Joint Standing Committee on the National Disability Insurance Scheme – Inquiry into Market Readiness
Leadership Plus Submission – March 2018
Leadership Plus sees many examples of issues of concern within each of the areas covered by the Market Readiness Inquiry, of particular concern to us, and closely related to each other, are the following critical items in the Terms of Reference:
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;
h. the impact of the Quality and Safeguarding Framework on the development of the market;
i. provider of last resort arrangements, including for crisis accommodation.
We are finding among our clients that the intersection of these issues demonstrate most critically areas where the market model that the NDIS is pursuing has yet to adequately provide for people with disability:
People with complex needs, are unable to find services even though they have the necessary
NDIS funding. We have clients who have the funding that is deemed appropriate by the
NDIS, and yet are unable to secure service providers willing to
provide the service. This is indicative of failure for the market to
provide the service (or market failure in a more general sense in
that the price of the necessary supports is not adequate to attract
providers).
Examples are:
o Agencies unwilling to provide services for participants with
complex needs, in particular residential services - funded
participants having to go without services for extended
periods due to unavailability of providers.
o Agencies not able to provide the coverage of services even
oniazid when willing to take on participants (e.g. not having
sufficient staff to fill shifts). We have clients who have
spent extended periods in hospitals due to inability of providers to supply workers
for necessary shifts. This results in limited and inappropriate supports, and of
course costs to the health system which are already provided for in the NDIS.
Huang Huang is a 56 year old man who lives with quadriplegia. With twice daily support for his personal care needs from two attendant carers, he lives with his sister in the family home. The two service agencies providing attendant care have been struggling for some time to roster appropriately trained staff, in part due to Huang’s complex support needs, but also due to the shortage of properly trained workers, a systemic issue for the sector. Because Huang’s shifts couldn’t be filled, he ended up in hospital while a new agency was sought. Our agency was involved helping to get the hospital to allow day release, which had been initially available then refused in a different ward.
This indicates that the market for providing this service is not adequate – providers are neither training workers nor paying sufficiently to attract them, and participants are left without the supports they need. o Existing Supported Residential Services clients not qualifying for SDA, and SDA arrangements not yet being fully understood by providers and hence unable to provide suitable services
Insufficient recognition of crisis accommodation requirements. There are situations where people with disability are in need of urgent accommodation: o As a result of processes in the transition to the NDIS, where existing client arrangements are not extended due to the advent of the NDIS, and no alternative process is available.
Absence of suitable provider of last resort services. Where there are complex needs, funded packages and no providers willing to support the participant, there is no mechanism to ensure that the participant is able to be supported. The consequences of this can be very serious for participants. For example, participants with mental health and behavioural issues have been refused accommodation by providers, and have ended up in detention and otherwise falling into the justice system. This situation would be avoidable were there a suitable provider of last resort arrangement in place.
Quality and safeguarding failures o As yet unclear enforcement standards on service providers with regard to commercial practices : Participant is paying provider A for day activity services, which are subcontracted to provider B. No specification is available to the participant as to what services are provided for the money paid, and requests to provide it are not responded to Agencies charging participants for clarifying the content of invoices to participants o Providers not staffed for adequate service provision due, apparently, to prices not reflecting the cost of funding the skills necessary to provide the service, insufficient staff training etc. Safeguarding and quality auditing ought to prevent this occurring but service quality is not adequately protected
Recommendations: In order to improve the market readiness of the NDIS, we suggest the following:
1. Formalise provider of last resort provisions, including:
a. clear pathways for participants, ability to notify the NDIA and for support in
accessing providers where the market does not provide suitable services
b. processes to ensure that services can be provided, with providers pre-identified and
pre-funded for complex needs participants.
2. Specific funding for crisis providers, responsive and appropriate access provisions, staffing
and assistance within the NDIA to support crisis situations.
3. Greater NDIA oversight of service providers, including ensuring appropriate commercial
practices for registration as a provider
4. Rapid deployment and enforcement of safeguarding standards, including easy and
responsive reporting and investigation
About Leadership Plus
Leadership Plus is a disability advocacy organisation based in Melbourne. We have particular
expertise in acquired brain injury and with culturally and linguistically diverse communities
Our mission is to advocate for individuals, ensure human rights and influence social change so that all people with disability may:
Exercise choice Have opportunity to reach their full potential Participate socially and economically
Leadership Plus promotes individual choice, the right to personal development and social and economic participation for people with disability. We believe that everyone benefits from living in an inclusive society that supports diversity.
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