Submission 51 — Assistive Technology Suppliers Australia — NDIS participant experience in rural, regional and remote Australia | External submission

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NDIS Joint Standing Committee

Inquiry into NDIS participant experience in rural, regional and remote Australia

20/2/2024

Assistive Technology Suppliers Australia

Suite 302, Level 3 Lawson Place

165-167 Phillip St

Sydney NSW 2000

02 8006 7357 www.atsa.org.au

Contents ………………………………………………………………………………………………………………………………………………………………. 2

Who is Assistive Technology Suppliers Australia (ATSA)?…………………………………………………………………………… 3

Recommendations …………………………………………………………………………………………………………………………………………….. 4

Introduction ………………………………………………………………………………………………………………………………………………………… 5

Response to the Terms of Reference ……………………………………………………………………………………………………………… 5

Who is Assistive Technology Suppliers Australia (ATSA)?

ATSA is a national organisation representing assistive technology (AT) suppliers, including manufacturers, importers, distributors, retailers, tradespeople and technicians.

Our 170 respondents comprise businesses and not-for-profit organisations and range from small family-owned concerns to multinational organisations throughout Australia. It is estimated that, excluding AT for communication and sensory disabilities, approximately 80% of the AT in Australia passes through the hands of ATSA respondents.

ATSA is a registered not-for-profit charity with the ACNC and requires its respondents to adhere to a comprehensive Code of Practice on the provision, sales and servicing of AT. We are also a member of the Australian Ethical Health Alliance.

The objects of ATSA are (a) funding and promoting:

i) research into Assistive Technology; ii) the education of the public as to the availability of Assistive Technology to meet the needs of persons with a disability; iii) “Best practice” in the way Assistive Technology is supplied; and iv) community accessible Assistive Technology events;

(b) giving the Assistive Technology users and suppliers a voice that:

i) provides positive influence on Government policy; ii) educates Governments and other stake holders about Assistive Technology; iii) promotes a robust competitive and commercially viable marketplace with the aim that Assistive Technology is available to users at a reasonable cost; iv) advocates to achieve excellence, quality, value and positive outcomes for suppliers, Assistive Technology users, stakeholders and the broader community;

v) works with governments at all levels to ensure the viability of the Assistive Technology industry for the sake of those who use Assistive Technology; and vi) delivers quality and value in Assistive Technology solutions for people with a disability and their carers;

i) supporting the ongoing training and education of health care professionals; ii) promoting ethical business practices that safeguard the interests of users of Assistive Technology; iii) participating in the development of appropriate and cost-effective product standards; and iv) maintaining and enhancing services standards, quality and reputation of the Respondents for the collective mutual benefit and interests of the Respondents and the public;

(d) developing alliances with all industry stakeholders to:

i) drive continued improvement in outcomes for Assistive Technology users; ii) minimise the total lifetime costs of Assistive Technology on society and Assistive

Technology users; iii) ensure an open, fair and competitive market; and iv) promote the services, activities and events of the Company; and

(e) undertaking such other actions or activities that are necessary, incidental or conducive to advance this Object.

Recommendations

Recommendation 1: The approval for services and products for participants in rural, regional and remote areas needs to be flexible to allow for the distances and extreme environmental conditions (e.g. AT for wet and AT dry seasons provided to the same participant).

Recommendation 2 The Department of Social Services to support training in

a) repairs and maintenance of AT to workers in country Australia who have the skills and capacity to learn about AT maintenance and repairs from manufacturers and

b) the professional development of clinicians in rural, regional and remote areas. Recommendation 3: The introduction of specific funded programs to cover travel and accommodation for participants coming to major centres and allied health workers and AT Technicians working in rural, regional and remote areas (e.g., Western Australia Patient Assisted Travel Scheme).

Recommendation 4: The introduction of three additional payment categories to allow for costs such as travel and delivery to either regional, rural or remote areas.

Recommendation 5: An analysis be conducted to assess the costs and benefits of introducing regular clinics in regions for NDIS participants which would include assessments, AT trials, servicing and repairs, and follow up.

Recommendation 6: A clear process and line of responsibility to be developed between the NDIS and Commission to prevent a “ping-pong” effect for participants. Call centre staff then need to be trained in the new process so they can refer participants to the right person in the NDIS/Commission to assist them.

Recommendation 7: AT suppliers to be provided with greater information from PACE on approvals and coding to create efficiencies in administration and reduce delays in approvals for participants.

Introduction

This submission is focussed on the area of assistive technology supply and the experiences reported by NDIS participants to ATSA members. It also includes observations from our members.

To inform our submission ATSA held a consultation session with members who work with participants living in rural, regional and remote Australia. We collated their feedback and identified some key themes which are reflected in the Recommendations provided in this submission.

