately 2% annually. Annual rate of turnover for Occupational Therapists has fluctuated between 12% and 20%. However, this includes inter DHB movement. Overall there has been an increasing length of service to 6.5 years from 5.0 six years ago. A majority female workforce (91.9%), this trend extends to new entrants in the workforce. Very gradual increase in age but relatively young workforce with a mean age of 41.0 years and only 16.1% over the age of 55. Under-representation of Māori (3.0%), Pacific (1.2%) and Asian (5.9%) ethnic groups in the workforce. Over representation Other Ethnicity when compared to the general population. Strategic Workforce Services Occupational Therapy Workforce Assessment July

6 Recommendations It is recommended that the Workforce Strategy Group consider the following actions in relation to the Occupational Therapy workforce: Request the National Directors of Allied Health Group to: Maori and Pacific Workforce Development: 1. Review the 2009 report Te Umanga Whakaora, (The Accelerated Maori Occupational Therapy Workforce Development Strategy). In conjunction with key stakeholders reassess workforce development initiatives and set goals to increase Maori and Pacific representation within the Occupational Therapy workforce. 2. Review and share current initiatives being carried out by DHBs to promote Allied Health careers to school age Maori and Pacific people. Education, Training and Professional Development: 3. Consider ways that we could better manage the pipeline of Occupational Therapy graduates and improve the capacity to accommodate clinical student placements. 4. Consider ways to standardise access across DHBs to professional development opportunities for Occupational Therapy staff. 5. Continue to support and promote the unregulated workforce in obtaining suitable training and qualifications through accredited training pathways. 6. Consider undertaking a stocktake of career progression pathways available across DHBs to ensure workforce awareness of the depth and range of opportunities for Occupational Therapists. Service flexibility: 7. Consider ways which could enable experienced staff to work part-time in specialist or in senior therapy positions when returning to work following parental leave without compromising service continuity. 8. Review the skill mix of Occupational Therapy services: i. To ensure it meets the changing nature of demand for services particularly for services delivered in the community. ii. Consider how Therapy Assistants could be further utilised in the delivery of Occupational Therapy tasks. 9. Review the trans-inter-professional approach to health care delivery being offered by Physiotherapists, Occupational Therapists and Nurses and consider if there are (further) opportunities for standardisation and the application of any practices for other workforce groups. Consultation with lead professional groups: 10. Consult groups such as the Occupational Therapy Key Strategic Group (OTKSS) and the 20 DHB National Occupational Therapy Leaders Network (NOTLN) in the implementation of the above recommendations. Consultation with Ministry of Health (MOH): 12. Review the impact of MOH prioritisation requirements imposed by contracted providers of community Occupational Therapy services in response to reports of increased administrative requirements for Occupational Therapy staff. Strategic Workforce Services Occupational Therapy Workforce Assessment July

7 Purpose 1. Purpose The purpose of this paper is to provide an overview of the current Occupational Therapy workforce and recommend actions for the development of this workforce based on the feedback received from DHBs and the workforce information data. The report has been developed in consultation with the Directors of Allied Health had been presented to the Workforce Strategy Group (WSG) in August The Employment Relations Strategy Group (ERSG) may utilise the report to inform strategic employment relations advice in relation to the Allied workforce. Background / Context On-going health workforce development is a key accountability for DHBs and has a significant impact on DHB outcomes. The Workforce Strategy Group (WSG) has an operational governance role over 20 DHBs workforce activity and has mandated a range of advice to ensure that workforce planning via Strategic Workforce Services (SWS) is well supported. The purpose of the operational advice is to ensure that annual workforce planning processes have the required level of workforce analysis, wherever additional focus or information is required. It is about improving overall accuracy of information to this group in order to allow informed decisions to be made regarding any potential intervention required. The purpose is to identify any staffing capacity and/or capability issues related to DHB operational delivery and/or service development needs, some of which may be addressed through the annual WSG workforce work plan process. The catalyst for this paper comes from the annual planning process directly. Occupational Therapy Defined Occupational therapy (whakaora ngangahau) is a client-centred health profession concerned with promoting health and wellbeing through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists (nga kaiwhakaora ngangahau) achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement. (World Federation of Occupational Therapy, 2012) Occupational Therapy Workforce covered within this Assessment This paper contains a summary of information that is predominately on the DHB employed Occupational Therapy workforce. A small amount of information has also been included on the non DHB employed workforce. Sources for this information are contained in the body of the report. Strategic Workforce Services Occupational Therapy Workforce Assessment July

