Portfolio Submission to the Joint Standing Committee on the National Disability Insurance Scheme

Portfolio Submission to the Joint Standing Committee on the

National Disability Insurance

Scheme

FEBRUARY 2024

Introduction ………………………………………………………………………………………………. 4 Executive summary ……………………………………………………………………………………. 4 Background ……………………………………………………………………………………………… 4 Defining remote and very remote communities in the NDIS …………………………….. 4 Remote and Very Remote Service Model ……………………………………………………. 5 Service model evolution …………………………………………………………………………… 6 Engaging with Remote Markets ……………………………………………………………………. 6 Specific NDIA Initiatives …………………………………………………………………………… 7 Remote Community Connectors ……………………………………………………………… 7 Early Childhood Services ……………………………………………………………………….. 7

Aboriginal Disability Liaison Officers ………………………………………………………… 7

Services Australia Partner Services – National Agents and Access Points ……… 8

Services Australia Partner Services – Mobile Service Centres ……………………… 8

Thin Market Trials …………………………………………………………………………………. 8 Pricing Incentives ……………………………………………………………………………………. 9 NDIS Quality and Safeguards Commission …………………………………………………….. 9 Engagement with First Nations Participants and Remote Communities …………….. 9 Initiatives……………………………………………………………………………………………… 10 Make it known, make it better ………………………………………………………………….. 10 Workforce Capability Framework ……………………………………………………………… 10 Grants …………………………………………………………………………………………………. 10 Future initiatives ……………………………………………………………………………………. 11 Whole of Government Actions ……………………………………………………………………. 11 Australia’s Disability Strategy 2021-2031 (ADS) ……………………………………….. 12 Alternative Commissioning Pilots …………………………………………………………… 12 Integrated Care and Commissioning Trials ………………………………………………. 12 Blended Payment Trials ……………………………………………………………………….. 12 Evidence-based Supports …………………………………………………………………….. 13 National Strategies …………………………………………………………………………………… 13 First Nations Strategy …………………………………………………………………………….. 13

First Nations Advisory Council ………………………………………………………………. 13

Stakeholder Engagement Plan………………………………………………………………. 13

Disability Royal Commission Recommendations ……………………………………………. 14

Independent NDIS Review Recommendations ………………………………………………. 14

Conclusion ……………………………………………………………………………………………… 14

Introduction

The Department of Social Services (the department) welcomes the opportunity to provide a portfolio submission to the Joint Standing Committee on the National Disability Insurance Scheme (NDIS) in relation to the inquiry into NDIS participant experience in rural, regional and remote Australia. This portfolio submission is a joint response from the department, the National Disability Insurance Agency (NDIA) and the NDIS Quality and Safeguards Commission (the commission).

Executive summary

This submission outlines the portfolio activities relevant to NDIS participant experience in rural, regional and remote parts of Australia. The submission:

 commences with an overview of the NDIA’s service model and approach to service delivery  provides background on key strategy and policy work underpinning service delivery  includes information from the commission regarding support for the participant experience in rural, regional and remote Australia, and  outlines policy directions within future areas of focus recommended by the

Royal Commission into Violence, Abuse, Neglect and Exploitation of People

with Disability (Disability Royal Commission) and the Independent Review of the NDIS (NDIS Review).

The NDIS aims to support people with disability living in rural and remote Australia, including First Nations communities, to participate in social and economic life, to contribute as valued members of their community, and to progress and achieve the goals and life outcomes they seek.

The department acknowledges access to the NDIS and other mainstream services in remote and very remote areas remains a challenge, and particularly impacts First Nations peoples who experience additional cultural barriers around access to services.

The portfolio (the department, the NDIA and the commission) continues to co-design strategies and policies with key disability groups. However, it is evident from the findings of the Disability Royal Commission and the NDIS Review that more needs to be done.

Background

Defining remote and very remote communities in the NDIS The NDIA uses a version of the Modified Monash Model (MMM)1 to determine a community’s remoteness, in particular for remote and very remote areas. A location’s MMM category drives both the service model the NDIA uses to work with communities and NDIS participants, and the pricing structure in place for supports

1 Further information on the MMM is available on the Department of Health and Aged Care website:

Modified Monash Model | Australian Government Department of Health and Aged Care

(see Pricing Incentives below). The NDIA works with Partners in the Community (PiTC) to deliver local access, planning, connection and information sharing in areas classified MMM1 to MMM5. In some MMM5 areas and in all MMM6 and MMM7 areas, NDIA directly delivers planning activities alongside local access, connection and information sharing pathways.

