Submission to the Australian Government on Current Scheme Implementation and Forecasting for the NDIS

Australian Community Industry Alliance Written by Associate Professor Nicole Brooke

N 153 423 799 O02 9264 7197

Level 13 465 Vichoris Avenue Chatswood NSW 2067

Contents

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Introduction

Australian Community Industry Alliance (ACIA) welcomes the opportunity to provide this submission to the consultation from the Australian Government on Current Scheme Implementation and Forecasting for the NDIS

Australian Community Industry Alliance

ACIA is the only peak body in Australia representing aged care, disability and community care focused on quality management in care and service provision.

ACIA is the national peak body representing community care and support providers, including private, not-for-profit, and charitable organisations. Nationally ACIA represents over 100 provider organisations, which collectively employ more than 150,000 FTE workers and supports more than 35,000 clients. ACIA also supports the disability and aged care sectors and works with government departments and authorities, including:

• State Disability Agencies such as Department of Family and Community Services, Ageing Disability and Home Care NSW, Department of Health Human Services Victoria and Disability Services QLD

• iCare NSW includes: Lifetime Care and Support Authority, Workers Insurance, Dust Diseases Care, Self-Insurance, and Builders Warranty.

• Lifetime Support Authority South Australia

• Motor Industry Accidents Board, Tasmania

• Transport Accident Commission Victoria

• Workers Compensations Schemes in multiple states

• Representation at the National Aged Care Alliance

• Department of Health

• Department of Social Services

ACIA’s vision is for community care and support industry known and respected as a provider of quality services. To achieve this vision, ACIA provides education, resources, and support to the industry and develops and administers its own quality standard and scheme (endorsed by the Joint Accreditation System for Australia and New Zealand JAS-ANZ).

ACIA seeks to be involved in the future development of policy and service reform, by bringing to the discussion our experience and expertise, including:

• Membership of over 100 provider organisations and individuals nationally, representing around 150,000 FTE workers

• Membership across the disability and aged care sectors

• Specific expertise in the delivery of support to people living at home or in supported and shared accommodation arrangements

• Lengthy provider experience of delivering individualised support according to the wishes of the individual in line with their funding

• Experience in compensable and business markets

• Experience in the development, implementation, and administration of quality certification systems that meets the national standards for disability services and home and community care standards (for example, the ACIMSS 2008, ACIS 2013, ACIS 2018 and nor ACIS 4.0))

• We have a proven track record of engaging positively with reform processes and working collaboratively with governments, providers, consumers, and interested stakeholders.

Australian Community Industry Standard

Australian Community Industry Alliance (ACIA) also operates under the framework of JAS-ANZ (similarly to NDS), the Australian Community Industry Standard (ACIS). ACIS has been operating across disability, home care, insurance and private or unfunded clients in Australia since 2008. ACIS has recently released its fourth edition of this based on a consolidation of the recent 22 sector reports on issues and challenges in the sectors, including Royal Commission findings (both interim and final). ACIS Providers are representative across all states and territories. ACIS certified organisations that have certified over the last three years include; 60,000 clients and 45,000 staff across home care, disability and community.

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Profile of ACIS Providers:

4:5 provides provide community access, personal care, domestic services, social support, medication management, catheter care, wound management, bowel management and enteral feeding

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3:5 provide positive behaviour management and 1:3 engage with restrictive practices.

More than 4:5 providers have clients with brain and spinal injury, mental health, autism, cognitive impairment

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1:2 ACIS provides are additionally credentialed against NDIS Standards

— | — | ——- =3-—>-—2-

Figure 1: % of services provided by and types of clients of ACIS Provides

% of Services Provided	Types of Clients
Physical Disability	Personal Care or…
? Ventilator Dependent	Respite Care
Clinical Supports	Mental Health
Housework or…	Autism
Nursing Services	ABI

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

WYes MNo mYes MNo

ACIA_Current Scheme Implementation and Forecasting for the NDS __0222 — ACIA

ACIS 4.0 meets contemporary and evidenced based needs across aged care, community care

and disability.

