Unit ing Vic.Tas vt.uniting .org
ABN 81 098 317 125 • •
Level 6, 250 Victoria Parade T 03 9192 8100Un1t1ng East Melbourne Vic 3002 F 03 9192 8199
6 September 2019
Joint Standing Committee on the National Disability Insurance Scheme
PO Box 6100
Parliament House
Canberra ACT 2600
To Committee Members,
Inquiry into NDIS Planning
Uniting Vic.Tas welcomes the opportunity to provide comment to the Joint Standing Committee on the National Disability Insurance Scheme (NDIS) to support the Inquiry into NDIS Planning.
Uniting’s experience with Inquiry into NDIS Planning Uniting is the community services organisation of the Uniting Church in Victoria and Tasmania. We are more than 7,000 people delivering over 770 program and services to people experiencing disadvantage including children at risk, aged and carer services, disability and mental health, employment services, alcohol and drug dependence services, housing, family violence and early learning.
At Uniting, we work alongside people to be independent and achieve their goals. We are a registered provider of disability services under the NDIS and take a person centred approach to all our services. Our focus is to help people be independent, get involved with their local community, and achieve their goals. We believe accessing the right supports is about being empowered through choice and this requires effective planning. Uniting, through our NDIS and disability services, sees firsthand the significant benefits that effective planning of NDIS services can have on people’s lives.
In accordance with the Terms of Reference, our program staff have identified several areas for advice to the Committee. These are grouped by theme as follows:
Ensuring planning meetings are responsive, person-centred and respectful Uniting program staff have identified some issues with the approach some Local Area Coordinators (LACs) take to planning meetings, including:
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A lack of understanding of psychosocial disability and the way in which mental health impacts on individuals. Anxiety levels can be incredibly high when going into a planning meeting and too many LACs do not understand the impacts this anxiety can have throughout the planning meeting for the participant.
• LACs sometimes try to make participants feel as if they need to agree to a time
for their planning meeting straight away and that participants cannot bring
others with them for support throughout the planning meeting. Further, we have witnessed examples where participants are not offered to have their planning meeting in their own home.
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LACs sometimes ignore information that is given to them by support workers. Even though the planning meeting is about getting the information from the NDIS participant, sometimes when participants are not able to articulate exactly what they mean or what they need a support worker may provide support by speaking up on the participants behalf based on previous conversations. In these situations, support workers are either ignored or treated as if the information they provide is not relevant.
• Inconsistent information between LACs and Planners can make it difficult to
assist participants in the preparation of their planning meetings. Enhancing the supportiveness of LACs Our program staff expressed a need for improving the attitude, communication and supports available through some LACs. Uniting staff have observed that:
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The request for support coordination is sometimes delivered late, after the plan has begun. In some cases, the request for support happens almost three months after the new plan is approved for a participant.
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There are occasions when LACs do not action a participant request to review their plans. There is also a sense by program staff that a LAC’s attitude can change when a participant requests a review of a plan, which leads to participants feeling like they have done the wrong thing.
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There are times when LACs make the review process so long that clients give up on trying to review their plan, as these long and complex processes create a lot of anxiety and stress for participants.
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There are some inconsistencies between the information provided by LACs and the information provided to participants. This results in some LACs not understanding what the client needs and making assumptions.
• When LACs hold the responsibility of support connection ( connecting participant
to support providers), often participants go for long periods of time before they hear from the LAC, and it can take a very long time before they are connected to services, and at times they have not been connected into any support services.
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Because LAC’s are not connecting participants into supports, the responsibility falls on the participant to follow-up the LAC, but for a range of reasons, they often struggle to make contact with the LAC. Ensuring supports are available during the appeal process The appeal process can be very lengthy, sometimes not until a participant’s plan is due for review. If the participant had support for mental health in their first plan and then does not receive it in their next plan, they often require support to put in an appeal. However, sometimes they are not aware of the processes or have support to assist them with this. Current supports often need to support the person with this process even though they are not being funded to do so.
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Case Study: Impact of the appeal process Kaila* receives regular mental health assistance through Uniting, where she accessed weekly one-on-one support to learn stress tolerance skills under the ‘Increased social and community participation’ funding . While receiving this support, she made considerable personal progress. After achieving her goal of finding a job and improving her ability to manage her household, she hoped to get out in the community and try new things and wanted to improve her ability to manage her anxiety in unfamiliar situations. However, after an NDIS Planner misallocated her funds, Kaila’s one-on-one mental health support ceased in February 2019. Her mental health workers had previously requested that her funding be re-allocated to allow her existing support to continue, but they were told by the NDIS Planner that Kaila would have to lodge an appeal. Kaila has since accessed support from another provider, but she feels that her current support worker is not adequately trained to assist her. As a result, Kaila has been unable to work with her on distress management skills and she doubts that an appeal will take place before her next NDIS plan is due in December. Kaila is worried that she will not receive any mental health funding as she has not had mental health support for the past year. Over this time, Kaila’s mental health has suffered, as she has not received support to learn and implement the distress tolerance strategies which had previously been so beneficial to her life. In particular, she feels that her anxiety has worsened.
