Submission
No 33

INQUIRY INTO FOUNDATIONAL AND DISABILITY SUPPORTS AVAILABLE FOR CHILDREN AND YOUNG PEOPLE IN NEW SOUTH WALES

Organisation: Allied Health Professions Australia
Date Received: 24 April 2025

Submission to Select Committee Inquiry into foundational and disability supports available for children and young people in New South Wales

April 2025

About Allied Health Professions Australia and the allied health sector

Allied Health Professions Australia (AHPA) is the recognised national peak association representing Australia’s allied health professions across all disciplines and settings. AHPA’s

AHPA and the Disability Working Group

Allied Health Professions Australia (AHPA) is the recognised national peak association for Australia’s allied health professions. AHPA’s membership consists of 38 member organisations, each representing a particular allied health profession. AHPA collectively represents over 185,000 allied health professionals and AHPA works on behalf of all Australian allied health practitioners.

AHPA’s Disability Working Group (the Working Group) comprises policy and clinician representatives drawn from the range of AHPA’s members that provide services to people with disability including through the National Disability Insurance Scheme (NDIS). The Working Group is therefore informed by the views and experiences of both individual allied health professions and the allied health sector as a whole.

AHPA and its member associations are committed to ensuring that all Australians, regardless of disability, can access safe, evidence-based services to assist them to realise their potential for physical, social, emotional and intellectual development.

AHPA’s response to the Consultation

i. Key recommendations

Allied Health Professions Australia recommends:

That a coordinated and expanded ecosystem of supports be established within NSW, based on a nationally consistent framework, to support children and young people with developmental delay and disability. This system must continue to provide access to NDIS services including an early childhood intervention pathway, along with separate but complementary investments in expanded mainstream allied health supports, and a broader system of general and targeted foundational supports.
That reforms to the disability sector, including any changes to NDIS services access, are coordinated and progressed in alignment to support service continuity for people with disability and their families, to allow appropriate planning and co-design to be undertaken, and to support providers and the sector to implement changes.
That allied health professionals are engaged in the design and delivery of foundational and disability services and supports in NSW.
That all children and young people along with their families and caregivers in NSW have access to sufficient foundational and disability supports, including the allied health services they need to support their development, health and wellbeing. Children and young people and their families and caregivers must have choice of the services and providers they use to provide the care to best meet their needs.
That the establishment of new and expanded programs draws on a range of workforce models to support the involvement of allied health providers, including those in the private sector. Failure to do so may result in the available workforce being smaller and less experienced.

ii. Background

AHPA thanks the Select Committee on Foundational and Disability supports available for children and young people in New South Wales, for the opportunity to respond to this inquiry. Our response focuses on the critical role of allied health services to support children and young people’s overall development, health and wellbeing.

AHPA welcomed the final report of the NDIS Review and particularly supports the recommendations to establish a more comprehensive ecosystem of supports for people with disability, to ensure all people with disability can access the care they need, when they need it, including allied health services. AHPA acknowledges the findings of the NDIS Review that highlighted that the establishment and prioritisation of the NDIS came at a cost to other supports outside of the scheme, leaving limited support for many people with disability.1

Successive reviews have shown clear gaps in the availability and appropriateness of supports for people with disability, particularly outside of the NDIS. For example, there are often limited foundational support services and there are few supports available through the Medicare Benefits Scheme. Allied health supports in schools and early childhood services are often limited and vary across locations. Even within the NDIS many participants cannot access the allied health services they need, either due to insufficient services within plans or because the allied health services they require are not available or accessible. AHPA agrees more needs to be done to ensure that people with disability are supported by a comprehensive ecosystem of well-connected services.

Despite recognising the need for a broader ecosystem of supports outside of the NDIS, including state-funded services, AHPA members are concerned that current changes to the NDIS are resulting in some children and young people who need support being deemed ineligible or being exited from the scheme. For these children and young people there may be no other suitable services or support accessible or available and where there are available services these may not sufficiently support their individual needs. This includes a lack of access to critical developmental programs, meaning that some children and young people with developmental delay or disability may be at risk of missing out on vital and time-limited opportunities to access allied health services to support their development and long-term function and wellbeing. AHPA argues in the strongest possible terms that NSW must ensure that NDIS changes are not rolled out until a new ecosystem of supports and services are funded and readily available in NSW. Only in this way can the state ensure that it minimises the chance that children and families miss out on developmental opportunities, and that other state programs are not overrun with demand that they cannot address.

We recognise the leadership of the NSW Parliament in undertaking this inquiry and investigating the available supports for children and young people in NSW. A government response and strategy for foundational supports is urgently needed to outline the plan and commitment for foundational supports across all of Australia. All reforms to the disability sector must be coordinated and progressed in appropriate timeframes, allowing for sufficient planning and co-design and comprehensive set up of services. Allied health professionals must be included in the design and delivery of future foundational and disability supports in NSW and throughout Australia.

iii. Response to select terms of reference

Below outlines AHPAs response to select terms of reference.

