NDIA Accountability Project

Systemic failings and accountability within the National Disability Insurance Agency

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Capability and Culture of the National Disability Insurance Agency

Having being directly part of the disability sector for more than twenty years as a parent of a child with disability, as a disability worker and educator and as a carer I have become a bit of an enigma.

I have found that the only way forward is to deal with facts. Most people who are in a subjective situation find this particularly difficult, however it is the only way to substantiate direction and purposeful goals. Consolidating facts determines a station or place and “Focus” these facts in relation to constructive resolution help determine the “Perspective” and direction and actions required. The dynamics between these entities determines the strength of the environment (Health of the System, the productiveness of the Process).

An example, was when our son’s scoliosis, during his early teenage years moved to a critical stage. The head surgeon of this area had died and surgeries were backing up. Within a period of eighteen months our son’s scoliosis went from 33 degrees to over 65 degrees. This horrific condition was traumatising and helplessness disarmed any strategy.

I had to write to the board of the Royal Children’s Hospital and state that the level of spinal distortion was resulting in the requirement of the most extreme surgical intervention and a much greater risk of a positive outcome from surgery. Any, longer time waiting before surgical intervention is directly exacerbating the complexity of surgery required to further correct the spine and results in a higher risk to the patient.

Once our son was ready to be discharged and go home, I enquired about the supports that DHHS were providing. DHHS refused to deliver the supports promised so my only alternative was to tell the hospital that we cannot take our son home because we don’t have the supports from DHHS which are needed to support him. A few days passed and eventually DHHS provided the supports and we went home.

Today six years later, our son is cared for under St Vincent’s Hospital. There are no electronic records sent to his “MyGov” health records and it is painfully obvious that generally across all engagement areas systemic issues plague our society but most specifically marginalize our most vulnerable and people living with disability.

I worked largely for the Department of Health and Human Services (DHHS) and was the first Human Rights Ambassador in Disability Accommodation Services (DAS). I witnessed staff client assault and cover ups from management. It perplexed me to conceive such moral dissention. In 2008 an inquiry was done into DAS and a term was recognised – Disability Services are “Crisis Driven”.

Previously I worked as a Finished Artist in commercial advertising where I was responsible to produce perfect art for camera and reproduction via printing process. Accountability was understood and bumped along despite our human failing. The point I am making is that where the focus is, is where the perspective will take us. It is imperative that focus is relative to the perspective of the desired outcome.

Prior to the National Disability Insurance Scheme (NDIS) my wife encouraged Yooralla to have a dissemination forum on the proposed NDIS at which Bruce Bonyhady presented. Keeping in mind the experience of staff client assault, systemic failings marginalising people with disability and the poor level of care provided I stated to Bruce, “this was a societal failure”. Bruce responded saying “this is an economic failure”.

In 2010 I worked for “Advocacy for Disabled in Ethnic Communities” (ADEC). While at ADEC I worked with individual and systemic issues and while it may be painfully obvious that there should be no place for systemic issues, they seemed to be the least to be actioned.

The relationship of Capability and culture of the National Disability Insurance Agency is one that is a product of what has come before. Focus and perspective and Participant focus has passed through the honeymoon period of implementing the NDIS and dropped away.

NDIS is currently at a stage where fundamental aspects of the NDIS for the Participant have been lost.

(i) I refer to the development of Service Agreements between Service Providers and Participants, where currently the Service Provider presents a Service Agreement to the Participant and the Participant signs it. *This directly re-enforces external control and directly disenfranchises the Participant.

(ii) I refer to the Participants ability to negotiate rates with Service Providers and the ability of Service Providers to charge beyond the standard NDIS rate by identifying a greater support level of the client. Yet the client is not formally notified. *This directly re-enforces external control and directly disenfranchises the Participant.

(iii) The training and trust and learning element between the Participant and their responsibilities while being supported by the NDIS is not nurtured. This is non existent yet both fundamental and foundational in establishing positive culture and trust between the NDIA and the Participant and vica versa. This can be developed with every exchange between the NDIS Participant and structured processes (such as the NDIS Quality Safeguards Commission, engagement) – but it isn’t. Positive culture tool - Participant and NDIS Engagement to assure Participant satisfaction regarding concerns – the Participant must be acknowledged and told that they have been heard. (if this is an issue that may be affecting others the Participant must be informed that the problem is being addressed to prevent the issue affecting other) – and an existentialist perspective of care structured.

