NDIA Accountability Project

Supplementary Submission on Foundational and Disability Supports for Children and Young People in New South Wales

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Submission
No 128

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

Organisation: NSW Nurses & Midwives Association
Date Received: 18 September 2026

SUBMISSION BY THE
NSW NURSES AND MIDWIVES’ ASSOCIATION

Supplementary Submission on Foundational and Disability Supports for Children and Young People in New South Wales

6 NSW AUSTRALIAN NURSES & NURSING & ASSOCIATION NSW BRANCH

This response is authorised by the Elected Officers of the New South Wales Nurses and Midwives’ Association.

Contact details

NSW Nurses and Midwives’ Association
50 O’Dea Avenue
Waterloo, NSW 2017
(02) 8595 1234 (METRO)
1300 367 962 (RURAL)

¢ Nsw NURSES & MIDINWES®

ASSOCIATION

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Introduction

  1. The New South Wales Nurses and Midwives’ Association (NSWNMA) is the industrial and professional body for nurses, midwives and carers in New South Wales, representing over 85,000 members across the full spectrum of health care services in NSW, including public and private hospitals, midwifery, corrective services, aged care, disability, and community settings.

  2. NSWNMA strives to be innovative in our advocacy to promote a world class, well-funded, integrated health system by being a professional advocate for the health system and our members. We are committed to improving the quality of all health and aged care services, whilst protecting and advancing the interests of nurses and midwives and their professions.

  3. We work with our members to improve their ability to deliver safe and best practice care, fulfil their professional goals and achieve a healthy work/life balance.

  4. Our strong and growing membership and integrated role as both a trade union and professional organisation provides us with a complete understanding of all aspects of the nursing and midwifery professions and see us uniquely placed to defend and advance our professions.

  5. Through our work with members, we aim to strengthen the contribution of nursing and midwifery to improving Australia’s health and aged care systems, and the health of our national and global communities.

  6. The NSWNMA thanks the Select Committee for the opportunity to provide additional feedback to the Inquiry into Foundational & Disability Supports Available for Children and Young People in New South Wales.

Summary of Recommendations

  1. Ensure Thriving Kids is implemented as a foundational support for children aged O-8 as intended. The risk exists that some who should remain in the NDIS may be transitioned to Thriving Kids. This will require ongoing monitoring and evaluation to ensure this is not simply cost shifting but is based upon acuity of need and appropriateness of service.

  2. Ensure children and families can access general supports without unnecessary diagnostic barriers, while expanding multidisciplinary diagnostic capacity for children who require assessment.

  3. Establish transition protections so that children do not lose access to necessary supports as NDIS access arrangements and foundational supports evolve.

  4. Develop a rural and remote access strategy including outreach, telehealth where appropriate (though this should never replace face-to-face options), funded travel options and stronger integration with local health districts, Aboriginal Community Controlled Organisations and community providers.

  1. Ensure the establishment of dedicated, recurrent and transparent funding for Thriving Kids as a priority that covers recruitment, assessment, coordination, workforce development, supervision, backfill, travel, outreach, evaluation and workforce wellbeing for nurses and midwives who are frontline professionals working with this cohort. This must include assessment of sustainable workloads and the prevention of psychological harm arising from work overload.

  2. Embed formal collaboration with families, Aboriginal Community Controlled Organisations, early learning services, schools, health services, disability organisations, unions and professional associations in program eligibility requirements, implementation and ongoing evaluation.

  3. Implement transparent monitoring and public reporting on access, wait times, diagnostic pathways, workforce capacity, child and family outcomes, cultural safety, regional equity, complaints and transition impacts.

  4. Placement of Nurse Practitioners in the Thriving Kids program, similar to the UK Health Visitor model which values their additional training, expertise and leadership and endorses prescribing rights to a limited formulary, is imperative. Nurses in this space should be afforded increased referral rights to reduce burdens on the healthcare system and to increase system efficiencies to the benefit of children and young people living with disabilities.

  5. Increase administrative support for clinicians, particularly in community health contexts including Local Health Districts, to free up time for clinical care and multi-sectoral collaboration. Nurses and midwives will face increased administrative burdens which must be alleviated by appropriate administrative support.

  6. Ensure staffing of child and family health nurses and midwives is enhanced to ensure appropriate staffing and skills mix is available to meet increased service needs arising from the introduction of Thriving Kids.

