Submission to the House of Representatives Standing Committee on Health, Aged Care and Disability Services Inquiry into Thriving Kids Australia

Submitted by:

Murrumbidgee Primary Health Network and Murrumbidgee Local Health District

Date: 3 October 2025

redacted

Executive summary

This joint submission between Murrumbidgee Primary Health Network (MPHN) and Murrumbidgee Local Health District (MLHD) to the Federal Parliamentary Inquiry into the Thriving Kids initiative to the Standing Committee on Health, Aged Care and Disability. The submission draws on more than 30 years of experience in supporting primary care in the Murrumbidgee region of New South Wales, which comprises more than 250,000 people living in 500 communities across 126,000 square kilometres. Moreover, our clinical stakeholders have also provided feedback for inclusion in this submission. This has been received from paediatricians (public and private), general practitioners and allied health professionals.

Children in the Murrumbidgee region face disproportionately high rates of developmental vulnerability, compounded by workforce shortages, geographic isolation, and socioeconomic disadvantage. MPHN, in partnership with MLHD, health professionals, education providers and the community, has developed innovative models to address these challenges.

Drawing on the experiences of several years of consultation, co-design and implementation, this submission outlines the strengths and gaps in current systems, highlights risks associated with proposed reforms, and offers recommendations to ensure equitable, timely, and family-centred care for all children.

About MPHN

Firsthealth is a not-for profit organisation which has been supporting and delivering primary health programs for 30 years. Our purpose is to create connected, dynamic and equitable healthcare through empowered workforce and communities as we move towards our vision of well people, resilient communities.

Firsthealth is federally funded to deliver the Primary Health Network program across the Murrumbidgee region. Murrumbidgee Primary Health Network (MPHN) is one of 31 local and independent PHNs established nationally to support the primary healthcare sector and improve health outcomes, particularly for people at risk of poorer health outcomes. We deliver the PHN program across approximately 126,000 square kilometres to more than 250,000 people living in our 508 communities.

With the person at the centre of care, we plan and deliver programs to ensure the needs of our individual local communities inform our approaches. We achieve this by working with our community and partners to:

Coordinate local services and systems to improve coordination of care.
Commission primary health services to meet population health needs with a focus on access and equity.
Support capacity-building to ensure sustainable healthcare workforce through quality improvement, professional development and other innovative measures.

Our work and engagement with our communities and stakeholders is underpinned by our values of work together, be honest, value everyone, aim to inspire and learn from others.

About MLHD

Murrumbidgee LHD covers almost 125,243km² and provides public health services to approximately 243,228 people across the Riverina, Murrumbidgee Irrigation Area and the South Western Slopes of NSW.

As the largest employer in the region, MLHD have over 5000 healthcare staff working across 33 hospitals and 12 primary healthcare centres. We’re supported by hundreds of volunteers who make an invaluable contribution to enriching the lives of people in our care.

Services are delivered through:

2 base hospitals
10 hospitals
19 multipurpose services
2 Mercy Care public hospitals: Mercy Care Centre Young and Mercy Health Albury
12 community health centres
1 brain injury rehabilitation service
mental health services, including an inpatient unit and mental health recovery services.

Introduction

Children living in the Murrumbidgee region of NSW experience greater vulnerabilities and poorer health outcomes, exacerbated by lack of access to screening, assessment and therapy services. Murrumbidgee’s rate of developmental vulnerability (23.5% on one or more domains) is about two percentage points above the NSW average. The gap is even wider for Indigenous children and those in remote communities (who nationally are twice as likely to be developmentally vulnerable as metropolitan children). Socioeconomic indicators likewise show the region is relatively disadvantaged compared to NSW and Australia on measures of income, education and service access. Health workforce data reveal below-average ratios of paediatric and allied health professionals per population in rural NSW, including the Murrumbidgee area.

To address these issues, Murrumbidgee Primary Health Network and Murrumbidgee Local Health District have been working in partnership for several years to bring about change. More recently, this partnership has expanded under the Murrumbidgee Health and Knowledge Precinct to explore collaborative opportunities to improve access to early screening and therapy, and to address the extensive wait times to specialist paediatric care.

This submission has been developed jointly between MPHN and MLHD and draws on local data, evidence and clinician feedback, to respond to the inquiry’s Terms of Reference.

Response to Terms of Reference

Examine evidence-based information and resources that could assist parents identify if their child has mild to moderate development delay and support parents to provide support to these children.

Avoid duplicating efforts and existing resources

Numerous resources are already available to support parents in identifying development delay, however awareness and access to these could be significantly improved.
As an example, The Raising Children Network is a nationally recognised, evidence-based parenting resource that includes comprehensive information on developmental delay. It is supported by organisations such as the Murdoch Children’s Research Institute and the Royal Children’s Hospital.

