The perspective of NDIS participants and their family members or carer
In wave 1, many NDIS participants were enthusiastic that new disability service providers would enter the region as a result of the roll-out of the NDIS. However, this enthusiasm diminished after little change was evident in available services.
In wave 2, there continued to be limited evidence of new providers entering the local provider market.
Respondents believed that the remote location continued to deter new providers. The cost of remote service delivery and a lack of affordable housing to encourage staff to move to the region were viewed as barriers to expansion in the provider market. Some respondents disputed the viability of the NDIS market model in remote locations.
I can see that in theory it can work well in a capital city. I can’t see how in a small town where the services are so minimal and that the quality of staff is so low and there’s such a high turnover of staff and this whole thing that it’s going to be driven by the market, well there is no market. It’s too expensive. (F21_C W2)
The perspective of the service provider and workforce stakeholder organisations
In wave 1, peak bodies and disability service providers reported little change to the disability sector in the Barkly region as a result of the NDIS trial. The sector was considered still to be experiencing considerable flux and little market development had taken place. Although several new providers were noted to have registered with the NDIS, they had not yet begun operating within the area. The lack of market development was attributed to the low number of NDIS participants, alongside the need for service providers to have prior experience, cultural competence and infrastructure to deliver services to remote communities. Most providers reported their organisation had undertaken preparatory work or had begun to adapt to the NDIS.
In wave 2, while peak bodies and disability service providers reported a small number of new providers entering the local provider market and a slight increase in service provision among existing providers, barriers to expansion continued to be reported.
Financial viability and sustainability of disability service provision under the NDIS individualised funding model was perceived as a key barrier. Concerns included funding not reflecting the true cost of remote service delivery; NDIS pricing not adequately covering management, training and administrative costs; and particularly for small fly-in-fly-out (FIFO) therapy providers, exposure to financial risk associated with travel costs when delivering services in remote communities. Smaller organisations were again identified as being more vulnerable and unable to absorb these unfunded costs and therefore less able to sustain disability services in the Barkly region under the NDIS.
Peak bodies and disability service providers also noted that unfunded work such as engagement work to create relationships with potential clients, assistance with planning processes, case management work and extra administrative work was further impacting on their financial viability.
Low numbers of NDIS participants also affected the financial sustainability of services and programs. Several providers who had entered the trial site reported they were not able to create sustainable services as they were not able to access many NDIS clients (despite being advised by the wave 2 interviews that there were 154 NDIS participants with plans in the Barkly region).
My difficulty as a service provider with that number is that we have 20….154 might only have equipment needs but where is everybody? We can’t find them. We don’t know where they are to even try to provide support and from a business perspective try to raise our revenue. That’s an absolute flaw in the whole Scheme that we can’t find those people and that they can’t seem to be finding us. (F13S W2)
Respondents reported that the NDIA had failed to adequately consider the appropriateness of an individualised funding model in the NT and the challenges of remote service delivery.
They should do their homework before they start. They should know that, don’t try and roll out a national program in places like the Northern Territory without significant consideration beforehand about what the pitfalls are going to be. Because it’s not going to work. (F06P W2)
It’s really hard to provide services in remote areas. Even if you get more service providers … the market’s only so big, you know? There’s only so much work here… You’re not going to make a fortune working out there. If you’re a private organisation – if you’re a for-profit – I think that it’s always going to be challenging. (F04P W2)
Concerns were raised that when the NDIS is rolled out across the NT, providers who had begun offering services in the Barkly trial site, would withdraw and focus on Darwin and Alice Springs where there are less remote servicing challenges and greater financial service viability.
I think my sense is that by rolling out, particularly in the Northern Territory, by rolling out the outlying areas, the remote areas first, that they will receive service, and then as Darwin and Katherine and Alice Springs are rolled out that perhaps we will go back to being in the situation that we’re in now where services then become centralised again. (F03S W2)
The perspective of the NDIA staff
NDIA staff highlighted that services to people with disability (which were very limited pre-NDIS) were provided locally by mainstream or generalist services, or by specialists from Alice Springs or flown in from further afield. Services were largely blocked funded and disability supports typically constituted only a very small percentage of an organisation’s total service delivery.
If we’re talking to the [Name of service provider] for example we are a very small part of their business you know so they might provide in-home care or meals to a lot of people but 95 per cent of those will be through the home and community care, HACC Scheme. A very small percentage of their client base will be through disability programs. (F08N W1)
The shift to an individualised funding model, was thought to have led to some providers whose main business focus is not disability to consider withdrawing from the sector.
Disability is just not their core business. And it might have been tacked on the end and now we’ve got a totally different financial system, how money’s allocated; they’re just saying ‘Look there’s just far too much and it’s not a huge part of our budget. We’ll just hand it on’. (F06N W1)
NDIA staff reported in wave 2, there were 28 disability service providers registered with the NDIS within the Barkly region, of which 24 were actively providing supports. Three large new providers had begun operating out of Tennant Creek and four new supported accommodation homes had been established. Beyond this it was noted that there was further interest from providers currently operating in Alice Springs and Darwin as well as providers from the Aboriginal controlled health sector in moving into the disability provider market in the Barkly region.
