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6th Annual National Disability Summit

2015

Thursday, 19 March 2015

Held at Sheraton Hotel, Melbourne

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Tina Karas: Good morning, ladies and gentlemen, and welcome back to

our 6th Annual National Disability Summit.

To begin, I would like to acknowledge the traditional owners and

custodians of the land on which we meet and pay our respects to elders,

both past and present.

Before we begin, I will just run through some housekeeping for today.

There is wifi in the room. If you choose the domain informa, the password

is Sheraton1. For those in the room, they are the same details as

yesterday.

If you have been logging on to SlideShare, you will notice the

presentations have been loaded as the day progresses. We will, hopefully

before the tea break today, also load the presentations from the workshop

on Tuesday.

There is also, if you have been taking advantage of the online networking

tool, I remind you that an email was sent out a few days ago, where you

each would have received a unique code which allows you to click in, view

the delegate list which is printed on the notice board. More than just

viewing the names and details of the people in attendance, it also gives

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you the opportunity to contact them via the secure server. That is active

for another two weeks from today.

Just to remind you, in terms of the documentation in your pack, the light

blue pice of paper includes details for SlideShare. Those presentations

are now posted on that server indefinitely, so you should be able to access

last year's presentations by using the code, and if anyone is interested

I can give you that information.

You are also more than welcome to pass on that information to any

contacts or colleagues who would be interested in accessing that

information.

The other coloured pieces of paper are the yellow feedback forms. As

I mentioned, the program is researched and developed in conjunction with

previous speakers, with attendees and with various advocacy groups.

Your contributions and feedback, both to the content and to the format of

the event are greatly appreciated by us as organisers. It is also

appreciated by the speakers. We do collate that feedback, especially the

feedback they receive on their individual participation, and forward it on to

the speakers, so it would be great if throughout the course of today you

can make the comments on the feedback form and we will be collecting

those at the end of the day.

All of the lunch breaks will be served in the foyer.

I would like to thank our exhibitors, Moores and UNE, for their support.

Moores have a prize draw of organic skin care products. We will be

drawing that prize after the lunch break. If you haven't already, feel free

visit their stand and leave your details.

Also today, the hotel does not have any fire drills scheduled, so in the

unlikely event of an evacuation, the hotel has a two-tiered bell system. We

have been advised to exit via the main doors, take the stairs down and you

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will be escorted to the emergency evacuation park, which is Gordon

Reserve.

Now, without any further ado, it gives me great pleasure to introduce to

you our chair for today, Sandy Forbes.

Sandy is principal at Nous Group, a leading management and consulting

and leadership development firm. She has 30 years experience in policy,

strategic planning, service delivery, human services and health and

education. She also has significant experience working with the disability

sector, mental health services, education, aged care services, Aboriginal

justice and vulnerable and disadvantaged youth.

Please join me in welcoming Sandy.

APPLAUSE

Sandy Forbes: Thank you very much, Tina.

Welcome to day 2 of the National Disability Summit.

I too want to acknowledge the traditional owners of the land where we

meet, the Wurundjeri people of the Kulin nation, their elders past and

present, and I particularly want to acknowledge any elders who are present

in joining with us today.

I thought I would spend a couple of minutes telling you about why

somebody from the Nous Group is chairing a National Disability Summit.

First of all, I should tell you, yes, it definitely says "Nous". Someone said to

me as recently as yesterday, "Is it Nu or Nus?" Usually when people ask

us over the phone, they say, "Do you spell that M-o-u-s-e?" So, no, I'm not

a mouse. It is actually Nous.

And that tells you quite a few things about the company. We are an

Australia-wide consulting firm and employ about 150 people.

There are a few things that motivate us, and I need to tell you a couple of

things about that. We are motivated by being bold thinking, challenging,

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producing challenging ideas for our clients, engaging people and delivering

enduring solutions. That is our goal and our aspiration.

We are very proud to have worked with community organisations and

governments as they prepare to work in the new NDIS environment.

The other thing that is really important for you to know is something about

us learning to be a better employer. We have been actively seeking to

have diversity in our workforce and we aim to be a great place to work, so

it is a bit of a learning journey for all of us. So, as employers, we have

worked with employment services to provide opportunities for people with

disability across all of our positions, both in our corporate services and in

our consulting arm.

That's been challenging for all of us, particularly because the kind of

people who come to work in a consulting firm tend to be young, highly

ambitious, those -- is it the alpha type personalities? They are driven.

Then there is a few of us, like me, who have been around for a little bit

longer.

What that means is that we have been able to incorporate a whole lot of

different learning and a whole lot of different diversities into our working

lives. We have learnt how to structure our work a lot better. We have

learnt how to structure and use technology. But I'm not going to say any

more about that because I know Scott is going to talk a lot about the

technology.

We have also learnt when we can and cannot play with the guide dog, who

is a particularly energetic adolescent pup, who really would prefer that we

play, but we are not allowed to.

We are trying to learn as an employer how we break down barriers to

employment, both because we provide that opportunity and also because it

has been an enriching experience for all of our teams.

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To the conference: I hear that yesterday became more and more enlivened

as you warmed to the task, so I'm hoping that you will be very enlivened

and quite energetic early today, then my task will be to keep you sticking to

time, guide the discussion and keep you all alert and energised.

Today we are going to concentrate on how service providers prepare

themselves to meet the new era, in terms of transition to NDIS, supporting

employment, supporting social participation. After lunch we have a very

important session where we will hear from a consumer and carer

perspective and look more at service delivery.

In terms of how I will help you during the day, I will certainly stick to time,

so if your question is too long, I will give you a little signal. If our speakers

start to go on a little bit, I'll give them a little bit of a signal. Let's stick to

time but use the time in the most profitable way and ask and learn from

each other as we progress through the day.

Our first speaker is Mr Adrian Munro. Adrian is the executive manager of

operations of the Richmond Fellowship WA. Adrian is currently working for

the Richmond Fellowship, he has worked as a physiotherapist, he is a

member of the Australian Institute of Company Directors, and has just

finished terms on two boards in WA.

He is a highly motivated individual, he has a strong sense of social justice

and a real passion for managing services that make a genuine difference

in the lives of people. There is a fuller bio there for you to look at.

Please join me in welcoming Adrian.

Adrian Munro: Thanks very much.

It's always easier speaking at this time of the morning, so people should

feel quite energised. But there have been already some fantastic

speakers, very highly credentialled speakers, so quite a sense of pressure

coming up after the people yesterday.

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Before I start, I want to acknowledge the traditional owners of the land on

which we meet, acknowledge them as the holders of Aboriginal culture on

this land.

A bit of an overview of what I have to go through today. It is really looking

at the funding models that have previously existed in Australia, having a bit

of a look at the history of them and really drawing from that to highlight that

so much of what we do and how we do it is actually based on the funding

models that we have had.

Therefore, as we are going into new funding models we need to make

significant changes really across every part of our organisation, rather than

these small incremental changes, because us the funding models change,

a lot of the fundamentals our businesses are built on are also changing.

I'll look at the lessons we have learnt from it, what happens in other

industries. I'm a huge fan of everything that flies and rocket and shuttles,

so I have a way of working those into the presentation as well.

My wife says, I am not funny, do not try to make any jokes, so I will try to

liven it up with interesting things about Concordes and Boeing 747s.

I will also look at the keys to success under the new funding models,

looking at how we capture the difference that we really make.

A couple of the funding models I will go through. I also need to point out

initially that these are five general funding models, but there are obviously

variations within them, so there is no hard and fast rule of exactly what it

looks like. Also I guess it is worthwhile to acknowledge in the room some

organisations work heavily in NDIS trial sites and you are a long way down

the track of what I talk about today, and you will think, "I've got that

Adrian." Other people here may not work in trial sites and it may be

completely new.

Also, I'm aware within individual states the disability funding and mental

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health funding could be quite different, so it would be foolish to think I know

everything about every state. There will be times when you see things

I talk about, you know in your state it looks a little bit different. I'm not

proposing everything I talk about applies 100 per cent to everyone, but you

will be able to pick out the bits.

In general, a lot of us have had block funding previously, where the

government says, this is how much we will spend and that is what we want

to get in return, and by and large there is really very little expected in

return, apart from the outputs. There is very low ability of the government

to have much say over the efficiency, the effectiveness, and it is really the

government giving over lots of money and a lot of control goes out to the

organisations.

There is very little incentive for efficiency and innovation, and I guess

Australian governments, like a lot of governments outside of Europe, have

not been very strong at getting good outcome measures and social returns

and net economic benefits, through really the last 30 years of our funding,

which really needs to change.

In block funding, if you look at the health policy behind it, it is aimed to

capture 95 per cent of the population, where governments say, look, that

extra 5 per cent of the population, law of diminishing returns sets in, it's

double or triple per person to capture them, therefore a lot of block models

aim to capture 95 per cent of the people.

The last sentence there, I have said that many clients miss out on services

are typically inflexible. To the credit of the funders, over the last few years,

I've worked in a lot of programs where that is changing. So PIR, Partners

in Recovery, has a lot of flexibility.

Historically, block funding has been like that, and, as I said, it has typically

excluded 5 per cent of people, but, as I said before, there are always

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variations on the theme, but a lot of us here are familiar with block funding.

There is activity based funding which some hospitals in Australia have. It

is largely used in other OECD nations, where the government says, "This

is how much we are going to pay for a certain procedure," and in hospitals

they can do as many as they want and they will get the money in return. It

really drives efficiency.

Last night I had dinner with a friend of mine who is a consultant neurologist

and he said, "You wouldn't believe it, in Melbourne before midday I do five

cases, whereas in Perth" -- he's from Perth -- "we only do three." I said, "Is

that to do with the funding?" He said, "Yes, the way it is funded in

Melbourne." He said, "The efficiencies, they are amazing. They have

whittled down the cleaning time in the theatres between surgeries, it was

an extra four minutes, they have cut it down by four minutes per surgery,

and you add it up over a day, that's 48 minutes." So lots of efficiencies

come in with activity based funding.

The government can control the cost per treatment but the treatments can

expand, an then the costs can run away. But there are a lot of benefits to

that.

A lot of us will be familiar with packaged care. It occurs in the disability

sector in a number of states in Australia and often happens in aged care,

where the government says, "Here is a package of care. We are going to

give this many dollars but we are going to give it to the service provider."

Where I've said the service provider owns it, the money is notionally

belonging to the individual, but really the service provider owns that

package. Unless the consumer can find a service provider who has a

package at the right price, they can't always get the service they want.

Often they are based on geography; I guess in the old aged care it was

CAPS and EACH and EACHD packages. I guess it has some advantages

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but it is not as consumer focused and individualised as it could be.

Fee for service, like the Medicare model, where the government says,

"This is how much we are going to pay for this type of service and these

are the only services we are going to buy," then healthcare services can go

out and provide those. You see with Medicare, unless you have lots of

caveats and restrictions and controls, there can be heaps and heaps of

services delivered and you can quickly lose control of the costs, as the

Australian Government is seeing at the moment. I guess Medicare is

costing the government a lot more than they ever thought it would

nowadays, because the occasions of services are so much greater.

Also there is an incentive for service providers to provide a service that is

based on them earning more money, which I guess they call it a perverse

disincentive in health economics.

Now we move to the insurance model. As I mentioned a little bit

yesterday, it is a real big paradigm shift. I guess the easiest way to look at

it, when I say to my staff, "Remember it's a big shift, it's not like the funding

we have had previously. You need to think more about your home or car

insurance." That is actually an easier way to understand how it works. It is

a cost containment measure where the government says, "This is how

much we will spend," and there are exclusions, the same way with

insurance.

How often have we seen in Australia where there are floods, and all these

people say, "I was insured," and day after day, these people are excluded

on these grounds. Insurance models have to do that, because they are

based on saying, "This is how many individuals we think will access the

service and we are going to provide that service and it's going to cost this

much," and it is a way of containing the costs.

I guess there is an element of the fee for service in there as well, because

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the government, the NDIS, says, "These are the services that we will

purchase, that is what they look like and this is the price." One change in

WA, the government has said they will be a price taker, but they allocate

prices within a band.

When people talk about funding models, they ask, what's best and what's

worst? There really is none.

I think there needs to be versatility in the way governments supply funding

to different programs. One fundamental key that has been problem in

Australia over the last 30 years with these different funding models is that

any health economist who develops a funding model will always say that

defining the model is just half of the job. The other half is having the

quality measures and the outcome and output measures to gauge if you

are doing a good job. But traditionally Australia has struggled, compared

to other OECD nations in doing that.

I guess that's part of my presentation today, looking at how we can better

capture that. Fortunately, I hear from WA government and federally in

some programs a greater push for this, but the debate on funding models

is not complete unless you look for the outcomes as well.

What motivates funding and governance models in healthcare? It is

certainly not true to say that the one and only and major driver is what's

best for people, because we know that's really not the case. There are lots

of political pleasures from professional bodies, political imperatives,

government cycles, public opinion and also the unmet need of the people

is a key factor.

If you look at the clinical governance model, which a lot of areas in

Australia and a lot of OECD nations have clinical governance, and people

often think, "That is best practice because surely it is best for outcomes."

Actually, it developed in the UK in the early 1990s. Tony Blair was going

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for an election, there had been all sorts of terrible things happened in the

UK health system and there was a lot of pressure on the government to

address it. So they thought, well, this is great, how about we use the

governance model in the commercial world and let's just change it and

we'll apply it to healthcare. They came out with a clinical governance

model, and all these strict governance measures in healthcare worked a

treat, great for public opinion, so now we have seen that developed in

other countries.

That's not to say it's not good. Yes, it's really good to have strict measures

in place to make sure people get the best outcomes but it's not always

driven primarily through client outcomes.

I am going to show a clip, in 1962 in America, JFK is president and

pushing for universal healthcare and he starts off by saying that everyone

over 65 in America should have free universal healthcare. It makes sense

to me. One of the leading doctors, Dr Annis, I will show a clip rebutting

JFK. He was saying, "No, we don't need that." I haven't got the clip here,

he doesn't mention it in this one, but one of the key pillars of his defence, it

is the height of the Cold War, and he says, "This system of taking tax from

everyone and providing healthcare for everybody, that's socialism." He

really stirred up lots of fear in people and said, "Don't let this government

take this great nation down the road of socialism. We are a capitalist free

world."

I will show you this clip, which is really quite fascinating.

Dr Annis: "I say any health program that calls itself insurance and isn't has

to be bad to begin with. What about those who would be covered?

Meaning everyone over 65 eligible for social security. That means

everyone -- the rich, the well to do and the comfortable, as well as those of

low income, whether they need it or not, whether they want it or not, they

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would be in.

"The American taxpayer, whose payroll tax would be hiked by as much as

17 per cent to start with, in order to pay for this program, certainly has a

right to question the free ride. Those who do not need these benefits

would be taking at the expense of his children.

"This Bill would put the government smack into your hospital, defining

services, setting standards, establishing committees, calling for reports,

deciding who gets in and who gets out, what they get and what they don't

get, even getting into the teaching of medicine, and all the time imposing a

federally administered financial budget on our houses of mercy and

healing.

"Ladies and gentlemen, this King-Anderson Bill is a cruel hoax and a

delusion. It wastefully covers millions who do not need it, it heartlessly

ignores millions who do need coverage. It is not true insurance. It will

create an enormous and unpredictable burden on every working taxpayer.

It offers sharply limited benefits. It will undercut and destroy the

wholesome growth of private voluntary insurance and prepayment health

programs for the aged, which offer flexible benefits in the full range of an

individual's needs. It will lower the quality and availability of hospital

services throughout our country. It will stand between the patient ..."

I think the clip is just amazing. The reason why it is empty, it is Madison

Square Garden. The night before, JFK had it completely filled by people

who were desperate to see healthcare come in. They thought it was great.

Why wouldn't you?

So the American Medical Association was so adamant they were going to

combat that, they paid out of their own pocket to rent out Madison Square

Garden and paid for a 30-minute time slot on American TV. There are so

many funny things on there, but one of the things he says at the end, he

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says, "There are few things so close to God as the relationship between a

doctor and a patient." He said, "We, your doctors, know best. Do not

listen to this president." It was amazing.

So, in insurance models -- because, obviously, America is built on

insurance models and there has been changes of insurance models in

other countries -- who survives and who thrives in these models? In

America, it is health maintenance organisations. In the UK, brokerage

organisations have done really well. Why are they successful? Their

entire business model is built on they funding. They come in with very new

models and they are so innovative and they will change very quickly.

Unfortunately, one of the things they do is they provide services at the

lowest possible cost and the they look for the highest amount of volume

and they often provide the lowest level of trained staff possible. The good

thing is that it doesn't have to be that way.

The reason that has occurred is because the other existing healthcare

services have not moved quickly enough, but hopefully today I will be able

to point out some ways that we can move quickly enough, because we

would hate to see in Australia all of the great expertise, knowledge and

passion held by the organisations, like the ones in this room, overtaken by

a large organisation based overseas that comes in and strips away the

quality of service and provides it dirt cheap, and all this knowledge and

passion wilts away.

So there is hope.

Now, you can learn so much from the aviation industry, because we are

going through what they went through in the '90s. Lots of great airlines

were created in the 1920s and '30s, and they went very well up to the

1990s. Then they had a really big change: deregulation, new people came

into the market. The routes were a free for all in terms of who could fly on

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the routes.

The existing ones, the ones down the bottom, Pan Am, Trans World

Airways, Swissair and Ansett, kept their old business models that were

decades and decades old, and thought, let's tinker around the edges and

do things differently. New airlines came in, budget airlines, low cost,

people like Virgin, and they started from scratch. They said, let's design

our business from the very beginning, we are not going to be tied to this

history. A lot of these airlines struggled and they were downsized or they

were bought out and they just didn't survive.

Really, the lesson we need to look at is that we are going through a

significant. For some of our organisations, 90 per cent of the money could

now be in NDIS. This is a massive change. Do not underestimate the

change that it will be and how much change we need to respond as an

organisation.

It is not going to work just by having one or two middle managers

overseeing your organisation's response to NDIS. I know some

organisations are having a really big response, which is great. It needs to

be led by CEOs and executives, it needs to include every staff member.

But it's not good enough to say, "We just employed someone to oversee

the transition to NDIS." That really won't cut it, I suggest.

How do we adapt to this market? This is a model that Eckerman and

Coelli came up with, the define/allocate/cost/count/bill. The other things

are things that I've put in, based on other things that I've read, but I guess

my experience as well, working in the changes here.

So what I have put, you see above the line where there is intake,

marketing and promotion, that is the point where we are trying to get our

individuals to choose our services under NDIS, or an insurance model, and

below the line is when they are actually into the service.

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Lets drill down through this a bit. Marketing and intake: at the moment,

organisations like Richmond Fellowship have some skill in marketing and

promotion but we are not good at marketing ourselves in a commercial

competitive environment, and the same probably goes for a lot of us. That

is a skill we need to learn, because it is not the case any more that we hold

the funding and individuals need to come and find us.

The intake role is now crucial. It has to have a customer service focus.

The difficulty is you need to have someone with clinical skills and

assessment and judgment, absolutely, but they need to have really good

customer service skills.

That is an interesting challenge for us. There are systems out there in WA

to help organisations, but that's a real paradigm shift for us in promoting

ourselves and marketing ourselves.

Every one of our staff on the frontline also need to know exactly what we

do under NDIS, what are we able to provide. Because people will be

asking around the community. If they ask one of our staff at a forum, our

staff will have to be able to say, "Yes, this is what we do, we can help you

this way, this is how you find out more." It's not going to be good enough

just to call some number off in the ether, that's not good customer service.

The next five points, part of it is what organisations do and part of it is what

the government does. This is really fundamental to how an organisation

thrives under insurance or fee for service.

The first thing is defining the service. The government has service items,

or clusters; there are a few different names; in WA we have the My-Way

program as well. The government says, "This is what these services look

like and this is the definition of that service." We need everyone in our

organisation to know what those services are and what they mean,

because no longer are we in the world of block funding where we get

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money and we can provide, like in PHaMS, and say, "What does the client

need today," and we will help them. No. We have to provide a very

specific service, because the government says, "This is what we will buy

and this is how many minutes a week we will buy."

The government defines the services and we need to know what those

services are.

The next thing is to allocate. You need to be able to allocate that service

you are doing today. As an example, a staff member at Richmond

Fellowship, or any organisation, is going out on a given day, they need to

be able to say, "Today our organisation is being paid to provide this

service, that is defined as this, and what I'm doing now is allocated to this

line item in this individual's plan." You can't say, "I'm spending three hours

with Bob today."

You have to allocate that and you need client information management

systems and billing systems, where you can allocate that. You can say, on

the computers, "Staff member X went out and provided this service to this

client at this time for this long."

These things are not easy to do, they require the whole organisation, all

your people in finance, all your systems processes, people in head office,

they need to know what the groups are, they need to be able to allocate

services to individuals.

Again, intake is critical. If you make mistakes at this step, you can lose a

heck of a lot of money because you will be billing incorrectly.

Governments are not typically great at getting back to service providers

and saying, "Hey, you know what? You underbilled us. We owe you

money. We have been running checks and here is all this money we owe

you."

At this stage, if it is done incorrectly, you lose track of the services you

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provided, and then you may end up down the track not billing the

government for what you have actually done.

If the portal runs really effectively, that should be overcome, but nothing is

perfect.

Cost: this is nothing new to everyone but you need to know exactly how

many dollars it is costing you to keep your staff members doing the job

they are doing. That has to include absolutely every single cost, every

overhead, direct, indirect, fuel, car service, training, the admin people, the

rubbish collection, absolutely everything. Because you need to be able to

say, every single day, this staff member, it cost us $400 to keep them on

the road and they earned $430. You need to be able to say that every

single day for every staff member, because if you can't say that, you don't

know if you are losing or making money and it might be six to eight weeks

before you find out.

So you need to know absolutely the cost you are working on, because we

don't have the luxury of block funding, to say, we have got all this money

and if we spend a little bit less in the first six months of the financial year,

then we use that underspend later on in the year. We don't have that

luxury any more.

We need to be able to count all those services. So this is a client

information system or billing system, and there are a lot of programs out

there. Nothing comes perfectly off the shelf to adapt, you need to be able

to change it and apply it to what you do.

You need to be able to count the services and allocate them to people,

which then comes to the billing. You need to be able to use that

information to export that to the government, in whatever database they

have, whether it is the portal -- as I said, in WA there are two systems we

are working on -- but you need to be able to say, "These are the services

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that were provided to these individuals at these times on these days and,

government, this is how much you owe us as a result."

You can spend a huge amount of time correcting these and inputting them

and double-checking them if you don't have systems and processes that

really flow and really work.

The challenge of this is keeping a values base. Because this looks very

money focused, very money driven, efficiencies, outputs, that staff member

can't spend that extra two minutes there because they are not paid for that.

It is really difficult. I would be a fool to sit up here and say, "Just remember

your values base," because a lot of our organisations are values based,

there would be a lot of NGOs here, but that's not to say that a for profit

can't be values based and person focused. But it is very difficult to keep a

values base, and a lot of organisations that have succeeded in these

models in other countries, unfortunately, in my view, don't have a values

base, they are very profit driven, margins, money.

I guess the difficulty is if you are a values based organisation and you

provide some services that run at a loss, but are just so amazing in

reaching the community that you want to keep providing those, that is a

challenge financially but it is really powerful for your organisation.

Social impact and net economic benefit: gone are the days of any sector in

healthcare or social services or human services being able to say, "We

know we make a good difference in the community just because we do."

We get a couple of stories from individuals, and we just know we do great

work.

That may be true, but we are competing against hospitals and primary

healthcare that have rolled gold double blind randomised control trials, that

say, "Government, this treatment works, we can prove it and this is how

much you are saving, because this person had a knee reconstruction and

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they got back to work, therefore they are paying this much tax." That's

what we are competing against. If we want to get money allocated to the

disability or mental health sector, we need to seriously invest in these

areas.

It can be really complicated, that is why I have written there that

universities are the greatest people to partner with, they have that

expertise. We need to be able to show the social return on investment and

the net economic benefit of what we are actually doing. Otherwise, how

can a government honestly justify allocating money to our services?

There are lots of great stories and it is really important to capture those. At

Richmond Fellowship we call them recovery stories, examples of

individuals recovering, and they are really powerful. But money is getting

tight in Australia; you are probably aware, the iron ore price is dropping

and the government is getting less revenue. Tough decisions will be

made. We need to compete.

I absolutely believe that the disability and mental health sectors make such

an amazing difference and community based healthcare makes an

amazing difference to our communities. I wish there was triple the amount

to spend. I would love to see less money in hospitals and primary

healthcare and more in our services, but we need the evidence to justify

that to government.

