Inquiry: The Capability and Culture of the NDIA
Submission from Able Australia
Able Australia provides the following submission in response to the National Disability Insurance Agency (NDIA)’s request for feedback on the capability and culture of the NDIA and the impacts on participants and their services.
Able Australia is supportive of the NDIA’s National Disability Insurance Scheme. We have seen overwhelming positive evidence and outcomes for participants of the scheme stemming from the access to services it supports and the participant independence and choice it strives for. We are hopeful that with continuous improvement the NDIA will remain a positive influence in changing the lives of people with a disability.
Able Australia strongly believes in the delivery of high-quality and safe services and understands the Agency’s systems culture and presentation heavily impact the work we do with participants and their families. We welcome change and improvement to the Scheme and hope this submission can provide some support and context to facilitate it.
All names have been changed/edited for participant privacy. All examples are real examples experienced by Support Coordinators, Team Leaders, Area Managers or Allied Health & Behaviour Support teams at Able Australia.
Outlined below are challenges we have found in accessing services, funding, and systems within the NDIA that appear to be a result of systemic and cultural issues. We have provided some examples of these issues in action, and some possible changes or solutions we believe could provide positive change for participants and services that support them.
Standardisation across services, supports & funding
Issues
- Large changes to funding have significant effects on services and individuals
- Particular risk has been noted for participants with high or urgent needs when the reviewing or alteration of their packages is managed in line with smaller package reviews
- Plan reviews and change of circumstances appear to follow the same processes and timeframe irrespective of the level of funding, risk, or outcomes for participants
- Services have been reduced with what appears to be little consideration as to the risks or issues participants and services may experience
- There is no pathway to review funding changes quickly
Participants and services are forced to decide between a participant not receiving enough care to have their needs met, or the organisation providing services required without the likelihood of being reimbursed
- NDIA will often take months to address an issue (e.g. funding review/change in services), and then resolve funding issues for the future (e.g. include funding in new plan) without consideration to historical issues or needs, or the impact their decisions have on services, individuals and families
Example 1
- Participant Daniel had high support needs, including severe behavioural needs such as verbal and physical intimidation of other participants and staff, and the potential for physical abuse of others. He was sharing a home with another participant who was deemed unsafe.
- Able Australia relocated Daniel’s Housemate and triggered a service review following a serious deterioration of Daniel’s environment. There was an immediate need for safeguarding for Daniel, the participant they shared a house with, and members of the general public. Daniel was at risk of seriously harming others. This led to 1:1 support being provided by Able Australia.
- Able Australia involved Daniel’s GP, Psychiatrist, PBS Practitioners and the Support Coordinator heavily in the review.
- It was insinuated during the plan review meeting that the funds would be reviewed and increased, but instead, the plan was rolled over (extended) with old, inadequate funding renewed
- Despite advocacy, support, and extra hours provided, Able Australia was unable to get understanding and traction from the NDIA to amend the plan to reflect Daniel’s needs
- Able Australia was unable to continue services at the rate provided in the new plan and was therefore forced to relinquish care and support to Daniel who was a long-term participant of Able Australia
- Another service was engaged to support, who then reported they were unable to provide services to Daniel at that level either
- The NDIA allegedly then changed the ratio for the new service so the new service could start support with Daniel
- This incorrect funding ratio and subsequent change of service was a significant disruption to Daniel’s life and support and appears to have been unnecessary considering the change of funding following accessing a new service
- It led to the cessation of significant long-term supports for Daniel, stress & concern from Able Australia staff for Daniels’s ongoing support and safety. The extra advocacy, information gathering, and time expended by Able Australia staff that didn’t lead to changes for Daniel also has a significant impact on staff and their willingness to work within the scheme.
- The perceived helplessness and inability to support change for a participant can lead to burnout and apathy in a workforce we are trying to encourage and professionalise.
- This put Able Australia staff and workers into a position we shouldn’t have been put into (relinquishing care) and shouldn’t be the only pathway available in these circumstances.
Example 2
- Stacey received NDIA funding and supports through Able Australia including supported independent living. She is a high-risk client with physical and cognitive support needs that dictate 1:1 or 2:1 funding and supports.
- With little to no warning, Stacey’s NDIS funding was moved, and she was informed she had to get funding through TAC
- While Able Australia and the participant may have been sent an email, no check or follow-up was completed to ensure the information was received, and that our services were aware of the impending change
- There was a significant outlay of costs and a significant impact on cash flow, due to a fragmented changeover between funding streams
- Able Australia continued to provide supports during this transition period to ensure safeguarding for the participant. Should services have ceased, the participant would have been put at serious risk of harm. Able Australia continues to wait on funding and checks through TAC, which has seriously impacted our organisational cash flow.
