NDIS

Last week, we attended two, lengthy webinars hosted by the team at The Social Deck, on behalf of the Department of Social Services, about Foundational Supports, including Targeted Foundational Supports. Our key takeaways for allied health providers of paediatric services are as follows*:

State of play:

Consultation period ends on 5 December 2024. Soon!
Weirdly, negotiations between governments are happening completely separately from community stakeholder consultations.
No update on the status of negotiations between the states and the Federal government, who will share the costs, 50:50.

General impressions:

Lots of stressed attendees. (Lifeline number shared!)
Frequent reminders from convenors that “we won’t be able to answer some of the specific questions about how foundational supports might work in the future” because they depend on what governments may decide to do.
Lots of very good ideas, but not clear how they could all work together in the real world. (One participant described the session as an “idea salad”, which I borrowed for the title.)
Private practitioners appeared to be under-represented in discussions, perhaps because the webinars occurred:
- in the middle of working days; and
- so close to the calendar year-end.

General themes:

Targeted Foundational Supports should:

include early recognition and assessment of needs;
be family-centred and holistic;
be consistent and continuous;
include disability-led organisations; and
include robust quality, safety and accountability controls.

Attendee concerns, including about:

NDIS changes and children falling through the “cracks” right now;
allied health workforce readiness, including training pathways and supervision;
gaps between evidence-based practices and front line realities;
how to ensure consistency and continuity of services;
how best to engage families and deliver family-centred care; and
how supports will work in rural and remote areas and for CALD populations.

Services delivery preferences:

General – but not unanimous – preferences for:

a move away from one-to-one, clinic-based therapy;
transdisciplinary and multidisciplinary teams;
service delivery in naturalistic settings using existing (public) infrastructure;
systems that promote longer-term relationships between families and professionals;
a movement away from medical models of care; and
key workers and allied health assistants having significant roles in the new system.

Many big questions remain:

Who will be eligible to deliver targeted supports and how will they be registered/certified?
Who will employ, train, and supervise them?
How (if at all) will allied health professionals access some settings, e.g. in states like NSW without a long history of integrated health/education service delivery?
Who will oversee and audit services, including outcomes?
How will services be funded? (Fee for service, block funding, fees for outcomes?)
What intensity of support is envisaged? (The consultation paper appears to envisage low intensity supports.)
Will recipients have any choice and control?
How (if at all) will upcoming elections affect the proposals, including their timing?

Lots of questions. Few answers.

Paediatric allied health clinic owners: things are not looking great when it comes to Targeted Foundational Supports

Foundational Supports for children with developmental concern, delay and/or disability and their families, carers and kin Consultation Paper

Foundational Supports | Department of Social Services

* Any errors of interpretation are – as always – completely our own.

We’d like to thank Mel Butcher and the rest of the team at The Social Deck for the work they are doing under enormous time pressures.

Key personnel of allied health NDIS providers: your legal risks will almost certainly increase in 2025

David Kinnane · 30 November 2024 · Leave a Comment

Big Picture:

Consultation is underway on proposed reforms to strengthen the regulatory powers of the NDIS Commission.

If enacted, the proposed changes will increase legal risks for providers and for their key personnel, including directors and executives of allied health providers.

What to watch:

Proposed additional:

statutory duties for providers and for key personnel of providers;
penalties for non-compliance;
restrictions on advertising and marketing for NDIS supports;
obligations to provide documents and information to the NDIS Commission; and
requirements to hold information in Australia.

New statutory duty owed by providers:

Provider obligation to ensure, as far as is reasonably practicable, that the conduct of the provider does not cause adverse effects to health and safety of participants while the provider is delivering those supports and services.

Breaches would attract a civil penalty.

New statutory duty owed by key personnel (personally):

Key personnel to exercise due diligence to ensure the NDIS provider complies with its NDIS Act obligations.

Likely to impose clear obligations on key personnel to train staff, manage risks, oversee and investigate incidents, and to address complaints.

New proposed penalties for providers include:

criminal offences for serious failures to comply with conditions of registration; and
significantly increased maximum penalties for serious harm or death of a participant.

