NACCHO Aboriginal Health Pre- #Budget2019 -2020 : #RefreshTheCTGRefresh :The following #ClosingTheGap policy proposals are informed by NACCHO’s consultations with its Affiliates and our 145 Aboriginal Community Controlled Health Services:

 

The proposals included in this submission are based on the extensive experience NACCHO member services have of providing many years of comprehensive primary health care to Aboriginal and Torres Strait Islander peoples.

We have long recognised that closing the gap on Aboriginal and Torres Strait Islander health and disadvantage will never be achieved until primary health care services’ infrastructure hardware is fit for purpose; our people are living in safe and secure housing; culturally safe and trusted early intervention services are available for our children and their families; and our psychological, social, emotional and spiritual needs are acknowledged and supported.=

If these proposals are adopted, fully funded and implemented, they provide a pathway forward where improvements in life expectancy can be confidently predicted. “  

Pat Turner AM NACCHO CEO on behalf of our State and Territory Affiliates and 145 Aboriginal Community Controlled Health Services operating 302 ACCHO Clinics

Download this 20 Page NACCHO Submission

NACCHO Budget Submission 2019-20 FINAL

NACCHO is the national peak body representing 145 ACCHOs across the country on Aboriginal health and wellbeing issues.

In 1997, the Federal Government funded NACCHO to establish a Secretariat in Canberra, greatly increasing the capacity of Aboriginal peoples involved in ACCHOs to participate in national health policy development. Our members provide about three million episodes of care per year for about 350,000 people. In very remote areas, our services provide about one million episodes of care in a twelve-month period.

Collectively, we employ about 6,000 staff (56 per cent whom are Indigenous), which makes us the single largest employer of Indigenous people in the country.

The following policy proposals are informed by NACCHO’s consultations with its Affiliates and Aboriginal Community Controlled Health Services:

  1. Increase base funding of Aboriginal Community Controlled Health Services;
  2. Increase funding for capital works and infrastructure;
  3. Improve Aboriginal and Torres Strait Islander housing and community infrastructure;
  4. Reduce the overrepresentation of Aboriginal and Torres Strait Islander children and young people in out-of-home care and detention; and
  5. Strengthen the Mental Health and Social and Emotional Wellbeing of Aboriginal and Torres Strait Islander peoples.

NACCHO is committed to working with the Australian Government to further develop the proposals, including associated costings and implementation plans and identifying where current expenditure could be more appropriately targeted.

1. Increase base funding of Aboriginal Community Controlled Health Services

Proposal:

That the Australian Government:

  • Commits to increasing the baseline funding for Aboriginal Community Controlled Health Services to support the sustainable delivery of high quality, comprehensive primary health care services to Aboriginal and Torres Strait Islander people and communities.
  • Works together with NACCHO and Affiliates to agree to a new formula for the provision of comprehensive primary health care funding that is relative to need.

Rationale: 

The Productivity Commission’s 2017 Indigenous Expenditure Report found that per capita government spending on Indigenous services was twice as high as for the rest of the population. The view that enormous amounts of money have been spent on Indigenous Affairs has led many to conclude a different focus is required and that money is not the answer. Yet, the key question in understanding the relativities of expenditure on Indigenous is equity of total expenditure, both public and private and in relation to need.

The Commonwealth Government spends $1.4 for every $1 spent on the rest of the population, while Aboriginal and Torres Strait Islander people have 2.3 times the per capita need of the rest of the population because of much higher levels of illness and burden of disease. In its 2018 Report Card on Indigenous Health, the Australian Medical Association (AMA) states that spending less per capita on those with worse health, is ‘untenable national policy and that must be rectified’.1 The AMA also adds that long-term failure to adequately fund primary health care – especially Aboriginal Community Controlled Health Services (ACCHSs) – is a major contributing factor to failure in closing health and life expectancy gaps.

Despite the challenges of delivering services in fragmented and insufficient funding environments, studies have shown that ACCHSs deliver more cost-effective, equitable and effective primary health care services to Aboriginal and Torres Strait Islander peoples and are 23 per cent better at attracting and retaining Aboriginal and Torres Strait Islander clients than mainstream providers.2 ACCHSs continue to specialise in providing comprehensive primary care consistent with clients’ needs.

This includes home and site visits; provision of medical, public health and health promotion services; allied health, nursing services; assistance with making appointments and transport; help accessing child care or dealing with the justice system; drug and alcohol services; and providing help with income support.

                                                        

1https://ama.com.au/system/tdf/documents/2018%20AMA%20Report%20Card%20on%20Indigenous%20Heal th_1.pdf?file=1&type=node&id=49617, page 6.

2 Ong, Katherine S, Rob Carter, Margaret Kelaher, and Ian Anderson. 2012. Differences in Primary Health Care

Delivery to Australia’s Indigenous Population: A Template for Use in Economic Evaluations, BMC Health

Services Research 12:307; Campbell, Megan Ann, Jennifer Hunt, David J Scrimgeour, Maureen Davey and

Victoria Jones. 2017. Contribution of Aboriginal Community Controlled Health Services to improving Aboriginal

There are limits, however, to the extent that ACCHSs can continue to deliver quality, safe primary health care in fragmented and insufficient funding environments. This is particularly challenging to meet the health care needs of a fast-growing population.3 There is an urgent need to identify and fill the current health service gaps, particularly in primary health care, and with a focus on areas with high preventable hospital admissions and deaths and low use of the Medical Benefits Scheme and the Pharmaceutical Benefits Scheme.

An appropriately resourced Aboriginal Community Controlled Health sector represents an evidence-based, cost-effective and efficient solution for addressing the COAG Close the Gap and strategy and will result in gains for Aboriginal and Torres Strait Islander peoples’ health and wellbeing.

Strengthening the workforce

NACCHO welcomes COAG’s support for a National Aboriginal and Torres Strait Islander Health and Medical Workforce Plan. A long-term plan for building the workforce capabilities of ACCHSs is overdue. Many services struggle with the recruitment and retention of suitably qualified staff, and there are gaps in the number of professionals working in the sector.

NACCHO believes that the plan will be strengthened by expanding its scope to include:

  • metropolitan based services;
  • expanding the range of workforce beyond doctors and nurses; and
  • recognising that non-Indigenous staff comprise almost half of the workforce. While Aboriginal and Torres Strait Islander health staff are critical to improving access to culturally appropriate care and Indigenous health outcomes, consideration to the non-Indigenous workforce who contribute to improving Aboriginal and Torres Strait Islander Health outcomes should also be given.

An increase in the baseline funding for Aboriginal Community Controlled Health Services, as set out in this proposal will enable our sector to plan for and build workforce capabilities in line with the Health and Medical Workforce Plan objectives.

2. Increase funding for capital works and infrastructure upgrades

Proposal:

That the Australian Government:

  • Commits to increasing funding allocated through the Indigenous Australians’ Health Programme for capital works and infrastructure upgrades, and  Telehealth services; noting that at least $500m is likely to be needed to address unmet needs, based on the estimations of 38.6 per cent of the ACCHO sector, and we anticipate that those needs may be replicated across the sector (see Table A below).

Rationale: 

There is a current shortfall in infrastructure with a need for new buildings in existing and outreach locations, and renovations to increase amenities including consultation spaces. Additional funding is required for additional rooms and clinics mapped against areas of highest need with consideration to establishing satellite, outreach or permanent ACCHSs.

Many of the Aboriginal health clinics are 20 to 40 years old and require major refurbishment, capital works and updating to meet increasing population and patient numbers. The lack of consulting rooms and derelict infrastructure severely limits our services’ ability to increase MBS access.

Further, whilst there may be some scope to increase MBS billing rates for Aboriginal and Torres Strait Islander peoples, this cannot be achieved without new services and infrastructure. A vital priority is seed funding for the provision of satellite and outreach Aboriginal Community Controlled Health Services that Aboriginal and Torres Strait Islander people will access, and which provide the comprehensive services needed to fill the service gaps, to boost the use of MBS and PBS services to more equitable levels, and to reduce preventable admissions and deaths.

Improvements to the building infrastructure of ACCHSs are required to strengthen their capacity to address gaps in service provision, attract and retain clinical staff, and support the safety and accessibility of clinics and residential staff facilities. However, the level of funding of $15m per annum, under the Indigenous Australians’ Health Programme allocated for Capital Works – Infrastructure, Support and Assessment and Service Maintenance, is not keeping up with demand.

In our consultations with Affiliates and ACCHSs, NACCHO is increasingly hearing that

Telehealth services,[1] including infrastructure/hardware and improved connectivity, is required to support the provision of NDIS, mental health and health specialist services. A total of 22 out of 56 survey responses (see Table A below) identified the need for Telehealth to support service provision.

NACCHO believes that insufficient funding to meet capital works and infrastructure needs is adversely impacting the capacity of some ACCHSs to safely deliver comprehensive, timely and responsive primary health care; employ sufficient staff; to improve their uptake of Medicare billing; and to keep up with their accreditation requirements. In January 2019, we surveyed ACCHSs about their capital works and infrastructure needs, including Telehealth services. We received 56 responses, representing a response rate of 38.6 per cent.

 

Survey respondents estimated the total costs of identified capital works and infrastructure upgrades (see Table A below). The estimated costs have not been verified; however, they do

suggest there is a great level of unmet need in the sector. Please note that not all respondents were able to provide estimates.

Table A. Estimated costs of capital works and infrastructure upgrades identified by ACCHSs

Type Number of respondents Percentage of respondents Total estimated costs
Replace existing building 43 76.7% 207,559,043
New location/satellite clinic 21 37.5% 53,480,000
Extension 24 42.8% 18,310,000
Refurbishment 29 51.7% 35,251,000
Staff accommodation 25 44.6% 39,450,000
Telehealth services 22 39.2% 6,018,763
Total estimated costs of capital works and infrastructure upgrades $361,068,806

 

37 survey respondents applied for funding for infrastructure improvements from the Australian Government Department of Health during 2017 and/or 2018. Of the 11 that were successful, four respondents stated that the allocated funds were not sufficient for requirements.

ACCHSs believe that the current state of their service infrastructure impedes the capacity of their services as depicted in Table B, below:

Table B: Impact of ACCHSs’ infrastructure needs on service delivery

Infrastructure impeding service delivery Highly affected Somewhat affected
Safe delivery of quality health care 48.1% 51.9%
Increase client numbers 74.1% 25.9%
Expand the range of services and staff numbers 83.3% 16.7%
Increase Medicare billing 66% 34%

 

An extract of feedback provided by ACCHSs relating to their capital works and infrastructure needs is at Appendix A.

3. Improve Aboriginal and Torres Strait Islander housing and community infrastructure

Proposals:

That the Australian Government:

  • Expand the funding and timeframe of the current National Partnership on Remote Housing to match AT LEAST that of the former National Partnership Agreement on Remote Indigenous Housing.
  • Establish and fund a program that supports healthy living environments in urban, regional and remote Aboriginal and Torres Strait Islander communities, similar to the Fixing Houses for Better Health program. Ensure that rigorous data collection and program evaluation structures are developed and built into the program, to provide the Commonwealth Government with information to enable analysis of how housing improvements impact on health indicators.[2]
  • Update and promote the National Indigenous Housing Guide, a best practice resource for the design, construction and maintenance of housing for Aboriginal and Torres Strait Islander peoples.[3]

Rationale: 

Safe and decent housing is one of the biggest social determinants of health and we cannot overlook this when working to close the gap in life expectancy.

1. Remote Indigenous Housing

The National Partnership Agreement on Remote Indigenous Housing 2008-2018 was a COAG initiative that committed funding of $5.4b towards new builds, refurbishments, housing quality, cyclical maintenance, and community engagement and employment and business initiatives.

In 2016, the National Partnership Agreement on Remote Indigenous Housing was replaced by the National Partnership on Remote Housing. Under this new partnership, the Commonwealth Government committed:

  • $776.403m in 2016, to support remote housing in the Northern Territory, Queensland, South Australia, Western Australia, and the Northern Territory over a two-year period; and
  • $550m in 2018, to support remote housing in the Northern Territory, over a five-year period.

New South Wales, Victoria and Tasmania are not part of discussions with the Commonwealth Government on housing needs.

A review of the National Partnership Agreement on Remote Indigenous Housing (2018) found that:

  • An additional 5,500 homes are required by 2028 to reduce levels of overcrowding in remote areas to acceptable levels
  • A planned cyclic maintenance program, with a focus on health-related hardware and houses functioning, is required.
  • Systematic property and tenancy management needs to be faster.
  • More effort is required to mobilise the local workforces to do repairs and maintenance work.[4]

There is currently a disconnect between the levels of government investment into remote housing and the identified housing needs of remote communities. This disconnect is increasingly exacerbated by population increases in Aboriginal communities.[5]

There is a comprehensive, evidence-based literature which investigates the powerful links between housing and health, education and employment outcomes.[6] Healthy living conditions are the basis from which Closing the Gap objectives may be achieved. Commonwealth Government leadership is urgently needed to appropriately invest into remote housing.

2.Environmental health

The importance of environmental health to health outcomes is well established. A healthy living environment with adequate housing supports not only the health of individuals and families; it also enhances educational achievements, community safety and economic participation.10

Commonwealth and State and Territory Governments have a shared responsibility for housing. Overcrowding is a key contributor to poor health of Aboriginal and Torres Strait Islander peoples. In addition to overcrowding, poor and derelict health hardware (including water, sewerage, electricity) leads to the spread of preventable diseases for Aboriginal and Torres Strait Islander peoples. Healthy homes are vital to ensuring that preventable diseases that have been eradicated in most countries do not exist in Aboriginal and Torres Strait Islander communities and homes.

4. Reduce the overrepresentation of Aboriginal and Torres Strait Islander children and young people in out-of-home care and detention

Proposals:

That the Australian Government:

  • Establishes an additional elective within the existing Aboriginal Health Worker curriculum, that provides students with early childhood outreach, preventative health care and parenting support skills
  • Waives the upfront fees of the first 100 Indigenous students to undertake the Aboriginal Health Worker (Early Childhood stream) Certificate IV course.
  • Funds an additional 145 Aboriginal Health Worker (early childhood) places across ACCHSs.

Rationale:

The overrepresentation of Aboriginal and Torres Strait Islander children and young people in the child protection system is one of the most pressing human rights challenges facing Australia today.[7]

Young people placed in out-of-home care are 16 times more likely than the equivalent general population to be under youth justice supervision in the same year.[8]

Government investment in early childhood is an urgent priority to reduce the overrepresentation of Aboriginal and Torres Strait Islander children in out of home care and youth detention. Research reveals that almost half of the Aboriginal and Torres Strait Islander children who are placed to out of home care are removed by the age of four[9] and, secondly, demonstrates the strong link between children and young people in detention who have both current and/or previous experiences of out of home care.[10] There is also compelling evidence of the impact of repetitive, prolonged trauma on children and young people and how, if left untreated, this may lead to mental health and substance use disorders, and intergenerational experiences of out-of-home care and exposure to the criminal justice system.15

Despite previous investments by governments, the Aboriginal and Torres Strait Islander children and young people remain overrepresented in the children protection and youth detention systems. The Council of Australian Governments (COAG) Protecting Children is Everyone’s Business National Framework for Protecting Australia’s Children 2009–2020 (‘National Framework’) was established to develop a unified approach for protecting children. It recognises that ‘Australia needs a shared agenda for change, with national leadership and a common goal’.