(iv) The Plan Review Process – particularly in regard to established regulation and process which systemically determines and is recognised, yet legitimate NDIS funding criteria is ignored and Participants abused via this process. This is a huge systemic and culturally negative area. For example, personally we have just spent eighteen months trying to get our son’s Plan reviewed with the necessary funding. The funding review focused on the fact that our son requires two support workers to manage his personal care and to allow him time out of his wheel chair and to conduct swimming and physio therapeutic exercises. This is also to satisfy Occupational Health and Safety act 2004. Firstly, the Planner stated that this was restrictive intervention – and an incident report of unreported restrictive practice was said to have been recorded. I subsequently had the Planner removed and investigated. However in compliance with this I engaged a Behavioural Practitioner who commenced and Interim Behaviour Management Plan.

(Please understand I am a qualified disability professional who has worked with the Department of Health and Human Services and other organisations including the department of Justice, I have written Behavioural Management Plans previously and know the Federal Senior Practitioner.)

The Behavioural Practitioner finished the Interim Behaviour Management Plan and I questioned her explaining that the scroll down menu of the form did not reflect the fact that our son did not require two workers to support to modify his behaviour. She replied that it is in the incident report. I asked whether she had seen the incident report because the documentation around the alleged incident report did not state what practice had not been reported. She replied, that she had not seen the incident report. I had the Interim Behaviour Plan withdrawn. I have yet to lodge a formal complaint to the NDIS Quality Safeguards Commission regarding the Behavioural Practitioner – But I will be asking she be struct off.

The Review progressed to the Administrative Appeals Tribunal (AAT) and I spoke with the NDIA lawyers to try to resolve the funding outside the AAT process. I had to write a number of detailed documents which identified every task and the period of time each task took for one hundred and eleven hours of funding required each week, plus other periods throughout the year. The lawyers sent us a number of Plan Reviews which were supposed to reflect this funding, each time it was incorrect. We were even sent a Plan which was written for our son to transition to supported accommodation – without any notice – when I opened the plan while in our drive way – I began to dry reach with shock.

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I contacted the Ministers office on a number of occasions which was helpful. Finally, I rewrote the lawyer’s document and resubmitted it to them further articulating the process. The previous Plan they sent excluded penalty hours and it was only when I found their document to us that they agreed it was incorrect – no apology.

I requested a draft Plan to be sent to ensure that it was correct. A draft Plan arrived and I spoke with the NDIA regarding some discrepancies which were minor, before agreeing to the Plan. All Participants should receive a draft Plan first. It was one of the Productivity Commission’s recommendations that every Plan should have a cooling off period in which to ensure the Plan is correct. Why was this not supported by Government? This would go a long way to restoring Participants and the NDIS culture. The process that we were subject to was direct abuse; especially given the extra worker was primarily to support OH&S.*This directly creates sanctions of distrust and destroys positive culture and builds negative culture.

(v) Engagement with the NDIS Quality Safeguards Commission. Having personally engaged with them on numerous occasions; I have found them to be more supportive of the Service Provider than the Participant. The need for positive feed-back from the Commission to the Participant is non-existent yet critical in developing trust and recognising the Participants ownership within the NDIS and building this positive culture and safe culture. For example, if a Participant is told how the issue has been addressed and that others are not being subject to this same issue – it instals trust and positive culture directly. Positive culture tool - Participant and NDIS Engagement to assure Participant satisfaction regarding concerns – the Participant must be acknowledged and told that they have been heard. (if this is an issue that may be affecting others the Participant must be informed that the problem is being addressed to prevent the issue affecting others).

(vi) Support Co-ordination is another critical engagement area for the Participant. Positive culture tool - Support Co-ordination and their role in supporting the Participant must be mandated highlighting the categories where the Support Co-ordinator is responsible. Despite the NDIS/A not funding Advocacy the role of the Support Co-ordination is by definition acting and resolving issues for the NDIS Participant/Guardian/Parent/Family,*These specific areas must be identified and mandated for the function of Support Co-ordinator & NDIS Participant. This mandate needs to ensure supports if required by the NDIS Participant to enable electoral participation –must be logged in NDIS Participant Plan – This is a mandatory compliance that NDIS Participants who are eligible to vote are supported to do so, if support is required – this is mandatory Commonwealth Electoral Law.

