Occupational Therapy Australia Limited ABN 27 025 075 008 | ACN 127 396 945

6 / 340 Gore St. Fitzroy VIC 3065

Ph +61 3 9415 2900 | Fax +61 3 9416 1421 | Email policy@otaus.com.au | Website www.otaus.com.au

AUSTRALIAN GOVERNMENT THE TREASURY 2018-19 PRE-BUDGET SUBMISSION OCCUPATIONAL THERAPY AUSTRALIA (OTA) SUBMISSION DECEMBER 2017

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Introduction

Occupational Therapy Australia (OTA) welcomes the opportunity to make a pre-Budget submission to the Federal Government. Occupational Therapy Australia is the professional association and peak representative body for occupational therapists in Australia. As of September 2017 there were more than 19,000 registered occupational therapists working across the government, non-government, private and community sectors in Australia. Occupational therapists are allied health professionals whose role is to enable their clients to participate in meaningful and productive activities. Occupational therapists provide services such as physical and mental health therapy, vocational rehabilitation, assistive equipment prescription, home modifications and chronic disease management, as well as key disability supports and services.

Summary of recommendations

Aged Care

The Federal Government should rebalance the distribution of home care packages to ensure that more level 3 and 4 packages are made available. However, consideration should be given to the impact this will have on the availability of level 1 and 2 packages for consumers with low level care needs.

The Government should allow for the temporary allocation of a home care package where there is a residential care place that is not being used.

The Government should introduce a level 5 home care package for consumers with complex care needs, however this should not come at the expense of funding for residential aged care.

The Government should undertake a comprehensive analysis of how home care package recipients are utilising their allocated funds.

Consideration should be given to removing assistive technology from home care packages and creating a separate pathway to accessing aids and equipment.

There should be greater investment in short-term restorative care (STRC) and transition care. The criteria for the STRC Programme should be amended to allow more consumers to access this type of care, and there needs to be more communication with GPs about the program. The number of transition care places should also be increased, especially in areas that regularly have waiting lists and 100 per cent occupancy.

A higher level of governance is needed to ensure that there is greater consistency across the country with regards to the allocation of level 4 home care packages.

Consumers who have been allocated a higher level home care package should be able to easily move to a lower level package if their needs change.

The Government should continue to provide funding to improve the functionality of My Aged Care. This should include funding for an advertising campaign to promote My Aged Care and available services.

Mental Health

Services provided by occupational therapists and social workers through the Better Access to Mental Health initiative should attract the same rebates as services provided by clinical psychologists.

Funding for the new measure allowing consumers to claim rebates for video consultations provided through Better Access should be increased and extended beyond 2020-21.

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Equipment/Assistive Technology

The Government should develop a nationally consistent approach to the prescription of aids and equipment.

NDIS

Details of promised psychosocial support services for people who are not eligible for the NDIS should be provided as soon as possible.

Funding should be provided to enhance the training of NDIS Planners, many of whom are inexperienced. Occupational therapists should be involved in the development and delivery of this training.

The NDIA should develop a risk framework which outlines how assistive technology applications are to be managed, depending on their level of urgency. The Agency should also develop a set of KPIs to measure the scheme’s capacity to provide participants with the devices they need within a reasonable period of time.

As the NDIS continues to roll out across Australia, funding should be provided for workforce readiness initiatives that promote evidence based-interventions for people with disability.

DVA

The DVA Schedule of Fees for Occupational Therapists should be reviewed as a matter of urgency to ensure that occupational therapists are fairly reimbursed for their work with veterans. This must involve an increase in the rebates to occupational therapists that is well above and beyond the mere reintroduction of indexation.

Research

The Government should provide funding for research aimed at quantifying the savings delivered to the health system as a result of investment in occupational therapy.

Primary Health

There should be greater investment in raising community and GP awareness of the vital “value add” provided by allied health professionals such as occupational therapists.

