Submission to the Inquiry into the National Disability Insurance Scheme Bill 2012

From: To: Community Affairs, Committee (SEN); Subject: Submission to the Inquiry into the National Disability Insurance Scheme Bill 2012 Date: Thursday, 24 January 2013 11:05:39 AM

Please consider this email a formal submission by me to the Senate Standing Committee on Community Affairs Inquiry into the National Disability Insurance Scheme Bill 2012.

The current disability system has many problems that need to be addressed.

TO WHOM IT MAY CONCERN

I am writing on behalf of the NSW HMMS State Council, the peak organisation for Home Modification and Maintenance Services in NSW. Home Modification and Maintenance Services provide modification and maintenance work to people with disabilities. Under the NDIS, major modifications will be funded/completed as a part of the scheme participant’s package.

On review of the National Disability Insurance Scheme Bill 2012 No., 2012, the NSW HMMS State Council recommends wording is included in the legislation to ensure scheme participant who require major construction work are protected by law against unscrupulous contractors and that appropriate quality assurance mechasnisms are in place to protect and advocate on behalf of the scheme participants if required.

Please find an abstract below from the Executive Officer’s 2012 Annual Report regarding the NDIS and home modifications for your information.

Yours faithfully Stacey Sheppard-Smith Executive Officer NSW HMMS State Council

SECTION 3

POLICY POSITION

Individualised Packages and Home Modifications A Client Centred Approach is the ethos driving both the disability and ageing spheres for the future. Whilst this concept is an integral component of future service delivery, home modification service providers have specialised in meeting clients’ individual needs over many years through both the Home and Community Care Program and disability programs in each jurisdiction across Australia. Modifying one’s home creates a safe and accessible environment to ensure the continuum of safe independent living within the home environment. Additionally, home modifications are vitally important as they create a safe care base for care givers and care workers in the home. Home modifications therefore offer a cost effective option for governments to continue to provide care in the home on a long term basis. As a result, the benefits of home modifications cannot be underestimated. The introduction of individualised funding via a packaged environment will allow clients the ability to have greater control and choice over who will complete their modification work, i.e. an established service provider or a commercial contractor of their choice. Before a policy decision is firmly made regarding the above scenarios, the Government must carefully consider the implications of such a policy shift for home modifications particularly with regard to consumer

Protection Safeguards

protection and the level of safeguards put in place to support people accessing services under this system.

Historically, home modifications for clients have been completed by funded service providers in each State and Territory. Service providers act as a conduit between the client and tradespeople/contractors to ensure completed work meets the client’s needs, i.e. that the work has been completed commensurate with the Occupational Therapist’s specifications, that a high quality of workmanship has been attained and that the most cost effective solution has been achieved with finite amounts of available government funding.

Comparatively, with the introduction of commercial contractors (without service provider supervision), clients/carers will be responsible for accessing their own builders/tradespeople to complete the work. Therefore, in essence, the client/carer will become their own project manager, managing the work from start to finish. This is of concern to the NSW HMMS State Council on two fronts: firstly, will the client be able to access adequately skilled, licensed, insured and reputable tradespeople? And secondly, the client may not have a high level of contractual, technical, legal compliance and building knowledge required when completing major modification work. Careful consideration of the client’s capacity to manage such works must be considered prior to funding being allocated for modification work.

The NSW HMMS State Council cannot stress enough the importance of appropriate safe guards to ensure consumer protection particularly with regard to the vulnerability and often stressful environment of the client group. There is a very real threat that clients may not choose a reputable builder and tradesperson with the result that the outcome will not be favourable for the client. Rectification work may be required which could double the cost of the work, which packages may not be able to support.

In such circumstances, the client/carer could be required to endure lengthy arbitration and mediation to resolve the dispute adding yet another level of stress to their lives. Either the existing contractor or new contractors would need to be engaged to rectify the works with the client undergoing a further level of disruption to complete the rectification works.

In the instance where a service provider is managing the package on behalf of a client, the same circumstances may apply whereby the service provider may not have the technical and legal knowledge to manage and supervise construction work. Therefore, the need for an independent building supervisor would be necessary to advocate and manage on behalf of the client and service provider. This may ultimately be the role of HMMS in the future under a pacakaged environment.

Policy makers need to reflect on previous experiences of unregulated building schemes such as the bungled management of the Home Insulation Scheme and BER Scheme. Due to these schemes not being regulated and the lack of compliance, this resulted in excessive quotations and substantial rectification work. Thus an investment in quality assurance (i.e. monitoring work and outcomes) to ensure that appropriate safeguards and consumer protection are in place with regard to construction work must be of the highest priority for the Government.

With the above scenario in mind, the Government will need to carefully consider how home modifications fit into the future context of a packaged environment for both ageing and disability. If a mix of service providers and commercial contractors are the way of the future, the following points need to be considered:

The formulation of a clear, nationally consistent policy for home modifications to create true equity
The policy should reinforce modifications based on the clinically justified need of the client and not renovation of the home
The creation of a national accreditation system for builders and tradespeople

Major Modifications and Individualised Packages

The NSW HMMS State Council’s other major concern is the cost of modifications and the impact this will have on packages and whether a package will indeed be able to accommodate modifications, particularly major modifications in the future.

As modifications are influenced by commercial inflationary costs such as specialised sub trades and material costs, their cost will never remain static but will indeed increase. For example, the average cost of major modifications (Level 3) in NSW in 2011 was $42,208.51. This is a large sum to outlay but often necessary for clients with complex care needs.

For disability, the Productivity Commission utilised available home modification data from the Lifetime Care and Support Authority to estimate calculations for the total cost of the NDIS. It is important to note that the major modification program established in NSW in 2001 (which caters specifically for clients with complex care needs) calculated the average cost for major modifications in 2011-2012 FYE to be $42,000, which is above the $10,000-$30,000 cost reported in the Productivity Commission Inquiry Report Disability and Care Support. From data collected by the NSW HMMS State Council, it believes the Productivity Commission may have under-estimated the cost of home modifications for the NDIS.

Comparatively, the Federal Government may need to consider a different viewpoint with regard to major modifications and the ageing policy as the number of people receiving aged care services is expected to increase by approximately 250% over the next 40 years with some 3.5 million people (or 1 in 10 people) using aged care services by 2050.

As major modifications are costly and only finite quantities of funding will be available, the Federal Government may need to explore alternative options for funding major modifications. As Living Longer, Living Better promotes home-based care, major modifications will be a necessary component over the long term for this strategy to be effective.

An equitable user pays system has been flagged for the ageing policy to ensure sustainability. Therefore larger co-contributions or low interest loans for major modifications may need to be considered in the future context of ageing clients who require major modifications.

With the above in mind, one must ask if a care package can accommodate major modification costs or should funding for home modifications sit outside a packaged environment or should access be available to a capital pool of funds, held and managed by a lead agency in each jurisdiction of Australia for both ageing and disability programs. Clear policy pertaining to home modifications and the monitoring of works in a fully subsidised NDIS system and ageing system will need to be established to ensure the appropriate support and safeguards are established for the client and the on-going sustainability of the NDIS.

The main features of the NDIS that will make a difference to the community are:

People with a disability can choose the types of support to use,
People with a disability can plan their lives and pursue their goals and dreams,
Increased ability to coordinate services to suit the “whole” person/family

The most important services for the NDIS to provide are:

Equipment and home/vehicle modifications,
Support for families and carers,
Flexible in-home/outside home respite

I support the introduction of the NDIS.

As it will create a nationally consistent equitable scheme across Australia .

I agree for my submission to be made public

Regards,

Executive Officer Stacey Sheppard-Smith