Advocacy Tetris

This photo shows coloured blocks being piled up.

Advocacy Tetris

This photo shows coloured blocks being piled up.

From member priorities to political attacks on the profession, juggling advocacy issues is a complex game.

The APA, like all professional associations, surveys its members to learn more about your issues and concerns and the priorities you want us to pursue.

Through a yearly member census, regular quick polls and other health metrics, we analyse information on member views.

Perversely (in a manner contrary to what is expected), we sometimes see that what members rate as their priority issues and principal areas of concern do not necessarily align directly to the APA strategic plan or our advocacy agenda.

Sometimes we find a strong match.

Knowing which topics to promote and when to promote them is a bit like the game of Tetris, where players rapidly position different shaped pieces as they descend.

Advocacy is not that dissimilar in that you’re scanning the political horizon to see where legislation and policy might land and how to best align with that.

When the federal government announced the Pharmacy Trial Program (in New South Wales, Queensland and the Northern Territory) of new services that expanded the role of pharmacists in primary healthcare to improve clinical outcomes, we immediately acted on it.

These trials align with our funded first contact physio agenda and showed that the Labor government has an appetite to look at health delivery that doesn’t rely solely on GP referrals.

APA National President Scott Willis met with the Pharmacy Guild of Australia and other health associations to pursue our policy position and, as in Tetris, to position us within the moving health policy system.

It doesn’t always align so neatly.

In a recent member survey, health priorities ranked by members were (in order) Medicare reform, skills recognition and scope of practice.

This absolutely supports our major campaign on valuing skills and defining physiotherapy scope.

However, when specific policy areas were ranked, the issues identified by practising physiotherapists were not as aligned with those that the Policy and Government Relations team sees as central to advancing the APA within the health system.

The priority order for APA members was aged care, rural health, disability care, veterans’ health, climate change and digital health.

All of these are important and mostly mirror our priorities but let’s unpack veterans’ health to explain this in more detail.

The APA has undertaken a major campaign to address the discrepancies in Department of Veterans’ Affairs (DVA) funding—discrepancies that are forcing some members to stop treating veterans.

We are pursuing this agenda even though the membership doesn’t see it as a priority because, to use well-worn clichés, it’s the thin edge of the wedge or the slippery slope.

Governments are citing the DVA fee schedule to claim that physiotherapists are price gouging in the National Disability Insurance Scheme (NDIS).

NDIS Minister Bill Shorten is regularly making these sorts of claims, talking about ‘dodgy’ billing practices and price gouging.

The minister’s rhetoric is based, in part, on comparing what a physiotherapist might charge a veteran under the DVA pricing model to what they may charge a complex patient within the NDIS schedule.

This means that if we don’t try to address the DVA inequities, we may face a cascading problem in other government-funded schemes.

We might not be successful in overturning the DVA funding inequity (we’ll know if we are when the May 2024 Budget is handed down) but in making our case loudly and robustly we place on the public record the evidence and facts.

Our campaign provides a template for similar advocacy.

The consequences and flow-on effects from decisions made by governments, insurers and funders are what we look at when determining where our best advocacy efforts should be resourced.

We must also be honest and recognise when we will not be able to change government policy and ideology.

Aged care is a policy area that illustrates this best.

The Labor Party went to the last federal election with a commitment to deliver 24- hour nursing care in every residential aged care facility.

This was their priority and the government has been focused on delivering its election promise.

Our priority is improving the quality of life for aged care residents through better use of highly skilled physiotherapy services.

In this situation, the APA has not failed in its advocacy and policy agenda although we must acknowledge that this may not be the federal government’s current agenda.

Although member surveys tell us that aged care is a high priority, we may not see the substantial changes we are pushing for unless the government decides on a different approach or circumstances change.

I mentioned earlier the cascading effect of policies.

I often cite the TV show Grand Designs to illustrate our approach.

You must start by having the proper architecture and design; otherwise, it costs more to go back, rebuild and repair mistakes.

Defining and defending physiotherapy scope of practice and clearly delineating the skills value of the profession is our ‘grand design’.

Once we have built our Valuing Skills assets we will be in a stronger position to prosecute specific campaigns, from NDIS fees to aged care, DVA, rural health, hospital physio, pain, women’s health and private insurers.


© Copyright 2024 by Australian Physiotherapy Association. All rights reserved.