Tasmanian Government Submission

Tasmanian

Government

Submission

JOINT STANDING COMMITTEE ON THE NATIONAL

DISABILITY INSURANCE SCHEME (NDIS)

September 2019

19/98946

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Table of Contents

1. Introduction ………………………………………………………………. 2
2. Response to Areas of Inquiry …………………………………….. …2 2.1 Experience, expertise and qualifications of planners …………………. 2

2.2 The ability of planners to understand and address complex needs . 3

2.3 The ongoing training and professional development of planners …. 4

2.4 Participant numbers and number of planners relative to demand for plans ………………………………………………………………………………… 4

2.5 Participant satisfaction and involvement in planning processes …… 5

2.6 Interim plans and discharge delay ………………………………………….. 6

2.7 The review process and means to streamline it ………………………… 7

2.8 The incidence of appeals to the AAT and possible measures to reduce the number ……………………………………………………………… 7

2.9 The adequacy of the planning process for rural and regional participants ……………………………………………………………………….. 7

2.10 Any other related matters …………………………………………………….. 8

3. Conclusion ………………………………………………………………………… 10

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1 INTRODUCTION

The Tasmanian Government welcomes the opportunity to provide a submission to the

Joint Standing Committee on the National Disability Insurance Scheme (NDIS) Inquiry

into NDIS Planning.

The NDIS is one of the most complex and important reforms that Australia has seen in recent years and its potential to transform the lives of Tasmanians living with disability cannot be overestimated. Tasmania moved to full scheme NDIS on 1 July 2019 and is now operating under the Bilateral Agreement between the Commonwealth of Australia and the State of Tasmania on the National Disability Insurance Scheme. This Agreement reflects the shared NDIS responsibilities of both Governments and locks in arrangements for on-going funding contributions to the Scheme.

Successfully transitioning to the NDIS has been a key focus for the Tasmanian Government. From 2013 to 2016, Tasmania was an NDIS trial site for young people in the 15-24 age group. During that time over 1,000 young Tasmanians transitioned into the Scheme. In July 2016, Tasmania commenced its three year transition to full scheme with eligible people entering the scheme by age cohort. It was estimated that 10,587 Tasmanians would be supported by the NDIS by 30 June 2019, the end of the transition period. As at 30 June 2019, 6,831 Tasmanians were receiving NDIS support. This represents 65 per cent of the Tasmanian Bilateral estimate met for the period 1 July 2013 to 30 June 2019 compared to a national average of 72 per cent.

The Tasmanian Government recognises NDIS Planning as a key focus area when assessing the implementation, performance and governance of the NDIS. Once deemed eligible, the planning stage is often the first interface a person living with disability, their family or carer has with the NDIS, and the ‘success’ or otherwise of the process can substantially shape the participants’ overall experience of the NDIS and ultimately as directly impacts their ongoing quality of life.

The planning process also has a direct impact on national and state participant numbers. Improved access and planning processes introduced by the National Disability Insurance Agency (NDIA) earlier in 2019 have been noted and are appreciated, but there is still more to be done to ensure eligible Tasmanians receive the supports and services they need, when they need them. As a co-funder of the Scheme, it is also important the Tasmanian Government achieves value for money from the NDIS on behalf of the Tasmanian people.

This submission does not specifically address each term of reference in this Inquiry. Rather, areas of particular relevance to the Tasmanian Government are highlighted as they relate to the experience of NDIS Planning in Tasmania.

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2 RESPONSE TO AREAS OF INQUIRY

2.1 Experience, expertise and qualifications of planners

When supporting NDIS participants, the Tasmanian Government has noted differences in the experience, expertise and qualifications of NDIA planners and Local Area Coordinators (LACs) which can affect the overall quality of plans.

This issue has been somewhat mitigated at a local level by building good relationships and trust between Tasmanian Government agencies and individual planners. However, it is recognised such a person-dependant approach has an increased risk of inconsistency and is not sustainable, particularly in an environment of high staff turnover.

