Submission to the Current

Scheme Implementation and Forecasting for the NDIS Inquiry

Joint Standing Committee on the National Disability Insurance Scheme

(FEBRUARY 2022)

Australian Association of Social Workers

The Australian Association of Social Workers (AASW) is the national professional body representing more than 15,000 social workers throughout Australia. The AASW works to promote the profession of social work including setting the benchmark for professional education and practice in social work, while also advocating on matters of human rights to advance social justice.

Acknowledgements

This submission has been developed in consultation with our members who are working across Australia in various social work areas of practice and, by consultation with our National Advisory Panels which are made up of experts in their field of practice.

For further information or questions relating to this submission, please contact:

Author(s) of the Submission

Social Policy and Advocacy Officer

Senior Policy Advisor

Manager, Social Policy and Advocacy

Rachel Reilly Manager, Policy and Advocacy

rachel.reilly@aasw.asn.au

Executive Summary

The AASW observes a difference between the intention of the original NDIS reforms to disability services and the current structure of the NDIS system as a disaggregated and under-regulated market of various specialised and unspecialised services. This marketised service system has created:

limited access to services in regional and remote areas,
poor accessibility of services and support for people with disabilities and associated disadvantages, and
barriers and disincentives to NDIS provider collaboration and planning coordination.

The current inquiry appears to conceptualise the sustainability of the NDIS in terms of the costs of running the current, fundamentally flawed system. The AASW is concerned that this approach to evaluating expenditure is a misunderstanding of the long-term nature of the scheme’s sustainability both in terms of a narrow focus on what the social costs of disability actually are, and in terms of failing to conceptualise a better organised service system.

The AASW’s position is that the scheme as a whole will only be sustainable in the long term if it can attract, retain and deploy the services which lead to the optimum outcomes for participants. We have concerns that attempting to curtail costs of the scheme by limiting the level of funding to participants will be counter-productive and will lead to higher costs in the long term.

Recommendations

The AASW recommends that NDIS resourcing:

Ensures NDIS provider accountability through improved regulatory oversight of registered and unregistered professions including tighter controls against fraudulent operators.
Ensures that collaboration and cooperation amongst NDIS and other service providers an NDIS participant is involved with are resourced, in order to support integrated care and improved outcomes for participants.
Removes the burden of individual advocacy on people with disabilities and associated disadvantages.
Ensures sophisticated measures of NDIS providers’ work are employed to accurately reflect the value of high-quality service provision toward short, medium and long-term outcomes for NDIS participants.
Attends to the oncosts associated with poor quality service provision to NDIS participants, their families and carers, the community and the economy.

Introduction

Disability represents the larger and more complex interaction between an individual with impairment and the structures and processes of society. It is not ‘physical, cognitive or sensory impairments that cause disability, but rather the way in which societies fail to accommodate natural aspects of difference between people. Therefore, social workers adopt a person-in-environment approach to maximising the wellbeing of individuals, families, groups, communities and society. We consider that individual and societal wellbeing is underpinned by socially inclusive communities that emphasise principles of social justice and respect for human dignity and human rights.

The Australian Association of Social Workers (AASW) supports the NDIS (National Disability Insurance Scheme) as a rights-based approach that promotes the independence and the social and economic participation of people with a permanent impairment or condition. The values of ‘choice and control’ that underpin the Scheme are consistent with the values and principles of self- determination and empowerment that have guided the social work profession for many decades.

The AASW considers that individual and societal wellbeing is underpinned by socially inclusive communities that emphasise principles of social justice and respect for human dignity and human rights. These values are in complete accord with the disability advocacy movement and the United Nations Convention on the Rights of Persons with Disabilities, which both inform the NDIS. Social workers recognise that people can only be understood within the social and community context in which they find themselves, and so they ensure they build a complete picture of the internal and external elements of a person’s life situation. Guided by their value base of self-determination and recognition of people’s strengths, social workers collaborate with people to plan the services that will help empower them to full economic and social inclusion.1

Social workers focus on maintaining and enhancing quality of life. The profession contributes knowledge and skills to assist people with disability, their families and communities through our work in a range of settings. Our work includes all levels of management and program design, individual planning, counselling, coordination and case management, as well as policy development, research and advocacy.

