EXERCISE & SPORTS SCIENCE AUSTRALIA
Submission to the Joint Standing Committee
on the National Disability Insurance Scheme
Inquiry into the NDIS Quality and Safeguards Commission
July 2020
1
1.0 About Exercise & Sports Science Australia
Exercise & Sports Science Australia (ESSA) is the peak professional association for exercise and sports professionals
in Australia, representing over 8,000 members, including university qualified Accredited Exercise Physiologists
(AEP), Accredited Sports Scientists (ASpS), Accredited High Performance Managers (AHPM) and Accredited Exercise
Scientists (AES).
1.1 AEPs and the National Disability Insurance Scheme
AEPs are university qualified allied health professionals who provide clinical exercise interventions aimed at
primary and secondary prevention; managing sub-acute and chronic disease or injury; and assist in restoring
optimal physical function, health and wellness. Clinical exercise interventions, as delivered by AEPs, provide a
range of physical, mental and psychosocial benefits to people with a disability. AEPs develop a range of exercise
based activities that empower NDIS participants and support them to achieve goals in the areas of daily living,
social inclusion and functional well-being.
AEPs can currently register under the ‘Exercise Physiology and Personal Well Being Activities’ and “Therapeutic
Supports” registration groups and deliver supports in both the ‘Improved Health and Wellbeing’ and ‘Improved
Daily Living’ categories of participant plans. The COAG Disability Reform Council’s Quarterly Reporti revealed that
as of June 2019, 2,557 approved providers are registered under the Exercise Physiology and Personal Well Being
Activities’ registration group.
1.2 AESs and the National Disability Insurance Scheme
AESs are university qualified professionals with high level training in exercise and sports science. AES apply the
science of exercise to design and deliver physical activity and exercise-based interventions to improve health,
fitness, well-being, performance and assist in the prevention of injury and chronic conditions. AES can register as
personal trainers in the ‘Exercise Physiology and Personal Well Being Activities’ registration group. AES are also
often engaged in the NDIS as therapy assistants, delivering exercise-based interventions that have been prescribed
by a health professional qualified in clinical exercise prescription. Some NDIS providers engage AESs to support
people with disability to engage in community sports and recreation opportunities under social & community
participation funding categories.
2
2.0 Summary of Recommendations
Recommendation 1: Data on the number of Agency managed participants per local area to be made publicly
available to NDIS providers to help inform business planning.
Recommendation 2: The NDIA and NDIS Quality and Safeguards Commission to work collaboratively to develop a
range of clear and accessible resources to support new entrants into the NDIS market.
Recommendation 3: The NDIS Quality and Safeguards Commission to promote established provider resources
such as the AHPA Allied Health NDIS registration website.
Recommendation 4: The NDIS Quality and Safeguards Commission to provide more detailed information to
support providers in selecting an approved quality auditor.
Recommendation 5: The NDIS Quality and Safeguards Commission work closely with stakeholder such as the
Aged Care Quality and Safety Commission and the Australian Safety and Quality Health Care Commission to
ensure a streamlining of quality standards and the introduction of mutual recognition across relevant schemes.
Recommendation 6: The NDIS Quality and Safeguards Commission develop an operation framework for plan
management to ensure minimum standards are upheld.
Recommendation 7: The NDIS Quality and Safeguards Commission to introduce quality measures to mitigate risk
associated with the delegation of therapy supports to unqualified support workers.
3
3.0 ESSA’s Submission to the Inquiry into the NDIS Quality and Safeguards Commission.
ESSA welcomes the opportunity to provide feedback to the Inquiry into the NDIS Quality and Safeguards
Commission.
ESSA’s submission is based on feedback from Accredited Exercise Physiologists and Accredited Exercise Scientists
delivering services under the NDIS, and provides responses to the following terms of reference:
- The adequacy and effectiveness of provider registration and worker screening arrangements, including the level of transparency and public access to information regarding the decisions and actions taken by
the Commission.
- Any related matters. 4.0 Response to Terms of Reference
4.1 The adequacy and effectiveness of provider registration and worker screening arrangements, including the level of transparency and public access to information regarding the decisions and actions taken by the Commission.
