National

Disability

Services

State of the Disability Sector Report 2022

It’s been another stormy year for the disability sector. Too few workers. Too much red tape. Reform fatigue and fears about the economy.

But with optimism about the early direction of federal government reforms, there may just be some blue sky ahead.

Cover art

Untitled (2021)

Medium: Copic marker on paper

About the artist:

“Untitled is part of Kate Knight’s most recent body of work whereby bright, multi-color swatches of irregular shapes fill the plane. The interlocking imagery morphs continuously from organic leaf-like grid lines through to more geometric and obscure shapes, creating a myriad of powerful directional shifts within each piece. The changing pattern of shapes and colors and the intersecting angles and linework results in a mesmerizing undulating optical effect.”

Submission 121 - —

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Contents

• The state of play ……..00..000 o.oo occ ece cece cette 2
• The way forward ………..0….. ecco ccc cec cece eee cece nee 4
• Northern Territory case study ….. 6
• Australian Capital Territory case study 8
• The state of the operating environment ………. 10
• South Australia case study… eer 4
• Queensland case study ………………….:ce 24
• The state of the NDIS …………………00…..ceeeeee 26
• The state of the Royal Commission ……………. 29
• The state of the workforce ………………………05. 30
• Tasmania case study … a Leceereeses OO
• Western Australia case study……………………..38
• The state of disability employment …………….. 40

The state of the broader policy environment .. 46

• Victoria case study… suaincaawass 48
• New South Wales case study…………………….50

Page Text Start

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The state of play

An expert, they say, is someone who will optimism about the new federal government’s NDIS reforms. Some 43 per cent of respondents believe that policy changes are heading in the right direction, compared to just 25 per cent last year.

This is a little unfair. But the world is not exactly short on confident pronouncements from columnists, economists, academics and think tanks that turn out to be quite off the mark.

We don’t think you’ll find many here. As NDS’s Annual Market Survey enters its ninth year, it’s pointing out just how remarkably prescient the people we talk to have, again and again,

In last year’s survey, for example, precisely 45 per cent of disability providers predicted they would make a profit in 2021-22. This year, 46 per cent of providers have told that, yes, that’s just what they did.

Similarly, last year, 23 per cent of respondents expected to end 2021-22 with a loss – and, 12 months later, that’s exactly what happened.

The real experts, results like this suggest, are often the people on the ground, rather than the strategists watching from afar. Providers know this industry because they are this industry. When they talk, policy makers need to listen. This is a survey to take very seriously.

So, what have providers been saying this year? The 2021-22 survey contains six major takeaways - the first being a real and growing ‘Sixty-seven per cent of respondents believe that We don’t think you’ll find many here. As NDS’s conditions have worsened, and 36 per cent expect to make a loss in the coming year.’ proved to be.

That positivity is tempered, however, with a profound pessimism about the Australian economy. Sixty-seven per cent of respondents believe that conditions have worsened, and 36 per cent expect to make a loss in the coming year. Alarmingly few organisations plan to deliver new types of services in the year to come, even though many were unable to meet the demand for services over the course of the last 12 months, often due to a shortage of workers.

takeaway number three is that workforce troubles continue: recruiting and retaining suitably qualified staff remains a major challenge. A skills shortage has become a full-blown labour shortage. Many report it’s now more difficult to find good support

• workers and finding allied health clinicians
• feels almost impossible. Corporate roles in
• IT and HR are also a challenge to fill.

On the regulatory front, more than 40 per cent of providers expressed concern about the Quality and Safeguarding Framework they’re guidelines to follow. Operating within current regulations clearly creates more administrative work. But is it actually helping to create safer outcomes?

The fifth takeaway involved Disability Employment Services: many are concerned about where they are headed. Some

48 per cent of DES providers do not believe that DES policy reforms are going in the right direction, while only four per cent take a positive view of the digital services model for job seekers that was rolled out in July.

Last but not least, this survey makes clear that, while the disability sector wants and needs more reform, it is also suffering from change fatigue. Far too many leaders have

spent far too much time dealing with never- going NDIS changes. And far too many disability workers feel exhausted by the challenge of constantly learning new systems and the complex administrative sagas that each tend to involve.

Here at NDS, we are cautiously optimistic that the year ahead will see great progress. The new federal government seems to be heading in the right direction.

But it will need to move in step with providers.

It will need to listen to the views of the experts.

And it will find them right here.

Page 6

The way forward

• Listen to providers

  • Focus on strategies that
    • address the recruitment of workers across all roles We encourage government to engage with providers and draw1 5 on their expertise to develop NDIS in the sector

• reforms and a new workforce strategy, focusing on where quick wins can be achieved.

• Talk to providers

• As reforms and improvements are identified, the sector will2 engage need support to implement them.

This will require clear communication to participants and providers, appropriate timeframes and resourcing, and mitigation of any unintended consequences.

More funding is needed for fit-for-purpose training, support and supervision, visible career parthways and leadership opportunities.

• Don’t just talk Focus on the things that matter to create safer services While providers welcome the potential of the NDIS Review3 7

-Focus on quality and safeguarding measures that improve outcomes and share data that support providers to innovate and identify good practice.

• Keep reviewing the cost model

While the price increases announced in June 2022 were welcome, it was a catch- up payment. Economic conditions remain challenging. The cost model needs to4 be continually reviewed to reflect wage pressures and changes, including changes to the SES and SCHADS award, adequate training, and support and supervision needs.

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Northern Territory

Case study

Kerry Bosch Helping People Achieve

Tell us about HPA

We provide employment opportunities to people with disabilities, as well as accommodation and community access services. And as part of our employment services, we run a couple of workshops which make metal and timber products.

What’s been your proudest achievement?

It’s really, really hard to pick one thing that you’re proud when every day you can come into work and see smiles on someone’s face. Just the number of people that we touch on a daily basis. That’s what makes me proud.

Has the past year been more or less challenging than most?

Obviously, the COVID situation has presented us with a few challenges. There was one instance there before Easter, where we kept having symptomatic people turn up at our day program who later turned out to be positive. We eventually had to close down a particular

NT 9,079

Active participants including ECA

sector stats

116 |

Active ECA participants

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program for a week, just for the sake of a circuit-breaker.

It was a decision that we didn’t take lightly, as we definitely appreciate the importance of outines and the impact that it would have on other support mechanisms.

What are the major challenges? The workforce is the main challenge for everyone at the moment, and I’m not just talking about the disability sector. It’s across the board.

The ever-evolving NDIS landscape is also presenting challenges. We’ve now been working within this new funding model for long enough that we’re starting to see the impact of the reforms and changes being implemented by the NDIS to their original model.

What are the major opportunities?| see the change of government as an

Page 9

Opportunity. Without wanting to make any sort Top three issuesof political statement, the NDIS was originally a Labor Party policy, and the new minister Workforceseems to be saying the right things. So, I’m feeling quite optimistic. Along with general shortage of people to fill roles across the industry, there is a shortage of people with the appropriate skill or experiences to hold specific roles to a high standard (e.g., behaviour support practitioners, management roles, support work for complex participants).  Quality and safeguarding compliance Providers understand their registrationis not protection against poor practice.Just the passion and the work ethic of the people in the sector. There’s some very, very smart people out there who could probably go make more money elsewhere, but they continue to work in this sector because they see the smiles on people’s faces. When you have a consumer-driven market, there are always going to be some slightly shady providers. But I’ve got to say that 99 per cent of the providers that I deal with are 100 per cent in it for the right reasons and simply want to give participants an opportunity to lead a fulfilling life. What’s impressed you most? The sense of unity is pretty remarkable. While we are nominally in a competitive market, we all work well together. When I took on this CEO’s role, I immediately started receiving phone calls from other CEOs within the sector, offering to catch up for coffee and just generally help me make the transition. Why did you get into the sector? Well, I worked in media and marketing roles for 20-odd years and my entire existence was basically getting up every day and making a shareholder rich. I had a bit of an epiphany a few years ago and decided that I wanted to get up out of bed every day and make a difference to someone’s life. Quality support for First Nations people with disabilities Registered providers are conscious of their responsibility to support people’s access to family, culture and country, and the need for well-trained staff to offer culturally sound support. But current NDIS planning and pricing does not consistently allow this.

Australian Capital Territory

Case study

Nadine Stephen Koomarri

Tell us about Koomarri

Koomarri provides support to people with intellectual disability in the ACT and surrounding regions.

It was created in 1952 by two women ina backyard garage who fought for the rights of their sons with disability to receive an education and the opportunity to work. This year marks our 7Oth anniversary!

What has been your proudest achievement?

With the impending introduction of the NDIS in 2014, we embarked on a journey to transition Koomarri to a more contemporary and personalised service delivery model.

After significant research, investment and implementation, we have a successful customised employment model that is seeing long-term, personally meaningful and socially valued work for our service users.

ACT 9,518

Active participants including ECA

sector stats

169

Active ECA participants

I’m so proud that, after 70 years, Koomarri continues to adapt to market changes

and trends while still successfully finding community-based jobs for people with disability.

What does an average day generally look like for you?

