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

Service Gaps

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  Overall, mainstream organisations felt that the NDIS supported greater access to funded supports and services for people with disability. A particular success, according to health organisations, had been the increase in access to early intervention services, which was facilitated by waiving the assessment requirements for children with developmental delay who were below school age.
  
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  However, a number of service gaps were identified in relation to the living conditions and circumstances for people with disability. Concerns were raised about children with disability being able to remain in foster care beyond the age of eighteen years without their foster parents needing to register as service providers. Similarly, concerns were raised about the lack of funding for accommodation for children living in voluntary out of home care resulting in families having to cover this cost. Mainstream organisations identified service gaps around access to respite, Home and Community Care (HACC) services and equipment, and raised concerns about who would fund home modifications in the future. It was also noted that some providers were now charging for services that were previously free (such as builder who provided quote for home modifications).
  
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  Other service gaps identified by mainstream organisations related to people with specific types of disability and the circumstances of individuals with disability. In particular it was identified that service gaps existed around mental health services, prosthetic services, and rehabilitation for people with brain injury. In addition, service gaps were observed for those not eligible for the NDIS, including refugees and New Zealand citizens residing in Australia, and long service delays were experienced by participants being assessed for eligibility and awaiting plan implementation. Health organisations also observed that due to the increased demand for therapeutic services as a result of the NDIS, clients who were not eligible for the NDIS experienced additional challenges in relation to accessing services.
  

If you keep clogging with the kids who could be seeing NDIS you don’t see the kids who aren’t NDIS and just have a problem with one area of development or whatever. So some of them are getting some service downstairs, but quite often they’re getting nothing. And if we assess a kid and say they have autism, OTs downstairs won’t see that kid because they’re eligible for NDIS occupational therapy. So they’ll assess them if we put them in there before their autism assessment, but they won’t assess them after it….And they won’t provide therapy once the diagnosis of ASD is made, and they’re clearly eligible for NDIS. (MS09 SA H)

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  Delays were experienced by participants as a result of the length of time taken to undergo eligibility processes, getting a plan developed, and having their plan implemented. These delays resulted in longer waits for participants to receive necessary services and supports. Delays due to NDIS processes were also creating bottlenecks in mainstream services and contributing to service gaps.
  

We’ve had patients on the ward having submitted their applications and waiting for NDIS to come on board, and then they’ve sat in a hospital bed for over 12 months. (MS22 ACT H)

I’ve had young children, three or four years old where they’ve said, ‘Twelve months later we still haven't met with a planner.’ (MS09 SA H)

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  Duplication of services was identified by mainstream organisations in two areas. First, it was noted that confidentiality processes prohibited mainstream organisations from receiving information about which of their clients were receiving NDIS funding. As a result, issues around the duplication of services for participants were experienced. Second, a higher education organisation identified that NDIS-funded plan management in relation to education goals was duplicating supports provided by their own staff.
  

The other thing is just all communication. Like people have a plan, and we don’t know what, who their care, they come in to have an appointment with us, or have an admission to us, and unless the patient tells us, and we have absolutely no idea of their plan, who their case coordinator, so we end up duplicating it because we don’t know whether they’re in NDIS. There’s nothing that tells us they’re in NDIS. Completely reliant on them or the carers to actually tell us and even when they tell us they might not tell us all of it, and so we have no visibility at that they’ve been accepted, there’s no feedback to us at all, whether they’re eligible. (MS 22 ACT H)

One of the other issues we’ve got is that we’ve got someone there for example who’s been there for six months, they go off and they actually have their planning session and there’s a plan, but we don’t know about that. So the person’s in our facility, we’re trying to organise discharge into the community but we don’t know that they’ve actually got an existing plan, because we weren’t involved in the process. (MS 16 ACT MH)

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  Mainstream organisations identified a number of factors that they felt contributed to these gaps in service provision for people with disability. These factors included boundary issues and conflict between the NDIA and mainstream organisations around their responsibilities, poor communication between the NDIA and mainstream organisations, and also delays in referrals and the ability of NDIS participants to be able to access services as a result of NDIA processes. For example, many respondents made reference to the long delays occurring between the time that participants applied to access the NDIS, to the time that their eligibility was ascertained, and again until planning commenced. These delays were perceived as potentially compromising service provision and health outcomes for individuals living with disability. Delays were also impacting on the ability of NDIS participants to be discharged from mainstream services which was creating a bottleneck effect. This bottleneck was particularly noted as occurring in the health interface.
  