Ensure equity of access to resources

Access to online resources is not universal. In regional areas, parents often rely on informal networks or incidental health visits and is therefore important to ensure resources are accessible at these touch points for families.

Embed developmental screening into routine care

Developmental checks are not routinely conducted during GP vaccination appointments, and Blue Book checks are inconsistently completed. There is a need to embed developmental screening into routine care and improve communication between early childhood educators, health professionals, and families.

Include education and resources for parents as part of the program

Build education, resources and support for parents into an initial therapy program to help reduce demand on limited allied health services. Lack of awareness contributes to delays, with many families unsure which developmental concerns require attention or which services are available.

Examine the effectiveness of current (and previous) programs and initiatives that identify children with development delay, autism or both, with mild to moderate support needs and support them and their families. This should focus on community and mainstream engagement, and include child and maternal health, primary care, allied health playgroups, early childhood education and care and schools.

The following elements are key considerations for implementing a successful Thriving Kids program.

Proposed three-year-old health check

Many children fall through the cracks between the 18-month and four-year immunisation checks; the three-year old health check will help fill this gap for children who attend a GP.
There needs to be a consistent algorithm for assessment and intervention and ensure priority populations are targeted.
Follow-up pathways for identified potential developmental delays are critical to this model and need to be adequately funded so that the most vulnerable children can access these services.
These allied health pathways must be linked in with the Primary Care team as part of a multidisciplinary team.

Primary care must be funded for care navigation, without this an MBS item alone will not result in the outcomes Thriving Kids hopes to achieve.
Urgently need to improve the currently fragmented communication between early education, general practice, and public health.

NDIS risks

There is potential for gaps or delays in support for children who are no longer eligible for the NDIS.
While it is hoped Thriving Kids will reduce the pressure on the NDIS by delivering more appropriate supports for children with less complex needs, it may be less intensive than individualised therapy, potentially limiting outcomes for children who require more comprehensive intervention.

Eligibility criteria issues

There needs to be clarification around “mild-to-moderate” vs “severe” developmental needs.
Risk of inconsistent application of criteria
Some children may miss out entirely on support.

Neurodiversity concerns

Need to ensure neuro-affirming approaches are considered as part of the program; otherwise there is a risk of children being placed in non-individualised support and potential for long term trauma.

Integration across the system key

While the program leverages mainstream touchpoints, effective integration across health, education, and community services will require strong coordination and oversight to avoid fragmentation.
Critical for Thriving Kids to be delivered through universal and mainstream touchpoints both inside and outside of the health system such as early learning centres, and schools, making it more accessible, reducing stigma, and avoiding over-reliance on expensive or specialist-only services.

Local models - Murrumbidgee Enhancing Paediatrics in Primary Care (EPiPC) model

Locally, the Murrumbidgee region has been implementing the EPiPC model to support children aged 0 to 7 years who have been identified as needing assessment for developmental and/or behavioural concerns. The model was co-designed in 2019/20 and takes an integrated and multidisciplinary approach to support children across the care pathway to access early screening, assessment and therapy support. The program incorporates a range of service components that work together to improve outcomes for the child and their family with a focus on early intervention including:

Primary care enhancement: Opportunities for GPs across the region to increase their skills and confidence in the identification, screening and ongoing support of children with developmental and/or behavioural concerns. This is delivered in partnership with the Community Paediatrician.
GPs with special interest: Support and referral access for up to 10 small or solo practices and Aboriginal Medical Services in the targeted communities to case conferencing with the Community Paediatrician and access the Waratah for Kids program.
Waratah for Kids: Increase access to and uptake of developmental and behavioural screening and therapies through speech and occupational therapy to improve outcomes through early intervention.

The EPiPC approach provides a great example of how local system can deliver multidisciplinary team based care for children, ensuring there is training and support for providers who are operating as the first point of contact in health, and could be considered as a model to support Thriving Kids.

Identify equity and intersectional issues, in particular, children who identify as First Nations and culturally and linguistically diverse

Children from First Nations communities, multicultural backgrounds, lower socio-economic families and those in out-of-home care face significant barriers to accessing early intervention. These groups are more likely to experience equity challenges and barriers to accessing supports, including awareness, culturally safe services, and local availability. All of which can lead to developmental vulnerability, particularly in language and communication domains.

Equity and intersectional issues

For First Nations and multicultural communities in particular, services targeted to these groups are often ad hoc and reliant on passionate individuals often through local Aboriginal Medical Services or multicultural groups rather than systemic design.
Attendance rates are low due to travel, cost, and cultural mismatch.
Care navigators, cultural awareness training programs and culturally led models of care have proven effective in bridging these gaps and should be expanded.
Consideration should be given to providing funding to vulnerable communities as a whole where we know that more than 50% of children are likely to be experiencing development delay.

