Room 212 Monday Part Two
DEBORAH WINKLER:
Folks, we might get started. I’m Deborah Winkler, I’m your chair this afternoon. Fiona Green is going
to host the panel this afternoon, she’s from Coolala human services network. For those who were in
the room earlier, we’ve got Dennis Ginnivan down the end, is John coming back? We’ve got Christine
Samy from Scope, we don’t have Rebecca Barton.
SPEAKER:
Angela …
DEBORAH WINKLER:
Ok, thank you. Liz Kelly and Julie Beetge are on the panel this afternoon, so I’ll hand over to you
Fiona.
FIONA:
Thank you Deborah, it’s lovely to be here this afternoon. I’ll just wait for John to join us on the panel.
I’ve been asked to chair this afternoon’s panel discussion. Some of you may have heard my
presentation yesterday afternoon, I was the project officer for the Gympie region NDIS transition
project which was about talking with people in the Gympie region community about the
DisabilityCare and what was coming and getting their ideas and practical advice on how it could be
implemented in a rural area. So, that was our project and we have a final report from it that’s
available, I’ve got a few copies here today if you’d like one otherwise you can get one from the
organisation’s website. Come and talk to me afterwards if you'd like the contact information for our
project.
But this afternoon we have an eminent panel that we’ll hear from and you’ll have the opportunity to
ask them questions shortly. I guess I wanted to start the afternoon off by asking each panel member,
what are the big issues in DisabilityCare and how it rolls out in rural and remote Australia? Liz, would
you like to start?
LIZ KELLY:
Look, I think that the biggest issue is workforce really. Having an appropriate skilled workforce, being
able to attract and retain workers within regional areas, how do you do that? There needs to be
recognition for the time spent travelling, people need to be appropriately rewarded for their work so
I think the only way for this to succeed is to have a well trained, well remunerated, professional
workforce that’s valued like other sectors do. To use an analogy, you need to be accredited to chop
down a tree but there’s no real, there’s a lot of skills that people use naturally when working with
people with a disability.
Whether it be a therapist, whether it be … and they go and do a professional degree but other
people that do important work in support, there’s no real level required. Yes, there’s training
delivered but it’s not necessarily compulsory and I’m not saying that every person has to have a
degree but there needs to be some recognition for the work that they do and some progression and
some career so people are actually attracted to the workforce. Even more so in the local area having
local community people recognising the people with skills in the area with the skills and attributes
and nurturing that. I think that’s about it, take too much time.
1
FIONA:
Thanks Liz. Julie from Autism Queensland I wonder if you'd like to …
LIZ KELLY:
Yeah, I guess Autism Queensland provides a lot of outreach programs to rural and remote areas. We
work with a lot of families directly but we also work with service providers closely and all of those
issues that you discussed about the workforce is something that frequently comes up for us. We’re a
specialist service based in a major city so there’s lots of issues with us providing support to families
in those areas as well so we would be fully supportive of supporting the workforces locally. Whether
we can have a role in that in terms of up-skilling and sharing our knowledge we would welcome
those opportunities and I guess we need to look at alternatives for us not being able to be there face
to face. And remote technology is one way we’re looking at doing that currently.
But there are big issues with the technology as well and that’s something that various supports will
have to be put in place to help adapt to that. So definitely building the workforce locally and also
giving other organisations the resources to be able to support local services as well.
FIONA:
Christine from Scope Victoria.
CHRSTINE SAMY:
Yeah I certainly agree that recruitment and retention of skilled staff is an issue in remote and rural
locations and I guess within large organisations even an experience of inequity within the
organisation of metropolitan staff having access to this amount of training or this technology or
these services and the regional staff not having that same access and therefore that extends to
clients and families. I guess I’d agree with that.
FIONA:
Angela Dew from the University of Sydney.
