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NDIS 2024-2025 Reforms

The 1st Foundational Supports Consultation has kicked-off. 8 things allied health NDIS providers need to know

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The Australian Government has kicked-off the consultation on Foundational Supports. As allied health NDIS providers, we’re following these developments closely because they have the potential to change our clients’ NDIS access and funding arrangements and, consequently, our service-delivery and general business models to support NDIS participants and others with disability.

On 20 September 2024, I attended a helpful webinar about one type of Foundational Supports called General Supports. I then reviewed the related General Supports Consultation Paper.

In this article, I’ll explain what the term “General Supports” means, and highlight my key takeaways for allied health providers from both the webinar and the consultation paper.

First, some context (because there is so much going on in the NDIS space!)

In 2023, the Independent Review into the NDIS recommended that governments fund and deliver foundational supports. They recommended that foundational supports would:

  • be additional supports to those delivered through the National Disability Insurance Scheme (NDIS) or through mainstream services; and
  • be available to all Australians with disability, whether they are NDIS participants or not; and 
  • interconnect with existing mainstream services, like mainstream childcare and schools. 

More specifically, the Review recommended governments deliver foundational supports for people with disability into two areas:

  • general supports to deliver access to trusted information and advice and build the capacity of all people with disability, including to fully participate in the community, and to make decisions and advocate on issues that impact them. General supports would also include information, advice and supports for families, carers and kin, and community organisations.
  • targeted supports to operate between inclusive mainstream services (for example in areas like early childhood, schools and community mental health) and the specialist supports accessed through the NDIS. These supports would focus on helping certain groups of people that are not accessing or not eligible for support that is delivered through the NDIS, in areas where the need is greatest.

In December 2023, National Cabinet agreed to design and jointly fund Foundational Supports, where appropriate, through existing services, with a view to phasing them in over time. 

On 19 September 2024, the Government released their Disability Reform Roadmap for 2024 and 2025, stating that phased implementation of Foundational Supports will commence in 2025-2026. According to the consultation paper, the Australian Government expects that governments will agree a Foundational Support Strategy later this year (2024).

Key takeaways for allied health providers:

1. Narrow scope 

    For service delivery and business planning purposes, allied health providers are most focused on what targeted supports may entail in the delivery of our services within mainstream and community settings. However, the consultation paper and webinar cover only general supports, with the consultation paper focusing mainly on information, advice and capacity building supports for people with disability. 

    2. For many people with disability, the stakes and stress-levels are high 

      This was made clear when the webinar hosts shared the contact details for Lifeline.

      In a vacuum, everyone might think that general supports are a good idea (and they are). But consultation on foundational supports is taking place in parallel with major legislative changes to the NDIS to restore “the original intent of the NDIS to support people with permanent and significant disability within a broader range of supports” (page 21). The reforms are also being carried out to ensure that the NDIS is financially sustainable, with implications for both existing and future NDIS participants.

      The webinar hosts were adamant that:

      • the NDIS is here to stay;
      • foundational supports (including general supports) are additional supports so that the NDIS isn’t the only lifeboat in the ocean; and
      • any NDIS rule changes would not take effect until foundational supports are in place. 

      The consultation paper also makes it clear that accessing General Supports should not preclude someone from accessing the NDIS or other supports in the community (page 6).

      But, with the new NDIS Amendment Act due to commence on 3 October 2024, some people are understandably worried that new “sustainability measures” (like the new concept of “NDIS support”) will reduce support for some participants before alternative supports can be put in place. 

      Time will tell. 

      3. People with disability should lead the design of General Supports

        According to the consultation paper, general supports will include:

        • trusted information about disability, rights, and services;
        • supports and tools that build the skills, capacity and independence of individuals to make and sustain social networks and community connections, to make decisions (including supported decisions) and to advocate on issues that impact them;
        • information, advice and supports that empower and build the capacity of families, carers, and kin in supporting people with disability to participate and exercise choice and control over their own lives;
        • assistance to find and access mainstream, community or disability-specific services and activities appropriate to needs and goals;
        • information and advice that assist community organisations and non-government public services/activities to become more inclusive and responsive to the needs of people with disability (page 6).