There is no such thing as an average day! Koomarri delivers supports to hundreds of people across multiple service lines and offerings. Therefore, my days are incredibly diverse, as | bounce between service users, family, staff, strategic, financial, regulatory, legislative, quality and compliance matters.

Has the past year been more or less challenging than most?

Quite honestly, the past few years have all been a bit of a blur. We have continued to operate within a flawed funding model, and during floods, fires, storms and a once-in-a- lifetime pandemic.

10.4%

Culturally and linguistically diverse

4.5% —

NDIS participants are Indigenous

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My focus over the past year has been on Top three issuesthe mental health and wellbeing of the Koomarri family. Our service users, families Pricing  and staff have all endured lengthy periods of Inadequate pricing remains a majoruncertainty, isolation and change, so we havebeen making a concerted effort to take care of the recent increase tobeen very welcome, the underlying hourlyone another whilst taking care of day-to-day rate still does not adequately reflect thebusiness.

What are some of the major opportunities? I think there is a level of optimism and new energy with the change in government. There NDIS prices pose a risk not only to The combination of ongoing inadequate is a great opportunity for the sector to come individual disability service providers, but pricing, ever-changing NDIA policies, together and provide practical solutions to the to the Scheme as a whole.  industrial requirements and increased (unfunded) regulatory work is placing What are some of the major challenges? Several organisations in the ACT have significant pressure on organisations to ceased support coordination services remain viable. in recent times, and many more are Pressures on support coordination  considering it. Support coordination is Why did you get into the disability sector? a critical component of the Scheme,Why did you get into the disability sector? especially for people with high andDisability has always been in, and a big part complex needs, but many supportof, my life. When growing up, there was no coordinators simply do not have thesuch word as ‘can’t’ in my home and this capacity to complete the work that istranslated into a strong desire to enable and expected of them, and express concernsempower people to be the best they could bein whatever they desired.

What’s surprised you most (about the sector)? The resilience of our sector is extraordinary. I challenge you to find and name another industry or sector that could operate as well as we do under the adverse conditions that we have experienced. Name one!

The state of the operating environment

The 2022 NDS Annual Market Survey was conducted by the Centre for Disability Research and Policy at the University of Sydney.

As NDS’s Annual Market Survey enters its ninth year, the results identity both growing optimism and residual uncertainty in the market, in part related to the COVID-19 pandemic.

We received 364 responses from across Australia, 96% of whom were registered NDIS service providers. Three-quarters were from not-for-profit organisations. Twenty-four percent of the organisations were established in 2014 or later (i.e., in the NDIS era). Of the respondents:

• 4% were sole traders
• 33% had less than 50 people in their organisation
• 35% had 50–199 people in their organisation
• 23% had 200–999 people in their organisation
• 5% had over 1,000 people in their organisation.

Incomes ranged, with:

• 17% of organisations having an income of less than $1m (very small)
• 24% having an income between $1m and $5m (small)
• 35% having an income between $5m and $20m (medium).

Ninety-eight per cent of respondents were providing NDIS services, nine per cent were providing employment services (DES/Job Active/NESM/Transition to Work), and 20 per cent were providing supports in employment services under the NDIS (including ADEs and social enterprises).

Continuing impact of COVID-19

Ninety-three per cent of respondents reported that the COVID-19 pandemic was having ongoing financial and operational impacts on the sector. Many cited staffing issues related to recruitment, sickness, costs of PPE and vaccination refusal.

‘The 2021-22 [finances] present a false illusion of a surplus, [due to] the COVID support payments.’

NSW medium not-for-profit: ‘Ongoing health impacts for workers – absenteeism (e.g., particularly for key roles like direct support workers) impacts participants.’

Qld medium for-profit:

Respondants noted a lack of coordinated support by governments. For example:

‘"The pandemic is still here and yet the government is taking an ad hoc approach.“’

Capability and Culture

Submission 121 - Att

Both participants and staff are still getting sick and require isolation, which is stretching the organisation’s ability to respond to changes, as the workforce is already stretched with extreme staff shortages which has still not been addressed by governments.’

Qlid small for-profit

NDIS Operating Environment

High levels of pessimism in 2021 have turned into greater optimism that NDIS policy reforms are heading in the right direction in 2022. Up from 25 per cent last year (the lowest level ever recorded), 43 per cent of respondents agreed or strongly agreed that NDIS policy reforms were heading in the right direction. However, seen over a longer period, the 2022 results are returning to pre-pandemic levels, which have not been higher than 55 per cent between 2016 and 2021.

Given the timing of the poll (September 2022), the results may reflect early messaging and action from the new Federal Labor Government. A series of announcements during and since the federal election in May 2022 included planned changes to the NDIA Board, the initiation of a review into the backlog of AAT decisions, a review into acute hospital beds blocked by NDIS participants awaiting suitable accommodation, the Jobs and Skills Summit, the NDIS Review and a disability employment national roundtable. This was reflected by a number of respondents:

‘We are looking forward to a change in direction from Minister Shorten — however, it is still early days.’

Tas large not-for-profit

‘I am hopeful things will improve under the new government — early indications are positive, but I fear operationalising good intent will take time.’

Vic large not-for-profit

However, a general optimism about the future direction of NDIS policy was not reflected in the overall assessment of the operating conditions for the disability sector. Business confidence has also softened. There was continued pessimism about the wider Australian economy, with 67 per cent of respondents considering that conditions had worsened. While pessimism about the wider economy appears to be linked to the pandemic (correlating with the pandemic years of 2020-22), the pessimism about the disability sector appears to show a longer trend.

Apart from 2019, which could be considered an anomaly, pessimism about the operating conditions facing the non-government disability sector has been increasing for a number of years. In 2016, just 36 per cent of respondents considered that operating conditions had worsened. This number has risen year on year, with 67 per cent of respondents in the 2022 survey considering that operating conditions had worsened, and just 8 per cent considering that they had improved.

Figure 1 Operating conditions in the non-government disability sector

Figure 2 Operating conditions in the wider Australian economy

The reasons for this have been well-rehearsed ‘… tight labour market; participants have not fully returned; also impacted [by] external operating environments supply chain shortages, limited skilled managers available in the market; continuing costs of PPE to provide safe environment for my people; exodus of volunteers from three years of COVID.’

Vic large not-for-profit

Page 15: Perception of NDIS Environment

‘The operating environment has been very challenging due to COVID-19, [especially] the NDIA’s ongoing reductions to participants plans without any information or notice of why the reductions have been made.’

NT small not-for-profit Seventy-nine per cent thought that the NDIS policy environment was uncertain. The number were more positive that the opportunities outweighed the risks.

Figure 3 Perception of NDIS environment

Legend:

• Disagree or strongly disagree: 0%
• Neither agree nor disagree: 20%
• Agree or strongly agree: 40%, 60%, 80%, 100%

Page 16

Two new questions were introduced this ‘The lack of consistency from the NDIA when we call about issues for clarification is poor. The rules change and the lack of information or reasoning is not clear for many of the participants we support. It is felt that NDIA has made changes and informed providers and expected us to communicate the changes to participants and families, leaving us open to the backlash when the changes are not our decision.’ Vic small not-for-profit

Perhaps one of the more significant consequences of these factors was that boards and leadership teams were finding it difficult to develop strategies and a set direction in the current policy and operating environment. Nearly half of respondents agree with the statement, ‘We are worried we won’t be able to provide NDIS services at current prices’ has remained remarkably stable over the last five years. Some 59 per cent of respondents agreed in 2022. NDIS pricing appears to affect different organisations in different ways. Very small organisations and organisations that were established after the introduction of NDIS in 2014 were less likely to agree with this statement, suggesting that these organisations were more confident that they could provide services at current prices. Post-2014 organisations were set up within the NDIS environment, so may be expected to be designed with NDIS operational confines in mind and, therefore, more comfortable with the pricing model. Despite that, almost half of the post-2014 organisations were still worried that they wouldn’t be able to provide NDIS services at current prices.