There are lots of great speakers at this forum, but if you just remember one

thing from my presentation, it's not about the medical association or

anything I've talked about with Concordes, remember this: the magnitude

of the change in your organisation has to match the magnitude of the

change in the environment and the funding model.

If your service is going wholly and solely into NDIS, it is a massive,

massive change. Do not underestimate the change. It is not just an

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incremental change and tinkering around the edges, it is a real

fundamental change.

One other key to success: listen to your clients. In the late 1950s, the jet

age was launched, no longer do people need to fly in propellered

aeroplanes that need to stop every 600 or 700 ks and only go 0.6 the

speed of sound. Two very different approaches were adopted. Boeing

says, "Okay, we need to consult with the people. We need to get this right,

we are going to ask the people who own airports, the people who fly on

aeroplanes, the people who send freight on planes and the airline carriers,

and we are going to take our time to get to the best model."

Concorde comes up with a different model. They say, "We are going to go

to the scientists and we are going to say to them, 'You build us the best,

fastest machine possible,' because surely we will win this race in air travel

if we get the fastest moving plane."

So the scientists went off and they built an incredible plane, which goes 1.8

times the speed of sound. People might think, what does that mean? It's

got a jet engine, it's not an air breathing engine, like these planes -- and I

could talk all day about that -- but it's more like a NASA shuttle than an

aeroplane. It gets so hot on the outside when it breaks the speed barrier,

it's got these really heavy tiles, just like the NASA shuttle. It's got these big

scramjet engines that are really loud, amazingly powerful. It is an amazing

feat of engineering. It's incredible.

The problem was that when you apply it to the airline industry, it was really

unsuccessful. If you're going to cover your whole plane with really heavy

tiles to shield against the heat, that's really heavy, that takes a lot of fuel to

power that thing. It could only really be used for passengers, not freight,

there was not a mix of that. It needs a long runway, and that prohibits it

landing in certain places.

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One of the biggest barriers, no one likes a sonic boom going off over their

head, and it is really loud. Imagine if you bought a new Ford Focus and

you drove it and it was really great, and then the car dealer said, "Look,

one problem: when you're going into your driveway or when you're just

driving around the shops, at 10km/h in first gear, you've got to rev it at

12,000 revs." You'd be, like, "What? That's so loud!" That's what a

Concorde does. No one likes that. It really doesn't work. Of course, only

15 were made, it had a very limited market and was ultimately

unsuccessful.

Boeing had a very different approach. The scientists came back and said,

"This is the plane we think we should make for you," and Boeing said, "No,

that's not going to work, because British Airways and Qantas don't want

that, the customers don't want that, the people who run the airports don't

want that. This is what we want." The scientists said, "You're never going

to get that. This is not going to happen."

Boeing were steadfast, they took an extra few years and they said, "No,

this is what we want. You guys build it or we will get some other people to

build it." They got what they wanted. They have the most successful

plane. Every five seconds around the world, two 737s take off. They have

built thousands and thousands. Boeing makes billions and billions of

dollars every year.

What is the moral of that story? The moral of the story is that in the 1950s

Boeing knew that if you wanted to have a successful business model, you

needed to ask the people who were actually using your business. Don't go

to the experts, who will impose a model.

The same applies in our sector of disability and mental health. If you want

successful model, go to the people using your service, ask your

consumers and ask their families, and you build a model based on that,

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because they know what they want.

It's very easy for someone like me to say, "Well, I'm an expert, I've done a

degree in physio and I work as a manager." It's very easy to say, "The

consumers, they wouldn't understand." Maybe it's executives like me who

don't understand and I need to learn off the consumers who live with their

impairment or live with their mental illness every second of every day,

decade after decade. I think they have the lived experience and the

knowledge.

I would implore you, if you want to build a successful model under NDIS, or

under anything, listen to the people who use your service, they have got so

much expertise.

I hate to see experts who think they have to dumb down things for

consumers, "They wouldn't understand" or "It's more complicated than

that." Actually, often it's not.

You read in here, one of the most important things is to keep it simple.

NASA, that was one of their key mantras, and still is. They build the most

complicated flying machines possible, but their mantra is keep it simple,

what's the simplest way we can do this? They are really amazing

intelligent people, who you would think they would want to show how smart

they are, but they have to keep it simple, that's what they do.

Other keys to success: measure your outcomes, look at the social return

on investment and the net economic benefit. This requires some research

and talking to universities.

Aboriginal fellowship, how do we measure value for money? I'm not

saying by any means that we are the world's best, we're not. We are at

the very beginning of the journey, like a lot of people. I don't know

everything about this, I just know that we need to do it.

We look at real tangible things. We want to be able to say to the

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government, "You gave us money to assist some of the most

disadvantaged disempowered people in our community and, as a result of

us supporting them, this is what they have been able to do. They have

been able to no longer need to live off welfare, they have done training and

education, they are no longer going to hospital as frequently, they are now

working, they are paying taxes, they are not living on the streets any more,

they have less contact with the Justice Department, they are now

participating in the community, they are volunteering." If you can show

that, no government can ever say, "Well, that's not worthwhile funding."

Governments will absolutely love that, because they love getting up in

parliament and saying, "Look, Mr Speaker, we funded this project and look

at the great outcomes." Of course they will take credit for it, but if that

means our funding is continued, I'm happy with that.

These are some real practical tangible things we can do that evidence that

we make a difference, in a way that the government really pays attention

to. Yes, it is still absolutely important to capture the stories and the

narrative, that is so powerful, but when we are talking to funders, this is

what they want to see.

The questions we need to ask ourselves: how do we maintain the values

base in this new model? Leadership is so important. Leadership often

isn't spoken about as much as it could be in healthcare. It so important to

have strong leadership where it is embedded in the culture, where we are

talking about it at staff meetings, where we are discussing in staff

performance reviews, "How did your performance and your attitude reflect

the values of this behaviour? In that situation, how did your response

reflect the values of the organisation?" Nothing will ever beat strong

leadership in having a values based culture.

Always keep at the forefront of the mind of everyone and look for

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opportunities to continue services that might lose money or might just

break even but are really powerful in the mission of the organisation.

One or two minutes: almost finished. How do we stay financially viable

and compete against large organisations? Invest in your IT, your client

information. Do not underestimate the change and leave no stone

unturned.

What skill sets do we need? We have done some training with some of

our staff around customer service. It seems to strange. The training was

delivered by someone who is not a healthcare expert, they are a customer

service expert, and the paradigm shift from staff was amazing.

What is important is the change from this idea, "I'm an expert because

I have a degree and you don't know anything and I'll tell you what to do." It

really changes things. I always say to my staff, "It's a person to person

interaction. Who cares what role or what qualification you have? That

individual knows their life better than you will." They are our customer. If

we were working in retail, we would say, the customer is always right. We

need to adopt that approach.

This is a good question I can ask with 30 seconds to go,

because it always gets raging debate. I would advocate

that, as a sector, we should push for stronger

accreditation. In WA in the disability and mental

health sector, the expectations are much lower than in

hospitals and in aged care. There are all sorts of

debates around that. But I know it is easier for

governments to put money into services that have really

high accreditation standards. I know it is onerous and

costs a lot of money and it may often not be highly

linked to outcomes, but governments look at that, so

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I'm a big advocate for that.

The last slide, in summary: change is here, whether we like

it or not. History shows that if you want to stay in

business you must also change. That change must at

least match the magnitude of the change and we are

going through a significant change.

It requires an all of organisation approach. This is a

time to be innovative, we have to maintain flexibility

and customer information and look at our evidence base

as well.

A few references, which are on the slide.

I'm not sure if I have any time for questions.

One question. Hopefully there is one easy question.

Sandy Forbes: Are there any questions for Adrian?

Question: Can you put up the original diagram?

Adrian Munro: The model. This will be available on the net as well.

Question: Hi, I'm Pam Quallo(?) from the community justice program, we

work in age and disability and home care in New South Wales.

Most of our services are block funded at the moment and most of our

clients spend a fair bit of time in and out of custody. So how does block

funding transition over to a more individualised service, if they won't get

funding while someone is in custody?

Adrian Munro: I'm not sure of your program specifically, but what I do

know is in what's been shown, is that block funding does work really well in

complicated areas like mental health. There were some countries in

Europe who went to activity based funding, fee for service, in all of their

services and found out that in mental health it didn't work. It worked for

acute and subacute services.

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This is why a mix of funding models is always best. There are some

services that need to be block funded. There is significant research going

on in Australia at the moment around Aboriginal services and maintaining

block funding there, and the research shows that some services just have

to be block funded, especially the really complicated challenging area you

are working in, you need that flexibility of block funding.

Sandy Forbes: Please join me in saying thank you to Adrian.

APPLAUSE

It is my pleasure to introduce you to Dr Scott Hollier, who is the WA

manager of Media Access Australia.

Scott is a leading authority in the area of access to computers and the

internet for people with disability. He will tell you what that all means, I'm

not even going to try.

He can also provide a very personal perspective, as he is legally blind and

relies on assistive technology to use computers. He is a recognised author

and he is the author of Media Access Australia's 'Sociability: Social Media

for People with a Disability' resource, which is now being used by the

United States Government to help agencies improve accessibility.

Please welcome Scott.

APPLAUSE

Scott Hollier: Good morning, everyone, thank you so much for the

opportunity to speak to you today. It is an absolute privilege.

I will be talking a little bit about how to support the communication needs of

people with disability around employment, and some of the things we have

picked up along the way in terms of what people have shared with us, and

in turn the information we have put together to help provide that to each

other.

Before starting, I want to say I'm a little bit jealous of our previous speaker,

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because I have also come over from WA and my get up and go in the

morning I do not think is quite as good. I'll be the one hugging the coffee

at the break.

Just briefly about the organisation I represent, Media Access Australia, we

are an independent not for profit organisation dedicated to providing the

media needs of people with disabilities. We focus particularly around TV,

DVD, digital online media and education and we aim to be a catalyst for

change.

Sandy has done a great job in introducing me, but I have a professional,

academic and personal knowledge in this area, and these issue are all

very close to my heart.

The eye condition I have is retinitis pigmentosa. In my particular case,

I have very narrow tunnel vision and I have no night vision, so in dark

areas it is a bit tricky. Also I have a bit of flashing in my eyes, a bit like

when you might briefly look at the sun and look away, you get those spots;

I have those all the time. While the prognosis for my condition is not the

best, to be honest, I have been very fortunate in life.

Coming from Perth, my friends aren't too worried about my disability, but

they cringe that I follow St Kilda in the AFL; very comfortable being in

Melbourne today.

I would like to share today some of the questions we get asked when it

comes to employment and supporting employment of people with

disabilities and sharing what has changed in this area, what technologies

are available in the workplace and how we can best support the needs of

people with disability.

There are three key questions we get asked. The first: how to make sure

that job seekers with disabilities can get the best opportunities when it

comes to ICT to be able to get involved in employment. The next one is:

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how do make sure our environments are as accessible as possible?

That's a really important thing which I will talk about a lot. The third

question is: how does the NDIS fit into those first two questions? I'll look at

that at the end.

To start with, what are the main things that have changed as time has

gone on?

There are three main things that have improved a lot when it comes to the

provision of accessibility. The first one is that mainstream technology has

improved a lot in recent times. By that I mean the accessibility features

available in Windows, Mac, iOS, android. Five or six years ago, if I wanted

to use a computer, I would have had to spend a lot of money on assistive

technology, there would be a lot of time around the process. While the

NDIS has helped with that, what is great is that in the typical office

environment today, the computers and mobile devices available are quite

likely to be accessible for many people with disability. So that's a great

step forward.

The second thing is around website accessibility. The government has

recently finished their transition strategy on making websites comply with

accessibility standards. The Human Rights Commission has a bit to say

on this and I'll touch on that shortly.

Importantly, we now know not just what to do in terms of the accessibility

features being available, but through making our websites accessible, we

can make sure those tools can be effective.

There is the role of the NDIA looking at the NDIS. I am a very strong

supporter of the NDIS and I'm a great believer that it is having a real and

profound benefit to the lives of people with disabilities. But there are a few

gaps in terms of some of the ways technologies are assessed and the

availability of mainstream technologies, feedback we have received,

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conversations with organisations and service providers, and also I have a

little bit of personal experience through the Perth Hills trial and some of

those issues need to be explored as well.

To go back to the first question, looking around, job seekers with

disabilities, what can be done to assist when it comes to technology? The

points here are both things that job seekers have shared with us in their

experience but also in terms of disability employment agencies and other

organisations have given to us some good tips.

One of the things that is often shared with us is that because the typical

office environment does have current operating systems and there is a

need to make sure those have accessibility features, it is really key that

people with disabilities are aware of those accessibility features in typical

operating systems like Windows, Mac and android, so when they come to

the office environment and they are seeking employment, they know with a

fair degree of certainty what is in the office and what their capabilities are.

If those tools aren't good enough, then at least they also understand what

type of specialist assistive technologies they might need and how they can

get up and going quite quickly.

One of the other things is that disability employment providers say they are

now trying to find out in advance what the office set-up is. For example, if

the office has a Windows 7 standard operating environment, that will have

some great accessibility features built in, but if it is Windows 8.1, there is

even better accessibility available, particularly with the screen reader and

devices being touch enabled. What is in the office and what is available

will make a difference and any heads-up for potential job seekers about

that is really helpful.

The first point is something I hope will disappear one day. I think it is

starting to decrease a bit. We still get told time and again that a person

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with disability will be in an employment situation and will often have to go

through the conversation of, "Okay, so you have a disability. How do you

use a computer? I don't understand."

Having that conversation come from the other side of the table means you

first have to prove that you are capable of using and computer and then

get on to addressing the job criteria. This can be quite challenging.

One of the things we found is that it is good for people with disabilities, job

seekers, to be prepared to answer that question, however unfair that

question may seem to be. If you can say with confidence, "Look, your

office environment has this version of Windows or is likely to be this and

I'm comfortable with that," or you can say, "I understand what your

environment is like and I can get the processes going to get set up in that."

If you can take away the fear of cost and time from a potential employer,

that can make a big difference. Again, I hope with the NDIS and other

things, that question will gradually disappear.

On technology, one of the great things is that where

mainstream technologies do fall down, there is often

good free assistive technologies. For example, in

Windows 7, the screen reader narrator is not great, it

is better in Windows 8.1. But if it is a Windows 7

office and a blind person wants to use a computer, they

can get a free NVDA reader on a USB stick, either as a

permanent solution or a stopgap measure, while

something like Jaws or something is sourced. That can

be a really good option.

With that in mind, let's go to the other side of the table

and look at the person doing the interviewing and the

recruitment. What are some of the things we have been

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told from employers are particularly good, and also pet

gripes from job seekers?

The number 1 thing people seeking a job say is really an

issue to us in terms of job seekers with disabilities

is scanned pdfs as jdx. The reason being is that a

common process -- I think it is starting to drop off a

bit now -- it is a story we hear a lot, particularly in

government, that a job will be advertised, that job

description will be typed up in a Word document, but it

has to be approved, so the document is printed out,

signed off by the manager, and that document is scanned

back into the computer, made into a scanned pdf, put

online, and that pdf is then completely inaccessible.

I guess a call would go out, while I fully understand the

need to ensure there is a sign-off process for any job

description, it is really important to make sure that

that accessible document is available. Yes, by all

means have that signed pdf but perhaps the document

that can actually go online can be the accessible

version.

We also need to make sure -- it is also imperative to make

sure at the interview process that people have an

opportunity to ask what the person, the job seeker,

needs from technology.

This is a very different question to the earlier one about

how you use an computer. This is a more inclusive

question, saying, "How can we support your ICT needs

and what do you need, if you need any assistance?"

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This is something that is important. Again, it is

important to structure that question differently to the

question previously on the slide, to show you are in a

supporting environment, and that can make a really big

difference.

Next, be open to possible different interview techniques.

For example, people who are deaf or hearing impaired

say they would like to communicate in an interview via

TTY, or phone might be an option or a written

application might be an option, so being flexible

around that is great.

Tying in with the last slide, importantly employers should

try to make sure they keep the assistive technology and

the mainstream operating systems up to date in

organisations. The more up to date the version of

Windows or iOS is on Apple devices, the better chance

there is that a person with a disability can come into

an organisation and get up and running quickly.

With that in mind, how exactly do we make sure our

mainstream technologies are ready to roll and what are

the accessibility features in them that people with

disabilities are likely to use?

What is exciting is that the current versions of Windows,

Mac, iOS and android are all very accessible,

especially when compared to a few years back, and in an

office environment you can get up and running fairly

quickly. We look at things like in Windows 8.1, you

can change the icon and the font size, having a high

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contrast colour theme, having things like toggle keys

and sticky keys, where if you have a mobility

impairment, instead of holding down the ALT key and

pressing F, you can press one then the other, which

makes a big difference.

The ability to magnify is something I use a lot. I use a

high contrast black theme and screen magnification to

help in my work. Also, the narrator screen reader, not

great up to Windows 7, but in Windows 8 is a lot

better, and the free NVDA makes a really good option.

In Windows, out of the box, if it is a current version of

Windows it has a lot of accessibility to offer. Again,

it changes that conversation from employers being

really concerned as to how a person with disability is

going to use a computer and makes it more, that they

have quite a lot of help, and you can look at other

options from there.

On the Mac side of things, for the most part, Macs are the

same as, if not more accessible than, Windows. They

have a good screen reader in the form of voiceover

built in, to assist people who are blind or visually

impaired. They have full supports across captions and

many of the other accessibility features in Windows.

The only major downer to the Mac is that unfortunately

Office for Mac doesn't work very well with built-in

assistive technology. Not a fault of Apple, given that

Microsoft created Office for Mac. But it is a deal

breaker and something that people have said to us makes

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it challenging to use Mac in the workforce, because

using Word, Excel and so on is a very common thing to

do in the workplace. There are a workarounds -- Open

Office for Mac is not too bad -- but this is a weakness

of Mac and often Windows is the preferred choice.

Recently we have been getting a lot of questions about

iPads and iPhones and even the Apple watch, being due

out not too far away. Apple do shine when it comes to

accessibility for their mobile devices. When it comes

to iPhone and iPad, both are quite accessible out of

the box, having a voiceover screen reader, the

magnifier, the ability to invert colours. If you are

hearing impaired, you can push all the audio into one

ear, and a number of features along those lines.

There is a great crowd sourcing site, viz.com, which is

crowd sourced. People post apps which are very

accessible and comment on ones that aren't. There are

some great resources out there for mobile devices. We

find more and more people want to use mobile devices in

the workplace. It is great. Whilst the Macs don't

have the touch support like Windows does, iOS really

shines and you can connect a Braille display, a

bluetooth keyboard and other things to assist with

that.

We are just recently getting a lot of inquiries about the

Apple watch and how accessible it is. Apple haven't

officially announced their accessibility features but

we have it on very good authority that it has similar

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accessibility features to iOS in terms of the voiceover

screen reader, zoom and high contrast themes. That has

not been officially announced, so we will look at that

and do more testing.

If anyone out there wants to pick up the $14,000 18-carat

gold version of the Apple watch and send it to me for

testing, I'll pass to my details in the break.

What about android? Android is the most popular mobile

platform in the world, more popular than Apple, mainly

because of the price point. You can get tablets for

$60 or $70 on eBay, which contain accessibility, so

this has piqued the interest of a number of employers

about having cheap affordable devices, and happily

accessibility comes into play as well.

We look at the talkback screen reader, which is very

accessible to support people who are blind or vision

impaired; we look at zoom; now there is global caption

playback, which is a great addition; also in android

5.0 lollipop, there is switching added and better

contrast.

The important thing to think about with android is that if

it is older than 4.2 jellybean, it is not worth it.

Android has evolved a lot with accessibility in the

past 18 months, but if you have an android device older

than that, it is not going to be very accessible.

When I talk about jellybeans and lollipops, people ask why

I'm so hungry. Google name their versions of android

after desserts. 4.2 is jellybean, 4.4 is KitKat, 5.0

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is lollipop. If anyone thinks of starting a betting

pool at the break about what M will be, my tip is

marshmallow.

That basically covers a bit of the different competing

operating systems and what accessibility features are.

It is exciting that devices have evolved to a point

where there is a lot of accessibility out of the box.

Whilst there are a lot of specialty products that are

still needed to provide support with people with

disabilities in the workplace, the tools which are

there for a lot of people are enough and, if not, they

might be a good stopgap measure while additional tools

are sourced.

Then we swing to the second of the questions we often get

asked: how do we prepare our workplace to make sure ICT

is effective for people with disability we employ, and

how can service providers and disability employment

agencies help support in terms of preparing that

workplace?

Really it comes down to the different roles. The key thing

is to make sure that every organisation has an

accessibility culture from the top and, from there,

different roles can take different responsibility for

accessibility.

What's nice is that it's not the case that everyone has to

know everything about accessibility. It's really about

making sure there is that culture within an

organisation and that the relevant roles understand

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their part in terms of making accessibility happen.

With that in mind, a good place to start is policy. When

it comes to accessibility policy, the definitive

international global standard of accessibility for the

web is the worldwide web consortium's web content

accessibility guidelines, or WCAG, 2.0. Many of you

will probably be familiar with WCAG, which is a series

of guidelines to help developers incorporate

accessibility into things like websites and web

content.

This is the absolutely critical thing to be aware of. It

is not just a WC3 standard, which is the global

organisation around web standards, but it is also an

ISO standard, which is a great thing as well.

The federal government recently completed a transition

strategy so in theory all government websites should

comply with WCAG standard level AA, which is the

intermediate requirement. If anyone is interested in

the levels, I would be happy to chat at the break. It

is a long story as to why AA was chosen; I would be

happy to chat more about that in the break.

It is also important that the Australian Human Rights

Commission has said WCAG2 to level AA is a requirement

across all sections of Australian industry, so it is

something that it is absolutely imperative to do.

Also, if we don't do it, there are issues around

section 24 of the DDA, and in terms of the United

Nations rights of people with disabilities, it falls

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under that as well. WCAG2 is absolutely essential. If

you are not across that, I would love to talk more at

the break.

We now move to the roles of ICT in our organisation and

what we can do to make sure our ICT staff, the people

in charge of our websites, content producers, can apply

WCAG2 to what they are doing.

WCAG2 has 12 key guidelines, and one of the highlights is

making sure there is alternative text for images. If

you are using a screen reader and things are read out,

make sure people understand what those images are.

Captioned video support is absolutely essential in

making sure people who are deaf and hearing impaired

can get access to videos. I will explain more about

how that can be done when we get to YouTube.

Colour contrast is absolutely essential. One of the big

issues we get back from organisations with colour

contrast is they say, we have our branding colours and

we really have to work with them. I do feel your pain

when it comes to how some branded colours aren't very

contrasting. Ultimately, if you can do the best you

can, that's great. We all agree, light grey and hot

pink are not the best colour combinations. There are

some obvious ones to stay away from.

Not having enough time to do things is something that has

come into prominence recently. There was a case just

settled, about a month ago, around Coles and a blind

woman who was unable to successfully purchase groceries

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from the website.

One of the issues around that was that it often takes

longer, when you are using assistive technology, to

make sure you can get everything in your shopping carts

and get to the other end of the process. It is

frustrating when you have a time limit to do something,

it takes a bit longer, you finally get to the end, you

click on the checkout button and it says time-out,

which is an absolute killer. That is something which

has been a particular problem recently. Also the need

to make sure that we can avoid and correct mistakes,

particularly when filling out forms.

That looks at policy in ICT.

What happens with documents? Most people in organisations

will be writing documents. This comes to content

producers, how you make sure those are accessible.

A few quick tips for staff in this area. Firstly, making

the choice between HTML, a Word document and a pdf

document is important. HTML is the more accessible of

the three, but I appreciate there are circumstances

where you need each of those. Just consider carefully

what your options are. If you are dealing with HTML,

WCAG 2 applies.

One of the big tips for content producers, people like to

say, for a link, "Click here". You can appreciate, if

you are using a screen reader and jumping from link to

link with a keyboard and it says, "Click here", it's

hard for people to understand what the content is

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about. Instead of saying, "Click here to go to the

NDIS website," you could change that and say, "For more

information, go to the NDIS website," with the NDIS

website as the link. It's not something that takes a

lot of extra time or effort, it's more a case of

structuring things differently to make it happen.

When it comes to Word, the best tip is to look at styles.

Also, if you are using Office 2010 or 2013, there is a

built-in disability checker, which is fantastic. When

you finish the document, run the checker and it will

give you a heads up of what accessibility issues might

be there and how to fix them. That is from Microsoft,

giving you more accessibility on their platform, which

is encouraging, and that is a very helpful tool.

