JCPSLP Vol 18 no 2 July 2016

Ethical conversations

Ethics and the National Disability Insurance

Scheme Cathy Olsson and Trish Johnson

This article seeks to identify anticipated and emerging ethical issues and challenges for speech pathologists working with National Disability Insurance Scheme participants, and to facilitate exploration of the ethical decision-making for clinicians working within that funding environment. S peech pathologists practise in a wide variety of environments and contexts, which result in the presentation of an equally wide variety of ethical issues and challenges. The diversity of clinical practice requires flexibility in ethical reasoning and decision-making, particularly when practising within a new context, such as the National Disability Insurance Scheme (NDIS), which is developing and changing as it expands. As professionals, speech pathologists are bound to uphold high ethical principles and standards, described within the Speech Pathology Australia Code of Ethics (2010). We demonstrate ethical behaviour by being aware of the ethical issues inherent within daily practice, considering the ethical implications of decisions and integrating proactive ethical reasoning into our everyday work by applying those principles and standards. A current challenge for speech pathologists is to become confident in understanding and responding to the ethical issues that arise when working with participants in the NDIS, and to develop proactive strategies for managing those issues. The National Disability Insurance Scheme − in brief Many commentators describe the NDIS as the most significant social policy reform since the introduction of Medicare in 1975. The scheme entails a shift from state and territory government and non-government organisations receiving block grant funds to provide services to people with disability, to funds being provided directly to individuals themselves. In the previous model, as part of their service provision, disability provider organisations may have had restricted eligibility and rationed and prioritised services in an environment of significant unmet need. Under the NDIS, people with disabilities are able not only to determine their own goals and priorities, but also to exercise choice and control over who provides services and how they are provided. While the changed relationship between providers and participants that comes with the new funding model

brings many advantages and opportunities, it also brings some challenges. The altered funding model is driving a range of changes in the service provider landscape and systems. Established service provider organisations which may have had a specialist focus are broadening the range of supports they offer (e.g., adding case management or accommodation) and their client group (e.g., children with autism spectrum disorder as well as children with physical disabilities). The increase in funding, and consequent demand for services, is leading to an increase in the number of speech pathologists who are expanding their skills set to work with children and adults with disabilities. Many new private practices are being established and existent practices are entering the arena as providers under the NDIS. Clinicians are required to have a broader personal scope of practice to provide for the heterogeneous needs of people with disabilities. In addition to new players in the field, some long-term service provider organisations are being devolved or are no longer continuing to provide allied health services for people with disabilities. “With the benchmarks for face-to-face contact I’m not getting time to write up my progress notes, let alone do the preparation for sessions or provide supervision to all the new staff.” Speech pathologists face challenges to their professional autonomy, application of their clinical reasoning and standards of practice in relation to their service provision. These challenges are occurring in the context of changes in provision of clinical governance. It is more difficult under the individualised funding model for organisations to prioritise activities such as clinical supervision and support and targeted clinical professional development, particularly in a contestable market. Organisations which are new to allied health service provision and/or service provision to people with disability may still be developing their understanding of the need for and value of clinical governance, and the structures and systems to provide this. Provider organisations are facing challenges to their financial viability, have had to shift to a more competitive mode and focus on marketing their services. Service managers who may have limited understanding of speech pathology service provision are now competitively contracting with individual participants to purchase

KEYWORDS ETHICS NATIONAL DISABILITY INSURANCE SCHEME

Cathy Olsson (top) and Trish Johnson

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JCPSLP Volume 18, Number 2 2016

www.speechpathologyaustralia.org.au