Australian Government
Office of the National Rural
Health Commissioner
Joint Standing Committee on the National Disability
Insurance Scheme Inquiry
NDIS participant experience in rural, regional and remote Australia
March 2024
… healthy and sustainable rural, regional and remote communities .~,;.; ~~~-.,,.
National
Rural Health
Alliance
Postal Address: PO Box 280 Deakin West ACT 2600
Address: 10 Campion St Deakin ACT 2600
Phone: 02 6285 4660 Fax: 02 6285 4670 Email: nrha@ruralhealth.org.au
Front image © 2016 Gary Radler, used under license from Austockphoto
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Australian Government
Office of the National Rural
Health Commissioner
Postal Address: GPO Box 6532 Cairns QLD 4870
Address: 1 Pier Point Road Cairns QLD 4870
Phone: 07 3360 2889 Email: NRHC@health.gov.au Web: www.health.gov.au/nrhc
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Terms of Reference
As part of the committee’s role to inquire into the implementation, performance and governance of the National Disability Insurance Scheme (NDIS), the committee will inquire into and report on the NDIS participant experience in rural, regional and remote Australia, with particular reference to:
a. the experience of applicants and participants at all stages of the NDIS, including application, plan design and implementation, and plan reviews;
b. the availability, responsiveness, consistency, and effectiveness of the National Disability Insurance Agency in serving rural, regional and remote participants;
c. participants’ choice and control over NDIS services and supports including the availability, accessibility, cost and durability of those services;
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; and
e. any other related matters.
Recommendations
- That the recommendations of the 2023 NDIS Review be implemented by government in a timely manner, with a focus on:
a. improving the participant (and family/carer) experience throughout the NDIS journey b. the integration of the NDIS with other sectors – especially primary healthcare in rural and remote areas
c. the roll-out of alternative funding mechanisms in thin markets as soon as possible d. the consideration of mechanisms to recruit and retain the necessary workforce in rural and remote Australia
e. addressing the needs of Aboriginal and Torres Strait Islander peoples and those from culturally and linguistically diverse backgrounds, particularly with relation to accessible and culturally safe communication and engagement methods.
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That the NDIS’s Rural and Remote Strategy be updated to incorporate the findings of recent reviews and inquiries, with emphasis on the consumer experience.
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That the Ngayubah Gadan Consensus Statement be implemented to facilitate multidisciplinary ways of working across the health and disability sectors in rural and remote Australia:
a. Collaborative work across the National Disability Insurance Agency (NDIA), health and aged care sectors should look at how best to improve the workforce available in rural and remote areas, especially allied health professionals. This requires joint service planning, common goals and locally appropriate solutions.
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b. Consideration should be given to how to ensure NDIS services and support are provided to participants in an integrated way with other members of their multidisciplinary care and support team, especially healthcare professionals such as GPs and allied health professionals.
- That a concerted effort be made to increase understanding of the NDIS in regional, rural and remote communities around the country, to ensure eligible people can access the scheme and obtain the services and supports they need.
Introduction
This submission is a collaboration between the National Rural Health Alliance (the Alliance) and the Office of the National Rural Health Commissioner. We jointly welcome the opportunity to make a submission to this inquiry with a specific focus on the experience of rural, regional and remote people with the National Disability Insurance Scheme.
The Alliance represents 51 member organisations encompassing healthcare professionals, health and wellbeing service and educational providers, researchers, the Aboriginal and Torres Strait Islander health sector and consumers located in rural, regional and remote Australia. The Alliance is committed to improving the health and wellbeing of the 30 per cent of the population (seven million people) living in rural communities. The Alliance would like to acknowledge the input provided to this submission by rural consumers and health professionals as members of the Friends of the Alliance.
