15 August 2017
Mr Gerry McInally
Committee Secretary
Joint Standing Committee on the National Disability Insurance Scheme
Department of the Senate Email: NDIS.Sen@aph.gov.au
Dear Mr McInally
The Royal Australian College of General Practitioners (RACGP) thanks the Joint Standing Committee
on the National Disability Insurance Scheme (NDIS) (the Committee) for the opportunity to contribute to its inquiry into the provision of services under the NDIS Early Childhood Early Intervention Approach (ECEI).
The RACGP is Australia’s largest general practice organisation, representing over 90% of Australia’s general practitioners (GPs). We advocate for affordable and equitable access to high-quality health services and improved health outcomes for all Australians. Due to our scope of practice, GPs work with patients on a wide range of issues. We understand the complex interaction between health, social issues, workforce participation and the ability to access education.
The RACGP strongly supports the vision of the NDIS “Optimising social and economic independence and full participation for people with disability”. Our members have been involved in supporting children with disabilities and their families throughout their lives. While our members’ primary function has been in health care, they have also been involved in counselling and advice on the social impact of their disability. GPs are often the first professional group consulted when families are concerned about a disability in their child.
This submission addresses a range of topics regarding the ECEI pathway:
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eligibility criteria for determining access
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service needs of NDIS participants receiving support
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timeframe in receiving services
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adequacy of funding for services
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costs associated with ECEI services, including costs in relation to initial diagnosis and testing for potential ECEI participants
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evidence of the effectiveness of the ECEI Approach, robustness of the data and other research matters
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adequacy of information for potential ECEI participants and other stakeholders
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accessibility of the ECEI Approach, including in rural and remote areas
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principle of choice of ECEI providers.
Eligibility criteria for determining access to the ECEI pathway The online information suggests that access to services is via assessments by Early Childhood Partners. It is not clear how other assessments made (in collaboration with families) by GPs, paediatricians in private practice and hospital clinics are to contribute to this process.
Service needs of NDIS participants receiving support under the ECEI pathway There appears to be better access to services for children with disabilities within this scheme. It is important that access is to quality services that are held accountable for outcomes
Timeframe in receiving services under the ECEI pathway While it is early days and some teething problems are understandable, our members have advised that some parents of children with recently recognised disability are experiencing considerable delay in accessing services in this introductory period. It is unacceptable that children who have a recently recognised disability miss the crucial early intervention they deserve.
Adequacy of funding for services under the ECEI pathway In order to make an informed comment we need an opportunity to understand funding and budgets.
Costs associated with ECEI services, including costs in relation to initial diagnosis and testing for potential ECEI participants The fragmentation of care implicit in the current arrangements with respect to the initial assessment of disability and the development of care plans that monitor progress, available to all stakeholders in real time, is a recipe for inefficiency.
Evidence of the effectiveness of the ECEI Approach, robustness of the data and other research matters Whilst the aims of the ECEI Approach are strongly endorsed we note that there is no clear strategy to reduce fragmented care. We urge the NDIS to develop a system that collects the robust data required for quality improvement in the care of individual children and populations of children with disability.
Adequacy of information for potential ECEI participants and other stakeholders While the information online is comprehensive, it lacks a general practice perspective. The RACGP acknowledges that general practice fact sheets will be disturbed by the NDIA shortly, however these present a broad picture of how GPs should approach NDIS provision. Cohort specific information, such as the ECEI pathway, targeted at GPs, needs to be provided by the NDIA.
Accessibility of the ECEI Approach, including in rural and remote areas Integrating health and disability services would benefit these communities, in which GPs have a wide reach and would increase efficiencies and provide better service coordination.
Principle of choice of ECEI providers The RACGP would support this as a principle, but in some more remote areas this may not be possible. At times, the use of properly qualified and recognised private services could provide greater flexibility and choice.
General comments The RACGP notes that we are in a period of transition to the NDIS, that this transition is staggered and there are variations in implementation between states and territories. This necessarily makes consistent communication with stakeholders difficult. However, there is a perception among RACGP members that general practice has had little input into the NDIS at this stage.
A recent RACGP poll showed that 93% of respondents indicated that they have had little information to help facilitate NDIS requests. GPs who are on the front line with patients and their families throughout the diagnostic process have a role as sources of information, advocacy, referral to services, linkage with local services and managing associated health issues. The sector would benefit from education programs and information targeting the role of GPs in this process. This would enhance the efficacy of Medicare funded services supporting children needs at this time. We are concerned that delays in the provision of services have been created within the transition period that have resulted in unacceptable delays in services to children at a critical time in their development. Developing care plans independent of general practice will further fragment care, while moving to better integrate general practice will bring about efficiencies and avoid doubling up of services.
The RACGP thanks you for your consideration of this feedback.
Yours sincerely