In January, the Australian Government announced a review into the sustainability and costs of the NDIS by the Productivity Commission. The $22 billion scheme that resulted from this is the biggest social policy reform since Medicare. The aim of the NDIS was to facilitate two things:
- To increase the economic participation of people with a disability.
- To enhance the social participation of people with a disability.
NDIS is an insurance scheme, a fact often forgotten by participants, carers and families; whereby it is confused with other forms of social welfare policies. It is most definitely not a welfare scheme, hence why the NDIS has two policy objectives.
- Where possible, building the capacity of participants so that they may eventually be able to live with less supports, or
- In the ideal situation, no longer need supports at all.
Now, there will be those that will instantly jump up and down and say some people may never be able to fully achieve these objectives of the scheme. This is a true statement, however, the scheme recognises this and it continues to provide supports to ensure quality of life and well-being.
Those of us here at Butter Fish Services have been working in the pilot site with NDIS now for 4 years. During this time we have had first-hand experience with providers, participants, families and carers. NDIS is the reason why Butter Fish Services came into being, we wanted to be innovative, and do things differently.
NDIS provided this opportunity. The last thing we want to see is the review by the Productivity Commission being used as a mechanism to reduce the amount of funding available to the scheme. We have seen how it can make a difference and help us deliver for our clients. Yet, there are ways to make it more sustainable and more outcomes focussed, which include the following:
A risk assessment should be conducted to ensure that the participant, and the parent of the carer has the competency to self-manage. Registered Providers have to be accountable and accredited, and therefore, it is not unreasonable to expect those that choose to self-manage have things in place to ensure traceability, and that public funds have been expended in accordance with guidelines.
In the early days of the pilot, relationships were important. It was not uncommon to forge relationships with planners and other staff within the National Disability Insurance Agency (NDIA). Then last year, we saw a shift by the agency to limit this contact with planners and direct interactions through Business Support Officers (BSO), and generic email addresses.
It is unreasonable and unacceptable at times to wait up to 2-3 weeks for a BSO to respond to an enquiry via email. Contact with planners directly has been limited. There is a culture of not returning phone calls and direct numbers. NDIA needs to do better on this score. Relationships are important with both providers and participants.
The volume of participants entering the scheme is considerable. This has led to planners conducting reviews by phone. In some cases, this may be appropriate, however I have had first-hand experience of when this can go horribly wrong. For example, a participant recently under went a plan review and changes were made to that plan.
As a coordinator of supports, it is important to be involved in this process for a number of reasons as we have the knowledge of the participant and any issues with plan implementation and associated issues. The planner conducted the review and issued a new plan, and when the participant received the plan it was clear that the planner had not considered some very important information.
On contacting the planner, they were asked if they were aware of the participant’s recent medication issues, which would have impacted on their cognitive ability. In essence, a plan review was undertaken with a participant who could not recall the review being done nor the questions asked. While it might save some time, phone reviews will not work with every participant.
Physical disability focused
It has become very apparent that planners and the scheme are very focussed on physical disabilities. The NDIS has struggled with the incorporation of mental health within the guidelines.
Of course, some parts of mental health are to be dealt with health, and should stay in that domain, yet there needs to be a better understanding by planners of mental health conditions and how mental health is a disability. We have seen on many occasions where planners have failed to look at a participant holistically and reduce the view of the plan to just the physical component. This must change.
NDIA has typically recruited planners with allied health backgrounds, such as Occupational Therapists. It is not to say this doesn’t lead to good plans, it is just our experience that at times, this can be limiting when building a plan for a complicated participant.
There needs to be more planners that have worked in the sector and have had a broad experience working with people with different disabilities and conditions.
My place portal
NDIA has made it clear that they want interactivity and that use of the portal by participants will assist them in exercising control and choice. The majority of participants we support however have made it clear that they do not wish to engage online. Many participants in our experience still don’t even have computers or the ability to use one. In some cases, the response has been “well if you are my Coordinator of Supports then why do I need to?”
Communicating with Participants
I personally attended a provider forum when the roll out of the new My Place Portal was being conducted, and staff from NDIA were talking up how much consultation and communication they had done with participants regarding the roll out.
They then began to explain how much the new portal would benefit them. I enquired further regarding the methods they had used to communicate with participants, and they happily announced they had sent out weeks of letters leading up to the event.
I responded that that technique would explain the pile of letters sitting unopened on my participant’s coffee table. This participant was vision impaired. For an agency that supports people with a disability, in this example alone it demonstrated a complete lack of understanding. It would be worthwhile NDIS working with the sector to help communicating policy initiatives.
Culturally appropriate supports
NDIS needs to recognise that Aboriginal people want to be supported, where possible by Aboriginal people. Providing a list of providers to an Aboriginal participant in most cases will not assist them in selecting a culturally appropriate provider (as many community members may not be able to read) and shows a complete lack of appreciation of issues specific to Aboriginal people.
There needs to be a greater sensitivity to Aboriginal issues during the planning and referral stages to ensure that there is empathy, respect and ultimately service.
Focus on capacity building
NDIS is an insurance scheme and providers should not only be accountable, they should also be able to demonstrate how their efforts are going towards capacity building. There needs to be a greater focus on outcomes.
Now, some will see this as an opportunity to say this is the wrong perspective and we would question why? If you are doing the supports, the work, and delivering, then why not be proud of your achievements? It demonstrates value for money and it shows to participants you are committed to delivering on their goals.
These are just some of the ideas we have here at Butter Fish Services that also help highlight our experiences with NDIS and our participants to date. We look forward to participating in the review and putting forward our perspective.
There is still a lot of work to do. The disability sector still needs to raise the standard of service delivery and outcomes for participants. There is still room to innovate and deliver more for participants. That’s exactly what we are about here at Butter Fish Services. And that’s our difference.