Peter Keegan

This is new & exciting - Check out the link in Emily Gillmartin bio - #ReflectivePractice #generalpractitioners #burnoutprevention #professionalgrowth #medicalpractitioner

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"Changes to NDIS legislation – frequently asked questions Have the rules for Short Term Accommodation (STA) changed? Short Term Accommodation (STA), also known as respite, is still part of the NDIS under the category 'assistance with daily life tasks in a group or shared setting.' Participants can continue to access STA based on the current guidelines. STA provides participants who have informal supports, like families and carers, the chance to stay away from home for at least one night. We usually fund this to help informal supports sustain their caring role and give participants and their informal supports time apart. It can be funded for up to 14 days at a time, with a maximum of 28 days per year. Self-managers can use unregistered providers, but STA funding cannot be used for holidays. Participants can access their usual NDIS supports while on holiday if needed. These must be from the approved list of NDIS supports." This info is from the National Disability Insurance Agency Newsletter

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"The (NDIS Support) lists are incoherent, heavy handed, and, worst of all, inconsistent with the purpose of the NDIS and with larger reforms the scheme needs to be sustainable. For the sake of public confidence in the NDIS, there may be good reason to create a shortlist of supports that are illegal or at odds with public expectations about the appropriate use of public funds. But trying to codify all supports that are ‘in’ or ‘out’ is a fruitless exercise. The government should ditch its 17-page list and focus reform efforts on bringing the NDIS back to its original design intent as a world-leading system of self-directed disability support." https://lnkd.in/g_9tMmDH

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People working in aged care should have access to the same legal rights as people working in other settings. One concern I have with the new Aged Care Act is that it creates broad powers for the Commissioner, Complaints Commissioner, or System Governor to compel people (not just registered providers or aged care employees) to produce information or answer questions, including compelling them to take an oath or affirmation [Ch6 Part 10 Div 3]. The threshold for applying this power is very low. As far as I can see the Commissioner just needs to believe the person has information relevant to whether a provider is complying, not that there is non-compliance; the Complaints Commissioner and System Governor just need to believe the person has information relevant to their functions [clause 488-489]. Standard legal protections are narrowed in relation to this power to exclude protection from a person making themselves liable for a penalty and legal professional privilege [compare s17 & s47 of the Reg Powers Act with clause 496 of the Bill]. The Bill already provides substantial monitoring and investigation powers under Ch 6 Part 2 – Part 5, which are broadly consistent with the Reg Powers Act but also allow warrantless entry where the Commissioner believes there is immediate and severe risk of harm to an older person [Ch6 Part 5]. The powers created under Ch6 Part 10 Div therefore, in my view, represent an extreme impingement on individual rights by the state without explanation or precedent being given. The Bill is supposed to be about human rights, but core element of human rights is protection from coercion by the state. This is mostly a matter of principle. A good provider will pretty much always be happy to answer questions from the regulator. And a good regulator won't misuse this power. However, we shouldn't design laws that rely on everyone being a good person. There are bad apples in business. And there are bad apples in government too. And lots of harm has been done in service to good intentions. Realistically providers will be well advised enough to make responses that protect their interests. E.g. That they are unsure. Can't remember. Need time to check their records and will come back with a written response. Individual workers are the people most likely to go into this process without representation and fall victim to misuse of this power. #agedcare

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Lights In The Darkness It is true that Iwi Māori Partnership Boards are doing good work co-ordinating and identifying health needs and opportunities in their various rohe. Their concept and establishment was never perfect but the hard work of creating them was done by Te Aka Whai Ora which the Coalition chopped. The IMPBs were not supposed to be simply advisory but to be conduits for health services working with Te Aka Whai Ora. They are not getting the funding or support they need to fulfill anything like their potential. Tautoko the people working so hard to make the best of it. They shine a light on health needs and service opportunities. But they are not, and should not be, viewed as window-dressing on a bad set off health policies.

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Is possible non-compliance enough to justify regulatory action? Apparently, yes. Under the Bill for the new Aged Care Act the Commissioner (or System Governor) can issue Non-Compliance Notices where they are “aware of information that suggests the provider may not have complied, or may not be complying” with the Act [clause 481(a)(ii), 482(a)(ii)]. These notices create enforceable actions [clause 483] with contraventions giving rise to a strict liability penalty [clause 487] currently worth about $19,000. Call me old fashioned, but I don't think regulators should be able to compel people unless there is evidence that they have actually broken the rules. There isn't even a case for this power on the basis of pre-emptive action against providers with poor processes or lack of capability since organisational problems of this nature constitute a breach of the standards in their own right. #agedcare