8 Occupational Therapy Workforce Overview This section provides a snapshot of the DHB workforce as at 31 December 2016: HWIP trend analysis from 2010 to 2016 demonstrates an increasing number of Occupational Therapists, with an overall increase of 70.9 FTE (67 headcount), equivalent to around 8% since December The increase in the last 12 months was 2% (FTE). Females account for 92% of the increases in headcount since December Since December 2010, the national FTE per 100,000 resident population has remained constant, at around 20 FTE per 100,000 resident population. Minor increases in FTE have been observed since December 2010 in the Midland region. In the Northern, Midland and South Island regions the rate of FTE per resident population has remained constant since 2010, whereas the Central region has seen a decline over the same period. The turnover rate has fluctuated between 12-20% between 2011 and Turnover is based on employees leaving their position and includes staff movement between DHBs. This combined with an increasing length of service and increase in mean age for both sexes, suggests a stable workforce. Nationally Māori and Pacific groups are underrepresented in the DHB employed Occupational Therapy workforce with ratios of 3% and 1% respectively. The proportion of females has remained high at around 92%. The proportion of Male Occupational Therapists is proportionately greater in older age groups, a trend that is set to continue as new entrants to the Occupational Therapy workforce are increasingly female. The average age of the DHB employed Occupational Therapy workforce is 41 years with Males tending to be slightly older. Age distribution suggests the Occupational Therapy workforce is relatively young with only 16.1% of employees over 55 years of age. The youngest Occupational Therapy workforce can be seen in the Northern region DHBs, whereas older and greater length of service can be seen in the South Island region. The Responsible Authority, the Occupational Therapy Board of New Zealand has reported a steadily increasing number of Annual Practising Certificates issued since 2006 and of those issued in 2015, 82% were issued to New Zealand trained graduates. The majority of overseas registrations came from the UK, South Africa and Australia. Data from the Tertiary Education Commission shows that the number of enrolments in bachelor degrees in Occupational Therapy has increased slightly in the last two years, up to 645 students in The number of completions of bachelor degrees in Occupational Therapy have fluctuated at around 160 per year since Given the increasing enrolments, steady increases in completions are expected from 2018, relative to the numbers in Information from Immigration New Zealand has been excluded from this report as Occupational Therapists are not contained in either of the skill shortage lists 1. The key statistics suggest a stable workforce, increasing in size, with dominant female representation and under-representation of minority ethnic groups. 1 The Long Term Skill Shortage List (LTSSL) and the Immediate Skill Shortage List (ISSL). Strategic Workforce Services Occupational Therapy Workforce Assessment July

9 Current Status of the Workforce 2. Current Status of the DHB Occupational Therapy Overall Assessment of the Occupational Therapy Workforce The current status of the DHB employed Occupational Therapy workforce was assessed by DHB Allied Health Directors, Allied Health Service Managers, Allied Health Team Leaders, Occupational Therapy Team Leaders and Human Resources Managers using a structured screening tool. (Appendix 1) The screening tool assigns a score to the workforce being considered according to: 1. Service Need - the operational stability/instability of the service; 2. Supply - demographic factors impacting on the overall availability of this workforce; 3. Operational Flexibility - operational flexibility around this workforce for service delivery and innovation; and 4. Operational Capacity - recruitment and retention. The purpose of the screening tool is to provide an overall assessment of the workforce to highlight any pressures impacting on the workforce operationally and/or in the context of wider planning processes. Results of the screening, place the workforce in one of four categories as shown in the figure below. Results should be considered indicative only. Health Workforce Classification Table Overall Classification Intervention Overall Score Stable Occupation WATCHING BRIEF 4 < 6 Transitional Occupation SOME INTERVENTION RECOMMENDED 6 < 10 At Risk Occupation INTERVENTION REQUIRED 10 < 15 Occupation Under Pressure INTERVENTION IMPERATIVE 15 Pre-Focus Group (Survey) Scoring was as follows: Domain Score out of 4 Descriptor for Score Service Need 3 Service Demand Progressively increasing / impacting on service level or peak demand periods increasing. Supply 3 Distribution and supply issues increasingly impacting on wider system. Issues with overall size of workforce available. Operational Flexibility 3 Emerging requirement for more flexible workforce options Operational Capacity 2 Some recruitment and retention issues are occurring, with slightly longer timeframes for gaining this workforce total 11 AT RISK OCCUPATION INTERVENTION REQUIRED Strategic Workforce Services Occupational Therapy Workforce Assessment July

10 The table above displays the DHB Occupational Therapy workforce assessment (aggregated results from the online survey) as ranked for the by sector experts. Forty eight stakeholders of varying roles (including DHB Allied Health Directors, Allied Health Service Managers, Allied Health Team Leaders, Occupational Therapy Team Leaders and Human Resources Managers) contributed to this workforce assessment. The aggregation of individual responses has resulted in a score in the at risk range. Comments referenced the difficulty in recruiting experienced and specialist staff, the relatively high turnover and the perceived mismatch of resources to demand. Two subsequent teleconferences with a subset of the group (12 participants) above confirmed this assessment. Issues of increasing demand, difficulties in sourcing appropriately experienced staff and limited career pathways were highlighted. The quantitative information indicates a growing workforce with more entrants being trained and more registrations being issued, a relatively stable turnover rate (with an annual fluctuation pattern), a stable length of service and mean FTE, and constant FTE per 100,000 population with no major distribution issues geographically. The workforce also has a reasonable bell shaped distribution with only 16% being over 55 years of age. These factors tend to suggest a more stable occupation than the at risk- intervention required category would indicate. The Strategic Workforce Team will be reviewing the workforce tool and its operation over the next few months. Originally designed for use as an input to bargaining strategy development, it may be that some adjustments are required for wider application. Summary of the Current Status of the DHB Employed Occupational Therapy Workforce: The table below provides a summary of the key elements of the Occupational Therapy workforce. 1. Operational Service Needs Summary of Key Service, Operational Workforce and Employment Drivers Current Increasing demand for both acute and community services. 12 month outlook Current trends likely to continue. 1-3 year outlook Changing models of care and targets leading to potential increases in the demand for community and mental health services year outlook On-going increases in demand. 2. Employed Workforce Structure (Demography) Average age Average age of workforce 41 years. Age profile of workforce is relatively young with only 16% over the age of 55 years. Ethnicity Lack of Maori (3%) and Pacific (1.2%) Gender balance Predominantly female workforce (92%) 3. Recruitment Current vacancies Issues exist with filling senior roles and those within community services. Average time to fill Long lead times for some senior & specialist roles Strategic Workforce Services Occupational Therapy Workforce Assessment July

