Submission Regarding Ongoing Concerns With the NDIS Performance

09.10.2022

To whom it may concern,

My Name is , I am the owner and managing director of . My company provides services under the NDIS. Predominantly Support Coordination and Psychosocial Recovery Coaching. We specialise in supporting people who are living with complex mental health concerns, although we work with any participants that are funded under the NDIS for the services we provide.

I am also a very passionate lived experience advocate and have lived with complex mental health issues for much of my life and a degenerative spinal disease. My recovery from mental health issues was one of the hardest things I have ever been through, but the thing I am most proud of in my life. My spinal issues are ongoing, and I will need to manage them for the rest of my life.

I started my business after working within the NDIS sector from its rollout in the area. I saw a need for services delivered by people who truly understand living with a disability, and people who have unscrupulous ethics, and a desire to ensure the safety and wellbeing of the people who required it. The participants of the NDIS.

I am not a participant of the NDIS. I have chosen not to apply, as I am lucky enough to be able to manage my own disabilities without further assistance at this point, and through the private system.

I am writing today to share my experiences as a provider within the sector and address my ongoing concerns with the NDIS performance, capability and culture and how this affects the people we support and ourselves as a business.

I am going to begin my submission with some examples of the ongoing issues that we as a business have had with particular branches of the NDIS, particular planners and the devastating outcomes that those interactions have had on the people we support.

My business is based in the of QLD; however, we support people across Queensland and Australia. My Staff have interactions with many different branches; but we have a large amount of contact with the office and have had for 3 years now.

Initially, I started my business as a sole trader Support Coordinator and dealt directly with the Planners in the office and was working with about 17 participants at the time. The role of a Support Coordinator is demanding and hugely varied, but an essential role for many people who cannot easily navigate the NDIS and service providers on their own.

Many NDIS planners/LAC’s have a terrible culture problem in particular offices, but overall, they are not fit for their jobs

From day one on working with the planners in the office, myself and the participants I supported have faced rudeness, hostility and traumatising behaviour from many of them. There are certainly some planners within the office that have been pleasant and helpful to deal with, but they are totally overshadowed by the horrible culture that is embedded within that office. A recent Community of Practice meeting found many local Support Coordinators talking about the culture within the office and how disgusting it is for participants and providers alike. A representative from the NDIS office was in the meeting and I put my thoughts and feelings about the negative and

bullying culture within the office across

to her and most others were in agreeance with me. Unfortunately, we were told to simply email a complaint to the feedback email, as she was limited in what she could do. I was quick to let her know that myself and other colleagues had provided multiple complaints both verbally and in writing, and also to the NDIS commission and the only action we had seen come out of the office was that the named planners were either protected or promoted.

We also discussed as a group our fears of being targeted by planners if our complaints were not kept confidential. It is commonly thought from the experience we have had as a group of providers, that you will be treated poorly or even have your business name tarnished, if the planners know that you have complained about them. The impact this can have on small business is devastating. And for every provider that walks away from this business, participants also suffer.

Please let me outline some of the things that we have personally experienced over the years of working with the office.

• A staff member put in a complaint about a planner, and the planner that was complained about rang my staff member back to investigate the complaint about themselves.
• Planners have given participants blatantly wrong information cause them distress and fear such as telling them they cannot have certain supports when legislation makes no mention that the supports cannot be funded
• A planner making a harassing amount of phone calls to me because one of my staff was supporting a participant to receive the funding she required to address her disability needs, yet the planner was personally outraged at the request for funding. I ended up needing to make a complaint to the planners’ team leader about the behaviour of this planner and the team leader told me that the “planner did not mean to be rude” and that was about as far as it went.
• A planner bullying a participant until they became suicidal and ended up in hospital. A complaint was made and yet again went nowhere.

• I met with the regional manager working out of the         office by chance, at a meeting and outlined some of the issues we were having with the        planners. I was given their email and asked to email through to start a dialogue. I did this the following day and got no response.
  

These events and actions are neither isolated nor uncommon. I now have a staff of eleven and every single day we discuss the rudeness and insensitive ways that planners are using when working with participants. If there was any other business in the world that allowed its staff to be so dismissive, rude and belligerent to its customers it would go broke. As Support Coordinators we deal with the fallout of this rudeness, bullying and arbitrary decisions that seem based on nothing more than how a planner feels on the day. As a person who keeps a very keen eye on online forums and chat pages, the impacts of poor planners, can have devastating effects on participants, including death. There seems to be no accountability for the decisions they make and the impacts that we see happen every day.