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I believe there will be amendments proposed to the NDIS bill today. I am still deeply concerned that the Bill will not take a whole of person approach to considering people's needs. There is a difference between saying that a condition is the responsbility of the NDIS and saying that a condition should feature in deciding what disability-related supports a person needs to live their life. For example, someone who has an intellectual disability might have a need for more or different NDIS supports if they're undergoing knee surgery or navigating cancer diagnosis and treatment. It's not the job of the NDIS to treat the knee or the cancer, but it is likely their job to help that person with additional support hours so they can get to their treatments and maybe have some assistance with communicating their needs during those appointments. The health system is not going to show up to do this, and even if theoretically they could, so much of this kind of support is relational. It's probably quicker and more helpful for the existing supports to offer more support - rather than bring in a new service system. Then there are people - like myself - who have multiple disabling conditions. At the moment the NDIA can list whichever of these conditions they like within your file and make decisions on that basis, without any rights as a participant to either know that decision, or appeal it. There is a lack of basic procedural fairness in this regard. This legislation is still insisting that this would form the basis of the needs assessment process. This is going to result in plans that don't meet people's needs, and unless the ability to appeal is cut (we keep hearing it isn't) then the Agency will be even more flooded with appeals than it currently is. The Agency seems quite desperate to limit their obligation to support disabled people to narrow parts of our experience. But it's simply not possible to do so without engaging in a dehumanising calculus of need and engaging in the fantasty that impairments need supports, not people.

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New! ✨ Video: Deputy Minister Leadership Reflections Series: Defining Leadership 📽️ https://lnkd.in/gSVK_MSx This video features excerpts from interviews with six former deputy ministers on what leadership means to them and how it can be applied in the public service. Check back on December 3, when we unveil the seventh featured speaker in the Deputy Minister Leadership Reflections Series! #GCLearning #LeadersGC

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Do NDIS providers not want a voice in the regulatory changes? Ive spent the last few hours (yes, on Christmas eve) reading the latest reports and consultation papers released by the NDIS commission over the past few weeks and whilst I have already posted on my takeaways, and the separation of SIL and SDA... There is something bigger here that I feel needs attention. There was only 18 submissions to the last open round of consultation to the Commission. With almost 200,000 providers, only 18 submissions!? Most of these were Advocacy bodies. This makes me wonder if NDIS providers dont want a voice or a say when it comes to these changes? Are we really ok with just dealing with the changes once in effect? Why was it only 18 submissions? 🙃 Is the consultation and submission process too hard? 🫠 Where providers not aware? 🙃 Are they too busy navigating the other host of changes thrown at them recently? The suggested changes to SIL affect just so many providers, and participants, and I am really a bit shocked that not more people had an opinion to share with the Government. I am wondering if there is value in me running an open session for providers to go over the consultation papers with them, brainstorm their thoughts and assist in writing up the submission so that more providers have a voice in these changes? Is that something that would help providers have a voice? If you would be interested in having a say, and would like to do a group submission with other providers facilitated by my team, please comment or tag a colleague here and I will organise something for the new year. Tagging some of my contacts who I hope have some insights to share! Yasser Zaki ♿Bruce Bromley Rachel Carey Paul Bryan Cedar Anderson JP Amy Gray Storm Menzies Damien Abdallah Karen Abdallah Perry Kleppe MINH LE DEBBIE KINDNESS James Loveday

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In light of all the recent discourse around changes to the NDIA, the pervasive sense of fear that essential supports will be reduced and the ongoing concern for each client as they enter a review period, I wanted to comment on the pressures faced by clinical supports working within the NDIS. I know I am not the only clinician feeling increased pressure and scrutiny, my co-workers, colleagues, friends and other care team members are experiencing the same. A new trend emerging in the past 3 months seems to be forcing participants with active plans into early review, while simultaneously ignoring urgent requests for change of circumstance. At the beginning of November I began experiencing an influx of requests to produce progress reports for participants, most of whom their plan had many months left to run. I cannot understand why participants who have plans running until 28th February 2025 are being forced into unwanted, early reviews. Most of these requests include expectations that reports are produced within a matter of weeks. Attempts to provide feedback and education around clinician capacity are met with feedback that progress reports are a requirement. Yes they are, however it has always been stipulated they are required 6 weeks prior to review, not 4 months? There is a lack of understanding from the NDIA about how much time it takes to produce an adequate report which ensures continuation of reasonable and necessary supports all the while supporting multiple other clients and care teams, who are at times, making decisions which are literally keeping people alive. Accounting for the typical caseload a clinician carries, it would be reasonable to assume there is already demand for approximately one progress report a month, if not more. Why is there no understanding that changing timelines for one participant, impacts everyone else? In the last month I have been asked to produce 7 reports, some for participants whose plans are ending in December 2024, however most with plans still active throughout the initial months of 2025. How are these requests of the NDIA reasonable and necessary? I have spent this morning working on a progress report, as I did late last night also. Not because my employer told me to, not because I am working flexibly, but because I honestly have no other option to ensure all participants are safe going into the high risk Christmas period. I don’t have any motivation in posting this other than to share my experience and provide a shout out to my colleagues navigating the endless demands of the NDIA while also providing compassionate, safe and effective support to high risk individuals. For anyone finding themselves in the same position, I see you, I appreciate you and thank you.