Allied health professionals should be contracted to consult with Health Care Homes to ensure they have a greater role in the development of patient care plans.

Private Health Insurance

The Government should alert private health insurers to the efficacy of occupational therapy and encourage them to incorporate it in their basic packages.

MBS

At a minimum, the number of allied health services for which rebates can be claimed through the Chronic Disease Management (CDM) program should be increased from five to ten per calendar year. Additional sessions (more than ten) should also be available in exceptional circumstances for people with particularly complex care needs.

The Medicare rebate for services provided by occupational therapists through the CDM program ($52.95) should be increased to offset the factors that contribute to higher out-of-pocket costs for consumers, such as travel expenses, the need to undertake follow-up visits, and report writing.

The Government should review the rebate structure of the CDM program every two years to better reflect the real costs of providing services to patients with chronic conditions.

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Workforce and Rural and Regional Services

The Government should work with state and territory governments to develop training networks that link major metropolitan hospitals with smaller regional and rural hospitals.

The government should increase the provision of rural based scholarships and fellowships to attract students and recent graduates to locations outside our major cities.

The office of National Rural Health Commissioner should be made a permanent entity, and funding and resources should be made available to support the functions of the Commissioner.

Aged Care

In OTA’s submission to the recently completed Aged Care Legislated Review, it was noted that there is an inadequate supply of level 3 and 4 home care packages (HCPs). As a result, consumers are being placed on long waiting lists. We are supportive of recommendation 5 of the Review – that the government re-balance the distribution of home care packages, by increasing the proportion that are high care packages, without a change in the overall home care ratio. However, OTA is concerned that the rebalancing of packages will result in a significant reduction in level 1 and 2 packages for consumers with lower level needs. In order to generate the funding needed for a level 4 package, we presume that a number of lower level packages would be cut. We also support recommendation 6 of the Legislated Review, which calls on the government to allow for the temporary allocation of a home care package where there is a residential care place that is not being used. While OTA supports the introduction of a level 5 home care package for consumers with complex care needs (recommendation 7 of the Legislated Review), it is imperative that this does not come at the expense of funding for residential aged care. OTA acknowledges that it would be costly to provide HCPs at a higher level. One option could be to increase the number of level 3 and 4 packages and allow consumers to access these on an as needs basis. Access/use of funds OTA believes that the Government should undertake a comprehensive analysis of how home care package recipients are utilising their allocated funds. There have been cases of consumers who are allocated a higher level packages expending all of their funding on a particularly large piece of equipment. Consideration should be given to removing assistive technology from home care packages and creating a separate pathway to accessing aids and equipment. There is also a need for greater investment in short-term restorative care (STRC) and transition care. The Short-Term Restorative Care Programme is currently underutilised due to the restrictive criteria for referral, and the fact that many GPs are not aware of the program. The criteria should be amended to allow more consumers to access this type of care, and there needs to be more communication with GPs about the program. The number of transition care places should also be increased, especially in areas that regularly have waiting lists and 100% occupancy. This program prevents consumers from needing higher level help at home once they complete the program. Inconsistent allocation of home care packages OTA believes that a higher level of governance is needed to ensure that only those with the most complex care needs are being allocated level 4 packages. At present, there is a great deal of inconsistency across the country with regards to the allocation of higher level packages, and there have been cases of consumers being allocated a level 4 package when they do not actually require this level of support. One example is a consumer who had suffered from a recent illness when they

