Joint Standing Committee on the National Disability Insurance Scheme

Hireup passes on its sincere congratulations to the Committee for raising such an important issue and making it the subject of their inaugural inquiry. Thank you for the opportunity to make a submission.

Hireup is an NDIS registered online platform for people with disability to find, hire and manage support workers who fit their needs and share their interests. It is one of the largest NDIS providers in the country, with more than 10,000 clients in the past year, and a similar number of support workers, whom we employ directly. Given our size , employment model and registration status, issues relating to the function of the enabling agencies in the NDIS are always of great interest.

To build a strong and sustainable NDIS, it is critical we have a high functioning implementation agency. However, we feel this is only half of the equation and request latitude to the Terms of Reference to submit with reference to the NDIS Quality and Safeguards Commission (the Commission).

The Quality and Safeguards Commission is an independent agency, and was established in 2018. It, for the first time, brings together the various quality and safeguards functions within the sector. Despite being separate from the NDIA, these two agencies are equally pivotal stewards in delivering the NDIS. Leaders of both agencies at the organisational and regional level meet frequently, and have bilateral agreements for their respective roles.

We believe that the capacity for the Commission to operate to its full potential is a critical enabler for the NDIA to do the same. Without a safe NDIS, the NDIA will always be limited in its capacity to implement the scheme to its full potential. It is our submission that the Commission is under-funded and under-resourced, and forced to operate alongside policy settings that actively undermine its authority, stifling its ability to act as an effective regulator.

Role of the Quality and Safeguards Commission

At its core, the Commission is responsible for improving the quality and safety of NDIS supports and services. While their work is varied, it ultimately aims to ensure participants can access services and supports that promote choice, control and dignity.

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It is responsible for establishing practice standards for registered providers, and monitoring compliance to them. It has the power to remove bad actors from the scheme, and investigate complaints from participants.

The original vision for the Commission is articulated in the NDIS Quality And Safeguarding Framework, a comprehensive plan that was specially designed to operate in the NDIS’s consumer-choice market.

The Framework was established with reference to multiple reports and inquiries, including:

1. The Australian Senate inquiry into violence, abuse and neglect of people with disability in institutional and residential settings,
1. The Victorian Parliamentary Inquiry into Abuse in Disability Services, and
1. The Victorian Ombudsman’s Inquiry into the handling of abuse allegations in the disability sector.

Not only this, but other policy reform work fed into the final Framework, including:

1. The NDIS Framework for Information, Linkages and Capacity Building,
1. The NDIS Integrated Market, Sector and Workforce Strategy, and
1. The review of the National Disability Advocacy Framework

After extensive consultation including public meetings in every capital city and many regional areas, as well as 800 submissions and questionnaire responses, it was determined that the NDIS needed a regulatory system that delivered “high regulatory standards”.

Based on this substantial consultation, the Framework that was ultimately adopted (and linked to above) focuses on the participant, worker and provider respectively and the interplay between them. The Framework is the guiding document to deliver an NDIS that is characterised by strong regulatory standards, leading to better provider practices, a safer and skilled workforce, and genuine choice and control for participants that is grounded in access to information.

In reality however, the majority of this plan is yet to be implemented, severely impacting the Commission’s capacity to execute its function to the standard first envisioned, and consequently limiting the Australian Government’s ability to ensure the NDIS is safe for all participants and free from bad actors.

Factors that contribute to the limited capacity of the

Quality and Safeguards Commission

It is our view that there are multiple policy settings that actively undermine the authority of the NDIS Commission, and its ability to undertake its role to the highest possible standard to keep participants safe.

Registration is opt-in Under current policy settings, the Commission only has the power to actively regulate and monitor registered providers. For the vast majority of providers, registration is opt-in - meaning providers can simply choose not to be regulated, and instead commit to adhere to the significantly weaker and unmonitored Code of Conduct .

As a result, the Commission – and by extension, the Australian Government – does not know how many providers are claiming tax payer funds through the NDIS, the quality of their service, or the appropriateness of their character. To make matters worse, this regulation black hole also means individual workers can avoid the requirement to undertake a worker screening check - a nationally consistent assessment of whether a person who works, or seeks to work, with people with disability poses a risk to them.

Based on most recent data1 ninety percent of providers (122,945) working with plan managed participants are unregistered and unregulated. As mentioned above, we do not know the number for those working with self-managed participants.