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There are two phrases we have been hearing a lot about in the NDIS reform process. "Putting people with disability back at the heart of the scheme" and "returning the scheme to it's original intentions." Looking at the actual change agenda, what we see are: 🚨 Entrenchment of the concept of a primary, eligible impairment that determines what support is appropriate and how much of it you can get. 🚨 The proposal to remove 'Improved Liveability' SDA 🚨 Removal of additional support funding for people with behaviours of concern 🚨 Introduction of 'early entry pathways' with a particular focus on psychosocial disability 🚨 Provisions in the reform Bill that would make it easier to demand any information the Agency wants to consider in relation to an access revocation decision, and increased powers to kick people off the scheme. We've also seen a lot of people talking about how somehow, these reforms are about addressing the supposed preponderance of people with *mild disabilities* who are getting support under the scheme, and taking it away from the people with *real disabilities* they claim to be speaking for. While it is probably not the first thing that comes to mind, one picture of profound disability is represented by a person who cannot take care of themselves, enter the shops or the office of a local service, maintain housing or relationships, or manage their money because of severe and profound psychosocial disability acquired as a result of profound childhood abuse and neglect. In my PhD research, I considered the lives of mothers who go to jail. Many of these women are victims of horrific childhood abuse and neglect and their lives have been shaped by violence. Many of them have brain injuries, intellectual disability and other mental health conditions. When this cohort of women are unable to access formal supports their informal support looks like violent relationships with abusive and criminalised men. The idea that these types of people were not part of the original vision of the NDIS is not entirely accurate. The NDIS was created as a result of coalitional politics, and there is no one arbiter of what its original intention was. But, the original legislation seems pretty clear that the NDIS was about supporting a particular population of people, who have significantly reduced functional capacity as the result of impairments across mobility, communication, social interaction, self-management, learning and self-care. What is being proposed is a reorientation of the NDIS. It seems increasingly clear that they want the NDIS to be solely focused on people who have *one* signficant impairment as a result of *one* specific diagnosis, and whose disability can be defined within a medical model without reference to social conditions. Then they want the ability to tell this narrower group of people, exactly what they can and cannot do and exactly how comfortable their lives are able to be, according to the actuary.

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🚨 NDIS Reform Update 🚨 The NDIS Commission is implementing important regulatory reforms to enhance the quality and safety of NDIS supports. 🔑 Key areas of focus: - Changes to mandatory registration for Platform Providers, Support Coordinators, and Supported Independent Living providers. - Proposed amendments to the NDIS Act (Bill No.2), following recommendations from the Disability Royal Commission, to address ongoing quality and safeguarding challenges. - A strengthened regulatory framework, with stricter requirements, stronger penalties, and criminal offences for non-compliance. 📅 Next steps: Mandatory Registration Step 1: Consultation (October 2024 – March 2025) Step 2: Decisions and Transition Plans (April 2025 – June 2025) Step 3: Commence Transition to Mandatory Registration (not before 1 July 2025) Changes to NDIS Bill No. 2 Roadmap Step 1: Consultation (October 2024 – December 2024) Step 2: Proposed NDIS Bill No.2 considered by Parliament no earlier than March 2025 Step 3: Implementation will commence after the Bill is passed by the Parliament of Australia. NDIS Practice Standards & NDIS Rules Reviews Step 1: Consultation commences (March 2025) Check out the NDIS Commission's Regulatory Reform Roadmap, outlining the activities planned to support reform priorities over the next 12 months, including key consultation timelines and events.

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This report favours a model called 'fundholding' where Navigator organisations would hold our plan funding in a 'pool.' They would use the money in this pool to procure services for us according to their ideas of quality and value. They wouldn't have to spend our plan value on us. They could spend it on someone else, or not at all. If they underspent our plans, they could keep the change. This is literally the definition of extractive abandonment. How easy do you think it would be to convince your Navigator at NIB that you actually needed the $15,000 wheelchair from a different company than the one they usually work with, or that you actually do need the number of support hours in your plan, not slightly less, when their yearly bonus was riding on you underspending enough that there was some left over for them. I can only hope that this has been drafted solely for titilation, and the government has no intention of indulging these purile fantasies.

