In an unpredictable, and at times frightening world, there are a few certainties that we can all take comfort in- taxes, the cycle of life, and government departments fighting amongst themselves about funding responsibilities. As the ancient proverb goes, there is no point spending taxpayer money if you do not ask somebody else to spend it first. So it was perhaps inevitable that the birth of the NDIS heralded a new era of intergovernmental wrangling, with one of the most epic battlefields being the one that is forming between the Commonwealth Health Department and NDIS.
Even without powers of divination, we all could have foreseen that this would be complicated intersection. Perhaps more than between any other government departments, these two have multiple points of contact. Without clear divisions of responsibility and coordination, gaps will inevitably occur leaving people with disabilities underserviced by both NDIS and the Health Department.
This article explores just three crucial points of intersection between Health and the NDIS that have so far not been adequately addressed by either department.
1. Accessing the NDIS
New participants seeking to access the NDIS rely on evidence provided by Health services. The Access Request Form requires a Professional Report completed by a specialist or allied health professional. Filling out these forms to the level of detail that is expected will take time and training. The question is, who is footing the bill?
If it is a GP or other specialist appointment, the time is currently being borne by the Health Department. However, it can only be billed for at the standard rates for a consultation, despite the time and in depth knowledge of the person’s circumstance required. If the Participant requires evidence from an allied health professional, there may not even be a Medicare rebate available. In such cases, potential Participants will be forced to pay out of pocket.
For many patients the idea of a regular GP who understands their unique circumstances is a myth. People move regularly, their needs change, and they are not able to develop the types of relationships that contribute to good health, and disability outcomes. For people who have disabilities where the impairment is clearly permanent and significant this may not be an issue. But people with impairments that are episodic or variable in nature may struggle to find a doctor willing to attest that they meet the access criteria.
2. Unique Health Needs of People with Disabilities
People with disabilities will often have unique health needs or face difficulties communicating with health professionals. Recently, I was horrified to learn that approximately 38% of deaths of people with intellectual disabilities are considered avoidable, compared to 17% of the general population. In other words, thousands of people are dying every year because they are not receiving adequate healthcare. If that is not a national emergency, then I struggle to understand what is.
However, it is not completely clear whether the premature death rate should be addressed by Health or NDIS. Both evidently have a role to play and coordination between the two will be essential. Theoretically, the Health Department would be responsible for training medical professionals to work with people with disabilities and the NDIS would provide capacity building and support to Participants to ensure they can communicate with their doctors. In reality, very few of these measures appear to be occurring. Even if they were, who would be responsible for ensuring that the training aligns and compliment each other, or measuring outcomes? It is not an exaggeration to say that thousands of lives are dependent on both departments working together to develop a comprehensive strategy to address the health needs of people with disabilities.
3. Health Conditions as Disabilities
Finally, many health conditions are also disabilities. Both physical and mental health impairments can significantly reduce a person’s ability to function. As a rule, health is responsible for treating and diagnosing conditions and rehabilitation and the NDIS is responsible for improving functional capacity. Yet when a medical condition is also a disability, what is treatment and what is about improving capacity is not always clear-cut. My own condition myalgic encephalomyelitis (ME) is a prime example, as interventions that help me manage the condition could easily fall under either label.
The COAG Principles and NDIS Operational Guidelines set to define the division of responsibility. However, in both disability and health, each circumstance is unique. Whilst it may be beyond any bureaucrat’s powers to account for all possibilities, there needs to be a fair procedure in place for when both Departments declare that an essential support is the other’s responsibility.
I began this article by describing epic battles between the Health and Disability Departments. Unfortunately, that was merely a creative indulgence or, perhaps, wishful thinking. In reality, they don’t fight about it; they barely even talk about it. Instead, they just send the Participant a letter saying “not my responsibility.” This can leave the Participant stuck in the middle. Health will not fund something just because the NDIS has said it was their responsibility, nor vice versa. In the end, both Departments get off the hook, and the Participant is left without services they might desperately need.
Health and Disability is not an intersection we can afford to ignore, gaps in either service can prove fatal. The NDIS and Medicare are two of the most loved and life changing public services this country has ever known. Yet if they do not develop a system for working together, they will both be responsible for letting people with disability in Australia down.