16 February 2017
Joint Standing Committee on the NDIS PO Box 6100 Parliament House Canberra ACT 2600
SUBMISSION TO THE INQUIRY INTO THE MARKET READINESS FOR PROVISION OF
SERVICES UNDER THE NDIS
The Federation of Ethnic Communities’ Councils of Australia (FECCA) is the national peak body representing Australia’s culturally and linguistically diverse (CALD) communities and their organisations. FECCA provides advocacy, develops policy and promotes issues on behalf of its constituency to Government and the broader community. FECCA strives to ensure that the needs and aspirations of Australians from diverse cultural and linguistic backgrounds are given proper recognition in public policy.
FECCA supports multiculturalism, community harmony, social justice and the rejection of all forms of discrimination and racism so as to build a productive and culturally rich Australian society. FECCA’s policies are developed around the concepts of empowerment and inclusion, and are formulated with the common good of all Australians in mind.
FECCA thanks the Joint Standing Committee on the National Disability Insurance Scheme (NDIS) for the opportunity to contribute to this important Inquiry.
Background
On the NDIS webpage it states that:
The Agency recognises the importance of developing a culturally aware workforce and is considering recruitment and retention strategies for people from diverse cultural backgrounds, cultural awareness training and representation of diversity groups in governance arrangements. The Agency will work to ensure that NDIS staff member competencies include the knowledge and skill sets necessary to understand and interact with CALD people with disability in family and community settings and have the attitude to develop relationships based on mutual respect.1
FECCA commends this approach of improving diversity and cultural competency. FECCA is however concerned that the transition to a market based system will be especially challenging for people living with disability from CALD backgrounds and their carers, and likely to result in service provision gaps that have a negative impact on an already vulnerable cohort. FECCA warns that the
1 IAC advice to the NDIA Board and Agency response https://www.ndis.gov.au/about-us/governance/IAC/IAC-advice-2015-NDIA-response
current NDIS participation rates for CALD people with disability are low (only 4 percent of the total cohort are CALD with have approved plans) and do not reflect the numbers of eligible participants.2
A study conducted in 2015 demonstrated that, although underrepresented in the access specialist disability services, people from CALD background have a similar level of disability as Australian born people. The study found that for every 100 Australian-born service recipients there were only 15 CALD recipients of specialist disability services.3 Furthermore, according to the study, CALD have a higher level of need for assistance in undertaking core activities. This means that for the same level of disability, CALD consumers will require higher level of care.
Service gap indicates a possibility that something more profound than the language barrier itself may be at work. People without adequate literacy and language skills, particularly those who come from cultures where states provide very limited support to people with disability, may not be aware of the existence of government funded service provision in Australia. Without knowing they would not proactively search for services, despite the available multi-lingual information.
Undoubtedly, CALD communities experience numerous challenges and barriers when engaging with the NDIS. In addition to the language barrier expressed above, the lack of cultural competency by staff is considered a barrier to access. There is limited understanding of the needs of CALD communities among providers, particularly regarding language, intercultural differences, traditions, appropriate gender of carer, etc. Finally, different aspects of service provision for CALD fall short of expectations, including LAC, planners and providers because of low general service quality as well as poor cultural competency.
FECCA is generally supportive of the NDIS but strongly recommends that the needs of CALD individuals be prioritised to ensure a high quality and consistent supply of services. We are concerned that the “one size fits all” approach of the NDIS does not adequately consider the needs and expectations of CALD participants and providers. FECCA fears that this approach might be further exacerbated with the transition to the market driven system. Therefore, we encourage the NDIA to implement improved and appropriate arrangements in order to provide necessary and reasonable supports for CALD NDIS participants, and fully realise the objectives of the scheme.
