The division of responsibilities between the NDIS and the Health system is complicated to navigate. It is marked by misinformation and inconsistencies within and between regions. Consequently, many participants and services providers find themselves confused about where to turn to meet their support needs.
The systems are designed to complement each other, with Health responsible for short-term care and the NDIS looking after long-term supports. The NDIS factsheet Mainstream Interface: Health outlines what healthcare supports the Scheme intends to fund. It classifies diagnosis and clinical treatment of conditions, time-limited recovery services, and pharmaceuticals as the responsibility of the Health Department. Meanwhile, NDIS will cover supports necessary to prevent functional decline, achieve incremental gains and assist daily living.
There are points in a person's journey where active cooperation between NDIS and Health will become crucial. Discharge planning is a prime example. The healthcare system will be responsible for the discharge planning. However, the NDIS will need to get involved in situations where discharge can only occur once additional supports are in place.
Of course, when dealing with two complex systems, things very rarely run smoothly. We have outlined below three key problem areas that have the potential to undermine cooperation in service provision.
1. Inconsistencies in Key Documents
Two key documents outline the interface between NDIS and Health; these are the COAG Principles to Determine the Responsibilities of the NDIS vs Other Service Systems and the NDIS Operational Guideline on Planning. They set the guiding principles underlying on who will cover what. However, ambiguities remain. For example, the COAG Principles state that pharmaceuticals covered by the Pharmaceutical Benefits Scheme (PBS) are the responsibility of the health system. In contrast, the NDIS Operational Guideline says this applies to all ‘pharmaceuticals…listed and not listed on the PBS.’
We see a similar inconsistency in Participant Plans. This can partially be attributed to the variances in state health systems. Nevertheless, it is undoubtedly also due to the varying interpretations by planners of the COAG Principles and NDIS Operational Guideline.
2. Evidence and Impact of Disability
The onus is on the Health system to provide NDIS with the evidence and impact of a participant's disability. Participants are expected to obtain the necessary reports from their current health care providers with whom they have an existing relationship. While this might sound good in theory, in reality, not all people with a disability have had consistent and ongoing relationships with their health care providers. Rather, care is often provided by the first health care professional available to attend to the situation.
No additional funding is available to compensate health care providers conducting assessments and writing the reports. For a participant to receive all the supports they require, these reports will need to cover all areas of a person’s functional capacity. Obtaining reports that encompass this level of detail is likely to be quite costly and time-consuming. The time factor is of crucial concern in inpatient settings where resources are already at capacity. Consequently, patients are at risk of being discharged without contact being made with NDIS or the reports and assessments they need to make an application.
3. Role of Allied Health
Allied Health professionals are sometimes described as the ‘gatekeepers’ of the NDIS. They are often responsible for conducting assessments and justifying a participant's funds. However, when it comes to the delivery of services, things become a little murky. Although there are provisions in the NDIS Price Guide for trained therapists to provide allied health services, there is a push for this to be a time limited service. Ongoing maintenance therapy is expected to be delivered by either a family member or therapy assistant. Underlying this is the dangerous assumption that therapies can be ‘dumbed down’ for people with disabilities. There is nowhere else in the current health care system that allows for Allied Health therapies to be delivered by anyone other than professionals with the appropriate accreditation, registration, and insurance. This also raises the question of who is going to insure a family member or Therapy Assistant to provide a therapy in which they have very little training.
Over time, we will have to watch the interface between NDIS and the Health system play out in practice. It is essential to ensure all teething problems are addresses and inconsistencies rectified. Many participants are dependant on both these services. We owe to them to ensure they are complementing each other and working together in harmony.