Terms of reference 1) That a select committee be established to inquire into and report on child development, early childhood intervention services and other foundational and disability supports available for children and young people with developmental concerns, delays, differences or disabilities in New South Wales, and in particular:

a) The role of such services and supports on a child’s overall development, health and wellbeing.

Foundational and disability supports for children and young people are essential to support their development, health and wellbeing. The childhood years are a critical development window and lay the foundations for the child’s future development, health and wellbeing outcomes. Appropriate and timely foundational and disability supports for children and young people are essential to support this critical development period. Early and proactive assessment and intervention is needed during this time to maximise future outcomes for children. For more than a decade, around 1 in 5 NSW children have consistently started school with concerns in at least one development domain.2 More needs to be done to ensure that we are giving NSW children the best start in life by investing in the range of supports that are needed to support developmental and other outcomes in key areas of a child or young person’s life.

The allied health sector is Australia’s second largest health workforce, comprising of over 300,000 allied health professions from a range of disciplines such as occupational therapy, social work, physiotherapy, psychology and speech pathology. Allied health professionals play an integral role in foundational and disability support services including through the provision of comprehensive assessments, diagnosis services, access to assistive technology, and evidence-based interventions tailored to meet the unique needs of individual children and young people.

Allied health professionals have the scope of practice, training and expertise needed to identify delays and concerns, support capacity building of families and carers, and provide interventions to improve outcomes for children and young people with developmental concerns or disability. Allied health professionals play a crucial role in supporting children and young people’s development, working across a range of settings to assess, design and deliver interventions in collaboration with children, young people, families, and those in caregiving roles.

For example, in mainstream education settings, allied health professionals focus on systemic interventions such as capacity building for educators and other staff. They support access to assistive technology, environmental and task adaptations to improve inclusion and participation, as well as provide more individualised support to maximise outcomes for the child. Outside of mainstream settings, allied health professionals have a well-established role in supporting developmental, health and wellbeing outcomes. They work with children, families and caregivers to understand the child’s unique needs, environment, and goals, to educate and empower caregivers about the child’s needs, and to design and deliver therapeutic interventions.

To best support a child’s development, health and wellbeing, AHPA recommends that all children, families and caregivers in NSW have access to the allied health services needed to achieve developmental, educational, health and wellbeing outcomes. These should be based on evidence frameworks and an understanding of the different training and scope requirements of the workforces delivering supports.

b) The types of services and supports available and measures to improve effectiveness, availability and access of such services and supports in metropolitan, regional, rural and remote New South Wales, including medical, community-nursing, allied health services, NDIS services and other service delivery models.

The NDIS Review noted that throughout Australia the availability and accessibility of services is insufficient to meet the needs of people with disability.1 Issues with access and availability are even more pronounced in rural, regional and remote areas. This includes access to assessment services, which can have significant consequences, given earlier identification, assessment and diagnosis can lead to better outcomes.

Even when services, including foundational supports, are available, often difficulties with navigation and awareness of these supports exist. There may be long waitlists, and the care may not always meet the specific requirements for the person. Furthermore, the available supports may have high-out of pocket costs, rendering them unaffordable for some people with disability.

For allied health services, people with disability cannot always access the specific services they need, particularly in a timely manner. The future establishment of foundational and disability supports must ensure that equitable, inclusive and quality services, including allied health services, are accessible and available to all people in NSW. AHPA recommends that children, families and caregivers have a choice of the services and providers they use for their care, including allied health professionals, to best support their development, health and wellbeing.

For many allied health professions, there is an existing workforce shortage, increasing issues with access to timely allied health support. During the transition to the NDIS, many existing disability support services changed or closed and trained and experienced allied health professionals were required to move into other services provision models.

AHPA recommends that the allied health workforce with expertise in developmental delay and disability, be utilised with the evolution of foundational and disability supports. These highly qualified professionals may exist outsides of NGOs and state funded services, such as in the private sector. Models of care will need to be developed to ensure the workforce can be best utilised to service foundational and disability supports. This will need to consider a range of workforce models to best meet the demands.

AHPA acknowledges there are a range of settings in which services can be provided, such as in homes, schools, early childhood services, health and community settings. Currently services are not always being best delivered across these settings. For example, a recent NSW audit report highlighted some shortfalls in the support of students with disability in NSW public schools.3 The

evidence on the range of settings where services can be provided should be considered as part of this current Inquiry. AHPA recommends that flexibility is built into the delivery of foundational and disability supports in NSW to account for a range of settings and environments, where evidence-based services can be provided.

The establishment of future services must be done in a coordinated and integrated manner considering all available services for children and young people with developmental delay and disability within the broader care ecosystem. It is imperative that this system is connected, provides continuity of care and allows for true collaboration and multidisciplinary care. This care must include allied health services. This ecosystem must ensure that all people with disability can access the right supports at the right time.