Finally, FECCA would like to draw the NDIA attention to FECCA Access and Equity to Feedback and Complaints Mechanisms for Multicultural Communities.4 The document seeks to assist government departments and agencies to meet their commitments and responsibilities under the Multicultural Access and Equity Policy by ensuring that feedback and complaints mechanisms are accessible to and equitable for CALD consumers. It contains recommendations to ensure culturally and linguistically diverse (CALD) Australians have equal access to, and receive equal outcomes from, Commonwealth Government services feedback and complaints mechanisms.
Recommendations
FECCA strongly encourages the NDIA to implement relevant actions in order that CALD communities are empowered to engage with the NDIS. The NDIS and other disability service organisations must improve equity and access to person-centred support.
FECCA uses this opportunity to once again re-emphasise the need for participant entry processes to be made clearer, simpler and more consistent. Participants and/or their guardians must have the right to review a draft of their NDIS plan so that they can ensure that it is suited to them and there are no errors. Telephone assessments are often considered inappropriate by CALD consumers
2 NDIS, Part 3.1 - Agency performance, https://www.ndis.gov.au/part3-agency-participants 3 University of Sydney 2015 - Accessing disability services by people from culturally and linguistically diverse backgrounds in Australia, by Quingsheng Zhou https://sydney.edu.au/health-sciences/cdrp/pdfs/accessing-disability- services-cultural-diversity.pdf 4 http://fecca.org.au/wp-content/uploads/2017/12/FECCA-Access-and-Equity-Report-Final.pdf 2
and their carers. We hear anecdotal stories of consumers being contacted by telephone and because of their inability to communicate in English, not being re-contacted through use of interpreters or files closed as “uncontactable”. In addition, the NDIA needs to provide additional support for people from CALD backgrounds, in particular when it comes to provision of information in-language. The NDIS was not co-designed with CALD individuals or with CALD communities in mind, especially those with significant mental health issues. Where there are issues that need to be resolved, NDIA personnel must easily accessible in a timely manner in order to assist. In addition, the NDIS portal needs to be simplified and improved so that it is user friendly.
FECCA has previously raised concerns about the availability of choice for CALD consumers in the NDIS, and the need to ensure that the NDIS accreditation system for providers recognises the needs of CALD communities, including increasing the availability of CALD specific providers.
FECCA would appreciate further clarity from the National Disability Insurance Agency (NDIA) regarding how it will accommodate our constituency during the transition period, particularly in the absence of a CALD strategy.
FECCA contributes the following responses to the Terms of Reference:
a) the transition to a market based system for service providers
The transition process can be challenging, expensive and takes time. In the case of human services, where services are provided to some of the most vulnerable and disadvantaged members of the community, there needs to be clear frameworks for responding to market failures, ensuring quality services to individuals and providing stability and certainty for providers.5
With the introduction of the market driven system in the area of human services, there is an increased risk that the number of service providers will grow, as has occurred in the community aged care sector with The Increasing Choice in Home Care Reform of 2017. FECCA however fears that this will not mean the increase of CALD specific providers, but rather their reduction. We know that smaller CALD specific providers find it hard to enter the market due to financial constraints (large initial investment needed) and ability to access consumers. Also, the changes to the funding models are adding difficulties for providers who no longer have access to block funding for specific services. FECCA warns that market intervention might be needed to ensure the continued operation and increase of CALD specific providers.
The experience from the aged care reform is that consumers need to be informed to be adequately empowered to exercise increased levels of choice and control. While an increased supply of providers leads to increased competition, which in turn can competitively price the provision of services and supports, there is risk of a decrease in the quality of service and reduction in number of niche (CALD) providers. FECCA is aware that a competitive market in the aged care home care service provision has seen some ethno-specific providers losing clients due to the larger, greater resourced providers adopting questionable tactics, to entice established clients away from their preferred providers with cheaper service rates.