Pdfs are a particular bugbear for many people with

disability, particularly if they are scanned. That's

not to say you can't make pdfs as accessible as

possible. I know the world uses pdfs, so I don't want

to trash pdfs in their own right.

One great thing to do is to make sure documents are well

tagged and also, for your staff, make sure they are

based on accessible documents. If you are creating a

pdf from a Word document, use the checker to make sure

the document is accessible and create the pdf from

that, and that will be a lot better.

One of the things that is becoming more and more prominent

is the importance of social media when it comes to

reaching people with disabilities. It is absolutely

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critical for all our organisations that when we have

personal communication, changing the net from being an

information resource to a more personal experience, it

is done in an accessible way.

I'm happy to report that in the past 12 months, Facebook

and Twitter have really stepped up in trying to make

their portals accessible. In 2012 there was a big

survey done and a test of the social media platforms,

and Twitter came in at zero per cent accessible at the

time. What's great is that Twitter have taken that

feedback on board and both Facebook and Twitter have

dedicated accessibility teams now, and we have seen

massive improvements over the past 12 months or so,

which is a very exciting.

A few tips around this: consider using relevant hashtags

when you are tweeting. #A11y is accessibility. If you

are interested in why #A11y, it is because there are 11

characters taken out between the A and the Y in the

word "accessibility", so that's their way of shortening

that one.

There is also an assistive technology help desk for

Facebook, which is great, and an alternative Twitter

portal, when it wasn't very accessible, called Easy

Chirp, which is a great name.

One of the things I want to come to now is about YouTube.

A lot of people say, "I would love to caption my

YouTube videos but captioning is a very long, time

consuming and complicated process." Often we find in

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organisations, even ones with really good accessibility

culture, there is a reluctance to caption videos.

One of the great things about what YouTube offers now is

that you can get the captions automatically done.

There is a process option in the settings where Google

uses the automated captioning feature to caption

videos. I say that and I put a little asterisk and a

disclaimer on what I have just said. Because it is an

automated process which analyses your video and tries

to give captions, if your video is a talking head with

low background noise and the accent is slightly

American, your captions will turn out reasonably well.

If it is two kids on a skateboard flying past the

camera screaming something, you have got no chance.

With that in mind, it is important to consider the accuracy

of the captions may not be that great, but the benefit

of automated captions is it will get the timing right,

it will get the indexing right, so whatever it thinks

is the right word, it will come up on the screen at the

right time.

Happily, YouTube just a few months ago significantly

updated their free caption editor, so now there is an

opportunity to get them done by YouTube, then fix up

where the captions went wrong, fairly easily.

That comes to the third part, in terms of the three things

we ask, which is the NDIS.

I know this is certainly a very topical thing and I would

again like to absolutely stress that I'm a strong

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believer in the NDIS and the NDIA and what is being

done, I think it is making a tremendous difference.

The feedback we are getting is there is some significant

issues around the process of the technology people want

as opposed to the technology that it is deemed people

need. We come from a mainstream focus, as you probably

notice, and we find when people are in the initial

sessions being assessed and they are setting up their

goals, often if people put forward that what they would

like is something like an iPad or a Surface Pro or

something like that, that's a difficult conversation to

have, rather than saying, "I need Jaws" or a special

assistive technology, that is that's a much easier

conversation, that often goes through.

What I've been told -- and I have a little bit of personal

experience -- when people say, "I know that something

like Jaws might be really helpful for me and that costs

$1,200, to be honest, what I would like is an iPad and

that's $600, can I have an iPad, because it has

built-in accessibility," the common response is, "We

don't deal with things you can buy at Myer or Harvey

Norman, we deal with things provided by a specialist

provider."

We notice that with the current procurement space for

government, it is very much around the assistive

technology and specialist products, there's not a lot

of scope in terms of mainstream things. People have

told us, even if in their goals they manage to get the

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assistive technology written down and assessed,

sometimes in the assessment process the mainstream

product disappears because the assessor knows a lot

about the specialist technologies but not as much about

what's built into an iPad.

These are some things to flag. I know there are a lot of

people, perhaps some from the NDIA and service provider

organisations, doing a lot of work in the assessment

space.

Basically I would like to raise this issue in terms of

Media Access Australia and myself personally, I would

be very happy to continue that conversation and to talk

about that. You may agree or disagree with this, but

I think -- again, I'm a strong believer in the NDIS,

I think it is a wonderful thing -- but I'm hoping there

are a few things in the trial process at the moment

that can be addressed.

That's it for me, for the most part. We have a free guide

called "The service providers accessibility guide,"

created specifically to provide support to disability

service providers as they work their way through some

of the roles in the office and the NDIS. It covers a

lot of what I've talked about today, and that is free

from our website right now, mediaaccess.org.au, you are

welcome to go there and grab that guide.

Briefly, a few things about the services we provided, if

anyone is interested. I co-teach a six week online

course called Professional Certificate in Web

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Accessibility, which is online and it is accredited by

Uni SA. That is basically to upskill professionals

around WAG2. If you or your staff are interested in

that, I will be happy to chat at the break.

Also, we provide free accessibility health checks to

organisations. If your organisation is interested in

getting a heads-up as to how the disability culture is

travelling in your organisation and what things you

might need to do, my colleague Geoff Knight in Sydney

and I are happy to chat or I can put you in touch with

him.

That's pretty much it for me. If anyone would like to get

in touch, Scott.Hollier@mediaaccess.org.au, and in

Perth, 08 93118230, and our Twitter handle is

@mediaaccessaus.

Again, it has been an absolute privilege to share this

information today. Thank you to the organisations for

inviting me, and I'm happy to take questions now or at

the break. Thanks very much.

APPLAUSE

Sandy Forbes: Can I have an indication of any questions for Scott.

We have had two lengthy presentations and very interesting presentations.

Can I suggest you talk to the person next to you, because often people

don't know what question they want to ask until they try to tell the person

next to them what they really heard.

If you want to take a minute and talk to the person next to you and see if

you have a question that you are going to be brave enough to ask.

We have someone with a question.

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Gail Palmer: Hello, Gail Palmer from the MS Society.

I'm hoping it's not politically incorrect.

Two things: your presentation was fantastic around employers and how

they can assist people. But do you also offer advice to people who are

going for a position, in what they can have or suggest? Is it all right when

someone is going for a position to say, "I have this particular disability, but

these IT products can really assist me," or is that not something you

suggest people should talk about upfront?

Scott Hollier: Thanks for that question, it's a great question.

I was saying earlier in the presentation, for job seekers, often they are in

the hot seat, not just in terms of trying to meet the requirements of the

position but also the issue of technology and trying to overcome the initial

thought from the potential employer of can you use a computer.

From the feedback we get, it is generally a personal choice as to whether

or not people feel comfortable. My personal choice would be to be upfront.

When I first completed university, doing computer science in the 1990s, all

my friends got employed quite quickly, and when I made interviews,

because our CVs were pretty much the same, having the same

qualifications, I often made interviews. But I would get to the desk and

often state upfront what my disability was and what my needs were. Quite

often you feel the atmosphere freeze and I would miss out on that position.

I appreciate that was quite some time ago. I would like to think that

20 years on things have changed a lot. The feedback we have had is that

some people had quite a lot of success in being quite upfront about, "This

is how I use computers and this is what my needs are," especially if they

have a heads-up about what that employer already has in terms of their

ICT infrastructure. If they know the employer already has Windows 8.1

installed and know how to use 8.1, it is not such a bad situation to say, "In

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terms of my disability, if you have any concerns, don't worry, I understand

the technology in your office and I can get up and running pretty quick, and

if there are any worries, then there are processes I can go through to sort

that out."There is opportunity for potential job seekers to put the employer

at ease if they have concerns.

But, that said, I have heard cases where the conversation has gone the

other way, similar to my experience in the 1990s, when people said,

"I have some particular technology needs but it won't be an issue for you,"

but then the employer has alarm bells that there will be additional cost or it

will take additional time.

One other thing with the NDIS process is that people have said sometimes

the time to get the technology they need can be an issue as well.

Yes, the conversation can go either way. Personally, I think it is always

good to be upfront to a potential employer about what your needs are, so

they don't feel surprised, or sometimes people say the employer felt

betrayed down the track when they found out what their needs were.

Different people have different views, but from my experience, when

I missed out on jobs because I was honest, that was disappointing, but

when I finally got a job the employer was very supportive.

Unfortunately, the conversation can go either way but I have always

believed honesty is the way to go.

Question: Talking about the access standards and adaptations people are

now expected to make, can you talk a little bit about the expectations

around making things accessible to people with cognitive disabilities who

usually have very low levels of literacy? It seems we are not paying a lot

of attention to that in terms of making this online world accessible to that

group of people, whereas increasingly customer services, all the

information about services and everything is online. What are the

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standards and expectations around that?

Scott Hollier: That is also a really good question.

I agree there are issues regarding cognitive disability. What has

happened, I have briefly explained the three levels of the WCAG2

standard. Most of the legislation and policy frameworks go to level AA,

which covers making sure websites are readable, understandable, easy to

navigate, clear navigation systems. But when it comes to how easy the

site is to read, in English, that's in AAA. Most legislation and policy

frameworks go with AA but when we get into the more specific detail of

cognitive disability, most organisations won't go that far.

It is disappointing, and it is certainly our stance that if you are building a

website around employing people with disabilities, it is good to go AAA, but

there are unfortunately things in AAA which are very difficult to do.

I think when it comes to WCAG, there has been criticism that AAA is hard

to achieve, not so much because of that point but because of some of the

other things that are quite hard to do.

Unfortunately, the reason why that is the case is that, while the standard

does try to support cognitive in terms of the points in WCAG2, most

organisations won't go to the AAA standard to make it happen.

I certainly am a strong supporter of things like making sure that information

is very effective in terms of the audience, so certainly I would encourage

people to make sure there are good options on the websites and a very

clear language structure. Unfortunately, the standards do cover it but

people don't usually use it.

Sandy Forbes: Thanks, Scott. I'm going to take it that people who have

other questions will talk to Scott or Adrian at the break.

If I can do a very small summary, we have had two quite different

presentations.

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Adrian, the message from you is listen to clients and build a Boeing, not a

Concorde. I think that's probably the summary.

Scott, thank you. I think there is a whole new world of assistive technology

and how we use technology to make it more accessible, and the message

I have taken is we need to get a great deal more sophisticated, both in

terms of WCAG, AA and AAA.

Thank you all very much. Thank you particularly to Scott and Adrian for

this morning's presentations.

APPLAUSE

I'll see you back here at 11 o'clock.

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Sandy Forbes: Welcome back to session number 2.

Thank you to those of you who are here.

It is my pleasure to introduce Prof Christine Bigby, who is the director

Living with Disability Research Centre at La Trobe University. I promised

not to read out Chris's background. I could tell you a great deal more than

is on the blurb anyway.

This is not the first time Chris and I have appeared.

One of the things I am very excited about, Chris, is that you are visiting

professor of disability research professor at Halmstad University in

Sweden and the Tizard Centre at the University of Kent. She is a fellow of

an international association, she is a national board member, she is a

founding editor of 'Research and Practice in Intellectual Disability'. She is

an active person and a great advocate, and I have known that for some

time. In addition to publishing six books and 90 peer reviewed articles, she

can be absolutely guaranteed to be passionate and well informed.

Welcome, Chris.

APPLAUSE

Christine Bigby: Thank you for inviting me. I'm going to try to do a number

of things today. I'm going to try to explain to you how ineffective current

services are and talk about the need to focus on thinking about evidence

based practice. I'm going to talk a little bit about some evidence based

practice and then show you some very nice materials that have come out

of our research over the last few years, so hopefully there are some

take-aways for everybody.

My focus is on people with intellectual disability, particularly people with

severe and profound intellectual disability, which is the majority of the

people who are going to be in the NDIS, who always get left out of the

discussions.

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One of the key aims of the NDIS, as everybody should know, is around

choice, control and social and economic participation. These are not new

aims. We have been trying to provide services that produces these

outcomes way back since at least 1986 in Victoria and the federal

legislation in 1986 across Australia.

The problem has been -- and it was very well set out by the Productivity

Commission -- that we didn't have enough services, so there were a huge

number of people who just didn't get the services or got less services than

they needed.

The other problem that was pointed to by the Productivity Commission was

ineffective services, so services weren't delivering what they were being

paid to deliver and weren't producing the outcomes. This is particularly the

case for people with intellectual disabilities.

I want to illustrate to you some of those problems, some of the data that

we have, which is very hard data, from a study we have been doing of

supported accommodation services which now runs across four states --

South Australia, Victoria, New South Wales and Queensland. We have

now 11 live services that are part of our study and we are collecting annual

data on the quality of those services and the outcomes for people with

intellectual disability. I want to illustrate, using that data, some of the

variability and the problems at the moment in service provision.

If you look at the first graph, one of the problems with supported

accommodation is people say, "It's a problem with the model, supported

accommodation doesn't work, supported homes don't work, they don't give

people choice and control."

This shows data for eight organisations, and the last column is the overall.

It shows the significant variability on a measure of engagement. This is

engagement with people with intellectual disabilities who are living in a

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supported accommodation setting and it is measuring what percentage of

an hour people are engaged in doing any form of meaningful activity or

social interaction.

You and I are engaged in those sorts of things for probably 99 per cent of

the time when we are awake. The average in our study for people across

these eight organisations was 49 per cent of the time. That means for half

of the time, on average, the people in our study were doing nothing. They

weren't Googling, they weren't amusing themselves watching television or

playing on their iPads, they were disengaged, doing nothing.

First of all, the outcomes are really poor. Secondly, you can see the

average outcomes are quite variable across these organisations. The

average is a triangle. Then if you look at the longitudinal lines, that shows

the range. It shows not only differences between organisations but it

shows that within organisations there is a huge range of outcomes for

people. So there are inconsistencies across services within the same

organisations. So you can have the same model that costs the same

amount of money that is being delivered in very different ways and

producing very different outcomes for people.

This is the second measure we use, which is a measure of the quality of

support. Engagement is the person with a disability, how long they are

engaged. This is the quality of staff support that they are receiving,

something called the active support measure, based on an overall

judgment, having watched for two hours what's going on in a house, a

rating against 15 items. Again, you can see that the target of 66 per cent

on this measure is only achieved by one organisation in our study.

They all fall below the average expectation and there is an enormous

range in those outcomes of staff support.

What is more disturbing is that on the measure of engagement there are

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significant differences between the levels of engagement for people with

more severe and profound intellectual disabilities compared to people with

mild or moderate intellectual disabilities in these services.

The lines show that if we look at people who fall under a score of 151 on

adaptive behaviour scale and people over 151, in most organisations there

is a significant difference in terms of engagement. People with profound

intellectual disabilities are spending much longer than people with mild to

moderate intellectual disabilities doing nothing. They are the people that

need support in order to be engaged. That the why we are funding

services to provide support for people, and it's not happening.

If you look -- again, this is the quality of support -- the quality of support is

much worse for people with severe and profound intellectual disability.

Some of you might say, okay, some services -- this is about staff, this is

about costs. It's not. There is comparability across these services in our

data.

We know from the data in the UK about what's possible for this group of

people, people with severe and profound disabilities can get really high

quality support that goes way above 66 per cent on this score. People with

severe and profound disabilities can be engaged for 60 to 80 per cent of

that every day if they get the right support.

My point is that we have fairly poor outcomes and we have very variable

outcomes between services that are running the same models but within

organisations that are running the same model too. So there are some

problems here in what we are delivering at the moment in supported

accommodation.

What we have done more recently is a study of people in supported living.

You will hear the word is, "Oh, well, there is a problem with group homes

so we need to provide people with supported living situations, people need

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to have individual tenancies and we will provide drop-in support to people,

they can share on their own or their with other people."

There is very little evidence about outcomes of people in supported living

situations. We did a matched sample of people with the same level of

capacity who were in the home study and the one in our supported living

study and found actually there was only one significant difference on one

of the measures, which was about access to a social club, so people in

supported living were more likely to access the social club than people in a

group home. Other than that, there were no significant differences,

although supported living was very significantly cheaper than supported

accommodation.

The message in that is if we could lift our game in supported living, we

might be able to do that cheaper than supported homes, the model is there

but it is not producing better outcomes than the traditional group home

model.

If we think about providing effective support services, how is that going to

happen? Central to the National Disability Insurance Scheme are

individual funded packages, individualised funding. That's the core of this

new scheme, which relies on the market to work, to provide things to

purchase, and demand from consumers who will have funds to purchase.

Those things, the market and consumer demand will drive the quality.

Consumers will have money to purchase and most of those

consumers will be purchasing support from established

organisations and services. Very few people, only a

small number of people, will actually create their own

individualised services and run their own show.

Primarily they will be people with physical and sensory

disabilities who are very able people with lots of

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social capital.

The assumptions of the NDIS model is that effective

services are available to purchase -- I'm not so sure

sure about that moment for this group of people; that

there is availability of information about

effectiveness of services so that people can make

informed judgments; that we have informed consumers who

know what they want, who can articulate that to a

planner and are able then, when they have got funds, to

negotiate that with a service provider; and that the

NDIA knows what effective services look like and will

be willing to fund effective services. Again, at the

moment that seems to be a bit of a sticking point.

All of those points are problematic for the largest group

of people in the NDIS, which is people with

intellectual disabilities, and they are particularly

problematic for people with severe and profound

intellectual disabilities.

Individualised funding hasn't solved the issues of quality

in the UK, it hasn't solved issues of quality anywhere

where it has been implemented. Those of you who follow

the literature in this area will be aware of major

scandals in the UK, where support staff have been

charged with criminal abuse, not simply abuse but

terrible situations in privately run services that are

funded individually. People go and purchase 20-bed

services for people with challenging behaviour and they

get appalling services and it ends up with criminal

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negligence of the staff. Funding as a model hasn't

solved those problems about quality.

What we do know from the research, specifically in the US,

and which is now coming out of the UK, is that

individualised funding models have benefited most the

people with social capital, the people who have high

cognitive capacity, the people who have really good

strong family support and really good access to

advocates, and the people without those things have

benefited least.

If you look at people with intellectual disabilities, they

are very poor consumers. Many have limited or no

social capital. If you think about the people who come

out of our institutions across Australia, many of those

people have no family members to act as advocates, many

people are known well by no one, which is from the

research we did, many people with intellectual

disabilities in supported accommodation services only

have a social network made up of paid staff and other

people with intellectual disabilities, and some, if

they are lucky, will have a family member. Often that

family member doesn't know them particularly well,

because of distance, of time or age.

People with intellectual disabilities will have difficulty

choosing support, negotiating and directing their own

support. Because of the nature of cognitive

disability, people will struggle with those sorts of

things.

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The NDIS at the moment appears to be based on, if you read

the Productivity Commission and follow what's been

happening, it appears to be based on a model of

attendant care. That is the way in which it has been

thought about.

My argument is, and the evidence backs it up, that it is

necessary to have skills and enabling support to be

engaged and to exercise choice and control and to

participate, if you are a person with intellectual

disability.

This idea is not yet core to the design of the NDIA. In

the same way there is a recognition about skilled

support is necessary for other groups -- we have heard

that this morning in terms of the communication access

things, Auslan interpreters, ramps, guide dogs,

accessible media and accessible websites -- all of

those things are recognised to be skilled support that

requires expertise. We haven't recognised we need a

level of expertise and skilled support in supporting

people with intellectual disabilities to be engaged in

their community and to exercise choice and control.

The currency at the moment of individualised funding is

around hours of direct support, relatively cheap hours

of direct support, relatively low skilled hours of

direct support, with very little room in the

organisational funding model at the moment for

overheads to provide support and guidance to those

frontline hours of direct support.

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It is based simply on an attendant care model, where you

have a worker who turns up to act as your companion and

take you somewhere or is directed by you in terms of

the type of personal care you need. It is much more

complicated than having an attendant carer to enable

people with intellectual disabilities to be engaged and

to exercise choice and control.

I argue that for organisations that are providing support

for people with intellectual disabilities, you need to

see as your core product enabling support. In the same

way the mental health people take for granted they are

providing a core product about people's recovery and

using skills to do that, we need to think about that

for the support we provide for people with intellectual

disability, what is it we are trying to produce.

There is a very strong evidence base about the types of

support that are necessary and the underpinning skills

and knowledge and staff practices and organisational

elements that are needed to drive the support.

What I want to do very quickly is to draw out some of the

evidence and look at some of the resources that are now

quite available for training staff, supporting staff

and illustrating what we are talking about.

People in the audience will be familiar with this diagram,

which comes from the work of Jim Mansell, who spent a

lot of type searching active support service delivery

in the UK. Instead of thinking from left to right, we

need to think from right to left, thinking about what

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is the outcome, what is the difference our service is

going to make to a person's life? Not to describe it

in terms of a service type, a program type or an

output, but the difference it will make to somebody's

life.

In supported accommodation services and community support

services, most likely it will be a combination of a

person's life, engagement in meaningful activity,

choice and control every day, personal capability, the

best health you can have and conditions you might have,

potential skill development and having relationships

with other people and being connected to the community.

All of those things, in terms of outcomes, require you to

be engaged. You can't be sick or have relationships or

participate in activity unless you are engaged. You

don't do it doing nothing. Engagement is a really good

proxy for those sorts of outcomes.

Then you have to think about how you produce those

outcomes, how they are achieved. If you look at the

bulk of disability services for people with

intellectual disabilities they are achieved by the work

of the frontline worker, the interaction between the

frontline worker and the person with disabilities and

the way that worker relates to that person, the type of

support they provide and maybe the type of technology

they use together with their support.

There is also some indirect work that is necessary, that is

not directly with the person, in terms of setting up,

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mapping, thinking about the community and preparing the

community to be ready to interact with that particular

person or mapping what type of organisation they might

go and join. So there is direct and indirect work that

is necessary.

Organisations need to say, okay, if this is the key element

that we are producing, then what is the evidence base

for our practice and what is our practice framework?

Do we have one?

I suggest a lot of organisations in this room, and we know

from our research that a lot of the organisations we

work with actually don't have a coherent practice

framework that is based on evidence about producing the

product they are supposed to be producing.

Then the final thing that you need to think about, which is

often the starting point, is what structures and

policies and procedures are going to most support the

production of that practice that is going to make the

difference? They are the afterthought, they shouldn't

be the first thing that comes along. At the moment we

are trying to identify the key things that impact on

practice, the most important things for organisations

to think about.

There is a significant body of evidence, which comes from

the work of Jim Mansell and Julie Beadle-Brown, about

people in supported accommodation. If you put all of

these factors into regression analysis, which one comes

out most important is a staff practice known as active

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support. Staff using that practice, together with

resident adaptive behaviour, are the two most important

things, in terms of outcomes of engagement, for people

with profound and severe intellectual disability in

supported accommodation services. You can't change

residents' adaptive behaviour so you have to focus on

the staff practice of active support.

Some of you will be familiar with what active support is

and others won't. Increasingly, we are finding people

are using the words without a full understanding of

what it is and it is just becoming part of the jargon,

so it is worth spending a moment to talk about what it

is.

The evidence is if staff use active support consistently

with people with intellectual disability, it shows an

increase in engagement, growth in skills, more choice

and control and significantly less challenging

behaviour.

Active support is frontline staff, all day, every day

practice of front line staff. It is not very skilled

professionals with tertiary qualifications, it is

frontline staff with no qualifications or cert 3 or

cert 4. This is the type of practice these staff can

do and should be doing. It is about providing enough

support to enable people to participate successfully in

meaningful activities and relationships, having an

enabling relationship with the people you are

supporting.

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Active support has been shown to be effective, irrespective

of the degree of intellectual disability or the

presence of other problems. It is one of a family of

person-centred approaches and it is the one for which

there is most evidence. You will be familiar with

person-centred planning, you will be familiar with

positive behaviour support, with intensive

communications, with the SPELL framework about

sensitising the environment to people with autism.

All of those things have very little evidence but they are

part of a family or person centred approaches, and

active support sits at the heart of those, it is the

foundation for positive behaviour support that people

often forget about. You spend a lot of money on

specialists coming in to look at people's behaviour,

but if you are doing good practices around active

support first, you have less challenging behaviour for

the specialists to come in and sort out.

We have spent the last year producing online resources to

illustrate what we are talking about and have made

these available for free on the internet, a whole

training package which is designed for people with low

levels of literacy, the type of direct support workers

employed in organisations.

This is a five minute clip and I want to show you some

illustrations of what I am talking about in terms of

active support, so you get a sense of what it actually

is.

