Blog December 2019: Let's Make it Work - Three Views of the NDIS!
Government/NDIA - Stuart Robert MP, The Minister for the NDIS;
NDS (peak body for 850 Service Provider members) - David Moody, CEO;
Academia - Professor David Gilchrist and colleagues from University of Western Australia (based on 63 reports on the NDIS and international experience)
Summaries of the presentations at the NDS CEO Meeting 20-21 November, 2019 in Sydney
The Minister: “the nirvana of a deregulated market”.
The NDIS Quarterly report released last week shows there are currently 310,000 participants in the NDIS. Of those, 114,000 are receiving support for the first time. The scheme will cover an estimated 500,000 people by 2025 and is expected to require an additional 90,000 workers. The report shows that there are 13,434 NDIS providers, including 797 new ones this quarter.
Minister Robert said key concerns remained, including long waiting times for assistive technology and delays obtaining and reviewing participant’s plans. The quarterly figures show people are now waiting an average of 88 days for a plan to be approved, and there is currently a backlog of 5,000 quotations for Assistive Technology and home modifications waiting for approval. However, the statistics show an improvement in both areas compared to the previous quarter. The quarterly report also reveals stakeholders have reported concerns around lower than expected utilisation of plans, challenges related to thin markets and the need to respond effectively to crisis situations.
Figure 2 The Hon Stuart Robert, MP
The Minister spoke about the six core areas, swim lanes, of how the NDIA aims to deliver the last 20% of the scheme. Those swim lanes include: quicker access and disability decision-making, increased engagement and collaboration, market innovation and more efficient use of technology, a financially sustainable scheme, equitable and consistent decisions and improving long-term outcomes. Minister Robert said retired senior public servant David Tune is currently looking at cutting red tape for providers and streamlining the system. A new NDIS Participant Service Guarantee, designed to set new standards for the time it takes for key steps in the NDIS process, is scheduled to come into effect midway through next year.
Minister Robert said the government is working to develop a national NDIS workforce strategy by the middle of next year to drive “one of the largest job creation opportunities in Australian history”.
The additional workers represent a doubling of the current NDIS workforce, with 6% of the new jobs representing managerial positions, 11% case and social workers, 12% allied health and around 70% support workers.
The Minister spoke in greater detail about one of the “swim lanes”, namely market innovation and improved technology. He looked at market data, pricing, the digital market strategy, the API layer and supporting market development. “If we are to reach the nirvana of a deregulated market I need lots of strong competitive provider businesses and for us to reach where we are going in the deregulated market it is in our collective interest to ensure you are strong and competitive.
Accordingly, we are working to enable a new digital market service”. The new initiative will facilitate, encourage and support the development of a vibrant market capable of delivering solutions and platforms - to make it easier for providers to develop the market. It will provide participants greater access to a broader range of providers, making it easier for them to identify which one may best suit their individual needs within the framework of choice and control. It will improve the transparency of the market. I want to see greater competition and hence more efficient pricing and provide data to enable market evolution and competition.
The Minister also spoke about the NDIA’s application programming interfaces. APIs enable seemless and secure integration between business systems and machines. It will enable that integration of the NDIA’s business systems with providers and other relevant parties. The API construct will be a bunch of software applications and tools that will make business processes reporting and payment processes for participants and providers more simpler and in real-time. Once implemented, it will significantly reduce the administrative costs of transacting with the NDIS.
David Moody CEO NDS – “State of the Disability Sector Report 2019”
David Moody – “If you’re not passionate enough from the start, you’ll never stick it out” (from Steve Jobs)
David presented the annual disability sector report which this year surveyed 667 respondents (from small to large providers). Financial sustainability remains fragile. 49% of those who responded indicated they had made a profit exceeding the Health CPI of 3% in 2018-19. In 2019-20, 56% are projecting to make a profit (up from 43% in 2018/19) and 13% are projecting a loss (down from 23% in the previous year).
David said that many providers remain concerned about their capacity to adjust to the ever-changing policy environment presented by the NDIS. This year’s report results also suggest that sector perceptions of the impact of the NDIS on providers and participants have not changed that much from 2018 to 2019. 75% of those surveyed said they were helping people understand and navigate the Scheme and that this was taking them away from service provision; and 75% also said that the NDIS policy environment remains uncertain. More than ¾ of providers in 2019 received a request they were not able to provide. While there’s still a great deal of collaborative activity he noted that in 2019, the numbers of providers engaged in resource sharing arrangements actually halved, from 28% to 14%. Data on the number of providers outsourcing back of house operations indicates a significant increase in this activity over 12 months: from 12 to 20 per cent.
David said: “What does this result tell us about the sector at present? What does it say about the culture of collaboration in our sector? Do we need to get it back? How?”