Confidence in the regulatory ’Changes in the NDIS have not been backed up by clear written policy and associated detail, including guidance. This year’s survey continued to explore provider support for all the regulatory details instruments that make up the NDIS Quality and Safeguarding Framework (the Framework). As with last year, large variations in confidence in the Framework’s components persisted, but

Figure 4 We are worried we won’t be able to provide NDIS services at current pricing

Not for profit 20% 16% 63%

For profit 28% 20% 53%

Established before 2014 19% 18% 63%

Established 2014 or later* 35% 17% 49%

Very small < $1m* 37% 20% 43% Small $1m - $5m 23% 18% 60% Medium $5m - $20m 24% 14% 62%

Large > $20m 14% 20% 65%

            0%       20%       40%       60%       80%       100%

Disagree or strongly disagree Neither agree nor disagree Agree or strongly agree

• denotes that this category was significantly different to the other categories in that group.

overall, there was declining support. The NDIS service ecosystem. This is shown by Code of Conduct received the most support 60 per cent of all respondents (about the (at 77 per cent), while the ‘Registered NDIS same as last year) agreeing or strongly provider notice of changes and events’ (which agreeing that ‘there are too many unnecessary only impacted larger providers) received the rules and regulations (that) my organisation least support (36 per cent). has to follow’. A major theme in respondents’ comments was calls for greater accountability Overall, only 39 per cent of providers were for unregistered providers and greater confident that the Framework supported the consistency and fairness in the application quality of services and outcomes (significantly of regulatory instruments between registered and unregistered providers. Forty-one per cent agreed or strongly agreed, worse than previous years. Support or lack thereof for the Framework and its components was consistent across key organisational features, including state, size (by income) and whether organisations were for-profit or not-for-profit. These results reflect general concerns about the regulatory environment across the entire

Figure 5 Quality and Safeguarding Framework is leading to good outcomes for participants

NDIS Code of Conduct 6% 17% 77%

Full worker screening requirements 8% 17% 75%

New worker - NDIS induction modules 26% 72%

NDIS worker orientation module 6% 23% 71% (Quality, safety and you)

NDIS practice standards auditing 16% 28% 57%

Complaints management and dispute 18% 30% 53% resolution in relation to our service Incident management and 22% 26% 53% reportable incidents

NDIS Commission practice guides 13% 38% 49%

Behavior support requirements, to reduce and eliminate restrictive practices 19% 33% 48%

Registered NDIS provider 23% 42% 36% notice of changes and events

                       0%     20%     40%     60%     80%     100%

        Disagree or strongly disagree       Neither agree nor disagree      Agree or strongly agree

Relationships with providers Comparatively, two thirds (64 per cent) disagreed or strongly disagreed that the NDIA The NDIS Commission’s relationship is working well with providers (only 11 per cent believe that they are working well). The NDIS Commission’s relationship appears to have deteriorated. Nearly half of respondents (47 per cent) disagreed or strongly On 18 October 2022, Bill Shorten, Minister disagreed that the Commission is working for the NDIS, announced an independent well with providers (significantly higher review into the NDIS ‘to improve the wellbeing than the 36 per cent of respondents who of Australians with disability and ensure the Disagreed or strongly disagreed in 2021), scheme’s sustainability’. Minister Shorten while only 22 per cent responded that it is stated that the NDIS Review will work with working well. participants, their families and carers, as well as providers.

Innovation, Data and Research

The 2021 survey identified a sobering assessment of the system’s failure to provide the conditions for innovation to flourish. The issue remains a major source of concern, with only 11 per cent of respondents agreeing or strongly agreeing that, ‘taken together, NDIS Pricing and Regulation are conducive to providing innovative services that respond’

e: Providers are clear that a review is well overdue:

e: disagreed that enough implementation-ready research is available to support evidence-informed services.

‘Our staff are feeling the ongoing pressure we place on them for compliance and quality safeguards. [Org name] as a business is concerned that registered providers have enormous compliance and pressure to ensure our staff are providing quality services, whereas workers can provide services unregistered or regulated. This makes people with disability very vulnerable to exploitation, etc. I do not understand why it seems that the push is for unregistered or private provision of services where historically the Dept knows this is where the highest area of fraud and abuse occurs. At times we wonder why we have gone through all the processes and pressure to be a registered provider. Being these businesses.’

WA small for-profit

Innovation, data and research

Vic medium not-for-profit

‘The true cost of compliance and on-costs needs to be absorbed across our part-time service offerings and we cannot afford to scale to a full-time large service. We also firmly believe we are commercially disadvantaged in competing against non-regulated NDIS service providers.’

NSW very small not-for-profit

‘NDIA implement policies without thinkingto Participant needs’. (A close match to the 12 per cent who did so in 2021, when the question was first asked).

Providers also continued to report a paucity of the kind of necessary, timely and easily accessible data that they need to plan their services.

Only 17 per cent agreed or strongly agreed that the necessary data was available. Similarly, 53 per cent disagreed or strongly disagreed with statements about access to essential information needed for effective planning and delivery of services.

Figure 6 Services provided

Currently providing services Planning to commence Vehicle modifications 1% 0% Specialised hearing services 1% 0% Hearing services 0% 0% Specialised driver training 0% 0%

Organisations and growth

• assistance with daily life tasks in a group or shared living arrangement (63 per cent) Alongside 2022’s increasingly pessimistic outlook, this year’s results revealed a significant decrease in the number of organisations who were growing. Respondents told us about NDIS services they currently provide – with over half responding that they provided services related to participation in community, social and civic activities, daily personal activities, development of daily living and life skills, and support coordination. Respondents were also asked if they planned to offer new services in the coming year. Very few organisations planned to begin delivering new types of services; hhowever, three per cent of organisations planned to begin providing services in the areas of group-and-centre-based activities, specialist positive behaviour support or community nursing care. Over 2021-22, growth was seen in the provision of: (58 per cent of respondents reported an increase) management of funding for supports • support coordination (56 per cent of respondents reported an increase) • specialist positive behaviour support (50 per cent of respondents reported an increase). There were fewer decreases in service provision across the board, though nearly one-third of organisations providing services for participation in community, social and civic activities and group and centre-based activities reported decreases. When asked about future planning, many respondents told us that they planned to increase their provision of: • support coordination (66 per cent)
• participation in community, social and civic activities (64 per cent)

Figure 7 We are actively growing our organisation

Organisations were also asked about organisations reporting they collaborate with areas they needed to improve. The most others to advocate for the sector in 2022. The frequent responses included HR strategy Similar to 2021, 79 per cent of organisations and workforce planning, costing and pricing, employee learning and development, information, communications and technology, quipped workforce, data reporting and use, financial processes and control. Though it was not one of the most commonly Despite the uncertainty around COVID-19, reported area of improvement, when predictions in the 2021 Annual Market compared to 2021, fewer organisations Survey regarding financial outlook were quite reported needing to improve market research, accurate. In 2021, 45 per cent of respondents strategies and planning. predicted they would make a profit or surplus in the 2021/22 financial year – and in this Operations and collaboration year’s survey 46 per cent of respondents reported that they made a profit or surplus Outsourcing of back-office functions and for that financial year. Similarly, last year, group purchasing remained consistent in 23 per cent predicted a loss or deficit and 2022. There was a slight increase in resource- 23 per cent did have a loss or deficit. sharing arrangements (14 per cent in 2022 This shows that the sector has a realistic versus nine per cent in 2021); however, understanding of the impact of the operating to a pre-COVID environment on financial operating conditions. operating environment (12 per cent in 2020) rather than significant change. In 2021, many organisations reported concerns about the impact that ending The sector continued to show high levels of JobKeeper would have on overall operating organisation and collaboration when it came profit or surplus. This was also borne out.

Page 23

The decrease from 2020/21 to 2021/22 in

the number of organisations making a profit was highly statistically significant (68 per cent versus 46 per cent). For-profit organisations were more likely than not-for-profit organisations to report a profit or surplus in 2021/22 (56 per cent versus 42 per cent).

There was more pessimism about operating conditions, with 36 per cent of organisations indicating that they expect to make a loss

21

or deficit in 2022/23, up from 23 per cent in 2021/22. As noted, historically, organisations have demonstrated high levels of accuracy in financial prediction, a record which suggests that the sector is likely to experience poor operating conditions into the immediate future. When compared with not-for-profit organisations, for-profit organisations were more likely to predict making a profit in 2022/23 (64 per cent versus 39 per cent).

Figure 8 In its most recent full financial year (year ending 30 June 2022) did this organisation

make a loss, break-even or make a profit (surplus) in regard to its disability services?

Mi 2016 2017 2018 M2019 M2020 M2021 WM 2022 80% 60% o s 32 22 wo 9 = <0 = = 20% RRoe sy Rees SN Broke even or close Made a loss/ Made a profit/ Don’t know or to break-even deficit surplus new entity

Figure 9 Do you expect your organisation will make a loss (deficit), break-even or a profit

(surplus) on its disability services in this current financial year (year ending 30 June 2023)?

M2015 MW 2016

80%

2017 2018 M2019 Mi 2020 Wi 2021

Wi 2022

60%

40%

to break-even

deficit

surplus

Case study

South Australia

Darrin Johnson Kudos Services

Tell us about Kudos

Kudos is Australia’s first not-for-profit, employee-owned mutual spun out of public service. We began in 2018 with around 90 staff from the Department of Human Services, some we have this strange blend of being a start-up but with a long heritage in working in complex needs disability services.

We formed with two key objectives: to be the Early Childhood Partner in Community for the NDIA in South Australia and to provide a therapy-based business for people over seven who are living with a disability.,

What’s been your proudest achievement?

The organisation had to do a lot in its early years — we needed a lot of back-of-house processes and systems to be developed very quickly. We also had to quickly establish a commercial model without the benefit of a fundraising arm, or without any of the investment income that many of the large SA 47,425 — Active participants including ECA sector stats 845 Active ECA participants established not-for-profit providers have.

| think the proudest achievement was when we could look at our results for a particular month and comfortably feel we had a viable business model.

Has the past year been more or less challenging than most?

| think we have had multiple challenging years, because we have needed to rapidly expand and grow our business, while still trying to bed down its basic systems and processes.

COVID has impacted everyone, of course, but we had a particularly hard couple of months earlier on this year. We deliver a large amount of our services through schools and many of them just couldn’t let us back on site for term one.

