STAFFING OPTIONS SUBMISSION TO THE NDIS AMENDMENT BILL 2024

Introduction

Staffing Options is a registered NDIS provider, delivering assistance with daily life and community participation supports as well as Support Coordination and Plan Management services. Core services and Support Coordination are predominantly provided in Brisbane, the Sunshine Coast & Gympie in Queensland. Our services have been provided in these areas for 25 years and have not expanded since the NDIS came into operation. Our Plan Management team provides services more widely across Queensland, mostly based on pre-existing relationships.

Staffing Options’ mission is and has always been to ensure people have authority over the supports they receive, can live their lives in the way they choose, in their own homes and communities, and are supported in innovative and flexible ways. The amendments outlined in the Getting the NDIS Back on Track Bill significantly challenge our ability to stay committed to this way of working with people and make our team feel uncertain of what the future of this industry will look like and our place in it.

Three focus areas underpin the work of the Support Coordination team: Home, Valued Roles, and Relationships. Staffing Options’ process of working with people has four components:

• Explore: vision, focusing on gifts and interests, working together, thinking typical.
• Design: understanding and prioritising needs, developing a vision and plan for a good life, separating the roles for informal and formal supporters.
• Deliver: shared management, meeting needs with focus on how, who and in what settings, creating teams and sustainable supports.
• Review: what’s working well / what’s not, life transitions, new and unexpected needs, succession planning.

We believe that our approach aligns strongly with the foundational principles of the NDIS. Our struggle to maintain this focus demonstrates to us how far the gap is between the conception and implementation of the NDIS.

KEY CHALLENGES

Based on the changes outlined in the Explanatory Memorandum, we have complied a response to the suggested reforms. Our overwhelming view is that the tabled Bill lacks a sound foundation and fully developed concepts that if legislated, will result in the erosion of human rights and opportunities for people with disability to have the same quality of life as other Australians. The suggested budget-focus will jeopardise the choice and control for NDIS participants, fostering greater system distrust and the exclusion of people with disability. This comment from an NDIS participant aligns with our broader organisational position:

“All that is good about the NDIS, and that improved my limited quality of life, now appears to be under threat”. This Bill reads to Staffing Options and our community as intending to reduce the cost of the scheme by increasing the barriers to receiving funding as well as decreasing the services paid for by NDIS funding. The long-term impact of this short-sighted economic decision will generate disastrous intersectionality for decades to come.

Requirements, rules, methods and criteria – What is happening?

Our service delivery experience and research show there are many structural barriers to people receiving NDIS funding, including homelessness, location, stigma, assumed communication capacity and a lack of culturally appropriate services. These elements MUST be considered in the system redesign to prevent the exclusion of already marginalised populations and the compounding of disadvantage. As well as the fact people currently receiving funding have to bend over backwards to ensure they receive the appropriate funding year after year, all while the price guide continues to rise. As we continue to support people in situations with escalating complexity, the increasing system ambiguity strains our ability to provide comprehensive and quality information and guidance. Without drafts of these new Rules or determinations, we are unable to prepare for the changes in implementation, fearing that the significant shift will result in the exclusion of people who are currently receiving NDIS and detrimental implications for participants. Service providers and participants need clarity and guidelines in order to successfully navigate ruptured changes. What is not clear based on community feedback is:

• Who is developing the new tools?
• What information/framework are they using to inform development?
• How will they uphold the original intention of NDIS to provide insurance against the cost of support for ALL Australians in the event of acquiring a significant disability?

More clarity from the NDIA and Government

is necessary because people with disability, their families, support networks and service providers are being expected to adapt to significant legislative changes with so many unknown or yet-to-be-determined factors.

‘Reasonable and Necessary Budget’ & NDIS Supports

We recognise the shift away from ‘reasonable and necessary supports’ as stemming from the Review feedback that this term can contribute to inconsistent/inequitable funding decisions and disputes between participants and the NDIA. With this in mind, we view it as a questionable decision to transform this term to ‘reasonable and necessary budgets’ without including greater conceptual clarity about the meaning of this term and more transparency surrounding the tools that inform decision making.

Revisiting this definition and determining the assessment tools prior to approving the Bill would be valuable in reducing convolution and inequitable outcomes for Australians living with a disability.

The introduction of ‘new framework plans’ has also added to the confusion and frustration of the community members and service providers, who are unsure how this will be rolled out incrementally and the impact that will have on current supports and what is included in NDIS plans.