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received an ACAT assessment and were approved for a level 4 package. This person’s condition then improves and they no longer require this package, however they are unable to move to a lower level package. National scheme for AT prescription OTA reiterates its call for the Government to develop a nationally consistent approach to the prescription of aids and equipment. At present, there are inconsistencies with regards to the types of aids and equipment available in each state and territory, eligibility criteria and subsidy levels. Attention should also be paid to addressing current issues associated with the prescription and installation of home modifications through My Aged Care. Workforce training The 2018-19 Federal Budget needs to reflect an ongoing commitment to the training of the aged care workforce. OTA welcomes the creation of the Aged Care Workforce Strategy Taskforce and hopes that this body will be provided with sufficient funding to allow it to consult as widely as possible with aged care sector stakeholders. OTA has previously highlighted the need for multidisciplinary aged care teams that include occupational therapists. My Aged Care functionality OTA calls on the Government to continue to provide funding to improve the functionality of My Aged Care, in line with recommendations 22 and 25 of the Aged Care Legislated Review. We also recommend that funding be provided for an advertising campaign to promote My Aged Care and available services (recommendation 24 of the Legislated Review), as there remains a lack of awareness around how to access support through the aged care system. RAS/ACAT amalgamation OTA fully supports the amalgamation of the Regional Assessment Service (RAS) and Aged Care Assessment Teams (ACATs) in order to create a more streamlined assessment process for consumers. OTA believes that a single integrated workforce will deliver better quality services for older Australians. ACFI The Review of the Aged Care Funding Instrument (ACFI) recommended that an expanded pain management program be introduced to residential aged care facilities, however we note that no decision has yet been made on the Review’s proposed reforms. OTA is a strong proponent of the need for multidisciplinary allied health teams in residential aged care facilities. We believe that the changes to the ACFI proposed in the report will allow for more accurate assessments of a resident’s needs, and the provision of a diverse range of interventions. Occupational therapists believe that participation in meaningful activities is fundamental to improving health and wellbeing, and we would welcome the introduction of a new therapy program focused on wellness and reablement.

Mental Health

Indexation The decision to delay reversing the MBS indexation pause until July 2019 for allied health services has severe implications for occupational therapists working in mental health. OTA joins with other allied health associations in expressing our disappointment at the Government’s decision to delay the reversal, as this has placed added pressure on practice owners who are already struggling to cover the costs of running a business.

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Occupational therapists are key providers of mental health services through the Better Access to Mental Health initiative. The reintroduction of indexation in 2019 is seen by many BAMH-endorsed occupational therapists as ‘too little, too late’. These therapists already have to contend with the fact that there is significant disparity in the size of the rebate for mental health services provided by psychologists, and those provided by occupational therapists and social workers. Adequacy and equity of funding A number of therapists have reported that it is simply not viable to work in this space due to inequities within the system. Lower rebates devalue the important work of occupational therapists and social workers and make it harder for consumers to access their services. The current rebate structure also undervalues the experience and qualifications of many occupational therapists who provide services through Better Access. For example, a psychologist with very little practical experience will be able to earn more than an occupational therapist with postgraduate qualifications and decades of experience in the mental health sector. A clinical psychologist who sees a client for between 30 and 50 minutes will also receive a higher rebate than an occupational therapist who sees a client for more than 50 minutes. OTA calls on the government to address this anomaly as a matter of urgency. The non-billable time requirements associated with providing services through Better Access, including database registration processes, documentation, report writing and financial processing, make it financially unviable to bulk bill in most circumstances. Video consultations OTA welcomes the introduction of a new measure that allows consumers in rural and remote areas to claim rebates for video consultations provided through Better Access. However, we note that only $9.1 million has been provided for this initiative over four years from 2017–18 to 2020–21. OTA recommends that funding for this initiative be increased and extended beyond this period to ensure that those living in rural and remote Australia continue to have access to these essential services. Psychosocial supports Finally, OTA notes that the 2017-18 Federal Budget included $80 million over four years to fund the provision of psychosocial support services for people with severe mental health conditions who do not qualify for the NDIS. We recommend that details of these services be provided as soon as possible in order to address growing uncertainty for consumers who have had their NDIS applications rejected.

