Concerns about the Partners in the Community (PITC) tender process | External submission

26 July 2022

104 Greenhill Road
Unley SA 5061
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e: admin@purpleorange.org.au
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Chair
Joint Standing Committee on the
National Disability Insurance Scheme
PO Box 6100
Parliament House
Canberra ACT 2600

Dear Chair,

Re: General issues around the implementation and performance of the NDIS –
Partners in the Community (PITC) program

Thank you for the opportunity to provide further feedback to the Joint Standing
Committee on the National Disability Insurance Scheme (NDIS). We do so with the hope
that the matters raised in this submission will be urgently prioritised by the members of
the Committee in the 47th Parliament.

We would like to draw the Committee’s attention to our concerns about the Partners in
the Community (PITC) tender process that was initiated just prior to the Federal Election.
The tender documents indicate that the National Disability Insurance Agency (NDIA)
intends to continue its existing approach to the largescale commissioning of PITC
providers, without addressing many of the shortcomings in this approach that have
previously been identified by a range of stakeholders. Consequently, JFA Purple Orange
urges the Committee to inquire into this PITC commissioning approach in order to
consider how the program could be improved to better achieve its purpose and to deliver
the outcomes that people living with disability seek and deserve, and to complete any
such inquiry in sufficient time to influence or reset the current commissioning process.
With the tender documents stating that notifications of outcomes pertaining to the next
five to seven years will be given to tenderers before March 2023, we would like to
underscore the urgency of discontinuing the current PITC commissioning
approach and replacing it with one that better reflects the values of the Scheme,
the strength of local communities, and the importance of people living with
disability having authentic choice. Otherwise, a deeply flawed model will be locked in
until at least 2028.

Background to this submission

PITC are providers commissioned by the NDIA to assist people living with disability to
access the NDIS and/or mainstream services and other supports within their local
communities. PITC providers are currently funded through a grants-based model and
deliver Early Childhood Early Intervention (ECEI) services for children under the age of

seven and Local Area Coordination (LAC) services to all others. They are usually the
primary point of contact available to people living with disability to discuss their options
or concerns. JFA Purple Orange regularly hears from people about how their
experiences with PITC providers fall short of reasonable expectations and it is these first- hand lived experiences that underpin our concerns.

Despite the issues within the current approach that many have identified, tender
documents indicate that the NDIA will commission PITC providers for the next five to
seven years in much the same way as it has done in the past. There will be some minor
modifications to the role and cohorts, but none of these adjustments significantly
changes the NDIA’s approach to the largescale commissioning of providers. For
example, the renamed Early Childhood (EC) program will now be for children under the
age of six with developmental delay and under nine for disability. The NDIA is also
signalling a greater “leveraging” of technology for budget development that may reduce
the involvement of PITC providers in this role at an unspecified future time. Additionally,
the future direction for ‘independent assessments’ is unclear, but the tender documents
foreshadow a possible role for PITC providers within whatever option is adopted, also at
an unspecified future time. It is expected that there will be a separate tender process for
PITC providers in some remote and very remote areas soon, but details of this are not
yet publicly available.

JFA Purple Orange believes the tender call documents reflect a significant missed
opportunity to improve the impact and outcomes of the PITC program. Leading up to the
tender document release, little attention has been given to assessing the effectiveness
of the current approach and whether it is the best way to continue to deliver this support
to people living with disability within their local communities. The limited market
consultation conducted late last year overwhelmingly focused on narrow issues, such as
an expansion into remote areas, specialisation, and a part-fixed / part-variable approach
to paying providers, rather than the current PITC approach as a whole. A much more
expansive consideration of the problems and potential solutions is needed.

We also believe that the tender documents are not sufficiently anchored in inclusion
practice, including how to assess a tenderer’s capacity for this when evaluating their
tender. Specifically, the tender call documents ask tenderers to detail how they will build
local knowledge and connections, which suggests the NDIA does not require tenderers
to already have this deep connectivity in place. Apart from the time it takes for agencies
to authentically build those connections, which typically is much longer than people might
think, it disregards the extent to which that local knowledge and connectivity is already
within communities, typically in smaller grassroots organisations to whom this tender call
is not really aimed.

It is hard to see from the tender documents how the NDIA will measure a tenderer’s
depth of commitment to the values underpinning inclusion, and how this is authentically
and credibly reflected in their previous work, or how the NDIA will measure a tenderer’s
capacity to undertake successful community connection that brings people into valued
membership of mainstream community life. It will be extremely difficult for whomever is
evaluating the tenderers to retrofit these considerations into the process now given their
absence from the tender specifications upon which tenderers understandably relied in

preparing their proposals. Without this degree of detailed rigour, the commissioning
process will lead to a transactional service that is unlikely to deliver on the Scheme’s
mandate to deliver transformational outcomes.