Turnover rates remain higher for casuals than part-time (food for thought in terms of the cost of churn). These figures are just some of the reasons why he was so pleased to co-launch with the ASU in NSW earlier this year, the Greenacres/RMIT Workforce Report, aptly titled, “Where Secure Employment meets Clients' Needs”.
“We cannot grow the workforce to meet sector demand off the back of precarious models of employment as the default approach. We look forward to working with Governments, the FWC and our industrial partners to identify and implement them”.
In summary, The Way Forward – What needs to Happen
1. Prices and funding models that stimulate growth and quality
2. Sector development that supports transition and progress
3. Market stewardship that responds to warning signs of market failure
4. NDIS processes informed by experience
5. Flexibility that reflects national diversity
6. Complex design problems resolved
7. Investment in quality and safeguarding
8. More open employment opportunities
9. Extended school-to-work support
10. More job opportunities for people with disability
11. An appropriately resourced National Disability Strategy
12. A National Mental Health Strategy
Six years and Counting: the NDIS and Australian Disability Services System, A White paper by UWA, Professor David Gilchrist, P.A Knight, C.A. Edmonds and T.J. Emery
Professor Gilchrist: Reform the Australian Disability System- it must be fit-for-purpose, not one-size-fits-all.
The NDIS has been compared to a plane that was built while it was in flight (being implemented). Unintended consequences of this implementation process have included: a break down in pre-existing inter-governmental and intra-governmental service structures; increased uncertainty preventing investment and expansion by service providers; significant workforce issues; and pricing based on funding availability rather than sound data on needs and costs of services. Most importantly, these changes have increased the risk that people with disability will not get the outcomes promised and are exacerbated by a lack of timely investment capital.
This white paper proposes that governments, advocacy bodies and industry peak bodies
work together to reform the Australian Disability System, inclusive of the NDIS element, rather than
focusing on the NDIS as a standalone element, utilising a timeframe and industry planning structure
that is inclusive of all.
What is needed: A national governance model and policy framework allowing for policy and investment to be informed collaboratively by all involved in the system including people with disability, governments and provider peak bodies. It is important to emphasise that the NDIS was not intended to be the whole system—nor can it be. Of the approximately 4.3 million Australians living with disability, the NDIS will support around 500,000 participants at full roll out. However, states and territories will still provide funding.
Like everyone in the community, people with disability have a broad range of needs, including health
care, housing, education, employment, social opportunities—in short, a big part of the national
discussion leading up to the establishment of the NDIS related to giving all Australians a fair go to
live their lives as fully as possible.
For the system to be considered effective, it must support all people with disability effectively and efficiently in the context of individual choice and control, and where this is not possible, by offering equity of access. The Australian Disability Services System is also structurally complex, partly because of the people it serves and partly because it includes the Commonwealth, state and territory Governments— including different departments such as health and education—disability services providers, the NDIS, as well as the broader industry components such as businesses involved in providing services like transport and recreation support. Figure 3 provides a simplified schematic view of the complexity of the system.
It is too simplistic to speak of the NDIS outside of the broader structural arrangements in which our government and other services operate or even as a single element within the system.
The system must be fit-for-purpose, not one-size-fits-all.
Indeed, without a systemic approach to planning and reform combined with flexibility in funding and access arrangements, there is very significant risk of systemic failure—not just market failure. Such failure will:
Impact many people with disability as they will not receive the services and supports they need. People with disability and their families are positioned as the shock absorbers for any volatility caused by poor policy across the system;
Impact governments because rectification will cost tax payers more and divert focus from the real work of achieving an efficient and effective system—prevention is better than cure; and
Reduce supply as disability service providers face increasing financial pressure, uncertainty (preventing investment) and are increasingly incentivised to exit service provision.
The current state of the system “is” the new system. It is a system that only works for some
service users and for some service providers.
The real cost of failing to reform this system will not be borne by service providers, tax payers or governments, but by people with disability. To develop and implement a good industry plan, five key elements are needed: knowledge, transparency, clarity, certainty and collaboration.
At the national level the focus is on policy, assurance and reporting; at the state/territory level, on co-ordination and systems. At the local level the focus is on service delivery, inclusivity and realisation of the aspirations of the system, including those of the NDIS which are the very purpose of the system itself. Each of these levels of policy, planning and governance need a plan that is collaboratively established, transparently implemented, integrated through the policy framework and for which the parties are accountable via a system of independent assurance.
At the most summarised level, these plans would include:
Responsible investment by government and using the funds already allocated to the NDIS but
unspent, will be an important investment in restructuring to ensure this asset is fit-for-purpose.
Such investment is critical to the ongoing capacity of the disability services sector as previous government policy has ensured the balance sheets of these organisations are largely unable to support investment of the level necessary—this is not a result of poor governance but, rather, a result of government spending priorities over many years.