5 September 2019
Joint Standing Committee on the National Disability Insurance Scheme [NDIS]
PO Box 6100
Parliament House
Canberra ACT 2600
Submission NDIS Planning
Cobaw Community Health Services Ltd. (Cobaw) is a small Victorian Community Health Service based in the Macedon Ranges in Central Victoria. We offer a range of health and community services and have been a registered to provide NDIS services since 2016. The NDIS activities are provided to 130 participants for NDIS Therapeutic services and 80 for Support Coordination. The first Cobaw NDIS participants transitioned into the scheme from Early Childhood Intervention Services [ECIS] funded by Victorian Department of Education and Training in September 2016 prior to the start of the Loddon rollout on 1 May 2017.
The following provides a summary of our feedback.
a. the experience, expertise and qualifications of planners Cobaw’s experience with some planners indicates that their experience, expertise and understanding of disability and its impact on participants and families is limited, giving us concerns about the competence of the people who are responsible for making planning decisions. For example, Participant A’s situation has been repeatedly and clearly communicated as urgent to NDIA due to the long history that Participant A has had with the Out of Home Care, Child Protection and Disability Services systems. The risks that have been monitored over the years have been significant and seem to have been lost in the transition to NDIS. The lack of timeliness of the response, the conflicting advice and lack of a single source of accurate information is potentially life threatening and could be regarded as a negative impact on this participant’s human rights. The development of the workforce has been slow, and with many being employed as planners with a clear lack of skills and experience in the Disability sector, resulting in a direct impact on the quality of plans. The concept of reasonable and necessary support is being interpreted inconsistently by planners and we find that the determination by NDIS Planners does not take into account the full impact of the disability on their ability to live an ordinary life.
b. the ability of planners to understand and address complex needs Cobaw’s NDIS teams are working with complex participants who require case
management and advocacy that is beyond the scope of practice of a Support Coordinator or Allied Health practitioner. We find that there is a lack of specialist psychiatrist or high level expertise for some participants that have multiple diagnosis. In engaging with the NDIS, planners often do not have the depth of understanding around the complexity of
the specific impact of a disability, limiting the level of reasonable and necessary supports included to enable people to take part in everyday activities. Cobaw’s Support Coordinators and Allied Health staff must work within the defined boundaries of their role and there is often no one available to look at a family or situation as a whole, to advocate on behalf of a participant or to fulfil the much needed case management function. During the rollout, families and participants have often reported to staff that they find this change challenging, as in the past the Victorian Department of Health and Human Services [DHHS] had someone in this position to assist them. The impact on families and the addition of this administrative burden is concerning and at times we can see escalating carer burnout. In the case where a participant doesn’t have a family member to fill this gap, organisations such as Cobaw are contributing unbillable, unsustainable time to do this. Cobaw’s skilled Allied Health staff are frustrated and challenged when they provide highly detailed reports as evidence of a participant’s need to the NDIS through an allied health assessment, only to find that a planner unqualified in that discipline makes a determination that disregards the evidence.
c. the ongoing training and professional development of planners Cobaw’s experiences with Participant A (above) is an example of some planners not having had the experience of working with other government systems or training around the interface of different services. The lack of understanding of specific disabilities, empathy towards families and participants who have been challenged for years as a result of systems that have not met their needs is not assisting with confidence that NDIS will be a positive experience.
d. the overall number of planners relative to the demand for plans Inadequate and lack of timely responses indicates that NDIA delays can only be the result of the huge demand and lack of resources to meet the demand. As a result of limiting the staff in the NDIS, poor quality plans for participants that require the need for reviews that can take months. This compromises the ability for participants to access vital supports and equipment, often for extended times.
e. participant involvement in planning processes and the efficacy of introducing draft plans The number of reviews submitted and the length of time taken to respond to a review request indicate that there are a higher number of reviews than anticipated. A high percentage of these could be resolved quickly if draft plans were introduced. Errors in participant information, fund management and exclusion of funding/equipment could be fixed within a short period of time and enable transparency in decision making from planning staff and the NDIA. Light touch reviews were introduced, however this process is questionable as it still requires a complete review to be completed and requests are not always responded to. The introduction of draft plans and a faster process to review small changes to the plans would be of benefit to participants, their support networks and the NDIA in terms of the number of reviews being submitted each year.
f. the incidence, severity and impact of plan gaps For Participant A, concerns have also been raised about gaps in the level and limitations of supports as the participants Guardian and Support Coordinator have limited ability to
approve supports, manage the budget and make decisions about day to day activities. This is a Plan issue that arises when NDIA have acknowledged need in conversations but have not provided sufficient funding for appropriate Support Coordination, short term accommodation, therapy and day service funding. Participant A’s Support Coordination funds are now expended whilst waiting for the review of her plan and no one is able to fill the gaps. This leaves Cobaw Community Health and other similar organisations in a situation where our moral and ethical obligations in providing a continuity of supports to local people results in significant financial risks to the organisation. We consider that it is important to continue without funding to ensure that the participant remains engaged and some of the vulnerable risks are mitigated whilst waiting for decisions to be made by NDIA. This means Cobaw has been underwriting the NDIS and this is unsustainable.
