Services for Australian Rural and Remote Allied Health (SARRAH) submission: Thriving Kids Initiative
Thank you for the opportunity to contribute to the Thriving Kids Initiative Inquiry. SARRAH strongly supports such initiatives that seek out sustainable solutions to ensure children and families have equitable access to early childhood supports. Successful implementation of Thriving Kids will have a profound impact on the health, well-being and potential of our Nation’s future.
Services for Australian Rural and Remote Allied Health (SARRAH) is the peak body representing rural and remote allied health professionals (AHPs) working in public, private and community sectors, across hospital services, primary care, disability, aged care, and other service systems. SARRAH was established in 1995 as a network of rurally based allied health professionals and continues to advocate on behalf of rural and remote communities to improve access to allied health services that support sustainable health and well-being. SARRAH maintains that every Australian should have equitable access to health services wherever they live and that allied health services are fundamental to the well-being of all Australians.
Our perspectives draw from the feedback and advice from our members who are delivering services in rural and remote communities. In particular, our corporate member organisations are actively delivering services across large geographic areas and in some of the most remote parts of the country.
Allied health therapies are often vital to the development and future life course trajectory of Australian children. Unfortunately, access to those services — to identify need as well as to deliver capacity-building therapy and services — is greatly influenced by where a person lives, among a range of frequently compounding factors. Consequently, the critical window of opportunity to influence outcomes and make the biggest impact on a child’s development has often closed before families can access the services they need. Allied health workforce shortages and maldistribution mean waiting times of 12 months or more are not uncommon, especially in rural and remote Australia.
Population demographics: geographic considerations
To illustrate the challenges facing rural and remote Australians in accessing timely supports, SARRAH, in collaboration with University of Western Sydney and Charles Sturt University, commissioned a comparison of Australians who live more than 30 minutes’ drive from any occupational therapist (regardless of service availability or appropriateness)¹
¹ Hayes, K (2025) Comparison of Australians who live more/less than 30 minutes’ drive from any occupational therapist (unpublished data)
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2021 census data shows that more than 550,000 Australians live more than 30 minutes from an occupational therapist. Of these people, 470,932 (84.8%) live in Modified Monash areas 5 — 7. This cohort of people who live more than 30 minutes’ drive from an occupational therapist are at higher risk of adverse outcomes, with 126,548 (23%) being of preschool and school-age, and 88,311 (16%) identified as being of Aboriginal or Torres Strait Islander background.
This data demonstrates that Australians living in rural and remote communities face significant challenges in accessing occupational therapy and other services necessary to address developmental delay. It offers some explanation as to why the independent NDIS Review completed in 2023 found that 33% of participants residing in in small and medium rural towns (MMM 4 - 5) who have been in the scheme for at least one year are not accessing any therapy supports, despite having funding for these services.
The 2025 NDIS Pricing Arrangements which came into effect from 1 July 2025 saw significant changes limiting therapy provider travel, and for many providers will make delivering services into rural and remote communities unsustainable. Advice from our members operating in MMM 4-6 areas identified that NDIS participants in these areas are at risk of losing access to therapy supports essential for maintaining quality of life. Recommendations arising from the 2023 NDIS Review have not been implemented, leaving participants with no back-up plan should their current provider withdraw services².
Rural and remote considerations provide the context in which SARRAH will respond to the terms of reference for this inquiry, along the following themes:
- Parental supports
- What is known about existing programs and initiatives delivered in mainstream settings
- Equity and intersection issues
- Gaps in workforce support
- System interface issues
1. Parental Supports
Our members advise that while there are elements of care parents could provide to identify and support children with developmental delay, consideration should be given to the level of training parents will require to be able to identify issues in the first instance, alongside of what training they may need to be able to deliver support.
Programs that support parents to identify developmental delay and provide care places significant responsibility on the parents and assumes that all parents are starting from a level playing field. The 2021 census data shows that of those people living more than 30 minutes’ drive from an occupational therapist, 30% did not complete Year 12 (compared to 21% of those who live within 30 minutes of an occupational therapist). Variation in parents’ educational attainment is likely to impact on the success of this approach, and could entrench existing sociodemographic disadvantage.