The National Rural Health Commissioner is an independent, statutory office holder, appointed under Part VA of the Health Insurance Act 1973 (the Act). The Office of the National Rural Health Commissioner (ONRHC) works with regional, rural and remote (hereafter rural) communities, the health sector, universities, specialist training colleges and across all levels of government, to improve rural health policies and ensure a strong focus on the needs of rural communities. In accordance with the Act, the functions of the Commissioner are to provide independent and objective advice in relation to rural heath to the Minister responsible for rural health. The ONHRC would like to acknowledge the dialogue of the National Rural Health Commissioner’s Consumer Advisory Group, which has supported this submission. The ONRHC welcomes the opportunity to join with the Alliance in providing input to the NDIS inquiry. The needs of rural Australian’s who utilse these services must be met in an equivalent way to that experienced in metropolitan Australia.
Epidemiology and demographics
At the population level, people residing in rural Australia have poorer health than their metropolitan counterparts. They experience a higher prevalence of numerous health risk factors, rate more poorly against the social determinants of health, and have reduced access to health, disability and aged care services.1 Consequently, rural people experience a greater burden of disease, higher rates of morbidity and mortality, and have a lower life expectancy.1
Prevalence of disability increases with age. There are varying degrees of disability. Even after adjusting for age and degree of disability, there are higher rates of disability outside of major cities. Of people living with disability aged 0 to 64 years (the target age-range for the NDIS), 16.8 per cent
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live in inner regional areas and 12.9 per cent live in outer regional and remote areas, compared to 10.4 per cent in major cities.2
Sixty per cent of Aboriginal and Torres Strait Islander people live in rural Australia. In all geographic areas, the rates of people living with disability are higher for Aboriginal and Torres Strait Islander people, with the highest rate in inner regional areas.3
a. The experience of applicants and participants at all stages of the NDIS, including application, plan design and implementation, and plan reviews;
The introduction of the NDIS was a significant policy reform and is highly valued by participants, their families and carers for the support it provides them and the impact it makes on their quality of life, participation in society and ability to gain independence. While we do not seek to minimise the benefits, it is clear from research evidence and the reports of consumers and health professionals/providers within the NDIS system, that there are several recurring problems for all NDIS participants and some particular issues experienced by rural participants.
Awareness and understanding of the scheme in rural Australia
Difficulties understanding the NDIS, the processes involved and the support available (in general and specifically, locally) have been reported in the research regarding the experiences of rural people.4 This is coupled with a lack of awareness about how to find additional information and whom to contact, indeed understanding of the rural context. Studies call out difficulties with the accessibility of information regarding the NDIS for people living with disability, and additionally for those from a culturally diverse background in navigating the website (which they were commonly referred to). In an evaluation published in late 2023, a lack of understanding of available supports by participants was recognised as a barrier to engagement in the scheme in thin markets.5
Concerns have also been raised about the degree of inclusion of the person living with disability in the planning process, in part due to inadequate modification of communication strategies to meet their needs, indeed understanding the rural context.4 Aboriginal and Torres Strait Islander people living in rural Australia are at particular risk of communication difficulties.
The well-known difficulty with access to reliable internet connectivity in rural Australia is an ongoing challenge that is likely to reduce the interaction of consumers with NDIA resources and information.
Interaction with the NDIA
It has been reported that some NDIA staff who interact with consumers lack an understanding of the challenges experienced by people living in rural, remote or regional areas.4,6 This includes a “lack of understanding of the geographical distances between remote/rural/regional communities” and the resultant need for costly travel4,p644, as well as the fact that there isn’t the breadth of services available in these areas. Concerns have also been raised about their understanding of disability and the needs of people living with disability.4,6 This has resulted in specific requests for support being declined, despite the presence of reports from the appropriate health professionals.
In addition, the underutilisation of funding is often seen as the service not being needed. In reality, finding a service, the waiting lists, the inflexibility of guidelines to enable utilisation of another service which would assist (but does not meet the guidelines), and/or the tyranny of distance, are the real reasons the funding is under-utilised.
