NDIA Accountability Project

Concerns regarding assessment methods and supports for people with swallowing needs

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National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill 2024 [Provisions]

Submission 95

Level 1/114 William Street T 61 3 9642 4899 office@speechpathologyaustralia.org.au Melbourne Victoria 3000 F 61 3 9642 4922 www.speechpathologyaustralia.org.au

Speech Pathology Australia

Ms Jeanette Radcliffe Committee Secretary Senate Standing Committees on Community Affairs Sent via: community.affairs.sen@aph.gov.au

17 May 2024

Dear Ms Radcliffe,

Speech Pathology Australia (SPA) thanks the Committee for the opportunity to make a submission in relation to the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill 2024 (the NDIS Bill).

SPA is the national peak body for speech pathologists in Australia, representing more than 15,000 members. Speech pathologists are university trained allied health professionals with expertise in the diagnosis, assessment, and treatment of communication and swallowing difficulties and as such provide crucial supports for NDIS participants.

SPA would like to formally raise our deep concerns regarding the lack of specificity in the NDIS Bill. In particular, it has been drafted in such a way as to enable delegated legislative powers without parliamentary oversight over much of the detail that is critical to the way the proposed changes will be implemented. Given the monumental complexity of NDIS reform, we do not feel it is appropriate - or indeed acceptable to the community that the NDIS serves - for parliamentary oversight to be removed, de facto, from the legislation.

From the specific perspective of SPA, we are deeply concerned regarding the definitions of early intervention or disability requirements and their associated pathways (as per Section 27) as this will have far reaching impacts upon access to the NDIS.

SPA is extremely concerned by the proposal for a new needs assessment within the NDIS Bill, which, prima facie, appears to be a rebranding of Independent Assessments. This assessment model has not been determined, and previous attempts by the NDIA to introduce a global assessment have been problematic and met with sector wide condemnation. The allied health sector (and other stakeholders within the scheme) advocated very strongly against the previous attempt under different nomenclature (Independent Assessments) due to a lack of consultation with the sector and concerns that these assessments were not fit for purpose. This was particularly the case for people who have communication and swallowing needs, as the assessments were not communication accessible and did not capture the possibility of mealtime concerns. The potential for this situation to be repeated, but with a Minister having the power to determine the assessment without Parliamentary oversight is of grave concern to us.

The allied health sector, in particular speech pathologists must be consulted to ensure these assessments are fit for purpose, communication accessible and will not cause harm to participants.

Concurrently, the working method to determine funding from the needs assessment is also not yet determined as per Section 32K. This lack of transparency breeds mistrust, particularly given that the Minister again has the ultimate control over this process, and the need to ensure financial sustainability is specified without any other detail. Similarly, it is unclear if the budget set as a result of a needs assessment will be a reviewable decision. Due to the lack of detail, the NDIS Bill is silent on this critical aspect of the process.

Supports that will and will not be funded by the NDIS

SPA is deeply concerned regarding the way that the lists of supports determining what will or will not be funded by the NDIS will be determined. Whilst some items, such as online gambling are obviously

National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill 2024 [Provisions]

Submission 95

     inappropriate, there are others that are not so clear cut. Household items such as blenders for
    instance, may be necessary for some people with swallowing needs as a result of their disability to
    prepare food that is the right consistency for them to eat safely. A blanket rule that does not allow
     participants to access certain items that have been determined to be necessary by a qualified speech
    pathologist will simply reinstate a two-tiered system whereby only people with disability who have
    the financial means can access these items and services.

     Similarly, prescribing therapy techniques that must be used would be inappropriate and have a
     significant negative impact upon participants. Speech pathologists have the  clinical  skills  to
    determine best practice for their therapy supports, and evidence based may be based upon clinical
    experience in conjunction with the participant’s history. It has also been expressed directly to the
   NDIA, as well as the Research and Evaluation team that there may not always be direct research
   evidence available. This is due to a significant history of people with disability being excluded from
    research studies. In addition, the controlled nature of research variables mean that supports will have
    only been trialled with a certain type of person or family and should not actually be extrapolated to
    others who do not fit that exact criteria.

     Finally, it must be acknowledged that it is not possible to label every support that a person might
   need; there needs to be trust in speech pathologists that are working within their scope of practice
   under the Code of Ethics (2020), specifically the principles of beneficence and non-maleficence.

  The use of the APTOS to determine supports

  The Applied Principles and Tables of Support to Determine Responsibilities of the NDIS and other
    service systems (APTOS) has been identified by the NDIS Review as causing confusion and
      difficulties for participants1. It has been proposed that this should not be used as an instrument to
    determine supports, as it lacks clarity regarding who should be responsible for funding supports- the
    states and territories, or the Commonwealth. This confusion leaves participants in a liminal space
   where it is unclear if the support will be funded by the NDIS, or there may be disagreement about
  who should be funding the support, causing significant delays. These delays can be disastrous for
     participants who may be needing to access mealtime supports critical to their safety and wellbeing,
    or assistive technology where there may be strict timelines regarding quoted costs, or where the
   person has a progressive condition and needs urgent modifications.

  SPA is keen to engage with the NDIA to improve health outcomes for people with disability. Please
    contact  Ms  Erin  West,  Senior  Policy   Officer  on  03  9642  4899  or  by  emailing
    policy@speechpathologyaustralia.org.au if Speech Pathology Australia can assist in any other way
    or provide additional information.

   Yours faithfully,

    Jodie Long
    Chief Executive Officer
   Speech Pathology Australia

      1https://www.ndisreview.gov.au/resources/reports/working-together-deliver-ndis/part-one-unified-system-support-people-
        disability-1

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