What are the major opportunities? Meeting the unmet demand for services. Despite nearly doubling over the last two years, we are set to expand probably even 6% NDIS participants are Indigenous 7.2% Culturally and linguistically diverse

Page 23

Faster over the next 12 months. So we are Top three issuesreally excited about our business at this point.

What are the major challenges?

Workforce Workforce, workforce and then workforce. The lack of available workforce across all disciplines is a key issue for the sector across Australia. However, in South Australia this shortage of workers is compounded by the inequity in the operating conditions for non-government and government providers. Support co-ordination is particularly at risk currently, due to insufficient pricing resulting in withdrawal of service providers.

Transition

The transition of people with disabilityout of government institutions (including aged care, hospitals, prisons and mental health facilities) and into vacancies needs to include greater engagement with non- government providers, who are interested and equipped in supporting this process, resulting in filling existing vacancies.

Provision of affordable quality housing

What’s surprised you most? With only six per cent of participantseligible for specialist disabilitycare. They care about their clients and theirfamilies, they care about their profession, andthey care about each other. You just don’tsee people going through the motions in thesector.

The nebulous policy environment that exists for housing requires urgent attention to encourage further investment.

Why did you get into the sector? My background is marketing and business development, but along the journey I’ve had a son who is legally blind, and who has been involved in the NDIS basically since its inception. I think for many working in the sector, disability is a calling not a career. Many of our team have lived experience, either personally or in their immediate family.

What’s impressed you most?

We are in a sector where there is never enough money and never enough time. But the team members are incredibly skilled at getting the most they can out of the funding and time available for their clients and their families. They do it professionally. They do it with a smile. And then they come back the next day and do it all again.

Queensland

Case study

Debra Burden

selectability

tell us about selectability

We’re a not-for-profit charity that works across regional Queensland to prevent suicide and improve mental health. We support about 3000 people, of which about a third would be in the NDIS.

What’s been your proudest achievement?

Probably the fact that we are so financially sound. When I joined selectability five years ago, we were going through the transition to NDIS and really feeling the pain.

But these days, we are doing well. And the basis of that financial success has been the NDIS.

Has the past year been more or less challenging than most?

Well, it’s certainly been busier. We’ve officially opened six new buildings and taken on about 350 new employees.

When COVID first hit, we just knew that there was going to be a huge increase in demand for mental health services — and most likely, a lot less funding. So, we decided to get on the front foot. We’d had a really good surplus the year before, and our board, who are very savvy, just said ‘put it all back into the business. Invest whatever you need to position us well for the future’.

We’re aiming to have 1000 employees by the end of this financial year and around 2000 the year after that.

What are the major opportunities?

I don’t know about the rest of the sector, but personally I am excited about some of the changes that the federal government is putting through.

What are the major challenges?

Like everyone, our big challenge is having a workforce that’s large enough to meet the demand that’s out there.

Page 27

Why did you get into the sector? Top three issues The first 30 years of my working life were spent in the credit union movement, then
I had a stint with an ASX-listed company. I learned a lot there, but it certainly wasn’t for me. At selectability, I get a great deal of satisfaction from the fact that we really can and really do make a difference in the lives of people with severe mental illness. I’ve had a lot of good gigs in my career, but this one is the best.

Worker screening What’s surprised you most? When I first joined the sector, we used to have regular meetings with a group of other CEOs, which I approached with a commercial lens. We were going through a merger at the time, so I’d be talking about how ‘we’re having a restructure’, how ‘we’re looking at pricing’, how ‘we’re working through our margins’ – only to be told ‘You know, Debra, you need to understand that that’s not how we do things in this sector’. And I thought to myself, ‘Wow, I thought financial viability was what every organisation did’. The CEO who were sitting around that table, I’m the only one who’s still here today.

NDIA pricing restructure Following the release of June’s price guide for 2022-2023, many providers have expressed their concerns around the sustainability of their services due to inadequate NDIA pricing systems. Current concerns in these areas have focused on lack of indexation for support coordination and plan management and therapy prices. I’m sad to share with you that, of the ten Another issue has been the removal of Level 3 high-intensity supports, which has left providers questioning how they can provide adequate services. At selectability, we don’t back away from the fact that we need to be financially viable, even though we’re not-for-profit. There’s 3000 odd people out there who are relying on us to support them and 650 employees who rely on us too.

What’s impressed you most? The people. The compassion and the commitment. People with severe and permanent mental illness can, at times, be very challenging, and to see the work that our people do just blows me away me every day.

Page 28

The state of the NDI

State of NDIA policy Parliament in early 2022 are likely to continue to drive policy changes. With a new government, new minister, and a new NDIA Chair and CEO only recently Primarily focussed on implementing the NDIS appointed, the policy environment remains Participant Guarantee, the reforms include uncertain. changes to how participant plans can be varied as well as some new terminology. In line with Labor’s election commitments, This will distinguish between scheduled and Minister Shorten has announced a significant unscheduled plan reviews and reviewable review of the NDIS. As such, the terms of decisions. Welcomed by the sector, risk reference are broad and will examine the assessments aligned to those who are fundamental elements of the Scheme. self-managing will be implemented where participants wish to use plan managers.Conducted over a 12-month period by an independent panel, and reporting to the A further amendment opens the door for the disability reform ministers, the review will Agency to pay service providers directly on consist of two parts. Part one will focus on behalf of participants (including self-managing the design, operation and sustainability of participants) through a new payment the NDI$, while part two will examine ways platform. As a first step, a new ICT business to build a more responsive, supportive and system called PACE will be introduced and sustainable market and workforce. is scheduled to be tested in Tasmania late in 2022. Improvements to the current ProviderWith such a broad remit, the 12-month Portal are necessary. However, rigorous$timeframe announced for the review is testing will be required to avoid the 2016$ambitious. So it will be important to look for provider payment debacle, caused by the$query wins that can be implemented easily introduction of a new portal.and result in tangible improvements. As part of his reform agenda, Minister Shorten State of NDIA prices is also tackling fraud. Continued review of provider claiming practices is likely to follow. The results of the Annual Price Review were a case of the best of times and the worst Legislative changes to the NDIS Act (The of times. A much-needed uplift in prices of National Disability Insurance Scheme supports based on the Disability Cost Model Amendment (Participant Service Guarantee was a great result, and we saw an average and Other Measures) Act 2022) passed by increase of nine per cent. This included:

Capability and Culture of th

Submission 121 - Atta

1.7 per cent increase to base prices

e 2 per cent temporary loading, reviewed annually

e 4.6 per cent increase in award minimum wages

e 0.5 per cent increase to superannuation guarantee charge.

NDS also welcomed a one-off payment to registered providers of daily living and community access supports. The payment recognised the significant costs that providers incurred keeping participants safe during COVID and complying with increased regulation.

However, the decision to not index price limits for plan management, level 2 and 3 support coordination and therapy and psychology supports hit providers hard. Plan managers, support coordinators and therapy providers continue to be challenged by cost increases in a wide range of areas, including wages (the competition from other sectors is intense), the superannuation guarantee, professional development (in specialised areas such as mealtime management and the prescription of assistive technology), supervision, and general CPI and compliance costs for registered providers.

These price settings also fail to recognise the specialisations required for NDIS therapists and could drive a more medicalised, clinic-based approach to delivery.

The decision to streamline the pricing of high-intensity supports is one that the sector supported. However, we were dismayed to see removal of the previous level 3 high-intensity price limits. This is likely to leave some participants with very complex support needs without the level of support that they need.

These concerns support our call for an independent pricing authority — as does the need to ensure that prices keep up with the market, enable participant choice and control, and generate further improvements in service quality and participant outcomes. Current arrangements that have prices set by the NDIA involve a conflict of interest. The NDIA should be trying to ensure there is a vibrant market for high-quality supports, but it also has a strong agenda on constraining costs — as evidenced by the public debate on the sustainability of the NDIS.

State of NDS Regulation

The appointment of a new NDIS Quality

and Safeguarding Commissioner early in

the year saw some developments in the

NDIS regulatory environment. Amid growing concerns about the two-tier system of registered and unregistered providers that currently exists, the NDIS Commissioner commenced exploring this issue with a Roundtable being held in March 2022 and has promised more discussion to come. NDS will continue to engage with the NDIS Commission and the government on this issue.

In August 2021, the NDIS Commission launched its first own motion inquiry into aspects of supported accommodation in the NDIS. Examining reportable incidents and complaints across six large SIL and SDA providers, the report, we hope, will also focus on models of best practice when it is released later this year.

The use of restrictive practices and unauthorised restrictive practices continues to be prominent on the agenda of the NDIS Commission. Providers continue to report difficulties in accessing behaviour support practitioners, variation in the quality of

behaviour support plans, and duplicative and cumbersome systems of authorisation and reporting across the different states and territories.

During the year, work began to better align regulation and reduce duplication across the care and support sectors. The first reforms saw changes to aged care legislation to recognise NDIS worker screening clearances. Other proposals on the table include the development of common core and sector specific supplementary service standards and single point monitoring (report once, use often). Such proposals have merit in a sector that has been required to adjust to ongoing changes in policies, procedures and processes. Alignment activities need to be minimal and fast-tracked, follow a co- design model, and take every opportunity to streamline compliance requirements (without compromising quality or safety).

