NDIA Annual Report 2018-19 – an Extract by Arahni Sont, Strategy and Partnerships at Centro ASSIST 29/10/2019
Figure 1 Martin Hoffman, new CEO of the NDIA
Figure 2 Independent Advisory Council members 2017
Figure 3 Stuart Robert MP, Minister for the NDIS and Minister for Government Services
You will find below, my 14 page summary taken from The NDIA 2018-19 Annual Report of 182 pages. I have highlighted various sections that are of interest to me and hopefully my readers.
The scheme has now been operating for 6 years. After reading the Report, I would highlight four issues of significance (in my opinion):
The underspend on Scheme Support Costs – budgeted at $15,139 million and actual of $10,460 million. In an article published in the Australian newspaper, the Minister has blamed this on “dodgy data”. Mr Robert said data from the states and territories had anticipated 302,000 Australians would have transitioned from existing programs to the NDIS but in reality that figure was 100,000 less than originally estimated. That data, he said, had been “wrong” or some participants had been double counted — contributing to the underspend.
There are a high number of service providers that are “not active” and the agency has not given an explanation for this [1]. I believe it is the main explanation for lack of access to services and under utilisation of scheme participants’ budgets. I think the Agency needs to investigate further, especially given the large investment made by providers to register and comply with the NDIS Commission’s quality and safety framework.
The integrity of the data depends on correct input of claims by service providers, plan managers and self managed participants in the scheme. Published increases in various outcomes like “increased social and community participation” assumes that claims are being inputted under the correct line item[2].
The Scheme is facing some sustainability pressures relating to operational challenges, “scheme coverage scope creep” and participant cost pressures. Management’s response includes “ensuring that there are consistent and equitable functional assessments – and the program aims to introduce a goal attainment framework[3].” I feel this could add to the burden already being felt by participants and their carers/families to produce copious, expensive reports and set and reach goals that are not always attainable.
Summary of the Report
The NDIS Scheme forms an important part of the Australian Government’s National Disability Strategy 2010–2020, a 10-year policy framework for improving the lives of Australians with disability, their families and carers. The current and future strategy is the cornerstone of Australia’s implementation of the United Nations Convention on the Rights of Persons with Disabilities, enabling people with disability to participate in all areas of Australian life and fulfil their potential as equal citizens.
The purpose of the National Disability Insurance Agency (NDIA) is to increase the ability of individuals with a significant and permanent disability (participants) to be more independent, and engage more socially and economically, at the same time as delivering a financially sustainable Scheme that inspires community and stakeholder confidence.
From the Chair, Dr Helen Nugent:
2019 has been a year of significant achievement and growth for the NDIS. Almost 300,000 participants are now in the Scheme, with close to 100,000 receiving supports for the first time. This is an unprecedented 10-fold uplift from just over 30,000 participants who had a plan at the beginning of Transition on 1 July 2016. We are also starting to see the impact of the Scheme on participants’ lives through improved outcomes, particularly in relation to choice and control, social engagement and support with daily living. We know that providers are central to the quality of the participant experience. As this new market for disability supports under the NDIS grows and evolves, ensuring an adequate supply of quality providers is critical. Much has already been done to ensure providers are able to offer participants services that increase their choice and control. This includes releasing enhanced information through the NDIS demand map, providing up to date forecasts of NDIS demand by postcode across Australia, and additional data on market demand in the COAG Quarterly Reports. The Provider Finder is also helping connect participants to providers. Data cubes that allow providers and others to undertake their own analyses are also being released.
From the Acting CEO, Vicky Rundle:
A vibrant market is critical for participants to be able to exercise choice and control over their disability supports. The provider market continues to grow across Australia. In 2018–19, 4,755 new providers registered to deliver services to NDIS participants across the country. In 2018–19 the NDIA delivered the Scheme within budget. The NDIS is expected to remain within the Productivity Commission’s estimated budget. While some challenges to the longer-term financial sustainability of the Scheme have been identified, the Scheme’s insurance approach enables us to proactively take steps to address them.
Part 1: Delivering to NDIS participants
Ch. 1.1 – A quality experience and outcomes for participants
Of the 298,816 participants who have been supported by the Scheme, 193,967 previously received support from existing state, territory or Commonwealth programs and 99,537 received support for the first time.
The Complex Support Needs Pathway commenced in March 2019 and is progressively being expanded across all states and territories. Existing participants assessed as having complex support needs will transition to the Complex Support Needs Branch over the remainder of 2019. From 30 April 2019, streamlined access for people with psychosocial disability became available to prospective participants from state programs in all states and territories. Foundational psychosocial disability training for planners and LACs was completed in June 2019. This training focused on making sure staff are better able to support participants with psychosocial disability. Nationally around 3,460 staff and partners have received this training. All new staff complete this as part of their standard induction training.
