8 March 2018
Joint Standing Committee on the National Disability Insurance Scheme (NDIS) PO Box 6100 Parliament House CANBERRA ACT 2600
Dear Committee
Re: Submission to the Inquiry into Market Readiness for the NDIS
Thank you for the invitation to make a submission to the Inquiry into Market Readiness for the NDIS. I offer this submission as a researcher who has worked with a number of providers of disability services since 2014. As part of this research, in the past 12 months we have conducted over 50 interviews with people with disabilities, their carers and providers of disability services in the lead up and transition to the NDIS. In late 2017 we also conducted a national survey of 1800 people with disabilities and carers about their feelings, preparation and expectations regarding the NDIS. The comments offered below are informed not only by my own observations but also the views and experiences of our research partners and participants. (Note that this research is not yet published, however some preliminary findings have been included in this submission).
Readiness of service providers
The preparation and transition to the NDIS has been extremely time consuming and labour intensive for providers of disability services. Some providers have created dedicated teams and hired new staff to manage the process effectively. For the most part, these new staff positions are not funded by the NDIS and service providers have had to find additional funding to support them.
The NDIS represents a significant change in the provision of disability services because of the shift from payment prior to service delivery to payment after service delivery. This has required a fundamental change to how disability services are provided and managed and agencies are still working through the processes and practices that will manage this optimally. Agencies acknowledge that they are still working through the issues associated with operating under the NDIS and expect that in coming months these systems will become more stable and the time required to manage them will reduce.
Key issues faced by service providers include the following.
- Systems and processes. The systems required to track the provision of services, and invoice them correctly and in a timely fashion, is recognised as critical under the NDIS. Some agencies have already invested in new information technology systems that can manage these processes and are currently working through the teething problems associated with any new
systems. Other agencies recognise the need to source more appropriate technologies that will enable effective delivery and management of services under the NDIS. Some agencies have deliberately not yet attempted to increase their client base because they are wary of doing so before they have the systems in place to support any expansion.
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Shifting the culture and mindset of staff. Many people choose a career in disability services because they want to care for and assist vulnerable people. Typically, their highest priority is ensuring these people have the services and assistance they need, which often involves a degree of flexibility in terms of meeting individual requirements on any given day. Staff have been particularly challenged by the notion that, due to the funding structure of the NDIS, they need to deliver only the services each participant is funded for. Not doing so could jeopardise the viability of the services being provided. This culture shift, particularly amongst front line staff who have direct contact with participants, has been a key challenge for agencies to manage.
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Supporting participants in planning and transition. There is great variability in the extent to which participants can effectively advocate for themselves or have someone who can do this for them. Agency staff have expressed serious concern about the welfare of people who cannot advocate for themselves. Where participants do not have strong advocacy, agencies have been performing this role in an attempt to ensure participant plans accurately reflect, and sufficiently support, individual needs. This has been a time consuming process but in many cases agency staff are the only ones available to perform this support role. This work is not funded by the NDIS and so agencies have had to find funding from other sources to support it. A similar scenario arises when participant plans are identified as not appropriate and therefore require review. A large amount of work is required of service providers in preparing for the review and much of this is not funded by government schemes.
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The financial viability of services. Agencies have had to closely examine the viability of the services they provide. This has been an adjustment for charitable organisations which have traditionally provided services based on individual needs rather than cost effectiveness. Previously, funding structures had a degree of flexibility that enabled less cost effective services to be balanced out by the more cost effective ones. However, the NDIS lacks flexibility in this regard and so some agencies have had to discontinue some services in order to remain financially viable in the longer term. If the majority of agencies make similar changes this could lead to a shortage of agencies willing to provide less cost effective services and gaps in service provision may emerge.
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Managing unexpected participant needs. Some cases arise where participants need unexpected services, for example emergency services. In these cases agencies often fill the need to ensure the wellbeing of the participant in the first instance. But they are then faced with a situation where, in order to pay for that emergency service, the participant needs to sacrifice other services agreed to in their plan. In this case this may have a serious impact on the wellbeing of the participant, or the participant may refuse to alter their original plan. In this case the agency may have no choice but to cover the cost of the unfunded emergency services.
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General support coordination. Service providers are finding that many clients require ad hoc support coordination at levels not covered by the NDIS. This might include, for example, arranging housing accommodation. In many cases even if support coordination is included in a participant’s plan it is often insufficient to cover actual costs.
Readiness of participants
There is much uncertainty about the NDIS amongst participants. There is a great deal of ambiguity and confusion regarding how and when people will transition to the new system, what options are available to them, how the system will work and process be managed, and what will happen after transition. There is also a degree of skepticism among participants regarding whether the government will be able to deliver what has been promised and whether there sufficient resources will be available to support such a scheme in the long term.
Many are unsure about what the NDIS will mean for them individually and the services they currently use and require. For the most part, participants just don’t want to be worse off than they currently are. Many participants are not being overly ambitious in trying to increase their levels of support under the NDIS, they are just focused on trying to ensure that it does not decrease.
A national online survey was conducted in July-August 2017 with 1800 people who make decisions about disability services but have not yet transitioned over to the NDIS. The sample included people who either (1) have a disability themselves or (2) are carers of people with disabilities and make decisions on their behalf. Some key insights regarding their transition to the NDIS are summarised below.
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Feelings about transitioning. When asked how they feel about transitioning to the NDIS participants were more likely to cite negative feelings than positive ones. For example, 62% report feeling confused, 59% feel anxious, 56% feel worried and 53% feel stressed. Conversely, only 21% of people feel excited, 26% feel relaxed, 29% feel happy and 46% feel optimistic about the prospect of transitioning.
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Sourcing information about the NDIS. Of those people who have a current provider of disability services, 30% report having received information from their provider about the NDIS, 70% had not. Of those who have received information, 73% believe they have been given about the right amount of information and 22% believe they have not been given enough. When asked where they would go to find information about the NDIS, the majority (75%) would use the internet, 30% would call the NDIS hotline, 30% would contact the appropriate government department and 29% would contact their current service provider.
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Planning. In planning for the NDIS, 45% of participants had not yet thought about their personal goals at all, and 82% had not collected any information to use in their NDIS planning meeting. 57% indicated they planned to manage their NDIS funding themselves.
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Expectations. Overall, 42% of participants expect that under the NDIS their lives will be pretty much the same. 39% expect it will be a bit different for them, while 19% expect it will be very different. More specifically, o 29% expect that the quality of services will be better under the NDIS, where as 40% expect that the quality will be the same or worse (32% don’t know). o 19% expect that they will be financially better off under the NDIS, whereas 47% expect they will be financially worse off or the same (34% don’t know).
Perceived readiness of the NDIA
There is a perception amongst participants and agencies that the NDIA is under-staffed and under-
resourced. Service providers report having called the NDIA with queries and not having the question answered, or receiving different answers from different parts of the organisation. Overall the NDIA is perceived as being somewhat chaotic, like they are ‘chasing their tale’ just as much as everyone else. It appears to participants and service providers that as an organisation the NDIA is struggling to keep up with the change and the volume of work. Service providers and participants see little evidence that the NDIA is effectively acting as a market steward for more vulnerable participants who do not have effective advocacy.
I would be happy to discuss any of the matters raised in this submission at your convenience.
Yours sincerely
Dr. Melanie Randle Associate Professor of Marketing