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:
- sit outside the NDIS and operate as a separate tier of services between mainstream services (like childcare and education) and NDIS disability services; and
- be funded jointly by federal and state governments.
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)
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