11 Distribution No major issues identified Pressures on related workforces No major issues identified 4. Retention Factors Turnover Relatively stable at 15.3% (including inter-dhb movement) Sick Leave No reports of current issues Part-time /Fulltime Stable at 0.85 FTE Skill Mix Issues with having adequately experienced skill mix specifically to cover specialist areas requiring appropriately credentialed staff. Access to Clinical leadership Relatively good access to clinical leadership Clear career path Some issues identified Development Some issues identified Workload management Increases in intensity of workload and case management requirements. Roster management No major issues identified 5. Ongoing Training and Development Entry/ Transition competency No reported issues Match to service requirements Some reported issues Access to on-going training (progression) Some reported issues Access to training to maintain practising cert No reported issues Key Working Well - no current problems, no immediate action required Moderate Alert - action required in short / medium term High Alert - immediate action required, extreme risk to occupation group Strategic Workforce Services Occupational Therapy Workforce Assessment July

12 Key Issues The observations below highlight likely trends that are impacting on DHBs based on sector expert views and currently available workforce information Service Demand Service stability: Increased presentation of complex conditions, co-morbidities and chronic illnesses driven by New Zealand s aging population and higher rates of social deprivation is resulting in nationwide increases in service demand. Practitioners and management report increased demand and unmet need within acute hospitals including Occupational Therapy input at admission, complex / early discharges and transition planning. Targets to decrease Length of Stay (LoS) and an increase in conservative management for orthopaedic cases are also leading to increasing demand; as are the complexity of discharge procedures and transition planning. In line with factors above, demand for Occupational Therapy services delivered in the community has increased. Staff and management report that waiting lists and unmet need for these services have increased particularly in the area of youth, mental health and addiction services. Staff and management report that across inpatient, outpatient and community services demand is continually increasing. The increase in demand for inpatient care has been backed up by evidence provided in Trendcare. Operational deployment and intensity of use: MoH Length of Stay (LoS) targets and increasing complexity of conditions mean patients are often required to be seen more times before discharge resulting in increases in the intensity of treatment. Pressures from early discharge from inpatient care is putting increased pressure on community services which also results in higher acuity patients seen within outreach services. This results in increased specialist skills needed in the community setting. Staff and managers reported increased contacts across inpatient, outpatient and community settings. Comments were made that priority one patients are increasingly triaged and that there has been an increase in unmet need for priority two and three patients. Staff report that traditional peaks in demand during winter months have been lasting longer and in some cases are sustained as a new business as usual resulting in increased waiting lists and unmet need. Strategic Workforce Services Occupational Therapy Workforce Assessment July

13 In some specialties there are emerging requirements for service to be delivered as a seven day service and outside of traditional working hours. Clinical processes / models of care influence on occupational requirements: Hospital managers report a trend to redistribute Occupational Therapists from orthopaedic to medical wards in response to increased acuity of patients and as caseloads change. Therapy Assistants are increasingly been called on to cover orthopaedic wards. Also, Occupational Therapy is increasingly being extended into traditionally non-occupational Therapy areas such as Emergency Departments, Medical Admission, Delirium Care and Intensive Care Unit / High Dependency Unit environments. Staff report that Occupational Therapists are being increasingly being required to case manage patients across disciplines and they consider which is taking away from time to deliver Occupational Therapy specific services. Efforts to reduce acute demand have resulted in a greater reliance on reablement approaches to support early discharge however this is transferring workload to community Occupational Therapists without associated transfers in FTE to support increased demands. In some DHBs the service delivery model has changed to provide less therapy and more time on equipment & housing modifications to address safety issues. There has been increased emphasis on community-based services / primary care to support people to remain well and at home in their own communities with services closer to home etc. (implications / influence of NZ Health Strategy, NZ Disability Strategy and DHB Strategies) Supply Community / population health requirements: The supply of Occupational Therapists has increased 8% since 2010 which represents a constant FTE/100,000 resident population. Practitioners and management believe that increases in the supply of the Occupational Therapy workforce kept up with associated increases in service demand. There is a view that services are operating at their capacity, particularly in the areas of community and mental health. The supply of graduate Occupational Therapists is currently sufficient and the number of students enrolled in Occupational Therapy degrees is increasing which suggests that there will be a growing supply of graduates available in the near future. The DHBs report there is a shortage of suitably experienced and specialist Occupational Therapists which has meant services sometimes are utilising graduate and junior Occupational Therapy staff to perform tasks above their level of experience and expertise. Strategic Workforce Services Occupational Therapy Workforce Assessment July