In line with some of the principles outlined in the review for the Early Childhood Intervention framework, all services within the ecosystem must be inclusive and provide culturally responsive and safe approaches.4 Furthermore, services must be appropriate to meet each person’s unique needs and focus on being strengths based, building capacity and outcomes.

c) The role of diagnostic services, existing gaps and barriers, and measures to improve effectiveness, availability and access of such services

The Early Childhood Targeted Action Plan, which forms part of the implementation of Australia’s Disability Strategy 2021-2031 identified the need to enable “early identification of disability or developmental concerns and develop clearer pathways and timely access to appropriate supports”.5 Timely identification and assessment can help support better outcomes for children and young people in NSW. For example, there is evidence that long term outcomes associated with disabilities such as cerebral palsy can be improved when timely early intervention is provided.6

Allied health professionals play a critical key role in undertaking assessments. Allied health professionals can help identify concerns, delays and disabilities in children and young people and provide comprehensive assessments to guide the support and interventions required to meet each child and young person’s individual needs. As highlighted in our response to 1b, access to services for people with developmental delays or disabilities is often limited, due to a range of service gaps and barriers. This must be addressed to ensure all children and young people in NSW can access early and timely assessments.

To support a much-needed connected ecosystem of supports as referred to in our response to 1b, eligibility and assessment processes that determine access to the range of supports available including foundational supports, mainstream supports, and the NDIS, should be streamlined and available across a wide range of mainstream, education and disability settings such as hospitals, maternal and child health programs, general practices, ECEC settings, and schools. Access to assessments must start with workforces that are trained to identify concerns and assessment pathways that provide streamlined access to experienced allied health professionals. These assessment services need to be available and accessible to all children and their families.

f) Other government or best practice child development and early childhood intervention service models and programs operating outside of New South Wales.

AHPA acknowledges the work in progress to develop a New Best Practice Framework for Early Childhood Intervention and the recent release of the review report.4 This work should be considered as part of this current Inquiry. It is critical that as part of this framework, work is undertaken to clarify who is the appropriate workforce to provide the evidence-based services. For more details about workforce, refer to our response to 1g.

g) Workforce issues in the child development and early childhood intervention sectors, including workforce demand and the availability, quality and capacity of existing workers, and

AHPA recognises that there are a broad range of professionals who work in disability, child development and early intervention services. Many workforces, including some allied health professions, have current workforce shortages, which can impact on the availability and quality of care. As noted previously, many allied health professionals with skills and expertise in early childhood intervention may now be working in the private sector, particularly since the introduction of the NDIS.

All professionals engaged in the early childhood intervention sector must have adequate training and expertise to deliver the services. All professionals have uniquely defined skills, knowledge, expertise and scopes of practice. It is important to note that the evidence for effectiveness for some interventions may lie with specific workforces delivering these services, which must be considered with the establishment of services. Models of care must consider who are the most appropriate professionals to deliver the work. This should consider the appropriate training, expertise, scope of practice and regulation/governance of the different workforces.

AHPA notes that a ‘key worker’ or ‘lead practitioner’ style approach, is a way of delivering services that may meet the needs of some children and families. However, it is not appropriate for all. Some children won’t benefit from this approach as their needs are best addressed by therapy from a single allied health profession. Others may require a more comprehensive and collaborative team-based approach. Each child and young person have their own unique needs, and the supports available must have flexibility to meet these.

Allied health professionals have a broad scope of practice and AHPA recommends that all allied health professionals should be empowered to work to their full scope of practice to deliver foundational and disability services for children and young people.

iv. References

Commonwealth of Australia, Department of the Prime Minister and Cabinet. Working together to deliver the NDIS - Independent Review into the National Disability Insurance Scheme: Final Report. 2023. Available from: https://www.ndisreview.gov.au/resources/reports/working-together-deliver-ndis

Australian Early Development Census. Public table by Statistical Area Level 2 (SA2) 2009-2021. April 2022. Available from: https://www.aedc.gov.au/resources/detail/public-table-by-statistical-area-level-2-(sa2)-2009-2021
Audit Office of New South Wales. Supporting students with disability. Performance Audit 26 September 2024. Available from: https://www.audit.nsw.gov.au/our-work/reports/supporting-students-with-disability
Imms C, Moore T, Bull K, Gavidia-Payne S, Lami F, Wilson M, Allen L & Knight S. Review of best practice in early childhood intervention: Desktop review full report. The University of Melbourne, funded by and provided to the Commonwealth of Australia’s Department of Social Services. 2024. Available from: https://www.preci.org.au/submissions-and-papers/
Commonwealth of Australia. Australia’s Disability Strategy 2021-2031. Early Childhood Targeted Action Plan. 2024. Available from: https://www.disabilitygateway.gov.au/document/3146
Cerebral palsy Alliance. Early assessment and diagnosis of cerebral palsy. A guide for parents and caregivers. Available from: https://cerebralpalsy.org.au/wp-content/uploads/2023/06/CPA44_EarlyDiagnosisGuide_LR-1-1.pdf