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NATIONAL DISABILITY
INSURANCE SCHEME
BILL 2012
SUBMISSION TO THE SENATE
STANDING COMMITTEES ON
COMMUNITY AFFAIRS
25 JANUARY 2013
Therese Adami
Chief Operations Officer
Helen Wilson
General Manager
Business Development and Research
Jasmine Calleja
Portfolios Manager, Disability
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Introduction
The KinCare Group (KinCare) supports the implementation of a National Disability Insurance Scheme (NDIS), and welcomes the opportunity to provide feedback on the National Disability Insurance Scheme Bill 2012 (NDIS Bill). KinCare has reviewed the NDIS Bill and Explanatory Memorandum against a framework of person centred pursuit of quality of life, balanced with the necessity for a sustainable NDIS that integrates effectively with the existing service sector and life experiences of people with disability.
KinCare is a national organisation, specialising in the provision of in-home care and community based support services for people with a disability, age-related conditions and other health care needs. KinCare‟s Home Care Division supports over 9800 clients across seven States and Territories.
KinCare‟s person centred practices are encompassed in our Quality of Life Philosophy;
recognising that individuals with a disability are likely to experience a reasonable quality of life when the following six life domains are working well:
Achievement Health Independence Security
Social Connection
Standard of Living
This philosophy aligns with the UN Convention on the Rights of Persons with Disabilities, the
Draft National Standards for Disability Services, the Social Inclusion Principles for Australia, and
the General Principles reflected in Section 4 and Section 5 of the proposed Act outlined in the NDIS Bill.
KinCare recognises the NDIS Bill as a solid foundation for the much needed reform of the disability services sector and „consumer‟ experiences of people with disabilities, with some minor adjustments. Our submission includes comments, observations and recommendations relating to
the reform of disability care and support currently underway, implementing the NDIS, the
participant journey, and sector capability. These are necessarily limited by the reality that the NDIS Rules and NDIS Launch Transition Agency (NDIS LTA) Guidelines are not currently available for comment. It stands without question that a review of the NDIS Bill in the context of proposed Rules and Guidelines would have produced a more robust and participant focussed
submission containing commentary on anticipated experiences of people with disabilities
accessing the NDIS, and their families and communities.
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Reform: Disability Care and Support The evaluation of the current disability support system conveyed in the 2011 Productivity
Commission Inquiry Report on Disability Care and Support is both confronting and fair.
Traditionally, the disability services sector has been marred by systemic inequities and
inconsistencies that fail to support people with disability to pursue or experience their desired quality of life across their lifespan on their terms (Australian Productivity Commission, 2011). KinCare recognises the need for Government „intervention‟, or legislated whole of industry reform, if people with disability and the wider community are to benefit from affordable and appropriate care and support, and if moreover, Australia is to benefit from greater productivity and social return on investments in the care and support of people with disability (Council of Australian Governments, 2012).
KinCare welcomes the NDIS guided evolution of the disability services sector, and the NDIS Bill‟s inherent capacity to execute aspects of the UN Convention on the Rights of Persons with Disabilities (the Convention) ratified by Australia on 18 July 2008.
As articulated in the National Interest Analysis of the Convention, no new rights are bestowed by the Convention; rather it is a mechanism to facilitate the application of pre-existing human rights to those with disabilities on an “equal basis with others” (National Interest Analysis: United Nations Convention on the Rights of Persons with Disabilities, 2008). KinCare strongly believes that the NDIS, as set out in the NDIS Bill, will transition the disability services sector and wider community‟s awareness of, and approach to, people with disability from care recipients to self determining participants.
KinCare is pleased that the disability services sector and all levels of Government are collectively taking action on the Convention, and believes that the NDIS Bill and its implementation will see the realisation of more equitable application of the basic set of human rights adopted by Australia in 1948 (United Nations, 1948). The NDIS Bill actively supports delivery of “Outcome B: People with disability enjoy choice, wellbeing and the opportunity to live as independently as possible”
established in the current (7 December 2012) National Disability Agreement (Council of
Australian Governments, 2012).
