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assistive technology suppliers australia sa
Submission in response to:
The Royal Commission into Violence, Abuse, Neglect
and Exploitation of People with a Disability
- Vision for an Inclusive Australia Date: 2nd December 2022
Contacts: David Sinclair, Executive Officer and Margaret Noonan, Senior Policy Officer
Email: david.sinclair@atsa.org.au margaret.noonan@atsa.org.au
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About Assistive Technology Suppliers Australia (ATSA)
ATSA is a national organisation representing assistive technology (AT) suppliers, including manufacturers, importers, distributors, retailers, tradespeople, allied health workers and technicians. Our 160 members comprise businesses and not-for-profit organisations ranging from small family-owned concerns to multinational organisations throughout Australia. It is estimated that, excluding AT for communication and sensory disabilities, approximately 80% of the AT in Australia passes through the hands of A TSA members. ATSA is a registered not-for-profit charity with the ACNC and requires members adhere to a comprehensive Code of Practice on the provision, sales and servicing of AT. We are also a member of the Australian Ethical Health Alliance.
About Assistive Technology
Assistive Technology (AT) covers a wide range of medical devices and every day products designed to support daily living activities. The WHO define AT as “the application of organized knowledge and skills related to assistive products, including systems and services. Assistive technology is a subset of health technology. An assistive product is any external product (including devices, equipment, instruments, or software), especially produced or generally available, the primary purpose of which is to maintain or improve an individual’s functioning and independence, and thereby promote their well-being. Assistive products are also used to prevent impairments and secondary health conditions. Source: Priority assistive products list. Geneva: World Health Organization; 2016 (https://www.who.int/publications/i/item/priority-assistive-products-list, accessed 20 April 2022).”
In general in Australia AT is deemed a medical device and is regulated by the Therapeutic Goods Administration (TGA). The higher the potential risks of a medical device, the more evaluation, information, and scrutiny is carried out by the TGA and is primarily Class 1 within their register. Assistive Technology which has a higher risk is registered with the TGA as a Class 1. include wheelchairs, beds, lifting chairs, shower chairs, pressure cushions and mattresses, commodes, kitchen stools and other medical devices which are weight bearing or come in prolonged contact with the skin.
The supply of other AT such as home monitoring devices, memory software systems, vision and external hearing assistive products and kitchen utensils come under the jurisdiction of the Australian Competition and Consumer Commission. The supply of modified vehicles comes under state regulations and is also covered by the Australian standards and recommendations from the National Transport Commission. Additionally, there are a number of Australian Standards for AT including ISO 9999:2018 Assistive products for persons with a disability.
Introduction
ATSA is appreciative of this opportunity to provide input on the Vision for an Inclusive Australia. In this submission, we are providing input on key areas we believe will have an impact on how effectively AT will continue to contribute to people who have a disability living well and as independently as possible.
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These areas are
(i) the collection of data to provide evidence of the need for AT including the type and volume of devices. (ii) The importance of education in assistive technology for consumers, planners, health professionals and mentors. (iii) Safety and quality in the maintenance and repairs of AT, particularly for second hand (reissued) AT. (iv) Consumers’ experience of repairs and maintenance of their AT. (v) Consistent legislation across States
Data
Useful data on the Assistive Technology (AT) sector is non-existent and the ability to determine volume and needs is currently limited to “market experience” and “observation.’ It is surprising that in the total NDIS budget of $166.6 billion over 4 years, there has been little importance placed on the collection of data by either type, category or value for products and services.
In a fast-changing market, i.e., shift from a restricted welfare support model to an open “choice and control” consumer focussed market designed to appropriately meet an individual’s clinical and life needs, accurate data is imperative in measuring outcomes and planning for the future.
The collection of data by the NDIS is improving and consultation has been held on the collection of data in the aged care sector. Further work is also required to map the data collected by state programs, the Department of Veterans Affairs and information held by not for profits on assistive technology (for example, the Motor Neurone Disease, Technical Aid for the Disabled and other assistive technology programs).