  7. Ensure Aboriginal and Torres Strait Islander nurses and midwives recruitment and retention are a priority to ensure culturally safe care and access to care is delivered.

Response to Terms of Reference

(a) The role of services and supports In a child’s overall development, health and wellbelng

  1. Thriving Kids should strengthen early, accessible and family-centred supports for children with developmental concerns. Services should include robust and timely access to child and family health, midwifery, disability and paediatric nursing, allied health, diagnostic, education and disability support that work together to support children’s development, health and wellbeing.

  2. Maternal, child and family health nurses and midwives are often the first point of contact for families with developmental concerns. Their role in developmental surveillance, screening, assessment, care planning, health education, referral and advocacy is clearly recognised in the Thriving Kids implementation plan. Early identification and timely intervention can improve developmental outcomes and reduce pressure on families and later service systems (Melvin et al 2026).

  1. Thriving Kids should also recognise the importance of continuity of care. Ongoing relationships between families and nurses or midwives support trust, timely identification of emerging concerns, practical family support and care coordination. Implementation should therefore ensure adequate staffing, administrative support and clear referral pathways so that clinicians have the time and authority to provide effective early support.

(b) Types of services and supports avallable, and measures to improve effectiveness, avallabliilty and access across metropolitan, regional, rural and remote NSW

  1. Thriving Kids must address inequitable access across metropolitan, regional, rural and remote NSW. Children and families in rural and remote communities have reduced access to specialist medical, nursing, midwifery, allied health, diagnostic and therapeutic supports. Long travel distances, limited local providers and workforce shortages can delay assessment and intervention during critical developmental periods.

  2. Implementation should include a rural and remote access strategy that provides outreach, visiting specialist services, funded travel, telehealth where appropriate, and stronger integration with local health districts, Aboriginal Community Controlled Organisations and community providers. Telehealth should be used as an adjunct to local face-to-face services, not as a replacement.

  3. Thriving Kids should also reduce service fragmentation. Families should not be expected to navigate disconnected diagnostic, therapeutic, education, health and disability systems alone. Local multidisciplinary models should bring together maternal, child and family health nurses, midwives, disability nurses, paediatricians, allied health professionals, general practitioners, Aboriginal health services, early childhood services, schools and community providers. These models should include clear referral pathways, navigation support and accessible information for families. Digital interoperability is imperative to ensure smooth referrals and continuity of care between services.

  4. Access measures must also address financial hardship, limited health literacy, language barriers and the need for culturally safe and responsive care. Financial assistance, interpreter-supported services, cultural safety training and navigation support should be built into implementation.

(c) The role of dlagnostic services, existing gaps and barrlers, and measures to Improve access

  1. Diagnostic services are important for clarifying a child’s needs and informing appropriate supports. Thriving Kids is not anticipated to create additional diagnostic bottlenecks or require families to wait for a formal diagnosis before receiving general early support. The Thriving Kids Final Report acknowledges this and recognises the important role nurses and midwives play in helping families and children navigate appropriate services. NSWNMA members working with children and families report existing issues of long waiting times for children accessing services involved in diagnostic processes.

  2. Implementation should allow children to access general supports based on developmental concern, while ensuring timely access to targeted multidisciplinary assessment where needed. NSW should invest in diagnostic capacity, community-based assessment options and clear referral pathways between child and family health nursing, general practice, paediatrics, early childhood education and schools.

  1. Thriving Kids should also address the impact of diagnostic delays on existing services and workforces. Long waits for allied health, paediatric and specialist assessment increase workloads on nurses and midwives, who often increase contact frequency and support while families wait for further assessment. Workforce planning, backfill and demand monitoring should therefore be linked to diagnostic pathway design (Johnston et al., 2020).

(d) Gaps and barrlers to accessing early childhood Intervention and the Impact on chlidren, familles, carers and other systems

  1. Thriving Kids implementation must address barriers that currently delay access to early childhood intervention, including long waitlists, cost, workforce shortages, transport barriers, limited culturally safe services and difficulty navigating multiple systems. These barriers can delay support during critical developmental windows and increase pressure on families, carers, health services, early learning settings and schools.

