It is fundamentally difficult to make plans right now.

Despite this, during 2021 the APA led with resolve, using the time to build strategies and take action to strengthen our position nationally.

Out of the chaos, we found new ways of working, forging new partnerships to chart a purposeful path.

So what can we expect in 2022?

Even if we could look into a crystal ball, not enough is known about COVID-19 to predict its future course.

What we do know is that we certainly won’t be returning to business as usual.

We will either adapt or be left behind.

This means that making predictions about 2022 is like being the couch footy expert dogmatically forecasting the upcoming season.

Nonetheless, there are issues and events that will have a huge impact on physiotherapists and the profession this year.

The federal election, irrespective of the outcome, will have an impact on the future of the physiotherapy profession.

Whichever political party takes office in the 47th Parliament, we will likely have a new health minister and assistant health ministers and a new agenda for the health portfolio.

The issues confronting the next government will be more challenging, given that the longer governments leave reform in the too-hard basket, the harder it becomes to implement.

This needs to be the year when transformations and the fundamental restructuring of health services and delivery begin.

What if it isn’t and we miss our only shot at real reform?

One scenario might see us have to start over.

This is the electoral cycle effect and it’s why hard reform rarely gets done.

Reform efforts to date have made little impact on strengthening our health system.

Certainly, an approach to financing healthcare that preferences solutions within existing medical models through a rigid focus on a singular ‘discipline’ will not achieve reform.

In restoring some balance, however, we’ve made strong gains in our role and contribution to key reform plans.

It is only now that we find ourselves at a critical point in the reform journey—a new policy window awaits in the form of the 10-Year Primary Health Care Plan.

Looking ahead in an uncertain moment is difficult but we know we can no longer afford for successive budgets to deliver no-to-low change from conventional primary care.

The good news is that this pandemic has a silver lining: trying new approaches

We have seen the recognition and take-up of telehealth.

Governments now accept that various aspects of healthcare can successfully be delivered remotely.

The role of physiotherapy in treating Long COVID is starting to be recognised.

APA President Scott Willis has scheduled meetings with state and territory health ministers and their officials to discuss the essentialness of physiotherapy in managing Long COVID and the reception to date has been very positive.

Although state government lockdown measures have been uneven, bumpy, frustrating and confusing at times, the APA’s robust and committed response to unfair restrictions that were detrimental to private practice has demonstrated how hard we fight for our members.

I can say with some certainty that any future restrictions are unlikely to treat physiotherapy and allied health the way some states have.

What lies ahead?

Physiotherapy will be key to the next phase of reforms.

A transition to value-based healthcare will involve a key shift, one that will see important quality-of-life aspects factor strongly alongside faster treatment, better outcomes and lower costs.

It will see solutions to connecting the patient to the most clinically appropriate and cost-effective pathway.

For our discipline, this is significant.

We have never before had so much evidence to support an expanded role for physiotherapy in making those transitions.

As our Value of Physiotherapy in Australia report showed, physiotherapy can improve the patient journey, reduce costs and improve outcomes.

The report demonstrated that widespread use of physiotherapy treatments, where clinically appropriate, deliver both health and economic benefits.

We also showed that physiotherapy treatments can replace other forms of treatment and reduce future avoidable costs.

What does reform look like?

We know that the patient journey and experience are not always good—long waits, delays, pain, discomfort, time off work.

We all know how frustrating it can be to navigate the health system.

To improve the patient journey, reform begins by removing structural barriers.

It lies in specialist referral and allowing physiotherapists to directly refer patients and to request imaging.

New treatment pathways will also optimise the patient journey.

This includes public funding of physiotherapists as first contact practitioners to provide better and faster access to diagnosis, treatment and care of musculoskeletal pain and conditions.

More specifically, significant gains will be made through expanding public physiotherapy for persistent pain, for chronic disease and to prevent injury.

So what about the end destination?

Our biggest challenge remains the unacceptable inequity driven by affordability barriers to care.

Reform success would see all Australians accessing high-value primary care physiotherapy through the Medicare Benefits Schedule.

Stronger investment in publicly funded physiotherapy will secure stronger health outcomes and it will be priority populations that stand to benefit the most from an expanded role for physiotherapy in our health system.

The APA has delivered the Holy Grail of health policies—improve lives while reducing costs.

It’s now up to whoever is governing to act on the evidence.