Joint Standing Committee Inquiry:
National Disability Insurance Scheme (NDIS) planning
Pre-Budget Submission 2019–20 | AOPA 1
Orthotics and Prosthetics in Australia
Orthotist/prosthetists assess the physical and functional limitations of people resulting from disease, illness, trauma and disability, including limb amputation, diabetes, arthritis and neuromuscular conditions, such as stroke. Orthotic and prosthetic services may involve the provision of orthoses and prostheses to restore function, prevent deterioration, and improve quality of life. Orthotist/prosthetists are commonly employed in Australian hospitals, private clinics, research institutions as well as rural and remote regions, working independently and as part of multidisciplinary healthcare teams to support the Australian community.
Orthotist/prosthetists are tertiary qualified allied health professionals. An Australian Qualification Framework level 7 is required to practice as an orthotist/prosthetist in Australia, consistent with education standards for other allied health professions. Orthotic/prosthetic students complete training alongside physiotherapy, podiatry and occupational therapy students.
The Australian Orthotic Prosthetic Association (AOPA) is the peak professional body for orthotist/prosthetists in Australia, with certified practitioners comprising 80% of the practicing profession. AOPA is responsible for regulating the profession and is a founding member of the National Alliance of Self Regulating Health Professions (NASRHP) in partnership with other professional organisations, including Speech Pathology Australia, the Australian Association of Social Workers and Exercise and Sports Science Australia. AOPA is recognised by the Commonwealth Government as the assessing authority responsible for conducting migration skill assessments for orthotist/prosthetists.
Leigh Clarke Chief Executive Officer
Planning and Orthotic/Prosthetic Services
The Australian Orthotic Prosthetic Association (AOPA) an ordinary life in accordance with their personal goals.
welcomes the opportunity to contribute to the AOPA is committed to working closely with the National
discussion on NDIS planning through the Joint Standing Disability Insurance Agency (NDIA) to ensure both
Committee Inquiry into NDIS Planning. administrative costs are minimised, and choice and
control is exercised by participants, allowing
AOPA is the peak professional body for orthotist/prosthetists to provide optimal services whilst
orthotist/prosthetists in Australia. Orthotist/prosthetists ensuring value for money.
are tertiary qualified allied health professionals who
assess the physical and functional limitations of people The planning process is an integral aspect of the NDIS
arising from illness, limb-loss and disability. to support participants to exercise choice and control.
Orthotic/prosthetic services typically include, but are Participants use many formal and informal supports
not limited to, the assessment, prescription, design and when preparing for their planning meeting, including
fitting of a wide range of orthoses and prostheses which information provided by their orthotist/prosthetist. The
support an individual to achieve their functional and planning process is highly dependent on the knowledge
participation goals. and capacity of participants and Planners to ensure the
plan doesn’t omit important supports, incorrectly
categorise supports or omit ongoing services and
consumables. Engagement with an orthotist/prosthetist
by the participant or Planner will assist the planning
process and limit the likelihood of these omissions
occurring.
The experience, expertise and qualifications of
Planner
Participants and practitioners often communicate with purpose of approval, and the clinical service to assess
Planners who demonstrate limited experience, expertise and collaborate with the participant in order to build the
and qualifications specific to orthotic/prosthetic quote should be supported under support code
services. This includes limited knowledge of 15_047_0135_1_3 – Selection And/Or Manufacture Of
orthotic/prosthetic devices and services, a lack of Customised Or Wearable Technology.
registration and support catalogue arrangements for orthotist/prosthetists, and a lack of
allocation for the clinical assessment component in a plan, or funding for this service is incorrectly allocated
to a different support code, such as the registration group number 0128 for Therapeutic Supports.
Omission of primary support items, such as orthoses Orthotist/prosthetists are unable to claim for services
and prostheses that they are not registered for. This results in the
participant initiating a plan review.