1 Australian Association of Social Workers (2015), The Scope of Social Work Practice: Psychosocial Assessments, Australian Association of Social Workers. Retrieved from: https://www.aasw.asn.au/document/item/8312

Our submission

The AASW’s submission includes a number of issues raised by our NDIS National Advisory Panel representatives working within the NDIS. The AASW appreciates that it is appropriate for this inquiry to address the issue of accountability for the way that public funds are being spent within the NDIS. A market-based model requires an accompanying mechanism for enforcing accountability and ensuring that all spending prioritises participants’ needs. Unfortunately, the current accountability arrangements are not sufficiently rigorous to ensure that this is always the case. The AASW has become aware of instances where the money in participants’ plans is not being spent in the most cost-effective manner, and where public funds are not being spent responsibly. The current system allows for assessment and planning processes by unregistered individuals and, for-profit entities who can escape existing regulatory oversight.

Recommendation:

Ensure NDIS provider accountability through improved regulatory oversight of registered and unregistered professions including tighter controls against fraudulent operators.

Every instance of questionable spending that has come to the attention of the AASW has occurred where the service has been provided by a for-profit company and where the service or provider has been unregistered and independent of any professional association. Some of these instances have consisted of shortcuts having been taken in the standard of care or services which have been provided to the participant. In other instances, funds have been spent on services or items that were not appropriate to the participant’s needs, but which created a benefit for either the unregistered carer, or their employer in the form of profit. Although complaints have been made through the NDIS’s internal avenues, the funds that were misspent have not been re-couped, and the companies and the individual workers have evaded negative consequences. The sustainability of the NDIS may be severely impacted by unscrupulous service providers where accountability measures are not detecting fraudulent activity. The AASW advocates for social work to be a registered profession and supports clear accountability for all NDIS providers.2

2 Australian Association of Social Workers (2021), ‘South Australian social workers the first state in Australia to be registered’, AASW Media Release, 1 December, 2021, retrieved from: https://www.aasw.asn.au/news-media/2021/south-australian-social-workers-the-first-in-australia-to-be-registered

The interfaces of NDIS service provision with other non-NDIS services

Social work practice standards include collaboration and cooperation with other professionals and professions to improve service provision.3 Collaborative relationships can take time to develop but ultimately lead to holistic, person-centred care and more sustainable positive outcomes for service users. NDIS price setting structures are not conducive to service coordination and collaboration.

Recommendation:

Ensure that collaboration and cooperation amongst NDIS and other service providers an NDIS participant is involved with are resourced, in order to support integrated care and improved outcomes for participants.

Price settings difficulties foreshadowed by the Commonwealth Government in the 2019 report Growing the NDIS Market and Workforce contribute to the problem of thin markets across geographic areas and for particular groups.45 When dealing with inadequate staffing amongst various NDIS providers, coordination and collaboration remain important but typically unfunded. This affects the quality of care and support provided to NDIS participants and leads to poorer participant experiences and outcomes.

Consistent recommendations from major inquiries concern the need for greater coordination and cooperation amongst services, workforce stability measures and de-siloing of supports, all of which appear not to have been actioned.67 Furthermore recommendations from numerous inquiries are echoed through the Royal Commission into Victoria’s Mental Health System’s focus on ‘Integrated care for better mental health and wellbeing outcomes’.8 The Australian Institute of Health and Welfare reports a high incidence of mental health issues amongst people living with disabilities.9 People living with a disability face many intersecting issues. These include limited access to health

3 Australian Association of Social Workers (2013), Practice Standards, retrieved from: https://www.aasw.asn.au/document/item/4551