ESSA response to this term of reference focuses on the challenges experienced by AEPs that have engaged in the provider registration process.
Many of the allied health professionals delivering NDIS supports are sole providers who operate a small business.
This is evidenced in the COAG Disability Reform Council’s Quarterly Reportii which reveals that the Therapy
Registration group had 3,928 sole traders as of December 2019. This figure equates to 49% of all therapy
providers, a percentage that is significantly higher than other NDIS registration groups. The Early Intervention and
Supports for Early Childhood registration group, which primarily engages allied health professionals, reveals
similar figures with 1,106 (42%) registered providers listed as sole tradersii. ESSA notes that sole traders represent
27% of registered providers within the Exercise Physiology and Physical Wellbeing Activities registration groupii.
However, figures from this registration group includes data on Personal Training which is not considered an allied
health profession.
ESSA members report that NDIS registration can be a costly and onerous process particularly for small businesses.
The Council of Small Business Organisations Australia (COSBA) advise:
4
The structure of small business is one characterised by lean management structures where most (if not all)
of the people employed in the business are dedicated to revenue generating activities. Within this context,
the accommodation of regulatory compliance and reporting cannot be easily accommodated in the
business without increasing direct costs (in the form of procurement of external service providers) or
creating an opportunity cost (through the diversion of staff from revenue generating activities to
compliance and reporting activities)iii.
COSBOA’s advice reflects the experiences of ESSA members undertaking NDIS registration, with AEP small
businesses indicating they have spent up to 60 hours researching and preparing for verification audits for NDIS
registration. The cost associated with dedicating this amount of time to audit preparation, in addition to the
expense of engaging an auditor (around $1000 for a verification audit), is significant given accredited exercise
physiologists can earn up to $166.99 an hour as an unregistered NDIS provider (60hours x $166.99/hour=
$10,019). It is difficult for many small businesses to justify this type of expense particularly when their business
services a very small number of NDIA managed participants.
Many providers seek access to data on the number of Agency managed participants in their local area to help
inform business planning and their decision to register with the NDIS. This type of detailed information is not
readily available to providers. Ideally this type of information would be presented in a demand map, similar to the
map developed by the Department of Social Services, and made available on the NDIS Quality and Safeguards
Commission and NDIA websites.
Broad figures from the COAG Disability Reform Council’s Quarterly Reports indicate that the number of Agency
managed participants decreased from 43% in June 2019i to 35% in December 2019ii. There appears to be no
publicly available data on the 2020 figures, but ESSA suggests that that if the number of Agency managed
participants continue to decrease, so will the number of registered providers.
ESSA acknowledges that the cost of NDIS registration was alleviated somewhat when Minister Stuart Robert
announced changes to the NDIS Provider Registration Rules in December 2019. This legislative change resulted in
a decrease in the number of high cost certification audits amongst many allied health professionals including
AEPs. However, it must be noted that it is not unusual for a small AEP or allied health practices to be the only
practice servicing a large rural and remote communities covering large geographical areas. In many
circumstances, these practices may be the only local service that has the potential to provide therapy under the
5
higher risk registration group of Early Intervention supports for Early Childhood (EIEC) but may be reluctant to
take on this role given high cost associated with registration in the EIEC registration group.
AEPs located in rural and remote communities have reported quotes between $6000 and $16,000 for auditing
fees, with many suggesting these costs are not financially viable given the small number of NDIS participants they
service. AEPs have noted costs associated with auditor travel and accommodation have a significant impact on
the price of audits conducted in rural and remote locations. In response to this concern, many AEPs have reported
they are considering not registering as a provider or de-registering and only providing services to plan managed
and self-managed NDIS participants. The flow on effect of this is a reduced therapy market for Agency managed
participants to access.
ESSA regularly hears from AEPs who did not plan to engage with the NDIS but have been approached by an NDIS
participant requesting exercise physiology supports. In these circumstances, the AEPs have generally searched the
NDIA website for information on the necessary regulatory requirements. Many do not realise that they should
also be referring to the NDIS Quality and Safeguards Commission website. Often AEPs contact ESSA seeking clarity
on these types of topics after finding the information on the NDIA and NDIS Quality and Safeguards Commission
website unclear and difficult to navigate. ESSA suggest this issue could easily be addressed if the NDIA and NDIS
Quality and Safeguards Commission worked collaboratively to develop a range of clear and accessible resources
to support new entrants into the NDIS market.
With regards to NDIS registration process, AEPs have called for access to sample documents such as service
agreements and complaints processes to help inform the development of their own policies and procedures. ESSA
notes that Allied Health Professions Australia were funded to develop an Allied Health NDIS Registration website.
The AHPA website provides detailed guidance on the registration process and includes access to several
informative webinars and sample policy and procedure templates. ESSA has promoted this resource amongst
members via various communication channels but suggests that the NDIS Quality and Safeguards Commission
should also provide access to these types of useful resources on their website.
ESSA members have also suggested that it would be useful if the NDIS Quality and Safeguards Commission’s
website could provide more detailed information to support providers in selecting an approved quality auditor.
ESSA members have reported that the process of selecting an auditor is a time-consuming exercise that could be
simplified if auditors maintained transparent publicly available information on their fees (i.e. baseline cost for
6
verification and certification audits, fees for extras such as auditor travel and accommodation). ESSA suggests
that this type of information could be presented in a similar way to how provider home care package fees can be
compared on My Aged Care.
Finally, ESSA notes that many allied health providers, including AEPs, deliver supports under multiple
compensable schemes/sectors including the Medicare Benefits Schedule, Department of Veterans Affairs,
workers’ compensation schemes, private health insurance, aged care and the NDIS. Each of these
schemes/sectors set regulatory and compliance requirements for providers. For small business the regulatory
burden associated with maintaining compliance across multiple, yet varying schemes can be both overwhelming
and costly.
ESSA recommends that the NDIS Quality and Safeguards Commission work closely with stakeholder such as the
Aged Care Quality and Safety Commission and the Australian Safety and Quality Health Care Commission to
ensure a streamlining of quality standards and introduce mutual recognition across relevant schemes.
Recommendation 1: Data on the number of Agency managed participants per local area to be made publicly
available to NDIS providers to help inform business planning.
Recommendation 2: The NDIA and NDIS Quality and Safeguards Commission to work collaboratively to develop a
range of clear and accessible resources to support new entrants into the NDIS market.
Recommendation 3: The NDIS Quality and Safeguards Commission to promote established provider resources
such as the AHPA Allied Health NDIS registration website.
Recommendation 4: The NDIS Quality and Safeguards Commission to provide more detailed information to
support providers in selecting an approved quality auditor.
Recommendation 5: The NDIS Quality and Safeguards Commission work closely with stakeholder such as the
Aged Care Quality and Safety Commission and the Australian Safety and Quality Health Care Commission to
ensure a streamlining of quality standards and the introduction of mutual recognition across relevant schemes
7
4.2 Any other matters
- Plan Management ESSA has concerns about the impact plan management is having on the financial viability of therapeutic supports
such as exercise physiology. ESSA members have reported that it has become increasingly difficult to recover
costs from plan managed participants. Plan managers frequently report that participants do not have the funds
required for the payment of invoices. These circumstances arise even in cases where therapists have contacted
the plan managers and checked the availability of funds prior to delivering supports. ESSA members report that
they have contacted the NDIA when costs could not be recovered via plan management. The NDIA advised that
the plan managers were not at fault and the participants would need to be taken to a debt collector.
One ESSA member, a small business owner who refused to send their client to a debt collector, wrote off $5000 in
losses in December 2019. This member noted that it did not seem ethical to send a person with a disability to a
debt collector, when they had engaged a financial administrator to manage their plan funds because they did not
have the capacity to do this for themselves. ESSA considers these practices to be both unethical and a significant
risk to the financial viability of the NDIS therapy market. ESSA recommends the development of an operation
framework for plan management to ensure minimum standards are upheld.
Recommendation 6: The NDIS Quality and Safeguards Commission develop an operation framework for plan
management to ensure minimum standards are upheld.