- The burden of responsibility for the transition to TAC was placed on the participant and their family, who had little to no capacity to manage this. Able Australia ended up facilitating the transition instead.
- This abrupt change without support put the client at risk of loss of services and loss of accommodation – was Able Australia not able to facilitate TAC supports, or engage with TAC.
- This has put significant stress and emotional pressure on the participant, their family, and Able Australia staff who have supported this participant through the transition
- This is an example of a lack of communication and lack of understanding of the consequences leading to what could have been a potentially dire outcome for a participant.
Proposed solutions/changes
- Alternative systems/processes for urgent cases
- Consideration as to funding levels, risk, and timeframes for reducing or changing services
- Adequate and formal communication with services in advance of changing/removing significant levels of funding
- Clearer parameters and transparency for decision-making and funding levels – allowing for more targeted reporting and provision of information by services
- Pathways for providers to report significant risks and issues, and ways to engage these urgently as required, and have plans and services reviewed more rigorously
Inequality between planners/LACs
- Participants with the same disability, similar circumstances, similar reports, and living in a similar area still receive very different plans from one another
- Evidence (by way of Allied Health and professional reports) provided regularly doesn’t appear to be reviewed before planning meetings
- Many LACs and Planners appear to have only a rudimentary understanding of disability services and supports
- Able Australia staff and participants report never having the same planner twice
Lack Of Consistency
- Taking more time to understand the participant and their needs, wasting time year on year re-explaining the same issues
- Support Coordinator and staff report often spending valuable planning time explaining NDIS Systems to planners & LACs
- LACs, planners and business liaison NDIA staff appear to only be around for approx. 6mths before a new one starts, reinforcing and likely being a cause of the issues above
Example
Able Australia Support Coordination assisted at Harriet’s planning meeting. Harriet and her support coordinator submitted multiple allied health reports and evidence before the meeting. The LAC present for planning did not demonstrate any understanding of Harriet’s disability, nor listen to the reasoning for supports. It was clear the supporting professional reports provided before the meeting were also not reviewed, based on the LAC’s questions and responses during the meeting.
The LAC’s conduct in the meeting made both Harriet and her support coordinator uncomfortable. The LAC was casual, rude, and inconsiderate of Harriet’s disability. The LAC was defensive when services were requested and accused the participant of wanting too much. Support Coordination left the meeting feeling shocked and required support and debriefing following. Support Coordination spoke to Harriet after the meeting, who said they were ‘frustrated but unsurprised’
Participants often report entering planning meetings with high anxiety and discomfort. Everyone deserves to feel heard, acknowledged and treated fairly. Long-term trust, confidence and engagement with NDIS and the agency can easily be broken based on these interactions.
Proposed solutions/changes
- LAC’s and planners need to be provided with specific training on:
- Appropriate engagement with participants, soft skills and
- Understanding a range of disabilities
- Importance of reviewing documentation and reports
- Process and systems for the NDA
- Establish NDIA systems to regularly request feedback regarding planner and LAC conduct during meetings
- Need feedback mechanisms that request input from participants/families/those present at planning meetings as to the extent to which they felt heard, understood and supported through the meeting
Evidence Required And Change Across Time
Issues
- Understandably, NDIA require evidence of need to fund supports
- There appears to be little consideration for appropriate implementation of supports reducing the evidence of need, however.
**Example
Client Jeff**
is constantly leaving his supported accommodation on his own. He is unsafe navigating roads, able to orient himself to get home and gets lost easily. With incidents and evidence provided at a planning meeting, Jeff receives more 1:1 support from a DSW. This 1:1 support worker engages Jeff in activities, they go out together, and Jeff directs where he wants to go and what he wants to do. Because Jeff feels in control, is making choices, and is meaningfully engaged - The reports of leaving behaviour reduce. At the next planning meeting, there’s a proposal to then reduce Jeff’s 1:1 supports because of leaving behaviour reducing, with little consideration to the fact that without the support and engagement these behaviours will return.
Proposed solutions/changes
- Re-evaluate review process, and types of acceptable evidence
- Provide clear guidance for services and professionals reporting on participant positive outcomes that require maintenance of supports
- Provide education and support for planners and LACs to delineate capacity building and ongoing supports required for participants, and differentiate the evidence required for both