For many in the disability community, their occupational, speech, physio or other therapists play a crucial role in their lives. But long waiting lists are indicative of a shortage of therapists, and there are fears this is placing people with disability at risk.
A workforce census report from National Disability Services suggests wait times for therapists can vary from six months to two years - with regional and remote areas impacted the most.
Hireup spoke to Dr Chris Atmore, from Allied Health Professionals Australia (AHPA).
The peak body represents some 145,000 members who support a wide cross spectrum of Australians, from older Australians to veterans and people with disability, to name a few.
Dr Atmore spoke to us about the challenges facing the workforce, and what needs to be done to fill the shortfall.
Hireup: We've had a change of government and the new [NDIS] minister has made it clear that he wants a reset and to have a look at what needs to be done. From the perspective of your organisation, where should we start?
Atmore: I think one of the things about the culture of the NDIA, which I think contributed to a lot of the current distrust, particularly from participants but also some providers, was just the opaque nature of the sort of bureaucracy surrounding the NDIS.
Even for organisations like ourselves, it's been an ongoing battle to get an early seat at the table whenever any policy or practice changes have been mooted. We've just had to keep repeating the fact that we are an important stakeholder and need to be involved. Not just consulting around the edges when something's announced … but actually being involved right from the beginning in the design.
The other related aspect, which we've also been pushing for for quite some time, is [regarding] the mechanisms of governance around the NDIS and the various committees that are consulting with them. [It] would be very useful to have much more direct interaction between participants and providers over the development of the scheme. We need to be talking with each other more directly rather than just hearing second hand via the agency what the other group of stakeholders thinks.
In terms of clinical supports on the ground, there is usually a much more collaborative approach. But yet when it comes to actually designing how the system operates, it's become removed from that. A lot of people have said all that stuff was there implicitly when the NDIS was first designed but somehow it's kind-of moved away from those principles.
Hireup: What is it AHPA would like to see happen within the scheme to make it more suitable for the allied health sector?
Atmore: The really big ongoing issue for us is the relationship between allied health supports and planning [for participants]. We find over and over again that often [this is behind] the cases that end up at the AAT (Administrative Appeals Tribunal).
There'll be an assessment of allied health support needs for the participant. That usually sets out what the participant wants. They then go to the planning stage and the planner in some cases decides, wrongly, that this kind of allied health doesn't have an evidence base. So they won’t sign off on it. For example, that happens a lot with music therapy, and it's an ongoing battle because we know that music therapy is efficacious for a lot of participants.
Another thing that's probably more common is that the planner won't sign off on the amount of support the person actually needs. So they'll get less. And part of the assessment has been, ‘well, no, just seeing physio for an hour every fortnight is not going to achieve the goals that we have planned’.
So the problem is quite often we can't talk to the right people in the agency to resolve these issues at a systemic level.
Hireup: Recent data suggests there’s a significant shortage of allied health therapists. What are your thoughts as to why and what can be done about it?
Atmore: Considering that allied health is the third largest health workforce in Australia, we have no national workforce strategy. We've never had one and we've been advocating for one for years now. And unfortunately, the NDIS workforce plan - as far as allied health went - is virtually useless.
[Another] thing that has really emerged with the development of the NDIS is that we've lost the opportunity for practical training for our students coming through because a lot of that used to be working with people with disability. It used to be done through the states and a student that was studying, for example, occupational therapy or physiotherapy could get a placement with some kind of state-based body where they were working with people with disability. So that doesn't happen now because of the NDIS. And the problem is nothing has taken its place. So one of our glaring problems is around training and trying to make sure that our students get the right practical experience before they graduate.
The other ongoing issue, and of course this is true for the NDIS overall, is that it's much worse in rural and remote areas in terms of trying to get the right allied health people. And part of the problem there is, again, because there's no workforce strategy.
There's just not enough [support] in place to supervise and mentor new allied health professionals who are starting in this job, or are quite junior and in a small, isolated place where they are probably going to be the only allied health professional. So they're really isolated.
We don't even have a decent map of where our professionals are in relation to the different disciplines. The age range, are they employed by a provider to do allied health or are they an independent contractor? Are they a sole trader because about a third of allied health [services] in the NDIA is provided by sole traders.
Also, a lot of the NDIS work that's done by allied health isn't billable and allied health professionals I know don't want to drain the participant’s plan. The problem is particularly in remote areas or areas where they're working with First Nations participants. There has to be extra work put in to develop trust with that community and form relationships. Those kinds of things aren't really billable. So what that means is the actual pricing caps for therapy support in the scheme have to be quite high because you have to charge an hourly rate that's enough to cover those other costs that actually aren't paid for directly by the NDIS, including things like supervision.
Hireup: Do you think there is a good understanding as to the costs of providing allied health services?
Atmore: One strategy that we want to try to develop is to have more direct collaboration with participants to talk about these issues. Because, you know, the last thing we want is for participants and allied health providers to be pitted against each other. We regard ourselves as having not just a clinical duty of care to our clients but also a broader duty of care to make sure that the system actually works as well as it possibly can for participants. And that's why a number of our members have actually been champions for clients who have gone to the AAT which, strictly speaking, isn't part of their role but they think it's really important. And in some cases nobody else is helping because there aren't enough advocates to go around.
Hireup: Bearing all of these factors in mind, what does AHPA want to happen now?
Atmore: We've written to Minister [Bill] Shorten and said we really want to be involved in the review at the earliest possible stage including contributing to the terms of reference. Because the workforce issues are clearly a priority for us, also getting to grips with pricing. And getting rid of opaque financial reporting from the NDIA where the claims about lack of financial sustainability are really hard to interrogate because we don't have the full picture. So, that's a bit of an elephant in the room. I think it's easy to say, ‘this is going to cost too much’, but what does that really mean? And has it been fully costed in terms of the benefits for participants of having the scheme and what that means for their future lives and impact on Australia? So really it's [about] collaboration and putting everything on the table for a frank and full discussion.
Not all stakeholders are going to agree all the time on everything, but that's an important part of the process. And in our view we need to understand what our different stakes are and how it all fits together, and how we can try to return the scheme to the principles that it began with.
