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Policy, Lobbying & Advocacy Update
OTA lobbying produces a win for vulnerable clients
Michael Barrett OTA General Manager, Government and Stakeholder Relations
This edition’s theme “This is OT” is a deceptively simple expression, implying occupational therapy is a vocation easily defined and categorised. In fact, occupational therapists can be found anywhere and everywhere, assisting just about anybody at any point in their lives.
The remarkable diversity of occupational therapy work across this vast and challenging continent is reflected in the great diversity of OTA’s lobbying activities in 2021.
The year has, of course, been dominated by the ongoing Covid-19 pandemic and the sudden need to lock down whole cities with just a few hours’ notice. Even with the capacity to support clients via telehealth, hard lockdowns have seriously impeded the progress of clinical care and challenged the viability of practices. OTA has sought to hold governments to account, demanding there be a credible rationale for suspending allied health services. In October, for example, the Victorian government belatedly saw reason and admitted it was anomalous to allow hairdressers to reopen in regional Victoria while still insisting that only essential allied health care be delivered face-to-face.
OTA knows it has been a very hard two years for many of its members, with few communities being spared lockdowns. We acknowledge and applaud your resilience and flexibility in the face of an historic challenge. The year will also be remembered for a concerted and passionate campaign to prevent the federal government and NDIA from introducing a crudely designed and potentially very harmful means of assessing eligibility for the NDIS. As experts in the assessment of functional capacity, occupational therapists immediately recognised the clinical shortcomings of so-called independent assessments and their potential to do real harm. And as university-educated professionals, occupational therapists saw through the NDIA’s selective use of evidence and a profoundly flawed pilot process.
In my five years at OTA, I have never seen occupational therapists come together so smartly, and join forces with other allied health professionals so readily, to achieve a common purpose: the defeat of independent assessments as initially proposed. And this was not a self-interested campaign. It was not about occupational therapists’ pay and conditions, for example. It was occupational therapists speaking up on behalf of highly vulnerable clients.
The OTA submission to the inquiry into independent assessments conducted by the Australian parliament’s Joint Standing Committee on the NDIS was described as “immensely powerful” by Professor Bruce Bonyhady, one of the architects of the NDIS and now executive chair and director of the Melbourne Disability Institute. The submission, based on feedback from scores of OTA members, exposed the flawed assumptions on which independent assessments were so precariously based, and called into question the NDIA’s belated and half-hearted consultation process.
The breadth, depth and passion of opposition to the proposal left the federal government with no option but to abandon independent assessments in early July. But we should be under no illusions. This abandonment is an attempt to kill a difficult issue less than a year out from an election. Next year, and irrespective of who wins the election, the federal government will be looking for means to rein in the cost of the NDIS. There is some disagreement about the extent of the cost blowout, but the scheme is costing considerably more than initially expected. OTA’s task remains one of ensuring any cost-cutting measures do not come at the expense of quality supports for participants. OTA remains willing and able to work with the NDIA to ensure genuine co-design of a scheme that should be uniquely supportive of participants and economically sustainable. In the spirit of co-design, we have already recommended a process which is effective, evidencebased and, most importantly, involves a comprehensive assessment conducted by a discipline-specific allied health professional the client knows and trusts.
Occupational therapists working with veterans and war widows had an important win during the year. After a sustained advocacy campaign involving the lobbying of successive Veterans Ministers and even
a stand-alone website, OTA achieved its goal of winning a substantial increase in the fee paid by the Department of Veterans’ Affairs (DVA) to occupational therapists working with veterans. In the 2021-22 Federal Budget, this fee was raised by 27 per cent, which will go some of the way to making this work sustainable. This was a welcome victory for occupational therapists and the clients they support.
Concerns remain, however, around a new treatment cycle for veterans, introduced on 1 October, 2019. The new cycle requires a client to get a fresh referral from their GP after 12 sessions with an allied health professional, or 12 months – whichever comes first. Unfortunately, the new treatment cycle imposes an enormous administrative burden on allied health professionals – work for which they are not remunerated. The problem is compounded by the fact that many GPs remain unfamiliar with the details of, and their key role in, the new arrangements. This leads to repeated and time-consuming interactions between a client’s GP and their allied health providers. This is frustrating for all concerned, and will remain a focus of our lobbying in 2022.
The unique role occupational therapists play in the delivery of mental health care is the subject of sustained and ongoing policy development and advocacy. Thinking Ahead: The future of occupational therapy and mental health in Australia is a project commissioned by OTA to ensure we have a strong understanding of the diverse nature of occupational therapy practice in the context of mental health. A series of workshops has enabled us to identify where and how occupational therapists are working, and the factors that help or hamper this work.
The project, being conducted by an outside consultancy under the supervision of an expert advisory group, addresses three separate but related areas: Advocacy and research – the development of a comprehensive advocacy strategy; Clinical and community practice – building the
infrastructure to support clinical competency and professional development; and Communications – raising consumer and referrer awareness of the occupational therapist’s unique role in mental health care.
Australia’s aged care sector is still coming to terms with the findings and sweeping recommendations of the Royal Commission into Aged Care Quality and Safety. Recommendations 36, 37 and 38 call for enhanced access to allied health care for senior Australians, whether they are in an RACF or ageing in place. The government accepted these recommendations, but only accepted in principle recommendation 38, something the commissioners themselves could not agree upon. Commissioner Pagone recommended improved access to allied health for people in RACFs, suggesting it be provided by outside service providers, while Commissioner Briggs recommended facilities be required to employ a suite of allied health professionals – clearly a much costlier arrangement.
This year’s federal budget included additional expenditure of $17.7 billion over five years on aged care, with $7.5 billion of that sum funding improved home care arrangements, and $7.8 billion supporting improved and more sustainable residential aged care.
Labor has differentiated itself from the coalition on several aspects of the aged care debate, so this may well prove to be an election issue. OTA continues to advocate in this space for a much greater role for occupational therapists, enabling them to bring the full range of their expertise to bear and, in so doing, enriching the lives of our seniors.
In the primary health space, there has been some recent movement after a 12-month lull owing to the pandemic. In July, we made a submission in response to the Primary Health Reform Steering Group’s draft recommendations discussion paper, which will inform the commonwealth government’s Primary Health Care Ten Year Plan. And in September, we made a submission to the Senate Community Affairs References Committee inquiry into the Provision of general practitioner and related primary health services to outer metropolitan, rural, and regional Australians. Both submissions stressed the importance of occupational therapy in multi-disciplinary teams delivering care in primary health settings.
In addition to this work, OTA’s policy and advocacy team has worked alongside members who give generously of their time and expertise to advance the interests of occupational therapists working with groups as diverse as schoolchildren, injured workers, those needing driving assessments, First Nations people, refugees and the terminally ill.
It has been a remarkable year for a remarkable profession.