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(Video played)

"I have epilepsy and in a wheelchair and I have my support

worker buzzing around and it is great, I get to eat

dinner, but they don't think about, hey, what about the

opportunity for me to participate, to stir, to smell

and to think, to feel the texture of what I'm going to

be putting in my mouth.

"Oh! Where is the shopping basket, here is the shopping

basket.

"Beautiful job. Thank you. Right, let's go.

"There you go. Have a good day.

"Shirley's got the chicken. Thank you.

"Shirley, will you press 'Start' then 'Scan'.

"We learn a new thing every day. This time, when we went

to do the scanning, which Shirley knows to help scan,

and Cameron passes the item to her to scan, that was

carried off smoothly. At the end, even after the notes

are put in to pay, some change came out, and to my

surprise Cameron knew how to get the coins out. So

that was an opportunity for me to get him engaged in

the process.

"Shall we get all our items and go back and cook. Good

job, let's go.

"These are everyday things we take for granted, like

shopping and cooking. We need to overcome them, things

they can do. There are opportunities for them, a

moment or potential for them to be involved.

"Pour it in. Awesome!

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"Okay, guys, you have had drinks, it's time for washing up.

Jason, we'll go to the sink and collect some water.

"It's important for Kylie and Jason to have the opportunity

to wash up because it gives them the dignity of doing

what we all do in our everyday life and the joy of

achieving things, goals that maybe they have never had

the opportunity to achieve before.

"Okay. Is that all? Are we done here?

"Finished.

"What are we going to do with this? We are going to take

this. Let's take this one to the counter and you can

pay for this.

"David, would you like to help me as well, please? This is

quite heavy. There you go, the two of us, okay, I can

help you pull this trolley, because they are quite

heavy.

"That is $41.50.

"It's $41.50 altogether, David. Would you like to pay?

"Yes.

"How much have you got in there?

"$45.

"$45, all right.

"Jerry, I'll come and help you.

"Hold this one. Good. Good. There you go.

(Laughing)

"Now, I'll turn it on. There you go.

"Press it again.

"Push.

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"Do it together.

"(Vacuum cleaner noise)"

Christine Bigby: Thanks for that.

That is active support. If you think about it, watching and doing all the

time, to enable people, rather than doing things for people, which would

have been so much quicker and much less beneficial for the people they

are working with.

What we know from the research is that you can train staff in active

support, and organisations have begun to do that and it is now really

accessible to do that, but what you need to back up active support is an

ongoing focus, so everybody in the organisation needs to see the quality of

staff support and the central things to what you are doing in that

organisation. The CEO and everybody down need to understand it and

you need to have practice leadership at the frontline, reinforcing that good

practice all the time.

We now have some really hard evidence that practice leadership is the

one organisational feature that makes a difference to embedding active

support within organisations.

Just to finish off, I want to show you a very short clip. We also have active

support in the community. People have often seen active support as

something that happens in the house and household chores, but it is much

wider than that. We looked at the encounters that people in the community

have, people who are strangers, have with people with intellectual

disability and how can the staff facilitate and enable those encounters to

happen or how can they get in the way of those encounters.

I'll show you the way they get in the way and then a good example.

(Video played)

"Hi, Sue Anne, how have you been?

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"Good, thanks, Tash, how are you?

"Who is this that you're talking to, Celeste?

"Everyone, this is Tash. Tash, everyone.

"I heard you're getting married on Facebook.

Congratulations!

"Yes, we're getting married in October.

"I thought that you had deleted your Facebook, Celeste.

"I didn't delete Facebook.

"Well, it was lovely seeing you again, but I have to go.

We'll catch up soon.

"Okay. Bye, Tash.

"Let's keep moving. Come on, everybody."

These were scripted from our research. We observed all of

these scenarios and then we hired a group of actors

with intellectual disabilities to act out the scenario.

It is very hard to film these sorts of things in real

time.

(Video played)

"Oh, excuse me.

"She just wants to roll your sleeves up.

"Oh, all right.

"Thank you, that actually feels a lot better. Thank you.

"Yum!"

Finally, the third part of the work we have been doing

actually took active support and turned it into

something called active mentoring, which was around

them resourcing community volunteers and members of

community organisations to understand and be able to

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provide enabling support to people one by one with an

intellectual disability who might want to participate

in their community group. It is very easy to train and

support volunteers to provide this sort of support to

enable people to be part of a community organisation.

We are proposing that you need to have a practice framework

that is based on evidence about enabling practice that

enables participation and inclusion and that that needs

to have direct support in terms of active support but

it also needs planning and thinking about in terms of

indirect hours, to lay the groundwork with community

organisations, with community leaders, an outing with

your local community. There needs to be time to

negotiate and resource other organisations and other

people to support people in the community.

You need to have practice leadership within your

organisation, to lead, to coach and to model good

practice, so it is there all the time for support

workers, so they are aware of what they are expected to

do and how to do it. Then you need to recognise in

your organisation at the senior level that this is a

key product of your organisation that everybody needs

to pay attention to.

I will leave this here. There are a number of slides.

This is a link to the three key resources that are now

available online for free, that are designed for

training direct support workers and for communicating

this type of stuff to parents, to other family members,

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to community visitors, to board members. It's like

this is the key for people with intellectual

disabilities to have some of the outcomes from the

NDIS. If we don't get practice right then we won't get

any of those outcomes that we expect.

Thank you.

APPLAUSE

Sandy Forbes: Thank you, Chris.

I did hurry Chris through the last video because I wanted to have an

opportunity for you to ask questions.

Before we move on, can I see if there are any questions for Chris.

Edmund McMahon: Edmund McMahon from Lutheran Community Care

Queensland. Professor, I'm one of those evil accommodation service

providers, and I accept and I'm willing to take responsibility for the

embedded support, I'm willing to accept and take responsibility for the fact

that it's my responsibility to ensure that my staff and my colleagues are

providing the best support possible.

But in your presentation you talked about two things, that was one thing.

The first thing you led with was advocacy. The reality is for a lot of those

individuals you were talking about who are most disadvantaged, those

individuals fall under the state, as far as advocacy goes. That might be the

public guardian.

I know for a fact in my state, 2006, we had the Carter inquiry, a state

based inquiry into abuse, that resulted in practices implemented with my

staff, requirements that were enacted imposed on service providers.

The interesting thing is the state had the information. In 2011, the

University of Queensland, through the Centre of Excellence, revisited that

cohort. 80 per cent of those individuals in the original inquiry, 80 per cent

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of them either had no increase in their quality of life or their quality of life

had decreased.

The fact is the state itself has some responsibilities there too and it is not

acting on those responsibilities. Can you comment on that?

Christine Bigby: Yes. In our study, we have the largest service provider in

Australia, which is based in Queensland, and they are doing active

support. We have seen them increase the outcomes for people over the

last two years of our study.

Yes, there are lots of barriers, there are lots of obstacles along the way.

But if we get obsessed with what the obstacles are, instead of focusing on

what we can do with our funding, that's what we have to do.

Advocacy is not the answer. There isn't one answer. What I'm saying is

that organisations providing support to people with intellectual disability

could do it much more effective. There are lots of other problems in the

system and we can't solve all those, but if you do good support in the

house or in the community, the chances are you might start to help people

to engage with other people in the community and have more

relationships, then you have more people coming into people's homes, and

that's one of the main preventative factors around abuse. It's not

legislation, it's not procedures, it's having other people coming in and out

and caring about you and watching what's happening.

Edmund McMahon: I totally agree, people protect people, systems don't.

But when we are talking about the initial engagement with the NDIA, who

is going to support that person who is severely and profoundly intellectual

disabled? The public guardian is supposed to be in place; they don't

necessarily have any background in disability.

Christine Bigby: I agree. At the moment we are doing a study in New

South Wales at the trial site, which is funded partly by the trial site and by

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partly by FACS in New South Wales, looking at the issue of support for

decision-making. The aim is to demonstrate the need for this group of

people to have somebody with them in the long term who will get to know

them and be the support for decision-making as part of the NDIS process.

I think they are beginning to realise there is a whole range of people and

some people don't have anybody who knows them well to speak for them

in the process. It is on their agenda, one hopes, but we have to keep

saying it.

Sandy Forbes: One very quick last question because we need to move on

our next speaker.

Janet Wagland: Janet Wagland from Brightwater Care Group.

I want to make a brief observation, to observe that active support and

positive behaviour methodology is also highly applicable to people with

neurological disability, and certainly that is something we have been

encouraging and using in our own organisation with people with

Huntington's disease and people with acquired brain injury.

The other comment I have is that choice and control is inextricably linked

to both and it can be a predecessor as well as a result of using that

methodology, and we find it highly successful in enabling people to have

better quality of life but also to have less reason to have challenging

behaviours because life is so much better.

Christine Bigby: There is strong evidence about that link. If you do good

active support, it reduces challenging behaviour.

We have just got funding from ISCA in Victoria to trial active support and

see if it works with people with acquired brain injury, so I would be

interested in your experiences of that, if you have got any evidence,

because there is no published literature about applying this to people with

acquired brain injury.

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One last plug: there are flyers here with information about these resources

and about our centre, which will be on the slide. The flyers are here and

they are outside. Thanks.

APPLAUSE

Sandy Forbes: Thanks, Chris. You fulfilled my expectations.

We are going to move on. We are now going to hear from two people from

Activ Foundation, Danielle Newport is the general manager strategy and

Shane Mauger is the general manager service improvement.

Danielle has been with Activ Foundation since November 2011. She leads

the corporate support teams that support the delivery of active strategic

plans, human resources, communications and has responsibility for

leadership of the business services team and providing employment

opportunities for over 1,000 people living with disability in 15 locations

across the state -- and we are talking WA.

I have to observe, we have had a number of people from WA speaking

with us this morning. They got up at 2 o'clock their time to start their day,

I think they have been doing well. But if they fall asleep this afternoon, we

will understand why.

I will introduce you, Shane, because I know you are going to share the

presentation.

Shane has over 20 years experience working in the disability sector.

I won't read it all but he has the current position of general manager

service improvement, where his focus is on the delivery and

implementation of the strategic plan, exploration of innovative service

delivery design and the NDIS roll-out across the organisation.

Please welcome Danielle and Shane.

APPLAUSE

Danielle Newport: Thank you. The first thing I would like to do is

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acknowledge the traditional owners of the custodians of the land on which

we meet and pay respects to their elders past and present.

The first observation I would like to make is although we all share an

interest in what we have been talking about yesterday and today, we all

come from very diverse organisations within that space. Every

organisation's experience of the change that we are all part of is going to

be different.

What we would like to talk to you about today is our experience through

that change because we believe there are some common factors. There

are some experiences and learnings that we have had, that we feel may

be of value to you and we would also love the opportunity to get feedback

on our change program.

As everybody is aware, there are as many change frameworks and

methodologies as there are changes. What we have found is that it is not

adopting a methodology that drives your success, but being flexible and

responsive to the change.

Our key take-away from our process today is that success is always about

asking the right questions.

We are going to briefly take you through the process that we have

experienced so far. We are about two years into our change program, so

we are going to talk a little bit about the foundations for that change

program and then about how we are actually translating that planning and

program into action, which of course is what change is all about.

A little bit about Activ, for those of you who don't know about the

organisation. We were founded in 1951 as a family support group. Since

then, we grew initially through adding additional family support groups,

both metro and regionally. Now, in 2015, under the title Activ we provide

support to approximately 3,500 people living with disability in WA. We

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have 1,200 staff who enable us to provide those supports.

We provide a wide variety of supports, we have already mentioned

employment, but we provide group accommodation, we support people to

live in the community, we support community engagement, we provide

recreation experiences and we are supporting a number of families to be

self or shared managed funding moving into the new world.

The first key point is motivation.

It is not enough for everybody to tell you that you need to change, it's not

enough to come along to these kinds of events and, quite rightly, for

people to say, "Now is the time to change." You have to have a genuine

motivation within your organisation to make that change.

For Activ, there were four key factors, four key motivators for our change.

To be frank, we have seen the NDIS as an opportunity to make changes

that we already needed to make within our organisation.

Our first motivator was relevance. We are a organisation with a long

history in the state that we operate in but we were starting to observe that

we weren't attracting new families and new customers living with disability

to come and purchase our services. So we had to consider whether what

we were bringing to the market was still what the market sought.

We also had to consider our viability. As a predominantly government

funded organisation, for the vast majority of our history, our operational

viability has been -- it wavers, as everybody who is government funded

would understand. One advantage of government funding, if the

government is your customer, is if they value the service that you provide

and they are sympathetic to your financial viability, many government

departments have the discretion to help you out on a non-recurrent basis.

In the new world, when we have 3,500 customers, we are not going to be

able to go to each of them individually and say, "Look, we have delivered

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really great service, we have had a bit of a tight year, could everybody

pitch in another $10," for example. We have to take our sustainability, our

financial sustainability, seriously. That needs to become our responsibility

and we have to ensure that we can survive the good years and the bad

years, so that we can provide those quality supports.

Competition: obviously, we talked yesterday about the number of new

entrants into the market. Western Australia hasn't seen a significant

number of new entrants related to the NDIS specifically but the market has

been changing over the last five to ten years, and entrants are coming into

the market who are much more focused on the individual requirements of

customers and families, rather than the servicing of government

requirements.

Finally, we have paid attention to our culture. Activ is funded by three

different government departments, three different governance regimes,

three different contracts, so we have three different cultures in our

organisation, which are targeted very specifically to meet the needs of

those government funders.

We need a one Activ culture, we need everybody within the organisation to

be working towards the same goal and the same future.

The next thing you should consider that we considered is your context.

For those of us who aren't from WA, WA is a very unique context. We

have the same Aboriginal issues as the Northern Territory, the same

metropolitan area as Canberra and the same rural and remote issues as

Queensland, all in the one state. The WA trials associated with NDIS add

a further context, so we actually have three operating environments in WA

at the moment.

We have the NDIS pilot running in the hills, which for everybody who is

involved in a pilot will know that is payment in arrears, no indexation in the

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foreseeable future, and for us a significant price reduction on the price that

we had previously negotiated with our funder.

We also have the NDIS My-Way pilot, which is our state government pilot

scheme, in agreement with the federal government. That is paid in

advance and there is state indexation. Again, we have seen up to a

20 per cent price reduction on previously negotiated prices.

Then we have the business as usual state, which for Activ is a mix of state

and federal funding. As I said, very different approaches, very different

governance, so quite a complex environment in and of itself.

To add to all of this, Activ, our position is unique because we are delivering

service and support and all three environments. At the moment our

organisation has to be able to fulfill the environments of all three of those

and fulfill the governance and contractual requirements.

It may not feel like a privilege or an opportunity but that's how we need to

look at it.

Hopefully, being part of all three will develop our understanding in a way

that other organisations aren't lucky enough to have.

Once we have looked at our context and who we are, we have to then

decide how we would plan for our strategic plan. This process in our

organisation started with the executive. What we have found is as an

executive team if we are very focused on the solutions that we are looking

for, we operate in an operational tactical phase rather than a strategic

space.

We focused on becoming aligned around the questions we needed to ask.

The executive spent a considerable amount of time making sure we

agreed on what the questions were that were relevant and that they were

going to lead us to a strategic roadmap that we could then share with the

organisation.

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We have established who we are, what our motivation is and what our

context is. What are the questions that we asked ourselves? The first

was: what are our future aspirations. That is not just about what you need

to be but about what you want to be.

NDIS is the operating environment that we are all moving into over the

next few years, but there is an opportunity for you to define your

organisation over and above your governance and funding environment.

We thought very hard about who we wanted to be in the future. Then we

had to be brutally honest about how far that future aspiration was from

where we are. In some areas it is a long way, it's not nearly as close as

we would like it to be.

Once we had assessed that gap, we needed to look at the skills we had in

the organisation. Again, there is an element of honesty and challenge and

being comfortable to perhaps confront some of the gaps you have. But

once you know the skills you have, you can ask: are those the right skills?

Are those the skills that will take us into our future?

Then you need to ask about what it feels like to work where you work. Do

we have the kind of culture that is going to allow us to change or move?

Or are we the kind of organisation that does what it has always done.

When we answered these questions, what was then key for us is what it

would look like when it was successful. There are two elements and the

first and most important is what it would look like for the customer. We

don't yet have that answer. We are still engaging with customers, working

on how we understand success looks like for them. The second is what

does it look like for the organisation. The board and all levels of the

organisation have been involved in defining that success.

It's not enough to have an aligned executive in an organisation who are

very clear about where everybody needs to be. You need to bring

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everybody with you. We all understand that change will only be successful

if everybody in the organisation responds to that challenge positively.

We have focused a lot of energy, probably three to six months worth of

investment, in developing a language to share our vision and developing a

picture of that vision.

What I'm going to put up now is what we call Activ's blueprint. You

probably won't be able to read all the detail.

To the point made earlier, our strategies: the dark blue row, strategies that

guide us, that is really the basis of our strategic plan. But it was key to us

that that was embedded in the organisation that we are and want to be.

So we framed that strategic plan within our purpose, our values and our

vision.

The strategic plan does sit off to the side, and we might talk about what we

value and now we are going to talk about our strategic plan. Our strategic

roadmap brings all of those elements together.

The four strategies we have identified are delivering an integrated service

to our customers. I have alluded a couple of times to the challenge we

have with multiple funders and how that prohibits us from offering

accessible support to our customers. It is very important to us that what

we offer can be navigated easily by customers.

The second is to be customer driven. Again, I have already referenced

that we currently have three very large and very powerful customers. In

the future we will have 3,500 much smaller but equally powerful

customers, so we need to be customer driven. For us, that's beyond being

customer focused, that's about having a conversation with each customer

about what they need and want and how we can provide the support to

enable that.

Somebody -- I can't remember which of the speakers -- yesterday said you

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can't be all things to all people. One of the principles we have had to

challenge in the organisation is that in the new world we will need to find a

way to say, "We are not the best organisation to support you in your

specific support, but we can find you somebody else who can." But that

will be quite a change for the organisation, which has prided itself on being

able to do whatever people need for support.

Our third strategy is to be a social business. This is going back to financial

viability. Being a social business is about saying we want to make a profit

but that we are going to use that profit to further our mission. That doesn't

mean that we can't invest in projects and work that won't drive profit but we

will do that explicitly and consciously, rather than being surprised at the

end of the year when that's the outcome. It's about making very clear

decisions about where our very precious dollar goes.

The fourth is about transforming through change management. That

covers not only our strategic plan but it is about the capability that we need

to build into the organisation going forward. It is going to be about change

from here on in. There is not going to be an end to this change because

our customer are going to have the choice and control to request the

supports that are reasonable and necessary for them.

We need to have the capability to change as they change.

Just for a second going back to our values, this is a very important part of

our communication. We refreshed our values, which had been in place for

a few years, and changed the tone. We made them active, which counts

as a pun in our organisation because we are called Activ, but put them into

the active voice and we have pushed down into the organisation around

behaviours. What are the behaviours that will support our future? What

will we tolerate and not tolerate? We need to become much more

assertive about that conversation within the organisation.

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The key around the values organisation is it gives everybody a role into

what we are doing. A lot of strategy might be conceptual or process and

people can't just grab a hold of that and be part of that. This gives people

a way to have a role in the change program that we are implementing.

Under those four strategies I just talked about, there are 38 different

strategic initiatives, each one of which has a project team, project status

report, project brief, heaps of governance, and we built a structure so that

we could communicate to the organisation.

What is key is understanding that, just because it isn't going according to

that plan, doesn't mean that it's going wrong. What it means is that you

constantly need to refresh your plan.

Even though our strategy has only been in place for just over 12 months, it

has already been reviewed by the executive twice and will be reviewed

every six months. It has been reviewed by the board once. That's not a

cursory, "Yep, that's fine, that will do." We have taken out quite key

projects and deactivated them and said, that's not what's going on, and we

have put new things in. It's really important that it's a living breathing thing

because we are in a living breathing environment.

The two potentially adverse consequences of continuous change, the first

is that some people really like the structure. We have a spreadsheet with

38 initiatives on and everybody who is involved in the strategy, or in a

strategy, has a copy of that. The first time we changed it, people got really

quite upset because they got attached to the structure, they knew what it

meant, they knew where the beginning and the end was.

My message to them -- and this applies to me as much as anybody else --

is to get comfortable with that chaos. Just because you can put it into an

Excel spreadsheet, doesn't mean in reality it's a bowl of spaghetti, because

that's really what it is.

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The second part is that everybody thinks their line in that spreadsheet is

the most important line. So if you deactivate somebody's cherished

personal project and tell them it really isn't going to cut it, there is a really

careful message that has to be created in that instance. To us, that's the

value of our blueprint, that we can go back and say, "Our strategic journey

is around our purpose, which is to enable people living with disability to

have a better life. You are still contributing to that, you are still doing work

in the values, you are still involved in the process." It is being able to take

people to that higher shared conceptual level makes those conversations

easier.

That's what we planned. Now you are going to here what we do.

Shane Mauger: Just to make you can all hear me. Fantastic.

As Danielle said, we spent 18 months in that plan, we spent it and lived it

and dreamed it. When we finished it, we congratulated each other, had

drinks and said, "Fantastic, we are there."

Then we started doing it. We found when we started into our planning

process, you know that unless you are an organisation that has begun in

the last five to ten years, you gain legacy. So the legacy issues that were

built 50, 40, 30, 20 years ago are now loading down the organisation, and

the part we need to keep mindful of is your business challenges aren't a

problem for your customer to solve. So if you can't operate the model, you

can't tell your customers, "Look, I'm sorry, you have to receive a lesser

service while we resolve this," because they will go somewhere else. They

are exercising the choice and control if you don't balance the two.

The other part to be mindful of is nobody started in the same place.

Because we are a 60-year-old organisation, we still have foundational

members in our organisation who set up the organisation to be where it is

now. This is their dream, where they were driving to, and this is what they

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want. When we tell them we want to go somewhere else, what we are

telling them is they are wrong. In an historical organisation, with the legacy

you have, how do you drive to a bold new future without disenfranchising

the people who set you up?

Talking about our key take-way, Adrian pointed out in his conversation,

there are all these different points. As Danielle has noted, what we have

planned and where we ended up is somewhere very different. So this is

not the end point of a journey, this is just what we have seen over the last

12 months as we have put this through the organisation, and the lessons

we have got today might not be the lessons tomorrow that we will take

away. It will be a moving feast.

For those people who haven't seen 'The Matrix', you're in trouble.

'Airports' was probably an easy one for us to get to.

Ultimately, for those who don't, in 'The Matrix', you had a choice, to take

the red pill or the blue pill. The blue pill was you knew that the matrix

wasn't real. There was something that existed outside of it but when you

took the blue pill, you went back to your home and woke up in your bed

and believed what you wanted to believe but nothing had fundamentally

changed.

As an organisation, we all know the NDIS will fundamentally change where

we are, but the reality is we don't know what that reality is. That is

choosing the red pill. As the NDIS is a real opportunity for us to go

somewhere else, we just don't know where it is.

When you look at this from an organisational point of view, we have the

red pill and the blue pill. We don't think of it as an organisation, yes, we

are part of the NDIS and we want go to a brave new world, it has to roll

down into the next level. The next level is: who in my team has taken the

red pill and the blue pill?

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When you are out there delivering messages and somebody in your

organisation who is actually key to where you are going has taken a blue

pill, and they have not engaged with the reality of change and they are

trying to deliver a key message, what are they saying? What message are

they delivering through your team and how far is your message diffusing?

What's your level of trust in the organisation? That is great, we all trust our

organisation, it's fantastic. But the reality is, can I trust what somebody is

telling me?

I'll go back. If they have taken the blue pill, are they giving me the reality?

Yes, everybody is happy, they are all receiving an individualised service.

But are they really? Really getting down to it is how much do I trust, which

drives down to the next one, which is: what do I need to measure? Do

I trust what they are saying but how do I measure it?

What Christine put up is how much active time are people involved in the

organisation? How much choice are they getting? Are they getting a

choice which is, you want the red cup or the blue cup or do you want to be

at home or go out? How do you want that experience to look like?

Regardless of the reality, you need to look at your data capacity in the

organisation to reinforce or drive change.

The second one is it's all about trains. I could have picked aeroplanes or

any other vehicle but we are going to go with trains. It's a metaphor.

The thing is, you can't wait for everybody to get on the train or it will never

leave the station. As we are going through, what are we really waiting for

to start this?

It's okay to depart but you have got to make sure the right people are on

board. As we start, this is what we have done, we have done our strategy,

looked at the strategy, everybody thinks it's fantastic, not only do they jump

on board but bring along other people, all going on the journey, this is the

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dream. What we would like is we actually lead off and there are people

who really want to come but they are just not in time and race to get on,

but everybody else is on board.

