5 March 2018 (Note: Extension approved)
Committee Secretariat Joint Standing Committee on the National Disability Insurance Scheme PO Box 6100 Parliament House Canberra ACT 2600
By Email: ndis.sen@aph.gov.au
Dear Mr Andrews,
Re: Ability Options submission on the Home Parliamentary Business Committees Joint Committees – Joint Standing Committee on the National Disability Insurance Scheme – Market Readiness
Thank you for the opportunity to provide comment on the Home Parliamentary Business Committees Joint Committees – Joint Standing Committee on the National Disability Insurance Scheme – Market Readiness that was issued by the Joint Standing Committee.
Ability Options provides person centred, whole of life supports to assist people at home, in the community, in education, with specialist and allied health, supported and independent living, transition to work and supporting people to find the job that’s right for them.
Accompanying this letter is Ability Options submission that contains our feedback, experiences and recommendations. If you would like to discuss any of the matters raised in the accompanying submission, please feel free to contact me either by phone on 02 8811 1712 or by email at Fred.VanSteel@abilityoptions.org.au.
Yours sincerely
redacted
Fred J P Van Steel
Chief Executive Officer
Ability Options
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Ability Options
Comments to the Home Parliamentary Business Committees Joint Committees – Joint Standing Committee on the National Disability Insurance Scheme – Market Readiness.
Contact:
Fred J P Van Steel Chief Executive Officer Ability Options
redacted: s47F - personal privacy
5 March 2018
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Contents
About Ability Options ……………………………………………………………………………………………………… 4
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The transition to a market-based system for service providers. ……………………………………… 4
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Participant readiness to navigate new markets. …………………………………………………………… 7
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The development of the disability workforce to support the emerging market. ……………….. 7
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The impact of pricing on the development of the market. …………………………………………. 8
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The role of the NDIA as a market steward …………………………………………………………………. 10
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Market intervention options to address thin markets, including in remote Aboriginal
communities………………………………………………………………………………………………………….. 11
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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. ………………………………………………………………………………………………….. 12
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The impact of the Quality and Safeguarding framework on the development of the
market. …………………………………………………………………………………………………………. 12
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Provider of last resort arrangements, including crisis accommodation. …………………………. 13
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About Ability Options
Ability Options began in 1976 when the Rotary Club of Guildford and the NSW Health Commission collaborated to enable people with intellectual disability to move from large institutions into their own home.
Our founder Greg McIntyre OAM was from Western Sydney and was passionate about ensuring people with disability led fulfilling and independent lives.
We provide person centred, whole of life supports to assist people at home, in the community, in education, with specialist and allied health, supported and independent living, transition to work and supporting people to find the job that’s right for them.
Ability Options is a strong and vibrant organisation with over 750 people working with us across all of our departments. Our Head Office is based in Bella Vista in Sydney and we have 24 sites across North and Western Sydney and the Central Coast, as well sites in the Hunter Region, and community partners on the Mid North Coast, and Northern Beaches of Sydney.
Ability Options would like to acknowledge the traditional custodians of this land, the Aboriginal people, and pay our respects to the Aboriginal elders past, present and future. Ability Options respect the significant contributions made by Aboriginal community organisations and groups, Aboriginal community members and Aboriginal employees.
Ability Options welcomes the opportunity to make the following submission to the Joint Standing Committee on the National Disability Insurance Scheme – Market Readiness.
- The transition to a market-based system for service providers.
The current environment of prices set by the NDIA is inadequate and as a consequence providers are unable to run financially viable operations in some key areas of NDIS supports. Ability Options feels that there has not been sufficient consideration given to the amount of expenditure required to transition from a block funded environment to a fee for service model. The additional complexity and lack of clarity surrounding the interpretation of the rules and regulations as well as the additional administrative burden placed on providers since the inception of the NDIS has resulted in significant increases in the levels of extra unfunded expenditure. This has resulted in the necessity to utilise balance sheet cash and asset reserves which negatively impacts other parts of the Ability Options business. The challenges experienced during the rollout phase has put significant financial stress on organisations.
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Ability Options has, and will continue to provide, support services to participants with the utmost level of dignity and respect, however, as a result of the move to a ‘fee for service’ model it has been necessary to make the very difficult decision to cease providing direct 1:1 support services in support categories 0001 and 0004. Costs incurred for recruitment, on-boarding, training, quality assurance, risk and compliance management, as well as marketing and many other costs are not funded under the NDIS. During the transition to the NDIS significant additional administration costs have been incurred to manage the NDIS systems issues and the delays in plan reviews and payments for claims has significantly contributed to the increased costs. For example, Ability Options along with other providers have invested significantly to build Information Communication Technology Infrastructure i.e. Customer Relationship Management, Customer Service Centre, financial systems and HRIS and we are all grappling with this whilst striving to build an efficient streamlined back of office setting in this high volume transactional environment.
