Review of 2021 Census Topics

• National Disability Services (NDS)
• Exercise and Sports Science Australia (ESSA)

This submission is intended to support separate submissions by Exercise and Sports Science Australia (ESSA) and National Disability Services (NDS). It argues that changes are needed to the classification of exercise physiologists and sports scientists and also argues for better categorisation of allied health professions, including speech pathology and audiology, and more nuanced questioning to ensure that workforce data can be collected about the disability-related workforce.
The issues it deals with need to be developed via a review of the ANZSCO and ANZSIC classifications, conducted in time to ensure the revised classifications can be used in the 2021 Census.
The issues mentioned have a range of consequences including My Health Record provider registration issues and workforce planning and development limitations. The latter is a key issue as currently neither disability occupations nor disability as an industry is visible via ABS data collections. Of particular concern is the current difficulty in enumerating disability support workers and allied health professionals working in the disability sector.
Our submission offers suggestions as to how the data collection issues in the next Census could be enhanced by changes to the ANZSCO and ANZSIC classifications. We note that the implementation of these changes will also improve other ABS Collections like 4364.0.55.002 - Health Service Usage and Health Related Actions, Australia, 2014-15 which relies on these classifications to survey the population on their health service usage (e.g. consultations with health professionals).

Allied Health Professions Australia (AHPA) believes that accurate data is essential to support policy development, workforce planning and overall monitoring of the use of health and health-related services, including disability services. One of the key challenges for AHPA and government bodies is access to accurate quantitative data about the Australian health and disability allied health workforces. Current limitations on the information that is collected mean that data about earnings, employment status, hours of work and areas of work are severely limited. This significantly impacts the effectiveness of workforce planning in key areas such as service availability for participants in the National Disability Insurance Scheme.

We note that the 2011 Productivity Commission report on disability service reform in Australia highlighted the high degree of variance in the estimates in the size of the disability workforce. We also note that limited access to reliable information about the allied health workforce impacts on the work of Primary Health Networks and their ability to undertake planning around community needs.

Accurate data about the allied health disability workforce is a particular priority given the degree of growth expected to be required to meet the needs of people with disability under the NDIS. Estimates by the NDIS suggest the workforce will need to double to meet those needs. Without changes to our ability to access data, it will be impossible to determine how and if the workforce is growing. This will exacerbate current issues around NDIS implementation. A 2018 published report based on the three-year Evaluation of the NDIS, found that the supply of disability supports is not growing sufficiently to meet the additional demand created by the NDIS. As a consequence of these issues, many NDIS participants and their carers experienced continuing difficulties in accessing disability supports. Without the ability to accurately assess the size and profile of the disability workforce, it will continue to be difficult to evaluate the provider workforce and where key gaps lie.

AHPA notes that the ABS Survey of Disability, Ageing and Carers was reviewed and updated to be purpose-designed for the Scheme, however we also note that the ABS instruments for the collection of workforce data have not been updated and remain unsuitable seven years after the Productivity Commission highlighted the problem.

The current classifications used in the Census and other ABS data collections are both inaccurate or inappropriate in the case of exercise and sports science and insufficiently detailed for other professions to isolate people working in disability services. ANZSIC (industry) and ANZSCO (occupation) classifications remain based on old understandings of the work of allied health practitioners and areas of work that have become large scale sites of employment, and will continue to grow quickly, remain lumped together in ‘other’ and residual categories while jobs in declining parts of the economy remain individually defined with detailed distinctions.

The impact of this is exacerbated by the use of ABS classifications for a range of other surveys and administrative categorisations used by government. The longitudinal Household, Industry and Labour Force Australia (HILDA) survey, for example, has become a useful complement to ABS surveys, offering the additional ability to track populations over time. However, since it also relies on standard ABS classifications, the same difficulties arise when seeking to isolate disability (in addition to sampling and other issues). The Australian Vocational Education and Training Management Information Statistical Standard (AVETMISS), the data standard for the National VET Provider Collection, provides a wealth of information about students, courses and qualifications, but also relies in part on ABS’s classification standards.