ANGELA:
Hi, our project looks specifically at rural private therapist and preparing them to work within
DisabilityCare so I guess one of the major things that we heard from them was around professional
isolation and really how they're not connected with service networks and so it’s their responsibility
to access professional development. And that’s really difficult for people to do in rural areas. And I
guess linked with that we heard two issues around geographic isolation that impacted on their
business model that if they weren’t able to claim for travel to see someone in an outlying area that
they did that in their own time they weren’t able to cost that in.
So I think those two issues for us were big ones.
FIONA:
Dennis, John from the national rural health alliance.
DENNIS GINNIVAN:
The issue that I wanted to raise is around the stereotypical character of rural, remote Australians is
being generous, community minded and supportive. I mean, it’s a stereotype, it’s not always like
that but one of the challenges is going to be the balance between the promise of a universal scheme
to deliver to everyone equitably. The balance between that and the pragmatic reality of how
2
someone can be supported in a rural and remote community and following on from one of the other
speakers, the issue of if the workforce cannot be delivered or cannot be in a particular community
what’s the way in which community members can be, for certain tasks, not necessarily clinical tasks
but supportive tasks to be accredited or recognised for the work they're going to do in a way that’s
up to a standard that DisabilityCare would accept.
So there’s a few elements in that equation but I think it’s how we’re going to best do this and still
continue to capture the spirit of rural people to look after their own in that community way.
FIONA:
Thank you, John did you want to add something?
JOHN FRANZE:
Yes, what others have said is quite correct of course. One issue that I think is very important is that
it’s not only about the person with the disability in rural and remote areas, it’s also about their
families, the effect that it has on siblings for example and on relationships and single parent families.
The strains a single parent family must be under. One of the people we spoke to said, ok we have a
need for medical but we know about medical, what about us? Sometimes we just need someone to
cook us a meal.
FIONA:
Thanks John. I’d add in terms of issues relating to workforce would be that whole choice and control
issue for people in rural Australia in terms of what’s available out there for them and how do they
make good choices A) if they don’t know what’s out there and available and B) if there hasn’t been
historically the choices for them to make. To me that’s one of the biggest issues we face in terms of
up-skilling people about their options and also raising expectations about a whole series of different
options that may not have been available to them before that may become available. How do make
that happen, how do we help people develop those skills and knowledge to work out what they
might want, what might be out there, what might not be out there but could be created.
Ok so I’ll pose one more question to the panel and then we’ll open up for the room to ask questions.
What are some examples of good practice in rural Australia that would enhance people’s choice and
control. Liz would you like to start?
LIZ KELLY:
I guess, thinking about it, I’m talking probably more workforce that’s the background I come from,
that’s what our project was about, looking at organisational change. I think to attract workforce into
rural and remote areas, there’s things that are happening in other industries that we could adopt.
For example, for teachers, my niece is doing a teaching degree and she lives in Wagga Wagga and
that’s where she’s doing her degree and she's grown up in the country and she’s happy to go to a
remote community but she also knows that she’ll get reimbursed for housing and so she gets quite a
good deal.
She’s not frightened of small communities so those practices that are happening in other industries,
one of the other things that we’ve thought about is a portable leave scheme so that if you're
working for three or four different employers that you can actually, your long service leave, they do
that in the building industry because there’s a lot of subcontracting type work arrangements.
They're the sort of things that we’re thinking around attraction for workers. Other things, we were
just at the NDS conference last week and what someone said, if I get a group of different employers
3
together would you come out and provide training. We said, yes of course so it’s actually partnering
and leveraging of other human service industries within communities.
Whether that’s health or aged care and leveraging of those different skill sets and working together
within communities. I can't stress enough the role of local area coordinator that’s been spoken
about under the NDIS and I think it’s so important that that role is actually someone who’s local and
understands the community and can link with the various leaders. Whether that’s the healthcare
leader, principles, industry, so they can link in to ensure the best outcomes and not only for disability
services but for mainstream services in the local community.
FIONA:
Thanks Liz, yeah. Julie.
