Chapter 4
The demand for speech pathology services in Australia
4.1
The previous chapter's focus was on the prevalence and incidence of
speech and language disorders in Australia. It found that, notwithstanding
several studies into the prevalence of particular speech and language disorders
and the incidence of these disorders among particular demographics,
Australia-wide data is lacking.
4.2
This is an important starting point for this chapter's concern with the
demand for speech pathology services in Australia. If there is no reliable data
on the prevalence of these disorders in Australia, it is difficult to identify
properly the dimensions of the demand for speech pathology services.
4.3
The committee has gathered anecdotal evidence from witnesses and submitters
that the demand for public speech pathology services exceeds supply of these
services. Many people join already lengthy waiting lists or, if there is no
service, simply go without. The extent and cause of these waiting lists,
particularly for paediatric speech pathology services, are discussed in detail
in chapter 5 of this report. Much of the evidence in this chapter, on the
strength of demand for services, foreshadows the themes of under-supply,
under-service and unmet demand that are the focus of chapters 5 and 6.
4.4
This chapter discusses the following issues:
-
the number of speech pathology Medicare service items;
-
the lack of reliable data on the demand for speech pathology
services;
-
demand as reflected in public waiting lists;
-
demand for private speech pathology services;
-
demand for speech pathology services in rural areas;
-
mapping demand for speech pathology services;
-
the projected demand for speech pathology services in light of;
-
the National Disability Insurance Scheme;
-
public awareness and research breakthroughs;
-
an impact of an ageing population; and
-
efficient delivery of services through different models of care.
The number of speech pathology Medicare service items
4.5
Figure 4.1 (below) shows the number of speech pathology Medicare items
processed for the calendar years of 2004 and 2013. The table is drawn from
Medicare statistics, compiled by the federal Department of Human Services.
4.6
There has been dramatic growth in the number of speech pathology service
claims made to Medicare. In 2004–05, only 3,051 speech pathology Medicare
service items were reported; in 2012–13, this number had increased by a factor
of 38 to 115 167. Over the last three financial years, however, there
appears to have been a slowing in the rate of speech pathology services
reported to Medicare. In the ten months to April 2014, the number of recorded
speech pathology services was 105 257.
Figure 4.1:
Number of speech pathology Medicare items—July 2004 - April 2014
Source: Department of Human Services, Medicare Statistics, https://www.medicareaustralia.gov.au/statistics/mbs_item.shtml
Item number 10970 (accessed 15 August 2014)
Chart 4.1: Medicare speech pathology
services by age & gender, 2009– 2014
Source: Department of Human Services, Medicare
statistics, Item number 10970, (accessed 15 August 2014)
4.7
Chart 4.1 presents reported speech pathology Medicare service items over
the past five years (2009–2014) by age and gender. It shows that the
overwhelming majority of speech pathology Medicare services were in the 0–14
years of age category. Further, the number of boys receiving a service in this
cohort outnumbered girls by a factor of more than 2 to 1. Over the
period, there were roughly 50 000 girls in the 0–4 age cohort and 80 000 girls
in the 5–14 age cohort, compared with roughly 140 000 boys in the 0–4 age cohort
and 200 000 boys in the 5–14 age cohort.[1]
The lack of reliable data on the demand for speech pathology services
4.8
The exact dimensions of the demand for speech pathology services in
Australia are not clear. There are several reasons for this, some of which are
indicated in the following comments from (the now defunct) Health Workforce
Australia:
We do not at this point have particularly good data on
expressed demand or on the occasions of service in speech pathology people are
receiving. The areas you might look to as areas of expressed demand would be in
the data from the private health funds although that will be incomplete because
of capped amounts of services that receive support through private health. The
national hospital morbidity data set would provide some information. Under
Medicare, services are provided under the Chronic Disease Management plan but
not otherwise. The ABS undertook an Australian health survey in 2011 and 2012
which sought to gain an understanding of access to services across a range of
health professions. I do not have that data to hand.[2]
4.9
The 2011–12 Australian Bureau of Statistics Australian Health Survey
does not provide a breakdown of the number of people who visited a speech
pathologist in the previous 12 months.[3]
4.10
Some submitters argued the need to collect data on the demand for speech
pathology services in Australia. The Tasmanian Department of Health and Human
Services recommended quantifying this demand:
...there is currently very limited data relating to the workforce
and prevalence and treatment of speech related disorders in Australia. In the
absence of adequate data regarding incidence rates, it is not possible to
project future demand for services...
