Submission to the enquiry into NDIS participant experience in rural, regional and remote Australia
Date: 6 March 2024
**Recipient Information:“ Ms Libby Coker MP Chair Chair, Joint Standing Committee on the National Disability Insurance Scheme PO Box 6100 Parliament House Canberra ACT 2600 Via email Dear Ms Coker,
Submission Overview:
Thank you for the opportunity to provide you with a submission into your current inquiry regarding NDIS participant experience in rural, regional and remote Australia, and for granting us an extension.
Marathon Health is a not-for-profit registered charity operating largely in regional NSW and VIC. Our 300 staff provide Primary Health services to vulnerable people, wherever they choose to live. hhttps://www.marathonhealth.com.au/
We currently provide NDIS capacity building (therapy) supports and Positive Behavior Supports for more than 650 participants in regional NSW and VIC, including speech therapy, occupational therapy and positive behavior support. We operate out of two main hubs; Dubbo and our office on the Albury campus of Charles Sturt University (CSU), and provide regular drive-in, drive-out (DIDO) and fly-in, fly-out (FIFO) services to small communities across western, central and southern NSW, including Walgett, Bourke, Bathurst, Grenfell, Deniliquin, Hay and all the way down into Bonnie Doon in regional VIC. We have 13 Speech Pathologists, 13 Occupational Therapists and 15 registered PBS Practitioners.
In addition to direct service delivery, we are committed to developing the rural allied health workforce of the future, particularly in disability. This is the primary driver behind our colocation on the Albury CSU campus. Last year we hosted nearly 80 student placements from 12 universities with the aim of showcasing the quality and value of work in the disability sector and the lifestyle on offer in regional centres. We are fortunate that ten percent of our students choose to join us in our mission as new graduates.
Here is a link to two recent case studies outlining our speech, OT and behaviour support work in regional communities.
We are here for participants in regional settings and have been strong advocates since the scheme’s rollout around the regional participant experience and the challenges that providers face providing high-quality, person-centred supports in thin markets.
Our submission outlines the opportunities and limitations of the scheme regarding NDIS capacity building (therapy) supports for rural/regional people across their life stages and our thoughts about how the NDIS review recommendations will assist to alleviate some of the issues that our participants, and our organisation, currently face.
Contact Information: T: 1300 402 585 ABN: 86 154 318 975 marathonhealth.com.au
Overview
More than 2000 NDIS participants living in 13 Local Government Areas (LGAs) across Far Western NSW face substantial barriers to using NDIS therapeutic supports. Close to $14million in committed NDIS therapy funding went unspent by this group last year. Plan utilisation rates range from 24% to 55% among these remote and First Nations communities. This underutilisation has persisted in Far Western NSW ever since public data on the NDIS market was first published.
The example above highlights the magnitude of the issue impacting the participant experience in the regions we service in NSW and northern Victoria. The common experience is no service; that is the barriers inherent in the system mean that many people with disability in rural/regional areas receive no therapy services, despite being eligible and having a current plan.
Three main factors impact the ability of people with disability to access therapy supports in the rural/regional areas we serve.
- Service connectivity and collaboration
An early focus of the National Disability Insurance Scheme was to create competition between providers. This was actively propagated by the NDIA under the belief that competition between providers would increase quality, drive down prices and create greater choice and control for participants.
What has actually happened, especially in regional areas, is that the relationships that existed between service providers in smaller communities have been fractured and are only just starting to rebuild. For our participants, the value they could derive from providers collaborating isn’t there.
The case study linked above outlines a great working relationship between Marathon Health and Aboriginal Controlled Organisation Birrang in Bourke NSW. This relationship is building on the strengths of both organisations, with Birrang offering service navigation and family support to participants in place, with Marathon Health’s regular DIDO and FIFO services providing assessments, therapeutic supports, goal setting and progress updates.
It’s important to note that relationships and outcomes like this are happening outside the NDIS. Despite both organisations being registered NDIS providers, it’s difficult to make these arrangements work within the current scheme structure.
- Workforce availability
The system-wide shortage of allied health clinicians in Australia is well-documented, with shortages exacerbated in regions and further exacerbated in the disability sector, due to the complexity of the work and intense competition for workforce. To make the most of this scarce resource to support more participant outcomes, we need clinicians to work to the top of their scope, supported by other providers who can hold participants and their families in between visits, help them to navigate system complexity and implement their therapy plans.
The current price guide offers no incentive for organisations like ours to develop innovative service delivery models that would enhance the availability of allied health services for participants in thin markets. For example, delegated models or group therapy models. The main therapy model that is incentivised through the price guide is one-on-one support, which doesn’t make the most of the limited allied health clinical resources available, especially in regional areas.
Service availability and sustainability
In 2022, modelling by Deloitte Access Economics showed a 7.1% gap between the NDIA price limit ($193.99) and the fully loaded cost to deliver an hour of therapy supports ($207.81) and with CPI increases since then, there is now an estimated 13-14% gap between the price limit and the cost-of-service provision.