One of the six outcomes of the National Framework is that Aboriginal and Torres Strait Islander children are supported and safe in their families and communities, with this overarching goal:

Indigenous children are supported and safe in strong, thriving families and communities to reduce the over-representation of Indigenous children in child protection systems. For those Indigenous children in child protection systems, culturally appropriate care and support is provided to enhance their wellbeing.16

Findings presented in the 2018 Family Matters Report reveal, however, that the aims and objectives of the National Framework have failed to protect Aboriginal and Torres Strait Islander children:

Aboriginal and Torres Strait Islander children make up just over 36 per cent of all children living in out-of-home care; the rate of Aboriginal and Torres Strait Islander children in out-ofhome care is 10.1 times that of other children, and disproportionate representation continues to grow (Australian Institute of Health and Welfare [AIHW], 2018b). Since the last Family Matters Report over-representation in out-of-home care has either increased or remained the same in every state and territory.17

Furthermore, statistics on the incarceration of Aboriginal and Torres Strait Islander children and young people in detention facilities reveal alarmingly high trends of overrepresentation:

  • On an average night in the June quarter 2018, nearly 3 in 5 (59%) young people aged 10– 17 in detention were Aboriginal and Torres Strait Islander, despite Aboriginal and Torres Strait Islander young people making up only 5% of the general population aged 10–17.
  • Indigenous young people aged 10–17 were 26 times as likely as non-Indigenous young people to be in detention on an average night.
  • A higher proportion of Indigenous young people in detention were aged 10–17 than non-Indigenous young people—in the June quarter 2018, 92% of Aboriginal and Torres

Strait Islander young people in detention were aged 10–17, compared with 74% of non-

Indigenous Islander young people.18

towardtraumainfo/Orygen_trauma_and_young_people_policy_report.aspx?ext=.; https://www.facs.nsw.gov.au/__data/assets/pdf_file/0016/421531/FACS_SAR.pdf

NACCHO believes an adequately funded, culturally safe, preventative response is needed to reduce the number and proportion of Aboriginal and Torres Strait Islander children in child protection and youth detention systems. It is vital that Aboriginal and Torres Strait Islander families who are struggling with chronic, complex and challenging circumstances are able to access culturally appropriate, holistic, preventative services with trusted service providers that have expertise in working with whole families affected by intergenerational trauma. The child protection and justice literature are united in that best practice principles for developing solutions to these preventable problems begin with self-determination, community control, cultural safety and a holistic response.[11] For these reasons, we are proposing that the new Aboriginal Health Worker (Early Childhood) be based within the service setting of the Aboriginal Community Controlled Health Service.

The cultural safety in which ACCHSs’ services are delivered is a key factor in their success. ACCHSs have expert understanding and knowledge of the interplays between intergenerational trauma, the social determinants of health, family violence, and institutional racism, and the risks these contributing factors carry in increasing Aboriginal and Torres Strait Islander peoples’ exposure to the child protection and criminal justice systems.

Our services have developed trauma informed care responses that acknowledge historical and contemporary experiences of colonisation, dispossession and discrimination and build this knowledge into service delivery.

Further, they are staffed by health and medical professionals who understand the importance of providing a comprehensive health service, including the vital importance of regular screening and treatment for infants and children aged 0-4, and providing at risk families with early support. Within the principles, values and beliefs of the Aboriginal community controlled service model lay the groundwork for children’s better health, education, and employment outcomes. The addition of Aboriginal Health Workers with early childhood skills and training will provide an important, much needed role in preventing and reducing Aboriginal and Torres Strait Islander children and young peoples’ exposure to child protection and criminal justice systems.

 

Aboriginal Peak Organisations of the Northern Territory, Submission to the Royal  

Commission into the Protection and Detention of Children in the Northern Territory, 2017

NACCHO supports the position and recommendations of Aboriginal Peak Organisations in the NT, that:

•        Aboriginal community control, empowerment and a trauma informed approach should underpin the delivery of all services to Aboriginal children and their families. This applies to service design and delivery across areas including early childhood, education, health, housing, welfare, prevention of substance misuse, family violence prevention, policing, child protection and youth justice.

•        The Australian Government develops and implements a comprehensive, adequately resourced national strategy and target, developed in partnership with Aboriginal and Torres Strait Islander peoples, to eliminate the over-representation of Aboriginal and Torres Strait Islander children in out-of-home care.

•        There is an urgent need for a child-centred, trauma-informed and culturally relevant approach to youth justice proceedings which ultimately seeks to altogether remove the need for the detention of children.

•        Early childhood programs and related clinical and public health services are provided equitably to all Aboriginal children (across the NT) through the development and implementation of a three-tiered model of family health care – universal, targeted and indicated – to meet children’s needs from before birth to school age. Services should be provided across eight key areas:  o quality antenatal and postnatal care;

o clinical and public health services for children and families; o a nurse home visiting program; o parenting programs; o child development programs; o two years of preschool; o targeted services for vulnerable children and families; and o supportive social determinants policies.

•        These services need to be responsive to, and driven by, the community at a local level.

5. Strengthen the mental health and social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples

Proposal:

That the Australian Government:

  • Provide secure and long-term funding to ACCHSs to expand their mental health, social and emotional wellbeing, suicide prevention, alcohol and other drugs services, using best practice trauma informed approaches.
  • Urgently increase funding for ACCHSs to employ staff to deliver mental health and social and emotional wellbeing services, including psychologists, psychiatrists, speech pathologists, mental health workers and other professionals and workers; and
  • Urgently increase the delivery of training to Aboriginal health practitioners to establish and/or consolidate skills development in mental health care and support, including suicide prevention; and
  • Return funding for Aboriginal and Torres Strait Islander suicide prevention, health and wellbeing and alcohol and other drugs from the Indigenous Advancement Strategy to the Indigenous Australians’ Health Programme.

Rationale: 

The Australian Institute of Health and Welfare has estimated that mental health and substance use are the biggest contributors to the overall burden of disease for Aboriginal and Torres Strait Islander peoples. Indigenous adults are 2.7 times more likely to experience high or very high levels of psychological distress than other Australians.[12] They are also hospitalised for mental and behavioural disorders and suicide at almost twice the rate of non-Indigenous population and are missing out on much needed mental health services.

Suicide is the leading cause of death for Aboriginal people aged 5-34 years, the second leading cause of death for Aboriginal and Torres Strait Islander men. In 2016, the rate of suicide for Aboriginal and Torres Strait Islander peoples was 24 per 100,000, twice the rate for non-Indigenous Australians.[13] Aboriginal people living in the Kimberley region are seven times more likely to suicide than non-Aboriginal people.

Many Aboriginal Community Controlled Health Services deliver culturally safe, trauma informed services in communities dealing with extreme social and economic disadvantage that are affected and compounded by intergenerational trauma and are supporting positive changes in the lives of their members. The case study provided by Derby Aboriginal Health Service demonstrates not only the impact that this ACCHS is having on its community. It also illustrates the rationale for each of the proposals described in this pre-budget submission.

Case Study: Derby Aboriginal Health Service, WA

Derby Aboriginal Health Service’s Social and Emotional Wellbeing Unit (SEWB) have partnered with another organisation to employ someone in our SEWB unit to work directly with families on issues that contribute to them losing their children to Department of Child Protection (DCP). This program is designed to help prevent the children from being removed by DCP by working one to one with families on issues such as budgeting, education, substance misuse, a safe and healthy home etc.

Our SEWB unit has a community engagement approach which involves working directly with clients and their families, counselling with the psychologist and mental health worker, the male Aboriginal Mental Health Worker taking men out on country trips as part of mental health activities for men, the youth at risk program (Shine), the Body Clinic, the prenatal program working directly with mums, dads and bubs around parenting, relationships between mums, dads and children etc. The team work directly with the community.

We are now introducing a new SEWB designed program into the Derby prison which focuses on exploring men and women’s strengths and abilities rather than looking at their deficits. Using a strengths based program was very successfully delivered with a group of 22 Aboriginal men and 16 Aboriginal women where, for many of the participants, they were told for the first time in their lives that they matter and that they have good things about them and they are strong men and women (this naturally brought in some behavior modification that they could attempt in making changes in their lives; e.g. one participant said that when he went home, he was going to make his wife a cup of tea instead of expecting her to make him tea – he said he had never thought of that before). The SEWB team presented this at the National Mental Health Conference in Adelaide, August last year.

Given the deep and respectful footprint the SEWB team has in the town and surrounding communities, they, and the people, deserve and need a new building in which to continue their important work. If we can help people deal with the issues above, then they will be much more empowered to prevent/deal with their own health issues – perhaps then we can Close the Gap.

Given the burden of mental, psychological distress and trauma that our communities are responding to and the impact this has on Aboriginal and Torres Strait Islander peoples’ life expectancy, educational outcomes, and workforce participation, NACCHO believes it is imperative that a funded implementation plan for the National Strategic Framework for Aboriginal and Torres Strait Islander Mental Health and Social and Emotional Wellbeing

2017-2023 (‘the Framework’) be developed as a priority. The following Action Areas of the Framework relate to this proposal:

  • Action Area 1 – Strengthen the foundations (An effective and empowered mental health and social and emotional wellbeing workforce);
  • Action Area 2 – Promote wellness (all outcome areas);[14] and
  • Action Area 4 – Provide care for people who are mildly or moderately ill (Aboriginal and Torres Strait Islander people living with a mild or moderate mental illness are able to access culturally and clinically appropriate primary mental health care according to need).

As the above case study suggests, our trusted local Aboriginal community controlled services are best placed to be the preferred providers of mental health, social and emotional wellbeing, and suicide prevention activities to their communities. Australian Government funding should be prioritised to on the ground Aboriginal services to deliver suicide prevention, trauma and other wellbeing services. Delivering these much-needed services through ACCHSs, rather than establishing a new service, would deliver economies of scale and would draw from an already demonstrated successful model of service delivery.

Further, NACCHO believes that the current artificial distinction between separating mental health, social and emotional wellbeing and alcohol and drug funding from primary health care funding, must be abolished. Primary health care, within the holistic health provision of ACCHS, provides the sound structure to address all aspects of health care arising from social, emotional and physical factors. Primary health care is a comprehensive approach to health in accordance with the Aboriginal holistic definition of health and arises out of the practical experience within the Aboriginal community itself having to provide effective and culturally appropriate health services to its communities.

The current artificial distinction, as exemplified by program funding for ACCHS activities being administered across two Australian Government Departments, does not support our definition of health and wellbeing. It also leads to inefficiencies and unnecessarily increases red tape, by imposing additional reporting burdens on a sector that is delivering services under challenging circumstances.     

APPENDIX A

Qualitative feedback from Aboriginal Community Controlled Health Services  capital works and infrastructure needs 

The following comments from ACCHSs have been extracted from a survey administered by NACCHO in January 2019:

  • Currently at capacity and as the government focusses more on Medicare earnings and less on funding we need the ability to expand into this area as well as the NDIS in order to meet our client service needs and build sustainability.
  • The facility that our service currently occupies is state government owned, on state crown land, is over 40 years old and is ‘sick’ – it is not fit for purpose with an irreparable roof, significant asbestos contamination, water ingress, mould and recurrent power outages. The maintenance costs are an unsustainable burden, it is unreliable, unsuitable and unsafe for clients and staff, and there is no room for expansion for program and community areas. We applied for funding from the Australian Government Department of Health, but the application was not successful. This figure is inclusive of early works transportable – temporary accommodation, building works, demolition works, services infrastructure, external works, design development contingency, construction contingency, builder preliminaries and margin, loose furniture and equipment, specialist/medical equipment, ICT & PABX, AV equipment, professional including.

disbursements (to be confirmed), statutory fees, locality loading, and goods and services tax.

  • We are in need of kitchen renovations to each of our community care sites that do meals on wheels. The WA Environmental Health unit has informed us that we need to upgrade all our kitchens to meet Food Safety requirements or they will enforce closure of some of our kitchens, which would then mean we are unable to do our Meals on Wheels service in some communities
  • Currently limited by space to employ support staff and increase our GP’s, our waiting room is around 3x4m and we are always having clients standing up or waiting outside until there is space for them. We currently have three buildings in the one township with two being rentals, if we could co-locate all services, we could offer a higher level of integrated care and save wasted money on rent.
  • Not currently enough space to house staff and visiting clinicians.
  • Have been applying for grants in infrastructure and included in Action Plan for quite a few years and still not successful.
  • We need a multi-purpose building to bring together our comprehensive range of services in a way that enables community to gather, express their culture and feel safe and welcome whilst receiving a fully integrated service delivery model of supports. We have more than doubled in staffing and program delivery and are still trying to operate out of the same space. The need for further expansion is inevitable and the co-operative welcomes the opportunity to bring more services to our community, but infrastructure

is a barrier and we have taken the strategic decision to acquire vacant land near our main headquarters with the view to obtaining future infrastructure funding – it is much needed.

  • The three sites we currently lease are all commercial premises and we have to make our business fit, the buildings are not culturally appropriate nor are they designed for a clinical setting.
  • For eight years we have struggled to grow in line with our community service needs and the requirement to become more self-sufficient in the face of a funding environment which is declining in real terms (not keeping pace with CPI and wages growth). Further to this, every time we add a building our running costs go up so even capital expansion comes at a cost to the organisation as it takes time to build up to the operating capacity that the new/improved buildings provide. This is the ongoing struggle in our space.
  • Our service was established in 1999 and has been operating from an 80 year old converted holiday house, with a couple of minor extensions. The clinic does not meet the contemporary set up for an efficient clinic from viewpoint of staff, medical services and for community members. Space is very limited, and service delivery is also limited due to room availability. Demand for services both for physical and mental health/SEWB is growing strongly. We have 425 Community Members (with 70 currently in prisons in our region) and our actual patient numbers accessing services over 12 months have increased 50%.
  • We never received support or funding to acquire a purpose-built facility from the outset and as there was no suitable accommodation for rent or lease, we acquired two small houses to deliver our services from. These were totally inadequate but all we could acquire at the time. We have 31 staff accommodated through three locations and require a purpose-built facility to deliver quality primary health care to our Community.
  • Over the last two years we have been able to purchase the site it is currently located on. This site is based on five contiguous residential properties, with each property containing a 2-3 bedroom, approximately 40 year old house. Two of these houses have been joined together to form the Medical Clinic, the other three houses have all been renovated and upgraded to various levels in order to make them usable by the service. The next step in the plan is to redevelop the entire site to build an all-in-one centre to replace the current four separate buildings. In our 12 years of service we have moved from renting at a number of locations to being able to purchase our current site. The current site of old, converted residential buildings while viable in the short term, does not allow for efficient use of the site nor capacity for growth. Parking is scattered around the site, staff are scattered and continually moving from building to building to serve clients. There is no excess accommodation capacity to allow for growth of services. Our intention is to re-develop the site to house all staff in one building, which will be configured for growth over the long term and allow efficient use of the available grounds for parking, an Elders shed, and so on.
  • We have run out of room. Every office is shared, including the CEO’s office. We can’t hire any staff – nowhere to house them. Whenever a visiting service is operating – GP clinic, podiatry, optometry, audiology, chiropractor etc, offices have to be vacated to house

them, displaced staff basically have nowhere to go. Fine balancing act to schedule things to displace as few people as possible.

  • We are currently located in two refurbished community buildings as there is no suitable accommodation for lease. Our organisation is growing very quickly, and we need all services located under one roof – one identity, one culture.
  • Rapidly reaching the point where services will be diminished because of failing infrastructure or insufficient housing for the nursing staff required.
  • Some clinical rooms are not fit for purpose. Clinicians working from rooms without hand washing facilities. Medical Clinic is old, out of date, some rooms not fit for purpose, ineffective air conditioning, clinical staff sharing rooms, no room for expansion, difficult to house students due to lack of appropriate space.
  • We have made a number of applications to improve infrastructure, and to replace current infrastructure, all have been unsuccessful, in some cases we have purchase buildings & land to try and demonstrate a commitment to ongoing growth and servicing of clients. We get little feedback in relation to funding applications.
  • Spread across three sites with some providers having to share rooms and staff being required to work outside on laptops at times. Desperately needing to build a purposebuilt facility in order to stop paying high amounts of rent and allow effective primary health care to an increasing client number.

Derby Aboriginal Health Service

The Derby Aboriginal Health Service (DAHS) Social and Emotional Wellbeing (SEWB) unit is housed in a 60+ year old asbestos building that was originally a family home. It has an old and small transport unit connected to the house by an exposed verandah. There are 6 staff working from the house who provide individual and family counselling and support. The clients who come to SEWB experience mental health issues, family violence, poverty, Department of Child Protection (DCP) issues around removal of children, alcohol and other drug issues and supporting those released from the Derby local Prison (approx. 200 prisoners). It is difficult to safely secure SEWB to the extent it is required given the age and asbestos nature of the building (security alarms etc). In the photos, you can see the buildings are old and are of asbestos. The transportable out the back houses the manager who is also the psychologist – this means she is in a vulnerable position when counselling should the session not go as planned (potential for a violent situation – see photo showing external verandah connecting to the donga).

