NDIA Accountability Project

NDIS Workforce: Universities Australia's Response

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SUBMISSION TO THE JOINT

STANDING COMMITTEE ON THE NATIONAL

DISABILITY INSURANCE SCHEME (NDIS): NDIS WORKFORCE

13 August 2021

INTRODUCTION

Thank you for the opportunity to respond to the Joint Standing Committee’s inquiry into the NDIS workforce. Universities Australia is the peak body representing Australia’s 39 comprehensive universities. Every member university delivers multiple health professions courses through which they educate and train virtually all new-entry health professionals in Australia. There is a critical link between university-based health professions education and future health workforce formation. Through this link, universities make a significant contribution to Australia’s health professional workforce. This workforce provides care across health, aged care and disability services.

Universities Australia takes a keen interest in health professions education and workforce policy. We maintain dialogue with the health, aged care and disability sectors and consult regularly with universities on these matters through Universities Australia’s Health Professions Education Standing Group (HPESG). HPESG comprises senior university leaders across all health professional disciplines and jurisdictions and is a unique forum in which multidisciplinary health professions education and workforce issues can be discussed (see information sheet attached).

Universities Australia continues to engage with the Department of Social Services regarding the NDIS workforce and the role universities can play. We have also encouraged dialogue between the NDIS, Health and Aged Care sectors given that these sectors share the same health professional workforce.

Universities Australia’s response to the inquiry is provided under Term of Reference g: any other matters. It focuses mainly on the critical link between health professions education/training and how experiences during formative educational years strongly influence graduates’ subsequent career choices and workplace preparedness. Our response also touches on several areas outlined in the inquiry’s other Terms of Reference (TORs). A list of the inquiry’s full TORs is at Appendix A.

RESPONSE TO THE INQUIRY’S TERMS OF REFERENCE

TOR G: ANY OTHER MATTERS

The growing need for disability workforce is well established. A recent Senate review and NDIS evaluation report have both identified significant unmet health workforce need within the NDIS, particularly for allied health professionals 1,2. The workforce need is greater in, but not limited to, rural areas. This is relevant to universities because they educate most of the new entry allied health, dentistry, medical and nursing

Workforce Development

The role of universities in shaping future workforce outcomes across multiple domains including health, aged care and disability cannot be overstated.

In 2019, there were over 310,884 university enrolled students studying health-related courses$^{\text{3}}$. Many will enter these sectors upon graduation significantly increasing our pool of qualified professionals. However, where new graduates choose to establish their careers often reflects experiences gained during studies rather than just academic qualifications alone.$

While some policies have acknowledged this connection $^{ ext{4}}$, it’s frequently overlooked how crucially important higher education institutions are for both forming as well as distributing skilled personnel within healthcare fields throughout various stages along career paths. Early educational encounters play an especially influential part determining later decisions regarding employment locations or types of work undertaken after completing degrees.

Clinical Experience & Placements

All undergraduate programs preparing individuals towards becoming licensed practitioners require supervised practical training opportunities inside actual service environments - commonly known either ‘clinical experience’ or simply referred-to-as placements’. These provide invaluable hands-on learning moments alongside experienced colleagues while simultaneously reinforcing theoretical concepts taught at campuses through direct interaction with patients/clients under professional guidance from established experts working directly on site.

There exists strong correlation between areas chosen by trainees when undertaking such fieldwork activities versus eventual workplaces selected post-graduation: quality exposure greatly increases chances that former pupils return back into similar contexts once fully certified. Exposure across diverse settings also enhances readiness levels amongst emerging workers entering full-time roles beyond mere technical competencies required before obtaining official status; understanding cultural nuances specific per sector plus awareness about differing operational models helps newcomers adapt quickly upon starting jobs without needing extensive additional orientation periods typically needed otherwise.

Educational establishments offer these kinds of immersive experiences covering wide array ranging disability support services among others although recent shifts have led to fewer available spots particularly related disabilities due mainly because:

  • The shift toward client-driven NDIS model has resulted in more private practice oriented delivery systems within this area (especially affecting allied health professionals who often operate independently);
  • There’s currently no financial incentive provided for non-medical staff involved teaching students during clinical rotations;
  • Supervisors aren’t able claim reimbursement via Medicare Benefits Schedule nor clear guidelines exist regarding billing practices applicable specifically towards student-provided care under National Disability Insurance Scheme framework;
  • Limited availability nationwide concerning potential supervisors capable providing adequate oversight combined lack comprehensive databases accessible locally identifying suitable candidates willing participate;
  • Complex regulatory requirements facing practitioners wishing become registered providers themselves within disabled person service industry.

All health practitioners provide care to a diverse range of clients, including those with disabilities.

However, The above factors combine to deter many private practice allied health and other practitioners from offering services and supervision under the NDIS. It also prevents services from harnessing the well-established benefits that students bring to practices 6,7. These NDIS workforce implications have an impact on the degree to which people with disabilities can access services.

