This article gives an overview of the Disability Royal Commission’s final report outlining the recommendations that the Australian Government must adopt to prevent violence, abuse, neglect, and exploitation of people with disability.
The final Royal Commission report outlined the key learnings from the inquiry from April 2019 to September 2023. It sets out the evidence, information presented and conclusions and recommendations.
The final report is set out in 12 volumes and covers many subjects. This document gives an overview of the Disability Royal Commission’s final report outlining the recommendations that the Australian Government must adopt to prevent violence, abuse, neglect and exploitation of people with disability.
Overall, the Royal Commission made 222 recommendations on improving policies, structures and practices to ensure a more inclusive and just society that supports the independence of people with disability and their right to live free from violence, abuse, neglect and exploitation.
Osteopathy Australia commits to integrating Disability Royal Commission (DRC) recommendations so that people with disability can enjoy all human rights and freedoms fully and equally.
The report failed to mention osteopathy, but the term allied health appears in several sections of the final report.
Volumes Overview: Volumes 1 and 2 present narratives of people with disability and details about the Royal Commission. Volumes 3 to 12 address critical issues and recommendations, with a spotlight on healthcare access (Volume 6) and disability services (Volume 10).
Executive summary
The Executive Summary extends for 356 pages, with recommendations starting on page 193. The Royal Commission collected feedback from people with disability, their families, and supporters on creating an inclusive society free from violence and abuse. Alongside prevention and response efforts, they highlighted the positive changes and the importance of recognising and valuing disability as part of human diversity. A human rights approach is crucial to address violence, abuse, neglect, and exploitation. The report emphasises the significance of listening to and recognising the leadership of people living with disability to achieve an inclusive society.
One major finding of the Commission was the need for greater collaboration and coordination among disability service providers, including allied health professionals, to improve outcomes for people with disability. The report also highlighted the need for increased training and education for health practitioners and providers to ensure they have the skills and knowledge necessary to provide participants with the highest level of care.
In addition, the Commission recommended that providers take a more person-centred approach to care, focussing on individuals’ unique needs and preferences. This new approach would include working closely with participants and their families to develop customised care plans that consider their specific circumstances and goals.
Osteopathy Australia is committed to incorporating these recommendations into our ongoing policy and advocacy efforts and keeping our members at the forefront of disability care. By working with other allied health peak bodies, Allied Health Professions Australia (AHPA), the National Disability Insurance Agency (NDIA), and the National Disability Insurance Scheme (NDIA), we can continue improving the quality of care and support available to people with disability throughout Australia.
Volume 1, Voices of People with Disability
Volume 1 includes some of the stories of 9,000 individuals living with a disability, their families and supporters who provided input to the Royal Commission. These narratives offer insight into the daily lives of people with disability and aim to raise awareness and promote inclusive and safer communities. The shared experiences informed the Commission's work but do not represent the findings of the Commission, nor do the participants serve as witnesses.
Overall, the Disability Royal Commission 2023 Volume 1 serves as an important reminder of the ongoing challenges faced by people with disability and the vital role that allied health professionals and providers play in supporting them. As a trusted peak allied health body, we are committed to staying informed and advocating for the best possible outcomes for all community members.
Volume 2, About the Royal Commission
Volume 2 of the DRC discusses the establishment and nature of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, including the announcement and consultation on the draft terms of reference. The letters patent defined the Royal Commission and its scope. The letters patent are official legal documents that grant authority and outline the scope, purpose, and powers of a Royal Commission. They are the basis for the commission's establishment and operation.
Chapter 2 explains how the inquiry gathered information and evidence from public hearings, community engagement activities and private sessions. This chapter examines decision-making on behalf of people with disability and its negative consequences, stresses the importance of supported decision-making for autonomy, and recommends reforms in guardianship and administration laws and changes in attitudes and policies.
Chapter 3 provides an overview of the Royal Commission's people, values, roles, responsibilities, staff, offices, finances, and funding. The volume ends with nine appendices detailing various parts of the Royal Commission's work.
Volume 3, Nature and extent of violence, abuse, neglect and exploitation
In Volume 3, the DRC addresses the issue of violence and abuse towards individuals living with disability, particularly women and those with psychological or intellectual disability. These individuals experience higher rates of such incidents. Perpetrators are often known to these individuals, including intimate partners, family members, friends and co-workers. Neglect of people with disability can take many forms, including deprivation of necessities, disability-specific forms of neglect, and exclusion from quality settings and services.