The size of the house means that counselling clients privately is difficult as everything happens in close quarters. The number of clients the team work with exceeds the capacity of the building which impacts on the number of Aboriginal clients the team can help. The SEWB building has been broken into a number of times the last being during the long weekend in September 2018 where significant damage was done. Given the age of the house, during the past 18 months, parts of the internal ceiling including cornices have been falling away from the structures creating potential issues of asbestos fibre being released into the air. In addition, there are plumbing problems and the wooden floor is becoming a safety issue in one area of the building.

SEWB runs a vulnerable youth programme (the Shine Group) and a Body Shop clinic for youth who will not attend the main clinic for shame and fear reasons (special appointments are made with a doctor so that the young person doesn’t have to wait in the waiting area. In addition, a doctor runs a monthly session at the SEWB building with youth around health education and also sees them if there is a clinical need). These programmes run out of another 60+ year old asbestos family house some distance from the main SEWB house. Not only is the house not suitable but there may be security risks for the staff member working with vulnerable youth.  The Shine House was also broken into in September 2018 where significant damage was done (see photos).

The DAHS main building has no further office or other space to house staff.  This is particularly the case for 2019 as DAHS takes on new programmes (e.g. 2 staff for the new Syphilis Programme).  DAHS is acutely aware of the need to source funding to build new administration offices in order to release current admin offices for clinical and programme purposes.

DAHS requires a new or upgraded SEWB building. DAHS first applied for service maintenance funding in March 2017 but were unsuccessful. DAHS applied in June 2018 for Capital Works but were unsuccessful because it didn’t fit in with IAHP Primary Health Care as it was about mental health. DAHS also paid for an Architect to draw up the plans for a new SEWB building.  It is my view that one of the main issues is that the government separates SEWB from primary health care.

Social and emotional wellbeing issues CANNOT be separated from primary health care.  As is well known, a person’s SEWB impacts on the physical health of an individual.  Physical illhealth is frequently caused by the SEWB condition of an individual (i.e. historical and current experiences of trauma frequently commencing in the pre-natal phase of a child’s life, family violence, alcohol and other drug use, smoking, anxiety, removal of children, mental health issues etc). Aboriginal people suffer greatly from SEWB issues which impacts on their overall physical health.  Mental health in all its forms is part and parcel of physical health so it must be included in primary health care.

However, both state and commonwealth governments do not seem to prioritise or even support funding for SEWB (such as service and maintenance work, capital works or funding to continue key positions in the SEWB team – in fact, the government actively separates funding for SEWB and primary health care).  DAHS also provides clinical services to 7 remote communities most of whom are up to 400 kms away with Kandiwal Community 600kms away where we supply a fly in/fly out clinical service. There are many demands placed on a team of SEWB workers stationed in a working environment that does not allow them to function to the best of their abilities or offer increased services to our clients. Passion for the cause alone does not help in Closing the Gap. Working with one hand tied behind one’s back is not effective in reducing mental health issues and chronic diseases.

Part of an upgrade we requested was to renovate reception to make it safer for receptionist staff and to increase confidentiality when clients speak with reception staff (it also doesn’t meet the needs of disabled clients). There are a number of times throughout the year when receptionist staff are verbally abused with threats of physical harm. The current reception was designed prior to more recent events of aggression exhibited by clients under the influence of drugs.  The design now enables abusive clients to quite easily reach across the reception counter and hurt staff or can jump over the same counter to gain access to staff.  In addition, given there is no screen and the current open nature of the reception area, sharing confidential information can be compromised. DAHS applied for services and maintenance funding to make the changes but were unsuccessful.

[1] ACCHSs may apply for Telehealth funding through the Indigenous Australians’ Health Programme, Governance and System Effectiveness: Sector Support activity.

[2] https://www.anao.gov.au/work/performanceaudit/indigenoushousinginitiativesfixinghousesbetterhealthprogram  

[3] http://web.archive.org/web/20140213221536/http://www.dss.gov.au/sites/default/files/documents/05_201 2/housing_guide_info_intro.pdf  

[4] https://www.pmc.gov.au/resourcecentre/indigenousaffairs/remotehousingreview, page 3.

[5] https://www.caac.org.au/uploads/pdfs/CongressHousingandHealthDiscussionPaperFinalMarch2018.pdf

[6] https://www.pmc.gov.au/resourcecentre/indigenousaffairs/healthperformanceframework2017report; https://www.mja.com.au/journal/2011/195/11/closinggapandindigenoushousing;  https://probonoaustralia.com.au/news/2016/02/housingkeyclosinggap/; https://ama.com.au/positionstatement/aboriginalandtorresstraitislanderhealthrevised2015; https://www.caac.org.au/uploads/pdfs/CongressHousingandHealthDiscussionPaperFinalMarch2018.pdf. 10 https://www.anao.gov.au/work/performanceaudit/indigenoushousinginitiativesfixinghousesbetterhealthprogram  

[7] Australia Human Rights Commission Social Justice and Native Title Report 2015, cited in the Australian Law

Reform Commission publication, Pathways to JusticeInquiry into the Incarceration Rate of Aboriginal and Torres Strait Islander Peoples (ALRC Report 133)https://www.alrc.gov.au/publications/crossoverouthomecaredetention.

[8] https://www.alrc.gov.au/publications/crossoverouthomecaredetention; https://www.aihw.gov.au/getmedia/06341e00a08f4a0b9d33d6c4cf1e3379/aihwcsi025.pdf.aspx?inline=true  

[9] https://www.snaicc.org.au/ensuring-fair-start-children-need-dedicated-funding-stream-aboriginal-torresstrait-islander-early-years-sector/

[10] https://www.alrc.gov.au/publications/crossoverouthomecaredetention;

https://aifs.gov.au/cfca/publications/intersectionbetweenchildprotectionandyouthjusticesystems 15 https://aifs.gov.au/cfca/sites/default/files/publicationdocuments/cfcapracticebraindevelopmentv6040618.pdf; https://www.orygen.org.au/PolicyAdvocacy/PolicyReports/TraumaandyoungpeopleMoving

[11] http://www.familymatters.org.au/wpcontent/uploads/2018/11/FamilyMattersReport2018.pdf; Thorburn, Kathryn and Melissa Marshall. 2017. The Yiriman Project in the West Kimberley: an example of justice reinvestment? Indigenous Justice Clearinghouse, Current Initiatives Paper 5; McCausland, Ruth, Elizabeth McEntyre, Eileen Baldry. 2017. Indigenous People, Mental Health, Cognitive Disability and the

Criminal Justice System. Indigenous Justice Clearinghouse. Brief 22; AMA Report Card on Indigenous Health 2015. Treating the high rates of imprisonment of Aboriginal and Torres Strait Islander peoples as a symptom of the health gap: an integrated approach to both; Richards, Kelly, Lisa Rosevear and Robyn Gilbert. 2011.

Promising interventions for reducing Indigenous juvenile offending. Indigenous Justice Clearinghouse, Brief 10.

[12] Australian Institute of Health and Welfare. 2018. Australia’s Health 2018. Australia’s health series no. 16. AUS 221. Canberra: AIHW.

[13] Ibid

[14] Outcome areas: Aboriginal and Torres Strait Islander communities and cultures are strong and support social and emotional wellbeing and mental health; Aboriginal and Torres Strait Islander families are strong and supported; Infants get the best possible developmental start to life and mental health; Aboriginal and Torres Strait Islander children and young people get the services and support they need to thrive and grow into mentally healthy adults.

NACCHO Aboriginal Health and the #NDIS : New @ozprodcom report calls for New agreement on #disability needed to improve the wellbeing of people with disability


” This Productivity Commission report was released on 1 February 2019.

It has found that a new National Disability Agreement (NDA) between the Australian, State and Territory Governments is needed to facilitate cooperation, enhance accountability and clarify roles and responsibilities.

We have made a number of recommendations for a new NDA that has at its core the wellbeing and needs of all people with disability and their families and carers. See Part 2 Below

Download the report HERE

NDIS disability-agreement

“Did you know the current National Disability Agreement is outdated and doesn’t reflect either the or the National Disability Strategy? A new is needed as a strong positive force to guide future policy.”

Read our report at

 ” NACCHO lodged a submission to the Parliamentary Inquiry into NDIS Readiness on 22 February 2018. When appropriately resourced, Aboriginal Community Controlled Health Services (ACCHSs) are uniquely placed to support Aboriginal people through the NDIS to improve health and wellbeing outcomes.

However, there are barriers for ACCHSs becoming providers of the NDIS including cost, thin markets as recognised by the Productivity Commission and limited Aboriginal workforce.

See Part 4 below

Part 1 : The Productivity Commission Press Release :New agreement on disability needed to improve the wellbeing of people with disability

The Productivity Commission has called for a new National Disability Agreement (NDA) between all Australian governments to promote cooperation, enhance accountability and clarify roles and responsibilities. A new agreement would help to improve the wellbeing of people with disability, particularly those not covered by the National Disability Insurance Scheme (NDIS), as well as their families and carers.

Commissioner Robert Fitzgerald said, “With so much focus on the NDIS, limited attention has been placed on achieving better outcomes for the many people with disability who are not supported through the NDIS. There’s about 3.8 million people with disability in Australia who are not supported by the NDIS. Most people with disabilities are not and never will be covered by the NDIS yet their rights, needs and aspirations matter”.

The Productivity Commission identified in a report released today that the disability policy landscape has changed dramatically since the current agreement commenced a decade ago and much of what is in it is now outdated and irrelevant. In particular, the current agreement does not reflect the implementation of the NDIS or the National Disability Strategy.

“There has been very little progress in meeting previously agreed goals such as raising labour force participation rates for people with disability or improving the wellbeing of carers. We have identified key gaps in the areas of advocacy services, support for carers, and supports for people with disabilities arising from mental health conditions, as well as access to community and inclusion programs,” Commissioner Fitzgerald said.

The Commission’s report concludes that a new, reinvigorated NDA could be a strong positive force to guide future disability policy, to promote better access to mainstream and disability services and to improve outcomes for people with disability.

The Commission recommends that the new NDA clearly set out the responsibilities of governments to provide disability services outside the NDIS, and to affirm the commitment of governments to address service gaps and barriers that people with disability face in accessing mainstream services.

“Improving the wellbeing of all people with disability, their families and carers requires a collaborative response from all levels of government, extending well beyond the NDIS to many other service systems such as housing, transport, health, justice and education,” Commissioner Fitzgerald said.

The Commission also recommends that the new NDA set out a single, strengthened national performance reporting framework, with progress towards the outcomes of the new NDA publicly disseminated via a new National Disability Report, to be tabled in Parliament every two years.

The full study report about the National Disability Agreement Review can be accessed from the Commission’s website at http://www.pc.gov.au. This is the first of the Commission’s reviews of nationally significant sector-wide agreements between the Australian and State and Territory Governments.

Background

In 2008, the Australian and State and Territory Governments agreed on a new framework for federal financial relations, to provide a foundation for collaboration on policy and service delivery, and to facilitate the implementation of reforms in areas of national importance. The centrepiece of this arrangement was the establishment of six National Agreements covering disability, education, health, housing, Indigenous reform, and skills and workforce development.

The Australian Government has asked the Productivity Commission to review nationally significant sector‑wide agreements, beginning with the National Disability Agreement (NDA) (box 1). The Commission was asked to consider the relevance of the agreement in the context of contemporary policy settings and whether it needs updating in light of these.

Read over articles Aboriginal Health and NDIS published over past 7 years

See also Community Planning for the National Disability Insurance Scheme (NDIS) in the
Northern Territory

Engaging Aboriginal Communiy Controlled Organisations in Disability Service Provision

Key points
The current National Disability Agreement (NDA) no longer serves its purpose, has a weak influence on policy, and its performance targets show no progress in improving the wellbeing of people with disability. A new agreement is needed to promote cooperation, enhance accountability and clarify roles and responsibilities of governments.

The disability policy landscape has changed markedly since the NDA was signed in 2008.

The National Disability Insurance Scheme (NDIS) commenced in 2013, focusing on supports for approximately 475 000 people with significant and permanent disability. And the National Disability Strategy (NDS), which covers all people with disability (approximately 4.3 million), was endorsed by all Australian Governments in 2011.

Improving the wellbeing of people with disability and carers across the nation requires a collaborative response from all levels of government, extending well beyond the NDIS to many other service systems, such as housing, transport, health, justice, and education.

There is an important role for a new NDA that has at its core, the wellbeing and needs of all people with disability and their families and carers. The purpose of a new NDA would be to provide an overarching agreement for disability policy, to clarify roles and responsibilities, to promote cooperation and to enhance accountability.

The new NDA should:

  • set out the aspirational objective for disability policy in Australia — people with disability and their carers have an enhanced quality of life and participate as valued members of the community — and acknowledge and reflect the rights committed to by Australia under the United Nations Convention on the Rights of Persons with Disabilities
  • outline the roles and responsibilities of governments in progressing that objective; the outcomes being sought for people with disability; and a nationally consistent performance reporting framework for tracking progress against those outcomes.

The NDS should continue to play the essential role of articulating policy actions, with these actions explicitly linked to the new NDA’s outcomes.

  • The agreements governing the NDIS would remain separate to the NDA, but should be referenced throughout so that the NDA is reflective of the whole disability system.
  • Roles and responsibilities in the NDA need to be updated to reflect contemporary policy settings, to reduce uncertainty and to address gaps in several areas — including in relation to advocacy, carers, and the interface between the NDIS and mainstream service systems.
  • To facilitate greater clarity in responsibilities, governments should articulate and publish which programs they are rolling into the NDIS and how they will support people with disability who are not covered by the NDIS. They should also (through the COAG Disability Reform Council (DRC)) undertake a comprehensive gap analysis, with the new NDA outlining responsibilities for addressing any gaps. A gap analysis should be undertaken every five years.
  • NDA performance reporting needs strengthening to improve transparency and accountability.
  • There should be a single person‑centred national performance reporting arrangement across the NDA and NDS, with performance indicators and targets agreed to by the DRC.

A ‘National Disability Report’ should be tabled in Parliament biennially, outlining progress against the NDA’s outcomes and performance metrics, and including the perspectives of people with disability and findings from policy evaluations undertaken as part of the NDA.

A new NDA should be agreed by the start of 2020. It should be a living document, with updates made to schedules as required, and should be independently reviewed every five years.

Part 2 :The Federal Government has welcomes the release of the Productivity Commission’s Final Report of its Review of the National Disability Agreement.

The National Disability Agreement is a high-level accord between the Commonwealth and state and territory governments that sets out roles and responsibilities for the funding and provision of specialist services for people with disability.

“The Australian Government will continue to work with all governments, people with disability and the disability sector to consider the findings and recommendations of the Report as we develop a new strategy,” Minister for Families and Social Services, Paul Fletcher, said.

“With one-in-five Australians living with disability, it is critical for governments to work together to help people with disability take control of their lives and have equal access and opportunity.

“We recognise the disability policy landscape has changed significantly since the agreement was first signed in 2008.

“The findings from this review are highly relevant for informing the design of a new National Disability Strategy for beyond 2020.”

Mr Fletcher said work has already started on developing the new National Disability Strategy for beyond 2020, with public consultation starting later this year.

“We understand the need for a renewed commitment between the Commonwealth and the states and territories,” Mr Fletcher said.

“It is imperative that states and territories continue to provide equal access to mainstream services, such as health, education and transport, so that people with disability can benefit from the same services that are available to, and to which all Australian rely.”

Assistant Minister for Social Services, Housing and Disability Services, Sarah Henderson, said the report reflects the enormous commitment to people with disability by all levels of government, providers, families and carers, and the community.

“We can all acknowledge that people with disability can face challenges with accessing and navigating mainstream services and the report highlights the need for all governments to focus more on overcoming these challenges,” Ms Henderson said.

“The NDIS is one of the biggest social reforms in Australian history and represents a very significant change to the way people with disability access support.”

The NDIS was never intended to replace all services that state and territory governments provide for people with disability, nor does it remove state and territory responsibility for providing disability support for people under 65 (under 50 for Aboriginal and Torres Strait Islander people) who are not eligible for the NDIS.

More than 250,000 Australians are now being supported by the NDIS including 78,000 receiving life-changing supports for the first time. As at 30 September 2018, 91 per cent of NDIS participants were also accessing mainstream services and supports.

