Joint Standing Committee on the National Disability
Insurance Scheme: Planning
Good planning is central to the success of the NDIS, highlighted by the attention given to it in every report of this Joint Standing Committee. The Committee’s first ‘Progress Report on the implementation and administration of the National Disability Insurance Scheme’ in July 2014 quoted an NDIA senior manager:
The task is to build a team…one which is about flexibility and responsiveness and the ability to work in this grey, not in black, not in white, and acceptance that you are no longer working in a rationed and sanctioned system but one word where it is your personal judgement about reasonable and necessary. The thing that I need to build more into our planners, which I suspect is at the basis of most of those concerns, is understanding and empathy and listening and being able to connect to that family and their circumstances and truly understand what a person-centred, family-centred approach is. Some of our planners have lived and breathed and dealt with that for many years. Some of them have come from perhaps a more academic background, or a more structured and constrained background, and they are struggling to have I suppose the individualised responsiveness.1
Five years later, the enormity of this task to deliver high quality plans remains.
While it is natural to focus on the problems caused by poor planning, it is important to note the substantial improvements to planning processes being implemented over the past 18 months or so. These include the commitment to introduce:
- 3 pathways: the NDIS Participant Pathway, Complex Support Needs Pathway,
and Early Childhood Early Intervention (ECEI) Pathway
- 2 service streams: for psychosocial and disability and hearing
- service enhancements to meet the communication and engagement needs of people from different backgrounds, including people from ATSI and CALD backgrounds, remote and very remote communities, and people who identify as
LGBTIQA+
The recent Quarterly Report summarises progress made on the implementation of these enhancements.2 NDS commends the commitment of the NDIA to improve planning, which will ultimately flow to all stakeholders. Our comments in this submission are made with that end in mind.
1 Joint Standing Committee on the National Disability Insurance Scheme, July 2014, Progress
Report on the implementation and administration of the NDIS, p. 43 2 NDIA, COAG Disability Reform Council Quarterly Report 30 June 2019, pp. 42–47
The experience, expertise and qualifications of planners The expertise of planners varies greatly. Throughout the implementation of the scheme, NDS saw a predictable pattern. As areas transitioned to the scheme, new planners were recruited. The quality of plans at this point was very variable and often poor. As these planners gained experience, the quality of plans gradually improved.
This points to the need to have strong induction and mentoring in place for all new planning recruits, and appropriate quality assurance processes (that will help mitigate problems associated with a lack of expertise and/or personal bias). It also highlights the importance of having relatively stable workforces (with only moderate turnover).
Employing people with no experience of disability as planners is problematic and complicates what is already a difficult task. If recruiting a planner without disability knowledge is the best option, comprehensive disability awareness training should be a core component of induction. Time spent shadowing experienced planners should be mandatory for all new planning staff and regular feedback on the quality of plans must be given.
Planning should be informed by a range of inputs. Too often a planner takes a response from a participant at face value; it other needs to be supplemented by information from other sources. Input from family members, friends and/or service providers helps ensure important supports are included (or adequately funded) in plans. Unfortunately NDS often hears that such information is ignored by the planner. Guidance to providers on how to provide this input in a form that is useful to planners would be useful.
Given the varying severity and sometimes episodic nature of psychosocial disability, skilled planners are required to develop quality plans for this group of participants. NDS is pleased that the Agency has identified the need for a pyschosocial disability service stream but does not have information yet about whether it is improving the planning for this group of participants.
The ability of planners to understand and address complex needs In theory, people with complex support needs should be assisted by a skilled planner employed by the NDIA. This is appropriate, and is a pathway that should be maintained. While problems with plans still arise, they appear to be less common as they are usually informed by both providers of informal and formal supports. With a good knowledge of disability, these planners seem more aware of the importance of using information from a range of sources. Unfortunately, the number of these Agency planners seems insufficient for the number of participants who would benefit from their skills.
Planning undertaken by Local Area Coordination partners should be for participants with less complex support needs. In reality, they do undertake the planning for some participants who would be better served by NDIA planners; this can result in poor quality plans. Minimising the occurrence of this would be welcome as the plans are more likely to not accurately reflect the needs of participants.
The NDIS Price Guide 2019–203 outlines higher intensity supports and when they might be required:
A support is considered a high intensity support if the participant requires assistance from a support worker with additional qualifications and experience relevant to the participant’s complex needs. The high intensity price limits may be considered when:
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frequent (at least 1 instance per shift) assistance is required to manage challenging behaviours that require intensive positive behaviour support; and/or
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continual active support is required due to high medical support needs (such as unstable seizure activity or respiratory support)
In determining which price limit for High Intensity Supports should apply to a given support, the provider should consider the skills and experience of the worker delivering the support. In general, the Level 2 price limit applies to most high intensity supports.
However, if the particular instance of support is delivered by a worker who does not have the skills and experience to deliver a high intensity support then the Level 1 price limit should be applied. If the particular instance of the support is delivered by a more highly skilled or experienced worker then the provider can consider applying the Level 3 price cap, with the participant’s prior agreement.