g. the reassessment process, including the incidence and impact of funding changes Earlier this year, we surveyed our Support Coordination team to gain an indication of the types of issues they are seeing. Out of 77 participants at that time, 33 of them had significant issues that were not being met efficiently by the NDIS system. Some plans were urgent, and yet remained un-approved for months. In many cases when Plans were approved the funding was reduced, which also did not reflect the conversations and understandings that had been held during planning meetings. Cobaw’s Participant B is an example where their request to access the NDIS was denied, however, a sibling with the same disability, with the same impact, is on an NDIS Plan of $36,000. The reason given by the NDIS National Assessment Team was as follows: ‘The permanent nature of the clients disability and its significant impact on her is accepted, however as the Access Request states that the client’s goal is to live independently and that with appropriate supports she can live independently then her need for the NDIS is only short term and therefore, under section 24 (f) of the act, is not ongoing and she does not qualify’. Cobaw’s staff member tried to reason with the National Access Team officer that the only way the client would become and remain independent is with NDIS support and that this
very scenario is exactly what the NDIS is designed for. Without NDIS support the
participant’s mother will have to continue to provide support and the person, in her 20’s, will remain unable to leave home and therefore never will. The National Assessment Team officer stated she was not in any position to change the decision, just to relay it, and stated she did not have access to the client file only to a summary of the decision. The only options presented were to formally ask for a review (this process is currently taking up to 6 months) or re-apply changing the focus of the application away from living independently.
h. the review process and means to streamline it The streamlining of the review process is urgent as is the response time for answers regarding reviews and the clarification of communication channels to follow up on time lines expected. As an example, ongoing attempts have been made to communicate with the NDIA in relation to the urgency of the review request for approval for SDA for Participant A. On the many occasions that Cobaw staff have spoken to NDIA, noting that each time they have had to speak to a different NDIA Planner, they have been given conflicting and confusing responses to the status of the request, vague advice and the Plan remains to be approved.
i. the incidence of appeals to the AAT and possible measures to reduce the number We have not had a direct experience with any AAT appeal.
j. the circumstances in which plans could be automatically rolled-over If NDIA were to introduce an option of self-directed planning, this will give another way for us to build the self-determination capability and give greater choice and control to participants.
k. the circumstances in which longer plans could be introduced; When a participant has a stable living environment and supports are in place and of adequate hours to meet the reasonable and necessary requirements that have been assessed in a plan, the cumbersome and often stressful planning process could be delayed with a longer plan period. This would decrease the amount of work and funding allocated for reviews by planners, support coordinators, allied health staff and all services providing supports that require review documents prior to a new plan being created.
l. the adequacy of the planning process for rural and regional participants With over thirty years of committed local community service delivery in a rural area, there is a growing reality that people in rural areas are being further disadvantaged by the NDIS. Over the past three years of NDIS service delivery, we have supported and filled in the gaps because of the local service constraints with few services. Cobaw has dedicated significant resources to our own systems design, yet the costs have not been recouped from any NDIS activity, and this is challenging for local place-based services that have a trusted relationship with the local community. Larger state or national providers have shown an unwillingness to move into rural areas as the profits they demand are unlikely to be realised given the small participant numbers. It is Cobaw’s contention that the rapid scaling of the scheme, lack of systemic planning design by NDIA, NDIS portal challenges, NDIS Plan targets, the pace of the roll-out and staff turnover has resulted in a negative impact for rural participants. The NDIS Practice Standard has guided Cobaw’s commitment to ensure continuous service for rural participants, but the quality standards are not understood or supported by the inconsistent NDIS planning process. As a result, like many other organisations, this has resulted in financial risks and costs for Cobaw. The wait times for payments and the level of NDIS debts, despite being monitored closely, has increased. Our investigations of the causes of these issues shows that this is not because the participant is disputing they have been delivered but because the plan manager or manual claims process fails. Local small rural organisations require transition costs for establishment infrastructure to ensure local place-based services continue so as to not further disadvantage rural people. In regional cities there is often a concentration of services but even people an hour from these places are unable to access services and are reliant on small organisations. The ongoing issue of lack of transport connectivity in rural areas, means that flexibility for NDIS participants is limited. This reduces their ability to engage fully in local community activities which again limits the Plan activities that enables them choice and control.
m. And, any other related matters. Cobaw made a commitment to ensure continuous service provision for our local place based services. NDIS participants are people we know in the communities that we service so we hold this responsibility, which is an NDIS Practice Standard, however this has resulted in a significant financial risks for the organisation and on many occasions we have
struggled to be paid for these services. We still have thousands of dollars outstanding which mostly relate to plan gaps.
Cobaw’s Access & Support Worker works with clients that are requiring assistance in navigating access to appropriate services and currently the demand is significant for those under 65 who require assistance to access the NDIS and to be connected with the LAC. This worker is seeing multiple clients who have been deemed ineligible more than once due to the lack of evidence they have capacity to provide, due mainly to their limited abilities. By acting as an advocate for these clients, they eventually have success but without this Access and Support role, these participants would not be able to access vital services that they require.
Face to face Advocacy services are not available in the Macedon Ranges. Although services are funded in Bendigo and Melbourne to cover the area, they do not have a physical presence and with limited transport options, they are not accessible to locals who have limited capacity to access them, and these are the people that require the service the most.