Submission to
The Joint Standing Committee on the NDIS
– Mental Health
February, 2017
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Introduction
The Queensland Nurses’ Union (QNU) thanks the Senate Standing Community Affairs
Committee (the Committee) for the opportunity to make a submission to the inquiry into the provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition.
Nursing and midwifery is the largest occupational group in Queensland Health (QH) and one of the largest across the Queensland government. The QNU is the principal health union in Queensland covering all categories of workers that make up the nursing workforce including registered nurses (RN), registered midwives, enrolled nurses (EN) and assistants in nursing (AIN) who are employed in the public, private and not-for-profit health sectors including aged care.
Our more than 54,000 members work across a variety of settings from single person operations to large health and non-health institutions, and in a full range of classifications from entry level trainees to senior management. The vast majority of nurses in Queensland are members of the QNU.
Our submission provides some general comments on the potential impact of the NDIS on the mental health workforce and people with psychosocial disabilities related to a mental health condition.
Services under the NDIS for people with psychosocial disabilities related to a mental health condition.
There are significant challenges arising from the changed focus of funding models towards consumer directed care, disability insurance funding allocations and the models being employed for Primary Health Care Networks (PHCN) to call for tenders to deliver services within a preordained model of care or scope of service. The QNU has concerns in a number of areas specific to the NDIS and mental health.
We anticipate there may be industrial and professional implications for Queensland’s Hospital and Health Services (HHS) who are currently funded to provide community focused services for mental health, aged care (increasingly recognising the need for psychosocial interventions), and community health services to youth, marginalised minorities and first people’s health services.
At this point, it seems uncertain whether these services will lose funding, be outsourced or discontinued. A HHS that may be faced with absorbing displaced ‘surplus to requirement’ health care practitioners may not have full capacity to do so or to transition such employees
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to a private provider or non government organisation (NGOs) in an industrially and
professionally robust manner.
There are also implications for smaller, private for-profit and not-for-profit service providers or coordinators similarly being lost to the market of consumer directed care through the sheer size and economies of scale of larger, more corporatised businesses that win tenders.
Those smaller providers may be faced with the possibility of downsizing their workforce and moving their employees into more casualised and precarious employment with lower rates of pay and lesser conditions.
The apparent preference for larger, corporatised business models to overtake the mental health and disability services sector (if not the whole human services sector) has been
similarly evidenced in aged care. These organisations dominate the more lucrative
geographic regions while the less populated regions in Queensland are left to deal with under-capitalised service delivery and limited choice.
There appears to be potential for service providers to operate in a profit driven market where: They can charge a fee for coordination of servicing arrangements from the consumer which may only be held in check by market competition and awareness of consumers or their representatives; They can charge a fee, seemingly uncapped, for a consumer who breaks their service agreement to change service providers; and They can charge ongoing fees throughout the duration of a consumer’s service agreement for ‘services’ and ‘education’ that may bear little relevance to the needs of the consumer.
In our experience, including participation in various information and planning sessions, there is no clear pathway to the introduction of the NDIS funding models for individuals and marginalised cohorts of consumers, nor certainty for the health practitioner workforce that has served communities diligently and faithfully for decades.
The PHCNs with which we have engaged are similarly in uncharted territory. They are
experiencing significant uncertainty around accountability for expenditures of public
monies, the performance criteria applied to eventual service providers, and the means to address consumer concerns or complaints. As PHCNs themselves deliver no direct service to the consumer, they, like the federal government, will be distant from inadequate or inconsistent service delivery.
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In theory, people with intellectual and psychosocial disability will be eligible for NDIS, however they may experience difficulty in obtaining support if they are socially isolated, homeless or have limited advocacy. The often unstable lifestyle of this cohort may preclude them from accessing individual NDIS packages. We support proactive outreach to link people with intellectual and psychosocial disability with NDIS packages and more accessible mental health programs.
We recognise there may be other unforeseen aspects of the NDIS rollout that may impact on nursing and mental health practitioners in the future and ask the committee to view this submission in light of those possibilities.
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