HOW TO GET THE NDIS ON TRACK...2 How to get the NDIS on track The vision of the National Disability...
Transcript of HOW TO GET THE NDIS ON TRACK...2 How to get the NDIS on track The vision of the National Disability...
HOW TO GET THE NDIS ON
TRACK
MAY 2017
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How to get the NDIS on trackThe vision of the National Disability Insurance Scheme (NDIS) is compelling:
• choiceandcontrolforpeoplewithdisabilityandtheirfamilies;
• doublethefundingfordisabilitysupporttorespondtothehighneedforservicesandequipment;
• aninsuranceapproachthatinvestsinearlyintervention;and
• increasedequityandlifeopportunitiesforpeoplewithdisabilityacross Australia.
TheNDISistherightreformforAustralia;butthescaleandcomplexityofimplementationisplacingenormouspressureonallstakeholders.Someofthispressureisaninevitableconsequenceoflarge-scalechange,butsomeisavoidable.TheroadtotheNDISisrougherandriskierthanitneedstobe.
CriticaltorealisingthevisionoftheNDISisthegrowthofadynamic,sustainableandvalues-drivendisabilitysector.Withoutthis,peoplewithdisabilityandtheirfamilieswillnothavethechoiceandqualityofsupporttheNDISpromises.Therisksfacingthedisabilitysectorareriskstotheschemeasawhole.Theyaresubstantialandrequireurgentmitigatingaction.
Inthispaper,NDSproposespracticalmeasurestoreducetheavoidablepressureandrisk–andsoimprovetheimplementationandsecurethefuture of the NDIS.
DisabilityserviceproviderscampaignedfortheNDISalongsidepeoplewithdisability,theirfamiliesandcarers.Theirmotivewastoimprovethelifeopportunitiesandwell-beingofpeoplewithdisability.Thatsamemotiveunderpinsthispaper.
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RecommendationsNDSrecommendstogovernmentandtheNationalDisabilityInsuranceAgencythattheytakethefollowingactionstogettheNDISontrack:
Trialplanningpartnershipswithspecialistdisabilityserviceproviders,utilisingtheirexpertiseandknowledgeoftheirclientswhilstmanagingpotential conflict of interest
Commenceplandevelopmentwithanaccuratedescriptionofcurrentsupports,sourcedfromtheparticipantandhisorhercurrentproviders
Allowparticipantstheopportunitytocommentontheirplanbeforeitisfinalised
Includecoordinationofsupportsintheplansofparticipantswithcomplexconditions
Withconsent,informthecurrentprovidersofaparticipantassoonassheorhehasanapprovedplan
Reducethehighnumberofquestionsaskedofparticipantsduringtheassessmentandplanningprocess
Adopta‘workfirst’approachinplanningtoincreasetheproportionofplanswithemploymentsupports
Commence access to School Leaver Employment Supports (SLES) as earlyasYear10andextendSLESbeyondtwoyearsifaparticipant’semployment is the probable outcome
SecureaviablefutureforjobsinSupportedEmploymentEnterprisesbyresolvingfundingandwageassessmentissuesandpromotetheprocurementofgoodsandservicesproducedbypeoplewithdisability
EstablishanemergencyresponsesystembyextendingtheNDIS1800phonelineto24hoursadayandformingresponsepanelsofdisabilitysupportprovidersinallregions
Compensateproviderswhentheyincurasuddenescalationofsupportcostsinrespondingtoanaturaldisaster
Subjecttocertainconditions,streamlineregistrationbyprovisionallyapprovingdisabilityserviceprovidersthatmeetqualityrequirementsinonejurisdictiontooperateinotherjurisdictionsand/ordelivernewsupports
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Do not compel the future separation of Specialist Disability AccommodationandSupportedIndependentLivingbeyondseparateserviceagreements(andtherequirementthatprovidershavesoundprocesses for resolving conflicts)
Fundtheusercostofcapitalforrespitehousesanddaycentres
