September 2012
Providing Assistive
Technology in the National
Disability Insurance Scheme
Summary Background
ATSA fully supports the establishment of a National Assistive technology (AT) is central to minimising long-term Disability Insurance Scheme, and believes the following costs and improving the lives of people with disabilities. measures must be undertaken if assistive technology Effective AT provision will help ensure that the NDIS is (aids and equipment) are to be effectively provided within affordable and economically sustainable. the scheme: AT products are often categorised in three main groups:
• The establishment of a single national assistive personal care; communication; and mobility. AT varies
technology scheme across the NDIS and NIIS from simple and inexpensive products such as aids to open cans or cut up food, shower chairs and canes, through to
• The establishment of a national AT accreditation very complex and high tech equipment such as a powered
system for suppliers and prescribers wheelchair with customised seating and controls (see the
AT Pyramid). The World Health Organisation defines AT as: • Recognition of the central role AT suppliers play in
delivering good outcomes for consumers, including: an umbrella term for any device or system that customised equipment solutions; trials in the home; allows individuals to perform tasks they would and ongoing support, maintenance and repairs otherwise be unable to do or increases the ease
and safety with which tasks can be performed. • Avoid bulk procurement approaches at the complex
end of the AT spectrum ATSA was established in 2000 to represent the interests of AT
suppliers who manufacture, import, distribute, service, and • Consideration of total lifetime costs of the equipment
hire equipment. ATSA members range from small, family when making purchasing decisions: durability, maintenance, repairs, training, owned businesses to international companies. and upgrades A viable and competitive supplier sector is pivotal to
• Flexibility in tendering and bulk procurement for rural ensuring choice and flexibility for people with disabilities
and remote settings within the NDIS.
AT Pyramid
AT varies widely in complexity, and this variation requires Good outcomes for people with disability require a different supply-chain and procurement approaches different approach at the top end of the AT pyramid as a to ensure good quality outcomes for consumers while consequence of: minimising costs (see the AT pyramid below).
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the relatively low volume of AT (estimated at between Creating a national AT system will enable the National 5-10% of all AT in the NDIS) Disability Insurance Agency to achieve significant savings
through competitive tendering and bulk purchasing across • the extensive labour costs and high skill levels needed
the two bottom layers of the AT pyramid. These tendering for both prescribers and suppliers (estimated at 15-35% and bulk purchasing arrangements must be done in of AT costs) consultation with both consumers and suppliers to help
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the uniqueness of each AT solutionensure that the intended procurement cost savings are achieved while at the same time providing a high degree All AT purchasing decisions must be based on the totalof consumer choice and control. lifetime costs of the equipment, and a national AT system
will enable data and evaluation to ensure that this is posHowever, the top segment of the pyramid – encompassing sible.Total costs need to incorporate not only the equipmentAT that is very complex, expensive and at high risk of itself, but also other costs including:failure if not done well – is not amenable to tendering and
bulk purchasing arrangements and will require purchasing • durability/life-span
structures that support the uniqueness and complexity of
the AT at this level. • repairs
For this ‘top’ segment of the market, utilisation of • maintenance
appropriately accredited suppliers is essential. An approved
• training for consumers, families, and professionalsprovider structure of suppliers with the highest levels of in the use of the equipmentaccreditation would ensure the necessary high levels of
skills, training, experience and capacity to support complex • future upgrades/modifications if required
AT solutions. Effective AT can be life changing for someone
with a disability, and have positive economic impacts • the often hidden costs of providing AT in rural and
regarding independence, participation and health remote areas outcomes – when it is done well.
Individualised procurement essential at this level: low volume/high cost
Highly customised power & manual wheelchairs, complex seating, high end pressure care, complex motor vehicle modifications, etc.
Highly Complex AT
Electric homecare beds, scooters, standard power wheelchairs, oxygen concentrators, patient lifters, mid-level pressure care, basic motor vehicle modifications, etc.
Moderately Complex AT
Standard wheelchairs, basic pressure care cushions, rollators, crutches, daily living aids, furniture, bathroom/toilet aids, ramps, etc.