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Please note that the name has been changed for confidentiality purposes. Improving understanding by NDIS Planners and LACs about mental health Program staff at Uniting believe that there needs to be improvement in how the planning process supports people experiencing mental health concerns:
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Some planners appear to have little understanding of the impacts of mental health conditions on participants or how individual mental health journeys can change over time. Participants, at times, may not use supports but can become more unwell if they think that this will impact on availability of future supports.
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Planners and LACs need to be aware that an individual’s mental health is constantly changing. The review process for a change of circumstances is lengthy, can exacerbate stress and anxiety and have serious impacts on the way in which people receive support when they are experiencing difficulty.
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Clients have difficulty proving their eligibility for NDIS which forces participants to often obtain and prove a diagnosis to obtain eligibility. In principle, if a person states that they require mental health support, they should not be excluded from a service. Services need to be more accessible at any time people require support. Difficulty accessing services means that many people will miss out on preventative or early intervention services.
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- Some participants only want mental health support in their plans as this is their priority/primary need. Often, their plans come back with significant funds allocated in core support, with minimal funds allocated for mental health supports, even though this is what participants have requested and outlined as their primary need. Planners have then informed participants that the core supports are for helping to get them out in the community. Putting in core supports for some can be viewed as disempowering and ‘decrease’ their independence. Significant funds for core supports, which for some participants is viewed as disempowering and ‘decreases’ their independence, with minimal/no funds allocated for capacity building and skill development which ‘empowers’ and ‘increases’ independence and social and community participation, does not appear to be in the best interests of the participants, or meeting their needs.
Case Studies: Mental health
On his first plan, Ben had previously accessed weekly support through community mental health and the NDIS. His second plan had a significant reduction in mental health support (an allocation for one hour appointment a month including travel) so it was sent back for a review, during which Ben received minimal support. Ben was admitted to hospital on three separate occasions during this time due to the reduction in mental health support he received. This was a significant increase in hospital admissions Ben had experienced over the past 6 years. Prior to cutting of Ben’s mental health supports, he was doing quite well and managing with the weekly mental health support he accessed through his first plan.
Pedro’s first plan had capacity building funding but Uniting were not aware that the NDIA had ticked the wrong box. Uniting staff realised this error after billing the NDIA and not receiving any payments for the supports provided. Uniting staff have been trying to obtain funds for the supports provided ever since but we are yet to receive any reimbursement from the NDIA. Pedro now has his second plan, but no capacity building funding was allocated to enable mental health support and skills development. Due to Pedro’s declining mental health, support has been provided by Uniting even though we are unable to obtain any funding for this support.
Jo was a MHCSS client who received regular mental health support but received no funding for mental health support in her first plan. After a review of Jo’s plan, which took some time, funding was reallocated to the correct area to enable the continuation of mental health support.
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Please note that the names have been changed for confidentiality purposes. Timeliness of plan review processes Staff have identified that plan review processes sometimes commences early. There are examples where participants are contacted months before their plan is due for a review and where plan reviews are being brought forwards. We have witnessed examples where participants have been contacted for review up to 3 months before end date of plan to process the approval of Assistive Technology submissions to NDIA.
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Reviewing plans early can reduce the support allocated to participants in the next plan because participants are unable to fully utilise funds to capacity in the shortened time period, as the support provider budgeted funds across the full 12 months for service. Conversely, Uniting has also witnessed examples whereby plans, particularly those which include Supported Independent Living (SIL) are currently out of date - with gap periods of between one and three months. In these circumstances, participants are self-funding supports or cancelling supports in the interim.
Case Study: Communication during plan reviews Antonia* lives in a small rurally isolated town and has previously had support coordination had support coordination in her first plan . Due to the isolation, it was very difficult to find supports. Antonia has received funding for plan management in her second plan, but she did not receive any support coordination to assist with finding and linking her into supports. Antonia requested a plan review but has had absolutely no contact from Local Area Coordinator with regards to this. She is feeling distressed about not knowing what is going on with her plan due to this lack of communication.
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Please note that the name has been changed for confidentiality purposes. Better communication between participants, planners and support services Sometimes participants have a reduction in support hours in their plans for unknown reasons. For example, on one occasion a participant was informed that her hours in her plan were reduced as she became more independent. However, this participant has since gone backwards since her supports have dropped. Supports were put in place to assist with motivation, yet once the support time was reduced, the client felt that her routine was ‘mucked up’ and she stopped support all together. Communication between support services and planners can also be very poor. There have been occasions where the support coordinator from another service may not contact the mental health service to allocate the service until long after the plan has started, even though the mental health worker is still supporting the participant. Timely communication about billing changes When a client changes from NOIA to plan managed, there can sometimes be a lengthy delay before the support coordinator updates services of the changes and hours may be still be billed for under NOIA (or vice versa). This situation results in payments not being effectively processed due to billing changes which occur. Yet, the service provider is not yet aware of the change. Ensuring location does not impact participant support In our experience, being in rural or remote areas makes it difficult to source supports that are willing to travel to participants if participants are not able to travel to them. This means that participants miss out on being able to utilise some of their funds and often loose these funds in their following plans even if workers may now be available.
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Thank you for the opportunity to comment and we look forward to seeing the outcomes of the Inquiry into NDIS Planning.
Yours sincerely,
Stav Stathopoulos
Acting General Manager, Disability & Mental Health Services
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