Inquiry into the implementation, performance and governance of the National Disability Insurance Scheme (NDIS) - Market Readiness
Joint Standing Committee on the National Disability Insurance Scheme PO Box 6100 Parliament House Canberra ACT 2600
To whom it may concern,
Thank you for inviting comment into the market readiness for the provision of services under the National Disability Insurance Scheme (NDIS). I would also appreciate the opportunity to provide further information in person to the Joint Standing Committee on the terms of reference for this inquiry and the matters outlined within this submission.
In 2017, Hear and Say celebrated 25 years of providing hearing, speech and language support to children with hearing loss and their families. We are a not-for- profit organisation located in Queensland and a member of First Voice, the national voice for member organisations whose primary focus is the provision of listening and spoken language therapy services for children with hearing loss in Australia and New Zealand. Hear and Say is privy to, and is supportive of, the submission made by the Shepherd Centre (also a First Voice member) to this Inquiry.
The Hear and Say experienced transdisciplinary team comprises audiologists, speech and language pathologists, teachers of the deaf, occupational therapists, clinical social workers and physiotherapists who work with families to not only provide an end- to-end service package that meets families’ health, education and disability needs and also achieves a set of outcomes for these children/adults which allows them to interact in the community just like children/adults with natural hearing.
The evidence based programs at Hear and Say interface state-of-the-art hearing technology (digital hearing aids and implantable technology such as cochlear implants) with the Auditory Verbal Therapy approach. Hear and Say has one of the largest hearing implant and listening and spoken language programs in Australia.
Our specialist transdisciplinary team assists each individual child and family using a coordinated approach, with a dedicated case manager or key worker who involves the family in all decisions related to their child’s care.
Hear and Say provides nearly 70% of its services to families of children with hearing loss living outside of the Brisbane metropolitan area and it is for this reason that it has opened centres in the Gold Coast, Sunshine Coast, Toowoomba, Cairns and Townsville. Our Telepractice program ensures that families living remotely can obtain the same level of services from their lounge room, as those families accessing our centre-based programs, reducing the cost and stress of having to travel to a centre.
The State Government provides some support however only through the support of Corporates, Philanthropists and the broader community, has Hear and Say been able to nurture the development of Queensland’s children with hearing loss, preparing
them with age-appropriate speech, language and social skills to enter their local primary school – not a special school. Through these ongoing partnerships we are committed to continuing equitable and quality services across all regions and settings in Queensland. With no other full service delivery models like Hear and Say in Queensland, our pioneering programs, forward-thinking approach and capacity to attract quality staff and international networks have allowed us to remain at the forefront of paediatric clinical and therapeutic excellence.
Hearing issues at any age affect a child’s social interactions, emotional development and academic performance. Hear and Say is collaborating on a number of projects to broaden our services so we can diagnose and treat children who may suffer late on-set or temporary hearing loss throughout Queensland, especially at the commencement of their formal education journey.
Acknowledging the magnitude of the social change associated with the implementation of the NDIS there are significant issues affecting the ability for service providers, particularly in the area of paediatric hearing loss, to deliver timely, client- centred and world class programs that have proven and long-term successful outcomes. The NDIA is implementing an inputs based pricing scheme that is fashioned around the number of hours of direct service received and has little or no correlation to the quality of the support or outcomes achieved. The philosophy of early investment to achieve quality, long term outcomes has been compromised seemingly by the unwillingness of the NDIA to recognise the combined voice of those participants and evidence of providers with have been delivering services in the sector for many years by funding programs with significant philanthropy and community support.
Please find following the key points addressing the Inquiry Terms of Reference and do not hesitate to contact me if I may provide any further information or if there is an opportunity for Hear and Say to present to the Joint Committee.
Hear and Say provides the following comments on a number of the Terms of Reference for your consideration:
a) The transition to a market based system for service providers;
- Education about the NDIS for Providers has been weak, and does not support capacity building of providers to develop the skills and knowledge to transition to the market based system.
- The way the information is presented, delivered and accessed reflects a limited understanding of the commercial world of providers and the complexity of business decisions to operate under the scheme.
- Providers have poor access to NDIA staff, experiencing difficulty reaching the right people in the right location for advice, troubleshooting, and consistent and accurate information.
b) Participant readiness to navigate new markets;
- Families of children with hearing loss often do not have any prior experience with disability, deafness or even often as parents. The linkages between State and Federal Health, the NDIS, private / public or NFP service providers and the range of other early childhood/ allied health professionals is often multifaceted and confusing and families often are seeking a ‘simple’ solution and are generally not equipped to easily navigate the complexities of the market.
- It has been our experience that NDIA staff are often not equipped to deal with the idiosyncrasies and the neurological emergency that is paediatric hearing loss and have been known to recommend inexperienced but ‘local’ and ‘cheap’ providers in order to access ‘more’ as opposed to ‘better’ services and unfortunately the consequences of these choices will not be seen until much later in the child’s life.
c) The development of the disability workforce to support the emerging market;
- To achieve quality listening and spoken language outcomes for children with hearing loss requires a specialist, multidisciplinary team. The specialised area of paediatric hearing loss requires a higher level of professional than is generally understood by the NDIA. There are currently not enough specialist Certified Auditory Verbal Therapists - Listening and Spoken Language Specialists and Paediatric Audiologists to support market requirements.
d) The impact of pricing on the development of the market;
- The NDIA pricing structure again does not recognise the specialist nature of paediatric hearing loss and is not geared to fund long-term evidence based outcomes for the child with hearing loss, their families and the community.
- The current NDIA pricing structure for provision of services for children with hearing loss has been demonstrated as significantly under that required to achieve quality outcomes and is forcing service providers to compromise long term outcomes in favour of commercial sustainability.
e) The role of the NDIA as a market steward;
- Under the current NDIA arrangements, children with hearing loss will be worse off than prior to the introduction of the NDIS.
- The NDIA as a market steward has already seen choice and diversity reduce for families of children with hearing loss.
g) The impact of the Quality and Safeguarding Framework on the development of the market;
- The Quality and Safeguarding Framework presents a positive opportunity to ensure accredited, evidence based providers and professionals only are delivering services in the paediatric hearing loss sector. The opportunity to engage Australian Hearing as a referral partner to those accredited service providers should not be missed.
Thank you again for the opportunity to provide a short submission to the Inquiry and I welcome the opportunity to present to the committee in the near future.