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

Change in Supply and Demand of Mainstream Service

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  Since the introduction of the NDIS, it was observed that some state governments had withdrawn from disability service provision as had some mainstream organisations. In part this was attributed to the cashing out of services and to the feasibility of continuing service provision, given that it is not the core function of these organisations. Another consideration for mainstream providers was difficulty of NDIS processes for registering as a provider.
  

As we’ve progressed through our registration process for becoming a provider I found that if there’s a problem with the application or information that’s missing there’s no, the communication is not two way. So I put our application in, I understood it to be complete, based on the work that I’d done. And heard nothing and heard nothing and heard nothing and heard nothing. And spent the best part of the last six months of last year chasing. It took from July, June until November to get our first registration through and that was the dietetics one and that was a very straightforward registration. It didn’t require any registration under the Disability Services Act, or any accreditation. That’s through now, but that, nobody could tell me why it hadn’t been processed and nobody returned my calls. (MS27 VIC H)

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  Overall, most mainstream organisations continued to provide some services under the in-kind arrangements set out in the bi-lateral agreements between the NDIA and the state governments. A number of these organisations acknowledged that the NDIA had exerted pressure to end in-kind arrangements. This was despite practical problems associated with doing this including maintaining the continuity of service provision for those not eligible for the NDIS.
  

So there’s been a certain amount of pressure to cash out. Because the dollars have been promised or have gone. (MS06 SA H)

More recently, equipment schemes across the country, including ours, have been requested by the NDIA to buy our governance arrangements, so around the provision of equipment. (MS14 ACT H)

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  A number of challenges in managing in-kind arrangements were noted by mainstream organisations. These included changes to the portal that impeded the ability to monitor in-kind arrangements. A lack of communication from the NDIA about the transition from in-kind to cashed-out arrangements was reported and organisations were therefore unaware that they were no longer operating under the in-kind arrangements. In-kind arrangements were also evidenced to result in a duplication of services when NDIS participants were not aware of the services they were receiving as a part of their plan.
  

Some clinicians were saying that they, there was also a lack of understanding on the client’s behalf about what they were receiving from who and so sometimes they would go to their NDIA planner and say ‘Well I get this from Health’ and so it would be left out of their plan, when in actual fact the service that Health was providing was on behalf of the NDIA. And so that we’ve actually had to instigate plan reviews to be able to say ‘Well actually you’ve left this out. It’s not a Health service that they were receiving. It was actually an NDIA service that Health provides on behalf of the NDIA’. (MS05 SA H)

The way the in-kind model should work is that we draw down on the money on paper, and as each child transitions that bit of money goes, and you don’t lose the whole lot at once. But we have only had less than 25 per cent of the children on plans. So the reasons for that have been: the slow transition of children to the Scheme; the lack of awareness or understanding of families that they need to even put this on their plan, so there’s been a lot of education, contacting families, explaining to them ‘When you do your plan you need to ensure this program is on it’. We are continuing to deliver these programs even if they’re not on the plan so these children can get to school and so on, but strictly speaking if we were to cash out we could not provide the service. And the third problem is that the planners themselves don’t know that the program needs to be on the plan. (MS06 SA H)

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  A number of changes in service provision from mainstream organisations were observed, particularly by those in the health and education sectors.
  
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  Demand for sole provider therapy services were observed to have increased under the NDIS, in part driven by the closure of some state disability services. Mainstream health organisations also reported that some of their own staff had left or reduced their hours to establish sole provider therapy services.
  

A lot of support was provided to help the staff there to transition to move out of [GOVERNMENT DISABILITY PROVIDER]. A lot of them have gone into private practice to support the client group they were previously seeing and are working for private industry now. (MS17 ACT H)

There’s also a temptation though for our staff to go and set up private practices as well. We’ve had a number of our staff leave or reduce their hours to go and set up private practice, that number has increased. (MS08 SA H)

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  Mainstream health organisations had also experienced an increase in demand for services, especially ECEI services and assessments, particularly in regional areas. As a result of this increased demand, concerns were raised about the crowding out of other clients from accessing mainstream services.
  

I think where they were just taking on more than what they would have, and what that actually meant is that other people who would, other children who didn’t have a disability, who would have had some sessions of therapy or whatever in outpatients, weren’t getting a service. (MS05 SA H)

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  Education organisations experienced increased demand for therapy provision within schools.
  
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  This level of demand for therapy provision created conflict for schools, whose priority was to maintain their duty of care and their educational obligations for students. Having these providers on site in schools introduced an administrative burden for staff both around managing these visits and ensuring that the provider had all the necessary security clearances to work with children. It also stretched already constrained space resources. In addition, taking students out of class for therapy sessions decreased the time available for their education and was disruptive not only to the student receiving therapy services but also to others in the class. As a result some schools were opting to cease allowing therapy provision.
  

Space in school is sometimes at a premium and then if they are using an office space that then can’t be used by one of our own school psych’s or speech and language pathologists and the costs around that sort of access need to be considered. (MS39 TAS E)

Look to my mind it’s probably the access of NDIA funded therapists, and I’m predominantly speaking about allied health professional wanting to access students during school hours and on school grounds. So it’s the role that those therapists play. And it sometimes comes down to, well there’s obviously legal issues at play around supervision, the purpose of the therapy, and whether the school really is the most appropriate place for it to occur, and then obviously the school’s obligations around duty of care not for that, just to that student but also to all other kids in the school. (MS31 VIC ED)

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  In addition, higher education organisations reported an increase in demand for modifications and equipment to enable students with disability to access their services.
  
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  Meanwhile child protection organisations described an increased demand for case management to assist their clients to navigate the NDIS. However concerns were raised that the skills required for this form of case management were outside the skill set of most of the social workers who typically provided this service.
  
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  Employment organisations observed that they were yet to experience any real change to the demand for their services as a result of the NDIS, as employment was not yet a focus for most NDIS participants. However, they expected that this would change in the future as participants progressed through the NDIS.
  
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  Although no evidence was collected about how the NDIS had impacted upon demand for crisis services, several barriers were identified in relation to accessing these services. First, delays in NDIA processes had resulted in a bottleneck of participants in the acute hospital system, placing pressure on already constrained resources. Second, concerns were raised about access to funding for accommodation as a result of boundary issues between the NDIA and mainstream services.