Discontinuein-kindarrangementsthatlimitparticipantchoiceandcontradicttheprincipleofcompetitiveneutrality
PendingthederegulationofNDISprices:
• setindividualparticipantbudgetsbasedonreasonableandnecessarysupports,realisticcosts(derivedfromrealdata)andevidence-basedreferencepackages;
• allowparticipants(theirrepresentatives)andproviderstonegotiatepricesforsupportswithoutexceedingtheparticipant’sbudget;
• publishapriceguidebasedonmarketinformationtoenableparticipants(andtheirrepresentatives)tocompareandnegotiateprices;
• basepurchasingonhoursorondeliverables
Revisethemethodfordeterminingremotelocationsandpriceloadingstoreflectthefullcostimpactoflocalconditions
EstablishanindustryadvisorygrouptodesignandtestICTsystemchangesbeforetheyareintroduced
Useco-designtoworkouthowparticipantswithcomplexneedsorwholiveinregionalorremoteareascanbestbeassistedtotravel
CeasetherequirementthatprovidersmustquoteforallSupportedIndependentLivingparticipants,notjustforthosewhosesupportexceedsthebenchmarkpriceandworkwiththesectortoimprovetheSupportedIndependentLivingtemplate
Establishadedicatedandresponsivetelephoneserviceforprovidersandastate-widepointofcontactfamiliarwithissuesinthatjurisdictionwhohastheauthoritytoresolvethem
Fundandassistthedevelopmentofanindustryplan,ledbythenon-government sector
Expandtheprovisionofmarketdatatoassistproviderswiththeirplanningandinvestmentdecisions
Establishanationaldisabilityresearchentity,structuredsimilartotheAustralianHousingandUrbanResearchInstitute
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The pressure on the NDIS has four principal sources:Speed: TheNDISisaccelerating.InthesixmonthstoDecember2016,theNationalDisabilityInsuranceAgency(NDIA)approvedasmanyparticipantplansasithadintheprecedingthreeyears.Thisdemandingpaceisbeingsetbyambitioustargetsininter-governmentalagreements.WhilepeoplewithdisabilityshouldnothavetowaitanylongerthanisnecessarytoaccesstheNDIS,thehasteinprocessingnewentrantsisaffectingthequalityoftheirplans.
Funding:AlthoughtheNDISwillachievelargeeconomicandsocialreturnsovertime,itisasubstantialinvestmentbyAustraliantax-payers.Whenfullyimplemented,itwillcost$22billionayear.EnsuringtheaffordabilityoftheschemeisakeyfocusfortheNDIAandFederalGovernment.Whiletheschemecurrentlyoperateswithinbudget,theNDIAhasidentifiedseveralcostdriverswhicharetestingthebudget.Forexample,therelativelyhighnumbersofchildrenseekingtoenterthescheme.Underfiscalpressure,theFederalGovernmenthasestablishedaspecialaccounttoquarantinesavingsfortheNDIS.Thisisawelcomedevelopment.Findingsavings,however,amidstthemanyclaimsontheFederalBudget,isanongoinganddifficulttask.
Systems:IndependentreportsoverrecentmonthshaveraisedconcernsaboutthecapacityofNDISsystemstofunctionatthescalerequiredforthescheme’sfullimplementation.Inits2016reviewoftheNDISMyPlacePortal,PwCstated:“thereisrealriskthattheNDIAoperatingmodelwillnotbeabletocope…whenthefullschemeisexpectedtobeoperating”.WhiletheflowofpaymentsthroughthePortalhasimproved,usingthePortalremainscumbersomeandslowatatimewhenefficiencyisimperative.Thequalityofparticipantplansisinconsistentandtherehasbeenaback-logofregistrationrequests:of8,000registrationrequestsfromprovidersattheendofDecember2016,3,000hadnotbeenprocessed.
Supply:Thegovernment-commissionedreportfromRobynKruk,‘IndependentReviewoftheReadinessofNDISfortransitiontoFullScheme’,states:
Inrelationtothemarketandproviderreadiness,alldocumentationreviewedandintervieweeshighlightedhighriskinthisarea.Thereviewerrecommendsbothimmediateandshort-termactionstostrengthenmitigationandresponsesinrelationtopotentialmarketfailureorprovidercollapse;andtosupportproviderreadinessandmarketdevelopment.
