Are NDIS Review and Dispute Resolution Processes Working Well? – Evidence from Large Scale Surveys
8.3.1 Plan reviews
In the second NDIS survey of people with disability, and their families and carers detailed information about NDIS participant’s experience of the plan review process was collected.
As shown in Appendix Table A8.13, around 92 per cent of all NDIS participants reported that they currently had an NDIS support plan.
Nearly half of all NDIS participants that were surveyed (49 per cent) reported that they had had more than two reviews of their support plan since joining the NDIS (Appendix Table A8.14). A further third (33 per cent) reported that they had had one or two plan reviews and around eight per cent had not yet undertaken a review of their support plan.
NDIS participants who had undertaken a plan review were asked about their level of satisfaction with the plan review process, the frequency with which they were able to have their plan reviewed, and the outcome of their last plan review (Appendix Tables A8.15-A8.17).
Around 40 per cent of all NDIS participants reported that they were either satisfied or very satisfied with the plan review process (41 per cent), the frequency with which they were able to have their NDIS plan reviewed (46 per cent), and with the outcome of their plan review (49 per cent).
Of concern, is that around a fifth of NDIS participants were either dissatisfied or very dissatisfied with the plan review process (22 per cent), the frequency with which they were able to have their plan reviewed (20 per cent), and the outcome of their last plan review (19 per cent).
8.3.2 Experience of plan review process – Evidence from in-depth qualitative interviews
The perspective of NDIS participants and their family members or carer
There were inconsistencies in how participants and carers understood the plan review process; some believed it to be a dynamic ongoing process while others believed plans could only be changed at annual or bi-annual review meetings. Many plans, however, had been changed outside of formal review but there was dissatisfaction with the level of paperwork involved in making even small changes to plans.
With the exception of one NDIS participant whose initial plan took much longer than usual to be completed, all respondents had experienced one or more annual plan reviews. The outcomes of the review process have been discussed in chapter 3 and 4. Here we consider the experience of the review process for participants and their families.
For most respondents the experience of review was different from initial planning. Home visits were generally not offered. Most respondents noted visiting the NDIA office for the review appointment and several reviews were conducted by phone.
For many there was considerable anxiety in advance of the plan review appointment. Concerns related to fears that plans would be required to fit within a standardised (capped) amount based on their severity of disability. Fears were also expressed that that unused funds would result in the down-sizing of packages regardless of reasons for this having occurred.
So that’s one concern that I've got is that if he doesn’t use his allocation this year then we don’t want to be penalised the next year because the next year could have been like last year when he used all his allocation. So that’s a concern I have. (A17C W2)
Plan reviews were generally undertaken by a different planner to the one that had put together the initial plan. This appeared in part due to high NDIA staff turnover and staff movement between NDIA offices. In the majority of cases this was unwelcome as it disrupted previously established relationships. In a few cases, however, having a new planner led to a more positive process.
The thing is when you set up, start with a planner and you let them into your home and your life and to do that all again with someone different in 12 months is not really a good thing I don’t think… but I didn’t have any choice. There was no choice in the matter. There was no are you okay with that Dani, you know? It was this is what’s happening. (C14C W2)
NDIA staff experience and knowledge of particular disability types was again raised as being an important factor that influenced satisfaction levels in the plan review process.
I don't believe I would have had to push for that with my original planner, she would have been absolutely, that's definitely what you need. Again, she comes from a background of understanding early intervention. I feel that's the difference with planners. I feel like grilling them, where have you come from, how did you get this gig? But I don't. (C12C W2)
As previously mentioned, most participants stressed the importance of preparing for the review to ensure the development of an appropriate and beneficial plan. Preparation appeared to be effective in assisting respondents to understand what supports they needed, to develop achievable goals and in justifying these to the NDIA at the time of the review. Some of the preparation tasks that respondents mentioned were discussing the participant’s needs and support services with relevant stakeholders (including therapists, advocates and case managers) and prompting therapists’ assessment reports to be completed prior to the review date.