the Tasmanian Department of Health and Human Services
recommends that: further work be undertaken to quantify the demand for speech
pathology services...[4]
4.11
The Centre for Clinical Research Excellence Aphasia Rehabilitation
identified the need for data on the incidence and prevalence of aphasia as
'essential to allow for adequate resource allocation and the formulation of
realistic projections of future demand on aphasia services'. It noted that
current estimates are often based on stroke figures with little information on
the prevalence of aphasia arising from other causes such as Primary Progressive
Aphasia.[5]
Demand as reflected in public waiting lists
4.12
One of the key indicators of pent-up demand for speech pathology
services is the waiting list for these services. This issue is examined in
detail in the context of the availability of services in chapter 5. It is worth
noting here the following findings of a 2010–11 survey, conducted by
researchers at the University of Sydney, of parents who sought access to speech
pathology services:[6]
-
parents reported being on long waiting lists with 25 per cent waiting
more than six months, 15 per cent waiting more than 1 year for assessment and
18 per cent waiting more than 1 year after assessment for treatment;
-
qualitative responses revealed concerns such as; a lack of
available, frequent, or local services, long waiting times, cut-off ages for
eligibility, discharge processes, and an inability to afford private services;
-
parents were overwhelmingly happy with their treating speech
pathologist and unhappy with the frequency, length and total number of
treatment sessions received;
-
parents in regional centres, and rural and remote locations were
more likely to have difficulty accessing any services including private
practitioners;
-
children in capital cities attended private practices more
frequently than those from small towns or rural and remote areas and children
from lower socio-economic areas attended private practices less often than
children from high-SES areas despite assistance from Medicare;
-
public sector services were reported to provide less frequent
services of shorter duration for fewer weeks than private practitioners and
University clinics. This exacerbates the gap in access to speech pathology for
disadvantaged families;
-
eighty per cent of parents indicated they would like their
children to receive individual sessions however many reported only being
offered group therapy or parent delivered home therapy. Only four per cent of
parents indicated that they would like such parent training or a home program;
-
the most commonly preferred session frequency was once per week;
-
children were most commonly reported to be discharged from speech
pathology services at age 5–6 years across all states and territories. Sixty per cent
of parents believed that their child's discharge was inappropriate for reasons
such as 'Child had not improved enough'; and
-
parents were angered that their children had become ineligible
for public services at a certain age, particularly if they had endured a long
waiting list only to reach the upper limit of services soon after.
4.13
The following selection of quotes—from practising speech pathologists, occupational
therapists and teaching staff—offers another perspective on the strength of
demand for speech pathology services:
In my position as learning support coordinator I have had
contact with a number of Speech Pathologist (sic). I have always found these
professionals to be extremely helpful and supportive of what we as a school are
implementing for particular students...The greatest difficulty experienced is the
wait time for the service to have an assessment; this is due mainly to demand.[7]
In each setting I have worked in, there are barriers to
accessing the service. In private services, this is obviously the cost of
accessing the service. Many families, who are vulnerable and most need the
supportive services, are prevented from accessing a health service...Within
public services, long waiting lists and demand exceeding supply.[8]
I have never worked in a service that didn’t have some sort of
waiting time to access speech pathology services. In multi-disciplinary
services, the speech pathology waiting list was always the longest. This is due
to the fact that most children with developmental difficulties will have some
level of communication and / or feeding difficulty which are often parents’
primary concern. It is not uncommon for public services to have waiting lists
of up to or over 12 months.[9]
[There is] difficulty [in] increasing service provision even
with documented evidence that the demand is increasing. Even with documented
waiting lists and increased referral rates, it is difficult to obtain increased
funding to meet these demands.[10]
Client access to Speech Pathology Services is impacted by
cost, location and availability. Limited funding for Speech Pathology Services
within the public health care system equates to limited access with long
waiting lists and a need to discharge clients quickly from services.[11]
The demand for Aspect's [Autism Spectrum Australia] services
is continually increasing and we endeavour to respond rapidly to requests for