Below, we identify the key principles that we believe should guide the development of an
alternative PITC model and suggest how this could be implemented.

Return the NDIS to its original concept

The NDIS was set up to deliver both transactional and transformational benefits for
Australians living with disability in line with the core values of choice and control.
Transactional benefits arise from supporting a person’s essential day-to-day needs, such
as assistance with personal care. Prior to the NDIS, many of these basic needs were not
met, or not sufficiently met, for example when a person only received irregular assistance
for showering.

Transformational benefits are those that support people into lives characterised by active
participation in the social, cultural, and economic lives of their communities, such as
through mainstream waged employment. In this way, they transform the experience of
being ‘shut out’ of society, as described in the 2009 National Disability Strategy
Consultation Report, into one of equal participation in a community where all people
enjoy equal opportunities to fulfil their potential. Although essential, the delivery of
transactional benefits alone is not fulfilling the promise of the NDIS; it must also deliver
transformational benefits in the lives of people living with disability if it is to be judged a
success.

The 2011 Productivity Commission report on disability support described three
necessary tiers in the proposed new approach under an insurance model: Tier 1 being
for everyone, Tier 2 being for all people living with, or affected by, disability, and Tier 3
being for those people with significant care and support needs. So far, most of the policy
and implementation focus has been on Tier 3, with the funding of personalised supports
through individual NDIS plans. There has been insufficient attention directed toward
enabling greater access and utilisation of community supports and mainstream services
under Tier 2. As states and territories have withdrawn from funding a range of legacy
services, an even wider gap in support has opened at this Tier than that which existed
prior to the NDIS.

Likewise, the resources of LACs and ECEI programs have been heavily directed toward
moving people into Tier 3 plans, while their envisaged role in relation to Tier 2 has not
developed as originally proposed. This has been a consequence of both an overly
complex, resource intensive, and time-consuming participant pathway to gain access to
Tier 3 personalised supports, thus drawing the resources of LACs and ECEI programs
away from Tier 2, and a lack of investment in establishing, funding, implementing, and
progressing Tier 2 opportunities through the Information, Linkages, and Capacity
Building (ILC) program to their full potential.

Recommendation 1: Governments should recognise that the success of the NDIS
requires that all three tiers envisaged by the Productivity Commission in 2011 be

appropriately funded and effectively implemented. Further, governments should
recognise that the failure of any tier will undermine the effectiveness and
sustainability of the others.

Establish a simple pathway and clear roles

The current NDIS participant pathway is too complicated, involves a lot of inefficient
back-and-forth wrangling between PITC and the NDIA, and routinely produces
inconsistent outcomes leading to costly reviews and appeals. It also provides the context
for ill-defined roles and responsibilities in relation to the Scheme. It is essential that the
PITC approach works well with all other aspects of the Scheme and that the work of
LACs and EC programs is distinct from, yet complementary to, other roles within the
Scheme.

A simple pathway based on a conceptual framework of ‘Indicate – Calibrate – Evaluate’
would improve the participant experience, lower the administrative burden, and create
clear distinct LAC and EC roles. Under this framework, a simple, non-clinical, NDIS
assessment process would focus less on mapping the person’s disability and more on
mapping the consequences of that disability. If accepted, an indicative budget that is
considered reasonable and necessary to change those consequences would be signaled
to the participant, so they can then consider how they might best apply that draft budget
to their situation. This ‘indicate’ step, comprising a simple assessment and the signaled
draft budget, should be undertaken by a delegate of the NDIA as the agent of the
Scheme.

Based on the indicative budget, a participant would develop a draft plan that focuses on
what is important to them. A PITC could assist the participant to develop their plan,
utilising their local knowledge and expertise to help identify relevant opportunities for
community connections and participation, as well as the mainstream services that are
suitable for the person’s needs. As such, the core components of the PITC role would
be:

Providing information to people through being embedded in the local community
and well-informed about the amenities, opportunities, supports, and services that
are available
Building relationships of trust whereby they can support the person’s decision
making and the emergence of the person’s stated priorities
Facilitating community connections for people that are enabled by maintaining
relationships across local organisations, businesses, institutions, agencies, and
councils; knowing who to ask for what; and promoting the values that create
connections and increase the chances of authentic valued membership of
mainstream community life

In providing these roles, the PITC (ie. LAC) is operating as the agent of the person, not
the Scheme.