As at 31 December 2023 there were:

 9,778 NDIS participants who live in remote and very remote areas, representing 1.5% of all participants across Australia. Of these, approximately half identify as Aboriginal and/or Torres Strait Islander.

 69,752 NDIS participants who live in regional areas, representing 11% of all participants.

 124,126 NDIS participants who live in rural areas, representing 19% of all participants.

 Of the 23,803 participants entering the Scheme and receiving a plan in the September 2023 quarter, 1.3% were from remote and very remote areas.

While the total number of NDIS participants in remote and very remote areas (MMM6 and MMM7) is low, the geographic spread of these participants takes in the majority of the Northern Territory and Western Australia, along with large parts of Queensland, South Australia and New South Wales.

Remote and Very Remote Service Model

In non-remote areas, the NDIA uses a national work pool model to allocate work (generally either planning or reviewing and making delegate decisions on plans

developed by PiTC to planners). This model supports the management of large volumes of plans most efficiently.

However, plans and supports for people living in remote and very remote areas require a different approach. The NDIA is in the process of augmenting an existing practice of dedicated Remote Planners. Remote Planners are NDIA staff with specific knowledge of the unique challenges of life in remote and very remote areas, and who have specific skills in planning and support for NDIS participants in these areas.

Remote Planners are supported by a network of Remote Community Connectors (RCCs). The RCCs are funded by the NDIA and provide place-based, trusted information and connection to the NDIA, guided by local community organisations, in

most cases, Aboriginal Community Controlled Health Organisations (ACCHOs). This

ensures the NDIA can maintain a local presence and contact point in areas without NDIA offices or where employment markets are thin.

The NDIA has offices in 20 remote and very remote locations across Queensland, the Northern Territory, South Australia, and Western Australia. As at 31 December 2023, the NDIA has 89 Remote Planner roles across Australia. As the NDIA moves to the 3P operating model2, the Agency is in the process of strengthening the operating model to build on the most successful elements of this model.

Service model evolution The NDIA is undertaking work to strengthen and formalise the existing service model for remote and very remote areas. Specific actions include:

 establishing dedicated planning teams allocated to geographic zones for all MMM6 and MMM7 areas, along with non-partnered MMM5 areas. These teams will continue to provide end-to-end planning and support services.

 growing the existing RCC network (using affirmative measures recruitment) in First Nations communities to ensure a place-based presence and perspective, and supplementing this with a Local Community Connector role in non partnered regional centres to ensure there is a PiTC equivalent.

 establishing a dedicated local problem-solving function within the NDIA, recognising the varied and complex challenges of service provision, participant support and connection in remote areas.

 strengthening co-servicing practice, working more closely with jurisdictional governments, other Australian Government agencies and community stakeholders to support NDIS participants more holistically.

Engaging with Remote Markets

2 The Participants, Platforms and Processes Improvement Initiative (3P) has been designed to provide a sharpened focus on improvements to previous planning and access processes and systems to benefit participants. Further information on the NDIS website: www.ndis.gov.au/improvements.

Thin markets and marginal service viability are a continuing challenge for NDIS participants, their families and communities in remote and very remote areas.

Specific NDIA Initiatives

The NDIA supplements its direct service delivery with targeted service contracts and partnerships.

Remote Community Connectors

As outlined above, RCCs fulfil a critical function in First Nations communities promoting awareness, understanding and connection between NDIS participants, providers, and the NDIS. RCCs also have an important role in participant wellbeing, undertaking follow-up and check-ins with NDIS participants locally. They are key to the NDIA maintaining trustworthiness and presence in remote Australia.

RCCs are employed through local service partners. Through these arrangements, the NDIA supports Closing the Gap Priority Reform 2 (Building the Community Controlled Sector), investing $11.6 million in these services in 2022-23. The RCC Program is geographically expansive and supports approximately 460 communities. As at 31 December 2023, RCC service partners employed 205 staff to deliver the RCC Program across Australia.

Early Childhood Services

The NDIA has established two sites with dedicated early childhood services: one in the Kimberley (Western Australia) for children under 7 years (increasing to under 9 years), and one in the Torres Strait (Queensland) for children under 9 years. Together, these services were funded $4.8 million in 2022-23.

These programs offer support for families by:  connecting children and families with mainstream and community services and providing information

 connecting with the NDIS

 delivering an early supports program for children with developmental concerns

 supporting information gathering for access and planning with the NDIS, and

 assistance with NDIS plan implementation.

These programs are providing data to inform a future national approach to early childhood in remote areas, working in cooperation with the NDIA Children’s Taskforce and the organisations currently delivering the program.