service; however, this is not always possible. We currently have a waitlist of
150 families with children aged zero to eight waiting for service. A further
700-plus children are waiting for school based programs. Families with young
children may have to wait up to three months to commence service, and Aspect will
only be able to respond to a small proportion of those waiting for school based
services. The principal barriers to accessing Aspect's services are location,
availability of government funding and families' financial capacity to purchase
services...We are of the view that there are significant opportunities to improve
the availability of speech pathology services across Australia to assist people
with communication impairments.[12]
The demand for therapy became so great and waiting lists so long
that some parents of young children entitled to funding were highly distressed to
find that they could not receive services before their child turned 6 and aged out.[13]
Most schools get only very limited funding for students with
autism (I will use our school as an example. In 2013, we had 12 children
diagnosed with an ASD but only 4 funded and of these only 3 were funded on
the basis of autism). This means that access to speech therapy is either
non-existent or again, comes from school’s SRP [global budget] if schools can
afford a private practitioner. (Metro Primary School)[14]
4.14
The Sydney-based not-for-profit organisation, Northcott, argued in its
submission that in its experience 'there is extreme unmet demand for
one-to-one, individual speech pathology services for school children'.[15]
The Australian Education Union noted in its submission that:
There is anecdotal evidence from teachers and principals that
the level of demand for speech pathology services is rising. They report an
increasing number of students identified as having speech and language
difficulties who require some form of intervention and support.[16]
4.15
The committee also received evidence on the type of conditions for which
services are in high demand. Dr Gabriella Constantinescu, a lead researcher at
the paediatric Auditory-Verbal and Implantable Technologies organisation Hear
and Say, told the committee that there is high demand for chronic middle
ear pathologies. She argued that funding support should reflect this level of
demand and there needed to be increased education at all levels of the medical,
allied health and general community about the risk of delays in spoken
language. Dr Constantinescu told the committee that:
When looking at microtia and atresia, which is earlobe and
canal malformations, there is also a definite need for intervention. As these
children have primarily unilateral hearing loss, Better Start funding is not
available for them; therefore, they are currently underserviced. We think that
increased awareness of the condition is needed as well as a range of options
and services and, alongside those, increased funding to support the services.[17]
Demand for private speech pathology services
4.16
The demand for private speech pathology services is also high. For those
able to afford it, private pathology services appear readily accessible, at
least in metropolitan regions. However, the cost of these services is a barrier
to meeting the high demand for them. The Australian College of Nursing (ACN),
for example, argued that these costs were deterring people in aged care from
seeking assistance:
ACN members who work in aged care have indicated that private
speech pathology services are underutilised due to high costs. Speech pathology
services are often used only for acute problems experienced by older people and
rarely accessed for their treatment plans, rehabilitation or ongoing therapy.[18]
Demand for speech pathology services in rural areas
4.17
Identifying the demand for speech pathology services in rural areas is
potentially a more challenging task than mapping demand in metropolitan
regions. In cities and larger regional centres, the services—both public and
private—are typically there which means that the services used and waiting
lists are a rough proxy for demand. In rural and remote regions, however, services
are often not there (see chapter 5). There will be people who, despite needing
a speech pathologist, will forego the time and expense of travelling to access
a service. It is difficult to identify this unmet demand.
4.18
Ms Debra Jones, the Director of Primary Health Care at the Broken Hill
University Department of Rural Health, commented in her evidence to the
committee on the extent of demand in rural and remote areas of Australia for
speech pathology services. She began by noting the difficulty of tracking
latent demand:
Traditionally, where you do not have a service, it is very
hard to map who is not accessing a service—if there has not traditionally been
one there. One of the other interesting things about identifying unmet need is
that a lot of public health facilities will have referral based systems. When
clients or families do not present for referral, they are classified as 'failed
to attend' or 'did not attend' and then can be removed or discharged from
service without actually being engaged in service. So the concept of having a
waiting list can be quite skewed...