National Disability Insurance Scheme (NDIS)

While OTA has long been a strong supporter of the NDIS, it is fair to say that our members and the participants they serve continue to experience significant challenges and barriers when trying to navigate the scheme. Efficient use of funding OTA recognises the economic challenges confronting the nation and accepts the necessity of budgetary restraint. As such, we stress that what is needed to fix the NDIS is not new money, but rather the more efficient use of funds that have already been allocated. It was recently reported in The Australian (22.11.17) that NDIS executives spent more than $180 million on consultants and contractors in 16 months, $41.5 million of which went to two top-tier private companies for “strategic advice”. At the same time, NDIS participants are being left in limbo

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due to the inexperience of Planners and seemingly endless delays in processing home modifications and assistive technology applications. NDIS Planners It is clear that Planners frequently underestimate the hours of therapy required for a participant to achieve their goals, which subsequently affects goal attainment and increases the likelihood of the participant needing a plan review. Too often the quality of a plan comes down to how effective the participant or their advocate are at articulating their needs during plan development conversations. OTA again calls for funding to be provided to enhance the training of Planners. We believe that occupational therapists, who experience first-hand the effects of disability on people’s daily lives, should be involved in the development and delivery of this training. Service delays As previously mentioned, we are highly concerned with the significant number of participants who are waiting months to access key items of assistive technology. OTA would welcome the opportunity to work with the NDIA to develop a risk framework which outlines how assistive technology applications are to be managed, depending on their level of urgency. We would also be willing to contribute to the development of a set of KPIs to measure the scheme’s capacity to provide participants with the devices they need within a reasonable period of time. Workforce readiness OTA reiterates its belief that the disability workforce requires ongoing support while the NDIS is being rolled out. Funding should continue to be provided for workforce readiness initiatives in the form of workshops and training programs that promote evidence based-interventions for people with disability. This should include training for allied health professionals to assist them to transition to the NDIS. We believe that adequate workforce readiness would increase the provider marketplace and reduce time and funding currently wasted in providers attempting to navigate the scheme.

Department of Veterans’ Affairs (DVA)

Adequacy of funding OTA welcomed the announcement in last year’s Federal Budget that the indexation of the Medicare Benefits Schedule (MBS) for allied health services would resume from 1 July 2019 and, for Department of Veterans’ Affairs (DVA) related services, from 1 July 2018. It is important to note, however, that during the period in which indexation was paused there was no attendant pause in the costs of doing business. Those of our members working in MBS funded service delivery roles have experienced a prolonged period in which, as a result of deliberate government policy, their outgoings have risen while their income has stagnated. In the case of occupational therapists working with veterans and war widows, there has been no increase in the rebate, beyond adjustment in line with the CPI, since 2007. That increase was modest and applied to only one item on the schedule of fees. And, of course, there has been no adjustment in line with the CPI since 2013. Those occupational therapists still doing veterans work, do so at a loss; they only keep doing it out of loyalty to longstanding clients and by cross subsidies from more profitable work. It should be noted that NDIS work pays more than double the DVA rate.

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It must also be noted that occupational therapists are different from other allied health professionals. They usually travel to and from the place in which the client is trying to function (their home or residential facility). This travel is inadequately subsidised. Similarly, occupational therapists are required to complete much more written reporting than other allied health professionals. Initial clinical assessments, the design of home modifications and the prescription of assistive technology all involve extensive written reporting. Significantly, the DVA’s audit requirements necessitate careful written reporting. But the time spent completing necessary documentation is not subsidised. Inexplicably, a single flat rate is paid for all consultations, irrespective of how long a consultation takes. As a thorough initial assessment can take up to two hours, only part of this time is effectively remunerated. In contrast, the fee schedules for other allied health professions make allowances for consultations of a longer duration. It should also be noted that the fee schedules for other allied health professions pay more generous rebates. The fee schedule is outdated, no longer reflecting the increased complexity of the work done by occupational therapists and the assistive technology they prescribe. Our members often identify mental health issues while doing assessments and are subsequently expected to perform a case management role which is not remunerated. An updated fee schedule should reflect the changing landscape in which occupational therapists work. It should remunerate them for the time it actually takes to perform increasingly complex consultations. If the exodus of experienced occupational therapists from DVA work is to be staunched, the Federal Government must act to render the provision of occupational therapy services, at the very least, modestly profitable. This must involve an increase in the rebates to occupational therapists that is well above and beyond the mere reintroduction of indexation.