14 Demography: The workforce is relatively young (average age of 41 years and only 16% of DHB employees are over 55 years). HWIP Data shows that Females account for 92% of the Occupational Therapy workforce. This was reinforced by staff members who commented on the lack of male staff within individual services and the entire profession. Maori (3%) and Pacific (1.2%) people are underrepresented in the DHB employed Occupational Therapy Workforce. Encouragingly, Maori students completing Occupational Therapy degrees have increased from 4%-13%. However, staff report that Maori and Pacific graduates tend to gravitate towards community organisations or not-for-profits that operate within their communities. Various initiatives have been used in the past to attract more Maori and Pacific people into the workforce. For example: o o o In 2009 the NZAOT and Te Rau Matatini sponsored a report called Te Umanga Whakaora, The Accelerated Maori Occupational Therapy Workforce Development Strategy which set 18 objectives to improve Maori participation in the Occupational Therapy workforce. This strategy is currently being revised by Occupational Therapy New Zealand. DHBs have scholarships available and incubator programmes for Y11-13 such as the Rangatahi Programme in Auckland where students are introduced to Maori and Pacific health professionals working in a hospital and facilitates: 1 day introduction Workplace experience weeks Support and mentoring towards tertiary study and into the workforce. Some training institutions also have mentoring programmes for Maori and Pacific Students. Many experienced Occupational Therapists (particularly in rural and regional centres) are overseas qualified and tend to originate from Australia, The United Kingdom and Ireland. Occupational Therapy Assistants that are recruited from overseas are often qualified physiotherapists that cannot get accreditation in New Zealand which causes challenges in regards to delegation Operational Flexibility Ability to substitute: The general nature of the Occupational Therapy scope of practice (refer to page 42) supports a inter-disciplinary model working with many staff working within DHBs performing a largely generalist scope of practice. However, some tasks require an Occupational Therapy to hold the appropriate accreditation such as housing and wheelchair assessments. Strategic Workforce Services Occupational Therapy Workforce Assessment July

15 DHBs report an increasing emphasis on inter-disciplinary ways of working with other Allied Health professions which is being met with some reservations by the Occupational Therapy profession. There has been a drive to delegate work to Therapy Assistants. In some cases for community care include sending Therapy Assistants to perform first visits and within the Service Accreditation Programme (e.g. issuing aids to patients in the community). DHBs report that there is limited use of allied health or Therapy Assistants within DHB specialist services. Suggestions were made that there is potential for this to expand. The increasing acuity of patients limits the extent to which Therapy Assistants can be utilised in some acute areas (e.g. Inpatient Medical Wards). Some DHBs report replacing Therapy Assistants with new graduate Occupational Therapists. Regulatory Influences: Ministry of Health standards mean it can take at least 18 months for Occupational Therapy staff to obtain accreditation for such tasks as wheelchair access and housing modifications. DHBs report that new prioritisation processes (e.g. applying prioritisation tools) have impacted on clinical availability for some patients and have increased administrative requirements for staff. Scope of practice: Occupational Therapy has one general scope of practice which is allows for flexible working across a broad range of settings, client populations and domains including health (See page 42). Within DHBs there are specialist areas of knowledge and skills required for working with different health conditions as well as MOH requirements for equipment provision, housing modification, mental health acute assessment, hand therapy and various other areas of service provision. DHBs report some difficulty matching the skill mix with the demand as acuity increases especially in community settings where Occupational Therapists are required to work independently. Smaller DHBs comment about difficulties regarding skill mix within community services where it is difficult to obtain the specialist skills and credentialed staff to deliver a complete service. Some DHBs report that within mental health services there has been some challenges around Occupational Therapists doing too much of a general role and losing confidence in their core Occupational Therapy skills. Counties Manukau DHB have specific projects in place to try and address this particular issue. Qualifications and Professional Development: Increasing enrolments in Occupational Therapy undergraduate degrees in recent years have led to challenges for DHBs in accommodating clinical placements. DHB representatives raised challenges around providing sufficient clinical supervision for students without compromising service coverage. Strategic Workforce Services Occupational Therapy Workforce Assessment July

16 Some DHB representatives expressed the view that Occupational Therapy Students are not equipped with the practical skills required to work within the DHB context on graduation especially in community services where Occupational Therapists are required to work independently. Many DHBs send their new graduates on post-graduate certificate programmes (e.g. Mental Health New Entrant to Specialist Practice Programme) to assist with integration and contextual up skilling and others rely on structured new graduate programmes in which staff participate in learning activities, set objectives and learn a broad range of setting based competencies during a 6-18 month period. Staff and management report that Occupational Therapy students are increasingly exposed to other allied and technical disciplines within their training which is preparing staff well for increasing interdisciplinary work (e.g. Inter-professional Working Programme through partnership between HWNZ and Otago University). Access to workforce development resources varies for the Occupational Therapy workforce. Often staff will have to compete with other allied health disciplines for a finite pool of money. At times operational priorities take precedence over staff development funding. However, some DHBs provide access to funds to attend conferences, good internal training opportunities and study leave to progress professional development opportunities. For Therapy Assistants many DHBs are developing consistent approaches to training and a competency base for assistants using the Calderdale framework. Many DHBs also put Therapy Assistants through the Careerforce National Certificate in Health Assistance Operational Capacity Recruitment issues: DHBs report that there are sufficient graduates to fill entry level Occupational Therapy positions. However, some noted that larger hospitals and centres do better at attracting junior staff over smaller centres and community services. In some cases DHBs also conveyed difficulties recruiting graduates during the year according to graduation times. There are general concerns about the difficulties recruiting and retaining experienced and specialist Occupational Therapists. Some DHBs face significant challenges sourcing specialist staff which contributes to growing waiting times for credentialed services such as wheelchair and seating assessments. DHBs face difficulties sourcing candidates for particular services such as community mental health due to lack of suitably qualified applicants, even in larger centres such as Wellington (Capital & Coast DHB). Specific difficulties were raised around the ability to source casual cover, short term locums or medium term for staff leave or maternity cover. Strategic Workforce Services Occupational Therapy Workforce Assessment July

17 Some managers reported that it can sometimes be a challenge to attract internal applicants for senior Occupational Therapy roles as roles carry a large caseload and high intensity of work with little financial uplift from mid-level Occupational Therapy positions. DHBs expressed that that they are receiving an increasing proportion of applications from less experienced Occupational Therapists for senior roles which has led some DHBs to replacing some senior positions with junior staff. In other cases DHBs are sourcing experienced candidates from overseas to fill senior positions. DHBs discussed difficulties specifically in relation to sourcing experienced generalists to fill roles in isolated rural and regional centres. There are graduates looking for their first role in these areas but in many cases there is not sufficient availability of senior Occupational Therapists to provide supervision and mentoring to support new graduates. Retention issues: DHBs that are recruiting increasing numbers of graduates find it challenging to provide sufficient training and mentoring support. Lack of this support may contribute retention of this segment of the workforce. Junior Occupational Therapy staff tend to stay for 3-5 years and then tend to go overseas or take maternity leave. When experienced staff return from maternity leave they are often limited to new entry roles due to inability to be able to commit to full time roles. As touched on in the section on recruitment a segment of our experienced workforce come from overseas and tend to stay for a fixed period of time due to work visas expiry or staff deciding to return home. Staff members showed concern that remuneration ceilings have an impact on retention as it is very difficult to progress after 6 years. DHB limits on how many staff members that are on upper levels per team and limited attrition within these teams mean that there is less opportunity to progress. Senior and experienced Occupational Therapists may seek employment within the Private Sector, NGOs, PHOs or with ACC. In some cases that Occupational Therapy workforce was reported as particularly stable when compared with other DHBs, e.g. Wairarapa where they we have not had to recruit to a permanent role for over 10 years and have always had reasonable access to casual staff. Some report that the impact of a MoH equipment management system (Accessable) on the Occupational Therapists practice (including significant increases in administrative requirements) has contributed to lower job satisfaction and resulted in retention issues specifically in physical health services. This continues to be a factor in recruiting to and retaining staff in community teams. Strategic Workforce Services Occupational Therapy Workforce Assessment July

18 HWIP data suggests that the annual rate of turnover for Occupational Therapists has fluctuated between 12% and 20% between 2011 and Overall there has been an increasing length of service which currently stands at 6.5 years. Strategic Workforce Services Occupational Therapy Workforce Assessment July

19 Headcount Operational Workforce Analysis 3. Operational Workforce Analysis Headcount 1,200 1, ,055 1,054 1,063 1,029 1,040 National Occupational Therapist Headcount 1,084 1,053 1,077 1,041 1,059 1,045 1,086 1,075 1,083 1,103 1,089 1,059 1,048 1,055 1,082 1,098 1,096 1,041 1,047 1, Over the six years of data shown, the DHB employed Occupational Therapy workforce has seen a small, but steady increase in headcount. The total increase between December 2010 and December 2016 was 67. On average, this equates to an increase of 11 employees per year. Headcount by Occupation Type Various categories or subgroups for Occupational Therapists were identified and include: (Visiting) Neuro Developmental Therapist, Needs Assessor & Service Coordinator, Wheelchair Therapist, Hand Strategic Workforce Services Occupational Therapy Workforce Assessment July

20 FTE Headcount Therapist, Community Occupational Therapy and Mental Health Clinician. These where included because the ANZSCO coding specified = / Occupational Therapist. Headcount by Gender 1200 National Distribution Sex Occupational Therapist Dec 10 to Dec OT - Generic Female Male The distribution of the Occupational Therapy workforce is predominantly female with slight increases in headcount over the past six years. Smaller increases were observed for males over the sample period. Full Time Equivalent (FTE) 1, National Occupational Therapist FTE Increases in full time equivalent (FTE) Occupational Therapists has been small and steady. There are 70.9 more Occupational Therapy FTEs in December 2016 than there were in December 2010, equivalent to an 8.2% increase. Strategic Workforce Services Occupational Therapy Workforce Assessment July

21 FTE FTE FTE by Region Occupational Therapist Distribution FTE Region Dec 2010 to Dec Northern Midland Central South Island When observing changes in FTE over the last six years at a regional level, the greatest relative increase has occurred in the Midland region. It is also evident that the Midland region has seen an increase in Occupational Therapists in March Since December 2010 regions have seen the following increases: Northern region 11% Midland region 19% Central region 3%. South Island 0.5% FTE by DHB Size Occupational Therapist Distribution FTE OT - Generic DHB Size Dec 2010 and When observing changes in FTE over the last six years by DHB size, the largest relative increases have occurred in the Large-sized DHB category. Changes in FTE by size were: Large DHBs - increase of 12% Small DHBs - increase of 4% Medium DHBs - FTE decrease of 0% Large Medium Small Strategic Workforce Services Occupational Therapy Workforce Assessment July