I think what was also interesting was that because there was
this culture of not expecting there to be a service, what would you refer to
then? Parents were typically giving up on trying to actually access a service.
Getting very distinct numbers is a real challenge, especially where families
feel really disillusioned by lack of access, challenges in access or lack of
responsiveness of access. The language of 'failed to attend' or 'did not
attend' is really concerning language for me. That is because typically it
means that we have failed to be able to respond in appropriate ways to
communities and especially our more remote communities. That language opens up
some really interesting philosophies on practice and how we provide services,
especially around speech, language and communication.[19]
4.19
Ms Jones gave the committee an overview of the challenges that people
living in regional and remote areas face in accessing speech pathology services.
In the first instance, she noted, there is a reliance on 'fly-in fly-out'
general practitioners to diagnose a speech or language communication need. Once
the need is diagnosed, there is often difficulty getting to the service 'especially
when you are talking about travelling up to two and a half hours, one way, to a
larger regional centre to access those services'. Private speech pathologists'
services are often beyond the financial means of her patients.[20]
Where a public speech pathologist does offer a service in town, it is often on
a short-term basis. As Ms Jones told the committee:
...prior to 2008–09, when we started thinking about working up
our service learning speech pathology model, our conversations with our public
health colleagues were very much around huge unmet need, huge waiting lists and
lots of tension and frustration in communities. That was about not being able
to access a service. There was also turnover and fragmentation in staffing. We
were in a cycle where we would have speech pathologists come, but for very
short periods of time. We were seeing a cycle of assessment, but limited
therapy intervention. There was assessment, re-assessment, assessment,
re-assessment, referral, re-referral and referral for service access.[21]
4.20
Ms Sarah Verdon, Dr Linda Wilson, Dr Michelle Smith-Tamaray and Dr Lindy
McAllister argued in their submission that there was a distance for people
living in Victoria and New South Wales beyond which they were unwilling to
travel to access speech pathology services. The researchers noted that nearly a
third of health services in their sample of 13 237 rural localities in NSW
and Victoria were outside this distance:
Using the recommended service frequency of weekly and the
recommended maximum travel time for a weekly service of 30 minutes a Critical
Maximum Distance of 50kms was calculated for rural NSW and Victoria...
29.3% of localities were outside of the critical maximum
distance for accessing speech pathology services.[22]
Mapping demand for speech pathology services
4.21
One of the challenges for service providers is to gather reliable
information on the extent of demand for speech pathology services in particular
areas. Ms Elizabeth Forsyth of Northcott told the committee that her
organisation would like to be able to offer speech therapy services in areas of
regional New South Wales. When asked to comment on the need for speech
pathology services in these areas, she responded:
[A]necdotally, we encounter families that tell us that they
require a range of allied health therapy services. Whether that is speech
pathology specific I probably cannot say, but certainly families identify the
need for those services. Clinically whether they need them or not, again, I
cannot say because we do not have that detailed analysis. I think part of the
problem broadly in the disability sector is being able to get accurate data on
the unmet need. There is no mechanism to capture that, and that makes it hard
for planning and for rollout of services.[23]
4.22
Speech Pathology Australia (SPA) argued in its submission that there
needs to be more detailed information on the demand for speech pathology
services so that providers can plan to meet these needs. It noted:
[T]he current lack of a detailed profile of the needs of
people with communication or swallowing disability limits the planning for and
provision of services to ensure the needs of individuals can be met and long
term outcomes optimised.
Detailed service needs analysis and demand mapping is
required to ensure those with communication or swallowing disability can access
vital intervention and supports to optimise their future educational, health
and social outcomes.[24]
4.23
SPA recommended that Health Workforce Australia and/or the Australian
Institute of Health and Welfare (AIHW) undertake a comprehensive analysis of
the speech pathology workforce, including the availability (taking into account
part time working), demand (current and future) and geographic spread of speech
pathologists in Australia.[25]
Chapter 5 of this report addresses this recommendation.