Primary Health – An emphasis on preventative health and chronic disease management

Targeted spending on primary health care is a means of addressing the health needs of individuals before they become more acute. A proactive investment in “wellness”, rather than reactive spending on the treatment of illness, represents a longer term investment in the health of the community. For example, government should immediately accept and act upon a fact long recognised by those who work with the elderly: that every dollar spent on falls prevention saves the health and aged care sector multiple dollars. But for the presence of an inexpensive grab rail or rubber shower mat, an elderly person would not be occupying an expensive public hospital bed, recovering from a broken hip and running the risk of contracting pneumonia or a superbug infection. Funding research to show efficacy A growing number of academic studies, many of them done in the United Kingdom, quantify the savings delivered to health services by investment in occupational therapy and, in particular, the assistive technology and home modifications prescribed by occupational therapists. One of the most recent can be found at: https://www.ageing-better.org.uk/news/small-changes-to-homes-can-improve-quality-of-life/

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OTA urges the Federal Government to make available funding for a similar study in Australia. We believe that the Australian Institute of Health and Welfare (AIHW) would be ideally placed to undertake such a study. PHNs and Health Care Homes While the creation of Primary Health Networks (PHNs) tasked with addressing local population health needs is a positive initiative for local communities, OTA believes there should be greater investment in raising community and GP awareness of the vital “value add” provided by allied health professionals. This will enhance the holistic nature, and therefore the effectiveness, of primary health care. OTA supports a multidisciplinary approach to the prevention and management of chronic disease, involving allied health professionals, GPs and carers. This could be achieved by contracting allied health professionals such as occupational therapists to consult at Health Care Homes and ensuring they have a greater role in the development of patient care plans. OTA remains concerned that the centralised role of GPs in the new Health Care Homes will limit the role and influence of allied health professionals in chronic disease management. While we understand that the Government’s foremost priority is to ensure enhanced access to general practitioners for all Australians, OTA again reminds government that occupational therapists are ideally placed to deliver primary health care. By enabling people to participate in daily activities, occupational therapists are key to illness prevention. By assisting the injured to return to work as soon as possible, occupational therapists enhance economic productivity. And by promoting wellness, occupational therapists help minimise avoidable hospitalisations, thereby relieving pressure on the health system. Private health insurance It has been brought to the attention of OTA that many of the packages offered by Australian private health insurers relegate occupational therapy to the status of an optional extra. Some packages exclude occupational therapy altogether, while including most other allied health services. This is counter intuitive given occupational therapy’s central role in the recovery process. It enables people to resume their productive role in the community more quickly than would otherwise be possible. This, in turn, decreases costs to other parts of the health system. It is therefore of real benefit to both the individual and the country. While OTA understands there is no overarching framework that determines which services are included in private health insurance packages, we recommend that Federal Government bring its not insubstantial influence to bear, alerting private health insurers to the efficacy of occupational therapy and encouraging them to incorporate it in their basic packages. This would enable policy holders to access therapeutic services of proven value if and when the need arises. A report released on 6 December by the Australian Institute of Health and Welfare found that private health insurance funded public hospital admissions grew from 8.2% of all admissions in 2006-07 to 13.9% in 2015-16. This represents a significant and growing burden on our public hospital system and a growing cost to the private funds. The same report found that a substantial proportion of these hospitalisations involved people aged over 75 years. It is timely therefore to remind all concerned that at least some of these hospitalisations are eminently avoidable and would be avoided with a relatively modest investment in assistive technology and home modifications.

