PO Box 492, Bega NSW 2550
P. (02) 6499 2222
F. (02) 6499 2200
E. council@begavalley.nsw.gov.au
bega valley | shire council
ABN. 26 987 935 332 DX. 4904 Bega
2 March 2018
Submission to the Joint Standing Committee on
the National Disability Insurance Scheme: Market Readiness for the NDIS
Disability Services delivered by Bega Valley Shire Council
Located on the Far South Coast of NSW, Bega Valley Shire is a rural region spanning 6052 kilometres. The town of Bega is the centre for most health, education and government services across the Shire. Its main satellite towns are situated up to a one hour drive away. In 2016 the resident population was 33,253, with 937 or 3% of the population under 65 reporting their need for assistance with daily living¹.
Bega Valley Shire Council has delivered disability supports in the Shire for over 25 years. The National Disability Insurance Scheme (NDIS) has now replaced state-funded disability programs, including Community Options (funded by the NSW Department of Family and Community Services). Council began delivering Community Options to people with a disability under the age of 65 in 1992. Community Options provided case management services to clients who were primarily characterised by their vulnerability, complexity and isolation. In many cases they also possessed an inability or unwillingness to receive services from other providers.
In March 2016, Council’s Disability Team began 36 month trial of delivering Support Coordination and Plan Management services under the NDIS. The trial was designed to assess the benefits and viability of Council delivering these services. One key factor prompting the trial was so that Council’s vulnerable clients would still be supported once the Community Options block funding model was abolished.
Council’s specialist Disability Team now delivers Support Coordination and Plan Management to over 100 NDIS participants. Council is the largest Plan Management provider in the Shire, regularly receiving referrals from the local National Disability Insurance Agency (NDIA) office, Local Area Coordinators (LACs) and Early Childhood Early Intervention (ECE!) agencies.
Council’s Disability Team has experienced numerous successes and challenges under the NDIS in the first 17 months of its trial. Council’s history of delivering disability supports in a rural setting make it well placed to contribute to the discussion of market readiness for the NDIS.
Terms of Reference
A. The transition to a market based system for service providers
Barriers to provision of Support Coordination and Plan Management
- Rollout of NDIS systems has been inadequate and slower than expected, resulting in reduced productivity
Productivity is restricted by a lack of specific information, unnecessary duplications and a poorly designed Portal. Information at www.ndis.gov.au is insufficient and too general, whilst Portal outages and technical issues create lengthy delays. It is common to wait on hold for 40 minutes before a call to the NDIA is answered. Email enquiries rarely receive a response. If frontline NDIA staff cannot resolve an issue, Council staff prefer to stay on hold rather than risk missing an anonymous NDIA call.
Recommendations:
e An urgent review of the NDIS Portal systems and inefficiencies in consultation with Providers and NDIA staff
e Ticketing system for all unresolved phone and email enquiries acknowledging receipt, indicating where an enquiry is on a queue, who is responsible and expected timeframe for response
- Lack of clarity in role/expectations of Support Coordinators and Plan Managers
The NDIA do not have a comprehensive set of publicly available policies. They have also not provided training in Support Coordination or Plan Management, both of which are unique to the NDIS.
Support Coordinators have been forced to navigate their role without adequate information. Hours are lost seeking answers from the NDIA regarding the most basic enquiries because reference material is either too general or does not exist. Answers from the NDIA are almost always inconsistent.
For example, the process for submitting Assistive Technology recommendations and quotes has changed without notification several times. As a result, even urgent Assistive Technology requests go missing in the system for several months and quotes expire. Participants then take out their frustrations on Providers who are the only consistent contact point in the process.
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Recommendations:
e Comprehensive and clearly defined instructions and policies for provision of Support Coordination and Plan Management and training from the NDIA e Regular review of current documentation to address gaps in information.