Response to the Terms of Reference

a) The experience of applicants and participants at all stages of the NDIS, including application, plan design and implementation and plan reviews

Navigating the NDIS – these comments have come from participants in non-metro and metro areas

Participants have advised they find the NDIS difficult to navigate particularly when there are a number of different groups involved (for example - support coordinators, planners, occupational therapists). This multi-handling has sometimes led to scripting for assistive technology not being accurate and participants becoming frustrated.
Some participants have stated they and their support personnel are not clear on whether their plan is plan or agency managed. Participants advise it becomes even more confusing for them if their plan is a combination of plan managed, self-managed and/or agency managed components.
The above also causes additional administration for AT suppliers in getting the right plan number, the correct date of birth, delivery address and other information. As a result, there are delays in the participant receiving AT. This can be exacerbated in rural, remote and regional areas due to the tyranny of distance.

Unique issues for participants in rural, regional and remote areas

Participants across the north of the country say they have the issue of limited access during flooding and the wet season. Distances are also problematic with regard to the delivery of AT to participants. For example, it can take days to provide one trial due to travel times and the logistics of delivering the trial equipment to the participant’s home.
The size of the transport (usually a van) used by AT suppliers limits the amount of AT that can be transported at one time. This then limits the range of AT the participant can choose from during the trial compared to other participants in metro areas.
Participants say they often do not have access to an occupational therapist (OT) who knows their history as there are too few and there is also a high turnover of OTs in rural, remote and regional Australia. Our members have observed that many OTs in these areas are inexperienced, often newly out of university and have little knowledge of scripting complex AT.
Participants want their plans to cover the additional costs of travel and delivery so that trials are undertaken at their home/workplace (e.g., the farm). Note: To create efficiencies and reduce costs for participants, AT suppliers try to book multiple trials for each area. (However, this often then means a delay for participants.)
Servicing of AT is not locally available in remote areas – and participants often state they weren’t aware they needed to have funds in their plan to cover repair and servicing costs including delivery of parts and travel. The impact on participants if their AT breaks down is that the wait time for repair can be numerous weeks due to the longer time for parts delivery

and skilled technicians to arrive. Participants in these regions do not have a process or sufficient funds to obtain approval to spare AT (i.e.: back up device).

When living in areas with tough environmental conditions, participants need AT which has been selected to be suitable for their local environment.

Participant experiences differ based on type and size of product

Where products are small and easy to ship around rural, regional and remote areas and where the set-up does not require an AT technician or specialist on site, participants advise remote online consultations are working well.
Some rural participants on properties require two power chairs – one for navigating the terrain of their property (e.g., an Extreme X8 or Trackmaster) to enable them to work on their land, and another for inside the home / out in the community. It is rare that these two things can be found in the same product. Participants advised the NDIS often view this as a double up and the participant is then forced to decide what is most important to them - their access to their property for work, or home and community?

Observations from ATSA members

Participants in rural and remote areas using complex AT required more online consultations as the number of face-to-face visits were limited. Note: Clinicians do an online preview session prior to AT being sent and discuss AT options for trial with the participant. This doesn’t work as well when participants do not have a primary clinician – this is an issue in remote areas due to too few clinicians, or movement of clinicians. (Note: Suppliers may ship the AT device in time for the face-to-face initial trial meeting between the participant and OT/therapist. The AT expert will then join this meeting online to provide guidance to the participant and OT.)
Where possible, the supplier may fly up (if money in plan) with the equipment to reduce the waiting time for the participant. When driving, AT suppliers do not book the trial in unless they have spoken to the therapist and there are 2 or 3 deliveries or other trials to split costs between participants and create cost and time efficiencies. If the NDIS does not approve the OT recommended AT order, it creates further delays.
Few people in remote areas can conduct the servicing and repairs on AT as they are not trained by the manufacturer. When an issue of fault is something major, the AT device may have to be shipped back to a major centre. Alternatively, the NDIS will pay for a person to drive and do a repair - in these cases, other trials or other deliveries are added where possible to share the cost across participants. This is particularly problematic in northern Western Australia and other remote areas.
Country OTs are ‘innovative’ and will try to learn how to repair AT on site for country-based participants to help reduce the time taken for the repair. The supplier has to advise which repairs require a technician trained in a product (ensuring the warranty is not voided).
The state based ‘therapy / technician’ teams that use to fly to country areas together scripting and fixing equipment no longer exist, further reducing capacity.
As noted above, there is a national issue with too few experienced clinicians in country areas. The training they currently receive is limited, which adversely impacts the outcomes for participants.
We believe this, plus the high turnover rate, could be addressed through an allocation of funds for professional development for workers in these areas. This should include an allocation of billable hours for professional development. ATS believe the outcome would be less pressure on OTs and an incentive for them to remain in country areas, thereby improving outcomes and quality of service for participants. 6

Recommendation 1: The approval for services and products for participants in rural, regional and remote areas needs to be flexible to allow for the distances and extreme environmental conditions(e.g. AT for wet and AT dry seasons provided to the same participant.)