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Whakamahia tō reo | Use your voice. We are reviewing the Health and Disability Commissioner Act 1994 (the Act) and the Code of Health and Disability Services Consumers’ Rights (the Code). The Act sets out what HDC can do, including how complaints can be resolved, and the Code sets out people’s rights when using health and disability services. Everyone who uses these services has rights and everyone who provides a service must uphold these rights, whether or not these services are paid for. We want to know how you think we can make the Act and the Code better. You can have your say in the public consultation, being held from 30 April to 31 July 2024, to help make sure HDC and the rights meet your needs and the needs of your whānau and communities. Find out more, and have your say, at review.hdc.org.nz. If you have any questions, you can email [email protected]; or call or text 027 283 2219 or 6448975955 if you’re using the NZ Relay Service.

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A hypothesis about NDIS compliance (tell me if I'm wrong...) Working with providers on their compliance recently, I have formed a theory: 70% of your NDIS compliance comes down to just TWO things: 1. Nailing your client and worker onboarding (especially that initial staff training) 2. Having a system that tracks your expiry dates and reviews Here is my thinking: Most providers I work with feel like compliance is this massive weight hanging over them. They're constantly playing catch-up, never quite feeling on top of things. But those who get these two pieces right? Everything changes. Instead of drowning in file management, they're: ✨ Growing their business ✨ Really connecting with clients and workers ✨ Managing risks effectively ✨ Actually improving their service quality (You know, all those things that usually get pushed aside when you're buried in paperwork!) 🤔 Curious: What's your biggest compliance headache right now? Can it be solved by nailing onboarding and keeping track of documents, or something else entirely? #NDISProvider #Compliance #BusinessGrowth #DisabilitySupport

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As the Lower House prepares to debate and vote on the NDIS Bill, before the remaining submissions to the Community Affairs Legislation Committee are even published, I can’t stop thinking about these parts of our submission. About everything – and everyone – that is really at stake here. That rushing is a recipe for both human and budget disaster, because we cannot achieve a sustainable NDIS if the Government does not listen to us when we say this will not work. That there is still time to show the humility and reflection we talk about in our submission. That lived experience is key to writing the amendments we need to unlock the outcomes the NDIS asked us to dream of. “The fact we are having trouble articulating our insights around the type of co-design we need into a framework that can be digested into a bureaucratic enough form to insert into legislation is part of the problem: This is, first and foremost, an ethics and human rights problem. It is a problem rooted in the Government being unwilling to share power with people with disability, and unwilling to acknowledge both the value of our lived experience and our capacity to take part in the drafting of legislation that impacts the most intimate parts of our daily lives. The Government would rather try to digest their view of how our daily lives should look into bureaucratic rules on their own, than listen to us about how it will impact our daily lives and their bottom line. The irony is that this Bill misses the mark by so much that it will likely cost Australia a great deal more in the coming decades, as a result of unmet needs...” “We believe that, at the heart of this discussion, this is the difference between the current NDIS Act and its intention, and the proposed legislative changes: The Bill that was tabled lacks the humanity of the original social model perspective and the ethical, compassionate approach to co-design that comes naturally to people like Uli who have lived it. And we cannot make the NDIS work without it. Genuine co-design would have found a way to make this perspective part of the fabric of the NDIS, and we cannot move forward without a legislated commitment to doing this most important part of the work... That commitment must begin with recognising the capacity of people with disability to lead this work and do it well, because the Government cannot do it well without us... [This] is what compliance with Article 4(3) of the UNCRPD looks like in practice: Letting people with disability co-design the laws and policies that enable us to be the authors of our own stories and the captains of our own ships.” Bill Shorten Amanda Rishworth Department of Social Services (DSS) Michael Sukkar Office of Senator Jordon Steele-John Public Interest Advocacy Centre Natalie Wade Chris Coombes Darren O'Donovan Rosemary Kayess Helen Dickinson Mitchell Skipsey Sheetal Balakrishnan Naomi Anderson Dr George Taleporos (GAICD, PhD) Sam Paior JP, MAICD

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Please consider taking the time to complete our survey on the state of the sector. This report is very influential and provides valuable insights to decision makers

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Wow. We all missed that one. Only funds for impairments you had at “time of access” to the NDIS. Really? That is crazy. The support you need is based on today. Not how you were aged 12. “The Bill further declares that participants can only access supports for the impairments identified at the point of access to the NDIS – not emerging or acquired disabilities, which are frequently experienced by people living in PCC. Thirdly, the Bill introduces mandatory assessments to the NDIS, for the first time. All current participants will be re-assessed for eligibility for NDIS supports. There is as yet, no clear process by which to appeal an assessment [6]. The Bill would enable assessment scores to be fed into an algorithm to generate a budget – you may recall this approach was previously dubbed robo-planning [7]. Currently, advocates are calling for the assessment process and the ‘method’ for budget setting, be more established prior to changing the legislation.”

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