JULIE BEETGE:
Thank you. So I guess our practical design fund really focuses on the use of technology so I’ll discuss
that as a way we can extend our current services. Generally what we do, we go out to a region for a
whole week and deliver face to face programs. The families are heavily involved and sometimes we
are able to get service providers to come to one or two sessions. Through the use of remote
technology we’re able to provide a lot more ongoing support and that was something that the
families really spoke about, it’s that opportunity to be able to touch base with someone once a
week, once a fortnight, once a month, once a few months to check that they're on the right track.
Through the use of remote technology we had a lot of service providers involved and they were able
to attend a lot more sessions and meetings because they weren’t required to travel as much. So I
guess to give you an example, one of the families was in Alpha their therapist was in Longreach
which is a couple of hours away and their special education teacher was three hours away in
Emerald. So geographically it’s very hard to get a team together and by doing sessions remotely the
family are able to stay at home, the teacher and therapist were able to stay at their offices and they
were able to attend more meetings as a result of that.
So I guess we see technology as a way of bringing people together and also up-skilling therapists in
those areas, so that was our big focus.
FIONA:
Thanks Julie, Christine.
CHRISTINE SAMY:
Yeah, well I have a similar example of a challenge that we turned into an opportunity which
facilitated a positive outcome for a number of key people. The issue was around a service being
provided to a child and family where a level of expertise was required that couldn’t be met within
the team and we knew that this expertise was held in a team in a metropolitan region. There was a
specialist speech pathologist who could provide input and the regional team was three hours’ drive
away. So an initial consul was set up with the family, the regional team and the metropolitan
therapist.
So initially some travel time was expended and a plan discuss and some goals proposed and the idea
was to try and use technology to review goals and outcomes via video conferencing. However, in the
regional team the level of internet connectivity and the pipe if you like for internet bandwidth
wasn’t big enough and so the idea was to try and collaborate with someone in the rural community,
in this case the child’s school, to use their internet connection. By doing so there was an even more
4
comprehensive approach to the strategies that were being addressed, so through collaboration and
sharing the technology resource the eventual outcome was a more holistic one.
FIONA:
Great, good example, thanks. Angela.
ANGELA:
So again in relation to rural private therapists, when we talk to people with disability and carers
about what some of the good things are about using private therapists we heard that consistency of
people is a key thing. That within service organisations people go on maternity leave, they move up
into other jobs so it’s quite rare to keep the same therapist working with you over a period of time
whereas private therapists, it’s their business. So once you’ve seen them and provided they don’t
leave the area or have a baby then you're much more likely to keep seeing the same person. That
consistency was really important for people.
From the private therapist point of view, the thing that came through really strongly was the
autonomy and flexibility that they have within their business model. So if they want to do something
in a different way then it’s up to them, they don’t have to pass it through management they just
work it out directly with the person and the family. So they were two of the really good practice
things that we heard from people.
FIONA:
Great, I’ll just ask the helpers to grab those mics we’re getting ready for the next lot of questions. Go
ahead.
DENNIS GINNIVAN:
Just following on from that idea from working with private organisations, I had an example that’s a
little bit different to what we’re speaking about this morning. It relates to that small number of
people for whom there’s really serious issues and I did elude to it earlier, people who are so severely
injured, maybe in a hospital, maybe in a trauma centre, high level of care needs resulting from their
injury. And as they move through the health system and through rehab and as they move out of
health structurally they're in the disability system, that’s the model that’s existed.
Anyway, and I should say in the absence of any age appropriate accommodation being available to a
younger person they’ll end up with high care needs in a nursing home which we all know is totally
unacceptable and unsatisfactory. But the opportunity came up in a regional centre where we
negotiated with a publicly listed company who provided high care needs accommodation for people
with brain injury to create an environment within which people with high care needs could be in an
age appropriate environment within which rehab could be provided in a context as opposed to a
nursing home which is the wrong context.
In addition, this opportunity lies at the edge of where health and disability and age all intersect and
it also provides a potential accommodation model for people who have been long in the community,
long past rehab and health systems so to speak but would still have access to age appropriate
accommodation with clinical input, reviewing clinical input rather than continuing rehab. So just a
creative way of looking around and seeing who else in the block might have interests that could
coincide with either our own system, disability, or other systems like age and health.
