Unreasonable and unnecessary risks to NDIS’ mission
A submission to the Joint Standing Committee on the NDIS
Re: NDIS Planning
September 2019
ABN 30 591 218 387
Leadership Plus
Anzac House Level 4
4 Collins Street
Melbourne VIC 3000
Phone: (03) 9489 2999 Fax: (03) 9489 2988 www.leadershipplus.com
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Contents
Executive Summary …………………………………………………………………………………………………………………… 3 Where is NDIS planning failing to deliver its mission? ………………………………………………………………….. 5
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People performance …………………………………………………………………………………………………………… 5
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Efficiency of processes ……………………………………………………………………………………………………… 11
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Client satisfaction …………………………………………………………………………………………………………….. 15
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Financial performance ……………………………………………………………………………………………………… 17 OUR RECOMMENDED SOLUTIONS ……………………………………………………………………………………………. 21
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Employee Performance …………………………………………………………………………………………………….. 21 Increase staff numbers……………………………………………………………………………………………………… 21 Employ and develop high quality staff, experienced in disability and skilled in administration. . 21
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Efficiency of processes ……………………………………………………………………………………………………… 22 Introduce Draft plans. ………………………………………………………………………………………………………. 22 Delegate financial authority for minor plan variations to the front line. ……………………………….. 22 In reassessment, investigate the causes of unspent funds rather than cutting them. …………….. 22 Streamline the review process, and thereby reduce number of appeals to AAT. ……………………. 22 Introduce longer plans. …………………………………………………………………………………………………….. 23 Introduce automatic rollover of plans. ……………………………………………………………………………….. 23
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Client satisfaction …………………………………………………………………………………………………………….. 24 Streamline all Agency processes so the Scheme is easier to navigate. …………………………………… 24 Fund additional services not currently provided for: …………………………………………………………… 24
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Financial Performance……………………………………………………………………………………………………… 25 Commit to funding staffing levels that can deliver the Scheme. …………………………………………… 25 Accept liability. ………………………………………………………………………………………………………………… 25
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Stakeholder satisfaction …………………………………………………………………………………………………… 26 Plan realistically for the future. …………………………………………………………………………………………. 26 IMPACT OF RECOMMENDED CHANGES …………………………………………………………………………………….. 27
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Executive Summary
Unreasonable and unnecessary risks to NDIS’ mission A submission to the Joint Standing Committee for the NDIS
The NDIS’ mission is to “build a world-leading national disability insurance Scheme”.
Seven years into implementation, there are many successful plans, yet aspects of the Scheme’s staffing and planning processes present unreasonable and unnecessary risks to ever achieving that mission for all participants, particularly the most vulnerable. Standard textbook measures of performance are perceived by Leadership Plus, and across the disability advocacy sector, as alarmingly low.
The changes recommended below could help the NDIS get back on track.
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Unreasonable and unnecessary risks to NDIS’ mission
Introduction
NDIS has an ambitious mission, to “build a world-leading national disability insurance Scheme”, providing funding packages for approximately 460,000 people aged under 65 with permanent impairment that substantially reduces their physical, intellectual, cognitive, neurological, sensory, psychological, and social functioning.
Yet, seven years into implementation, elements of the Scheme pose unreasonable and unnecessary risks to achieving that mission. These risks are ‘unreasonable’ because of the burden they put on people with disability, both participants and those attempting to be participants; they are ‘unnecessary’ because a few informed changes can make the mission achievable.
The NDIA has organisational values to “aim higher”, “seek feedback to reflect and act on”, and “is resilient and has the courage to do better”. While these aims are laudable, we have not yet seen these values expressed operationally on a day-to-day basis. We welcome this opportunity to provide feedback to reflect and act on.
Leadership Plus
We are advocates and decision supporters working closely with people living with complex disabilities in Victoria. Over 60% of our work now concerns interactions with the NDIS. We advocate for nearly 300 people with disability each year, and are intimately acquainted with examples of the Agency failing to work appropriately for people with disability, and failing to recognise and take corrective actions when the Scheme is not working.
Our individual advocacy work relies on building strong relationships with people living with disability, family members and their loved ones. Similar issues are raised time and time again, and confirmed by all the advocacy organisations in our state-wide and national networks.
