Committee Secretariat contact:
PO Box 6021
Parliament House
CANBERRA
Canberra ACT 2600
Phone: +61 2 6277 4145
Health.Reps@aph.gov.au
Submission to Inquiry into the Thriving Kids initiative.
The recent announcement of the Thriving Kids initiative has raised many concerns with Speech Pathologists currently working in rural and regional public health services.
The demand for paediatric services for children who do not present with mild to moderate development delay, already far exceeds the capacity to provide timely access to services. This is further compounded by the lack of investment and development of paediatric allied health services in the public health space over the past 20-30 years. This was highlighted in the Henry Review of Health services for children, young people and families within the NSW Health system, 2019 and previously in the Garling Review (2008)
The removal of children with mild to moderate developmental delay from the NDIS to the Thriving kids initiative, has the potential to grossly increase demand for public health community based allied health services without significant capacity building (inclusive of infrastructure and human resources). Thriving Kids will create waiting lists for public health services the likes of which we have never seen. This will have considerable ramifications on access to services for priority populations which have no other access to affordable or local services. Eg. Children aged 0-5 years
Identify gaps in workforce support and training required to deliver Thriving Kids.
Since the introduction of NDIS, there has been no significant growth in the allied health workforce in public health providing the much-needed intervention and support for parents. Additionally, staff working in public health have been deskilled in the area of disability services. Many clinical staff work in the public health as their chosen career pathway which is requires a considerably different skill set to the provision of disability services. A considerable level of change management and support would be required to transition existing staff to the provision of disability services. Ther would also be a risk of staff exiting the system if they were forced to work in areas they were unskilled in or was outside their chosen career path.
The public health system is not currently resourced with the necessary physical spaces, clinical knowledge or financial support for clinically relevant professional development. Clinicians would be unable to personally bear the cost of this.
Variable models of operational management for paediatric allied health services in public services can create challenges to service delivery, recruitment and retention of skilled AH staff. There is no standardised multi-disciplinary model of care across local health districts in NSW. This has lead to significant variation and inequity of allied health services at a local level.
Psychosocial services are also resourced at a very low level or not at all for the paediatric population in public health. These are essential services in supporting parents and without these
1
services it creates a reactive model of care rather than a supportive model of care where families can be provided with information and education. This includes the disciplines: social work, counselling, psychology and genetic counselling. A model of care which reflects an integrated approach with all professionals providing services for kids, is required. Siloed models of care do not provide positive outcomes for children with developmental needs.
Given the history of NDIS and high costs associated with provision of care to children with mild to moderate developmental delay, Thriving Kids initiative needs to have high levels of organisational, strategic, clinical and professional governance to ensure families are receiving consistent evidence-based care and that resources are used efficiently and effectively.
Identify mechanisms that would allow a seamless transition through mainstream systems for all children with mild to moderate support needs.
Currently the unclear criteria for transition into the NDIS is a regular complaint for families. A clearly defined criteria for eligibility will essential for a successful program and transition through mainstream systems. Alongside this, there is a need for clear delineation for which services children with mild to moderate developmental delay are able to access. Public services should not be seen as a provider of last resort or to cover gaps in services, eg. to see children who are on waiting lists to access Thriving Kids services or the NDIS.
There also needs to be consideration given to the suitability of different service delivery models depending on the geographical location and individual needs of each child. For example, group intervention programs are often seen as a positive way of providing services to larger numbers of children at one time. This is often made untenable due to the distance rural and remote families have to travel to access services. Additionally, unreliable or expensive satellite internet access can and often makes joining virtual services difficult. Group settings may also not meet the needs of children with social anxiety or sensory issues which often present with mild to moderate developmental delay.
A locally trained allied health workforce is vital for supporting children in rural areas because it ensures consistent, culturally responsive, and community-embedded care. Unlike fly-in or visiting services, local clinicians can build long-term relationships with families, schools, and other professionals, providing continuity of care that is essential for children’s development. They also understand the unique challenges and strengths of the community, which helps tailor interventions to local needs. In contrast, visiting services are often limited by short contact times, long wait periods, and reduced opportunities for follow-up, making it harder to achieve sustainable outcomes for children and families in rural areas. Any workforce plans need to consider plans that invest in a local workforce.
Many regional, rural and remote public health services provide clinical services across the lifespan and are not predominantly paediatric, this would further reduce access to paediatric clients.
Summary
Considerable funding and workforce development would be essential if public health services were identified as an option to provide the allied health therapy services under the Thriving Kids initiative. As previously discussed, paediatric allied health services in public health have already been found to be underfunded and have seen inadequate workforce growth to meet demand.
2
It is essential that the models of care developed with Thriving Kids are considered at a local level. This would include input from local services regarding their physical resourcing, staff skills and capacity with other demands of their services. It cannot be a one size fits all approach. The assumption that there is a plethora of existing community-based services which could be redirected from NDIS to a new initiative is incorrect, especially in rural and regional locations. Children can still require the assistance of paediatric allied health professionals and not have a diagnosis of mild to moderate developmental delay. They also deserve to have equitable access to intervention services to ensure positive developmental, academic, vocational and health outcomes across the lifespan.
As Speech Pathologists working in rural and regional mainstream public health, we thank you for the opportunity to submit to the enquiry into the Thriving Kids initiative.
Rachael Lawrence
Member of Speech Pathology Australia Certified Practicing Speech Pathologist
Christina Mildren
Member of Speech Pathology Australia Certified Practicing Speech Pathologist
3