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MBS items – Chronic Disease Management (CDM) Occupational therapists are key providers of services to people with chronic conditions and complex care needs. The Chronic Disease Management (CDM) services on the MBS enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions. Currently, CDM is conducted primarily through general practices and access to other services relevant to chronic disease (such as allied health services) is sporadic, particularly for people living in rural and remote communities. GPs act as a central gatekeeper of sorts whose role it is to coordinate the patient’s care and refer them to other service providers as required, including occupational therapists. GPs often have limited knowledge of the roles of allied health professionals, including occupational therapists. This can result in limited referrals to occupational therapists and minimise the opportunity for a cost-effective, multidisciplinary intervention. GPs also have an inconsistent working knowledge of the CDM claims structure. There have been numerous reports of GPs incorrectly advising consumers that they will not incur any out-of-pocket expenses for CDM services under current MBS funding arrangements. At the point of intake, occupational therapists advise consumers that they will incur out-of-pocket expenses, however many consumers still assume that Medicare will cover the costs when they present their receipts because of information provided to them by their GP. Adequacy of CDM funding A fundamental shortcoming of the CDM program’s funding model is the limited numbers of episodes of care funded through the MBS. Currently, a Medicare rebate is only available for a maximum of five allied health services per calendar year, which must be shared among 13 different allied health providers. Additional services are not possible in any circumstances. In many cases, patients require services from a number of allied health professionals, such as occupational therapists, speech pathologists and physiotherapists. Some patients may require multiple sessions with an allied health professional in order for their care needs to be properly assessed. Most people will need more than one occupational therapy session – one to assess and one to provide an intervention (at a minimum). OTA does not believe that a maximum of five allied health services per year is adequate for patients with a CDM plan, as this impedes the ability of allied health professionals to provide evidence-based, best practice services. Patients who reach this limit will thereafter need to pay for these services privately, and the cost may or may not be covered by their private health insurance given the variability of the packages available. There is also no allowance for group therapy that may be provided for more than five sessions. The current rebate also seems to be related to half hour appointments, as it is only $52.95. It is extremely rare for an appointment with an occupational therapist to last less than 50 minutes, and this rebate means a higher co-payment/gap fee for clients. The rebate is also well below the amount charged for a standard private visit to an occupational therapist. There are a number of reasons why occupational therapists are often unable to accept the Medicare benefit as full payment for CDM services, such as the fact that they incur greater travel expenses than other health professionals. When occupational therapists visit clients in the home, they undertake home modifications assessments to determine how the client’s living environment can be modified to better support

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their care needs. Additionally, therapists prescribe equipment to facilitate independent living and to enhance mobility. Home modifications require assessors to prepare detailed drawings and complete extensive paperwork, however this administrative work is not adequately subsidised by the Medicare rebate. In addition to the out-of-pocket costs incurred for the consultation, many clients also face additional charges for the delivery of their aids and equipment (items such as wheelchairs and hand rails). Follow-up visits are an integral part of assessing how clients are managing in their new surroundings. However, in many instances these visits are not occurring because clients must fully meet the costs themselves.

