JCPSLP Vol 18 no 2 2016

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JCPSLP Volume 18, Number 2 2016 75
Ethical conversations
Cathy Olsson
(top) and Trish
Johnson
KEYWORDS
ETHICS
NATIONAL
DISABILITY
INSURANCE
SCHEME
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.
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.
Speech 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
Ethics and the National
Disability Insurance
Scheme
Cathy Olsson and Trish Johnson
“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