(vii) Perhaps the easiest and yet most efficient reform to improve practical application within the NDIS and the NDIA and improve culture is the reform of policy that systemically marginalises Participants. Again, as in (iii) education and learning for the participant but also the introduction of “competencies” where individual support workers can achieve via a Registered Training Authority (RTA) the necessary compliance to support Participants who have Behaviours of Concern. (This training will need to be individual specific.)

(viii) Amalgamation of whole of government policy. As described in (vii) above, there are many entities of legal standing that have existed before the introduction of the NDIS. For example, Guardianship, and while this gives individuals the right to support and make decisions for people with disability this legislation has not been updated to support the current application required under the NDIS. As such Guardianship is marginalised. This is also the circumstance for parents of people with disability and the regulations imposed by the 2018 Restrictive Practices Rules under the NDIS. An example part of this marginalisation is the reporting criteria that affects parents and guardians it is the ability to oversee restrictive intervention.

(a) A parent can oversee and implements restrictive practice – however no reporting criteria is available to be allowed to report on the restrictive practice. (Yet restrictive practice must be reported on)

(b) A guardian cannot overseerestrictive practice and does not have the avenue to report on restrictivpractice, either. Update Policy - Guardians should be allowed to oversee restrictive practices. Update Policy – Guardians and Parents should be given the choice and conduit to report on restrictive practice.

(c) Both the parent and the guardian are ostracised from a highly regulated process while still having fundamental responsibilities for the person with disability. This choice to report has been taken away and heavily marginalises the value of the parent and a guardian – this builds poor culture and actually creates a greater restriction upon the person with disability. The ability to report should be made available to both Parents and Guardians as a constructive and inclusive measure to support individuals who has behaviours of concern.

Update Policy – Parents and Guardians should be allowed to report on restrictive practices. For parents implementing restrictive practice where a Behaviour Management Plan has not been required the NDIS Quality Safeguards Commission should be periodically supporting them to examine ways of reducing or removing restrictive practices – THIS CURRENTLY DOES NOT HAPPEN!

(d) Further to the 2018 Rules of Restrictive Practice which must be carried out with the least restrictive process. Because the report process demands a worker from a registered NDIS Service Provider who is registered to report on restrictive practice; this directly conflicts with choice and control and restricts the Participant from being able to use their chosen individual worker. Hence individual workers should be allowed to achieve competencies via an RTA to ensure preservation of choice and control – this would build better culture and greater inclusion/recognition of family and the valued contribution of individual support workers within the NDIS. Update Policy – Individual workers should have the avenue to be given training to be compliant to report on restrictive practices.

This amalgamation of whole of government policy extends to Commonwealth law and in particular Commonwealth Electoral law. Participants who cannot carry their own burden of proof cannot be expected to vote in Australian elections, however under Commonwealth Electoral law it is mandatory that they participate. This is governments “Adverse Action” and these Participants require the necessary equity/supports to vote. These eligible citizens must have their need for supports to enable them to vote recorded and provided to them to do so. This must be done at the Participants Plan Review and a Service Provider should be nominated, recorded and booked to provide this support. If the Participant is not enrolled then process should be taken to enrol them, this must be registered in the Participants Plan and undertaken before any election. Update Policy – Record on the Participants Plan whether a Participant can carry their burden of proof and what supports they require to participate in the electoral process, register and book a Service Provider to support them and ensure they are enrolled to vote before the next election. The Service Provider should be accountable to the Electoral Commission in the event that the Participant does not vote.

*Update Policy – Support Co-ordination and their role in supporting the NDIS Participant must be mandated highlighting the categories where compliance and mandatory compliance of the NDIS Participant must be met.

In Relation to Specific Dynamics as mentioned earlier in this submission –

An adaption from the PRE - NDIS “NDIS Consumer Quality Assurance Tool 2011” could be developed to improve the NDIS.