Aboriginal Disability Liaison Officers

Aboriginal Disability Liaison Officers (ADLOs) support people with disabilities in urban and rural areas to understand, navigate and participate in the NDIS. ADLOs work locally to ensure the NDIS has a positive impact for people with disability and their communities. ADLOs operate alongside the NDIS PiTC model and provide

insights and advice to partners for culturally safe and competent practice guidance to better support First Nations peoples to access and use the NDIS.

ADLOs are employed through the National Aboriginal Community Controlled Health Organisation (NACCHO), the national peak body for Aboriginal and Torres Strait Islander health in Australia. Through this service the NDIA invests approximately $4 million per year in the Aboriginal Community-Controlled sector.

Services Australia Partner Services – National Agents and Access Points

Services Australia has existing National Agents and Access Points across the country. The NDIA utilises these to increase awareness of the NDIS in remote areas and have contracted 92 Agents to be an NDIS contact point in their communities. The NDIA also has information in 10 local languages displayed on screens at 72 remote Service Australia locations.

Services Australia Partner Services – Mobile Service Centres

Services Australia operates a fleet of Mobile Service Centres (MSCs) which bring government services to people throughout rural and regional Australia. The NDIA is partnering with Services Australia to travel with the MSCs to engage with communities which otherwise wouldn’t be serviced face-to-face.

The MSC fleets visit between 650 and 700 locations, with approximately 300 NDIA and PiTC staff providing face-to-face support.

Thin Market Trials

In 2019, the then Disability Reform Council (DRC), now the Disability Reform Ministerial Council (DRMC), decided each state and territory would host a thin market trial in agreed locations. In addition, the NDIA identified other thin market locations to implement market coordination activities. The trials tested three approaches to address market challenges:

market facilitation, to improve connections between NDIS providers and participants, such as focused engagement and sharing targeted market information;
coordinated funding proposals, to enable NDIS participants to pool funding to more efficiently secure services from providers; and
direct commissioning, which directly contracts providers to deliver supports to a participant or a group of NDIS participants.

In October 2023, the NDIA published the Thin Market Trials Final Evaluation Report

on the NDIS website, which compiles the learnings and recommendations from the 2019 DRC thin market trials.

Key findings included:

 Coordinated funding proposals (CFPs) and direct commissioning, especially in remote and very remote locations, are promising approaches to increase participant use of NDIS supports in thin markets, more so than LGA-level market facilitation.

 Most CFPs to date have focused on coordinated sourcing of one-off functional assessments. To understand the potential of CFPs, they need testing across a wider range of support types and locations.

The portfolio has an ongoing commitment to work closely with local communities to build sustainable service markets, including identifying pathways to rely on locally available workforce. This includes developing thin market projects, in consultation with stakeholders, which are relevant to the local context, to ensure projects are culturally appropriate, fit-for-purpose and meet local needs. Learnings and evaluation from the range of work underway will inform evolving and any further new projects.

Pricing Incentives

Remoteness has an impact on whether providers can claim remote loadings to price limits. Loadings on price limits are higher for providers in remote and very remote locations. The remote (MMM6) and very remote (MMM7) loadings are 40% and 50% respectively. The remote and very remote loadings incentivise providers to deliver supports in remote locations.

NDIS Quality and Safeguards Commission

The NDIS Commission is the independent regulator that works to uphold the rights of NDIS participants and improve the quality and safety of NDIS supports and services. The NDIS Commission has undertaken engagement with remote communities to better understand the experiences and unique challenges that affect the quality and safety of NDIS supports for First Nation, Culturally and Linguistically Diverse (CALD) and low socio-economic participants. The NDIS Commission has utilised these insights to enhance the work that is intended to ensure that all NDIS participants are aware of their rights to access quality and safe supports.

Engagement with First Nations Participants and Remote

Communities

The commission has recently established an Indigenous and Remote Operations team dedicated to quality and safeguarding in Indigenous and remote communities. As part of forming a dedicated team, the NDIS Commission has and continues to engage with communities to improve the quality and safeguarding arrangements for NDIS, and promote the delivery of safe and culturally appropriate services. The focus of engagements have included workshops focused on regulating for safe and quality supports. The NDIS Commission, in partnership with the Queensland and Northern Territory governments and First Nations providers, facilitated workshops focused on regulating for safe and quality supports in regional and remote communities. The workshops highlighted both the achievements and challenges encountered by providers striving to deliver culturally responsive, safe, and high-quality services to First Nations participants in regional and remote communities.

The discussions were supported by regulatory data specific to the respective regions. The workshops, and ongoing collaboration, have significantly influenced the NDIS Commission’s approach to remote areas, ensuring it aligns with the unique needs and circumstances of remote communities. Engagement extended to Maningrida with cross-government collaboration with the

Northern Territory Minister for Disabilities and National Disability Insurance Agency

on the Disability Deep Dive Project.