Our daily experience gives us a unique position to identify and articulate the issues, and to pinpoint the most important solutions to enable the NDIS to achieve its mission.
We at Leadership Plus enthusiastically applaud the aims of the NDIS and have no illusions about the enormity of the task it has undertaken. We join all the disability advocacy networks in which we are represented and involved (Victorian Disability Advocacy Network, Disability Advocacy Victoria and Disability Advocacy Network Australia) in wishing only for the success of NDIS’ mission, and trust that providing our feedback and examples of real clients’ challenges in dealing with the NDIS will help the Joint Standing Committee make meaningful changes to the Scheme’s operation and help lead to meaningful outcomes for participants.
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Where is NDIS planning failing to deliver its mission?
We have grouped the Joint Standing Committee’s inquiry topics and relevant feedback under five textbook elements that, when measured and managed properly, ensure strong all-round performance. They are: people performance, efficiency of processes, client satisfaction, financial performance, and stakeholder satisfaction.
- People performance The aim: “We empower and invest in our people.”
NDIS Values, Capabilities & Behaviours
The experience:
(i) Capping staff numbers poses an unreasonable risk to NDIS’ mission.
It is well-documented that initial estimates were that the NDIA would need 10,000 staff and were limited to 3,000.
Insufficient front-line staff places excessive burdens on too few.
Setting up the external LAC/Planner layer was fundamentally a way of extending reach, and perhaps a way of not building in a permanent headcount for the planning work which, it was assumed, would diminish after first wave of implementation.
Yet limiting internal resources and placing key determinants of Scheme success outside the organisation has proved detrimental.
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Risk of death not enough to prompt allocation
A participant with an acquired brain injury and short term memory challenges as well as other complex disabilities did not remember a planning meeting date. The LAC developed the plan alone without any consultation from the participant or her only supporter who had asked to be contacted when a planning meeting was set. Consequently the plan produced was entirely inadequate and the support coordinator’s hours were used up within the first 3 months due to the complex nature of the participant’s disabilities and emergency hospital admissions.
A request for a review (A review of a reviewable decision) was submitted 2 months ago requesting a plan that provided adequate supports and funding and outlining the precarious situation of the participant. This was substantiated by a number of medical reports including an OT report stating that the participant was at risk of death without adequate support and hours to coordinate these supports.
Two formal complaints have since been lodged regarding the lack of response to these urgent needs. A phone call to the department last week by Leadership Plus resulted in an admission that the request had not yet been allocated to a delegate to review and rectify.
Participants fall through dangerous staffing and prioritising gaps in the NDIA.
(ii) Planners have insufficient experience, zero expertise, inappropriate qualifications and no authority.
Prior to the introduction of the NDIS, staff working with people living with disability had experience and knowledge of their conditions. Now, insufficient training of front line staff and insufficient experience leads to ill-conceived and insufficient plans, which in turn lead to increased and unanticipated demands for reviews and appeals and increased delays in reviews and appeals, all to the direct detriment of participants.
Position descriptions in recruiting advertisements specify that no experience with disability is required, setting the scene for almost inevitable failure of the process. Many are from industries with no connection to the disability sector, such as a retail or insurance broking.
It is unlikely, and unreasonable to assume, that these staff will have sufficient experience or knowledge to effectively support the planning process, particularly in the early stages of their employment. In effect, planners run the risk of “not knowing what they don’t know” and this directly impacts the quality of plans. Often planners lack any conception of what support means for people living with complex disability.
Many in the sector have inadequate qualifications. Even those in the sector who have completed training may not know what is needed - 40% of those accessing the NDIS are on the autism spectrum; only 1 in 5 studying Certificate IV in Disability have Managing Autism as a core elective.
In addition, Local Area Coordinators and Agency planners have no delegated authority, so decision-making processes are necessarily protracted, creating internal costs and external costs.
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(iii) Planners and staff currently have minimal training and professional development.
Turnover in the NDIA has been endemic since the NDIS commenced. Enormous amounts of money and time must have been spent training people who have left.
Initially, training sought to cover all forms of disability within 6 weeks, which overwhelmed learners. Then specialties were offered, yet planners could not be reliably matched to meet the needs of the increasing numbers of people living with a wide range of significant disabilities. Training is now reportedly concentrated on negotiation and denial with impunity. Administration and customer service training would clearly also be of value.
