The world of work has changed significantly in the last 25 years. Permanent employment is declining and casual and part time work are on the rise. Outsourcing is fashionable, and markets (we are told) can deliver whatever we need. Trade unions are in retreat, real wages have flatlined, and our personal household debt, per capita, is amongst the highest in the world.
In this environment the ranks of the self-employed have risen, in our industry and others. There are now around 2,000 social workers in private practice across Australia, counseling, consulting, teaching and training. Needs must when the devil drives! We are all familiar with the alphabet soup of acronyms that are the sources of our income- DVA, MBS, NDIS, and EAP to name a few.
Whilst not telling the whole story of the rise in private practice, a cursory glance at MBS item number 80160, (individual focussed psychological strategies provided by a social worker) illustrates some of this growth in the mental health social work sector.
In the financial year 2007/2008, almost 71,000 services were provided, and this had more than trebled by 2015/16 to over 231,000 services, for which Medicare payed out approximately 18 million dollars. The strongest growth was in Victoria.
The story of how the AASW gained social work access to Medicare goes back to the 1990’s. In 1997 the Commonwealth Department of Health, as part of a mental health services reform process, held consultations with social work, nursing, psychology, occupational therapy and psychiatry, as well as consumers, to discuss the future of education and training of the professional mental health workforce.
The AASW was granted $50,000 by the Department of Health to develop standards of social work practice in mental health settings. When these competencies were published in 1999 they were groundbreaking, and remain the foundation document on which the AASW Practice Standards for Mental Health Social Workers is based. It is these standards that informed the mental health accreditation of social workers and their entry into the Better Access program in 2006.
It was also around this time too, that the AASW set recommended fees for its private practitioners. These fees were unfortunately set lower than Australian Psychological Society recommended fees for similar services- a mistake that would come back to haunt us, as Medicare used our own recommendations against us when setting MBS fees and rebates. Since then the AASW has made repeated representations to government (to no avail) to establish rebate parity with psychologists for similar services. On top of this social workers have suffered the further indignity of a Medicare rebate freeze since 2013.
Many social workers will remember the 2010 budget cuts that threatened social work clients access to Medicare rebates. The AASW led a strong political campaign, reminding the public at the time that more than one-third of social workers using Better Access were based in regional, rural and remote parts of Australia, more than 60% of them offer bulk-billing to at least some clients, and more than two-thirds of clients when surveyed, said they would be unable to access these services without Medicare funding. The direct action of the private practitioners forced the government to back down.
Private practitioners have become a cornerstone membership cohort within the AASW. In other parts of social work, membership penetration is usually no more than 25% to 30% of the maximum membership potential. But in private practice it is likely to be more than 90%. That constitutes a relationship of profound significance for both sides.
The AASW is not a trade union, but it should by necessity include some elements of industrial representation for its members in private practice. There is no alternative.- and private practitioners are doing it tough. Those of us working for an employer enjoy regular pay rises, but the self employed are forced to pass on rising costs to their clients or take a pay cut. And the current Federal Government is as mean spirited as they come in setting rates in ‘markets’ it has created in education, health and welfare.
Whilst the AASW cannot be faulted for its efforts in making representations to bureaucrats, these are not administrative issues, but politics pure and simple.
We have governments that are hostile to pay rises, and indifferent to the marginalized and the disadvantaged. ‘User pays’ and ‘outsourcing’ are their chief weapons. Political problems require political solutions. The AMA has no fear when it comes to political campaigns on behalf of its members. Go to their website and you will find a range of campaign resources related to the Medicare freeze, including templates that can be used to print a copy of the AMA’s Medicare Freeze poster in the tear off portion at the bottom of computer prescription forms. You will also find instructions on how to share campaign material on social media. The poster itself is highly emotive, featuring a distressed mother and a crying baby with some bold text stating- “The cost of running this practice will rise substantially between now and 2020. You will pay a new or higher copayment every time you visit you GP, every time you visit other medical specialists, every time you need a blood test, and every time you need an x-ray or other imaging. Tell your local MPs and election candidate you are not happy.”
There is an urgent need for a well resourced political campaign of this kind on behalf of social workers and their clients, perhaps in concert with the other allied health professions affected by the freeze. It is about time that every Coalition and independent MP heard from us.
The AASW also need to think very seriously about the resources that private practitioners need in order to thrive in the current marketised environments. On top of their annual membership fees ($670 in 2016), mental health practitioners pay an additional $200 pa for their ongoing accreditation. Assuming 2,000 members, that amounts to $1,340,000 pa in regular fees and $400,000 pa for the accreditation surcharge. Add this up and it reveals that 20% of the members account for 45% of member revenue! Despite achieving their highest ever profit in 2016, and having a strong ratio of assets to liabilities, the AASW has introduced a 4% fee hike this year to both the full membership component ( to $697 pa) and the accredited mental health social worker fee (to $208 pa). It will be interesting to see how this hike is justified.
The $208 pa fee is levied only on the mental health accredited practitioners – and so ought to be applied exclusively towards capacity building for that group. This includes not only customized CPD, but also workshops to train our most experienced private practitioners so that they can pass on their knowledge and skills to fellow members. We can create a virtuous circle, skilling up our experienced members, on the proviso that they will offer some of their time in the following year or two, to teaching fellow members at subsidised rates. I am fed up with seeing non social workers advertising expensive training in our National Bulletin. Access to our members is a precious resource, and our motto must be ‘members first’.
Just as important is enabling those who want to take the next step beyond solo practice. Professor Ian Hickie, a National Mental Health Commissioner has called on PHN’s to deliver more appropriate, multidisciplinary care for those service users with complex and ongoing needs. Wholistic models of care are built in to the social work DNA. The AASW needs to be providing the skills and resources to help social workers build multidisciplinary practices that can bid for tenders to provide packages of care.
And last but not least, private practitioners need a professional networking platform on their smartphones linking them to fellow members in a community of practice. The small proportion of private practitioners who use AASW SWOT will agree with me on how clunky it is.
These urgent steps have not been taken because of a failure of governance. Private practitioners do not have a proper voice in the life of the AASW. They need a well-resourced policy development forum, a transparent conduit to the Board, and some measure of independence in running their own affairs.