22 FTE per 100,000 population FTE per 100,000 population Occupational Therapist FTE per 100,000 population Since December 2010, the national FTE per 100,000 population has remained constant, at around 20 FTE per 100,000 population. When observing the resident population increases since December 2010 (sourced from Stats NZ) the Northern, Midland and South Island regions have seen relative increases in FTE in line with the rate of resident population growth. However, the Central region showed a decline in FTE per resident population. Cumulative Increase in FTE and Population Cumulative increases in FTE and Population since Dec % 8% 6% 4% 2% 0% -2% 6% 5% 4% 4% 4% 3% 3% 3% 2% 2% 2% 2% 1% 0% 0% 0% 0% 1% 1% 1% 1% 1% 2% 2% 2% 2% 3% 3% 3% 3% 6% 6% 6% 7% 5% 6% 6% 5% 5% 2% 2% 4% 4% 4% 9% 8% 8% 8% 7% 7% OT - Generic NZ Population Using December 2010 as an index, FTE increases exceeded population increases until September 2013 and tracks very closely afterward. As described in the FTE per 100,000 population section, the increases are most pronounced in the Midland, Northern and South Island regions. Strategic Workforce Services Occupational Therapy Workforce Assessment July

23 Mean FTE Mean FTE Occupational Therapist Mean FTE (Part-time status) Part-time status had remained constant as measured using Mean FTE 2. The Mean FTE has remained around 0.85 for the observable period. Turnover 25% Occupational Therapist Annual turnover rate (headcount year-to-date) 20% 15% 10% 14.9 % 18.6 % 18.5 % 17.5 % 18.4 % 13.7 % 15.8 % 16.2 % 14.9 % 12.6 % 15.6 % 14.4 % 14.6 % 13.6 % 14.2 % 20.3 % 14.0 % 14.4 % 17.3 % 17.5 % 17.3 % 19.2 % 16.1 % 16.6 % 15.3 % 5% 0% The annual year-to-date turnover rates 3 have fluctuated between 12% and 20% for the duration of the reference period, which indicates a reasonably stable workforce. It is important to note that the turnover rates include movement between DHBs. DHBs do not provide information to HWIP on the intended destination of leavers. 2 Calculated by dividing the FTE by Headcount 3 Turnover is calculated by summing the number of positions terminated over the previous year, then divided by the mean number of positions employed at each of the reporting quarters over the previous year. Turnover calculations exclude those staff with zero contracted hours, those on fixed-term contracts. Strategic Workforce Services Occupational Therapy Workforce Assessment July

24 Years Years Mean Length of Service Occupational Therapist Mean Length of Service (years) The mean length of service has gradually increased in a consistent manner over the reference period until December 2014, since then it has since levelled out. Mean Length of Service by Sex 7.0 Occupational Therapist Mean Length of Service (years) Sex F M The mean length of service at the national level, when comparing males and females, shows a consistent growth trend for both sexes. There is a difference in length of service however, with females tending to stay longer in post than males. Strategic Workforce Services Occupational Therapy Workforce Assessment July

25 Years Mean Length of Service by Region 9.0 Occuptaional Therapist Mean Length of Service by region (years) Northern Midland Central South Island Occupational Therapists tend to stay in post for a longer period of time in the South Island region. The Northern region sees the shortest average length of service. Age Distribution 40% OT - Generic Distribution of ages Dec-10, Dec-16 Region: All 35% 30% 25% 29.9% 25.9% 26.8% 24.5% 22.8% 22.8% 20% 15% 10% 7.2% 10.5% 10.8% 14.8% 5% 2.4% 1.6% 0% < >65 31/12/ /12/2016 The chart detailing age distribution per age group is based on two snap-shots of data (at 31/12/2010 and 31/12/2016). Between 2010 and 2016 the distribution of Occupational Therapists has seen increases in the <25 years and years age groups. The 25-34, and >65 year age groups have shown an opposite trend years age group has remained constant. Strategic Workforce Services Occupational Therapy Workforce Assessment July

26 Mean age OT - Generic Age Distribution by Sex and age band Female/Male Age Distribution Age Group Sex Dec-16 < >65 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% F M The chart shows proportion of male and female Occupational Therapists by age group category as at December The male proportion increases as the age group increased, which implies less male Occupational Therapists are entering the workforce than seen historically. Average Age 42.0 Occupational Therapist Mean Age (years) Between 2010 and 2016 nationally the average age of Occupational Therapists has been gradually increasing, albeit with some minor fluctuations. The scale of the chart axis demonstrates a national increase of 0.7 years between December 2010 and December Strategic Workforce Services Occupational Therapy Workforce Assessment July

27 Average Age by Sex Occupational Therapist Mean Age (years) Sex F M When observing the average age by sex, both males and females track very closely to the overall national average which is 41.0 years. Average Age by Region OT - Generic Mean Age (years) Region Northern Midland Central South Island Occupational Therapists tend to be very slightly older, on average, in the Central region. The Northern region has the youngest Occupational Therapy workforce. However, there is only a four year range between mean ages between the regions. Strategic Workforce Services Occupational Therapy Workforce Assessment July

28 Percentage of Workforce Over 55 Years Old 20% Occupational Therapist Percentage of workforce over 55 years old 16.1%16.3% 16.7% 15.9% 15.4% 16.4% 16.1% 15% 10% 11.7% 12.1% 10.0% 10.3% 12.6% 12.4% 11.2% 13.2% 13.3% 12.6% 11.8% 14.2% 14.4% 13.6% 13.2% 15.1% 15.1% 15.2% 5% 0% The percentage of the workforce that are over 55 years of age has gradually increased over the referenced period from around 10% to 16%. This is lower than compared to the national average for all Allied Health occupations as at 31 December 2016, which is 23.7%. Ethnicity (headcount) OT - Generic Distribution of known ethnicity Dec-10 and Dec % 90% 94% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 6% 3% 2% 3% 1% 1% Other Asian Maori Pacific 31/12/ /12/2016 Between 2010 and 2016 the ethnicity distribution of Occupational Therapists has seen increases in the proportion of Asian ethnicity relative decreases in the Other ethnicity category. Māori and Pacific are the least represented ethnicities in Occupational Therapists. Strategic Workforce Services Occupational Therapy Workforce Assessment July