ACIS is split into 5 core areas which are proportionality reviewed against the providers scope and service provision. These Core areas are:

• Rights & responsibilities
• Corporate Governance
• Clinical Governance
• Service Delivery
• Service Environment

Then additional modules are included in the three-year certification and annual surveillance reviews, where the provide undertakes these areas. These include:

• 42 — Physical Supports
• Medication Management
• Wound Management
• Catheter Management
• Complex Bowel Management
• Enteral Feeding and Management
• Advanced Airway and Suctioning Management
• Ventilator Care and Management
• Subcutaneous Injections
• Brain and Spinal Injury management
• Palliative Care and Pain Management
• Diabetic Management
• Bariatric Management -. Oncology Management
• Altered Nutrition and Dysphagia
• Commalex Behavioural Support
  • Positive Behavioural Support
  • Complex Cognitive Impairment Support
• Mental Health Support
• Assistive Technology

Sg3rReT Ferg an oD

Following a comprehensive mapping activity, ACIS 4.0 shows alignment to 50% of NDIS and another 50% to Aged Care Act as indicated in Figure 2.

Figure 2: Mapping of ACIS to NDIS and Aged Care Act

ACIS 4.0	NDIS Standards	Aged Care Standards
Rights & Responsibilities	® O Increased human rights	Corporate Governance ) @@
Clinical Governance	@ New standard © Increased governance	Service Delivery @@
Service Environment	@ Inc new requirements @	Add. Physical Support © Increased scope © Increased scope
Add. Behav. Support	@ New cognitive imp. std @	Add. Mental Health @ New standard @ Newstandard
Add. Assistive Technology	@ New standard @ New standard	TEAM: RN +1 2 (non RN*) 2 (non RN)
DURATION: 1yr*	1.5 years	3 years
@ Similar standard	© Largely Similar	@ New Standard

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The biggest issues currently impacting on providers

as per Figure 3 is workforce (456 responses).

Figure 3: Biggest issues effecting the sector

What is the number one issue in aged care,

disability and community care today?

You can see how people vote. Learn more

• Lack of workforce 50%
• Inadequate Funding 33%
• Workload 12%
• COVID 5%

We further asked our members if we are adequately supporting the people in our community with disabilities (289 responses), and the response was 95% no as indicated in figure 4.

Figure 4: Are adequately supporting the people in our community with disabilities?

Are we adequately supporting the people in our

community with disabilties

You can see how people vote. Learn more

• Yes 5%
• No @ 95%

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Current Scheme Implementation and Forecasting for the NDIS

Thank you for the opportunity to consider our response to the Australian Government on Current Scheme Implementation and Forecasting for the NDIS.

Summary of Recommendations

Australian Community Industry Alliance recommends the following:

1. NDIS standards should be dramatically reviewed to greater safeguard against the needs of their vulnerable participants by aligning NDIS standards to ACIS 4.0;

2. NDIS and NDIA governance and leadership lacks transparency, contemporary data and strategy to adequately support this population and sector;

3. The findings of various committees and hearings have not been considered, heard not actioned and this suggests negligence from an advocacy and representation position.

Response to Terms of Reference

Australian Community Industry Alliance recommends the following against the Terms of Reference identified in the Injury:

1. Australian Community Industry Standard (ACIS) has been in place and effective in ensuring compliance and high quality of care and service provision across disability, community care, insurance and aged care for 16 years. ACIS should be considered as the model of credentialing for NDIS and non NDIS services. ACIS should be considered for the Linkages and capacity building grant to move to regulatory alignment and future compliance management to ensure adequate safeguarding of clients care and service provision.