Once the draft plan is developed the NDIS delegate, as the agent of the Scheme, would
meet with the participant to make sure the draft plan contents are within the Scheme’s
parameters, are relevant to the person’s situation, hold the promise of a positive impact,

and are reasonably priced. This is a process we term calibration, to help make sure
there is a workable match between the participant’s planned intentions and the Scheme
parameters for the finalisation of the individual budget. On this basis, the delegate signs
off the plan so funds can flow.

At the end of the plan’s term, or other significant point in time, the NDIA delegate and
the participant would evaluate how well the budgeted plan achieved the desired
outcomes. This would be done using the same assessment process as that which
mapped a person’s circumstances initially, because it does not make sense to have an
assessment tool that is different from an outcome measurement tool. This evaluation
also provides information about the participant’s current circumstances (in other words,
it serves as an updated assessment) and heralds a new draft budget.

The data obtained through this step could also be collated and analysed to help the
Scheme evolve by identifying what types of investment provide the most positive impact
on the participant’s circumstances, in areas such as mainstream employment, inclusive
housing, and authentic membership and participation in the social, cultural, and
economic lives of local communities. Once again, in undertaking this work the delegate
is operating as the agent of the Scheme to uphold and advance the Scheme’s values
and parameters. As such, the delegate serves to uphold the social insurance model that
underpins the Scheme.

In summary, the PITC (ie. LAC) is the agent of the person, whereas the NDIA delegate
is the agent of the Scheme. The role of PITC is to stand alongside the person,
supporting them to access information, make decisions, and connect to their community.
The role of the NDIA delegate is to apply the parameters of the Scheme ensuring the
participant plan fits with Scheme outcome values and sustainability. Currently these roles
are confused due to an unnecessarily complex pathway.

Recommendation 2: The NDIA should implement a simple participant pathway
based on the conceptual framework of ‘Indicate – Calibrate – Evaluate’ to ensure
that Partner roles (LAC and EC) are clear and distinct from the Scheme delegate
role, where the LAC/EC is the agent of the person, and the delegate is the agent of
the Scheme.

Harness local expertise

The role of PITC outlined above is inherently local. In our experience it is grassroots
organisations and agencies that are embedded in local communities that offer the
greatest prospects of delivering the best outcomes for people living with disability,
ensuring that they can build lives characterised by valued membership of, and active
participation in, their local communities. The current largescale commissioning of PITC
providers is not a good fit for the objective of harnessing existing local resources and
achieving effective outcomes within communities. To date, large organisation PITC
providers have not demonstrated any significant advantages in connecting people to
mainstream services and community supports over what could be expected from
networks of smaller local agencies that already know their communities. Likewise, it is
not clear that the NDIA itself (or another national government body) taking on the roles

included in the PITC approach, as proposed by some advocates especially in Western
Australia, would achieve better outcomes. If we are seeking to harness local expertise
to build genuine local community connections, the most likely source of this will be found
within local communities.

We recognise that there are additional challenges in delivering PITC programs in remote
areas with thin markets, however we think a developmental approach to commissioning
programs, whereby the NDIA partners with local communities and leaders to co-design
and co-produce appropriate local solutions, offers an effective solution. This approach
would be particularly useful in First Nations communities, and in disability demographics
where there is limited expertise and capacity in response.

Recommendation 3: PITC providers should be commissioned in ways that
facilitate the involvement of small local grassroots agencies that bring well- established community expertise to providing PITC programs. The NDIA should
end its preference for commissioning large organisations without any genuine
local community presence (that is, knowledge and connections, not just physical
office premises) as PITC providers to cover wide geographical areas.

Recommendation 4: In remote areas and other ‘thin markets’, the NDIA should
utilise co-design and co-production approaches to ensure appropriate tailored
PITC solutions can be found from within those local communities.

Focus on relationships

PITC programs should be designed and commissioned to reflect the utmost importance
of the development and continuity of relationships between:

PITC providers and people living with disability so that trust and insight are built
and sustained
PITC providers and local communities so that a shared history and depth of
knowledge are built and sustained

The current largescale approach to commissioning PITC providers does not provide an
adequate basis to ensure they invest resources, time, and effort into these relationships
or the quality of the support they provide. The incentive for providers to improve the
quality of their work in order to be regarded as a provider of choice by people living with
disability is missing.

Recommendation 5: PITC providers should be commissioned in ways that ensure
that their focus is on the development and continuity of relationships, high-quality
engagement, and LAC or EC programs that genuinely advance the life chances of
people living with disability.

