Joint Standing Committee Inquiry:
National Disability Insurance Scheme (NDIS) planning
Pre-Budget Submission 2019–20 | AOPA 1
Orthotics and Prosthetics in Australia
Orthotist/prosthetists assess the physical and functional limitations of people resulting from disease, illness, trauma and disability, including limb amputation, diabetes, arthritis and neuromuscular conditions, such as stroke. Orthotic and prosthetic services may involve the provision of orthoses and prostheses to restore function, prevent deterioration, and improve quality of life. Orthotist/prosthetists are commonly employed in Australian hospitals, private clinics, research institutions as well as rural and remote regions, working independently and as part of multidisciplinary healthcare teams to support the Australian community.
Orthotist/prosthetists are tertiary qualified allied health
professionals. An Australian Qualification Framework
level 7 is required to practice as an orthotist/prosthetist in Australia, consistent with education standards for other allied health professions. Orthotic/prosthetic students complete training alongside physiotherapy, podiatry and occupational therapy students.
The Australian Orthotic Prosthetic Association (AOPA) is
the peak professional body for orthotist/prosthetists in Australia, with certified practitioners comprising 80% of the practicing profession. AOPA is responsible for regulating the profession and is a founding member of
the National Alliance of Self Regulating Health
Professions (NASRHP) in partnership with other professional organisations, including Speech Pathology
Australia, the Australian Association of Social Workers
and Exercise and Sports Science Australia. AOPA is recognised by the Commonwealth Government as the assessing authority responsible for conducting migration skill assessments for orthotist/prosthetists.
Leigh Clarke
Chief Executive Officer
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Planning and Orthotic/Prosthetic services
The Australian Orthotic Prosthetic Association (AOPA) an ordinary life in accordance with their personal goals. welcomes the opportunity to contribute to the AOPA is committed to working closely with the National discussion on NDIS planning through the Joint Standing Disability Insurance Agency (NDIA) to ensure both Committee Inquiry into NDIS Planning. administrative costs are minimised, and choice and control is exercised by participants, allowing AOPA is the peak professional body for orthotist/prosthetists to provide optimal services whilst orthotist/prosthetists in Australia. Orthotist/prosthetists ensuring value for money. are tertiary qualified allied health professionals who assess the physical and functional limitations of people The planning process is an integral aspect of the NDIS arising from illness, limb-loss and disability. to support participants to exercise choice and control. Orthotic/prosthetic services typically include, but are Participants use many formal and informal supports not limited to, the assessment, prescription, design and when preparing for their planning meeting, including fitting of a wide range of orthoses and prostheses which information provided by their orthotist/prosthetist. The support an individual to achieve their functional and planning process is highly dependent on the knowledge participation goals. and capacity of participants and Planners to ensure the plan doesn’t omit important supports, incorrectly The NDIS has had, and will continue to have, a categorise supports or omit ongoing services and substantial impact on people who use consumables. Engagement with an orthotist/prosthetist orthotic/prosthetic services in Australia. Successful by the participant or Planner will assist the planning operation of the NDIS will allow people with disabilities process and limit the likelihood of these omissions to participate in the community, engage in work and live occurring.
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The experience, expertise and qualifications of
Planner
Participants and practitioners often communicate with purpose of approval, and the clinical service to assess Planners who demonstrate limited experience, expertise and collaborate with the participant in order to build the and qualifications specific to orthotic/prosthetic quote should be supported under support code services. This includes limited knowledge of 15_047_0135_1_3 – Selection And/Or Manufacture Of orthotic/prosthetic devices and services, a lack of Customised Or Wearable Technology. familiarity of registration and support catalogue Orthotist/prosthetists report that often there is no arrangements for orthotist/prosthetists, and a lack of allocation for the clinical assessment component in a comprehensive knowledge on the ongoing needs to plan, or funding for this service is incorrectly allocated effectively deliver orthotic and prosthetic services. to a different support code, such as the registration group number 0128 for Therapeutic Supports. Omission of primary support items, such as orthoses Orthotist/prosthetists are unable to claim for services and prostheses that they are not registered for. This results in the participant initiating a plan review. Planners often do not have the requisite experience relating to orthoses and prostheses and therefore these Omission of ongoing services and consumables supports are often overlooked during the planning process. AOPA certified practitioners report numerous The limited knowledge of orthotic/prosthetic devices instances of participants seeking a new and services by Planners results in plans missing vital orthosis/prosthesis once their plan is approved, but orthotic/prosthetic ongoing supports and services. For where an orthosis/prosthesis has not been included in example, where a Planner is unfamiliar with the the plan. It appears the orthosis/prosthesis is either longevity of consumable items, such as prosthetic liners, overlooked in the planning process or that assumptions sleeves or foot shells, then the Planner may not allow for are made regarding the longevity or appropriateness of these within the planning process. The omission of the participants current prosthesis. Greater ongoing supports and services results in a participant orthotic/prosthetic knowledge or prompts to initiate a experiencing extended delays whilst a plan review conversation with the participant and/or consult the occurs and continuing to use items that have perished participant’s orthotist/prosthetist are encouraged. and require replacement. In cases where vital supports and services are missing, participants will need to Incorrect categorisation of supports in the plan initiate a plan review and will experience a delay in service delivery. Many Planners are not aware that orthotist/prosthetists provide both clinical prescription and assistive Recommendations: technology and have different registration requirements to other allied health and assistive technology AOPA recommends that Planners receive education on
providers. Planners are often unfamiliar with registration orthoses and prostheses. Having Orthotic Prosthetic profession specific knowledge will allow Planners toand support catalogue arrangements for develop plans with appropriate supports and reduce the
orthotist/prosthetists, and therefore it is not uncommon need for plan reviews.