FIONA:
Great thank you. John did you want to add anything?
5
JOHN FRANZE:
No thank you.
FIONA:
Just another example that we came across in the project in Gympie region was a group of families
who are isolated from other parts of the region and have very, very limited access to services and
supports and in the context of the project itself, when they came together and started talking
realised that they had a common need for particular type of therapy service that wasn’t currently
available. But starting to think about when DisabilityCare begins they may be able to pool some of
their resources and attract therapists to their area more readily, with the pooling of the resource still
providing an individual service to each family but not with the travel costs for each individual service.
Combining those, maybe having appointments on the same day or an overnight stay there and then
provide the necessary appointments but doing it in a pooled way so that the resources get stretched
a bit further. So that was another example, they started to think about themselves about how that
might work.
Ok I’d like to open it up to the floor if anyone has a question they would like to put to the panel?
QUESTION FROM THE FLOOR:
I’m Brett Donald from Western Australia. Although we’re a little bit behind the game I work for the
Commonwealth Respite and Care service in the wheat belt, we have around 75,000 people spread
over an area twice the size of the wheat belt. There’s probably people in the room who relate to
regional isolated areas, obviously workforce is a big issue and that was mentioned that the issue is
going to be competition amongst providers and also with the living better, living stronger
innovations the age care workforce is going to be an issue going forward.
I think we’re competing for the same workers, I’d be interested to hear from anyone in the panel,
you’ve talked about leveraging off age care providers. Given that in isolated areas there may only be
one or two people that are qualified for, say, a home care package at the same time one or two
people in the same area that need disability services and I’m stating that age care and disability
probably needs to be working together in regards to the training of those people and trying to find
some common ground. I’d be interested to hear from anyone on the panel if there’s anyone that’s
doing this well because there’s a few organisations that I hear that are doing that sort of thing but
I’d be interested if they’ve got input on that.
FIONA:
Who’d like to take that one? Liz perhaps?
LIZ KELLY:
I’m happy to take that one. I think the age care sector are in some way ahead in expecting skills of
their workforce. I think the disability sector have got a way to catch up as they do with the health
sector around, I was talking this morning with someone about the nursing industry and how it went
from being probably a very underpaid, undervalued workforce to a much better, professional
workforce. Probably still not paid well enough but I know providers, I live in Melbourne and I know
providers who provide disability services and they provide aged care services. So they actually do
that in that way, they probably work together from a senior perspective but I don’t know how at the
ground level, the service level, how much they leverage off each other.
6
I think it’s a really important thing in smaller communities that aged care, health services, other
human services can work together and pool resources whether they can be mentorships and those
sort of things. From our experience and what we heard we didn’t see anything in regional areas that
was working that we saw. That’s my thoughts on it.
FIONA:
Angela, something to add?
ANGELA:
I just wanted to something around that in terms of work we’ve been doing in rural communities
looking at people being trained as therapy support workers and this is an opportunity where people
about building the capacity of the local workforce so they might be working five hours a week with
someone in that role plus working as a therapy aid in community health or whatever so I think that’s
a great suggestion.
FIONA:
There’s was a question at the front there.
QUESTION FROM THE FLOOR:
Hi, my name’s Andrea Ferguson I’m from Talk Switch pathology in South Australia. My business has
really looked to expanding to the rural regions of South Australia and we have different issues in that
numbers tend to be very low. I go to Kangaroo Island once a month and that started with one family
and then I discovered there were other families with kids with autism in particular that weren’t able
to access services there and it’s been very exciting and we’ve been well received by the island and
I’ve got a (Inaudible) coming on board as well.
Like you said Angela, the consistency of services is really appreciated but my big frustration has been
that when I first started going I tried to link strongly with the government services 'cause I’m a
private practitioner but I’ve had very little response from them. Community health, the links have
stopped, someone I spoke to at the conference here didn’t even know I was going, education they
haven’t responded to email. So I feel like we’re all going not seeing the same kids but there could be
a more frequent service if there was just one person going and there were links to those agencies.
