NDIS participant experience in rural, regional and remote Australia

Advocacy WA’s response

Included in the attachments is AWA’s recent systemic advocacy survey, handed out to clients throughout the southwest. While not all of it is directly related to the NDIS, it provides an insight into life with a disability in regional, rural and remote areas.

• the experience of applicants and participants at all stages of the NDIS, including application, plan design and implementation, and plan reviews;

We run sessions throughout the southwest of WA to assist people with their applications. Many people with disability find the process difficult to understand and navigate.

The negative experiences of our regional clients in applying for the NDIS begins with NDIS Planner’s limited understanding of the intricacies of disability. We find that Planners and the NDIS have limited skill sets to engage with people from diverse backgrounds (ATSI, CALD) and limited understanding of regional, rural and remote contexts.

Our clients come to us with conflicting advice from NDIS phone operators. We often find that all of the advice given is wrong. Some of our clients also complain about NDIS staff being rude and impatient with them, particularly those clients from diverse backgrounds.

Additionally, plan designers have little understanding of the cost of what is considered reasonable and necessary in a regional, rural and remote area. Costs are quite different to the costs in the cities. AWA’s experience with regional, rural and remote clients is that plan budgets are not keeping pace with cost of living pressures.

There is also an additional impost on what is considered Reasonable and Necessary, when considering the level of red tape that goes to the substantiation of needs articulated in NDIS Plans. An arbitrary decision by a Planner to not include an item such as an AUSLAN Interpreter for a NDIS Plan when there is a Support Worker present seems almost ludicrous. To get this plan amended may take months in NDIS meetings and in the tribunal. Access to Specialists to facilitate diagnosis for people living in regional and/or remote settings is an important part of designing interventions that can support them. Regional, rural and remote people living with disability have limited access to specialists, and limited access to transport to visit a specialist.

When aspirations and goals are discussed, the context of those goals and the reality of whether they can be achieved in regional, rural and remote areas also needs to be discussed. The NDIS Plan ‘owner’ needs more than just goals, they need a regional, rural and remote area plan on how to achieve them that includes action steps required, resources provided/needed, timeframes and an idea of what success looks like.

• the availability, responsiveness, consistency, and effectiveness of the National Disability Insurance Agency in serving rural, regional and remote participants;

The NDIS has been designed with a market economy approach in mind. That demand will drive a fair market, and that this demand and market engagement will manage costs. This is not reality.

AWA has in a number of instances worked with clients that have had their Plans drawn down by Plan or Support Coordinators, leaving them with little funds for the rest of the transactional year.

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suggests that there is liƩle control or understanding about how, when and where their funds are expended. If our client lived in a major city they could easily find another Plan or Support Coordinator, however, in regional, rural and remote areas there may be only one.

• b. parƟcipants’ choice and control over NDIS services and supports including the availability, accessibility, cost and durability of those services;

Our clients have difficulty finding service providers in some rural towns and oŌen have to use non registered providers. All remote, rural and regional seƫngs are impacted by ‘thin markets’. It is acknowledged that the NDIS has considered some of the factors when responding to thin markets, however, the very model that delivers the planning processes and tools is the very mechanism that undermines any aƩempt to increase services, provide for a beƥer coordinated approach to funding and service delivery.

AWA recently encountered an individual that requires the services of an AUSLAN Interpreter when aƤending meeƟings and a Support Worker, but only has sufficient funding for one or the other, not both at once. The only AUSLAN interpreter lives in a separate town so needs to charge for extended travel (making it unaffordable in the plan). This creates issues for the individual to express his ‘voice’ as he needs the assistance of the Support Worker to aƤend a meeting and the assistance of the interpreter to engage. This is a clear example of the NDIS Plan not meeƟng the ‘Reasonable and Necessary’ qualificaƟon.

DES providers are another issue in many rural towns. DES contracts may constrict outcomes, choice and control. This is because workforce placements are transacƟonal between government and DES providers, ignoring parƟcipant interests, workplace aspiraƟons such as creaƟing their own business, where work is located, or suitability for the type of work the placement offers. In small towns there are few jobs and liƩle transport to get to a job. Dealing with these rural job seekers with disability becomes too expensive for many DES providers, easier to focus on ciƟes.

There are many people with disability in regional and remote seƫngs that have liƥle or no real access to services, and limited opportunity for choice and control of providers, or of price control through a market economy. More worryingly, regional areas may only have one LAC monopolising the market resulƟng in a lower service quality. AWA had a recent client that had a very bad experience with the LAC and felt very uncomfortable having to go back, requiring the support of an advocate. The client had no choice as they are the only LAC in the area.

This extends to the commissioning of contracts to private companies to develop and implement NDIS Plans. The basic economics of this approach ignores the ethos that commissioning a company to undertake and produce ‘x’ amount of NDIS Plans means that the quickest and most efficient way of producing those plans, is not going to speak to quality. Nor is it going to speak to the design of integrated acƟviƟes across communiƟies with thin markets, market facilitaƟon or coordinaƟng funding proposals with plan implemenƟation. In fact, we are seeing the opposite in regional, rural and remote areas, with private companies partnering across plan management, coordination, and service provision, resulƟng in some of our clients having 12 month plans spent in a few months, favouring the providers to the detriment of the parƥcipant. Regional, rural and remote people with disability are oŌen too afraid to complain in case they lose the only support in their town.

The Scheme in relaƟon to market delivery and service provision cannot be considered in isolaƟon from every other element. It could be argued that discussions around ‘thin markets’ have been

• undertaken without due consideration of service delivery commitments and markets.
• The broader service delivery environment was not considered when working out unit costs. This has led to the ‘loading’ of NDS Plans by providers, which the environment permitted to happen, without discussion around levels of service, flexibility to pool funds, or the efficiency that might be gleaned in regional or remote settings.