The NDIS review also includes a focus on the Quality and Safeguarding Framework and the role of regulation. This will provide a critical opportunity for the sector to give feedback on how quality and safeguarding mechanisms can continue to be improved.

The state of the

Royal Commission

The Royal Commission into Violence, Abuse,

Neglect and Exploitation of People with Disability continued to hold public hearings and receive submissions across 2021-22 into the adequacy, quality and safety of services and supports.

With two hearings on the experiences of persons with disabilities who receive supports from Disability Employment Services or work in Australian Disability Enterprises, the Royal Commission also looked at the work, wages and support structures for persons with disabilities who are either transitioning from supported employment or accessing and maintaining open employment.

Two policy roundtables were convened on a national supported decision-making framework and best practice models of guardianship. A public hearing on substitute and supported decision making will be held in late November.

A further service provider hearing will be held in February 2023. At this stage, the areas that it will examine have not been released.

As 2022 draws to a close and we await both the reports from various hearings and the Royal Commission’s final report, there is an opportunity for the sector to act now.

It behoves providers to undertake a close examination of their organisation against the themes, findings and recommendations emerging from the hearings and reports and to consider the implications for their operations, systems and processes.

Other key takeaways include the adequacy and nature of their responses to abuse or allegations of neglect, and the extent to which these take a proactive or reactive

Capability and Culture of the

Submission 121 - Attachment

The state of the workforce

In terms of workforce, 2022 is probably most accurately described as ‘going from bad to worse’. Recruitment and retention challenges remained across the board and many staffing categories became substantially worse. As one respondent put it:

‘We are no longer in the midst of a skills shortage. It’s now a labour shortage, which means that across most sectors even unskilled or low-skilled jobs are more difficult to fill.’ Tas large not-for-profit Recruiting a suitably qualified workforce continued to be a significant challenge, with more organisations reporting moderate or extreme difficulty recruiting allied health clinicians, including speech pathologists (98 per cent) occupational therapists (97 per cent), psychologists (94 per cent) and physiotherapists (86 per cent). Organisations reported that they received limited applications for positions and identified the bureaucratic burden as a barrier associated with employing international candidates. ‘Occupational therapists — no response to advertising for jobs. New graduates who have applied have asked for higher wages than we can reasonably offer. Currently still recruiting. Speech pathologists — limited responses to advertisements for jobs. We have recruited an international speech pathologist. Long and arduous process held up by bureaucracy. Psychologist — limited or no applicants in response to advertisements.’ WA small not-for-profit Some organisations reported increased salary expectations among allied health practitioners, which could not be met, and noted the loss of candidates to more lucrative sole trader positions. ’Speech pathologists, occupational therapists — they don’t want to be mobile, and they want a much higher salary. There aren’t enough out there. We can’t afford to take students. Staff don’t have the time.’ NSW small not-for-profit ‘Finding staff that are qualified and open to the level of pay relevant to the position is tricky. It is also disappointing to employ staff (and) train them up (only) for them to then leave and start up as a sole trader. This has occurred a number of times and is difficult to navigate.’ Vic small not-for-profit Organisations reported having difficulty identifying and recruiting suitably qualified disability support workers and noted that current award pay rates do not reflect the complexity of the role.

Figure 10 Occupational Groups proving difficult to recruit competent staff

Speech therapists* 93%

Occupational therapists* | ae i

Psychologists* 89%

Physiotherapists* 80%

Disability support workers**

— es 53°, Dietitians* | Managers/supervisors i I 55/0 ee disability Support WOrk€r’S _eete eee ererREERERETIEEER 77°), Volunteers + 56% SEALED PAPE PLOD EPA OPLEDPDOPLEDOPA 71%

Early childhood - educators

Allied Health Assistants | SSE | ET ETT ETT TETTTTIEILED (57° Support coordinators* . 65%

HR/Workforce development**

Finance/accounting —

Information technology ** —

Marketing/business development* | M2020 | | 2021 LAC/Planners 48% @ 2022 LTD Plan managers | | ULELEEEDLDEEDDEDE, ’\“ 0% 20% 40% 60% 80%

31

100%

*significantly more difficult in 2022 compared to 2020 + significantly more difficult in 2022 compared to 2021

Key barriers and facilitators to recruiting competent staff

32

‘Award pay rates do not acknowledge the level of skill required by DSWs. As a NFP organisation, we cannot pay above-award rates and therefore constantly struggle to attract qualified, experienced staff and struggle to retain them due to for-profit competitor salary rates.’

Compared to 2021, in 2022 it was significantly more difficult to recruit disability support workers, managers or supervisors of disability support workers, volunteers, and people working in HR or workforce development and information technology.

Facilitators of recruitment Open-ended responses indicate that recruitment of non-clinical staff has also been impacted by increased salary expectations

‘The pool of quality staff has been poor. People are constantly unwell or not willing to work. We offer a hybrid workplace and some people don’t even want to come in one to two days a week for collaboration. We struggle with poor attitude and high expectations regarding salary when we pay all staff under the SCHCADS award. We cannot compete with intermediaries who do not pay the same award.’ NSW small not-for-profit

Key barriers and facilitators to recruiting competent staff reported by respondents were:

This year was also a particularly challenging one in terms of retention. While Allied Health staff remained challenging to retain, the biggest jumps occurred in the ‘non-clinical’, support worker and managerial staff. The most substantial increases in retention issues were seen in the following staff groups: HR or workforce development; managers or supervisors of disability support workers; information technology; marketing or business development; finance or accounting; volunteers; and disability support workers and support coordinators.

Figure 11 Occupational groups proving difficult to retain competent staff

Early childhood - @qUCtOrS | seeeeteerRIRRES 7 1°

Speech therapists * Psychologists Occupational therapists * Disability support workers ** Volunteers Physiotherapists Dietitians HR/workforce development ** Managers/supervisors of disability support workers + Allied Health assistants =LITLLETETTDDLTDDDOE 46% Support coordinators ** Information technology ** LAC/planners Plan managers Marketing/business development Finance/accounting **

19°, ES 45°, % 66% 63% EEL, SAY 45° 65% A a 26° TELL EEEEDEDEED, NBYp im 26% 31% : 36% LTTE DEDYEDDDDD A, % WY) 39% 47% oo 1% LTT me 13% “19% 12% 5% 40% 55 55 % % % 60% Wi 2020 2021 WB 2022 80% 33 100%

Key barriers and facilitators to retaining

competent staff reported by respondents were:

Barriers to retention

• Competition and poaching
• Low pay rates
• Burnout and COVID fatigue
• Attraction of solo practice or unregistered ABN work
• Lack of career pathway
• Working for multiple agencies or casualised nature of the industry
• Complexity of the work or it not being what staff expected
• Leaving for ‘easier’ work in different sectors
• Transient workforce, students move on
• Casualised workforce
• Workload
• Headhunting by other companies.

The NDS Workforce Census response rate was substantially reduced this period. However, some trends were still apparent.

Firstly, the trend towards a shift from permanent staff to casual staff appears to be continuing. This is consistent with the qualitative feedback from the Annual Market Survey. Many respondents reported casualisation of the workforce was making retention more challenging. This was often related to unpredictable income and reticence to appoint staff to permanent positions. One respondent to the Annual Market Survey exemplified this by saying: > ‘[The] casualised nature of the industry makes it difficult for staff to make ends meet and therefore [they] leave for permanent roles in other industries.’

Employment types

A dramatic feature of the disability services workforce (similar to other highly feminised workforces such as aged care and childcare) is the sustained, very high level of part-time workers. Despite the slight drop in percentages in the most recent survey, the rate of part-time workers remains very high at between 75 per cent and 80 per cent.

In the greater job market, ABS data suggest that about 70 per cent of workers work full-time hours and, at last collection point (data collection ceased from 2018), about 60 per cent were employed in a full-time position. In the disability sector, this number has ranged between 20 per cent and 24 per cent over the last five years, indicating dramatically lower rates of full-time employment.

This issue is worthy of closer investigation, as it may have complex implications for the sector. Firstly, this situation is likely related

Page 35

to the continued casualisation of the sector shifts and unpaid travel time between shifts. mentioned above and may have implications Secondly, staff costs are likely to be much for retention. Many respondents described higher when there is a high proportion of staff issues related to employees who worked who are not full-time. Given these factors, it for multiple organisations and had limited will be prudent to further explore the drivers availability to cover shifts, as well as the and implications of this issue for the disability sector.