Volume 4, Realising the human rights of people with disability
Findings and relevant key recommendations
The DRC recognises that Australia has obligations to promote the human rights of people with disability under the Convention on the Rights of Persons with Disability (CRPD (Convention on the Rights of Persons with Disability)). Although Australia has taken measures to implement the CRPD, the abuse, neglect, and exploitation of people with disability has not been prevented. Current laws provide limited legal protection of CRPD rights and lack effective remedies when rights are breached.
Osteopathy Australia’s suggested next steps:
- To achieve equality and inclusion, a stronger and more comprehensive legal framework is needed;
- The Australian Government should commit to the enactment of an Australian Disability Rights Act (DRA) after consulting with people with disability;
- The new National Disability Commission (NDC) should support the implementation of the DRA and deliver education and training programs. Each jurisdiction should enact legislation that is complementary or equivalent to the DRA.
Commissioners Bennett, Galbally and McEwin propose that Australia establishes a Disability Rights Act (DRA) that recognises every individual’s right to make decisions that affect their lives, live free from violence and abuse, and have equitable access to healthcare. It should also create a National Disability Commission (NDC) to ensure compliance, allow only reasonable and justified limitations on rights, and enable claims against duty-holders for contraventions.
Osteopathy Australia’s suggested next steps:
- The DRA should mandate consultation with people with disability, promote disability equality, provide interpreters and accessible communication, and be interpreted in accordance with international human rights treaties;
- To address discrimination, the Disability Discrimination Act 1992 (Cth) should be amended to shift the burden of proving non-discrimination onto alleged discriminators and include exemptions for unjustifiable hardship. Offensive behaviour and vilification should also be prohibited;
- Finally, the Disability Discrimination Act should be amended to give effect to Australia's obligations under the Disability Convention.
Volume 5, Governing for Inclusion
Findings and relevant key recommendations
Volume 5 emphasises the crucial role of robust national disability frameworks and leadership in promoting equality, inclusion, and the rights of people with disabilities. The report suggests a National Disability Agreement (NDA), an independent National Disability Commission (NDC), a Minister for Disability Inclusion, and a Department of Disability Equality and Inclusion (DDEI). The report also recommends ways to prevent violence, abuse, neglect, and exploitation of people with disability. The volume is divided into three chapters that discuss national disability policy, evaluate its effectiveness, and assess governance and leadership arrangements.
There is a call for a new National Disability Agreement in Australia to advance equality, inclusion, and the rights of people with disability.
Osteopathy Australia’s suggested next steps:
- The new National Disability Agreement should support developing and implementing reforms requiring national attention and coordination. Australia's Disability Strategy 2021–2031 should also be reviewed and updated, and state and territory governments should revise their disability strategies and plans.
Recommendations include the creation of a National Disability Commission and a new department responsible for disability and care policies and programs. These recommendations should be implemented between the end of 2024 and mid-2025.
Volume 6, Enabling autonomy and access
Findings and relevant key recommendations
Volume 6 of the DRC is divided into six chapters and addresses the issues faced by people with disability when accessing health care services. Each chapter focuses on a different topic. Chapter 1 emphasises the significance of accessible information and communication. It focuses on the inaccessibility of information for individuals with disability. (The DRC was inaccessible to AUSLAN users unless they have someone with the ability to open the files in Word and go to the review tab and read aloud), Emphasises the life-or-death consequences during emergencies and explores the role of interpreters in facilitating understanding and decision-making.
Chapter 2 looks at decision-making and suggests reforms to guardianship and disability administration laws. This chapter examines decision-making on behalf of people with and its negative consequences, stresses the importance of supported decision-making for autonomy and recommends reforms in guardianship and administration laws and changes in attitudes and policies.
Chapter 3 discusses advocacy and informal support networks. This chapter promotes the importance of having access to advocacy and informal support networks for autonomy and protection. It identifies barriers preventing timely advocacy and proposes changes for culturally safe services.
Chapter 4 concentrates on the healthcare system. This chapter addresses the challenges in accessing safe and high-quality healthcare for people with disability, critiques the current service system design and treatment by healthcare professionals and calls for significant changes in healthcare delivery to better serve individuals with disability.