The reality is, as you look at this, people need to see a seat for themselves

on a train, to find a space they see, when we are going to deliver on this,

where do they see themselves?

What we are is basically selfish by nature. What's in it for me? You have

got to be able to answer that, from the CEO level and the board level.

From the board to the CEO to the executive to the senior managers to the

managers, to direct care staff, to your customers and their families, what

they are all trying to see is: what's in this change for me? That is not one

communication, that is a lot of communication we are trying to get out.

One of those things is where you focus your communication when you are

looking at this. This is, for me, that as an organisation we don't want to

concentrate our communication on the 15 per cent of people who are

against the change. We don't want to focus on that. We don't want to

focus on the 25 per cent of people that are so keen and rearing, they are

tearing ahead of the organisation. It's how we concentrate our

communication on the 60 per cent of people waiting to be convinced.

For us, in preparing our staff, we have got three key focuses: individualised

service development, self-determination and the responsive service

delivery platforms.

We can't wait for the full NDIS roll-out in WA because we have multiple

sites, we have competition between the state government and the federal

government to roll out the best system. Therefore, as one puts something

out, what does the other do? It changes it and challenges it.

We can't wait for them to find their level and median, we have to prepare

our staff to make sure they understand that people's choice is paramount

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in where our organisation's future is and how we interpret that choice,

giving people what they want is critical. So, getting to that 60 per cent is

absolutely critical for our organisation's future success.

In asking this, when it's all about trains, you have to look at how aligned is

our current business to our future aspirations? Who is it that we need to

be on board?

How aligned is our current business to our future aspirations? At the

moment we are not, we are in multiple spaces and sites, so when we are

delivering a message, we move staff from one area of the business to the

another area and the message is lost and they get disheartened about

where they are.

What roles and seats need to be filled? What do we have in place and

what are our future capacities? But how do we still continue to service our

current cohort of families who want delivery in a certain way and still meet

our future business aspirations? That's the real balance for us: who

absolutely has to be on board to be successful.

One of the examples we had, as an executive, we spent hours and hours

looking over our client support and how we do it. We couldn't agree

whether it was in our HR capacity, staffing capacity, should it be in a

business function? What we did, we stopped and drove it down to the

lowest part of the business. Not only did they decide quickly but they did it

more efficiently and better than we could. Getting people on and letting

them solve the problem, rather than trying to solve it at the top and

cascading it down, you have to have the ability to solve it at all the different

levels of the organisation, otherwise you will get lost.

The last one is leaving the station is a matter of timing. When we are

going through the change process, driving through the change process,

you can't wait for all the seats to be filled. You might have to pick up that

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capacity at the second, third or fourth stop, but at some point you have to

leave, because while you are sitting at the station, you are burning

resources. You are using staff time, staff resources, staff funding. Also,

the ability and the wanting of the keen people, the 25 per cent of people

who are already on board, you start losing them, and the 15 per cent

becomes greater because their voice starts influencing the 60 per cent you

want to influence.

The timing is you cannot wait for everybody. It is a matter for everybody in

your organisation to make the changes and to make that decision.

The next thing is really about what. There is no point getting people

together if they can't speak the same language. Everybody is probably

aware that the Inuits have between 40 and 70 words for snow. It is not the

word but the context that changes.

The real challenge for us is: how do we develop a rich description of the

NDIS when all staff are seeing is snow and they are not the variations

between what it means? When we are planning, we have to enable a

place to get people to understand what is the problem.

You heard Danielle refer to us as our use of customers and we talk to

people and we use customers because people have the choice to come

with us or not and tell us how to spend, and customers have a rich ability

to influence the decisions of businesses.

Where that goes wrong is where you have a direct care staff who thought it

was a great idea and sat with a family and then said, "I have to get my

customer out of the bathroom now." That's when you miss.

One of the things we have to be mindful of is that even though the

message at this level is right, how do you cascade the right message

down? That staff member didn't have poor values, they just believed they

wanted to offer the person choice over what they are doing.

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Over the NDIS, looking at the current environment, what doesn't translate

to the future, one of the things for us is the use of coordination. In one day

we lost $20,000 worth of funding for one funding cycle because the people

in our area who focus on clients and developing their plans didn't

recognise the use of coordination was different between My-Way, the

NDIS and our existing plans, submitted the plans and got them signed off,

and we were $20,000 poorer by the end of the week before we caught it

up. What did the funders say at the end of the period? "Come back and

see us next year."

How we communicate and what we are saying through the transition

process is absolutely critical in doing that.

The other thing is "what is our capacity to monitor the environment? We

realise that we probably weren't monitoring the environment and telling our

staff the right things for them to translate. The language is ever changing

in the environment. What we tell them at 5 o'clock today might be different

from what they know at 9 o'clock tomorrow. Part of that is who needs to

know and what and making sure we have daily, weekly and monthly

updates on general information.

The last thing is: what is the key message you want to endure and how do

you want people to feel? Language is about how people feel. If we lose

customers along the way because we are too business focused and we

lose our audience because they don't see themselves on the train, or we

are too emotional and we lose our meaning, so the business gets lost. So

this is where the challenges are sitting at the moment.

I am flying through now.

We need to always come book to our blueprint and make sure it's a central

theme of what we run through. For us, around the blueprint, our learnings

and our take-aways are that having the strategic roadmap, with so many

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distractions and so many different things in our environment, you have to

have something central to come back to.

While this has saved us a few times, $20,000 could have been $100,000,

but it saves you and it brings you back to what you are here to deliver.

You need to be clear with your motivation and environmental planning

process, and continuous improvement is your organisations's future. If you

are not prepared to adapt and change and to abandon a bad idea, we

made this plan two and a half years ago, what makes it valid today,

because the environment is in so much flux and there is so much change.

Our learning is around the red or blue. That is, in accepting the realities of

the current environment, you don't need everybody to be red. Some

people have to be blue. They have to stay and help bring along the

families along who want to stay in their current reality. And that's okay.

But how do you choose who stays in the current environment and who

goes forward, and at what point do you stop offering blue as an option?

That's a really tough decision because those people who have built and

sweat and done fundraising and lamington drives at the start of the

organisation to where you are now, we have to figure out a way to bring

them along, and we haven't got anywhere near to finding a solution for

that.

It's all about trains. At the end of it, you will have your different plans, but

when you leave is the most important decision you can make. We are

saying that if you haven't started thinking about who's on board and where

you are going, it's probably too early to leave, but at some point you have

to get going because it's a reality. If it's not in your area now, it will be next

year or the year after or the year after.

The "what" is about communicate, communicate, communicate, absolutely.

But it's nothing if people don't know what you are saying. If you don't

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develop your language, you are not making sure you are consistent, the

language is not consistent across every part of the organisation, then it's

all for nought and you are spending time selling the wrong message.

The last thing which is put out there, is be aware of the lacky band effect.

In certain parts of the business we are stretching so far and snapping back

to the current reality, which is that people are adapting the right

communication, they are understanding the right language but they are

selling what we sold in the past. That is really difficult because all the key

indicators are telling you, with the exception of the metrics, that we are

doing the right thing, the message is getting through, but people aren't

accepting the magnitude of the change. That is really important. You

have to be mindful that, even though everything sounds right, what are you

measuring that is really important in the organisation? What's the really

important thing you need to get to? Again, by going back to the roadmap,

it allows you to say, "We are on budget." I love the NDIS, we are under

budget, we are on plan, and the third one I can't remember. But

realistically, what are we delivering?

The challenge as we move forward is that we are a sector of story tellers.

We need to connect with the emotional memories of our collective

organisation about where we are, we have changed many times. We need

to create the stories with the power and vision that can really outshine the

past. Part of that is that's what's going to drive the train; not the dollars

from the NDIS, not the way we implement the strategy, but the way people

are emotionally driven into our organisation, the experiences they are

having with us.

Thank you.

APPLAUSE

Sandy Forbes: I might get you to hold your questions for the end of the

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session, and invite Rohan Brady to join us.

You have been sitting there for almost an hour and a half, so if you need to

wake up, have a wriggle in the chair or stretch, or any of the things that

you need to do. Don't be shy. Some people know how to do it. Do have a

bit of a stretch, while I introduce Rohan.

Rohan Braddy has been the CEO of Mambourin Enterprises since 2002.

Mambourin is a highly respected disability services organisation. I won't

read out the list of the things they do.

Rohan is here. He has been a National Disability Services board member

for more than three years and is also a member of the board's risk and

audit committee.

He is absolutely determined to do everything in his power to see the

National Disability Insurance Scheme become a great success story of

public policy.

Let's welcome and hear what you have to say, Rohan.

APPLAUSE

Rohan Braddy: Before we start, can I check, we are running over time.

Do you want me to make that up? I need to plan my run.

Sandy Forbes: How long do you expect?

Rohan Braddy: I was planning about 30 minutes.

Sandy Forbes: Okay.

Rohan Braddy: Sounds good. Like the old school teacher in me, I always

prepare more material than I have time for, because I live in dread of the

year 8s in period 6, running out of material halfway through the class.

In the spirit of reconciliation, I would like to acknowledge the traditional

owners of the land upon which we meet, in the Melbourne area that is the

mighty tribes of the Kulin nation, and pay my respect to their elders past

and present, including any elders of any of our indigenous communities

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who may be here today.

The title of today's presentation is "Remaining Competitive in a New

Market: Understanding Key Drivers for Effective Transition". Some of what

I was going to say was covered by Adrian this morning, and now by

Danielle and Shane. The pessimist calls it repetition, I'm an eternal

optimist so I'm going to call it reinforcement, but I may go faster in some of

the areas I was going to cover and allow some time for questions at the

end.

I have been sitting there reflecting on what I prepared to say over the

course of the last couple of days. I want to start with an apology and

apologise to the people with lived experience of disability in the room and

family members and carers, in fact everyone with a beating heart, because

everything I'm going to say is heavily laden in business, process, systems,

viability and sustainability and yada, yada.

I'm glad Sandy read that bit out from my bio. I do actually care and we are

committed deeply to everything we do, being for outcomes, creating great

outcomes for people we support.

We want to be around to be able to provide those supports in the future,

and that's where the business side and the viability side comes in.

I want to give you a little bit of background to our organisation, to get some

context, and perhaps a few disclaimers.

Mambourin is a company limited by guarantee, with what we believe to be

a lean senior management structure for an organisation of our size, around

$10 million turnover. We don't have vast teams of administrative staff,

accountants, business analysts, et cetera, that we can ask to do the

preparation we need to do for the NDIS. Everything we do is alongside our

day jobs, and I know that's true of many people in the room.

Mambourin operates on the edge of the Barwon trial site and we have

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some experience with current participants who live in Barwon and are in

the scope of the NDIS, but our company hasn't been fully exposed to the

scheme across the breadth of the organisation.

This presentation is from the perspective of but one service provider and

one of our size and structure, so depending on your organisation's size

and complexity, parts of this presentation may be overly simplistic --

Danielle and Shane, you can take an early mark and get lunch -- or not

relevant or more complex than you need to hear, but it is from our

perspective alone.

Having said that, based on the conversations I've had and what I've read

about the NDIS, I believe our organisation would be typical, more or less,

of probably hundreds of others across Australia.

At Mambourin we have been talking about the NDIS for quite a few years.

We were very excited by and committed to the prospect of an NDIS from

its earliest inception. Mambourin was one of the first organisations to

submit funds to the Every Australian Counts campaign and the quantum

we submitted was significant.

I would like to share a personal thought. What frustrates me in the current

dialogue is that service providers are somehow being couched as the

enemy of people with disability and of the scheme, when in fact the NDIS

probably wouldn't have happened if it wasn't for the sector's leadership and

drive and passion.

Mambourin remains committed to the NDIS being fully rolled out across

Australia, as closely aligned to the design articulated in the Productivity

Commission's Disability Care and Support report of 2011 as possible. We

are concerned, thought, that in some ways the scheme unfolding is not

what we signed up for, but that's a topic for another day. The fact of the

matter is we are getting the NDIS we are getting and we have to get on

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with preparing for it. Of course we can continue our strong advocacy along

the way to make sure it becomes the best scheme it can possibly be.

In the time I have available I'll be speaking about all six Ps on the scheme:

preparation, price, partnerships, performance, planning and processes,

with more emphasis on some than others. Let's get into it.

Preparation: I've heard some people say they can't start concrete business

planning because there are still so many unknowns. That, in my view, is a

recipe for disaster. The fact is there is an enormous amount of information

already available on the NDIS website; through National Disability

Services, if you aren't a member, become one; through the media; from

politicians' media releases; from site visits you can make to organisations

in trial sites. The list goes on.

Yes, it's a trial, which means things do change. For example, we spent

many hours poring over the NDIS prices and starting to map them on to

the supports we provide, only to be told by David Bowen in a seminar in

February that the catalogue of supports is to be reduced from 600 items to

the 24 areas of support. But we don't feel the work is completely wasted

because we need to understand how the supports we provide might be

sliced up differently under the NDIS compared with traditional funding

lines.

We have reverse engineered as best we can the pricing architecture from

the NDIA's pricing paper and made assumptions about what is in the

corporate overhead and what's out. We started with the assumption that

virtually everything is in because the architecture underpin the NDA's

pricing is pretty crude from an accounting perspective and basically, if it is

not labour overhead, such as the various types of leave, WorkCover,

superannuation, training and the like, then it is corporate overhead, as far

as we can see, unless it is funded separately in a participant's plan, such

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as transport.

For this reason we have stripped transport out of the calculations for now

but left virtually everything else in. So this has led to a corporate overhead

percentage that is higher than the numbers in the agency's paper. If these

assumptions turn out to be not correct -- for example, some things under

the accounting heading of cost of goods sold, such as what we call

program expenses, turn out to be funded separately or can be the subject

of a co-payment, it is easy to knock them out, but we wanted to make sure

we didn't miss anything. Nothing would be worse than getting to the end of

the financial year, or even the end of the month, and saying, "Why the

heck did we lose money?"

Planning: there are a number of simple tools you can use. The common

ones are cost benefit analysis, proposal planning, pros and cons, SWOT

and PEST. At this stage, if you haven't started, don't waste time on the big

picture stuff, you need to quickly get down among the weeds: who is going

to do what by when?

And don't forget planning with your participants. If you don't already have

these conversations with your participants, you need to find out why they

purchased their supports from you and what supports they might want you

to provide in the future.

It is all very well thinking about capturing new market share under the

massive growth of the NDIS but if you don't retain your existing customers

at least through the transition period, the jig will be up.

We have participated, for example, in a customer experience program. CX

is the latest buzzword that you will see consultants trotting out, and it is

important that you get to know your customers.

This is an excerpt from our strategic plan. No, I've lost a slide. I can move

past it.

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The strategic plan talks about how the NDIS is on the horizon and if we

don't live and breathe it, it could affect our organisation's viability.

It has gone out of order. You might need to bear with me, I'll have to flick

around. I'm not sure how that happened.

This is the excerpt from our strategic plan. Not only does the NDIS get its

own key focus area but all other key focus areas in the strategic plan are

written with it clearly in mind. If the implementation at Mambourin is not

planned carefully and implemented well, it could affect our organisation's

very existence. It probably doesn't need any further commentary.

Price: most organisations like Mambourin will have a significant shortfall

based on current business practices and/or the current prices being paid

by the NDIA. I predict many won't be in existence, at least in their own

right, within a few years. The message is: change or perish.

If you haven't already, you need to get started on detailed analysis of your

current business. One simple ready reckoner is as follows. Do you know

how many hours of support you provide in a year? If not, make some

assumptions and guesstimate it. Actually, a good thing about writing down

your assumptions is that you make them overt, you make them front of

mind, and you can easily play with them when doing the scenario planning:

what if this or that were to change?

To calculate the cost of an hour of service delivery, divide this number into

the total annual expenses from the P&L. I said it was crude. You might be

surprised at the real cost of providing one hour of service.

You can do this exercise using different parameters. What about per site

or per cost centre? Could you do it per client group, per activity or even

per participant? If you can't -- don't get me wrong, we aren't there either.

I should have said, I don't claim to have all the answers; we are only here

to share one journey with you. You will need to be able to do this within

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the next 12 to 18 months to inform decisions and budgets as the NDIS rolls

out. Or you can use the pricing methodology in the NDIA's pricing paper

and build your hourly rate from the ground up.

What's the average hourly rate for your support staff? If your staff is highly

part-timerised -- is that even a word? -- you might need to weight the

average. What's your client's facing time? Add the on-costs. Don't forget

sleepers like long service leave and other leave types and don't forget the

management and admin costs.

Add your corporate overhead. There is probably more in it than the

traditional accounting method. Watch out for sunk or hidden costs like IT

infrastructure, transport, depreciation, and then add a margin. The NDIA

call it return on capital but I believe it is different from margin. Maybe you

need to add both. When you have done the exercise, give me a call. I'll

happily show you mine if you show me yours!

We are working toward modifying our business models and practices to

cover the shortfall that we expect, including running mini-NDIS trials across

the organisation, which has included appointing a trial site manager at a

site and trying to get away from traditional funding silos and trying to think

about a one-stop shop or a wraparound service.

I should emphasise we don't necessarily mean by that we are the

organisation providing all the services, but a one-stop shop in terms of the

participant only needs to stop once and we have all the information and

are able to provide referrals.

More than ever before, cash is king. Count it, collect it, guard it, be the

proverbial Ebeneezer Scrooge. Monitor your cash ratio at least monthly. It

must not fall or at least it must not stay below 1. If it does, sooner or later

you will be calling in the receivers.

Can you do a cash flow forecast one to three years out, predicting what

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your current asset ratio will be at any point in time? That is even better.

You need to have systems in place to provide this and lots of other

information accurately and in a timely manner, ideally automated.

You will need working capital not only to survive the transition but to thrive

in a new market. For example, have you thought about the cost of debt?

Have you thought about how you will switch from funding in advance to

invoicing in arrears for supports already provided?

Let's go through a simple exercise. If you estimate this to be a turnaround

of eight weeks, that is four weeks in advance switching to four weeks in

arrears one crude check to see if you can manage the switch goes as

follows. Look at the amount of what I call freeboard cash you have on your

balance sheet, basically the amount of money you have available to spend

which is not allocated anywhere else, like staff entitlements. It is basically

current assets minus current liabilities. Now look at your weekly expenses.

You might not account on a weekly basis, but take the annual expenses off

your P&L and divide by 52, then divide the number into the freeboard cash.

The answer is the number of weeks you can survive without any income

and without starting to sell the farm. If the answer is less than eight, you

need to think about how you are either going to invoice the agency quicker,

in other words get the cash coming in faster, and/or reduce your expenses

and/or find other income sources.

Systems and processes: I'm probably butchering the technical definitions

of systems and processes, but I don't have time for semantics, so bear

with me. The point is, I strongly advise you think of new and different ways

of slicing and dicing your organisation. Try thinking outside the confines of

traditional funding silos. These silos will be completely irrelevant in a

couple of years.

I mentioned earlier that one way to do this is to look at the pricing bundles

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on the NDIS website and mapping these on to your current support

offerings. You might find you will be invoicing the agency for the same

supports provided to participants who traditionally drew funding from

different pools. For example, personal care is personal care, whether the

funding is from Futures for Young Adults, as it is called in Victoria, or the

TAC, our accident insurance, or HAC. Another way to do this is to break

up the systems into various processes which cut across the whole

business.

There are eight items on the screen behind me, and this probably cover

the major ones, but I expect you could think of 88 more. The point is you

need to analyse your business and divide it up into a list of systems and

processes that make sense to you. As I said, try not to think along the old

service delivery lines or funding silos.

Then start asking questions: what training do we need to in customer

experience? We have undertaken a customer experience analysis and

design program. How much does debt cost your business now? How

much will it cost under the NDIS? What level of bad debt are you planning

for? How will potential participants find out about you and the supports

you provide? What systems do you have in place to ensure quality? How

can you deliver this at the prices being paid? Are there supports you

currently offer that you might no longer wish to offer under the NDIS or are

there other supports you don't currently provide that you might expand

into?

Mambourin has built up a reputation through highly qualified and

experienced staff providing second to none supports to adults with

intellectual disability in the main. People with ABI have traditionally not

been a market for us because they have been funded through health or

through the Transport Accident Commission and these have not been

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funding streams that we have accessed in the past, but many of our skills

we have built up are readily transferable to support people with ABI. Also,

we have high quality infrastructure to support people who use wheelchairs.

Might there be people with a physical disability who would like to be

supported by us?

If you don't have a system to capture all the information on the screen and

to link it to individual participants, then you need to get one post haste.

Every dollar you spend that cannot be invoiced to a participant's package

will effectively be a dollar lost, as Adrian pointed out this morning.

For example, do you know how much of the depreciation of a building in

which an activity is conducted to allocate to an individual participant in that

room? Depreciation at Mambourin runs to north of $400,000 a year.

That's a big number to overlook and have to front the board at the end of

the year and say, "We forgot to include something in the multi-hundreds of

thousands of dollars in our price."

What about heating and lighting costs, fuel in the bus, costs to attend

conferences?

I would like to spend a little while speaking about IT systems. We are all

faced with the challenge of finding an IT system which enhances

operational management and delivers quality services to participants

without breaking the bank. Updating or investing in information systems is

not an activity that most of us undertake every day. Most organisations

take at least six months to acquire a suitable system to meet their needs.

The advantage to working through your process and system requirements

now means you can take time at the implementation and not rush through

the process at the last minute, whilst also having to deal with the inevitable

processes associated with the implementation of the NDIS itself, with

apologies to my friends in the audience who are already in the trial sites.

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These points on the screen could apply to an IT system or just about any

other system or process you are looking to implement. In selecting a

system, you must ensure it not only meets the financial requirements of the

NDIA but must be able to track and support the needs of participants ...

(Whistle) My time is up already!

... thereby driving great outcomes.

That point is often lost in the whole discussion around business viability,

and I appreciate Prof Christine Bigby's timely reminder about how it needs

to be all about the person.

I would recommend a resource enterprise planning system, commonly

abbreviated to ERP, which is process management software that allows an

organisation to use a system of integrated applications to manage the

business and automate many back office functions related to technology,

services and human resources. Ideally, ERP software integrates all facets

of an operation.

When selecting a new system, I recommend the steps on the screen:

firstly, conduct a process review and analysis. Since IT is first and

foremost a business issue, you should start by defining and documenting

your current business processes, pain points and strengths. This analysis

should also include what you think your processes should look like in the

future and the corresponding business requirements.

Next, evaluate the technical fit. Although the ERP should be a business

rather than technology initiative, it is also important to understand how a

potential software solution will align with your current infrastructure.

You need to understand the total cost of ownership. Software sales reps

are interested in downplaying the costs and risks associated with

purchasing their software. However, it is a lot easier to plan for and

manage potential costs if identified earlier in the process rather than after

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you are already committed to a particular solution.

I have lots more information about this, I'm just skipping through, and I'm

happy to share it later if you would like it.

Develop a realistic implementation plan. Vendor implementation duration

estimates are only one piece of the puzzle. By all means, hold your

vendor to their commitments in this area, but it is also important to develop

a comprehensive project plan that includes not just the activities required

to install the software but the ones required to ensure the software is fully

functional, tested and accepted by end users.

As part of this change management, remember, it's important to take your

staff on the journey too. If your staff are not used to bringing a system

similar to the one you are implementing, used to using it, ensure you

consider this in the implementation plan. This means improving their IT

skills before implementation and involving them throughout the

implementation to ensure they have ownership.

In our case, we underestimated how long it would take for frontline staff to

get comfortable using the system implemented and to have the skills to

use it effectively, so I made unrealistic commitments to the board about

how quickly meaningful data would be flowing through to them

demonstrating progress towards goals by our participants. Oops!

We need to track the potential benefits of the new system. There is a

saying in management that if you don't measure it, you likely won't achieve

it, and ERP projects are no different. Chances are your organisation is

looking at an ERP as a way to reduce costs, increase revenue or scale for

growth. You should estimate and measure the benefits against these

metrics if you are going to realise the full potential.

Second last, keep your options open. This might sound like dating advice

but it is also relevant to choosing an ERP package. At last count, there are

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at least 70 viable ERP software options in the market, all with varying

degrees of functionality and strength. Too many companies choose a

solution based on brand name or based on what their competitors are

doing. Instead, you need to consider the options that will best meet your

business requirements and source of competitive advantage.