Why no wheelchair?
A Participant who sought review at the Administrative Appeals Tribunal had been contacted by the then ‘Early Resolutions Team’. A meeting with the Participant’s mother, the Instructor for the Agency, and the Advocate was held in May 2019. At the time of writing, the Participant has still not received the wheelchair that they have needed for approximately 12 months.
While there are many reasons why this is so, the majority can be attributed to the fact that the Instructor for the Agency removed themselves from the matter without notice. The replacement Instructor failed to respond to requests for follow up on reaching a consent order. It is only in the last month that the quote provided to the Agency for the wheelchair has been taken into account, and the process of manufacturing the wheelchair from SWEP has commenced.
(iv) Planners and staff lack the ability to understand and address complex needs.
Urgent and Complex Needs meet NDIA obscurity and silence
Michael is a gentleman in his early forties who requires 24/7 care and is required to leave the institution in which he now resides. His NDIS plan expires soon. Leadership Plus put in a review application on behalf of Michael to request a complex planner and to seek a review for a new NDIS plan. The advocate was advised by NDIA that ‘the criteria for eligibility for access to a complex planner are not available to the public’.
Despite the urgency of the issue, and prompting from both the advocate and DHHS, there has been no communication from NDIA on the progress of the review to either Michael, the advocate or Michael’s family, who are understandably concerned about the level of support Michael is likely to receive under his new NDIS plan.
This is not an exception. Other individuals with complex needs have similar experiences.
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While the Agency has recognised the need for a dedicated Complex Care Team, that team doesn’t meet with people, yet makes decisions about their level of care.
Planners and staff alike seem not to understand that challenging behaviour is often an attempt at communication, rather than a symptom of a disability.
Any system where people who have no experience, expertise or even contact with a participant are making decisions about what is ‘reasonable’ and ‘necessary’, is doomed to fail.
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(v) Planner numbers are too low relative to demand for plans.
Due to low numbers and staff caps, planners allow one meeting only to discuss a person’s life and choices for a whole year, and come unprepared, without having read the history, and allow no time to get to know the person. The chances of devising a suitable plan reflecting a person’s will and preferences are remote, particularly in the case of complex needs.
Some people with Acquired Brain Injury miss planning meetings due to their disability, and because of low planner numbers, plans are simply developed without any input from the person.
(vi) Staff morale is low and harmful behaviour is incentivised.
We have many interactions with Agency staff, LACs and Support Coordinators, and have heard many instances of poor morale and inappropriate incentives.
After a meeting, senior NDIS staff explained to advocates that they would never see them again; they were not allowed to build empathy.
A Support Coordinator was investigated for advocating for a client. Commitment to promoting the rights of the person with a disability has apparently gone from mandatory to forbidden.
Many NDIS staff are defensive and combative through dealing with daily conflict and confusion.
(vii) Support Coordinators are underused, lack skills and are often underpaid.
Too many participants who will clearly require assistance with plan implementation do not have adequate support coordination built in their plans.
Even when support coordination is available, it is often insufficient. As critical players in the success of planning processes, the performance of this group is key. Unfortunately, employers often pay Support Coordinators as little as $30/hour, while NDIA are paying $96/hour. The NDIA has reportedly turned many service providers into businesses with a profit motive, with an imperative to provide services that fit the funding regime, not the participants’ needs.
(viii) Case management is missing.
A serious flaw obvious to anyone experienced in the field is that there is no Case Management included in any of the support categories funded by the NDIS.
There is a category of people with complex needs which are not being met through support coordination. The sector has traditionally recognised there are people whose needs are
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sufficiently complex and dynamic that dedicated case management is required. While the Scheme has recognised additional complexity in planning, it hasn’t recognised the requirement for supporting additional complexity in implementation.
It is essential, for many of our clients, to have a single, trusted point of contact to coordinate supports. It is inappropriate for a person to have to disclose private matters to support workers who come and go. People have issues that require professional, organised responses, outside the coordinating services for the NDIS.
In many instances there is a tension within the role of Support Coordinator due to the need for a Case Management role, which has an impact on their role as support coordinator.
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- Efficiency of processes The aim: “We grow together. We collaborate to work as one for better outcomes.”