Chapter 5 explores the overuse and inappropriate use of restrictive practices on people with disability, highlights the physical and mental harm caused, and advocates for reforms to reduce and eliminate such practices.
Chapter 6 delves into involuntary sterilisation and recommends reforms to prohibit non-therapeutic procedures. This chapter examines the legal aspects of involuntary sterilisation in Australia and advocates for reforms to prohibit non-therapeutic procedures, emphasising the need for informed consent.
Throughout the DRC, numerous barriers were reported that prevented people with disability from exercising autonomy. These included a lack of access to essential information, inability to communicate effectively due to the absence of reasonable adjustments, insufficient support for decision-making, and the overuse of restrictive practices against people with disability. The report recommends that health professionals and providers receive training to understand better the needs of people with disability.
Osteopathy Australia’s suggested next step:
The report also highlights the importance of ensuring that people with disability have access to appropriate and timely healthcare services. Greater access to healthcare services requires better coordination between healthcare providers and more accessible and inclusive healthcare facilities. The Translating and Interpreting Service (TIS) National offers phone interpreting services, and the Free Interpreting Service is available for eligible groups. Clinical placements are an ideal way for educational providers to expand students’ access to training in r cognitive disability health, creating more opportunities for their development and training. Unfortunately, funding mechanisms serve as a significant obstacle to achieving this goal. Most funding is directed to acute public hospitals, even though future practice will be in community and home-based settings.
Osteopathy Australia’s suggested next step:
- It is crucial to fund supervisors for time spent overseeing and training students, including via funding provided by the NDIS (National Disability Insurance Scheme).
Recommendations for Improving Access to Information and Communication for People with Disability include:
- Establishing a national plan for promoting accessible information and communications in collaboration with people with disability and their representative organisations;
- Considering diversity in disability, language requirements, and the roles of stakeholders such as disability service providers, disability representative organisations, and organisations representing people from diverse backgrounds;
- Focus initially on emergencies, natural disasters, and public health and include targeted actions to ensure access to information and communications in various settings;
- Finalise the plan by the end of 2024, with appropriate funding and resources allocated, and provide mechanisms for public reporting and review of progress.
Recommendations to Improve Access to Interpreters for People with Disability include:
- Developing a workforce strategy to increase the number and quality of Auslan interpreters;
- Ensuring access to appropriately skilled and qualified interpreters and providing training for interpreters in disability awareness;
- Amending guardianship and administration legislation to include new terms and definitions consistent with the Convention on the Rights of Persons with Disability and a statement of statutory objects that promote the rights of people with disability and recognises the role of decision-making support.
Recommendations for Reforming Guardianship and Administration Legislation include:
- Reforming guardianship and administration legislation to include supported decision-making principles;
- Providing provisions for statutory and personal appointments of one or more supporters for personal and financial matters;
- Ensuring representation orders are made only as a last resort and in a way that is least restrictive of a person's rights, autonomy and actions;
- Providing provisions for review and revocation of representation orders;
- Include a decision-making process that involves supporting the person to express their will and preferences and assisting them to develop decision-making ability;
- Giving effect to the person’s will and preferences, or if not possible, act to promote and uphold their personal and social wellbeing with the least possible restriction on their dignity and autonomy;
- Updating guidelines to align with these recommendations and consider adopting the updated guidelines.
Recommendations for Improving Transparency, Collection of Data and Advocacy include:
- Repeal provisions prohibiting publication of material identifying a party to the proceedings;
- Empower tribunals to make orders prohibiting the publication of material identifying the party based on circumstances;
- Provide information, education, and training on supported decision-making;
- Undertake systemic advocacy to promote supported decision-making;
- Update national standards for public advocates, public guardians, and public trustees to include supported decision-making principles;
- Offer a financial skills development program, publish information about services provided and fees and charges, and review fees and charges to ensure they are fair;
- Develop a national approach to collecting and publishing de-identified data on support and representation arrangements;
- Withdraw the interpretative declaration in relation to Article 12 of the Convention on the Rights of Persons with Disability;
- Provide additional funding for advocacy programs and improved data collection and reporting on disability advocacy demand;
- Expand the role of the Intellectual Disability Education and Training Expert Advisory Group to develop an implementation plan for the cognitive disability health capability framework and expand the scope of health workforce capability development to address all forms of cognitive disability.