FECCA urges the NDIA to incorporate provisions into service provider agreements to ensure that they are responsible for providing cultural competency training and education to those employed to work under the NDIS. It is advisable to have both internal and external oversight mechanisms and review processes for service providers to ensure that the employers are delivering the services in an appropriately professional manner. Apart from the NDIA, the service providers should also bear the responsibility of informing the participants about their rights to change the provider if they are unhappy with their service provision, change employees of a service provider, lodge complaints against them, etc. It is imperative that the service providers work in collaboration with LACs and
5 KPMG: Unleashing value: rethinking regulation in the human services sector https://home.kpmg.com/au/en/home/insights/2014/06/rethinking-regulation-human-services-sector.html 3
other community organisations to ensure that CALD participants have access to a choice of culturally appropriate staff to deliver the services.6
FECCA stands ready to support the NDIA and providers in establishment of culturally appropriate practices.
b) participant readiness to navigate new markets
The NDIS is based on an individualised approach and the concept of consumers exercising ‘choice and control’. Instead of making people fit into fixed support options, NDIS participants are informed consumers making individual choices that can be tailored to their preferences and cultural needs.
The individualised approach becomes problematic if a participant is not empowered to understand the scope of the system and FECCA warns of multiple difficulties in its implementation in relation to people living with disabilities from CALD backgrounds. For people to make informed choices, they need to have the relevant information accessible to them, to be able to understand and utilize that information and to feel empowered to make specific demands that meet their cultural and social needs. From substantial previous research and frequent anecdotal evidence, FECCA understands that CALD consumers face particular difficulties with all of these.
FECCA therefore believes that it is imperative that the implementation of the NDIS includes strengthening the capacity of CALD individuals to navigate the free market and to make informed choices about the services that respond to their requirements, including cultural needs. Without capacity building, there exists the risk that many participants from CALD backgrounds will not receive the same benefits from this social reform as others, due to the difficulty in understanding the processes and with limited access to information. FECCA warns of risk of creating a system where particular groups are further disadvantaged.
Information about services must reach CALD communities through active engagement. Placing information on a website and expecting consumers to access it will not be sufficient to enable participants in the NDIS to be informed about the services available to them.
Other means of communicating including community radio and ethnic print are crucial. The NDIA should carry out awareness activities that specifically target this cohort, and provide them with extra support when navigating the system. Also, CALD individuals with a disability require culturally appropriate and often in-language information that ranges from basic to comprehensive information depending on need. FECCA was made aware of an experience of a father of two disabled boys from CALD background who had to take a year off his job to work through the NDIS system to enable proper care for his children, because his wife spoke no English and received no language support in the process.
So that this cohort is fully included and made aware of issues that may impact them, the NDIA and service providers must actively engage with CALD people and employ specific targeted campaigns. Such measures can include directly engaging and working with communities (face to face presentations), engaging General Practitioners or other medical professionals providing health support to CALD NDIS consumers, and other community organisations. All of these could be effective ways of delivering information to CALD communities. FECCA cannot emphasise enough the importance of provision of information in-language.
Furthermore, feedback and complaints mechanisms drive quality and improvements to systems. All consumers must be aware of their right to complain and how to access complaints mechanisms. In certain countries making complaints about services is not a cultural norm, thus the promotion of feedback and complaints mechanisms is particularly important for migrants; laws and procedures in their country of origin are likely to be different to those in Australia. Details of complaints mechanisms should be provided to all participants in the NDIS at the planning stage.
6 FECCA Access and Equity in the Context of the National Disability Insurance Scheme 4
There should also be multiple ways of lodging a complaint, including online, over the phone, in writing and in person. Again, the option of providing feedback in language of choice is of crucial importance.
An effective advocacy framework plays a key role in empowering individuals to be proactive self- advocates, assert their rights, and efficiently use complaint and feedback mechanisms. Peer support and professional advocacy services are also vital in enabling people to use these mechanisms. Effective advocacy will be particularly important to CALD consumers. FECCA urges the government to address the gaps in funding for advocacy beyond the transition period. FECCA also recommends that a CALD representative is appointed to the NDIS Independent Advisory Council.
In conclusion, when considering the readiness of CALD consumers to access the market driven system, language and communication barriers should be considered, capacity of individuals to make informed choices should be improved, feedback and complaints mechanisms should be put in place that centre around the consumer and effective advocacy framework for CALD should be established.