Part 3 : The Australian Federation of Disability Organisations (AFDO) fully supports the recommendations and commends the Productivity Commission in its latest review outcomes into the National Disability Agreements (NDA).

AFDO urges the Federal Government and every State & Territory government to adopt these recommendations and through the Council of Australian Governments (COAG) commence building these recommendations into a new NDA inclusive of relevant funding, outcomes and reporting.

“I commend the work and the depth of consultation which Commissioner Robert Fitzgerald and the Productivity Commission team have undertaken which is reflected in the richness of the recommendations, they have nailed it!, said Mr Joyce, CEO of AFDO.

“We have been very concerned about the ongoing confusion over responsibilities and service provision across jurisdictions following the implementation and roll-out of the National Disability Insurance Scheme (NDIS) particularly for the 4+ million Australians with disability who are not and never will be covered by the NDIS. The NDIS is essential and will cover 460 thousand Australians at full roll-out, those outside of this and ineligible to join still need relevant supports across all communities. All State & Territory Governments have an ongoing responsibility to people with disability to provide relevant services and supports, no different to anyone else”, advised Mr Joyce.

“The Productivity Commission has investigated and provided key, pertinent and practical recommendations which will ensure that new National Disability Agreements will be an overarching agreement covering all people with disability. The new Agreements need to be about meeting the rights, needs and aspirations, of all people with disability in Australia, and reflect the role of the National Disability Strategy and the NDIS. This is welcomed and would create a new dynamic for people with disability and bring about greater inclusion.”

“We need the Federal Government and all State/Territory Governments to get on board, endorse these and ensure that agreed funding is provided to enable implementation in an effective and timely manner”, said Mr Joyce.

The full review by the Productivity Commission is available here.

Part 4

NACCHO lodged a submission to the Parliamentary Inquiry into NDIS Readiness on 22 February 2018. When appropriately resourced, Aboriginal Community Controlled Health Services (ACCHSs) are uniquely placed to support Aboriginal people through the NDIS to improve health and wellbeing outcomes.

However, there are barriers for ACCHSs becoming providers of the NDIS including cost, thin markets as recognised by the Productivity Commission and limited Aboriginal workforce. The submission also highlights the barriers many Aboriginal people face in accessing NDIS services which include not fitting the assumed client model, limited NDIS service providers in rural and remote areas and not catering for the specific needs of Aboriginal culture.

NACCHO is supportive of the NDIS and understands it is a complex and highly valued national reform. If implemented well, the NDIS will substantially improve the health and wellbeing of people with a disability and Australians more generally. We are keen to collaborate with the Commonwealth Government to develop better solutions for Aboriginal people with a disability.

The full submission to the Parliamentary Inquiry including recommendations for improvement can be found here – NACCHO NDIS submission

NACCHO Aboriginal Health and #NDIS News : 1. Aboriginal people with disabilities and their families need our support and 2. the Ombudsman releases report into the National Disability Insurance Agency’s handling of reviews

 ” In 2014 the Australian government commenced rolling out the NDIS. But Aboriginal participation in the new scheme remains unacceptably low.

This means that despite increases in the funding available, there is a real danger that without culturally appropriate services, supports and pathways the Aboriginal community will not get access to all of the opportunities that the NDIS represents.

Daily our mob lives with the impacts of disability more than any other section of the Australian population: almost half of our Indigenous population aged 15 years and over live with disability or a restrictive long-term health condition and experience disability at more than twice the rate of the general Australian population which increases further with the inclusion of psychosocial disability (mental health).

We need solutions to ensure that all Aboriginal people and their families have access to quality disability services that respect their culture and meet their needs.”

Joseph Archibald is a Gamilario man living on Birpai country mid-north NSW coast. He is manager of Windaan Aboriginal Services. Joseph has worked in the disability sector across areas including sector capacity building for Aboriginal engagement and Aboriginal employment and workforce strategy with industry peak National Disability Services (NDS) and NDIS service development with Galambila Aboriginal Health Service

Read over 20 recent NACCHO Aboriginal Health and NDIS articles HERE

Commonwealth Ombudsman Michael Manthorpe today released a report into the National Disability Insurance Agency’s (NDIA) handling of reviews of decisions under the National Disability Insurance Scheme Act 2013 highlighting complaints and stakeholder feedback including significant backlogs, delays in decision making and poor communication practices.”

In releasing the report, Mr Manthorpe acknowledged the considerable pressure the NDIA has been under to meet bilateral targets since the national rollout of the NDIS, which began in July 2016.

Download a copy of report Here

Report-on-NDIA-administration-of-reviews-under-the-Act_1

However, the Ombudsman stressed this must not be used as a reason to deprioritise or delay other work, including reviews.

“It is clear from this report there are a number of areas in which the NDIA can, and should improve its administration of participant-initiated reviews. Without significant efforts to improve the timeliness of its approach and its communication with participants, there remains a risk that participants’ rights to review will be challenged and the review process will continue to be unwieldy, unapproachable and the driver of complaint volumes” Mr Manthorpe said.

Since mid-2016, complaints to the Commonwealth Ombudsman about the NDIA’s review process have represented around 32 per cent of all NDIA complaints.

The report makes 20 recommendations aimed at improving the NDIA’s administration of reviews, all of which were accepted by the NDIA. The Ombudsman’s Office will continue to monitor the implementation of the recommendations in the report, which is available at:

Media Part 2

People with disabilities are facing delays of up to nine months when they attempt to have their bungled National Disability Insurance Scheme (NDIS) plans fixed, an investigation has found.

From the ABC Report

Key points:

  • NDIS participants seek reviews when their plan does not fit with their needs, for example if they receive funding for fewer hours of care than needed
  • Ombudsman’s report found up to 8,000 people are still waiting for an outcome on their reviews
  • Agency accepted finding that it was not prioritising urgent cases, where people could be at risk of harm or homelessness

People seek reviews for many reasons, including when their plan includes wrong or inadequate equipment and support, for example if they receive funding for fewer hours of care than needed.

“[Delays] pose a particular risk to those who may be at risk of losing services or experiencing deterioration in their capacity if their plan is not adjusted quickly,” the report said.

The Ombudsman said it received 400 complaints about the National Disability Insurance Agency’s (NDIA) review processes over the 18 months to January.Reports to the watchdog included:

“In one case, a participant did not know why her plan was changed because the NDIA had not told her it had accepted (and given effect to) her request for a plan review,” the report said.

“Some participants have told us they have been waiting for up to eight or nine months for a decision on their review request, without any update on its progress or explanation of the time taken.”

The Ombudsman described the review processes as “unwieldy”, “unapproachable”, and lacking “fairness and transparency”.

The Commonwealth Ombudsman’s report into the NDIS’s plan review system has revealed up to 8,000 people are stuck waiting for an outcome.

  • The agency not prioritising urgent cases where, for example, people could be at risk of harm or homelessness
  • NDIA staff and contractors discouraging people from seeking a review
  • The NDIA not acknowledging requests for review or responding to enquiries

The NDIA has accepted the Ombudsman’s 20 recommendations.

“The NDIA has established a dedicated team to manage outstanding reviews.

Social Services Minister Dan Tehan reinforced the message that the NDIA was dealing with the issues outlined in the report.

“Obviously when you undertake a reform of this scale there will always be issues that we need to work through … we’re doing everything we can to speed up the process.

“”These problems need to be fixed, and fixed right now,” Ms Macklin said.

“Get peoples’ plans right the first time so we just don’t need all these reviews done, and people waiting for much-needed support.”

Federal Labor’s social services spokeswoman Jenny Macklin said it was “an absolutely damning report”.

“This was something that was identified some months ago and special teams have been put in place to address this issue,” he said.

“The NDIS is a world-first reform, the size and scale of which means the scheme will not be without challenges.”

“[The agency] has started determining the most practical way to implement responses,” a spokesman said in a statement.

More than 140,000 Australians are now covered by the NDIS — a number expected to reach 475,000 by early next decade.

Example of AWABAKAL ACCHO NDIS Promotion

You are invited to our FREE information sessions to learn more about the National Disability Insurance Scheme (NDIS).

AWABAKAL NDIS GATHERING
14 June 2018
• 10am to 12pm at Wickham Office
• 2pm – 4pm at Cardiff Office

We will explain:
• What is the National Disability Insurance Scheme?
• Accessing the National Disability Insurance Scheme.
• What is funded by the National Disability Insurance Scheme?
• What supports are available if I am not eligible for the National Disability Insurance Scheme?
• Your Consumer Rights when accessing Service Providers
• What is a service agreement?

Yarn to people who have been National Disability Insurance Scheme participants for several years about exercising their rights as consumers.

LOCATION: 10am to 12pm 64 Hannell st Wickham
2pm to 4pm 15 Kelton St Cardiff

For further information contact Suzy Trindall – CDAH
M: 0428 840 953 E: suzy@cdah.org.au

Part 3 Aboriginal people with disabilities and their families need our support

FROM INDIGENOUSX / THE Guardian

Before I worked in the sector, I didn’t know much about disabilities and felt it had little to no relevance to my personal life. How wrong I was. I have been a carer for immediate and extended family and have grown up around family members with disability, but as in many of our Indigenous communities across the country, care and acceptance were our cultural norm and labels were not required.

Pictured above : Editor of NACCHO Communique and Stroke Foundation Consumer Council Co chair & Board Member 2017 Colin Cowell (left ) with fellow stroke survivor Tania Lewis at an NDIS workshop in Coffs Harbour conducted by Joe Archibald (right )

Read Tania’s story HERE

The question of how much of a difference access to quality formal disability supports could have made to the lives of my family members with disability, as well as our lives as carers, is more relevant now then ever.

We need solutions to ensure that all Aboriginal people and their families have access to quality disability services that respect their culture and meet their needs.

The National Disability Insurance Scheme (NDIS) boasts some pretty impressive statistics, including the largest social reform since Medicare, increased funding in the sector from about $8bn per year to $22bn in 2019-20, and providing supports to about 475,000 people.

In 2014 the Australian government commenced rolling out the NDIS. But Aboriginal participation in the new scheme remains unacceptably low. This means that despite increases in the funding available, there is a real danger that without culturally appropriate services, supports and pathways the Aboriginal community will not get access to all of the opportunities that the NDIS represents.

Daily our mob lives with the impacts of disability more than any other section of the Australian population: almost half of our Indigenous population aged 15 years and over live with disability or a restrictive long-term health condition and experience disability at more than twice the rate of the general Australian population which increases further with the inclusion  of psychosocial disability (mental health).

Research and statistics demonstrate the overwhelmingly adverse intersectional impact of being Aboriginal and Torres Strait Islander and having disability across a range of wellbeing and social indicators including health, educational attainment, employment participation, personal safety and exposure to the out of home care and criminal justice systems. Indigenous youth in juvenile detention are recorded as having very high rates of significant intellectual disabilities or mental health conditions.

Aboriginal people living with disability, their carers and families need our support.

Every day Indigenous families enter the NDIS system and service marketplace, many with little support and knowledge of what to do and where to go. This will continue as the NDIS evolves and adapts its generic approach, after having already acknowledged more culturally appropriate strategies and pathways are needed to create equity.

There are cohorts of participants for which supply shortages are high-risk due to the increased cost of service provision and limited availability of workforce, including those who: are in outer regional, remote or very remote areas; have complex needs; are from culturally and linguistically diverse backgrounds; are Aboriginal and Torres Strait Islander Australians; or have acute care needs such as in crisis situations.”

For those who have knowledge of the NDIS space you don’t have to look hard to identify the significant risks in becoming a participant or service provider within an evolving scheme. Acknowledging NDIS is a tough market and costs are yet to reflect the “high risk” and specialist service delivery required to achieve effective outcomes, so it is essential to identify what you do well.

We need culturally appropriate services with sustainable models that can compete in the NDIS open market and be around for our communities for the long term.

Seek to collaborate with existing culturally appropriate services.

Our mob still requires a lot of advocacy in the disability space, and services cannot meaningfully address the needs of Aboriginal communities alone. Adopting models that work closely with Aboriginal families and local partner organisations is important, such as our partnership with Galambila Aboriginal Health Services. It complements existing strengths and services pathways to provide comprehensive care coordination across disability, primary health and allied health services. We know that isolating disabilities from our other services does not work in achieving the positive engagement and outcomes for overall health and wellbeing of our communities.

Historically culture and community supports have been excluded from formal disability service provision, but the right supports and services can empower our families to maintain community and culture in services as much as possible.

At Windaan we have made a commitment to weather the storm of NDIS service delivery and seek out partners where our values and vision align. This allows our Indigenous communities to receive services they’re entitled to and deserve.

  • Guardian Australia is proud to partner with IndigenousX to showcase the diversity of Indigenous peoples and opinions from around the country.

NACCHO Network Submission to the Parliamentary Inquiry into #NDIS National #Disability Insurance Scheme Readiness from the Aboriginal Community-Controlled Health Sector @NDIS

 ” NACCHO lodged a submission to the Parliamentary Inquiry into NDIS Readiness on 22 February 2018.

When appropriately resourced, Aboriginal Community Controlled Health Services (ACCHSs) are uniquely placed to support Aboriginal people through the NDIS to improve health and wellbeing outcomes.

However, there are barriers for ACCHSs becoming providers of the NDIS including cost, thin markets as recognised by the Productivity Commission and limited Aboriginal workforce.

The submission also highlights the barriers many Aboriginal people face in accessing NDIS services which include not fitting the assumed client model, limited NDIS service providers in rural and remote areas and not catering for the specific needs of Aboriginal culture.

NACCHO is supportive of the NDIS and understands it is a complex and highly valued national reform.

If implemented well, the NDIS will substantially improve the health and wellbeing of people with a disability and Australians more generally.

We are keen to collaborate with the Commonwealth Government to develop better solutions for Aboriginal people with a disability.

From the Aboriginal Community-Controlled Health Sector comprising

Download the full NACCHO Submission HERE or extracts below

NACCHO-NDIS-submission

Read over 27 NACCHO Aboriginal Health #Disability #NDIS articles here

Executive Summary

The Aboriginal community controlled health sector provides primary health care services to almost half of all Aboriginal people. This paper draws on experience from across our Sector and finds the following.

1.There are problems for many Aboriginal people accessing NDIS services:

  • Some people struggle because they do not fit the assumed NDIS client model, given that they do not have access to online services, transport or someone who can advocate on their behalf;
  • Some find the system does not always provide for needs specific to Aboriginal culture (such as sorry business and interpreter services) and is not always welcoming to and respectful of Aboriginal people, and:
  • Some Aboriginal people, such as those living in remote areas and many regional areas find there are no disability services available at all, let alone the choice of an Aboriginal organisation.
  1. Our members, the Aboriginal Community Controlled Health Services (ACCHSs) are experienced at providing extra assistance to Aboriginal people as needed. They fill out forms on behalf of some clients, help them with housing and justice issues, and provide outreach services and transport. Our members are also well-established and reliable, with some operating for as long as 40 years, and many are accustomed to dealing with multiple different and complex funding arrangements (one Member Service in Western Australia reported they were managing applications and reporting requirements for over 100 State, Commonwealth and private funding agreements).
  2. Many of our ACCHSs are attracted to providing NDIS services to assist the most vulnerable Aboriginal people in their communities and to help reduce the cost-shifting they are currently experiencing (when NDIS services are not working for Aboriginal customers, they often seek (unfunded) help from their local ACCHS).
  3. However, there are barriers to our ACCHSs becoming service providers including:
  •  Given the extra costs associated with providing some Aboriginal people with the extra support that they need to interact with the existing NDIS system, the pricing for funded services is too low. It is so low that ACCHSs are choosing not to be providers so that they do not endanger the viability of their existing health services.
  • There are also problems with the market (the number of participants) being too small to support the competitive provision of services to Aboriginal clients. The problem of ‘thin markets’ was identified by the Productivity Commission some time ago, but this problem has yet to be addressed by the NDIA.
  • There is insufficient workforce. If our ACCHSs want workers, they find that they need to train their own. Again, this is at cost to the ACCHS.
  • We also anticipate that many ACCHSs would struggle with the upfront investment needed to start providing NDIS service delivery.
  1. The NACCHO network is very supportive of the NDIS. We understand it is a complex and highly valued national reform that if implemented well, it will substantially improve the wellbeing of people with disability and Australians more generally. We are keen to collaborate with the Commonwealth Government to develop better solutions for Aboriginal people which may include increased NDIS service delivery by our members.