Recommendations for Improving Healthcare Access for People with Disability include:
- Expand the National Centre of Excellence in Intellectual Disability Health to include autism and other forms of cognitive impairment;
- Embed the right to equitable access to health services in policy instruments and increase capacity to provide supports and adaptations;
- Develop specialised health and mental health services for people living with cognitive disability;
- Introduce disability health navigators to support the complexity of healthcare;
- Establish legal frameworks for the authorisation, review, and oversight of restrictive practices to protect the rights of people with disability and prohibit certain restrictive practices.
Recommendations for Improving Care and Protection of People with Disability include:
- Joint annual progress reports on the use of psychotropic medication;
- Longitudinal study on reducing and eliminating restrictive practices;
- Consistent data collection and reporting on the use of restrictive practices;
- Establish targets and performance indicators to reduce and eliminate restrictive practices;
- Prohibit non-therapeutic sterilisation except under certain circumstances;
- Expand annual collation and publication of data on the sterilisation of people with disability by AGAC.
Volume 7, Inclusive Education, Employment and Housing
Findings and relevant key recommendations
Volume 7 of the DRC speaks to how Australia’s current education, employment and housing systems fall short of providing full inclusion for people with disability, especially those with high support needs. The DRC suggests that mainstream systems need significant reform to eliminate barriers and promote inclusion. They recommend changes to establish a safe and inclusive school system, provide genuine employment choices and offer inclusive housing options. The report identifies barriers to inclusion and the need for significant transformation and reform. Commissioners hold different views on some issues, but all support greater inclusion for people with disability.
Submissions received by the Commission highlight the need for allied health services, funding for Auslan interpreters and allied health professionals to work in partnership with students, families, and schools.
The Commission suggests various recommendations to enhance education, including changes to education acts to establish the legal right for people with disability to attend mainstream schools. Schools should provide necessary adjustments to develop local policies for student participation. Inclusive education units with First Nations expertise and improved workforce capabilities are also suggested.
Osteopathy Australia’s suggested next steps:
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The National School Reform Agreement should include milestones for phasing out segregated education settings;
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The government should adopt customised and flexible employment supports and funding arrangements to improve employment. Procurement policies should favour businesses that offer employment opportunities for people with disability, and the Fair Work Act 2009 and Disability Discrimination Act 1992 should be amended for consistency.; The NDIS should adopt an open employment first approach and raise subminimum wages for employees with disability. A National Inclusive Employment Roadmap must be developed to transform Australian Disability Enterprises and eliminate subminimum wages;
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For housing, the Australian federal government and state and territory governments should prioritise people with disability in housing agreements and planning. Recommendations include increasing the supply of accessible housing, establishing policies to prevent homelessness, and improving supported accommodation. These recommendations must be implemented through measures such as the Australian Building Codes Board Liveable Housing Design Standard and the NDIA. Additionally, there should be a focus on community participation, flexible funding, and clear transition pathways.
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Progress must be tracked and reported annually.
Volume 8, Criminal Justice and People with Disability
Findings and relevant key recommendations
Volume 8 discusses the over-representation of people with disability in the Australian criminal justice system. Public hearings were held to examine the experiences of people living with cognitive disability, women and girls living with disability, conditions in detention and violence against people with disability in public places.
One particular from this volume outlined how a lack of multidisciplinary care in a forensic facility led to catastrophic consequences, the death of a staff member and many years in conditions that were
“Filthy and degrading, substandard and clearly not aimed at helping her recover.”
Once a dedicated nursing and allied health team were allocated to the participant, she was able to come out of prolonged seclusion for the first time in years. Melanie's story can be found in section 4.2 of volume 8.
Improving Disability Treatment in the Australian Criminal Justice System
Volume 8 of the report recommends several steps to enhance screening activities for disability throughout the assessment process for new prisoners in the justice system. Recommendations include providing increased education and training for disability service providers, such as disability awareness training, communication strategies, and best practices for supporting individuals living with disability. The report also highlights the importance of including the perspectives of individuals living with disability and their families in the development of healthcare policies and practices.
