Martin Foley mp
Minister for Housing, Disability and Ageing 50 Lonsdale Street
Minister for Mental Health Melbourne, Victoria 3000 Australia
Minister for Equality
Minister for Creative Industries
B17/4201
Committee Secretariat
Joint Standing Committee on the NDIS
PO Box 6100
Parliament House
CANBERRA ACT 2600
Dear Committee Secretary
| enclose for your consideration Victoria's submission to the Joint Standing Committee on the
National Disability Insurance Scheme (NDIS) inquiry into transitional arrangements for the NDIS.
The Victorian Government is firmly committed to the original objectives and vision of the NDIS and welcomes the opportunity to provide its views on the implementation, performance and governance of the NDIS during this critical stage of transition.
Victoria has experienced significant delays transitioning people to the NDIS, observed sub optimal outcomes for some participants through the planning process, and has concerns about emerging mainstream interface issues. Our submission proposes a number of recommendations to ensure the NDIS can deliver on its original vision, in which people with
disability are at the heart of the scheme. | urge the Committee to consider these
recommendations.
If the Committee requires any further information or clarification, please contact John Batho,
Assistant Director, NDIS Branch, Department of Premier and Cabinet on
| look forward to the report in December 2017 and welcome any further engagement on this
important m
Yours 8ipicergly
Martin Foley MP
Minister fof Housing, Disability and Ageing
It/ 08-201
Your details will be dealt with in accordance with the Public Records Act 1973 and the Privacy and Data Protection Act 2014. Should you have any ORIA queries or wish to gain access to your personal information held by this department please contact our Privacy Officer at the above address. State
Victorian Government submission to the Joint Standing Committee on the
NDIS
Inquiry on the transitional arrangements for the
NDIS
August 2017
Contents
1. Introduction 3
2. Improving transition and participant outcomes 5
2.1 Participant planning issues continue to impact the pace and quality of transition 5 2.2 Current planning processes are not always effective 5 2.3 Access processes are creating barriers for some cohorts 6 2.4 The urgent needs of children are not being met 6 2.5 Victoria is proactively supporting the NDIA 7 2.6 More needs to be done to resolve access and planning issues 8
3. Getting Victoria’s mainstream services NDIS ready 11
3.1 Mainstream services are fundamental to financial sustainability 12 3.2 NDIS interface with health and aged care services 12 3.3 Victoria is working collaboratively to resolve education interface issues 13 3.4 Victoria is working through transport interface issues 14
4. The roll out of the Information, Linkages and Capacity Building program 15
4.1 Greater clarity on ILC is critical during transition 15 4.2 LACs are not performing their core function 15 4.3 The infrastructure required to deliver ILC is underdeveloped 16
5. Getting critical market and planning infrastructure in place 17
5.1 Priority should be given to getting critical market strategies in place 17 5.2 Clarity on Provider of Last Resort arrangements is necessary 18 5.3 Appropriate pricing is critical to the development of a sustainable NDIS workforce 18 5.4 Workforce growth is a shared responsibility 18 5.5 Victoria is committed to robust safeguards 19
2 Victorian Government submission to the Joint Standing Committee on the NDIS
- Introduction The Victorian Government welcomes the opportunity to provide input into the Joint Standing Committee on the National Disability Insurance Scheme (NDIS) inquiry on the transitional arrangements for the NDIS (the Inquiry).
This Inquiry is an important opportunity to influence the implementation, performance and governance of the NDIS. The NDIS is in a critical stage of transition and the Victorian Government reaffirms its commitment to the original objectives and vision of the NDIS, in achieving the aspirations and goals of people with disability.
To date, Victoria has experienced significant delays transitioning people to the NDIS, observed sub-optimal outcomes for some NDIS participants through the planning process, and has concerns about emerging mainstream interface issues. The rapidly increasing scale of transition will present even greater risks if existing issues are not adequately addressed. To this end, the Victorian Government urges the Committee to consider a number of recommendations outlined in this submission, including adjustments to the NDIA’s operational approach, to ensure the NDIS can deliver on its original vision.
More needs to be done to deliver a better planning experience for participants and resolve access issues
The Victorian Government is working in collaboration with the NDIA and the Commonwealth Government to support the transition of existing state clients into the scheme and to meet bilateral estimates for transition. However, more needs to be done so people with disability are able to access the benefits of the scheme as soon as possible. One key area of concern during transition has been access issues for particular cohorts. To address these concerns the NDIA needs to prioritise an individualised approach with greater specialisation of planners. Further the NDIA needs to continue to monitor the Early Childhood Early Intervention (ECEI) approach to ensure it is meeting the urgent needs of children.
Victoria considers that a significant cause of transition issues are the limitations placed on the NDIA’s operating costs and subsequent resource constraints. The NDIS is an insurance-based scheme and it is essential that the insurance principles which underpin it operate effectively so it does not revert to a welfare model. To this end, the NDIA needs to be given greater operational autonomy over its budget and staffing arrangements so it can make greater up front investments during this critical transition period and minimise future costs.
Victoria is increasing investment in mainstream services to support the NDIS
Strong mainstream services are the foundation for a successful and financially sustainable NDIS. Equally, a well-functioning NDIS will support mainstream services by reducing pressure on these services. While the NDIS is not intended to replace mainstream services (and vice versa), the financial sustainability of both relies on the continuing collective efforts of the NDIS and mainstream services to support people with disability.
Under the NDIS, Victoria is significantly growing its investment in disability services. Victoria is also increasing its investment in mainstream services to ensure people with a disability are supported by the state-based supports they need to live ordinary everyday lives. This will ensure that the NDIS does not operate as an ‘oasis of support’ for people with disability.
Victorian Government submission to the Joint Standing Committee on the NDIS 3
Similarly, there is work to be done with the NDIA to ensure that Victorian services are seamlessly integrated with NDIS supports. Further work is required to operationalise the interface between NDIS mainstream services, particularly with regard to health and the mainstream interfaces that are critical to maintaining the safety of citizens, such as child protection, family violence and justice interfaces.
Victoria is continuing to work collaboratively with the NDIA, Commonwealth and states and territories to resolve a number of outstanding mainstream interface issues.
Investment in Information, Linkages and Capacity Building (ILC) activities is inadequate
ILC activities should support both NDIS participants and people with disability that are not eligible for the scheme. ILC is integral to the insurance model and is a key way to support financial sustainability of the scheme. Given the likelihood of high demand for ILC funded supports and the important benefits it will generate, Victoria is concerned that the allocated level of funding is inadequate. Greater clarity on how the ILC will work is also necessary to provide assurance to people with disability and providers.
During transition, priority should be given to getting critical market and planning infrastructure in place, improving pricing, investing in workforce readiness and ensuring robust safeguards are in place
Transition to the NDIS requires large-scale structural change. For transition to be successful, it is important that the NDIA performs its market stewardship role effectively to build markets, particularly in rural and regional areas and for participants with complex needs where there is a heightened risk of thin markets or market failure.
Further, it is important that the Commonwealth, states and territories invest in building a skilled workforce. The Victorian Government is investing $26 million (including $4.88 million from the Commonwealth Sector Development Fund) in Keeping our sector strong: Victoria’s workforce plan for the NDIS. This plan supports the disability workforce to transition to the NDIS through research, workforce development and training.
Market and workforce development are reliant upon both transparent price settings and a strong quality and safeguarding system. To this end, Victoria would welcome the move to an independent price regulator. Victoria is also committed to ensuring people with disability are afforded the same standards of protection currently afforded to them under state arrangements and is working with the Commonwealth so the National Quality and Safeguarding Framework (the Framework) is implemented in line with its original objectives.
4 Victorian Government submission to the Joint Standing Committee on the NDIS
- Improving transition and participant outcomes
2.1 Participant planning issues continue to impact the pace and quality of transition
Victoria has experienced significant delays in bringing Victorian participants, particularly existing state clients, into the scheme against bilateral agreement estimates (see table 1). Plan approvals (including for children in the ECEI gateway) are significantly below estimates and plan reviews have been deferred.
NDIA data also shows an emerging upward trend of people who: are waiting an extended period of time to have plans approved; cannot be contacted; are being requested to provide additional evidence to support their access; or are declining to phase in to the scheme.
For example, as at 30 June 2017, the NDIA has made 3500 access decision cancellations in Victoria on the basis that it was unable to make contact with clients (following four calls and a letter), even though many of these clients are in supported living arrangements with a fixed address. Anecdotal feedback from participants and service providers suggest that these contact attempts are not always reasonable or appropriate (e.g. cold calling, or considering an engaged signal a reasonable attempt at a phone call). The rate of uncontactable clients with an access decision cancelled has increased by four per cent over the last three months.
Table 1- Victorian participants in transition as it 30 June 2017 (excludes Barwon trail)
Expected at Actual at 30 Variance
30 June June 2017 2017
Transitioning state clients 12,549 7,485 Over 5,000 person shortfall
(60% of bilateral estimate)
Commonwealth & other new 2,553 2,069 81% of bilateral estimate
participants
Total NDIS participants 15,102 9,554 About 5,500 shortfall (63% of
end of 2016/17 bilateral estimate)
2.2 Current planning processes are not always effective
One area of concern during transition has been the practice of completing participants’ plans over the phone. While this may be an efficient approach, it is not an effective approach for all participants – particularly those with cognitive, psychosocial and other mental health disabilities, as well as participants who are less able to advocate for themselves and have limited access to others who can advocate on their behalf.
Victorian Government submission to the Joint Standing Committee on the NDIS 5
Victoria is aware of anecdotal evidence of some individuals being contacted by telephone in circumstances where it would be very difficult for them to deal effectively with the planning process. There are also some reports that families of young children with a disability or developmental delay have not fully understood the implications of what they have agreed or their ability to request a plan review. Furthermore, anecdotal evidence suggests many participants are unhappy with their plan once it is in place. Participants are currently only able to view their plan after it has been finalised and are unable to review a draft of their plan following planning discussions.
Victoria acknowledges that the NDIA is currently developing a range of improvements to its planning processes and pathways.
2.3 Access processes are creating barriers for some cohorts
Current NDIS access processes for some cohorts, including people with complex needs, psychosocial disability and hard to reach clients are not operating satisfactorily.
The Victorian Government is concerned that some individuals with psychosocial disability may experience difficulty in collecting the evidence required to complete NDIS access and review processes. To date,18 clients on the Mental Health Community Support Service (MCHSS) Needs Register in the North Eastern Melbourne Area have been assessed as not meeting the disability access requirements. This may be a result of the combination of the need to prove functional impairment, and permanency of impairment, coupled with the way the NDIS Access Team is determining eligibility. The majority of these existing clients are now being supported by the Victorian Government to appeal this decision.
Given the barriers experienced by existing state clients, the Victorian Government is concerned that there may be even greater obstacles for individuals with psychosocial disability who are not existing state clients. The relatively low number of ‘new’ applicants in this cohort may be an indication that NDIS access processes are impacting scheme participation.
2.4 The urgent needs of children are not being met
There are a number of children whose needs are not being met through the ECEI approach. Under the NDIS Bilateral Agreement for transition, it was agreed that approximately 1800 children on the ECIS waitlist would transition to the NDIS during the first two years of scheme rollout. However, there have been significant delays in these children gaining access to the scheme and having plans approved. Reasons for this include:
- delays in appointing ECEI partners;
- insufficient resourcing to provide timely access and planning for transition clients;
- difficulties contacting families to commence the transition process; and
- challenges associated with meeting families and engaging service providers for children transiting in areas that are not yet live. Victoria is working closely with the NDIA to better understand the reasons for these delays.
This raises concerns about the impact of delayed early intervention for this specific cohort, given the critical opportunity for early intervention to minimise or prevent longer term developmental issues for these vulnerable children, and subsequent costs to the state.
6 Victorian Government submission to the Joint Standing Committee on the NDIS
2.5 Victoria is proactively supporting the NDIA
The Victorian Government is working with the NDIA to support the transition remediation effort. Examples of Victoria’s efforts are summarised below.
Challenge Support efforts
Meeting ▪ Allowing the NDIA greater flexibility with phasing to allow people into the
bilateral NDIS earlier than expected. targets
-
Providing planning support to the NDIA to maximise entry of waitlist clients.
-
Establishing an Intensive Support Team to assist people with complex needs to review their current supports, prepare for the NDIS and to navigate the transition pathway.
-
Maximising the transfer of existing Victorian knowledge to the NDIA, including secondments of experienced Victorian Government staff to the NDIA to assist with planning.
-
State-wide recruitment process of NDIA positions as the NDIS is implemented in Victoria.
-
Investing $20 million through its Transition Support Package (TSP) to prepare providers for the NDIS and increase the capacity of disability support organisations.
Delays with ▪ Supporting people to make telephone contact with NDIA access team and
access for to complete and return the Access Request Form. existing clients
-
Engaging service providers to assist with completing Access Request Forms.
-
Engaging advocacy groups such as VALiD to support potential participants.
-
Allocating additional funds to allow more children on the ECEI waitlist to be supported while they wait to enter the NDIS.
-
Sharing local and operational knowledge with newly appointed ECEI partners and ensuring compliance with the Victorian Early Childhood Intervention Standards.
-
Seconding Victorian Government staff to assist the Brotherhood of St Laurence (BSL) to undertake planning for ECIS children.
-
Working with the Commonwealth to ensure all children on the ECIS waitlist are prioritised for transition to the NDIS in the first two years of rollout.
Quality of ▪ Improving the quality of client record data from state disability systems
client data transmitted to the NDIA and development of data remediation procedures provided to the with the NDIA to assist clients to access the scheme.
NDIA
Cash flow ▪ Providing fortnightly data to service providers on their clients’ access and
disruption for plan status. providers at
- Varying contracts in arrears on average two to three months after planplan activation approval.
Victorian Government submission to the Joint Standing Committee on the NDIS 7
Supporting ▪ Establishing a new single point registration triage unit within DHHS to
provider manage the inflow of NDIS provider registration requests for state registration approval.
-
Producing communication materials for Victorian providers to assist in understanding the transitional quality and safeguarding arrangements, and through the TSP, funded provider and consumer groups to support effective engagement around transitional arrangements.
-
Providing dedicated training and support for departmental staff responsible for managing contracts with funded service providers.
-
Worked with the NDIA to correct registration errors that arose from the migration of NDIA data records to its new Client Records Management System.
2.6 More needs to be done to resolve access and planning issues
An estimated 33,000 Victorian state clients are expected to transition to the NDIS in 2017/18, with the NDIA commencing operations in an additional seven areas, including high volume areas of Inner Eastern Melbourne and Outer Eastern Melbourne.
The rapidly increasing scale of transition will present even greater risks if existing issues are not adequately addressed. Victoria is seeking reassurance from the NDIA that targeted actions are being taken to both improve the flow of people entering the NDIS and to ensure a high quality participant experience. To support these improvements, the Victorian Government has a number of recommendations, including adjustments to the NDIA’s operational approach, to ensure the NDIS can deliver on its original vision.
The NDIA needs greater operational flexibility
The NDIS is an insurance-based scheme and, as such, it should seek to maximise lifetime opportunities for participants whilst minimising lifetime support costs. It is essential that the insurance principles that underpin the NDIS operate effectively so that the NDIS does not revert to a welfare based model.
Ensuring that targets are met in terms of the number of plans approved should not compromise the quality of the planning process. Adequate time, by an experienced person with sufficient skills, needs to be allocated to gather the necessary information to understand the complex circumstances of some participants. As a matter of priority, the NDIA needs budget flexibility to build its capacity and capability during this critical transition stage.
A significant cause of delays in Victoria can be attributed to NDIA personnel shortages. This is likely attributable to the capped operating budget the NDIA is subject to. The NDIA is staffed to operate under ‘business as usual’ conditions, rather than to deliver the considerable plan approval rates required for transition, which the Productivity Commission has estimated will ultimately be 500 plan approvals per day.1
1 Productivity Commission review into NDIS Costs, Position Paper
8 Victorian Government submission to the Joint Standing Committee on the NDIS
Robust longitudinal data is integral to the insurance model
As with any insurance model, the NDIA should also continually compare experience with forecasts, using sophisticated data analytics to build a strong evidence base for determining reasonable and necessary supports and measuring optimal support arrangements and best practices.
The NDIA needs to develop an individualised approach for some cohorts
People with a psychosocial disability (particularly those on compulsory treatment orders), people experiencing homelessness, people with disabilities, and those with little informal support networks, are often reluctant to engage with formal service systems, have no treating health professional and are at a heightened risk of not engaging with the NDIS access process.
To address access issues, partly caused by this reluctance, Victoria considers that greater specialisation of planners as well as individualised gateways/outreach is required. Victoria’s Streamlined Access Approach for people on the MHCSS Needs Register could inform the development of a dedicated psychosocial gateway. The NDIA should also provide specialist planning for this group.
Further, Victoria considers that the NDIA should:
-
Simplify planning processes (particularly for approvals that are low risk) and ensure communication materials focus on participant needs rather than administrative processes and back end systems. Equally, simpler plan documents would enable increased self direction on the part of participants.
-
Bolster support coordination by improving training of support coordinators and developing specialist coordination. There has been inconsistent information about the expectations of support coordination as well as limited training of support coordinators to support people with complex or specialist needs.
-
Allow intermediaries to play a role in both financial and support coordination, if coupled with clarity and training on what this role should cover, monitoring of outcomes for these participants and clear quality and safeguarding responsibilities for intermediaries.
More needs to be done to ensure access for people with psychosocial disability
Victoria would welcome the opportunity to assist the NDIA to develop the evidence base to:
-
assess permanency of functional impairment associated with psychosocial disability;
-
determine eligibility of people who experience significant psychosocial functional impacts episodically;
-
develop a more effective entry pathway for people with severe mental illness and psychiatric disability who are hard to engage, cannot advocate for themselves or find it difficult to navigate the NDIS access process;
-
attract specialist NDIA staff to determine eligibility for people with psychosocial disability, noting the MHCSS intake service uses occupational therapist, psychologists, mental health nurses and social workers;
-
identify circumstances when this cohort would be eligible for early intervention supports and the types of supports that will improve psychosocial functioning and recovery outcomes; and
-
ensure plan outcomes support the recovery of people with a psychosocial disability. Victorian Government submission to the Joint Standing Committee on the NDIS 9
Greater clarity on the role of advocacy is required
Advocacy plays a fundamental role in supporting participants to exercise choice and control. The Disability Reform Council (DRC) has agreed that the NDIA would fund certain types of advocacy (e.g. decision making supports), while systemic advocacy and legal review and representation would be funded outside of the NDIS (such as through the National Disability Advocacy Program). More clarity is required on how systemic and legal advocacy will be delivered in a nationally consistent way.
Greater transparency on the ECEI approach is required
The NDIS needs to continue to monitor the ECEI approach to ensure that it delivers significant gains for young children with developmental delay and disability as well as managing demand for the scheme. Although there are signs that the NDIA is implementing more consistent planning and better communication with family, more transparency is needed around the framework, how conflict of interest is being managed in contracts and how the efficacy of supports is being evaluated.
10 Victorian Government submission to the Joint Standing Committee on the NDIS
- Getting Victoria’s mainstream services NDIS ready
Victoria is taking a proactive approach to making sure mainstream systems are ready for the NDIS. Under the NDIS, Victoria is significantly growing its investment in disability services. In 2013-14 (which broadly represents Victoria’s spend on disability services ahead of Victoria committing to the NDIS) Victoria invested $1.57 billion in the provision of care and support services for people with disabilities. At full scheme, Victoria will contribute $2.5 billion to the NDIS (compared to the Commonwealth spend of $2.6 billion).
Victoria is also fully committed to providing continuity of support for people with disability that are not eligible for the NDIS. This means that as the NDIS is rolled out, Victoria will be responsible for continuing to support people under the age of 65 (under the age of 50 for Aboriginal or Torres Strait Islander Victorians) receiving Victorian disability services who are ineligible for the NDIS.
Over the past two years, the state has invested an additional $300 million into disability-related initiatives. This includes approximately $150 million to ensure services and systems, as well as workforce, clients and their families are ready to transition to the NDIS. The Government has funded investments in areas such as the State Disability Plan, strengthening oversight to reduce abuse in disability services, and additional placements in disability services.
In parallel, NDIS readiness planning is underway across the 11 key mainstream service interface areas identified by the Applied Tables and Principles of Support (APTOS) to ensure the interface between the mainstream services and the NDIS is coordinated and streamlined. The readiness planning process is designed to provide a practical and consistent approach for Victorian state mainstream systems to interpret and implement the principles articulated in the APTOS.
There are a number of recurring themes across portfolio NDIS readiness plans:
-
Mainstream support: Ensuring that state mainstream systems can offer adequate support during and post roll-out (for example, monitoring and measuring if additional demands are falling on mainstream service and making necessary plans for any gaps identified);
-
Workforce capacity: Developing the ability of state mainstream service workforces to identify the needs of people with a disability and support their access to the NDIS and similarly developing the capacity of the NDIS workforce to understand state based services;
-
Access and early intervention: Building the capacity of mainstream services to identify and respond to the needs of people with a disability who may benefit from early intervention services, both within existing state services and via referral to the NDIS;
-
Maintaining quality and safety: Ensuring that quality and safety for people with a disability is protected through detailed protocols so that standards are not compromised in transition;
-
System collaboration, linkages and referrals: Ensuring that Victorian and NDIS funded services are integrated and provide a seamless system of supports for NDIS participants; and
-
Financial risk: Working with the NDIA to ensure Victoria and the NDIA meet the agreed division of responsibility in the APTOS.
Victorian Government submission to the Joint Standing Committee on the NDIS 11
3.1 Mainstream services are fundamental to financial sustainability
Strong mainstream services are important for a successful and financially sustainable NDIS. Equally, a well-functioning NDIS places less pressure on mainstream services. While the NDIS is not intended to replace mainstream services (and vice versa), the financial sustainability of both relies on the entire system continuing efforts to support people with disability. All Governments consequently have an interest in a financially sustainable NDIS that implements insurance principles to reduce lifetime costs of disability support.
The NDIS is already placing additional strain on state-funded mainstream services. These strains are in part due to lack of clarity regarding the boundaries between the NDIS and the mainstream system, but also reflect acknowledged operational shortcomings that have arisen in the initial stages of the scheme rollout. These include:
-
where NDIA pricing is insufficient to provide a supply of agreed supports;
-
where the administrative burden associated with NDIS funding is discouraging providers from registering with the scheme;
-
where poor or inconsistent NDIS planning is forcing participants back onto state services; and
-
where support coordinators are inadequately equipped to ensure a smooth transition from transitioning programs to the NDIS. The Victorian Government considers that there is more work to be done to operationalise the interface between NDIS mainstream services, particularly with regard to health and the other mainstream interfaces that are critical to maintaining the safety of citizens, such as child protection, family violence and justice interfaces.
Victoria is continuing to work collaboratively with the NDIA, Commonwealth and states and territories to resolve a number of outstanding mainstream interface issues.
3.2 NDIS interface with health and aged care services
Effective interaction between the NDIS and Victoria’s health and aged care services is critical to ensuring a smooth transition to the NDIS for eligible Victorians and ensuring good quality coordinated care and support for individuals. Effective interaction between the NDIS and Victoria’s health and aged care services will depend on clear delineation of roles and funding responsibilities.
For instance, Victoria is concerned that the timeframes associated with NDIS access, planning and plan implementation for people who require a NDIS plan to support hospital discharge are resulting in protracted hospital stays. Protracted hospital stays can have a negative impact on the health and wellbeing of prospective participants and are putting pressure on hospital throughput and budgets.
Further, there is a risk for young people with complex health and disability needs that they may be referred to residential aged care (RAC) as timely bespoke solutions are not yet available under the NDIS. Data from the Australian Institute of Health and Welfare (AIHW) indicates that admissions of young people with disability to RAC has not reduced, in fact the data suggests that there has been an increase in 2016 in two of the three NDIS trial sites (including Barwon) despite the NDIS being available.
12 Victorian Government submission to the Joint Standing Committee on the NDIS
Victoria’s concern about young people in residential aged care extends to delays in NDIS access, planning and plan implementation. Young people in RAC are disadvantaged compared to their counterparts who have become NDIS participants, due to decreased opportunities to achieve their goals and due to the risk of being required to pay residential aged care fees. Victoria has particular concern for people living in RAC who are aged 63 and 64 years, who may miss out on the opportunity to join the NDIS due to delays in meeting bilateral estimates.
3.3 Victoria is working collaboratively to resolve education interface issues
Personal Care in Schools
The Council of Australian Governments (COAG) agreed that, under the NDIS, Personal Care in Schools (PCIS) will be funded by the NDIS when full scheme commences on 1 July 2019. PCIS is one on one support for students with disabilities requiring assistance with activities of daily living, such as mealtime assistance, dressing, toileting assistance and complex care.
Personal care is not currently provided as a discrete program or by a discrete workforce in schools. The supports are funded from a range of sources and delivered by teachers and teacher aides among other educational roles and responsibilities.
Issues that have not been resolved include:
-
reaching agreement on the ‘in scope’ personal care supports that will be funded by the NDIA versus ‘reasonable adjustments’ that schools will continue to fund; and
-
identifying an agreed process for assessing, costing and delivering NDIA funded supports in schools. At the request of DRC, the Victorian Department of Education and Training is leading a national project to provide a stronger evidence base around the most desirable PCIS options and future operational arrangements.
Student transport
Victoria’s Students with Disabilities Transport Program (SDTP) currently provides transport assistance for approximately 9,000 students attending their designated government specialist school.
COAG agreed that transport to and from school will be funded by the NDIA at full scheme. The transition to NDIS full scheme presents opportunities to create a new NDIS-funded school transport model that:
- builds the life skills of NDIS eligible students to travel independently;
- provides flexible transport options; and
- provides assistance to NDIS eligible students enrolled in non-specialist and non-government schools who are not currently provided this service. Inadequate design of NDIS-funded school transport could lead to students not getting to school if travel assistance ceases for them, or inequitable transport arrangements. To address these risks, Victoria is working in collaboration with the Commonwealth Government, the NDIA and other jurisdictions to develop a new model for NDIS funded student transport.
Victorian Government submission to the Joint Standing Committee on the NDIS 13
3.4 Victoria is working through transport interface issues
Victorians with disability who meet eligibility requirements receive subsidised taxi travel through the Multipurpose Taxi Program (MPTP). When MPTP members become NDIS participants, it is expected that the NDIS should provide all reasonable and necessary transport supports and those participants can be transitioned off the MPTP. However, Victoria continues to pay MPTP subsidies to NDIS participants because:
-
Victoria holds concerns that the NDIS may not be providing adequate transport support to participants;
-
there does not appear to be a payment mechanism that will allow NDIS participants who cannot manage cash to pay fares for taxis (or similar transport options); and
-
further data matching arrangements need to be put in place to ensure that NDIS participants are transitioned off the MPTP as they join the NDIS, and that MPTP subsidies are not removed from others because of data matching constraints. As a result, Victoria is currently paying taxi subsidies to NDIS participants as well as making its agreed contributions to the NDIS under our bilateral agreement with the Commonwealth.
Several states and territories share Victoria’s concerns that NDIS participants are not receiving adequate transport support. Victoria is working with the NDIA, Commonwealth and states and territories to work through transport interface questions and seek assurances that NDIS participants are receiving adequate transport support.
14 Victorian Government submission to the Joint Standing Committee on the NDIS
- The roll out of the Information,
Linkages and Capacity Building
program
The ILC program intends to connect people with disability, their families and carers to supports beyond the scheme and to facilitate community awareness and capacity building within mainstream services and supporting organisations.2 It is therefore integral to the scheme as a social insurance model. It is also a key way to manage financial sustainability, by making sure people with disability access appropriate mainstream services and early intervention supports in their plans.
Local Area Coordinators (LACs) will be the single largest investment by the NDIA in delivering outcomes for ILC. LACs will play a central role in delivering the NDIS and ILC outcomes, including working directly to connect participants to mainstream services; connecting people who do not have an NDIS individually funded package to mainstream services; and ensuring local communities are accessible and inclusive for people with disability.3
4.1 Greater clarity on ILC is critical during transition
The Victorian Government considers that greater clarity on how ILC will work is required as soon as possible. This includes further articulation in the ILC Commissioning Framework on what outcomes the NDIA expects to be delivered through ILC activities. Greater transparency on the types and range of supports funded under the ILC is critical for providing assurance to people with disability that they will receive an equitable share of the funding and for providing support to organisations in transition, particularly smaller user led services to prepare for ILC commissioning in 2019.
Of equal importance is how the ILC will be implemented, including the type of delivery arrangements that will be funded and the associated risk of funding low scale fragmented activities. The Victorian Government has concerns regarding the proposed grants model for commissioning and seeks clarity from the NDIA on the length of time grants will be allocated. To effectively build capacity in the community and mainstream services the NDIA will require a longer term view, with coordinated planning to ensure long term outcomes are realised. Careful consideration should be given to the efficacy of one-off grants or small amounts of funding for local information, peer support and capacity building programs.
4.2 LACs are not performing their core function
The Victorian Government is concerned that LACs are performing a number of NDIA administrative functions during transition, including participant planning. There are widely acknowledged concerns that LACs do not have sufficient time and capabilities to perform their role (e.g. only 20 per cent of their effort, and funding, is allocated to the delivery of ILC activities). A disproportionate focus by LACs on planning will come at the expense of building
2 ILC Policy Framework (NDIA 2015a)
3 ILC Commissioning Framework (NDIA 2016)
Victorian Government submission to the Joint Standing Committee on the NDIS 15
community infrastructure and mainstream capacity. This in turn risks undermining the effective implementation of the NDIS. Further there is concern that LACs are not performing core activity in facilitating the delivery of the ILC six months ahead of full scheme.
4.3 The infrastructure required to deliver ILC is underdeveloped
Given the likelihood of high demand for ILC funded supports and the important benefits that will be generated through ILC, the Victorian Government considers that the level of funding committed is not adequate. The NDIA should consider whether the one per cent cap (of scheme costs) on ILC expenditure should be adjusted to accommodate increased investment in ILC in transition and at full scheme. Further, investment should focus on:
-
building the planning capability and capacity of LACs particularly in relation to supporting linkages to mainstream service systems and supporting integrated planning;
-
building relationship between LACs and the NDIA to ensure consistency of approach;
-
leveraging the expertise of the state disability system to perform key tasks critical to the transition effort; and
-
adopting more flexible models of service delivery to address transition challenges facing the NDIS, including recognising and building on the various states’ equivalent ILC arrangements. Investment in these areas will generate better participant outcomes and greater sustainability and success of the NDIS.
16 Victorian Government submission to the Joint Standing Committee on the NDIS
- Getting critical market and planning infrastructure in place
5.1 Priority should be given to getting critical market strategies in place
A successful NDIS means that participants are able to exercise choice and control over the supports and services they need. This can only be achieved if the supply of services in markets is ‘healthy’, and participants, particularly from vulnerable cohorts (culturally and linguistically diverse (CALD) communities, Aboriginal and Torres Strait Islander communities, rural and remote areas), have the information they need and are otherwise empowered to operate effectively in the NDIS environment.
The most effective way to address thin markets is to ensure adequate pricing that takes into account the real cost of service delivery in these markets. It is critical that prices are set at a rate that generates and maintains a market and workforce capable of meeting demand for services and delivering services with consistent quality and safety standards. (See 5.3).
As system steward, the NDIA is ultimately responsible to ensure that the nexus between capability to identify thin markets and market intervention is operational by full scheme.
While working arrangements are in place during transition on market and provider readiness, strategies need to be developed in a timely manner, including being able to identify early warning signs around emerging thin markets and an ability to monitor experience through good data that can be used to inform future market development or interventions. The evaluation of interventions is also fundamental to ensuring a fit for purpose supply of supports is available to all participants.
Work with the NDIA and the Commonwealth is underway to develop a Market Intervention Strategy for full scheme, and while details are still being worked through, timely resolution of the following priorities is necessary:
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how the NDIA collects data and monitors markets- including a strategy for capturing and publishing service delivery data, best practice models, participant outcomes and satisfaction levels;
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arrangements for early intervention through to crisis/emergency response- this includes ensuring that the NDIA has made clear its market levers and strategies that are responsive to market failures are in place; and
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respective roles and responsibilities between the NDIA, NDIS Quality and Safeguarding Commission (the Commission), Commonwealth and state and territory governments- for example detail on the links and connections between the proposed regulatory market oversight function, the NDIA and states and territories is not yet determined. Consistent with the national Market, Sector and Workforce Strategy and the roles and responsibilities during transition agreed by DRC, Victoria has prioritised efforts to ensure providers and the wider disability sector is ready for the NDIS. However, these efforts alone will not address supply in thin markets.