1.Introduction

The Aboriginal community controlled health sector

There are 143 Aboriginal Community Controlled Health Services (ACCHSs) who are members of NACCHO. Our members provide services through over 300 clinics. We offer three million episodes of care each year to about 350,000 people, servicing over 47% of the Aboriginal population. About 1 million episodes of care are delivered in remote areas. We employ 6,000 staff, the majority of whom are Aboriginal.

In fact, we are the largest single employer of Aboriginal workers in the country

Aboriginal people are more likely to have a disability but are less likely to access disability services

Aboriginal people are more than twice as likely to experience a disability than non-Indigenous Australians (9% with a severe condition compared to 4% for non-Indigenous).1 Around 60,000 Aboriginal people in Australia have significant disability that could make them eligible for NDIS support, representing 12.5% of potential NDIS participants (while Aboriginal people only represent 3% of the total Australian population).2 We note that currently 5% of NDIS participants are Aboriginal or Torres Strait Islander3, which some consider to be ‘about right’ but we suspect this is far too low.

The percentage of NDIS participants who are Aboriginal is indicative of the numbers of Aboriginal people with plans, but is not necessarily indicative of the extent to which Aboriginal people are receiving assistance under those plans (see box in Section 2 on Indications of under-supply of NDIS services for Aboriginal people).

We welcome the introduction of the NDIS, but are concerned that consistent with previous experience, Aboriginal people may not benefit from the NDIS to the same extent as non-indigenous people.

2.The appropriateness of NDIS arrangements for Aboriginal participants

Based on our experience providing health services, we suspect that Aboriginal people are less likely to use disability services than non-indigenous people owing to:

  • lack of available disability services, especially in remote areas
  • lack of available disability services that are culturally competent
  • lack of accessible disability services (owing to barriers faced by some Aboriginal people including the need to use interpreters, lack of access and skills to use on-line information, needing to travel long distances, not having transport, unstable housing and many other potential issues).

State Governments are withdrawing supports faster than the NDIS can replace them

People who were previously receiving disability support services under State Government schemes are sometimes finding it difficult to obtain replacement services under the NDIS.

NDIS participant planning process is inappropriate for many Aboriginal people

There are significant issues with the NDIS planning process, where participants work with an NDIS planner (who may be either a Local Area Coordinator or an NDIA representative) to develop their care plan based on their ‘reasonable and necessary needs’. NDIS planning conversations are brief and in the past, have sometimes been conducted over the phone and participants were not given adequate time or resources to prepare for their conversations. We understand that some of the issues around the planning process have already been addressed by the NDIA, with the possible exception of the need to provide more pre-planning support by LACs.

It has been reported by our Member Services across the country that NDIA planners are not always sufficiently culturally aware to assist participants appropriately, to understand their goals or to offer them the supports that they need or are entitled to. One example given is that the NDIS is supposed to fund participants’ ability to participate in social and cultural life. Without a proper understanding of Aboriginal culture, planners do not offer or allow for Aboriginal people to choose supports to participate in family, spiritual and traditional cultural practices that are of significant benefit to them

There is a lack of culturally appropriate resources to assist participants and providers. Other services routinely provide interpreters for Aboriginal people but there appears to be no allowance for this under the NDIS. NDIS resources are often in technical language, can require a high degree of computer literacy (and a good internet connection, not always available in remote areas). There are few informational or planning resources specifically tailored to Aboriginal people and their needs.

Lack of case coordination for NDIS participants

Another concern is a lack of organisations who are willing to take on case coordination roles. Where case coordination is funded under an NDIS plan, there is often inadequate allocation of hours in a plan to reflect the amount of support required.

As a result, many Affiliates and Members Services have reported cost shifting to ACCHSs. NDIS participants who have difficulty in the planning process or who cannot access services, often seek help from their local ACCHSs. They trust their local ACCHS to ensure quality, cultural safety and advocacy for Aboriginal people and families that is not adequately provided/funded under the NDIS. ACCHSs are taking on this role at cost to themselves.

Even when Aboriginal people have plans under the NDIS, many are still not receiving the supports to which they are entitled, due to a lack of available providers. There are two aspects to this: a lack of Aboriginal specific or otherwise culturally appropriate disability providers in general, and a lack of any providers at all in parts of regional and remote Australia where Aboriginal people are over-represented and disproportionately suffer from a lack of services.

Thin markets for disability service providers for Aboriginal people

In its recent enquiry into NDIS costs, the Productivity Commission reported on the existence of ‘thin markets’, where the market-based model of the NDIS does not work because there is insufficient supply of participants or disability service organisations to provide a genuine market.

While the Productivity Commission particularly found regional and remote Australia is likely to have thin markets, it also noted that there may be thin markets for Aboriginal specific providers all over Australia, even in urban areas. As an example, one of our members reports that in the ACT, only around 10% (20-40 of 250-300) of eligible Aboriginal people within ACT were accessing NDIS supports under their plans in 2016, in part due to the lack of any Aboriginal specific or culturally safe providers in Canberra.

There are few, if any incentives within the NDIS for service providers to actively work to build community capacity or show that they are able respond to the unique cultural, social and health needs of Aboriginal people. Competitive market models may in fact discourage this. Smaller ACCHSs and other Aboriginal organisations, and particularly those operating in remote areas with thin and fragmented markets, will be unfairly disadvantaged when compared with the economies of scale of larger mainstream providers, including those who operate for profit.

3.Benefits associated with ACCHSs becoming providers of NDIS services

Many of the problems discussed in the previous sections could be addressed if Aboriginal Community Controlled Health Services became providers of NDIS services such as:

  • Undertaking Local Area Coordinator roles (i.e. developing client plans)
  • Providing support coordination (i.e. linking up clients with plans to service providers)
  • Becoming a NDIS registered service provider (i.e. providing disability and allied health services consistent with a client’s plan)
  • Receiving block grant funding for community engagement and participant access support (including identification and engagement, as well as practical support through eligibility and assessment, pre-planning and planning processes)

As far as we can tell:

  • Up to 40 ACCHS are providing allied health services to clients paid for by NDIS packages (this is effectively a new source of fee-for-service funding for service delivery already undertaken by ACCHSs). We are unsure how many are registered providers.
  • Only a few ACCHSs provide the remaining possible services (e.g. LAC services, support co-ordination services or the extensive range of disability services that do not require an allied health professional).

Provision of more disability services by ACCHSs would have the following advantages:

  • Our Member Services already have a relationship with many Aboriginal people who are or will become NDIS clients.
  • We specialise in providing services that are accessible.
  •  For those people who need it, we undertake home and community visits, we use available opportunities to treat people (e.g. we treat all attending family members as needed when they visit the clinic), we provide transport and make specialist appointments on behalf of our clients. We also provide wrap around care relating to other services such as housing and justice.
  • Our Member Services are culturally safe for Aboriginal people.
  • Our Member Services are reliable. Some of our members have been in operation for over 40 years. Our services have been maintained in rural and remote areas in which other services often fail.
  • We are accustomed to dealing with funding complexity, with some of our larger ACCHSs juggling requirements from over 100 funding agreements.

4.Barriers to ACCHSs providing NDIS services

However, our ACCHSs are choosing not to become registered providers of NDIS services owing to issues relating to:

i) pricing of services below cost to the provider

ii) lack of available disability workers

iii) need for upfront investment

Pricing of services below cost to the provider

Only a few ACCHSs are becoming registered NDIS providers, as it is not financially viable for most of them to do so and they are not willing to put at risk their organisational viability and/or existing service delivery.

  • One of the major problems identified is that NDIS funding support is priced at a level that in practice only pays for costs at the point of care as it is based on assumptions about wages, organisational overheads, supervision and billable time that are completely unrealistic and inadequate. In addition, it does not cover holistic care and participant support.
  • Training and recruitment costs for staff are also problematic for organisations, as training is not funded under the NDIS.
  • Transport for participants, disability workers and other sundry costs are not sufficiently considered or provided for, especially for regional and remote participants and workers who must travel long distances to access or deliver services.
  • In general, the remote 25% loading provided by the NDIA is simply inadequate and does not reflect the true costs of providing services in these locations. Our members and other organisations on the ground suggest that 80-100% loading might be more appropriate, given experience in the cost differentials for very remote services.

5.Suggested solutions

1.As recommended by the Productivity Commission (2017) in their report, National Disability Insurance Scheme (NDIS) Costs, the National Disability Insurance Agency should address thin markets with a focus on thin markets for disability services suited to the needs of Aboriginal people by:

  • Considering a range of approaches, including block-funding
  • A possible funding model could be a case-based model, akin to the model being trialled under the ‘Health Care Homes’ program. Under this model ACCHSs would receive direct funding based on the number of participants they enrol for care and the assessed needs of those participants, along with an amount of block funding to cover organisational transformation and overheads.
  • As a matter of urgency, publicly releasing its Provider of Last Resort (POLR) policy and Market Intervention Framework discussed in the NDIS Market Approach: Statement of Opportunity and Intent
  • Collecting and making publicly available disaggregated data, feedback and reports on thin markets, including when POLR arrangements are used.

2.Devote significant investment into training to grow the Aboriginal disability and allied health workforce.

  • We note that the Government has recently announced the appointment of a consortium led by Ernst and Young to implement its $33 million measure announced in the 2017-18 Budget, Boosting the Local Care Workforce Program. Minister Jane Prentice’s media release (20 December 2017) notes that the consortium includes the First Peoples’ Disability Network. We are keen to know more about the governance of this scheme, what services will be available and whether these will be sufficient.
  1. That the NDIA develop and implement specific processes/standards and training regarding interactions and engagement with Aboriginal and Torres Strait Islander people that respect their cultural practices and ways of doing business, both for planning staff and local area coordinators. Again, NACCHO and the sector could assist.
  2. That the NDIA develop improved pre-planning and reference tools and resources suitable for Aboriginal participants and providers. NACCHO and the sector would be able to assist with the development of these materials (but need to be funded for the capacity to do so).
  3. That the NDIA fund dedicated project officer positions within the sector to assist clients to access the NDIS and advocate for them during interactions with planning officers. These positions must be dedicated within the ACCHO sector to support community engagement and funded on an ongoing basis to have real long-term benefits. Furthermore, positions within the Affiliates are required.
  4. Introduce Aboriginal Cultural Support as a funded support category under the NDIS and/or introduction of weighting of packages for Aboriginal people. This will help ensure the cultural needs of Aboriginal people with disability can be taken into account when planning for access to an ‘ordinary life’. It will also improve the incentives and financial viability of organisations that are Aboriginal specific, or who invest in becoming culturally safe providers.
  5. We need revised standard to become providers as these are complex and administratively onerous.
  6. Undertake an independent review of the impacts of NDIS on Aboriginal and Torres Strait Islander people and how to build an effective system to meet the needs of Aboriginal people.
  7. That DSS consider providing funding to the NACCHO network to help fund the development of policy advice specific to each State on Aboriginal NDIS services.

NACCHO Aboriginal Health and #Disability : Can #NDIS Agency Actions Improve #Indigenous Participant Experience ?

 ” Participants by Indigenous and CALD status : The number of NDIS participants who identify as Aboriginal and Torres Strait Islander is broadly in line with estimates of disability prevalence for Aboriginal and Torres Strait Islander Australians. Aboriginal and Torres Strait Islander people represent 3 per cent of the population (ABS 2017a), and estimates of disability prevalence range from between 1.5 to 2 times the prevalence of the non-Indigenous population (ABS 2016a, 2016b; AIHW 2016).

The NDIS data indicate that about 5 per cent of NDIS participants identify as Aboriginal and Torres Strait Islander.

However, some caution is warranted as it is not clear how the rollout schedule has influenced the number of Aboriginal and Torres Strait Islander participants in the scheme and there are some factors that may make it difficult for the NDIS to engage with Aboriginal and Torres Strait Islander people (many Aboriginal and Torres Strait Islander people with disability are reluctant to identify as people with disability and have only had a limited interaction with the disability service system (FPDN 2016)).

Download the NDIS Summary Report  ndis-costs-overview

Download the full NDIS Report ndis-costs2

Read over 25 NACCHO Aboriginal Health and Disability NDIS articles

 ” The NDIA said work was also underway to develop tailored pathways to ensure the NDIA had the right response for all participants, including people with psychosocial disability, children, people from Aboriginal and Torres Strait Islander communities, those from culturally and linguistically diverse backgrounds and people with more complex needs.”

NDIS Agency Takes Action to Improve Participant Experience

Download 9 Page New-pathway-experience-combined

 ” It is [also] anticipated that the capacity for outreach will be significantly diminished due to the NDIS pricing structure. The most marginalised and vulnerable groups (eg homeless, CALD [culturally and linguistically diverse] communities, young people, Aboriginal and Torres Strait Islanders), and those who are particularly unwell, often need assertive and active outreach to engage.

With a framework based on individual choice and control, consumers who don’t have knowledge of the NDIS, the ability to advocate for themselves or connections with support services (eg people who are homeless or socially isolated) may miss out on the benefits of the NDIS. It is critical that existing services and supports continue to be funded to ensure supports are provided to the most vulnerable groups. (sub. 50, p. 13) “

NACCHO has #NDIS questions for our ACCHO member discussion

1) Are any of your members approved providers of disability services under the NDIS? What services do they provide?

2) What is your members’ experience of accessing the NDIS, both as providers and assisting potential participants? What works, and what needs improving?

3) What accessible and culturally appropriate resources and documents are available for ACCHS and participants seeking to access the NDIS? Have you developed any resources for your members that you would be willing to share with the network? 

4) If insufficient resources exist, would you be willing to lead a network collaboration to develop some?

5) What other assistance can NACCHO and affiliates provide in supporting ACCHS to access NDIS funding?

NACCHO  welcomes your feedback and comments

NACCHO Contact

Paul Gardner NACCHO Policy Officer Ph: (02) 6246 9314 Email

OR  leave comments below

 ” Thin markets need more attention .When creating a new market for disability supports, there is a risk that, in some areas, or for some types of supports, the market (the number of providers or participants) will be too small to support the competitive provision of services (‘thin market’).

Thin markets are not new — they have been, and will continue to be, a persistent feature of the disability support sector.

In the absence of government intervention, there will be greater shortages, less competition, and ultimately poorer outcomes for participants. Participants at most risk are those who:

  •  live in outer regional, remote or very remote areas
  •  have complex, specialised or high intensity needs, or very challenging behaviours
  •  are from culturally and linguistically diverse backgrounds
  •  are Aboriginal and Torres Strait Islander Australians
  •  have an acute and immediate need (crisis care and accommodation).

NDIS timetable won’t be met, Productivity Commission warns

The federal government will not meet its target of 475,000 national disability insurance scheme participants by 2019-20, and is failing to grow the disability workforce fast enough to meet the looming demand, the Productivity Commission has warned.

From The Guardian

The commission releases its report on the costs of the $22bn NDIS on Thursday, and offers a bleak assessment of its chances of meeting the tight deadlines set out in a series of bilateral agreements between the commonwealth and the states and territories.

About 100,000 people have already been signed up but the government must develop support plans for at least 475,000 by 2019-20.

To meet that deadline, the NDIS – the biggest social reform since Medicare – is being implemented at a dizzying speed. Advocates have long voiced concerns that the pace of the rollout is compromising decision making and leaving people with a disability with inadequate support packages.

Those fears were confirmed by the Productivity Commission’s report, which said the “[National Disability Insurance Agency’s] focus on participant intake has compromised the quality of plans and participant outcomes”.

“Quality plans are critical, not only for participant outcomes but also for sending the right signals to providers about demand for supports and containing long-term costs of the scheme,” the Productivity Commission said.

The report described the pace of change brought by the NDIS as “unprecedented”, and warned meeting the intake targets would require the approval of hundreds of plans a day, and the review of hundreds more.

In the final year of the transition, it would require the approval of 500 plans – each complex and tailored to the needs of the individual – every day.

“The reality is that the current timetable for participant intake will not be met,” the report said. “Governments and the NDIA need to start planning now for a changed timetable, including working through the financial implications.”

The timetable would be pushed out by at least a year, the report warned, or possibly longer, if the rollout continues to fall behind.