FECCA recognises the vital role of multicultural sector organisations in providing culturally sensitive and appropriate support. Again, FECCA stands ready to support the NDIA through outreach to consumers and provision of resources for establishment of culturally appropriate practices.
c) the development of the disability workforce to support the emerging market
FECCA acknowledges general concerns about the difficulties of attracting and maintaining a skilled workforce for the NDIS. We are aware of difficulties in building the market in regional and remote areas, and guaranteeing appropriate services for culturally and linguistically diverse communities.
With the growth of NDIS, there will be an increased need for new care workers. For example, it is estimated the workforce needed in South Australia to service the increased demand for disability support will grow from 5,650 to between 10,250 and 12,550 full-time equivalent (FTE) workers by 20197 which equates to more than double the current need. Furthermore, it is expected that the actual number of jobs will be higher through the availability of part time and casual positions. This means that new people will have to be introduced to the system in astonishing rates in a short period of time. FECCA urges the government to introduce the requirement of cultural competency training for staff by providers. When receiving services people need to feel respected and valued for what they are, rather than experiencing cultural biases from support staff.
FECCA acknowledges that the increased need for support staff could be met by increased workforce participation by CALD migrant workers. Working in care industry is often seen as an attractive career path for many CALD migrants. However, they need to be reassured that this career path will also enable professional development, work-life flexibility and career progress. Unfortunately, CALD migrant workers are often faced with the opposite: no opportunities for education and development and lack of career progress, frequently due to racism and discrimination. FECCA urges the government to introduce the requirement of cultural competency training for both employers (providers) and employees (their staff). FECCA is able to provide relevant tools and resources for provision of cultural competency training for both.
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FECCA firmly believes that through employing CALD workers and working with local CALD communities to develop engagement strategies and deliver services, NDIS could increase access and participation for people from CALD backgrounds.
Finally, FECCA warns that if increased need for care staff is to be met by migrant workers, any plan will need to be coordinated with proper immigration policies. We have seen that with the change of Temporary Work Skilled (457) visa, providers in the aged care sector face the possibility of losing qualified staff.8 With the increased need, appropriate immigration policies are needed to attract workers to the disability sector, while protecting them from exploitation.
d) the impact of pricing on the development of the market;
Transition to a market driven system in human services is a considerable change from traditional models where government decides the nature and scope of service delivery. In commissioning models built around individualised funding, the recipient of the services is the customer, with the power to decide which services they need, from whom, and how they want them delivered. This means that providers must have a greater focus on customer engagement and understanding customer needs and preferences, rather than relying on accepted wisdom and presumptions.9
Like any other sector in the economy, this one will have more efficient and less efficient organisations. Less efficient (perhaps predominantly smaller) organisations will likely struggle to survive because funding is unlikely to be sustainable to support the whole sector. Here we are entering a double risk. Larger providers may be able to offer services at lower prices to attract new clients. This may drive smaller providers who are capable of providing culturally appropriate services to CALD out of market. FECCA warns that this is a particular hazard for an already disadvantaged CALD group. If we want to improve CALD participation in NDIS and provide equal opportunity, the government will need to ensure the continued existence of the small culturally specific services. We have proposed several strategies for market intervention under section f).
Additional risks include underpayment of staff, lack of resources invested in staff training and large staff turnover. These risks could be additionally exacerbated for migrant CALD workers. Proper accreditation processes need to be maintained to avoid any such event. FECCA also recommends requirement of full cost transparency placed upon all service providers in the NDIS. For people, not just CALD, to be able to make informed choices, they need to know what they are getting for their money.
e) the role of the NDIA as a market steward
The NDIS webpage states that the Market Approach outlines how the Agency will work with industry and the wider community, as Scheme stakeholders, to support major growth in the number, range and size of disability support providers and the services they offer. Where market problems are observed, such as participants not being able to access services to support the achievement of their goals, the NDIA will consider how to improve the situation and make the right changes.