Finally, look for objective and independent advice. Selecting and

implementing a system to enable you to deliver individualised disability

services is a significant undertaking. Budget plays a big role to support

activities such as requirements, documentation, infrastructure upgrades,

software training and system implementation. Ask colleagues and other

contacts what they use or recommend for a company like yours. Conduct

research on the internet or, if your organisation has not been through the

process of procuring a system in the past, consider utilising a professional

specialist to guide you.

Find other sources of independent ERP advice to validate what you are

hearing from the software sales reps. In our case, I roped in a consultant

who had previously done work for us on a paid basis to continue on a

steering committee overseeing selection and implementation pro bono.

There are many things to consider when selecting an ERP system.

Wherever possible, we would recommend finding organisations that are

already using the system that you are considering and asking the people

who use it to demonstrate it to you and tell you exactly what they think of it.

If that is not possible, ask the vendor to set up a demonstration system that

you can play with at your leisure, ideally with your own data. And the least

best option is to base your decision on a vendor presentation alone,

because they only show you what they want you to see.

The things you can consider are on the screen: does it simplify complex

admin processes and save time? Is it easy to use? Does it drive better

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participant outcomes? Is it compliant with the reporting regimes you need

to deal with? And ideally it needs to be automated as much as possible.

As I understand it, this is not yet possible because the NDIA's new system

has not been rolled out, so I would treat any vendor with suspicion if they

say they are NDIS ready at this stage.

Another thing to consider is: does the system provide better

communication and transparency and does the vendor provide

after-implementation support?

What would an ideal IT solution look like? One of the great inefficiencies in

an organisation is multiple record keeping and multiple processes for the

same task; for example, organisations who have the staff availability, staff

roster, participant timetable and resource allocation booking system, all on

different pieces of paper, often in different locations.

What about a model site service where a participant notifies one site of a

change of address but there is not system in place to notify the rest of the

organisation? Before we implemented our system, one carer lamented to

me that she hadn't received an organisational newsletter from us for the 18

months since she moved house but we had managed to find her with our

invoices from day 1.

Other areas where you don't want to redo things which lead to inefficiency,

you want your system to comply with Australian accountings standards

and to cope with the complexities of the Australian industrial relations

system.

Under the NDIS, organisations need to be able to track service delivery to

the original participant level and drill through to single expense item levels.

The roster should include, staff, participants, rooms, activity, buses,

external resources, all the things relevant for you.

Importantly, with the NDIS basing pricing on an overhead of 15 per cent

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currently, to move to 9 per cent theoretically by 1 July 2016, it is crucial

that the system you choose is as low cost as possible. You may notice

how many times I say "automate" during the course of the presentation. It

is critical that in order to keep costs as low as possible processes are

automated as much as possible, including payroll and the assets register.

In organisations like ours, and I'm sure in yours too, we shuffle data from

one place to another, often simply to comply with different reporting

regimes, and the ideal IT solution will move that data about for you.

Reporting capability at various levels within the organisation is also very

important. In my organisation, as the CEO sitting at my desk, I can find at

any moment in time where a participant is or where they are meant to be,

which staff member is facilitating their activity, and much more, all without

leaving my computer. It is critical your system is able to track service

delivery participant by participant and moment by moment.

Thank you. Nearly there.

Don't forget the nice to haves. There are lots of good features you can

hang off a nifty system if you turn your mind to it.

We have developed our own system. I just mention it, I'm not here to plug

it to you. We are willing to share it with you, basically on a cost recovery

basis. But the bottom line is, if it's not us, it's got to be someone, get a

system.

Looking at performance: as I said before, you manage what you measure.

Work out what's important for your business and your participants and set

measures to monitor how you are going. There are lots of opportunities to

share back office, offer complementary services, share in overheads like

training and quality systems, find like-minded partners and get on with

finding opportunities to save money, drive efficiencies and improve

outcomes.

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My contact details are on the screen. I would be delighted to continue the

conversation. Thank you for listening.

APPLAUSE.

Sandy Forbes: Thanks very much, Rohan.

I will take five or ten minutes for questions, and see how enthusiastic

everyone is.

We have heard from Prof Christine Bigby, we have heard from Shane and

Danielle from Activ and from Rohan from Mambourin.

Let's see if we have some questions.

Mary Nolan: I probably have two questions. One, you used the image of

the train. I use the image of the train too and I invite new people coming

on to get on the train that's moving, don't try to stop it and don't try and turn

it back, but we might take some detours, so you can set alive the people

who are on the train.

I didn't like your image of being stopped at the station with everyone trying

to get on. For what it's worth, an observation.

The other question is for Rohan. Consumers -- I hate that word -- family

members who might be interested in self-managing, who in the world helps

us to get something going? I'm not saying it's not service providers and

there wouldn't be a partnership in that.

Rohan Braddy: That is a great question.

I would link it also even to people who are not interested in self-managing

but how they self-advocate.

We have had experiences, really mixed and variable at the moment, with --

I'm sad to say this -- families who advocate strongly ending up with a better

outcome through the planning process than those who acquiesced and

took what was offered.

It's not an easy question to answer, other than to say, if you can find a

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service provider that you trust, that lives and breathes their value

statements and makes themselves available, you'll get the information that

you need.

I would be absolutely delighted. We celebrate it as a huge win, for

example, when one of our supported employees ends up, to use the old

Amway expression, breaking a leg and working directly for one of our

commercial customers, or when one of our people who are funded

currently through the state packages decides to self-manage but needs

some assistance to set that up.

We are willing to provide all of that, as much support as humanly possible.

I have a private vision of a world where we are out of business, where the

specialist disability support sector doesn't need to exist.

I don't want to see market failure, where we just crash overnight, that's

terrible for everybody, but if we can have those successes with one person

at a time moving on to managing their own circumstances, then, as I said,

we celebrate that as a great success, even if it means a little bit less

money on the income side, on the P&L.

Sandy Forbes: Any other questions?

I think this is what's standing between people and their lunch.

If I can do, again, a very quick summary and thank you, on your behalf, to

all of our speakers. It's been a particularly challenging session from all of

our speakers.

From Chris, saying individualised funding does not necessarily mean

quality, and very particularly reminding us about the level of thinking and

effort we need to put in for people with intellectual disability.

Danielle and Shane were also very challenging in terms of a deliberate and

rigorous approach to planning and continuous change.

Rohan, I don't know the last time I heard someone pack so much into such

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a short time. It was detailed and provocative in terms of, hopefully,

frightening people into that catch-cry that you used, which was change or

perish. Well done.

Thank you to all of our speakers.

APPLAUSE

Before we break for lunch, I'm going to hold you back for one more minute.

At 2 o'clock we have a very important panel, a panel of consumers. We

will be back in this room to hear from our panel, if. The panel is in the

room now, could you meet with me now, delay your lunch for just a few

more minutes, so we can plan the session.

For everyone else, I will see you back in here at 2 o'clock. Thank you.

20150318 NDS 2015

Sandy Forbes: Has everyone put in their card in the prize box from

Moores? Has everyone had an opportunity to put their card in? Is there

anyone who wants to put a card in who hasn't had the opportunity. Quick!

A couple more.

Thank you.

Lee, could I ask you to draw the prize.

Lee Newnham: I would just like to say we are delighted to be here to

support this conference. Our law firm has been involved in the not for

profit sector for over 40 years now and we have a special not for profit

team that works within our firm.

We know you are facing a lot of challenges over the next few years and

hopefully we will be there to support you as required. You will have

received all our contact details in your packs. Please feel free to call us at

any time.

That's enough about us.

This little hamper is full of natural organic products for both adults, children

and the home. I wish you luck!

Katherine Kucher of DCC or Deco respite care program.

APPLAUSE

Sandy Forbes: Thank you very much and thank you to Moores, and

congratulations, Katherine.

We will have a photo opportunity.

Welcome to this afternoon's session. We are very privileged to have a

carer and consumer representative panel. I am going to introduce them to

you and then invite each of the members of the panel to speak to us for

about five minutes, and it would be really good if as they are speaking you

think of your questions and we will then spend 20 minutes having some

discussions and probing the experience of each of our panel members as

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they comment on their experience of the NDIS.

Krystyna Croft is a carer. Krystyna lives in the Barwon region and is the

mother of Robert, aged 30, who has a severe cognitive impairment and

was one of the three people in the Barwon region to have a plan under the

NDIS approved on 1 July 2013. Krystyna has been trying to implement

that plan over the last 18 months.

Nathan Grixti is working as an advocate with a peak consumer

organisation in Victoria. He has a background in peer support work and

PHaMS role and has been speaking publicly about his experience of

receiving a diagnosis of mental illness for a number of years. He has

worked extensively with consumers in the Barwon region during the

implementation and trial of the NDIS, an experience which has influenced

his decision to move into a consumer focused advocacy role.

At the far end, we have Deborah Haygarth, who is a consumer at the

Barwon trial site. Deborah lives in the Barwon area. She has multiple

sclerosis, it is degenerative. She has developed a need to adapt when

doing things, an example being when her fine motor skills deteriorated, she

could no longer play the tin whistle and started playing the harmonica.

She has been with the support group for 10 years.

Joe Micallef is Deborah's partner and carer, a retired chef and musician,

who once attended many festivals as a performer for charities and cooks

his beautiful food for Deborah. Joe is involved with carer groups in

Geelong.

Please welcome our panel.

APPLAUSE.

I have warned them, so none of these things are a surprise. Krystyna, you

are going to talk to us first.

Krystyna Croft: I guess I have been defined by my son. I just live his kind

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of life at the moment, so I think my only identity is his mother and his

advocate. I am very much aware of what my story is, and it is often very

hard to try and pitch it in the right amount of time.

I would like to start by saying I think the NDIS is very good, it will ultimately

give us flexibility and choice. Like coal, it is good, coal is good, NDIS is

good.

The good thing about is it forced me to go on a journey that I perhaps

wouldn't have otherwise gone on. Not only is my son institutionalised by

the system, I was also institutionalised by the system. When you come to

look at flexible options, what you can do, you can't think of anything except

what you have been doing for the last umpteen years.

My son has been in the system for 12 years, and we put a lot of support

into his upbringing, his skills learning, and when he left school at the age of

18 he had a moderate ability to read and write; after 10 years in the system

he can neither read nor write.

I have for 10 years asked the provider if they could provide some

appropriate skills learning for him. They couldn't, they could only provide

accredited training, which he couldn't access. When I went to other

organisations, like special schools which had skills to teach my son, they

said, "Our job is to teach people here in the school." I said, "But I'll pay

you extra to teach my son." No, they couldn't do that. So a real frustration

in the way things were slotted.

My son will be 31 shortly and he lived home until July 2013. I had spent

the previous five years trying to find a way of him leaving home, because

although he's nonverbal he gave me very much to understand by his body

language that he didn't want to be at home living with me and I was

certainly getting to the point where I didn't want to keep living with him.

We spent five years trying to find a way out of it. Of course, there is no

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vacancies in shared supported accommodation, as any of you in those

fields would know. Eventually an agency offered him a bed, which they

were building, and it came online just before the NDIS rolled out in

Barwon. So we were very lucky and he got that bed and left home in July.

But it didn't work out. The placement broke down, he became very

unhappy, and I've sort of wondered how this could happen and how I could

have led him in that situation. Recently, somebody pointed out to me, it

depends where your point of reference is. My son had come from a happy

home where he was actually engaged in part of an active family and had

gone into a house which was only a step removed from a institution.

If your point of reference is what mine was then it wasn't meeting his

needs, but I didn't speak the same language as the service providers. So

it broke down and we had to pull him out.

Since then, I've found a couple of people with whom he lives and they are

being paid what you might call a fairly reasonable remuneration to support

him 24/7, and it was a figure initially that the NDIS was quite happy with,

and in one way you might say, well, these people earn a lot of money just

to look after your son, but in another way, if you look at the hour by hour

support they give him and the way they have engaged him, and continue

to engage him as I did, it's a reasonable way of their being recompensed,

putting their lives on hold while they focus on him being the most important

thing in their household.

The NDIS has now decided that is costing too much and they have come

up with a proposal that we should find a host family who is prepared to

accept $75 a day. This is not quite how I expected it would turn out.

On the one hand, the NDIS is meant to go on a journey to think out of the

box but then they come back and they place or put brick walls in front of

me.

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I'm not happy with the day program that the service providers -- and I have

been trying to work out a better program for my son to attend -- with the

service providers he has been with for 10 years. You might say, change

service providers. They are all the same, and basically in the Barwon

region we have a choice of three and with the new scheme there has been

no sign of new service providers. However, they are popping up

everywhere in attendant care because that's how the scheme really

operates.

In the case of having someone with a severe intellectual disability, they

need actually to be supported and supervised 24/7. My son can't safely

cross the road, therefore if he's left in an unlocked house, he will leave the

house and wander in the streets and be run over. He doesn't like

someone having someone peering over his neck watching what he's doing

all the time either, so it's very difficult to find the right balance of support.

We need what are historically called day programs, because we need

somewhere for our children to go 30 hours a week, which either gives us

the opportunity to work or to have some respite, because you can't care

24/7.

The agency has placed some thresholds, which I have only just

uncovered, which is about 30 hours a week of group funding and eight

hours a week of one-to-one funding. It makes it hard because you have to

rely on the current service providers, because they run the groups,

otherwise I have to find a few people I can join together and employ

someone to support our three members of our family. That's not easy to

do and I don't want to now become an employer.

I have tried to set the scene of the difficulties I'm faced with and what my

needs are and how really those needs aren't being met under the current

service provision.

20150318 NDS 2015

We heard Stephanie Gunn say yesterday, "You create the need and the

services will follow." Well, they are taking a long time to follow. I would

really like to see some more.

Having talked a bit about my situation, I now make a plea to the service

providers in the room, and that is about your preparedness for the scheme.

The service provider I have been using for 10 years sent me a bill in recent

weeks for services provided in April 2013. I understand from looking on

the portal in relation to my son's plan under the NDIS that they have only in

the last few months made claims that go back over 12 months. So it's

really very important, as the previous speaker said, to get your financial

systems online, otherwise you just won't have the cash flow. That's simply

my perception, and a lot of money in my son's plan has never been

claimed.

The other suggestion I would make is to engage with your customer,s as

we have been calling them this morning -- I don't like the word either.

Somebody said that yesterday. Participant is perhaps not even a better

term.

The question is: who is your customer? In my son's case, because he's

nonverbal and I struggle to understand what he would like, I'm really the

customer, trying to make decisions as I see is best for him. So I would

expect a provider to engage with me as the customer and talk about what

it is I would like for my son and how we can go about achieving what his

goals are. But, to date, the provider I use hasn't approached me to discuss

those issues with me.

Also, from my perception it would have been useful if the service provider

I have been using said to me, "Look, if you want your son to attend these

sorts of programs, then I would suggest you go for those line items." But

I have never been told what line items I should go for.

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So I ended up getting what the planner tells me is probably going to be

appropriate, which I don't think is appropriate and I think we should have

been going for other line items.

I think it is very important for service providers to be engaging with their

clients -- I think we used to call them -- prior to this scheme being rolled

out, because that's going to be the fundamental business base. If you

engage well with them, that's a good start to when the scheme rolls out.

I have gone and spoken to a few organisations where they have brought

parents in to do a bit of Q&A on how the scheme is going from a

participant's perspective. That is very useful.

The two things I would say to service providers, engage with your current

client, work out what they want and what you can do for them and get your

IT systems up and running so you can be billing the fortnight after you start

rolling out the services.

That's probably all I'll say for the moment, thank you.

APPLAUSE

Nathan Grixti: There's that moment at the microphone when you hear your

voice bounce back, which is a bit disconcerting.

As mentioned, I'm an advocate working with the Victorian Mental Illness

Awareness Council. VMIAC is the peak consumer body in Victoria for

people with lived experience in mental health issues, diagnosis of mental

illness and experience of emotional distress.

I only recently began with VMIAC. It would have been about mid last year

I made the move to become an advocate. I was originally working with

one of the personal helpers and mentor teams in Geelong. I had been

there for a number of years and had done quite a bit of work with mental

health consumers during the transition and implementation of the trial

there.

20150318 NDS 2015

While I identify as a consumer and I'm not a participant of the scheme

myself, a lot of the work I have done over the past several years has really

involved pretty extensive consultation and support of other consumers

accessing the scheme, as well as taking feedback and feeding that back

into the greater system.

It's probably difficult to sum up everything that's going on in Barwon and

what that experience has been for consumers, in five minutes, but

I propose to give a brief snapshot.

You hear the word "journey" gets thrown about and we know, particularly in

relation to mental health, it's been an arduous journey for most consumers

in the region. I understand there have been a number of presentations

over the last two days on some of the issues around mental health in

particular which have been raised, not the least has been the disjoint

between the NDIS principles and the language of permanent impairment

and the way we work in mental health, which is around recovery.

The overwhelming feedback from consumers in Barwon is a general

feeling that perhaps mental health and the NDIS aren't really suited for

each other. It is something we understand has been worked on, a lot of

different voices have gone into that space and it's really developing in

some interesting ways.

More interesting is recently where we are starting to hear more and more

people are finding their way through, navigating the system and being

happier with the outcomes.

It's been a difficult conversation we have been having around what it

means for mental health consumers to transition to the NDIS. I mentioned

before the idea about recovery. For most people, I guess it's been a real

shift in the way supports are organised, in the way people think about it.

I'm thinking how we can actually sum these issues up. I guess an easy

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way to put it is we have been kind of able to break it down into two very

distinct sets of issues, the issues related to the NDIS and the NDIA

specifically and the issue related to what's happening with the bilateral

agreement between the state and federal governments. While there has

been a lot of confusion on what this shift means, it means we have done a

lot of work in figuring out who is responsible for what, what information

goes where and how it fits together.

I'm not sure how many people in the room are familiar with the current

situation. In Victoria we face a unique challenge because most of the

funding for community management support has been shifted into the

NDIS through the bilateral agreement between the state and federal

governments. That means the people who are found ineligible for the

NDIS now have nowhere else to go. This is the current situation. We

understand there is a lot of work being done to address these issues.

I think one of the biggest challenges for consumers in particular is around

the need to get an assessment reform diagnosis and have that assessed

as a permanent impairment, given we know the fluctuating nature of

mental health issues and all the other factors in there.

One of the other issues a lot of consumers reported is that the diagnosis in

itself can often prove to be a barrier to access to services. We know there

have been reports from quite a few people who have decided to opt out of

the NDIS simply because they didn't identify with the diagnosis of mental

illness. It still doesn't mean they don't want or need access to some kind

of support.

I won't try and go on too much about that. It might be better if people have

questions I might be able to answer, because it is such an in-depth and

complex set of issues.

One thing we know is with the release of the information about the capacity

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building framework paper, a number of funding streams in there,

interestingly enough, look like they have the capacity to be able to provide

for what the mental health participants say they want, which is around the

ability to build consumer communities, drop-in spaces and the like.

We have faced a number of other reforms in Victoria over the past 12 to 18

months, one of those is the PDRS, the mental health community support

sector reform.

With the work we do with VMIAC, quite a lot of the feedback about the

state reforms -- this has been the shift in the old PDRS sector into what is

called the MHACSS space -- one thing consumers report wanting most of

all is the sense of consumer community. These are the drop-in spaces,

the areas that people can come together as a community, not as

individualised support, where people can have access to peer support,

those kinds of conversations that go on amongst people with lived

experiences.

It is one thing that people feel they have lost with the state reforms and it

seems to be the one thing that in Barwon there has been a greater

continuity of that kind of support going on.

I understand in that ILC framework they talk about peer support and part of

the funding is about that. When we talk about consumer communities, it

goes much deeper than that, it's not just about peer support and being able

to use the spaces for recovery, it is about building community and the

communities that share ideas, share knowledge, spaces for shared

learning. Also, we find in these kinds of spaces, this is where the

innovations happen.

At the moment we feel like we have lost that across the state and the

consumers in Geelong have lost that, but what the ILC framework is

looking like, there is the potential to start building that again.

20150318 NDS 2015

Sandy Forbes: Thanks, Nathan.

Deborah.

APPLAUSE.

Deborah Haygarth: I'm from the Barwon region trial site. Having multiple

sclerosis, I come in at a different level from the mental illness and severe

disability, and at this stage I've found it to be really good, it's helped me in

lots of ways.

Prior to the NDIS coming in down there, I had nothing, no ISP at all. I had

a second-hand, very heavy wheelchair that I got through SWEP and had

that for seven years before anything else was done. I had an orthotic for

my leg, which took 12 months to come through, through SWEP, so NDIS is

like a breath of fresh air, there are things available I could get reasonably

quickly.

The first thing I got is my electric wheelchair, which is over there, which is

fantastic, it has given me so much independence, I can go shopping now

and tell Joe, "I'll meet you back here in an hour," and go off and do what

I like, whereas before I had to rely on someone to push me around in my

wheelchair.

They have done a modification on my car. My left side is quite weak and

I'm having difficulty turning the steering wheel, and I thought, that's it, I'm

giving up my licence and not driving any more, and the planner said, what

about modification, so they have put a spinner on my steering wheel, so

I can still drive. That has given me back so much confidence, it's amazing

the difference it has made me feel, now I can actually do things for myself.

We are in the process of getting the OT to come out and have a look at my

house. It is a rental accommodation, through the Office of Housing, and

nothing has been done to it for 15 or 20 years. The bathroom is a little bit

inaccessible. I can't get into the toilet, even with the walker, it won't get in,

20150318 NDS 2015

so I'm bouncing off walls and holding rails. That's got to change because

it's a fall waiting to happen and if I fall there could be lots of dramas.

That's happening and I'm really pleased about that and I thank the NDIS

for getting that moving quickly.

They have also allowed me to have some interim care if Joe goes away,

because I'm a bit frightened to be alone in the house on my own to shower.

I'm okay to get around but I don't like showering unless there's another

person in the house because if I slip there's no one there to help me. They

have allowed interim care, which I hadn't thought of or knew existed prior

to the NDIS, so it's opened my eyes to a lot of things.

The other thing with having multiple sclerosis and it being a degenerative

disease, the plan is made for 12 months but because of the likelihood of

me deteriorating in that 12 months, they have allowed it to be changed

within; if I find I need something in the meantime, because of my

deterioration, they are happy to change the plan. That to me has been

fantastic.

Like I was saying before, I have facilitated an MS peer support group for

10 years, and the people in that peer support group who have gone on to

the NDIS in the Barwon region, I've had nothing but good things come

back from them. One girlfriend is more disabled than myself, she has

deteriorated quickly, they have given her a bed. In the middle of the night,

she might need to get up and couldn't get out of bed. She lives on her

own, her 24-year-old son lives around the corner and numerous times she

had to ring her 24-year-old son and say, "Come and help me, I can't get

out of bed, I need to go to the loo." They have given her a bed which is

operated so she can lift herself up and manage.

I have only had good reports from the people I know, but once again we

have all got multiple sclerosis as a disability.

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I think there is still navigation happening with the NDIS, like it was two

weeks ago I was at a meeting about the change to the portal. That portal

really had my head spinning at first, not being a person to get online and

do stuff. I have got my way around it now and having these little meetings

that you can go to and feed off and learn things. Probably my main thingo

about learning how to navigate around the situation, go to any focus group

or info session that is there before they bring it in and just soak up

whatever you can. That's what I have chosen to do and it's worked for me.

I'm having a little bit of a problem with them at the moment, so I'll do a

negative in here, because my local area coordinator, or LAC-y, as we call

them, went missing. Things were slow, what's happening, and I got in

touch with the NDIS, after getting voicemail messages, to find out she had

been on leave for six weeks, but no one had informed me or put another

LAC in place. That upset me, because we were having great times, then

all of a sudden a spanner in the works.

I still don't have a LAC but my planner is dealing with me closely, waiting

for my LAC, who I love, to come back after leave or put someone else in

place. There is just this loophole at the moment and I have got a few

things in the interim I'm waiting on and nothing is moving until that gets in

place. That is something that should be looked at for the future, because

they are such an important part to you, your local area coordinator, they do

a lot of the work. The planner does the plan but they do the running

around, and if they go on leave and you don't know about it, they are

AWOL, and I think, where do I stand now. The planner has said she will

organise it for me.

Apart from that, it's been really good, I have only positive things, but that's

on the physical disability side and a degenerative disability side, they have

been really good to me. That's about all I can say, I think. Thank you.

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APPLAUSE

Joe Micallef: Hi. There's a few things I would like to say, like navigating a

new system, there are plenty of forums and sessions about the new

system, forums, but there is an old saying, you can lead a horse to water

but you can't make him drink. I've found the people who don't go to the

info sessions are basically left behind. I don't know what is the answer,

how to get people to learn what they should be learning. That's one thing.