The commission also recommended that states and territories increase their funding to the scheme by 4% from 2019-20, rather than 3.5%.

The growth of the disability workforce was found to be “way too slow”. At full operation, the scheme will require 70,000 additional disability support care workers. That means one in every five jobs created now need to be in the disability sector.

The Productivity Commission recommended the looming shortages be addressed by a targeted approach to skilled migration, intervention in thin markets, and independent price monitoring and regulation.

The report also urged for state and territory funding to be restored to disability advocacy groups.

Advocacy groups fight for the rights and interests of people with a disability and their carers, families and providers, a service particularly important during the complex and confusing NDIS transition.

But in NSW alone, 50 groups are facing closure as the state pulls funding and puts the onus on the NDIS and Commonwealth to replace it.

“As advocacy remains important over the transition period, the commission recommends that funding be restored by jurisdictions that have ceased or reduced funding, and data collection and evaluation of disability advocacy be increased,” the report said.

But the overall message of the report was positive. The NDIS, if implemented well, would greatly improve the lives of people with a disability, it found. The support for the scheme was described as “overwhelming” and “extraordinary”.

The costs were broadly in line with what was expected, although that was largely because not all supports were being used by participants.

The report called for greater attention on the pre-planning and planning phases of the NDIS, which help determine what supports an individual is eligible for and for how long.

It comes just a day after the NDIA announced an overhaul of the way it interacts with people with a disability, promising more face-to-face planning conversations, and simpler and clearer communications.

The NDIA chief executive, Robert De Luca, conceded there had been flaws in the early implementation of the scheme, which were being learned from and addressed.

“What we’ve heard through the process is that the phone conversation hasn’t always been as engaging as it could have been in a face-to-face environment,” De Luca told Guardian Australia.

“The capability of the people on the phone wasn’t at the right level to understand the needs of the people that we’re helping.”

 

Aboriginal Health and #Disability #NDIS : $3 million plan to address the cultural barriers and disadvantage

7

Aboriginal and Torres Strait Islander people are 1.8 times more likely to have a disability than other Australians

“We are announcing today up to $3 million in funding over three years for two targeted projects that will support the Plan; a research project to support Aboriginal and Torres Strait Islander prisoners and ex-prisoners with disability as well as a trial on integrated health and education approaches to support students with disability in remote communities.”

Federal Government Press Release 17 October 2017

Read 23 NACCHO Aboriginal Health and Disability Articles

Read 18 NACCHO Aboriginal Health and NDIS Articles

A $3 million plan has been unveiled to address the cultural barriers and disadvantage faced by Aboriginal and Torres Strait Islander people with disability.

Minister for Social Services, Christian Porter, Assistant Minister for Disability Services, Jane Prentice and Minister for Indigenous Affairs, Nigel Scullion, said the Australian Government Plan to Improve Outcomes for Aboriginal and Torres Strait Islander People with Disability (the Plan) will drive better outcomes for Aboriginal and Torres Strait Islander people with disability, their families and carers.

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dss0001_atsi_disability_plan_accessible_v1

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“We are announcing today up to $3 million in funding over three years for two targeted projects that will support the Plan; a research project to support Aboriginal and Torres Strait Islander prisoners and ex-prisoners with disability as well as a trial on integrated health and education approaches to support students with disability in remote communities.”

Assistant Minister Prentice said consultations over the last three years show that Aboriginal and Torres Strait Islander people with disability face unique challenges.

“The Plan recognises the importance of supporting Aboriginal and Torres Strait Islander people with disability, particularly in remote locations.

“We need to ensure services are delivered within a cultural framework that is appropriate for the community’s customs and practices.”

The plan identifies five key priority areas for action:

  • Housing – access to appropriately designed shelter and accessible, well-designed communities that are fully inclusive of all residents.
  • Justice System – the right to be free from racism and discrimination and a disability-inclusive justice system
  • Education – an inclusive high quality education system that is responsive to the needs of Aboriginal and Torres Strait Islander people with disability
  • Economic security – including employment and business ownership opportunities
  • Health Services – that meet the needs of Aboriginal and Torres Strait Islander people with disability to ensure the highest possible health and wellbeing outcomes.

See Detail Below or in the Plan

“By addressing these issues head on, this Plan aims to achieve improved outcomes and overall social, emotional, cultural, and economic wellbeing for Aboriginal and Torres Strait Islander people with disability and their families and carers,” Minister Porter said.

Extract- Executive Summary

The Australian Government is committed to building an environment that enables Aboriginal and Torres Strait Islander people with disability to achieve improved life outcomes and overall social, emotional, cultural and economic wellbeing.

The development of a dedicated Australian Government plan to improve outcomes of Aboriginal and Torres Strait Islander people with disability seeks to build the capacity of service systems, including disability services and Indigenous programs, to better meet the needs of Aboriginal and Torres Strait Islander people with disability in a culturally safe and appropriate way. The Plan also aims to support workers and carers in their continuing efforts in Aboriginal and Torres Strait Islander communities.

The Plan acknowledges that disability is everyone’s responsibility:

• Australian Government

• state/territory government

• local government

• business and industry sectors

• not–for–profit and community organisations

• Aboriginal and Torres Strait Islander people, communities and organisations.

The Plan is the first of its kind and will be built on over time. The Plan will build on significant work currently being undertaken by the Australian Government to improve outcomes for Aboriginal and Torres Strait Islander people with disability. Consultations on the Plan have been undertaken over the last three years across government agencies together with community stakeholders, including Aboriginal and Torres Strait Islander people with disability, their representative organisations, researchers and community organisations.

The Plan highlights five key areas that stakeholders view as priorities for future consideration by the Australian Government, highlighting work that is already underway in these areas, along with potential strategies to address each of the areas:

1. Aboriginal and Torres Strait Islander people with disability have access to appropriately designed shelter and live in accessible, well designed communities that are fully inclusive of all their residents.

2. Aboriginal and Torres Strait Islander people with disability have the right to:

• be free from racism and discrimination

• have their rights promoted

• a disability inclusive justice system.

3. Aboriginal and Torres Strait Islander people with disability achieve their full potential through participation in an inclusive, high quality education system that is responsive to their needs. People with disability have opportunities for lifelong learning.

4. Aboriginal and Torres Strait Islander people with disability, their families and carers have opportunities to gain economic security through employment and business ownership, enabling them to plan for the future and exercise choice and control over their lives.

5. Aboriginal and Torres Strait Islander people with disability attain the highest possible health and wellbeing outcomes throughout their lives, enabled by all health services capabilities to meet the needs of people with disability.

6 .To ensure that the Plan leads to substantive and meaningful change for Aboriginal and Torres Strait Islander people with disability, any actions or strategies under the Plan must be:

Measurable The priorities and actions outlined in the Plan must be measurable to track progress and outcomes.

Replicable While Aboriginal and Torres Strait Islander people and communities are diverse, there needs to be some consistency in approach and general principles for success that can be applied across different communities.

Sustainable The Plan represents a starting point in the development of a new approach for improving the lives of Aboriginal and Torres Strait Islander people with a disability. The Plan seeks to outline reform and action that will be sustainable over the long-term.

Flexible The Plan recognises that different people and different communities have different needs. While adhering to principles of sustainability and best practice in the delivery of services, implementation needs to be responsive to the unique requirements of individuals and communities.

Cultural The Plan recognises that Aboriginal and Torres Strait Islander people with disability will have similar physical and structural requirements as non–Indigenous people, but that service delivery needs to be undertaken in a cultural context to achieve success.

Area 5: Aboriginal and Torres Strait Islander people with disability attain the highest possible health and wellbeing outcomes throughout their lives, enabled by all health and disability services having the capability to meet their needs.

Why is it important?

Holistic health care and coordination between health and disability services are paramount for those with disabilities. Many Aboriginal and Torres Strait Islander people, those with a disability and those without, access Aboriginal and Torres Strait Islander community controlled health services as they deliver holistic, comprehensive and culturally appropriate health care, and have an understanding of the cultural needs of Aboriginal and Torres Strait Islander people.

While these services meet general health needs through comprehensive primary health care, there is still a need for health workers to receive appropriate training on disability issues. Workers aware of disability needs are able to facilitate appropriate referral pathways for clients to receive any required additional disability services and supports.

Access to disability services is limited by cultural considerations as well as by geographical location, environmental factors, capacity and level of need. Cultural safety can be at risk where the only service within geographic reach is designed for the general population without achieving cultural competency for Aboriginal and Torres Strait Islander care.

Summary of press release

The Australian Government is committed to working in a spirit of collaboration with states and territories, local government, Aboriginal and Torres Strait Islander people, and communities and organisations to deliver real outcomes and foster greater opportunities for Aboriginal and Torres Strait Islander people with disability, their families and carers.

 

Aboriginal Health and the #NDIS #disability debate : Are Aboriginal people being left out of the new @NDIS funding system ?

One year into the national rollout of the NDIS we have 100,000 people with disability living more independent lives, accessing the services and equipment they need, participating in their communities, entering the workforce and contributing to the economy.

To have 100,000 people now receiving reasonable and necessary supports from the NDIS is a major milestone. ”

Minister for Social Services, Christian Porter, said the achievement represented significant progress for the NDIS see Part 1 below for full release

Read over 20 Disability NDIS articles published by NACCHO

 “Nevertheless, the speed of the NDIS rollout, as specified in Bilateral Agreements between governments, has put the scheme’s success and financial sustainability at risk. It has resulted in the NDIA focusing too much on meeting participant intake estimates and not enough on planning processes, supporting infrastructure and market development.

This focus is manifest in poor outcomes such as confusion for many participants about planning processes; rushed phone planning conversations; inadequate pre-planning support for participants; problems for providers with registering, pricing and receiving payment; and a lack of effective communication with both participants and providers.

For the scheme to achieve its objectives, the NDIA must find a better balance between participant intake, the quality of plans, participant outcomes, and financial sustainability.”

From the June Productivity Commission report or Part 4 Below

Download report HERE ndis-costs-position-overview

 

 ” The NSW peak body for Aboriginal children and families is advocating for urgent action to stop Aboriginal and Torres Strait Islander people “being left behind” by the National Disability Insurance Scheme.

Following the recent milestone of engaging 100,000 participants in the scheme, AbSec has raised concerns that only 5 per cent of that number were Aboriginal and Torres Strait Islander people, despite being 70 per cent more likely to experience disability than the general population.

They claim the figures were even more pronounced for Aboriginal and Torres Strait Islander children aged 14 and younger, who are more than twice as likely to have a disability as other children.”

AbSec is calling for long-term funding for Aboriginal community-controlled organisations, to equip them to provide disability services to their local communities.”

See Peak Body Demands Action to Stop NDIS Leaving Aboriginal People Behind Part 2 Below

 ” AbSec project support officer Brian Edwards, who is an NDIS participant himself, having lost his eyesight after developing a brain tumour at just 18 years of age, said it was not acceptable that those who needed the NDIS most were benefiting from it the least.

Aboriginal people experience disability differently to other Australians.

There’s no word meaning ‘disability’ in our languages – it’s not a widely recognised concept in our culture. So there’s a bit of a communication barrier from the start.”

The 27-year-old is currently developing his NDIS disability support plan, which will provide funds to help him access occupational therapy and keep his guide dog healthy see media SBS

” By any measure Aboriginal and Torres Strait Islander people with disability are amongst some of the most disadvantaged Australians; often facing multiple barriers to meaningful participation within their own communities and the wider community.

The prevalence of disability amongst Aboriginal and Torres Islander people is significantly higher than of the general population. Until recently, the prevalence of disability in Aboriginal and Torres Strait Islander communities has only been anecdotally reported. However, a report by the Commonwealth Steering Committee for the Review of Government Service Provision made the following conclusions:

The proportion of the indigenous population 15 years and over, reporting a disability or long-term health condition was 37 per cent (102 900 people). The proportions were similar in remote and non-remote areas. This measure of disability does not specifically include people with a psychological disability. [note 1]

The high prevalence of disability, approximately twice that of the non-indigenous population, occurs in Aboriginal and Torres Strait Islander communities for a range of social reasons “

SEE First Peoples Disability Network Australia (FPDN) Intro and Ten-point plan for the implementation of the NDIS in Aboriginal and Torres Strait Islander Communities VIEW HERE

See Part 3 below FPDN Ten-point plan for the implementation of the NDIS in Aboriginal and Torres Strait Islander Communities

Part 1 NDIS supporting 100,000 Australians : NDIS Press Release

“All Australians should be very proud of this landmark Scheme that replaces a system where the level of support a person with disability received was determined by their postcode and the vastly different funding provided from all levels of government.”

Whilst this milestone is significant, we know there is much more to do to ensure the best NDIS possible is delivered during the three-year transition to full scheme.”

Assistant Minister for Disability Services, Jane Prentice, said the NDIS was transforming people’s lives.

“In my discussions across Australia with NDIS participants, and their families and carers, it is clear that they believe the NDIS is making their lives better,” Assistant Minister Prentice said.

“The NDIS is focussed on building capacity and delivering outcomes so more people with a disability can participate in their community and enter the workforce and live the life they choose.”

The NDIS commenced on 1 July, 2013 in several trial locations across the country. During the three-year trial period, 30,000 Australians with disability entered the Scheme.

Following the successful trial, the national rollout commenced on 1 July, 2016. The NDIS is being introduced in stages around the country over three years, reflecting the scale and complexity of the reform and the need to ensure it delivers positive outcomes for participants. .

The NDIS will provide about 460,000 Australians under the age of 65 with a permanent and significant disability with the reasonable and necessary supports they need to live an ordinary life, including personal care and support, access to the community, therapy services and essential equipment

Part 2 Peak Body Demands Action to Stop NDIS Leaving Aboriginal People Behind

Following the recent milestone of engaging 100,000 participants in the scheme, AbSec has raised concerns that only 5 per cent of that number were Aboriginal and Torres Strait Islander people, despite being 70 per cent more likely to experience disability than the general population.

They claim the figures were even more pronounced for Aboriginal and Torres Strait Islander children aged 14 and younger, who are more than twice as likely to have a disability as other children.

The organisation is now calling for long-term funding for Aboriginal community-controlled organisations, to equip them to provide disability services to their local communities.

AbSec senior project officer for sector capacity Mick Scarcella told Pro Bono News there were a number of reasons Aboriginal people were not engaging with the scheme, which needed to be addressed.

“In Aboriginal communities, ‘people who are different’ are looked after by family with the minimum of fuss, they do not see them as disabled,”  Scarcella said.

“For example, little Johnny in a wheelchair wants to play at the beach, the local kids being family and friends will pick him up in his wheelchair and throw him into the water with the wheelchair so they can all play together. They see him as Little Johnny in the wheelchair, not Johnny with a disability.

“The other reasons for the low engagement comes to trust issues of government agencies and injustices of the past.

“Access to services is an issue as well. Many Aboriginal people have never accessed disability services because there is none in their local area.”

Scarcella, who said the figures quoted erred “on the conservative side” due to undiagnosed cases and lack of engagement, said it was important Aboriginal people had Aboriginal-run services to turn to.

“It has proven repeatedly that self-determination works in the Aboriginal Community,” he said.

“Aboriginal people need to be listened to and become part of the solution and not be told what their problem is and how to fix it, by people who have no idea of the significant cultural differences and family dynamics Aboriginal people have.

“Establishing a system that enables people to recruit family members needs more discussion as well. The way family members rally around a person with disability and focus on their positives instead of believing they are a burden to society is something mainstream Australia can learn from us.”

He said while a commitment to tailored Aboriginal services already existed in the NDIA’s Aboriginal and Torres Strait Islander Engagement Strategy, the reality on the ground showed “little reflection” to the strategy.

“All of these reports are being generated and are coming back showing all of this information we already knew but very little is being done to reflect the report findings and address the recommendations,” he said.

“One of these reports, without mentioning any names, is a 17-page document and the word Aboriginal or Indigenous is not even mentioned in it at all, not once which is very alarming, considering the fact of the low engagement so far to date with the Aboriginal communities.

“We need transparency and accountability for measurable outcomes not token promises and feel good gestures.”

AbSec project support officer Brian Edwards, who is an NDIS participant himself, having lost his eyesight after developing a brain tumour at just 18 years of age, said it was “not acceptable” that those who needed the NDIS most were “benefiting from it the least”.

