ACTCOSS FORUM 26 February 2016
Presentation by Leith Felton-Taylor, MHCC ACT
LOST IN TRANSITION – THE NDIS EXPERIENCE
Thank you for the opportunity to contribute to this important discussion.
I think everyone here will have heard of the National Disability Insurance Scheme (NDIS).
It is a huge social reform, and coincides with widespread reform of mental health policy
and community services.
Today I am speaking from the perspective of my role with the Mental Health Community
Coalition – the peak body for NFP providers of mental health support services in the ACT.
I am therefore looking at the NDIS only as it applies to mental illness and psychosocial
disability. As a trial site the ACT has been challenged by a scheme being tested before it
has been built. But we have also been able to influence the scheme.
The ACT is widely acknowledged to be one of the better places to live if you need support
due to mental illness. Collaboration between government and the community sector has
resulted in increased professionalism, adoption of national mental health standards and a
culture of collaboration, cooperation and continuous improvement.
A majority of the ACT mental health support workforce now have at least a Cert IV
qualification, and increasingly people with higher qualifications are being attracted to the
sector - despite the competition posed by higher wages in the ACT and Commonwealth
governments.
This does not mean that everything is perfect. Far from it. There are always things that can
be improved. And there are always stories of people with both good and bad experiences.
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So what is the NDIS? To quote from their website, the NDIS aims to provide to eligible
people ’a flexible, whole-of-life approach to the support needed to pursue their goals and
aspirations and participate in daily life.’
I am pretty sure everyone would agree that the NDIS gives hope for a better life for people
with disability.
But, as they say, the proof is in the pudding – it might look great, but what is it like to
consume?
In the year since I have been in this job, more and more people have good news stories
about the NDIS. Lots of people are working hard to implement it. Collaboration in the ACT
between government, the NDIA and the community sector has been strong. Many issues
have been sorted out.
But I have also read, heard, and witnessed many things that make me concerned about
whether in fact the NDIS will achieve its objectives.
Put bluntly, it is my view – and that of others - that some aspects of the NDIS framework
threaten to erode the quality and range of services available to people disabled by mental
illness. And without good quality support services, clients of the NDIS and their carers and
families, will not get the better life, and the choice and control that has been promised.
Clients and services – a classic chicken and egg scenario. Services need to be good
enough to attract clients. Clients’ lives will only be improved by having a range of quality
services available.
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There are four key areas of concern.
The first is that the NDIS model was not built to cater for the needs of people with
psychosocial disability.
It was built for people with ‘general disability’. Mental health related disability was included
later, and was largely assumed to just fit the existing model.
Right from the beginning, there have been informed voices warning that this was a flawed
assumption. Sadly they have largely been ignored.
As a result, the NDIS does not easily cater to the complexities and episodic nature of
psychosocial disability.
If someone has lost the use of their legs, it is reasonably straightforward to engage them in
the NDIS process, demonstrate permanent and significant disability, develop a plan of
support, and all the while maintain that person’s dignity and self-esteem through the
process. And the business planning to provide the support is relatively straightforward.
If, on the other hand, a person has a background of severe mental illness – such as
trauma, PTSD and anxiety - it is more difficult, complex and time-consuming to bring the
person into the NDIS and deliver the supports to them.
Service providers in the ACT are commonly reporting that it can take months – of
largely unfunded - intensive work to engage people with severe mental illness with
the NDIS.
Many people with mental illness don’t relate to having a problem, let alone a
disability. The language and application process is deficits focussed – which can be
distressing and humiliating for clients.
Prior to the advent of the NDIS, significant progress had been made in embedding a
recovery framework around support for people with mental illness. But the NDIS is
inconsistent around recovery – in its language and the supports offered. Service providers are working to try and embed recovery into plans; Page 3 of 8
but the jury is out on whether in the long run the NDIS model supports recovery or is
more a type of ‘maintenance model’.
2.The funding model is flawed
Because of the complexities of psycho-social disability, it often costs more to support a
person in daily life and recovery. More time is required just to engage with clients and to
build trust.
The episodic nature of mental illness makes planning and service delivery much more
complex. How do you plan for a sudden crisis? Or for a client who suddenly refuses to open the door to the same support worker
who has been happily received for months before?
Staff working in this sector need to be well qualified, and require induction, training, and
supervision.
NFP organisations delivering mental health support do not usually operate with big
budgets or offer high salaries. Yet the NDIS pricing framework is widely reported as
roughly halving the hourly rate that providers can offer staff as compared to what was
possible under block funding.