The above segment is particularly relevant for CALD consumers. FECCA urges the NDIA to maintain systematic collection of information of NDIS uptake by CALD, monitor the feedback and complaints mechanisms particularly in relation to CALD consumers and to ensure that providers implement relevant policies to guarantee culturally appropriate services. That will be the best and the only way for improving CALD participation in NDIS, as the current lack of data impedes on the NDIA’s ability to develop targeted strategies for CALD. FECCA also recommends that the NDIA
8 https://www.australianageingagenda.com.au/2017/04/19/visa-changes-highlight-need-aged-care-workforce-strategy/ 9 KPMG Competition in the human services market 2017 6
Customer Relationship Management (CRM) system is modified to enable collection of accurate data regarding participation of people from CALD backgrounds in NDIS.
Finally, again, FECCA urges the NDIA to urgently release the NDIS CALD Strategy. The Strategy should outline clear roles and responsibilities of all actors in the sector to increase CALD participation and improve service provision for people with disability from CALD backgrounds. It is therefore, in our view, imperative that the Strategy is made official as soon as possible so that the entire sector could start working strategically toward addressing the issues and improving the situation for CALD members of our communities.
f) market intervention options to address thin markets, including in remote Indigenous
communities;
FECCA recognises the service provision market for CALD as one of the thin markets due to small numbers of culturally appropriate providers nationwide, and in particular in rural and remote communities. As stated above, we fear that introduction of market based system could potentially worsen the situation by driving smaller culturally specific providers out, due to their inability to compete with larger providers, resulting in further reduction of overall CALD participation in NDIS. FECCA recommends implementing following strategies for improvement of market for CALD, including:
Increased funding for existing culturally specific services to engage with NDIS.
Support the development of new community based CALD support through for example
provision of grant funding for establishing new not-for-profit providers (community
organisations that will be reflective of the community composition and employ community
members, providing them with relevant training and enabling development of skills –
education/certification – to implement the tasks).
Introduction of Allied Health Assistants (AHA) of culturally diverse backgrounds. AHAs are
certificate-qualified individuals who can implement interventions under the guidance of an
allied health professional, remotely or in-person. AHAs can have an in-depth knowledge of
local community needs at the same time as having a broad knowledge of allied health
services.
FECCA warns that the above strategies for improvement should not be left to the market and providers to decide as they will be driven by profits. It is our position that NDIA should take an active role in this.
g) the provision of housing options for people with disability, with particular reference to the impact of Specialist Disability Accommodation (SDA) supports on the disability housing market;
Recognising that a vast cohort of CALD consumers is not properly informed on the NDIS housing options policies, FECCA urges the government to communicate this information to CALD consumers through various mediums, as suggested under point b).
h) the impact of the Quality and Safeguarding Framework on the development of the market;
FECCA stance is that, if anything, the Quality and Safeguarding Framework should have positive effect on the development of the market as it outlines clear standards for measures and national requirements to protect the safety of people with disability and to ensure high quality support. FECCA has one concern regarding the Quality and Safeguarding Framework though. The Framework for providers includes no requirement of diversity or cultural competency. We are concerned that this, in combination with the lack of CALD disability strategy, could put CALD consumers in an even more disadvantaged position.
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Conclusion
The true measure of the success of system change will be how well it empowers all people with a disability, not simply those who already possess the skills and resources necessary to manage individualised and self-directed funding.10
FECCA will continue to monitor the implementation of the NDIS, and engage with the Government to ensure that the needs of CALD people with disability are considered in policy-making.
FECCA stands ready to support the NDIA in the transition process through outreach to consumers and provision of resources for establishment of culturally appropriate practices and would welcome the opportunity to contribute in more detail on matters relating to this issue. For further information please contact FECCA Director, Dr Emma Campbell, on emma@fecca.org.au or 02 6282 5755.
10 PwC Report Disability expectations: Investing in a better life, a stronger Australia 8