Problems arise as this requires planners to understand the complexity of the supports required and to fund plans at prices related to that complexity (for some supports, prices are set for three levels of complexity). If they calculate funding using a pricing level lower than a provider believes is appropriate (because they are using more skilled workers), fewer hours of support will be able to be purchased. Participants with complex support needs should not be placed in the position of deciding whether to trade hours of support because the funding in their plan is not adequate (and this should not occur for participants with challenging behaviours).
The NDIA has indicated that providers have the ability to quote for the supports for participants with very complex needs. Comments from providers suggests this does not seem to be an option in use for determine the supports for many high need participants.
Participants with complex needs are likely to receive funding for support coordination (including specialised support coordination). Close working relationships between the planners and support coordinators working with participants with complex supports needs is essential.
3 Available at https://www.ndis.gov.au/providers/price-guides-and-information, pp. 21–22
Participant involvement in planning processes and the efficacy of introducing draft plans The introduction of face-to-face planning for all participants (unless they request otherwise) was a welcome initiative by the Agency. It has improved the experience for participants, families and carers and has improved the quality of plans.
As noted above, the propensity of some planners to take participant information at face value causes problems, particularly for some people with an intellectual disability, cognitive impairment and psychosocial disability. Positive responses to questions can result in necessary supports being omitted from plans. This problem is exacerbated if the planner ignores additional information which may have been submitted by formal or informal support providers. All available information should be used to inform the development of plans.
NDS understands that the current planning process includes showing the participant a draft plan at the conclusion of the planning meeting but does not give it to them to take away to consider. In an ideal world, they would be given a draft plan to take away to consider. We cannot comment, however, on what impact the provision of a draft plan would have on things like plan completion time, increased requests for funding or additional supports that are outside the reasonable and necessary criteria, or perhaps on the improved quality of plans.
Unfortunately, the draft plan shown to the participant during their planning meeting may not be the same as what gets funded (the planner needs to submit the draft to a delegate for approval).
A limited trial on the impact of providing participants with a draft plan to take home to consider is warranted.
The incidence, severity and impact of plan gaps Others will comment on the problems plan gaps cause participants and their families and carers.
From a provider perspective, the impact of plan gaps is substantial. Scheme design inappropriately limits the information available to providers. Even when providers have a service agreement in place with a participant, they will not be informed of a plan review. The consequence is they may continue to provide services for which they are unable to receive payment. This is unacceptable.
When a plan review is initiated, providers with existing service agreements with the participant should receive notification that it is occurring. They should also be notified when a new plan is in place or when a plan has been extended. A weekly report to providers that have service bookings with participants who have a plan that may change would reduce the administrative and financial costs to providers. It would flag they need to check with the participant about plan changes.
To respond to circumstances where a plan expires before a plan review is completed, the NDIA has announced a portal change that automatically extends the plan (with pro rata funds) for some supports. This recent portal update is welcome. NDS understands
an additional update will be implemented to do the same for quotable supports (such as Supported Independent Living). If and when this occurs, the financial impost of plan gaps on providers will be greatly reduced.
NDS has yet to hear whether these portal updates are generally working as expected but we do know that the extension of plans with pro rata funding does cause problems for some participants (such as those planning a high cost, irregular support such as Short Term Accommodation and insufficient funding is added to the extended plan).
The reassessment process, including the incidence and impact of funding changes Plan reviews result in a substantial administrative, and often financial, costs for providers. A major contributor to these costs is the lack of information available to providers that are supporting the participant. Providers are not informed that a review is underway so have no awareness that they may need to stop providing supports or amend the service agreements they have in place with a participant. The participant can change cancel or amend a contract without informing providers that then find they cannot claim for the work undertaken during this period.
As noted above, the Agency should flag the initiation of a plan review with all providers that have a service agreement in place with the participant. Poor NDIS processes should not result in the provision of services which a provider cannot claim payment for.
The review process and means to streamline it Lack of notification about a plan review limits the information available to inform the new plan. This is short-sighted and contributes to poorer quality plans. All available information, from both informal support and support providers about what has been delivered and the outcomes achieved should be used to construct a new plan.
Plan reviews should trigger an automatic request for information from relevant sources – to be provided in a concise, streamlined format – which should inform the review process. Planners should not be able to ignore these inputs (which some currently do).
The time between initiating a plan review and completing it is generally too protracted. This should be addressed with the introduction of the Participant Service Guarantee.
The circumstances in which longer plans could be introduced or rolled over Prior to the NDS, clients receiving state or territory government-funded disability supports generally struggled to have their supports increased if their needs changed. It was hard to convince the state or territory of the need for additional funding, and even if you did, available funding was limited. It was not uncommon for people to never have their support needs re-assessed other than if/when they were at risk of not being able to be supported in their home or group home. It was crisis driven.