- Allied health delegation to disability support workers. ESSA has concerns about NDIS cost cutting measures that occur at both the planning and review stages. In
particular, ESSA is concerned about the growing trend in NDIA planners pushing the use of unqualified support
workers for the delivery of therapy. AEPs have flagged several concerns associated with this practice including
- Organisations employing support workers can be reluctant to allow their employees to engage in the delivery of therapy supports, acknowledging that assistance with therapy may not be within their scope of
practice or their job description.
8
-
Some participants receive supports from more than one therapist which increases the amount of therapy that is expected to be delivered by unqualified support workers (refer to Case Study A)
-
Participants do not always receive the same support worker day to day or week to week, making it difficult to train a consistent team off support workers to deliver safe and effective therapy supports (refer to Case
Study A).
-
Support workers who are trained by therapists often do not follow through on actively supporting participants to engage in therapy.
-
Group home staff sign off on records to confirm that home exercise services have been provided but these records conflict with the advice of participants.
Case Study A
A 17-year-old female had been receiving a range of therapies including exercise
physiology, occupational therapy, physiotherapy and speech pathology. Following a
review, funding was reduced across all therapies and the therapists were asked to train
the participant’s support workers in the delivery of therapy supports. The AEP noted
that the participant received support from over 20 different care workers a week and
concerns had been raised about the risks associated with training such a large number
of care workers in such a diverse range of therapy supports. The participant’s mother
was appealing the decision and expressed fear that her daughter may need to consider
residential aged care if her body deteriorates any further.
These types of scenarios have the potential to significantly impact on the quality and quantity of care that
participants receive and the ability of participants to achieve their goals. ESSA acknowledges that assistance with
therapy related activities have not historically been included in the training and job description of support
workers but suggests that this needs to change if the NDIA is to continue to promote their involvement in
therapy.
ESSA would certainly be very supportive of any efforts made to increase the overall levels of physical activity
amongst people with disability and acknowledge that there is a role that support workers can play in engaging
participants in physical activity and incidental movement. However, it must be noted that there is a significant
9
difference between providing support to engage in physical activity and delivering clinically prescribed exercise
programs designed to achieve a therapeutic outcome.
AEPs delivering supports under the NDIS have significant concerns about the risk associated with unqualified
support workers delivering clinically prescribed exercise treatment programs. Support workers would rarely have
the knowledge nor the skills to conduct ongoing risk stratification, monitor symptomology, and adjust the
prescription of exercise based upon complex interactions of diagnosis, exercise tolerances and changing medication
regimes.
ESSA understands the NDIA support the Supervision and delegation framework for allied health assistants and the
support workforce in disability. ESSA is also supportive of many of the processes promoted in this framework. The
Identification model in particular would be an ideal model for ensuring that disability support workers are only
delegated low risks tasks that are within their competency levels. ESSA is concerned that the NDIS system does not
currently support the appropriate application of this framework.
Recommendation 7: The NDIS Quality and Safeguards Commission to introduce quality measures to mitigate risk
associated with the delegation of therapy supports to unqualified support workers.
5.0 Contact ESSA
Thank you for the opportunity to provide feedback to the Joint Standing Committee
on the National Disability Insurance Scheme’s Inquiry into the NDIS Quality and Safeguards Commission.
10
i National Disability Insurance Agency, COAG Disability Reform Council Quarterly Report 30 June 2019 [Internet]. [place unknown]: National Disability Insurance Agency; 2019 [cited 3 Sep 19]. Available from https://www.ndis.gov.au/about-us/publications/quarterly-reports . ii National Disability Insurance Agency, COAG Disability Reform Council Quarterly Report 31 December 2019 [Internet]. [place unknown]: National Disability Insurance Agency; 2019 [cited 28 Jul 20]. Available from https://www.ndis.gov.au/about-us/publications/quarterly-reports/archived-quarterly-reports-2019-20 iii Council of Small Business Organsiations Australia [Internet]. [Sydney, AUS]: Council of Small Business Organsiations Australia; 2020 [cited 28 Jul 20]. Available from https://12181f63-b7b9-4e2e-b33f-d3d17c4a6b46.filesusr.com/ugd/5d6b2a_549acc8c4e6a4fcb887c884f37f4fa3f.pdf
11