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Consumers have also reported being “placed under the umbrella of a particular disability”, when many have multiple, “thus taking away from being seen as ‘whole’”.6,p655 These deficiencies result in a lengthening of administrative processes, require significant self-advocacy, and contribute to the collective emotional burden of bureaucratic processes.
NDIA staff have been reported as being overworked and time-poor, reducing their ability to communicate with consumers in a clear, efficient, timely and empathetic manner.4,6 It is clear that standards and training requirements for these staff need to be adjusted to ensure their skills and understanding of rural situations are fit for purpose to improve the experience of consumers in all interactions with NDIS staff.
Consumers and health professionals report battling bureaucracy as a recurring theme in their interactions with the NDIA. Challenges relate to the accessibility of written information provided to consumers; timeliness, clarity and patient-centredness of communication; complex, lengthy, fragmented and inefficient processes during application, planning and for appeals via the Administrative Appeals Tribunal; and include “delays in the provision of equipment, difficulties with reports and forms, or not having consistency in who they needed to contact to address issues”.6,p.653
An advocate for a consumer in rural New South Wales highlighted the difficulty in obtaining a change to a NDIS plan after its initial approval, due to NDIA processes:
“Rolling over plans is of a lesser administrative burden for the NDIS, however if even a minor change is sought by the client a full plan review is triggered . . . and may result in unfavourable changes to the plan. Therefore, you need to consider the risk of requesting a plan review as you could lose budget for items you require.”
These bureaucratic hurdles generate significant emotional burden4,6 for consumers and their families/carers and require substantial skills in self-advocacy.6 Consumers report feeling “disempowered and fearful about the uncertain nature of the planning process and inconsistencies in plan outcomes”6,p.653, as well as exhaustion and frustration at having to keep following up with the NDIS.6 The need to educate NDIA staff involved in planning is reported as stressful and emotionally draining.6 The planning process has been described as emotionally traumatic, due to the need to prove the existence of a lifelong disability that will not improve and the paradox of having to provide evidence of support needs yet being encouraged to engage in a strengths-based approach, which might result in a reduction in the amount of funding received.4 Carers report being overwhelmed by the difficulties of managing the demands of their household while concurrently navigating the NDIS planning process and the travel involved for rural consumers.4
While some consumers and their families/carers have the resources and skills to work around the bureaucratic hurdles, for example by choosing to self-manage their plans,6 those experiencing higher levels of social disadvantage and without these resources are most likely to be adversely affected.
Research suggests that rural Aboriginal and Torres Strait Islander communities have difficulty understanding the NDIS and that there is a reluctance to access its services and support due to historical distrust of government.4 A provider from rural NSW reported an Aboriginal and/or Torres Strait Islander client was “very reluctant to have application filled. Unable to self-enrol . . . big distrust of government . . . constant fear of questioning to enable processing of application”. But this provider was positive about the targeted appointment of an Indigenous worker who the client had a good relationship with and though the application process took 18 months to complete, they report “this would never have been achieved . . . without personal relationship with local org worker.” We note the assertion by the NDIA that they employed 173 Remote Community Connectors as at March 20217 and hope these staff are fulfilling this role across the 274 rural and remote communities they are reported to cover. The absence of any evaluative information specifically relating to these roles makes it difficult to draw clear conclusions.
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A scoping review of NDIS planning experiences in rural Australia found that the presence of liaison people within Aboriginal and Torres Strait Islander communities was needed to link needs to supports and enable appropriate service delivery.4 These authors also identified training as essential to cultural safety of the service system.
The need for culturally safe processes is important for all Aboriginal and Torres Strait Islander peoples, but especially so for people living in remote or very remote communities where English may be a second language. The following quote from a GP who has worked in an Aboriginal community-controlled health organisation in the Northern Territory (NT) illustrates some of the challenges posed by having an English-language based system for these people:
“The patients that require the NDIS rarely have literacy skills, they cannot fill out any of the paperwork required and therefore I as their clinician will do this. It is then often difficult for the clients to be contacted as they don’t have emails and often no phones so with their permission will put down my details so we can see what happens with the application.”