In essence, we ask the Commission to ensure that the supports participants’ access are safe. At the same time, we allow those delivering the services to choose whether they are included within this remit, or not. From the data available, we know the vast majority choose the latter.

Poor sector understanding of the role and importance of the Commission It is sometimes suggested that for those providers who do choose to register, they are benefitting from a point of difference that improves their marketability. Unfortunately, thiis is not the case.

In our experience, most people assume that a government funded and administered scheme has some level of oversight of the quality of support that is being delivered (and paid for). This erroneous assumption means few truly know what they are choosing between when deciding between a registered or unregistered provider – if they are aware of the difference at all.

1 Report to disability ministers for Q4 of Y9 Full report pp. 100

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It is a fair assumption. There is no other government funded sector in which individuals can access the funding with zero oversight. Particularly not one in which the risks are so significant, or the capacity to do harm so great.

While Hireup is not supportive of a program in which a worker can enter a participants’ home and deliver the most personal support without so much as a police check, the fact that there is extremely limited information on what ‘unregistered’ truly means is putting participants and the scheme itself at risk, and eroding the authority of the Commission set up to protect them.

3. Only partial implementation of the Quality And Safeguarding Framework

As has been discussed, the foundational document outlining the role and function of the Commission has only been partially implemented. While we must remember that the Commission is only four years old, there are still critical pieces that remain outstanding. Including:

Participant capacity building: as has been alluded to, there is still much work to be done to better equip NDIS participants with the knowledge and skills to effectively navigate the NDIS marketplace, understand its risks and execute their right to choice and control armed with all the information they need to make an informed choice.
Building a safe workforce: The Commission has been charged with responsibility to promote a safe and competent workforce and ensure people who are unsafe are not able to support NDIS participants. Due to the aforementioned policy conditions amongst other factors, this area is being largely neglected.
Provider practices: The NDIS is a hyper fragmented marketplace with extremely limited capacity for oversight. As has been discussed, less than ten percent of providers are registered, detrimentally limiting the Commission’s ability to regulate and monitor them.

4. The Commission is underfunded

The Commission has an enormous task to regulate the NDIS and keep over 500,000 Australians with disability safe. To do this, it needs adequate resourcing – something that we believe is currently lacking when compared to similar sized schemes with similar risks.

The consequences of an underfunded agency has been recently highlighted in media reports2 of their annual census. The results paint a picture of overworked staff, close to burnout, with two thirds looking for other employment. Only one third reportedly felt they had the tools and resources they needed to do their jobs. These results are unsurprising

Funding Discrepancy Between Disability Sector Regulator and Aged Care

when we consider the funding the Commission receives, when compared to the similar aged care sector.

In 2022/23, the Australian Government will spend $81.4 million3 on the operations of the Commission, to oversee a scheme valued at $33.9 billion4 . In comparison, in the same year it will fund the Aged Care Quality and Safety Commission $225.3 million5 to overse Australia’s $29.8 billion6 aged care system.

From the 2021/22 Estimated Actual to the 2022/23 Agency Resourcing, the aged care regulator saw an increase of approximately $20 million. Appallingly, the Commission’s resourcing this year is around $400,000 less than its actual spend last year.

The discrepancy in regulator resourcing between these two similar and high risk sectors is stark. While the Australian Government should be commended for its commitment to a stong and safe aged care sector, it must – as a matter of priority– treat the disability sector with the same sense of priority.

Recommendations

A review of the role and function of the NDIA should be undertaken in conjunction with a review into the Commission’s function, and its capacity to deliver. Both need to be operating at the highest possible standard in order to deliver a safe, strong, and enduring NDIS.

While we acknowledge there will soon be a Quality and Safety review that is likely to address many of these issues, it is our submission that the sector can not afford to wait. The following recommendations can and should be implemented without delay:

Increase the funding of the Quality and Safeguards Commission in line with other regulators of publicly funded programs.
Similarly, increase the headcount within the Commission, with a focus on the currently unimplemented priorities of the Framework.
Reiterate the Australian Government’s commitment to fully implementing the original remit of the Quality and Safety Framework.

3 2022/23 Budget Paper no. 4 (pp. 108) 4 2022/23 Budget Overview 5 2022/23 Budget Paper no. 4 (pp. 77) 6 2022/23 Budget Overview