        Once implemented, these supports will be available nationally, will connect with other services, and tap into local community knowledge and networks. 

        As multiple webinar speakers noted, each person with disability is the expert on what they need, and what works for them. Discussions about accessibility and inclusion often include sweeping generalisations about what we think people with disability need, e.g. “more visual supports”. But, as Jane Britt, senior consultant and advisor of The Social Deck, highlighted, different people need different things. For example, someone who is deaf and blind is not going to be helped by visual supports or maps, and would – obviously – prefer information to be presented in a way they can access and understand. When encountering an obstacle to participation, a person with disability might need information about their rights and who to contact to enforce them.

        It’s obvious, but needs to be said: different people have different needs and goals. But, as leading disability advocate Dr George Taleporos noted, common themes underpinning the consultation paper include empowering people to live independently and autonomously, to exercise choice and control, to live with dignity, to understand their rights, to self-advocate, and to participate, and to increase peer and other networks to to reduce isolation, and eliminate abuse and neglect. 

        Importantly, for allied health providers, people with disability should be able to access our services that are relevant to their needs and goals.

        4. The design of General Supports will not start with a blank slate

          A wide range of services and supports already exists, including the Information Linkages and Capacity Building (ILC) program, the Partners in the Community program, and the Disability Gateway.

          For communities, workplaces, and schools who want to take action to be more inclusive, other resources are also available, e.g. via this helpful list of inclusion resources on the International Day of People with Disability website.

          In the consultation paper, there’s not a lot of detail about the perceived deficiencies of the existing systems and resources. But it is apparent from the Independent Review recommendations, that, as things stand, we can do better. For example, the consultation paper writers note that, at present, “there are limited supports focused on early intervention, prevention or low intensity support needs for certain groups of people with disability that are not accessing or not eligible for support through the NDIS” (page 22).

          General supports may include reforming some of these existing programs and services. But they are also likely to include additional programs beyond supports delivered through or in partnership with the NDIS. 

          5. Allied health providers shouldn’t wait to make their services more inclusive and accessible

            As providers, we all need to work harder with people with disability (including our clients) to ensure our allied health services are inclusive and accessible to everyone, including people with disability and their families, carers and kin. We also need to understand the rights of people with disability; and to train our staff so that they understand people’s disability rights, too. 

            If we have knowledge gaps, we need to educate ourselves about the rights of people with disability. We should also share resources and best practices with each other to avoid reinventing wheels. 

            General supports may help us to do this. But lots of good information and resources exist to improve our understanding of disability rights and to get good ideas to improve the accessibility of our services (including here and here and here). 

            We all have a role to play in helping people with disability to access the allied health services they need, when they need them, and in a way that:

            • works for them;
            • respects their legal rights; and
            • reflects their goals. 

            This includes:

            • providing people with disability and others with accessible information about our team and services. We may need to provide this information in multiple ways, e.g. on our websites, via digital apps, through online chat and phone services, with links to quality information and resources about disability and childhood development relevant to our clients and services (see, e.g., page 9); 
            • increasing our focus on providing services within local community settings to help build the capacity of community organisations like sports groups and arts groups to support people with disability (see, e.g., page 13); and
            • connecting people with disability to trustworthy information, tools, resources and other services as general supports progressively roll out.

            We can all improve accessibility, and we can start work now. As allied health providers, we should lead the way by example.

            6. Help your team get up to speed on core concepts

              Appendix A of the consultation paper (pages 17-23) includes a very helpful glossary of terms relevant to Foundational Supports and the NDIS. While most allied health providers will be familiar with most terms, it’s a potentially helpful tool for training staff. It’s also a helpful reminder that we all need to be mindful of the language we use, even when fiercely debating the pros and cons of potential reforms.

              7. Caveat: everything is subject to intergovernmental agreement

                Page 3 of the consultation paper includes an important note for service providers:

                “Any future funding opportunities will be promoted via normal procurement/commissioning and grant round mechanisms and will take into account transitional arrangements associated with reforms to existing programs. As the concepts in this paper have not yet been agreed by governments, they have no status within the provider market and should not be relied upon.” (Our emphasis.)