Regardless of what training and support is made available, parents and carers will still require professional support to monitor their child’s progress and assess whether their child is
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responding as expected to the intervention. Escalation pathways will be required for those children who are not responding adequately to parental supports.
2. What is known about existing programs and initiatives delivered in mainstream settings
Members are aware of a range of programs and initiatives delivered by mainstream organisations that support children with mild to moderate development delay and/or autism. These vary substantially from region to region and from state to state. There is considerable variation in the approach and the settings in which these programs are delivered, and all are highly dependent on the available workforce. Consideration should be given to approaches that can be tailored to meet the needs of the child and the family supporting them. There is no “one- size-fits-all” solution.
While school-based models may offer logistical advantages, it is essential to recognise that effective support for children, particularly those who are neurodiverse, requires more than simply embedding services within educational settings. Allied health professionals must be engaged not only to support individual children, but to work collaboratively with families and schools to shift performance expectations and environmental demands. The goal should not be to compel children to conform to preferred behaviours or approaches, but to foster inclusive practices that accommodate diverse ways of learning, engaging, and participating. To do this meaningfully, allied health professionals should be physically present within school environments. Observing the interactions between children, teachers, and the broader school community is critical to understanding the contextual factors that influence participation and wellbeing. This kind of nuanced, relational work requires ongoing, in-person engagement to support sustainable change in school practices and culture.
3. Equity and intersection issues
As we have described, there are significant equity issues facing rural and remote communities in accessing timely assessment for children with developmental concerns, in addition to a lack of available programs to support children with identified needs. SARRAH is aware that families can wait for more than twelve months to access speech pathology services in rural and remote areas. For many children this delay presents a missed opportunity to provide interventions that ensure children can start school having reached essential developmental milestones. Such delays can have lifelong consequences for the child.
This inequity is likely to be reinforced by recent changes to NDIS pricing arrangements that disproportionately affect rural and remote service provision. The new travel limits are likely to mean more therapy supports will be delivered in virtual formats. While this may result in some improved efficiencies, participants living in rural and remote areas are more likely than their city-based peers to be forced to accept a greater proportion of services delivered virtually, contrary to best practice and not reflecting their individual needs.
But some therapy supports are complex and highly specialised, and therefore unsuited to virtual formats. Speech pathologists work with children with complex communication needs, supporting participants who have limited speech or are non-verbal to use customised assistive technology. Prescribing the right technology, customising it and training in its use requires face to face input and consistent follow-up to ensure learning sticks. These complexities make
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virtual modalities impractical. The situation is compounded by poor bandwidth and connectivity issues routinely faced by rural and remote Australians.
4. Gaps in workforce support
Inequitable access to early intervention is underpinned by longstanding and significant workforce maldistribution. Maldistribution of the allied health workforce - that is, a high concentration of allied health professionals per capita in metropolitan areas compared to remote areas - is more severe than for General Practitioners and Nursing, and is more like the distribution of the medical specialist workforce. Despite marked growth in the allied health workforce over the past decade, data comparing workforce distribution between 2019 and 2023 indicates maldistribution of the workforce has remained unchanged in recent years.
Figure 1: Workforce distribution by remoteness
Distribution of selected health professions by remoteness - Employed FTE per 100,000 popn - 2021
- The distribution pattern for AHPs follows that of non-GP medical practitioners - rapid decline with rurality.
- The drop in distribution, magnifies other access issues in rural and remote - such as distance, geography, lack of transport options, cost etc
- The distribution pattern is broadly similar for other AHPs not shown (to the extent data is available for comparison).
- GPs are included as a point of comparison.
Policies and programs that support the growth of an own-grown rural health workforce to deliver therapeutic interventions to vulnerable populations are lacking and urgently require investment.
