10th National Disability Summit - Day 1
National Disability Summit 14-15 August, 2019 Melbourne - quality and safeguarding, interface with health and mainstream services, and collaboration across sectors.
What an incredible 2 days in Melbourne for Centro ASSIST as a major sponsor of the Summit for the first time – and on the 10th anniversary of this annual event. The overall mood was positive and less critical about the NDIS than I have seen in the past 2 years – the Agency is making some great improvements and the Minister has just announced reviews into the planning process and access to the scheme.
The first speaker was Graeme Head AO, the Commissioner and head of the NDIS Quality and Safeguards Commission. The Commission is now firmly established as the registration and oversight body for the scheme with only WA left to fully roll under its umbrella on 1 July 2020. He stressed that “he wants to lift the system and not just use command and control”.
Graeme stressed that “there are no unregulated providers” as even unregistered service providers must comply with the Code of Conduct. Under the statutory rules in place, the Commissioner has the power to take action [1] with fines and can take complaints from anyone (the participants, family members or people in the community). The Commission will also be the host of the worker screening database. After 14 months, the Commission now has 200 staff and are opening offices in Hobart and Darwin. WA office will be opened next year. Graeme stressed that the safety of the participant is at the heart of their oversight role – a participant has the right to feel safe. He described the three dimensions of the NDIS Quality and Safeguarding Framework – developmental, preventative and corrective (see image 1). Via the audit process, the Providers need insights into how their practice compares to others and what is Best Practice. The Commissioner was very happy with the success of the Worker Orientation Module which they launched in May. 100,000 have already done the module!
[1] At the Quality and Safety in the NDIS conference the following week, Graeme said he had the power to ban an unregistered service provider.
Figure 2: Three Dimensions of the NDIS QS Framework
Peter van Vliet, from the Victorian Department of Health and Human Services, spoke about the journey so far with the NDIS mainstream interface stating “it’s hard to measure how well this is going”. He started with a comprehensive and interesting overview of the Disability Policy architecture at the Federal and state levels. In summary: mainstream services must be accessible and participatory; “reasonable adjustment” must be made unless this causes unreasonable cost/hardship to do that. 1 in 5 Victorians have a disability but 1 million people will not be eligible for the scheme. He spoke about the key focus areas for mainstream interface which are summarised in Figure 3.
Figure 3 Mainstream interface focus areas
Steven Davison, NSW Ministry of Health and Kathryn Whitfield, Victorian Dept of Health and Human Services gave a joint presentation on the Health/NDIS interface. The challenges encountered were summarised as:
Fitness for purpose - processes, logistics and structure
New consumer expectations
Markets have not developed at the same pace as the NDIS Scheme roll out
Workforce issues (quality and quantity especially for complex consumers and in rural and remote areas)
The health system is adapting to new disability care models
Limits to joint decision making at individual and system levels
Complex care needs – can markets manage this?
Figure 4 Steven Davison, NSW Ministry of Health and Kathryn Whitfield, DHHS Victoria
Steven spoke about October being a key date for the NDIS with policy clarified about stronger plans and better markets being developed - the Complex Needs Pathway will be rolled out under the solid leadership of David Coyne (ex ADHC NSW), plus ECEI (early childhood early intervention) and the psychosocial disability stream (Tasmania and SA are piloting this right now). The CSIR, Critical Services Issue Response is also being set up to bring together key Government agencies including housing, justice and health. “Making sure there are providers in the future and quality and safeguarding are the critical factors in making sure things work smoothly with the NDIS - if there are no providers there is no scheme”.
Wayne Zahra and Zoe Harrison, Senior Psychologist from Disability Services Australia (DSA) spoke about cross sector collaboration especially when presented with people having complex behaviours within an NDIS framework. DSA has 1500 employees supporting 5500 clients. DSA considers five areas when designing the best outcomes framework for their clients including: risk, need and responsivity; the Good Lives Model (www.psychicplumbing.com) and the Recovery Model (for therapeutic support).
Figure 5 Therapeutic model used by DSA
They spoke about some of the challenges being faced and how DSA is working to overcome these challenges including:
Continued open communication with NDIA local offices has been essential and have achieved positive outcomes for the participant and the service provider
Valued information sharing to help demonstrate ‘reasonable & necessary’ psychosocial disabilities.
Willingness to collaborate with Senior NDIA employees to work through systemic challenges to support continuous improvement
Willingness to collaborate with other key stakeholders with the person’s best interest at the centre
Complex needs pathway has been developed which allows for an open dialogue on the needs of the people that we support
Jenny Weldon from SWSLHD (South West Sydney Local Health District) spoke about My Choice – Pathways to Community Living Initiative (PCLI) a program providing pathways for mental health consumers incorporating NDIS funded services. This “Freedom for the Forgotten Few” program has been offered to patients that have been more than a year in a psychiatric ward in a mental health unit – 48 people who have been in the ward from 3 to 50 years are now living in the community with support. The cost per annum equated to $29.7 mm in excess bed costs that have now been saved. Prior to the PCLI there was no discharge plan for these patients. In NSW there are 380 people living in mental health wards with an average 14 year stay. The challenge is to find enough skilled and competent providers in the NGO sector now that the PIR and PHams programs are being closed down across the country.
Kim Lane from Hunter New England Mental Health spoke about the MyLink website that has been built to increase collaboration between community managed organisational partners and HNEMH.
Figure 7 HNEMH MyLink website
At the end of Day 1 there was a dynamic panel discussion about updates on NDIS rollout across Australia and interfaces with providers. Walter Tran, Head of Target Markets at Centro Assist and Holocentric was joined by Libby Callaway, Monash University; Adrian Munro, Richmond Wellbeing and Linda Hayes, Feros Care (LAC) with facilitation by Nick Mann from Polaris Lawyers.
Figure 8 Nick Mann, Walter Tran, Libby Callaway, Adrian Munro and Linda Hayes