As NDIS planners are not required to hold formal disability or health qualifications, the Tasmanian Government fully supports the NDIA’s commitment to enhancing the skill level of NDIA planners and LACs through improved linkages, training and updated guidelines. Agreements reached on disability-health related supports at the June 2019 Council of Australian Governments (COAG) Disability Reform Council (DRC) will be reflected in updated guidelines for planners and LACs. Guidelines should be person centred and provide clear delineation of system responsibilities to support planners’ capacity to build quality plans in partnership with participants, their families and carers.

The Tasmanian Government is keen to reach a point at which participants are achieving consistently good outcomes under the NDIS planning process and are engaging with planners and LACs who have the appropriate experience, expertise, qualifications and skills to respond effectively and consistently to their needs.

2.2 The ability of planners to understand and address complex needs

2.2.1 People with complex needs and the Psychosocial Disability Service Stream

The level of complex need of people presenting with psychosocial disability is an area of concern for Tasmania, particularly in the context of a developing support coordination market.

As a general comment, the ability of planners to respond to people with complex needs is not sufficiently agile and flexible to concurrently address participants’ short term needs and medium to longer term goals. This cohort often experience challenges and long delays accessing the NDIS; therefore, good outcomes in the planning stage are critical to long term success in meeting needs and attaining goals.

The Tasmanian Government welcomed the introduction of the psychosocial disability service stream earlier in 2019 and acknowledges that there have been considerable

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improvements in access for this cohort in recent times. Tasmania is participating in the work currently being progressed at a national level through DRC Senior Officials Working Group (SOWG) and looks forward to further improvements, particularly in relation to recognition of the episodic nature of psychosocial disability and the focus on recovery based support.

2.2.2 Complex Needs Support Pathway

The Tasmanian Government has identified areas for improvement in relation to NDIA planners’ ability to understand and address complex needs, particularly where the participant is:

• in a custodial setting;

• a young person living in residential aged care;

• a child who is unable to remain living in the family home due to the impact of their disability; or

• an inpatient of a hospital facility. A recent example highlighting this issue involved a hospital patient assessed with cognitive impairment. The NDIS planning process was completed in hospital by a planner who gathered some background and clinical information regarding the participant’s functional capacity, but did not make contact with hospital staff to consult or confirm on a mutually agreed approach. A plan was issued, which recommended independent living for the participant. In contrast, due to the individual’s functional cognitive impairment and perceived safety risks, the hospital was recommending 24 hour supervised care. This case study highlights the need for improved coordination, collaboration and specialist knowledge between clinical staff and the planner at the NDIS pre-planning and planning stages.

In the case above, the planning process may have worked better if a specialist planner, preferably with a health professional qualification (such as Nursing or Allied Health), had been available and assigned to the participant with complex needs. This approach could also have assisted with interpretation and understanding of clinical language across the NDIS and health interface to reduce confusion and provide greater clarity for the participant, planner and health professionals.

The NDIA’s Complex Supports Needs Pathway (which commenced roll out nationally in March 2019) will provide specialised support for people with a greater need for coordination of multiple services to access and engage with the NDIS. This approach is strongly supported by the Tasmanian Government and we look forward to seeing a positive impact for Tasmanians with complex support needs through this Pathway.

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The Tasmanian Government is participating in work at a national level through SOWG in relation to people in custodial settings, the Hospital Discharge Delay Action Plan, the plan for Young People Living in Residential Aged Care and children who are unable to remain living at home due to the impact of their disability.

2.3 The ongoing training and professional development of planners

The Tasmanian Government notes national NDIA policy decisions can take considerable time to filter down to the local operational level and are often not reflected in planning conversations with participants.

In addressing this, ongoing training programs and guidance for planners should include a focus on the implementation of national policy at a local level. This would enhance practice at the operational level without the need for escalation processes to resolve day to day planning issues.

Notwithstanding the above, the Tasmanian Government is pleased to note positive developments in the areas of training and information availability. Guidelines that have been developed to assist planners to implement recent decisions in the funding of disability health related supports and other mainstream interface areas are welcome. The introduction of direct links to planners (via a phone line) has also worked well in improving the relationship between planners and Tasmanian Government agencies.

2.4 Participant numbers and number of planners relative to demand for plans

The overall number of planners relative to demand for plans has had significant impacts for Tasmania, particularly in regard to participant numbers and quality of life for eligible Tasmanians.

Tasmania’s transitional agreement, the Bilateral Agreement between the Commonwealth and Tasmania for the transition to an NDIS, estimated that 10,587 Tasmanians would be supported by the NDIS by 1 July 2019.

Becoming an NDIS participant is essentially a two stage process. The first stage determines whether the applicant is eligible to receive services from the NDIS. If an applicant is determined to be eligible (referred to as an access met decision), the second stage requires an NDIS participant plan to be developed. It is only when a participant plan is approved that an applicant is counted as an NDIS participant and can receive NDIS services. There are often unacceptably long wait times for participants between an access met decision and a plan approval.

Up to 31 March 2019, only 6,314 Tasmanians were receiving NDIS support. This issue was raised formally with the NDIA with the Tasmanian Government requesting re direction of NDIA planning resources to Tasmanian participants to meet demand and

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boost the number of plan approvals in the lead up to full scheme. This is the subject of ongoing discussion with the NDIA.

As at 30 June 2019, a total of 6,831 Tasmanians were receiving NDIS support. This represents 65 per cent of the Tasmanian Bilateral estimate met for the period 1 July 2013 to 30 June 2019 compared to a national average of 72 per cent. This slower than expected rate of eligible Tasmanians phasing into the Scheme means that many eligible Tasmanians are not receiving the supports they need, when they need them. Also of concern is Tasmania’s funding contribution at full scheme is fixed regardless of participant numbers. During 2019-20, the Tasmanian Government will contribute $233.3 million to the NDIS (based on the estimate of 10,587 participants).

Not only are additional planning resources required to assist Tasmanians to progress more rapidly to the plan approval stage so they can start to receive services, there is also a likely increase in scheduled plan reviews as a consequence of the length of time many participants have already been in the Scheme. Additional reviews as a result of recent decisions made by the DRC regarding the NDIS/Health interface are also anticipated. Upcoming decisions by DRC may also trigger the need for additional plan reviews to accommodate changes to transport supports.

The Tasmanian Government continues to work closely with the NDIA to maximise participant uptake, including discussion on NDIA planning resources and processes as they affect eligible Tasmanians and participant numbers. The Tasmanian Government strongly advocates for more NDIA planners with the appropriate skills and resources to be directed to Tasmanian applicants and participants to meet increased demand.

2.5 Participant satisfaction and involvement in planning processes

Participant satisfaction surveys have been developed by the NDIA to better record the experience of NDIS participants and their families and carers at different stages of the participant pathway. Plan development is a key milestone on the participant pathway.

The COAG Disability Reform Council (DRC) Quarterly Performance Report 30 June 2019

shows that 67 per cent of Tasmanian participants rated their overall experience with the NDIA’s planning process as either good or very good, compared to 90 per cent nationally. Compared to data from the same time last year (97 per cent as at 30 June

2018. it is evident there has been a significant dip in levels of satisfaction with the planning process in Tasmania over the last 12 months.

Further analysis of survey data shows improvements in the area of ‘participant attitude regarding the planner’ but a decrease across all other areas. The data shows only 62 per cent of Tasmanian participants agreed or strongly agreed that “the planner listened to me” and 67 per cent agreed or strongly agreed that their plan will make life better.

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Tasmania is performing well in the area of NDIS pre-planning, however performance in some aspects of the planning stage are concerning, particularly in relation to participants’ understanding what happens next with their plan (only 56 per cent reported they were clear on what happens next in the planning stage compared to 78 per cent in the pre-planning stage) and whether participants felt that decisions about their plan were clearly explained (with 63 per cent reporting they were clear in the planning stage compared to 85 per cent in the pre-planning stage).

This may reflect different processes for pre-planning and planning activity. Pre-planning is primarily carried out by LACs with planning undertaken by NDIS planners. It is possible LACs and NDIS planners have a different approach and/or skillset which results in different experiences and outcomes for participants across the stages.

There are also occasions where participant involvement in planning processes could be improved, particularly where the participant has cognitive impairment, or has significant complex needs. It is our experience that participants’ requirements, even with an advocate, may be underestimated in their plans. Conversely, in instances where participants, their families and carer have greater capacity to articulate needs, this results in a better outcomes through the planning process.

The Tasmanian Government would like to see improved consistency of participant outcomes across the pre-planning and planning stages and further guidance for planners in developing plans for participants who require support with decision making.

2.6 Interim plans and discharge delay

In the case of Tasmanian participants in hospital, the introduction of interim plans and the early involvement of a coordinator of supports have generally been positive, although this has sometimes led to delays.

A plan review generally occurs six months after the interim plan. This can create challenges, as it is often the expectation of the coordinator of supports that the participant will remain in hospital until their plan review occurs, leading to discharge delay.

There can also be differences in plans developed by NDIA planners and LACs which may trigger the plan review process, again leading to delays and lengthy inpatient stays for participants.

The Tasmanian Government notes there are financial implications for state public health systems in providing ongoing care to NDIS participants who experience delays in discharge, which result in increased avoidable costs to the health system. This is often the case for participants who might require support from multiple service systems such as clinical, accommodation, and mental health supports. We look forward to

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improvements in this area through the Complex Needs Support Pathway and the Hospital Discharge Delay Action Plan.

The Tasmanian Government notes the recent implementation of the Critical Services Issues Response (CSIR), a process for escalating complicated and intractable matters that impact on an NDIS participant and cannot be resolved at the local level. This has enabled a more consistent and rapid response from the NDIA with improved outcomes for participants.

2.7 The review process and means to streamline it

Once a participant receives an approved plan, the NDIA builds in a scheduled review of the participant’s goals, needs and reasonable and necessary supports, usually 12 months from the date of the initial plan. An unscheduled review can occur before the scheduled review date. The proportion of unscheduled reviews is, at times, an indicator of the quality and appropriateness of the initial plan.

In Tasmania, 20 per cent of participants are likely to have an unscheduled plan review compared to 16 per cent nationally. This reinforces the need to direct more NDIS planners with the right skills and with appropriate resources towards Tasmanian applicants and the continued roll out of NDIA improved planning processes.

A lack of suitable accommodation has also been identified as a barrier to discharge delay and the planning and review process. There have been recent examples where suitable accommodation has been identified but the NDIS plan does not allow for those accommodation options to be considered. Again, this can trigger a plan review, often causing lengthy delays for participants. National work on Specialist Disability Accommodation (SDA) progressing through SOWG should alleviate some of these issues in the future.

2.8 The incidence of appeals to the Administrative Appeals Tribunal and possible measures to reduce the number

The Administrative Appeals Tribunal (AAT) is an independent body that conducts reviews of administrative decisions made under Commonwealth laws.

The COAG Disability Reform Council (DRC) Quarterly Performance Report for

30 June 2019 shows there are 2,233 AAT cases nationally, of which 31 are Tasmanian cases.

Of the 2,233 national cases, 33 per cent relate to Access, 48 per cent to Planning, 11 per cent to Plan Review and 7 per cent to other. It is clear from this data that the planning and review processes generate a higher percentage of AAT cases nationally.

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Potentially, this indicates a level of dissatisfaction with the planning process consistent with our experience in Tasmania.

2.9 The adequacy of the planning process for rural and regional participants

The adequacy of the planning process for participants is significantly affected by thin markets across the State, particularly in rural and regional areas of Tasmania.

Access to allied health professionals has been especially challenging such that even where a plan is approved, participants in rural and regional areas often have difficulty sourcing providers that can deliver approved supports.

Tasmania has actively participated in projects to identify and address thin markets, particularly as they relate to rural and regional areas. There is a need to analyse further participant plan use data at a regional level to understand if there is a correlation between use and thin markets. Tasmania believes this could inform more direct action.

There are various causal influences for thin markets which include geographic challenges, skill set shortages and, more generally, workforce shortage. The Tasmanian Government has identified and invested in priority areas such as disability support worker certificate level training, allied health professional skill shortages and better use of technology to connect participants and providers of support and services. Tasmania believes a multilayered approach at the local community level is required to address the challenges in rural and regional communities. This requires State and Commonwealth cooperation and collaboration.

2.10 Any other related matters

2.10.1 Plan activation

The COAG Disability Reform Council (DRC) Quarterly Performance Report 30 June 2019

shows a clear delay between a participant’s plan approval and plan activation (plan activation is defined as the time from a participant’s initial plan approval to when the participant first uses plan supports). In Tasmania, 68 per cent of plans are activated within 30 days of plan approval and 85 per cent within 90 days. This means participants do not access their approved reasonable and necessary supports for significant periods of time post plan approval.

The NDIA has commenced a roll out of joint planning meetings to include participants, planners and LACs to help address this delay. It is understood these joint meetings have commenced in South Australia but are yet to roll out nationally. The Tasmanian Government supports this approach and calls for a more rapid roll out of these meetings to ensure Tasmanian participants receive their approved supports and services as soon as possible.

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2.10.2 NDIA Restructure at Regional level

The Tasmanian Government has observed differences in Tasmania’s capacity to resolve issues quickly at a local operational level since the NDIA restructure merging Tasmanian and Victoria in July 2018. This restructure saw the loss of the Regional Manager position in Tasmania.

The Tasmanian Government remains committed to working collaboratively with the NDIA through the regional governance arrangements to ensure that Tasmanians with disability receive the supports they need in a timely manner.

2.10.3 Delays in providing equipment

Delays in providing Assistive Technology (items of equipment) in participant plans have caused additional stress for some Tasmanian participants, their families and carers.

It would be helpful if planners work in partnership with participants to understand the issues relating to these delays and collaborate with appropriate partners to minimise waiting times for participants.

2.10.4 Early Childhood Early Intervention

The NDIS Early Childhood Early Intervention (ECEI) program began in Tasmania on 1 July 2017 and currently runs alongside the Tasmanian Government’s Early Childhood Intervention Service (ECIS), which is yet to be cashed out. Tasmania’s Department of Education continues to build collaborative relationships with ECEI providers to support good outcomes for children in the state. As at 30 June 2019 232 Tasmanian children were accessing ECEI supports.

Earlier this year, the Minister for the NDIS, Stuart Robert announced several short term measures to resolve delays in accessing ECEI supports. It is understood that from August 2019, NDIA staff have started to contact those families and carers of children who have been waiting for 50 days or longer since receiving an access decision, to discuss the option of a six month plan. This is starting in South Australia with the intention for it to be rolled out nationally.

The Tasmanian Government calls for this measure to be rolled out in Tasmania as soon as possible in order to reduce waiting times for Tasmanian families and carers of children accessing ECEI supports.

2.10.5 Transport

Access to transport is critical in enabling Tasmanian participants to access their communities and to live an ordinary life.

Since the beginning of the NDIS transition the Tasmanian Government has raised issues around the adequacy of transport supports in participant plans, particularly when

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compared to existing state-funded taxi subsidies provided and funded by the Tasmanian Government.

The NDIS provides reasonable and necessary transport supports based on an individual’s assessment of need. The NDIS assessment of need in relation to transport supports has, for many Tasmanian participants, resulted in a reduced capacity to travel: to work or place of study; to access funded supports; and to participate in community events or recreational activities. This has greatly affected participants’ quality of life and has been the cause of significant dissatisfaction both within the Tasmanian disability sector and the broader community in Tasmania.

In March 2019 the Tasmanian Government endorsed the continuation of a State funded taxi subsidy in the form of a capped, time-limited (up to December 2023) Taxi Supplement to assist NDIS participants with transport costs until such time as a national NDIS Transport policy is in place.

Work on progressing a national transport policy through SOWG (which was, until recently led by the Tasmanian Government) is fully supported. The Tasmanian Government calls for NDIS Transport funding supports to be included in participant plans that: are consistent with the Applied Principles and Tables of Support (APTOS); adequately reflect participant transport support needs; do not reduce participants’ existing capacity to travel; and enable state transport subsidies for NDIS participants to cease.

2.10.6 Local Area Coordination (LAC) and Information, Linkages and Capacity Building

(ILC)

Tasmania is yet to realise a complementary and supporting ILC service system, including LACs as originally envisaged by the Productivity Commission. While this part of the NDIS system remains underdeveloped, NDIS participants and people with disability remaining outside the Scheme will not achieve the full intended benefits of the NDIS.

Tasmania notes the considerable time and effort invested by LACs in the pre-planning stage. Of equal importance, is the community and individual capacity building function of LACs to support the ILC service system and enable participants to connect with the full range of mainstream and community services available to them. It is important that LACs have sufficient capacity and resources to be able to deliver across both of these functions.

The Tasmanian Government has asked for a Tasmanian ILC round table to be held as soon as possible to further the ILC discussion and advocates for sufficient resources to allow LACs to deliver on their community and individual capacity building function to support a successful roll out of ILC in Tasmania.

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3 CONCLUSION

The Tasmanian Government acknowledges the complexity of NDIS implementation nationally and welcomes recent changes to access and planning processes to improve the experience of participants and providers as they navigate their way through the scheme.

In providing information on the Tasmanian experience of NDIS Planning, the Tasmanian Government provides the following as a summary of key points:

• The Tasmanian Government continues to participate in work currently progressing at a national level through the SOWG and welcomes the development of national policy and ongoing improvements, particularly in relation to NDIA planning processes and resources.

• Working closely with the NDIA to maximise participant uptake, including further discussion on NDIA planning resources and processes as they affect eligible Tasmanians and participant numbers remains a priority for the Tasmanian Government. We strongly advocate for more NDIA planners with the appropriate skills and resources to be directed to Tasmanian applicants and participants to meet increased demand.

• The Tasmanian Government looks forward to Tasmanian participants achieving good outcomes and quality plans by working with planners and LACs who have the appropriate experience, expertise, qualifications and skills to respond effectively and consistently to their needs.

• Participants with complex needs would benefit from specialist planners, preferably with a health or allied health background, to help improve the quality of plans and assist with the interpretation and understanding of clinical language across the NDIS and health interface to reduce confusion and provide greater clarity for participants, planners and health professionals.

• Improved consistency of participant outcomes across the pre-planning and planning stage is critical to achieving better outcomes for Tasmanian participants.

• The Tasmanian Government supports a rapid roll out of joint planning meetings to include participants, planners and LACs to ensure Tasmanian participants receive a quality plan and can access their approved supports and services as soon as possible.

• The Tasmanian Government calls for measures to resolve delays in accessing ECEI supports to be rolled out in Tasmania as soon as possible to reduce waiting times for Tasmanian families and carers of children.

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• NDIS Transport funding supports should be included in participant plans; be consistent with the Applied Principles and Tables of Support (APTOS); adequately reflect participant transport support needs; not reduce participants’ capacity to travel and should be sufficient to allow state transport subsidies for NDIS participants to cease.

• Noting concerns regarding the roll out of ILC commissioning in Tasmania, there is a need for an ILC round table to be held in the State as soon as possible. The Tasmanian Government also advocates for sufficient resources to allow LACs to deliver on their community and individual capacity building function to support a successful roll out of ILC in Tasmania. The Tasmanian Government looks forward to the outcomes of the Inquiry on NDIS Planning.

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