4 Department of Social Services (2019), Growing the NDIS Market and Workforce, Commonwealth of Australia, retrieved from: https://www.dss.gov.au/sites/default/files/documents/03_2019/220319_-_ndis_market_and_workforce_strategy_acc- _pdf-.pdf 5 Commonwealth of Australia (2022) Joint Standing Committee on the National Disability Insurance Scheme NDIS Workforce Final Report, retrieved from: https://parlinfo.aph.gov.au/parlInfo/download/committees/reportjnt/024621/toc_pdf/NDISWorkforceFinalReport.pdf;fileType=a pplication%2Fpdf 6 Productivity Commission (2010), Contribution of the Not-for-Profit Sector, Research Report, Canberra, retrieved from: https://www.pc.gov.au/inquiries/completed/not-for-profit/report/not-for-profit-report.pdf 7 Carey, G., Weier, G., Barnes, E., Muir, K. (2020). Moving the Conversation Forward. A decade of reform recommendations for the community services sector. Centre for Social Impact UNSW. Sydney, retrieved from: CSIA_Report_FINAL.pdf 8 State of Victoria (2021), Royal Commission into Victoria’s Mental Health System, Final Report, Volume 3: Promoting inclusion and addressing inequities, Parl Paper No. 202, Session 2018–21 (document 4 of 6), p.326 retrieved from: https://finalreport.rcvmhs.vic.gov.au/wp-content/uploads/2021/02/RCVMHS_FinalReport_Vol3_Accessible.pdf 9 Australian Institute of Health and Welfare (2020) People with disability in Australia 2020, retrieved from https://www.aihw.gov.au/getmedia/ee5ee3c2-152d-4b5f-9901-71d483b47f03/aihw-dis-72.pdf.aspx?inline=true

and education, and daily examples of discrimination. For many people this results in poor mental health. The NDIS does not typically provide funding to address mental health issues without diagnosis of psychosocial disability. The NDIS forces many people with disabilities, who are also experiencing mental health issues or psychological distress (along with other disadvantages) to rely on individual advocacy, or representation by unregistered workers when dealing with the NDIA. This is not only unjust, it is also fiscally irresponsible. Poor client outcomes lead to increased costs either for the NDIA itself or for various other government and government funded agencies.

Reasons for variations in plan funding between NDIS participants with similar needs

Variation in support available to assist a person with developing an NDIS plan is likely correlated with variations in plan funding and ultimately plan effectiveness and client outcomes. Challenges in individual advocacy are paralleled by challenges in systemic advocacy – how accessible is this submission process to NDIS participants for example?10

Recommendation:

Remove the burden of individual advocacy on people with disabilities and associated disadvantages.

Further explanations for variations in plan funding between NDIS participants with similar needs concern service availability. Service providers typically require stability of income through service provision demand (which is inherently variable in the NDIS market) in order to make their service available. This variability cannot be sustained by all NDIS providers and is undoubtedly particularly challenging for specialised and high-quality services operating in:

regional and remote areas
fields of practice focussed on rarer and/or less recognised conditions and degenerative disease

This lack of access to services where NDIS participants deteriorate in their health before they are granted access to supports results in the need for more intensive (and expensive) service and/or treatment interventions. Receiving earlier intervention to improve quality of life and outcomes benefits participants, their families and carers, the wider community and the economy.

The Productivity Commission’s 2010 Contribution of the Not-for-Profit Sector report notes that:

10 Making a submission – Parliament of Australia (aph.gov.au)

where truly competitive markets develop and clients face real choice in the services available to them, governments should consider moving to client-directed service delivery models. This transition should be conditional upon there being appropriate safeguards in place to protect and empower vulnerable clients (or their carers) in exercising choice and ensure an acceptable minimum level of service quality and provision.11

The AASW observes neither appropriate safeguarding for vulnerable clients, nor an acceptable minimum level of service quality and provision across the NDIS nationally. Variations in plan funding between NDIS participants with similar needs is to be expected from a system that lacks effective coordination and collaboration funding and rigorous regulatory oversight mechanisms.