Planners often do not have the requisite experience
relating to orthoses and prostheses and therefore these Omission of ongoing services and consumables
supports are often overlooked during the planning
process. AOPA certified practitioners report numerous The limited knowledge of orthotic/prosthetic devices
instances of participants seeking a new and services by Planners results in plans missing vital
orthosis/prosthesis once their plan is approved, but orthotic/prosthetic ongoing supports and services. For
where an orthosis/prosthesis has not been included in example, where a Planner is unfamiliar with the
the plan. It appears the orthosis/prosthesis is either longevity of consumable items, such as prosthetic liners,
overlooked in the planning process or that assumptions sleeves or foot shells, then the Planner may not allow for
are made regarding the longevity or appropriateness of these within the planning process. The omission of
the participants current prosthesis. Greater ongoing supports and services results in a participant
orthotic/prosthetic knowledge or prompts to initiate a experiencing extended delays whilst a plan review
conversation with the participant and/or consult the occurs and continuing to use items that have perished
participant’s orthotist/prosthetist are encouraged. and require replacement. In cases where vital supports
and services are missing, participants will need to
Incorrect categorisation of supports in the plan initiate a plan review and will experience a delay in
Many Planners are not aware that orthotist/prosthetists service delivery.
provide both clinical prescription and assistive Recommendations:
technology and have different registration requirements
to other allied health and assistive technology - AOPA recommends that Planners receive education on
providers. Planners are often unfamiliar with registration orthoses and prostheses. Having Orthotic Prosthetic profession specific knowledge will allow Planners toand support catalogue arrangements for develop plans with appropriate supports and reduce the
orthotist/prosthetists, and therefore it is not uncommon need for plan reviews.
for a plan to be developed with allocation of - AOPA recommends that Planners are consistent in theirorthotic/prosthetic related devices and services under application of the NDIS supports catalogue.
incorrect catalogue support codes. Prosthetic devices
(excluding Low Cost AT) require a quote for the
Participant involvement in planning processes and the efficacy of introducing draft plans
Participants are experts in understanding their own communication issues during the planning process. future needs in relation to daily living and life goals, Introducing draft plans will allow participants to reflect on the planning conversation, provide additional evidence or information to support decision making or to seek support both formal and informal to ensure all their needs have been adequately communicated and captured. Introducing draft plans will increase a participant’s choice and control over their plan. Recommendation:
AOPA recommends that draft plans are systematically used as a mechanism for participants to fully exercise their choice and control over their plan, and to ensure all reviews. their needs are adequately met by their plan. The introduction of draft plans for participants with complex support needs would support the principles of choice and control and decrease the need for plan reviews associated with misinterpretation and
Pre-Budget Submission 2019–20 | AOPA 5
The review process and means to streamline it
Plans may be reviewed either because a participant Given the varying reasons for a plan review, there are opportunities to streamline the process and reduce the impact on participants. Processes to triage plan review requests based on change in circumstances, omissions and/or inadequate funding allocations could streamline the process and reduced plan review delays.
A plan review is required where a participant’s initial plan is either missing an orthosis /prosthesis, supports or services are allocated incorrectly, or plans are missing ongoing services and supports crucial to a participant’s orthosis/prosthesis. In these instances, whereby omissions and/or administrative errors have occurred, it is unreasonable that participants should not have to durend a lengthy delay associated with the typical plan review process. It is therefore AOPA’s position that the review process must be streamlined and simplified for these cases of planning error.
Recommendations:
- The NDIS should adopt a triage procedure to address planning omissions and administrative errors and in a timely mannerplan reviews due to planning omissions in the first instance.
Recommendations
The Australian Orthotic Prosthetic Association has Recommendation two identified several issues with current planning relating to orthotic/prosthetic services and impacting the delivery Addressing participant involvement in planning of timely services to participants. processes and the efficacy of introducing draft plans:
We provide recommendations for consideration to AOPA recommends that draft plans are systematically assist with improving and streamlining the planning used as a mechanism for participants to fully exercise their choice and control over their plan, and to ensure allprocess. their needs are adequately met by their plan Recommendation one Recommendation three
Addressing the experience, expertise and qualifications Addressing the current review process and means to of Planners: streamline it:
AOPA recommends that Planners receive education on The NDIS should adopt a triage procedure to address orthoses and prostheses. Having Orthotic Prosthetic planning omissions and administrative errors and in a profession specific knowledge will allow Planners to timely manner develop plans with appropriate supports and reduce the nee d for plan reviews. AOPA recommends that Planners are consistent in their application of the NDIS supports catalogue.
7 AOPA | Joint Standing Committee Inquiry – NDIS Planning