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In particular, programs that support allied health professionals to retain a broad skills set to be able to respond to the needs of rural and remote communities are preferred to avoid service gaps arising from specialisation in discreet areas of clinical practice.
Allied health rural generalist training positions offer support to early career allied health professionals to embed clinical skills, grow in confidence and develop additional competencies shaped by community need. There is a growing body of evidence supporting rural generalist training for the allied health professions as an effective mechanism to develop and retain a fit- for-purpose rural and remote allied health workforce³.
5. System interface issues
Our members advise that they are frequently placed in the position of managing their clients’ transition from one program to another as their eligibility for support changes. Families struggle to access and maintain services, often forced to juggle multiple programs and funding streams as their loved ones’ needs change or as the system changes around them.
Our members described their efforts to assist clients to navigate pathways through health, education and disability systems, plugging gaps and finding work-arounds in order to maintain continuity of care. They identified many other families living in their communities in need of allied health services who are unable to access care because they do not neatly fit within a funding stream and cannot afford to pay, notwithstanding that our members are reluctant to turn people away. These system interface issues must be addressed to ensure children are not stranded between health, education and disability services.
SARRAH would be happy to contribute to or support development of the Thriving Kids Initiative, with regard to rural and remote health workforce wherever possible.
redacted
Yours Sincerely
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Cath Maloney Chief Executive Officer
³ https://sarrah.org.au/ahrgp-evaluations
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Appendix 1:
Comparison of Australians who live more/less than 30 minutes’ drive from any occupational therapist (regardless of service availability or appropriateness)
| More than 30 minutes from ANY OT | Within 30 minutes of ANY OT |
|---|---|
| 550,155 | 24,801,896 |
| 1,481 (0.3%) | 18,343,665 (74.0%) |
| 19,637 (3.6%) | 2,335,194 (9.4%) |
| 16,968 (3.1%) | 1,726,164 (7.0%) |
| 41,137 (7.5%) | 1,091,567 (4.4%) |
| 290,210 (52.8%) | 1,070,256 (4.3%) |
| 79,572 (14.5%) | 175,102 (0.7%) |
| 101,150 (18.4%) | 59,948 (0.2%) |
| 126,548 (23%) | 5,955,062 (24%) |
| 29,917 (5%) | 1,430,782 (6%) |
| 96,631 (18%) | 4,524,280 (18%) |
| 111,473 (20%) | 4,251,669 (17%) |
| 88,311 (16%) | 703,791 (3%) |
| 51,882 (9%) | 6,980,173 (28%) |
| 29,549 (5%) | 1,431,218 (6%) |
| 53,625 (10%) | 2,417,827 (10%) |
| 273,246 (50%) | 12,172,988 (49%) |
| 54,565 (10%) | 2,090,853 (8%) |
| 43,114 (8%) | 2,019,339 (8%) |
| 16,558 (3%) | 713,651 (3%) |
| 2,679 (0.5%) | 170,034 (1%) |
| 9,790 (5%) | 1,165,785 (5%) |
| 25,975 (5%) | 969,581 (4%) |
| 5,480 (1%) | 217,136 (1%) |
| 13,210 (2%) | 422,827 (2%) |
| 40,278 (7%) | 2,182,795 (9%) |
| 5,166 (1%) | 219,634 (1%) |
| 36,431 (7%) | 2,001,353 (8%) |
| 159,484 (29%) | 11,614,353 (47%) |
| 45,625 (8%) | 1,757,306 (7%) |
| 122,229 (22%) | 3,588,698 (14%) |
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| More than 30 minutes from ANY OT | Within 30 minutes of ANY OT |
|---|---|
| 32,204 (6%) | 1,780,223 (7%) |
| 134,507 (24%) | 4,683,664 (19%) |
| 93,920 (17%) | 4,524,327 (18%) |
| 55,815 (10%) | 3,207,523 (13%) |
| 32,896 (6%) | 2,100,239 (8%) |
| 22,553 (4%) | 1,550,614 (6%) |
| 13,325 (2%) | 1,001,746 (4%) |
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