Figure 12 Type of employment (per cent)

80%

70% 60% 62% 62% 61% 60%60% 57% 55% 58% 54% 54% 51%50% 41% 41% 41% 41% 40% Permanent (%)40% 35% 37% 34% 34% 33% 31%30% Casual (%)

20% Fixed (%) 10% 8% 5% 6% 6% 4% 6% 5% 6% 6% 5% 5% 0%

17   17   18   18   19   19   20   20   21   21   22
   Jun    Dec    Jun    Dec    Jun    Dec    Jun    Dec    Jun    Dec    Jun

Figure 13 Full-time permanent and part-time permanent work: employment share (per cent)

100% 80% 77% 79% 78% 78% 80% 77% 79% 82% 79% 79% 76%

60% Part time (%)

40% Full time (%) 23% 21% 22% 22% 20% 23% 21% 18% 21% 21% 24%20%

0%

17   17   18   18   19   19   20   20   21   21   22
  Jun    Dec    Jun    Dec    Jun    Dec    Jun    Dec    Jun    Dec    Jun

Case study

Lisa McConnon Enriched Care

Tell us about Enriched Care

We were started in 2013 by two foster parents who were caring for three young men with disabilities. We provide SIL, community access, respite care and in-home care and will be looking to extend into providing a day support centre in the future. Our point of difference is our ability to match participants to staff and ensure that our participants feel like part of a larger family.

What’s been your proudest achievement?

My proudest achievement is the way that the staff have adapted to change. The support staff and office staff have been fantastic at embracing new ideas and new ways of doing things and moving away from the ‘that’s what we do in this industry’ attitude.

What does an average day look like?

| don’t think | have average days. Each one is different, which | love.

Tas 12,295 — Active participants including ECA sector stats

191 Active ECA participants

Has the past year been more or less challenging than most?

It’d be hard to comment, as | have only been in the sector 13 months, but I’ve been really grateful for the support and guidance from other, more experienced CEOs. They have really welcomed me into the sector.

What do you think are the major opportunities?

| definitely think that providers could work more cohesively. We are all facing the same rules and guidelines from the NDIS and there is plenty of business available. We should be working together to be able to provide services to those that require it, no matter which provider this comes from. We are all looking towards the same result.

What do you think are the major challenges?

Major challenges are around workforce. As someone with a background in HR, | have never seen such a challenging sector. We struggle to attract people to the sector and

9.3% NDIS participants are Indigenous

3.1% Culturally and linguistically diverse

Page 39

Top three issues

Workforce

Like employers all over Australia, Tasmania’s disability service providers have been finding it difficult to attract and retain staff. The other challenge is around the ever-changing playing field of the NDIS and the red tape surrounding what providers can and can’t do. My biggest frustration is around the differences in what registered and unregistered providers do. It leads to frustration with providers, participants and families, and it is all too easy now for people to just become an unregistered provider without proper balances and checks in place. It would be good to be spending more time providing actual service than to be continually creating documents and doing paperwork.

Housing

Tasmanians with disability continue to find it harder than they should to access affordable, accessible and well-maintained housing stock.

Reform fatigue

The impacts of COVID continue to be felt all over the state, most noticeably in Why did you get into the sector? The after-effect After spending the past 11 years at a utilities company, I wanted to be working in a sector where it felt like I was making a difference. I am a people person and love seeing people thrive. If I can help facilitate that then I am happy!

What’s surprised you most?I was surprised to find that staff care more about participants than themselves at times. This is something I am actively working on changing in our business. We are all important and we all need to look after ourselves and each other, no matter what our role.

What’s impressed you most? The commitment from staff to make sure that we are all doing the right things. The ability to be able to adapt, especially when the goalposts move. And most of all, how incredibly able our participants can be when given the right environment and support to thrive.

Case study

Western Australia

Gordon Trewern

PeopleKind Group

Tell us about PeopleKind Group

We’re a parent company which enables six organisations to provide services to West Australians with complex needs. In disability, we offer supported accommodation, nursing, occupational theory, physiotherapy and speech pathology.

What has been your proudest achievement?

| have been CEO for 28 years. My proudest moment was when we closed the big hostel, essentially a typical congregate setting for people with severe and profound disability. We supported people to move and integrate into the community.

The consensus at the time for people with profound and severe disability was; “You can’t move these people out in the community. They won’t survive. It won’t work for them.’” Needless to say, it did!

WA 47,302

Active participants including ECA sector stats

• Active ECA participants: 827

What does an average day look like for you?

My day typically starts at 5am. | get on the computer straightaway, check email and review the day ahead, then | go off to the gym. From that point on though, it varies, because anything can pop up at any time when you’re dealing with human services.

Has the past year been more or less challenging than most?

It’s a very timely question. We’ve been an advocate for the NDIS, but I’ve been bitterly disappointed by the way it’s been rolled out. It’s been a classic example of poor execution of public policy. The architecture of the scheme was wrong from the start.

Our disability service has been tracking deficits every year and we came very close to shutting it all down. That’s how bad it got. Long story short: we’re now at breakeven, but that’s not a sustainable model.

NDIS participant demographics:

• Indigenous: 7.8%
• Culturally and linguistically diverse: 8.1%

What are some of the major opportunities?

Top three issues

This is not a political statement, but my optimism today comes from the fact that investing in the disability workforce.

We’ve got a minister who understands what the problems are, and I think he’s genuinely trying to resolve them.

There’s a lot of work to be done, but there’s also a lot of confidence that we might actually get it right this time.

What are some of the major challenges?

I think the main challenge is that so many organisations have burned their cash. I think we will lose some organisations in the future, which is a concern and challenge.

A siloed sector approach is unlikely to meet the demand Second, disability workers aren’t valued for care and support services which is enough, and I think that’s a terrible thing. They should be a valued workforce, just the same as essential services like nurses and doctors and they should be paid a better wage for what they do.

Housing

In the period since 2020, the specialised disability accommodation environment has undergone significant change, with private developers and disability service providers entering the market as property developers to capitalise on SDA funding, and many existing properties become increasingly unfit for purpose.

Administrative burden of the NDIS

The system is groaning under red tape and this impacts on the financial viability of service providers who want to provide quality services. Much of the burden for providers relates to the content and structure of pricing arrangements.

What’s impressed you most?

The people in our sector have a great capacity to come together when we need to. You come across great people all the time - and their resilience is just extraordinary.

####### What’s surprised you most (about the sector)? The way that we’ve allowed ourselves to become a market. Personally, I don’t go to work every day to put money in a shareholder’s pocket. It’s about delivering a social dividend rather than a shareholder dividend, and many of my colleagues would say the same thing.

The state of disability

employment

Australia’s relative performance supporting ‘The complete lack of clarity around the new model for DES certainly keeps me awake at night.’

SA medium not-for-profit

‘The Royal Commission calls out notrecent reforms (including DES and Workforce meeting individual needs and person-Australia) were designed to redress persistent centred, individualised support – theinequities. The disability employment sector’s [DES policy] model does not support thisview is that they are likely to fail. approach.’

NSW medium not-for-profit

Australian Disability Employment Similarly, very few respondents believed Outcomes2 that Workforce Australia policy reforms were Working-aged people with disability heading in the right direction. have a lower employment rate (48 per cent) than working-aged people without Attitudes towards DES reforms disability (80 per cent)

Almost half of respondents (48 per cent) disagreed or strongly disagreed that current DES data provides comprehensive information which can be used to support business decisions. Two-thirds (67 per cent) disagreed or strongly disagreed that the digital service model had enhanced employment opportunities for DES participants, while only four per cent agreed or strongly agreed with ‘If DSS proceed to build a new DES without taking on board the problems that exist in the current program from a provider in the current program from a provider perspective, there is high risk that these ‘Shift to digital does not factor in capacity, perspective, there is high risk that these problems will be perpetuated in the new access, connectivity for a large cohort of problems will be perpetuated in the new model.’ people with disability.’ model.’

WA very small not-for-profit NSW medium not-for-profit

Figure 14 Employment services

       DES policy reforms                              2021 (n=25)     56%                    32%       12%
          are heading in the
                  right direction    2022 (n=33)     48%                    48%

  Policy reforms for Workforce                              2021 (n=25)     36%                    52%       12%
  Australia are heading in the
                 right direction*    2022 (n=33)     42%                    42%       15%

   The digital service model                              2021 (n=25)     56%                     24%     20%
 has enhanced employment

opportunities for DES participants 2022 (n=33) 67% 30%

          The overall DES                              2021 (n=25)     20%                    76%
     administrative burden on
 your organisation is onerous    2022 (n=33)     36%                    64%

  The current model for DES
                          2021 (n=25)     28%                    48%       24%   provides equitable job support
   for all people with disability                              2022 (n=33)     58%                    27%       15%
  who use these services+

                           0%     20%     40%     60%     80%    100%

Disagree or strongly disagree Neither agree nor disagree Agree or strongly agree

• 2021 wording was ‘Policy reforms for Job Active/NESM are heading in the right direction’

• Significant difference between 2022 and 2021

Page 44

‘The Commonwealth view that digital ‘The compliance elements are onerous and platforms have a significant role in counter-intuitive.’ employment services I think is misguided.’ Vic large not-for-profit SA medium not-for-profit ‘The incentives are money and avoiding Administrative burden continues to be an punitive departmental action for what are issue for DES providers. Sixty-four per cent often mistakes, or simply being one day of respondents agreed or strongly agreed late. Financial is ok as it relates to sustained that the overall DES administrative burden on employment for participants. We, DES, on organisations is onerous. Tellingly, not a single spend enormous resources trying to ‘get respondent disagreed with this statement. it right’ then responding to audits, then Respondents commented that administrative responding to the audit finding, which in burdens and time constraints were impacting many cases have been reversed after our their practice. further action.’ Vic large not-for-profit

Figure 15 What type of administrative burden is the most onerous?

