Referral changes, funding model flexibility and a cultural shift are needed, say GPs, allied health and NDIS participants.
Broadening the system that supports kids can give them earlier access to interventions and better outcomes, allied health professionals and GPs told the Standing Committee on Health, Aged Care and Disability’s public hearing in Melbourne on Monday.
If not done well, Thriving Kids will just add more complexity and won’t reach those who need it, participants warned.
The Thriving Kids announcement had caused some distress, according to patient representatives who emphasised that it was more important to get the design right than to “rush” things, that families needed to feel confident about continuing to get the support they needed, now and after the age of eight, when children aged out of the program.
A committee member hastened to reassure speakers that NDIS participants and families need not be “anxious” about losing services.
“We’re not anxious, we’re informed,” a spokesperson pushed back. “We’ve seen this before and we’ll see it again.”
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Unintended consequences of the NDIS
There was general consensus that the NDIS was a very good thing, with words like “revolutionary”, “amazing” and “game-changing” used to describe it. But it had some unintended consequences.
One was that those with better health literacy got more services, whereas those with less awareness of what was available and how to get it joined long queues or missed out altogether on high level supports.
And because NDIS funding was tied to diagnosis, parents felt they needed to push for a higher level of diagnosis that attracted funding for services not available with a level 1 autism spectrum disorder diagnosis, according to GP and allied health spokespeople.
This was reflected in the steady increase in higher levels of autism diagnoses since the NDIS, said the RACGP.
Uncoupling funding from diagnosis
GPs hoped that the NDIS would enable funding of interventions prior to diagnosis, said the RACGP representatives, but that was not the case, and they hoped Thriving Kids would remedy this.
Uncoupling funding and diagnosis meant children could access interventions much faster and the impacts would be felt quickly, hearing participants said. It would also improve outcomes for children in families who were not seeking a diagnosis, perhaps for fear of being labelled or for cultural reasons, they noted.
Interventions could also start earlier if allied health practitioners were embedded in community settings, where children and their families already were and already felt comfortable, the committee heard.
A system of “soft referrals”, where children could be referred by non-GP practitioners, would also increase access and was part of a “conceptual model of Thriving Kids”, described as an ecosystem of formal and non-formal entry points into the system.
Obtaining a diagnosis was a major barrier to children and families accessing intervention services, according to those present at the hearing.
Currently, children have to see a GP, who then refers the patient to a paediatrician. There were long waiting lists – around 12-18 months in most areas – to see these specialists, and Medicare did not cover the full cost. One spokesperson said families were often $1000 out of pocket, and that was before the assessment had been done.
There also needed to be provisions for GPs to refer patients to allied health for neurodevelopmental reasons, which weren’t adequately covered in chronic conditions management plans, according to allied health spokespeople.
Related
Funding models
There was a lot of discussion of funding models, with the suggestion that a blended funding model might be best – block funding to provide for choice, as with the NDIS, with the opportunity to combine block funding to, for example, bring in services needed in a rural location, and funding for embedding allied health practitioners in schools, early childhood learning and other community settings, like Victoria’s programs for GPs and mental health professionals in schools.
There was also talk of Primary Health Networks funding allied health programs, but this was controversial, with one spokesperson saying this kind of funding could not be replicated in all settings, and Thriving Kids required a model that could be applied everywhere. They noted two instances where programs had ceased once the PHN funding dried up.
Another, related model discussed was that of colocation of services, which the RACGP said was already working in Western Sydney. There, blended funding with the PHN supported co-location of GPs, nurses and allied health. Similarly, an eating disorder clinic enabled multidisciplinary collaboration that could be replicated in the early intervention space, they said.
But this was not practical for many practitioners, said an allied health representative. General practice settings were not equipped to house them, and the idea was not feasible under the current infrastructure arrangements, they said.
Cultural shift
Block funding was focused on the individual, an allied health representative pointed out, but group therapy was not an inferior intervention in many cases.
However, a cultural shift was required to accept that one-to-one care was not always the best kind, they said.
Another facet of the NDIS funding model was that families felt they needed to advocate for as much therapy as possible, out of fear that they would otherwise lose access to necessary services. This needed to change, an allied health spokesperson said, but not at the risk of losing access to one-on-one services where they were needed.
There was an artificial distinction between health services and disability services, it was noted, which prevented the necessary “whole of system” funding. Without that, funding would drive activity and performance, and it should be the other way around.
Missing workforce data and resources
Surprisingly, there is currently not a clear picture of how many allied health practitioners there are in Australia and where they are, nor of the allied health needs around the country, the committee heard.
Once this gap analysis was available, the funding model required to address them could be determined.
There was certainly a workforce shortage, particularly in regional and remote areas, and there were barriers for practitioners wishing to complete their studies, psychology spokespeople said. This included placement poverty, lack of places for postgraduate study, and lack of appropriately qualified supervision.
“We’re losing really qualified really keen people all through the pipeline,” a spokesperson said.
Since the NDIS, many allied health practitioners had moved from a public setting to a private practice, and Thriving Kids would need to make use of the workforce in both kinds of settings, allied health spokespeople said.
At the moment, allied health practitioners did not have the kinds of incentives to practice rurally that GPs had, it was pointed out. If there was payment for placements in these areas, workers would be more likely to remain practising in those areas, they said.
Everyone said that Thriving Kids would require collaborative care, across allied health and medical networks. But there were barriers.
Allied health practitioners, for instance, had a wealth of data which they could not currently share with other practitioners, it was said. Access to the technology to share data was essential, the committee heard, especially to providing equitable access to services for people in regional, rural and remote areas, and vulnerable populations.
The inquiry continues.