Given the aforementioned experiences, we are pleased to see recognition of the need to “ensure the NDIS experience is centred around the whole person and their disability-related support needs”8, within the 2023 NDIS Review.
Quality of care and support
Information from health professionals on-the-ground in rural Australia calls out what they see as the “complete lack of coordination of care” within the NDIS for rural and particularly remote/very remote consumers. They highlighted to us the challenges in communicating with the NDIA as part of the application process and the difficulties obtaining information pertinent to holistic primary healthcare from service providers, including allied health professionals. A GP from a remote community in the NT reports having:
“No idea if a patient is on the NDIS or not . . . ” and getting “. . . no information from NDIS about a patient being linked into the system, no information about what type of services they receive and in general no feedback from the providers about the service they are providing including allied health. This makes it very difficult at times to know what a patient is receiving, if they are getting what they need and the progress they are making in regards to allied health”.
The same GP also reported that:
“As a GP in the community I often identify needs that the patients require or are struggling with and so it is integral that I can contact NDIS providers to help get these into place.”
These comments relate to a client population who are at high-risk of poor outcomes, who often cannot navigate the system or advocate for themselves and therefore require the health service to facilitate this. Without engagement from the NDIA and service providers, these clients are put at additional risk.
Differentiation was made between local service providers with a presence in rural communities and those located at a significant distance providing infrequent, visiting services. Communication with local services was much better. Communication with visiting providers was improved only due to professional relationships with providers developed over time.
This feedback highlights the benefits of local service provision regarding high quality care which is coordinated and integrated. Visiting services must forge relationships with local health services to provide adequate holistic care, not ‘cherry-pick’ the easiest service delivery without making a commitment to the local community and its development of sustainable services.
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Specific focus – the experiences of children
While it was noted by grass-roots health professionals that some paediatric clients are getting what they need from the NDIS, they noted that these clients are usually children whose “parents are excellent advocates and have good contact with their provider”.
As will be elaborated in TOR c. below, rural children are often impacted by the lack of allied health workforce available and resultant long waiting times to get the assistance they need within schools. Contributing factors include the siloing effect in rural communities between health and education; pay disparities for allied health workforce between state and national health and education departments, the NDIS and private employers; and the red tape involved in obtaining additional assessments for verification of developmental conditions upon starting school, when they had already been performed in the early years.
While the 2023 NDIS Review recognises, under recommendation 2, the need to improve the integration between the NDIS and other services accessed by people with disability9, we are concerned that this does not specifically call out primary healthcare, given the important interface of this sector with many others and its central role in rural and remote communities where hospital services are limited. Creating a system where NDIS providers connect with a multidisciplinary team that traverses the disability and health sectors is key to improving the participant experience and related outcomes and is particularly important in rural and remote areas. Such sustainable rural and remote multidisciplinary health teams are also key to the recruitment and retention of the high quality, culturally safe workforce required to serve these regions, as championed in the Ngayubah Gadan Consensus Statement released by the Office of the National Rural Health Commissioner in mid 2023.10
b. The availability, responsiveness, consistency, and effectiveness of the National Disability Insurance Agency in serving rural, regional and remote participants;
Please see TOR a. above – specifically “interaction with the NDIS” for an exploration of this issue.
c. Participants’ choice and control over NDIS services and supports including the availability, accessibility, cost and durability of those services;
Availability and accessibility of services
A core issue for rural consumers of the NDIS is difficulty accessing the services and support they are funded for under their plans, due to the lack of availability close to home and requirement for considerable travel.
Despite an increased need for disability care and support outside of metropolitan areas in Australia (increased prevalence of NDIS participants), there are lower numbers of providers per participant in rural areas, with 80 per cent of the NDIS’ thinnest markets located in rural Australia.11 This indicates that thin markets are a significantly greater issues in rural areas, compared to metropolitan areas.