NDIS Values, Capabilities & Behaviours
The experience:
Planning processes are inefficient and time-consuming, and put extraordinary and unprecedented demands on vulnerable Australians.
(i) The fixed-term structure of plans creates unnecessary pressure and workload for participants.
Fixed terms and the necessity of regular reviews produce stress for participants, who have to go through the demeaning processes of obtaining reports again and suffer the threat of removal of funds.
People with stable conditions and clearly identified needs are forced to re-identify their required supports causing unnecessary annual stress and the expense of obtaining fresh reports.
Further, planners and delegates are thereby incentivised to cut funds at each review, to prove their value and ‘earn their keep’, by putting pressure and stress on participants.
(ii) Participants have minimal involvement in the creation of their plan.
Planning meetings are often unilateral, so participants feel disempowered and at risk.
Planning meetings are often inadequate/ inappropriately conducted. One meeting only is offered, which goes for too long, often covering far too much information and exchange, particularly for people with complex needs. It is arguably discriminatory to provide no plain English explanation and summary.
“I can’t do this alone…”
People are traumatised either by their first planning meeting or simply by the communication leading up to the planning meeting and are desperate for someone who can guide and support them through the process.
Limited contact with the planner limits the potential for a satisfactory plan. There is a window of contact for perhaps 4 to 6 weeks only. Generally no contact phone number is provided but
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only an email address. There have been a few cases (out of several hundred) where we have had phone contact, but largely not.
The participant does not have opportunity to ‘agree to’ the plan. There is no review copy made available. A participant does not sign off on the plan; it is there, take it or appeal it. This is a step back for Victoria, where in the state system there was a more collaborative approach with the participant signing off on a plan. Meaningful participation in plan development and ownership are much more likely to foster agency in a person living with disability.
“What happens to people who have no family to support them???”
This is from the perspective of family members who are bamboozled by the process and find it difficult to comprehend how someone without family can navigate the system.
(iii) Plan gaps are the norm, ensuring expensive systemic failure and reputational damage.
Out of several hundred plans advocated for by Leadership Plus, we have seen ONE plan that works and meets the client’s needs. The issues and case studies in this submission are not exceptions, they are the rule as we see it. The NDIS demeans everyone in its processes – the person, the family, the advocate, the planner, and even Agency personnel – which fuels further mental health issues for all.
There is no consistent format to plans, making them difficult to read and understand.
The majority of plans we see have inaccurate information or incomplete information, with significant contributions about the person provided at planning meetings not reflected in their plan. The planner or delegate often misses essential elements, to the extent of not even correctly identifying the participant’s disability.
Whoops, forgot to mention…
In a plan for a teenager, the NDIS Statement of Participant’s Function included, “they got up, got dressed and took the dog for a walk in the morning”. When the advocate spoke with the young person’s mother, it became apparent that none of these activities were done independently. All required the mother to be present to prompt the young person – to dress for the weather, to ensure their teeth were brushed etc. – and most significantly, the young person would either get lost or abscond without mum being present on the walk.
Informal support provided by exhausted family members is too often overlooked in deciding what is “reasonable and necessary”.
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(iv) The process is even harder for regional and rural participants.
Most of our participants are Melbourne-based. The largest issues for regional clients that we are aware of are in implementation, rather than planning, with a severe lack of Service Coordinators available locally.
(v) The reassessment process is opaque and mystifying.
When fund usage varies, participants face the implied threat and sometimes actual automatic removal of unspent funds, and the Agency seem to have no recognition or understanding of the difficulty in obtaining services that often causes the underspend.
Secondary plans are often automatically reduced because there is an incorrect theory held that people improve after their first plan, which simply isn’t the case in the case of most lifelong disability. Let us remember and reflect on the need to meet the permanency criteria in order to gain access to the scheme.
With no sense of mutual obligation, communication with the NDIS breeds insanity. “The NDIS never get back to you.” The reassessment process seems aimed only at reducing costs. Reducing funding and failing to justify cuts means trust cannot be built.
(vi) The review process is protracted and unreliable.
Intimidating conciliation process Participants are confronted with an NDIA person, a NDIA lawyer and sometimes counsel, when there is no guarantee of participants’ having any support at all, let alone legal representation.
