Conclusiones generales y específicas

Education and health have long included work-integrated learning (WIL) through practicums and clinical placements. As described the previous chapter, other disciplines are increasingly utilising WIL, often as a requirement for professional accreditation driven by professional bodies. These reforms reflect the global trend towards improved job-readiness for graduates.

From 2005 the CGS funding cluster rates for nursing and education units of study have included amounts in recognition of the costs of nursing clinical placements and teaching practicum ($1,126 and $773 per EFTSL respectively in 2011), and universities are required under their funding

agreements to use these amounts only for such placements and practicums. Universities enrolling medical students receive a Medical Loading of around $1,198 per place under the Higher Education Support Act 2003.

In contrast, other university courses do not have WIL funding included in CGS amounts, and no Commonwealth funding is specifically allocated for WIL/work experience in industry units. The Panel believes that this could be addressed through a mode of teaching model for distributing base funding, as discussed in the previous chapter.

4.6.1 nursing and medical clinical training

Universities have traditionally relied on goodwill and partnerships with organisations to provide clinical placements. However, increasingly universities are being charged a fee by providers. The Council of Deans of Nursing and Midwifery indicated that some large private health care providers are now charging $10 per hour for each nursing student undertaking a clinical placement at one of their facilities (submission no. 124).

A number of submissions argued that current funding arrangements for medical education in clinical practice are unsustainable. In consultations, the sector highlighted the recent Health Workforce Australia (HWA) initiative of providing financial support for growth in clinical placements as a significant risk. Their concern was that this funding would have the impact of setting a precedent for all health providers to charge for all clinical placements, and would undermine current pro bono arrangements and in-kind agreements with state and territory governments. The HWA initiative, announced by the Council of Australian Governments (COAG) in November 2008, committed $1.6 billion from the Commonwealth, and $0.5 billion from the states and territories for health workforce reform. For undergraduate clinical training, HWA provides subsidies to health care providers to help with the cost of placing and training students in ‘growth’ places.

The sector is concerned that the HWA subsidy had established a higher benchmark cost to be charged by all providers for all clinical placements, not just the additional ‘growth’ places. If this were to eventuate it would add significantly to clinical costs for universities. Historically, the majority of clinical places have been provided pro bono to universities (often through agreement between Commonwealth, state and territory governments). It may be too early to assess the impact of the HWA funding, but the Panel notes the sector’s concerns as to these possible unintended consequences of the initiative.

The scale of the potential problem can be illustrated using the case of medical studies at James Cook University (JCU). Through the HWA initiative, $192 is available for each student per placement day. In 2010, JCU medical students utilised 31,842 placement days. If all days were paid for at the

being paid (submission no. 106, Attachment A, p. 31). In its submission to the Panel, the Medical Deans of Australia and New Zealand (MDANZ) drew attention to the new activity-based funding model being implemented in the health sector (submission no. 26, p. 28). This development may result in increased scrutiny of costs by the independent Hospital Pricing Authority and may lead to universities being charged for clinical placements. It noted that in Victoria public hospitals now charge universities for all clinical costs.

The various pressures in clinical education led the MDANZ to conclude that:

The funding of clinical education in medicine is at a tipping point. There has been a lack of investment by governments in clinical education staffing and infrastructure to meet the doubling of medical students over the past decade. Without a sustainable funding model for existing clinical education services, medical schools will not be able to continue to innovate and transform clinical education into the future (submission no. 26, p. 36).

The available evidence related to international comparisons of the costs of teaching medicine, dentistry and veterinary science were presented in the previous chapter and indicate that by comparison Australian funding levels are below the international benchmarks.

4.6.2 Costs of health and education practicums and COag

During its consultations, the Panel noted jurisdictional variation in charging practice between state and territory systems in health and education. Funding for WIL in health is variably supported through some government and non-government health system budgets. In some cases teaching practicums within the non-government system are supported by associated school systems. The range of Commonwealth, state and territory government funding for clinical and practicum training lacks transparency and is further complicated by some students being sent across state borders. Practicum/clinical loadings and the broader funding requirements for training teaching, allied health, nursing, dentistry and medical students involve complex Commonwealth–state responsibilities and multiple agencies in education and health. The Panel heard of inconsistencies of treatment between states and between institutions within a single state or territory health system.

In receiving the detailed arguments of the sector regarding the costs of these elements, the Panel considered that a detailed response to this issue was beyond the scope of the Review, and that this is an area that deserves specific consideration, including at COAG level. The system appears to be in urgent need of real reform at a national level.

The Panel does not believe that unlimited funds should underwrite these activities, especially as professional bodies are apparently unrestrained in mandating their requirements. The Panel therefore recommends that following consultation with state and territory governments, including within COAG, professional bodies and with Health Workforce Australia, the Australian Government should undertake a detailed assessment of the costs of health and education placements to ascertain the variety of arrangements across Australia, the roles of Australian governments in maintaining the relevant workforces and ways to avoid cost escalation.