Allied health professionals who work in disability are difficult to isolate, since many work across several settings. However, an unnecessary additional complication currently is the mis-location of exercise physiologists, currently grouped with Natural and Physical Science Professionals not elsewhere classified (unit group 234999). In this unit group they are wrongly classified with the following occupations:
• Ceramics Scientist
• Mineral Processing Engineer
• Polymer Scientist
• Sports Scientist
Exercise physiologists should be included within ANZSIC classification in Division Q – Health Care and Social Assistance, Subdivision 85 Medical and Other Health Care Services, Class 8539 Other Allied Health Services to reflect its place within the allied health sub sector and health industry. There should also be a listing in the ANZSIC classification in Division R Arts and Recreation Services, Subdivision 91 Sports and Recreation Activities, Group 911 Sports and Physical Recreation Activities, Class 9111 Health and Fitness Centres and Gymnasia Operation as the current primary activities within the Class 9111 Health and Fitness Centres and Gymnasia Operation (Fitness centre operation, Gymnasia operation and Health club operation) do not adequately allow for the many businesses engaged in providing exercise science services.

The ABS is the only source of workforce-related data in Australia when analysis at the sub-state and Local Government Area (LGA) level is required and where other characteristics such as birthplace, language, immigration status, size of the disability population, comparisons between workplace and home address can be cross-referenced and used to enhance understanding of the size, structure and characteristics of the allied health workforce.
This national data enables national agencies and peak professional bodies to monitor the impact of various public health policy and program initiatives in rural and remote areas compared to metropolitan areas and target services where needs are highest.

AHPA notes that the National Health Workforce Dataset does collect accurate data for registered professionals. However, non-registered professionals are not included and it is not currently easy to identify people working in disability. The data set classifies workplace using the concept of the ‘principal setting’ in which the professional delivers services. This can be limiting when a professional works across a range of settings, or where professionals work across a range of organisations.

AHPA believes that only minor changes are required and that these will not significantly impact on the ability of respondents to understand and respond. Our requests primarily focus on the analysis and coding of data.
The questions AHPA would like to see changed are:
1. What best describes the industry or business of the employer at the location where the person usually works?
2. What are the main goods produced or services provided by the employer’s business?
3. In the main job held last week, was the person: Working for an employer/ Working in own business?

AHPA believes some changes are required to ensure that these questions account for the fact that many allied health professionals work at a range of locations during a day or week, which can include private practices, client homes, community facilities, hospitals, aged care facilities and sports facilities. Allied health practitioners also frequently work across a range of sectors such health, aged care, disability, mental health, prisons and the juvenile detention system, high performance sport and exercise science. Reducing these to a single category is likely to result in highly inaccurate data about the different workforces for each industry area/sector.
Questions also need to account for the very common scenario under which allied health professionals may work for multiple employers as well as work in their own business or work as contractors. One option may be to re-word the questions to provide a more detailed response using a multiple choice response. For example, question 3 could be rephrased as:
“In the main job held last week, was the person:
1. Working for one employer
2. Working for two or more employers
3. Working as a contractor
4. Working in their own business?”

AHPA does not believe that the changes to the Census form outlined in the previous section are likely to require additional consideration or are likely to be the cause for objection.

AHPA does not believe that the changes proposed are likely to significantly decrease the efficiency of collection. Any additional complexity arising from the changes proposed are likely to be minor and will not require significant additional processing. Any minor decreases in efficiency are heavily outweighed by the increased effectiveness of the data.

The need for time series data collected via the Census on the nature of work performed, the type of working arrangements and location/s of work will remain relevant in the future as more and more pressure is placed on the health sector and allied health sub sector to provide low cost, high value health services that enhance the wellbeing of the Australian population.

AHPA notes that while a range of peak and industry bodies as well as government and non-government agencies undertake surveys and otherwise attempt to model data about the allied health workforce, these surveys are limited by their response rate and the range of providers that they cover. As such AHPA believes there are no other alternative data sources or solutions that provide the data that the household survey can provide. AHPA believes that reliable workforce data collected from individual households through the ABS Census provides the most comprehensive overview of the nature of work done by allied health providers, the type of working arrangements they have and their location of work.

AHPA notes that the ABS currently aggregates speech pathologists and audiologists in the unit group 2527. While the occupations are listed separately by ANZSCO within the unit group, they are not published as such. This is a significant issue as the scopes of practice of both professions are completely different and there is no other source of data about the two professions as they are not currently counted in the Health Workforce dataset.
AHPA also notes that the use of the term ‘disability carer’ in ANZSCO is inaccurate and doesn’t match use elsewhere resulting in confusion between paid and unpaid services. A more appropriate term would be ‘disability support worker’.