Poorly prepared representation Even with significant resourcing, too often the Agency’s legal representative is clearly not familiar with the content of the case or even the relevant NDIS Act and Guidelines.
Appealing plans that are inadequate is a protracted, uncertain, and extremely stressful process. Moreover, Agency conduct encountered by Leadership Plus indicates that even a ‘successful’ outcome is vulnerable to unilateral alteration by the Agency in the course of proceedings. Until money is deposited into bank accounts, anything could happen. NDIA staff are not following their own processes.
The resources invested in appealing inadequate plans, both by the Agency and by Advocates, could be avoided if planning meetings conducted at the first instance took into account the circumstances of the people affected by planner and Agency decisions.
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AAT orders contravened and incompetent communication
After approximately 105 hours of Advocacy work over 15 months, a conciliation was held at the Administrative Appeals Tribunal, and a consent order was prepared in March 2019 that outlined the Participant’s statement of supports.
A plan was provided to the Participant that failed to adhere to the supports discussed at conciliation and was in direct contravention of the orders issued by the Tribunal and those agreements reached in correspondence between the solicitors involved in the matter.
The conduct of the Agency in this matter is reprehensible. As a government body, the Agency has obligations to conduct itself as a model litigant. Unilaterally altering the agreed orders is contrary to the very purpose of merits review.
Moreover, the Agency, rather than contacting the solicitor about their apparent “miscalculations”, contacted the family directly in an attempt to justify the plan provided to the Participant, failing to consider that the family had spent over eighteen months in a state of severe stress and uncertainty over the Participant’s future, and a considerable amount of time and energy in navigating the review process.
At the time of submission, no explanation has been provided.
Disregarding the Appeals process wastes the valuable time of the Tribunal, lawyers and Advocates, is a stressor for families, carers and Participants and poses a reputational risk to the Agency.
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- Client satisfaction The goal:
“We value people. The Agency puts participants at the heart of everything it does”.
NDIS Values, Capabilities & Behaviours
The experience:
All the issues noted above have significantly affected participant satisfaction with the Scheme and more importantly have eroded public and sector trust in the NDIS and confidence in the future performance of the Scheme.
“The plan meets the needs of the NDIA, not the family or person.”
Murray Dawson-Smith, former CEO of Autism Victoria
Director, Live Work Relate
(i) Access and planning processes have not built trust.
The humiliation of creating reports, the invasion of having to share all the details of one’s disability, and stress are regularly raised as deeply upsetting elements of gaining access. Many people and families have developed a significant lack of trust with the NDIS due to their damaging experiences of the planning process and outcomes. The very notion of 12 month plans also implies the matter is a curative complaint rather than having lifelong status, despite permanency criteria needing to be met at access.
“I fail to see how the support can reignite my previous exuberance and love of life.”
This woman has a range of complex issues exacerbated by the exhausting process of dealing with the NDIA.
(ii) Moving from the old to the new has been draining for vulnerable Australians.
While the NDIS is designed only to meet the needs of approximately 10% of people living with disability, its introduction has impacted the entire sector. Though flawed, there were elements of support provided by the ‘old’ system that worked well, which the NDIS has failed to understand and accommodate, and the change, disruption and stress of moving from ‘old’ system to ‘new’, has been difficult for individuals, families and loved ones. Some describe it as ‘traumatic’.
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“We were better off when we had an ISP”.
An ISP (individual support package) was funding under the previous system. Although this too had its flaws, the planning process was shared between the individual/family members and the department.
Still waiting…
George, 43, was born congenitally deaf and has cognitive dysfunction resulting from being struck by a motor vehicle when aged five. His neuropsychological diagnosis from DSM-V is Major Neurocognitive Disorder.
Accused of crimes that resulted from internet scams and behaviour related to his disability, George faces incarceration unless covered by an NDIS plan. It took a Leadership Plus advocate over three months of agitating to gain George proof of his access to the NDIS. To produce a plan, George’s family were advised by NDIS to use a Local Area Coordinator. None were available as the provider had a back-log of 17,000 people awaiting coordination.
Three months later a guardian was appointed, who escalated the issue to NDIS’ National Access Team. A planning meeting was finally held in January 2019. In early September, the plan has still not been received.
Complex needs and urgent circumstances get ignored by the NDIS.
