FOI 23/24-1370 DOCUMENT 2

Standard Operating Procedure – Referring Provider Complaints to the NDIS Quality and Safeguards Commission

This Standard Operating Procedure (SOP) provides guidance to National Disability Insurance Agency (NDIA) staff and partners about how to refer complaints about providers to the National Disability Insurance Scheme (NDIS) Quality and Safeguards Commission (NDIS Commission). This SOP also applies to complaints relating to providers that have been received through internal processes.

A communications protocol is in place between the NDIA and the NDIS Commission advising that relevant complaints about provider’s received by NDIA staff and partners should be channelled through the Complaints and Participant Incidents Team (CPIT) Oversight Team.

Some complaints about providers that are NDIS related can be managed and resolved as part of standard complaints processes. However, complaints should be referred to the NDIS Commission when the complaint is about:

• NDIS services or supports that were not provided in a safe and respectful way;
• NDIS services and supports that were not delivered to an appropriate standard; or
• How a NDIS provider has managed a complaint about services or supports provided to a NDIS participant.

1. Recent updates

What’s changed

Date	What’s changed
March 2024	Transferred to new template.

2. Checklist

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Topic Checklist

Topic	Checklist
Pre-requisites	You have: [ ] Received a complaint about a NDIS provider [ ] Determined a Participant Critical Incident has not occurred [ ] Read the Standard Operating Procedure — Record and Update a Complaint
Actions	[ ] 3.1 Determine if a Participant Critical Incident (PCI) has occurred [ ] 3.2 Investigate and Action Complaint [ ] 3.3 Quality Assurance of referral

3. Procedure

3.1 Determine if a Participant Critical Incident (PCI) has occurred

If a PCI has occurred, action must first be taken to ensure the participant’s safety. The PCI should then be reported to the PCI Team, as per process outlined in the Participant Critical Incidents Intranet page.

The PCI Team will refer any concerns raised about providers to the NDIS Commission as part of the PCI process.

Reportable incidents include:

• the death of a NDIS participant
• serious injury of a NDIS participant
• abuse or neglect of a NDIS participant
• unlawful sexual or physical contact with, or assault of, a NDIS participant
• sexual misconduct committed against, or in the presence of, a NDIS participant, including grooming of the NDIS participant for sexual activity
• the unauthorised use of a restrictive practice in relation to a NDIS participant.

For further information refer to Participant Critical Incidents Intranet page.

3.2 Issues regarding provider performance or conduct received or observed during regular business activities (all staff and Partners)

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If concerns about the way a provider is delivering services or conducting themselves is received or observed during ordinary business activities (planning, check ins, enquiries etc.) and a PCI has not been identified, the following process applies:

3.2.1 Reported concerns

• Encourage the reporter to complain to the provider directly and explain that if they are dissatisfied with the provider’s response they can raise a complaint with the NDIS Commission directly via 1800 035 544 (free call from landlines), TTY 133 677 or online at https://www.ndiscommission.gov.au/contact-us/makeacomplaint
• If the reporter does not want to complain to the provider directly, the staff member can explain that the reporter can make a complaint to the NDIS Commission via their email.
• If the reporter requires assistance and does not want to raise the issue with the NDIS Commission or provider themselves, the staff member should offer to transfer the complaint to the NDIS Commission at 1800 035 544.
• Staff should complete the NDIS Commission Complaint Referral Form (Appendix A) with as much detail as possible, then email the referral to the redacted: s47E(d) - certain operations of agencies inbox (redacted: s47E(d) - certain operations of agencies) for Quality Assurance (QA) and dispatch. It is preferable to have the reporter’s consent.

3.2.2 Staff observations

• If a staff member observes and has concerns about a providers conduct and/or service delivery, the staff members should make a referral by completing the NDIS Commission Complaint Referral Form (Appendix A) with as much detail as possible, then email the referral to the redacted: s47E(d) - certain operations of agencies inbox (redacted: s47E(d) - certain operations of agencies) for Quality Assurance (QA) and dispatch.

