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The NDIS (National Disability Insurance Scheme) Wants Support Workers Do the Work of ICU Nurses! Australian Federal Court Ruled Against It!

Hi, it’s Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies and where we also provide tailor-made solutions for hospitals and intensive care units whilst providing quality care for long-term ventilated adults and children with tracheostomies. Also, otherwise medically complex adults and children at home including home BIPAP (bilevel positive airway pressure), home CPAP (continuous positive airway pressure) ventilation, home tracheostomy care when adults and children are not ventilated, also Home TPN, home IV potassium, home IV magnesium infusions, as well as IV antibiotic infusions at home. We also provide port management, central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as palliative care at home, and that also includes ventilation weaning at home.

We have also provided an emergency department bypass service in the past for the Western Sydney Local Area Health District. We’ve successfully kept patients at home as opposed to them going to the Emergency Department. So, Intensive Care at Home is really making a big difference for our clients and their families, and of course, also for hospitals, intensive care unit, but also for emergency departments.

Now, in today’s video, I actually want to talk about a recent court case. When I say recent, the court case was in November 2022, at the time of this recording, it’s April 2024. The court case is around the National Disability Insurance Agency, also known as NDIS, versus some NDIS participants. The court case was around funding registered nurses are not under the NDIS and what is reasonable and necessary.

Now, let me give you some background why this is important for the work that we are doing and why this is important for our clients, in particular. In 2020, there were three of our clients that were ventilated and/or had a tracheostomy in the community. They were not funded for 24-hour nursing care with intensive care nurses, as is evidence-based, because the NDIS rejected that. Those clients were only funded for night shifts and did have no daytime ICU nurse.

We predicted at the time that if the NDIS wasn’t funding 24-hour intensive care nurses that these clients are at risk of dying during the daytime when there’s no intensive care nurse present. Unfortunately, our predictions became a reality very quickly. All those three clients passed away in the absence of an intensive care nurse because support workers, family members, or even registered nurses without ICU experience could not manage the medical emergency that came up for patients that have a tracheostomy and/or were ventilated.

They’re technically intensive care patients because if they had gone back to hospital, they would have presented back into intensive care because the general ward or the general floor areas do not have the skills or the expertise to look after them. So, why would it be different in the community, especially since the goal in the 21st century should be to keep patients out of hospitals, not to keep them in hospitals?

Now, two out of those three clients with children, one was a 5-year-old, and one was a 17-year-old girl. The 17-year-old girl was 4 weeks away from having the tracheostomy removed. Let that sink in. Let that sink in.

The NDIS is trying to sweep it under the carpet. However, they slide at the end of the tunnel, which is why I want to talk about this court case today. The NDIS is initially rejected nursing care for some clients that are listed in the court judgment, in the court report. Those clients are not identified in there and they are not our clients, I have to say that too. It’s got nothing to do with Intensive Care at Home.

But it’s more about the bigger picture here that three NDIS participants went initially to the NDIS tribunal, the AAT (Administrative Appeals Tribunal) and the AAT decided in favor of the NDIS participants that they need nursing care for certain tasks, whereas the NDIS wanted to delegate that from the nurse to a support worker.

Now, obviously, the AAT gave the NDIS participants the right to have the NDIS funded nursing care. The NDIS took that to the federal court to challenge the AAT decision. The Federal Court of Australia also rejected the NDIS claim that the disability support worker can do the job of a registered nurse.

The court case is, “National Disability Insurance Agency versus KKTB by her litigation representative CVY22 [2022] FCAFC 181”  I will put a link to that court case below this video.

In a nutshell, the NDIS claim that the disability support worker can do the work of a registered nurse for clinical tasks such as insulin management, such as PEG (Percutaneous Endoscopic Gastrostomy) tube management, PEG changes, catheter management, suprapubic catheter management, medication management in particular. For patients with brain injuries that are on anti-seizure medications, the NDIS wanted to delegate to support workers, that is ludicrous. Thank God that the AAT as well as the Federal Court of Australia have knocked that back in no uncertain terms and saying, “No, a registered nurse cannot delegate to a support worker in those instances.”

Now, the reason this is so important is, I know if you’re watching this, you might have a loved one on a ventilator with a tracheostomy or you might have a loved one on BIPAP, CPAP, Home TPN, central line, Hickman’s line, port management, whatever the case may be, you know why you’re here. You know why you’re watching this.

So, the court case really talks about lower acuity registered nurse type of work. We’re not talking about intensive care nurses in the community. We’re talking about entry-level registered nurse work really, and even that can’t be delegated to a disability support worker.

So, for ventilation, tracheostomy care, that is the skill of an intensive care nurse that needs to go to university for 3 years minimum, then needs to do a new graduate program, then needs to work in intensive care, then needs to do postgraduate qualifications. Only then can work confidently in ICU, then after two years may join Intensive Care at Home, because we exclusively work with critical care nurses with a minimum of two years critical care nursing experience in a hospital, ideally with a postgraduate critical care qualification.

So, how can the NDIS even remotely claim that disability support worker can do the work of an intensive care nurse if not even a general registered nurse without intensive care nursing experience can do the work of an intensive care nurse? Please explain that to me. Bill Shorten, please explain that to me. Anyone who wants to advocate for a delegated model from registered nurse to disability support workers please explain to me how that would be safe.

It’s like flying the airplane with the cabin crew instead of the pilot. It’s the best comparison that I’ve come up with to this point. Please let me know if you have a better comparison here.

