Australian Association
of Social Workers
Submission to the Joint Standing Committee on the NDIS
Re: NDIS Planning
September 2019
© Australian Association of Social Workers
National Office — Melbourne
Level 7, 14-20 Blackwood Street
North Melbourne Vic 3051
PO Box 2008
Royal Melbourne Hospital Vic 3050
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INTRODUCTION
Who we are
The Australian Association of Social Workers (AASW) is the professional body representing more than 12,000 social workers throughout Australia. We set the benchmark for professional education and practice in social work, and advocate on matters of human rights, social inclusion, and discrimination.
The social work profession
The social work profession is committed to pursuing social justice and human rights. Social workers aim to enhance the quality of life of every member of society and empower them to develop their full potential. Principles of social justice, human rights, collective responsibility and respect for diversity are central to the profession, and are underpinned by theories of social work, social sciences, humanities and Indigenous knowledges.
Professional social workers operate at the interface between people and their social, physical, and natural environments. They consider a person’s biological, psychological, social, and cultural factors and how they influence their health, wellbeing and development. Social workers work with individuals, families, groups and communities. They maintain a dual focus on improving human wellbeing; and identifying and addressing any external issues (known as systemic or structural issues) that detract from wellbeing, such as inequality, injustice and discrimination.
The role of social work with people living with a disability
Social workers believe that all people regardless of difference have the right to be included in society and to have outcomes equal to other citizens. It is this understanding and commitment that social workers bring when working with people with disability. This view is driven by a deep belief in the intrinsic worth of all human beings and their inalienable right to dignity and self-determination. In all contexts, social workers focus on individual, family, carer and community strengths and needs, and work collaboratively to support people to achieve the lives they want. Social workers are employed in many disability supports and programs operating in government, community and private organisations, in roles which include individual planning, counselling, coordination and case management. They develop evidence-informed assessments, planning and interventions within a client empowerment framework. Social workers also play a significant role in improving services and the community sector more broadly. As well as working in service management, program design and improvement, they provide professional development and training; and they undertake policy development, research and advocacy.
Our submission
The AASW welcomes the National Disability Insurance Scheme (NDIS) as a rights-based approach that supports the independence and the social and economic participation of people with a permanent impairment or condition resulting in disability. The values of ‘choice and control’ that underpin the NDIS are consistent with the values and principles of self-determination and empowerment that have guided the social work profession for many decades. The AASW believes that the experience that participants have of the planning process and the quality of the resulting plan have a critically important influence on the participant’s overall outcomes form the NDIS. It is therefore crucial that the planning processes within the NDIS are improved. The AASW welcomes the opportunity to contribute to this inquiry.
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Response
a. the experience, expertise and qualifications of planners The AASW is concerned at the variation in the level of qualifications, skills and experience of people in the planning role, and the low levels of these that some planners appear to display.
Several reports into aspects of the NDIS have heard evidence from participants describing shortcomings in the process of formulating plans, the poor quality of plans and the impact of this on their overall experience of the NDIS.1 Our members experiences of working with planners is that generally they have low levels of understanding about the issues facing people who live with a disability in general, and about the details of particular disabilities; they identified that this resulted in plans that do not adequately capture people’s needs nor describe the services that those needs require. People cannot exercise choice in and control over the services they need unless their needs are identified and their aspirations for their lives are understood.
b. the ability of planners to understand and address complex needs; The AASW is particularly concerned at reports which suggest that many current planners do not have the knowledge or skills that are required to work with people with complex needs, complex social and emotional histories, diverse cultural backgrounds, multiple conditions, and people who live in a rural and regional areas, To adequately assess and respond to people with complex and changing needs, planners need specialist knowledge and competencies. Social workers know that to assist someone to identify their goals, to express the nature and extent of their needs and to formulate an achievable and empowering plan is the result of a process which includes: getting to know the person, building rapport, understanding the broader environmental factors and systems e.g. the person’s social connections, other informal supports and knowledge of the interactions between multiple needs.
Providing a high standard of planning and support coordination is pivotal to addressing the multifaceted aspects of complex needs as no single service will address every need. For social workers, support coordination is about developing a relationship with the person that seeks to foster collaborative decision-making in assuring that services are well targeted and person/family centred. Social workers understand that support coordination is most importantly about building a positive working relationship with the client in order to develop care plans that address their needs, strengths, and goals.
Professional social workers bring valuable skills and knowledge to the support coordination process. Social workers operate from a person-in-environment perspective and recognise that individuals can best be understood within the multifaceted context of their environment. With this perspective, social workers are well equipped to assess both the psychological and social aspects of a person’s situation, and to develop plans accordingly. This expertise is especially critical given the complex psychosocial issues that people can experience and can pose
1 https://www.everyaustraliancounts.com.au/have-your-say-on-ndis-planning-or-sil/ https://www.aph.gov.au/Parliamentary_Business/Committees/Joint/National_Disability_Insurance_Scheme/General_NDIS/Rep ort; Commonwealth Ombudsman – response to Productivity Commission’s Issues Paper, ‘National Disability Insurance Scheme Costs’: https://www.ombudsman.gov.au/ data/assets/pdf file/0024/43449/OCO-submission-to-PC-inquiry-into-NDIS-costs,
March-2017.pdf
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significant barriers to care and improved wellbeing. In this regard, social work support coordination is distinct from other approaches as it addresses the client’s needs at both individual and larger systemic levels.
The AASW welcomes the creation of specific pathways into the NDIS for participants with particular categories of need, including people with complex needs.2 The opportunity for people to see drafts of their plans has been welcomed as leading to an improvements by AASW members, however the evidence remains anecdotal. The AASW encourages the NDIA to continue to monitor whether these pathways lead to better outcomes for participants.
c. the ongoing training and professional development of planners; The AASW notes that planners are not required to have any formal qualification; and that their preparation consists of an 8-week course at the commencement of their roles. The report of Parliament’s Joint Standing Committee demonstrate that this has proven to be inadequate, particularly for participants with a psycho-social disability.3 The AASW supports the call of Mental Health Australia for a psycho-social competency framework for the NDIS and would welcome the opportunity to contribute to this important work.
d. the overall number of planners relative to the demand for plans; The backlog of participants waiting for plans to be formulated indicates that there are insufficient planners to meet demand. There are a number of factors that contribute to this. Participants’ circumstances often change, and the NDIA does not respond quickly enough, leaving participants in limbo for weeks or even months. If plans are inadequate in their first version, they need to be reviewed immediately. Finally, the state funding for psychosocial support services has transferred to the NDIS and the Continuity of Supports measure as of 1st July 2019, and so there are many potential participants only just beginning to test their eligibility and completing their Access Requests now.
e. participant involvement in planning processes and the efficacy of introducing draft plans; In their submission to the Productivity Commission’s inquiry, people with experience of the NDIS have described several problems with the planning process.4 Participants cite lack of skills by some planners as influencing their experience of the process, because they were forced to demonstrate how some supports were reasonable and necessary. Other participants reported some planners using inappropriate or inaccessible methods of communication, such as the telephone, and planners not allowing enough time for interpreters while they were speaking.
We are concerned that the purpose of the meeting seems to have become a narrow diagnosis of impairment rather than a holistic participant’s functional capacity, which is the primary measure the NDIA uses to determine eligibility.
2 Joint Standing Committee on the National Disability Insurance Scheme Report, parliament of Australia, March 2019 p6 3 ibid 4 Disabled People’s Organisation, Australia, Issues Paper submission to Productivity commission Re: NDIS Costs, 2018,
Productivity Commission, p13
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Our members report that many planners they have worked with appear to rely on the assumption that the Support Coordinator has explained everything to the participant about the planning process and what they would like to achieve in the next plan period.
However, many participants described not having enough support either in the pre-planning phase or the planning meeting itself, nor enough time to work through suggestions of what they needed. Given that the NDIS is based on the principle that participants exercise choice in and control over the supports they receive, it is particularly concerning that many participants describe the opposite. The AASW has seen reports of instances where participants and carers views were disregarded without explanation during the planning process.5
Other participants report confusion during the planning process to the extent that it was disempowering. Some participants report that they believed that they would have had a better outcome if they had been conversant in the jargon associated with their condition. Similarly, some participants have been surprised when told that a meeting they attended in the past was in fact a planning meeting.6
In a system designed around the rights of the participants, it is the job of the professionals to ensure that the status and the content of the meeting is understood by everyone present, preparing participants for the meeting and using language that everyone can understand.
The AASW believes that successful planning is dependent on:
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Establishing an empathic and respectful working relationship with the participant
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Developing an assessment of the participant’s circumstances and needs in collaboration with the participant, other members of the treatment team, other service providers, and family and friends wherever possible
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Developing a service plan with the client that takes account of short‐term and long‐ term goals and identifies how staff will support those goals
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Advocating with and for the participant to obtain resources and to support them to achieve goals
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Reviewing, revising and monitoring the plan regularly with the participant The AASW recommends that these actions are undertaken as a matter of course.
f. the incidence, severity and impact of plan gaps; We are concerned that there commonly two types of gaps in NDIS plans: in relation to whether all the supports identified are approved; and the length of time between one plan ending and the next one being built and approved.
This has impacts for the whole health system as well as for the participant. When funded supports are withdrawn, many participants’ experience a deterioration in their condition which may require more intensive medical interventions. Many of the participants with a
5 Warr et al op.cit. 6 Ibid.
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psychosocial disability can maintain stability with appropriate supports but are at high risk of relapse if their funded supports are reduced. As well as resulting in higher costs to the health system through admission to mental health acute and sub-acute units, these incidents are deeply distressing to participants and their families.
Social workers have the impression that some NDIS planners rely heavily on an assumption that a participant has informal supports to minimise costs to the Scheme. There are a multitude of problems with this. For some participants, there is in fact no such informal network willing to consistently support the participant and the NDIS will not fund formal supports to fill in those gaps. This is one group of participants who almost inevitably fall through the cracks of the Scheme.
For other participants, factors relating to their carers are not taken into consideration when their plans are being built. If the participant has a carer at the time when the plan is built, the NDIA does not look beyond that fact, and does not account for carer burden and potential breakdown. For example, when participants are living with elderly parents, transition and contingency planning are not identified as goals for their plans, which seems antithetical to a Scheme that is reliant on Capacity Building to reduce future costs.
Conclusion
The AASW is concerned at reports which suggest variability and inconsistency in plans, the planning process and the outcomes of the plans. The underlying rights-based principle of the NDIS should lead to every participant experiencing optimum results from their engagement with the NDIS.
With the focus on self-determination and holistic analysis, social workers can offer a unique and valuable contribution to the improvements in the NDIS which are necessary to ensure that it provides rights based, appropriate and targeted services to meet the complex needs of individuals, their families and communities; and to service provider organisations.
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