                8. Get involved!

                  The consultation period closes on 30 November 2024. This is the first consultation on Foundational Supports, and may have knock-on effects to consultations for other supports, including Targeted Supports. You can give feedback in lots of ways, including via the DSS Engage website and/or by filling in an online questionnaire.

                  Key source:

                  Foundational Supports | engage.dss.gov.au

                  Our related articles:

                  Will NDIS reforms and foundational supports trigger the end for many paediatric allied health clinics?

                  NDIS “ins and outs” for participants seeking “mixed” disability, health and education supports: mind the gaps between NDIS and mainstream services

                  Paediatric allied health providers: let’s tackle our NDIS worries by improving our services, bit-by-bit, and monitoring general reform trends

                  Our new and updated NDIS provider resources:

                  NDIS Provider Human Resource Management System and Registers (HR System) Template

                  NDIS Worker Screening Policy and Risk Management Plan Template

                  NDIS Service Agreement Template 2024-25

                  Paediatric allied health providers: let’s tackle our NDIS worries by improving our services, bit-by-bit, and monitoring general reform trends

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                  Many paediatric allied health providers are taking a wait and see approach with NDIS reforms. 

                  We get it. 

                  In just the last few months, we’ve faced:

                  All this VUCA – volatility, uncertainty, complexity and ambiguity – can be paralysing. And it’s not as if we have a lot of spare time to ponder or plan for it all while supporting participants, families, and staff through difficult business conditions.

                  But, even if you’re not up for a full service delivery review right now, there are plenty of small things we can do – or at least start – to improve participant safety and service quality for the people who matter most: participants and their families. 

                  A. Taking small, positive actions can increase your sense of control in uncertain times and improve our care and services

                    Here are some simple quality improvement ideas we’ve extracted from the NDIS Quality and Safeguards Commission’s recent Quality support for children guide:

                    1. Improve families’ confidence in your team
                    • Ensure your register of Working With Children Checks on all staff is complete and up to date.
                    • Even if you are an unregistered NDIS provider, have your team complete NDIS Worker Screening Checks. (It seems likely these checks will become mandatory for most staff who interact with people with a disability.) 
                    • For each of your professional staff, run annual checks of the AHPRA registration and/or membership status with the NASRHP member peak bodies (as appropriate).
                    • Double check the currency and adequacy of your professional indemnity insurances and the status of insurance arrangements for each professional staff member. 
                    • Train all staff, in detail, on the NDIS Code of Conduct and remind staff they must abide by it. (This Code applies to both registered and unregistered providers.) 
                    • Consider incorporating the NDIS Code of Conduct and professional Ethics Code requirements into your existing organisational Code of Conduct so the key expectations are set out in one place.
                    • Review the NDIS Early Childhood Support Standards for early childhood support. (Although these apply to registered providers, there is no reason quality unregistered providers shouldn’t understand and comply with them.) 
                    1. Improve client decision-making supports
                    • Train (or refresher train) your staff to communicate with children in a range of ways that clients prefer, including through the use of assistive technology, augmented and alternative communication, and visual supports.
                    • Review the strategies and set-ups you use to support children to feel safe and calm in your workplaces.
                    • Think about how you can better support children to speak up when they are unhappy, uncomfortable or feel unsafe when working with your practice.
                    1. Enhance client privacy and dignity
                    • Review spaces for safety and ensure confidential conversations happen in private spaces.
                    • Review and communicate your privacy policy and confidentiality arrangements to families in an accessible way.
                    • Always ask for consent to share information with others and remember that consent can be withdrawn.
                    1. Improve client safety
                    • In addition to Working With Children Checks and NDIS Worker Screening clearances, make sure staff are trained at least annually in CPR/first aid.
                    • Institute a plain English Incident Management System. (For unregistered providers,  benchmark the policy to requirements of the NDIS rules.)
                    • Make sure your team members are trained about the laws relating to restrictive practices as they apply to your supports and practices.
                    • Review your emergency and disaster management procedures. (For unregistered providers, benchmark them to the standards required of registered providers.)
                    1. Improve transparency around competence
                    • Review and explain to families the scope of services you provide (and don’t provide), your qualifications to provide them, the associated costs, risks and benefits, and the expected timeline for supports.
                    • Increase the transparency of your disclosures to clients around staff qualifications and experience.
                    • Explain staff supervision and training arrangements to clients (and the public).
                    • Review and update your referral policies for when the services sought are outside of qualifications and experience. (Make sure there are no secret commissions or conflicts.)
                    • Review your Complaints Management System Policy. (For unregistered providers, benchmark it to the level required of registered providers under the NDIS rules.)
                    1. Improve the integrity, honesty and transparency marketing materials
                    • Review your marketing materials to ensure they are up-to-date, accurate and honest.
                    • Be clear about what families can expect and your terms of service: the who, what when, where, why and how much.
                    • Train your team to ensure that no one engages in “hard selling” practices or plays on family fears, e.g. around service scarcity and waitlists.
                    • Review the accessibility of consent forms and processes to make sure they are understood.
                    • Restate how you manage and avoid potential conflicts of interest.
                    • Increase the quality of your written reports, based on evidence-based assessments, that can be shared with families and other professionals working with clients.
                    • Do what you say you will do in a timely way – including revisiting policies on your timeframes for reports.

