Aboriginal people are valued, culturally safe, well supported and working in all levels, health disciplines, roles and functions of the NSW health system.
A strong Aboriginal health workforce is a powerful driver of a more effective health system for Aboriginal people and families76. It supports improved cultural safety, holistic approaches to the cultural and social determinants of health, stronger relationships of trust between patients and health organisations and delivers better outcomes for Aboriginal people77. Growing and supporting the Aboriginal health workforce is a major national priority under the National Aboriginal and Torres Strait Islander Health Plan 2021–203178 and the core focus of the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework and Implementation Plan 2021–203179.
To have true self-determination in health and wellbeing, Aboriginal peoples need equal representation in all roles, levels and locations across the NSW health sector. This requires leadership and involvement in strategic workforce and service planning, policy development, program implementation, research, monitoring, evaluation, governance and service delivery. It will also require strategic and targeted formal education and training programs to address gaps in the workforce and facilitate career pathways.
The importance of integrated and holistic approaches to healthcare delivery80 means Aboriginal representation in both clinical and non-clinical roles needs to increase across sectors involved in the provision of health-related care, but often do not fall under the explicit remit of health service delivery. The aged care, disability, mental health, alcohol and other drugs, environmental health, violence, abuse and neglect family support and health research sectors are examples, and this is relevant for both ACCHOs and mainstream organisations.
Strategic, long-term and place-based planning, informed by robust local-level data and backed with significant investment, is needed to grow the pipeline of Aboriginal people entering health education and training pathways, progressing in their careers and advancing to system leadership roles. A dedicated focus on strategic workforce planning aligns with the expectations outlined in strategic direction 2 of the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework and Implementation Plan81.
This strategic workforce planning focuses on the whole NSW health system, adopting strategies or shared workforce initiatives that benefit both NSW Health and the ACCH sector. It needs to be inclusive of Aboriginal people working in Aboriginal health roles as well as Aboriginal people working in a variety of roles across the health system. Consistent with priority reform 1 of the National Agreement on Closing the Gap, it is essential that planning takes place in genuine partnership with ACCHOs, Aboriginal health peak bodies and workforce organisations, Aboriginal researchers and local communities82.
Regular Aboriginal health strategic workforce planning and progress reviews, informed by detailed and transparent health workforce data, are undertaken in genuine partnership with Aboriginal people and organisations as standard practice at state, district and service levels.
Engaging Aboriginal young people early through promotion of health careers can create a future where all health services have a higher proportion of Aboriginal staff and are enhanced by the cultural expertise they bring to their roles. Promotion of health careers should also extend to Aboriginal people returning to education and/or changing their current work focus. Strategies that broaden and accelerate the education, training and recruitment pipeline of future Aboriginal healthcare professionals are essential. Strategies should be designed to benefit both NSW Health and the ACCH sector, and, where relevant, support cross-sector workforce mobility. While NSW Health has a track record of providing Aboriginal traineeships and scholarships, such as in nursing and environmental health, there is an opportunity to expand this work to a range of other roles required in the health sector. Business, finance, IT, logistics and maintenance, as well as specific health professions–Aboriginal Health Workers and Practitioners, allied health, nursing and medicine, would all benefit from a higher proportion of Aboriginal staff.
A dedicated focus on promoting health careers and providing education opportunities that support pathways into the health sector aligns with the expectations outlined in strategic direction 4 of the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework and Implementation Plan83. The plan recognises that “access to and continuity of educational opportunities and supportive pathways from school to tertiary education and into practice”84 are consistently identified in Aboriginal health workforce consultation and research85.
There is a consistent flow of secondary and mature age students entering tertiary and vocational education and training courses across a diverse range of areas leading to health careers and the pipeline of people entering health careers is commensurate with need.
“Aboriginal community sometimes access mainstream services more than targeted Aboriginal services…shows that mainstream services are where we need to make the most difference. We need to support Aboriginal staff in mainstream service roles, and recognise the value they have in improving outcomes for Aboriginal people”. Aboriginal NSW Health staff (regional) consultation participant
“Aboriginal community sometimes access mainstream services more than targeted Aboriginal services…shows that mainstream services are where we need to make the most difference. We need to support Aboriginal staff in mainstream service roles, and recognise the value they have in improving outcomes for Aboriginal people”.
While the number of highly skilled Aboriginal health professionals is growing, representation remains below population parity, with Aboriginal people making up 3% of NSW Health staff as at June 202386, compared to 4.2%87 of the New South Wales population. Further, in NSW and across Australia, Aboriginal people working in health are more often in lower-paid and less-recognised positions, despite their unique skillsets that support culturally safe and responsive care for families and communities88. There are a significant proportion of NSW Health roles that require professional qualifications.
Investment in training pipelines will support growth as more Aboriginal people attain relevant qualifications and progress towards senior positions.
”We aren’t growing or providing an opportunity for our own staff to grow. The retention is just not there. We’re not doing exit interviews; we’re not asking what our staff needs to come to work every day” Aboriginal NSW Health staff (metropolitan) consultation participant
”We aren’t growing or providing an opportunity for our own staff to grow. The retention is just not there. We’re not doing exit interviews; we’re not asking what our staff needs to come to work every day”
Workplace environments that are culturally safe, responsive and free of racism foster the recruitment and retention of Aboriginal staff89, including their longer-term career advancement. Embedding cultural safety in the workplace for Aboriginal staff must therefore be a high priority strategy for the mainstream NSW health system90. Further, all NSW Health Aboriginal staff should have access to ongoing professional development, education, training and support in planning and pursuing their career. For Aboriginal people in identified roles and positions–such as, but not limited to, Aboriginal Health Workers or Aboriginal Health Practitioners–it is vital for their non-Aboriginal colleagues to have a clear understanding of and respect for, and to maximise, their full scope of practice in the workplace and service delivery.
Focusing on culturally safe health workplaces, supporting capability strengthening opportunities and recognising the unique skills sets of Aboriginal identified positions aligns with the expectations outlined in strategic directions 1 through 3 of the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework and Implementation Plan91. This priority is complementary to the work outlined under Reform priority 3.2: Cultural safety and anti-racism.
The number of Aboriginal people employed across NSW Health is equal to or greater than population parity in all health disciplines, levels of seniority, roles and functions of the health workforce. Cultural safety is institutionally embedded so Aboriginal staff experience cultural safety in all levels, areas and services of NSW Health.