The replacement of the existing eligibility tests with the definition in clause 10 also has significant impact to service provision and the supports available for people living with a disability. This restrictive definition limits what participants are able to spend their funding on, which reduces choice and control and could have vast unintended legal ramifications. The cherry-picking of some elements from the CRPD leaves important areas outside the scope of funding, such as supports that would specifically facilitate a participant’s economic participation, which will have ten-fold impacts on the Australian economy as a whole.

Taking a budget-focused approach over a person-centred one has enormous impacts on the livelihoods and wellbeing of our most vulnerable populations. The funding of supported independent living (SIL) support in ratios such as 1:3 mean that people living with a disability almost never have the opportunity to exercise choice and countrol in the planning and delivery of the shared elements of their supports. These atios, determined by a complex economic instrument, undermine people’s fundamental human rights, forcing them into a position of dependence on a service provider, often without consultation. SIL ratios actively undermine the intention of NDIS to promote the provision of high quality and innovative supports that enable people with disability to maximise independent lifestyles and full inclusion in the community. SIL maintains the congregation of people with intellectual and cognitive disabilities, and those with significant physical disabilities, in forms of accommodation

Needs Assessment Process

“It is so disheartening. As like many others, we have advocated incessantly for Dylan* with NDIS, including review of an NDIA decision through the Administrative Appeals Tribunal, to secure his current level of funding and now it seems we may have to do it all over again.” – Parent of a NDS participant

The proposed needs assessment process brings more challenges for service providers who value the individuals they work with holistically. Demanding people fit themselves into the restrictive requirements for disability or early intervention support imposes unnatural divisions of complex, interrelated disabilities, and poor health outcomes. This reduces a person’s humanity in the eyes of the system and does not uphold respect for the inherent dignity, individual autonomy or full realisation of all rights as outlined in the CRPD, of a person living with a disability into consideration.

The ‘needs assessment’ would not be a ‘reviewable decision’ under section 99 of the NDIS Act and cannot be reviewed through internal or external review. As well, it goes against the NDIS Review findings and does not ensure that a participant has the opportunity to see the needs assessment report before it is ‘given to the CEO’. The Bill proposes allowing the NDIA to restrict how a participant can spend flexible funding

In a new framework plan and gives the NDIA more power to deny a participant’s plan management request, which removes choice and control. The Bill does not make it clear who will conduct the needs assessment, nor is it clear what a participant can do if they do not agree with the outcome of the need’s assessment. The NDIS Review stressed that the decision should be made by an allied health practitioner or social worker with disability expertise, which we fully support as long as there is an appeal mechanism in place.

The tabled process lacks natural justice and protection measures for participants in the instance of biased or unfair rulings, which reduces choice and control. The process currently allows room for human bias and error, contributing to the discrimination and exclusion of people living with a disability from the Scheme in the name of ‘curbing cost blowouts.’ We suggest a redesign of the NDIS price guide and revaluation of the service agreements and cancellation policies put in place by allied health professionals and service providers, alongside an increase in accountability measure for gatekeepers and decision makers.

As we carry the load of increasing rates of disease and chronic illness, Australians’ volunteerism capacity in turn shrinks, due to the altruistic population struggling with the cost of living. This erosion of the formal and informal social welfare support, coupled with the increasing demand for social and health services, mean we are going to have more and more Australians not having their wellbeing needs met.

It is vital to invest in the future of our communities today, as opposed to restricting funding now, only to spend even more money when these problems are exacerbated in the foreseeable future.

Gross imbalance of power between executives and participants: Keep Support Coordination

The Bill entrenches hierarchy into the development and implementation of the NDIS reforms, which guarantees poorer outcomes for NDIS participants who will rely on the value framework of two individuals and their staff. The NDIS Minister and Chief Executive Officer of the NDIA would hold extraordinary powers granted by the Bill, with limited Parliamentary oversight, including the ability to make decisions that will determine the method for calculating budgets and how needs assessments are conducted. Also, the NDIS will receive new powers to request information and impose punitive consequences if this is not provided, including suspending or revoking a participant’s status, which moves in the opposite direction to the recommendation from the NDIS review to adopt a trust-based approach.

Our staff and community are highly concerned about the quality of decision making, as the Bill states the CEO must read all participants’ needs assessments and allied

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health reports before coming to a decision on a person’s eligibility. As well the CEO must make determinations within 14 days of receiving the assessment, which is an incredibly idealistic timeframe considering we are supporting people who are currently waiting months to hear back from the NDIA after lodging a Change of Situation (S48) and Review of a Reviewable Decision (S100) reviews.

