Level 1 / 114 William Street T 61396424899 office@speechpathologyaustralia.org.au Melbourne Victoria 3000 F 61396424922 www.speechpathologyaustralia.org.au
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Pathology
x J Australia
8 November 2021
Senator Wendy Askew
Chair
Senate Community Affairs Legislation Committee
PO Box 6100
Parliament House
Canberra ACT 2600
Sent electronically: community.affairs. sen@aph.gov.au
Dear Senator,
Re NDIS Amendment (Participant Service Guarantee and Other Measures) Bill 2021
Speech Pathology Australia is the national peak body for speech pathologists in Australia, representing more than 12,000 members. Speech pathologists are university-trained allied health professionals with expertise in the assessment, diagnosis and treatment of communication and swallowing disabilities. The speech pathology NDIS provider market reflects a small but specialised disability service within the NDIS market. Speech pathologists provide services across the lifespan, and work across a range of business structures, including large companies, multi-disciplinary organisations, and small or sole private practices.
The Association welcomes the opportunity to provide feedback regarding the proposed changes to the National Disability Insurance Scheme (NDIS) legislation, and appreciates the range of feedback opportunities that have been made available as part of the consultative process.
The Participant Service Guarantee
There are many positive aspects to the suggested changes, particularly those contained with the new Participant Service Guarantee that have been the subject of advocacy by the Association and others in the past. The changes to terminology to make it more inclusive, and encouragement of greater involvement of people with disability on the board, are both welcome. The evolution of the scheme should have participants at its core, and enable true co-design with people with disability. Speech Pathology Australia also strongly supports the notion of greater transparency regarding NDIA data and decisions, and the provision of clear timeframes around many NDIS processes, as per the Tune Review.
The Association would specifically draw attention to item three of the proposed Guarantee and the engagement principle of ‘respect’. The importance of the NDIA adhering to these service standards, cannot be over-stated. They must be enshrined in both policy and action at every level as expected practice. Speech Pathology Australia has heard numerous complaints from members and participants alike about the lack of knowledge of NDIS staff regarding disabilities, and reports and recommendations from qualified professionals who have known the participant for many years being ignored. The Association therefore welcomes specific strategies being put in place to address these significant issues.
@& The Speech Pathology Association of Australia Limited
ABN 17 008 393 440
Assistive Technology
Speech Pathology Australia would like to highlight one area where there are currently no specific time frames in place, when they are desperately needed. There should be clear expectations around the provision of Assistive Technology, and in particular the approval of Assistive Technology requests with regard to communication devices. This space has been in flux for some years, with significant inconsistency between NDIS staff members regarding what is approved, and incomprehensible waiting times for vital equipment.
Speech Pathology Australia members consistently raise concerns with the length of time participants are having to wait for their assistive technology to be approved, and policies which unfairly disadvantage agency managed participants. Communication is a basic human right, and as per article 21 of the United Nations Convention on the Rights of Persons with Disability1, participants have a right to be able to communicate in the form of their choosing. When their chosen communication device takes more than nine months to be approved, or is denied by a staff member of the NDIS who does not have the appropriate knowledge or experience, this denies them access to their ‘voice’ and limits their freedom of expression.
Accessibility
Speech Pathology Australia supports the proposed strategies and standards relating to providing draft plans to participants, as well as information regarding the reasoning behind reviewable decisions. However, it is the position of the Association that these should be standard procedures that occur automatically, rather than being only at participant request.
Additionally, the definition of ‘accessible formats’ should be extended to incorporate communication accessibility, with a concerted effort by the Agency to provide information in Easy English and other formats to make all information, plans, and aspects of the NDIS website accessible to every participant or potential participant. In relation to the expectation placed upon participants to provide “accurate and up-to-date information”, it must be clarified that this is not a requirement for participants to constantly prove their disability, particularly when it is a permanent or lifelong condition. This would create unnecessary stress and burden upon participants and families, and directly contradicts the service standard of only having to tell their story once.
New digital platforms
Speech Pathology Australia supports the notion of a point of sale/service application or option for self-managed participants to not be out of pocket when paying for their supports. It would also be desirable for a platform to allow participants who are plan managed to track their spending, and potentially share this with providers to ensure that there are no outstanding debts being incurred.