                    B. All too much right now? At least keep your eye on these 7 bigger themes

                    If you’re still intent on a ‘wait and see’ approach, at least pay attention to key themes underpinning many of the proposed reforms. Watch the following general trends because they are likely to affect your business planning and service delivery models in the longer term:

                    1. A focus on providers working more collaboratively with the family and the rest of the client’s support team – not in isolation – including with regular team meetings.
                    2. An emphasis on using evidence-based functional assessment tools to measure baselines and progress more rigorously.
                    3. More focus on goal-setting with families, skills measurements, and outcomes that promote increased participation.
                    4. A general preference for delivering supports in homes, in the community, and in education settings.
                    5. More direction to providers to:
                      • provide strategies and tools that enable young children to take part in play, daily activities and routines (rather than doing therapy at the expense of play, rest and social opportunities); and
                      • coach family members, educators, and support workers to use evidence-based strategies in real world situations.
                    6. An expectation that providers will honestly and transparently:
                      • discuss supports that are unlikely to be funded by the NDIS; and 
                      • help families find other ways to get help, e.g. through mainstream or community services.
                    7. A policy objective of reducing conflicts of interests and duplication of functions as part of proposed transition to “navigators”.

                    Bottom line

                    In the short term, allied health NDIS providers – including sole traders – should take small, incremental actions to ward off fears about the future of the NDIS, and increase service quality and safety standards and to improve our supports for participants and their families.

                    We should also start thinking about strategies to build tighter collaborative networks with other providers, deliver more services in home, school and community settings, increase the rigour of functional assessments and outcome measures, and, ultimately, eliminate over-reliance on NDIS-funding to secure our long-term success.

                    Will NDIS reforms and foundational supports trigger the end for many paediatric allied health clinics?

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                    Some of our best private allied health clinics have shut down. Others may soon follow suit. 

                    NDIS red tape and frozen price limits are part of the story. So too, are rising fixed costs, wages, and all the uncertainty about future NDIS registration requirements. 

                    But, for allied health professionals operating clinics supporting children, there’s another source of uncertainty: the government’s proposal to create a new “foundational supports” regime for children with developmental concerns, delays or disability, and their families. These will be much-needed supports for children who have significant needs but do not – or will no longer – qualify for access to the NDIS. As yet, little is known about how they will work in practice.    

                    Sounds like a good idea. So why the worry?

                    Many allied health services operate from small private clinics based in local communities. Many of these clinics are operated by sole traders, families, and small businesses. For many clinics, NDIS participants make up a sizeable part of their current caseloads, enabling owners to invest in improving their services, supervising and training staff, and keeping their lights on. 

                    As proposed, foundational supports will:

                    Allied health providers who currently offer in-clinic NDIS-funded services to support children with developmental concerns, delays or disability are vulnerable to these regulatory changes because, if implemented, the reforms will see:

                    • fewer children admitted to the NDIS as participants (i.e. fewer NDIS-funded clients); and
                    • at least some in-clinic services replaced by services to be delivered in mainstream settings like childcare centres, preschools or schools. 

