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

Recommendations for Change

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  Although mainstream organisations were generally satisfied that the NDIS had had a positive impact on participants, they also highlighted a number of areas where the NDIS could be improved.
  
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  The speed of the roll-out and the associated pressure this placed on NDIA staff was identified as having had a negative impact on the implementation of the NDIS. As a result mainstream organisations felt that the quality of services provided by NDIA staff was impeded and that systemic issues identified during the trial phase of the NDIS were not addressed before the roll-out of the full NDIS was initiated.
  

The surprising thing is how little continuity, or rather how little things have been learnt in the trial. So there was never an opportunity for the Department to catch breath, or the NDIA more to the point, and say, ‘Right, we’ve ironed out all these problems in the trial. Now the full-scale rollout will be a great deal smoother, won’t it?’ It has not been like that at all, like starting from scratch again, and the momentum that is building up now is, everybody, what is the word, reeling? (MS25 VIC H)

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  A further concern about the implementation of the NDIS was the complexity of the systems associated with the NDIS and the difficulties that people with disabilities experienced navigating the system as a result. These difficulties were also experienced by mainstream organisations in relation to their own interactions with the NDIA, either as mainstream providers or as NDIS registered disability service providers. A lack of communication and feedback from the NDIA exacerbated these issues.
  
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  Mainstream health and mental health organisations raised a number of concerns about the quality of service provision as a result of the NDIS. The first of these concerns related to the observation that as a result of delays in obtaining NDIS plans, mainstream organisations were filling service gaps and providing services to cohorts of people with disability that they had previously little experience of working with. It was acknowledged that mainstream staff often lacked the disability specific skills required to deliver quality services to these people.
  

I mean one example is kids with Down Syndrome, they always went, almost at birth they were transferred. We never actually saw those children. They went immediately to [Disability service provider name]. We never actually saw them. But now we have currently got six infants that we are seeing while they’re waiting for planning meetings. Now historically my staff would never have seen them. And do I actually think that’s, it’s a risk because we really shouldn’t, we’ve historically haven’t seen those children. (MS08 SA H)

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  Furthermore, the marketisation of disability service provision had resulted in some providers either not having the appropriate skills to work with, or choosing not to service, more complex clients. It was observed that these more complex clients then inappropriately ended up in mainstream health services.
  

We’ve had evidence of cases where the client becomes too complex in the community and there’s a decision made within the organisation that they can no longer provide that support, and they bring them to hospital and that’s where they withdraw from care. So then we find ourselves that with people in our acute system that we’re not able to discharge because they’re complex, and there’s really no services that are happy to I guess provide the support for that complexity when they’re getting the same rate as providing support for someone that’s probably less complex and very easy to work with.…the cherry picking isn’t it, that kind of ‘We’ll take the people who are much easier to manage’. (MS29 NSW MH)

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  The second issue raised in relation to service quality was that of quality control and regulation of the market. Mainstream organisations identified the need for accreditation within the disability service sector. However, they cautioned against repeating existing accreditation already being undertaken by organisations which had the potential to create an administration burden to managing multiple accreditation frameworks.
  

There’s a lack of clarity around how they’re going to manage quality going forward at the moment, which we’ve got on our radar. Because we will really need to take that into consideration as we grow our services under the NDIS…Well we’re already subject to a range of different accreditation standards, because of the services that we provide, and the NDIS will be another one. And as I’m sure you’re probably aware there tends to be a lot of similarities across those accreditations but not a lot of consistency. So the admin burden is significant. And this will add to that. (MS27 VIC H)

That I think is a major issue and we’re dealing with sectors in many cases that have never actually had to go through quality assurance themselves. Is there going to be an accreditation framework? How is that going to be managed and undertaken what are in many cases are vastly different types of service, mental health versus chronic care, versus social care? What accreditation framework is going to be used to determine good from bad providers? (MS40 TAS H)

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  Mainstream organisations recommended better collaboration, communication, and information sharing by the NDIA and between sectors. They felt that this would help smooth the transition for clients into the NDIS and later transitions into education, employment and health/mental health services.
  

I feel extremely confident that any degree of resource that’s available for health services needs to be put into communication pathways. We need people, we need bodies, we need brains who can liaise with health services around these very specific issues and needs and it’s, the needs not of the health services but of the participants who are stuck in the health services, and they need to start their day in a hospital and get this information and they need to in the afternoon go to some NDIS office and do the things that they do and process it and then come back the next day and this is what it takes to move these things along. (MS28 VIC H)

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  It was also recommended that measures were taken to improve the accessibility of NDIA staff for people with disability and their families. In particular it was identified that assistance was required around helping people to navigate the NDIS system.
  
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  One suggestion for improving the process of transitioning people into the NDIS was to embed NDIA staff in hospitals and schools to facilitate entry into the NDIS and to expedite more complex cases where needed.
  

Having somebody come in a couple of times a week who we could ask, families at least, the other day because we’ve had a couple of inpatient and refugee families where we’ve been working very closely with them, said ‘While you’re here, we want you to see this family and can you also bring the forms for this family’ and so we’ve been able to do it as a, because it’s worked, and we’ve pulled it all together. But we could do that more often if they were a presence here. (MS06 SA H)

I think they should actually put one of their staff members in the hospital, and I think it would actually almost be a full-time position. Because there’s a huge clientele that come from here, and I have proposed the idea to them, and even through the clinical partner model I think that they could have someone on site, but they sort of half warmed to the idea through the clinical partner but we haven’t heard anything further. (MS08 SA H)

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  Better education for people with disabilities and their families about NDIS processes was also recommended to help alleviate some of the difficulties created by unrealistic expectations about the planning process and supports which could be funded.
  

I think a lot of the issues that the parents may have had have been because they haven’t fully understood the process or they’ve had some misinformation and gone into meetings expecting something and it hasn’t happened. (MS23 ACT E)

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  A further suggestion made by mainstream organisations was to increase the involvement of mainstream professionals in the planning process to allow them to advocate and provide expertise. This was thought to be important given the vulnerability of some people with disability who may unaware of what supports they need.
  
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  For those who already had an NDIS plan, it was proposed that it would be beneficial to increase the use of plan managers to assist people to navigate their services. However in doing so it was cautioned that the use of case management needed to be implemented in an effective and efficient manner to ensure there was no doubling up on assistance already being provided by mainstream services.
  

Like an example I’ve got here is a student who I’ve dealt with the last year or two and she has now moved on to campus this year, and so she’s got an insurance scheme and she’s got a case manager. And so they became involved and it just seemed to duplication, because I was there providing advice and the Uni was there providing advice, and then this person was coming, and she seemed to come to meetings where I didn’t think she needed to come to meetings, and I could just see it as a making of money because every time she came, ching, ching. The money adds up. (MS32 TAS E)

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  Recommendations for improvements to the NDIS at the broader systemic level included the need for more assistance for mainstream organisations preparing to register to deliver services through the NDIS and, within the employment sector, the need for more integration between open and supported employment programs.
  

They talk about one of the biggest risks to the success of the NDIS being workforce and the availability of services for clients, and that’s based on the results of the trial sites. We’re desperately trying to become a service. And if that’s flagged as one of the risks then I think they should be putting some effort in to making sure that those services that want to come online can come online. (MS27 VIC H)

From a big picture policy position, should there be one gateway into employment for people with disabilities, and that’s possibly through some sort of common assessments that’s done for everyone that there’s supported employment, this door, open employment, that door. But it’s all done in more consistent and coherent way, because it seems to be at the moment we’re going to have, well, at the moment I don’t think, we’ve got two programs in DSS that don’t talk very well to each other. (MS30 NSW EM)