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- Financial performance The goal: “We take care. The Agency owns what it does and does the right thing.”
NDIS Values, Capabilities & Behaviours
The experience:
(i) Apparent savings mask waste and delay.
Too few and/or not competent planning staff has meant that the NDIA haven’t met their rollout goals as fast as they should have, which has meant ‘savings’ in actual plan costs. Too little has been spent on enabling, resulting in too little being spent on the actual program.
However there has been considerable expenditure on consultants to implement changes and review subsequent implementations. Actual permanent staff who knew the terrain might have been more cost effective.
(ii) Funding allocations are biased.
The funding models rewards service providers for dealing with “easier” clients, so only the most able end up being well supported (For example: Centre based weekday rates for 1:1 are $54.95 per hour, 1:2 $57.06 per hour, 1:3 59.16 per hour and 1:4 $61.24 per hour).
(iii) Liability is avoided.
The autonomy and legitimacy brought about by the Agency’s establishment as a Commonwealth Corporation successfully ensures that it is beyond electoral cycles, but with the result that traditional means of accountability for government practice do not apply to the NDIA.
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The NDIA gave Gabrielle the wrong advice about reimbursement. And refuses to fix it.
Gabrielle has an NDIA plan which includes Assistive Technology funding. Her physiotherapist supported using that funding to buy three items of furniture to manage the physical impact of Grace’s disability. The total cost was within the $1000 allowed in her plan.
She sought advice from her Local Area Coordinator and on that advice, in January 2018, she purchased the furniture directly from a retailer who had told her they were a registered NDIS provider. Expecting it to be reimbursed by the NDIA, and with no savings, Gabrielle took out a personal loan to buy the furniture.
Following the purchase, Gabrielle was unable to get reimbursement from the NDIA. She pursued the issue, sometimes with the help of an advocate. Finally the NDIA agreed to an ‘irregular’ payment, yet reimbursed only a third of the amount.
A series of farcical, confused and expensive AAT teleconferences followed over the following 18 months, involving the costly time of NDIA lawyers, Registrars and the Deputy President of the AAT and advocates, concluding that the AAT had no jurisdiction over matters of reimbursement, and advising other paths for restitution, neither of which have proved applicable as the NDIS is a “corporate entity”.
Gabrielle’s eventual direct call to the NDIS Minister’s office, describing the saga of 18 months of misleading advice and unsatisfactory administration produced a full investigation, which concluded that NDIA had given incorrect advice, followed incorrect procedures and took full responsibility for the errors, yet no responsibility to reimburse!
To save $600, the NDIS wasted approximately $20,000 of administrative, legal and judicial time, and failed to deliver a meaningful outcome for the participant.
(iv) Reassessment and rate changes create dismay and defy logic.
Unspent funds are simply eliminated from the following year, regardless of valid reasons such as people spending time in hospital, not having a Support Coordinator, equipment not yet purchased because of non-delivery and lack of follow-up, specialist services not available or specialist staff leave mid program making report/outcomes impossible to deliver. This may look like a saving on paper, yet poses a significant reputational risk for the Agency.
Often people are not able to implement their plan immediately or at all because they do not have the support to do so, and Support Coordination is either missing or insufficient. The assumption made by the Agency is that the person does not need the funds and usually there is a significant reduction in their next plan. We know of examples of subsequent plans from which $30,000 has been removed without consultation.
In contrast, there are instances where services previously provided by state-based systems are now costing twice as much through NDIS funding, with no apparent change in service level.
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(v) Reviewing inadequate plans via the AAT is wasteful and expensive.
Too many matters are going to the AAT which could have been resolved through suitable interaction with the participant and adequate internal review.
“The amount of money that is spent on legal representation for matters at the AAT is a huge concern. A plan is implemented which is insufficient, and an untenable amount of public funding is spent rectifying plans through the review process.”
NDIS Appeals Officer
Simple category mistake goes to AAT
A participant had a suitable plan with all the supports she needed for achieving her goals. When she sought supply of one of her supports from a service provider, she was told that the planner had placed the funding for that support in the wrong category and that the service provider wasn’t authorised to supply supports in that category.
She contacted the NDIA, seeking to have the plan adjusted so that the support was in the right category. The agency did not adjust the plan, but treated it as a request for a plan review, which was denied, resulting in the participant taking the issue to the AAT.