I’m wondering if you anticipate DisabilityCare changing that in the future and also I wanted to say
thank you about the information about technology 'cause I’m excited about taking some of those
ideas away and how we might use those in our business. So just wondering about the future in
DisabilityCare if you anticipate the government agencies and practitioners not having this enemy
attitude but looking to work together.
JULIE BEETGE:
I think that’s a good question. I’m hoping the role of local area coordinators and there’s a lot of
hope, I’ve heard hope a million times at this conference, I think we need some action but to me that
is the classic role of the local area coordinator is coordinating your service with the education
service, with any other community mainstream services that that person whether they're a child or
adult so they're not just sucked into some therapy disability world, that they're actually engaged
with the whole of life approach. So I’m, that’s what I’d be batting for as far as local area
coordinators, that’s what they do, they know the local area, they can connect in with the right
people.
7
SPEAKER:
Yeah and I think debunking some of those myths around the private public divide, we certainly came
across that in our broader work what we have in (Inaudible) project which we’re actually in
partnership with (Inaudible) in New South Wales. And quite a feeling about private people are in
there for themselves and they are just making money out of this and that’s really not what we heard
when we spoke to private therapists so I think we’ve got to debunk some of those myths around.
DENNIS:
Just wondering whether there might be an opportunity for a recommendation but maybe
DisabilityCare has an opportunity to really work hard at understanding and encouraging
collaborative partnerships across the sectors. The example I used before was one that was
surprising, for some of my stuff I work in a public health sector rehab service as well but the people
from this corporate organisation had cared just as much about our clients as we did. It wasn’t just a
zone that they necessarily occupied solely so maybe there’s an opportunity for these different
sectors of DisabilityCare and the others to better improve and understand the culture of working
together with a common goal.
It seems like it’s an obvious thing, for rural and remote we’re going to have to do those sorts of
things.
ANGELA:
We’re a private organisation, a not for profit organisation, and collaboration is integral to us
providing a quality service and at times we’ve looked at brokering in private therapists to work and
fulfil some of our contracts. So that collaboration is something that is key to being able to offer, as
Stella Young was saying, a quality suite or buffet of services so that people can make quality choices
and exercise that control.
FIONA:
Thank you, there’s probably time for one more question.
QUESTION FROM THE FLOOR:
Hi, I’m Sam Connor from Western Australia, I’m highly amused that this guy’s also from the wheat
belt of Western Australia where I am and we’re in the same session. So, my question, and also I have
some other roles in Western Australia which include being on the NDIS workforce expert group. My
question is about, I guess, we have difficult situations with our local area coordinators in our area
with really huge caseloads where we have one 70 people to one area coordinator who has to service
this whole area.
And they're the types of issues that local area coordinators face, they're often dealing with people
who are in extreme crisis and that may or may not be projected about need, it might just be how
people cope with things. So my question is about how we can, I understand exactly what you're
saying, because the issue with workforce with us is a really huge one. I guess my question is about
how we can stop big providers coming in and losing local knowledge, we have small not for profit
organisations who do really good things on a basis of values 101 and they don’t do things great in
terms of business 101.
So they may not have cash reserves, they may not have bad debt assistance that kind of thing, my
concern is that the big organisations will come in and those things that the local area coordinators
know like who the great local services are, all that local knowledge and the indigenous people in the
community, how can, this is probably a Liz question, sorry Liz.
8
LIZ:
(Inaudible) else a go. Do you want to answer it John?
JOHN FRANZE:
Don’t know if I can answer the question but I can certainly put my thoughts in. One of the
recommendations that the NRHA came up with was sure, we think the local area coordinator role is
good but as you mentioned yourself, they're going to have a huge workload and we’re
recommending that on the ground right within local communities there need to be people who
report back to the coordinator but people who are there, next door neighbours with the people with
disability or even from within the same family, those locals who really know what’s going on in that
community.
