Vision Australia Submission
Response to the Inquiry into transitional arrangements for the NDIS
Submission to: Joint Standing Committee on the National Disability Insurance Scheme
c/o Committee Secretariat
Date: 10 August 2017
By email: ndis.sen@aph.gov.au
Response approved by: Karen Knight
General Manager Advocacy and Engagement
Response submitted by: Scott Jacobs
NDIS Lead
Advocacy and Engagement
Vision Australia National Head Office
454 Glenferrie Road
KOOYONG VIC 3144
Introduction
Vision Australia appreciates the opportunity to provide a response to the Joint Standing Committee on the National Disability Insurance Scheme – Inquiry into transitional arrangements for the NDIS (the Inquiry). The United Nations Convention on the Rights of Persons with Disabilities recognises the rights of all people with disabilities have the right to access services and technology and to live independently, inclusively and with dignity in the community.
We have been actively engaged with successive Australian Governments since 2011 and the precursor bodies and groups and departmental officials who designed the initial National Disability Insurance Scheme. We are a registered provider of services in multiple jurisdictions, including since launch in ACT, Victoria, NSW, WA and Queensland.
While we acknowledge there has been great progress made in the design and operation of the NDIS, there are several critical pieces which remain largely untouched, or where the response to date from the agency, and government have been inadequate.
We implore the Joint Standing Committee and the NDIA to instigate the necessary changes on these matters. The longer they persist unresolved, the more detrimental their absence becomes.
Vision Australia recommendations
Vision Australia recommends that the Australian Government, parliamentarians, departmental and NDIA decision makers address the following matters:
Interface issues as identified by the Productivity Commission, and repeatedly raised by Vision Australia to ensure that people don’t fall through the cracks – including in relation to state based systems, Commonwealth systems, and mainstream arrangements identified by
COAG
Wholly inadequate Tier 2 arrangements that are not anything like that which the Productivity Commission described in its comprehensive report, which represent a shift in the goalposts and which in their current form will lead to market failure and a loss of expertise and services for small cohorts and people living in regional and rural areas, which are delivered
by Specialised Service Providers
Ongoing lack of clarity and support for Specialised Services such as Vision Australia to ensure the availability of service to vulnerable people, and for whom mainstream services are not able to respond effectively Lack of understanding of the impact of withdrawal of funding for individual transport, as well as failure to grasp the consequences of rolling up block funding for alternate information provision and the negative impact it would have on supply for participants as well as the mainstream community Urgent need to reduce red tape issues such as MyPlace Portal operation, registration, reporting and payment arrangements Consistency and continuous improvement required from the NDIA including in relation to the need for the development and delivery of simple, coordinated, consistent information and advice to all stakeholders Removal of Pricing decisions from the NDIA and clarifying how providers are expected to deliver services to all Australians Reversing current approaches by the NDIA which have failed to grasp that mainstream technological solutions have specific and tailored benefits to overcoming functional impacts of disability for cohorts and should be funded by the NDIS Co-design must include providers. Mission driven providers like Vision Australia have been consciously omitted from key aspects of the build of NDIS, to the detriment of participants and their families, providers and the scheme itself.
We implore you to make the changes now so that Australians get the best possible system for supporting Australians with a disability, for the economic and social benefit of all Australians.
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Terms of Reference
a. the boundaries and interface of NDIS service provision, and other non-NDIS service provision, with particular reference to health, education and transport services
The introduction of the NDIS has meant that many different services and programs need to interface with the NDIS. The transitional arrangements have had an effect in the following ways:
Aged Care – The aged care sector is not adequately geared or supported to support an older person with disability. Older Australians with disability are faced with an aged care system that relies largely on philanthropic funded service providers to deliver Specialised Support Services, a network of assessors who lack the tools and support to know what to do to meet their needs, and a patchwork of 11 state based aids and equipment schemes with different arrangements and levels of support left to supply life changing supports. Current Commonwealth spending on Aids and Equipment in the Commonwealth Home Support Program is less than $10 million, while 11 uncoordinated state based aids and equipment schemes total more than $200 million. Together, these Commonwealth and State arrangements leave older Australians significantly worse off and blunt the capacity of Specialised Support Services to deliver the Restorative Care options that can deliver independence, safety, wellness and connection to individuals. An older person with disability be forced to rely on charity to get the services and supports they require which other Australians with different conditions are able to receive through the aged care system. Education – the interface between the NDIS and the education system has created a blurring between education/schooling and community involvement and family support. The NDIS says it provides support for ‘participants to attend school education’ while the education system is said to have responsibility for ‘assisting students with their educational attainment’. This interface is not always clear and not always appropriate as it prevents families and communities from obtaining a holistic approach to a child’s needs while they are of school age. In many cases, the education system lacks an understanding of these boundaries, and either refuses entry for allied health professionals seeking to deliver supports ‘in place’ at the school, or expects the NDIS to fund supports that are the responsibility of the education sector (i.e. specialist equipment). We know of many instances where student participants have faced serious delays to their education related to this lack of clarity and understanding. Transport – the future of schemes such as the Mobility Allowance and taxi subsidy schemes are currently in question and the interface between the NDIS and transport schemes is unclear. For example, there is a proposal before Parliament to roll the Mobility Allowance into the NDIS. The Mobility Allowance is a transport allowance for people with disability and has always been crucial to maintaining employment with the flow-on effects of independence and social interaction for people who are blind or vision impaired. We are deeply concerned that the proposed Bill transferring the Mobility Allowance into the NDIS will have detrimental effects on people who are blind or vision impaired who are not receiving an NDIS package due to ineligibility, particularly if they are over the age of 65.