                    Recently, Professionals & Researchers in Early Childhood Intervention (PRECI) published an interesting discussion paper on the foundational supports. If you own or work in an allied health clinic, it’s well worth a read. 

                    As a clinic owner, a couple parts of the paper jumped out at me:

                    • “Foundational supports should be embedded in mainstream settings and service systems and not be provided in clinical settings.” (p10.)
                    • “Many service providers will need to refocus their services, retrain their staff and form new partnerships with other services. This will take time and a phased transition may be needed to avoid too much disruption.” (p12.)

                    My key takeaway: although it seems early, allied health clinic owners who support children with developmental concerns, delays or disability need to start rethinking their service delivery and business models to make sure they can adapt and stay in business.

                    How did we get here?

                    As the PRECI authors note,

                    “the current service system may not be fit for purpose….There are lots of resources and services but they do not form a coherent system that ensures that all families of young children get the support they need in a timely fashion. Services are funded and delivered in silos, not in an integrated way that enables them to respond to the needs of families in a holistic way.” (p10.) 

                    Before the NDIS was a thing, states and territories were responsible for most publicly funded childhood intervention services for young children with developmental delays and disabilities. These services were limited, and some families elected to pay for private services, like speech pathology, occupational therapy and physiotherapy, often with the aid of Medicare and other rebates and schemes, and/or private health insurance. 

                    When the NDIS came in, states and territories withdrew or significantly curtailed their services for children with developmental concerns, delays and disabilities. Understandably, many families of young children sought support for their children from the NDIS, resulting in an unexpected number of child participants. To borrow Bill Shorten’s phrase, for many families the NDIS was “the only lifeboat in the ocean”.

                    The resulting spike in the number of children admitted to the NDIS, and surge in demand for allied health services, and the atrophy of public sector services, increased the number of allied health professionals entering the private sector workforce to support paediatric NDIS participants, either through services delivered in homes, mainstream preschools and schools, in clinics, or both. The growth of the allied health industry was propelled further by a rapid increase in the number of universities offering allied health degrees to students (with government encouragement). Many allied health students and graduates are now trained and supervised in private sector clinics.

                    No one thinks the current system is perfect

                    Truth be told, it’s a bit of a mess. As the authors of the PRECI paper note, at least 10 recent or ongoing government reviews have focused on early childhood and/or disability services, with consistent findings that the market for childhood services is not delivering inclusive, timely, accessible help for children who need it. Silos operate across different government programs, with a lack of communication and coordination within them. 

                    We all want better services and outcomes for children; and we all know NDIS reforms are necessary. Foundational supports are a good idea in theory. But the lack of detail makes it very hard for clinic owners to plan businesses and develop new service delivery models. This uncertainty is a disincentive to invest in clinic facilities, equipment, training, supervision, and teams. It’s easy to see why some clinic owners – already struggling to stay in business – might conclude that it’s just all too hard and exit the sector.

                    Don’t panic, but prepare for different scenarios

                    Although clinic owners working with children should start thinking about contingencies, the PRECI authors note that:

                    • “[t]he transition to a service system that provides general and targeted foundational supports is a major undertaking…This will take time and a phased transition may be needed to avoid too much disruption.” (p12.) 
                    • “Many service providers will have a vested interest in participating in a new stream of foundational support services and funding. Care needs to be taken to ensure that their legitimate needs for an income stream do not outweigh the need to create a system that works for children, their families and communities.” (p13.)

                    As the late Charlie Munger once said: “The iron rule of nature is: you get what you reward for.” Incentives go a long way to explaining why we have so many private allied health clinics and so few public service systems; and why disability services and mainstream services (like health and education) operate as separate fiefdoms at state and federal levels, despite being so interconnected. 

                    Governments know they need to move carefully, and that, if they change the incentives in one part of the system, they will change the system. They also know that, in complex adaptive systems, like disability, health and education, a change in one part of a system may have unintended and unpredictable knock-on effects for other parts of the system – and any other systems it interacts with. 

                    State governments, in particular, face two major challenges: budgetary constraints and a service system challenge, e.g. about where the services will sit in early child education and care, health, education and welfare systems. For example, state governments will need to invest significantly in facilities, personnel, and systems to facilitate service delivery in mainstream settings.