How can this problem be solved?

• Planners must be contactable, accountable and properly trained to work with people with disability. Support Coordinators must be able to contact planners and receive a response in a timely manner. Right now, 75% of our communication is ignored.

• Planners must show respect and acknowledge the very important role of Support Coordinators in supporting participants to implement their plans
• Plainers must provide written explanations for the decisions made by them when building plans. All plans should come with a clear outline of why the support was or was not funded and what evidence they have based those decisions on.
• Planners must NOT ignore recommendations and evidence in any way, shape or form. Planners are NOT qualified to override the evidence given to them and this is a massive problem. Planners need to stop seeing a recommendation for 100 hours of support and then funding 50 hours simply because the “NDIS won’t fund that much support”

Psychosocial Recovery Coaching and the decision to make it a Support Coordination Role. This is not true recovery work in spirit or when held up against the peer work framework.

We have made the decision to stop, at least temporarily delivering Psychosocial Recovery Coaching. We will be informing the participants we work with for this service this week. This was prompted by the recent resignations of our Recovery Coaches and an ongoing concern that the scope of Recovery Coaching, as directed by the NDIA is:

• Not true to the Mental Health Recovery Framework – partly proven by the fact that the NDIS has developed its own Framework around this support which we fully believe was done so that they could use the premise of Recovery Coaching to discount the price of Support Coordination
• Is simply Support Coordination with the expectation that the Support Coordinator will have more qualifications, deliver an extra element of support (Recovery Coaching) and be paid less.
• Does not allow time to do any real Recovery Coaching as staff are being overwhelmed with having to coordinate a person’s supports, report to the NDIS, deal with providers and supports and this leaves no real time to engage in any kind of recovery work with participants
• One of the main premises of Recovery is that the individual must be open to and ready to engage in Recovery Work, NDIS planners are removing Support Coordination and giving people Recovery Coaching funding when they are not willing nor able to engage in steps toward recovery due to the impacts of social determinants such as homelessness or inappropriate living conditions, AOD usage, problems finding suitable services that require intensive support to rectify, personal barriers, issues with justice/child safety/other government departments and more.
• Planners are reducing and denying psychology funding and putting in Recovery Coaches and stating that Recovery Coaches can provide psychological support to participants, but not funding that support at the required level or not understanding that Recovery Coaches are not able to provide the same type of support as a psychologist and if they were to support participants in the way required, they would need to be funded at a minimum of three hours per week. It is unacceptable that the NDIA is directing planners to reduce psychology supports but then does not allow Recovery Coaches to do what they traditionally are meant to be doing.
• Plainers do not have a true understanding of mental health recovery, and this is not surprising due to the fact that the over arching NDIA has stated that Recovery Coaches must

• Participants are confused as they are told that their Recovery Coaches will carry out Support Coordination at the lower rate. When we identify that a participant requires intensive Support Coordination, and want to charge accordingly, this confuses the participant and has the potential to lose us business because they are told by planners “Recovery Coaches will do your coordination and it is at a much lower rate”
  • Recovery Coaches are being expected to end of plan reports that focus on service delivery and supports, when they should be writing reports that focus on the mental health recovery of the participant, the stapes taken towards it and the challenges faces during the period.

How can this be fixed?

 -   Every person who receives Recovery Coaching Funding and it is identified that there
   supports are not stable in any way, should automatically receive 35 hours of Support
    Coordination. This allows time to stabilise supports and includes time to write an end of plan
    report.
 -   Recovery Coaching should be focused on mental health recovery and working with
    participants to identify goals, strategies and barriers to that recovery. Then supporting the
    participant to work towards those goals.
 -   Recovery Coaches should not be expected to prioritise Support Coordination work.
 -   Recovery Coaches should be funded an appropriate number of hours to carry our true
   Recovery Work. This includes travel time, non-face to face supports and face to face
   coaching sessions.
 -     If the NDIA model of recovery coaching remains the same, Recovery Coaches should be paid
   a higher rate than support coordinators, due to the higher qualification and experience
   requirements.

Support Coordination – Overall disdain and contempt for Support Coordinators

We are disappointed to see that the most recent price rises did not apply to Support Coordination businesses. My Business is “hanging in there” we make no real profit and at this point am only ever a few bad weeks away from a negative financial situation. This is something I am managing and is not the main purpose of my complaint. My complaint lies in the contempt and disdain that is shown to Support Coordinators and the people we support, by the NDIS.

