Evaluation of the ndis final Report Kostas Mavromaras, Megan Moskos, Stéphane Mahuteau, Linda Isherwood

Introduction

The NDIS is a new way of providing individualised support for people with disability, their families and carers. However, the NDIS is not intended to replace other mainstream supports. To be fully included in society, people with disability should be able to access mainstream systems such as education, health, and be supported to participate economically. Hence, wherever possible the NDIS assists participants to access mainstream services.

In this chapter we present key findings arising from the Mainstream Study, an extension of the broader NDIS evaluation. The overall objective of the Mainstream Study was to explore the impact of the NDIS on mainstream health, mental health, education and employment sectors. A particular focus was on the interface between the NDIS and these mainstream sectors. The Mainstream Study consisted of one wave of in-depth interviews with senior NDIA staff involved with the design and implementation of ILC and interviews with representatives from mainstream providers/state government agencies who interact with the NDIA and/or NDIS participants.

Interviews with NDIS participants and their carers, disability service providers, representatives from workforce stakeholder organisations, and NDIA staff conducted for the main evaluation also discussed mainstream interface issues.  The information collected in these interviews, however, was very similar to the feedback provided by representatives from mainstream organisations, with no unique issues uncovered. To assist readability, this chapter focuses solely on the findings of the interviews conducted with mainstream organisations.

As a standalone study, the Mainstream Study addressed specific KEQs relating to the impact of the NDIS on mainstream services (see section 1.3). The interviews, however, also uncovered mainstream sector perspectives on broader issues and impacts of the NDIS. While these findings are similar to those presented in preceding chapters relating to our interviews with other respondent groups for the main evaluation, they are included separately here for two reasons. The findings highlight the specific experiences of these issues for the mainstream sector and, furthermore, they show the systemic nature of many issues experienced with the roll out of the NDIS.

This chapter explores several areas relating to the impact of the NDIS on the mainstream sectors. First, the interface between the NDIS and mainstream services is examined to understand how effective the interface is, and the extent to which it has been clearly delineated.  Second, we explore changes in the use of mainstream services by people with disability and whether areas of duplication are apparent or if service gaps have emerged. Third, we consider how well the individualised funding model of the NDIS aligns with the program funding model of mainstream services. Finally, this chapter presents the views of mainstream organisations of the impact of the NDIS on people with disability, the lessons learned from the NDIS roll-out and areas for future improvement. 

Interface between Mainstream Sectors and the NDIS

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  Most mainstream organisations observed that the interface between the NDIS and mainstream sectors was not a priority for the NDIA, particularly during the earlier phases of the roll-out. They noted that high level interagency and intergovernmental communications between departmental heads had been successful in providing information about the NDIS and developing escalation pathways for unresolved operational issues or systemic challenges. However it was observed that these meetings were tailing off and the NDIA was becoming less collaborative and more insular.
  
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  Meanwhile, at the local level, most mainstream organisations had a key person or team that had primary responsibility for managing the interface, communicating with local NDIA contacts and for educating staff. Forums were evolving as the NDIS roll-out continued; these included local organisational or interagency implementation committees, working groups, meetings with representatives from different mainstream sectors and involvement in the Disability Reform Program Steering Committee.
  
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  A number of challenges were identified in relation to the interface between mainstream organisations and the NDIS. Communication with the NDIA, particularly with head office, was a primary challenge identified by mainstream organisations. Difficulties in communication included contacting the NDIA, a lack of NDIA staff knowledge of the NDIS, delays in obtaining responses from the NDIA in relation to the outcome of client referrals, a lack of consultation with mainstream organisations, and frequent changes to NDIA policies.
  
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  The use of the national 1800 NDIS number was noted by several participants as being problematic, particularly when making referrals from the mainstream sector. Several respondents mentioned the value of having direct phone access to NDIA managers, but also noted their hesitation to overuse these to escalate individual cases.
  

Trying to contact that person, knowing who they are can be really difficult to get through to because of the way their phone systems operate. So even if they give you a direct number, going through a national line and you can be on hold, so most of my communication I have to resort to email; I can’t just pick up the phone and get the person I want at the other end. (MS 21 ACT E)

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  Many respondents considered that there was a lack of consultation and limited collaborative practice from NDIA Head Office around the development of protocols relating to the boundaries between the NDIS and other mainstream sectors. The lack of consultation meant that expert guidance from the various mainstream sectors had not been utilised and could prevent effective cross-sector approaches to support people living with disability.
  