BASIC AT
Potential for bulk procurement at this level: high volume/low cost
Role of suppliers ATSA members, and AT suppliers generally, deliver many essential services that are vital to ensuring that people with disability get the equipment they need. This includes:
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Importers/manufacturers/distributors – known as ‘sponsors’ within the Therapeutic Goods Administration’s (TGA) framework
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sourcing products, including research and development of new products
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information on the availability, function, and detailed specifications of AT products that are TGA listed and meet Australian/international standards
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training and education for therapists and retailers
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product inventory and spare parts – immediate availability is essential for many products, especially spares for ‘life critical’ items such as wheelchairs, pressure mattresses and hoists
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warranties; quality assurance; standards testing and regulatory compliance; product recalls; and participation in the review and development of Australian standards
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Loan products to ILCs (Independent Living Centres) and major specialist facilities (e.g. spinal care and rehabilitation)
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Retailers / Local Suppliers:
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Assist consumers with appropriate product selection, often in conjunction with prescribing health professionals such as occupational therapists, physiotherapists and speech therapists
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At the middle and top of the AT Pyramid retailers/ local suppliers are the primary source of expertise A national AT system regarding specific product selection, measurement,
customisation/modification and fitting – getting this ATSA proposes the establishment of a single ‘right’ is fundamental to good consumer outcomes, and national AT system within the NDIS and NIIS. A national requires a very significant investment in staff training system would significantly reduce complexity for people with disabilities and simultaneously increase service
• Trialling AT – making equipment available for delivery efficiency. consumers to take home and trial to ensure
appropriateness (e.g. which hoist will work in that A single national AT system under the NDIS (and NIIS) will: space and which sling is most suitable) and to
determine exact specifications for more complex AT • enable effective oversight by the NDIA (e.g. a control system, frame configuration and/or
seating for a wheelchair). This includes undertaking • collect national data for review/evaluation modifications when required, delivery, set-up and
training in use of trial equipment • drive cost effective solutions based on consumer
choice and control
- Order, assemble and deliver AT products, including final fitting and adjustments, and consumer/carer training • enable integration with other NDIA/NIIS structures
and other assistance as needed
- provide a focal point for collaboration with other key
- Service, maintenance and repairs portfolios such as employment, health and aged care Prescribers and consumers both rely on the expertise of • provide capacity for efficiencies only achievable on a
suppliers in identifying and bringing to fruition the best national scale AT solution. For consumers whose needs are at the middle and higher end of the AT pyramid, suppliers and therapists ATSA believes these goals will only be achieved via the work together to develop the detailed specifications to establishment of a new national AT system, rather than the configure the AT to the person’s capacities and body. ‘harmonisation’ of existing state and territory schemes which Suppliers then procure, assemble, test and trial the solution are not designed to operate in an insurance environment with the consumer, usually with oversight from the prescriber. and are not underpinned by the NDIS principles or aims.
Rural and remote settings Timely and efficient supply, support, maintenance and repair of AT in rural and remote communities requires a high degree of flexibility in relation to procurement – particularly in relation to tendering and bulk purchasing. There are relatively few suppliers in rural and remote communities as meeting the needs of a very wide range of consumers is difficult to do economically with low profit margins and significant additional expenses.
The range of inventory for both equipment and spares, and the depth and variety of skills required to ensure the consumer gets the right product, and that it is configured and customised appropriately, along with the problems of distance and travel times and costs, are major challenges when population densities are low.
Tendering and bulk purchasing arrangements must carefully take into account AT provision in rural and remote communities. Tendering and bulk purchasing in several state programs has resulted in absurd situations such as where an urban supplier has the contract, so a consumer must wait for weeks to get a piece of equipment to trial – but
the local supplier has the appropriate piece of equipment • providing nationally consistent standards, quality,
and could supply it within a day or two. transparency, accountability and safeguards for AT prescription and supply Similarly, at the bottom end of the AT triangle contracts for
supply of high volume low cost equipment held by individual • supporting a market-based approach, including
large suppliers can ultimately reduce the capacity of local competition, consumer choice and control, and rural and remote suppliers to operate viable businesses and assisting people with disabilities to readily identify service their local communities. appropriate sources of expertise and assistance
ATSA proposes that the NDIA’s procurement strategies • ensuring minimum AT supply-chain transaction
ensure that bulk purchasing arrangements take into account costs and time if prescriber accreditation is linked to the value and advantages of local suppliers in rural and funding authorisation, as well as minimising delays and remote areas: relationships with local consumers; timely reducing risk supply; timely maintenance and repairs; local support and training for consumers and carers. Many rural and remote Accreditation for suppliers should be linked to their capacity suppliers also have a wide range of essential skills related to to match consumers to the right equipment and to support ensuring the right fit between the consumer and their AT, and and maintain that equipment, and at the higher end of the knowledge of local conditions and needs. Additionally, most AT Pyramid their capacity to do the complex and detailed of the cost savings from tendering and bulk procurement will fitting and customisation required. For prescribers be realised in urban areas, so the value of extending these accreditation should be linked to different levels of expertise to rural/remote areas should be carefully examined. and different areas of practice such as mobility, seating, vehicle modifications and communication. Accreditation ATSA proposes a two-stage approach, with an independently ATSA’s Code of Practice for members ensures fair, ethical commissioned options paper exploring the best alternatives and consistent provision of equipment and services to for an accreditation system as the first stage. The second consumers with disabilities and older people, and stage would be securing funding to underwrite the safeguards all stakeholders’ interests. establishment and operation of an accreditation body for three years, when it should then be fully self-sustaining. However, there is still a pressing need for the development This process needs to proceed immediately, and should and implementation of a national accreditation system involve key stakeholders such as ATSA, ARATA (Australian for AT prescribers and suppliers as the most effective and Rehabilitation and Assistive Technology Association), economical way to meet many of the High Level Principles OT Australia, AFDO (Australian Federation of Disability for an NDIS in relation to AT, including: Organisations) and Carers Australia.
Dr Michael Summers Chris Sparks
Senior Policy Advisor Executive Officer
www.atsa.org.au | P: (02) 9893 1883 | F: (02) 8212 5840
A: Level 7 - 91 Phillip St, PARRAMATTA, NSW 2150