  2. The transition from NDIS supports to foundational supports must be carefully managed. Thriving Kids should not result in children losing access to necessary supports, nor should it shift demand from the NDIS onto already stretched mainstream and community services without additional funding and staffing. While the Thriving Kids Advisory Group Final Report acknowledges this, NSWNMA members have reported concerns that workload will increase for already stretched maternal child and family health services. Improved funding, appropriate staffing levels, staff retention, skills mix and ongoing evaluation of these factors must be built in to Thriving Kids.

  3. Families should have a single, clear pathway into supports, with navigation assistance and mechanisms to share relevant information so that families are not required to repeatedly retell their story across disconnected systems, this includes digital systems and shared records that talk to each other across different services. Transition protections, clear eligibility arrangements and transparent communication will be essential.

(e) Opportunities to Increase engagement and collaboration across sectors

  1. Cross-sector collaboration must inform design and delivery of Thriving Kids. This should include shared planning, governance, service design, referral pathways, workforce development and evaluation across health, disability, early childhood education, schools, Aboriginal Community Controlled Health Organisations, Aboriginal Health Workers, Aboriginal Health Practitioners, community organisations and families.

  2. For Aboriginal and Torres Strait Islander children and families, the NSWNMA supports implementation that is culturally safe, locally led and grounded in Aboriginal community control and the support for place-based models that allow children and families to access early development supports on Country, in partnership with trusted local services. It is important to ensure that this happens in practice during the rollout and ongoing implementation of Thriving Kids. Service must be periodically evaluated to ensure it meets this cohort’s needs. Closing the Gap outcome 4 indicators should be utilised as part of ongoing evaluation (Closing the Gap 2024).

  3. Disability, child and family health nurses and midwives are well placed to work collaboratively with Aboriginal Health Workers and Aboriginal Health Practitioners to build trust, identify developmental concerns early, support referrals and improve engagement with services. The Bellies and New Life program in Warren demonstrates the value of culturally grounded, community-led approaches that connect families with maternal, child and family health services through language, culture, Elders and Aboriginal health workforce support.

  1. Implementation should also address the under-representation of Aboriginal and Torres Strait Islander nurses and midwives. Increasing Aboriginal and Torres Strait Islander representation within the nursing, midwifery and Aboriginal health workforce would strengthen cultural safety, improve engagement and support earlier identification and intervention. Closing the Gap outcomes 7 and 8 support this and should be actively utilised to improve employment and representation.

(g) Workforce Issues In the child development and early childhood Intervention sectors

  1. The program will increase demand for maternal, child and family health nurses, midwives, disability nurses, allied health professionals, Aboriginal Health Workers, Aboriginal Health Practitioners, care coordinators and early childhood intervention workers. Without additional staffing, supervision, backfill and workload controls, Thriving Kids risks shifting demand onto services that are already overstretched.

  2. Implementation should include a dedicated workforce strategy covering recruitment, retention, skills mix, deployment and funding across metropolitan, regional, rural and remote NSW. Workforce shortages in child and family health and related services already affect service availability, continuity of care and the quality of support available to children and families. Shortages and low retention rates of nurses and midwives in rural remote and regional areas are, in fact, even worse than the challenges also faced with medical and allied health staffing (Bakar et al., 2026). A staff retention plan with measurable indicators, including turnover, vacancy rates, time-to-fill and vacancy duration, should accompany Thriving Kids (Johnston et al., 2020). Thriving Kids must incorporate workforce wellbeing measures, including manageable caseloads, backfill, clinical supervision, staff safety, continuing professional development and monitoring of workload, vacancies, turnover and burnout. Funding should recognise hidden implementation costs such as training, supervision, technology-enabled care and employer-support strategies that reduce burnout and turnover (Naegle et al., 2023).

  3. Thriving Kids should fund staff training and education pathways in child and family health, disability, developmental surveillance, early childhood intervention, cultural safety and family-centred practice. This is particularly important in rural and remote communities, where targeted staffing, incentives, travel supports and professional development will be required to attract and retain skilled workers. Competitive pay and conditions, safe workloads, supervision and sustainable employment arrangements are essential to retain expertise in rural regional and remote areas.