Victorian Government submission to the Joint Standing Committee on the NDIS 17
Victoria is investing $20 million through its Transition Support Package to prepare providers for the NDIS and increase the capacity of disability support organisations. In addition, the Victorian Government has received funding from the Sector Development Fund to build capacity in rural and regional communities and among CALD and Aboriginal and Torres Strait Islander communities, and to test and promote best practice approaches to working across the interface between the NDIS and key mainstream services.
5.2 Clarity on Provider of Last Resort arrangements is necessary
The NDIA is responsible for market development and intervention, including in the event a provider fails. The NDIA has indicated that a Provider of Last Resort will only be utilised when all other avenues and market stewardship approaches have been unable to gain an appropriate response from the market to secure appropriate supports for participants. As a priority, additional information is required from the NDIA about how this will function both during transition and under full scheme arrangements.
5.3 Appropriate pricing is critical to the development of a sustainable NDIS workforce
In the immediate term, the NDIA must take action to address the inadequacy of prices. Victorian stakeholders have consistently raised concerns around:
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True cost of delivery: In some areas current transitional prices may not reflect the costs of service delivery or what can be realistically achieved as providers transition from block funding. To take the ‘Overhead Assumption’ as an example, Victorian analysis of service providers’ audited 2015-16 financial statements shows that estimated overhead/indirect cost percentages are mostly around 30 per cent, but range up to almost 50 per cent. For most providers a reduction to the current NDIA overhead allowance of 15 per cent is not achievable in the short term, and this gap will widen with the 9 per cent overhead assumed in the NDIA efficient price.
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Skilled workforce: Current pricing may incentivise existing skilled workers to seek roles in other parts sectors (for example the aged care sector).
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High quality and safe services: It is unclear if the current pricing structure makes provision for adequate professional development, which may lower the quality of services.
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Reasonable and necessary supports for clients with complex needs: Across all areas of service provision there are cost drivers for people with complex support needs that do not appear to have not been appropriately factored into NDIS pricing. To support resolution of these issues, Victoria would welcome the move to an independent price regulator.
5.4 Workforce growth is a shared responsibility
Growing the required workforce will be a key challenge and Victoria is committed to working with the Commonwealth to support this growth. To meet this challenge, the Victorian Government is investing $26 million (including $4.88 million from the Commonwealth Sector Development Fund) in Keeping our sector strong: Victoria’s workforce plan for the NDIS. This
18 Victorian Government submission to the Joint Standing Committee on the NDIS
plan supports the disability workforce to transition to the NDIS through research, workforce development and training.
Victoria considers that greater sharing of data and information between the NDIA, the Commonwealth and providers is needed to ensure that workforce development strategies are aligned. Victoria seeks to engage with the Commonwealth to inform national workforce development approaches and outline respective roles and responsibilities to support the development of the market. Victoria expects that the Commonwealth will:
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lead national workforce activities and coordinate and facilitate responses to workforce challenges;
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take the lead in coordinating Commonwealth agencies to provide a comprehensive approach to workforce supply;
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lead the development of a coordinated response to meet the demand for allied health services and appropriate alternatives by working with professional bodies, tertiary institutions including Universities Australia, and the Commonwealth Department of Health;
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monitor the Fair Work Commission’s review of the Social Community Home Care and Disability Services award for potential impacts for NDIS providers and workforce; and
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engage with states to ensure that regional differences are addressed and learnings applied across all jurisdictions.
5.5 Victoria is committed to robust safeguards
The Victorian Government is committed to maintaining and strengthening safeguards for people with disability. As part of this commitment Victoria is currently amending its own legislation to introduce a ‘zero tolerance’ approach to abuse in disability services and to strengthen the Disability Services Commissioner’s independent oversight role, prior to full transition to the NDIS.
In signing up to the Framework endorsed by COAG in 2016, Victoria had a clear expectation that its own commitment to maintaining and strengthening safeguards would be replicated in national arrangements. Further, in line with the partnership approach taken to developing the Framework, it is Victoria’s expectation that states and territories will continue to play a meaningful role in developing the establishing architecture of the Framework. This takes into account the significant experience states have in meeting the challenges associated with protecting people with disability.
The Victorian Government continues to advocate for robust safeguarding arrangements in the detailed design and implementation of the Framework, so people with disability experience no diminution in the level of protection currently afforded to them under existing state arrangements. Consistent with this, Victoria continues to raise concerns about some aspects of the NDIS Amendment (Quality and Safeguards Commission and Other Measures) Bill 2017. Additional priorities for Victoria include:
- establishing a local Commission presence in Victoria;
- ensuring national consistency in the establishment of a behaviour support function; and
- developing a nationally consistent policy on worker screening and a national database to allow for interoperability across jurisdictions.
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