3.3 NDIS Commission referrals received in open complaints (Complaints Staff)

If a complaint received by the NDIA includes concerns about a provider and a PCI has not been identified, the following process applies:

• Create a complaint in the NDIA Business System and make contact as outlined in Standard Operating Procedure - Allocating and Receiving a Complaint.
• Encourage the complainant to contact the provider directly to explain that they are dissatisfied with the provider’s response. After this they can raise a complaint with the NDIS Commission directly via their website at: https://www.ndiscommission.gov.au/about/making-complaint

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• If the complainant does not want to complain to the provider or NDIS Commission directly or have complained to the provider directly and are not satisfied with the outcome, the Complaints Officer should offer to refer their complaint to the NDIS Commission. It is preferable to have the complainant’s consent.
• The Complaints Officer should complete the NDIS Commission Complaint Referral Form (Appendix A) with as much detail as possible, then email the referral to redacted: s47E(d) - certain operations of agencies inbox.
• Where a complaint is best managed by the NDIS Commission the Complaints Officer should attach the email referral to the open complaint record.
• If there are no other concerns raised in the complaint that require NDIA action the complaint can be closed.
• Where there are other concerns requiring NDIA action, the Complaints Officer must keep the complaint open and action as per the complaint management process relevant to the appropriate complaint channel.

3.4 Quality Assurance of Complaint referral

On receipt of a NDIS Commission Complaint Referral, the Track Triage team within Complaints and Participant Incidents team will create a new complaint record in the NDIA Business System and allocate to an Oversight Complaints Officer for QA and dispatch.

3.4.1 The assigned Complaints Officer will consider the following requirements during QA:

• There is sufficient information provided within the referral template to enable to the NDIS Commission to effectively investigate the complaint.
• That the complaint falls within the NDIS Commissions remit

3.4.2 Dispatch or return

• If the request meets the QA requirements, the referral will be sent to the NDIS Commission redacted: s47E(d) - certain operations of agencies by the Complaints Officer via the redacted: s47E(d) - certain operations of agencies inbox and the complaint referral will be closed with the NDIA.
• If the Complaints Officer determines that the referral to the NDIS Commission does not meet the QA requirements, it will be sent back to referrer for action.
• If the Complaints Officer identifies the complaint should remain with the NDIA it will be reallocated to the appropriate area for resolution.

4. Related procedures or resources

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• NDIA Act 2013

• Standard Operating Procedure - Allocating and Receiving a Complaint

• Operational Protocols between the NDIA and the NDIS Commission

5. Feedback

If you have any feedback about this Standard Operating Procedure, please email the CPIT Business Improvement Team. In your email remember to include the title of the product you are referring to and describe your suggestion or issue concisely.

6. Version control

Version	Amended by	Brief Description of Change	Status	Date
1.0	GLW650	Branka redacted: s22(1)(a)(ii) - irrelevant APPROVAL.	APPROVED	2019-08-05
2.0	SW0065	Amended WA transition to NDIS Commission from 1 July 2020 to 1 December 2020. Moved to new template. Minor changes to language and formatting.	APPROVED	2020-06-02

7. Appendices

7.1 Appendix A — NDIS Commission Complaint Referral Form

Referring agency and contact name
Contact Phone
Email
Name of participant
Participant Number
Participant Date of Birth
Contact details (phone, email)

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Referring agency and contact name
Capacity to be involved in complaint
Consent by participant/complainant to refer the complaint to the NDIS Commission or NDIA
Complainant’s name (if not participant)
Relationship to Participant
Contact details (phone, email)
Which service provider is the complaint about?
Location of Service Provider
Service Provider contact details
Incident Date (if known)
Incident Time (if known)
What is the complaint about?
What has the complainant done so far to resolve the issue?
Has a complaint been made to another agency, if so, which and when?
What was the outcome?
What would the complainant like to happen to resolve the complaint?

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