Please let me know if in 2024 in the 21st century, we would be letting disability support workers with all respect, there’s some wonderful, wonderful disability support workers and they work alongside us every day from other organizations, but they’re not equipped or don’t have the qualifications to do registered nurse work, let alone intensive care nurses’ work.

The NDIS has the gumption to put up some online modules about ventilation, tracheostomy that takes an intensive care nurse 5 years to learn and practice in intensive care. So now, a disability support worker can do an e-module online and be ticked off by the NDIS to be competent to look after the ventilation and tracheostomy. Please. Please. Please explain to me how that is safe or ethical or cost-effective for that matter, because patients either die or they go back to ICU all the time if they get that level of care in the community.

Moreover, as registered nurses, we are also bound by AHPRA (Australian Health Practitioner Regulation Agency) legislation as well as by the nursing and midwifery code of conduct. Those both of those AHPRA and nursing and midwifery code of conduct do not allow us to delegate registered nurse work to disability support workers. It’s just not part of our professional standards, which also means we are not covered if we did that.

So basically, the NDIS is asking registered nurses to break their own code of contact, put their registration on the line, and also have no insurance whatsoever because the professional liability insurance would not cover that delegated model of care. So, the NDIS is basically asking registered nurses to do illegal work. Again, Bill Shorten, please explain to me how that is justifiable or ethical or any of that.

Now, I will say this, and I’ve been saying it for a long time. The NDIS overall is a good thing, it has come a long way. I agree with the NDIS stance that in certain circumstances that the states should also fund some of the disability related health supports because at the end of the day, the NDIS is also responsible for keeping patients out of hospital, and that is a good thing.

However, that’s saving the state’s money. I have no interest in getting into a political debate here. The reality, though, is that federal funding for the NDIS is keeping state funded hospitals empty or keeping some patients at home, that would be in state government funded hospitals.

So, not getting political here but the federal politicians and state politicians need to talk to each other in the best interest of a patient and a family. It’s as simple as that. Don’t make this political. Make it about patients and families, that is the bottom line.

So, I hope that shed some light on what’s going on in the environment and how it impacts on your situation or your family’s situation if you have a loved one in intensive care or if you have a loved one in the community already or you might be a pa patient or participant yourself watching this. We can certainly help you.

Now, with Intensive Care at Home, we are currently operating all around Australia, in all major capital cities as well as in regional and rural areas. We are an NDIS (National Disability Insurance Scheme) approved service provider all around Australia. We are TAC (Transport Accident Commission) approved and WorkSafe approved in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme in Queensland), as well as DVA (Department of Veteran Affairs) approved service provider all around Australia. We have also received funding through public hospitals, departments of health, as well as private health funds. So, reach out to us if you need help.

We are also sending our critical care nurses into the home to keep your emergency departments empty. If you want that for your hospital, we want to hear from you. We have done that successfully for the Western Sydney Local Area Health District in the past.

Now, we’re also providing Level 2 and Level 3 NDIS Support Coordination. If you need help with your NDIS plan, if you know you have a loved one or your plan doesn’t give away what you need, especially when it comes to registered nurses, just as explained today, we absolutely want to hear from you, and we can help you. Otherwise, we would not be in business.

If you are an NDIS Support Coordinator and you’re looking for nursing care for your participants or for more funding because you don’t know how to advocate for nursing care, please reach out to us as well. We can help you also with the specialist NDIS nursing assessment.

If you are a critical care nurse and you’re looking for a career change, we want to hear from you as well. If you have worked in ICU or critical care for a minimum of two years, and you ideally have completed a postgraduate critical care qualification, we want to hear from you. We currently have jobs in Sydney, Melbourne, Brisbane, Albury, Wodonga, Bendigo in Country Victoria, as well as in Warragul in Country Victoria. We absolutely want to hear from you.

Please keep in mind we’re looking for intensive care nurses or critical care nurses that want to complement our team. We’re looking for team players, and we’re looking for people who are wanting regular work. We are a service provider that has a tailor-made solution for our clients and their families. We are not an agency. We pride ourselves on having this tailor-made solution with a regular team, with regular staff that want to build relationships with our clients, and we want to build relationships with you as well. But please, let me be clear that we are not an agency. We have rosters, we have work in advance, and we do not want people coming and going because that’s not what our clients want.

If you are an intensive care specialist, we’re currently expanding our medical team as well. We want to hear from you.

If you are an intensive care specialist and you have bed blocks in your ICU, I encourage you to reach out to us as well. We can help you eliminate your bed blocks. But more importantly, we improve the quality of life and sometimes quality of end of life for your patients and their families, and you won’t even pay for it.

If you are a hospital executive watching this, we also want to hear from you because once again we can help you eliminate bed blocks in ICU, ED, respiratory wards, et cetera.

Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website, or simply send us an email to [email protected]. If you are in the U.K. or in the U.S. watching this, we can help you there privately. Please reach out to us as well.

Now, if you like, my videos subscribe to my YouTube channel for regular updates for Intensive Care at Home, but also for families in intensive care, click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next, what questions and insights you have from this video.

I also do a weekly YouTube live where I answer your questions live. Therefore, subscribe to my YouTube channel so you get the notifications for the YouTube live.

Thank you so much for watching.

This is Patrik Hutzel from intensivecareathome.com and I will talk to you in a few days.

Take care for now.