These new options for participants will need to be developed with regard to Universal Design, so that they are accessible, and able to be used by all participants, including those with cognitive disability, or complex communication needs. Additionally, any new system or platform will require training and support in order to implement it effectively. It would be reasonable to expect that training packages will be developed to assist providers in implementing these programs, and ensure any training provided around participant facing platforms is communication accessible.
Plan management requirements
With regards to the flexibility measures suggested, Speech Pathology Australia would like to highlight several areas of concern. In particular, the proposal to subject plan managed participants to the same financial risk management requirements as those who are self-managed. The Association feels this is both unnecessary and unreasonable to expect when plan managed participants do not have any responsibility for, or involvement in, payments being made.
Data from the most recent quarterly report2 shows that 49% of participants are third party plan managed and this is by far the most popular plan management option. To introduce these measures would potentially limit those who can plan manage, correspondingly limiting their choice and control regarding using any provider of their choosing, and goes against the ethos of the NDIS.
There is also a thin market for registered speech pathologists, with less than 40% of all Speech Pathology Australia members who see NDIS clients being registered. Many of our members have chosen not to register, or re-register, under the Commission due to the overly onerous registration process, in addition to high financial burden that is not proportionate to their businesses, particularly for certification. Speech Pathology Australia receives regular communication from speech pathologists who are delaying entering the NDIS market, reducing the share of their practice caseload of NDIS clients and/or restricting service to self-managed or plan managed clients only, in order to avoid the costs associated with excessive administrative burden.
Concurrently, it is unclear how requiring plan managed participants to be subject to these financial requirements in any way reduces the risk the Agency appears to assume is present in using un-registered providers. Speech pathologists are already well regulated through various pre-existing mechanisms, including the Working with Children Check system, and requirements of governing bodies such as Speech Pathology Australia and the Code of Conduct for self-regulated and unregistered health professionals in place in several states.
Simply put, registration in its current form is not sustainable for small businesses, and the low numbers of Speech Pathology Australia members who are registered is reflective of the difficulties with the registration process, and administrative burden, rather than compliance. It should also be mentioned that the NDIS code of conduct applies to all providers, both registered and unregistered, and that participants can request and only work with providers who have a NDIS Worker Screening Clearance Check.
The Association also suggests that these financial requirements do not address any potential issues around safety and governance, particularly when it is considered that the company that provided services to Ann-Maree Smith and contributed to her tragic death in 2020 was NDSI registered. Other measures, including building circles of support, supported decision making, and cultural changes in regard to the treatment of people with disability have been suggested to be important in the responses to the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability’s Issue Paper on Safeguards and Quality3. Several of these proposed changes may be more effective in providing additional safeguarding for people with disability.
Additional CEO powers
Speech Pathology Australia has significant concerns around additional powers being given to the NDIA CEO to restrict a participant from accessing services from a particular provider, as this directly contradicts the notion of choice and control. If this measure is to protect participants due to concerns regarding the provider’s conduct, then hypothetically this type of serious matter would be dealt with through the Quality and Safeguarding Commission, rather than the NDIA, and would be reflected by
restrictions upon the provider, rather than participant. If this measure relates instead to potential conflict of interest, it may be more effective for this to be addressed through specific conflict of interest guidelines. It should be noted however that such policies would need to be flexible and adjust to areas where there are thin markets, and limited choice of providers.
Additionally, the Association proposes that rather than the CEO being able to alter a participant’s plan, that this only be with the participant’s knowledge and consent, except in circumstances outlined within the Tune Review in section 8.33. This would enable the benefits to the participant of lessening administrative burden and avoiding delays, but ensure that decisions where the participant should be centred are being made with their involvement.
Regarding the suggested changes for thin markets intervention, the Association would urge the NDIA to consider preventative market approaches, rather than just reactionary interventions. Many of the short-term interventions currently used by the NDIA could be interpreted as championing certain providers, and skewing the market toward provision of services by larger providers. Data must be analysed and widely published regarding current, emerging, and potential thin markets, and broader approaches put in place to address these issues in the longer term if thin markets are to be avoided.
We hope you find our feedback useful. If Speech Pathology Australia can assist in any other way or provide additional information please contact Ms Amy Fitzpatrick, Senior Advisor Disability, on
or by emailing . Thank you for the opportunity to provide feedback.
Yours faithfully