I’ve got to tell you I get a little bit angry when I think about those processes… because the NDIA do it in isolation. They are deciding what the interface between the Health and the NDIA looks like, from their perspective … I’ve had numerous conversations. I can’t say that I’ve ever got anywhere with them, but where it’s a one size fits all approach, always, for the NDIS. This is the model. It was imposed. There was very little, well there was no consultation about how it was going to work. It was just ‘Here you go, do it’. No nuanced sort of flexibility for a State like South Australia, which is fairly small [I] suppose again that just reflects this one way communication a lot of the time. We are always seeking information from them trying to, we’re following up. It doesn’t come in reverse very easily. (MS 05 SA H)

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  Other challenges for the interface between mainstream organisations and the NDIS included the perceived inflexibility of the NDIA, the overall complexity of NDIA processes, the increasing amount of bureaucracy within the system, and a disconnect between NDIA policies and how they are applied at the operational level by local NDIA staff.
  

And the thing is, they are the NDIA; we don’t know any individuals. It’s this big, amorphous group […] It’s worse than Centrelink, and that’s saying something. (MS 09 SA H)

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  These interface challenges were compounded by the regular turnover of NDIA staff:
  

I’ve been dealing with head office in Geelong and I’ve just had the run around. Mainly because people have left. I get a relationship with someone and I’ve got a commitment we could develop some case studies that would kind of highlight the intersection between the post-secondary education and the agency. And they put some guidelines in place, but I kept not keeping the contacts, because they move. (MS 32 TAS E)

There has been quite a change in leadership at a regional manager level, so I think in the ACT there’s now been three or four different people come and go in that manager role. So every time you feel like you’ve built a relationship and you’re starting to make progress we feel like we’re going back to square one. But at that operational level we’ve had some great connections with senior planners, and that’s working very well; it’s the relationship with the Agency is really difficult. (MS 21 ACT E)

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  Mainstream organisations reported that overall there were clear boundaries between the responsibilities of their sectors and the NDIS. However some unresolved issues remained, in particular around which sector is responsible for funding shortfalls.
  
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  For the health sector uncertainty was expressed about what should happen in complex cases and chronic health conditions where there are grey areas around responsibility, and who is responsible for rehabilitation services. For example, there was limited clarity about the funding responsibilities for the various services associated with ongoing support of clients who presented initially with health problems (e.g. the supply of medical equipment, personal care and learning supports in schools and other services such as medication management and nutrition):
  

There’s a number of grey areas still, which there’s still a lot of discussion about, and I think the burns rehab, obviously the acute treatment of a burns patient, I don’t think there’s any discussion. Everyone agrees that’s a Health responsibility. But the long term rehab and equipment that might be needed to allow a child post a significant burn to attend school, they might need some specialist equipment for hand writing or a laptop or something like that. Whose responsibility is that? (MS 08 SA H)

So the challenges come down to definition as to whether it’s a disability support and when it’s a health support. So the example that we talk about commonly are nutrition and the provision of feeds and consumables associated with feeds, or continence equipment and the provision of consumables associated with continence equipment. There’s a list of sort of six or eight regular medication management, those sort of things come up. (MS 20 NSW H)

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  Issues with boundaries were also identified in the mental health space where confusion persisted around whether rehabilitation for psychosocial disability should be seen as a process of recovery or long term support.
  
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  Areas for confusion were also highlighted by respondents from the education sector. Most significantly was the lack of clarity in relation to funding school transport, personal care in schools and allied health services for students during school time:
  

We’re trying to work through with the agency where we say, ‘Well, here’s our eligibility for special needs transport, and it seems quite in line with your reasonable and necessary but there may be some differences, and what does that mean for the long-term viability of the service if you’re not [going to] fund a whole heap of kids? And we’ve committed a certain amount of in-kind funding around the fact that we think it’s this many students, if you’re going to sort of cut that in half and not give transport to half of them, what does that mean?’ So, it’s all those things. It’s a bit up in the air. (MS 11 ACT E)

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  These boundary issues were exacerbated by a perception that NDIA staff lacked understanding of mainstream organisations, a lack of shared language between mainstream sectors and the NDIA, and inflexibility from the NDIA around these boundary issues.