“Aboriginal people experience disability differently to other Australians,” Edwards said.

“There’s no word meaning ‘disability’ in our languages – it’s not a widely recognised concept in our culture. So there’s a bit of a communication barrier from the start.”

He said said lifting the number of Aboriginal and Torres Strait Islander people accessing the NDIS was “absolutely vital” to closing the gap in health and wellbeing.

“The NDIS is being billed as a revolution in social services – but its impact can’t be truly revolutionary unless all of us are on-board,” he said.

Part 3 Ten-point plan for the implementation of the NDIS in Aboriginal and Torres Strait Islander Communities

Introduction

We are First Peoples Disability Network Australia (FPDN) – a national organisation of and for Australia’s First Peoples with disability, their families and communities. Our organisation is governed by First Peoples with lived experience of disability

By any measure Aboriginal and Torres Strait Islander people with disability are amongst some of the most disadvantaged Australians; often facing multiple barriers to meaningful participation within their own communities and the wider community.

The prevalence of disability amongst Aboriginal and Torres Islander people is significantly higher than of the general population. Until recently, the prevalence of disability in Aboriginal and Torres Strait Islander communities has only been anecdotally reported. However, a report by the Commonwealth Steering Committee for the Review of Government Service Provision made the following conclusions:

Ten-point plan

  • Recognise that the starting point is the vast majority of Aboriginal people with disability do not self-identify as people with disability. This occurs for a range of reasons including the fact that in traditional languages there are no comparable words for disability. Also, many Aboriginal people with disability are reluctant to take on the label of disability; particularly when they already experience discrimination based on their Aboriginality. In many ways disability is a new conversation in many communities. In these instances the NDIS is starting from a baseline position. As a consequence change in this area is likely to happen on a different timeline to that of the mainstream NDIS.
  • Awareness raising via a concerted outreach approach informing Aboriginal and Torres Strait Islander people with disability, their families and communities about their rights and entitlements, and informing Aboriginal and Torres Strait communities about the NDIS itself and how to work this new system effectively. There is no better way to raise awareness then by direct face-to-face consultation. Brochures and pamphlets will not be appropriate as this is a new conversation in many communities.
  • Establish the NDIS Expert Working Group on Aboriginal and Torres Strait Islander People with disability and the NDIS. In recognition of the fact that there is a stand-alone building block for the NDIS focused upon Aboriginal and Torres Strait Islander people with disability, FPDN views it not only as critical but logical that a specific Expert Working Group be established to focus on Aboriginal and Torres Strait Islander people with disability. The new working group would operate in the same way the four current working groups do, that is it would be chaired by two members of the National People with Disability and Carers Council. To ensure its effectiveness but also critically to influence prominent Aboriginal leaders as well as the disability sector, members would be drawn from Aboriginal and Torres Strait Islander people in community leadership positions, as well as involving prominent disability leaders. The FPDN believes such an approach is warranted not only because of the degree of unmet need that is well established but also because this has the potential to be a very practical and meaningful partnership between government, the non-government sector, and Aboriginal and Torres Strait Islander communities.
  • Build the capacity of the non-Indigenous disability service system to meet the needs of Aboriginal people with disability in a culturally appropriate way. Legislate an additional standard into the Disability Services Act focused upon culturally appropriate service delivery and require disability services to demonstrate their cultural competencies.
  • Conduct research on the prevalence of disability and a range other relevant matters. Critically, this work must be undertaken in partnership with Aboriginal and Torres Strait Islander people with disability to ensure a culturally appropriate methodology. There remains very little reference material about disability in Aboriginal and Torres Strait Islander communities. This needs to be rectified to ensure that we are getting a true picture of the lived experience of Aboriginal and Torres Strait Islander people with disability.
  • Recognise that  a workforce already exists in many Aboriginal and Torres Strait Islander communities that does important work, often informally. This work needs to valued and recognised, with the potential for employment opportunities in some communities.
  • Recognise that it’s not always about services. Many communities just need more resources so that they can continue to meet the needs of their own people with disabilities. There may be perfectly appropriate ways of supporting people already in place, however what is often lacking is access to current technologies or appropriate technical aids or sufficient training for family and community members to provide the optimum level of support.
  • Recruitment of more Aboriginal and Torres Strait Islander people into the disability service sector.
  • Build the capacity of the social movement of Aboriginal and Torres Strait Islanders with disability by supporting existing networks and building new ones in addition to fostering Aboriginal and Torres Strait Islander leaders with disability. These networks play a critical role in breaking down stigma that may exist in some communities but are also the conduits for change, and will be integral to the successful implementation of the NDIS in Aboriginal and Torres Strait Islander communities.
  • Aboriginal and Torres Strait Islander ‘Launch’ sites focused upon remote, very remote, regional and urban settings. It is critical that this major reform be done right. Therefore it is appropriate to effectively trial its implementation. To this end, FPDN can readily identify key communities that would be appropriate as trial sites.

Part 4 From the June Productivity Commission report

Key points
·      The National Disability Insurance Scheme (NDIS) is a complex and highly valued national reform. The scale, pace and nature of the changes it is driving are unprecedented in Australia. If implemented well, it will substantially improve the wellbeing of people with disability and Australians more generally.

·      The level of commitment to the success and sustainability of the NDIS is extraordinary. This is important because ‘making it work’ is not only the responsibility of the National Disability Insurance Agency (NDIA), but also that of governments, participants, families and carers, providers, and the community.

·      Based on trial and transition data, NDIS costs are broadly on track with the NDIA’s long‑term modelling. While there are some emerging cost pressures (such as higher numbers of children entering the scheme), the NDIA has put in place initiatives to address them. The benefits of the NDIS are also becoming apparent. Early evidence suggests that many (but not all) NDIS participants are receiving more disability supports than previously, and they have more choice and control.

·      Nevertheless, the speed of the NDIS rollout, as specified in Bilateral Agreements between governments, has put the scheme’s success and financial sustainability at risk. It has resulted in the NDIA focusing too much on meeting participant intake estimates and not enough on planning processes, supporting infrastructure and market development.

–     This focus is manifest in poor outcomes such as confusion for many participants about planning processes; rushed phone planning conversations; inadequate pre‑planning support for participants; problems for providers with registering, pricing and receiving payment; and a lack of effective communication with both participants and providers.

·      For the scheme to achieve its objectives, the NDIA must find a better balance between participant intake, the quality of plans, participant outcomes, and financial sustainability. Steps are now being taken by the NDIA to better balance these aspects. Greater emphasis is needed on pre‑planning, in‑depth planning conversations, plan quality reporting, and more specialised training for planners. The Commission is unable to form a judgment on whether such a refocus can be achieved while also meeting the rollout timetable.

·      The interface between the NDIS and other disability and mainstream services is also critical for participant outcomes and the financial sustainability of the scheme. Some disability supports are not being provided because of unclear boundaries about the responsibilities of the different levels of government. Governments must set clearer boundaries at the operational level around ‘who supplies what’ to people with disability, and only withdraw when continuity of service is assured.

·      A significant challenge is growing the disability care workforce required to deliver the scheme — it is estimated that 1 in 5 new jobs created in Australia over the next few years will need to be in the disability care sector. Present policy settings are unlikely to see enough providers and workers as the scheme rolls out. Some emerging shortages need to be mitigated by better price monitoring and regulation; better tailored responses to thin markets; formal and informal carers allowed to provide more paid care; and a targeted approach to skilled migration.

·      NDIS funding arrangements could better reflect the insurance principles of the scheme, including by allowing more flexibility around the NDIA’s operational budget and providing a pool of reserves. Funding contributions made ‘in‑kind’ must be phased out.

NACCHO Aboriginal Health #Strokeweek : #Fightstroke Aboriginal people are up to three times more likely to suffer a stroke than non-Indigenous

 

” Aboriginal and Torres Strait Islander people are up to three times more likely to suffer a stroke than non-Indigenous Australians and almost twice as likely to die, according to the Australian Bureau of Statistics. It’s an alarming figure and one that  prompted the National Stroke Foundation in 2016 to urge the Federal Government to fund a critical $44 million awareness campaign in a bid to close the gap .

The good news is most strokes are preventable and treatable.

However communities need to be empowered to protect themselves from this insidious disease.”

Sharon McGowan, Stroke Foundation CEO ( see full Aboriginal Stroke statistics part 2 below

Download the 48 Page support guide :

journeyafterstroke_indigenous_0

Read over 75 Stroke related articles published by NACCHO over past 5 years

“Never had I ever come across one ( stroke ) or heard much about them. I had nothing to do with them,”

When I woke up, I didn’t know what was going on. I couldn’t communicate. I couldn’t tell anyone I was still here. It was really scary. I’d never seen the effects of a stroke.

First, I lost my voice, then my vision, my [ability to] swallow and my movement of all my body parts. I lost all my bowel and bladder function. I’ve still got bad sight but I can see again. My speech took about six months.

With help from the Aboriginal Disability Network, they advocated to get me out and get the right support equipment at home “

For Tania Lewis, an Awabakal woman, stroke was something that only happened to older people. But in 2011, Tania suffered a severe stroke at the age of 39 that would leave her with permanent right-sided hemiplegia – paralysis of one side of the body.

Pictured above : Editor of NACCHO Communique and Stroke Foundation Consumer Council Board Member Colin Cowell (left ) with fellow stroke survivor Tania Lewis at an NDIS workshop in Coffs Harbour conducted by Joe Archibald (right )

Part 1 Stroke Foundation in 2016 called on government to close the gap

Originally published here

A stroke occurs when supply of blood to the brain is disturbed suddenly. The longer it remains untreated, the heightened the risk of stroke-related brain damage.

Medical treatment during the first onset of symptoms can significantly improve a sufferer’s chance of survival and of successful rehabilitation.

In Australia, stroke is the leading cause of long-term disability in adults, accounting for 25 per cent of all chronic disability. The NSF reports that roughly 50,000 strokes occur per year with over 437,000 people living with stroke across the country. While severity varies, two thirds of victims, like Tania, are left with impeding disabilities

But in 2011, Tania suffered a severe stroke at the age of 39 that would leave her with permanent right-sided hemiplegia – paralysis of one side of the body.

The burden of stroke doesn’t just fall on the patient, but can take a significant toll on family and carers.

“The doctor at the hospital tried to take Power of Attorney and Guardianship away from me and give it to the Guardianship Board, because he didn’t believe that [my husband] Len or anyone could look after me,” Tania recalls.

“I was put through hell. I figured life wasn’t worth living anymore because they took everything away from me. I couldn’t go home to my family. So I tried to off myself.

“Then all of a sudden, one day the doctor said, ‘You can go home. We can’t rehabilitate you anymore’. At home, I was having seizures for a while. My hubby wouldn’t sleep. He and his mum would take shifts looking after me. We tried to get assistance but there was nothing for young people. So one day, my husband collapsed on the lounge room floor from exhaustion. It was just a nightmare. That’s how I ended up in aged care.”

Tania spent the next two and a half years between three aged care facilities.

“I wouldn’t wish it upon nobody,” she says.

It was during her nightly ritual of chatting with her daughter via Facebook that Tania typed “young people in nursing homes” into Google. The search engine’s results would lead to her life-changing encounter with the YPINH.

“With help from the Aboriginal Disability Network, they advocated to get me out and get the right support equipment at home. Whatever I need, physio, OT – they’ve got my back. I can’t thank them enough for what they’ve done for me.”

Today, Tania is working with the Aboriginal Disability Network, helping Indigenous Australians navigate their way through the National Healthcare System.

It has long been recognised that Aboriginal and Torres Strait Islander people have a life expectancy that is approximately 20 years less than non-Indigenous Australians (Australian Bureau of Statistics). Recent data from the ABS shows that up to 80 per cent of the mortality gap can be attributed to chronic diseases such as heart disease, stroke, diabetes and kidney disease.

For many Aboriginal communities, especially those in remote regions, socio-economic factors play an important role. Kerin O’Dea from Darwin’s Menzies School of Health Research cites unemployment, poor education outcomes and limited access to fresh foods as key factors in her paper, Preventable chronic diseases among Indigenous Australians.

Lifestyle related risks such as smoking, alcohol misuse, stress, poor diet, and inadequate physical activity also need to be addressed, according to the Australian Institute of Health and Welfare .

But the first step, McGowan says, is for indigenous stroke sufferers to recognise the signs of a stroke in themselves and their family members. The NSF recommends the F.A.S.T. test as the most effective way to remember the most common signs of a stroke.

Face: Check their face. Has their mouth drooped?
Arms: Can they lift both arms?
Speech: Is their speech slurred? Do they understand you?
Time: Is critical. If you see any of these signs call 000 straight away.

“If I had known that because I’d lost my vision I had suffered a stroke, I could’ve put two and two together and got help, but I didn’t know anything,” Tania says.

“I was a heavy smoker, but not anymore – no way. Life’s too important. I didn’t ever know anything about a stroke – I was more thinking when you smoke, you can have lung problems and lose your fingers, like on the packets. But they don’t say anything about a stroke – they don’t advertise that stuff.”

The Stroke Foundation called on the Federal Government to fund an urgent $44 million campaign to address the gap in stroke care. For more information on stroke and the campaign, visit strokefoundation.com.au.

Part 2 Aboriginal Stroke Facts

From here

  • The incidence rate of stroke for Aboriginal and Torres Strait Islander Australians has been found to be 2.6 times higher for men and 3.0 for women (Australian Institute of Health and Welfare, 2008; Katzenellenbogan et al. 2010) compared to non-Aboriginal and Torres Strait Islander Australians and many suggest that these figures may in fact be underestimates (Thrift et al 2011).
  • Aboriginal and Torres Strait Islander Australians are known to experience stroke at a younger age than their non-Aboriginal and Torres Strait Islander counterparts, (Katzenellenbogen et al., 2010; Australian Institute of Health and Welfare, 2004) with 60% of Aboriginal and Torres Strait Islander non-fatal stroke burden occurring in the 25-54 year age-group compared to 24% in the non-Aboriginal and Torres Strait Islander group (Katzenellenbogen et al., 2010).
  • The prevalence of stroke is similarly significantly higher at younger ages among Aboriginal and Torres Strait Islander people (Katzenellenbogen 2013), with a significantly higher prevalence of co-morbidities among Aboriginal and Torres Strait Islander patients under 70 years of age, including heart failure, atrial fibrillation, chronic rheumatic heart disease, ischaemic heart disease, diabetes and chronic kidney disease. This reflects the increased clinical complexity among Aboriginal and Torres Strait Islander stroke patients compared with non-Aboriginal/Torres Strait Islander patients.
  • Aboriginal and Torres Strait Islander stroke patients aged 18–64 years have a threefold chance of dying or being dependent at discharge compared to non-Aboriginal and Torres Strait Islander patients (Kilkenny et al., 2012).

NACCHO @FPDNAus Aboriginal Health @NDIS 2016 progress report survey The National #Disability Strategy

 ” By any measure Aboriginal and Torres Strait Islander people with disability are amongst some of the most disadvantaged Australians; often facing multiple barriers to meaningful participation within their own communities and the wider community.

The prevalence of disability amongst Aboriginal and Torres Islander people is significantly higher than of the general population. Until recently, the prevalence of disability in Aboriginal and Torres Strait Islander communities has only been anecdotally reported. However, a report by the Commonwealth Steering Committee for the Review of Government Service Provision made the following conclusions:

The proportion of the indigenous population 15 years and over, reporting a disability or long-term health condition was 37 per cent (102 900 people). The proportions were similar in remote and non-remote areas. This measure of disability does not specifically include people with a psychological disability. [note 1]

The high prevalence of disability, approximately twice that of the non-indigenous population, occurs in Aboriginal and Torres Strait Islander communities for a range of social reasons “

SEE First Peoples Disability Network Australia (FPDN) Intro and Ten-point plan for the implementation of the NDIS in Aboriginal and Torres Strait Islander Communities VIEW HERE or Below

Read over 15 NACCHO NDIS Articles published

 See Background 1 below

The DSS need to improve under the National Disability Strategy.

We want to hear your thoughts about disability policy in Australia!

Are you a person with disability, a family member, a carer, or are you just interested in the rights of people with disability?