Prior to the introduction of the NDIS (In 2010-2011) I was working with Infoxchange a technology IT Company and the CEO of Yooralla, Sanjib Roy to develop an NDIS Consumer Quality Assurance Tool. I presented at the 2011 DARU Conference. Below is a simplified representation.

As described to Ms Rebecca Falkingham and Ms Corri McKenzie at the Geelong hearing I referred to a specific conduit developed to support NDIS Participant and family/Carer/Guardian engagement which I pitched in 2011 at the DARU Conference in Melbourne.

However, I am suggesting that this same tool could be used in an updated manner to capture and support for example“

(1) Focus and Perspective are paramount and cross all genres. However, for this submission I suggest, (a) Morality and Safety, (b) Competition and Economics, (c) Person Centred and Accountability

It is obvious that none of these genres are exclusive to each other and this is largely the point I am trying to make. Where in 2008 when Pearson stated the Sector was Crisis Driven also Bruce mentioned it is an Economic Problem, we need to have all areas engaged with the focus on the same perspective.

While the NDIS is a Health reform it is also an Economic Reform and a Cultural Reform (a) Morality and Safety, - Health reform (b) Competition and Economics, - Economic Reform (c) Person Centred and Accountability - Cultural Reform

Consolidating facts determines a station or place and “Focus” these facts in relation to constructive resolution help determine the “Perspective” and direction and actions required. The dynamics between these entities determines the strength of the environment (Health of the System, the productiveness of the Process).

(a) The Quality Safeguards Commission/The Office of the Senior Practitioner
(b) Service Provision/Practice Costs Delivery
(c) The Process of Plan Reviews/Support Co-ordination

The “NDIS Consumer Quality Assurance Tool” (below), before the NDIS, was designed on these principles and is basically described below and can be structured to focus on or other directives.

(a) Morality and Safety, - Health reform (b) Competition and Economics, - Economic Reform (c) Person Centred and Accountability - Cultural Reform

CURRENT STATUS - TRANSITION (In 2010)

GOVERNMENT

  • Relies on knowledge from surveys and research in order to develop cost effective strategies, direction and establish best action

POLICY

  • Also relies on research and demand and the balance of affordable benefit and protection

SERVICE PROVIDER -“PROVISION”

  • Relies on funding, demand, training, policy/practice, research and development, and professionalism

FUNDING

  • Is elusive and escapes at every junction and handover. It can be wasted by poor service provision/consumer outcomes

RESEARCH & SURVEYS

  • A necessity, although time consuming, expensive and not always used

ADVOCACY

  • A necessity to navigate a difficult system to support the consumer and equality although there is no exclusive register of issues and systemic issues

CONSUMER

  • Constantly trying to get the right service and support. The Consumer is information poor and choice poor. Always struggling to be heard. Change is slow and uncoordinated

NEW STATUS - IN TRANSITION

GOVERNMENT

  • Have the resources of an integral, continually evolving CONSUMER driven, information system which is evidence based where all areas can be assessed monitored and developed. A full faceted demographics

POLICY

  • CONSUMER driven where the client focus is a reality. Fee for service bridges jurisdictions. This underpins Human Rights and Inclusion and will consolidate understanding and cultural development.

SERVICE PROVISION

  • CONSUMER rated, accreditation and brokerage creates a business model which drives accountability, service quality, professional application of standards and best practice held accountable by the consumer.

CNDQA tool logs deficient areas, areas of quality and gaps in services and provides the conduit from the Consumer to the specific areas of solution, i.e. specific service need, service development, training, assessed referral to specific advocacy and/or policy and procedure development

RESEARCH & SURVEYS

  • Importantly supplemented with the CNDQA tool, it gives analysis which will be critical to monitoring and maintaining healthy service provision and advocacy and Consumer satisfaction

ADVOCACY - Advocacy will be tailored in many cases to consultation and conflict resolution. Issues will be referred to the specific Advocacy Organization. All issues including systemic, will be recorded on a register.

THE INFORMED CONSUMER - Will be controlling, driving and articulating the quality of service and THEIR support need. Given direct support into complaints; all complaints returning to the Client/Consumers’ concerns. Specific advocacy referral. No struggling to be heard.

FUNDING - Services expenditure quantified via direct fee for service. Funding is held accountable to a high standard service, where previously poor service would waste money. Administration, training and policy development is streamlined.

3 NEW STATUS

For the first time the Consumer receiving a Service has the same rights as any of us in the Community.

This QA tool gives the consumer the support and power to make the best choices possible by being an Informed - Consumer.

It unifies and streamlines problem areas; areas of quality and deficit -not after a study, not after a crisis -This system operates PRO -ACTIVELY!

All players are involved and supported. With the introduction of the NDIS Service Provision will be changing enormously.

The CNDQA tool provides the necessary conduit from the grass roots in a clear evidenced based fashion. It gives the Service Provider prompt feed-back and with support from Advocacy and responsible Governance within the CNDQA tool -an environment of “creative practice, problem identification and professional application” will create cultural change.

Policy will be developed based on direct Consumer/Service Provider experience and evidence. Jurisdictions will be united as Fee for Service via the CNDQA tool Provides a collaborative identity of the people with disability living in the community. This will generate a greater understanding and pave the path towards genuine community inclusion. The application of Human Rights will become generic.

4. NDQA tool

THE INFORMED CONSUMER

While three is no such thing as perfect information; Consumers for the first time will begiven enough information to make informed choices. With the use of the CNDQA tool Consumers will have a streamlined system designed to work with them

CASE MANAGEMENT –

Either via a case manager or independently, this process is critical, for good consumer relations and accurate drafting of the Consumer’s ISP. It will be the Case Manager or Consumer who records RATING the consumers’ RATING - response to Service Provision using a specific mix of questions relative to each Service Provider, Human Rights components and of cause the Individual

ACCREDITATION -Is the business rating component for the Service Provider, held accountable by Quality Assurance over Fee for Service. BROKERAGE is the competition element where the Quality of and the Kind of Service inform the Consumer how to best choose their supports. The Service Provider needs to be continually implementing improvements and works closely with Advocacy and Case Management in order to remain cost effective.
CNDQA Information Technology HUB – coordinates all information to find the best Service Provision amongst all Service Providers relative to each Consumers needs. It correlates and registers issues. It identifies gaps in Service to Consumer and outcomes to contribute to Consumer/Service Provider Research and Development and Policy Development

####### ADVOCACY -Consumers are referred with issues qualified and consultation between the Consumer, Service Provider, and or Case Manager will be the most common practice

5. NEW STATUS For the first time the Consumer receiving a Service has the same rights as any of us in the Community. This QA tool gives the consumer the support and power to make the best choices possible by being an Informed Consumer. It unifies and streamlines problem areas; areas of quality and deficit -not after a study, not after a crisis -This system operates PRO -ACTIVELY! All players are involved and supported. With the introduction of the NDIS Service Provision will be changing enormously.

The CNDQA tool provides the necessary conduit from the grass roots in a clear evidenced based fashion. It gives the Service Provider prompt feed back and with support from Advocacy and responsible Governance within the CNDQA tool -an environment of “creative practice, problem identification and profession application” will create cultural change. Policy will be developed based on direct Consumer/Service Provider experience and evidence. Jurisdictions will be united as Fee for Service via the CNDQA tool Provides a collaborative identity of the people with disability living in the community.

“Important developments by Service Providers – That provide compliance and have potential to build greater outcomes for NDSI Participants with the capacity to build accountability and strengthen culture.

When I attended the hearings held for the „Capability and culture of the National Disability Insurance Agency„ I also invited two CEO’s from the Service Provider sector.

       from „Complete Nursing“ has been consistent in delivering disability supports in the sector.

While there are short comings in all areas, I believe IT System development greatly helps Service Provision to establish compliance and monitor regulation of staff within Service Provision.

It is easy to identify how this IT application can save the Service Provider and the NDIA significant money while growing compliance and influencing inclusion for NDIS Participants.

Much of the checks and balances that I have included in these submissions can be qualified and further implemented via this system.

  • Please follow up (this is not a solicited recommendation) – with on „Complete Nursing“ has a Digital Expo on the 22nd November at their Bundoora premises.“

Thank you for accepting my submissions. Regards Matthew Potocnik