Ability Options has had to employ a number of contractors and analysts to work through the many icees and challenges during the rollout. Ability Options has invested in excess of ten million dollars in the past three years to rollout the new program. Unfortunately, Ability Options can no longer continue with this situation and must focus on those parts of the operation where it can sustainably provide the most viable high quality supports to participants.
Unfortunately, it is the participant who, by no fault of their own, will suffer the consequences, being denied the choice and control to choose Ability Options to provide the service. Over the coming 5 months, this will impact over 650 participants who are with Ability Options. Further compounding the sustainability of providers generally, and Ability Options specifically, has been the significant impact of the extensive delays in the NDIA payment to providers for services delivered, together with the backlog in renewing plans and reviewing and authorising SIL (Supported Independent Living) quotes. Providers have had to fund the NDIA in respect of this unpaid debt, significantly diminishing their cash reserves and putting additional strain on the finances of these organisations. All service providers must ensure that they provide continuity of service despite the delays in receiving payment which has increased the financial pressure. Effectively the providers have become financiers to the NDIA.
There is considerable confusion amongst participants as to who has responsibility with regards to the renewal of plans. Many times Ability Options, where it is not the coordinator of supports but provides other NDIS supports, other participants should renew the plan but fail to take action which requires Ability Option to do the work before the first plan expires. This has occurred in approximately 80% of circumstances. This is an additional cost to the business for which it is not funded.
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Ability Options since our inception has provided quality Supported Living Options for people with disability. The process of SIL quoting has the effect of forcing the provider to bear the costs of administration and management of the home together with other costs. It has the effect of key workers then not being funded for completing their tasks to ensure compliance with their legislative obligations. There are also no provisions to fund the expense of Restricted Practice Panels or any of the related administrative preparation work for the submissions.
The SIL quoting process also has the effect of forcing ‘underquoting’. That is, Ability Options has to submit a quote and a copy of the roster without any overheads built in, which then results in a reduction of the number of ‘face to face’ hours provided once essential overheads are subsequently allocated. Unfortunately, this approach will result in a reduction of hours across the sector and may ultimately place participants at risk. This also creates significant delays in finalising plans and delays in receiving funding for services provided.
Some other key drivers that impact the sustainability and viability for Ability Options and providers include:
a) Award rate vs Reasonable Cost Model of 2.3 SCHADS award. For a large cohort of Ability
Options and sector workers, the model is flawed as the historic profile of casual workforce
was already on 2.4 SCHADS award;
b) The Recruitment, On boarding, Training and Coaching, as well as Marketing/ Branding are all
baseline business practices, unfunded within the current NDIS funded envelope;
c) Governance and compliance is unfunded;
d) The Proposed Provider Benchmark of a 9% back office is untenable in order to comply with
administrative and operational requirements to deliver supports as an NDIS Registered
Provider; and
e) The significant financial investment and ongoing development in Information Technology
Infrastructure and related compliance has been prohibitive to say the least. The successes in
the space is the agility required in order to respond to the scale in this high volume
transactional environment is just compelling, while noting the volatile landscape, Ability
Options had not fully contemplated the extent and range of significant transformational
developments that have subsequently impacted our Information Technology Infrastructure
environment.
Recommendations:
a) The Government and NDIA Board considers a set discretionary compensation
reimbursement to sector providers for the significant cost associated with preparation,
building and implementation of NDIS commercial interface; and
b) NDIA funds organisations to adequately implement, build, train and monitor relevant
compliance and safeguard outcomes.
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- Participant readiness to navigate new markets.
The NDIS is a complex social, political and economic reform which has become very complicated. Since 2013, Ability Options has had to navigate the significant transformation required for Government, other participants, sector providers and the general community. All participants are grappling with the complexities of the schemes implementation and this has had the effect of distracting from the core purpose of the NDIS.
The complexities of the system has created a number of issues for participants and the wider community. For example:
a) A failure to meet expectations. It is regularly reported that participants and the wider support mechanisms are left confused, overwhelmed, frustrated and saturated with competing opportunities by the Agency and Providers information across the community.
b) LAC Supports – since the initial implementation of the scheme in 2013 Ability Options receives feedback about the inefficiencies of the LAC partnership with the NDIA. There is confused messaging regarding roles and responsibilities between the LACS and the NDIA and a feeling of a lack of value for money during the ‘Activation phase of their plans’ provided by LAC’s. There is also a high attrition rate and a high number of inexperienced LAC’s which results in reduced responsiveness.
Recommendations:
a) Clear and consistent communication be disseminated across the different market segmentations,
participants, circle of support, carer groups, LACS, planners, sector providers
b) Review the effectiveness of the LAC contract in ensuring that the key stakeholder understands their
role and responsibility as part of plan activation, implementation and review, this is of the upmost
importance, especially with regard to key milestones around plan expiry and outcome measures.
3. The development of the disability workforce to support the emerging market.
A crucial issue for Ability Options specifically, and the disability sector generally, is attracting and retaining an effective workforce (this was identified in the NDIS Sector Report in 2017). The result is that the participants are not receiving the requisite level of support. Increased funding is necessary to alleviate the employment issues.
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The issue of limited people resources means that existing employees are working for multiple providers, working longer hours to cover vacant shifts and are suffering ‘burn out’ which results in a high turnover of staff. This, of itself, places a significant cost burden on providers in relation to on- boarding and training of new employees.
Other issues for the sector are;
a) The workforce is highly casualised and transient. This not only impacts employers with staff turnover but, just as importantly, the continuity of support for participants.
b) The market is highly regulated, yet does not provide adequate funding for staff training, professional development and career progress. Furthermore, many of the staff work in isolation and/or in remote areas.
c) Legislation penalises workers when working a second job across multiple organisations.
The cornerstone for the success in the NDIS market is and will be a highly trained, engaged and effective workforce. We will also need to improve the marketing reach to attract suitable candidates.
Recommendations:
We recommend consideration of the following:
a) the use of foreign workers;
b) better training opportunities for all staff; and
c) more effectively utilise the ageing workforce to redirect their skills to the disability sector.
- The impact of pricing on the development of the market.
A market economy relies on a system where prices are determined by the rules of supply and demand, rather than by government or other bodies setting price levels. In order to achieve this, the market has to be efficient, promote fair competition and enable market consumers to determine prices based on the principles of supply and demand.
Ability Options was a willing and early adopter of the NDIS, participating in the Hunter trial site and working with the NDIA from the early stages of rollout. Ability Options has always been a strong advocate of the NDIS and the potential to positively impact the lives of the participants to whom we deliver supports. However, throughout the trial stage and the subsequent rollout of the full NDIS, Ability Options has found that the scheme, in particular some of the NDIS funded supports, are unsustainable.
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One of the crucial impacts on pricing is costs and particularly wages costs. With the transition of FACS SDS the modelling was skewed due to the pay rates of staff being roughly 30% higher than SCHADS Award. Yet there is no recognition in the go-forward SIL quoting methodology under NDIS or the Monash Reasonable Cost Model for this different transferred Crown Award structure. Also significant concern regarding the SIL quoting process where there is a requirement for registered nurses, enrolled nurses, assistants in nursing to be recruited, obviously attracting higher rates of pay than direct support workers, and yet there appears to be no corresponding acknowledgement of the additional costs in the quoting process.
Historically, Not–for-Profit’s, as with Ability Options, have built a legacy on delivering 1:1 community and in home supports to some of the most vulnerable people in our communities. We are proud of our record and developed a costing structure to deliver these services based upon the then funding model. This is no longer sustainable.
Pre- 2013, the average output / funding for an hour of service delivered 1:1 supports under a State funding model was sustainable and it was extended as a result of innovation and responsive supports. A significant portion of funding was block funding, so there was a level of autonomy within allocation of supports based on needs in line with the funding and contractual agreement with Government.
The current pricing/funding model disregards the Commonwealth Fair Work and Award system and devalues the work undertaken to provide supports to people with disability by under valuing the capability of the workforce needed to supply complex supports at a high quality. This disregards the crucial aspects of WHS and the continued education, training and development of a transient workforce. The alarming concern, given the level of compliance and quality outcomes that are required to be achieved within the NDIS pricing and funding envelope are not feasible due to the lack of funding.
Historically in a non-Government space day program, funding included a provision for transport, thereby allowing accommodation providers to receive 100% of the mobility allowance and subsequently providing transport to and from day program/work/school. In the current climate there is a constant debate between providers in relation to claiming the Transport Allowance which, as a result, in the majority of cases the provision of the allowance is for community based activities which results in Accommodation providers having to rely upon the small contributions from board & lodgings to cover the annual expense of owning/leasing, insuring, maintaining and running a vehicle. The contribution equates to roughly $700 per person per year provided out of the board and lodgings or roughly 7% of their contribution is apportioned to transport costs. Once again this creates ongoing risks to participants as Accommodation providers consider the financial viability of maintaining a fleet with minimal funding.
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Recommendations:
a) Review mainstream NDIS interface with transport, health, housing, community services and
education. Government in consultation with NDIS registered providers review the COAG
principles in particular targeting the effectiveness and outcomes achieved where
participants can truly receive the supports they are entitled to as an Australian citizen.
b) Funding to be proportionate and relative to ensure appropriate recruitment, training,
development and compliance in line to achieve the standard required by the National
Quality and Safeguard Framework
5. The role of the NDIA as a market steward
The Agency’s ethical responsibility in its stewardship requires monitoring, evaluation, oversight and, where necessary, support and intervention, in pursuit of a sustainable and successful NDIS. Ability Options is committed to the principles of the NDIS, recognising that it is truly transformational, being the largest social reform since the Medicare implementation.
We note a number of crucial aspects:
Mainstream Interface - For participants to be truly included in their community, access to mainstream and specialist supports needs to work in collaboration. Too often participants and their circle of support express frustration and isolation as a result of the mainstream interfaces with NDIS participants. For example: Push and pull between Health and NDIS as to “who funds what” e.g., when individuals leaving the health system (i.e. hospital) are informed they need to seek NDIS funding for equipment and support when the reality is that their hospitalisation is attributable to their health needs rather than their disability. Other contentious areas include child protection and support, education, housing and transport.
NDIS Engagement and Support- “Listen, Learn, Build and Deliver” is the NDIA mantra. From the very beginning there have been issues in communication and consultation regarding areas of transition and in support delivery. The message received impressed the importance of not having any direct contact with the local NDIS offices, nor having access to specific emails or direct contact of local engagement representatives, which significantly increased the stress on providers and increased the need to contact the NDIA 1800 number.
Regulatory Requirements- NDIS Provider Assurance Program (‘Program’). The Program involves auditing for portal claims which, whilst we accept is necessary, creates a further unfunded obligation on providers. Ability Options has been responsive in committing to the requirements and timeframes provided to furnish the relevant evidence and documentation. In the Agency’s commitment to “stewardship” our firsthand experience shows that the Agency has yielded no outcome or recommendations from these external audits for Ability Options
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NDIA Portal Functionality – Sector interface - The interface between the sector and the NDIA portal could be significantly enhanced in functionality by providing providers with portal interface and reporting capability, this would create significant efficiencies for NDIS register providers, NDIA and participants:
the ability to have limited organisational edit capability to adjust a service booking in circumstances of user set up error and or individual participant requests to respond to choice and control within support categories and flexible supports
provide organisations the capability to extract reports to assist with organisational overview on plan utilisation – forecasting - resourcing
streamline NDIA administrative processes and participant frustration, where by at present there is a 14 day service booking update window set, before any changes can be updated on the NDIA portal
Recommendations:
a) NDIA implements true “Engagement Officers” forging organisational relationships with key
business stakeholders in the commitment to address operational and sector matters
prioritising pressure points i.e. claiming errors, portal issues
b) Strengthening and delivering consistent messaging across the NDIS regions regarding NDIS
policy and procedure practice
c) provide organisational / provider reporting functionality for participants that are in receipt of a
funded service
d) enable providers to have limited edit functionality to amend an existing service booking “be it an
organisational super user / champion”
6. Market intervention options to address thin markets, including in remote Aboriginal communities.
Engagement in the aboriginal community requires the provision of culturally appropriate resources and culturally capable staff. To this end, the employment of at least some aboriginal staff to work side by side with culturally capable non-aboriginal staff will generally result in higher engagement rates and better overall results.
To compliment this, education of the community about the services and resources and how they are to be accessed is essential. Attending community events and being seen as involved in and part of the community remains critical to build trust, the first step to quality engagement. It is all about consultation and connection.
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Recommendation:
a) If there is genuine desire to address and support this specific cohort, funded resources will be
required now and for the foreseeable future for the initial engagement and then to assist in building
capacity and capability into the future. Failure to do this and you could only reasonably expect short
term results and limited impact. It’s about developing self-sufficiency.
7. 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.
As at November 2017, 5,331 participants had received SDA payments and 403 dwellings have been registered for SDA – whether these are just new builds or includes existing / legacy dwellings is unknown. We suspect that the number includes all SDA so it includes existing and legacy stock as well as new builds.
The DRC (Disability Reform Council) requested the NDIS Board provide further information to the market and consider mechanisms to further encourage SDA investment. This statement suggests that the DRC is aware that SDA delivery, especially with new builds, is falling behind where delivery meets demand for new SDA. In order to stimulate further supply of SDA, we have been advocating throughout 2017 that there must be greater certainty around SDA payments. In particular, SDA payments either need to be “grandfathered” from the date a new build is registered or there needs to be a range set for the maximum price movement possible at a price review. Without one of these approaches there simply is not enough certainty of price continuity for banks or other financiers / investors to make investment decisions which in turn reduces supply. Ability Options is pleased that the Council has agreed to develop Terms of Reference for the 2018-19 review of the SDA framework which will establish a price setting approach.
- The impact of the Quality and Safeguarding framework on the development of the market.
Ability Options is committed to working with the Australian Government in the delivery of NDIS services and in doing so meeting the Quality and Safeguarding Framework (Framework). Specifically, Ability Options supports people with disability exercising choice and control so that they can meet their goals and improve their outcomes but recognises that consistency and quality in the delivery of such supports is vitally important. However, the disparity between the costs of delivering supports to participants and the funding received for such supports is widening.
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Ability Options also recognises that there can be a duplication of regulatory, contractual and other legislative requirements placed on NDIS service providers, in particular, for multi-state providers where there is a requirement to separately maintain compliance with state-based NDIS registration requirements. It is also anticipated that the new Framework will bring with it additional resource and cost impacts on the industry together with separate reporting requirements to the newly established Quality and Safeguards Commission, which would divert resources from the delivery of supports to our participants.
Recommendation:
a) In order to avoid additional resource and cost impacts as result of the implementation of the
Framework, and to continue to encourage providers to develop a disability workforce whilst being
innovative. Ability Options recommends that the disability sector receive additional funding during
the transition period, which is targeted at the professional development of the disability workforce
to ensure the ongoing viability of disability providers. We would also welcome any reduction in the
duplication and overlap of compliance requirements.
9. Provider of last resort arrangements, including crisis accommodation. As a large Coordination of Supports provider in NSW, Ability Options has been forced to address the reality of “provider of last resort”. Our past experience saw FACS historically as the Government body providing an incredible amount of funding in regards to crisis accommodation – it was previously funded through ERTP or Emergency Response Transition Program. Accommodation providers were tasked with finding private rentals to accommodate people in need in emergency situations due to relinquishment of service provision causing homelessness, the carer being unable to provide care or parent/carer dying. As there was never an option to complete compatibility assessments, the rates of pay for staff were much higher than usual due to the requirement to manage critical situations with little or no information on the participant. The cost of property damage was generally covered by the funding as this was a regular occurrence and capital commencement costs were also included. The result of this program was a number of ‘blocked beds’ as there was never a long term solution proposed prior to people moving into the accommodation. Consequently, these units became managed similar to a group home and less like a crisis unit.
There is a clear lack of tangible pathways for funded crisis accommodation options. Many questions arise such as who takes the lead in these situations? In Ability Options experience this is left with Support Coordinators who must navigate a crisis pathway for participants at the risk of relinquishment and/or homelessness with very few options outside the existing SIL guidelines. This includes, for example:
a) identifying NDIS registered SIL providers;
b) navigating other housing options: Department of Housing, private rental, emergency shelters, community shelters, emergency respite centres and short-term accommodation providers;
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c) in the event of identifying an NDIS registered SIL Provider, participants require the support coordinator to submit the following:
i. Change of Circumstances Form for SIL request;
ii. Offer of SIL;
iii. SIL Quote;
iv. assessments to determine capacity and active daily functionality;
v. life transition plan identifying the supports and services needed to assist in transition to
SIL; and
vi. NEST vacancy list of all providers / respite centres accessible to those in need of
emergency housing.
It is time intensive to complete these tasks but there is no choice as the participant may be homeless and emergency placement is necessary.
Ability Options respect that the underpinning principles of choice and control are absolutely important key drivers in the scheme but the complexities of the system mean that participants require significant support to navigate accommodation options and supportive documentation.
Recommendation:
Ability Options recommends the following:
a) a review of the process for securing emergency accommodation with the aim to simplify and expedite the process;
b) improve access to emergency brokerage funding; and
c) a panel approach to decision making with a targeted response/triage/governance framework so that the vacancy management is not in isolation to individual organisations.
Thank you for the opportunity to provide comment on the Home Parliamentary Business Committees Joint Committees – Joint Standing Committee on the National Disability Insurance Scheme – Market Readiness that was issued by the Joint Standing Committee.
We would welcome the opportunity to meet and discuss our feedback and experiences in further detail.
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