Some nine months after the original request, at the AAT case conference, the NDIA representative agreed that correcting the plan was the appropriate action and the correction was subsequently made.
Simple adjustments at the front line could prevent waste of time, money and reputation.
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- Stakeholder satisfaction The aim: “We seek to understand and address our stakeholders’ needs.”
NDIS Values, Capabilities & Behaviours
The experience:
For many stakeholders, the concerns identified in the Productivity Commission’s 2011 pre NDIS sector report largely remain, seven years into NDIS implementation: many people with disabilities are unable to access services, their will and preferences are not being taken into account and now they must exert enormous amounts of time and energy in rectifying the insufficiency of their plans.
These are all unreasonable and unnecessary risks to NDIS success. The solutions suggested below could make all the difference.
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OUR RECOMMENDED SOLUTIONS
- Employee Performance Increase staff numbers.
Employ the number of planning and review staff required to deliver the Scheme effectively.
Employ and develop high quality staff, experienced in disability and skilled in administration.
Employ staff with a thorough understanding of human rights, who are committed to understanding the experiences of people with disabilities.
Employing people who have disabilities themselves can provide valuable experience in benchmarking what is reasonable for particular disabilities and circumstances.
Provide more training for all staff and planners. Training needs to address the diversity of ‘disability’ (for example, Acquired Brain Injury can include issues with memory, with initiating, planning and follow-through with daily activities, with attending to matters outside of daily routine.) Training also needs to develop skills in efficient and effective administration.
Education about family dynamics around a person living with a disability is also vital; for example, often significant levels of informal support is being provided by family members and loved ones, yet the NDIS plan should not assume that such support is ongoing and reliable and this information should not be an indicator of the level of funding one receives; carers and supporters are often exhausted and risk mental illness themselves without the extra formal supports promised by the introduction of the NDIS. Many parents will not be comfortable criticising their children. It is critical therefore that planners meet the participants independent of family support if possible, to truly appreciate the challenges families consistently confront.
Follow an established process of planner preparation for planning meetings – reading the history, researching the implications, taking time to get to know the person, taking into account the circumstances of all the people affected by planner and Agency decisions, understanding the significant contribution made by informal supports, being prepared for it to take several meetings to complete an entire plan, particularly in the case of complex needs.
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- Efficiency of processes Introduce Draft plans.
Introducing Draft plans, plus direct interim access to the planner – via phone, email or meetings – would be very helpful – for the person, for the planner and for advocates. Draft plans, with modifications and variations possible, with authority delegated for variations to a suitable dollar value, until a satisfactory compromise and signature is reached, would save the Agency substantially in time, money and reputation currently wasted rectifying mistakes and misunderstandings.
Also, meaningful participation in plan development and ownership are much more likely to foster Agency in a person living with disability.
Delegate financial authority for minor plan variations to the front line.
Delegate authority for trained LACs and other planners to vary plans up to a certain dollar value, so that if something is missed, it can be rectified without resorting to a full review process. Use of a panel for a plan review would then only be necessary for, e.g., a $400,000 variation, saving time and money and winning meaningful outcomes for participants efficiently and quickly.
Planners with delegated authority would be more confident and committed if they can own a plan and manage variations, which will provide beneficial experience for future plan preparation.
In reassessment, investigate the causes of unspent funds rather than cutting them.
Have planners/delegates in a reassessment process follow an established process of inquiry into all the relevant circumstances, to understand why funds have not been spent.
This has the additional benefit of highlighting gaps in supply of services, helping inform the Scheme’s insights into thin markets and other supply issues.
Streamline the review process, and thereby reduce number of appeals to AAT.
If draft plans could be reviewed by participants and stakeholders, and reasonable and necessary variations included before sign-off, the number of reviews required would plummet.
Shorten and guarantee the time from review request to internal decision. While participants have three months to lodge a review, there is no legislated time frame for the agency to complete the review, which is viewed by many as unfair and hypocritical.
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Shorten and guarantee the time taken to provide evidence to the AAT. Leadership Plus would welcome and support a cap on the amount of public money the NDIA spent on legal representation at the AAT. This would motivate efficiency improvements.
Introduce longer plans.