TheAustralianNationalAuditOfficereinforcedthisviewinitsNovember2016reportontheTransitionoftheDisabilityServicesMarket,which
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concludedthatthescheme’simplementationisoutpacingthepreparatoryworkneeded.
ThegrowthindemandforNDISserviceswillseverelytestthecapacityofthemarket.ResearchbyCurtinUniversityandNDSsuggeststhatmanynon-governmentdisabilityserviceproviderslackthecapacitytoinvestinmajorgrowth1;two-thirdsreportthattheyareworriedabouttheircapacitytoprovideserviceswithNDISprices.2Newprovidersarealsohesitanttoinvest.Unlessthenon-governmentsectorhasthecapacityandconfidencetogrowsubstantially,thegapbetweendemandandsupplywillincrease.
Therecommendationswhichfollowareguidedbytheneedtobepragmatic,flexibleandlessbureaucratic;tore-invigoratetheprincipleof co-design,toimprovecommunication;andtoboostsector development.
NotallthepressuresandproblemswiththeNDIScanberesolvedovernight.NDSisproposingpracticalresponsestoimmediateproblems.
• Partner with specialist providers to undertake planning
Thequalityofparticipantplansisinconsistent.Someareexcellent;othersarepoorandabsorbsubstantialeffortbyparticipants,theirfamiliesandproviderstorectify.
Thequalityofplansisimpairedbythreestructuralfactors:
• ambitiousNDISimplementationtargetsaredrivingrapidhigh-volumeprocessingofparticipantplans;
• plannerslackdirectvisibilityofthesupportspeopletransitioningintotheNDIScurrentlyreceive,causingthemattimestoomitessentialsupportsfromplansinadvertently;and
• newly-recruitedplannersoftenlackexperienceandknowledgeofdisabilityservices.TheNDIAmandatesthatLocalAreaCo-ordinators(LACs)whichundertakemostoftheplanninggenerallycannotbedisabilityserviceorganisations,arguingthatsuchorganisationswouldhave a conflict of interest.
Thequalityofplanningwouldimproveifdisabilityserviceorganisationswereinvolved.Providersofspecialistsupportshavedeepknowledgeofdisability–andtheyknowtheirclients.Usingthisknowledgetoinformplanningwouldmakesense.Thisisparticularlytrueforpeoplewithcomplexneeds.
TheNDIArecognisesthevalueofexpertproviderinputinlimited
1 National Disability Services and Curtin University, Australia’s Disability Services Sector 2016, Report 1: Financial Sustainability summary of key findings
2 National Disability Services, State of the Disability Sector Report 2016
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circumstances.Forexample,ithasissuedguidancetoNDISplanners–developedwithproviders–specifyingthesupportsthatshouldbeinabasicplanforpeoplewithMotorNeuroneDisease.
PlanningpartnershipsbetweentheNDIAandspecialistprovidersshouldbeextended.
TheNDIAisreluctanttoinvolveprovidersinplanningbecauseofthepotentialforconflictofinterest.Conflictofinterestcouldbemanagedwithoutexcludingproviders’expertise.Otherhumanservicessystems,suchashealth,achievethisbalance.
TheNDIAcouldmanageconflictofinterestby:
• maintainingtheauthoritytoapproveindividualbudgets;
• continuingtodevelopevidence-basedreferencepackages;and
• supportingparticipantstoexerciseinformedchoiceofprovider.
Themanagementofconflictofinterestshouldextendtogovernmentprovidersaswellasnon-governmentproviders.
• Useproviders’knowledgeofexistingsupportstoinformplans
Topreventinadvertentgapsinparticipantplans,planningshouldcommencewithanaccuratedescriptionofcurrentsupports,sourcedfromtheparticipantandhisorhercurrentproviders.Theapprovedplanshouldmaintainorbuildonthesesupports,omittinganyonlywhentheparticipantmakesadeliberatedecisiontodosoorthesupportisclearlynolongerrelevant.
• Alwaysallowaparticipanttorespondtoadraftplanbeforeit’sapproved
DuringthetrialphaseoftheNDIS,participantswereinvitedtocommentontheirdraftplanbeforeitwasfinalised.Thatpracticehaslargelyceased.Theconsequenceisthatparticipantscanendupwithaplanthatdoesn’treflecttheirneedsandgoals.Someparticipantsreceiveplanstheydon’trecognise.ConsistentwiththeNDIS’sfocusonchoiceandcontrol,participantsshouldalwayshavetheopportunitytocommentontheirplanbeforeitisfinalised.
Peoplewithcomplexconditionsshouldhavecoordinationofsupportsintheirplan.ThisincludespeoplewithprogressiveneurodegenerativediseaseswhoseconditionischangingandwhohavetocombineNDISsupportswithhealthservices.
• InformproviderswhenparticipantshaveanapprovedNDISplan
TheNDIAstatesPrivacyLawpreventsitfrominformingproviderswhenaparticipanthasanapprovedplan.Thisposesafinancialriskforproviders.
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ManyprovidersonlybecomeawarethatatransitioningparticipantwhomtheyaresupportinghasanapprovedNDISplanwhenstateorterritoryfundingforthatparticipantceases.SomegovernmentsceasepaymentfromthedayanNDISplanisapproved.Unawareoftheapprovedplan,theproviderwillcontinuetoprovideserviceswhichmaynolongerbefunded.
ServiceprovidersneedtoknowwhenaparticipanthasanapprovedNDISplansotheycanbilltheNDIAandalignthesupportstheyareprovidingwiththeplan.Consentfromparticipantstoinformtheircurrentprovidersshouldbesoughtduringtheplanningprocess.
• Reducethenumberofassessmentandplanningquestions
Theplanningandassessmentprocessrequiresparticipantstoanswer126questions.Theintentionofsomeofthequestionscanbeeasilymisunderstood.Forexample,‘whatisyourhouseholdincome?’Thequestionnaireimposestoogreataburdenonparticipants,particularlywhentheyareinterviewedoverthephone.Thenumberofquestionsshouldbereducedsubstantially.
• Strengthenthefocusonemployment
Employment–openandsupported–mustbecomeaneasyandattractivechoiceforNDISparticipants.Inits2011reporton‘DisabilityCareandSupport’,theProductivityCommissionarguedthattheNDISwoulddeliversubstantialeconomicbenefitstoAustraliathrough“increasedeconomicparticipationforpeoplewithdisabilities(againstabackgroundofAustralia’slowperformanceinthisareacomparedwithmostotherdevelopedcountries)andtheirinformalcarers.”3
Todate,theproportionofNDISplanswithemploymentsupportsisdisturbinglylow.Inthefirsttwoquartersof2016-17,only2%ofcommittedsupportswereforemployment4andintheOutcomesFrameworkpilotonly13%ofrespondentsreportedthattheNDIShadhelpedwithwork,thelowestofanydomain.5
Abroadspectrumofemploymentoptionsshouldbeopentopeoplewithdisability,includingSupportedEmploymentEnterprises.SecuringaviablefutureforSupportedEmploymentEnterprisesandthethousandsofjobstheycreaterequiressatisfactorilyresolvingwageassessmentandfundingissuesandpromoting(acrosspublicandprivatesectors)theprocurementofgoodsandservicesproducedbypeoplewithdisability.
Buildingemploymentaspirationsandengagementbeginsatschool.
3 Productivity Commission, Disability Care and Support, July 2011 Overview and Recommendations pp 54-55.
4 NDIS, January 2017, COAG Disability Reform Council Quarterly Report, p. 70
5 NDIS Annual Report2015-16, p. 60
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Internationalevidencepointstotheimportanceofworkexperienceandpart-timeemploymentinbuildingworkconfidenceamongyoungpeoplewithdisabilityduringtheirsecondaryschoolyears,beginninginYear10.TheNDIAhasintroducedSchoolLeaverEmploymentSupport(SLES)–awelcomeinitiative.However,accesstoSLESshouldbeabletocommenceearlierthanYear12andanoptionintroducedtoextendtheprogrambeyondtwoyearsifemploymentistheprobableoutcome.
Moremustbedonetoboostdemandfor,andaccessto,NDISemploymentsupports.NDISplannersandLACsshouldadopta‘workfirst’approachwhichmotivatesandassistsanincreasedproportionofNDISparticipantstoconnectwithwork.
• Establishanemergencyresponse
Inevitably,eventsoccurwhichaperson’splancannotanticipate:afamilycarerisinjuredorfeelsover-burdenedbytheircaringresponsibilities;aperson’schallengingbehavioursescalateunexpectedly;theparticipantneedsadditionalpersonalcareorhouseholdassistance.
Stateandterritorygovernmentshaveprocessestoimplementemergencyresponses(mostlyusingnon-governmentdisabilityserviceproviders),butthesewillceaseastheNDISisimplemented.
ItisessentialthattheNDIAestablisharrangementsforrespondingtoemergencies.ItshouldextendtheNDIS1800phonelineto24hoursadayandformemergencyresponsepanelsofdisabilitysupportprovidersinallregions across the country.
Whennaturaldisastersstrike,providerscanincurasuddenescalationofsupportcosts.Floods,forexample,mayforceproviderstostafftheirgrouphomesformanyadditionalhours.Inthesecircumstances,theNDIAshouldcompensateproviders.
• Streamlineregistrationforapprovedproviders
ToregisterasaproviderofNDISsupportsrequirestheNDIA’sapproval.Thisappliestoexistingregisteredproviderswantingtoextendtheirservices,aswellastonewproviders.Iftheregistrationprocessisslow,marketsupplywon’tkeeppacewiththeexpandingdemandforservices.
RegistrationsometimesrequirescomplexnegotiationsbetweentheNDIAandstateandterritorygovernmentswhichadministerthequalitystandardsthatapplytoserviceproviders.Addingtothecomplexity,qualityaccreditationdiffersacrossjurisdictions.
Tostreamlineregistration,anyspecialistdisabilityserviceprovidermeetingthequalityrequirementsinonejurisdictionshould,oncompletionofastatementofintent,beapprovedprovisionallytooperateinother
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jurisdictionstodeliverlikesupports.Theprovisionofthesenewsupportsshouldbecheckedwhentheproviderisnextscheduledforqualityauditing.Thesameprovisionalaccreditationshouldapplytosomeservicetypes,althoughnottohigher-risksupportssuchasSupportedIndependentLiving(SIL).
• Donotprescribetheseparationofhousingandsupportbeyondseparate service agreements
ThewelcomeintroductionofSpecialistDisabilityAccommodation(SDA)paymentswillstimulatehousingconstructionandhelpcoverthecostofmaintainingspecialisthousingforabout6%ofNDISparticipants.SDAisinadditiontoaccommodationsupportorSIL.
Overtime,participantswithbothSDAandSILintheirplanwillexerciseincreasedchoiceaboutwheretheylive,withwhomandwhichorganisationsupports them.
Investorsandprovidersneedpolicyclaritytomakedecisions.Atpresent,thereisuncertaintyabouttheNDIA’sfuturepolicyonwhetherhousingandsupportmustbeprovidedbyseparateorganisations.Atpresent,organisationsthatprovidebothhousingandsupporttoaparticipantarerequiredtohaveseparateagreementsforeach.
InseveraldocumentstheNDIAstatesthatitwill“promotetheseparability,andultimatelyseparation,ofprovisionofSDAandSIL.”However,inDecember2016NDIACEODavidBowentoldanNDSconferencethattheAgencywouldnotinsistonacompleteseparationofhousingandsupport.Thiswouldmeanaparticipantcouldchoosetoliveinahouseownedbytheorganisationthatprovidedtheirsupport.
TheNDIAshouldpublishaclearstatementconfirmingthatitwillnotrequirethefutureseparationofSDAandSILbeyondseparateserviceagreements.Itshouldrequireproviderstohavesoundprocessesforresolvingconflictsifthey arise.
Thereisanunder-supplyofdisabilityhousinganddemandisincreasing.Iffullseparationofhousingandsupportwerecompulsory,non-governmentproviderswouldreducetheirinvestmentinhousingforpeoplewithsignificantdisability,thusexacerbatingtheunder-supply.
• Fundtheusercostofcapitalforrespitehousesanddaycentres
TheNDISfundstheusercostofcapitalforlong-termhousing(SDA)butnotforshort-termaccommodation.Thelatterprovidesessentialrespiteforfamilies,enablingthemtocontinuetheirprovisionofinformalsupport.TherestrictionofSDAtolong-termhousingcouldseerespitehousesconvertedtolong-termaccommodation.Withoutaccesstorespiteservices,morefamilieswouldseekSIL,amoreexpensiveoptionfortheNDIS.
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NDISpricesdon’tcoverthecostofmaintainingadaycentre.Attendanceatadaycentre,includingasabasefromwhichtoembarkoncommunityactivities,isanessentialmeansofcommunityaccessforsomepeoplewithdisability.Itenablesthemtobeawayfromhomeduringtheday(beingaloneathomewhileparentsworkisnotsafeforsomepeoplewithdisability;othersmayliveinagrouphomewhichisnotstaffedduringtheday).Adaycentremaybetheonlybuildinginthelocalcommunitythatoffersfullyaccessibletoiletswithchangetablesandhoists.Thecapitalcostofusingadaycentreshouldbefunded.
• Discontinuein-kindarrangementsthatrestrictchoice
MostAustralianadultsexpecttochoosewithwhomtheylive,butanNDISRulepreventsresidentsofgovernment-rungrouphomesfromchoosinganalternativeproviderduringschemetransition.TheRulerequiresthatwhereanin-kindsupportisprovided,theparticipant’splan“mustspecificallyidentifythatthesupportwillbeprovidedbytherelevantproviderofthatin-kindsupport.”
In-kindarrangementsoutlinedinbilateralagreementsallowgovernmentstofundtheirgrouphomesatahigherratethantheNDIApaysnon-governmentproviders,perpetuatingadisparityinpublicfundingbetweengovernmentprovidersandnon-governmentproviders.6In-kindarrangementslimitparticipantchoiceandcontradicttheprincipleofcompetitiveneutrality.Theyshouldbephasedoutquickly.
• Allowflexibilityinpricing
TheinadequacyofsomeNDISpricesposesasubstantialrisktoserviceprovidersandthustothecapacityofthedisabilitysupportmarkettomeetthegrowingdemandforservices.
Currently,theNDIAsetsmaximumprices(exceptforthe5%ofparticipantswhoself-manage)andiscommittedtoimposingauniformpriceregimeacrossmostofAustralia.Someoftheassumptionsthatunderpinthehourlypriceareunrealisticand,unlessadjusted,willerodethequalityofsupport.Theassumptionthat95%ofasupportworker’shoursofemploymentarebillableunderestimatestheimpactofpaperwork,training,personalleaveandtravel.Similarly,theassumedsupervisionratioof1:15FTEisuntenablewhenthehighproportionofpart-timeandcasualworkersisfactoredin;anditdoesn’tallowthelevelofsupervisionnecessaryforqualityandsafeguarding.
Inthelongrun,theNDIAsayspriceswillbederegulated;butastheeconomistJohnMaynardKeynesfamouslyremarked,“Inthelongrunwe
6 According to the Productivity Commission’s 2017 Report on Government Services, state and territory governments fund their group homes, on average, at $32,510 per resident more than they fund non-government group homes.
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arealldead…”Thequestionis:whatshouldbedonenow?
TheNDIAcouldmakepricingmoreflexiblewithoutjeopardisingthefinancialsustainabilityoftheNDIS,inthefollowingway:
• setindividualparticipantbudgetsbasedonreasonableandnecessarysupports,realisticcosts(derivedfromrealdata)andevidence-basedreferencepackages;
• allowparticipants(theirrepresentatives)andproviderstonegotiatepricesforsupportswithoutexceedingtheparticipant’sbudget;
• publishapriceguidebasedonmarketinformationtoenableparticipants(andtheirrepresentatives)tocompareandnegotiateprices;
• basepurchasingonhoursorondeliverables.Ratherthanspecifyanumberofhoursofsupport,aserviceagreementcouldspecifythetasksthattheparticipantwantscompleted.Forexample,theparticipantagreestopayanamountequivalentto10hoursofsupporteachweek,aslongaseachweekdaymorningtheproviderassiststheparticipanttoshower,dressandprepareameal.Iftheprovidercompletesthetasksin9hourstothesatisfactionoftheparticipant,theproviderstillreceivestheagreedamount.
• Revisethemethodfordeterminingremoteprices
TheNDIAappliesmodestloadingstopricesinregionswhichtheModifiedMonashModeldeterminesareremote.TheloadingsdonotadequatelyreflectthecostsofserviceprovisioninsomeregionsofAustralia,includingDarwin.Providershavenocontrolovermanyofthefactorsdeterminingcostsinareaswheredistancesarelargeandsuitableworkersareinshortsupply.ThegeneralNDISproblemsofpricingtravelappropriatelyandaccessingtransportaremagnifiedinruralandremoteregions.ThemethodforfundingsupportsinthesepartsofAustraliashouldberevisedtoreflectthefullimpactoflocalconditions.
• Workwithdisabilityprovidersasco-designpartners
InthehastetoimplementtheNDIS,theNDIA’suseofco-designhasdiminished.Serviceprovidersareomittedwhenco-designismentionedintheNDIA’scorporateplanandabsentfromtheAgency’sAnnualReport2015-16whenitsays:“TheSchemeisbuiltonaco-designapproachinvolvingcollaborationbetweenmanypeople(participants,community,NDISPlanners,Agencypartners).”
Whileco-designcanaddtimetothedevelopmentandtestingphaseofaninitiative,overthelonger-termitproducesabetteroutcome.ThisisakeylessonfromtheJuly2016launchoftheNDISMyPlacePortal.WhiletheflowofpaymentsthroughtheportalhasimprovedsinceJuly,poorfunctionalitycontinuestoimposecostsonusers.TheNDIAandrelevant
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CommonwealthdepartmentsshouldestablishanindustryadvisorygrouptodesignandtestICTsystemchangesbeforetheyareintroduced.
ParticipanttransportisemergingasaproblemfortheNDIS,withtaxicostsrisingandagrowingnumberofprovidersconsideringdisposingoftheirtransportfleets.Aco-designapproachwouldexploreoptionsabouthowparticipantswithcomplexneedsorwholiveinregionalorremoteareascouldbeassistedtotravel.
• ChangetheapproachtoquotingforSupportedIndependentLiving
Inachangeofpolicy,theNDIAisrequiringnon-governmentproviderstoquoteforallparticipantswhoreceiveSILfunding.TheAgencybelievesthatquotinggivesparticipantsaclearerunderstandingoftheserviceofferingfromproviders.
IfaproviderbelievesthataSILparticipantneedsfundingabovethebenchmarkprice,theprovidershouldsubmitaquote;butnotiftheproviderispreparedtoacceptthebenchmarkprice.ThechangeofpolicyimposesadditionalunpaidworkonprovidersandiscontrarytotheAustralianGovernment’sstatedaimofminimisingtheburdenofregulationon community organisations.
TheNDIAistestingadraftquotingtemplatewithanumberofSILproviders.FeedbacktoNDSindicatesthatthetemplaterequiresfurtherwork.Thereisconfusionaboutthescopeofactivitiesthataquoteshouldcoverandthedrafttemplateprovidesonlyapartialpicture.TheNDIAshouldworkwithNDSandthesectortoimprovethetemplateandclarifythatSILismorethanattendantcare.
• Establishnewpointsofcontacttoresolvetransitionproblems
Duringtimesofgreatchange,frequentandeffectivecommunicationisessential.
CallerstotheNDIS1800telephonenumber(operatedbytheDepartmentofHumanServices)oftenexperiencelongdelays,noresolutionofaproblemandfindthemselvesrepeatingtheirstory.Adedicatednumberforprovidersshouldbeestablishedandstaffrespondingtothesecallsshouldbeabletoprovideimmediateadviceandbecapableofrectifyinganarrayofportalandpaymentclaimissues.
NDShearscomplaintsfromstate-wideormulti-regionalproviders(inNSW,forexample)thattheabsenceofastatemanagermakesitdifficulttoresolveinconsistentpractices(orinterpretationsofpolicy)amongLACsandacrossNDIAregions.WhiletheAgencyhascreatednewGeneralManageroperationalroles,theyareeachresponsibleforfourstatesandterritories.Providerswouldwelcomeastate-widepointofcontactwhoisfamiliarwith
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theissuesinthatstateandhastheauthoritytoresolvethem.
• DevelopandimplementanIndustryPlan
The‘IndependentReviewoftheReadinessofNDISforTransitiontoFullScheme’(writtenbyRobynKruk)flaggedhighrisksfortheNDISmarket,andhighlightedtheneedfor“bothimmediateandshorttermactionstostrengthenmitigationandresponsesinrelationtopotentialmarketfailureorprovidercollapse;andtosupportproviderreadinessandmarketdevelopment.”
Aclearandcoherentnationalindustryplanisrequiredtosupportthesector’sdevelopmentandtransitiontotheNDISmarket.Governmentfundingshouldbeprovidedtoenablethenon-governmentsectortoleadthedevelopmentofsuchaplan.Theplanshouldincludeastrongfocusonworkforcegrowthanddevelopment.Itshouldoutlineactions,timeframes,accountabilitiesandmonitoringarrangements.Anindustryplanshouldbuildonthecommitmentssomegovernmentshavealreadymadetoworkforcedevelopmentprojects(oftenwithafundingcontributionfromtheSectorDevelopmentFund).
• Informthemarkettoassistplanningandinvestment
ProvidersneedinformationtomakeinvestmentandplanningdecisionsastheNDISexpands.TheNDIAistobecommendedforitspublicationofMarketPositonStatements;however,thereismorethattheAgencyshouldpublish.Forexample,dataonpatternsandtrendsinparticipantdemandforsupports.Itshouldcontinuetoexpanditspublicationofdataanalysis.
• Createanationaldisabilityresearchentity
Competitionaloneisinsufficienttodevelopaneffectiveandefficientmarketfordisabilitysupports.Researchanddataanalysisareneededtoassistmarketstewardshiptoanswercriticalpolicyquestionsaboutsocialcapital,marketrisksandworkforcetrendsandexplorequestionssuchashowtechnologywillshapethedemandforsupports.
Currentdisabilityresearchfundingisinadequateandresearchispoorlycoordinated7.ExistingfundingmechanismsfordisabilityresearchsuchastheNationalHealthandMedicalResearchCouncil(NHMRC)andtheAustralianResearchCouncil(ARC)havenotassigneddisabilityresearchahighpriorityandareunderpressurefromotherresearchdemands.
Acollaborativeresearchstructureisneeded,similartothesuccessfulAustralianHousingandUrbanResearchInstitute(AHURI).Itsobjectiveswouldbe:
7 Centre for Disability Research and Policy, 2014, Audit of Disability Research in Australia, University of Sydney, Lidcombe
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• efficientco-ordinationofdisabilityresearchactivities,expertiseandspending;
• appliedresearchtoinformmarketstewardship;
• buildcapacityandcapabilityofresearchend-users;and
• facilitatesystem-wideinnovation.
Theestablishmentofanationaldisabilityresearchentitywouldrequireapartnershipapproachwithuniversitiesandothersandfundingcontributionfrom government.
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Contact:DrKenBakerChiefExecutiveNational Disability ServicesPh:0262833203M:[email protected]
National Disability Services is the peak industry body for non-government disability services. It represents service providers across Australia in their work to deliver high-quality supports and life opportunities for people with disability. Its Australia-wide membership includes over 1100 non-government organisations, which support people with all forms of disability. Its members collectively provide the full range of disability services - from accommodation support, respite and therapy to community access and employment. NDS provides information and networking opportunities to its members and policy advice to State, Territory and Federal governments.