NDIA Accountability Project

Submission 139 — South Australian Government — Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability

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Royal Commission into Violence, Abuse,

Neglect and Exploitation of People with

Disability

Voluntary Submission of the State of South Australia

21 December 2022

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Acknowledgment of Country

We acknowledge and respect Aboriginal people as the state’s First Peoples and nations, and recognise Aboriginal people as Traditional Owners and occupants of lands and waters in South Australia. We recognise:

  • the spiritual, social, cultural and economic practices of Aboriginal people come from their connection to traditional lands and waters

  • maintaining cultural and heritage beliefs, languages and laws are of ongoing importance to Aboriginal people today

  • Aboriginal people have made and continue to make a unique and irreplaceable contribution to SA.

We acknowledge Aboriginal people have endured past injustice and dispossession of their traditional lands and waters and the effects of such injustice and dispossession are still felt today.

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State of South Australia

  1. The State of South Australia (the State) provides this submission in relation to recommendations made to date by the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (the Royal Commission) and recommendations proposed by Counsel Assisting the Royal Commission.

  2. The State has been and remains committed to engaging with, and contributing to, the inquiries of the Royal Commission and has had substantial involvement across the life of the Royal Commission, including contributing the following (in no particular order):

  • A detailed response from SA Health regarding the State’s forensic mental health services, including the provision of detailed data. 1

  • A multiagency statement on the interaction between the State’s criminal justice system and the National Disability Insurance Scheme (NDIS), with input from SA

Health, the Courts Administration Authority, Department for Correctional

Services, South Australia Police and the Department of Human Services (DHS). This statement formed part of the evidence in Public hearing 15.2

  • A whole of government response detailing the State’s response to the COVID-19 pandemic.3

  • Detailed statements from the Chief Executives of OHS and the Department for Child Protection provided as part of the evidence in Public hearing 8, which inquired into the experiences of First Nations people with disability and their families in contact with child protection systems.4 Both Chief Executives later gave oral evidence during Public hearing 8.

  • Six detailed statements from five officers of OHS which formed part of the evidence of Public hearing 14,5 which inquired into the experience of people with disability receiving services from OHS.

1 ’SAG.0003.0008.0001 - ‘SA Health Response to request from Disability Royal Commission_ SA Closed Institutions Data’, January 2020; ’SAG.0003.0008.0012 - ‘SA Health Response to request from Disability Royal Commission_ SA Closed Institutions Data’, January 2020; ‘SAG.0003.0028.0001 - Statement of Dr Christopher Henry McGowan’, 2 September 2021. 2 Exhibit 15-015, ‘SAG.0003.0025.0001 - Multiagency statement on the SA criminal justice system and the NDIS’, 7 June 2021. 3 ‘SAG.0003.0193.0001 - The State of South Australia’s response to CTH-NTG-00193’, 11 April 2022. 4 Exhibit 8-019, ‘STAT.0194.0001.0001 - Statement of Catherine Taylor’, 22 October 2020; Exhibit 8-020, ‘STAT.0195.0001.0001 - Statement of Lois Boswell’, 22 October 2020. 5 Exhibit 14-121, ‘STAT.0320.0001.0001 - Statement of Lois Boswell’, 19 February 2021; Exhibit 14-093, ‘STAT.0350.0001.0001 - Statement of Antony Allwood’, 13 May 2021; Exhibit 14-109, ‘STAT.0349.0001.0001 - Statement of Stewart Dodd’, 13 May 2021; Exhibit 14-064, ‘STAT.0348.0001.0001 - Statement of Wayne Cunningham’, 14 May 2021; Exhibit 14-122, ‘STAT.0353.0001.0001 - Statement of Lois Boswell’, 19 May 2021; Exhibit 14-116, ‘STAT.0352.0001.0001 - Statement of Muriel Kirkby’, 19 May 2021; Exhibit 14-065, ‘STAT.0358.0001.0001 - Statement of Wayne Cunningham’, 24 May 2021.

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  • Four officers of OHS, including the Chief Executive, gave oral evidence during Public hearing 14.

  • The evidence at Public hearing 14 also included a statement and oral evidence from the Public Advocate and Principal Community Visitor.

  • Detailed response regarding youth justice and data about children and young people with disability.6

  • Provision of disaggregated data by the Department for Education about students with disabilities in the State education system_?

  • Detailed written statement and oral evidence from a senior executive of the Department for Education (DE),8 as part of Public hearing 24.