- Lack of information on plans
Only some NDIS plans state the Participant’s disability. In cases where a Participant also has health issues, they are often confused about the types of paid supports that are ‘reasonable and necessary’. Support Coordinators and Plan Managers are forced to base decisions about support provision on what the Participant shares, and not why the NDIA made decisions to provide budgets. This leaves potential for misdirected spending and possible fraud.
Recommendation:
e All plans to state the Participant’s disability or disabilities specific to allocation of Plan budgets.
- Arbitrary nature of Support Coordination provision in Plans
Support Coordination is only provided to certain Participants based on their complexity. However, the allocation of a Support Coordination budget appears arbitrary, with no visible, accountable or consistent processes in place.
In the pre-planning stage (before first Plans were rolled out) recommendations from therapists, doctors and skilled case workers for Support Coordination assistance were often not taken into account. This was most noticeable for Participants with a history of complex mental illness. Lengthy review requests created significant stress for these Participants, who often received substantial Support Coordination budgets only after a Plan Review.
Participants who do not receive Support Coordination are expected to contact their Local Area Coordinator (LAC) for support. However, LACs have immense workloads and can only provide ‘Support Connection’: simply giving the Participant a list of names and phone numbers, whereby Participants are required to organise supports themselves. Council’s Support Coordinators regularly receive requests for help from complex ex-clients and new Plan Management clients who are overwhelmed with the demands of coordinating their own supports.
Recommendations:
e More transparency in NDIA decision making processes and reasonable explanation to participants regarding outcomes
e Individualised planning pathways for Participants who do not fit the NDIA’s current one-size- fits-all approach
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e A dedicated phone line for Participants who did not receive Support Coordination and need support to implement plans e Systematic complaints process to address problems and report changes regularly on Portal
- Difficulty retaining skilled staff, resulting from unmanageable workloads due to low NDIS billing prices and inadequate (or no) Support Coordination in Participant budgets
High turnover of skilled staff and staff burnout has been observed in Support Coordinators and Plan Managers across different organisations in the Bega Valley Shire. Feedback from these service partners has shown that the reason for resignation is due to significant stress and hours of unbillable time spent dealing with Participant issues that must be resolved regardless of whether or not the person has funds left in their Plan.
Council staff also experience unmanageable workloads and the ethical standpoint of feeling the must provide Support Coordination to Participants clearly in high need, but who have no Support Coordination in their budgets. If this did not occur, Participants would experience great difficulty accessing services, an escalation of their disability, and health problems.
Council’s Support Coordination and Plan Management staff experience also unsustainable workloads as a result of time spent attempting to resolve a multitude of problems for both Participants and Providers with the NDIS rollout. These problems include issues with Portal systems and outages, NDIA phone staff who appear unable or unwilling to resolve issues, and enquiries being redirected to sections in the NDIA that fail to respond and offer no access to direct contact details.
Recommendations:
e Comprehensive and clearly defined instructions and policies for provision of Support Coordination and Plan Management and training from the NDIA
e Increased Support Coordination and Plan Management budgets for Participants that reflect skill level
e Improved method of assessing Participants for Plan development to better assess those individuals who do not have good knowledge of the NDIS, do not understand how to develop goals, or cannot articulate themselves very well. Improved assessment of individuals should lead to better understanding by the LACs and NDIA about whether Participants should have Support Coordination placed in their Plan budgets
- Lack of consistency in NDIA processes and lack of consultation
As an example of lack of consistency, methods of submitting Assistive Technology (AT) requests have not been made clear and seem to differ depending on region. They change without consultation from the NDIA. Email requests for confirmation of receipts are not answered and requests for information on progress of submissions often appear to be met with resistance.
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This has resulted in an extremely large backlog of AT submissions, with most being caught in the NDIA system for months. It appears as though issues are not allocated to an individual NDIA staff member who then is the responsible person for dealing with a sometimes critical enquiry. Participants in urgent need of equipment can at times take out their frustration out on Support Coordinators, who are unable to provide answers despite their best and time-consuming efforts. This situation creates immense stress for Support Coordinators who bear the brunt of complaints and, in some cases, abuse. It can also lead to Support Coordinators from different organisations throughout the Shire being disparaged to new and potential clients, despite the reason for the hold up not sitting with the Support Coordinators.