      Evidence collection                                        38%
            requirements                                                46%

                                                        38%
      Compliance audits
                                                        38%

                               13% Using the electronic calendar
                            10%
                                                                          2021
                            10%
                   Other                                                       2022
                     5%

               0%       10%       20%       30%       40%       50%

In 2022, almost half (46 per cent) of ‘DES doesn’t work. Supported employment respondents cited the requirements around does, but [it] is the embarrassing cousin no evidence collection as being the most onerous one wants to acknowledge.’ type of administrative burden. This represents NSW large not-for-profit an increase of almost ten per cent on the ‘DES is clueless as to what happens inprevious year’s reporting. providing value services to participants.’ Qld medium not-for-profit Only 15 per cent agreed or strongly agreed that
The current DES model can provide equitable job support. This represents a drop of almost ten per cent from the previous year’s results.

Figure 16 Employment services funding and incentives

Should the current funding structure be retained for the next DES contract?

Are the right incentives built into the operation of DES, Workforce Australia and Transition to Work to assist a range of people with disability into employment?*+

                           0%     20%     40%     60%     80%    100%
                                               Yes      No       Don’t know

• 2021 wording was ‘Are the right incentives built into the operation of the DES, JobActive and NES to assist a range of people with disability into employment?’

• Significant difference between 2022 and 2021

Over one-third (39 per cent) of respondents did ‘Funding is not competitive relative to other employment contracts with government (e.g., wage subsidy differences between contracts).’\nNSW medium not-for-profit

The majority of respondents (78 per cent) did not believe that the right incentives to assist a range of people with disability into employment are built into the operation of DES, Workforce Australia and Transition to Work. This is a notable and statistically significant increase on last year, where only 46 per cent held this view.

Supported employment operating environment Vic large not-for-profit This year, only 18 per cent of supported ‘All wage subsidies should be removed from the contract – to stop providers paying for jobs and buying outcomes.’
ACT medium not-for-profit This year, only 18 per cent of supported ‘All wage subsidies should be removed from the contract – to stop providers paying for jobs and buying outcomes.’\

’Providers are gaming the system to get the funding they need rather than providing person-centred services that help participants achieve long-term, sustainable employment outcomes.’

(56 per cent) did not agree with this statement.

Respondents commented:

e ‘The new framework is overly complex from an administrative basis (and) thus margins have decreased further. Supported employment is clearly not favoured and under escalating pressure. Nothing is being done to encourage improved transition to open employment or to recognise that a lot of people with disability simply do not want to be in open employment.’

WA large not-for-profit

e ‘We have lost 50 per cent of our workforce since the commencement of the NDIS as work is no longer a priority and for- profit providers and LACs are actively discouraging people from working so they can attend their non work options. Instead, they go as far as telling people to stop allowing us to rip them off.’

NSW medium not-for-profit

Similarly, barely one-third (86 per cent) of respondents agreed or strongly agreed that the transition to the NDIS has enhanced their

capacity to provide employment opportunities.

Forty-two per cent of respondents disagreed or strongly disagreed with this statement.

Finally, almost half (45 per cent) of respondents agreed or strongly agreed that their organisation can provide the support required for individuals under the NDIS pricing arrangements. Over one third (34 per cent) of respondents disagreed or strongly disagreed with this statement. One commented:

e ‘The pricing arrangements are the lowest in the sector for the delivery of disability supports and could definitely be increased to ensure greater capacity for service delivery.’

NSW medium social enterprise

Employment sector update

NDS sought feedback this year from supported employment providers on their headline issues. These included the outcome of the SES Award review and wage setting arrangements for supported employees, business sustainability, difficulty recruiting supported employees, and NDIS compliance and red tape.

During a three-day hearing in April 2022, The Disability Royal Commission (DRC) also examined the experiences of supported employees in disability enterprises. NDS provided evidence to the DRC during this hearing.

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A large provider of supported employment 52 providers lose some business, while about in Western Australia announced a significant 15,000 participants will need to move to a number of supported employee redundancies, new provider. It is important to note that the prompting the new federal government FPA was always scheduled to be conducted to announce a relief package designed to during the current contract and was not support those losing their jobs into alternative connected to the DRC’s examination of the employment and day support options. NDS DES program. has been working closely with both supported DSS, industry peak bodies (including NDS)employment providers and other disability and providers contributed to some importantservices through its membership of the work illustrating good practice in opentaskforce set up to manage the transition. employment service provision. NDS has been NDS members continue to focus on ways active in guiding the development of the new to broaden their provision of employment DES contract which will now commence supports and services, while being guided by mid-2025. Particularly through our role on the the principles identified in our industry vision DES Reference Group, which is charged with for the sector. A new vision reference group leading the DES reform process. have established that better reflected a broad DES participant numbers continue to fluctuate,range of expertise and views on the future of with clear evidence that younger participantthe supported employment model. varying numbers are down, while older participant numbers continue to increase. The most numerous age cohort now in DES is the 55-64, with almost 29 per cent of the caseload. The removal of two previously eligible DES cohorts has seen total program numberscontracted significantly, last being reported by the NDIA as being below 16,000. This represents a contraction of around 20 per cent over the last few years. This contraction is also reflected in a stagnant NDIS participant rate of 22 per cent, well below the target rate for June 2023 of 30 per cent. if it is the service model that best meets their needs. The outlook for DES providers has improved
following the re-opening of the economy, but Both open and supported employmentthe inflexibility of the DES program continues providers are cautiously optimistic that ato hinder their delivery of employment new federal government will be more willingsupports. NDS has heard from DES providers to heed their feedback and to investigatethat their headline issues include the DES reform agenda and the timing of the new contract, the general level of compliance, excessive claim compliance and the Right Fit for Risk IT security requirements.

A formal performance assessment for DES providers conducted by DSS in 2022-3 saw

The state of the broader

policy environment

Number of DSP recipients increases workforce plan for the disability sector following 2021 COVID restrictions (and pleasingly, workforce is a key area of focus in the NDIS review). At a time when According to DSS data,$4 the number of DSP unemployment rates have hit an all-time low recipients rose by 11,958 over the 2021-22 and demand for workers across the care and financial year, the largest increase in over support sectors is predicted to continue its a decade. The increase follows significant upward trajectory, we need a coordinated and economic and labour market disruption integrated response to lessen competition for caused by severe COVID restrictions workers. imposed in NSW and Victoria from mid-2021.

The October 2022 Federal Budget included aEncouragingly, the number of DSP recipients commitment to establishing Jobs and Skillsreporting earned income recovered across Australia and there are significant opportunitiesthe course of the year, starting at 6.9 per cent for this new body to drive through whole-of-in July 2021 and dipping to 6 per cent in the government strategies that address barriersSeptember 2021 quarter (the lowest rate in to workers entering and remaining in thedecades) before finishing at 6.8 per cent as of sector. This response will depend on improved30 June 2022. workforce data.

Unfortunately, the rate of earned income by DSP Workforce and training solutions must berecipients has been stagnating at around seven developed in partnership and led by the sectorto be effective. Training that does not respondper cent since mid-2020, down from previous to the needs of employers or the end users ofmid-2014. These figures highlight yet again the supports will not result in the outcomes thatimportance of government policy initiatives and the community expects from the sector orstrategies that encourage increased workforce from government.participation by people with disability. DSP recipients can be encouraged to gain work by National Disability Strategy sets providing better information on how earned ambitious agendaincome affects their welfare benefits and easing disincentives by giving them access to the Rebadged ‘Australia’s Disability Strategy’ and pensioner work bonus. with a much-needed outcomes and reporting framework, the strategy sets an ambitious New workforce plan for the sector agenda for a more inclusive and accessible The new government will develop a new Australian community.

Targeted action plans have been developed to

support work over the next 12 months in the areas of employment, early childhood, safety and emergency management and community attitudes. However, with no outcomes reports available and funding for the strategy unclear, how well we are progressing is yet to be determined.

Modern Award reviews demonstrate inconsistent outcomes

Reviews by the Fair Work Commission (FWC) of two modern awards covering the disability sector — the SCHADS Award (covering community services workers) and the SES Award (covering employees of supported employment services) — each experienced significantly different outcomes during 2021-22.

After many years of complex negotiations and proposed wide-reaching changes to pay and conditions, the SCHADS Award review concluded. The outcomes of the review saw new or changed provisions covering minimum shifts, guaranteed hour reviews for part-time employees, a soiled clothing allowance, remote response work, broken shifts, client cancellation, overtime for part-time and casual staff and the payment of employee travel time between shifts or client appointments.

Following submissions by the employer parties (including NDS), the Fair Work Commission postponed the most extensive changes affecting employer costs until October 2022. NDS also worked closely with members to ensure that the effects of the changes were fully understood by providers.

The review of the SES Award is finally nearing completion with the FWC releasing a Decision in November 2022 confirming the inclusion of its originally proposed wage structure through a draft variation of the Award. The most important matter covered during the review — the payment of wages to employees with disability will be determined by a new classification structure containing two grades for employees with disability, seven mainstream grades and the inclusion of SWS assessments for those employees whose productivity is reduced by their disability.