                    The “real world” constraints and barriers to change associated with the current systems and access to mainstream settings should also not be underestimated. Child services and government support and regulation at the state and federal levels are highly interconnected. The predicted effects of major policy change must be assessed across the whole system.  

                    Clinic owners are not alone: connect with others to make sure our voices – and the voices of the clients we serve – are heard

                    Some allied health peak bodies are on the case. And some terrific private allied health initiatives have been launched to raise awareness of the issues and to ensure our voices are heard. For example, check out – and follow – the important advocacy work of Yellow Ukulele, a consortium of seven allied health businesses across NSW, Victoria and Queensland.

                    Demand for allied health services from families of children with developmental delays and disability will remain strong because evidence-based allied health services help children to participate and are a good thing in the world. The key questions are whether and how various supports will be funded, how they will be delivered, how accessible they will be to children and their families, and what any new tier of disability services will mean for our service delivery and business models ‘on the ground’.

                    For those of us who own and work in clinics, it’s not too early to think about rebalancing our service mix to reduce risk, retraining our teams to deliver services in different ways, and forming new partnerships with other services. If we learned one thing from the pandemic, paediatric allied health professionals are adaptable to big changes while working within imperfect systems – with all their cost and time constraints – to deliver quality care to children who need it. 

                    Recommended reading: Professionals & Researchers in Early Childhood Intervention – Foundational Supports for young children with developmental concerns, delays or disability, and their families: Discussion Paper (1 August 2024)

                    NDIS “ins and outs” for participants seeking “mixed” disability, health and education supports: mind the gaps between NDIS and mainstream services

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                    Consultation on the Government’s proposed lists of permissible NDIS supports ends on Sunday. Many people have strong views about what participants should – and shouldn’t – be allowed to spend their NDIS funding on, including, of course, participants.

                    Public commentary has been spirited. Pockets of the media have fixated on a few hot topics, like fraud allegations, adult services, and obviously inappropriate spending on things like gambling, alcohol, tarot card-readings, and holidays. 

                    But state governments, disability advocates, and many providers see a bigger problem brewing. It’s not a new problem, but it’s about to become more prominent and urgent.

                    Disability vs. Mainstream Services: where is the line? 

                    As with the current system (and with some exceptions), the proposed “out” list includes “mainstream” government services like health, early childhood development, school education, higher education and training, justice, and aged care. 

                    In theory, the split seems sensible. People should get the help they need from the most appropriate system. Participants should have the same access to health and education services as everyone else. 

                    But, in practice, when looking at individual cases, the NDIS/not NDIS distinction is often harder to make than the current rules or proposed lists suggest.

                    A real world example

                    To understand some of the complexity, it helps to look at real world specifics, rather than abstract systems. In particular, it helps to focus on the individuals most affected: NDIS participants.  

                    Take, for example, this Administrative Appeals Tribunal case from 2023. You had an 11 year-old Canberra boy with level 3 autism, a language disorder, ADHD, dyslexia, dyscalculia, and anxiety. The boy was an NDIS participant, probably because of his autism diagnosis. The AAT had to decide whether supports related to his dyslexia and dyscalculia – reading, writing, and maths intervention – should be funded through the NDIS.

                    Right now, when faced with this type of decision, the NDIA and the AAT have to decide whether specific supports are “most appropriately funded or provided through the NDIS” or through another service system, like health or education. 

                    In this case, the NDIA argued that dyslexia was a learning disorder, that support with reading was primarily related to educational attainment, and that, therefore, the NDIS was not the most appropriate funder. Instead, the ACT Education Directorate was responsible for helping the boy to overcome his dyslexia. With regret, the AAT agreed.

                    Sounds logical. So what’s the issue?

                    The AAT decision seems like a logical application of the rules. Reading, writing and maths are school matters. So what’s the problem? Why was the AAT so reluctant to agree with the NDIA?