Anti-promotion orders

Restrictions on advertising and marketing that undermines the integrity and principles of the NDIS.
Broadly consistent with existing allied health professional and ACCC advertising rules.
Will capture shopping coupons and other exploitative and inaccurate advertising.

Expanded information-gathering powers:

Proposed powers to:

require providers to provide documents and information; and
require information be provided in less than the current 14-day timeline.

Provider information must be held in Australia:

Information that is cloud-based and held overseas is sometimes hard to get.
All providers will be required to hold information within Australia.

Have your say and plan for 2025:

The consultation period ends on 20 December 2024. Give feedback as explained on the NDIS Commission reform hub.
Ahead of any changes, review your risk management systems, including your provider and key personnel insurance arrangements to ensure they remain adequate.

Go deeper:

Consultation on proposed changes to the NDIS Act (Bill 2)

Reform Road Map (as at 20 November 2024)

Paediatric allied health clinic owners: things are not looking great when it comes to Targeted Foundational Supports

David Kinnane · 14 November 2024 · Leave a Comment

Another week, another consultation paper. And, as an independent speech pathology clinic owner who sees many children with developmental delays and/or disability, this one did not speak to my inner optimist.

1. But, first, a bit of context

Back in late September 2024, we wrote about the first Foundational Supports Consultation, looking at a consultation paper and webinar about General Supports.

A second paper – Foundational Supports for children with developmental concern, delay and/or disability and their families, carers and kin Consultation Paper – has been released. It’s dated October 2024. But I only found out about it last week; and only then by accident while looking for something else.

It’s more ambitious than the General Supports paper, and includes a discussion of “Targeted Foundational Supports” for children with developmental delay and their families who need more assistance than General Supports and mainstream services.

2. For strategy and business planning, paediatric allied healthcare providers need to understand what’s proposed

Targeted Foundational Supports are intended to include some allied health services, and so are of interest to paediatric allied health providers (like me), as we look to evaluate our service-delivery models to adapt to new systems of supports made up of three connected tiers:

mainstream early childhood education and school supports;
Foundational Supports, including Targeted Foundational Supports; and
a (yet-to-be developed) new early intervention pathway in the NDIS for children with the highest level of needs.

The idea seems to be that some families will access a combination of these supports, and perhaps different combinations of these supports at different stages as children’s needs change.

The key challenges for allied health providers are how to work within and across such complex systems to deliver quality, evidence-based services to children while keeping staff satisfied with their work – and staying solvent!

3. Reality check: On the ground, funded supports for children with developmental delay and/or disability through the NDIS are shrinking

On a first read, page 9 of the paper caught my eye:

“The recent ‘Getting the NDIS Back on Track” changes to the NDIS Act do not change a child’s participant status or remove their access…Nothing is changing now.”

These statements are hard to reconcile with recent news stories, like this, with journalist Rick Morton reporting that:

the NDIA is sending out more than 1,000 eligibility reassessment letters each week;
in the last six weeks, almost 7,500 eligibility reassessments have been performed – 78% of which are on children aged up to 8 in the early intervention scheme – with 48% of the total being removed from the NDIS, and 20% being asked to provide more information (so-called “general evidence”) within 28 days if they “think they still meet the NDIS eligibility requirements and wish to continue with the NDIS”; and
the NDIA is completing around 1,250 eligibility reassessments per week, aided by 95 new dedicated staff.

“Nothing is changing now”? Many families and health care providers would disagree.

4. Two predictions, and a comment

A. Allied Health Targeted Foundational Supports will not be provided in clinics

According to the authors of the consultation paper:

the 2023 Independent Review of the NDIS found that, under the current system:
- “supports for children with emerging developmental concerns and disability are too focused on a clinic-centred model of support and not enough on functional and support needs”; and
- there was “not enough focus on supporting children in everyday settings where they live, play and learn” (see page 13);
decisions on how to deliver Targeted Foundation Supports are yet to be made by governments. But the options to be considered:
- will look to use existing services and infrastructure to deliver supports to where children live, learn and play;
- may be provided in group settings (helped by an allied health worker or a multidisciplinary team) or individually in a child’s natural environment;
- mark a change of approach that “shifts away from a mostly one-to-one therapy model in clinical settings, which is not seen as best practice early intervention for most children”; and
a child may have access to allied health:
- through a referral to a group with other children getting similar supports “helped by an allied health worker or a multidisciplinary team”; or
- individually in the child’s natural environment (page 18).

