NDIA Accountability Project

Experiences of AASW members working within the NDIS and surrounding service systems

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Submission to the Community Affairs

Legislation Committee

NDIS Amendment

(Getting the NDIS Back on Track No1) Bill

May 2024

SUBMISSION TO THE COMMUNITY AFFAIRS LEGISLATION COMMITTEE | MAY 2024 1

About the Australian Association of Social Workers

The Australian Association of Social Workers (AASW) is the national professional body representing more than 16,000 social workers throughout Australia. The AASW works to promote the profession of social work, including setting the benchmark for professional education and practice in social work; while also advocating on matters of human rights and discrimination to advance social justice and improve people’s quality of life.

The social work profession in Australia is based on an abiding respect for all persons and the principles of social justice and professional integrity. The AASW’s vision is one of “Wellbeing and Social Justice for All”. To fulfill this vision, the AASW works toward a society in which all people can thrive, develop their potential, contribute to their community, and pursue lives of meaning and purpose. In such a society, all people enjoy the fulfillment of all their rights under the International Bill of Rights (IBR).1

Acknowledgements

This submission is informed by the experiences of AASW members who work across all sectors and service systems. The AASW consulted extensively with members who work within the NDIS in multiple roles, members who work in other services which interact with the NDIS, and members who are NDIS participants. We heard their observations and analysis of the issues that affect people with disability, and their recommendations for improvement for the NDIS and the surrounding service system.

For further information or questions relating to this submission, please contact:

  • Author of the Submission
  • Angela Scarfe
  • Senior Policy Advisor

redacted: s47F - Personal privacy

SUBMISSION TO THE COMMUNITY AFFAIRS LEGISLATION COMMITTEE | MAY 2024 2

The context for this submission:

The social work profession

Social work is a tertiary qualified profession recognised internationally that pursues social justice and human rights. Professional social workers aim to enhance the quality of life of every member of society and empower them to develop their full potential. They consider the relationship between biological, psychological, social and cultural factors and how they influence a person’s health, wellbeing and development.

In all contexts, social workers operate from a ‘person-in environment’ perspective which recognises that individuals can best be understood within the multifaceted context of their environment.2 Social workers focus on individual, family, carer, and community strengths and needs. They take a holistic approach that includes the individual’s inherent physical and psychological characteristics, as well as the broader, cultural, social and economic aspects of their situation. With this perspective, social workers are well equipped to assess the capacities and needs of a person in interaction with their social, economic and physical circumstances. It can be seen that this approach is closely aligned with the understanding of disability that informs the United Nations Convention on the Rights of Persons with Disability (CRPD).

Having conducted their holistic, strengths-based assessments, social workers work collaboratively to support people to achieve their goals. Along with the person-in-environment approach to assessment, case management and care co-ordination has always been a core skill of the social work profession. For social workers, care coordination is about developing a relationship with a person that seeks to foster collaborative decision-making in order to develop care plans that address their needs, strengths, and goals.3 The similarity between this way of working with people and the goals of the NDIS, make social work a natural fit for many roles in the NDIS.

The NDIS Review

The AASW has an unwavering commitment to pursuing and defending human rights. Therefore, The AASW has always supported the NDIS as a rights-based approach that promotes the independence and the social and economic participation of people with a permanent impairment or condition. The original conception of the NDIS was that it should embody the central right expressed in the CRPD: the right to be the key decision maker in your own life. The values of ‘choice and control’ that underpin the Scheme are consistent with the values and principles of self-determination and empowerment that have guided the social work profession for many decades.

Unsurprisingly, social workers are present throughout the NDIS in a variety of roles, working as individuals or in organisations. Social workers are employed as planners, LAC’s, managers, and supervisors. Many are providing Co-ordination of Supports or Specialist Support Co-ordination.

Other services provided by social workers include:

  • therapeutic supports (individual and group),
  • early intervention supports for early childhood,
  • behaviour support (assessment and development of support plans),
  • assistance in coordinating or managing life stages, transitions and supports,
  • assistance to access and maintain employment or higher education,
  • assistance with obtaining or retaining accommodation and tenancy,
  • group and centre-based activities. Nevertheless, many AASW members have been disappointed that the original vision for the NDIS has not been adequately realized. Therefore, the AASW welcomed the NDIS Review with its emphasis on returning to the original vision based on the right of people with disability to be the primary decision maker in their own lives. The AASW concurred with many of its recommendations and welcomed its emphasis on a staged, and gradual implementation.

This bill is the first indication of the government’s response to those recommendations. Although we agree that the areas of the NDIS that this bill addresses were in need of reform, the AASW is equally interested in all the review’s recommendations; and how they will all be implemented. The details of each of the review’s recommendations will have consequences throughout the whole NDIS. Therefore, the following comments should be considered as the opening in a collection for a suite of responses to the whole package of reforms.