  • Detailed submissions in response to the submissions of Counsel Assisting the Royal Commission following Public hearing 8, 14, 16 and 24.9

  • Two witnesses appeared at Public hearing 28 on behalf of the State - An Assistant Commissioner of South Australia Police participated in a panel discussion and oral evidence was provided by an executive from the Office for Ageing Well in relation to the SA Adult Safeguarding Unit. 10

  • Ongoing responses to ad hoc inquiries, notices and summonses. Contributing agencies

  1. The information included in this submission has been provided by the following agencies:
  • Department for Education
  • Department for Health and Wellbeing (SA Health)
  • Department of Human Services. 6 ‘SAG.0008.0233.0001 - Statement of David Richard Latimer Whittle’, 18 August 2022; ‘SAG.0004.0232.0001 - Statement of John Strachan’, 5 September 2022; ‘SAG.0003.0248.0001 Statement of Andrew Wiley’, 6 September 2022; ‘SAG.0002.0248.0001 - Statement of Lois Boswell’, 9 September 2022. 7 ‘SAG.0006.0178.0002 - SA Response’, 30 March 2022. 8 Exhibit 24-026, ‘STAT.0542.0001.0001 - Statement of Dr Caroline Croser-Barlow’, 6 May 2022. 9 ‘SUBM.0014.0001.0023 - Written submissions in response to evidence given during Public hearing 14’, 10 September 2021; ‘SUBM.0017.0001.0567 - Submissions of the State of South Australia following Public hearing 8’, 20 December 2021; ‘Submissions of the State of South Australia following Public hearing 16’, 4 February 2022. 10 Exhibit 28-26, ‘STAT.0642.0001.0001 - Statement of Cassie Mason’, 22 September 2022.

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Key issue summary

  1. A significant issue for people living with disability is the lack of integration of health care services with disability and community care provisions.

  2. The Royal Commission provides an opportunity to consider how disability services can better integrate with the healthcare system to provide wraparound supports for people with disability so they receive equitable access to health care.

  3. The State invites the Royal Commission to consider recommending the development of policies and pathways for improved access to routine health screening for people with intellectual disability. This is aimed at improving healthcare for people who find regular screening appointments distressing.

  4. An update relating to disability approaches and reforms within the Department for Education since Public hearing 24 is provided for consideration in conjunction with the State’s response to Counsel Assisting’s submissions regarding Public Hearing 24.

  5. South Australia notes that significant work is being undertaken at a national level, in relation to the NDIS Review and Disability Reform Ministers’ Meeting agenda.

  6. South Australia continues to look forward to contributing in such forums, along with other states, territories and the Commonwealth.

Health and disability interface

  1. SA welcomes the commitment made by the Commonwealth through the First Secretaries Group Improving Care Pathways review to progress immediate actions to address the health and disability interface. While these measures are presently focussed on short-term outcomes over the next 6 - 12 months, a sustained focus is necessary to reform the service continuum to meet client need. It will be important to continuously engage with clients and providers over this time, and concurrently improve data capabilities and mechanisms for escalation across portfolios.

Health system pressure points

Hospital discharge delays

  1. A barrier to timely discharge from hospital is the availability of appropriate Specialist Disability Accommodation (SDA) in the community. In South Australia, there also continues to be an undersupply of robust SDA for people with disability who have complex needs. This needs to be an ongoing discussion between governments and key stakeholders.

  2. The State acknowledges the increased focus by the NOIA on hospital discharge with the implementation of the Hospital Interface Branch in late 2021 and prioritisation of NDIS participants in hospital for home and living decisions through the NDIS.

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Avoidable hospitalisations

  1. In South Australia, there is an increasing number of NDIS participants with high and complex needs being admitted to hospital for non-health related reasons, for example, when their service provider has relinquished care.

  2. Hospital admission for non-health related reasons is not the appropriate care setting for NDIS participants, as it limits the levels and quality of supports they can receive, including support to access the community and engage in activities. They may experience functional decline and an increase in support needs.

  3. Non-health related admissions to hospital or presentations to emergency departments also shifts demand to the acute care system which is already under increased pressure.

Thin accommodation markets

  1. Whilst there are thin accommodation markets in South Australia, particularly for robust and improved liveability SDA, finding an appropriately skilled and experienced provider that can provide the participant with an appropriate level of support, especially where there are behaviours of concern, is also a challenge in the South Australian provider market.

Healthcare screening for people with intellectual disability and high levels of anxiety

  1. The report of Public hearing 4 outlines the compounding negative health effects on people with disabilities who fail to access health services because they find the appointments distressing and traumatic. This issue was described by both lived experience witnesses and health experts. Examples of services people with disability avoided included preventative screening, dental appointments and palliative care.11

  2. The absence of a policy framework, in the area of pre-procedure sedation services in particular, creates significant barriers to appropriate healthcare screening. This is true across both the community setting and the hospital setting where a diagnosis or demonstrable pathology result is often a precursor to further investigation. The resultant delays in diagnosis and care for basic health conditions and the attribution of ‘behaviour’ related to physical pain and discomfort to mental health issues or the person’s disability contributes to the high levels of distress and increased morbidity, increased emergency department attendance and reduced life expectancy experienced by this cohort.