Thin markets result in a reduction in access to care and also in the choice of providers. A reduction in access to care is illustrated by data on utilisation of plan funding, which declines with remoteness
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and is more pronounced for non-supported independent living (non-SIL) participants. Non-SIL participants in remote (MM7) areas utilise only 35 per cent of their allocated plan value, on average, compared with 62 per cent for non-SIL participants in metropolitan areas (MM1). Non-SIL supports include the services of allied health professionals.12
There is broad recognition that thin markets in the disability sector require targeted approaches by government.13 We note work undertaken by the NDIA recently to address market challenges, including the evaluation of thin market trials, and the publication of an evaluation of these trials.14 The findings suggest that coordinated funding proposals (CFP) and direct commissioning might be useful to address access to assessments and ongoing services and support in thin markets, with CFP suggested as the first option of choice. Market facilitation activities are recommended at both the macro and local levels as part of business-as-usual, rather than being limited to thin markets, and should occur in a strategic and coordinated way. We look forward to seeing how these alternate models of funding might be rolled out permanently to support participants in rural areas, as rural populations are very concerned about the ongoing trials and pilots which result in distrust of government commitment and less willingness to utilise services.
Market challenges are closely related to the lack of necessary workforce with increasing geographic remoteness. There is a shortage of disability support workers across Australia and inflexibility in whom one can employ in rural Australia, that affects access to and use of the NDIS across geographic areas.15 Limited supply of health workers in rural areas, such as allied health professionals, also has an impact on access to and use of the NDIS. This has resulted in a government underspend on services in rural areas, when in reality more spending is needed than in urban populations.
The supply of allied health professionals available to provide disability care and support (and health and aged care services) in rural Australia is limited. For example, numbers of dieticians, audiologists, speech pathologists and social workers are lower in remote and very remote areas.16 The prevalence of most other allied health professionals (including occupational therapists, psychologists, physiotherapists, podiatrists) generally reduces with remoteness, with the lowest numbers in either MM5 or MM7.1 This is illustrated in Table 1 below.
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Table 1.i
Not only does a lack of access to providers reduce the ability of participants to utilise their plan funding, but thin markets and limited local provider options and capacity mean that even when services and support are available close to home, there is limited choice for participants.
Long travel distances to receive services and support generate additional costs, both financial and social/emotional, for rural NDIS participants. The lack of availability of appropriate, accessible transport options is likely to reduce the ability of participants to travel to receive services.
Lack of workforce and the resultant poor or non-existent access to services and support can, at worst, force participants to leave a region, “which creates isolation and places a greater burden on those localities that do have places.”13,p49. It can also result in Aboriginal and Torres Strait Islander participants leaving country for less culturally safe locations. A contributor to the Australian government’s State of Australia’s Regions 2024 report noted that “if kept closer to family, support can be provided by family members, thereby reducing the level of external support required”.13,p49.
Services required as part of the application and planning process
Consumers from rural Australia experience specific challenges when it comes to accessing the health professional services required to support their applications or as evidence for a funding request. Considerable travel is often required and the services are not reimbursed under the scheme or if it is, the funding is well below what is needed.
A GP from a remote community in the NT reports facing considerable difficulty getting access to the NDIS for clients with intellectual disability which was clear and diagnosable to her as a clinician but had not been formally assessed (and with little chance that it would ever be formally assessed).
“GP assessment is not deemed as ‘enough’. . . there is no service that I can send a patient to, to have an assessment for intellectual disability at all in the NT public system. . . getting a private assessment for these patients would cost thousands of dollars which the patient can’t afford.”
i Figures are represented as full time equivalent (FTE) of workforce per 100,000 population.
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These consumers are left without the services they are in dire need of and would have access to if they lived in a less remote area.
Similar challenges are faced by children when they move from the early-years to the school-aged system and have to obtain verification of their conditions for a second time, against a different set of assessment criteria, with the medical, NDIS and education systems being disconnected.