for a plan to be developed with allocation of AOPA recommends that Planners are consistent in theirorthotic/prosthetic related devices and services under application of the NDIS supports catalogue.
incorrect catalogue support codes. Prosthetic devices (excluding Low Cost AT) require a quote for the
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Participant involvement in planning processes and the efficacy of introducing draft plans
Participants are experts in understanding their own communication issues during the planning process. future needs in relation to daily living and life goals, Introducing draft plans will allow participants to reflect however they may require support to fully communicate on the planning conversation, provide additional their detailed orthotic and prosthetic needs. This evidence or information to support decision making or support can be provided by orthotist/prosthetists, to seek support both formal and informal to ensure all consumer advocates or through informal supports such their needs have been adequately communicated and as friends and family. It is our understanding that for captured. Introducing draft plans will increase a many participants the planning process is overwhelming participant’s choice and control over their plan. and the interpretation of clinical reports from providers can be difficult. Draft plans would decrease the Recommendation: likelihood of plans omitting orthoses/prostheses and ongoing services and supports crucial to their AOPA recommends that draft plans are systematically
orthosis/prosthesis, all of which result in internal plan used as a mechanism for participants to fully exercise their choice and control over their plan, and to ensure allreviews. their needs are adequately met by their plan.
The introduction of draft plans for participants with complex support needs would support the principles of choice and control and decrease the need for plan reviews associated with misinterpretation and
Pre-Budget Submission 2019–20 | AOPA 5
The review process and means to streamline it
Plans may be reviewed either because a participant Given the varying reasons for a plan review, there are experiences a change in their circumstances, or because opportunities to streamline the process and reduce the does not feel their initial plan was adequately addressed impact on participants. Processes to triage plan review their goals. Often, however plan reviews occur in requests based on change in circumstances, omissions relation to orthotic/prosthetic services due to the and/or inadequate funding allocations could streamline omission or orthotic/prosthetic devices and the the process and reduced plan review delays. associated ongoing supports and services from the initial paln. Plan reviews lead to significant delays in A plan review is required where a participant’s initial orthosis/prosthesis delivery, with the potential to impact plan is either missing an orthosis /prosthesis, supports a participant’s function and participation in daily life. or services are allocated incorrectly, or plans are missing ongoing services and supports crucial to a participant’s Plan reviews will always be necessary for participants orthosis/prosthesis. In these instances, whereby whom experience a significant change in their omissions and/or administrative errors have occurred, it circumstances, however a lengthy plan review process is unreasonable that participants should not have to has the potential to significantly impact a participant in endure a lengthy delay associated with the typical plan reaching their personal goals. If a plan is approved with review process. It is therefore AOPA’s position that the an amount of funding allocated towards review process must be streamlined and simplified for orthoses/prostheses but a participant’s circumstances these cases of planning error. change significantly requiring new orthoses/prostheses that exceed the allowance in the current plan, the Recommendations: participant must request a plan review. Currently the
lengthy plan review process is having substantial impact The NDIS should adopt a triage procedure to address
on participants who use orthoses/prosthesis, with many planning omissions and administrative errors and in a timely mannerplan reviews due to planning omissions in the first
instance.
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Recommendations
The Australian Orthotic Prosthetic Association has Recommendation two
identified several issues with current planning relating to orthotic/prosthetic services and impacting the delivery Addressing participant involvement in planning of timely services to participants. processes and the efficacy of introducing draft plans:
We provide recommendations for consideration to AOPA recommends that draft plans are systematically
assist with improving and streamlining the planning used as a mechanism for participants to fully exercise their choice and control over their plan, and to ensure allprocess. their needs are adequately met by their plan
Recommendation one Recommendation three
Addressing the experience, expertise and qualifications Addressing the current review process and means to of Planners: streamline it:
AOPA recommends that Planners receive education on The NDIS should adopt a triage procedure to address
orthoses and prostheses. Having Orthotic Prosthetic planning omissions and administrative errors and in a profession specific knowledge will allow Planners to timely manner develop plans with appropriate supports and reduce the nee d for plan reviews. AOPA recommends that Planners are consistent in their application of the NDIS supports catalogue.
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