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NDIS: Complexity and Uncertainty The National Disability Insurance Scheme (NDIS) is an incredibly complex social policy. At an estimated cost of $22b and potentially impacting the lives of 450,000 Australians – not to mention their families – the NDIS is one of the most significant initiatives devised in Australia. However, in WA, the complexity of implementation is increased as uncertainty regarding the model remains. The NDIS model has at its core the idea that people living with disability should have choice and control over the services they access and how they access them. Like the NDIS itself, this is an almost universally agreed aspiration. Many aspects of the NDIS which are designed to achieve this outcome were inspired by WA’s pre-NDIS disability services model. Elements such local coordinators (assisting people to access services and navigate the processes) and individualised funding and person-centred care (supporting choice and control) were part of the original WA model. As a result, the previous state government did not agree to hand over disability services to the NDIS in the way that the other states and territories did.
WA’s arrangements are unique in that decisionmaking control and leadership are retained here. This has great advantages... Rather, while each state and territory bilateral agreement with the Commonwealth is different at the margins, WA’s arrangements are unique in that decision-making control and leadership are retained here. This has great advantages, not least of which that the now redundant Disability Services Commission was able to continue its close relationship with the disability services sector and pass that relationship onto the new Department of Communities, created by the new McGowan Government. However, the State Government also opened up a can of worms when it questioned whether the unique WA arrangement should be retained or whether WA should join other jurisdictions and hand over control to the NDIS.
It is a very difficult question – there are marginally more costs borne by the WA Government under the current arrangement but, on the other hand, disability service providers have a strong relationship with the state government (which is not replicated by an NDIS that does not see a relationship with the sector to be important) and the NDIS is still very immature. These two factors ensure that uncertainty reigns under the NDIS for service users and providers alike – prices are not settled satisfactorily, peripheral services, such as transport, remain unresolved and demand remains unconfirmed. The level of uncertainty is also compounded by the fact that the NDIS has a new board and will have a new CEO soon, which could potentially change the game. It is clear that a WA-based model articulating into the NDIS is likely to be a sensible and risk-averse model to adopt at least in the short-to-medium term as the NDIS beds down and the realities of costs, pricing, service delivery requirements and demand become better known.
C L I N I C A L R E S E A R C H S T U DY F O R
SOCIAL ANXIETY DISORDER We are recruiting for a Phase 2a study to investigate the safety, efficacy and tolerability of a new investigational medication as a possible treatment for social anxiety disorder. Participants must meet the following minimum criteria: • Male and female participants, 18-64 years of age with moderate to severe symptoms. (will be assessed for eligibility using the Liebowitz Social Anxiety Scale). • Female participants must not be pregnant, breastfeeding or able to become pregnant. • Participants must not currently be using psychotropic medications or in psychotherapy for social anxiety disorder. • Participants will receive a placebo or the investigational oral medication during the study. Maximum participation time in the study will be 20 weeks and participants will remain under your care and returned to you after the study ends. For further information please contact: Nicole Emmott on 08 9347 6574 or nicole.emmott@health.wa.gov.au Approval to conduct this research has been provided by the Human Research Ethics Committees of the North Metropolitan Mental Health Service Research Ethics and Governance Office (NMHS MH REGO). Any person who wishes to raise an ethics issue or concern about this research project may contact the NMHS MH REGO Executive Officer on (08) 9347 6502 or NMAHSMHREGO@health.wa.gov.au
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18 | SEPTEMBER 2017
MEDICAL FORUM
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UWA’s Prof David Gilchrist sees benefits in WA sticking to its own form of the NDIS but uncertainties around prices and likely demand.