GUEST BLOG: Ian Powell – The forgotten health professionals

On 4 August Radio New Zealand’s Morning Report broke a story about North Shore Hospital having an entire ward of people with no medical reason to be there: Patients stuck in hospital ward.

North Shore Hospital special ward centre of RNZ story

It involved a 20-bed ward created in May for patients who no longer needed hospital care but had nowhere to go, such as to aged care facilities.

Two days later Jane George, a clinical social worker based in Christchurch, posted a strong compelling piece on LinkedIn. She is also a rural workforce strategist. Her forthright views are slightly edited below:

Reading Monday’s RNZ article about North Shore Hospital’s 20-bed ward for people awaiting community placement got me thinking about how we frame healthcare stories in Aotearoa.

The headline suggests these patients have “no medical reason” to be in hospital. But they’re receiving care from nurses, physiotherapists, social workers, and other allied health professionals. They have “complex discharge pathways” requiring “specialist nursing and allied health workforces.”

So here’s my question: When did “medical” become synonymous with “clinical”?
The journalist speaks to the Association of Salaried Medical Specialists and APEX unions. Why not approach NZNO or PSA – the largest nursing and AHP [allied health professional] unions – to speak to the actual roles nurses, physiotherapists, or social workers play in these patients’ hospital journeys? Or the professional bodies who represent the disciplines actually mentioned as providing the care…

The story frames everything around medical oversight, when nurses and allied health professionals spend far more direct time with patients and contribute the majority of what makes someone “ready to leave hospital.”

This isn’t just about one news story. It reflects deeper assumptions about whose expertise counts in healthcare. When we default to medical perspectives to tell stories about multidisciplinary care, we reinforce hierarchies that don’t serve our communities well.Our health system works because of the combined mahi of all healthcare professionals. Nurses assess, monitor, and coordinate care. Physiotherapists restore function. Social workers navigate complex discharge planning. These aren’t just “support” roles – they’re clinical expertise in their own right.

Maybe it’s time our media coverage reflected that reality?
What do you think? Is this a missed opportunity to showcase the clinical impact of allied health professionals, or am I reading too much into the framing?

Terry Taylor: a laboratory scientist passionate about equitable and sustainable healthcare

The post received positive responses. They included Terry Taylor, a laboratory scientist at Dunedin Hospital and Past President of the Institute of Medical Laboratory Science, Few can match his passion for equitable and sustainable healthcare (you can’t have one without the latter).

In his words:

But it is only Doctors and Nurses that provide healthcare right!? Listen in parliament, public and media. The perception is so hard to break. As I say without the diagnosis and treatment by Allied health and scientific health professionals, doctors and nurses are effectively going blind. Keep up the great work Jane George. It falls on people like us to promote and break down those historical ways and views.

What do allied health professionals do

Before commenting on Jane George’s thought-provoking post (that’s a giveaway on my opinion) it is important to understand what allied health professionals actually do; where do they fit in with the rest of the health system.

They are a diverse group of statutory regulated health professionals who provide a wide range of diagnostic, preventive, therapeutic, and rehabilitative services. Largely these are public hospital based.

Their various roles involve collaborating with doctors and nurses to deliver comprehensive healthcare, often specialising in areas like rehabilitation, mental health, and preventative care.

Some non-exhaustive examples are:

• anaesthetic technicians;
• laboratory scientists and technicians;
• audiologists;
• podiatrists;
• clinical physiologists (use technical equipment to measure or organise patients organs or internal systems);
• clinical psychologists;
• clinical social workers;
• dieticians;
• medical physicists;
• dental hygienists and therapists;
• radiographers;
• physiotherapists;
• occupational therapists;
• radiation therapists;
• perfusionists (operate cardiopulmonary bypass machines); and
• sonographers (operate ultrasound imaging equipment).

Even though non-exhaustive, this is quite a list. It covers a broad spectrum of clinical activity from ears to feet to therapy to diagnostics to mental health to dentistry to science to laboratories to nutrition to operating theatres.

Each occupational group is relatively small in number. But their roles are critical to the ability of doctors and nurses to safely do their jobs. To express it in a nutshell, no anaesthetic technician, no operation.

Back to Jane George

Jane George in her above-mentioned post makes the valid point that while these patients may have had no medical reason for remaining in hospital, they had “complex discharge pathways”.

Thes pathways require specialised care from nurses and allied health professionals (such as physiotherapists and clinical social workers).

While there is usually an appreciation of the role of doctors and nurses in hospitals, the role of allied health professionals is usually left unnoticed.

In the North Shore Hospital ward case the role of physiotherapists is to restore function while social workers navigate complex discharge planning. Jane George is right. These are more than support roles. They are clinical expertise in their own right.

Consequently, she calls on the media to recognise this reality in its coverage. She concludes with a question:

Is this a missed opportunity to showcase the clinical impact of allied health professionals, or am I reading too much into the framing?

The report on the event that triggered the Morning Report item was more than about which occupational group performed what role. It correctly included the serious under-capacity in community support services for patients such as these.

But the role of allied health professionals was missing in the story; she is not “reading too much into the framing”.

Health professionals work as teams

Radio New Zealand, however, should not be blamed. Healthcare in public hospitals centres on teamwork between doctors, nurses and allied health professionals; one cannot do without the others.

The problem is that while doctors and nurses have high visibility, because of their wide range of specific and small occupational groups, allied health professionals are largely invisible; except when, for example, a shortage of or strike by anaesthetic technicians leads to operations being cancelled.

Hats off to Jane George for raising this issue. It deserves to be part of a catalyst for enhancing the visibility of this forgotten but critical workforce. Without them our public hospital system would collapse.

 

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion