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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).
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 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 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.
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.
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.
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.
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.
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 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.
The training provided to health professionals and providers should cover communication, accessibility, and the provision of reasonable adjustments.
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.
Recommendations for Improving Access to Information and Communication for People with Disability include:
Recommendations to Improve Access to Interpreters for People with Disability include:
Recommendations for Reforming Guardianship and Administration Legislation include:
Recommendations for Improving Transparency, Collection of Data and Advocacy include:
Recommendations for Improving Healthcare Access for People with Disability include:
Recommendations for Improving Care and Protection of People with Disability include:
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.
The National School Reform Agreement should include milestones for phasing out segregated education settings;
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;
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.
Progress must be tracked and reported annually.
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 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.
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:
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.
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 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:
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.
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.
A list of FAQs to help you interpret and respond to subpoenas
Osteopathy Australia's whistleblower policy outlining reportable issues and the process for raising concerns about governance and management.
We provided feedback to the NDIA on their draft Agency Strategy, focusing on key areas for improvement and emphasising the need for measurable outcomes to enhance disability support.