The maldistribution of the health, aged care and disability workforce

In a land as vast as Australia, and with a population as urbanised as Australia’s, it is unsurprising that our health, aged care and disability workforce is stretched so thinly between our major cities. But while the problem comes as no surprise, it nonetheless remains a problem. Key issues behind these workforce shortages include the difficulty of recruiting and retaining workers, high turnover rates, inadequate availability of senior/experienced staff, and an oversupply of part-time and casual workers. The Federal Government should work to address this maldistribution as a matter of urgency, ensuring those Australians living outside our major cities and regional centres enjoy reasonable access to health services befitting one of the world’s most advanced countries. The stated determination of all governments to “close the gap” of Indigenous disadvantage is another compelling reason to ensure such access. Ongoing and unprecedented change to the manner in which health, aged care and disability services are being delivered have thrown our workforce shortages into stark relief. As the rollout of the NDIS is demonstrating, it doesn’t matter how well developed a client’s NDIS plan might be, it is all rather pointless if the providers aren’t there to deliver the services. This is often the case in rural and remote communities. PHNs, a responsibility of the Federal Government, are supposed to ensure better coordinated care across 31 designated geographical areas. While it is too soon to pass judgement on their efficacy, and it should be noted their structures vary widely, PHNs are obvious mechanisms with which to at least measure, and ideally address, workforce shortages at the local level. Education must also play a key role in any long-term solution to this problem. Regular and meaningful rotations through regional and remote locations during the training of medical and allied health professionals heighten the possibility that the student will eventually settle and practice in such a location. This is most easily achieved by way of training networks that link major metropolitan hospitals with smaller regional and rural hospitals. While this is largely the responsibility of state and territory governments, the Federal Government should work with, and encourage, these governments to implement such arrangements.

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The provision of rural based scholarships and fellowships is another means of attracting students and recent graduates to locations outside our major cities. A related problem is the extent to which the changing landscape is compromising the supervision of students, new graduates and less experienced allied health professionals. These providers need on-the-ground support and supervision if they are to practice with the utmost effectiveness and grow in confidence. Mentoring can be hard to come by, and nowhere is it harder than in remote locations. Inexperienced occupational therapists, for example, need experienced practitioners to help them navigate such minefields as high tech assistive technology which, while it may be clinically appropriate to prescribe, is also very expensive. If this on-the-ground support doesn’t exist we need to consider alternative arrangements, such as a broader support network that younger health professionals can access remotely or, as is increasingly common, fee-for-service supervision. While the growth of telehealth might alleviate the problem of remoteness, there are obviously occasions when the health practitioner must be there with the client. (This is particularly true of occupational therapists, who need to work with the client in the environment in which he or she is trying to function – i.e. the home, the workplace, the school.) The maldistribution of our health, aged care and disability workforce is not a problem that will be solved quickly. It is of concern therefore that the new office of the National Rural Health Commissioner is only funded, and indeed only legislated, through to June 2020. Inadequate access to healthcare in regional and remote Australia is not a problem that will be solved in three years; it is unlikely it will be solved in three decades. OTA accordingly calls on the Federal Government to take the opportunity presented by the 2018-19 Budget to make the office of National Rural Health Commissioner a permanent entity. Funding and resources must be made available to support the functions of the Commissioner, including engagement with a broad spectrum of key stakeholders across the health sector, such as allied health professionals. Additionally, financial incentives should be provided to allied health professionals opting to work in designated areas of workforce shortage. Case study: Outback NSW Unfortunately, quite the opposite appears to be happening. A case in point are developments in and around the community of Bourke in outback New South Wales. Several allied health services, including occupational therapy, have recently been decommissioned as a result of new contractual arrangements between the Western NSW PHN and the NSW Outback Division of General Practice (ODGP). Moreover, a letter to stakeholders from the ODGP dated 4 August 2017 indicates that, despite earlier hopeful signs and its best efforts, no other funding avenues have been identified to maintain the remotely located therapy teams which had a significant focus on supporting children. The importance of therapy services to promote the social and emotional wellbeing of children cannot be overstated. Given that PHNs were designed to ensure better integrated care in a given geographical area, it is incongruous that occupational therapy services should be excluded from the Western NSW PHN’s integrated planning for its remote communities.

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OTA is gravely concerned that, as a result of these developments, people in places like Bourke and Lightning Ridge must now travel to Dubbo to access occupational therapy. This involves an eight hour round drive. OTA also notes with concern that at a time when healthcare is such a fundamental part of “closing the gap”, the affected communities are predominantly Indigenous. The Federal Government should act immediately to address this particular failure of the PHN system, and to ensure that such failure is not replicated across other remote areas of Australia.