15NRHC Recommendation - 03/27/2019 - 11:47

Since the roll out of the NDIS, a crisis has developed in the availability and delivery of disability services in regional and remote Australia. This is due to the thin markets in smaller communities that make delivery of fee for service clinical operations nonviable. In summary, the current factors that contribute to this include:
1. Not enough Allied Health Professionals present in these areas.
2. The burden of unrecoverable operating costs. This includes time required to:
a. Support participants engage with the scheme (e.g. education about the scheme and processes of access and planning processes, support to make decisions to engage with the scheme). Additional support is needed to enable organisations to do this vital work.
b. Ensure clinicians meet basic professional development requirements. Clinicians are not able to attend professional development and remain up to date. Support to attend professional activity is essential
c. Travel beyond 45 mins in MM5. This prohibits service delivery.
3. No access to information to inform strategic operating decisions in thin markets. This prohibits planning for service delivery in small communities. Access to basic information would encourage services to consider innovative service models
4. Limited allocation of specialist and multidisciplinary items to deliver these services in complex cases. This results in poor plans and inadequate service delivery. Specialist planning services are required to ensure best practice models of care for complex child and adult cases (e.g. severe mental illness and developmental disability).
Since the roll out of the NDIS, a crisis has developed in the availability and delivery of disability services in regional and remote Australia. This is due to the thin markets in smaller communities that make delivery of fee for service clinical operations nonviable.

In summary, thListed below are 6 suggested posts on specific NDIS issues (headings in bold) for the Sharing Shed that may elicit other comments from conference delegates on the issues.

Lack of critical Allied health resources
There is a critical lack of allied health services in rural and remote Australia that is impacting the ability for NDIS services to be established. Given the nature of these thin markets existing providers are struggling to operate commercially in an immature market and are at a crossroad whereby without immediate investment and support, decisions by providers to exit the scheme will become commonplace, leaving individuals and communities without the ability to access vital NDIS packages. Costs to retain and maintain experienced staff in rural and remote locations has not been factored into pricing mechanisms which further impacts both viability and the critical infrastructure required to see the scheme’s successful implementation in regional and rural Australia.

Potential Market Failure in rural Australia
Service providers are currently investing significant amounts of unpaid time explaining the scheme to people, outlining the access process and how to use their plan to purchase supports, as well as giving people the confidence to participate. This vital component of scheme establishment needs to be recognised and supported to facilitate take up. Furthermore, a more targeted market and structural adjustment support is required for providers operating in thin markets, to maintain the specialist disability support staff until full scheme rollout and full market development. Detailed, publicly-available market intelligence from the NDIA to inform provider business decisions is essential for viability to be achieved. For example, numbers of participants by location, plan utilisation rates and areas of immediate need will help inform service delivery models and staff resourcing decisions. Currently we are operating blind. An open and productive relationship between providers and the NDIA to build a vibrant service delivery market that puts the need of the participants first, giving them choice and control in an environment where quality partnerships are valued.

More specialist planners in rural and remote Locations
Complex care requires multidisciplinary teams working together in order to meet the need of proper planning. This investment should be consistent with the productivity commission mandate. Also, we have not seen any specialist support co-ordination funding within plans to support participants with severe and complex mental health issues. Further education and encouragement for NDIA planners to utilise this line item would result in these participants having access to a support coordinators with a comprehensive understanding of psychosocial disability, a clinical background and able to manage the risk factors.

Supporting pathways for the development of an adequate and necessary specialist disability allied health rural workforce to satisfy the NDIS through:
· Supported allied health student placements with disability providers
· Intensive support for allied health new graduates entering the workforce with disability providers
· Establishing Communities of Practice to support the current rural allied health workforce to expand their practice to include complex disability

The professional development of staff (e.g. cultural awareness, psychosocial training and clinical training for allied health staff) is not funded within the NDIS pricing structure and if organisations are in a position to fund training and travel for staff, there are huge financial losses through the lost opportunity cost (e.g. $180 per hour for occupational therapists) to the business which is not sustainable. It is concerning that the quality of the workforce will diminish as will the sector as a whole. Also, clinical supervision and quality assurance, which are crucial to maintaining a high quality workforce in the disability sector is not funded with organisations being expected to fund this themselves, again adding to the pressure to make NDIS commercially viable and risk providers exiting the market. It is recommended that the NDIA make professional development to ensure quality within the sector a priority and support providers to enable their key staff to access the above opportunities.

Adequate support for the needs of people with a psychosocial disability living in rural and remote locations has not been factored into the transition from Commonwealth funded programs to the NDIS with those living in NSW more severely impacted given the non-existence of state government services. This has resulted in a reliance on the private and not-for-profit sectors to provide critical services for these incredibly vulnerable people, who in most cases have no ability to access payment for services as billing can only commence once approved packages are in place. Immediate investment into sustaining existing services is required to support rural and regional people access the scheme and services and stem the flow of organisations leaving these thin markets.

For those participants with a package we have found, in some cases, that the 12 month review process for plans doesn’t allow for flexibility and is too slow when clients have a change in circumstances (e.g. carer death). This has led to great barriers for participants receiving the services they require or using the funds in their packages too quickly, exasperating their mental health. There needs to be some contingencies built into plans which can be accessed quickly rather than waiting for slow response times for reassessment in order to keep people out of hospital and well in their community

Non-recoupable travel (NDIS)
Genuine engagement between rural service providers and the NDIA is required to ensure adequate pricing for travel in these locations. For example, clinicians requiring to travel beyond 45 mins in MM5 is non-recoupable under current NDIS rules resulting in an inability for service providers to deliver viable services in rural areas. There is underutilisation of packages with funding for therapeutic services being used for travel instead. This is not consistent with the choice and control ethos of the scheme.e current factors that contribute to this include:

Recommendation Type: 
Emerging Theme: