NDIA Accountability Project

NDIS services in regional and remote Australia

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23 February 2024

Vertaview Group Response to

Overview of Vertaview.

The Vertaview Group brings through shared social purpose, leading providers of Disability, Mental Health, System Navigation and Housing services to amplify service pathways, connections and outcomes for the people and communities we serve right across Australia. Our diverse and passionate workforce of close to 2000 employees, work each day to create more positive and independent futures for the people we support, helping to reach and support over 8000 individuals across Queensland, New South Wales, and Victoria each year.

Working together under a unified vision, The Vertaview group amplifies the impact of our individual organisations to positively impact lives and contribute to a holistic support ecosystem, leaving a enduring impression on communities. Our commitment to excellence drives us forward as we evolve and expand, striving for societal betterment in disability support and mental health services.

Multicap Limited

Open Minds Australia Limited

Allinto Australia Limited

Scope of enquiry

Collectively our organisations share a long history of delivering NDIS services in regional and remote areas. Through our experience, we’ve gained valuable insights into the unique challenges and opportunities present in these settings. This submission aims to share some reflections on the past decade’s developments in disability care and support, particularly in the context of regional, rural, and remote geographic areas, in light of the introduction of the National Disability Insurance Scheme (NDIS) and the recommendations produced via the NDIS review. In this discussion paper, we’ll share our perspectives, informed by both our staff and clients, on how to improve services in regional and remote areas. By drawing on our practical experience and stakeholder feedback, we aim to contribute meaningfully to the conversation about enhancing services in these important geographic areas.

Themes

Limited Access to Services: Despite the introduction of the NDIS aimed at providing greater choice and control over supports and services, individuals with disabilities and mental illness residing in regional, rural, and remote areas continue to encounter significant barriers to accessing essential services. Veli-Gold et al (2023) suggested five themes that described the challenges of NDIS access in rural/remote areas:

  1. Healthcare workforce and NDIA staff (examples of barriers include insufficient staff for number of clients, transient workforce);

  1. NDIS package holders and carers lack of awareness of the NDIS (examples of barriers include lack of appropriately accessible information on the NDIS website, lack of culturally appropriate information, exclusion of the participant from planning);

  2. Cultural/socio-economic barriers (examples of barriers include lack of appropriate support for First Nations people to access the NDIS, historical issues preventing First Nations people from being able to trust government agencies and programs);

  3. Travel funding (examples of barriers include lack of understanding from the NDIS of the amount of travel required to access services);

  4. Emotional burden of the NDIS planning process. (examples of barriers include continuous burden of participants to prove their need for funding, impact on the family from travel related to accessing services)

These observations have been supported in other papers (Johnson et al., 2020, Loadsman & Donelly, 2021, Prowse et al., 2022, Wakely et al., 2023). While potential access to funding may have increased under the NDIS, obtaining that funding is contingent on successfully navigating the system, something which families may not be well supported to do. Families have also noted that services have become less diverse after the introduction of the NDIS (Loadsman & Donelly, 2021).

Service Quality and Relevance: Service provision in non-metropolitan areas has been characterised by a lack of consistency and expertise, further exacerbating the challenges faced by individuals with disabilities and their families. Furthermore, there is a perception that the NDIS is driven by financial motives rather than person centred practice (Prowse et al., 2022). People in rural areas have suggested that the services they have access to provide inconsistent responses to queries (or fail to respond at all) and often use jargon (Prowse et al., 2022). Operating in rural areas represents a challenge to service providers as well. This may impact the quality of service they can provide and when the challenge becomes too great, they may withdraw support, creating further burdens on NDIS participants (Prowse et al., 2022). Challenges to service providers include attracting, training, and retaining appropriate staff, removing disability related stigma, and dealing with systems change (e.g., the rise in the use of telehealth) (Cuskelly, 2022). Rural providers report feeling overburdened and having difficulties navigating NDIS processes – this mirrors comments from consumers (Dintino et al., 2019).

Policy Implementation Challenges: Disability policy has historically been metro-centric, with limited consideration for its implementation in regional, rural, and remote areas. Indeed, some policy makers have suggested that it is reasonable to set lower expectations for service availability in rural/remote areas (Dew, 2022). As a result, workers in these locations often find themselves operating outside policy guidelines to ensure positive outcomes for participants and their families. Efforts to “rural-proof” disability policy have been initiated but require further investment to address the ongoing challenges experienced in remote areas.