b. the consistency of NDIS plans and delivery of NDIS and other services for people with disabilities across Australia
Accessibility
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There can be no clearer example of the failure of the NDIA in relation to NDIS plans and delivery of services than the fact that: more than 4 years after launching, people who are blind or have low vision are still unable to receive most information about the NDIS, including planning information and the plans themselves, in their format of choice.
For people who are blind or have low vision, the greatest gap in preplanning is in high quality, accessible planning materials and tools. People who choose to conduct preplanning independently require accessible and intelligible materials if the principles of choice and control are to be met. As noted above, and reinforced on many occasions with the NDIA, much information produced by the NDIA is inaccessible – either not electronically accessible, or the print versions are not produced in either braille or large print. Informed choice and decision making requires information: the current situation forces many people who are blind or have low vision to rely on supports of others, despite preferences for independence. Vision Australia will be making a separate submission on this to the Standing Committee’s ‘General Issues’ inquiry.
Complexity and systems issues The failure to provide accessible information is symptomatic of other failures that negatively impact Participants and Providers on a daily basis:
Providers who already engage with the system and have a good understanding of it still struggle to explain it to participants. The NDIA website is confusing: something as simple as a ‘the Six Steps to NDIS Success’ would be hugely beneficial, as the lack of a clear process or flowchart hampers participant understanding. Urgent need to resolve and reduce technical problems and red tape issues such as MyPlace operation, registration, reporting and payment arrangements. This should include consideration of national providers who are forced to deal with multiple duplication when engaging with NDIA. Generalist planners and assessors have a lack of understanding of blindness or low vision including the impact of vision loss and the particular equipment and supports that are required, such as assistive technology and the adaptation of mainstream technology. This includes generic technology that provides specific benefits relating to functioning as applies for people who are blind or have low vision.
Reasonable and necessary
The scope of supports for an NDIS plan is defined as ‘reasonable and necessary’, a definition that Vision Australia supports. Not specifically defining this term can be beneficial, giving participants choice and control about what they deem to be reasonable and necessary and which supports they choose to access.
Our concern is in the way this is applied: it seems that a lack of specialist knowledge is brought to decision making in this area. The Productivity Commission identified the role of court and tribunal decisions in shaping the application of reasonable and necessary. This is a reactive, costly and inefficient mechanism, and does not recognise the burden placed on the individuals required to pursue this action: stress, expense, and a heavy emotional toll.
It also fails to recognise that many people with disability are reluctant to pursue court or tribunal action, and that those who do are more likely to be seeking changes on larger issues or supports. Those issues that are on the margins that may affect people in small ways yet are not life changing
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– there will be limited interest to pursue court or tribunal actions in these cases, particularly where the NDIA firmly defends their position.
The Productivity Commission identified that ‘The NDIA has operational guidelines, practice guides, work practices and task cards to help planner exercise their judgement about what is reasonable and necessary’. Assessors and specialist providers get very limited information about how these decisions are made: at times a device with a report that is near identical will be approved in one region, and denied in another, despite similar participant plans, goals, and needs. The issues are twofold:
Having these decision making tools does not seem to be leading to an increase in consistency; There is limited communication about how these tools might be applied in any given situation, leading to confusion for providers and participants.
Assistive technology
The issue that causes our clients the most confusion, and creates headaches for Vision Australia as a provider is that of everyday items. The two Assistive Technology items this has the most relevance for are smartphones and tablets. For a sighted person, a smartphone or tablet is considered an everyday item. However, for someone who is blind or has low vision, these items have in-built accessibility functions that contribute to a participant meeting their goals.