2. Interfaces between NDIS and Non NDIS services are essential to support; reduced administrative burden, improve transition between and within programs, support learnings and trends across sectors, and increase communication and engagement nationally. This should include areas such as code of conduct, complaints, certification and quality management, approved provider management, qualifications and competence,

3. Reasons for variations in NDIS plans include:

a. Availability and costs of services in rural and remote areas are substantially more expensive and where equitability is evident on paper, accessibility is far more prevalent;

b. Participants success for having plans assessed fairly and against the needs of the professionals and key stakeholders engaged in supporting the care of participants, is largely dependent on the skill and knowledge of the participants plan manager in order to be able to write the correct wording and navigate the NDIA processes more efficiently. Often only metropolitan participants have access to these experienced plan managers;

c. Appeals processes are costly, time consuming, stressful on top of dealing with complex conditions as a result of the disability, rarely are helpful advocates engaged and in majority of circumstances as evidenced by senate hearings recently these appeals are long in duration, costly and highly mismanaged;

d. Participants and their key stakeholders rarely have knowledge of all the rules and loop holes;

e. Plans are often limited by the total amount rather than starting with what are the goals and needs of the participant;

f. The reporting and insights available by the NDIS and NDIA are very limited to enable transparent benchmarking and easy accessibility of variations in plans often no until periodic audits are undertaken in hindsight;

g. Variations in plans occur often quicker than the deterioration and changes in care needs of participants which is often limited by geography and accessibility to health professionals and services.

Funding Considerations, System Flaws, and Recommendations

Point 4: Alignment With Means Testing Approach

Funding of NDIS should be considered in alignment with a user pay and means testing approach, in line with the previous means testing aged care undertook rather than including assets. There is a significant need for reserve pool funding and an ability to prioritise and distribute based on assessed need.

Assessments should be almost based on case mix approaches as a starting point and then reviewed up from there in line with specific goals and individual milieu.

Point 5: Financial Modelling Issues

Financial modelling as aligned to insurance modelling as indicated in recent years reviews of iCare insurance reviews have demonstrated significant flaws in these processes.

One of the major flaw in the NDIS system is that not all staff and providers supporting NDIS participants need to be registered in NDS as approved providers and along with self management, participants become largely unsupported and more vulnerable.

In iCare and MAIB (other states are moving towards this), all providers must be ACIS accredited to ensure they are meeting the needs of client as aligned to their scope of services. This has been enforced by the recent parliamentary review of iare that ACIS must stay in place as a safeguarding of clients needs.

Point 6: Flawed Standards And Scheme Requirements

NDIS standards and scheme requirements are largely flawed. They are not contemporary, risk based and nor do they adequately cover the governance and clinical governance needs of the sector.

| would strongly encourage you to consider reviewing ACIS 4.0. ACIA provides transparency of all reports, engaged in supervision and education of auditors to ensure contemporary and relevant knowledge of scheme requirements and standards, as well and supporting providers through their weaknesses.

It is almost impossible to get a direct answer out of the Commission, there is rarely positions that they have shown leadership on with good planning, data that is evidenced based and root cause focused to inform strategic approaches in management.

There is a largely autocratic approach to NDIS management rather than co-design or engagement based approaches with decisions made and consultation follows to ensure due process.

| would encourage a more proactive approach with the learnings of ACIA to how to provide standards across multiple sectors, work with providers and auditors through transformation and develop against trends and client acuity patterns.

As an example; complaints in NDS are largely not risk managed, don’t facilitate engagement with providers and participants, rarely provide direction and there is little to no analysis of trends and themes to inform improvements and strategy.

Point 7: Early Intervention Strategies And Recommendations

ACIA supports early intervention strategies as is well evidenced in research as reducing the total disability and comorbidity resource requirements in the longer term. Ongoing measures in alignment with ACIS direction should consider the needs and initiatives including;

• Standards around assistive technology

• Home modification guidelines and measures for consistent implementation

• Requirements of all supporting providers and non providers supporting J participants :

• Mental health support for carers and participants Increased accessibility for respite services a

• Review of SIL environments to ensure these are adequately funded and \managed against best practice approaches \

• Plans should have additional and flexible monies allocated in the circumstances that allow for urgent changes and unexpected needs it

• NDIS standards should be modelled to ACIS

• Clinical governance needs to be added as a matter of priority to NDIS 4 requirements of providers;

• NDIS auditors need regular training and development to support consistent auditing and reporting.