The NDIA recognises carers now, because of the benefits to the

consumers, clients, whatever you call them, Deb.

They look at my needs as well. I can give you an example with that chair

that Deb said she had earlier, they said, you need a new chair, then asked

me, how do you go lifting it up and throwing it and carrying it over my

shoulder and all the rest of it. They looked at the chair she needed, then

what I needed, which was a lightweight chair, so I could put it in and out of

the chair really easily. That made a huge difference because the old

thumper, I used to dread it, especially if we went 100m down the road,

I had to put it in the car, then take it out and put it in again.

Now she has got the electric wheelchair, which is a great bonus, she

doesn't have to look at all the fishing gear and tools!

As a bloke, I didn't think I needed any help with house cleaning and what

not, I thought I'm doing all right. I was told that I clean the bathroom "like a

bloke". They actually supported us or supported me now basically by we

get a cleaner in once a week and she does all the things that I don't do too

well, apparently.

Key expectations and concerns: from the NDIA, for me and for them as

well, to be to get everything right, which is a huge task, because of all the

differing disabilities. After all, up until now it was called a trial. Mistakes

were meant to happen in order so that they can iron them all out. They

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have learnt, we've learnt, and it's getting to be a much better system.

There's going to be more mistakes, because everyone is individual, every

person with a disability is an individual, they have totally one person with

the same disease as this one is going to have totally different needs that

need to be met.

I think that's it for me, unless there are questions.

APPLAUSE

Sandy Forbes: We have got our first question.

Jarrod: Hi, my name is Jarrod and I have a background in advocacy and

community work. I will make a comment and then ask a question.

When I was here I was talking to my friend Jeff, we were watching

Deborah climb up the stairs here, and at the National Disability Summit,

I just find that a real bitch.

APPLAUSE

Not only to do that, but there is the expectation that you should tell people

what you want, when you are running a summit like this. I would expect

there to be not only more people with disabilities presenting but also their

needs met. Anyway.

I think when it comes to the NDIA and the NDIS, we need to get out of this

mindset that the NDIA is going to solve all of our problems. It's not. And it

shouldn't just be about the NDIS or the NDIA. It should be about

employment, it should be about education, it should be about a lot of

things, and those people that should be here need to be here, someone

from the employment sector, someone from education, and for things like,

Christine was talking about the day services are a good thing. It's not. It's

easy for me to say because I have a disability, I'm fairly well educated and

I have a well paying job, but I don't think we should just relax our standards

or what people expect.

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I think if your son has some kind of meaningful work, I do believe

everybody is capable of meaningful work. I think the NDIS, there's

avenues you can explore with an employer and employment services to

maybe take on some of your son's needs and wants.

Sorry I'm a bit long-winded.

Sandy Forbes: Thank you. I'll give you each an opportunity to respond.

Krystyna Croft: I left the statement a little bit unfinished, because what

I was trying to say, as a parental carer and worker, I need my son to be

safe for so many hours per week, and historically we have gone for what

we call day services or day programs.

I quite agree with you. The two goals I have for my son are appropriate

accommodation and something meaningful to do each day. That can

mean voluntary work or work. I think study is probably out of the question

for him.

The way the day services operate, I'm finding it very hard to satisfy the

need for something meaningful each day.

My son is very fortunate because he participates in the Theatre of Speed,

which is part of a back-to-back theatre, he has a fantastic day on

Wednesday as an actor. To my absolute surprise, they have employed

him at a full wage for a couple of days in the last six months and he has

thrived on that. They are really nurturing his skills and ability there and I'm

very grateful to them.

Another two days a week he participates in an arts studio and he has had

a lot of success in exhibiting his work and actually selling it, but we have

some issues developing with that studio which need to be resolved.

Another day, as a result of being frustrated about having something

meaningful, which I think is so important, even though I can't really

communicate with him, I suddenly realised I could get eight hours of

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one-to-one funding, so we ditched the day program and I got eight hours of

one-to-one funding, then found a service provider that is in the space of

just providing the hourly funding supports, and he now does a paper round.

He spends a bit of time in the morning under my supervision unbundling

the papers and folding them up and getting them ready to be delivered,

then somebody comes from a service provider and they spend about three

and a half hours walking around the block doing the paper delivery. I'm

getting there.

As I said when I started, the scheme has forced me to go on a journey

which has pushed me out of being lulled into the institutional thinking and

what can I really try and achieve for my son.

There is a lot of work and I guess it goes back to comments which have

been made today by Prof Bigby, if you have the wherewithal to get the

outcomes -- people say, "How did you manage to get that funding? How is

your son doing that?" It is because I have gone out and advocated for him

and got the outcomes for him, but it does take a lot of work. It is full-time

work.

Sandy Forbes: Thank you for your comment.

Joe Micallef: Can I just respond to the helpful remark, which is very good.

In defence of this establishment, they have got a ramp somewhere, they

couldn't find it, they tried madly to find it. But the staff were very apologetic

and obviously gave us a hand helping and were very nice about it.

Sandy Forbes: Thanks, Joe.

John Paton: My name is John Paton from Oak Tasmania. I want to make

some comments and perhaps ask some questions.

We are in the trial site in Tasmania, which is 15 to 24, and it is limited and

it is structured; I think it is about 900 or 1,000 people they are targeting.

There is a whole host of people that are desperate for a service and just

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aren't going to be able to get a guernsey at this stage.

It is a trial site, as we keep being reminded, and initially we were absolutely

prevented from having anything to do with the planners. We weren't

allowed to talk to them. Families would come and talk to us and say, "We

don't know what we want. Can you come and help us advocate?" We

weren't allowed to. We kept being reminded, "It's not about you, it's about

the individual." So we were actively prevented from doing so.

It's getting a little better but there are still issues to do with service

providers that have the best of intentions to advocates on behalf of some

clients, people with disabilities, but not being allowed to do so.

The issue with the portal is one of the most problematic ones we have had

in Tasmania, inasmuch as it took probably six to 12 months to get right.

We hadn't been able to claim for long periods of time, it was in kind, so it

wasn't as if we were having a shortfall in cash, but had it been that new

cash in arrears system, we would have been facing a significant problem.

The portal just wouldn't work. You couldn't find people in the system.

Planners were doing plans for six months and not having a reminder to

themselves, oh, we should be renewing the plan and extending the plan for

another six or 12 months, to reach the end of the plan. We had to

approach the NDIA to say, "We don't have any money now for that person.

What's going to happen?" And it was some weeks later.

Families are being put under an awful lot of pressure and service providers

potentially are being put under a lot of pressure.

Sandy Forbes: Sorry. Do you have a question for the panel?

John Paton: The question is one of the things we are doing at the moment

is trying to relate to families of people with disabilities as part of a project

initiative we are looking at, and I would like a bit more information,

Krystyna, and to Joe, what sort of questions should we be asking families

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to help us identify what it is that you want? Because we, I think,

sometimes assume we know what we provide and we have a knowledge

of what we think we want but I don't know that we get down to a process of

asking.

What sort of way would you like that done? How would it work best, do

you think? We could do forums, newsletters, individual consultations.

Krystyna Croft: It's quite a good question, because half the time I don't

know what I want either.

Going back to the start of your comments, initially the agency wouldn't

allow service providers to come in with clients. Who is going to advocate

for people who can't advocate for themselves? That created a sort of an

us and them approach, so that providers, in my experience, backed right

away: "Okay, we are not wanted in that space, we are not going to go into

it." They didn't support -- a lot of people felt they didn't have any support.

Then the agency mellowed a bit and said, you had better send in a

provider, and they had to agree to providers going in. The result of this,

you are told, I'm told I've got choices and control, which I suddenly find

very isolated because I don't have a working relationship with a provider

because I'm seen as a potential customer.

So the whole relationships that people have had with providers, sometimes

over 30 and 40 years, are breaking down as you are being pushed away

because you are now a customer and you have choice and control and

you don't have to go there.

From my perspective, I see the norms breaking down. It has been talked

about, it's about communication. Let's just sit down and talk.

My needs are pretty basic: appropriate housing and something worthwhile

to do. I don't know beyond that where we take the conversation, but let's

sit around the table and discuss it.

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I think providers in areas where the scheme hasn't come in, you have to

develop that relationship with your clients and skill them up to go in to ask

for what it is they need.

I think we are institutionalised so we don't know what to think and what is

there out there. I am finding that more and more, people are coming into

the field who don't have disability backgrounds and they start asking

questions you never thought to think of before. It is going to take a period

of time.

In the end, it is just communication, dialogue, sitting down talking to

people.

Joe Micallef: The other main thing is find an OT, an occupational therapist,

that specialises in the area of that disability. We were very lucky in our

planner was an MS nurse in her previous life, so she knew exactly what

Deb was going through. Then she organised an OT to come out and talk

to Deb and she was specialising in or knew a lot about MS. That just

helped so much.

We even got, which we both forgot to mention, we go camping quite a lot,

but lately it's been getting harder for Deb. I made a wider step that clips on

to the caravan step for Deb, and for me, because they are bloody narrow,

those things.

The OT said, "Would you like to get a handle on the door, on the caravan?"

I said, "What do you do there?" This thing folds out, locks into place and

it's like a rail. That was like $300-odd or something, that we never even

knew existed for a start. Now on our caravan we've got one of those.

That's the most important thing, a good OT who specialises in the

particular disease.

Deborah Haygarth: Just recently we were invited to come to one of the

service providers had a meeting with their clients, an invitation to come

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along, and the CEO was there, and it was great. They sat around a table

and asked the clients, "What do you want? What can we do for you?" The

input was fantastic and it has really moved since then. They are actually

doing things. They say they go around the state doing that, it wasn't just to

Geelong, he goes around to all of them, the CEO, and that's how we build

up what we think our clients want and need. That's on a one-on-one

face-to-face meeting with them, invited to come and see us. So that

works.

Nathan Grixti: The question about advocacy, it was an issue we are facing

in Geelong with consumers transitioning over to the scheme. What we are

hearing from mental health consumers in Geelong is that people are

starting to be a bit more comfortable or happy with the plans they have got.

The overwhelming feedback we have got is the recommendation to take

an advocate with you. There were a lot of issues in the beginning where

people were going with support workers that they had already established

trust and relationships with, and support workers were being politely or not

so politely asked not to speak.

My understanding of the rules is that an advocate can be anybody who a

participant or a consumer chooses. If that is a support worker they have

got an existing relationship with, there is no reason for the NDIA to say

they can't do that.

I think it is important to make the distinction between the scheme and the

agency, that at the end of the day the agency has described its own role as

interpreting the legislation for the scheme and they are still working on that.

On your comment around families, this is another challenge we face in

mental health. While we want to be able to include family, carers and work

effectively, we also understand, particularly in mental health, often families

can be a big component of the issues people are facing. If the NDIS or

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services are chasing families' opinions, it doesn't factor into the consumer

voice and often families can be heard over consumers and actually

contribute to the issues.

Sandy Forbes: Thank you to all of our panel members.

We have gone over time in this particular part of the agenda.

I'm going to let two more questions, please make them very brief, and your

responses, to give some time to our final two speakers.

Question: I'm thrilled to hear from all of you this afternoon, and Jarrod.

A quick question: I'm interested to know where you are getting your

information from that helps you make decisions around who is providing

what, which providers are in the area, what services and supports are

available? Is the agency helping you in forming those decision or what

would you recommend be put in place to help you be better informed as far

as what is available?

Joe Micallef: Your planner should really be helping you do that. That's

what we have found. They will make the plan with you and then they can

offer you several different companies that do whatever she said you need.

That's what we have found, anyway.

Deborah Haygarth: Apart from that, we can actually look through

ourselves, we are in a position where we can, so that's good. If you are

not, I've found it has been the planner or the local area coordinator that's

been giving you a list of that is what's available and then it's up to you to

ring up and check and see what you want.

I know of friends who have gone to three or four different service providers

before they have got the one they are satisfied with, but that's looking for

themselves, I suppose. It's through a list that's been given from their area

coordinator.

Krystyna Croft: It was explained to me that the agency is the funder, they

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will quantify the cost of the services they decide you require, you take that

money and go and buy the services. It's not their job to suggest where you

might go. The local area coordinators are supposed to pick up after the

plan has been made and assist you to implement your plan.

It's not working in Barwon because they are busy still trying to transition

people into the scheme. The way the scheme is supposed to be working

isn't actually quite working that way for people like us.

In the situation of my accommodation, they are so frustrated I haven't been

able to resolve it, they are taking it on and trying to resolve it through the

maze and they are getting no further than I did.

Sandy Forbes: One last very quick question.

Mary Nolan: This is a comment; I don't expect there is an answer.

We had a very lively conversation, interesting conversation, two or three of

us over lunch and there are elephants in the room that haven't been

addressed or talked about or aren't of relevance. What about people who

have no one to speak for them? We spoke about that this morning.

The other one is the quality of the attendant care. That seems to be a

really big thing for many people. I just leave that hanging. Thank you.

Sandy Forbes: We really have run out of time. Please join me in thanking

our very generous panel.

APPLAUSE

I would like to invite Toby O'Connor.

My apologies, there was a great deal of passion for the last session.

Welcome.

Toby is the CEO at St Laurence Community Services, also in Barwon. He

arrived there in 2009, introducing social inclusion to underpin a move to

consumer governance, client directed services and the next generation of

services to people with disability, in preparation for the NDIS.

20150318 NDS 2015

Welcome, Toby.

APPLAUSE

Toby O'Connor: Could I start by acknowledging the people of the Kulin

nation and their elders past and present.

A couple of days ago I got a cold, so I'm hoping I can get through the

session without losing my voice. Much to the glee of my senior staff this

morning, I was very quiet, so I protected my voice.

Let me say a couple of opening remarks. Particularly I want to indicate

that I'm not standing up here pretending I'm the expert and have got all the

answers. Certainly some of the things I am going to reflect on are really

the result of a lot of conversations with my colleagues in health and others

around the Barwon trial site.

I also want to acknowledge Krystyna Croft. Krystyna was a long term,

10-year board member of St Laurence and has brought us a lot of, I guess,

pretty down to earth approach about how to deal with a lot of our services.

I thought it would be interesting for you to just know very quickly that St

Laurence is a multiservice organisation. Only 22 per cent is in the

disability space. I guess we have tended to specialise in offering services

to people who have an intellectual or cognitive disability or an acquired

brain injury.

Today's reflections are really around that very specific cohort and, as I'm

going to show you, there is a very significant cohort in the NDIS

population. The sorts of services we run are the very terribly named day

services. ADEs, or social enterprises, in home support, and some of that

is also to folk who have dementia or are ageing, and we are the only

agency, I believe, in the trial sites that have got the HAC linkages program,

and all of that in kind contribution mess and fiasco has been difficult for us.

We also have an RTO that delivers a variety of programs to folk with

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disability.

I thought this is what we would get through today, if you don't mind.

I want to start the session by saying that even though I have been

sometimes critical of things that the NDIA agency has done, there is no

doubt that the scheme has been very positive in the Barwon trial site.

There is no doubt that for a large number of people in the area around

Geelong it has been a God send, a lot of the people have not been

receiving services. I think we need to be really clear it is very positive. A

big but.

I thought we would go through a quick environmental scan around where

the agency is placed, where is the Commonwealth in this space.

I hate going to conferences where the person reads off the screen.

I realise I am in the graveyard shift of the conference and I did think earlier

in the week to jettison my 25-page tightly spaced speech to just go to

slides.

There are a lot of slides. Keep up with them. Some of them are slightly

amusing, hopefully, and they are aimed at giving agencies who are

thinking about being in this space some tips on where to go, how to

advance, and even though my group is really around folk with cognitive

disability, the principles are exactly the same for other types of disability

cohorts who are in the scheme.

We need to recognise the Commonwealth has absolutely zero experience

in this space -- none, nothing. Not a brass razoo. The closest they have

got is in the ADE space. For those of you who might know about the

ADEs, they put out a strategic plan with a 10-year focus. Any public

company that puts out a strategic plan of 10 years would be sacked, the

board would be sacked. Clearly the Commonwealth has no idea about

what they are doing in the ADE space, which doesn't give you a lot of

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confidence about how they are now tackling moving forward in this area.

Clearly, it has been a stormy relationship between agencies and the NDIA

agency itself. As we've said, some of the pitfalls the agency fell into

around the free market, and agency providers should not be talking to

planners with their clients, is just a fiasco of a philosophical approach gone

crazy.

It is very clear that David Bowen is now beginning to wake up to the fact

that he has a large number of problems on his plate.

As if that's not enough, Australia's premier three most senior ex-public

servants put this on the cover of their report -- a very, very unfortunate

analogy, because by the end of that week MH17 went down. Now, I'm not

quite sure why they haven't pulled that cover, to be frank, but it's there.

However, and this is still an environmental scan, and this is really where it

applies to the sector, the NDIA is not our only challenge. Our sector also

presents significant challenges for the success of the program and

specifically for participants.

Victoria, like most states, I've worked out, but Victoria certainly boasts that

it introduced ISPs in the early 2000s. The individualised approach doesn't

itself drive change. These are photos of a service in a rural town in

Victoria. The interesting thing about these slides, apart from the work we

have got to do around presenting people with disability as actually

respectful adults, is that this was in a facility opened by the department.

They had to come and do audits. These diagrams, these pictures, have

been in this building for over 10 years. When St Laurence took this

program on, what do you think the very first thing I did in the very first day

that I got control? I whitewashed the walls. Much to the shock of the town.

We have got a lot of work to do. This was a program, same place. Many

of the folk in their 50s.

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It's not just the agency that we have to struggle with to deliver a quality

scheme.

I think this was me at the end of the first year of the trial. I don't say that

lightly. We lost off my bottom line a minimum of $350,000. For many

NGOs in the disability sector, that would probably close them. There is no

doubt some agencies are trading insolvent. At the same time, my audited

financial statements had the Commonwealth as a debtor of $8 million, so

very significant problems with these guys.

If this environmental scan doesn't frighten you, well, it should. But there's

good reason to keep going.

There is great opportunities. I'm now talking as a provider because

providers do have to cover these services. There is great opportunity to

expand and grow. This is a massive initiative, this is the biggest public

policy in the world, and you can bet your bottom dollar there are

companies in the OECD looking at here, wanting to be here because, as

you may know, the OECD, other than really Germany, is bankrupt. I was

at a finance meeting with Melbourne University a couple of weeks ago,

they were saying that Europe will be bankrupt during my lifetime, and my

immediate children's lifetime. My grandchildren might see something of

this. Companies operating in the OECD want to come out here.

Let me say to those of you who are thinking that the free market and

private for profit companies are dirty, the facts of the matter are,

particularly in relation to the employment projects which were heavily

privatised about 15 years ago, they run very efficient, ie lean, and effective,

ie they deliver the outcome services. So we need to be not too worried

about the fact we are going to have some competition.

The thing I think is most fundamental to the success of an agency is you

need to have a leader, in most cases it is the CEO or at least the general

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manager, in a large organisation looking after disability who can actually

articulate your response to this massive initiative.

I'm going to try to get this to work, remembering that CEOs and IT don't

generally go hand in hand. I hope if I press this -- I want to show you a

quick video.

I will come back. That is to demonstrate to you what normally happens in

the not for profit sector when there's change. I get a little bit excited, we

bounce up and down, that was the first bounce, very little bounce, more

change, a couple more bounces. The issue is we basically go in one

direction, we know where we have got to go.

I am going to go backwards. Just bear with me.

Obviously I shouldn't be doing this.

The third one just typifies what the NDIS is about.

You get the idea. Because in the first year of the NDIS that is how it was.

And that is how it will be when it lands in your space.

It's not just one thing. It's multiple things all at once. And any number of

those, if you happen to be the poor bugger at the top, like the CEO, it feels

like juggling those axes. Because if you don't keep control of it, you are

going to cut your veins. So you need to find somebody who is pretty good

at juggling.

I hope that I'm not going to teach people what they already know, but bear

with me, because I want to quickly go through the business model. It is

something very new to our sector. I have broken it into three. I love three,

the triangle, the trinity, there are three components I'm going to go through

quickly.

You need to start thinking about this in your own space, so you can begin

to work out what services you want to deliver, before you start working out

how you are going to market them.

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The obvious question is: where do I get the information from? I suggest to

you there's a lot of information out there. The NDIA is highly scrutinised.

They have to deliver reports to COAG and they have to deliver reports to

the parliament, so they are getting hit from two angles. They put out

regular quarterly reports. Not all of that stuff is guff, like the fact only two

people have ever complained, which is just nonsense. There is a lot of

stuff hidden in the material, if you go through it.

What I said there is that you can actually ascertain that there are

10 per cent of participants in the trial sites who have got a package of

$100,000 for more. If you are a disability agency and you have got full

funding, that is a pretty significant hit on your register or your radar.

Translate that into what's the percentage in the Barwon and you work out

there are 882 of those floating around -- sorry, 332 in the Barwon site.

Where else might you get some information? Remember, at the beginning

I was making some comments about both cognitive disability and how

I think they are the major part of the scheme participants. I know you can't

read that. There is a reference on there, it's the September 2014 report,

the latest report that came out. It's table 1.1.1 on page 27. It gives you the

breakdown of disability category or cohorts defined by the NDIS. There

doesn't seem to be great logic in how they have done it but it gives you the

breakdown across the states.

I was with a colleague at another conference in Tasmania, apparently

Tasmania has 2 per cent higher than everything in the disability space. If

I was wanting to get into this space, I would certainly be taking that into

account because basically the cost of living is lower in Tasmania, the

wages are lower, you are going to get a higher rate of return.

The other thing to notice about the scheme is participants are there for the

lifetime, and that's literally what it means. From zero, I know it was 65,

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that's clearly not going to be the case, there are some folk who will be in

the scheme forever because they just haven't work out why things should

suddenly stop at 65 when the age pension kicks in or as it goes up to 67.

You need to be looking at this data to work out where you sit with your

potential customer base, consumer base, particularly if you are already

delivering services to any of these folk.

63 per cent. 63 per cent have a cognitive disability. You might think, if you

are not delivering services to folk with cognitive disability, you might think

you have got something to offer.

Products: products are a another part of the triangle. This data is

available, again, at page 21. It tells you the sorts of supports that are

being provided at the moment. I have circled New South Wales and

Victoria because they are the ones where the trial is across the total

population. So you can see, it's very difficult to see, but that barcode on

the left-hand side, the purple one, is education services. The next one is

called self-care, the one after that is a little bit more amorphous, it is

community and social life, the next one is unclear, general tasks and

demand, then "Other".

You need to go to the NDIS schedule of items, the 65-page list of items, to

work out what is in there, to then hone down what sorts of product you

might want to deliver.

You need to work out what sorts of activities actually fall under self-care.

Do you do any of those? What actually is part of community and social

life? Remembering, community and social life should be pretty high

because the aim of the scheme is to get people integrated into life in the

community. For those of us who have been running specialist services, we

need to get our head around the fact we need to run more and more

activities in the local community; not in our centres. That's pretty

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fundamental.

The aside to that is, think about this, if I'm Coles Myer and I want to come

into this space because I know there's $24 billion up for grabs -- my

calculation, it's actually $28 billion, but there's $24 billion at the moment,

it's set there for life, it's government money, it's guaranteed, it's easy to

make, I don't want to have a return on investment that includes me having

to buy property, bricks and mortar. If I can design services that are about

getting people into the community, exactly the sort of things Krystyna Croft

was talking about, accompanying her son Robert to do a paper round in

the community, no cost to set that up. Agencies like me, I've got

overheads and infrastructure, I'm at a big disadvantage and so are you.

You have got to think differently.

Here is an example to really hone this down. For those of you who are not

from Victoria, I'll try to explain this really quickly. The levels on the

left-hand, they are assessments done of folk who have an intellectual

disability and when you get assessed you get a dollar rate put on to you.

DHS tells us what the funding is, which is the next column, SNA level 1,

$9,540. That tells us the hourly rate is $6.91 but the actual cost is worth

$4.83, so the only way I can make this work, I must run a staff member to

a ratio of 11 clients. This is the basis of your business modelling that you

need to be doing if you are doing group activity. It gives you the staffing

cost.

You need to remember one thing here again -- there's a lot you have got to

remember -- the NDIA has said they want the overheads for service

providers to be -- does anyone know what they said?

Question: 9 per cent.

Toby O'Connor: Anyone know what they are now?

Question: 11.

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Toby O'Connor: If you're doing 11, I want you on my team.

Question: It depends what they classify as overhead.

Toby O'Connor: Exactly. As my colleagues go from my agency to the

NDIA, they suddenly an extra jump in superannuation, for a start. I wonder

whether that's in or not.

