Rehabilitation and Disability Service
Spectrum and NDIS
CENTRE FOR
DISABILITY RESEARCH
AND POLICY
Professor Gwynnyth Llewellyn
26th June 2014
FACULTY OF
HEALTH SCIENCES
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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
• Health funding to States - National Health Performance
Agreements – Department of Health
Federal • Disability funding to States - National Disability Agreement –
Department of Social Services
• State health funding + Federal health funding to Local Health
Districts with performance targets
State/ • State disability funding + Federal disability funding to Disability
Support Services (mostly non-government organisations)
Territory
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
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National leadership with state engagement
Recent brief history – critical events in disability sector
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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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-andcarers/program-services/government-international/national-disability-strategy
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Areas of policy action
Inclusive and accessible communities
Rights protection, justice and legislation
Economic security
Personal and community support
Learning and skills
Health and wellbeing
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Disability support services in transition
Block funded services
personal plans and individual budgets
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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National Disability Insurance Scheme
NDIS is a three tiered 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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Individualised supports
Tier 3 – planning and support process
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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Rehabilitation in Australia
Brief overview
 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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Rehabilitation Model of Care
Figure 1: NSW Rehabilitation Model of Care
Principles – “statements of intent for rehabilitation services”
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2
3
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Leadership
Equitable access
Multidisciplinary care teams
Care coordination
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6
7
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Patient journey – “across one or multiple
care settings”
Referral
Care
setting
Patient centred care
Evidence based care
Appropriate care setting
Clinical process and outcome indicators
Patient journey – “consistent patient
journey within a care setting”
Discharge
Care
setting
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Enablers and care settings for effective
rehabilitation systems and services
Enablers – “support implementation”
•
•
•
•
•
Workforce
Data and performance improvement
Care coordination and linkages
Technology
Appropriate infrastructure
Care settings – “six defined care settings”setting 1: e
inpatient
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
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Aids and Equipment Program
http://www.enable.health.nsw.gov.au/
Aids and Equipment Program
Continence Assistance
Home Respiratory Program (HRP)
Prosthetic Limb Service
Specialised Equipment Essential for Discharge
Speech Generating Device
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Centre for Disability Research and Policy
www.sydney.edu.au/health_sciences/cdrp/
Email: disabilitypolicy.centre@sydney.edu.au
gwynnyth.llewellyn@sydney.edu.au