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- Implementing the NDIS KinCare supports the general implementation principles outlined throughout the NDIS Bill, and recognises that Section 4 and Section 5 specifically guide activities of the NDIS and NDIS LTA, along with all others who “do acts or things on behalf of others” with disability (National Disability Insurance Scheme Bill 2012, 2012). These principles echo the draft National Standards for Disability Services‟ focus on the rights and experiences of individuals with disability and their pursuit of self-determination across the lifespan (Secretary to the Victorian Department of Human Services, 2012).
On reviewing the NDIS Bill, KinCare recognises that the scope of judgement assigned to the Chief Executive Officer (CEO) of the NDIS LTA is significant, yet practicable. Whilst this may be seen to afford the CEO the opportunity to inspire a more responsive NDIS LTA in each of the
„host jurisdictions‟, KinCare appreciates that participants may believe that this operational
discretion could give rise to actual or perceived inequities in access and provision; and thus fail to negate major flaws in the current disability care and support environment – systemic inequity and
inconsistency (Australian Government Productivity Commission, 2011). Given that CEO
decisions regarding reasonable and necessary care and support require a certain degree
of interpretation, it is important to ensure that the CEO‟s „discretion‟ does not
inadvertently negate the NDIS‟ design to deliver reasonable and necessary supports through an insurance approach.
The CEO considerations of what is reasonable and necessary, itemised in Section 34 are commensurate with those used in other insurance schemes such as Compulsory Third Party Insurance. As such, they provide a broad base for determining appropriate supports; however KinCare recommends an additional parameter be included to reflect reasonable and necessary supports “are required to maintain an equitable standard of living”.
KinCare hopes that legislation of the NDIS Bill will be supported by bipartisan agreements
for the continuation of the NDIS beyond the launch/trial phase between the
Commonwealth and individual State Governments.
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The Participant Journey In view of the NDIS Bill, KinCare appreciates that the (potential) participant journey will typically follow the path reflected in Figure 1. The 3rd phase, „Good Life Future‟, represents KinCare‟s expectation that people participating in the NDIS will experience an improved Quality of Life, improved measures of resilience across the lifespan, and increased productivity (both personal and vocational) as a result of the care and support delivered to them through the NDIS. This also
reflects the design and outcomes of the local area coordination model apparent in the
implementation design conveyed by the NDIS Bill, and successfully operating in Western
Australia for the past 25 years (Bartnik, 2010).
NDIS
Participation
•Awareness •Quality of Life •Capacity Building •Resilience •Self-determination •Productivity •Care and Support
General Good Life
Supports Future
Figure 1: Depiction of NDIS Participant Journey and Outcomes (KinCare)
The Access Criteria outlined in the NDIS Bill are broad; however, KinCare recognises that the NDIS Bill does not adequately address the NDIS‟ capability to support capacity building and self actualisation of individuals with disability and their surrounding communities. For example in addressing the parameters of the NDIS‟ early intervention functions, Section 25 cites eligibility based simply on need for intervention in cases of decline or carer resilience building. KinCare proposes that Section 25 adopt a strength-based approach and acknowledge the role of the NDIS to provide early intervention to support capacity building in people with disability.
Furthermore, KinCare observes that continuity of care may not be adequately addressed. Section 22 asserts an age requirement of less than 65 years at point of access request, whilst Section 29 suggests that persons aged over 65 years and in receipt of community care on a permanent basis cease to be eligible for participation in the NDIS (National Disability Insurance Scheme Bill 2012, 2012). Whilst this may appear clear on first reading, this arrangement does not address the potential for people to inappropriately seek and be granted access to NDIS funds just before
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turning 65 years, where the NDIS LTA is perceived to provide more care and support than local aged care providers.