4.24
The committee was impressed by the level of detail on projected demand
provided in a submission from the South Australian branch of Speech Pathology
Australia. The submission made the following observations about the demand for
paediatric and early intervention services in the Adelaide metropolitan area:
Adelaide metropolitan growth is occurring at the extreme ends
of the metropolitan area. Services are not being relocated to these areas as
the population increases. An example of this is the growth in the Playford
Council area in the Northern end of Adelaide:
-
Children 0 to 4 years increased by
1 440 from 2006 to 2011 with no increase in the Primary Health speech pathology
positions.
-
In the Playford Council area the
Australian Early Development Index identified 18.1% of children as being
vulnerable in the Communication and General Knowledge domain.
-
This means that since 2006 there
are approximately 260 extra children requiring access to speech pathology
services (18% of 1 440).
The increasing demand in disadvantaged communities like
Playford Council area may be more efficiently serviced should speech pathology
staff be employed to build capacity amongst teachers and child care staff so
they understood how best to support speech and language development.
Further, 50% of three year old children in Australia are in
formal child care and an increasing proportion of children aged 0–4 years
attend out of home care. Building the capacity of these environments to support
the development of children’s communication abilities would help address
communication and developmental needs at a population level and also help
support children who are not able to access speech pathology services for a
range of reasons.[26]
4.25
The committee believes that this type of analysis should be conducted in
a thorough and methodical way across metropolitan, regional and remote areas of
Australia. Chapter 3 of this report made recommendations to support this
research.
Projected demand for speech pathology services
4.26
The terms of reference for this inquiry direct the committee to examine
the projected demand for speech pathology services in Australia. The committee
gathered various perspectives on this issue, but the differences related mainly
to the quantum of the expected increase (rather than whether there will be an
increase).
4.27
This section considers some of the reasons why submitters believe that
demand for speech pathology services in Australia will increase in future
years. SPA identified the following drivers:
-
the effects of an ageing population;
-
improved survival rates of premature, chronically ill and infants
with disability;
-
an increase in the detection of early speech and language
disorders; and
-
the increase in opportunities to provide support to participants
of the National Disability Insurance Scheme.[27]
The National Disability Insurance Scheme
4.28
The table below shows the speech pathology services and speech pathology
equipment that is currently being offered in the National Disability Insurance
Scheme (NDIS) trial sites.
Table 4.1: Speech pathology services and speech pathology equipment
supports offered by National Disability Insurance Scheme, 12 May 2014[28]
Support
|
Description
|
Price*
|
Speech and Language pathology with an individual
|
Optimise ability to understand information and communicate
thoughts and needs. Assistance to ensure safe and effective mealtime support
for participants with difficulty feeding / swallowing
|
$168.26 per hour
|
Speech and language pathology in a group
|
Optimise ability to understand information and
communicate thoughts and needs. Assistance to ensure safe and effective
mealtime support for participants with difficulty feeding / swallowing
|
$56.09 per hour
|
Speech and language pathology distance travel
|
Travel to participant to and from either providers
work location where travel is more than 10kms
|
$168.26 per hour
|
Voice generators
|
Device held to neck which picks up vibrations and
amplifies as speech
|
$650 each
|
Voice amplifiers for personal use
|
Device to amplify voice
|
$400 each
|
*
Prices are the same in each of the trial sites
4.29
Many submitters identified the NDIS as a driver of increased demand for
speech pathology services. Exactly how much extra demand the Scheme will create
is not clear at this stage. As the Queensland Government stated: 'there is
insufficient information to make an analysis of how much additional funding
might be required, or how many additional speech–language pathologists might be
needed'.[29]
4.30
National Disability Services foresaw an increase in demand for speech
pathology services arising from the NDIS but did not comment on specifics:
Increased demand for speech pathology will also arise from
the NDIS improving the access that adults with disability have to therapy
services. In the case of speech pathology, it is expected that some adults with
long-term disability will have improved access to communication services and
equipment, and to services such as the treatment of swallowing disorders
(dysphagia). Assessing and treating communication disorders improves a person’s
quality of life and improves their ability to participate in the community and
to work; diagnosing and treating dysphagia reduces the incidence of chest
infections and pneumonia. Appropriate access to speech pathology services will,
therefore, improve people’s lives and reduce acute health care costs.[30]
4.31
Northcott envisaged that the increase in demand for NDIS speech
pathology services will require more speech pathologists and will challenge the
profession to devise new models of practice and service provision:
The expansion of the NDIS to cohorts of people who have
previously missed out on speech pathology services (e.g. adults), and the sheer
increase in funding in the sector under the NDIS, is likely to significantly
increase the demand for speech pathology services in Australia. The increase in
demand for speech pathology services under the NDIS also highlights a major
workforce issue within the disability sector, where the current challenges in
the supply of speech pathologists available will only be compounded.
