The history of institutionalising people with intellectual disability in Queensland is similar to the history of institutionalisation of people with intellectual disability in many other western and developing countries, including the United States and the United Kingdom.

Up until the 1980s in Australia, it was common practice for people with disability to reside in large institutions on the outskirts of cities. These institutions housed both children and adults with disability in congregate living environments, with all day‐to‐day decisions made on their behalf by staff.

Originally people with intellectual disability in Queensland were placed in asylums and described as ‘lunatics’ or ‘insane’. Early ‘reforms’ in the 1960s saw the separation of many people with intellectual disability from people with mental illness and the development of training centres and other facilities specifically for people with intellectual disability.

Queensland, like other Australian states experienced significant closures of large institutions and the relocation of people with disability to community‐based living in the 1980s and 1990s. This coincided with increases in community‐based accommodation provided by government and non‐government services. This movement was also given impetus by investigations into cultures of abuse and neglect of people with disability in some of these facilities.

YPIRAC1 was the first truly national effort to tackle the YPINH issue. This report outlines the achievements of this introductory initiative; identifies where YPIRAC1 was unable to have impact; and indicates what YPIRAC2 must do to build on the foundations YPIRAC1 has established.

The Alliance was a key contributor to the Continuous Care Pilots (CCPs) delivered by MS Australia within the Young People in Residential Aged Care (YPIRAC) initiative to prevent younger people with progressive neurological conditions from premature admission to residential aged care. These pilots were delivered in NSW and Victoria and provided joined up specialist and generalist clinical services with funded disability services in community settings.”

In Victoria a tertiary neurological hospital (Calvary Healthcare Bethlehem) was the health service provider, while in NSW a metropolitan Area Health Service (South West Sydney) partnered with disability services. In both pilots, the linking of clinical and social supports was highly successful and achieved a 100% success rate in managing the many risks faced by participants. A key success factor in the CCPs was the linking of existing health service offerings with existing disability services through specialised care coordination.

The National Compact between the Australian Government and the not-for-profit or Third Sector, was launched by Prime Minister Rudd on March 17 at Parliament House in Canberra.

The Compact represents an undertaking by the Commonwealth Government and the Third Sector to develop a new, collaborative way of working together to achieve to address key social, economic and environmental challenges.”

Prior to the launch of the compact, extensive community consultations were held, the results of which are published in the National Compact Consultation Report.

In April 2008 the Parliamentary Secretary for Disabilities and Children’s Services, the Hon Bill Shorten MP, assembled a group of prominent Australians with a wealth of experience and knowledge in philanthropic investment and asked them to explore innovative funding ideas from the private sector that will help people with disability and their families access greater support and plan for the future.

The Disability Investment Group (DIG) was chaired by Ian Silk. Its members included Bruce Bonyhady, John Walsh, Bill Moss, Kathleen Townsend, Allan Fels and Mary Ann O’Loughlin (until October 2008). The Australian Government released the Disability Investment Group’s report called The Way Forward: A New Disability Policy Framework for Australia on December 3 2009.

The report makes six recommendations. The principal recommendation is for a feasibility study into a national disability insurance scheme for Australia.

Other recommendations refer to:

• Special Disability Trusts
• savings and investment incentives
• private investment in housing
• better employment opportunities and
• building best practice and research

According to The Way Forward, over the next 40 years in Australia the number of people with severe or profound disability is projected to grow from 1.4 million to 2.9 million. Recent trends indicate growth in demand for specialist disability services of 7.5 per cent per annum in real terms.

In 2006, the Council of Australian Governments (COAG) announced a limited, five year initiative to address the growing Younger People In Residential Aged Care (YPIRAC) issue. Held midway through this national program’s five year term, Shaping the Future Today reviewed the initiative’s achievements to date; and highlighted priorities for the final two years of its life.

The Council of Australian Government’s (COAG) Younger People in Residential Aged Care (YPIRAC) Program’s Mid-Term Review report analyses the targets, performance to date and key issues associated with the YPIRAC Program.

This landmark collaboration between Commonwealth, State and Territory Governments was always intended as a first step towards final resolution of the young people in nursing home issue, and not a solution in and of itself.

Aiming to provide community based accommodation and support alternatives to younger people with disability living in or at risk of admission to residential aged care (RAC), the YPIRAC program has three key objectives.” These are to:

• offer community based alternative supported accommodation options to younger people with disability currently accommodated in RAC
• prevent or divert further admissions of younger people with disability who are at risk of admission to RAC
• and provide disability services to younger people with disability whose health prevents them exiting RAC, or who choose to remain there for reasons of proximity to family and community in remote and rural areas.

Each state and territory government signed a bi lateral agreement with the commonwealth to implement the program. These bi lateral agreements contained targets specific to each objective. The Commonwealth Government provided 50% of the initial funding or $122m with each State and Territory matching this amount dollar for dollar on a per capita basis. Victoria provided an additional $10m for capital development.

A second phase of this landmark initiative is currently under discussion.

Leaders from Victorian health, disability and aged care sectors met in the K Room, Parliament House Melbourne, to discuss the need for coordinated care pathways for young people with complex support needs at the Victorian Joint Solutions Leaders Summit convened by the Young People In Nursing Homes National Alliance.

Dr. Bronwyn Morkham, the Alliance’s National Director, welcomed those present and asked each person to briefly introduce themselves, outlining their role and what outcomes they hoped to obtain from the morning’s proceedings. A desire to address some of the major service system blockages experienced across programs emerged as an early concern.

The arrival of the National Disability Insurance Scheme (NDIS) and the ongoing imperative to progress the National Disability Strategy (NDS), have highlighted the pressing need for mainstream programs to participate in the reforms underway around services and supports for people with disability. While the issue of developing workable interfaces between specialist disability programs, mainstream programs and the NDIS has been discussed in many forums, little practical attention has been given to how this can be achieved and what outcomes are sought for governments, providers and people with disability.

The Joint Solutions Roundtables have been convened by the YPINH National Alliance in the jurisdictions to interrogate how these cross-­‐program connections can be developed. The Perth Roundtable focussed on the imperatives around the NDS and the NDIS in Western Australia and included discussion about the My Way and NDIS trial sites.

Alliance head, Dr Bronwyn Morkham, said many young Australians with a disability require services from several areas of the human services system at the same time but rarely get them as the systems don’t work together.

“As our report indicates, cross sector collaboration will not only deliver the integrated services young Australians with disability need, but will help the NDIS deliver on its social and economic objectives.”

The report explores best-practice examples of coordination currently occurring in the disability sector and recommends the NDIS roll-out incorporates and trials potential models.