The NDIS has an exceedingly high expectation of the actions and supports a coordinator should do for a participant yet continues to underfund the support significantly. Support Coordination is a capacity building support, so there is an expectation that Support Coordinators will build the capacity of the participant to their supports to manage the plan themselves at some point. However, we are routinely funded to do the bare minimum in implementing supports, let alone then support participants to build the capacity to manage their plan. Providers routinely expect Support Coordinators to carry out actions that are not our responsibility, such as chasing up payments, deal with complaints and issues between them and the participant or their families, and many other actions that fall outside our scope, and even though we are clear on what our roles are, this all takes up an extraordinary amount of time.

Planners expect us to manage everything in the participants lives such as housing, hospital admissions, work with guardians, the justice system and mange crisis and barriers amongst many

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many other roles. Yet they do not fund us appropriately. We have had people come to us with coordination funding and they are expecting us to find them SIL and settle into SIL, and they have 40 hours of coordination and many other issues occurring simultaneously. Support Coordinators are the backbone of the NDIS system in complex situations. We are told we are not case managers but expected to act as case managers. I do not think the NDIS understand the guilt and frustration when a participant has multiple complex issues going on and coordination funding is run down quickly due to these circumstances and then we either have to provide pro bono support – which is untenable from a business point of view or abandon the participant to move forward without support which is callous and cruel and leaves participants at a high risk of harm.

How can we fix this?

• All people receiving Support Coordination should receive a minimum of 52 Hours per year in the first two years. This is the minimum required to fully implement and manage a new plan and settle in supports until they are working well, which does not often happen, to be honest.
• Support Coordinators should be able to request (with evidence) an increase of hours with the planner in cases of crisis or rapid use of the funds due to extenuating circumstances. They should be able to do this without going through a 6-week process and it should be able to be done prior to SC hours being run down completely to allow continuity of support (which a provider MUST do when working with a participant)
• Currently we are told repeatedly that we cannot do a change of circumstances for just an increase in Support coordination hours. This needs to stop. Planners and LACs are NOT available to help participants and never have been. Support Coordinators are the only people out here supporting participants in any practical way. They should be able to lodge a change of circumstances that is prioritised as urgent and seen as a way to avoid harm t the participant.

The Audit and registration process is entirely broken and flawed

I have been a registered provider since I started providing supports. I chose to do this as I believe in being held accountable for the standard of work I provide, and I want participants to be able to have faith and trust in my company to appropriately support them against a code of conduct and practice standards.

My first registration audit took place in around September and by July the following year I was still not registered even though my auditor signed me off as doing things perfectly against the practice standards. In the end I had to bring in the QLD ombudsman and my local member to force the NDIA to approve my registration. It costs me thousands of dollars.

I have since then changed from a sole trade to a company. That triggered another audit & registration process. I was once again signed off as compliant, yet it took over 7 months for the NDIA to approve. It cost me thousands more dollars and days of my time.

I have since then added registration groups. This was another audit and registration process, which was singed off from my auditor as being 100% compliant, yet again. After 6 months of waiting, I called in the ombudsman again and my local member. The ombudsman had an 8 month wait list for complaints against the NDIS to processed but let me know they had accepted my complaint for future attention. After much back and forth with the commission where I told them about my complaints to the ombudsman and the local member, they finally approved my registration with the new groups.

As my mid term audit falls this month, I now must go through a further audit to meet my obligations.

As I have just been audited, they are giving me a discount. It is still costing me $3000.

I do this all voluntarily, over time, audit costs have come to almost twenty thousand dollars. A huge amount for a small business. I do this because I am ethical and want to do the right thing. Therefore, I am stunned and dismayed at the massive compliance obligations I must meet, the overall audit process and the fact that unregistered providers get all the same benefits as I do, yet do not have to comply to any real standards. Yes, the NDIS says all providers must mee the practice standards but only I face any real consequences if I do the wrong thing. If I was unregistered, I would be free of the massive compliance obligations and free to essentially do what I wish as a provider.

The Audit process itself is a massive problem. Why one earth, do I pay an independent auditor, thousands of dollars to come in an audit my business, declare my compliant and then must wait 7-12 months for the NDIS to then say they agree? I have paid my auditor; I have been declared compliant and competent to provide the supports I do. Why does the NDIS need to tick that off before I can go ahead and provide supports? It is without any sane reasoning that this happens.