29 Percetnage Distribution Headcount Headcount of unknown ethnicity Headcount of Unknown Ethnicity The chart shows the number of Occupational Therapists by headcount whose ethnicity is unknown. As at December 2016, 71 Occupational Therapists have an unknown ethnicity, around 6% of the national total. This figure has been very gradually reducing since December DHB Workforce ethnicity compared to population ethnicity 100% 90% 80% 70% 94.04% 67.41% OT - Generic DHB Workforce Ethnicity and Population Ethnicity 89.95% 63.98% 60% 50% 40% 30% 20% 10% 0% 15.36% 13.75% 15.82% 10.89% 6.33% 5.85% 6.46% 3.30% 1.90% 3.02% 0.76% 1.17% Other Asian Maori Pacific Other Asian Maori Pacific 31/12/ /12/2016 DHB HC NZ Population Between 2010 and 2016 the ethnicity distribution of Occupational Therapists when compared to the ethnicity distribution of the population has remained largely unchanged. There has been a consistent over-representation of the Other ethnicity within the Occupational Therapy workforce when compared to the population. Conversely, Asian, Māori and Pacific ethnicities are under-represented when compared to the distribution of the population. This over and under representation has remained consistent in both yearly observations. 4 4 For the purposes of the chart above the ethnicity categories are those described by Statistics New Zealand. Other ethnicity is a grouping which includes all ethnicities except Māori, Pacific and Asian. Strategic Workforce Services Occupational Therapy Workforce Assessment July

30 HWIP Technical Notes The data is drawn directly from the central repository (HWS) of all HWIP data, except population data which has been supplied by Statistics New Zealand. Excludes staff with zero contracted hours and those on long term leave (where paid Employment Status = '4', '5' or '6' in HWIP). Only staff employed on the reporting dates (quarter end dates) are included - except those used for leaving/turnover calculations. All FTE figures are Contracted FTE (2086 hours per annum) - see the Practical Guide to FTE Calculations for more details on how this is calculated. Turnover is calculated by summing the number of positions terminated over the period being measured, then divided by the mean number of positions employed at each of the reporting quarters over the reporting period. Turnover calculations exclude those staff with zero contracted hours, those on fixed-term contracts. Calculations involving sex exclude the few employees with an unreported sex. Calculations involving ethnicity exclude employees with an unknown ethnicity. Averages are shown as mean unless otherwise stated. Disclaimer: While care has been used in the processing, analysing and extraction of information to ensure the accuracy of this report, TAS gives no warranty that the information supplied is free from error. TAS should not be liable for provision of any incorrect or incomplete information nor for any loss suffered through the use, directly or indirectly, of any information, product or service. HWIP Occupational Coding of Occupational Therapist For Occupational Therapists, it includes: o employees with ANZSCO (Occupational Therapist). o employees with other ANZSCOs but job titles containing text which included 'occ the', 'O.T' or 'O/T '. Some of the different categories or subgroups for Occupational Therapists identified were (Visiting) Neuro Developmental Therapist, Needs Assessor & Service Coordinator, Wheelchair Therapist, Hand Therapist, Community Occupational Therapy and Mental Health Clinician. These where included because the ANZSCO coding specified = / Occupational Therapist. For Occupational Therapy Assistants, it includes: o employees with ANZSCO (Occupational Therapist) and job titles containing 'assista','asst' or 'aid'. o employees with ANZSCO (Therapy Aide) and job titles containing text which included 'occ the', 'O.T' or 'O/T '. Strategic Workforce Services Occupational Therapy Workforce Assessment July

31 4. Non DHB Employed Workforce Information Occupational Therapist Board of New Zealand Annual Report The Occupational Therapist Board of New Zealand is the regulatory body for Occupational Therapists, established under the Health Practitioners Competence Assurance Act 2003 (HPCA Act). The Occupational Therapist Board is the statutory body is responsible for setting qualifications needed and standards for the clinical competence, cultural competence, and ethical conduct of Occupational Therapists. It also registers and recertifies them each year, promotes competence, sets proper conduct for the practice of Occupational Therapy in the interests of public health and safety. To practise in New Zealand, all Occupational Therapists need to be registered and hold a current annual practising certificate (APC). Practitioners have one scope of practice they can register for but conditions can be applied to extend scope. The number of Annual Practising Certificates issued Source: Occupational Therapist Board of New Zealand Annual Report March A total of 2,294 applications were received. As the chart demonstrates there has been a consistent increase in the number of scopes of practice issued from 2012 to There was a decline in However, in 2016 a small increase was recorded. Strategic Workforce Services Occupational Therapy Workforce Assessment July

32 Annual Practicing Certificates by Gender Source: Occupational Therapist Board of New Zealand Annual Report March The increase in 2016 is made up of net increases of 91% female Occupational Therapists and 9% male Occupational Therapists. Number of Overseas Qualified Occupational Therapists Source: Occupational Therapist Board of New Zealand Annual Report March Out of the 2,294, 40 registrations came from overseas countries. This number has decreased from 54 in 2012 but is higher when compared to 2013 registrations. Strategic Workforce Services Occupational Therapy Workforce Assessment July