Significant workforce development investment, flexibility in contractual and
industrial arrangements, and exploration of new models of practice and service
provision, must be considered for the sustainability of speech pathology (and
arguably all allied health professional) services under the NDIS.[31]
4.32
Early Childhood Intervention Australia (ECIA) argued in its submission
that the need for—and the shortage of—speech pathology services for very young
children is evident from the federal government's decision to introduce the Better
Start and Helping Children with Autism initiatives (see
chapter 4). However, it argued that tight eligibility for these programs
has meant there is still unmet demand which needs to be addressed prior to the
full introduction of the NDIS (in 2018–19). ECIA anticipated a significant
increase in demand for speech pathology services for children from the broader
eligibility requirements of the NDIS.[32]
4.33
Down Syndrome Australia (DSA) foresaw that the advent of the NDIS will
'substantially' increase the demand for speech therapy services among people
with Down syndrome. It noted the higher demand will result from the Scheme's closer
targeting of service provision to need. Currently, there is a clear lack of
services provided to:
-
children over the age of 7 who have no access to Better Start
funding;
-
children at independent and private schools in some states and
territories;
-
teenagers and adults with Down syndrome who would benefit from
speech therapy but currently have little or no access to services; and
-
toddlers and babies in some states or territories where access to
early intervention, particularly for children under the age of 2 is lacking.[33]
4.34
To some extent, the NDIS may stimulate demand by raising awareness of
speech and language disorders. The Association for Childhood Language and
Related Disorders (CHI.L.D.) noted that this trend may already be occurring:
While evidence suggests that the incidence of primary
language disorder has not increased over time, it is possible that increasing
awareness of the condition at earlier developmental stages in conjunction with
increasing awareness of other developmental disabilities (such as autism
spectrum disorder) has increased the demand for services and specific
intervention before and during school.[34]
Public awareness and research
breakthroughs
4.35
Professor Mark Onslow from the Australian Stuttering Research Centre
commented that Australian clinical research into the treatment of stuttering
among 7–17 year olds will place pressures on the public waiting lists for speech
pathologists. By his estimates, the fruits of this research are 'inevitable'
with 'convincing randomised controlled trials to be completed 'within this
decade'.[35]
4.36
In its submission, Autism Queensland did not identify what was driving
the significant higher level of diagnosis of autism spectrum disorder, but it
did highlight the likelihood of growing demand for speech pathology services.
It put the following view:
The prevalence of children diagnosed with ASD has increased
dramatically in the past two decades. Where a prevalence rate of around one in
2000–2500 was widely accepted until the 1990s (Baird et al., 2006), a recent
American study revealed a prevalence rate of 1 in 88 (Centers for Disease
Control and Prevention, 2012). Given this escalating prevalence rate, and the
fact that speech pathology is the most widely used service in this field, the
demand for speech language pathologist for individual (sic) with ASD and their
families is likely to continue to grow.[36]
An ageing population
4.37
Several witnesses and submitters identified the ageing of the Australian
population as a key driver of increased demand for speech pathology services.