There is a strong commitment from the Agency and the Department of Social Services to implement an employment strategy to improve job opportunities for people with disability. The NDIA is acutely aware of the benefits employment brings to participants and the economy and has prioritised employment options in planning discussions. In November 2018, the Department of Social Services and the NDIA formed a Participant Employment Taskforce to recommend measures to improve employment outcomes for NDIS participants. The Taskforce has met with more than 250 people through this process, using these consultations as an opportunity to identify, test and refine ideas that will help more people with disability participate in the Australian economy. The insights from these stakeholder consultations are informing the development of an NDIS Participant Employment strategy.
Ch. 1.2 - A Growing and Competitive Market with innovative supports
As at 30 June 2019, there were a total of 21,510 registered providers, compared with 16,755 registered providers as at 30 June 2018, or growth of 28 per cent. Of the total number of providers, 57 per cent (or 12,361) were active as at 30 June 2019[4].
Information to encourage market supply
The supply of information on market demand is important to encourage supply. The NDIA is active in providing such information. Additional information is being provided in the following ways:
Enhancements to the Provider Finder to assist in connecting participants and providers
Release of additional data through Demand Mapping, a project which has been undertaken with the Department of Social Services
The provision of additional data through the COAG Quarterly Report. This includes more local data in relation to Supported Disability Accommodation, as well as data on thinner markets. The release of more granular market data through the provision of data cubes that will allow providers to undertake their own deeper analysis based on the NDIA’s data sharing policy.
Plan Utilisation
Detailed analysis is being undertaken by the Agency to better understand the nature and causes of lower utilisation[5]. More specifically, the Chairman and the Acting CEO are discussing specific state and regional data within states to develop action plans to address this issue. As a background to those discussions, the NDIA has released far more granular information in the COAG Quarterly Report.
Ch. 1.3 - A Financially Sustainable Scheme
Pressures on the NDIS have been identified and are being responsibly managed. The drivers of costs to the NDIS include the number of participants, the amount of support allocated to each plan, how that allocated amount will change over time, the utilisation of individual supports, and the rate at which participants exit the Scheme. The current primary financial pressures relate to eligibility and participant costs.
The NDIA is working on strengthening the outcomes focus of the Participant Pathway Review to improve participant satisfaction and enable individuals to reach their goals and aspirations, while also increasing the consistency and reliability of access and plan budget decisions. To better align a participant’s support package with their level of function, the NDIA introduced the reference package and guided planning process, which works to ensure that the right assessment questions and tools are being used to inform plan decisions.
Ch. 1.4 - A high-performing NDIA
The NDIA’s Information, Communication and Technology (ICT) Strategy was endorsed in August 2018 and provides the basis for investment in technology assets within the NDIA over the next five years in a way that is consistent with the Agency’s overall approach in relation to participants and providers.
The functionality of our core Customer Relationship Management (CRM) system has been improved and relevant features expanded throughout the year. Additional features have been enabled allowing an increase in on-system processing and moving off-system processes into the system. As more processes are supported by the CRM, the NDIA is able to optimise workflow and other features to improve general efficiency and improve service levels to participants and providers. A particular focus has been improving ICT support to Agency staff who use assistive technology. The Data Stabilisation program continues to provide greater control and flexibility for the Actuarial team allowing the development of an operational reporting platform so that the NDIA’s frontline teams have the data and insights to support the management of their service delivery.
Embed refreshed NDIA values and behaviour
A prioritised set of behaviours has been developed to show what living the values looks like, sounds like and feels like. The NDIA values behaviour statements are:
We value people —We put participants at the heart of everything we do
We grow together—We work together to deliver quality outcomes
We aim higher—We are resilient and always have the courage to do better
We take care—We own what we do and we do the right thing
Reference groups
The NDIA has a number of reference groups, advisory groups and small working groups drawn from stakeholders who provide advice to the Agency on the design, development and implementation of aspects of the Scheme. These groups have clear terms of reference and deliverables that link to the current NDIA Corporate Plan. Current reference groups include:
Autism Advisory Group (AAG)[6] - The Co-operative Research Centre for Living with Autism (Autism CRC), Amaze, Autistic Self- Advocacy Network - Australia and New Zealand (ASAN), Australian Advisory Board on Autism Spectrum Disorder (AABASD) and the Australian Autism Alliance are part of the Autism Advisory Group.