Just some fees. These are the actual fees that are being paid. The

column on the left, group based activities, the one in the middle is group

based in a service centre. The one in the green is assisted self-care.

They are the hourly rates being paid. You need to calculate how you can

offer that.

There is no NDIS manual to tell you how to do this. Are you delivering

some of these services already? More importantly, who in your workforce

is delivering these services?

In Victoria, the agencies, the NGO sector moved to increase the skills of

our staff and we supported them to get a cert 4, almost all of my disability

staff are cert 4. You now what the NDIS hourly rate is based on: cert 3

level 2. So for every hour I offer service, I lose money. You will lose

money. Think about that. It's not cert 4. So anyone who has an RTO who

runs cert 4 training, a very limited lifetime in that. These are things you

should be asking your finance department or CEO, or your board should

be asking you.

A bit of advice here: in our sector there are a large number of smaller

disability organisations. A lot of those probably have boards of

management, where you have got your directors actually involved in the

day-to-day operations of the agency. You are going to be in strife if you

don't have your models worked out now. For instance, do you continue to

provide a service to a bunch of clients that you are going to lose money

on? You need to have that out with your board now, because I'm sure they

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will be saying yes, but you will be saying, if we do that, we are out of

business.

It's very clear, particularly from the chairman of the NDIA, that he is a

believer in the free market approach. There's absolutely no doubt in my

mind because I've been around for a long time and I've seen them come

and go at the Commonwealth level. He is going to come a cropper, but

that will take some time.

Two bits of advice: really, the first one, I can't emphasise enough. If you

are delivering your services one year after the NDIS comes to you, the

same way that you were doing it before they came, you are going to be out

of business. Absolutely make no doubt. If there's something that you can

take from the agencies who have been thrown into the cauldron in the trial

sites, that would be it. You cannot deliver the same services the same

way that you are doing it now.

Let's talk about products and customers. I was going to say at the front

that I have used the term "consumer" and I have used the word

"customer". I have done that deliberately. In my organisation, about three

years ago we wanted to change from a charitable model to one where we

were very responsive to the individuals asking us for services or for

support. The way to do that in my mind was to try to get staff thinking

about our folk as being consumers, because if they are a consumer, we

deliver something to them, hopefully what they want. It has been quite

deliberate to use the term "customer", although I say that in the context of

the current discussion I'm having with my line staff at the moment. I think

we are in a good space and maybe it's time to go back to calling people

"clients", for want of a better term. I think it's done its term. But it's all

about the customer. If you haven't worked that out, you are in a bit of

strife.

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It is really about choice. One of the things that I want to highlight to you,

this is what's termed day services. Do people know what day services

are? They are the really terrible services that the state governments have

funded. That's the model they operate on. You can see roughly from 8.00

in the morning to 3.00 or 3.30, Monday to Friday, that's what they offer.

The NDIS in my mind was a great opportunity to move away from that and

to do that. There is a whole lot of problems in going from those two areas,

from one to the other. Our problem at the moment is because providers

are not making those jumps, the NDIA is tending to just reinforce the old

patterns of sending people to the historical hours, because nobody is

saying, we want to do it differently. That does need to change. And it is

massive change.

Very quickly: some of the product development that we have done has

gone back for a couple of years. Because this is about marketing, let me

be really honest, I'm now marketing to you. We develop what we call My

Path, it's an integrated set of curriculum based services, that was really a

response to the really, really terrible services we used to run in our day

service areas.

So it was a deliberate attempt to actually move to a TAFE-like environment

for our folk, our consumers, when they come to us for day activities. We

gave people variety.

This is about four years ago.

We gave them booklets so they could choose, outlining what we were

doing.

We have now integrated all of that on a portal which allows our staff to

download the teaching materials for each lesson.

These are just examples of what's in the materials. We have got boxes

where we need, some of our programs, for instance in cooking, there are

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boxes that alert staff to ensure that any allergies are going to be taken into

account before we start. There are OH&S highlights built in, et cetera.

We were speaking earlier about some of the continuums. What we have

built is a whole range of products, of services that hopefully people want to

choose.

We have got My Path Plus, which is accredited training in the foundational

skills area.

You have got to be bold, decisive. We listen, you choose, we respond.

The board, throughout our previous vision statement, which was we help

people help themselves, I went to the board and said, so long as we have

got "help" there, it's very difficult to get our staff to think about actually

being accountable to the folk we are delivering service to.

Very quickly, the last one -- here is a tip again -- when the NDIS comes to

your space, you actually need to be thinking about driving this from your

back of house. In the first year or so it was our finance department that

I heavily relied upon to make decisions about whether we should do some

activities over others.

Again, you have got to be very flexible.

The next couple of examples are just to show you how complex the system

with the NDIA has been, who comes into the system. We were aiming at

trying to retain our current clients but there were also potential future

customers so we needed to have different systems in place. We changed

this about every two weeks because the NDIA kept changing their

protocol. We have a large organisation and we needed staff to know how

it all worked, who were the decision makers, what were the key points of

signing, who signs the individual contracts.

That's our current one at the moment, much more simple than the first one.

Then quickly, we moved down the path of going into a specialised client

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service system that tracks our participants through the lifecycle with

ourselves. It's got our product delivery there, and it's got the schedule of

NDIA fees in some of the screenshots and it tracks their attendance.

Remember, you have to prove that a participant has actually turned up and

been at your service. If you cannot prove that, you cannot make a claim.

As you know, or as you should know, the agency is also very interested all

of a sudden in outcomes so we have developed an outcome tracker, which

is computerised. We can push a button and show to a client what

progress is made over a one month, two months, three months process

and report that back to them as well as the NDIA. It is really about proving

that the goals are being met.

I am hoping that after that very quick movement through the environment

that St Laurence encountered around the NDIA, you have some hope that

all is not lost yet but it is a tough assignment.

I guess finally, these are some of the products that St Laurence has

developed, that are available for agencies who want to go down the NDIA

path, without reinventing the wheel.

Thank you.

APPLAUSE

Sandy Forbes: Thanks, Toby. We might let you have one question.

It's that time of the conference where I know people have got to leave

because they have to head off to catch planes or trains.

We will keep going. One question.

Question: Thank you for that. You made statements about the

laissez-faire and we have heard that this is now a free market system, but

it is the only free market system I know where the unit cost price is set by

the government, so it's not a free market system.

Toby O'Connor: That's not quite true, because the price is set in aged

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care and the price is set in employment.

Question: All right. I acknowledge that. The feds like to set the unit cost

price and then call it a free market system.

In your opinion, because those of us who are in services worry about the

bottom line, is that unit cost price likely to change?

Toby O'Connor: This is where I probably depart from most of my

colleagues, in fact I know I depart from my colleagues at the Barwon site,

where agencies spend a lot of time arguing the toss about whether it

should be 10 per cent more or less.

My own view, I'm absolutely pragmatic. If that's the price, that's the price.

Because whether the price is 10 or 15 per cent more, let me guarantee

you, it ain't enough to do what we were doing when it was full funding. You

still have to do something differently and make it work. It's a little bit about

if the price gets increased, that's a windfall to us and that would go to our

bottom line. But the reality is, frankly, I'm tired and I'm sick of hearing my

colleagues argue the toss every time I set down at a meeting with the

NDIA. I think it's unfair on the colleagues.

You have to remember, the trial site NDIA staff are simply postboxes, they

are the mailmen, they make no decisions and they have really not a lot of

experience in this space. My view is it would be great to have the price

higher, but I don't have time to muck around, I'm here, I've got to deal with

it now.

Sandy Forbes: Thanks, Toby.

APPLAUSE

I am now going to invite Prof Laurie Brown, who is a very patient person.

Prof Laurie Brown is deputy director of the Institute for Governance and

Policy Analysis at the University of Canberra. I am going to cut right to the

chase here and say her work is recognised for its emphasis on the social

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determinants of health framework and the health in all policies approach.

In 2013, Prof Brown won the University of Canberra's Vice Chancellor's

Award for Research Excellence in the Social Scenes.

Thank you, Laurie.

Laurie Brown: Thank you.

I would also like to acknowledge and pay my respects to the traditional

owners of the land on which we are holding the meeting, past and present.

What I plan to do at this presentation is to look at the more aggregate

level, building up from a lot of the discussion we have had today, up to

asking how we are going to assess the actual success of the NDIS. What

is it that we need to understand, how do we set up benchmarks now, so in

the future we can go, yes, this was a policy success, or no, there are some

unexpected outcomes that we really didn't want to have.

Just very quickly, I'll just recap on the visions and objectives of the NDIS.

You all know it, but fundamentally what I want to do in that discussion is

pull out some ideas in terms of performance indicators. Then what I'm

going to do is just do recap some information about what are the attributes

we want to see in good performance indicators.

It's really building up on a lot of the discussions we have had from the

individual service providers and some of the business models we have

talked about, building that right up to, if you like, the more aggregate level.

The NDIS does have performance indicators, some of those being

legislated, some in the vision statements. What sort of key benchmarks

are we going to use? What I want to do is to give you an overview from

some of the work we have done, which is really almost like a state of the

nation, saying, this is where we're at, and then just provide some

concluding remarks.

We all know it's about creating social and economic independence. It's set

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within the UN Convention on the Rights of Persons with Disabilities and it's

all to do with trying to encourage full and effective participation and

inclusion. So that's the broad background.

Sitting alongside those types of objectives is also saying, look, it's got to be

financially sustainable and it's got to be governed in terms of some sort of

insurance principles. In other words, we are pooling risk together to try to

pay for services that people with disability want and require.

Then there's the idea of the buy-in from the community.

More specifically, the objectives are really saying, in terms of people with

disabilities should pursue their own goals, maximise their independence,

social and economic participation. That filters through in terms of issues of

activities within communities, in terms of employment, there are these

supports and intervention supports are going to be available, and it's all to

do with choice and control.

If you go back to the literature surrounding the NDIS as a policy, this is the

sort of jargon that is encapsulated within the framework and establishment

of the scheme.

How are we going to measure the success, one year, two years, three

years, five years or ten years down the track? We know in terms of

individual trial sites there is already ongoing evaluation specific to that.

I am taking it one step further. Australia, when we look in 10 years time

and go, what's the outcome of the scheme at that higher level, what are we

going to say? I'm arguing that we have to have clear benchmarks against

which the progress can be monitored and evaluated.

Broadly speaking, we can use information from the health sector to look at

indicators. In some of the slides today and yesterday, you can see things

like key performance indicators coming up. They will operate at the level

of the individual provider but they have to go even higher.

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In the health sector the argument has been performance indicators need to

have certain attributes. They have got to be worth measuring. There's no

point highlighting something if it doesn't have some inherent value, it

represents something that is important and salient in terms of, in this case,

public health. That's to do with the performance of the system.

Another attribute, and this is certainly the case in the disability sector, is

these indicators have to be measurable for diverse populations. They

make sense, they are valid, reliable for the general population, but also for

particular groups. However you want to slice the population pie, if you like,

they have got to relate to a broad cross-section.

You have to understand what they are about, particularly those people who

are going to act upon them. If you are going to -- you need to understand,

they have got to be comprehensible and you have got to be able to move

forward. Once you have them, they have got to be able to galvanise

action, whether that's at the level of the individual or groups, service

providers, government.

Relevance to policy and practice: it can lead to improvements that you are

expecting, so that they will be relevant, they will lead to plausible actions

that can alter the course of events.

Also you want to make sure that they are going to be consistent over time.

There's no point having something relevant today that may not be relevant

in a few years when you are trying to look at the general outcomes.

From another perspective, they have got to be feasible in terms of

collection and reporting. You don't want a large burden placed on

individual providers with a huge administrative workload that may or may

not be useful in the long term.

Essentially you have got to be able to develop something where it is easy

to collect that information and in my view it's fairly straightforward, not

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complex and represents the key issues you are trying to get to.

Then there are elements in terms of the processes of data definition.

In the NDIS, and its establishment, you can find key performance

indicators in the portfolio -- it was called portfolio additional estimates

statements, and you can dig down and these performance indicators

reflect the reporting framework. It was all agreed upon in the

intergovernmental agreement at the time of the launch, so the buy-in from

state and territory governments and Commonwealth government.

Then if you drill down into the rhetoric from the NDIA board, you can look

at the strategic plan and again come up with various performance and

scheme success indicators.

So they are there. What's unclear to me is how some of these will actually

be implemented.

Digging down a little bit further, you can find a number of statements in

terms of the expectations of the NDIS.

Looking at assessing the scheme performance, you are looking at

outcome and performance indicators that are linked to the objectives of the

scheme, and I'll just go through very quickly some of the performance

measures.

The ones I have highlighted in red on the slide are some of the key issues,

I think, in terms of establishing benchmarks.

In this first case, there are a number of outcomes, and I'm particularly

interested in people's lived experiences. I'm not focusing so much on the

financial structure of the NDIS but what does it mean for individuals who

are going to be in receipt of services of packages funded through the

NDIS.

In this first element, we are looking at people with disability and how they

will achieve their goal of independence, social and economic participation.

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Then there are a number of particular measures.

I think one of the ones that I'm interested in is the proportion of participants

achieving their plan goals in one or more specific domains. The ones

I have highlighted are economic, social, education, health and wellbeing

and living arrangements. Following on from that, there is interest in terms

of labour force participation and social and community activities.

Then we can go -- for the sake of time I won't go through the other

measures, but they are still within the overall outcome of people with

disabilities, in terms of leading lives of their own choosing.

We have got entries of support options and innovative approaches in terms

of the provision of care, and that's in response to assessed need.

The third element here -- I won't go through the particular performance

measures -- is again a question of are people with disability supported and

able to exercise choice.

I was fortunate enough to be able to take what I call a bit of a state of the

art report, called 'Diversity, Participation and People with Disability', and

I have got a few copies with me. You can download it from our website,

which I will give at the end. The slides I am presenting are out of this

document. If you have difficulty accessing off the web the reports like

these, please feel welcome to come and get one. I'm quite happy to send

them through if we run out.

What I want to do is now go, okay, where is Australia up to in terms of the

world of disability and people with disability?

Coming back to some of the key performance indicators, the first slide here

is about family and household situations. What the slide shows is that

while the most common type of family or household situations of people

with disabilities is couples with children. I also should say, this information

only relates to people aged between 25 and 65, so it is across the working

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age group.

Just quickly for both males and females, what this information shows,

which is taken from the latest survey of disability, ageing and caring, is that

there is a greater proportion of people either living in lone parent

households or sole person households. There are significant issues

surrounding households and family. I am saying this is a like a

benchmark, how did that occur and how do we improve that over time?

One of the issues for this particular age group is that relationship

breakdown is common among people with disability of working age. It

gives rise to the stats of people with no disability, and they are the bar

charts at the end, and those that do.

Again, this is information not directly related to those people had are

eligible for the NDIS. The information is using that basic disability status in

terms of people with profound disability, severe disability, mild, moderate,

with schooling or employment restriction, no restrictions but still has in

disability.

In this information, most of the people who are eligible for the NDIS will

come out of those groups with profound and severe disability. Not

everyone in those categories will be eligible and there could be some

others.

Living arrangements: this shows home ownership, renting or other forms of

accommodation. Again it is showing that people with disability, the

working age, even though a large proportion are home owners, have either

brought their homes outright or are mortgaged, a lot of people are living in

rented accommodation.

What I'm telling you, we could have sat down, you didn't need these slides

and said, "These are the equity differences." I am saying information like

this needs to be black and white and if we say, as a community involved

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within the sector, to government, what is it that we need at an Australian

level, you might argue you want equality, equity, in terms of living

arrangements.

Okay, now you don't need certain supported accommodation, but why is it

that we see this large difference between the left-hand side of the slide and

the right-hand slide, in terms of people with profound disability, no disability

and something like home ownership? I'm saying, given division, given the

objective state of the NDIS, is this something we should be moving

towards to try to minimise this difference?

You can go through, in terms of other elements. This particular slide

shows the prevalence of homelessness or being without a permanent

place to live.

As it turns out, those people with profound disability, the distribution on the

left is not that dissimilar to people with no disability, but those in the middle

experience much higher rates of homelessness or having experienced --

I think the definition was like in the previous year -- they didn't have a

permanent place to live. That raises certain issues.

I'm saying, five years down the track, with provision of NDIS funding, are

we going to see something different?

Education: I'm conscious of the time. A large proportion of people with

disabilities at the moment are early school leavers, with a significant

difference in terms of completion of year 12. I know there could be

different expectations in terms of qualifications. I'm just saying, if we go

back to the aims and visions of the NDIS, then we want to look at moving

outcomes in terms of educational achievements further on.

We might start at a whole range of different levels. This is a theory

aggregate measure in terms of the highest educational qualifications

attained.

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It is also interesting to sigh that, particularly for the males, entering into

vocational education, getting certificates and diplomas, the proportion of

individuals achieving that at the highest level of qualification is significantly

higher than those without any disability.

There are issues in terms of where people are being steered and the

overall expectations in terms of attain.

We can drill down. Again, you will be well familiar with labour force

participation. Again, I'm not going to run through the slide. What I'm

saying is we need information such as this at this aggregate population

level to say at the moment those with profound disability, something like

three-quarters -- it's not much different -- three-quarters for males and

80 per cent for females aged 25 to 64 with profound disabilities are not in

the labour force. So they are not working part time, they are not working

full time. That is significantly different to those with no disabilities.

The flipside of that is those who are employed full time.

Again, it's setting a line in the sand for saying, okay, this was information

from 2013, I think the latest survey of disability, age and carers, what will

the same type of table show us in five years or ten years? Are we going to

see the gap closing.

Some of the experience in terms of indigenous disadvantage policy has

been significant concerns that those gaps aren't closing using some of the

standard benchmarks.

Income: this is a slightly tricky slide to interpret. Basically, what I've done

here is a line -- there should be a straight line and it is building up the

proportion of people who are income quintile. So it is taking the bottom

20 per cent, the next 20 per cent, right up to 100 per cent. If the world was

evenly distributed, you would expect a straight line running as you would

see for no disability for females.

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The top line for males is those people with profound disabilities. What it is

saying is nearly 90 per cent of people with profound disability are in the

bottom three quintiles.

So there is a big skewing in terms of income between the different scales

of disability.

Again, you could have told me this, that if we look at the earning capacity

of people with disability at the moment, in terms of income from paid work,

you know a significant number of people aren't in paid work, income is

going to be lower, they are in the bottom socio-economic classes.

This is just a convenient way of looking at the gap. You look at the curve

and you look at the difference between where that line would be, that gives

you an indication of the inequality. What we would like to see over time is

all the curves coming together, where there's closing that term in terms of

an even distribution across the income quintiles.

This is the last slide in terms of a potential benchmark. In the report we

look at participation in things like sporting activities. Not saying you are an

actual participant but you could be a spectator. If you happened to be

interested in the current world cricket, which I gather has really booked out

a lot of the accommodation in Melbourne at the same time, given India is

playing Bangladesh today -- if you are a person with disability and you are

interested in cricket, do you have the same access to going down to the

MCG today to watch that game as if you don't have disability? Are you

stuck at home? Some people might like to watch TV. But what is the level

of participation?

This is just looking at some cultural activities that a lot of people in

Australia would take as part and parcel of standard life: going to the

cinema to see a movie, maybe going to the art gallery, maybe you like

plants and you want to go to the botanical gardens. Again, is this an

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appropriate measure to have as a benchmark?

So we see quite significant differences, again. You guys know, in terms of

your own experience about social exclusion. How are we going to

measure the success of the NDIS if the argument is for full social and

economic participation?

Transport: in terms of transport, this is the ability of people with disability in

this working age to access public transport. It is broken down by all forms

of public transport, in terms of some forms or no forms. Again, that's a big

issue. Maybe we need a benchmark like this.

In conclusion, how are we going to measure the success of the NDIS in

terms of achieving its policy outcomes in future years? What I'm arguing

for is, even though there have been some performance indicators identified

and agreed upon between state and Commonwealth governments, built

into the legislation and the structure, it needs to be articulated into robust

benchmarks that meet those criteria of being a good performance

indicator. They have to be worth measuring.

I'll run through what I think are only areas we should look at. There needs

to be discussion, was that reasonable, what specific indicators do we

want? They are measurable, the data can be collected and reported upon,

they are statistically valid and reliable and they are relevant to policy and

relevant to practice.

Finally, I think it's time we confront reality. I quite like the previous talk in

terms of what is actually happening on the ground. It is early days for the

NDIS and the NDIA but we need to confront reality. We have to recognise

where we're at now and where we want to go to and then how we are

going to go about measuring that success.

That raises issues in terms of critical governance. We have got to look at

what may hinder or promote the social and economic inclusion of people

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with disability.

As I said, you can access this report from the website,

www.governanceinstitute.edu.au. I have got a few copies now for anyone

who would like one.

Thanks.

APPLAUSE

Sandy Forbes: Thank you.

Are there any questions for Laurie, or are you so overwhelmed by the

numbers?

Katherine Shank: Hi, Laurie, Katherine Shank from the Australian Bureau

of Statistics.

Just a comment: thank you so much for giving such a beautiful and

succinct presentation and making the case for the benchmarks that come

from our survey of disability, age and carers.

The point I want to make is really that in terms of understanding the whole

population, everybody with a disability, some, as you have pointed out, the

NDIS will capture a lot of that profound and severe disability status, but

you really made a very clear point about we need to understand the whole

picture, we need to understand what's happening over time and potentially

who is being left out of the scheme in terms of disability types, whether it's

people with mental health issues or people with intellectual disabilities and

understanding how that scheme is performing over time for everybody, and

we may or may not get that just from NDIS data. So thank you.

Laurie Brown: In our report, if you want to get some very basic

information, in terms of prevalence of disability in Australia -- and, by the

way, you get it from the ABS website as well -- where we start with the

people aged 15 to 64 and we can go, okay, in terms of reporting and

answering the survey, then weighing it up to represent the whole

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Australian population, you go, numbers with disability, numbers without

disability and break it down in terms of limitations and restrictions.

It probably is a subject for another time and another debate as to eligibility

criteria.

I have done this here today, partly focusing on the NDIS, but there are a

large number of people who will be excluded. So what happened to those

individuals? Where are we collecting information? How much

administrative data can we use alongside the type of data that is collected

from the ABS?

Question: Not so much a question. The other part of the question is how

many of them then come back with a higher level of need at a later date,

the ones excluded, at a higher cost?

Laurie Brown: The comment was made, for those excluded, what happens

in terms of their own trajectories in disability status? Will they come back

into the system at a later date with more severe problems and with that

higher costs?

Sandy Forbes: Thank you, Laurie.

APPLAUSE

It is my task to sum up, and I think we have got back on track, which is

excellent, particularly as we have lost a few people. I blame this on

airlines and trains.

What a rich day we have had. We have had perspectives from people with

disability, carers, service providers, and academics. It's been an incredibly

rich day of information.

I hope that you in your own way will integrate all of that information and

take from it the things that you really most want to take out. In particular,

I thought there were three or four things that really stood out for me.

It said to me that fairly unanimously everyone said, listen to your individual

20150318 NDS 2015

clients/consumers and their carers, prepare for the change, because

certainly we heard the message a number of times, "Change or you won't

be here in a few years time if you are a service provider."

I thought Krystyna's story was the most compelling, about being prepared.

Nobody wants to receive an invoice 12 months late. The challenge is

definitely there for providers to be prepared.

I think we had some very salutary reminders about the percentage of

people with cognitive impairment and how we really do need to actively

include people with disability, regardless of what that disability is within our

community.

Finally, Laurie, taking the final shift, what a spectacular effort, and giving

us a reminder about the aspirations and making sure we think through, if

that's where we're going, let's get on with it.

Thank you to all of our speakers. On your behalf, I want to thank them all

for their fabulous presentations, knowing full well how much preparation

they put into it and how well presented everyone was today. Thank you

all.

APPLAUSE.

I think that's it.

Tina, did you want to make any final comment?

Tina Karas: I want everyone to take this opportunity to thank Sandy for her

efforts today, it was very well chaired.

We will be making those comments -- you would have noticed, it's very

helpful to have Sandy's summary points throughout, so we will be putting

together those comments, which will be helpful for a lot of you when you

leave the venue.

I also want to thank Helen Case from Bradley Reporting, who has been

providing the live captioning skills.

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I want to thank you all for coming. We will be collecting the yellow

feedback forms. Most of the forms are available on SlideShare. Any

presentations which are not currently on SlideShare will be loaded within

the next few days and you will all receive a reminder email.

Thank you for your support and feedback and encouragement for this

event. Happy and safe travels. Thank you.

APPLAUSE