NDIA Accountability Project

Providing Assistive Technology in the National Disability Insurance Scheme

‹ PrevPage 1 of 4 · Source p. 1Next ›

Providing Assistive Technology in the National Disability Insurance Scheme

Summary

ATSA fully supports the establishment of a National Disability Insurance Scheme, and believes the following measures must be undertaken if assistive technology (aids and equipment) are to be effectively provided within the scheme:

  • The establishment of a single national assistive technology scheme across the NDIS and NIIS
  • The establishment of a national AT accreditation system for suppliers and prescribers
  • Recognition of the central role AT suppliers play in delivering good outcomes for consumers, including: customised equipment solutions; trials in the home; and ongoing support, maintenance and repairs
  • Avoid bulk procurement approaches at the complex end of the AT spectrum
  • Consideration of total lifetime costs of the equipment when making purchasing decisions: durability, maintenance, repairs, training, and upgrades
  • Flexibility in tendering and bulk procurement for rural and remote settings

Background

Assistive technology (AT) is central to minimising long-term costs and improving the lives of people with disabilities. Effective AT provision will help ensure that the NDIS is affordable and economically sustainable.

AT Products Categorisation

AT products are often categorised in three main groups: personal care; communication; and mobility. AT varies from simple and inexpensive products such as aids to open cans or cut up food, shower chairs and canes, through to very complex and high tech equipment such as a powered wheelchair with customised seating and controls (see the AT Pyramid).

The World Health Organisation defines AT as:

an umbrella term for any device or system that allows individuals to perform tasks they would otherwise be unable to do or increases the ease and safety with which tasks can be performed.

About ATSA

ATSA was established in 2000 to represent the interests of AT suppliers who manufacture, import, distribute, service, and hire equipment. ATSA members range from small, family-owned businesses to international companies.

A viable and competitive supplier sector is pivotal to ensuring choice and flexibility for people with disabilities within the NDIS.

The Assistive Technology (AT) Pyramid

AT varies widely in complexity, and this variation requires different supply-chain and procurement approaches to ensure good quality outcomes for consumers while minimising costs (see the AT pyramid below).

Creating a national AT system will enable the National Disability Insurance Agency to achieve significant savings through competitive tendering and bulk purchasing across the two bottom layers of the AT pyramid.

These tendering and bulk purchasing arrangements must be done in consultation with both consumers and suppliers to help ensure that the intended procurement cost savings are achieved while at the same time providing a high degree of consumer choice and control.

However, the top segment of the pyramid – encompassing AT that is very complex, expensive and at high risk of failure if not done well – is not amenable to tendering and bulk purchasing arrangements and will require purchasing structures that support the uniqueness and complexity of the AT at this level.

For this ‘top’ segment of the market, utilisation of appropriately accredited suppliers is essential. An approved provider structure of suppliers with the highest levels of accreditation would ensure the necessary high levels of skills, training, experience and capacity to support complex AT solutions.

Effective AT can be life changing for someone with a disability, and have positive economic impacts regarding independence, participation and health outcomes – when it is done well.

Individualised Procurement Essential at This Level: Low Volume/High Cost

Highly Customised Power & Manual Wheelchairs,

complex seating, high end pressure care, complex motor vehicle modifications, etc.

Highly Complex AT

Electric homecare beds, scooters, standard power wheelchairs, oxygen concentrators, patient lifters, mid-level pressure care, basic motor vehicle modifications, etc.
Moderately Complex AT

Standard wheelchairs, basic pressure care cushions, rollators, crutches, daily living aids, furniture, bathroom/toilet aids, ramps, etc.

####### BASIC AT

Potential for bulk procurement at this level: high volume/low cost

Role of Suppliers

ATSA members, and AT suppliers generally, deliver many essential services that are vital to ensuring that people with disability get the equipment they need. This includes:

  • Importers/manufacturers/distributors – known as ‘sponsors’ within the Therapeutic Goods Administration’s (TGA) framework

    • sourcing products, including research and development of new products

    • information on the availability, function, and detailed specifications of AT products that are TGA listed and meet Australian/international standards

    • training and education for therapists and retailers

    • product inventory and spare parts – immediate availability is essential for many products, especially spares for ‘life critical’ items such as wheelchairs, pressure mattresses and hoists

    • warranties; quality assurance; standards testing and regulatory compliance; product recalls; and participation in the review and development of Australian standards

    • Loan products to ILCs (Independent Living Centres) and major specialist facilities (e.g. spinal care and rehabilitation)

  • Retailers/Local Suppliers:

    • Assist consumers with appropriate product selection, often in conjunction with prescribing health professionals such as occupational therapists, physiotherapists and speech therapists

    • At the middle and top of the AT Pyramid retailers/local suppliers are the primary source of expertise regarding specific product selection, measurement, customisation/modification and fitting – getting this ‘right’ is fundamental to good consumer outcomes, and requires a very significant investment in staff training

    • Trialling AT – making equipment available for consumers to take home and trial to ensure appropriateness (e.g. which hoist will work in that space and which sling is most suitable) and to determine exact specifications for more complex AT seating for a wheelchair. This includes undertaking training in use of trial equipment

    • Order, assemble and deliver AT products, including final fitting and adjustments, and consumer/carer training and other assistance as needed

    • Service, maintenance and repairs

Prescribers and consumers both rely on the expertise of suppliers in identifying and bringing to fruition the best AT solution. For consumers whose needs are at the middle and higher end of the AT pyramid, suppliers and therapists work together to develop the detailed specifications to configure the AT to the person’s capacities and body. Suppliers then procure, assemble, test and trial the solution with the consumer, usually with oversight from the prescriber.

Rural and remote settings

Timely and efficient supply, support, maintenance and repair of AT in rural and remote communities requires a high degree of flexibility in relation to procurement – particularly in relation to tendering and bulk purchasing.

There are relatively few suppliers in rural and remote communities as meeting the needs of a very wide range of consumers is difficult to do economically with low profit margins and significant additional expenses.

The range of inventory for both equipment and spares, and the depth and variety of skills required to ensure the consumer gets the right product, and that it is configured and customised appropriately, along with the problems of distance and travel times and costs, are major challenges when population densities are low.

Tendering and bulk purchasing arrangements must carefully take into account AT provision in rural and remote communities. Tendering and bulk purchasing in several state programs has resulted in absurd situations such as where an urban supplier has the contract, so a consumer must wait for weeks to get a piece of equipment to trial – but the local supplier has the appropriate piece of equipment • providing nationally consistent standards, quality, and could supply it within a day or two. transparency, accountability and safeguards for AT prescription and supply Similarly, at the bottom end of the AT triangle contracts for supply of high volume low cost equipment held by individual • supporting a market-based approach, including large suppliers can ultimately reduce the capacity of local competition, consumer choice and control, and rural and remote suppliers to operate viable businesses and assisting people with disabilities to readily identify service their local communities. appropriate sources of expertise and assistance

ATSA proposes that the NDIA’s procurement strategies • ensuring minimum AT supply-chain transaction guarantee that bulk purchasing arrangements take into account costs and time if prescriber accreditation is linked to the value and advantages of local suppliers in rural and funding authorisation, as well as minimising delays and remote areas: relationships with local consumers; timely reducing risk supply; timely maintenance and repairs; local support and training for consumers and carers. Many rural and remote Accreditation for suppliers should be linked to their capacity suppliers also have a wide range of essential skills related to to match consumers to the right equipment and to support ensuring the right fit between the consumer and their AT, and and maintain that equipment, and at the higher end of the knowledge of local conditions and needs. Additionally, most AT Pyramid their capacity to do the complex and detailed of the cost savings from tendering and bulk procurement will fitting and customisation required. For prescribers be realised in urban areas, so the value of extending these accreditation should be linked to different levels of expertise to rural/remote areas should be carefully examined. and different areas of practice such as mobility, seating, vehicle modifications and communication. Accreditation ATSA proposes a two-stage approach, with an independently ATSA’s Code of Practice for members ensures fair, ethical commissioned options paper exploring the best alternatives and consistent provision of equipment and services to for an accreditation system as the first stage. The second consumers with disabilities and older people, and stage would be securing funding to underwrite the effectively safeguards all stakeholders’ interests. establishment and operation of an accreditation body for three years, when it should then be fully self-sustaining. However, there is still a pressing need for the development This process needs to proceed immediately, and should and implementation of a national accreditation system involve key stakeholders such as ATSA, ARATA (Australian for AT prescribers and suppliers as the most effective and Rehabilitation and Assistive Technology Association), conomical way to meet many of the High Level Principles OT Australia, AFDO (Australian Federation of Disability for an NDIS in relation to AT, including: Organisations) and Carers Australia.

Dr Michael Summers Chris Sparks Senior Policy Advisor Executive Officer

www.atsa.org.au | P: (02) 9893 1883 | F: (02) 8212 5840 A: Level 7 - 91 Phillip St, PARRAMATTA, NSW 2150