  4. Home visiting should remain a core delivery model within Thriving Kids. While telehealth can support access as an adjunct service, it should not replace face-to-face services, particularly for families experiencing socioeconomic disadvantage or limited access to reliable digital services. Adequately staffed home visiting enables assessment in the child’s family and community context and supports developmental, parenting and maternal wellbeing outcomes. Brighter Beginnings and Sustaining NSW Families supports an evidence-based model with a ratio of 1.0 FTE nurse managing a caseload of no more than 25 families in urban sites and 1.0 FTE nurse managing a caseload of 20 families in rural areas with appropriate access to allied health support services (NSW Ministry of Health 2023). While our members have stated that the above provides a ratio metric, it is an inadequate one. Our members’ concerns include that this staffing level is no longer relevant to current care acuity and complexity, and does not take into account the increased client numbers that Thriving Kids will add to caseloads. Members expressed that there are cases where clinicians have had close to double the clients they were meant to have within their sustained families programs, which is both unrealistic and unachievable.

  1. Given this, our members have concerns of the burden to care that Thriving Kids will add to service provision. Further input from frontline nurses and midwives is imperative and additional research required ongoing.

(h) Measures to Implement recommendations of the NDIS Review Final Report and the Disablilty Royal Commission Final Report In relation to foundational supports

  1. The NSWNMA agrees that Thriving Kids should be implemented consistently with the intent of the NDIS Review and Disability Royal Commission by ensuring foundational supports are accessible, inclusive, rights-based, adequately funded and that they are not used as a cost-shifting mechanism.

Conclusion

  1. This supplementary submission, which focuses on the forthcoming introduction of Thriving Kids, is to be read in conjunction with our original submission.

https://files.parliament.nsw.gov.au/fileapi/ParlFiles/GetArtifact/NSWNMA%20Submission.pdf?serverRelativeUrl=%2Filcdocs%2Fsubmissions%2F90080%2FNSWNMA%20Submission. pdf

References

  1. Australian Government. 2024. Closing the Gap. (2024). https://www.closingthegap.gov.au/

  2. Australian Government Department of Health, Disability and Ageing. (2026). Thriving Kids Service Design, Engagement and Consultation. https://www.health.gov.au/our-work/thriving-kids

  3. Australian Government Department of Health, Disability and Ageing. (2026). Thriving Kids Advisory Group Final Report. https://www.health.gov.au/resources/publications/thriving-kids-advisory-grou final-report?language=en

  4. Bakar, K. S., Radchenko, P., Ho-Nguyen, N., McDonald, E. & Bailie, R. (2026). Area Remoteness and the Distribution and Attrition of the Rural Health Workforce in Australia. Human Resources for Health 24 (1). https://doi.org/10.1186/s12960-026-01050-6

  5. Johnston, R., Sunners, J., & Murphy, E. (2020). Child and family health nursing: A workforce profile. Journal of Nursing Management, 28(3), 532-539. https://doi.org/10.1111/jonm.12953

  6. Lee, T., Good, L., Lipton, B., & Cooper, R. (2022). Women, work and industrial relations in Australia in 2021. Journal of Industrial Relations, 64(3), 347–361. https://doi.org/10.1177/00221856221099624

  7. Melvin, K., Smith, H., Dunstan, K., Balfour-Ogilvy, J., Benham, C., Olsen, J., O’Keefe, A., Burn, N., Aitchison, D., Ware, D., Folbigg, S., Scarinci, N. & Armstrong, R. (2026). Turning Waiting Time to Action: Co-Designing Solutions to Support Families Waiting for Appointments in an Australian Metropolitan Child Development Service. BMC Health Services Research. England. PubMed Central. https://doi.org/10.1186/s12913-026-14503-4

  8. Naegle, M.A., Kelly, L. A., Embree, J. L., Valentine, N. M., Sharp, D., Grinspun, D., Hines-Martin, V., Crawford, C. L., & Rosa, W. E. (2023). American Academy of Nursing consensus recommendations to advance system level change for nurse well-being. Nursing Outlook, 71(2), 101917. https://doi.org/10.1016/j.outlook.2023.101917

  1. NSW Ministry of Health. 2023. Technical Budget Notes Far West Local Health District: 2023-24 Service Agreement. https://healthcarefunding.specialcommission.nsw.gov.au/assets/Uploads/publications/Exhibits- 142/Exhibit-F TAB F.035 MOH.9999.1284.0001.pdf

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