Implementation of the NDIS in Rural, Regional and Remote Areas

2.1 System-Related Burden

From articles in this virtual issue, some rural people with disabilities and families have described their dealing with the NDIS system as battling a bureaucracy [6]. It would appear that the complexity of the system is a major obstacle [4], and that for rural and remote people, their experience is of a system that has lost touch with its core values [7].

2.2 Burden of Distance

Insufficient funding for travel, to compensate for rural and remote realities [8] is a key part of the negative experience of rural people with disabilities and their families. If they are awarded funding but there are no local or other available services, they perceive the NDIS aspirations of choice and control as meaningless [6].

2.3 Access Burdens

Understandably, limited access to NDIS-related and professional services is a key theme for rural people with disabilities and their families [4]. As reflected in this virtual issue, the NDIS has not consistently improved access for all rural people with disabilities, leading to frustration in some small communities where substantial disparity [3] or inequity of access [7] becomes evident. Access burdens are also exacerbated when NDIS personnel have limited knowledge about disability, disability services and regional/remote realities [8].

2.4 Family Member Burden

The lived experience of family members within the NDIS sphere has not been depicted positively by the articles in this virtual issue. For some, meaningful benefit can only be gained from the NDIS if they take an active and ongoing involvement, provide advocacy and at times even fulfil some functions of NDIS staff [7]. Such reliance on families perpetuates inequity [4].

Family members described feeling overwhelmed by the complexity of the system. Coordinating across scarcity is very difficult [7]. Limited supports, limited choice and availability [4], delays, isolation [7] and uncertainty of access [6] mean that confusion and frustration are common [6]. This results in a great emotional burden [8] and mental health consequences for family members [7].

3.1 Personnel-Related

Rural people's experience of dealing with NDIS personnel was described as predominantly negative and burdensome, leading to greater strain [4]. Whether due to limited skills [8] or lack of understanding of the challenges of distance and rurality [7], the result was often unrealistic with insufficient plans and expectations [4, 8]. NDIS personnel and systems have been seen as lacking flexibility and compassion [4], with inconsistent and poor communication [6].

3.2 Skills-Related

Articles in this virtual issue suggest implementation of the NDIS in rural communities will impact on the local skills base. While many rural disability-related staff, providers and other workers recognise that it is their role to provide quality support for people with disability [9], inexperienced staff may not know how to provide the support that is necessary [10]. Regional staff often want to enhance their knowledge, reporting insufficient undergraduate education and limited professional development; however, there are barriers to upskilling [9]. This forces them to rely on knowledge and skills gained from other experiences or personal interest in disability [9, 11]. This skills deficit must be recognised in rural NDIS service planning.

3.3 Cultural Safety

Of particular concern is that recent literature has found NDIS workers to lack cultural competence and cultural safety [8], and as a result, NDIS services have fallen short of meeting the needs of Aboriginal people with disabilities [8].

3.4 Workforce Isolation

Disability service providers and workers in rural and regional areas often work in isolation with little supervision or support from those with expertise [9, 10]. As highlighted in this virtual issue, this poses a risk to the adequacy and quality of advice and support provided by those workers. It may also lead to staff disengaging from the process if the role is perceived as too difficult [10]. Professional isolation is recognised as a possible predictor of burnout [12]. These issues must be considered in the development of rural NDIS service responses.

3.5 Workforce Time Constraints

Time pressures on disability workers and providers also hinder their ability to develop a deep understanding of the person's needs [9]. In contrast, when there is sufficient time and engagement between workers and the person with disability and their family, it is easier to complete tasks and provide comprehensive support [9, 10]. This should also be a key consideration for NDIS planners.

3.6 Recruitment

Beyond issues facing individual workers, the shortage of existing healthcare workers (and potential candidates) in rural locations has broader consequences. It has constrained the capacity of NDIS services to adequately address the complex realities faced by people with disabilities [10]. Recruiting staff with appropriate knowledge and experience is challenging, sometimes resulting in regrettable competition between organisations [10].

3.7 Retention

Staff turnover and limited retention of rural workers with experience of NDIS processes and planning were highlighted by articles in this collection, and adverse impacts for people with disability were noted [10, 13]. In some instances, this might be related to poor remuneration [10] which has been found to be a possible predictor of burnout along with the stresses of rural work [12]. In other instances (as noted above), it may be linked to staff poaching, where experienced staff are in short supply, which increases the likelihood of moving to another service or relocating [10].

3.8 Impact on Other Services and Workforces

The implementation of the NDIS has also put considerable pressure on health services in smaller rural towns to meet increased demand [14]. Many rural towns already have limited service infrastructures and a shortage of allied health service providers. As a result, despite the potential of extra services through the NDIS, increased demand cannot be met locally and people with disabilities are still required to travel to access health and disability services [14].

The implementation of the NDIS appears to have had an impact on most service providers, but especially local disability and community health services [14]. Some services or organisations have changed their service models, narrowing or discontinuing services in order to target NDIS funding. Staff levels and types were also adapted, such as drawing on more allied health professionals to meet service demands, yet difficulties in recruiting have been ongoing [14].

3.9 Workload of Other Agencies

Studies included in this virtual issue indicate that the complexity of the NDIS planning process has increased the administrative and bureaucratic burden for services [13]. This is further exacerbated by the limited training of disability workers in regional, rural and remote areas [13].

The allied health workforce in rural and remote areas who are involved in advocating for people with disability in the NDIS planning process have described being overwhelmed by increased workload [13]. They have also reported dissatisfaction when professional recommendations are disregarded by NDIS planners, resulting in an inadequate NDIS plan for their rural client [13].