In the weekly Question and Answer posted on the NDIS website (QandA, https://www.ndis.gov.au/news/qanda-16june.html, 16th June 2017), the NDIA highlighted iPads. We frequently receive the same advice for smartphones and other tablets:
‘Generally, the NDIS won’t fund the purchase of an iPad. If there are certain apps that relate directly to your goals and support needs, and are beneficial to reaching those goals, the cost of those apps can be funded by your NDIS plan […] An iPad can be a great educational and communicative tool for a lot of people. Some people use certain iPad applications to help them overcome barriers they face in society because of their disability. The device is not what helps people reach their NDIS goals but rather the applications specific to the disability.’
For someone who is blind or has low vision, the iPad or smartphone device frequently is what helps people reach their NDIS goals. There are built in accessibility features not present in other devices, including:
Voiceover (speaks items on screen and enables different touch functions to navigate a screen and apps without relying on sight) Zoom Magnifier Contrast and colour inversions Switch control
Many apps that the NDIS fund rely on these in-built accessibility functions to be accessible for people who are blind or have low vision, and on other devices would either be impractical or impossible to use. While a smartphone or tablet may have everyday applications, it also allows navigation of the built environment: relying on the accessibility functions of voiceover and text to speech to input information to the maps applications and output directions.
They can also act as a portable device which captures the functions of a range of other specialist devices: relying on the camera to act as a barcode scanner (and the inbuilt accessibility functions to activate and receive information from the barcode scanner app), colour identifiers, etc. These are functions that otherwise may require multiple devices to be carried outside the home, yet can
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be captured within a portable smartphone or tablet. Importantly, this contributes to independence – as a navigation aid, a smartphone is a specialist tool that can assist participants to meet goals around accessing the community or independently travelling on public transport, among other goals.
There is inconsistency around how different NDIS regions are making decisions in this space. Occasionally we have seen participants get smartphones or tablets approved; more commonly they are not. Sometimes the planner tells the participant they are able to get an iPhone: we have had instances where participants are told by NDIA staff (either helpline or planners) that their plan allows them to buy laptops or smartphones, where their applications for such devices are later denied.
A lack of understanding about how Assistive Technology is approved, or miscommunication where they are told that laptops will be funded, has led some participants to take out loans in order to buy a computer, assuming they can get the NDIS to reimburse them once their plan is approved.
We acknowledge that the flexibility inherent in the ‘reasonable and necessary’ framework can be hugely beneficial and improve choice and control for participants; this flexibility can be to the detriment of clear application. The NDIA acknowledge the confusion in the sector and the community around the meaning, scope, and application of ‘reasonable and necessary’ as a definition. This confusion is largely of their own making, as the guidance given to providers and participants is hazy or conflicting.
We implore the Australian Government, parliamentarians, and the NDIA to address these matters for the benefit of Participants and Providers, and ultimately the Australian community.
c. the rollout of the Information, Linkages and Capacity Building Program The range and type of services initially proposed by the Productivity Commission to be funded under the ILC program has changed substantially. The original proposal was that ILC would reflect the “Tier 2” programs including block funding and early intervention programs. The goal of this was to continue to provide disability services to those who were not eligible for the NDIS, and support providers to make the change as well as ensure continued service to thin markets. However the ILC program covers only tools and awareness programs, delivered by mainstream services for a limited time or on an ad hoc basis.
The ILC program as it currently stands is not going to provide any useful ongoing services and it will not help ensure individuals do not fall through the cracks – the work will fall to the existing specialist service providers such as those in the blindness sector who, for many years, have been providing services to people with disability and will have to continue to do so despite substantial reductions in funding. Unless block funding or funded programs are created, resources and necessary skills will be lost and each disability group will lose their specialty. These programs should include dedicated funding for delivery of a national alternate format service for all Australians, programs that support specialist providers to deliver mainstream education and information, operation of services in thin markets such as blindness which is low cost and low incidence.
The lack of clarity and support for specialist providers such as Vision Australia to ensure the availability of service to vulnerable people, and for whom mainstream services are not able to respond effectively, is now a threat to the NDIS and must be addressed.
The terms of reference also state that the committee will have regard to:
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i. the Bilateral Agreements between the Commonwealth and State and Territory
Governments
ii. the Operational Plans between the Commonwealth and State and Territory
Governments
iii. the risks borne by the Commonwealth and State and Territory Governments in the rollout of the NDIS nationally iv. NDIS decision-making processes, particularly in relation to the Disability Reform
Council and COAG
v. the impact on rural and remote areas, with particular reference to Indigenous communities.