Recommendation 2: The Department of Social Services to support the training in

a) repairs and maintenance of AT to workers in country Australia who have the skills and capacity to learn about AT maintenance and repairs from manufacturers.

Recommendation 4: The introduction of three additional payment categories to allow for costs such as travel and delivery to either regional, rural or remote areas.

b) The availability, responsiveness, consistency and effectiveness of the National Disability Insurance Agency in serving rural, regional and remote participants

Participants have advised the level of administrative burden when they are plan-managed is too high.
Participants advise approval for trials can be difficult. For example, a supplier who was in Darwin did a call with the participant and clinician to assess what the participant needed for a trial, but then had difficulties in getting the trials approved. (Note: The dealer had met with Minister Shorten who asked for case studies be sent to him.)
Participants have advised they don’t know where the communications from NDIA go or where the approvals are up to. One participant provided the example where they wanted a review of their plan, however, their plan had been rolled over and funding cut and neither they nor their support workers knew this had happened. This example is not a one off, our members state they have heard this same issue a number of times.
Participants say when they have an issue, the NDIS passes the issue to the Commission who then passes it back to the NDIS. The NDIS call centre may need more information on how to find who can support country based participants.
ATSA Members have advised the removal of plan managers will increase the administration work for providers, adding to the cost of services and products for participants.

Recommendation 6: A clear process and line of responsibility to be developed between the NDIS and NDIS Commission to prevent a “ping-pong” effect for participants. Call centre staff then need to be trained in the new process so they can refer participants to the right person in the NDIS/Commission to assist them.

c) Participants’ choice and control over NDIS services and supports including the availability, accessibility, cost and durability of those services

Participants have commented to suppliers on the OT/physiotherapist they have and say they didn’t get what they wanted from the clinician. Many of these participants do not seem to know they have the right to change their provider – this may be more difficult for participants in rural, remote and regional areas. Our members advise these participants to speak up as there are few clinicians.
Choice of AT is limited because of the difficulty of getting equipment to participants for trials in country areas and there are limitations in funding, creating a “double edge sword” for the participants.
To address the costs and time around the distance in bringing AT to the participant, AT suppliers have to make decisions about the AT before the client is involved. For example, where possible, suppliers will provide AT they know can be serviced in those areas so the participant will have ongoing access to the AT they need. Participants need to be sure the supplier they choose can respond as quickly as possible to get the participant’s AT working again. Suppliers often only have one delivery truck /van which also limits the number of devices carried and shown to the participant and OT.

d) The particular experience of Aboriginal and Torres Strait Islander participants, participants from culturally and linguistically diverse backgrounds, and participants from low socio-economic backgrounds, with the NDIS

Aboriginal participants in northern Australia advise they cannot use power chairs in the pouring rain of the wet season – the AT suitable for the wet season differs to that used during the dry season. Having AT for both seasons is not normally approved as it is considered “doubling up”. Providing AT that works for the climate extremes allows the client to be as independent as possible. It also extends the life of the AT making it easier and less costly for the participant and the NDIS scheme in the medium to long term. Suppliers try to provide AT which is as “bush proof” as possible to reduce the risk of equipment failure.
Western Australia has a large number of very remote indigenous communities, not always accessible in a van so participants have to come to the nearest town for services and to collect their AT.
There is some cultural resistance to AT and participants do not always show up for booked trials leading to delays in the provision of AT.
AT can be borrowed by others in remote communities and damaged, leaving the participant with no equipment to support them.
For participants living in more remote areas, the physical environment is tougher on the equipment than in regional and metro areas – dust, dirt and rain is hard on electronics for example and can lead to an increase in AT turnover.

e) Any other related matters

Participants advise the PACE system is confusing, in particular for self-managed new participants. This is also true for clinicians and AT suppliers.
The new PACE system is not accessible to providers. They therefore have to “guess” the right line item by going through a series of payment rejections before they find the right one. This can result in the participant having further delays in receiving their AT. Where the participant is agency managed, it is “guess work” for suppliers to correctly enter the line item. For example, suppliers advised they have attempted to submit a service booking in order to work out if the participant is on the new system or not (get rejection – which flags they must be in new system and then have to move to the PACE system).
Providers need to know where the funding is available in order to invoice correctly. Recommendation 7: AT suppliers to be provided with information from PACE on approvals and coding to create efficiencies in administration and reduce delays in approvals for participants.