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

Impacts on Referral Pathways

• 
  Referral pathways from mainstream organisations to disability services prior to the NDIS were observed to have been collaborative and to have worked well. While these networks were largely informal and had been developed over long periods of time, they established practices for referral which were clearly defined and efficient.
  

I know that there were a lot of good relationships on the ground between clinicians in hospitals and outpatients, and local disability service providers, that were just a series of networks and protocols that they had developed over time and that just worked very well…And what I observed when the NDIS came in is that a brick wall went up in all of those, that all of these networks that people had just had to stop. (MS05 SA H)

We did have things like actual protocols which talked to the expectations of Victorian Disability Services system where people were ready for discharge, and what exploration of disability supports we would undertake…. So there were clear authorising documents and clear procedures in which the systems could talk to each other and know how to, expect a response. That of course needs to all be rewritten, and there is absolutely a reluctance from the NDIA to look at protocols to that, or even we don’t call them protocols, arrangements, whatever they could be, something which describes how we work together in those typical circumstances. (MS 25 VIC H)

They worked very well. They were really smooth. So what we would do is obviously we had two service providers, [NAME OF NGOs]. Or if they were a child with a physical disability we would go to [NAME OF NGO]. If it was early intervention or more of an intellectual disability it would go through [Name of NGO]. We’d ring the service provider, we’d get the forms. We would do the referrals. You know if it was [NAME OF NGO] they’d actually be out here the next day meeting the child, meeting the family, therapy would start, a smooth transition from hospital to home having those service providers in place. (MS 10 SA H)

• 
  With the advent of the NDIS these referral pathways had been disrupted and many considered that the interface with the disability sector had gone ‘backwards’.
  

[Prior to the NDIS] we had fairly good systems that were quite responsive. This has been a huge backwards step really for the way that we have operated for children with disability with complex health needs. In terms of our, from a hospital to disability interface in terms of our ability to move children through the system that is hugely backward. (MS 06 SA H)

• 
  Indeed several respondents reflected that the loss of pre-NDIS referral pathways had disrupted contact between services and clinicians. Indeed the loss of these relationships impeded what mainstream organisations referred to as ‘warm referrals’ (MS06 SA H) in which clinicians would facilitate the transition from mainstream services to disability services and provide personalised handovers, rather than placing the responsibility for navigating the system on the person with disability and their family.
  

It’s a fundamental change to the way people access their services. It’s not about service providers talking to each other and providing a handover of information, it’s about the client seeking services, the client having to go to the NDIA, having to get a plan, having to negotiate a plan and having to then choose the services that they access. It’s cut off the ability for service providers to be able to talk to each other to be able to hand over information, and our clinicians found that very frustrating […] So previously they would have phoned somebody, said ‘I’ve got this person here’, and they could have done a direct handover, but they can’t do that anymore. (MS 05 SA H).

Clinicians had a role in referring to providers. That’s been a fundamental shift with the NDIS because it puts the choice and control in the hands of the family, which is good from a philosophical point of view, not necessarily practical […] at the point of referral the clinician, the clinician would make contact with another clinician. It would be service to service, to say ‘Here we’ve got [name] who’s coming to see you. We want to refer him to you. These are his conditions, dah, dah, dah, dah, dah, dah, dah, and particularly note this, this and this’ and it’s sort of warm referral as opposed to this up to the parent to then go and find someone. (MS 06 SA H)

• 
  There was, however, some suggestion that ‘work arounds’ and personalised relationship building with the NDIA at the local level had started to happen.
  

I think the people on the ground are starting to develop local relationships and they’re starting to develop work arounds to the system, so that they can talk more openly. The people at the start were very purists and saying ‘No, we can’t do this. No, we can’t talk to you. No, we can’t do whatever’ because they were rolling out a purist model. And I suppose in many ways, shapes and forms that’s still there because the NDIA are very clear about what their remit is and what they will and won’t do. But what I’m observing is that clinicians on the ground are still developing their relationships, ‘Oh no, we shouldn’t be giving you this referral form so that you know what’s in it but if you could be completing this information and giving it to us well that’s going to help the NDIA to be able to make a decision’. So I’m seeing far more work around type situations developing through relationships that are being built now than what was possible in the early days. (MS 05 SA H)

• 
  Under the NDIS, referral pathways for those who were already receiving services and simply needed to swap their funding provider were reported to have been less problematic than referral pathways for people with disability who had not previously received services. For this latter group, it was observed by health organisations that a number of their clients had needed assistance from frontline staff to navigate NDIS eligibility processes.
  
• 
  A number of challenges were identified in relation to the effectiveness of the referral process to the NDIS, including difficulties contacting and communicating with NDIA staff, a lack of feedback about eligibility outcomes, delays due to NDIA processes, and the loss of pre-NDIS relationships between mainstream and disability providers.