We’re talking fairly quickly into that and making that phone call to the NDIA and as much as you can getting on to a planner, but there’s delays in all of that. As you know, there’s delays in getting through to the National Access Team for a start. They say they’ll call back, and they don’t. We’ve got a family sitting in hospital waiting for a phone call from somebody and they don’t call back so we spend a long time, so we’ve just recently had a child who waited six weeks just to get the access request form sent to them. So they can’t even get past that first step in the process. (MS 08 SA H)

Our own allied health is having difficulty keeping kids who are eligible for NDIS but not receiving NDIS, so there’s this backlog that kids are being assessed, diagnosed, getting to the NDIS waiting list, and then being left in limbo for a year And the other impact has been our ability to, what do you do when you’re waiting? There seems to be less and less options for families to access affordable therapy services while waiting for their NDIS package. (MS 09 SA H)

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  It was observed that the NDIS had resulted in longer outpatient waiting lists and lengthier hospital stays for clients due to delays in transitioning people into the NDIS and therefore enabling them access to necessary services.
  

This has been a huge backwards step really for the way that we have operated for children with disability with complex health needs. In terms of our, from a hospital to disability interface in terms of our ability to move children through the system, that is hugely backward. (MS 06 SA H)

…there’s increased length of stay. I mean yes it’s an impact on us but from my perspective it’s the impact on the client which is the hardest. (MS10 SA H)

We actually started collecting some stats like waiting list data in outpatients, and we started to collect some information about length of stay in hospital, and we did actually notice a demonstrable increase in length of stay in hospital because it was taking so long to negotiate the system and to transition people out of hospital. Our waiting lists in outpatients also blew out to the point that I was really concerned that we were, the staff in some of our outpatient areas were starting to provide services to people that they would never have usually provided services to, because they were concerned that their delay was going to be impacted, like impounded, I suppose, compounded, because there was such a delay in that access to services through the NDIA, which me, from a purist inter-government relations perspective, went ‘Please don’t, because what the NDIA is then going to do is point to us and say ‘Hang on, you’ve been providing that service to that person, you should continue from a continuity of care perspective, you should continue to provide that’’, and it’s like ‘But hang on, we’re only providing it because you’re taking so long to provide your services, we’re providing a stop gap’. (MS05 SA H)

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  The potential implications of delays for early intervention services on outcomes for children with disability were also highlighted.
  

The timeframes are so exorbitant as well. I mean we’ve got some children that have been waiting so long that early intervention isn’t really [laughs] the right term because they’ve actually been waiting so long. (MS 13 SA E)

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  In order to overcome some of these service gaps, mainstream organisations acknowledged that they continued their in-kind service arrangements with the NDIA beyond their original agreements. In doing so, they hoped to minimise the impact of these service gaps on their clients.
  

And for a while we did the ‘We’ll advocate within NDIS for you ‘ and that failed, and so now we’ve actually put in non-funded services to meet this growing need of people and I think they’re the tip of the iceberg, because we don’t do it for the adults. We’re only doing it for children. (MS22 ACT H)

It’s actually recognised now that it’s not just about who gets access, it’s about all the people who don’t get access and as part of mainstream we have a responsibility under the bilateral agreement to obviously provide services to those people who don’t get access, but also where people don’t get access to the full range of services that they might need, that the state also has a role to play in terms of continuity of care. (MS15 SA H)