Responses to the Bill

In his Second Reading Speech for this bill, the Minister for the NDIS, The Hon Bill Shorten MP, outlined its four goals:

  1. that the NDIS provide a better experience for participants,
  2. that the scheme be restored to its original intent to support people with significant and permanent disability,
  3. that the scheme be equitable,
  4. that the scheme be sustainable.4

The AASW agrees that these goals require changes to the way that assessing needs, budgeting and planning are undertaken in the NDIS. They are fundamental to a participant’s experience of the scheme. We appreciate that enabling legislation is required to establish the mechanisms for these changes, but we are disappointed that this bill contains such scant information about the new arrangements, or even the process by which the new arrangements will be developed. Our comments on the following aspects of the bill are necessarily general and are subject to seeing the instruments, arrangements and formulae that the bill foreshadows.

4 (Shorten MP, 2024) SUBMISSION TO THE COMMUNITY AFFAIRS LEGISLATION COMMITTEE | MAY 2024 4

Item 14. New section 10 Definition of NDIS Support

In principle, the AASW supports the inclusion of a definition for ‘NDIS support’. We welcome the bill’s alignment of the definition with the provisions of the CPRD. By focusing on supports that result from impairment, we believe that this clause will assist the community and prospective participants maintain clear expectations about the scope of services that fall within the NDIS.

This measure represents a significant change from the current arrangement of a set of lists. While there are some services that clearly should be self-funded, there are other items which meet genuine needs, but which will in future be funded from sources other than the NDIS. We anticipate that this transition will be difficult for certain groups of participants. For example;

  • people with complex or unusual needs,
  • people whose disability is related to other factors as well as an impairment,
  • people who live in locations that are poorly served by services. The consequences of this bill will be that these people will need to have some of their services provided from sources other than the NDIS. The AASW is concerned that this transition will not be smooth or timely. The AASW is also concerned that other sources might not exist in the participant’s community, they might not be appropriate for the participant’s need, that they might not be accessible or that they might already have long waiting lists.

Many of these people are the participants with whom many AASW members are currently working as Specialist Support Co-ordinators. These members use their social work care co-ordination expertise skills to unite the disparate services in the participant’s plan into a coherent whole. Many who provide this service are familiar with the interface between the NDIS and other service systems. This gives AASW members a clear understanding of what supports and services will be needed from the services system around the NDIS.

This raises the question of the other recommendations from the NDIS Review: those concerning foundational supports, and the anticipated service navigators. The AASW welcomed these recommendations because they respond to concerns that that AASW members share. We have written before expressing our dismay at the shrinking of the community-based care system that has accompanied the implementation of the NDIS.5 Many of these services were recovery oriented, holistic, group based, inclusive and flexible. AASW members have observed that funding for these was withdrawn or reduced when the NDIS was implemented. These services had been staffed by multi-disciplinary teams, which included social workers who worked with the people with the people whose needs were the most complex.

We have also described the detrimental consequences of the atomization of the service system within and around the NDIS.6 Many of the people with whom social workers work have complex needs and are in contact with multiple other sections of the service system. Social workers have always been, and still are important in ensuring that people were in contact with the most appropriate and effective elements of the health and community services system.

With their holistic, person-centred approach, and their knowledge of the service system, social workers are needed by many people with compound health, mental health and disability needs.

It will be social workers who are assisting them to co-ordinate their care into a cohesive whole. In the case of current NDIS participants, the social workers might be employed from within either the NDIS or the health system.

Therefore, AASW members have significant contributions for the co-design process that will implement Section 10 of this bill, as well as for the process of implementing recommendations 4 and 7 of the NDIS Review. Noting the emphasis on co-design in the Minister’s second reading speech, the AASW looks forward to participating in this process.

Item 36 32E Flexible funding, or stated supports

The AASW welcomed the recommendation by the NDIS review that participants should have greater flexibility in how they spend their budget. We also recognise that the NDIS must achieve the appropriate balance between allowing for choice and control for participants on the one hand, while also ensuring that people receive the high cost supports that professionals and experts know to be effective. We appreciate that the combination of stated and flexible supports represents an attempt to strike an appropriate balance between these two, but we will be observing the implementation of this clause closely to ensure that it does not limit the rights of participants.

32H Possible alternative commissioning

AASW members who provide highly specialised supports to participants with complex needs, or work in rural and remote locations, or who are of Aboriginal and Torres Strait Islander descent have described the limiting effect of thin markets. They accurately conclude that the mechanisms of a market do not provide a guarantee of service. We have previously advocated for commissioning to be made available to ensure that this occurs. This clause has the potential to create a positive contribution to people with complex needs. The AASW will be closely observing the implementation of this clause to ensure that it is used for the purposes of providing services to participants whose needs would otherwise not be met.