Well skilled staff and or the provision of reports from specialists could/should enable the NDIS to approve longer plans (potentially up to 5 years in duration?), particularly for those with severe disabilities both physical and intellectual. It is well recognised that most physical and intellectual disabilities are lifelong and the need for support will not diminish significantly in the short to medium term. An additional benefit would see the reduction in staffing as many participants will fall in the 3 to 5 year bucket as the very nature of their eligibility to the Scheme requires significant impairment.
We suggest that there need be no expiry date on plans. The deadline creates unnecessary pressure on all parties; the plan could remain in place until replaced by a new plan.
Introduce automatic rollover of plans.
In a significant proportion of cases, automatic rollover of plans would be appropriate where the person, supporters, service providers and the Agency find the plan satisfactory.
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- Client satisfaction Streamline all Agency processes so the Scheme is easier to navigate.
Deliver and reward efficient administration. For example, provide greater administrative clarity by sharing publicly clear written criteria for access to a complex planner, and schedule active communication by NDIS with relevant parties to clarify matters for a review for a complex planner.
Guarantee timeliness of all stages in the process. Some suitable time limits are: o Response to access application – 21 days o Application for a complex planner – 21 days o Plan preparation once meetings with participants completed – 21 days o Internal review request – 21 days
Fund additional services not currently provided for:
Case management for people with complex needs
Case management has no equivalent in NDIS plans, but clearly some equivalent is very necessary for the vulnerable and those with complex needs. Support Coordination and Agency managed plans are not a solution.
Respite for family carers
The request for respite by family carers has been a long and very vocal demand, and is an ongoing concern among carers due to both lack of funding for respite and access to respite services (particularly for complex needs individuals).
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- Financial Performance Commit to funding staffing levels that can deliver the Scheme.
Delivering on the NDIS promise made to the Australian public requires tenacity and political determination. While the structure of the program is meant to be demand driven, restricting staffing has reduced the capacity of the system to actually meet participants’ needs and compromised the quality of participants’ plans.
By fully committing to appropriate staffing levels, Australia could present to the world a brilliant comprehensive system (including innovative long-term accommodation arrangements) that delivers measurable improvement in quality of life indicators for people living with disabilities.
Accept liability.
Improve processes and accountability for administrative errors and complaints (for example, establish a policy for reimbursement). When the Agency gets something wrong, fix it quickly.
Refer back to the ethos of Scheme: promotion of the rights of people with disabilities. Commit financially to the values outlined in the conception of the Scheme.
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- Stakeholder satisfaction Plan realistically for the future.
The number of people living with complex disability will only increase. It is ‘unreasonable’ to pretend otherwise. Yet precisely because disability affects so many, the willingness of the electorate to fund a Scheme that operates well should not be underestimated. So it is ‘unnecessary’ to continue to fail so many participants and potential participants and risk the mental health of everyone involved in the sector.
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IMPACT OF RECOMMENDED CHANGES
If the staffing levels reflect the Scheme’s actual requirements, and the right behaviours are rewarded, people performance will improve.
If planning processes are conducted properly from preparation to completion, by skilled and informed planners with delegated authority to vary plans to a specified level to reach agreement, the Agency will save money and retain talent, and participants will feel heard and properly supported.
If clients are satisfied, that means the Scheme is achieving what it set out to do in its Second Reading in Parliament… “bring an end to the tragedy of services denied or delayed and instead offer people with disability the care and support they need over their lifetimes.”
If financial performance delivers the right staffing levels and funds to those who need it, the NDIS will be able to deliver on its promises.
If stakeholders are satisfied, the NDIS can achieve its mission to deliver a world-leading Scheme.
We recognise that our position as advocates exposes us to the issues with the Scheme more than it exposes us to the NDIS’s successes, and we acknowledge the Scheme’s benefits to thousands of people. Our recommendation are intended to help the NDIS achieve its objectives more quickly and more thoroughly, with fewer obstacles and stresses to participants.
More effective operation of the planning process, processes that recognise more complex needs, more efficient resolution of incorrect plans and greater efficiency throughout the planning process can only improve the chances of the NDIS achieving its mission and delivering a Scheme which people with disability trust and which actually helps them achieve their goals.
“We grow together. The Agency is committed to working together to deliver quality outcomes.”
NDIS Values, Capabilities & Behaviours
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