According to the Ability Roundtable, registered providers of therapy supports show median losses of 14% in the 2022-23 financial year. A projection for the 2024-25 financial year, which assumes that the price cap for therapy remains unchanged, indicates a median loss of 14.2%.
We currently decline referrals and do not go to certain towns to provide services when the scheme limits our ability to recover the cost of travel, making this service unviable for us and reducing the services available for participants.
We have developed philanthropic partnerships to assist with the cost of travelling (flights) to increase access to services in smaller, more isolated communities where the scheme pricing will not cover the cost or it would be prohibitive to the participants to pass the cost on.
We are currently in partnership with the Variety Club of Australia working on a project to support increased access to specialist assessment services in Lightning Ridge and Walgett. The Principal of Walgett Public School says that he knows of 18 children that would be ready for immediate referral if we were able to run a pediatric clinic.
The participant experience
The table below outlines some of the factors impacting the experience of the rural/regional participants across three broad cohorts.
| Top issues impacting participant experience from our perspective | |
|---|---|
| Early childhood | • Lack of access to supports to assist with NDIS eligibility e.g. assessments |
| • Families and carers overburdened by system complexity, navigation and support for their children | |
| • Families having to travel long distances (5 hours) to access therapy supports | |
| • Lack of coordination/collaboration between services means that kids can be on a waitlist waiting long periods to be assessed only to find they are waiting on the wrong list | |
| Complex adults | • Lack of capability in regions around PBS implementation, leading to poor outcomes for participants, often stuck in hospitals until plans can be developed |
Top issues impacting participant experience from our perspective
- De-skilling of the support coordination function due to the price guide not supporting the retention of qualified people
Psychosocial disability • Access to registered behavior support is impacting rural and remote communities - to exit hospital and return to appropriate supports.
- Lack of provider capability leading high numbers of social admissions to hospital
Recommendations
Marathon Health welcomes the NDIS Review recommendations. The table below outlines how key recommendations will address some of the issues outlined above.
Key Recommendation Benefits for rural/regional participants and solution for issues outlined
Recommendation 1: Develop Foundational Supports: Jointly design and fund a broad range of disability supports, outside individualised NDIS budgets, including for people with disability not eligible for the NDIS and whose needs cannot be met through mainstream services. We see that this will provide much needed support in place for participants, particularly in early childhood. The ability for families to access some ECEI supports within mainstream settings, such as schools, will reduce the stress on vulnerable families.
Recommendation 3: Streamline Participant Pathways: Introduce consistent processes for NDIS access and budget setting, focusing on individual needs. A focus on the whole person as part of planning processes should consider place-based impacts, such as the availability of services.
Recommendation 4: Improve Navigation of Services Establish local and specialist navigation functions to help people with disabilities access community supports. In some instances, up to 50% of a participant’s therapy budget can be used supporting them and their family/care community to navigate supports. The introduction of specialist navigation in rural/regional areas will allow clinicians to work to the top of their scope, adding the value that they can uniquely provide for participants and allow others to provide vital confidence-building and access skills.
Recommendation 6: Focus on Children’s Needs Invest in a range of supports for children under 9, reforming the NDIS pathway and early intervention processes to Age 9. We hope that this will reduce the gap between mainstream and disability supports for children and their families, reducing the stress on navigating fractured pathways in rural/regional areas.
Key Recommendations
Benefits for Rural/Regional Participants and Solution for Issues Outlined
Recommendation 7: Revise Psychosocial Disability Approach Implement Recovery-Focused Strategies and Better Coordinate Care for Complex Needs.
In our experience, psychosocial disability is a secondary disability in many of the complex people we work with. These participants are being bounced around the system due to lack of capability within disability accommodation providers and end up with police, in an ambulance and then in hospital as a social admission. The development of early intervention pathways and sector capacity building around psychosocial disability is critical to reduce traumatizing events for complex participants.
Recommendation 14: Improve Access to Supports for First Nations Participants Across Australia and for All Participants in Remote Communities Through Alternative Commissioning Arrangements.
This will create opportunities for partnership approaches like the one described above between Birrang and Marathon Health in Bourke, drawing on the strengths of partners and sharing capabilities across the sector for the benefit of rural/regional participants.
Recommendation 15: Attract, Retain and Train a Workforce That Is Responsive to Participant Needs and Delivers Quality Supports.
As mentioned above, Marathon Health invests significantly in the development of the regionally based allied health workforce to work in the disability sector, both tertiary and VET-trained. This investment benefits the industry as a whole and is entirely at our own cost. We have significant experience in the approaches that work, and we welcome the focus on the attraction, retention and training of the workforce for the sector.
We would welcome the opportunity to discuss our experience in more detail if it would be useful to the enquiry. You can contact me on 0428 246 480 or jessica.brown@marathonhealth.com.au for more information.
Yours sincerely,
Jessica Brown General Manager – Strategic Policy
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