Allied health provision in the region consisted of the use of existing allied health services through the Office of Disability for assessments and initial consultation, and the use of FIFO therapists brought into the region by local Aboriginal Health organisations. However, there continued to be an under-supply of allied health services in the region attributed to the high cost of service provision.
Whilst services in the region were both government and Aboriginal controlled, the arrival of the NDIS provided scope for the Aboriginal service providers to include non-Indigenous clients. Previously, this was not allowable under funding arrangements.
Although no service providers had exited the market in the Barkly since the wave 1 interviews, several NDIA staff acknowledged that they knew of a few current providers who were reassessing whether they should continue in the region.
NDIA staff also voiced concerns about whether the new providers in the Barkly region would remain once the NDIS was rolled out in other regions in the NT. It was believed that once provider resources were constrained by the extra demand in other sites, providers would no longer have the time, nor would they find it cost effective to continue to travel to those more remote areas such as the Barkly.
If you haven’t got the people that want to go to them, well, where are they going to get their money from? So I’m not sure if it works in little places like this. (F15N W2)
The financial viability of disability service provision in the region was a major concern given the distance required to travel both to and within the region and the small number of participants requiring services.
Confusion and lack of understanding of either the purpose of the NDIS or the processes involved in delivering services under the NDIS were viewed as a further challenge.
11.5.2 The disability workforce
The perspective of the service provider and peak body organisations
Peak bodies and disability service providers reported that the NDIS had not enhanced the size or diversity of the disability workforce in the Barkly region and that worker recruitment and retention continued to be difficult. Respondents reported specific challenges in recruiting and retaining Aboriginal workers including problems with police checks and identification documents, alongside a lack of qualifications and literacy or computer skills.
Disability service providers considered that these workforce challenges predated the NDIS: ‘historically it’s been difficult, not impossible, but difficult to recruit to these positions in remote areas’ (F06P W2).
Providers noted the need for experienced allied health staff and those with cultural competency to work in remote locations. Several providers reported that advertised allied health positions were not being filled over some months due to a lack of suitable applicants. Providers seeking to attract allied health staff noted the need for competitive salaries and opportunities for professional development. It was also claimed that these potential employees were often seeking permanent appointments, which were no longer being offered due to uncertainty about future service provision under the NDIS.
Providers noted the cost of training and developing their own staff was problematic under the NDIS as there was no provision to fund training. The extra costs involved in training staff in remote locations was also highlighted.
Yet they want your staff to have all this training. So who’s going to pay them for all those days off, who’s going to pay them to get to there, who’s going to pay their accommodation, their travel, their, come on. Yeah. Not good for us. It really isn’t. (F17S)
11.5.3 The NDIA workforce
At the time of the wave 2 interviews there were 10 employees based at the Barkly NDIA site. Of these employees, six identified as Indigenous. A further six employees were based in the NT regional hub that had been established in Darwin. It was anticipated that in the future the number of employees based in the Barkly region would decrease, while the total number of NDIA staff in the NT would increase to approximately 80 employees as the NDIS was rolled out across the territory.
The perspective of NDIS participants and their family members or carer
In wave 1, a lack of local Aboriginal NDIA staff within the Barkly trail site was noted. It was suggested that the employment of local Aboriginal people would have enhanced the capacity and cultural appropriateness of the NDIA to engage the community from the outset.
In wave 2, while several respondents welcomed the appointment of more Aboriginal NDIA staff, others believed that the Agency had not fully appreciated the cultural and language skills that were needed to effectively work with local Aboriginal people.
I think they’ve... employed two, two of the staff members only this year... Well they both don't speak language... And that’s my big concern is they are really missing the point again… They’re the mob, all of them Aboriginal but they don’t tick box, culture box or language for me. (F03_PWD W2)
As in wave 1, many NDIS participants perceived NDIA staff to lack disability experience, knowledge and training.
Again the training with the NDIA staff is that, I believe that they have been trained but they’re not coming from a position of working with disability for very long, there’s still a very many of them are just stepping in out of communities and into the roles or out of Centrelink and into the roles and they don’t come with the inherent knowledge around disability that they need to be performing in that role. (F37_C W2)
So the thing is that NDIS in this office in Tennant Creek... none of them have disability certificate, have no aged care or disability experience, looking after or responding to needs of a child, or a person, with a disability so how can they write a care plan and then how can they also look after carers and parents of people with disability? (F35_C W2)
The perspective of the NDIA staff
NDIA staff recognised that rolling-out the NDIS in the remote and largely Indigenous context of the Barkly region required changes to the ways in which the NDIS had been implemented elsewhere.
In addition to the remote context, the Barkly region is characterised by a low socio-economic profile reflecting high unemployment, low levels of education, and poor health. NDIA staff recognised the additional challenges this presented to the roll-out of the NDIS in the NT, including the problem of multiple disability and disadvantage.
In wave 1, NDIA staff indicated that their involvement in the Barkly region trial site primarily came about in response to an Expression of Interest circulated by the NDIA or by being directly approached. Respondents reported that decisions to work in the Barkly trial site focused on the opportunities this provided in terms of living in the NT or pursuing employment opportunities such as working with Indigenous people.