Barriers to accessing care

Long waits for autism, developmental, and psychological assessments delay early support, especially in public services.
High costs limit access to private therapy, even with Medicare or NDIS subsidies.
Many families lack awareness of developmental concerns or available services.
Rural and remote families face limited access due to geography and transport barriers.
Fragmented systems (NDIS, health, education) with separate processes increase stress and slow access.
Strict eligibility and diagnostic criteria exclude children with mild or undiagnosed conditions; while it will be a positive to remove the need for diagnosis, we need to ensure there is a way to manage demand and ensure that our most vulnerable children and families get access.

While many barries identified above are not unique to those children experiencing health inequities, Thriving Kids should remove such barries for children from First Nations communities, multicultural backgrounds, lower socio-economic families and those in out-of-home care as a priority.

Identify gaps in workforce support and training required to deliver Thriving Kids

Workforce availability in regional and rural locations is an ongoing challenge. Innovative and flexible approaches to building workforce capacity and recruitment are critical to ensuring successful implementation of Thriving Kids.

Key gaps and challenges

Lack of multidisciplinary team support and transdisciplinary training
Limited non-clinical time for peer review and mentorship
Absence of funded care coordination and health linker roles
Clinicians performing ‘social work’ functions to ensure children get access to care

Many clinicians’ report burnout and a lack of clinical supervision
Allied health professionals, psychologists, and developmental specialists are in short supply, with long waitlists and limited regional coverage posing risks to timely service delivery

Opportunities

Include social workers, behavioural psychologists, and allied health assistants in the model, with investment in training and regional incentives.
Online training and NDIS-funded services have expanded rural paediatric expertise.
Physiotherapists are key to early intervention, especially for motor and physical development.
Partner with private practices to support GP referrals and deliver assessments, education, and interventions.
Build on existing regional services with established community links.
Small businesses offer supportive workplaces and retain staff through strong community relationships.
Provide incentives for therapists to work in and stay in rural and remote areas.
Upskill workers for foundational developmental support under supervision.

Draw on domestic and international policy experience and best practice

It will be critical for designing Thriving Kids to draw on existing evaluations and recommendations from various organisations and reviews to avoid duplicating co-design and consultation activities, and ensuring activities are targeted and specific. Looking at outcomes of the NDIS review and the Healthy 4 Year Kids check will be important.

The approach being implemented in the Murrumbidgee through the EPiPC model aligns with:

NSW Health’s First 2000 Days Framework
The Henry Review and its recommendations for system-wide integration
National Action Plan for the Health of Children and Young People
National Aboriginal and Torres Strait Islander Health Plan

The NSW ACI tiered paediatric development model provides a that enables a system level approach to streamlining the journey for children and families, and should be considered more broadly to support implementation of Thriving Kids.

Identify mechanisms that would allow a seamless transition through mainstream systems for all children with mild to moderate support needs

Seamless transition requires:

Clear systems and referral pathways
Care navigators to guide families and clinicians
Integration between health, education, and social services
School readiness programs that align with early intervention efforts
Removal of cost barriers to access services

A tiered model supports these factors by allowing children to move between levels of care based on need. However, successful implementation depends on investment in Tier 1 and Tier 2 workforce, care coordination, and access to allied health.

School-based allied health services offer a promising model to improve access and enhance developmental outcomes. These services also support teacher education and integration of therapy goals into the learning environment.

Cost remains a significant barrier for families without NDIS funding or access to public community allied health services. In rural and regional areas, public services are often unavailable, and private care is unaffordable for many families. Government support to subsidise private allied health access is essential.

Recommendations

As part of the development and rollout of Thriving Kids, it is recommended that consideration is given to the following:

Invest in care coordination roles to support families and clinicians, especially during service transitions.
Strengthen primary care through training, mentorship, and access to paediatric expertise.
Expand allied health access in underserved areas and among priority populations.
Ensure continuity of care during transitions from NDIS to Thriving Kids.
Support culturally led models aligned with Closing the Gap for First Nations and diverse communities.
Avoid single tender models that risk displacing trusted local providers.
Scale up successful pilots like EPiPC and WARATAH for Kids across the region.
Embed developmental screening into routine GP, maternal and child health, and early education services.
Fund social work and behavioural support to address social determinants and reduce clinician burnout.
Collaborate with private practices and small businesses to deliver trusted, stable services.
Provide rural practice incentives and invest in training for foundational developmental roles.
Support school-based allied health models to integrate therapy into education.
Introduce new funding items to improve access to allied health services such as physiotherapy, occupational therapy, and speech pathology.

Conclusion

MPHN and MLHD welcome the opportunity to contribute to the Thriving Kids Australia initiative. Our region’s experience demonstrates the importance of locally led, integrated, and culturally responsive models of care. With targeted investment and policy alignment, we can ensure every child in the Murrumbidgee region has the opportunity to thrive.