FACULTY OF HEALTH SCIENCES

CENTRE FOR DISABILITY RESEARCH AND POLICY

Rehabilitation and Disability Service Spectrum and NDIS

Professor Gwynnyth Llewellyn

26th June 2014

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Australia

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Australian desert

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All people with disability

Disability support services

Rehabilitation

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Federal and state organisation of rehabilitation and disability

Federal

• Health funding to States - National Health Performance Agreements – Department of Health

• Disability funding to States - National Disability Agreement – Department of Social Services

State/

Territor

y

• State health funding + Federal health funding to Local Health Districts with performance targets

• State disability funding + Federal disability funding to Disability Support Services (mostly non-government organisations)

Service

level

• Local Health Districts distribute to hospitals, specialist rehabilitation centres and community services with performance targets by DRG and Casemix

• Disability services provide programs – e.g. community support, employment, recreation, behaviour support, personal living skills

National leadership with state engagement

UN Convention on Rights of Persons with Disabilities signed March 2007 and July 2008 ratified the Convention and the Optional Protocol

Strong push from DPO’s, NGO’s, parliamentarians for a coordinated federal and state response to disability

National People with Disabilities and Carer Council – representatives from all states and territories

Late 2008 Report Shut Out: The experience of people with disabilities and their families in Australia

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Recent brief history – critical events in disability sector

National Disability Reform Agenda

National Disability Agreement (2009)

All Australian governments report to Council of Australian Governments on performance on the National Disability Agreement

Provides the framework for delivering government services to people with disability

Development of person-centred services as a key policy direction

National Disability Strategy 2010-2020 (2011)

National Disability Research and Development Agenda (2011)

Productivity Commission Inquiry into Disability Care and Support (2012)

National Disability Insurance Scheme (2013)

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National Disability Strategy 2010-2020

The Human Rights Imperative

Attitudes and practices are disabling

Reporting to the United Nations

Advocacy

The Social Imperative

Everyone is part of the solution

The Economic Imperative

Improving productivity

Looking to the long term

Available at http://www.dss.gov.au/our-responsibilities/disability-and-carers/program-services/government-international/national-disability-strategy 8

Areas of policy action

Inclusive and accessible communities

Rights protection, justice and legislation

Economic security

Personal and community support

Learning and skills

Health and wellbeing9

Disability support services in transition

18.5% of Australians report a disability – 4 million people

Only around 25% use disability support services

Many use mainstream services

Services are unevenly distributed

Around 2,500 agencies in Australia providing disability support services

The National Disability Insurance Scheme Act 2013

Person-centred support to maximise social and economic participation

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Block funded services personal plans and individual budgets

National Disability Insurance Scheme

Tier 1

Targets everyone in Australia

Creates general community awareness about the issues faced by people with disability and promotes inclusion and opportunities for people

Tier 2

Targets about 800,000 people with disability and their family and carers

Provides general information about the most effective care and support options within generic and community support groups and services.

Tier 3

Targets 400,000+ people who need specialised supports

Provides specific supports, aids and equipment from specialised and/or generic services and facilities in the community, according to an agreed plan and resource allocation for each person

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NDIS is a three tiered scheme

Individualised supports

Individual support plans developed with NDIS planner

Outcome is a Participant Plan

Management of the plan options

Self managed by the participant

Registered plan management provider

The National Disability Insurance Agency

Combination of the above

Referral or linking in with mainstream services

Allocation of resources determined by Participant Plan

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Tier 3 – planning and support process

Rehabilitation in Australia

Rehabilitation

Inpatient rehabilitation units in Australia (100 public/ 80 private)

Ambulatory and community rehabilitation services (attached to hospitals around the country)

AROC – Australasian Rehabilitation Outcome Centre

Conducts a national benchmarking system to improve clinical rehabilitation outcomes in both the public and private sectors

Produces information on the efficacy of interventions through the systematic collection of outcomes information in both the inpatient and ambulatory settings

http://ahsri.uow.edu.au/aroc/index.html

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Brief overview

Rehabilitation Model of Care

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Figure 1: NSW Rehabilitation Model of Care

Principles – “statements of intent for rehabilitation s e rv ic e s”

1 L e a d e rship 2 Equitable a c c ess 3 Multidisciplinary care te a m s 4 Care c o o rd in a tion

5 Patient centred c a re 6 Evidence based c are 7 Appropriate care s e ttin g 8 Clinical process and outcome in d ic a tors

Patient journey – “across one or m u ltip le care s e ttin gs ”

Patient journey – “consistent p a tie n t

journey within a care s e ttin g ”

R e fe rra l D is c h a rge

Care setting

Care setting

Enablers and care settings for effective rehabilitation systems and services

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Enablers – “support im p le m e nta tion ”

• W ork fo rce • Data and performance im p ro v em ent • Care coordination and lin k a g es • Te c h n olog y • Appropriate in f ra s truc ture

Care settings – “six defined care s e ttin g s”setting 1: e in p a tie nt Care setting 1: Inreach to acute Care setting 2: Sub-acute inpatient

Care setting 3: Ambulatory care- day hospital

Care setting 4: Ambulatory care- Outpatients Care setting 5: Ambulatory care – Home based Care setting 6: Outreach

Aids and Equipment Program

Aids and Equipment Program

Continence Assistance

Home Respiratory Program (HRP)  

Prosthetic Limb Service

Specialised Equipment Essential for Discharge  

Speech Generating Device 16

http://www.enable.health.nsw.gov.au/

Centre for Disability Research and Policy

www.sydney.edu.au/health_sciences/cdrp/

Email: disabilitypolicy.centre@sydney.edu.au

gwynnyth.llewellyn@sydney.edu.au