• NDIS needs to improve its governance and leadership approaches to ensure if that changes are planned and well communicated in alignment with the % intention of the NDS.

|. Complex care needs of participants needs need to be better addressed by the modules to ensure adequate provisions are in place to safeguard these needs including bariatric, pain management, palliation, acquired brain injury and advanced airway management.

Comments on Governments Position and LACK of accountability on Disability

It is important to first acknowledge that the intent of the NDIS is as defined in its operational guidelines:

The NDIS is a new way of providing individualised support for people with disability, their families and carers. The NDIS will provide all Australians with a permanent and significant disability, aged under 65, with the reasonable and necessary supports they need to live an ordinary life. Eligible people, known as participants, are given a plan of supports which is developed and tailored to their individual needs. A plan could include informal supports that a person receives through family, friends, mainstream or other community services. If required, The NDIS will also fund reasonable and necessary supports that help participants achieve their goals. Not all people with disability will become NDIS participants. Only those who meet the access criteria will become a participant and receive an individualised plan. However, the NDIS can provide people with disability, their families and carers support through information, linkages and capacity building by connecting people to the mainstream community. (NDIS, 2019).

Are we achieving this? NO

providing individualised support for people with disability, their families and carers. with the reasonable and necessary supports they need to live an ordinary life.

given a plan of supports which is developed and tailored to their individual needs fund reasonable and necessary supports that help participants achieve their goals NDIS can provide people with disability, their families and carers support through information, linkages and capacity building by connecting people to the mainstream community

x * *® *® *

The Productivity Commission Report (201 1b) found that the disability system was underfunded, in fair, fragmented and inefficient and gave people with disability, their families and carers little choice and no certainty of access to appropriate supports

Are we achieving this? NO x Funding appropriately x Funding and managing a system fairly x Providing a streamlined and efficient service x Providing increased choice x Ensuring certainty of access to appropriate supports

The National Disability Strategy (201 1a) sort to improve the accessibility of mainstream services for people with disability will complement specialist disability services and programmes currently provided by Commonwealth, state and territory governments, including those provided through the NDIS.

Are we achieving this? NO

x Reducing barriers in the community to stop people with a disability actively participating in the community

• Creating better linkages with community for people with disabilities

ACIA_Current Scheme Implementation and Forecasting for the NDIS __0222 — ACIA 9

Implementing strategies to ensure people with disabilities can engage in more activities Ensuring the community understand and implement fair rights for people with disabilities

All people with disabilities are treated fairly

Helping them understand the laws, including ALL of the NDIS rules and regulations Ensuring they have access to money

Ensuring they have access to good housing

Ensuring they can access a good job

Ensuring people with disabilities have more choices

Ensuring people with disabilities have more control over their lives

Helping people with disabilities be more independent

Government offering more information, choice and control

The inquiry into NDIS Planning (Tune, 2019) recommended 42 recommendations of long standing issues that remain yet to be addressed:

Are we achieving this? NO

• Major inconsistencies in plan funding between participants with the same disability type;

• Plans not including funding for particular supports for the reason that a participant already has informal supports, despite the participant stating that they have no informal supports;

• Plans not including funding for particular supports for the reason that these should be available in another service system, such as health, without the NDIA first checking to determine whether the supports are indeed available and the participant is eligible for them;

• Planner errors, including listing the wrong disability type on participant plans;

• The experience, expertise and qualifications of planners;

• Planners ignoring or changing expert recommendations from allied health professionals about the supports appropriate for a particular participant;

• The planning process for particular cohorts, including participants with psychosocial disability, Aboriginal and Torres Strait Islander people with disability, children and young people, and participants in custodial settings;

• Issues with external appeals to the Administrative Appeals Tribunal (AAT), and allegations that the NDIA was not offering participants new plans in the form that the AAT had ordered following an appeal; and

• Problems with communication from and by the NDIA, including slow or non-existing responses to queries, and participants not being invited to their own planning meetings.

The Joint standing committee on NDIS produced a report on NDIS Workforce (Australian Government, 2021b), yet none of these recommendations have been implemented.