We appreciate the recognition of some of these issues in the 2023 NDIS Review, which notes the need for a reassessment of the participant journey through the NDIS, including a return of eligibility to being functional impairment based rather than requiring medical diagnoses.8
Cost
As discussed above, applicants are often faced with considerable additional financial costs as part of the application process and delivery of care purely due to their postcode, and these are not reimbursed.
Rural people are also faced with costs related to travel to access services and support. Research suggests that many plans do not factor in sufficient funding to cover the travel required during the planning process, often due to the lack of awareness of NDIA staff involved in the process.4
Summary
While the 2023 NDIS Review recognises, under Recommendation 13 and 14, the important need to recognise thin markets and intervene to improve access to support and services in these markets, stating in 14.1 that: The National Disability Insurance Agency, in partnership with First Nations representatives, communities, participants and relevant government agencies should progressively roll-out alternative commissioning arrangements for both First Nations communities and remote communities, starting as soon as possible.9,p12.
the Alliance and ONRHC reiterate the overlap in workforce required to deliver NDIS support and services - particularly allied health services – between the disability and health sectors, and the importance of addressing barriers to the recruitment and retention of this workforce broadly and strategically. Hence, we repeat our reference to the need for sustainable rural and remote multidisciplinary health teams, as called for in the Ngayubah Gadan Consensus Statement.10
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; and
Please refer to the section on Aboriginal and Torres Strait Islander communities and quality of care under TOR a. above.
Due to the remote nature and socioeconomic challenges experienced in many Aboriginal and Torres Strait Islander communities, the issues of availability and accessibility, along with cost, as discussed in TOR c. above, are also very pertinent.
Additionally, feedback from health professionals on-the-ground suggests that it can be difficult to engage NDIS providers regarding the specific challenges experienced in remote/very remote Aboriginal and Torres Strait Islander communities to make allowances for these issues, which do not
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eventuate in metropolitan areas due to the proliferation of service providers. An example is the provision of medication support to people with mental illness (and those on the Autism spectrum) living in remote communities who cannot manage their medications independently due to intellectual impairment and who do not have family support. The health service cannot provide daily medication support to remote clients, hence the consumer needs the assistance of an NDIS provider. When these medications are not attended to, these consumers are placed at increased risk for various other health conditions.
The need for disability services that are tailored to the specific requirements of culturally and linguistically diverse (CALD) people and groups, including the provision of resources and care in the appropriate language, is well recognised. As absolute numbers of people from a CALD background are smaller outside of major cities, provision of specialised services is less likely, with a concomitant impact on the accessibility of disability support and services and a participant’s experience of the NDIS journey.
We note the presence of a Cultural and Linguistic Diversity Strategy to guide the NDIS, along with a Rural and Remote Strategy but both of these are now out of date and due for renewal. We hope the outcomes of this inquiry will feed into the development of updated strategic guidance within the NDIS.
e. Any other related matters. Influence of NDIS on cost for services outside of the scheme
Elevated costs for services provided outside of the scheme, in line with the NDIS pricing guide, have had a detrimental impact on affordability outside of the scheme, particularly for private allied health services. This is felt acutely in rural areas due to the lower socio-economic status on average and the acute shortage of service providers, especially allied health professionals.
A parent of a child from a regional area with a developmental condition (not on the NDIS), reported to us that:
“It is very difficult to access educational psychologists, social workers, allied health professionals (such as speech and OT) etc. This is for two reasons. One, the demand for their services is so high that there is a shortage of practitioners. Two, most now charge ‘NDIS rate’ regardless of whether their client is an NDIS recipient. This makes it prohibitively expensive for many families. For those who can afford to pay, often the practitioner’s books are closed or it is a very long wait”.