As a result, organisations are employing cheaper, less qualified and less experienced staff.
On the job induction, training, and supervision has been reduced significantly. There is
also a move towards a more casualised workforce.
Many organisations are cross-subsidising these costs from other parts of their organisation
- if they are able to. But this is not sustainable over the long term, nor is it reasonable to expect.
Service providers are told to get used to operating in a market environment.
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However, the NDIS is no market in an economic sense: prices are fixed, crucial business
planning information is unavailable, existing funding is being withdrawn before a critical
mass of clients are flowing from the NDIS; and noone really knows how those ineligible for
an NDIS package will be funded after June 30.
There is a genuine concern that: business models will be pushed to ‘lowest common denominator’ service offerings there will be no room for smaller independent operators offering innovative higher
quality services that require more skilled staff supports judged as economically unviable will become unavailable ‘cherry picking’ of clients will occur – leaving those with the most complex and
difficult needs, nowhere to go it will be increasingly difficult to attract and retain a quality workforce
We already have examples in the ACT of services being withdrawn as they become
unviable under the NDIS.
Just because a person gets a support item in their package does not mean that there will
be an organisation prepared to offer it at NDIS prices.
Plus there are just wholesale shortages of some services – such as supported
accommodation. Will the current NDIS model provide incentive to increase the supply of
such services?
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- The NDIS is being implemented back the front It is no secret that the strongest movements, institutions and organisations are built from
the ground up.
But the NDIS has been built from the top down, particularly with psychosocial disability.
There has been a serious lack of consultation and codesign applied to its
development and implementation – people with expertise are not being listened to The most costly part of the scheme which relates to the smallest proportion of
people with the most complex needs, is being implemented first. The ILC –the more basic building block - still lacks clarity. The amount of national
funding is seen as too small to have much impact
o It also appears that the ILC has a strong reliance on formal and informal
community supports and, therefore, the unpaid workforce.
This is directly at odds with the objective of the NDIS as having a strong enough base level
of support such that a relatively small number of people would end up needing the higher
Individual Package level of funding.
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4.The focus has been unbalanced.
Risk associated with the NDIS seems to be shifting from all directions onto the Service
Providers.
It is very difficult to get the sort of concerns I have raised today, taken seriously.
Most often, the response is to ‘stop whinging, embrace change, trust the market and get
on with it.’
I’ve seen an official say to an audience of service providers ’dont worry about the
individual amounts allocated to support items – just get on with implementing it.’
Really? Another said that he would be extremely ‘disappointed’ if they did not successfully
transition all their clients to the NDIS on time.
And then there is the ‘buck passing’ - “That’s nothing to do with us – its now a
Commonwealth matter”
I have seen again and again Service Providers concerns being dismissed.
But their questions sound legitimate to me: How do we do business planning with such big information gaps? We are not all getting the same information at the same time We need to know how the ILC will work We are not adequately funded for the time required to get people engaged We are experiencing an enormous unfunded increase in administration costs Where are the safety, quality control and incident reporting aspects of the scheme? Plans are inconsistent and demonstrate a lack of understanding of psychosocial
disability How can we sustain a quality workforce and deliver quality services with this pricing
model?
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So I see much being put at risk during the implementation of the NDIS
What could be done differently?
Significant social reform should not be rushed and should be informed by experts in
a proper co-design process. A realistic pricing model should support the reform The transition should be carefully planned and implemented to a realistic timeframe,
taking into account all the players, the likely spill over effects and with the capacity
for change. The costs of transition should be adequately funded. When issues are repeatedly raised they should be taken seriously. There is
probably something important in them. No organisation should be expected to fundamentally change their business
practices without adequate information. Would we ask this of the corporate sector? Key players, including different levels of government, should work cooperatively
together and communicate openly.
Yes, it is complex and expensive to implement the NDIS such that its intentions and
objectives are aligned. But it is a worthy investment. Even just empowering people to join
the workforce, makes good social and economic sense.
But more fundamentally, disability does not just disappear because support is not
adequately funded – the costs simply get transferred to other areas of the economy, such
as emergency services.
The ACT is a small jurisdiction and the first to transition entirely to the NDIS. The
cooperation and collaboration in the sector has been strong.
The organisations that make up the NFP community managed service providers are
committed to making the NDIS work. They are not afraid of change but they have found it
a very difficult environment to operate in, not least due to the uncertainties and
inadequacies around funding. Despite this, organisations are giving their best to make it
work. Page 8 of 8