Recommendations:

  1. Invest in Foundational Supports: Allocate resources to bring fairness, balance, and sustainability to the disability ecosystem, addressing systemic barriers to service provision in regional, rural, and remote areas. Programs like CREST demonstrate the expertise Open Minds brings to this area, servicing the needs of First Nations people.

  1. Increase Mainstream and Community Inclusion: Enhance efforts to improve mainstream service accessibility and connectivity with the NDIS, ensuring a fairer and more consistent participant pathway.

  2. Support Navigating Service Systems: Provide better support for individuals with disabilities to navigate mainstream, foundational, and NDIS service systems, empowering them to make informed decisions about their lives. This is particularly relevant for people in First Nations or CALD communities as these people report facing additional challenges accessing support. Allinto’s expertise in NDIS systems allows them to make positive changes for rural/regional Australians, locating appropriate services and ensuring those services are of high quality and are person-centred.

  3. Enhance Decision-Making Support: Strengthen supports for individuals with disabilities to make decisions about their lives, promoting autonomy and self-determination.

  4. Develop Inclusive Housing Supports: Fund housing and living supports that are fair, consistent, and promote genuine choice and control for participants, delivering a diverse range of inclusive housing options.

  5. Invest in Digital Infrastructure: Improve NDIS digital infrastructure to enable accessible, timely, and reliable information and streamline processes, enhancing market functioning and scheme integrity. With the advent of technologies like telehealth, Vertaview is committed to ensuring that NDIS participants have flexible and person-centred methods of accessing supports.

  6. Reform Pricing Frameworks: Implement pricing and payments frameworks that improve incentives for providers to deliver quality supports to participants, promoting continuous quality improvement in the market.

  7. Strengthen Quality and Safeguarding: Embed, promote, and incentivize continuous quality improvement in the market, supported by a dedicated quality function in the National Disability Supports Quality and Safeguards Commission.

  8. Improve Market Monitoring: Strengthen market monitoring and responses to challenges in coordinating the NDIS market, ensuring better access to supports for all participants, including First Nations participants and those in remote communities.

Conclusion:

In conclusion, meaningful change requires a comprehensive approach that addresses systemic barriers, enhances service accessibility, and empowers individuals with disabilities to make informed choices about their lives. By implementing the recommendations outlined above and collaborating with stakeholders across the disability ecosystem, we can work towards creating a more inclusive, equitable, and person-centred NDIS that meets the diverse needs of participants across all geographic regions.

References:

Cuskelly, M. (2022). Challenges for the National Disability Insurance Scheme in regional, rural, and remote areas. Reflections on “Connecting Tasmanian National Disability Insurance Scheme participants with allied health services: challenges and strategies of support coordinators”(Jessup & Bridgman, 2021). Research and Practice in Intellectual and Developmental Disabilities, 9(2), 124-133.

Dew, A. (2022). What, if anything, has changed over the past 10 years for people with intellectual disabilities and their families in regional, rural, and remote geographic areas?. Research and Practice in Intellectual and Developmental Disabilities, 9(2), 103-107.

Dintino, R., Wakely, L., Wolfgang, R., Wakely, K. M., & Little, A. (2019). Powerless facing the wave of change: the lived experience of providing services in rural areas under the National Disability Insurance Scheme. Rural and remote health, 19(3), 1-10.

Johnson, E., Lincoln, M., & Cumming, S. (2020). Principles of disability support in rural and remote Australia: Lessons from parents and carers. Health & Social Care in the Community, 28(6), 2208-2217.

Loadsman, J. J., & Donelly, M. (2021). Exploring the wellbeing of Australian families engaging with the National Disability Insurance Scheme in rural and regional areas. Disability & Society, 36(9), 1449 1468.

Prowse, A., Wolfgang, R., Little, A., Wakely, K., & Wakely, L. (2022). Lived experience of parents and carers of people receiving services in rural areas under the National Disability Insurance Scheme. The Australian journal of rural health, 30(2), 208–217. https://doi.org/10.1111/ajr.12837

Veli-Gold S, Gilroy J, Wright W, Bulkeley K, Jensen H, Dew A, et al. The experiences of people with disability and their families/carers navigating the NDIS planning process in regional, rural and remote regions of Australia: Scoping review. Aust J Rural Health. 2023; 31: 631–647. https://doi.org/10.1111/ajr.13011

Wakely, L., Green, E., Little, A., Fisher, K., Wakely, K., Currie, K., & Wolfgang, R. (2023). The lived experience of receiving services as a National Disability Insurance Scheme participant in a rural area: Challenges of choice and control. The Australian journal of rural health, 31(4), 648–658. https://doi.org/10.1111/ajr.13000