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

Individualised Funding

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  Although mainstream organisations supported the philosophy behind the NDIS model of individualised care and welcomed improvements to funding and the individual’s choice and control over their services and supports, the fit between their programmatically funded services and the individual funding of the NDIS was not without its difficulties.
  
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  Mainstream organisations observed that the NDIS had created extra work for their administration and frontline staff such as having to learn the new systems associated with the NDIS. For those organisations providing services under the NDIS, gaining access to the portal had also required costly IT changes.
  
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  Mainstream providers reported that they were spending more time engaged in case management activity. They observed staff devoting more of their time to supporting clients to navigate their interactions with service providers and with the NDIA, as well as advocating for clients around their funding needs. In some cases mainstream staff had to upskill their knowledge in relation to working with people with disability in general or with new types of disability, and also around NDIS processes. Conflict between the ethos of the new NDIS system and the values of mainstream staff arose when there were concerns about clients not receiving the services they requires.
  

In terms of our clinicians, there’s definitely a massively increased workload in terms of advocating for them, trying to educate them, trying to support them through the processes. (MS17 ACT H)

That’s been a huge shift I think for the staff as well that it will be one of the unintended consequences I would think, where there hasn’t been appreciated the impact of staff, and it’s not about control I don’t believe. I think it’s about duty of care. For staff they want to be able to hand over their client to somebody else and know that they’re being picked up and cared for. I think it’s been hugely challenging for staff to say ‘Okay, here you go. Here’s, this is what you need to do. Maybe I can help you with this process, because I’m really concerned that you’re not going to be able to do it yourself. Let’s go through this process. But then basically you’re on your own. (MS06 SA H)

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  Mainstream sectors and organisations identified several examples whereby collaboration within service provision had been compromised as a result of the NDIS. It was noted that in the health sector multidisciplinary care teams were no longer able to be supported by available funding. The establishment of a market approach to service delivery was perceived to have introduced a competitive environment that further obstructed collaboration between the sectors.
  

We still have a good working relationship with [NAME OF NGO], because we’ve got a long standing connection with them. But I think it will change over time as they become more like a large private competitive provider. (MS06 SA H)

Once the NDIA came on board, [NAME OF NGO] became very aggressive in their marketing and withdrew any services or any involvement or discussion with us, so became a competitor in the market. (MS07 SA H)

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  However, an example of new collaboration was also identified, between educational organisations and the NDIA. An education organisation described their involvement in the School Leaver Employment Supports (SLES) program, in which the school and the NDIA collaborate to provide supports to participants undergoing the post-school transition into employment.
  

It’s new, and it’s actually a bridge. So the Commonwealth have their employment programs but they’ve introduced SLES as a two year interim period when the child leaves school, although they do the assessment prior to, to actually get supports in place. But it’s for the two years after school if they need additional assistance I guess to transition them either to work or transition them onto their traditional employment network programs. (MS13 SA E)

Equity, Fairness and Navigating the NDIS

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  In general, mainstream organisations considered that the impact of the NDIS for people with disability and their families was largely positive. Many representatives from mainstream organisations felt that people with disability had greater access to, and choice and control over, the supports they needed under the NDIS.
  

I think it’s just opened up opportunities that may not have, or that may have happened, may not have been particularly evident before. (MS38 TAS)

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  A number of mainstream organisations acknowledged that although they had witnessed considerable issues with the NDIS, this was in part because their role placed them in a position to capture instances where the system was not working well and also because participants were still in the more challenging stage of transitioning between systems. Most anticipated that once properly established, the NDIS would greatly benefit people with disability and their families. However there were some design flaws that needed to be addressed before this could fully transpire.
  

There’s the experience, I think, which has been particularly rocky and the work around troubleshooting plans or the access process whatever, haven't been ideal. But again, they’re things which I think will settle in time, and a full Scheme, you won’t have the surge of transition, so I guess you could run an operating model more consistently. But this is, I think, we’re trying in this conversation to separate transition issues to full Scheme design issues, and I think the design issues are the national consistency is a significant one that won’t be resolved if I can’t see a design structure yet. (MS25 VIC H)

We mostly hear the bad stuff, so, there’s been real issues with the agency’s communication and planning processes…. you've got to separate the transition issues which the agencies have against the broader impact, and I think also the Scheme has sort of been, it’s a disruptive implementation, it’s purposely on services and meant that there’s been quite a bit of innovation too, and new thinking, and I think that’s been really good, too, and people have got some creative results, if they can tell, I don’t mean this in a make-it-up way, but they need to tell their story in the right way to the agency, about what they want and their situation, and a lot of them probably need continued support to do that through advocacy and other things, so, I think we spend our days dealing with some of the issues we’ve got to work through, but overwhelmingly, you've got to say it is all ready and will be a very positive social change. (MS24 VIC DPC)

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  Mainstream organisations were concerned about those participants who were less able to advocate for themselves. The consumer driven model implemented by the NDIS required that the person with disability and their family have a clear understanding of both the NDIS and their own support needs and the ability to articulate those needs to NDIA staff. Moreover participants and their carers needed particular resources including the time, energy and the means (e.g. access to the internet and the ability to afford clinical assessments for providing proof of eligibility) to actively engage with the NDIS. It was identified that the NDIS worked less well for CALD and Aboriginal and Torres Strait Islander participants, those with high support needs or limited capacity, and those who were newly diagnosed or had recently acquired a disability.
  

A family cannot be expected to sit down with a planner and talk about their goals and aspirations and dreams for their child, when they’ve just arrived here. They have no idea what services available, what their child even needs, what they’re entitled to. It’s just hugely problematic for CALD families. (MS06 SA H)

You know it’s all well and good the way they’ve rolled out the Scheme for consumer control, but someone who broke their neck two days ago can’t tell you squat about what they need, they just can’t. And in fact in a lot of ways it’s almost cruel to sit down and ask them that…And that’s really the skill of the health service is to support that, you know to support that information sharing and gathering and that sort of thing. So, and like I said this wheel has been invented several times. It’s in existence, there’s plenty of places to learn from. I‘m just, I’m really, really hopeful that that message gets across to the NDIS and they take some learnings from some of that. (MS28 VIC H)

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  People with disability living in regional areas were also identified by mainstream organisations as being a group for whom the NDIS was not working well. This was attributed to the lack of a provider market, and to difficulties with engaging with the NDIA as a result of limited access to the internet.
  
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  Mental health organisation also expressed concern about the ability of the NDIS to be responsive to people with psycho-social disabilities.
  
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  Many respondents were also concerned about recent changes to the way in which initial planning and plan reviews were being undertaken. Undertaking these processes via phone was noted as detrimental particularly for people with mental health disabilities or those from remote areas:
  

The expectation that plans happens, either going to happen online or by phone, is certainly not a good way to go for many of our rural and remote clients. (MS 07 SA H)

Recently the planner just sort of said, ‘Wouldn’t it just be easier if we do it over the phone and do a quick review just to get you by and get the child out of hospital and we’ll review again in April?’ And went you’re working with parents with mental health conditions or - you actually cannot do it over the phone. (MS 10 SA H)