The process to get ready for audit takes a minimum of a month with three staff working on it in my business. We then give up to full days to have the auditors here in person or remotely with us and go through all our compliance requirements. This is not a quick or easy process. It is time consuming and there are truly no real benefits to being registered except being able to work with NDIA managed participants. We do this for one simple reason as noted. To provide assurance that our service is of a high quality and meets the standards handed down by the NDIA.

The compliance we are required to take on is burdensome to say the least. There are requirements to self-report, requirements to report other providers, requirements to meet every obligation in the practice standards or else. An example of the burdensome nature of this requirement is an incident that occurred with us 3 years ago when I was registered sole trader and hospitalised in an emergency and was unable to support my participants for a week. I arranged for a colleague to take over the support of my participants, yet one of them reported me for not providing continuity of support to them, even those according to the standards I had done so by engaging a colleague. That took me over 6 months to work through with the commission before they would sign me off as not having a case to answer too. Another incident was where a participant received food from a provider who had not labelled the food as having nuts in it, and she had a nut allergy. She reported me for neglecting to provide safe supports by engaging a provider who did not label their food correctly. She reported me because the food provider was not registered, and she wanted to ensure that somebody was held accountable – rightfully so. Another 6 months of back and forth this took before I was cleared by the commission again. After both incidents, I was required to record them and address them from my end in a complaint register and show how I was going to avoid this happening again in the future. This took an extraordinary amount of time.

I am required to go to exceptional lengths to prove my ability to provide safe and competent supports under the NDIS banner, yet there are absolutely no benefits to it for us as a business. We work with extreme and complex mental health and situations, and we are also registered to allow us to access all the systems and supports we need to so we can best support people who face serious challenges. The whole process of registering is ridiculously hard and full of hurdles. It is poorly handled, and the system actually penalises you for being registered in many ways. Registered providers should be provided benefits for becoming registered. I am unsure at this point how that may look, but we certainly should not be penalised for it, which is where it sits right now.

• Once an auditor has been engaged and the person has passed the audit, that should be the registration process done. Auditors can be given access to banned providers so they are able to ensure they are not passing off on providers who cannot work within the NDIS. The NDIA should not have to sign off on an audit after it has been completed and passed
• Registered providers should be provided financial incentive to implement and manage all the systems that they need to have in place to meet compliance requirements. This could include large discounts on CRM systems (Ours costs us over $10000 per year) HR Systems and compliance systems (Approximate cost to us of $8000 per year) This is just for the cost of subscriptions to the programs and does not include the cost of personnel/staff hours
• Registered providers should be offered incentives for the cost of staffing required to manage compliance. We have estimated that we require 1 full time staff member to manage all the compliance requirements for registration
• The NDIS Quality and safeguards Commission requires a huge influx of new staff. Registration, complaints and all correspondence with them takes an excessive amount of time and puts people and providers at risk of harm and impacts to the business. The Commission plays a very important role in safeguarding participants lives yet cannot manage their current workload. I believe they are over a year behind with dealing with some complaints. We have made multiple complaints to them about providers doing the wrong thing and just never hear back from them. The system is broken.

Thank you for your attention to my submission. I am mindful of its length and have chosen to stop here, however I would like to note that I have reduced information and focused on my key issues so as not to make the submission too long. If given the time and ability to outline things in greater detail, I feel like I could write twenty pages. I have been working within the NDIS sector long enough now that I am almost numb to any expectations of true change or positive growth, however I wanted to have my voice heard, as not only am I a provider, although I am not on the NDIS (I wouldn’t put myself through that process) I am a person with disability as well.

I urge the joint committee to make true changes to the NDIS. I have encouraged everyone I know to make a submission on this very broken and dangerous department of the government. I hope that every person who has bee harmed, hurt or died because of the broken system we take part in, is represented and those representations are taken seriously.

The NDIS is not Centrelink or Medicare, it is not the transport office. It is a department dealing with the most vulnerable members of society who have serious disabilities. Although I understand the limitations of working with half a million people and still achieving personalised and compassionate service, there needs to be a drive for this to happen.

I have been almost broken working within this system, many, many times. Every day I wake up and think about what terrible things are going to happen for the participants and my staff, what basic human right are we going to need to argue for and what kindness and compassion we are going to have to remind people to have.

When people ask me what I do, I say ‘I fight with people for a living’ because that is the life of a

Support Coordinator and business owner within the NDS.

That makes me sad, and it should make everyone else sad too.

09.10.22