Initiatives

Analysis of complaints and incidents in remote areas has enabled the NDIS Commission to better understand some of the unique safeguarding issues and continues to inform and strengthen consultation, engagement and regulatory initiatives.

Make it known, make it better NDIS participants have the right to be safe and to receive quality services from the providers and workers they choose to support them under the NDIS. The NDIS Commission has developed a series of videos to empower people with disability, or their support networks, to raise a concern or complaint if they are not happy with the quality or safety of their NDIS supports or services. The video scenarios are based on the NDIS Code of Conduct and were co-designed, tested with, and feature NDIS participants, their families, providers and workers. Accessible versions are available in Auslan, 17 languages and for First Nations peoples and LGBTQIA+ communities.

Workforce Capability Framework

The Workforce Capability Framework is an online tool that supports NDIS providers and workers. It translates the NDIS Practice Standards or Code of Conduct into practical actions and behaviours they should adopt when working with people with disability. Booklets tailored to recruitment of Aboriginal and Torres Strait Islander workers have been developed as a dedicated resource with an animation.

Grants

The NDIS Commission delivers the Support for NDIS Providers Grants program. The

program provides tools and resources informed by people with disability that help providers meet their NDIS quality and safeguarding responsibilities. Funded Grants have focused on resources for rural and remote, First Nations and CALD participants and providers which include:

The Aboriginal Resource and Development Service Aboriginal Corporation were funded to work with participants and providers in remote communities across northeast Arnhem Land to inform the development of resources that will strengthen First Nations participants’ understanding of their human rights and how complaints can make issues known and NDIS services better.
Keogh Bay People were funded to create a new training platform, NDIS Walking and Working Together Learning Place, to build the capacity of

providers to meet NDIS registration obligations and deliver culturally responsive supports for First Nations participants in rural and remote communities.

Settlement Services International was funded to develop resources to assist CALD participants to understand their rights, make complaints and raise issues with NDIS providers.
Kaleidoscope Focus was funded to develop resources to support providers to meet the new Practice Standards on emergency and disaster management. The standards require providers to be able to communicate with participants about the risk of disruption of continuity of service during an emergency or disaster event and mitigate those risks for participants.

Future initiatives

The NDIS Commission is committed to working closely with NDIS participants, communities, and the broader disability sector to identify and implement solutions, which deliver quality and safe supports in regional, remote, and very remote areas of Australia. In response to engagement, operational experience and the significant reform recommendations from the NDIS Review and Disability Royal Commission, the NDIS Commission is currently considering developing a roadmap to strengthen the quality of supports and respond to systemic themes raised by participants and providers across communities. Early themes which require further review and development include:

Non-place based supports including drive-in-drive-out and fly-in-fly-out providers play an important role in remote communities, however, challenges have been raised that relate to continuity of support and quality of support that impact participant outcomes.
Provider and worker quality, cultural responsiveness and safety to support participant outcomes.
Providers delivering supports in alternative commissioning arrangements to strengthen quality and safeguarding of supports.
The need to strengthen Intermediaries’ focus on working with participants to build support connection and more accountability to deliver quality outcomes. The development of this work will be considered with the significant reform recommendations from the NDIS Review and Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability.

Whole of Government Actions

Enabling access to inclusive care and support to people with disability in their own community means they can maintain crucial connection to family, carers, friends and the wider community, as well as increase independence and improve social and

economic participation. Across parts of regional Australia with low populations, thin markets require targeted approaches3.

Australia’s Disability Strategy 2021-2031 (ADS)

Australia’s Disability Strategy 2021-2031 (ADS) recognises that all level of governments are responsible for supporting people with disability to reach their full potential, as equal members of the community. It appreciates that many services and systems for people with disability rely on governments working together, and sets out key outcome areas, policy priorities and an outcomes framework to drive collaboration. ADS recognises the importance housing, infrastructure and disability services play in creating inclusive communities so that people with disability can actively take part in their communities.

Alternative Commissioning Pilots

As part of the 2022-23 Budget, the Australian Government announced the “Alternative Approaches to Commissioning for Remote and First Nations Communities” initiative (Alternative Commissioning). Alternative Commissioning is about partnering with communities to pilot alternative approaches to improve access to NDIS supports in remote and First Nations communities. It will create opportunities for more culturally appropriate and sustainable services to strengthen the First Nations disability sector and build a sustainable supply of NDIS supports in remote areas.