CEO Forum – 24 CEOs from national peak and advocacy organisations
Industry Reference Group (IRG) includes the following members: Ability First Australia, Alliance20, Allied Health Professions Australia, Australian Community Industry Alliance, Australian Institute of Company Directors, Consumers Federation of Australia, Disability Intermediaries Australia, Early Childhood Intervention Australia, Independent Advisory Council, Mental Health Australia, National Aboriginal Community Controlled Health Organisation, National Assistive Technology Alliance, National Disability Services, People with Disabilities WA
National Mental Health Sector Reference Group (NMHSRG)[7]
Participant Reference Group (PRG)
Specialist Disability Accommodation (SDA) Reference Group
Pricing Reference Group
CEO Forum
In 2018–19, the NDIS CEO Forum continued to be a platform for the disability sector to engage, discuss and collaborate directly with the Agency on important areas of work relating to the operation and implementation of the NDIS. Membership consisted of 24 CEOs from national peak and advocacy organisations. CEO Forum members met quarterly in person with senior executives from the Agency and participated between meetings in purposeful, action-focused working groups as relevant.
Industry Reference Group
The purpose of the IRG is to advise on improvements to the NDIS which support the development of a competitive market of innovative supports and services that empower participants to achieve their goals in inclusive communities and workplaces. The IRG meets three times per year.
National Mental Health Sector Reference Group
The NMHSRG was established to develop a strong working partnership between the mental health sector and the NDIA. The group meets quarterly and consists of consumers, carers, peak associations, NDIS Independent Advisory Council (IAC) members and key government representatives, including mental health commissions.
Figure 2 Members of the IAC 2017
IAC – Independent Advisory Council
From the inception of the IAC in 2013 to April 2019, Professor Rhonda Galbally AC held the position of Principal Member. In April 2019, Mr John Walsh AM was appointed as the new Acting Principal Member following Professor Galbally’s resignation from the role to take up her role as a Commissioner with the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability. During 2019, the IAC maintained its focus on a number of priorities through its expert reference groups, which continue to help inform the Agency and provide valuable advice. These are the:
Intellectual Disability Reference Group
Self-Management Reference Group
Contemporary and Innovative Approaches Reference Group
The current membership of the IAC consists of: • Mr John Walsh AM (Acting Principal Member)10 • Ms Jennifer Cullen*11 • Ms Sylvana Mahmic* • Ms Janet Meagher AM* • Prof Anne Kavanagh • Ms Kerry Allan-Zinner • Mr Kevin Cocks AM • Mr Maurice Corcoran AM • Ms Judy Huett • Mr James Manders • Ms Leah van Poppel • Ms Liz Reid • Ms Sue Salthouse.
The IAC continues to be supplemented by five Expert Advisers engaged to provide advice to the IAC from the perspective of the key national peak bodies: • Mr David Moody, Acting Chief Executive of National Disability Services • Ms Ara Cresswell, CEO Carers Australia • Mr Ross Joyce, CEO Australian Federation of Disability Organisations • Dr Ben Gauntlett, Disability Discrimination Commissioner • Ms Therese Sands, Director Disabled People’s Organisations Australia.
Part 2 – Our Structure and Accountability
Ch. 2.5 - Workforce Management[8]
As at 30 June 2019, the NDIA workforce comprised 3,495 Australian Public Service (APS) employees[9], 2,278 labour hire contractors and secondees, and 5,288 Partners in the Community (PITC).
The People Strategy 2022 includes four key pillars built on the foundation of a solid people infrastructure. The four pillars are:
Workforce—Establish an NDIA workforce that reflects the community it serves with the capability and capacity to deliver the NDIS
Capability—Support the NDIA workforce to deliver consistent and positive participant experience performance
Performance—Provide clarity of performance expectations and reward for outcomes
Engagement—Build and embed a culture that cares about safety and staff wellbeing and drives for high performance.
Part 3. Sustainability and Performance
Ch. 3.1 Financial Sustainability
The NDIS is available to the majority of eligible Australians as at 30 June 2019.1 The Scheme has continued to experience rapid growth in the year to 30 June 2019, increasing the number of participants with active plans from 172,333 to 286,015, a growth rate of 66 per cent. A total of $14.5 billion was committed in participant plans for the 2018–19 support year and $10.0 billion in payments was made to providers engaged by participants to meet their support needs. Utilisation of plans has been steadily increasing since the start of the Scheme’s transition period, from 68 per cent for the 2016–17 support year and 70 per cent for the 2017–18 support year. An ultimate utilisation rate of 72 per cent is projected for the 2018–19 support year.
