You can’t out-give chronic underfunding

I’m very concerned about the current challenges to the well-being of our professional healthcare community.

As you know, this is something I have been focussed on for many years, but the recent decisions regarding funding cuts is causing an unprecedented level of strain and uncertainty.

I will be sharing a series of newsletters each fortnight in June and July, drawn from the work underpinning my book Caring Costs - Addressing the cost of caring in healthcare and the wicked problems we face working in healthcare.

Each newsletter will offer practical support, prompts for reflection and language for naming what is structural and systemic, and how to find ways to keep going in the face of a very challenging system.

You can’t out-give chronic underfunding

The cost of working in healthcare keeps climbing, and the resources are not stretching to adequately meet community needs. They also don’t align with what our evidence-base recommends for our community.

Whether you are working on your own, holding a caseload inside a larger service, running a practice or leading a team, it is extremely likely you have stretched yourself, your time and your goodwill to keep being of service to those you work with. You also know that this is not short-term, you know you will most likely be doing the same again next week, next month and next year.

The gap between what is needed and what is available is very real. The unease you carry from holding it is not a personal failing. It is your professional judgement noticing a problem that is not yours to fix. Healthcare research increasingly recognises that professionals are working within systems of growing complexity, demand and resource constraint, where workforce pressures cannot be understood as individual resilience or performance issues (Giovanelli et al., 2024).

The squeeze you are working inside

Many forces are pressing in.

• Funding supporting the work of healthcare professionals who work across a range of sectors has not kept pace with rising demand or running costs.

• Remuneration freezes have held fees flat while wages, rent and insurance have risen.

• Demand keeps rising, with longer waitlists and more complex client needs

• Critical services get cut when no other option is available, leaving clients stranded and vulnerable

This is not a personal management problem. This is not a professional or personal failing. It happens when funding policy and the cost of running a service are out of step. Clinicians and team leaders stretch themselves to make up the gap with their own time, energy and goodwill.

In my book Caring Costs - Addressing the cost of caring in healthcare, I name this as one of the most painful wicked problems in the sector: chronic underfunding inside a system being kept running on the goodwill of the healthcare workforce.

What the research shows

This issue is not just our lived experience. It is now documented evidence.

Nickless and colleagues (2023) interviewed Australian independent speech pathologists. A majority described funding pressure shaping both the work and the workforce delivering it. The study links funding pressure to a pattern of workforce strain including

• rising demand the system cannot absorb,

• expectations of overtime,

• declining quality of service, and

• burnout that drives attrition from the profession.

A scoping review by Archer and colleagues (2025) found that fee-for-service funding can discourage integrated and collaborative care. The time required to coordinate activities such as collaboration and complex care planning can be difficult to support within these funding models, creating barriers to more integrated service delivery. This work does not disappear because it is difficult to fund. Instead, these gaps often increase reliance on the commitment and discretionary effort of healthcare professionals to sustain quality care.

In aged care, Farrer and Tieman (2025) interviewed stakeholders about the impact of recent reforms on the allied health workforce. Funding models intersected with every other theme they identified. Without specific funding for healthcare, stakeholders described scope of practice being compressed, permanent roles giving way to ad hoc contracts, and likely flow–on effects on workforce retention, particularly among new graduates.

The funding gap is structural, and it is costing the sector its workforce.

The shift

You cannot “out-give” chronic underfunding. You cannot resilience your way through funding shortfalls. The longer you try, the more the system looks like it is working, when it is running on the unpaid labour of people who care.

We are a crew bailing water from a boat with a slow leak. The leak needs attention, not the attitude of the people bailing.

The more useful question is not “How do I do more with less?” It is, “What is genuinely mine to carry, and what belongs to the system?”

That distinction is not abandonment. It is what professional integrity looks like inside a constrained system. Naming what belongs to the system protects your capacity and makes the gap visible to those who can impact it.

Reflection

If you sit in senior leadership or governance:

1. Are our service models honest about what current funding can sustainably deliver?

   For example, are our KPIs set above what staffing can realistically deliver? Do they consider issues such as travel and preparation time?

2. What advocacy am I doing, with the executive team, peak bodies and funders, to close the gap rather than passing it down?

   For example, providing an example of what is happening in my workplace to contribute to a submission for a peak body.

If you supervise or lead a team:

1. What would it look like to name the funding gap explicitly in team meetings or supervision, rather than letting it sit as background noise?

2. Am I rewarding over-functioning without meaning to, through praise, expectations or silence?

   For example, unconsciously praising a team member for being 'always available?

If you are working with clients

1. Where am I absorbing system gaps with my own time, without naming it?

   For example, not taking work home in the evening.

2. What is one boundary I could hold this week that protects my capacity for the long run?

   For example, not looking at work emails over the weekend, finishing work day on time.

Where to start

• Name the gap, in writing. Brief, factual notes on what your service costs to run, set against what current funding covers. Capture this in supervision, team meetings and governance reports.

• Match scope to funding, with integrity. Where funding will not stretch to a full intervention, be transparent about what you can and cannot do. Reduced scope with limits named protects everyone better than full scope compromised in private.

• Advocacy The most generous thing experienced clinicians can do for the next generation is to write submissions, contribute to peak body consultations, and brief funders on what current rates actually buy. Personal workarounds keep the gap invisible. Collective voice makes it visible.

• Protect the recovery time. If you have absorbed system pressure today, your nervous system needs explicit recovery before tomorrow. A walk or some stretches before bed. Time outside in the sun. Real conversation with someone outside the sector. Time away from devices, especially work emails.

A closing word

The unease you carry when the funding stops keeping up is not weakness. It is your training, ethics and care for the people you work with, registering a real gap.

You are not failing. You are working inside a system that has drifted away from what it was built to deliver. Naming that, without blame, is the first act of above-the-line leadership.

The work now is to give differently, protect your capacity for the long run, and keep naming the gap so it is no longer carried in private.

Want to read more?

Peter Senge's The Fifth Discipline encourages us to look beyond individual actions and understand the patterns, structures, and assumptions that shape how organisations function.

In healthcare, this perspective can help explain why the same challenges continue to emerge, even when skilled and committed professionals are working hard to do their best. Rather than focusing only on individual performance, it invites us to examine the broader systems influencing outcomes.

For clinicians, this can provide a useful way of understanding workplace challenges within their wider context. For leaders, it offers practical frameworks for exploring the patterns and organisational conditions that influence team performance, learning, and wellbeing.

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