Recommendation:
e Ticketing system for all unresolved enquiries and Assistive Technology submissions, acknowledging receipt, indicating where an enquiry is on a queue, who is responsible and expected timeframe for response
e Implementation of a single process for Assistive Technology submissions
B. Participant readiness to navigate new markets
1. The socioeconomic and gender impacts on plans
Plans are based on the information a Participant provides. We have seen numerous inconsistencies in plans that can reflect a Participant’s literacy and comprehension skills, their ability to self-advocate and even pride.
For example, one couple with the same disability received very different Plan budgets. The wife reported that her husband was too proud to admit he needed help in certain areas. His communication with the LAC did not verbalise certain matters due to his personal stance, however his wife reported that his body language always clearly reflects his apprehension and need for further probing. As a result, his Core budget was significantly lower than his wife’s, despite his obvious need for assistance.
Recommendation:
e Language in Plan meetings that is considerate of differences in gender and socio-economic background
e Training for LACs in reflective communication and sensitive enquiry when an individual appears reluctant or otherwise uncommunicative
2. No provision for emergencies
The NDIS makes no provision for unexpected issues or emergencies or for a sudden deterioration of a Participant’s condition. The Scheme does not prioritise Participants who
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cannot wait for Assistive Technology requests to be approved. It seems as though risk factors are not attended to by the NDIA. Participants wait throughout lengthy bureaucratic processes and feel helpless because they have no power to make an urgent request.
For example, local Participant Mr Robert Graham², who urgently needs a new prosthetic leg, is forced to go through the same Assistive Technology request process as all other Participants. As a result of pressure wounds created by his existing prosthetic leg, Mr Graham is now unable to use this leg and requires a replacement prosthetic leg. He is now unable to work or participate in household, property maintenance and social activities until the request for his new prosthetic leg is approved. Mr Graham has been waiting for months for this approval.
Mr Graham is a karate instructor and a highly independent person. He is devastated that his inability to replace his current (inappropriate) prosthetic leg means that he cannot participate in the physical activity which he considers his livelihood.
Previous to the NDIS, Mr Graham simply called his longstanding state-funded supplier and received support immediately. Under the NDIS Mr Graham received no Support Coordination budget and was expected to go through a whole new set of processes (contacting an Occupational Therapist who would then write a recommendation with quotes) to receive his new leg.
Plan Management and Support Coordination staff are the only consistent contact people who can offer direct support to Participants. Many Participants express their frustration, anger and disappointment in the NDIS to our Plan Managers and Support Coordinators.
Recommendation:
e Prioritisation of need for certain Participants based on functional impact in Assistive Technology approval process
e More transparency in NDIA decision making and processes
e A dedicated phone line for enquiries for progress of assistive technology requests
e Systematic complaints process to address problems and report changes regularly on Portal.
3. Service gaps in regional areas
Significant service gaps remain in the Bega Valley, meaning that Participants still fail to have a choice in which Provider to use. Whilst Participants generally have good access to unskilled services like home and yard maintenance, local availability of skilled service providers remains limited, or there are still no local Providers at all.
Council initially supported the Disability Team’s trial of NDIS service provision so that the existing community and clients would remain supported. 17 months into the NDIS rollout,
² Mr Graham urged Council to provide his name and situation within this submission as he wanted to publicly to communicate his frustration and disappointment with how his situation has unfolded. Mr Graham has provided written consent for his name to be published and for all of the above personal information relating to him to be included.
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Council’s activities under NDIS have been vital to maintaining effective support for clients and partner agencies. This is reflected in the exponential and unexpected growth of Council’s Plan Management business under NDIS.