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References
1 National Rural Health Alliance. Rural health in Australia Snapshot 2023. 2023 Dec [cited 2024 Feb 29]. https://www.ruralhealth.org.au/rural-health-australia-snapshot
2 Australian Bureau of Statistics. Disability, ageing and carers, Australia: summary of findings [data download]. 2019 Oct 24 [cited 2022 Sep 16]. https://www.abs.gov.au/statistics/health/disability/disability-ageing-and-carers-australia-summary findings/latest-release
3 Australian Bureau of Statistics. Aboriginal and Torres Strait Islander people with disability [data download]. 2021 Jun 11 [cited 2022 Sep 16]. https://www.abs.gov.au/articles/aboriginal-and-torres-strait-islander-people-disability
4 Veli-Gold S, Gilroy J and Wright W et al. The experiences of people with disability and their families/carers navigating the NDIS planning process in regional, rural and remote regions of Australia: Scoping review. Australian Journal of Rural Health. 2023;31:631-647. DOI:10.1111/ajr.13011
5 National Disability Insurance Scheme. Report: thin market trials final evaluation.2023 Aug [cited 2024 Mar 8]. https://www.ndis.gov.au/about-us/research-and-evaluation/market-stewardship-and-employment/evaluation-ndia thin-market-trials
6 Wakely L, Green E and Little A et al. The lived experience of receiving services as a National Disability Insurance Scheme participant in a rural area: Challenges of choice and control. Australian Journal of Rural Health. 2023;31:648-658. DOI:10.1111/ajr.13000
7 National Disability Insurance Agency. Rural and remote strategy [web page]. 2021 Jul 30 [cited 2024 Mar 8]. https://www.ndis.gov.au/about-us/strategies/rural-and-remote-strategy
8 Department of Prime Minister and Cabinet. NDIS Review - Working together to deliver the NDIS: NDIS Review at a Glance. Commonwealth of Australia: Canberra. 2023 [cited 2024 Mar 8]. https://www.ndisreview.gov.au/resources/reports/working-together-deliver-ndis
9 Department of Prime Minister and Cabinet. Working together to deliver the NDIS - Independent Review into the National Disability Insurance Scheme: Final Report. Commonwealth of Australia: Canberra. 2023 [cited 2024 Mar 8]. https://www.ndisreview.gov.au/resources/reports/working-together-deliver-ndis
10 Office of the National Rural Health Commissioner. Ngayubah Gadan Consensus Statement – Rural and Remote
Multidisciplinary Health Teams. Commonwealth of Australia: Cairns. 2023 [cited 2024 Mar 8]. https://www.health.gov.au/resources/publications/the-ngayubah-gadan-consensus-statement-rural-and-remote multidisciplinary-health-teams?language=en
11 National Disability Insurance Agency. Market monitoring. 2022 Mar 29 [cited 2022 Apr 07]. https://data.ndis.gov.au/reports-and-analyses/market-monitoring
12 National Disability Insurance Agency. Participants across remoteness classifications (report). 2020 Jun 30 [cited 2022 Mar 9]. https://www.ndis.gov.au/news/5344-ndis-releases-latest-public-data
13 Department of Infrastructure, Transport, Regional Development, Communications and the Arts. State of Australia’s regions 2024. Australian Government: Canberra. 2024 Feb [cited 2024 Mar 8]. https://www.infrastructure.gov.au/territories-regions-cities/regional-australia/state-australias-regions-report
14 National Disability Insurance Agency. Report: Thin Market Trials Final Evaluation. 2023 Aug [cited 2024 Feb 29]. https://www.ndis.gov.au/about-us/research-and-evaluation/market-stewardship-and-employment/evaluation-ndia thin-market-trials
15 National Rural Health Alliance. Disability and access to the NDIS in rural Australia [fact sheet]. 2023 Feb [cited 2024 Feb 29]. https://www.ruralhealth.org.au/factsheets/thumbs
16 National Rural Health Alliance. Allied health workforce in rural, regional and remote Australia [fact sheet]. 2019 Jul [cited 2022 Mar 11]. https://www.ruralhealth.org.au/factsheets/thumbs
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