The Queensland Government was one of these submitters:
With a growing ageing population, the demand for
speech–language pathology services from conditions such as stroke or dementia
will likely increase. Specifically, the population of people with a disability
are also living longer and thus there is a need for specialisation in
speech–language pathology for older adults for speech and swallowing
difficulties.[37]
4.38
The National Stroke Foundation identified significant prospective demand
for speech pathology services among Australian stroke survivors. It noted that
in 2012, there were around 420 000 Australians living with the effects of
stroke, which is expected to increase to 709 000 by 2032. The Stroke
Foundation estimated that if the rate of need remains static, by 2032 there
will be:
-
280 000 stroke survivors with swallowing needs;
-
370 000 stroke survivors with speech needs; and
-
270 000 stroke survivors with reading needs.[38]
4.39
The President of SPA, Professor Deborah Theodoros, identified a need for
the speech pathology profession to make greater use of telehealth delivered
services to cope with the demands of an ageing population. She explained this
need as follows:
Population ageing will have a significant impact on the
demand for speech pathology services. By 2030, persons over 80 years of age in
Australia will increase by 140% (ABS, 2006). With increasing age, people will
live longer with chronic diseases and conditions that may be associated with communication
and swallowing disorders e.g., Parkinson’s disease and stroke (Morris et al.,
2010). It is likely that older people will remain living in their own homes and
communities, even though transport issues will arise as their capacity to drive
decreases (Morris et al., 2010). Speech pathology services will need to evolve
in order to accommodate these societal changes.
Alternative means of service delivery are also needed to meet
the demand for equitable access to speech pathology services. In Australia,
68.7% of the population lives in major cities with the remainder (30%) living
in regional and rural/remote areas (ABS, 2011). Previous studies have identified
disparities in speech pathology services in rural and regional areas with
residents in these areas having access to significantly fewer speech
pathologists per head of population than counterparts in urban areas (Lambier
& Atherton, 2003; Wilson et al., 2002).[39]
Other factors
4.40
Worryingly, the committee also received evidence that demand for speech
pathologists services was likely to increase as the rate of child abuse and
neglect and the number of children in out-of-home care continues to rise. The
Benevolent Society stated in its submission that 'it is anticipated that demand
from this group will increase in coming years'.[40]
It recommended that all programs targeting disadvantaged and vulnerable
children, whether funded by the federal or state governments, include provision
for the employment or engagement of speech pathologists.[41]
4.41
Dr Jennifer Oates of La Trobe University commented on the projected
demand for speech pathology services among transgender individuals:
At the recent World Professional Association for Transgender
Health conference in Bangkok (February 2104), nearly all providers reported an
increase in demand for their services, in particular an increase in the number
of children and adolescents seeking help. This trend has been experienced in
Victoria. The Victorian Gender Clinic has reported a significant increase in
the number of new referrals in recent years (there have been 250 new referrals
between October 2012 and October 2013). The Royal Children’s Hospital has also
reported a 10-fold increase in referrals over the past year (38 referrals from
September 2012 to September 2013). If 85% of these transgender individuals
would benefit from speech pathology services (see above), it is clear that
currently available services through the La Trobe Voice Clinic and other speech
pathologists in the private and public health system will be unable to meet the
projected demand.[42]
Models of care
4.42
A final and very important determinant of the future demand for speech
pathology services in Australia relates to the model of care that is
implemented. It is crucial that in projecting future workforce and service
demands, careful thought is given to the most efficient model for introducing
best practice care.[43]
Chapter 6 of this report gives consideration to the most efficient models for delivering
paediatric, education and aged care speech pathology services.
Committee view
4.43
This chapter has presented a range of evidence indicating the current
and future demand for speech pathology services in Australia. Following from the
evidence presented in chapter 3, its starting point was the lack of reliable
data on the demand for speech pathology services. In the absence of this data,
the committee has relied on anecdotal evidence from people with speech and
language disorders, the parents of those with these conditions, and many
practicing speech pathologists. This evidence was unequivocal:
-
waiting lists (a proxy for demand) for public speech pathology
services are lengthy;
-
these lists understate actual demand given services are
unavailable in some regional and remote areas, while the length of waiting
lists will deter some from seeking a service;
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there are a number of factors that will further increase the
demand for speech pathology services in coming years.
In light of all these factors, the committee reiterates
recommendation 2 (see chapter 3) that the federal Department of Health consider
the data that is necessary to identify the areas of current and prospective
need for speech pathology services.
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