Capability and Culture of the NDIA: Submission to the NDIS Joint Standing Committee
Joint Submission from Darwin Community Legal Service and Rights Information Advocacy Centre
16 December 2022
Introduction
Darwin Community Legal Service (NT) and the Rights Information Advocacy Centre (VIC) welcome the opportunity to provide the Joint Standing Committee (JSC) with this submission related to the capability and culture of the NDIA.
Our organisations have separately provided submissions to this current inquiry.1 We are jointly providing this brief submission to highlight an increasing and concerning trend of the NDIA to reduce and under-fund Support Independent Living (SIL). We share case studies to demonstrate the impacts of this decision making.
Currently, the culture of the NDIA’s decision making process is driven by cost cutting rather than adopting a focus on the needs of participants to maintain their dignity, health, and wellbeing. This is especially obvious in decisions relating to SIL, as changes in funding for SIL can have immediate and catastrophic consequences.
Our organisations are experiencing an increase in demand for support to appeal SIL related decisions to the AAT. Our organisations are collectively witnessing the health, wellbeing, and human rights impacts of these decisions on the people with disability we can assist. Due to capacity limitations, we are unable to support the increased demand for SIL appeals, this causes an unacceptable additional layer of distress for participants appealing decisions.
We appreciate the NDIA must make individual decisions regarding SIL funding. However, there are general principles around the culture of the NDIA’s decision making that require immediate improvement.
1 See submission 7 and submission 49 https://www.aph.gov.au/ParliamentaryBusiness/Committees/Joint/NationalDisabilityInsuranceScheme/CapabilityandCulture/Submissions.
Recommendations
We recommend the following to improve the culture and capability of the NDIA’s decision making:
- Participants and their support team must be involved in a collaborative person-centric planning process to ensure all efforts are made to have the best available evidence to determine the appropriate level of funding.
- Draft plans must be provided to determine if there are any issues or disputes regarding funding.
- In the event of any issues or disputes regarding funding, the planner and the participant (and their relevant supports) must collaborate to clarify any gaps in evidence.
- If an internal review is required, all efforts are made by the internal review team to collaborate with the participant (and their relevant supports) to obtain further information.
- If the participant is seeking to review a reduction of SIL support, the NDIA must commit to funding the previous amount until the outcome of the internal review or appeal to the AAT has been determined. This will ensure continuity of support and basic human rights of the participant, especially if the impact of the decision requires the participant to relocate or be at risk of harm if supports are reduced.
- Greater transparency from the Home and Living Team regarding reasons for their decisions.
Case Studies
The following case studies highlight the impact of the NDIA’s decision making relating to SIL. The case studies highlight the importance of person-centric decision making to prevent unnecessary internal reviews and appeals to the AAT which significantly impacts the wellbeing of participants and is economically inefficient.
Client A
Brief outline of A is an elderly, aboriginal man with a non-indigenous wife that is proficient in English, this makes accessing supports easier for A than for many. A is experiencing a type of early onset dementia that includes violent episodes when he experiences misapprehensions. A is a large man who used to be a soldier. During episodes he often believes he is in a war zone and that his support workers are trying to kill him. This leads A to attack the support workers before they kill him.
The NDIA reduced A’s ratios from 2:1 to 1:1 SIL. In addition to the above episodes, A experiences faecal incontinence and because he is a very large man, he needs the assistance of two people to
Impact
on The decision and appeal process were upsetting for A’s wife who suddenly had to worry about the continuation of A’s supports. It also negatively impacted the SIL provider/coordinator who had been organising A’s supports.
If the decision had been upheld it would have been dangerous for A, his wife and the support workers trying to care for him.
Systemic cultural issues
Detrimental decisions made without consulting clients, families, support workers or legal representatives.
Client B
Brief outline of situation
B is a young person experiencing intellectual disability and dyspraxia. B has a significant and documented history of behavioural problems. B lives in a privately rented unit. He has SIL supports that come into his house 24/7 at a 1:1 ratio.