Create community connections

It is widely acknowledged that under the current approach PITC providers are required
to spend most of their time concentrating on connecting people to the NDIS rather than
to mainstream services and supports within their local community. The role of PITC
providers to connect people to their communities and communities to all their residents

on an instinctively inclusive basis has been neglected. We are often told by people living
with disability that their PITC provider has limited knowledge of, or presence in, their local
community. Therefore, the benefits that could come from this role, as envisaged by the
2011 Productivity Commission report, among others, are missing.

As a result, all the focus is on what the NDIS itself can offer to a person living with
disability. However, often a person does not qualify for the NDIS and is left languishing
without options for support. Alternatively, the funding within an NDIS plan might not be
sufficient to extend to community connection. Community connection and Tier 2 supports
remain essential elements of a successful approach, as well as an essential pathway
toward ending segregated service provision and developing more inclusive mainstream
options.

Importantly, PITC practice should be anchored on best known practice in relation to
community development, and how the work to connect specific individuals into
community opportunities (including how to ask, how to support, and how to step back) is
often the most powerful way to change community capacity towards welcome and
inclusion.

Recommendation 6: PITC providers should be commissioned in ways that ensure
that access to informal supports, mainstream services, and local community
connections for people living with disability are enhanced, the accessibility and
inclusiveness of communities are increased, and that highly individualised
community development work is the cornerstone of PITC practice.

Enshrine choice

We strongly believe that the NDIS principle of choice should apply to PITC programs.
Currently, providers are commissioned in large demographic and geographic blocks
meaning each person living with disability is designated a single provider through which
to access programs. If, for whatever reason, they are unhappy with what they receive
from that provider there are no alternative options available to them.

Given the Scheme is anchored on the values of choice and control, it seems deeply
counterintuitive and disingenuous to commission a pivotal role within the Scheme in a
way that is the opposite of choice and control. It is not defendable. NDIS participants
should be able to choose who supports them to develop and implement their plan.

Additionally, choice would be a strong incentive to improve the quality and consistency
of PITC programs.

Recommendation 7: PITC providers should be commissioned in ways that allow
NDIS participants to choose which provider they wish to access LAC or EC
programs from, and to change provider if and when they choose.

Measure impact

For a program that awarded $524 million of funding to commissioned providers in the
2020-21 financial year, the impact and outcomes of the current PITC approach are
unjustifiably opaque. The continuation by default of a set-and-forget approach without
consideration of alternatives will result in a PITC program that fails to fulfil its promise.
Comprehensive independent evaluation and transparency against a framework of
verifiable accreditation of practice, are key tenets of sound program delivery in any
context. The absence of any key performance indicators in the recent tender documents
is of great concern to us as it suggests a regression in accountability and transparency.

Recommendation 8: PITC providers should be subject to comprehensive and
rigorous independent evaluations and accreditation against publicly available
criteria to measure their impact and outcomes, with results released publicly to
ensure transparency.

Improve quality

People living with disability have told us that there is significant variability in the quality
of PITC providers and between individual staff. The largescale commissioning of big
organisations as PITC providers to offer services across wide geographic areas has not
avoided this problem. It is far from clear that the quality of services derived from the
current approach is superior to what could be offered by smaller genuinely local agencies
with longstanding community connections. We believe that a substantial investment in
improving the quality of PITC programs through workforce development initiatives,
robust provider networks, Communities of Practice for managers and staff, and other
similar types of investment are needed irrespective of the size or number of providers
commissioned by the NDIA.

We also note that in our recommended alternative approach to commissioning, where
participants choose their LAC or EC provider, they can take personal and potent action
when they encounter lower quality by simply changing providers. In this way, we think
that the market will be more likely to increase quality in line with the growing expectations
of NDIS participants for community connection.

Recommendation 9: The NDIA should invest substantially in improving the quality
of the PITC programs it commissions through workforce development initiatives,
robust provider networks, Communities of Practice, and other similar types of
investment and support that identify and share best practice approaches.

Co-design a more innovative commissioning and funding model

We are confident that all of these key principles can be achieved within a new innovative
approach to the commissioning and funding of PITC. A co-design process that brings
together people living with disability, providers, peak organisations, disability sector
experts, and other stakeholders should be utilised to design a commissioning model that
maximises the involvement of local grassroots organisations. The model should enable
individual choice when accessing PITC without resorting to a rigid service-recipient

orientated model with unnecessary barriers to access or to splitting the LAC and EC
programs provided to participants eligible for an individual plan under Tier 3 from
programs available for those being supported by Tier 2. We also believe that an
innovative funding model can be designed that ensures that accountability and oversight
imperatives are fulfilled without creating unjustified or inefficient contract management
and administrative burdens. In any case, we believe that the transformational benefits
for Australians living with disability that would result from rethinking the PITC approach
in line with these principles would far outweigh any additional costs that may potentially
arise from a redesigned approach.