Tell us what you think about the lives of people with disability in Australia. This may include questions about things like health care, employment and access to the local community for people with disability.

Answer this survey and tell us how things have improved in the last two years. This feedback will help us understand what areas need to improve under the National Disability Strategy.

The National Disability Strategy

The National Disability Strategy 2010-2020 (the Strategy) helps us to create better policies, programs and communities so people with disability are able to lead happy and fulfilling lives.

The Strategy identifies six areas that people with disability are concerned about.  They are:

  1. Taking part in the in the community
  2. Your rights to fair treatment
  3. Work and money
  4. Personal and community support
  5. Learning and Skills
  6. Health and Wellbeing

What will my feedback be used for?

Your feedback will help inform the 2016 Progress Report.  Reporting is an important part of the Strategy.  Every two years we develop a progress report that looks at the achievements of the Strategy.  An important part of the report is finding out what people with disability, their families and carers think.  We also work with other government agencies and state and territory governments to collect feedback and data to help inform the 2016 Progress Report.

How can I access the survey?

The survey can be completed online via the 2016 Progress Report Stakeholder Survey page.

If you would like a hard copy of the survey to complete, please email nationaldisabilityst@dss.gov.au or ring (02) 6146 2507.

Please note: Requests for a hard copy of the survey must be made by 4 August 2017.

Completed hard copy surveys can be mailed to:

National Disability Policy Team
The Department of Social Services
Reply Paid
GPO Box 9820
Canberra ACT 2601

When will the survey open/close?

The survey will be open from Monday 17 July 2017 and will close on Monday 21 August 20

Background 1 of 2

What is the NDIS?

Will the NDIS mean more or less support?

Is the NDIS diagnosis based or needs based?

Am I eligible for the NDIS?

Where is the NDIS available now?

What supports does the NDIS cover?

How does the NDIS process work?

I have an NDIS plan. What’s next?

When will the NDIS be here for all Australians?

Where can we get more help

Full details below or download Help Guide Here :

NDIS your Questions answered Download

NACCHO Aboriginal Health #disability and @NDIS : Your Top 10 Questions answered about the National Disability Insurance Scheme

BACKGROUND from FPDN

Ten-point plan for the implementation of the NDIS in Aboriginal and Torres Strait Islander Communities

Introduction

We are First Peoples Disability Network Australia (FPDN) – a national organisation of and for Australia’s First Peoples with disability, their families and communities. Our organisation is governed by First Peoples with lived experience of disability

By any measure Aboriginal and Torres Strait Islander people with disability are amongst some of the most disadvantaged Australians; often facing multiple barriers to meaningful participation within their own communities and the wider community.

The prevalence of disability amongst Aboriginal and Torres Islander people is significantly higher than of the general population. Until recently, the prevalence of disability in Aboriginal and Torres Strait Islander communities has only been anecdotally reported. However, a report by the Commonwealth Steering Committee for the Review of Government Service Provision made the following conclusions:

The proportion of the indigenous population 15 years and over, reporting a disability or long-term health condition was 37 per cent (102 900 people). The proportions were similar in remote and non-remote areas. This measure of disability does not specifically include people with a psychological disability. [note 1]

The high prevalence of disability, approximately twice that of the non-indigenous population, occurs in Aboriginal and Torres Strait Islander communities for a range of social reasons, including poor health care, poor nutrition, exposure to violence and psychological trauma (e.g. arising from removal from family and community) and substance abuse, as well as the breakdown of traditional community structures in some areas. Aboriginal people with disability are significantly over-represented on a population group basis among homeless people, in the criminal and juvenile justice systems[note 2], and in the care and protection system (both as parents and children).[note 3]

The advent of the National Disability Insurance Scheme (NDIS) presents an opportunity for Aboriginal and Torres Strait Islander people with disabilities to engage – many for the first time – with the disability service system in a substantive way. Currently, most Aboriginal and Torres Strait Islander people with disabilities remain at the periphery of the disability service system. This continues to occur for a range of reasons some of which are well established. However, one factor that remains little understood is the reluctance of Aboriginal and Torres Strait Islander people with disabilities to identify as people with disability. This preference to not identify presents a fundamental barrier for the successful implementation of the NDIS. The First Peoples Disability Network (Australia) (FPDN) argues that it has a central role in addressing not only this fundamental barrier but also in facilitating the roll out of the NDIS more broadly into Aboriginal and Torres Strait Islander communities.

FPDN argues passionately that for positive change to happen in the lives of Aboriginal and Torres Strait Islander people with disability, the change must be driven by community itself. It cannot be imposed, implied, intervened or developed with well-meaning intention from an external service system that the vast majority of Aboriginal and Torres Strait Islander people with disabilities have little or no experience of in the first place.

Throughout many communities across the country, Aboriginal and Torres Strait Islander people with disability are supported and accepted as members of their communities. However, many communities lack the resources to adequately support people with disability. Furthermore, the service system tends to operate from a ‘doing for’ as opposed to ‘doing with’ approach, which only further disenfranchises communities because they simply do not feel that they can self-direct their future. The NDIS does have the potential to address some of these concerns by giving Aboriginal and Torres Strait Islander people with disability the opportunity to self-direct their funding, for instance. The challenge in this area will be that many Aboriginal and Torres Strait Islander people with disability have had little or no experience in self-managing funds.

It must be remembered that in many ways the social movement of Aboriginal and Torres Strait Islander people with disability is starting from an absolute baseline position. This is reflected, for example, by the fact that few Aboriginal and Torres Strait Islander people with disability have an understanding of the language of the disability service system. It is the view of FPDN that the application of the NDIS in Aboriginal and Torres Strait Islander communities will need to have a different look and approach to what is advocated for with regard the rest of the Australian population. It may be that the application of the NDIS in Aboriginal and Torres Strait Islander communities takes a longer process. But the FPDN argues that it is critical to get it right as it is the experience of many Aboriginal and Torres Strait Islander people that they are usually the first to be blamed when new programs are not taken up by Aboriginal and Torres Strait Islander people.

FPDN has developed a 10-point plan for the implementation of the NDIS in Aboriginal and Torres Strait Islander people with disabilities. The development of this 10 point plan is based upon extensive consultation as well as drawing upon the decade long experience of the FPDN in advocating for the rights of Aboriginal and Torres Strait Islanders people with disabilities.

The plan was launched in May 2013 at Parliament House, Canberra.

Ten-point plan

  • Recognise that the starting point is the vast majority of Aboriginal people with disability do not self-identify as people with disability. This occurs for a range of reasons including the fact that in traditional languages there are no comparable words for disability. Also, many Aboriginal people with disability are reluctant to take on the label of disability; particularly when they already experience discrimination based on their Aboriginality. In many ways disability is a new conversation in many communities. In these instances the NDIS is starting from a baseline position. As a consequence change in this area is likely to happen on a different timeline to that of the mainstream NDIS.
  • Awareness raising via a concerted outreach approach informing Aboriginal and Torres Strait Islander people with disability, their families and communities about their rights and entitlements, and informing Aboriginal and Torres Strait communities about the NDIS itself and how to work this new system effectively. There is no better way to raise awareness then by direct face-to-face consultation. Brochures and pamphlets will not be appropriate as this is a new conversation in many communities.
  • Establish the NDIS Expert Working Group on Aboriginal and Torres Strait Islander People with disability and the NDIS. In recognition of the fact that there is a stand-alone building block for the NDIS focused upon Aboriginal and Torres Strait Islander people with disability, FPDN views it not only as critical but logical that a specific Expert Working Group be established to focus on Aboriginal and Torres Strait Islander people with disability. The new working group would operate in the same way the four current working groups do, that is it would be chaired by two members of the National People with Disability and Carers Council. To ensure its effectiveness but also critically to influence prominent Aboriginal leaders as well as the disability sector, members would be drawn from Aboriginal and Torres Strait Islander people in community leadership positions, as well as involving prominent disability leaders. The FPDN believes such an approach is warranted not only because of the degree of unmet need that is well established but also because this has the potential to be a very practical and meaningful partnership between government, the non-government sector, and Aboriginal and Torres Strait Islander communities.
  • Build the capacity of the non-Indigenous disability service system to meet the needs of Aboriginal people with disability in a culturally appropriate way. Legislate an additional standard into the Disability Services Act focused upon culturally appropriate service delivery and require disability services to demonstrate their cultural competencies.
  • Conduct research on the prevalence of disability and a range other relevant matters. Critically, this work must be undertaken in partnership with Aboriginal and Torres Strait Islander people with disability to ensure a culturally appropriate methodology. There remains very little reference material about disability in Aboriginal and Torres Strait Islander communities. This needs to be rectified to ensure that we are getting a true picture of the lived experience of Aboriginal and Torres Strait Islander people with disability.
  • Recognise that  a workforce already exists in many Aboriginal and Torres Strait Islander communities that does important work, often informally. This work needs to valued and recognised, with the potential for employment opportunities in some communities.
  • Recognise that it’s not always about services. Many communities just need more resources so that they can continue to meet the needs of their own people with disabilities. There may be perfectly appropriate ways of supporting people already in place, however what is often lacking is access to current technologies or appropriate technical aids or sufficient training for family and community members to provide the optimum level of support.
  • Recruitment of more Aboriginal and Torres Strait Islander people into the disability service sector.
  • Build the capacity of the social movement of Aboriginal and Torres Strait Islanders with disability by supporting existing networks and building new ones in addition to fostering Aboriginal and Torres Strait Islander leaders with disability. These networks play a critical role in breaking down stigma that may exist in some communities but are also the conduits for change, and will be integral to the successful implementation of the NDIS in Aboriginal and Torres Strait Islander communities.
  • Aboriginal and Torres Strait Islander ‘Launch’ sites focused upon remote, very remote, regional and urban settings. It is critical that this major reform be done right. Therefore it is appropriate to effectively trial its implementation. To this end, FPDN can readily identify key communities that would be appropriate as trial sites.

NACCHO Aboriginal Health #Disability #NDIS : ACCHO Submissions to #NDIS close 12 July 2017

 ” This position paper outlines the Productivity Commission’s early thinking on NDIS costs. The purpose of this position paper is to seek feedback on the Commission’s preliminary conclusions, and on any additional issues that should be considered before the public release of the final study report.

This position paper was released on 14 June 2017. You are invited to examine the paper and to make a written submission or comment by Wednesday 12 July 2017.”

People who want to comment or make a submission for the final report, due to be released in September, can do so at pc.gov.au

Download the PC Overview and Position paper here

ndis-costs-position-overview

ndis-costs-position

or Download MS Word copies here

‘The National Disability Insurance Scheme (NDIS) is a major, complex national reform — the largest social reform in Australia since the introduction of Medicare,’

Social Policy Commissioner Richard Spencer

 ” For Aboriginal and/or Torres Strait Islander people living with disability and their carers, this is a much-needed conversation.

FPDN estimates 60,000 Aboriginal and/or Torres Strait Islander people will potentially be eligible for NDIS. Whilst there might be new opportunities for First Peoples through the NDIS, such as a growth in Aboriginal and/or Torres Strait Islander health and disability services workforce, valid concerns are being raised.

Some of these include how effective NDIS rollout will be in rural and remote Aboriginal and Torres Strait Islander communities, and concerns of eligibility criteria not being inclusive or culturally relevant for First Peoples living with disabilities ”

See all NACCHO posts Disability NDIS

OR

NACCHO Aboriginal Health #disability and @NDIS : Your Top 10 Questions answered about the National Disability Insurance Scheme

 ” For many, language barriers can prevent meaningful engagement with planning processes. Neami National (sub. 63, p. 6) said that ‘consumers without English as their first language describe difficulties in participating in planning and in getting plans that they can fully implement on account of their language needs’.

This is an issue which disproportionately affects Aboriginal and Torres Strait Islander communities: English is a second language for many Indigenous people in remote communities. The majority of participants in Barkly identify as being Aboriginal or Torres Strait Islander and for 67% English is not their first language. Many have limited capacity to understand or read it.

This has a significant impact on their ability to have genuine input into the formulation of their plans and also impacts on decision making and choice. (Brain Injury SA, sub. 116, p. 3) “

From Page 172 Submission

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In 2020, when the NDIS is fully rolled out, around 475 000 people with disability are expected to receive individualised supports, at an estimated cost of $22 billion per year.

In a position paper released today, the Commission finds that while it is early days in the transition to full scheme, the NDIS is on track in terms of costs.

KEY POINTS

  • The National Disability Insurance Scheme (NDIS) is a complex and highly valued national reform. The scale, pace and nature of the changes it is driving are unprecedented in Australia. If implemented well, it will substantially improve the wellbeing of people with disability and Australians more generally.
  • The level of commitment to the success and sustainability of the NDIS is extraordinary. This is important because ‘making it work’ is not only the responsibility of the National Disability Insurance Agency (NDIA), but also that of governments, participants, families and carers, providers, and the community.
  • Based on trial and transition data, NDIS costs are broadly on track with the NDIA’s long-term modelling. While there are some emerging cost pressures (such as higher numbers of children entering the scheme), the NDIA has put in place initiatives to address them. The benefits of the NDIS are also becoming apparent. Early evidence suggests that many (but not all) NDIS participants are receiving more disability supports than previously, and they have more choice and control.
  • Nevertheless, the speed of the NDIS rollout, as specified in Bilateral Agreements between governments, has put the scheme’s success and financial sustainability at risk. It has resulted in the NDIA focusing too much on meeting participant intake estimates and not enough on planning processes, supporting infrastructure and market development.
    • This focus is manifest in poor outcomes such as confusion for many participants about planning processes; rushed phone planning conversations; inadequate pre-planning support for participants; problems for providers with registering, pricing and receiving payment; and a lack of effective communication with both participants and providers.
  • For the scheme to achieve its objectives, the NDIA must find a better balance between participant intake, the quality of plans, participant outcomes, and financial sustainability. Steps are now being taken by the NDIA to better balance these aspects. Greater emphasis is needed on pre-planning, in-depth planning conversations, plan quality reporting, and more specialised training for planners. The Commission is unable to form a judgment on whether such a refocus can be achieved while also meeting the rollout timetable.
  • The interface between the NDIS and other disability and mainstream services is also critical for participant outcomes and the financial sustainability of the scheme. Some disability supports are not being provided because of unclear boundaries about the responsibilities of the different levels of government. Governments must set clearer boundaries at the operational level around ‘who supplies what’ to people with disability, and only withdraw when continuity of service is assured.
  • A significant challenge is growing the disability care workforce required to deliver the scheme — it is estimated that 1 in 5 new jobs created in Australia over the next few years will need to be in the disability care sector. Present policy settings are unlikely to see enough providers and workers as the scheme rolls out. Some emerging shortages need to be mitigated by better price monitoring and regulation; better tailored responses to thin markets; formal and informal carers allowed to provide more paid care; and a targeted approach to skilled migration.
  • NDIS funding arrangements could better reflect the insurance principles of the scheme, including by allowing more flexibility around the NDIA’s operational budget and providing a pool of reserves. Funding contributions made ‘in-kind’ must be phased out.

 

‘While there are some emerging cost pressures, such as higher than expected numbers of children entering the scheme, the National Disability Insurance Agency (NDIA) has put in place initiatives to address these cost pressures,’ Commissioner Angela MacRae said.

‘Given the extraordinary scale, pace and nature of the changes the scheme is driving, we are seeing some big challenges. A key concern is the speed of the rollout and its impact on the experience of participants and providers through the planning process, plan quality and market development,’ Mr Spencer said.

‘A real challenge is growing the disability care workforce needed to deliver the scheme. As many as one in five new jobs created in Australia over the next few years will need to be in the disability sector. There are unlikely to be enough providers and workers as the scheme rolls out under current policy settings,’ Mrs MacRae said.

The paper finds that the NDIA must place greater emphasis on pre-planning, in-depth planning conversations, plan quality reporting, and more specialised training for planners. And governments must set clearer boundaries around who supplies what, so that people with a disability are assured of continuity of service.

‘Everyone wants the NDIS to work, but there are challenges to be overcome and work is needed by all governments. Putting the enormous goodwill behind the NDIS into action is needed now more than ever,’ Mr Spencer said.

The Productivity Commission’s position paper is National Disability Insurance Scheme (NDIS) Costs.

People who want to comment or make a submission for the final report, due to be released in September, can do so at pc.gov.au