04 May 2017
Hi, the last time I blogged was on 28 February after giving evidence to the Federal Joint Standing Committee on the National Disability Insurance Scheme (JSC-NDIS) inquiry into hearing services under the NDIS.
Today I’m blogging straight after presenting to the House of Representatives Standing Committee on Health, Aged Care & Sport which is inquiring into the hearing health and well-being of Australians.
Yesterday I had a long chat to one of the Deputy CEOs of the NDIA about problems facing families, hearing-impaired children and their early intervention providers under the NDIS and why it’s taking so long to fix them.
Back on 3 March I and others from First Voice enjoyed the privilege of talking with the Hon Jane Prentice MP, Federal Assistant Minister for Disabilities & Social Services and in late March, while in Canberra for the marvellous Power of Speech Awards, Jim Hungerford (The Shepherd Centre) and I had meeting with a number of members of the Federal Parliament.
So awareness of NDIS issues is increasing rapidly and everyone seems sympathetic to our arguments – but there are no easy solutions.
But things are happening - expected developments in the weeks and months ahead include:
1.NDIA announcements on the long-promised reference packages to guide funding levels and possibly improved referral arrangements. These are expected within the next 2-3 weeks: so let’s say by the end of May; and
2.Completion of the report of the Federal JSC-NDIS: this had been expected by end April but is still in progress. We are hopeful that this will result in some positive new directions and an acceleration in government decision-making before it is all too late.
The Federal House of Reps Standing Committee hearing health inquiry is not due for completion until later in the year. It has very broad terms of reference but is taking an active interest in sector concerns about the risks posed by the NDIS to deaf children’s outcomes.
So you can all see that I have a lot of fun in my job – writing submissions, making phone calls, emailing and meeting face-to-face with federal and state politicians and senior government administrators - all with the aim of getting better outcomes for hearing-impaired children and their families. This is necessary because of the sad reality that the transition of children’s hearing services to the NDIS, which started nearly 4 years ago, has failed and is placing deaf children’s communication, education and life outcomes at risk.
My summary of the situation to the House of Representatives Committee yesterday was as follows:
1. Deaf children are demonstrably worse off under the NDIS than previously,
2. NDIS policy and funding arrangements do not work in highly-specialised early intervention programs - an alternative ‘investment-based’, outcomes-focussed funding mechanism is needed for listening and spoken language early intervention programs such as ours under the NDIS,
3. Notwithstanding goodwill and best endeavours on all sides, the NDIA has been unable to resolve any of the major policy and funding issues despite 3 years of submissions, discussions and an expert reference group,
4. There is an urgent need to fix these problems as there are an additional 4,000 deaf children aged 0-5 years due to join the Scheme in the next 2 years, as well as many more older children and youth in the 6-26 years age bracket; and
5. If children are excluded from the NDIS, are delayed, go to unsuitably qualified providers or are inadequately funded they will inevitably get worse outcomes than at present and it will be a minimum of 12 months before they will get a Plan Review. This is tragedy that must be averted.
The more detailed analysis that I presented to the Standing Committee is that all four of the foundation blocks of pre-NDIS children’s hearing services arrangements in Australia are compromised by the NDIS policy and funding arrangements because they simply do not understand the requirements for evidenced-based multi-disciplinary early intervention.
Before the NDIS, Australia enjoyed one of the best systems in the world for the identification and management of children with hearing loss. The four core elements of this system are:
1. a comprehensive, evidence-based clinical pathway from identification to early intervention - this ensures no time delays in diagnosis and referral,
2. universal access to services for children diagnosed with hearing loss, including children with unilateral and mild bilateral losses,
3. highly expert service provision - across-the-board - by specifically trained professionals through (i) Australian Hearing (for children’s audiology and hearing aids); (ii) Cochlear Implant Centres for implantable devices; and (iii) Specialised Early Intervention Speech & Language providers such the First Voice centres, RIDBC, and a small number of other bodies; and finally
4. sufficient funding from government, philanthropic and community fundraising to meet service provision costs.
As a result, Australian children graduating from specialist speech and language programs have routinely achieved remarkable results, as evidenced in the recent First Voice Graduates Outcomes survey report which showed that:
- 95% of respondents attended mainstream classes in mainstream schools,
- 86% completed year 12,
- 82% proceeded to further education,
- 62% had completed a tertiary level qualification; and
- 77% had enjoyed regular paid employment.
In addition, 80% of First Voice children, by the time they start school, have achieved speech, language and comprehension comparable to children with normal hearing. This gives them a good start to their mainstream education putting them on the pathway to school completion, further education and permanent jobs.
So, what’s the issue with the NDIS?
First let me say that our sector strongly supports the NDIS and its statutory objects of improving the lives of people with disabilities by adequately resourcing their personal support needs and providing them with choice and control over their lives. However the NDIS is also meant to be based on the insurance principle and it publicly espouses evidenced-based programs that will achieve practical and proven outcomes in reducing long-term government costs in health and social services and increasing national productivity through workforce participation.
The NDIS may well be on track – or at least moving in the right direction – with regard to better meeting the needs of people with permanent lifelong disabilities. However the NDIS experience to date shows unequivocally that its operating policies, funding allocation model and activity-based payments system do not work for highly specialised, interactive, multi-disciplinary early intervention programs such as ours.
The impact of the NDIS on each of the 4 essential conditions for consistent, high level outcomes for deaf children that are listed above can be summarised as follows:
1. the COAG-endorsed clinical pathways and protocols have broken down and significant delays can occur between diagnosis and early intervention as well as between commencement of intervention and provision of NDIS funding.
2. universal access is threatened as the NDIA appears poised to exclude children with unilateral hearing loss presumably in the interest of cost containment. This is notwithstanding that (i) there are only about 150 new cases of unilateral hearing loss a year; (ii) EI service costs to these groups are characteristically small (generally no more than say $10K in total over all 1 or 2 years unless there are further complications); and (iii) the evidence suggests that early intervention could prevent up to 30-40% of children from subsequent failure at school;
3. guided referral of families to specialist providers appears to be a thing of the past – evidence from South Australia shows that significant numbers of children are not finding an expert EI provider until 2 or 3 years of age at which point they will present with a significant language delay that may never be made up before the child starts school; and finally
4. NDIS funding arrangements result in a gap of $6-8K per child per year which means that a provider with say 250 children is facing an NDIS revenue shortfall of $1.5–2M a year. This is obviously unsustainable and providers will either have to reduce services – putting children’s outcomes at risk – or become financially unsustainable.
That’s it for now – hopefully my next blog will be full of better news.
You can help the Centre overcome these financial difficulties by making a donation to our mid year appeal.
CEO, Cora Barclay Centre