Trained for best practice, funded for less

This is the 2nd newsletter this month, drawn from the work behind my book Caring Costs - Addressing the cost of caring in healthcare and the wicked problems facing the health workforce.

Below, I describe the gap between what we are trained to deliver and what funding will pay for. I hope it supports you in naming the gap, rather than carrying it on your own. I also hope it provides you and your colleagues with some practical support around what to do next.

You are trained to deliver evidence-based care. You maintain your registration or certification, meet ongoing CPD requirements, and practise within the standards set by your professional regulatory body.

However, you are now working within funding and service systems that make it difficult to consistently provide the level of care you trained for and are expected to deliver.

The impact extends well beyond being in a situation where you need to offer shorter or fewer sessions. It also affects access to services, continuity and quality of care, professional decision-making, and your long-term sustainability and wellbeing as you continue to provide that care.

This gap between best-practice expectations and the realities of service delivery can create significant strain for you, your colleagues and the people you all support.

The squeeze you are working inside

There is a growing gap between what your training and accreditation require, and what funding and service systems actually allow.

• Clinical standards, established through your professional training and supported by ongoing regulation or certification processes, outline what high-quality care involves. This may include recommended session length and frequency, care planning, collaboration with families and other professionals, documentation, follow-up, and continuity of care.

• Funding models and service systems often allow significantly less time and flexibility than these standards require. This can mean shorter appointments, fewer sessions, reduced opportunities for coordination and preparation, and limited capacity for follow-up. They also mean less thinking time, less consultation and less reflective clinical practice.

In my book Caring Costs, I describe this as another one of the wicked problems in the sector: trained and accredited to best practice, but not funded to deliver it.

What the research shows

The literature points to a cluster of pressures affecting workforce sustainability, including administrative burden, supervision load, regulatory pressure, escalating client complexity, implementation strain and retention risk.

The National Disability Services (NDS) 2025 State of the Disability Sector Report surveyed 290 providers. Eighty-one per cent said they could not continue operating at current prices, and 77% reported delivering unfunded services in the previous year, at an average of close to $500,000 per provider. The report names "the disconnect between the expectations placed on providers by the NDIS and the NDIS Commission, and their own ability to uphold those standards".

Robson and colleagues (2025) reviewed 20 studies of allied health professionals working in aged care and disability. Practitioners named the same pressures on workforce sustainability, including administrative burden, underutilisation of skills, deficit-focused funding, and professional isolation. Across the studies, the pattern was consistent. Practitioners had been trained to one standard, but the systems they worked in did not provide the time, scope or resources to deliver it.

Nickless and colleagues (2024) found that funding pathways shape what care looks like in practice. Funding decisions set session length, session frequency and eligibility, often at levels below the threshold the evidence identifies as needed for clinical change. When this happens, a practitioner is left to negotiate between what their training requires and what funding will pay for, and to carry the gap in their own time.

The Australian Government's Draft National Allied Health Workforce Strategy (2025) notes that Australia's Primary Health Care 10 Year Plan 2022–2032 acknowledges current funding models "do not sufficiently incentivise team-based care within practices, across different workforces, healthcare and related care systems". The work of collaborating with another professional, such as a case conference, a joint session, a handover, or a call to plan together, may not be funded or adequately supported under current models of care.

The disconnect is well documented. It is not in your head.

The shift

This gap is not a sign you are falling short. It is built into how the work is funded.

You were trained to one set of standards and are held to them by your regulating body. The funding where you work was set to a different shape: shorter sessions, fewer follow-ups, and less time for coordination. When the two do not match, the difference can be yours to manage, and this can end up occurring in your own time, often without anyone noticing.

The more useful question is not, "How do I keep delivering best-practice care inside service models that do not cover what this best practice asks for?" It is, "What does sustainable and ethical practice look like inside the funding I have, and how do I make what is not getting done each day visible?"

Covering the gaps in service delivery yourself can look like you are working hard and performing well. However, in reality, it is the system relying on your unpaid time to fill what it does not fund. Identifying, naming and discussing these gaps makes it visible to the people who can change it.

Consider the following…..

If you sit in senior leadership or governance:

1. Where in our reporting do we make visible the gap between what standards require and what funding sustains?

   For example, highlighting unpaid, additional work carried out by your team in management reports and workforce data.

2. What advocacy could we lead, with funders and peak bodies, to close that gap? For example, joining a working group or contributing data to a submission.

If you supervise or lead a team:

1. How often, and how openly, does my team get to name the gap between what we are trained to deliver and what funding covers?

   For example, a regular discussion with your team around what work is difficult to complete.

2. Where am I, often without meaning to, asking my team to over-function to cover shortfalls in funding?

   For example, am I treating unpaid overtime as a sign of commitment?

If you are working in direct care

1. Where am I over-functioning to help close the gap between what I am trained to do and what the funding allows, and what is the cost to me?

   For example, am I working through lunch, working after hours, or compromising my professional standards?

2. If I tracked the additional, out-of-hours work I am doing, what would this tell me, and who could I share this with?

   For example: keeping a simple log for two weeks of tasks you are finishing after hours at home and then taking it to supervision or your manager.

Where to start

Match scope to funding, with integrity. Where funding will not cover a full intervention, name what you can and cannot deliver. Reduced scope, named clearly, protects everyone better than a full scope compromised in private.

Document the implementation work. The unpaid time spent translating policy, navigating systems and absorbing administrative load is real labour. Tracking provides concrete data to work with.

Engage in Collective Advocacy. Submissions to peak bodies, contributions to consultations, briefings to funders on what current rates actually buy. Personal workarounds keep the gap invisible. The collective voice makes it visible.

You were trained to deliver best practice because the people you work with deserve care that is safe, effective and considered. The unease you feel when funding will not stretch reflects your training and professional standards and values. You are not failing the standards. The funding is failing them.

The work now is to uphold what you can, name what you cannot, and stop absorbing the gap in private. Please contact me if you would like to discuss developing an in-house program for your workplace to support your team.

If you want to read more

Michael Henderson's Above the Line offers a framework for taking accountability without absorbing blame for the things that are not yours to fix. It distinguishes between the responsibility that belongs to you and the system pressures that sit beyond your control.

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Relevant previous newsletters you may be interested in…