B. Allied Health Targeted Foundational Supports:

a. will be more limited than under the ‘former’ NDIS; and

b. may not always be delivered directly by allied health professionals

The paper’s authors state that some children could be eligible to get one or more of:

low intensity or periodic child and and family-centred allied health supports, including from speech pathologists, physiotherapists, psychologists, occupational therapists or other allied health specialists;
more intensive, one-to-one capacity-building from a (not specified) “suitably qualified and experienced worker” who could provide coordination and help families get appropriate supports. This support may be delivered jointly with allied health supports (page 17);
a one-off, low-cost assistive technology consultation to increase independence at childcare, school or home (page 18); and/or
extra supports if the child is “identified” as having concerns across a number of developmental areas, delivered by a “qualified and experienced person with child development expertise”. It’s not clear who will identify the concerns, or what qualifications, experience or child development expertise will be required (page 18).

C. A closing comment

The consultation period appears to end at midnight on 5 December.

Based on what happened with the NDIS supports consultation, a cynic might suggest that the Federal Government has already decided what it wants from Foundational Supports and will now work with the states to make it happen, regardless of what families or allied health providers think or say.

I don’t know. But it’s hard to justify spending significant time or resources responding to consultation papers when we have so many clients needing help, when so many changes are happening at once, as we approach calendar year-end and have already weathered so much change in such a short period.

But we can’t ignore the changes, either.

Paediatric allied health clinic owners must start to think about whether they want to deliver Targeted Foundational Supports, recognising that:

adding Foundational Supports to service-mixes may:
- increase business risks and complexity;
- take away resources from other services and projects; and
- affect staff satisfaction with our workplaces;
one-to-one or in-clinic models are unlikely to work;
therapy dose constraints may reduce outcomes;
service-delivery constraints may reduce control over service quality; and
cost-effective access to mainstream and other ‘natural’ settings may be difficult in some states and regions for logistical, compliance, or financial reasons.

We must also remember that proposed changes will be hard to navigate and deliver for other stakeholders, too, including educators in childcare settings and schools, and governments.

As the authors of the paper note, effective, early child- and family-centred care, through the delivery of strength- and evidence-based services, can lead to significant improvements for children across developmental domains. We all want systems that deliver good outcomes for children and families.

One other thing we must not forget: the stakes of getting this right are life-changingly high for children with developmental delays and/or disability and their families – particularly for children who are (or become) ineligible for the NDIS, but who need more help than is and will be available through mainstream services.

Allied health providers: get up to speed on the key NDIS reforms that will affect your practice (a free resource)

Allied health providers must review services for young participants to ensure they’re NDIS supports

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

Allied health NDIS providers: back yourself to try new things, and help more people: a case study

Allied health providers: prepare for NDIS reforms with an updated Incident Management System

David Kinnane · 31 October 2024 · Leave a Comment

The challenge:

To increase safety and quality, NDIS providers should have clear incident management systems to record and manage incidents that happen while providing supports and services to people with disability.
But the rules are complicated, and the guidance is very detailed.

Why it matters:

The NDIS (Incident Management and Reportable Incidents) Rules 2018 require registered NDIS providers to have incident management systems.
The NDIS Quality and Safeguards Commission says that:
- it is good practice for unregistered-providers to have an appropriate and effective incident management system for all participants; and
- having policies and procedures about incident management is a feature of quality practices providing support for children in the NDIS.
NDIS reforms may mean that many unregistered providers will have to implement incident management systems in the near future, and it’s a good idea to prepare.

Yes, but:

Translating the rules and guidance into plain English is time-consuming.
A blank page can be paralysing, and lead to procrastination.
It’s hard to tailor a system to the needs of your participants and operations without a solid base.

Get started:

Check out our updated, plain English Incident Management and Reportable Incidents System Policy and Procedures Template.
Written for small and medium-sized providers who are determined to improve support quality and safety.
Fully editable, so you can tailor it for your needs, and the needs of participants, and workers.