33 Country of Origin for Registrations Source: Occupational Therapist Board of New Zealand Annual Report March In 2016, the second highest registration was recorded from the United Kingdom at 11% whereas in 2015 and 2014, South Africa was on the second lead with 13% and 12% respectively. Occupational Therapist Board of New Zealand Workforce Data Occupational Therapists complete a (voluntary) workforce survey when they apply for their Annual Practising Certificates. The workforce data captures information from years 2012 to Strategic Workforce Services Occupational Therapy Workforce Assessment July

34 Registration by Organisation Type The chart above shows that around 50% of workforce survey respondents indicated they worked in a DHB and 15% of workforce respondents indicated they worked in Private Practice settings (both employed as self-employed and in hospitals or rest homes). Strategic Workforce Services Occupational Therapy Workforce Assessment July

35 Breakdown of Occupational Therapist by Gender As the chart above demonstrates, from 2012 to 2016 on average and as evidenced by the workforce survey, around 90% of Occupational Therapists workforce groups are females. New Graduates qualified at NZ Tertiary Institution As the chart above demonstrates, 2013 recorded that highest number of NZ qualified Occupational Therapists from a NZ tertiary institution. In both 2015 and 2016, the numbers show a downward trend. 149 in 2016 was the second lowest recorded for the past 5 years with the lowest being 132 in Strategic Workforce Services Occupational Therapy Workforce Assessment July

36 Breakdown of Employment Roles The chart above exhibits the breakdown of Occupational Therapists into different employment roles. Nearly 50% of workforce survey respondents indicated they were employed as Occupational Therapy with the focus on physical health of patients and almost 15% dedicated to Mental Health. The later portion indicates the various categories of patients these Occupation Therapists focus on and as demonstrated close to 50% are Adults. Strategic Workforce Services Occupational Therapy Workforce Assessment July

37 Age profile of Occupational Therapist practitioners The charts above shows the age profile of Occupational Therapy practitioners from New Zealand, Australia, United Kingdom and South Africa. Strategic Workforce Services Occupational Therapy Workforce Assessment July

38 The chart above is an extract from the chart above with focus on average age of Occupational Therapy practitioners. This graph shows an upward trend of the average age from 40.5 in 2012 to 42 in Tertiary Education Commission: Education Counts Total Student Enrolment To become an Occupational Therapy in New Zealand, students will have successfully completed one of the following qualifications: Bachelor of Health Science (Occupational Therapy) at Auckland University of Technology Bachelor of Occupational Therapy at the Otago Polytechnic The duration to attain a Bachelor degree in Occupational Therapy is around 3 years. Domestic and international students enrolled in Occupational Therapy Degree Domestic and international students enrolled in an occupational therapy degree International Domestic Notes: Strategic Workforce Services Occupational Therapy Workforce Assessment July

39 1. Data relates to any student enrolled in a Bachelor of Health Science (Occupational Therapy), at Auckland University of Technology or in a Bachelor of Occupation Therapy at the Otago Polytechnic. 2. Data relates to students enrolled at any time during the year with a tertiary education provider in formal qualifications of greater than 0.03 EFTS (more than one week's full-time duration). 3. International students are those studying here without New Zealand/Australian citizenship or permanent residence status. Students studying off-shore at tertiary education providers that are registered in New Zealand are considered international students unless they hold New Zealand citizenship. 4. Totals also include those students with unknown values. 5. Data in this table, including totals, have been rounded to the nearest 5 to protect the privacy of individuals, so the sum of individual counts may not add to the total. The chart above demonstrates the number of International students has remained stable since 2008, the number of domestic students seen in 2015 was the highest since Domestic students enrolled in Occupational Therapy Degree by ethnic group Domestic students enrolled in an occupational therapy degree by ethnic group Other Asian Pasifkia Maori European All ethnicities have gradually increased between 2008 and 2015, with the exception of Māori and Asian ethnicities which has remained constant at 12% and 8%. Strategic Workforce Services Occupational Therapy Workforce Assessment July

40 Domestic and international students completing a qualification in Occupational Therapy Domestic and international students completing a qualification in occupational therapy International Domestic The chart above demonstrates since 2009 the number of students completing a qualification in Occupational Therapy has remained 140 on average. Given the increase in recent years in enrolments, and the fact that a bachelors degree in Occupational Therapy taken three years to complete, it would be reasonable to expect to see an increase in the number of completions from Domestic students completing a qualification in Occupational Therapy by ethnic group Ethnic Group European 79% 85% 85% 79% 78% 76% 82% 81% Māori 4% 5% 8% 8% 6% 10% 11% 13% Pacifica 4% 0% 4% 0% 3% 0% 4% 3% Asian 13% 5% 12% 8% 9% 10% 7% 9% Other 8% 10% 4% 4% 9% 10% 4% 3% The most significant change observed in the Occupational Therapy completions data (above) was that the proportion of Maori students graduating has grown from 4% to 13%. This is a significant change that will lead to an increase in the representation of Maori people in the Occupational Therapy workforce. 5 Total percentage of completions does not include unknown (ethnicity) Strategic Workforce Services Occupational Therapy Workforce Assessment July

41 Appendices 5. Appendices Appendix A: Health Workforce Classification Scoring Matrix Strategic Workforce Services Occupational Therapy Workforce Assessment July