Recommendation:
e Provision in Plans for travel from rural and remote areas and accommodation to consult with specialist Providers that Participants can only access in major cities
4. Limited or no access to internet in rural areas
Participants can theoretically monitor their NDIS Plans on the Participant Portal, but many residents in the Bega Valley Shire live in internet ‘black spots’ where they have no access to internet, or where their internet services are unreliable. These Participants rely on Plan Managers for information about their Plan budgets - yet Plan Managers are not funded to do this.
Recommendation:
e Assessment of “black spots” and additional funding available for service provider’s if internet access support is required by participant
C) The development of the disability workforce to support the
emerging market
1. Service gaps: unskilled versus skilled workforce
A major barrier to a thriving NDIS in the Bega Valley is that the market in regional Australia has significant service gaps, meaning that some clients still fail to have a choice with which Provider to use.
Core budgets in NDIS Plans provide a great deal of funding for unskilled services such as cleaning and yard maintenance, whilst budgets for and supply of skilled Providers is limited. A number of Providers in the Bega Valley have opted not to enter the NDIS environment due to the rate being unviable — or have tried to deliver services under the NDIS and then exited the Scheme due to financial unsustainability.
Recommendation:
e Review of chargeable rates for providers in regional areas
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D) The impact of pricing on the development of the market
1. Unsustainable business model
There is no incentive for Providers to invest capital or operational costs in an NDIS service, agency or satellite branch that is likely to become financially unviable. NDIA policy to reduce or eliminate Support Coordination budgets creates long term planning issues and a lack of job security. Small, mid-size and many larger Providers have no financial inventive to develop services or branches in the Bega Valley Shire where the pricing and market cannot justify this.
It is compulsory for Support Coordination providers to have Third Party Verification at considerable cost. This guarantees their suitability as providers of what is recognised as a complex service for vulnerable clients. It is a stated goal of the NDIA, however, to gradually minimise or completely eliminate Support Coordination from most Participants’ plans. Council’s Support Coordinators have already witnessed significant reductions in Support Coordination budgets after the first Plan reviews in recent months.
Likewise, Plan Management budgets are highly underfunded, only including funding of $98.12 per month for ‘processing’. Plan Managers are obliged to police payment requests for inconsistencies and fraud, yet no provision is made for funding this role.
Recommendation:
e Increase Plan Management allocations to reflect time spent resolving Portal issues, reporting fraud, investment in capital and dealing with complaints that are a direct result of external Portal issues
e Increase Support Coordination budgets to reflect actual and ongoing levels of need for many Participants
e Consider how developing new services, agencies and a competitive market is possible in regional areas and provide support to do so
2. Insufficient funding of Support Coordination and Plan Management in plans and the
resulting consequence that skilled Providers will also provide unpaid services
Support Coordinators have been expected to adapt to a continual series of new and unannounced NDIA processes and reporting requirements. Support Coordination budgets for Participants with high needs have been reduced, achieving no tangible results for Participants. Often these participants cannot articulate their needs and goals sufficiently, or their pride may prevent them from admitting to certain difficulties - leading to a further consequence that Support Coordination is reduced or eliminated in new Plans. This is particularly the case for Participants in need who received no Support Coordination in their first Plans, meaning that pre-planning for second Plans could not occur and a snowball effect is created.
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Council’s Participants, by nature of their complexity, often expended their first Support Coordination budgets long before the introduction of Plan Review Reports by the NDIA late in 2017. Discussion with other Support Coordination agencies confirmed the same. As a result, Providers have been pressured to either, a) provide services for free or b) refuse service to their most vulnerable clients who are then at risk of not receiving the Support Coordination they need in their next Plan.
Failure to fund travel for regionally based Support Coordinators means quality of service provision is compromised. Complex clients are often unaware of the gaps in Assistive Technology and/or services that may help them, so they may not think to ask. A home visit by a skilled Support Coordinator would be considerably more informative in assisting pre-planning and preparing for future Plans. It allows the Support Coordinator to identify the needs of a Participant through both conversation and observation, and to help them start thinking about goals.