Under a new model, LACs and EC programs would have clear and distinct roles to
provide information, build relationships and support decision making, and facilitate
community connections within the context of a reimagined simple NDIS participant
pathway that ensures greater efficiency and avoids costly reviews and appeals. This co- design process can sit alongside, and complement, the current review of the Tier 2 ILC
program, further ensuring that all aspects of the NDIS work together to produce the best
possible outcomes.

Recommendation 10: A co-design process should be established to develop a new
innovative approach to the commissioning and funding of PITC in line with the key
principles identified in this submission. As such, the NDIA’s current PITC tender
process should not proceed in its current form.

Time to rethink PITC approach

JFA Purple Orange believes that it is time to rethink the NDIA’s approach to the
largescale commissioning of PITC providers. Continuing with the current tender process
will not allow enough flexibility to significantly change the PITC approach after contracts
have been signed and any prospect of exiting contracts mid-term would undoubtedly
pose additional challenges, as well as exposing the NDIA to potential long-term
reputational damage. We do not accept that the current tender process can in any
way deliver the outcomes that people living with disability seek and deserve and,
therefore, it should not proceed in its current form.

We recognise that having proceeded this far with the current approach, limited time
remains to change course without jeopardising the continuity of essential elements of the
work undertaken by PITC. However, there are options to work around this problem, such
as only contracting these essential elements for a shorter period or extending existing
PITC contracts by a year. We would support the government implementing either of
these options if it results in the establishment of a credible, fast-paced, co-design process
to reset how PITC are commissioned and funded longer-term, including by:

Mapping a simple participant pathway with clear distinct roles for NDIA delegates
and LAC and EC programs
Establishing a co-design process to properly contemplate and articulate what the
purposes of LAC and EC programs are (and are not) and to identify the lessons
of the current largescale commissioning approach in order to inform the design
of a better alternative

Designing a commissioning and funding model, such as an accreditation process
for providers with an ongoing demand-based payment scheme
Establishing a pilot program of the alternative model in order to gather data,
finetune details, and lay the groundwork for scaling up
Developing a strategy for the Tier 2 cohort that integrates contributions from the
PITC program, ILC program, and other initiatives from Australia’s Disability
Strategy 2021-2031

We appreciate that the NDIA is currently navigating a range of challenges across the
Scheme and has signalled its openness to co-designing solutions to many of these going
forward. We also appreciate the NDIA role operates in an environment where
responsibility for some parts of the Scheme is held elsewhere (eg. Department for Social
Services, the NDIS Quality and Safeguards Commission) and by the expectations of a
range of government stakeholders. We are keen to work with and support the NDIA in
establishing the processes we recommend and share the agency’s desire that it continue
to build on its work so far to respond to the various difficulties within the Scheme.
However, we strongly believe that change in how PITC are commissioned needs to be
urgently prioritised and considered immediately alongside the NDIA’s current range of
initiatives aimed at strengthening the Scheme as an integrated whole. All the parts must
work well together, not just separately.

In this submission, we have put forward some key principles and ideas that we believe
can assist the NDIA to drive positive changes in the PITC approach. We hope that the
Committee will recognise the huge opportunity that currently presents to redesign
the future approach to LAC and EC programs, appreciating the significant impact that
these could have in advancing the life chances of Australians living with disability if a
more suitable and purposeful commissioning and funding model is adopted.

Thank you again for the opportunity to provide feedback regarding the PITC program as
part of the Committee’s “General issues around the implementation and performance of
the NDIS” inquiry. We hope that the Committee will recognise the importance of the
concerns that we have raised here, as well as the urgency with which it will need
to act to ensure that a sub-optimal PITC approach is not locked in for another five to
seven years.

We are keen to assist the Committee in its important work to help build a better NDIS for
Australians living with disability. Accordingly, we request the opportunity to meet with the
Committee to explore the matters raised in this submission. To arrange this, please
contact Mr Robbi Williams, CEO of JFA Purple Orange,

Committee members may also find the attached paper “Keeping the Promise” helpful in
considering how an alternative approach could better achieve the purposes of PITC in
line with the core values of the NDIS. Please keep in mind that this paper was developed
and written in 2017, however the fundamental principles and ideas remain highly relevant
despite the presence of some data that is now outdated.

Yours sincerely

Robbi Williams CEO, JFA Purple Orange