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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.