                    Just because a system is the appropriate funder doesn’t mean it actually provides the support 

                    The evidence in this case established that the school system did not in fact provide a service that could remedy the boy’s reading and writing difficulties. All the school could offer was a bit of in-class help from a Learning Support Assistant who was also supporting other students. The AAT found it was:

                    “clear from the evidence given at the hearing that this intervention had no prospect of remedying the [boy’s] deficiencies in reading, writing and mathematics” and that the “interventions which the school is making are not sufficiently targeted to make any difference to the [boy’s] ability to read or write or progress in mathematics”.

                    But the AAT decision saved the taxpayer money, right?

                    It meant taxpayers didn’t have to pay for dyslexia support through the NDIS. But the longer-term costs to taxpayers can’t be so easily calculated.

                    The decision left a level 3 autistic, language-disordered, anxious 11 year-old in upper primary school without basic literacy skills. It left him without public funding for evidence-based help to overcome his illiteracy. 

                    Not being able to read has significant adverse implications for a person’s education. But school ends when you are 17 or 18 years-old. Un-remedied illiteracy lasts a lifetime and, for many people, leads to significant adverse social effects and negative health, work, and justice system outcomes. 

                    Schools are responsible for making reasonable adjustments to personalise and support students with reading and writing. But, if they don’t actually provide it, illiterate children become illiterate adults. Taxpayers may end up footing a larger bill for longer-term supports from another public service, like health or justice.

                    No bright-lines

                    The Canberra boy has a permanent disability. He has health needs. He has educational needs. His disability, health, and education issues interact with each other. His disability, his health needs, and his educational challenges all affect his ability to function and to participate in life. 

                    In truth, you can’t draw neat lines between disability and mainstream health and education services for people with disabilities, despite what the rules say. As noted by the AAT:

                    “The rules set up a dichotomy between supports which ameliorate the functional impact of a disability of activities of daily living [which are NDIS-funded] and supports which primarily relate to educational attainment [not funded by the NDIS]….The [boy] in his submissions highlights that there is a relationship between his educational attainment and his activities of daily living and so this strict dichotomy is hard to apply. If a person has not mastered basic…reading, there will be an impact on their functional capacity to undertake activities of daily living.”

                    The AAT didn’t disagree with the boy’s point, but concluded they did not have discretion to disregard the rules as written.

                    Remember that taxpayers are on the hook for all public services

                    Disability and mainstream health and education systems operate independently but are interdependent – and all funded by taxpayers. This was recognised by the Productivity Commission way back in 2011:

                    “Access to generic services, such as health…can affect demand for NDIS-funded services, and vice versa. It will be important for the [NDIS] not to respond to problems or shortfalls in mainstream services by providing substitute services. To do so would weaken the incentives by government to properly fund mainstream services for people with a disability, shifting the cost to another part of government (such as from a state government to the NDIS…). This ‘pass the parcel’ approach would undermine the sustainability of the [NDIS] and the capacity of people with a disability to access mainstream services.” (My emphasis.)

                    Arguably, this game of pass the parcel is exactly what’s happened. States have underinvested in funding mainstream education and health services for people with a disability. Too few supports exist for people with disabilities who are not NDIS participants. One of the main reasons so many people fight so hard for access to the NDIS is that it’s the only real help available.

                    So why’s the problem about to get bigger?

                    The Federal government has decided to implement ‘foundational supports’ – disability supports outside the NDIS. If you don’t know much about them, check out this excellent summary by Sina Gingold of DSC.

                    The foundational supports proposal is a good idea in theory. It is intended to ensure the NDIS is sustainable and focused on supporting people with lifelong disabilities, while also supporting people with a disability who are not participants to get support when they need it in childcare, schools, homes, and community care settings.  

                    Properly funded and skilled front line disability supports in mainstream settings, like schools, could provide exactly the type of help needed by people like the dyslexic Canberra boy. But it has triggered a furious debate between Federal and state governments about the future interdependence of disability and mainstream health and education services for people with a disability and, most immediately, who will fund them. 

                    It’s no surprise that state governments are asking for more time and a new intergovernmental agreement. They’re facing two main issues: a lack of detail on the funding for these proposed additional mainstream services for people with a disability; and a lack of trained people with the skills and systems to deliver them. 

                    Conclusion

                    Most allied health NDIS providers – including speech pathologists, occupational therapists, and physiotherapists – support people to increase their functional skills, independence and participation, consistent with the purpose of the NDIS. 

