Opinion
NDIS wasn’t equitable or sustainable for families. As a paediatrician, I welcome change
Harriet Hiscock
Paediatrician and researcherEvery week, I meet with parents who have been waiting for months to access early intervention. It’s an anxious wait for treatment that could transform the life of their child with developmental delays or autism. But as much relief as they may feel from walking through the doors of my practice, or those of other experts, it is by no means the end to their journey. They have merely reached the starting line for a long trek ahead.
Their children are part of a growing number who reach school developmentally vulnerable in two or more areas on the Australian early development census – a number that has risen to 12.5 per cent in 2024.
The Thriving Kids initiative offers an opportunity to get things right.Credit: Marija Ercegovac
Once parents get the intervention they’ve so desperately sought, they will have to juggle work and preschool or school to get their child to therapy sessions. Some parents have to take time off and take children out of school to get them to weekly appointments. The work required to see two or three different therapists starts to add up.
For some years, Australia’s system has favoured one-on-one therapy at the rooms of health professionals, meaning children had less exposure to group therapies to help them practise their skills. All those interventions were available only if your child was eligible for the National Disability Insurance Scheme or you had the resources to advocate strongly enough for them. If not, your child missed out.
The Thriving Kids initiative announced by Health and Disability Minister Mark Butler this week offers an opportunity to get things right. While the NDIS has enabled better access to supports for some children, it is neither equitable nor sustainable. Some children have ended up with supports they did not need while others have missed out. Many families have not had access to support in their region.
Further issues have arisen with a lack of affordable access to early intervention. An unintended consequence of the NDIS is that it has funded the large-scale movement of health professionals such as speech therapists, occupational therapists and physiotherapists into private practice. This loss of publicly funded professionals has meant children without a clear diagnosis, or who fall outside vague eligibility criteria, have missed out because there are simply not enough health professionals left in the public system to see children.
This new approach offers some exciting opportunities. It will offer early intervention to children in the places they already go – play groups, early childhood education centres, preschools and schools. These platforms, alongside universal and primary health, can then be supported to engage parents around their concerns and respond rather than refer. This should improve access to supports for all children and make it easier for families.
They will not need to take their child out of preschool to get therapy because the preschool will be part of therapy. Children will receive supports through combinations of group-based therapy, digital support and where needed, one-on-one therapy. The planned increase in group-based therapy offers an efficiency of scale and allows children to practise skills such as emotional regulation and social skills with their peers.
For Thriving Kids to work, it will need to be carefully planned, implemented and evaluated. Many families are understandably concerned about what these changes mean for their child. Families will need to be involved – they have key insights into where the NDIS has failed children, and what is needed to fix this.
Waiting lists to see health professionals will not magically disappear. We will still need to empower parents to support their child’s development while they are waiting to get help. I would like to see the establishment of a micro-learning platform where parents can access engaging, evidence-based content on what they can do to help their child’s development at home. Butler has also suggested a portal where parents can go to find help. This portal should take advantage of some of the national resources we already have, such as the Raising Children Network and the National Child and Family Hubs network. This network brings together more than 460 “hubs” or one-stop shops where families can go to get supports for their child’s development alongside broader family challenges that need to be addressed for a child to thrive. These include poor parent mental health, unstable housing and food insecurity.
Butler has announced another welcome initiative under Medicare – a health check for three-year-olds. This will be a valuable opportunity for early detection of developmental concerns, but only if support is put in place for doctors and nurses working in primary care on how to identify warning signs and there is a clear path for referrals. This check could also address broader family needs by screening for parent mental health problems. We know that it becomes much harder for parents to care for their child if they are struggling with their own mental health.
We must be careful not to discard what has worked in the NDIS. Many families anecdotally report that support workers have been key to allowing their child to thrive (support workers are non-clinicians who support the child in day-to-day activities). These can include support to get to school, learn to use public transport, or try a new skill. Importantly, many support workers enable parents to get to work. This is good for Australian’s productivity and good for parents’ mental health and wellbeing.
This reform is welcome. Thriving Kids is a chance to build a system that truly supports every child. Let’s learn from the past, listen to families and evaluate early and often to make sure we are helping all children. With thoughtful planning and collaboration, we can create a future where all kids thrive, no matter their background or diagnosis.
Professor Harriet Hiscock is a paediatrician and researcher at the Murdoch Children’s Research Institute.
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