32 K Reasonable and necessary budget

The process of determining the total funding in a participant’s budget is critically important to a participant’s ultimate outcomes. We note that the process is described as having 3 components:

  • Needs assessment,
  • The method of applying information in accordance with a yet to be specified legislative instrument,
  • Other factual information about a participant and where they live.

The bill does not provide information on how these critical processes will occur. By specifying only that the Minister will develop further instruments, this bill avoids indicating what the future of this vital step will look like.

AASW members have a significant stake in how this process will unfold. Their roles in the NDIS require them to be closely involved in implementing plans and ensuring that participants receive maximum benefit from their plan. The description above of social workers’ expertise in collaboratively developing plans of action demonstrates that they bring valuable skills to this process for the benefit of the people they work with, whether or not they are in the NDIS.

Therefore, the AASW welcomes the undertaking that the ‘relevant stakeholders’ from disability sector will be involved in designing the processes necessary to implement this section; and looks forward to participating in this process.

32L How assessments will be undertaken

The AASW agrees that there needs to be changes to the way that needs are identified; and we welcome the Minister’s stated intention that it be “Dignified, (and) person centred”.

Again, this step is critical to determining the experiences and outcomes of all participants. AASW members who work in the NDIS have observed that the method for undertaking these assessments vary greatly, and that this has significant consequences for the quality of individual plans and for the equity across the whole scheme. After the failure of previous attempts to reform this stage of the scheme, the AASW welcomes this legislation’s aim to impose rigour, reliability and fairness onto this process.

The Bill will allow the Minister to determine 4 matters about assessments. It is no co-incidence that these are matters on which AASW members have reported many inconsistencies. The questions of what the process of assessing needs will entail, how it will be conducted, by whom, and the role of participants, are all matters on which AASW members can provide important insights. This submission has already described the approach that social workers use to assess needs, and its congruence with the definition in the CPRD and the assumptions embedded in the NDIS. Therefore, the AASW welcomes the undertaking that the disability sector and professional experts will be involved in designing the evidence-based assessment tools. We look forward to contributing actively to the next steps in this work.

Prioritizing evidence-based supports in setting budgets

As this submission has already stated, the early stage of a person’s engagement with the NDIS is critical to their overall outcomes through the NDIS. Beyond the obvious consequences of determining their access to supports, decisions taken in the early stages have a profound influence on the participant’s capacity building potential.

The AASW endorses the removal of the distinction between primary and secondary disability. Members report that NDIA staff generally have an undeveloped awareness of the psychosocial consequences of physical disability and that it has been much more difficult to secure services for participants to deal with these needs. They believe that removing this distinction will make it easier for participants to receive capacity-building supports to assist them overcome the isolation and marginalization that accompanies a physical impairment.

For example: AASW members have experienced multiple instances where NDIA staff have not accepted the recommendations of assessors nor the wishes of participants about the supports and services that are necessary to build the capabilities of participants. The decisions have often been taken without communicating with participants or the workers involved with that participant. These instances fall into two types:

  • Instances where planners disagree that a service is needed by the participant, or disagree with the assessment of the duration, intensity or level of complexity of the service. Examples include planners determining that a diary to assist with timetabling would be sufficient for the foster carers of a Culturally and Linguistically Diverse child participant who entered the child protection system and needed to be re-located. The assessment had recommended that the child needed Specialist Support Co-ordination to assist with the transition to new services and ensure that each delivered a culturally safe, trauma informed capacity building continuation of the child’s previous services.

  • Instances where the NDIA staff agree that a service is required by a participant but they do not have a consistent and comprehensive understanding of the most appropriate, best

Conclusion

The AASW notes that this is the first piece of legislation arising from the NDIS Review, and we anticipate that subsequent pieces will be needed to implement other recommendations. Many of these recommendations will have consequences for social workers: those already working in the NDIS and those who work in the surrounding service system. For example, the proposed roles of navigators and lead practitioners align closely with the competencies of qualified social workers.

Therefore, the AASW believes that the reforms in this bill should be implemented in a way that anticipates the future reforms. Decisions taken now should not constrain or predetermine important future decisions. The AASW welcomes the Minister’s commitment to co-design of all stages of implementation and looks forward to participating in this process alongside all the other stakeholders in the NDIS. In that way, we believe that the NDIS can continue to fulfill Australia’s obligation under the CPRD to ensure that people with disability are the key decision makers in the matters that will affect them.

Submission to the Community Affairs Legislation Committee

| May 2024 | |

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Submission to the Community Affairs Legislation Committee

May 2024

For enquiries relating to the Submission, please contact: Angela Scarfe Senior Policy Advisor