SUB.001.00442_0002
Your Submission
How are you going to share your experiences with us? I am using this form to make a written submission (with or without attachments) Who are you making this submission for? I am providing information on behalf of an organisation or institution How would you like us to use your information? Public What would you like to share with the Royal Commission about your experiences or knowledge of violence, abuse, neglect or exploitation of people with disability? I would like to share our experience of people with disabilities unable to effectively utilise their NDIS packages, and to exercise choice and control, and the serious implications of this. Have you shared these experiences with anyone before? Who did you tell and what happened? I have previously provided a submission to the government’s Thin Markets Strategy (https://engage.dss.gov.au/wp content/uploads/2019/04/Thin-Markets-Project-Discussion-Paper-2019-04-05.pdf) and also to the Inquiry into food pricing and food security in remote Indigenous com muniti es (https://www.aph.gov.au/Pa rliam enta ry _Business/Comm ittees/House/1 ndigenous _Affairs/Food pricing) Is there anything else you would like to tell us?
Background
Aboriginal people have higher rates of disability, higher needs and less access to disability services than other Australians. This is especially so in rural and remote Australia. Whilst Aboriginal people in rural and remote Australia have been allocated NDIS packages, in many cases they are not able to use them because suitable services are not available. There are euphemistically termed “thin markets” by the NDIA. The utilisation rate in regional, rural and remote Australia reflect the impact of thin markets, and Aboriginal Australians are particularly disadvantaged. New approaches are needed that can respond to the unique needs of people in regional, rural and remote Australia where thin markets predominate. It is insufficient for government to continue to describe problem and do little - in practical terms - to address it.
Limited services Whilst people with disabilities in regional, rural and remote Australia have NDIS funding packages, their capacity to utilise these resources to exercise choice and control and to enable independence and quality of life is limited by the availability of the services they need. Governments including the NDIA need to take more active steps to build a sustainable service system for all people with disabilities.
Local service provision (barriers) There are two major barriers to building local services in regional, rural and remote communities: (1) the administration related to becoming and maintaining registration as a provider under the NDIS and (2) the availability of a skilled local workforce.
Access to allied health services There is very limited access to allied health services in regional, rural and remote Australia. This has been exacerbated by state and territory governments progressively disinvesting in community allied health services over the past five years. The lack of access to allied health services has the flow on effect of equipment prescription and supply as well as the independence and skills of people with disabilities. Are there any suggestions or recommendations you would like to share, including any examples of what worked well, or ideas for how things could be done better? You might also like to tell us about any people that have supported you. Providing services immediately It is unreasonable for government to have expended public funds scoping and describing the problem of thin markets and then doing very little to address it. The NDIA commitment to market based approaches in regional, rural and remote Australia is not working and investment and market-specific intervention is needed to build services and infrastructure which enables people to benefit fairly from the NDIS. A package, no matter how generous and flexible has little value if you can’t spend it and people with disabilities and their families in regional, rural and remote Australia are suffering as a result.
If governments invest in building service and system capacity in regional, rural and remote Australia, service delivery targets must be immediate. It is possible for services to begin meeting urgent needs whilst they co-design their medium to longer term strategy.
Trust and credibility Outside organisations need to build trust with regional, rural and remote communities in order to provide services effectively, and services need to be co-designed and customised to culture and context locally. Outside services are needed because existing services are unable to meet local needs. Outside services must establish a presence within communities and work with existing organisations to meet community needs.
Establishing a skilled and credentialed local workforce Key to sustainably developing local services is a local skilled and credential led workforce. Any new models of care must include local skills development as this supports culturally safe care, create local employment and embeds sustainability form the outset. Qualifications should be at a minimum of Certificate Ill because this ensures people have a reasonable skills base and it also aligns with the new Closing the Gap target with respect to tertiary qualifications.
To achieve the local, skilled and credentialed workforce we recommend the Poche 7-step model. This model has enabled more than 500 vocational qualifications awarded to Aboriginal scholars with 93% completion rate over the past five years. Expanding the use of tele-allied health
Allied health services can be provided via telehealth with local support and engagement. By using tele-allied health (Occupational Therapy) for equipment assessments (for wheelchairs, special beds, toileting and shower aids) and immediate assistance with swallowing and dietary issues (Speech pathology and Dietetics) waitlists could be eliminated within weeks.
It is unclear why the NDIA has been immobilised by the “thin markets” issue but the time for fact finding is past. People with unspent or under spent NDIS packages need services and assistance now and innovative approaches are needed that stretch beyond the existing systems and infrastructure within regional, rural and remote Australia.
In a few sentences, what would you like to tell our nation about your hopes for the future?
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SUB.001.00442_0003
The NDIS, notwithstanding some early teething problems like all projects requiring transformational systems and practice change, remains extraordinarily visionary public policy that we can all be proud of. The NDIS must continue to strive to meet the meet the needs of all Australians with disabilities, not just those fortunate enough to live near a mature disability marketplace. This will require government, including the NDIA, to think differently about the ways services can and should be urgently provided outside of urban centres. This will require investment in and support of novel approaches.
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