One of the main drivers of lower utilisation is the high proportion of participants entering into the Scheme, because first plans typically have materially lower utilisation rates than subsequent plans[10]. Monitoring changes in participants’ economic and social participation is an important financial sustainability indicator. Better outcomes for people with disability maximise their opportunities for independence as well as reducing their long-term costs of disability support. The first longitudinal study of changes in outcomes for participants who have been in the Scheme for at least two years has shown early positive results, with increases in participant employment outcomes[11] and social and community participation outcomes[12] between the baseline and second plan review for participants over 15 years old. Further, there have been increases in employment rates for families/carers of participants in the Scheme[13].
Scheme Projections
The Scheme is projected to continue to grow rapidly and by 30 June 2023 to reach about 500,000 participants, of which about 478,000 are expected to be aged 0 to 64.
Scheme costs for all participants are projected to be about 0.9 per cent of GDP for 2019–20, 1.2 per cent in 2022–23, and 1.4 per cent for 2029–30.
This projection is in line with the estimates shown in the 2017 Productivity Commission report on National Disability Insurance Scheme Costs at 2022–23, after allowing for costs not included in the Productivity Commission estimate, such as the introduction of school transport, personal care in schools, developmental delay and the incomplete implementation of the National Injury Insurance Scheme.
Current sustainability pressures
While the Scheme cost has been within Productivity Commission estimates for the first six years, there are some current pressures which require management responses. In particular, these pressures relate to:
i. Operational challenges. The focus on the timely transitioning of people with disability into the Scheme has led to some operational challenges such as eligibility reassessment, recovery of compensation amounts, and the timely provision of assistive technology supports. There has also been evidence of inconsistency in decision making for access decisions and plan budget levels. Improvements are possible in decision-making consistency, operational stability, and controls around aspects of the participant pathway and plan budget determinations.
ii. Scheme coverage scope creep. The Scheme is facing a number of pressures in entry and funding decisions, particularly in relation to how the Scheme interfaces with mainstream services, and community and informal supports. This is testing the boundaries of who can access the Scheme and what constitutes “reasonable and necessary” supports. These cost pressures will require management responses so that the Scheme does not become a “funder of last resort”, especially where other arrangements may be better suited to provide the required supports.
iii. Participant cost pressures. Plan budgets and support payments made to participants continue to grow by more than would be expected solely due to normal inflation and ageing. For example, the support costs for participants in supported independent living are a material component of Scheme cost that is continuing to increase significantly above normal inflation. Management of these cost pressures, while ensuring participant outcomes, will be important for financial sustainability.
Management response
Specific management responses are being developed to address the sustainability pressures listed above:
The Insurance Support Program aims to provide a consistent approach to assess Scheme eligibility and determine equitable plan budgets that help support a participant’s goals. A key input to inform decision making is consistent and equitable functional assessments which will lead to fairer outcomes. The Program also aims to support plan flexibility and introduce a goal attainment framework to improve the monitoring of progress against plan goals and measurement of plan effectiveness.
Supported independent living (SIL) forms a large proportion of Scheme costs with average SIL costs increasing beyond normal inflationary levels. Ensuring SIL costs are both appropriate and deliver support outcomes is a key management priority. The Agency is also exploring innovative ways of delivering supports to people with significant needs.
The Agency’s participant and provider pathway review continues to be rolled out to improve people’s individual experience with the Scheme. A key area of focus is the rollout of the complex pathway, including following hospital discharge. In addition, the psychosocial stream and ECEI pathway are both being enhanced, joint planning is being delivered, and a single point of contact for participants to improve their interactions with the Scheme is being put in place.
Chapter 3.2 Annual Performance Statements
Aspiration 1: A quality experience and outcomes for participants – on target
The NDIA is increasing community and social participation, with more participants included after two years in the Scheme. For participants aged 25 years and over, there was an increase in the number of participants participating in community and social activities from 36% in 2017–18 to 47% in 2018–19. The overall result of 47% exceeds the NDIA target of 41%.
Aspiration 2: A growing and competitive market with innovative supports
Target and Results: Portfolio Budget Statements 2018-19 (Tables 3.2.7 and 3.2.9 on page 85)
Scheme support costs : Costs are within expected amounts as per bilateral agreements and actuarial forecasts. For the year ending 30 June Scheme costs were $10,460M compared to the Budget of $15,139M. Scheme costs were lower than projected in the 2018–19 Budget due to the slower phasing of participants into the Scheme than anticipated in the bilateral agreements, reflecting the availability of actionable records. In addition, plan expenses have been adjusted on review by the Scheme Actuary to reflect a lower utilisation rate of committed supports than the rate anticipated in the Budget.