Health professionals play a key role in supporting people with disability to maintain or improve their independence, quality of life and ability to exercise their personal choice and control. To achieve these health and wellbeing outcomes, at least two workforce dimensions need to be addressed:

  • Firstly, we need a greater overall number of health professionals to choose to work specifically in the NDIS/disability sector. Evidence suggests this is especially true for allied health professionals, in particular physiotherapists, podiatrists, occupational therapists, psychologists, social workers, speech pathologists and audiologists.
  • Secondly, we need to ensure that our overall health workforce is disability-aware, whichever service domain they choose to work in.

Universities can assist with this through facilitating significantly more clinical experiences for students with disability service providers. However, mechanisms need to be put in place to overcome the barriers outlined above and enable health professional students to access supervised placements with disability providers/practitioners. Helpful steps towards this include:

  • introducing a student supervision payment to health practitioners providing disability care, especially private allied health providers, given that allied health is an area of identified, significant unmet workforce need under the NDIS;
  • developing a national database, able to be analysed at more granular levels, of disability health service providers. Data would include provider capacity/willingness for student supervision. Primary Health Networks are well positioned to facilitate this data collection.
  • potentially developing an NDIS specific clinical placement software system that could support student placements by showing where unused/available clinical placement capacity existed and where it could be built up
  • offering an initial, short-term disability-provider placement fund to universities. The fund could be used specifically for universities to work in partnership with disability providers /practitioners to increase practitioner supervision capacity and disability-specific student clinical experience. Effective examples of these approaches already exist in other domains and can be used as models8,9.

The NDIS National Workforce Plan 2021-2025

The NDIS National Workforce Plan 2021-2025, announced in early June 2021, shows promise in that it recognises the pipeline approach to workforce development. The aim of Initiative 9 under the Plan’s Priority Area 2 (Train and support the NDIS workforce) is to “Support the sector to grow the number of traineeships and student placements, working closely with education institutions and professional bodies”. The Plan suggests that:

6 Health Education and Training Institute (HETI) and NSW Interdisciplinary Clinical Training Networks (ICTN) 2015: Clinical Placements in NSW, 2015.:https://bit.ly/37d5Nfo 7 Buchanan et al 2014. Student clinical education in Australia: A University of Sydney scoping study. The University of Sydney 8 Final Report Royal Commission into Aged Care Quality and Safety 2021: https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1_0.pdf 9 TRACS to the Future: National Evaluation of Teaching and Research Aged Care Service (TRACS) Models supported through the Aged Care Workforce Flexible Fund: Final Report 2015 https://digital.library.adelaide.edu.au/dspace/bitstream/2440/123068/1/Barnett_National_Final_P2015.pdf

  • “Education providers, disability providers and state and territory governments need to work together to re-establish pathways between education and industry that may have been disrupted through the introduction of the NDS”; - “Governments will explore how training organisations, tertiary institutions and professional bodies can be supported to increase the number of traineeships and student placements offered in the sector: – Tips and guidelines about offering effective traineeships in the NDIS workforce will be developed by industry and governments. – Traineeships will be promoted to various cohorts (e.g., students, workers transitioning from other industries). – Governments will work with tertiary institutions and professional bodies to explore how student placements can be delivered efficiently in a disaggregated market. Initial stakeholder engagement on the NDIS workforce plan has been undertaken and details of further action are awaited.

Collaboration between educators, disability providers and governments is important. There is good evidence that collaborative partnerships between universities and service providers to expand placement models within services brings short and longer-term workforce gains.

However further action and additional support is needed at the Commonwealth level and between portfolio areas: many of the barriers to student placement listed above could be addressed through Commonwealth policy reform in health and disability. Effective steps towards addressing the identified NDIS workforce needs could be taken by establishing:

  • a mechanism to enable multistakeholder NDIS workforce development collaboration; and
  • policy to support extended placements in disability services through partnerships between universities and disability service providers. Evidence from other areas shows that this approach is effective.

Appendix A: NDIS Workforce Inquiry - Terms of Reference

As part of the committee’s role to inquire into the implementation, performance and governance of the National Disability Insurance Scheme (NDIS), the committee will inquire and report on the workforce providing NDIS services (the NDIS workforce), with particular reference to:

  • The current size and composition of the NDIS workforce and projections at full scheme;
  • Challenges in attracting and retaining the NDIS workforce, particularly in regional and remote communities;
  • The role of Commonwealth Government policy in influencing the remuneration, conditions, working environment (including Workplace Health and Safety), career mobility and training needs of the NDIS workforce;
  • The role of State, Territory, Commonwealth Governments in providing and implementing a coordinated strategic workforce development plan for the NDIS workforce;
  • The interaction of NDIS workforce needs with employment in adjacent sectors including health and aged care;
  • The opportunities available to, and challenges experienced by, people with disability currently employed, or wanting to be employed, within the NDIS workforce; and
  • Any other matters