Other recommendations include providing necessary disability support, abolishing solitary confinement, and developing screening and assessment methods specifically for children living with cognitive disability. The report also calls for guidelines for disability screening, funding for transitional supports and the inclusion of police services in the Disability Discrimination Act (DDA). Furthermore, the report urges governments to take action to address violence against women and children living with disability and to raise the minimum age of criminal responsibility to 14.
Volume 9, First Nations People with Disability
Findings and relevant key recommendations
Volume 9 of the report highlights the need to address systemic barriers that individuals in the First Nations community living with disability face. Access to culturally sensitive support services, including support workers with a deep understanding of their unique experiences, is crucial.
The report calls for collaboration between the Australian Government and First Nations communities to establish disability-specific policies and programs that reflect their cultural values and priorities. This approach will ensure that First Nations individuals living with disability can contribute to shaping policies and services that directly impact their lives.
Additional recommendations include education and awareness-raising initiatives to combat discrimination and stigma against First Nations individuals living with a disability. By working together to implement these recommendations, we can build a more inclusive and equitable society that caters to the needs of all Australians.
Volume 10, Disability Services
Findings and relevant key recommendations
The DRC received distressing evidence of maltreatment towards people with disability, including neglect, abuse, and violence. The report discusses the responsibility of disability service providers to prevent and respond to such maltreatment and systemic issues affecting access to safe disability services. It also examines the role of the NDIS Quality and Safeguards Commission in preventing and responding to maltreatment, identifying areas that need improvement, including incident oversight, complaints handling, and behaviour support. The report highlights the importance of embedding human rights into service delivery, strengthening choice and control for service users, and increasing resources to meet the demands of the Commission.
The report recommends several measures to improve disability services, focussing on disability service providers. These include:
- Recommendation 10.1: The NDIS Quality and Safeguards Commission should order a capacity-building program that supports disability service providers in integrating human rights into their services. This program should be co-designed with people with disability, organisations for people with disability and peak bodies;
- Recommendation 10.2: A provider of support coordination should differ from the provider of other funded supports in a NDIS participant’s plan. Exceptions to this rule need to be developed in consultation with organisations for people with disability, disability representative organisations and peak bodies;
- Recommendation 10.3: The National Disability Insurance Agency should include funding for support coordination in the NDIS plans of participants at risk of violence, abuse, neglect, or exploitation;
- Recommendation 10.4: The NDIS Quality and Safeguards Commission should examine the quality and consistency of support coordination, focussing on specific groups of people with disability;
- Recommendation 10.5a: The NDIA should develop a program to connect NDIS participants living in supported accommodation with an appropriate disability advocacy organisation. The program should be co-designed with people with disability, organisations for people living with disability and peak bodies;
- Recommendation 10.5b: The NDIS Quality and Safeguards Commission should promote the value of independent advocacy for NDIS participants who are at risk of violence, abuse, neglect, or exploitation and those who live in supported accommodation when reviewing complaints and reportable incidents.
In addition to these recommendations, the report also proposes other measures to improve disability services. These include amending the NDIS (Quality Indicators for NDIS Practice Standards) Guidelines 2018 to reflect that each participant is entitled to support for everyday life decisions, developing a practice guide on supported decision-making, establishing a national disability support worker registration scheme, considering equal remuneration for disability support workers, and designing a provider of last resort scheme to address failed or thin markets. The government should engage with relevant organisations and stakeholders to ensure effective implementation.
The DRC has proposed ways to improve the NDIS, including strengthening internal monitoring procedures, introducing 'class or kind' determinations, establishing a panel of independent investigators, developing model procedures and guidelines, amending NDIS rules, providing safeguarding indicators and encouraging access to specialist safeguarding advice. Further recommendations include improving access to behaviour support practitioners, expanding data reporting, establishing a dedicated First Nations Unit, and continuously monitoring criminal charges.
Volume 11, Independent Oversight and Complaint Mechanisms
Findings and relevant key recommendations
Providing independent and accessible pathways for reporting violence and abuse experienced by people with disability is crucial.
States and territories must uphold the rights of people with disability and protect them from mistreatment, with an authorising environment that facilitates cooperation between the Commonwealth and states and territories. Oversight functions must be independent and adequately resourced, while better quality data should be collected and reported to address trends.