Financial sustainability of the NDIS: data, modelling, and forecasting issues

The Scheme covers both equipment and services, which are different in terms of the way their costs are understood. Whereas the cost of an item of equipment can be easily and independently determined, this does not apply to all of the services provided by professionals. This is because the type, level and frequency of the service that will deliver the best outcome for the participant is frequently a question of professional judgement that is not always accessible to an unqualified observer. The AASW is aware of instances where participants’ plans have received reduced funding and that the supports specified in a participant’s plan have been downgraded, reduced or cut short by NDIS staff. The committee’s own report into NDIS planning heard that there is a lack of transparency in NDIS funding decisions. That report concluded that there was inconsistency and a lack of rigour in the way that the terms ‘reasonable and necessary ‘are interpreted by the NDIS.12 This has led to increased costs to the scheme overall in the form of appeals by participants over the NDIS’s interpretations of those terms.13

Recommendations:

Ensure sophisticated measures of NDIS providers’ work are employed to accurately reflect the value of high-quality service provision toward short, medium and long-term outcomes for NDIS participants.

Attend to the oncosts associated with poor quality service provision to NDIS participants, their families and carers, the community and the economy.

11Productivity Commission (2010), Contribution of the Not-for-Profit Sector, Research Report, Canberra, retrieved from: https://www.pc.gov.au/inquiries/completed/not-for-profit/report/not-for-profit-report.pdf

12 Commonwealth of Australia (2020) Joint Standing Committee on the NDIS: NDIS planning final report, retrieved from: https://www.aph.gov.au/Parliamentary_Business/Committees/Joint/National_Disability_Insurance_Scheme/NDISPlanning/Fin al_Report

13 Clun, R. (2022) ‘National disability insurance agency spends millions on external legal costs’, Sydney Morning Herald, February 17 2022, retrieved from https://www.smh.com.au/politics/federal/national-disability-insurance-agency-spends-millions-on-external-legal-costs-20220216-p59wxs.html

Social workers take a holistic ‘person-in-environment’ approach to psychosocial assessments. As an outcome of this, they are concerned with an individual’s support needs in the broader context. The AASW is concerned about the consequences for families and carers of reducing or withdrawing NDIS funding and supports. Such an approach to considering the sustainability of the NDIS simply defers costs from one site to another. Shifting responsibilities for care to family and other carers creates other costs to the economy in the form of health burdens created by overwhelmed carers. Further, family and carers are drawn away from the labour market when they are required to care for people who require significant assistance. Improving the capacity of carers improves outcomes and experiences for people with disabilities and arguably the reverse is also true – reducing the capacity of carers will likely have significant health and wellbeing implications for NDIS participants, their families and carers, the community and the economy.14 Providing best practice support to NDIS participants can also increase workforce participation in mainstream employment.15 High quality services produce better outcomes and this is what leads to service sustainability.

Conclusion

The AASW reccomends caution when assessing the costs and funding sustainability of the NDIS to avoid a narrow focus on immediate costs at the expense of a sophisticated cost-benefit analysis that includes the broader benefits to the community of having adequate, responsive and effective services available to assist Australians who are living with disabilities and associated disadvantages.

14Mental Health Carers Australia (2016), Service Delivery Model For A Proposed New Carer Support Service System, A submission by Mental Health Carers Australia, retrieved from: https://www.mentalhealthcarersaustralia.org.au/wp-content/uploads/2018/05/MHCA-response-to-integrated-carer-support-system.pdf

15 Per Capita (2021), False Economy: The economic benefits of the National Disability Insurance Scheme and the consequences of government cost-cutting, retrieved from: https://percapita.org.au/wp- content/uploads/2021/11/NDS_031121_per-capita-report.pdf

Current implementation

Forecasting

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