What Happened to the NDIS Core Values? Whole of Person not Health Model

What happened to the fundamental commitment in NDIS to client centred choice and control?

The simple answer is that a paternal NDIS Commission stepped in to decide what was in the best interests of NDIS recipients. As a cost containment measure.

Without doing the hard work of actually listening to the voices of the people on the ground working with NDIS clients. Therefore without learning from those with the practical experience. And building on this knowledge and experience to improve the delivery of services.

Any quality management expert will tell you this is a vital step before making fundamental structural change decisions, such as has occurred, in realigning NDIS to a Health Practitioner Delivery model

Quality and Efficiency

What was needed was a more nuanced approach to navigate both the efficiency and quality considerations. And to interrogate whether, for example the Behaviour Support Plan process "owned" by psychologists was actually effective in equipping NDIS participants to take charge of their own life and decisions.

Or whether instead it was simply a maintenance model without any requirement on the psychologist to demonstrate that their interventions, or service was necessary.

Only after a thorough process of conducting a review and researching the efficacy of the work of all service providers can we be confident that we have covered our bases.

Lost Learnings

This is a call out to everyone who cares about the wellbeing of NDIS recipients. To acknowledge that a health model of NDIS delivery of service does not meet the overall needs of the individual person and the system as a whole. We are at risk of losing the acquired working knowledge of all those practitioners now excluded.

Instead of learning from my success in bringing out the potential of a person with a serious acquired brain injury the NDiS system has completely devalued my service. And now it is Art and Music therapy or facilitator practitioners who will be locked out of continuing to provide meaningful practical facilitation for their existing clients.

We have been restricted to a redacted Health Practitioner model. A much better way to handle the costs issues and blowouts would have been to create an equal level playing field where all practitioners health or otherwise had substantive KPIs to meet.

And ones in which the NDIS recipients themselves had a say.

How disappointing and disrespectful to all of we practitioners who make a real contribution to the wellbeing of our clients. And what a lost opportunity to garner the best of what we do to build a more robust delivery service model.

Personal Story

I am no longer authorised to provide the equine supported life and social skills service to my client. Despite having adult education qualifications at PhD level. Where is the sense in that?

If my work had not been worthwhile my client would no longer come. Simple as that.

I have worked with a person with acquired brain injury for 5 years who when I met her could hardly verbally communicate. Many of her carers and family members acknowledge the progress we have made together.

A missing link throughout the 5 year duration was the acknowledgment by the health practitioners of the value of my services. They seemed to be considered to be "add ons" to the main game. Which was? Let me think - maintenance of behaviour. Surely not. This is not related to self-interest by any chance.

Challenge to Health Practitioners

I note the silence of the many health registered health practitioners who continue to deliver services under the NDIS Scheme without any threat to their livelihoods.

Does the current Behaviour Support Plan Model make any health practitioner including psychologists accountable?

Or is it that the maintenance not an independent development approach suits their interests.

A Whole of Person Model

We need a Whole of person model not a health model. Accountability not report writing.

Dr Deborah Hann

26 November 2024