On Bilaterals and Operational Plans
Vision Australia notes that many of the assumptions of costs of the NDIS, and the development of alternative programs, have been made without due consideration of the negative impact on Specialist Providers like Vision Australia. For example, we have historically been underfunded in many jurisdictions due to a lack of relevant programs being made available by those jurisdictions. This has negatively impacted us as national programs and funding opportunities have rolled out, and which have been modelled without consideration of important Specialist Services.
Vision Australia urges the Commonwealth to assume full responsibility for the NDIS and to bring forward necessary COAG agreements that deliver a seamless service experience for all Australians with a disability. This includes a national aids and equipment program in aged care including for older Australians with a disability. Vision Australia also highlights the lack of understanding of the impact of withdrawal of funding for individual transport, as well as failure to grasp the consequences of rolling up block funding for alternate information provision and the negative impact it would have on supply for participants as well as the mainstream community. This gap must be addressed in future bilateral discussions, and should include Vision Australia being provided the opportunity to input to informed decision making.
On National risks
There is an urgent need to resolve and reduce technical problems and red tape issues such as MyPlace operation, registration, reporting and payment arrangements. This should include consideration of national providers who are forced to deal with duplication when engaging with NDIA.
There is consistency and continuous improvement required from the NDIA including in relation to the need for the development and delivery of simple, coordinated, consistent information and advice to all stakeholders
Vision Australia requests that pricing decisions are made by an independent body, as recommended by the Productivity Commission, and further clarification on how providers are expected to deliver services to all Australians.
Vision Australia asserts one of the biggest challenges to overcome is that co-design must include providers. Mission driven providers like Vision Australia have been consciously omitted from key aspects of the build of NDIS, to the detriment of participants and their families, providers and their staff and the scheme itself.
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On NDIS decision making
NDIS decision making must be more transparent across all aspects of operation. The price review, for the second year running, failed to: publish submissions; give justification for changes; or provide any information on how decisions were reached.
In particular, Vision Australia asks that the NDIA disaggregate and report on blindness so that all stakeholders may be fully informed of the level, type of support, number of participants, across jurisdictions.
Conclusion
Vision Australia is conscious that readers of this submission would be aware the transitional arrangements for NDIS have resulted in negative consequences for people who are blind or vision impaired.
Flexibility is required to ensure people with disability are not disadvantaged by the transition of many disability programs to the NDIS, especially those who are not eligible for an NDIS package, such as people with disability over the age of 65. With measures such as block or program funding, specialist disability sectors such as the blindness sector, can continue to provide services to consumers and continue to remain viable.
Vision Australia would be pleased to provide additional information, case studies, or further support to the Committee, and appear at any public hearing, should it be required.
About Vision Australia
Vision Australia is the largest national provider of services to people who are blind, deafblind, or have low vision in Australia. We are formed through the merger of several of Australia’s most respected and experienced blindness and low vision agencies, celebrating our 150th year of operation in 2017.
Our vision is that people who are blind, deafblind, or have low vision will increasingly be able to choose to participate fully in every facet of community life. To help realise this goal, we provide high-quality services to the community of people who are blind, have low vision, are deafblind or have a print disability, and their families.
Vision Australia service delivery areas include: Registered provider of specialist supports for the NDIS and My Aged Care Aids and Equipment, and Assistive/Adaptive Technology training and support
Seeing Eye Dogs
National Library Services
Early childhood and education services, and Feelix Library for 0-7 year olds Employment services, including national Disability Employment Services provider Accessible information, and Alternate Format Production Vision Australia Radio network, and national partnership with Radio for the Print
Handicapped
Spectacles Program for the NSW Government Advocacy and Engagement, working collaboratively with Government, business and the community to eliminate the barriers our clients face in making life choices and fully exercising rights as Australian citizens.
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Vision Australia has unrivalled knowledge and experience through constant interaction with clients and their families, of whom we provide services to more than 27,500 people each year, and also through the direct involvement of people who are blind or have low vision at all levels of the Organisation. Vision Australia is well placed to advise governments, business and the community on challenges faced by people who are blind or have low vision fully participating in community life.
We have a vibrant Client Reference Group, with people who are blind or have low vision representing the voice and needs of clients of the Organisation to the Board and Management. Vision Australia is also a significant employer of people who are blind or have low vision, with 15% of total staff having vision impairment. Vision Australia also has a Memorandum of Understanding with, and provides funds to, Blind Citizens Australia (BCA), to strengthen the voice of the blind community.
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