11 Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, Report of Public hearing 4: Health Care and Services for People with Cognitive Disability, February 2020, at [377-396].

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  1. Examples of effective procedural sedation services exist in the paediatric setting where children and adolescents are able to access pre-procedural sedation such as nitrous oxide or intra-nasal Midazolam, to support routine investigations. However, this is not available in adult healthcare settings and creates a significant barrier to appropriate and timely care for people with intellectual disability and anxiety. Challenges posed by the transition from paediatric to adult healthcare were also described by several witnesses at Public hearing 4.12

Recommendations

  1. The State invites the Royal Commission to make a recommendation that state and territory Health Departments work with Primary Health Networks and the Royal College of Anaesthetists to establish clear national clinical policies and pathways to ensure access to routine healthcare screening, prevention and intervention for people who experience procedural anxiety who may otherwise be precluded from accessing such healthcare due to lack of access to procedural sedation. This may include adults with intellectual disability or cognitive impairment or other conditions that impact on the ability to undergo routine procedures without an appropriate level of sedation.

  2. The resultant policies and pathways should deliver universal access to a tiered sedation pathway to support low level sedation provision in primary care whenever possible, with clear referral pathways to a specialist sedation support service(s) able to provide moderate sedation support in a community setting and escalation pathways to hospital-based services for general anaesthetic support for consumers with the highest care needs. The solution should enable collection of data regarding access to procedural sedation to support monitoring and evaluation of access to healthcare for people with intellectual disability or cognitive impairment.

Education

Context for South Australia

  1. During Public hearing 24, the Royal Commission heard from witnesses in relation to two case studies from South Australia. A senior executive from the DE gave oral evidence.

  2. This section provides the DE’s current approaches and reforms and should be read in conjunction with the State’s response to Counsel Assisting’s submissions regarding Public Hearing 24.

Discussion

Settings for students with disability

  1. Students with disability can attend their local school in a mainstream class. 12 Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, Report of Public hearing 4: Health Care and Services for People with Cognitive Disability, February 2020, at [328-330, 376].

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  1. Whilst mainstream classes are available for all students, those who meet eligibility requirements can be offered a place in a special option (special class, disability unit or special school). Parents and/or families can choose a special option if they see this as better meeting the needs of their child or young person. Funding for students with disability

  2. In 2021, the DE funded around $320 million to schools and preschools for children and students with functional needs compared to approximately $240 million in 2018. This does not include the significant state-wide services delivered to support schools.

  3. The DE is making access by schools to funding support simpler and reducing administrative burden. For example, the Inclusive Education Support Program provides support to students with disability in preschools and schools in mainstream settings and is based on a student’s functional needs. Selected schools are piloting a new process for allocating certain levels of individualised funding without the need to apply to a centralised panel, which will inform future improvements. In addition, as part of reducing burden whilst improvements are made, DE schools and preschools will not need to reapply for individualised funding for a 12-month period where a student’s funding review would have occurred.

Family Voice

  1. The DE has recognised that there is an opportunity to better systematise and embed the voices of families and students with disability in its reform agenda.

  2. DE mechanisms for parents of students with disability to provide feedback to the department include parent forums for families with children with disability, and a new Autism Education Advisory Group, established to involve and collaborate with people with lived experienced, parents and carers of autistic children and young people, experts on autism, advocates, and community organisations.

Teacher training and capability

  1. DE is developing professional learning packages to build the capability of school­ based staff to develop and deliver inclusive teaching practices.

  2. Practice guides for educators of children and students with functional needs is being developed. Practice guides are resources designed with educators, for educators, that articulate the evidence-based strategies and advice to improve learning and wellbeing outcomes for children with disability. The first tranche was released early in term 3

  3. A second series of practice guides will be released in early 2023. Page 8 of 9

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Support for schools and preschools in creating inclusive environments

  1. Over the forward estimates, $28.8m has been committed to introduce an autism inclusion teacher in every public primary school (including reception to year 12 schools) from 2023. The autism inclusion teachers will form a network of autism expertise that:

  • provides support to their fellow educators on how to best support and educate students with autism

  • drives improved practice relating to children with autism that works for their school.

  1. This commitment is an opportunity to enable a shift in DE school practice by providing specialist teaching expertise in schools, supporting educators to achieve practice change in the classroom.

  2. In addition, $50m over years is being invested to enable 100 FTE mental health and learning support specialists to provide more support to students across South Australia in DE settings. The workforce will include psychologists, social workers, occupational therapists, speech pathologists and other learning support specialists.

  3. This investment is in addition to the existing staff in DE who provide an integrated, multidisciplinary service to assist schools and preschools to meet the needs of children with additional learning needs. Expenditure for the 2021 calendar year was approximately $57 million.

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