Impact on Participant/Individual
As a result of the decision B may be forced out of his comfortable, safe environment. B may be placed in an environment where his behaviours of concern endanger both others and themselves.
Systemic Cultural Issues
Detrimental decisions made without consulting clients, families, support workers or legal representatives. This also seems to violate Article 19 of the CRPD dealing with living independently.
Client C
Brief outline of C is an Aboriginal man from a remote area. C has a physical disability meaning he needs supports with all activities of daily living. C was previously funded for 24/7 care at a 2:1 ratio. C had two assessments: an OT functional assessment and a physiotherapy assessment. Both assessments concluded that C required support at a 2:1 ratio or an increase to 3:1.
The NDIS plan included funding for 1:1 supports only. C ’s case was referred to disability advocacy, who initiated a review. The review took 7 months largely because C can only communicate
Impact
On Participant/Individual
Detrimental effect on C who missed 3 lots of sorry business during this lengthy process.
The SIL provider introduced house mates in response to absorb the loss in funding and C lived with several successive housemates because they were all competing for support. C’s Relationship with his SIL provider was impacted because of the strain on resources.
C suffered frequent hospitalisations from UTI’s as the care workers were not able to change his pads enough etc due to limited resources.
Systemic Cultural Issues
Communication on the part of the NDIS was poor. C’s disability specifically requires face to face communication which never occurred. The interaction was culturally insensitive. Well documented evidence of C’s requirements was not considered. There did not seem to be a person-centred focus in the decisions especially when cutting funding, isolating C from friends/family and culture.
Client D Brief outline of situation Client D previously resided in single-occupancy SDA. The NDIA did not approve the funding for D to live at this accommodation
Client D
Impact on Participant
D has Huntington’s Disease and is fully dependent on support workers to manage their daily care.
Systemic Cultural Issues
The NDIA did not provide proper consideration of reports from medical practitioners and therefore did not understand the complications of D’s disability.
The NDIA evidently did not review the evidence provided appropriately and did not provide adequate consideration of the progressive nature of Huntington’s Disease when making its decision.
Client E
Brief Outline of Situation
Client E has a history of complex cognitive and physical disabilities and requires 1:1 24/7 support. Prior to the most recent NDIS plan, Client E was receiving 1:1 24/7 support and has been living in a rental home that was purposely re-built for his accessibility needs.
All E’s evidence highlights they will be at risk of death or serious injury without 1:1 support.
However, in 2022 E’s plan was reduced to 1:3 support without consultation and approved SDA funding without this being requested.
Impact on Participant
As a result of the NDIA’s decision, E would have to move away from the home that he has been renting for 30 years and will be forced to move away from the community where they are a well-known and respected member.
E’s wishes are to remain in their home and to be supported to continue living in their community. E’s disabilities result in them becoming distressed, dysregulated, and confused when there are small changes to routine.
E is going through the AAT process and is utilising the plan funding at 1:1 to ensure they remain in their own home. They are under a significant amount of stress and the thought of this funding being utilised before the plan ends.
Systemic Cultural Issues
The NDIA has a culture that lacks collaboration with the participant, their treating practitioners, informal supports and support coordinators. Instead of focusing on the needs and wishes of participants, the NDIA’s decision making is focused on cost-cutting at the detriment of NDIS participants.
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The NDIA’s culture of cost-cutting is resulting in an increase in the need for participants to engage in advocacy and legal resources which is draining these organisation’s budgets and reducing the number of people that can be provided with assistance. Advocacy organisations are unable to assist all people who request assistance due to their limited resources. This often results in participants not being able to receive the necessary support that is required to access their appeal rights, and many give up on appealing the NDIA’s decision and miss out on necessary funding and supports.
If you have any questions, please contact:
Rachael Thompson Jessica Brugmans Rights Information Advocacy Centre Darwin Community Legal Service
Regards,
Amanda Robinson Judy Harrison Acting CEO Principal Solicitor Rights Information Advocacy Centre Darwin Community Legal Service