To ensure the safety of people with disability, various government entities at different levels should collect data and establish independent and accessible reporting pathways for violence and abuse.
The report recommends nationally consistent legislation, a National Adult Safeguarding Framework, complaint reporting and support mechanisms, resourcing for places of detention and community visitor schemes, and legislating National Preventive Mechanisms. Amendments to the National Disability Insurance Scheme Act 2013 and resourced disability death review schemes are also suggested. States and territories are urged to create nationally consistent reportable conduct schemes for disability service providers working with children.
Volume 12, Beyond the Royal Commission
Findings and relevant key recommendations
Volume 12 of the DRC recommends key steps for implementing and monitoring its recommendations, including publishing a written response to the report by 31 March 2024, overseeing implementation through the Disability Reform Ministerial Council, and evaluating the effectiveness of the recommendations. The report also emphasises the importance of high-quality data and research for measuring policy effectiveness and recommends improving the evidence base for disability policy and services. Additionally, the report suggests developing a nationally consistent approach to collecting disability information and establishing the National Disability Data Asset as a national resource for linked longitudinal analysis. Volume 12 includes three chapters on the implementation of recommendations, the need for improved data and research and the impact of the Royal Commission during its inquiry.
The DRC further proposes steps for implementing and monitoring their recommendations, including collaboration with disability organisations and people with disability. Chapter 2 highlights the difficulty in obtaining reliable data and research during the inquiry and recommends ways to improve data collection and analysis, including establishing the National Disability Data Asset. Chapter 3 highlights the report's impact on policy, programs, and services, including changes to education policies and healthcare for people with cognitive disability. The report also discusses the Royal Commission's impact on the Australian Government's response to COVID-19 for people with disability.
The Disability Royal Commission's Volume 12 report offers critical insights into the lives of people with disability in Australia, along with crucial suggestions for improving the quality of their care.
To achieve this, the Royal Commission recommends:
- Governments at all levels publish a written response to the Final Report, outlining a plan for implementing accepted recommendations, reasons for rejecting any recommendations and a timeframe for further consideration;
- The Disability Reform Ministerial Council should oversee the implementation and report every six months;
- The National Disability Commission should report annually on progress and conduct independent evaluations of recommendation effectiveness;
- Implementing a nationally consistent approach to collecting disability information and developing disability flags;
- Creating a strategy to extend disability data collection as part of Australia's Disability Strategy 2021–2031 Data Improvement Plan;
- Committing to long-term support for the National Disability Data Asset (NDDA) to establish it as a national resource for longitudinal analysis of linked data.
Moreover, the report highlights the importance of a national Disability Workforce Strategy to address the shortage of skilled workers in the sector and empower people with disability to make their own decisions about their care. The report also calls for establishing an independent complaints mechanism to deal with complaints promptly and transparently. In addition, all governments must publish a written response to the report's recommendations, implement accepted recommendations and develop a plan for those rejected.
Conclusion
Osteopathy Australia is committed to incorporating these recommendations into ongoing policy and advocacy efforts and ensuring members remain at the forefront of disability care. Collaboration with other peak bodies, the NDIS, and NDIA is crucial for continuous improvement in the quality of care and support available to people with disability throughout Australia.
Osteopathy Australia would like to thank the Commissioners who worked extremely hard to assemble this report and to the individuals, families, supporters, and providers who shared their stories. As a peak allied health body, we look forward to implementing recommendations in our policy and advocacy work.
The comprehensive approach outlined in these volumes emphasises the importance of accessible information, person-centred care, and systemic reforms to create a more inclusive and supportive environment for individuals with disability. Advocacy, collaboration, and a commitment to human rights are key elements in driving positive change in disability services and healthcare access.
Acknowledgement of Country
Osteopathy Australia acknowledges Australia’s First Nations peoples as the Traditional Custodians of the lands, seas and waters of Australia, and pay respect to all First Nations Elders, past. present and emerging. We pay our respects to all First Nations people with disability and recognise the distinct contributions they made to the outcome of the inquiry.
Acknowledgment of people with disability
We acknowledge people with disability who fought and campaigned long and hard for the establishment of the Royal Commission. We acknowledge the courage and generosity of people with lived experience of disability who share their knowledge and experiences of violence, abuse, neglect and exploitation with the Royal Commission.