The FWC will allow one final round of written and oral submissions, closing in December 2022 and is then expected to deliver a final determination on the future of wage setting in supported employment shortly afterwards.

New South Wales

Case study

Belinda Colombrita McCall Gardens

Tell us about Mcall Gardens

Based in north-west Sydney, mcCall Gardens provides supported independent living, specialist disability accommodation, support coordination, community activities, inclusive play options and school holiday programs, as well as before-and-after School supports for children with disability.

We operate ten purpose-built group homes, a community centre at Box Hill and an inclusive play centre for people of all ages and abilities.

what’s been your proudest achievement?

we are very excited that our team has been able to commit $40 million to redevelop our community Centre. we will soon be providing allied health, community participation, swimming School, hydrotherapy, sensory gardens, a café and a vast outdoor landscaped area to enjoy the rural setting With family and friends.

NSW

Active participants including ECA sector stats 165,811 4,756 © Active eca Participants

What does an average day look like? No two days are the same. With the redevelopment, mcall has a dual focus at the moment and I’m needing to devote a great deal Of time To work on The sale of A large portion OF Our land At box hill, And THE redevelopment Of roughly four hectares.

Has the past year been more or less challenging than most? Probably Less although after Year one Of Covid i think That OUR baseline For what is considered Challenging Has shifted!

What Are the major opportunities? The NDIS has already provided so many Opportunities FOR People With disability It’s definitely made providers change the way they do business AND provide More dynamic services it’s forced the entire Sector TO Think differently and become MORE professional and commercially focused.

109% Culturally and linguistically diverse 8% ndis participants are Indigenous

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With that shift, the sector now offers the Top three issuesworkforce a broader range of opportunities.

What are the major challenges?

Workforce 

Attracting, training, developing and retaining In speaking with service providers about issues, time and time again the response is ‘workforce, workforce, workforce.’ The issue relates to both attraction and retention of workers. The problem extends to Allied Health services, where there is much discussion across the sector around waiting times to get appointments for necessary supports.

Secondly, while we wholeheartedly support
compliance and regulation, we are operating
in a market where unregistered providers can Excessive administration burden remains provide just the same service, but with very a challenge. The requirement of dual little oversight and additional costs. reporting to both the NSW Government and NDIS Quality and SafeguardsWhy did you get into the sector? Commission, the need to renegotiate A general manager of disability services service agreements resulting from sudden provider sought my assistance for a particular changes in participant’s plans, quality task. It was a rewarding and fulfilling short audit activities and recruitment activitiesthat awakened my desire to all add to the drain on already stretched work in the sector. Twenty years later, I still resources and result in increased cost of believe that it is the best job in the world! delivery.

What’s surprised you most?

Financial viability

When I entered the disability sector back in Financial sustainability was a major issue2002, funding was very limited, and services for a great many services during theproviders like McCall had to operate on the state’s 2020-21 COVID lockdowns – andsmell of an oily rag. 2021-22 has not been much better in the absence of a JobKeeper-style scheme. Despite that, there were so many individuals,
staff and families ready and willing to give
time to fundraise, paint houses
and provide additional supports (and so
much more) to people in need of care
and assistance.

What’s impressed you most?

People are always willing to share and support
each other. During the past two COVID years,
providers have really rallied together. Although
it was the most challenging time I have
experienced in my career, I always knew that I
had a network to call on.

Case study

Haley Dean Melba Support

Tell us about Melba

Melba is a not-for-profit Victorian-based provider from the outer east of Melbourne. We are celebrating our 50th birthday this year. We’re well known for our outcomes-based human rights approach and for supporting people with complex needs.

What has been your proudest achievement?

We became a registered NDIS provider in 2015 and during the next two years more than quadrupled in size. And then COVID hit. So, we’ve had lots of big and unprecedented changes. I’m immensely proud of our fabulous staff and their ongoing resilience, commitment and dedication.

If | had to pick out one moment that filled me with pride, it was when | was finally able to go and visit a woman we support who had moved into her own home. Melba and a community housing provider built the townhouses and apartments through COVID. This person finally had a home of her own, where she had the freedom to do what she wanted, when she wanted, and was now directing her own supports. When she invited me in to see her home recently, that was a great moment.

What does an average day look like?

There is no average day! | start my day with exercise at 6am, emails at 7am and then review priorities and what the day holds. That might be presenting the human rights and zero tolerance section of our induction program, or meeting a group of people supported by Melba and their families, or reviewing different models of service.

Has the past year been more or less challenging than most?

My first reaction is more — but it’s a different challenge. The peak of COVID was a very reactive, adrenaline-fuelled environment where everyone just had to pull together and get through it. It went on for longer than we had

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hoped, but we did incredibly well. Now we are Top three issuesexperiencing some fallout, including a very tired workforce. Thankfully, we are seeing some Economic viability  welcome changes to what has been a volatile Regular NDS polling indicates thatNDIS. economic viability is a major concern, What are some of the major opportunities? with many members facing challenging Some people only know the NDIS and are budget situations. Day services are looking for innovation, responsive flexibility, experiencing particular challenges with creative solutions and options. So, I think that the shift to the new pricing model, and we live in exciting times. ‘Challenging’ doesn’t reports of some participants who have have to be a negative word. Every challenge chosen not to return to services after presents an opportunity. the pandemic lockdowns. Short term measures such as JobKeeper payments What surprises you about the sector? and one-off NDIS funding have been What surprises me most is that we don’t see welcome, but do not address the more disruption. I’d particularly like to see more underlying multiple pressures impacting innovation driven by people with disability. the market.  For all its operational challenges, the NDIS is Mental health and wellbeing  philosophically fantastic. The power is in the The extent of pandemic restrictions in hands of the person who can vote with their Victoria has resulted in an exhausted toes. As providers, it often feels we are just workforce. Participant routines were tinkering around the edges of systems and disrupted during lockdowns, and programs that have been around forever and providers report continuing mental health weren’t created by people with a disability. effects. I’m surprised that there’s not more responsive Onerous reporting innovation. You don’t want to be a Blockbuster. The Victorian government’s laudableYou want to be a Netflix. commitment to quality and safeguarding What’s impressed you most? has increased reporting requirements We’re a sector that pulls together when and resulted in a complex tangle of required and always does what’s needed. administrative requirements. The overlay of state and federal bodies interested I think COVID was a fabulous example of in reporting, and limited information incredible individuals from different parts of the protocols between such bodies, sector being willing to help each other. It’s not continues to pose a challenge to NDS about competing; it’s about enabling better members.  lives for people with a disability.

Why did you get into the disability sector? Serendipity! I was 15, and a job experience placement accidentally sent me to the wrong place. It turns out it was the right one!

References

1. (p.34) Australian Bureau of Statistics, Australia, Understanding full-time and part-time work (18 February 2021), ABS Website, accessed 18 October 2022. https://www.abs.gov.au/articles/understanding-full-time-and-part-time-work

2. (p.40) Australian Bureau of Statistics, Australia, Disability, Ageing and Carers, Australia: Summary of Findings (24 October 2019), ABS Website, accessed 26 October 2022. https://www.abs.gov.au/statistics/health/disability/disability-ageing-and-carers-australia- summary-findings/latest-release

3. (p.45) Department of Social Services, Australia, DES Monthly Report — 30 June 2022 (10 July 2022), accessed 8 November 2022. https://www.data.gov.au/dataset/ds-dga-e258b678-eb6b-4ebb-92d8-0fe7c1%20122c42/ distribution/dist-dga-6dd0cde2-843d-41%f5-bc54-6f38a4(fb806e/details? q=Disability%20 Employment%20Services

4. (p.46) Department of Social Services, Australia, DSS Demographics — June 2022 (26 August 2022), accessed 8 November 2022. https://www.data.gov.au/dataset/ds-dga-cff2ae8a-55e4-4%7db-a66d-e1%207%207fe0ac6a0/distribution/ dist-dga-1188c950-542a-4ca6-9e3e-9f91(f53d93%201%204/details?q=DSS%20data

State and territory sector statistics: NDIS Quarterly Report to disability ministers (30 June 2022) © National Disability Insurance Agency. ndis.gov.au, accessed 6 September 2022

Publisher National National Disability Services NS Disability Services

Laurie Leigh CEO 03 8341 4343 laurie.leigh@nds.org.au

All rights reserved. No part of this publication may be reproduced, distributed or transmitted in any form without the prior written permission of the publisher. Except in the case of brief quotations embodied in critical reviews and certain other non-commercial uses permitted by copyright law.

About National Disability Services

National Disability Services is Australia’s peak body for non-government disability service organisations, representing over 1000 service providers. Collectively, NDS members operate several thousand services for Australians with all types of disability.

Acknowledgements

The 2022 Annual Market Survey was carried out by Professor Jennifer Smith-Merry, PhD, and her team at the Centre for Disability Research and Policy at the University of Sydney

Thank you to members who participated in our case studies.

National Disability Services acknowledges the Traditional Owners and Custodians across the lands in which we live and work and we pay our respect for Elders past, present and emerging.

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National Disability Services