In light of this, KinCare must express concern that the NDIS Bill does not seek to formalise or enact a continuum of care between the disability and aged care systems that supports individuals with disability as they age – a systemic parallel recognised as important in avoiding cases of „falling between the cracks‟ of two service systems, or seeking unreasonable/inappropriate care and support from an ill-equipped sector (Australian Government Productivity Commission, 2011). KinCare proposes that the relationship between the disability and aged care systems be addressed through the NDIS Rules or NDIS LTA Guidelines, and publicised to promote awareness.
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- Sector Capability:
Registered Providers of Supports
KinCare supports the Council of Australian Governments (COAG) Regulation Impact Statement‟s calls for disability service sector preparations to meet the self/consumer directed design of the NDIS Bill and associated NDIS LTA. This impact statement also suggests that the disability sector may need support to make these preparations and evolve paradigms and models of care and support (Council of Australian Governments, 2012).
KinCare anticipates that market failures will be a significant pressure on the disability services sector. Further clarity within the NDIS Rules around the NDIS‟ role in responding to market failures within related sectors may be necessary. Some sectors of concern include:
Aged Care
Disability Services
Education
HACC
Housing Insurance
Acknowledging that this may be within the NDIS LTA Guidelines, KinCare seeks further
information about how market failures in „more appropriate‟ sectors will be managed to ensure that a NDIS is not used to inappropriately fill service gaps that could be addressed/prevented through other measures.
Guidelines around expected service sector interactions are also required, as this will support clear delineation of the roles of different service providers, and contribute to community capacity building initiatives. These will need to be broad enough to remain relevant with changes across other related sectors.
Access to proposed NDIS Rules and NDIS LTA Guidelines will inform service providers‟ self directed evolutions and self-assessment of progress. This will be necessary for service providers to play a more active role in informing their existing service users and community about the NDIS and the foreseeable future of disability care and support.
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Conclusion
In principle, KinCare supports the NDIS Bill as an instrument of industry reform. However, to strengthen the impact of the NDIS and associated disability services sector reforms, KinCare makes the following recommendations:
Recommendations for Implementing the NDIS o Given that CEO decisions regarding reasonable and necessary care and support require a certain degree of interpretation, it is important to ensure that the CEO‟s „discretion‟ does not inadvertently negate the NDIS‟ design to deliver reasonable and necessary supports through an insurance approach. o An additional parameter be included to reflect reasonable and necessary supports “are required to maintain an equitable standard of living”. o Legislation of the NDIS Bill be supported by bipartisan agreements for the continuation of the NDIS beyond the launch/trial phase between the Commonwealth and individual State Governments.
Recommendations for The Participant Journey
o Section 25 adopt a strength-based approach and acknowledge the role of the NDIS to provide early intervention to support capacity building in people with disability. o The relationship between the disability and aged care systems be addressed through the NDIS Rules or NDIS LTA Guidelines, and publicised to promote awareness.
Recommendations for Sector Capability: Registered Providers of Support
o Further clarity within the NDIS Rules and NDIS LTA Guidelines around the NDIS‟ role in responding to market failures within related sectors may be necessary. o Guidelines around expected service sector interactions.
KinCare would welcome the opportunity to provide feedback on future legislation, forums and discussion papers.
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References
(2008). National Interest Analysis: United Nations Convention on the Rights of Persons with Disabilities.
(2012). National Disability Insurance Scheme Bill 2012. The Parliament of the Commonwealth of Australia: House of Representatives.
Australian Government Productivity Commission. (2011). Disability Care and Support: Overview.
Australian Productivity Commission. (2011). Disability Care and Support.
Bartnik, E. (2010). Liberation Welfare. Chapter 7, Putting People in Control: Reforming the System of Support for People with Disabilities. Demos.
Council of Australian Governments. (2012). National Disability Agreement.
Council of Australian Governments. (2012). Regulation Impact Statement: National Disability
Insurance Scheme.
Secretary to the Victorian Department of Human Services. (2012). Draft National Standards for Disability Services.
United Nations. (1948). The Universal Declaration of Human Rights.
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Contact Details
For further information please contact:
Therese Adami
Chief Operations Officer
Online: www.kincare.com.au