By David Stokes MAPS, Manager, Professional Issues, APS National Office
From the very moment the APS began the campaign to obtain Medicare benefits for psychological services, the possible consequences for public sector health services has been a major consideration. It is incumbent on the APS Board of Directors and National Office staff to always keep in mind the ‘big picture' issues. In this case it was the ramifications of publicly-funded private psychology services and their potential for undermining, or at least altering, the public sector workforce. In negotiations with government bureaucrats and Ministers, the issue of how to maintain good public sector mental health services and keep experienced psychologists in their workforce has been frequently discussed.
As public health services are run by State Governments, once the Medicare items for psychologists were announced in April 2006, the APS Board of Directors and National Office staff committed themselves to meeting each State government Minister for Health and their senior advisors. The focus of these meetings was to specifically advocate for the need to make special efforts to retain senior and experienced psychology practitioners within public health services.
The APS stressed that many of these senior staff were very committed to the public sector and could be retained if better conditions of service were provided. We advocated for expanding career structures and opportunities, real support for professional development, rights of private practice, and new opportunities to acknowledge achievement and seniority within the current management structure (e.g., eligibility of psychologists for appointment as heads of inpatient units in public hospitals).
The APS has a strong conviction that initiatives in the private sector such as the Better Access Medicare program should not be allowed to disrupt effective and vital services in the public and nongovernment sectors. The APS is particularly opposed to practices that endorse cost shifting from public to private sectors - as has been happening already. It also resists practices that distort service provision in established areas and result in making clinical roles less effective, attractive or professional. The emerging character of public hospital acute mental health services is one such example.
On the other hand, mixed roles and flexible working arrangements that enhance the services to the community, while offering variety and acknowledgment of expertise to the psychology service providers, are to be encouraged. The benefit to the consumers of public health services must be of paramount importance, but practitioner support and respect comes next.
Although the APS has received mixed responses from politicians we have continued to advocate for our position. Psychologists have seen progress in some States - the report in this InPsych cover feature on the recent favourable Enterprise Bargaining Agreement for psychologists in Victoria is demonstration of this.
One way in which the APS National Office supports public sector practitioners is by responding to issues of importance which have been identified through APS member surveys. The APS has, for instance, developed a prototype of a career structure and a set of definitions that may assist individual psychologists when arguing a case with hospital administrations or developing a departmental structure. Positions on file management and peer consultation have been established, and a number of resources and documents for public sector practitioners have been developed and are available to members from the APS website. One example is the Psychology and Rehabilitation document which identifies the various roles of psychologists in rehabilitation services and provides evidence of effectiveness of such services. This was developed in collaboration with experienced members in the field.
A number of new Advisory Groups were established following the APS governance review in 2006, one of which is the Professional Practice Advisory Group. This is a group of self-nominated professionals including private and public sector practitioners who meet regularly to provide advice regarding both policy and practice to the Board of Directors. To provide ‘coal face' opinion and ideas to the Advisory Group, the Public Sector and Non- Government Organisation Reference Group was established and is also based upon self-nominated public sector practitioners. These members represent the large number of different sectors within both public and non-government organisations.
Through these and other mechanisms, the APS is able to access guidance and sound advice from members in the field to assist the APS Board's policy decisions regarding professional practice. Members can also use these groups as a means of communicating with the APS Board in regard to professional and practice issues. We need engagement with all of our members in the public sector for us to enact good policy and its implementation.