• How does a single person have the capacity to make well-considered decisions that impact the life quality and trajectory of millions of Australians?
• Who else will be making these decisions when the CEO is inundated?
• What safeguards are in place to ensure the accountability of decision makers?

We recommend that decision making powers are shared amongst a committee, as opposed to an individual, which are overseen by a review board to ensure that decisions are made in the best interest of people, not short-term, politicised budgets.

As well, when considering the changes to the eligibility criteria, needs assessment and agency powers, it seems ill-advised to remove the role of Support Coordinator and replace this gap with Navigators. SC’s are already highly skilled in navigating the complex system and many do not wish to move into this new role, feeling that it will increase their already large workloads, jeopardise the relationships they have spent years building with participants and families and limit their flexibility. SC’s act as one layer of quality safeguards, wanting the best for the people they support and having a thorough understanding of their needs while working independent to the NDIS. Our community wants to know:

Who will fill the role of Navigators if not Support Coordinators?

Overall, this Bill suggests so many steps backwards for the sake of short-term economic interest, while speaking over the voices of people with lived experience who cry out ‘community is the answer’. Criminalising service users while increasing the convolution of the Scheme is a recipe for disaster and follows the same pathway as Centrelink and Robodebt. The way to get the NDIS back on track is not to abandon the principles and ideals that contributed to its birth, it is to align with and uphold them more strongly.

Recommendations:

1. Far greater transparency around the development of new requirements, rules and decision-making methods. Develop clear and accessible guidelines to communicate with the sector within no more than 6 months of the legislative change.

2. Collaborative practice: Open up the development process to people with diverse knowledge, skills and lived experience as opposed to solely legal and financial professionals making decisions.

• Form a taskforce, inclusive of people with disability, family and carers, to provide input during the development of criteria, rules and needs assessments.

• Increase the training of professionals and staff working at the NDIA andwith persons with disability to better provide assistance and services guaranteed by the CRPD in its entirety.

3. All levels of Government must take responsibility to ensure all mainstreamand community services are accessible to all.

• A formalised, coordinated response model for all government agencies, including housing, health, education and justice. This would ensure there are no gapsfor marginalised groups of people to slip through and no confusion about ‘whose job it is?’

• Stream-line the system: Complexity makes it more difficult to ensurerules are being followed, and allows for people to exploit the system.Decreasing the complexity would significantly increase its successful outcomes and be value formoney.

4. Uphold natural justice: There must be an appeal mechanism to safeguardparticipants from biased or unfair decisions. This must be separate from theNDIA and enforce agency accountability to protect Australians from discriminatorydecisions. Legislation must provide clear and straightforward rights for aparticipant to receive the needs assessment before it is finalised toensure it accurately reflects their needs and circumstances, and to request anew needs assessment where appropriate.

5. Take a trust-based approach: Restriction of funding or plans should only applyin cases of intentional and repeated non-compliance. Information-gatheringpowers should be limited, with greater limits on the type of information thatcan be requested, and restrictions on the severe consequences of failingto comply with information requests.

6. Share the decision-making load: Decision makers should be a part of a committee or unit that is made up of experienced and qualified people with expertise in this area, including industry professionals and community members, as opposed to the singular CEO.
7. Keep Support Coordination: There is a great need for highly skilled people independent of the NDIA to oversee the use of funding, facilitate relational practice and gauge whether particular supports are meeting the participants’ needs. The role of navigators could function alongside Support Coordination but the role does not even begin to cover the scope which SC’s fill.

• Current set up of SC allows for participants to have choice and control over their support coordinator. The diversity of support coordinators in the community gives people choice allows them to find the right fit for them. It also allows for participants to change who supports them in this role at any time.

8. Reform the price guide: We continue to hear from our community that allied health services and support providers are overcharging and this threatens the financial viability of the Scheme. SIL providers are under no obligation to reimburse unspent funds once they have extrapolated the yearly costs for a participant. The issue of overspending lies not with the participants, but with the price guides and providers.

• Remove SIL from the Scheme and replace it with stronger individualised funding packages which give people the freedom to explore more autonomous accommodation arrangements.
• Review the profit margins of large NDIS housing and support providers

9. Much more preparation before rollout: Spend more time engaging in credible research and community engagement to conceptualise how the proposed changes will impact the lives of millions of Australians living with a disability, their families and support networks.