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Positive change and a growing presence
This issue’s theme “Brighter Futures” is appropriate given that, as I write, occupational therapists and their clients across Australia are applauding the recent decision by disability ministers to abandon NDIS independent assessments. All who opposed independent assessments as envisaged by the National Disability Insurance Agency have good cause to celebrate. OTA fought the proposed individual assessments with great determination, skilled advocates, and, most importantly, irrefutable evidence. At first glance, it is terrific news.
An NDIS architect and compelling critic of independent assessments, Professor Bruce Bonyhady, said OTA’s submission to the Australian parliament’s Joint Standing Committee was “immensely powerful”–and OTA sincerely thanks the scores of members who supported its long campaign to defeat independent assessments. It was their clinical evidence–and passion–that won the day.
However, a note of caution.
The NDIS is costing more than envisaged, and over time is likely to cost even vastly more–all at a time of historic budget deficits. As governments strive to pull in the reins, we are likely to see new ways of cutting costs. We must remain vigilant to ensure these do not come at the expense of client care or the professional responsibilities of our members. We are pragmatic enough to realise that if the NDIS is to be sustainable, some form of eligibility screening process will ultimately be introduced.
Michael Barrett, OTA General Manager, Government and Stakeholder Relations
We know the Morrison government is convinced of this and, significantly, any future Labor government will also have to oversee a screening process that ensures access and equity without rendering the scheme unsustainable. The important thing, surely, is to develop a screening process that also allows the NDIS to remain true to its foundational principles: principles such as scheme co-design, reasonable and necessary supports, and enhanced choice and control for participants.
In the spirit of co-design and collaboration, we will work with our colleagues at Allied Health Professions Australia to facilitate the work of the NDIA–an agency that must become genuinely consultative if it is to regain the trust of the sector. We have already recommended a screening process that is effective, evidencebased, and, most importantly, involves a comprehensive assessment conducted by a discipline-specific allied health professional the client knows and trusts.
So, in terms of the NDIS, the future does appear brighter, but we must remain vigilant.
The future is certainly a little brighter for Australian war veterans and widows who scored an occupational therapy victory in the May 11 federal budget. After almost 20 years without a meaningful increase in the fee paid to occupational therapists, the Department of Veterans’ Affairs has raised it 27 per cent. While modest in the context of a multi-billion-dollar budget, it is hugely important in making work sustainable for this particularly dedicated group of occupational therapists and their clients. Until now, many of these experienced occupational therapists had worked at a loss–continuing out of loyalty to long-standing and highly complex clients–and had survived through cross subsidies from more viable work.
OTA fought long and hard for these members, raising the issue at every opportunity, and even establishing a standalone website that declared: “This is not the way a grateful nation treats the people who treat its veterans.” OTA acknowledges those members who worked with veterans from the goodness of their hearts for so long, and who helped us campaign for a fairer deal. Once again, we know this fight is not over, and we must ensure a fee schedule never becomes so outdated again.
The federal budget has unprecedented expenditure on mental health and suicide prevention, which emerged as urgent problems long before natural disasters and the Covid-19 pandemic threw them into even sharper focus. After a year’s delay due to Covid-19, the federal government late last year released the findings and recommendations of the numerous committees reviewing aspects of the Medicare Benefits Schedule. The committee charged with reviewing mental-health-related items (i.e. BAMHS) was unable to make decisive recommendations, opting instead to recommend another review. Significantly, it recommended that the make-up of the new
committee be more professionally balanced–an acknowledgement that the former review was dominated by the psychology profession.
While good news for OTA, it will require mounting arguments we have already made, often in front of hostile audiences, for up to another year. However, substantial funding has been committed to diverse initiatives too numerous to list here. Conscious of this rare opportunity to raise awareness of the unique role that occupational therapists play in the delivery of mental health care, the OTA board has approved development of a white paper to explore the best way to make a compelling case to decision-makers. Scoping work on the white paper is already under way.
There was also unprecedented expenditure on aged care, largely in response to the recommendations of the Royal Commission into Aged Care Quality and Safety. Our submissions to that royal commission emphasised the need to ensure that residential aged care facilities provided a decent quality of life–and the key role that occupational therapists should play in achieving this. For too long, occupational therapists have been denied the right to bring the full range of their clinical expertise to bear, often only practising massage because the old Aged Care Funding Instrument rewarded it. This was professionally frustrating and a personal tragedy for residents.
However, we also reminded the royal commissioners that most of our population will age at home, and their homes must be safe and fit for purpose. Here, of course, occupational therapists have a crucial role to play. We stressed–as we do whenever we can–that falls prevention should rank alongside obesity and road safety in the national consciousness. Falls end lives prematurely, place a huge strain on our overstretched health systems and are largely preventable.
On a related matter, on Friday, 30 April, Australian building ministers agreed to include mandatory minimum accessibility standards in the National Construction Code–to the Silver Level. The Gold Standard will also be included in the code as a technical referral, meaning states and territories can decide to upgrade to Gold Level voluntarily. From September next year, all new houses will in theory be required to be built to the new standard.
OTA was a key player in the fight for greater accessibility in new Australian residential dwellings, encountering fierce resistance from the construction industry. OTA lobbied all nine building ministers, arguing that accessibility standards would be of lasting value to all Australians for generations to come. A small team of OTA members also met senior public servants to make the case. OTA thanks these members for their fine work.
We also signed up to the Building Better Homes Campaign, a coalition of interested parties largely driven by the Summer Foundation. As the campaign notes: “While there is still work to do to secure a mandatory gold standard, this is a big win for people with disability, seniors and indeed all Australians.” Regrettably, some dissenting jurisdictions are likely to refuse to implement the new standards, so lobbying work goes on under the auspices of the Building Better Homes Campaign.
All of these new or expanded initiatives will require thousands of extra occupational therapists at a time when there is already a worsening shortage. Despite new undergraduate courses being established almost every year, those graduating often do so with multiple job offers awaiting them. OTA members operating larger practices routinely tell us they cannot fill job vacancies, despite often very generous packages.
Two things are abundantly clear. First, this problem is going to become even more pronounced as more Australians join the NDIS and, in particular, our population ages. Whether opting to age in place or move into a residential aged-care facility, Australia’s rapidly growing elderly population will need the expertise of occupational therapists to ensure their physical safety, health, mental well-being and quality of life.
Second, the workforce shortage will present new opportunities for individual practitioners while posing profound challenges to the profession as a whole. How do we rapidly increase the number of occupational therapists without compromising the quality of care being delivered? How do we protect the occupational therapy scope of practice in the face of incursions by other allied health professions? How do we ensure overseas-trained clinicians continue to meet Australia’s rigorous professional standards, and then have the clinical supervision and support they need?
In one sense this challenge is not a bad thing. It shows the value of occupational therapy is being recognised at last–and, accordingly, demand for services is outstripping supply. This points to an even brighter future for the profession.