For Plan Managers, funding in a Participant’s Plan often cannot be accessed for a multitude of technical reasons that are unique to each Plan. Core budgets are broken down into three categories that Plan Managers must know in order to make service bookings on the Portal, but Plans do not contain this information. The only way to resolve issues is to call the NDIA and hope that the respondent has enough knowledge to assist. Providers then face long delays in payment for services. Smaller local Providers have refused services for Participants whose plan budgets cannot be accessed.
Recommendations:
e Reimbursement for unpaid/unbillable hours spent resolving issues
e Breakdown of Core budget allocations in every hard copy NDIS plan and on Provider Portal
e Dedicated phone line for Plan Managers (specifically as opposed to general Providers) to contact NDIA Finance staff
e Travel allowance for Support Coordinators for at least two home visits per year: one at initial consultation stage and a second for resolving any service delivery issues that may arise
3. Distances between Participant and Provider a lack of funding for Provider travel in a
rural setting, reducing the quality and or provision of some supports
Providers of Support Coordination are not permitted to claim for travel under NDIS requirements. The main role of a Support Coordinator is to link the Participant with a range of Providers to help them achieve their NDIS goals and build their capacity to do so. Participants are often not even aware of gaps in their supports. Without a home visit where a Support Coordinator can view and assess certain gaps, there is a high risk that Participants will receive generic services that do not adequately cater to their individual needs.
Recommendation:
e Inclusion of travel allowance for Support Coordinators in regional areas
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4. The burden of Plan Management as a community service
Portal inefficiencies create an unnecessary waste of administrative time and make Plan management unprofitable. Council has become the Shire’s largest Plan Management Provider as a community service. Several other local Providers who forecast budgets based on original Plan Management allowances have found it unviable to continue this service and have ceased their provision of Plan Management.
Recommendation:
e Reappraise Plan Management budgets to reflect time spent resolving Portal issues; reporting suspected fraud; investment in capital; and dealing with complaints that are a direct result of external Portal issues
E) Any other related matters
1. Potential for Fraud
Plan Managed Participants can select Providers of their choice as long as the Provider has an ABN. If a Participant and Provider claim that a service was provided, there is little that Plan Managers can do about suspected fraud; unless, for example, invoices are received for services provided in locations that are impossible to attend at the exact same time.
In one case, Bega Valley Shire Council rejected invoices from a Provider who had been engaged by a Participant to make extensive property improvements. Council refused to pay these invoices because under NDIS terms and conditions, property improvements are not an approved service type. Neither the Participant nor Provider appeared to understand the difference between ‘maintenance’ and ‘improvement’ under the NDIS. Council explained the issue to the Provider and Participant so that they understood why Council could not pay these invoices or consider this type of service as legitimate under the NDIS.
In future weeks, the same Provider issued Council with invoices listed as ‘yard maintenance’. Despite our staff suspecting that the works were still property improvements, we could do nothing but accept the Participant’s word that the service provided was maintenance only. Insufficient funding of Plan Management services leaves no funding for time spent monitoring suspected fraud or reporting this.
Recommendation:
e Stricter guidelines for invoicing requirements and education for small Providers
e A review of funded Plan Management activities and costings in consultation with Plan Managers
e Consideration of the introduction of a new, unit-costed service type, such as ‘Plan Management Monitoring’, to be included in all Plan Managed Plans so that Plan Managers could monitor plans and encourage a higher level of accountability and scrutiny in Providers and Participants
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Contacts:
Angelique McKechnie
Support Coordinator
Bega Valley Shire Council
redacted
Kristina Brenner
Manager Children, Families & Ageing
Bega Valley Shire Council
redacted
Authorised by:
Anthony Basford
Director Community Relations and Leisure
Bega Valley Shire Council
redacted
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