And that’s what I often say to anyone who's going in, ‘Go prepared, know what you want’. If you don’t know what you want you won't get it and you can't guarantee coming in four weeks or six weeks or eight weeks later saying I thought of something else. (B11 C W2)
I was a bit more prepared and confident in myself with dealing with them because I’d gone to two workshops that [Name of provider] had held about your plan and what to ask for if you’re up to it and break it down. They empowered us on what our rights are. (B08 PWD W2)
A commonly reported challenge related to plan review processes in wave 2 was the experience of long delays for reviews to be held and plans to be finalised or that revised plans were not efficiently finalised by the NDIA. This caused frustration on the part of respondents, strained relationships with service providers who were not being remunerated in a timely manner, and in extreme cases prevented access to funding for services because a finalised plan had not been received.
So no plan came by the end of November. I had service providers saying ‘We’ve now provided into early December. We’re providing services for your son. Your plan’s expired. What’s happening with your new plan?’ So I would write to [the planner] and nothing would come from it. And so it went on. We didn’t get a new plan until mid-January, by which time the service providers were a bit cross. (B10 C W2)
Another challenge in the review process related to obtaining assessment reports from therapists as per NDIA’s evidence requirements. Respondents reported therapists were slow to provide assessment reports. There also appeared to be an inconsistency over who paid for these reports; the respondent or the NDIA.
But they hadn’t written their reports so trying to hassle them to get their reports in time I guess. Especially the OT report which we managed to get the day of the plan review. (B02 PWD W2)
Several respondents had disputed decisions in their own or their child’s plan, following initial planning. Many NDIS participants had sought help from an external advocate and felt this had been beneficial, while in other cases disputes were satisfactorily mediated by senior NDIA staff. For some though, the process of resolving disputes was more difficult and took time.
The perspective of people with disability not participating in the NDIS
None of the non-NDIS participants reported participating in NDIS dispute resolution processes because they were unhappy with their support plan or with being found ineligible for the NDIS. One respondent reported receiving advice from the NDIA that a re-application would be easier than appealing an ‘ineligible’ decision. This appeared to be reinforced by the number of non-participants who reported making multiple applications to enter the NDIS.
The perspective of the service provider and workforce stakeholder organisations
Evidence was provided of clients who had at first been very satisfied with their NDIS plan but had then had their plans and funding cut considerably at review with little or no explanation as to why.
So we have people that go look my first was fantastic, I got what I needed, I felt supported, I went back for the review and I got someone who was useless and they decided to take away money, they didn’t explain to us really why. (A03S W2)
Some providers suggested that the NDIA were under pressure to cut back funding and supports which meant that the funding levels in initial plans in the trial sites would be reduced to ensure the NDIS remained sustainable in the future.
I think a big question exists as to the overall system’s long-term sustainability, and I suspect that the quantum of money that is assigned to each plan over time will reduce. (A01S W2)
The perspective of the NDIA staff
Efficiencies in the NDIS planning and review process had been introduced between the wave 1 and 2 interviews. Efficiencies included reviews conducted by telephone rather than face-to-face and the move to biennial rather than annual reviews of participants’ plans.
One of the main challenges with the plan reviews was NDIA staff workload. planners were not only engaged in conducting reviews for participants, they were concurrently also working with new participants on plan development; with the review process often being just as labour intensive for the planner as developing initial plans. In many instances this resulted in plan reviews being conducted by any planner available at the time of review rather than the original planner.
You know when we first started, I think I said to you last year we had said that, ‘You’ll have a PSC [Plan Support Coordinator] who’ll be your PSC, you’ll see initially and you’ll see at review and they’ll be with you for your NDIS journey.’ That’s not happening at all. It’s basically, whoever is available to do the review does the review. (E05N W2)
Inefficiencies in the computer system, which required double entry of data, further exacerbated the workload for NDIA staff engaged in planning and review.
Difficulties around interpreting and reviewing plans developed by another planner/PSC were also reported.