ATSA’s recommendation: The Australian Bureau of Statistics be the repository for data from the above sources and private sector for reporting and the Australian Institute of Health and Welfare to conduct an annual analysis of the data to show trends to inform policy and budget decisions.
Education on Assistive Technology: AT underpins the independence and inclusion of people with a disability in the community, work, education, and recreation/social activities but there is a lack of information and training. Knowledge optimises client outcomes through the correct selection, application, client use and experience of AT. This results in increased economic efficiencies, improved health outcomes and inclusion.
Education on AT will benefit consumers, families, carers, planners from government funded programs and health practitioners. This shared knowledge will support transparency and good decisions and planning involving these stakeholders.
Consumers, families, and carers. In the WHO Global Report on Assistive Technology, May 2022, p5 one of the key messages is “Access to assistive technology is a multi-step process that begins with a potential user being
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aware of possible assistive technology solutions and ends with the person realizing their rights and goals.“ Ref: https://www.who.int/publications/i/item/9789240049451 Programs such as the NDIS provide information on the type of AT available under the program, however, there is no context to explain how to use the AT or the outcomes a person should expect from the use of that AT. Additionally, carers and family members supporting the consumer also need to understand how to use the AT correctly for the safety of all involved. Another key focus is the need to attract workers to the Disability sector by offering a professional development pathway in Assistive Technology. The Education should provide the Allied Health professional or technician with a certificate of attainment/qualification. New workers also need to understand the way the AT sector works - there are approximately 108 non-NDIS schemes in Australia (source: 2022 Australian AT Equity Studies Report). How does the average person navigate this? Where do they find the information? With our limited resources ATSA is working towards an education package for consumers, their family and carers and allied health workers aimed at explaining AT and where it can benefit consumers. Another group are new workers in the supply of AT who will learn about consumer rights, ethics, how AT works and the correct maintenance and repair procedures.
Phase 1 of the Education project is the initial work being done by ATSA is to bring
information and education packages together in an easy-to-follow menu on our website. existing.. We
are forming an expert panel to vet the information we have collated. Once the menu system is online, we will establish a pilot for consumers and allied health workers to provide feedback. Phase 2 of the Education project is the development of a recognised training program with qualifications to upskill workers in the AT sector and create a pathway for professional development. This will be critical in the area of repairs and maintenance of AT and is further addressed below under Reissued AT.
It should be noted the speed of this project will be governed by available funding and resources.
A TSA ’s recommendation: We are seeking the support of this Royal Commission for the development and funding of this education program.
Safety and Quality of Reissued AT
As governments look for options to reduce costs, delivery time and waste (land fill), there is a move towards the use of reissued AT for people with disabilities and older Australians. While A TSA’s members support the use of reissued AT there are some areas that need urgent attention to ensure the AT provided is safe, fit for purpose and of a high quality for the consumer.
Consumer safety
There is no formal education for repair and maintenance in Australia or any accreditation model for technicians. The majority of reissued AT comes from state programs or not for profits who have technicians checking the AT, however there are no universal standards for them to work to in this process. ATSA is recommending recognised education on repairs and maintenance be developed to address this issue. The manufacturers of AT are quite good at
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providing training and technical manuals - certainly better than in agriculture and other industries. There is a need to ensure the size of the reissue market in Australia does impede access to innovation in the AT sector. Product whole of life product management needs to be considered e.g. from product release to raw materials recycling/waste.
Today in Australia, the staff of AT suppliers receive training from the manufacturers in the maintenance of the Class 1 AT medical devices they sell. This includes the provision of manuals and parts in order for the maintenance and repairs to be conducted in accordance with the manufacturer’s specifications. This is extremely important when it comes to higher risk items devices such as bed poles or wheelchairs. As an example, in the USA a person had a repair made to their wheelchair and the replacement front wheels were not to the manufacturer’s specification. The chair was tested on the flat and was fine, however, as the person drove their chair up the ramped curb guttering, the incorrectly sized front wheel became caught in the footplate causing the chair to tip resulting in the person’s death.