NDIA operating costs: NDIA operating costs are within budget. For the year ending 30 June 2019, scheme costs were $1,310M compared to the Budget of $1,478M. NDIA operating costs were lower than projected in the 2018–19 Budget due primarily to lower supplier and community partnership costs, linked to a lower than anticipated level of participant inflow and overall participant numbers.
Notes to the Financial Statements (from page 101 onwards):
Participant plan expenses [14]
The Agency makes payments to registered providers and self-managed participants for supports delivered in line with a participant’s approved plan. Registered providers and self-managed participants are able to access NDIS portals to submit payment claims for delivered supports. Claims from providers and self-managed participants can lead to payments that are inconsistent with Agency guidance, even where no deliberate fraud is intended by the claimant. To mitigate this risk the Agency has progressively rolled out a compliance and assurance program aimed at substantiating a statistically selected sample of claims lodged by providers and self-managed participants. Errors identified can be either critical (having a potential negative financial impact) or non-critical (having no, or a potential positive, financial impact).
Provider payment accuracy
The review conducted in 2018-19 has identified 40 provider payment critical errors (2018: 48). After extrapolating the 40 critical errors over the total value of provider payments made in 2018-19 the accuracy rate in payments made to providers was 99.5 per cent (2018: 95 per cent). The estimated overall financial impact of the provider error rate is $34.6m compared to $179.6m in 2017-18. This significant decrease in the financial impact can be attributed to: improvements in payment processing; having a full year of data to base the estimate on; plus a lower number and value of individual identified errors.
Self-managed participant payment accuracy
In 2018-19, the review also included a full year of self-managed participant payments for the first time with 19 critical errors identified. After extrapolating the 19 critical errors over the total population of self-managed participant payments made in 2018-19 the accuracy rate was 96.2 per cent. The estimated overall financial impact of the self-managed participant error rate was $32.5m. All critical errors are subject to further validation, with recovery action undertaken where required and considered economical, in accordance with the Agency’s Debt Management Procedures. The Agency’s compliance and assurance processes are in addition to the NDIS Fraud Taskforce established by the Commonwealth in 2018-19 to prevent fraudulent claims being lodged.
3. People and Relationships
Total Board and Key Management Personnel[15] remuneration expenses decreased from $9.6 mm in 2018 to $5.3 mm in 2019. There were 52 people included in 2018 (average of $184,615) and 22 in 2019 (average of $240,909). The CEO Robert de Luca received $587,241 and the senior management team about $365,000 each.
Appendix G: F: Administrative Appeals Tribunal (AAT) reviews and decisions (from page 139 onwards) - just a sample from the Report
Appendix H: Other PGPA (Public Governance, Performance and Accountability Rule 2014) reportable items
17BE (l)—Outline of the location of major activities or facilities: The NDIA continues to expand its presence and property across Australia. As at 30 June 2019, NDIA staff were located in 190 sites, which included 96 sites co-located with other government services and agencies, and 94 sites managed by the NDIA. Co-location of public-facing service delivery centres and non-public-facing offices with other government services and agencies is a key strategy to ensure property locations are in the most appropriate and accessible areas for participants and staff. Standalone NDIS sites have been chosen only when co-location options are not available. In January 2019, the NDIA’s new Geelong national office achieved building practical completion and, following some final fit-outs, NDIA staff occupied the site on 8 April 2019.
Appendix I: Workforce Statistics
| As at June 2019 | 2017-18 | |
| NDIA ongoing employees | 2603 | 1922 |
| NDIA non-ongoing employees | 892 | 712 |
[1] “Not active” providers were 54% at June 2017, 50% at June 2018 and 43% at June 2019.
[2] More details are included in the Notes to Financial Statements p 106 of The Annual Report
[3] See page 71/72 of the Report
[4] The NDIA does not explain why so many providers are not active. It is my opinion that this is part of the explanation why plans are being underutilised across Australia, but especially in rural and remote areas.
[5] See my comment on page 1 of this article
[6] The NDIA released a Report in June 2018 on the Outcomes for Participants with Autism Spectrum Disorder
[7] I was the Carer representative on this Reference Group from the first meeting at end 2014 to April 2017. The last published communique of the Group is from April 2018.
[8] See page 65 of the Report
[9] See last page of this article, Appendix I: Workforce Statistics
[10] See my comment on Page 1 of this article
[11] A one percentage point increase in paid employment
[12] An eleven percentage point increase in social and community participation.
[13] A three percentage point increase in employment rates for families/carers of participants aged under 25 years over a one year time period
[14] See page 106 of the NDIS Annual Report 2018-19
[15] See Figure 3.2 from page 117 of the Report