Are we achieving this? NO

• Increasing NDIS workforce data collection

• Consulting NDIS workers and other key stakeholders in all NDIS pricing review processes

• Improving employment opportunities for people with disability and Aboriginal and Torres Strait Islander people within the workforce

• Addressing the funding and resourcing implications of new training and upskilling initiatives

• Increasing student placement opportunities within the workforce

• Developing clear and measurable outcomes for the initiatives in the NDIS National Workforce Plan 2021-2025; and

• Developing a comprehensive consultation strategy for the implementation of measures under the Workforce Plan.

ACIA acknowledges the Major changes that the NDIS has implemented since December 2020 as outlined in the General Issues Paper (Australian Government, 202 1a). However, it is remise in the needs of participants and alignment to the goals and directions as set out by the NDIS Act.

Are we achieving this? NO

Alignment of plans to individual goals;

Active engagement in the community;

Appropriate funding;

Flexible funding to support the needs of the participant and their carers;

Quality assurance processes and transparency in the NDIS and NDIA systems;

Lack of choice and control of participants;

Co-design and adequate consultation with participants and key stakeholders in

practices and system improvements;

• Lack of legislation that ensures providers are adequately safeguarding the needs of participants to meet current needs;

• Lack of advocacy and support to translate the complexities of the NDIS system;

NDIA lacks consultation and engagement as evidenced in this report;

• Active outputs to support homelessness

® ® * XK OX

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Comments on Joint Standing Committee on NDIS; General Issues

2021

As evidenced in the above commentary there is a significant and almost negligent response to the way we treat, support and engage our vulnerable community who have a disability. We concur with the report that:

• A21% of appeals suggest a mismanagement of issues and poor management

• An 18 week average resolution is not conducive to the needs of the community of reflective of the intent of the process;

• There is a significant lack of advocacy for people with disabilities;

• ACIA should be considered as a lead advocacy support organisation for people with disabilities;

• Greater accountability and transparency is needed in the management of cases and appeals;

• Response times, appeals timeframes and process management should be defined as KPls for senior management in both the NDIS and NDIA;

• A review of the NDIS standards is needed to align it with ACIS in order to ensure providers are adequately scoped and capable of managing the complexity and needs of clients;

• Plans need to be individualised and focused on the goals of the participants as opposed to financial targets;

• Similar to the Aged Care sector there needs to be a system where navigators are used to support participants navigate the process;

• A review of the skill set and experience of planners is necessary;

A review of communication strategies with participants is necessary;

• Additional support is needed given the distress that is endured during these processes, without due regard for the challenges and life changing needs that occurring despite the legislative barriers that are imposed;

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References

Australian a (201 1a). 2010-2020 National Disability eee Canberra Retrieved d bli

dificlea alice reawarchihatiohal: disability-strategy-201 oe

Australian Government. (201 1b). Disability Care and Support. Canberra Retrieved from https://www.pc.gov.au/inquiries/completed/disability-support/report

Australian Government. (202 1a). General Issues 2021. Canberra Retrieved from https://parlinfo.aph.gov.au/parllnfo/download/committees/reportjnt/O24620/toc pdf/G enerallssues202 1 .pdf:fileType=applicationZo2Fpdf

Australian Government. (202 1b). WD/S Workforce Final Report. Canberra Retrieved from https://parlinfo.aph.gov.au/parllnfo/download/committees/reportjnt/O24621/toc pdf/N DISWorkforceFinalReport.pdf-fileType=application%2Fpdf

NDIS. (2019). Overview of the NDIS Operational Guideline - About the NDIS. NDIS. https://www.ndis.gov.au/about-us/operational-quidelines/overview-ndis-operational- duideline overview-ndis-operations)-quideline about

orts 62 he 620 eed? 20to 420live 20. 6200rdina e20life.

Tune, D. (2019). Review of the NDIS Scheme Act 2013 - Removing Red Tape and Implementing the NDIS Participant Service Guarantee Retrieved from https://www.dss.gov.au/sites/default/files/documents/O1_2020/ndis-act-review-final- accessibility-and-prepared-publishing 1.pdf

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