The introduction of the NDIS has dramatically improved this situation. During the trial and implementation of the Scheme, participants support needs have been re-assessed at least yearly. But that also has a downside. The pressure on planners during the implementation of the NDIS has been intense, and will have contributed to poor quality plans. If planners continue to review most plans every year, this intensity will not diminish. For this reason, NDS supports efforts to identify participants who could be well served by longer plans (noting they retain the ability to request a plan review at any time).
It is easier to respond to the question on the circumstances in which longer plans could be introduced by considering when longer plans are not recommended. These include:
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early childhood
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transition to school
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leaving school
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transition to work years
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degenerative conditions
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ageing (noting it is important to take account of disability types e.g. people with Down syndrome have a relatively high prevalence of early onset dementia, which will increase support needs)
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participants living at home with elderly parents
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participants with specialist support coordination in their plans
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participants with challenging behaviours who have authorised restrictive practices
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participants who have connections with mainstreams services such as justice, child protection, homelessness or domestic violence
Participants should have to agree to the longer plan and understand they can seek a review at any time. When longer plans are in place, the NDIA should do a yearly ‘check in’ to ask whether the plan has been working well for the participant, whether there have been changes to their goals or informal supports. Plans should automatically be indexed for any support price increases.
Consideration should be given to whether some safeguards need to be built in for participants. For example, should service bookings be limited to a certain time period to ensure the provider discusses/negotiates changes to support arrangements with a participant at least yearly?
The adequacy of the planning process for rural and regional participants Rural and regional participants experience similar problems with the quality of plans, as outlined earlier in this submission.
In addition, they (along with participants living in outer suburbs) commonly experience additional disadvantages associated with provider travel and transport (limiting their ability to engage providers or participate in activities).
While the Agency improved the provider travel allowances for this financial year, the new arrangements remain insufficient to cover the travel time to support some participants. This problem is compounded by the fact that travel costs associated with
the use of a vehicle are not claimable. A provider travelling 100 kms to support a participant will be out-of-pocket by almost $80 for travel. Until the NDIA allow providers to claim for the use of vehicles, rural and regional participants will have restricted access to supports even if they are contained in a participant’s plan.
Providers of specialist supports (such as therapy or behaviour support practitioners) must be able to quote for the provision of critical supports for remote and very remote participants.
Rural and regional participants report great frustration at the inadequacy of funding in plans to cover their transport needs. NDS understands the NDIA has been reviewing participant transport issues for some time but no report has been released. We also understand that the Disability Reform Council has a working group on participant transport which again, has not released any information.
Other matters
- Remote and very remote participants Providers working in remote and very remote parts of Australia are concerned plan reviews are resulting in substantial reductions in funding, which they believe is due to participants struggling to purchase supports. Reduced funding in plans will reduce demand, which will then fail to signal what level of supports are actually needed in these communities.
NDS requests that regular information on supply and demand be released for remote and very remote communities alongside detailed information on changes in the size of funding packages. This will allow planning for participants living in these regions to be monitored and responded to.
- Support coordination and plan management When a participant has funding for a support coordinator and/or plan management, a flag on the portal should notify other providers. At present, this does not occur and is problematic.
With respect to plan management, actions by a participant can result in the provision of services for which a provider cannot be paid. A participant negotiates a service agreement directly with a provider. They are under no obligation to inform the provider that a plan manager is in place, nor will they necessarily inform their plan manager that they have negotiated service agreements with one or more providers. Non-payment of a provider can result.
Providers are also not informed when there is funding for a support coordinator; they do not necessarily know a support coordinator is available to assist with problems that may arise. Providers end up undertaking unfunded coordination work. In addition, it is not uncommon for support coordination in plans to be funded for very few hours (enabling the coordinator to meet the participant to discuss arrangements and to develop the first report for the NDIA). There needs to a minimum time allocated for support coordination support (definitely not less than 20 hours).
- Funding for Supported Independent Living and Specialist Disability
Accommodation
Planners are often not adept at identifying participants who may need to move into Supported Independent Living (SIL), and even when it is identified, having funding allocated is a slow process. Planner training is needed, alongside work to streamline the determination of funding. Providers may have a housing option available but the allocation of SIL takes weeks or months to be made.
Similar problems arise in the allocation of funding for Specialist Disability Accommodation (SDA). Improved coordination when allocating funding for SIL and SDA needs to occur.
- NDIS Act review A review of the NDIS Act is underway, primarily to introduce a Participant Service Guarantee. During this review, NDS urges consideration be given to Act changes that would reduce the circumstances that trigger a new plan. Whenever a plan is developed, providers are forced to make new service bookings (even if the bookings were for supports not changed by the new plan) and renew service agreements. It is administratively burdensome for providers, but also for the NDIA.
September 2019
National Disability Services is the peak industry body for non-government disability services. It represents service providers across Australia in their work to deliver high-quality supports and life opportunities for people with disability. Its Australia wide membership includes over 1050 non-government organisations which support people with all forms of disability. Its members collectively provide the full range of disability services—from accommodation support, respite and therapy to community access and employment. NDS provides information and networking opportunities to its members and policy advice to State, Territory and Federal governments.