                    Ideally, our aims should be to support the whole person in front of us, rather than to focus on arbitrary and false distinctions between an individual’s disability, health and education difficulties. 

                    In reality, like NDIS participants, we have to operate within different systems and to follow different rules around different supports depending on the system or systems we are working within at the time. Regrettably, this means we sometimes have to work with participants on discrete challenges in isolation, while ignoring significant challenges that may affect the participant adversely more in the longer-term. 

                    The Canberra boy’s situation is a good case in point. Presumably, he was receiving some NDIS supports for his oral language disorder associated with autism, executive function challenges, and anxiety under the NDIS, while not receiving supports for his written language (reading or writing) despite lots of evidence showing that oral communication skills, mental health, and literacy are related, and that illiteracy leads to poorer longer-term social and mental health outcomes for adolescents and adults.

                    People with a disability should be able to access support for their health and education challenges like everyone else. Taxpayers fund the NDIS and mainstream services, and games of pass the parcel between governments do nothing to help participants live their lives well. It’s also unclear if they end up saving taxpayers money after you consider the long-term consequences of limiting supports in one system knowing that there are major deficiencies in the system “most appropriate”.  

                    The Government’s Draft List of Allied Health NDIS Supports: What’s In; and What’s Out 

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                    On Sunday, 4 August 2024, the Federal Government released a consultation paper on draft lists of NDIS supports. It gave everyone only 14 days to respond.

                    Big Picture

                    If enacted, the NDIS Amendment (Getting the NDIS Back on Track) Bill will allow the Government to make new rules about what is – and isn’t – an NDIS Support. But Commonwealth and State governments will then need to agree on the detailed rules, which will take time. Until this happens, the Government wants a transitional rule in force, including lists of supports that will – and won’t – be funded.  

                    Proposed “ins and outs” for allied health-related services

                    What’s inWhat’s out
                    Therapeutic supports: “evidence-based therapy supports provided to assist a participant to apply their functional skills to improve participation and independence in daily, practical activities in areas such as language and communication, personal care, mobility and movement, interpersonal interactions and community living”, including “further assessment by health professionals for support planning and review as required”.

                    Early intervention supports for 0-9 year-olds, including “a mix of therapies”.

                    Specialist positive behaviour support.

                    Some disability-related health supports (including some dysphagia, continence, respiratory, nutrition, diabetes, epilepsy, podiatry and wound and pressure care supports).

                    Communication, information and personal mobility equipment.

                    Exercise physiology, specialist hearing supports, therapeutic massage directly related to disability, and some interpreting and translation help.                     		Alternative and complementary therapies like crystal therapy, tarot cards and clairvoyants, cuddle therapy, reflexology, aromatherapy, sound therapy, yoga therapy, wilderness therapy, alternative or complementary medicine.

                    Wellness and coaching services like general massage, sports supplements, life-coaching, hypnotherapy, neurofeedback, gaming therapy, mastermind coaching, somatic therapy and kinesiology.

                    Energy and healing practices such as Reiki, Scalar Lounge, frequency healing and energy balanced massage, deep energy clearing, spinal flow technique and shamanic healing, hair and beauty services (including nail salons).

                    “Mainstream” services, including health,  mental health, child protection and family support, early childhood development, higher education and vocational education and training, employment, housing and community infrastructure, transport, justice, and aged-care services.  

                    Lists have limits

                    Many participants, providers, and taxpayers want clarity on what NDIS funds can be spent on. But the lines between “disability” and “mainstream” services are harder to draw in practice than the lists suggest, and disputes are inevitable.

                    Will (can) the States cover support gaps for participants and others with disabilities in health and education services?

                    What happens if governments can’t agree on a future ‘permanent’ rule?

                    Will we be stuck with the lists?

                    Have we considered the second– and third- order effects of these changes for participants, state governments, providers, and taxpayers?

                    It’s very hard to think through these issues properly in the very short consultation period while also delivering services to participants.

                    Go deeper 

                    Consultation on draft lists of NDIS supports

                    Check out our NDIS provider and health provider resources Go to Shop