THE COMMONWEALTH JOINT STANDING COMMITTEE ON THE NDIS
INQUIRY INTO TRANSITIONAL ARRANGEMENTS
NSW GOVERNMENT SUBMISSION, JULY 2017
SCHEME BOUNDARIES
The boundaries of the NDIS are also the boundaries of other service systems, such as health, education, transport and the justice systems. Scheme boundaries must be clearly defined to provide certainty to participants, providers, NDIA planners, and staff in other service systems. Governments require certainty so they can plan and budget for the ongoing delivery of services without concern of unexpected changes to responsibilities and increases (or decreases) in demand.
The boundaries of the NDIS should not be at the discretion of the Commonwealth alone or the NDIA. Rather, boundaries must reflect the realities of disability and mainstream service delivery and be negotiated and agreed between governments. Boundaries should be agreed with a number of considerations (policy, operational, clinical), and when decided in isolation will have significant impacts on how individuals interact with other service systems. To the extent possible, boundaries should be nationally consistent.
The COAG agreed Principles to Determine the Responsibilities of the NDIS and Other Service Systems and the Applied Principles and Tables of Supports outline the boundaries of the NDIS with other service systems. The Applied Principles are broad and high-level and were reviewed in 2015 to reflect early experiences of NDIS trials. Extensive further work is required by the States and the Commonwealth to scope, agree and communicate service boundaries. Any movement of boundaries (existing responsibilities) between the NDIS and other service systems should be implemented with associated resourcing considerations. At this early stage, NSW considers reviewing scheme boundaries to be of limited value given extensive work is still required by governments to define and agree boundaries.
CONSISTENCY OF PLANS
The NDIA has experienced a range of operational issues and constraints which have impacted its capacity. This is partly the result of the transitional environment in which the scheme is currently operating, and partly due to other constraints associated with the NDIA’s ICT platform and the capacity of its new workforce.
It is recognised that the transition is a significant logistical exercise. However, a compromised planning process can mean that people may feel their plans are not sufficiently individualised, do not meet their needs, and will not help them to achieve their goals. There is a risk that a comprised planning process may lead to an increase in demand for mainstream services to meet unmet participant need.
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There are reports that for some participants the planning process is rushed and unclear. And it appears that plans are inconsistent and show variability in the quality, quantity and types of supports approved. There are reports that participants may have only a single conversation with a planner, often over the phone. In some cases, existing reports and assessments undertaken for a participant through other service systems are not being used to inform what reasonable and necessary supports are needed.
It also appears that planner knowledge and capability is highly varied, as is their interpretation of reasonable and necessary supports and understanding of interim working arrangements with mainstream services. Approved supports are less likely to be based on a participant’s needs and more on a planner’s knowledge of the disability and / or how effectively the participant or their carer advocate for certain supports.
Also, there is some indication that plans are not reflecting the participant’s needs because the right stakeholders haven’t been engaged, or they have been contacted at short notice, limiting their ability to advise. A participant’s carers and family may also not have the experience and skills to support them in the NDIS process. Costs associated with urgent plan reviews are likely to place pressure on the NDIA through increased administrative effort and costs and poor participant outcomes.
There is capacity to improve the planning process, including: Participants should have the choice of how they would like the information gathering and planning to be conducted: by phone or in person The NDIA should utilise existing state information to inform determination of the level of need and supports required during plan development The NDIA should consider conducting an analysis of participant support costs pre and post NDIS planning The NDIA should consider allowing the participant and their family / carer to review the plan prior to final approval Pre-planning meetings would provide an opportunity for better planning and may reduce the need for plan reviews Plans could also undergo moderation to ensure quality, appropriateness and consistency The NDIA should consider alternate, more supportive, methods for plan activation other than through web-based programs
The NDIA must continue to improve systems and processes. In particular, strategies are required to build the capacity and capability of NDIA operational staff to deliver person-centred planning. This includes improving their understanding of mainstream services.
During transition, the NDIA also needs to work in close partnership with and utilise the expertise of State governments, recognising that governments will continue to play a significant role during the transition to full scheme.
Further consideration is also required for Aboriginal and Torres Strait Islander people and their communities. Delays in finalising the Aboriginal Engagement Strategy and its implementation have impacted on the planning experience for this group.
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INFORMATION, LINKAGES AND CAPACITY BUILDING
A social insurance model invests in formal, disability-specific support to reduce the lifetime cost of disability, at both the population level and individual level. Investment in community education, broad-based interventions and capacity building and supports for carers and families has been shown to reduce the long term need for more intensive supports.
This investment sustains and strengthens informal support and promotes the social and economic inclusion and meaningful participation of people with disability in their communities, including through the mainstream support systems that are available to all citizens.
To facilitate ILC implementation, the NDIA has released the ILC Commissioning Framework and the ILC Program Guidelines, which contain application details and funding criteria. However, there is still a gap in the information presented in relation to the Commissioning Framework not setting out what activities the NDIA will actually fund under the ILC budget for full scheme. Further work by the NDIA is urgently required to map specific ILC infrastructure required for full scheme, including how the ILC environment will develop over time as the scheme and market mature.
ILC is a key component of the NDIS insurance model and investment in ILC infrastructure will be critical to the long term sustainability of the scheme. ILC will contribute to the sustainability of the NDIS by building the capacity of the community, people with disability, their families and carers, thereby reducing the need for specialist supports funded by the scheme. The level of investment in ILC under the full scheme is a critical consideration for the Commonwealth government. Ongoing investment will also need regular review as the market and society matures in how people with disability are supported to participate in society.
OTHER MATTERS
The NDIS is a new, national market for disability supports. It is not the transfer of existing contracting and delivery arrangements from the States to the Commonwealth. While NSW is transferring the participants we have previously been responsible for, we are transferring them into a new market for funding, supplying and consuming disability supports. This market relies on the interaction of participants’ decisions and NDIS pricing arrangements to incentivise service providers to meet participants’ needs. Choice and competition are key. Effectively competitive markets are generally characterised by: Engaged consumers that are willing and able to switch providers in response to price and quality differentials Sustainable suppliers that are able to recover their costs of supply, including a return for risk
The primary risks to the achievement of the vision for the NDIS, and its financial sustainability, given where we are at in implementing the scheme are: A lack of recognition of the institutional and governance arrangements that are needed to facilitate the development of the new national disability market
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Participants need to more effectively engage in the NDIS with information and assistance to help them exercise choice The market for the provision of supports is developing, but this will likely be slow if there is uncertainty regarding the ability of service providers to recover their reasonable costs, including their capacity and willingness to support people with complex needs The significant increase in workforce required to support the NDIS
However, NSW maintains that transition considerations are different to the long term implementation of the NDIS as intended, and that it is critical to ensure that the NDIA is able to manage the implementation in full with clear roles and responsibilities from full scheme in July 2018. The transition period was not expected to deliver the full benefits of the NDIS. The full benefits of the NDIS are expected to begin to be apparent once the NSW system is fully managed within the new national model. It will take time for the new national market to develop and mature. People with disability need time to build their understanding of the Scheme and to begin to exercise their sovereignty as consumers. It will take time for the NDIA to fully resource and implement all its required functions, capabilities and expertise. It will take time for providers to adapt and bring new service offerings to the market.
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