Following the announcement of a trial in Maningrida, NT, the NDIA and DSS are working closely together to identify the additional pilot site through detailed market analysis and in consultation with key government and sector stakeholders.

Integrated Care and Commissioning Trials

The Australian Government is undertaking the Integrated Care and Commissioning project to respond to community identified needs, and to help build a sustainable care and support sector. In the 2023-24 Budget, the Government provided $27.0 million over 4 years, from 2023–24, to improve the provision of, and access to, care and support services in thin markets by trialling integrated services and joint commissioning across primary health, First Nations health services, disability, aged care, and veterans’ care sectors in up to 10 locations.

Blended Payment Trials

The Government is investing $24.6 million to work with NDIS participants and providers to trial blended payment models, consisting of both an enrolment and outcome payment, to incentivise providers to innovate service delivery and improve outcomes and value for money for participants. The department is leading the co-design of the payment models, to be subsequently trialled by the NDIA for two cohorts – Supported Independent Living and Youth Employment Supports.

3 NDIS Review, (2023), Improving access to supports in remote and First Nations communities

Evidence-based Supports

Through the 2023-24 Budget, the Government is investing $29.3 million to support measures to incentivise market innovation and flexibility in meeting individual needs. This initiative will improve the effectiveness, accountability, and transparency of providers to deliver value for money and participant outcomes.

National Strategies

First Nations Strategy

The NDIA has committed to co-designing a new NDIA First Nations Strategy (the Strategy) with NDIS participants, First Nations people with disability, their families, carers, communities, and sector stakeholders. The Strategy is expected to be completed in 2024 and will replace the inaugural 2017 NDIA Aboriginal and Torres Strait Islander Engagement Strategy.

The NDIA has entered a Partnership Agreement with First Peoples’ Disability Network (FPDN) to work together on the co-design of the Strategy.

Extensive public engagement will also be undertaken to ensure the Strategy is co designed with First Nations people with disability, their families, and communities.

First Nations Advisory Council

With FPDN, the NDIA has established a First Nations Advisory Council (FNAC). The purpose of the FNAC is to provide strategic advice and ensure the NDIA’s actions to support and improve outcomes for First Nations people with disability are guided by First Nations peoples and sector representatives at the highest level.

The FNAC has held its first ‘caucus’ meeting, where First Nations members held independent, community-led conversations to self-determine what matters should be raised at official meetings with the NDIA.

The FNAC has indicated a desire to work with the NDIA to co-develop its own work plan as a priority. This work plan will focus on the key priorities identified by FNAC members, together with the NDIA, to improve outcomes for First Nations NDIS participants and people with disability.

Stakeholder Engagement Plan

The NDIA has developed a first draft of a stakeholder engagement plan for the Strategy and has incorporated feedback received from internal and external stakeholders. The NDIA is working with the FNAC, the NDIS Independent Advisory Council’s (IAC) Equity and Inclusion Reference Group, and an Aboriginal and Torres Strait Islander Leadership Group, to determine the most culturally appropriate and accessible approach and timing, for commencing broader public engagement and co-design with First Nations people with disability and communities.

The NDIA will also work with internal and external stakeholders and governance groups, who have existing community relationships, to undertake culturally safe outreach to First Nations communities and sector stakeholders. The NDIA is

committed to building trust and determining the most respectful, culturally inclusive, and community-led ways to engage with First Nations communities.

Disability Royal Commission Recommendations

The Australian Government is committed to driving change across the country to uphold the rights of people with disability to live free from harm. The Government is carefully considering the Disability Royal Commission’s final report and its 222 recommendations before commenting on individual recommendations.

Independent NDIS Review Recommendations

The NDIS Review suggests that while “NDIA thin market trials have explored a few commissioning approaches, efforts to gather data to improve market functioning have been too narrow”, a “more active and flexible role for governments, as stewards of the NDIS Market is needed”.

The Review recommends changes to improve access to supports for First Nations participants across Australia and for all participants in remote communities through alternative commissioning arrangements. The Review recommends alternative commissioning approaches should be designed in partnership with First Nations representatives, communities and participants, and should be underpinned by governance structures that share decision-making power with communities, including First Nations representatives in non-remote communities as well as remote community representatives (which also encompasses the non Indigenous local population).

Conclusion

The department, the commission and the NDIA are committed to working closely with NDIS participants, communities, and the broader disability sector to identify and implement solutions which deliver better services that meet needs in regional, remote, and very remote areas of Australia.

Government review of recommendations by the NDIS Review and the Disability Royal Commission will progress in early 2024. We look forward to working with the Committee with its inquiry to improve the participant experience and provide better outcomes for NDIS participants and all people with disability.