NDIA staff highlighted the importance of having experienced people from other trial sites on staff in the NT in the early stages of the roll-out, to share their knowledge and skills, and to give context to how things would need to work differently in the NT.
NDIA staff were optimistic about the hiring of local people within the Barkly region. However, given their current skill level, there was also some concern about the ability of these new staff to undertake their necessary working responsibilities. The more skilled and experienced staff were therefore having to devote time to training new staff, adding to their already high workloads. In addition it was observed that a number of local staff exhibited high levels of absenteeism that negatively affected the rest of the team.
In wave 2, recruitment placed a stronger emphasis on seeking interest from local people, and ‘they are probably the first jobs too within the agency where we actually had specific Indigenous criteria that we ask people to address to in their jobs (F01N W2)’.
NDIA staff in the NT trial site enjoyed being in a small team and reported good relationships with colleagues. Several respondents indicated appreciation of the skills and experience of other team members, contributing to feelings of being supported when at work and fostering a learning culture.
The principal challenge for staff (and especially those who were temporarily placed in the trial site) was associated with the personal impacts of working in an isolated region, away from family and friends. NDIA staff in the Barkly experienced a number of challenges around living and working within such a small community. In particular, managing relationships could be difficult especially when responsible for determining whether people they know receive funding or services. The level of support provided to NDIS staff new to the region was considered to be insufficient.
A lack of available disability services due to the remoteness of the region, provided NDIA staff with an additional challenge. The dearth of existing services meant that much more effort needed to be devoted to market development. This was further exacerbated by NDIS pricing for services which was considered insufficient in such a remote area and the logistical difficulties around service provision even in those instances where a provider was available.
There’s also the issue around pricing, so the cost of remote service delivery is very high. And whilst they’ve got a remote and very remote pricing catalogue it still doesn’t cover, for some providers or businesses that are looking at providing services, it’s just not viable for them to be providing those services… the sheer cost of delivering services to very remote locations and the staff that you need, and the vehicles, and the time. (F10N W2)
NDIA staff reported needing to provide considerable support to providers both to negotiate NDIA processes and also on how to use the provider portal. Educating providers was complicated by frequent staff changes within these organisations so that the NDIA needed to ‘start again’ whenever someone new came on board. A particular issue in the Barkly trial site was the uncertainty about the ongoing provision of therapy services by the NT government.
Respondents felt the NDIA should have a stronger focus on staff wellbeing in light of the additional stress factors of working in a remote and challenging location. They also described the need for the NDIA to work towards a greater community engagement and relationship building with mainstream services in the NT, and felt this should ideally happen well ahead of any future roll-out to new geographical areas.
Role specific challenges
As already discussed, as part of the rollout of the NDIS in July 2014, the NT trial site started operation staffed with PSCs, rather than planners and LACs as in other trial sites.
While in other trial sites the role of the PSC encompassed plan development and implementation, in the Barkly trial site, this role also involved locating potential participants and undertaking assessment as part of eligibility and planning. They were also required to undertake tasks associated with provider and stakeholder engagement (along with managers). As one PSC described it ‘up there you really just rolled your sleeves up and did a little bit of everything (F02 W1)’.
Performing the role of PSC in a remote location had different challenges compared to other trial sites. Travelling between the trial site office and Aboriginal communities took considerable organisation and advance planning and coordination. However, working in a small, remote team was also reported to have a number of benefits, including increased flexibility in their role and the ability to try different things rather than adhering to a prescribed process. For some, this was a closer match to their expectations on starting work with the NDIA.
I think you have to be flexible in a small, remote team. And I think that’s probably why staff up here like their role, because they do get that… Just really getting into it and going ‘Yes, this is what I signed up for in the first place, this is what I thought I was going to be doing.’ (F05N W2)
Staff new to the NDIA, however, still had some difficulty adjusting to what they described to be ‘bureaucratic processes’, found NDIA procedures hard to understand, and felt the Agency was ‘top heavy’.
Other challenges related to the burden of paperwork (in context of inadequate IT systems) and the detrimental impact this had on availability of time to spend with participants and their families (echoing feedback given by NDIA staff in other trial sites).
Skills and training
In both wave 1 and 2, NDIA staff identified that they had experienced some challenges with training as a result of the remoteness of their location.
Initial training for staff was reported to be very ‘Barkly site’ specific, involving four wheel drive and first aid training. Cultural awareness training was considered to be inadequate and consisted of: ‘A very unsatisfactory online module which assumed that you had no knowledge at all (F03N W1)’.
Staff often relied on the experience and knowledge of the fly-in-fly-out staff members to bolster their understanding of disability areas. A decreased use over time of fly-in-fly-out staff in the NT trial site, reduced these opportunities for learning.
Another training resource that staff used was having colleagues from national office or independent contractors come to the Barkly site to deliver training. However, difficulties were experienced both in getting training providers to come to a remote location as well as staff availability to attend training sessions due to frequently working away in remote communities.