So that way the local area coordinator might have the bigger view but they are being helped by
people who have the small community view. On your other question about the big organisations
coming in and swamping the small local providers, I think that the market mechanism of the NDIS
where people really do have a choice that will possibly take care of that. If they're not happy with
the service that some big provider is giving, if they think they're being treated with a lack of respect
and dignity they don’t have to hang around any longer under the new paradigm.
DEBORAH WINKLER:
I think services give them something that people can't.
FIONA:
We actually found in our project in Gympie region 'cause we have state version of local area
coordination as well in Queensland, we found that the feedback from the people with disabilities
and families about service delivery was we want local, we want flexible, we want small. We don’t
necessarily want big so that was an interesting message, local service providers were concerned
about the big providers coming in and they voiced that concern quite strongly but when we heard
from people in quite remote areas they were really talking about what we want is small, local,
flexible.
That’s where we think we’ll get the best outcomes 'cause that’s about relationships based, that’s
about the linkages and connections in the local community and that’s what people were valuing in
the feedback we received. Sorry just one other point, in relation to local area coordination we’ve got
a couple of recommendations around that in our report and that was that they do need to be based
in smaller rural community and not assume that they're going to be in big regional centres 'cause
that model won't work in that way in local communities unless they are out in smaller rural
communities.
That’s the only way that model will work so can I ask you not to assume that they will only be in big
regional centres. And someone else on the ground has got the eyes, I think they need to be the eyes
and ears down there absolutely linking with all of those local networks and community groups and
the rest of it but let’s hope, anticipate and expect that they're part of local communities in smaller
rural and remote areas as well.
LIZ:
Fiona, I couldn’t agree more with that point about local area coordinators. Absolutely they got to be
local and just from, I was going to put my business hat on and talk about probably organisations that
can be flexible and responsive to their clients and provide customer service are the ones who are
9
going to champion this. Who, whether you're a private provider I don’t think it matters, I think you
need to be an effective provider and efficient and you don’t need a huge bureaucracy behind you to
provide really good service. I think that’s going to be one of the winners, I hope, when the power
and the money is in the people’s hands to make choices as long as the choices are there and there’s
the right resources and infrastructure to support that.
So I think, yeah, you don’t need really flash back of house, you need a responsive back of house that
are going to support your direct service which is your clients.
QUESTION FROM THE FLOOR:
(Inaudible)
DEBORAH WINKLER:
Thanks, just on the basis of the question in relation to the small organisations and values 101 I think
was mentioned. We’ve actually, I’m president of (Inaudible) services network who did a pdf project
that Fiona was involved with but as part of our other work we’ve also been involved with getting our
community and non-government community organisations together to start a conversation among
ourselves about how we as small, not for profit organisations come together to be able to be more
flexible, more responsive as a community.
We’ve got lots of quite small organisations so we’re having those conversations around what do we
need to do, how do we need to do it better, how can we be more responsive, how can we put in cost
savings because it’s not about, I think the values aren’t around not making a profit but the values are
around being able to make a profit so you can put that profit back into your community. I think
there’s a lot of work in the non-government sector that we need to do as well to make sure the
small organisations survive.
FIONA:
Thank you, I think we’ve pretty much run out of time now in terms of further questions. I’d like to
thank the panel members for all your words of wisdom and for the questions from the audience, I
hope you found that helpful and let’s hope this is just the start of discussions. We are certainly
talking about having some kind of network around rural and remote and if people are interested
come and have a chat and we’ll start some kind of email group or some network or other. If you're
interested, come and talk to us and we’ll start making that happen. Thank you very much.
JULIE BEETGE:
The final comment that I’ll just make is, we obviously from DisabilityCare Australia have a pool of
money that’s tied up in sector for sector development and we are hoping that perhaps a bit later,
once we get past 1st of July, that there might be an open grants round associated with that. We’ll
look at some of the issues, thanks.
10