Professor Malcolm MacLachlan:

I thank the Senator. I will respond to her first question about gatekeepers by contrasting other countries with our own. If you are seeking to get assistive technology in Greece or Germany, you can only get access to that technology if it is prescribed by a medical practitioner. In my view, that promotes a very medical model that we would not want to endorse. From a systems point of view, it creates a bottleneck by involving professions that are not perhaps best versed in doing that and take longer to do it. You get waiting lists for access by proceeding in that way. From the WHO's perspective, as it says in the world report, leadership around providing assistive technologies should not reside in any particular profession; it should be based on competence and that competence is particular for certain types of technologies. In the cases of some of the communication technologies we have heard about, speech and language therapists would have particular competence. There are other types of technologies that other professions would have competence in. One thing in terms of gatekeepers is to have a much broader range of people and not have them as gatekeepers. The reason that system exists in Greece and Germany is that assistive technology is paid for through an insurance system, which will only accept a prescription from a medical practitioner. We definitely should not go down that road. We could have a national insurance policy more like the one in Australia, which is less restrictive in access to gatekeepers. More fundamentally, on the concept of gatekeepers, it is not appropriate that professions should be curators or guides. Ultimately, people should be able to make choices for themselves about what the most appropriate technologies are. Some people with communication difficulties, in particular, have significant expertise in terms of what the appropriate technologies for them to use would be.