To reduce the level of risk as much as possible, the Education project ATSA is scoping will include a qualification in the repairs and maintenance of AT. While there will always be a need for the training and support from manufacturers, we believe the development of a universal approach to the reissue and recycling of AT will create efficiencies and reduce waste. By providing a qualification, we will also be able to encourage new workers into the sector and build their confidence, understanding of the importance of the manufacturers’ standards and skill levels. It will ensure reissued AT is safe and of a high quality for people who have a disability.
ATSA envisages a suitable education framework will enable greater choice of repairers for consumers of AT across the country including thin markets as repairers are able to access training.
Recommendations: Australia continues to monitor the impact and effectiveness of changing repair regulations in Europe and the USA in regard to repairs and maintenance of class 1 AT. Labelling of reissued AT is also critical in the event of a recall and to alert funding bodies when the AT has reached the end of its’ product life cycle and needs to be replaced. Note: The labelling of Class 1 AT devices comes under the responsibility of the TGA and manufacturers.
Online platforms as a source for reissued AT
Currently, there is no consumer protection for AT sold via digital platforms by individuals. As some state and federal entities move towards the consumer owning the AT, no process for people to pass unwanted AT back to funding bodies or suppliers has been developed. This has resulted in a second-hand market where families and consumers sell AT in order to remove it from their home. It also creates waste as non-sales lead to the AT being thrown out rather than the parts being recycled. This issue is also being accentuated by people receiving the wrong AT for their needs. As noted above, this would be minimised through improved education. Recommended solution: ATSA is looking to identify a suitable sustainable solution to reclaim unwanted AT for reissue or recycling to address the needs for consumers, their families, industry, and government.
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ATSA also recommends the introduction of set guidelines for the safe sale of second-hand AT in conjunction with the TGA, ACCC and government funding bodies. In the interim, ATSA recommends the ACCC establish an alert for reissued AT sold by individuals on online platforms. This would advise the consumer to seek allied health advice
to ensure the AT device is the correct one to
and that it is "buyer beware" regarding the safety....meetoftheirthe device.needs (harm prevention strategy)
Consumers Experience of Repairs and Maintenance of their Assistive Technology ATSA would like to acknowledge the support of the Physical Disability Council of NSW who recently undertook a survey of people with a disability on our behalf. Unfortunately, there was little response possibly due to survey fatigue by consumers. Recommendation: The experience of consumers regarding repairs and maintenance of AT needs to be monitored. ATSA recommends this be done through existing processes where consumers can submit complaints to the NDIS Quality and Safeguards Commission. We would ask the Commission to advise A TSA of any trends so that we can initiate appropriate training for our members.
Consistent legislation across States
It would seem in Australia that some areas of government assume a person who has a disability or an older Australian never travel, work, or move interstate. This assumption is reflected in inconsistent legislation across Australia. Two examples of where this issue is problematic and discriminatory for people who have a disability are
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Child’s car safety restraints such as buckle covers. Mobility and Accessibility for Children in Australia (MACA) have developed a policy to guide allied health professionals to use buckle covers for children with disabilities who get out of their vehicle restraint. Currently some state and territory governments do not have adequate legislation and processes in place for the safe use of buckle restraints. A family travelling by car from state to state may be within the legislation in their state of origin but in breach in another state.
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The speed and weight of motorised wheelchairs. The National Transport Commission (NTC) has developed recommendations for the weight and safe speed for motorised wheelchairs. Unfortunately, these have not be consistently adopted across all states and territories. For example, in NSW the limit is 11 0kgs, but in Queensland it is 300kg and in Tasmania it is 150kg. The reality is that bariatric motorised chairs and many others weigh more than the weight limits in some states as they are designed to meet the needs of the individual. Additionally, the NDIS, Aged Care and the Department of Veterans Affairs plus other funding bodies are placed in a difficult situation of needing to respond to their clients or meeting multiple state legislation.
ATSA recommends the establishment of a cross jurisdictional body to resolve these matters.
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