1. Improving NDIS services in rural and remote areas

Participants in rural and remote areas are highly disadvantaged.  Limited supply means they don’t have choice and control over their services and they have inadequate access to services to benefit from the NDIS.  Choice is further constrained where the higher cost structures of supplying services to these areas is not adequately recognised; travel costs being the obvious example.

Alliance20 wants to ensure that everyone can be supported, no matter where they live. Alliance20 has suggested solutions ranging from better processes for addressing travel viability cases through to engaging large providers in partnership with government/s to assist in areas with significant supply issues and with integrating more fully across health and human services funding and operations.

2. Boosting work outcomes (Including Supported Employment)

The introduction of the NDIS was greeted with significant expectation that employment outcomes would be enhanced, but this has not eventuated. In late 2017 the Productivity Commission noted that only one in five participants had plans with employment supports. Work promotes social and economic independence, providing families and carers with an increased ability to build and maintain their own social and employment relationships. This is an area of significant priority.

Alliance20 has identified possible solutions including raising awareness among planners and participants of employment opportunities, the inclusion of a generic employment line item in the plans of all NDIS participants of working age and improvements to the plan review process.

3. Service provider travel

The cost of travel for a significant number of clients is above the current provisions of the NDIS. Alliance20 believes that up to 20% of clients may be affected.

The result of this situation is that providers often support participants by incurring a loss, or the participants negotiate with providers to utilise their allocated funding to cover travel costs leaving them with less services than planned, that is, less services than they have been assessed as requiring. Both of these situations are untenable.

Service Providers may also have to roster service times for those clients in Regional, Remote and Very Remote zones to minimise the cost of travel. For example, these clients may not receive their preferred service time because the provider is unable to claim for the first or last ‘job’.

The NDIS need have a formal, readily engaged and speedy process identified to deal with travel viability cases. This is especially important for clients in thin markets.

4. Improving NDIS planning and local area coordination

Planning and Local Area Coordination are central to the success of the scheme. The skills, consistency and ability of planners to support participants and families remains limited.  Participants are not being adequately supported and empowered.  Additionally, people with disability who are not eligible for the scheme are not being sufficiently supported to find alternative services.

Alliance20 members can assist with solutions such as revised training and recruitment practices. While respecting the need for an independent planning process, Alliance20 believes that there is a role for greater engagement between the NDIA, LAC providers and service providers which ultimately work with participants and implement plans. Alliance20 members. Additionally, the planning process and funding arrangements need to better integrate elements of the broader human services sector, such as health services, that impact on the lives of people with disability.

5. Enabling effective supported independent living

Supported Independent Living (SIL) services are for a small group of people who typically require substantial levels of NDIS supports and for whom it is important to ensure that accommodation requirements do not restrict their choice and control.  Currently, all SIL providers are experiencing major delays in receiving payments for accommodation services provided to participants.  Many are also having the serious cash flow issues arising from this compounded by inadequate vacancy management funding arrangements.  Taken together, these two issues risk the viability of providers supplying this crucial component of NDIS services.  Their failure will produce very adverse consequences for overall NDIS outcomes.

Alliance20 notes the work underway by the NDIA and while hopeful for improved SIL processes, secured independent living remains complex, cumbersome and inefficient.  Alliance20 has suggested solutions ranging from changed processes to better links across funding requirements, handling of vacancies and planning timeframes.

6. Supporting people with complex and high needs

Alliance20 providers have significant concerns that planners and the NDIA may not have sufficient experience in understanding the requirements of people with complex and high needs. A very small number of people with disability in Australia need specialist and often integrated supports. Many report that they are facing difficulties in having appropriate individual plans developed and are therefore not receiving the services and level of funding they need.  The consequences for their live outcomes and costs to government can be extreme and are unnecessary.

Alliance20 proposes solutions which include greater investment in training and upskilling the current and future workforce, developing and applying a consistent definition of ‘complex’ and ‘high support needs’ and investing in and developing specialised supports in ‘thin markets.

7. Getting Early Childhood Early Intervention right

With the right interventions in early childhood, the lifelong future for children with disability will be open to greater opportunities and choices, often with lesser dependence on disability services.  A determination to achieving this must be a key focus of the NDIS.

Alliance20 has identified a range of matters that need to be addressed and which it could provide assistance with shaping future approaches.  These range from better integration of NDIS with health and education systems to more effective practices and systems.

8. Improving NDIS therapy services

Therapy supports for people with disability is fundamental to promoting independence and quality of life.  For many participants they are a central element in ensuring successful NDIS outcomes.  Therapy services are not being effectively used because of, among many reasons, inadequate expertise in accessing the services, pricing limitations, inadequate investment in higher skills development for therapists and lack of clarity on health versus NDIS responsibilities.

Alliance20 wants to ensure that the benefits from effective therapy services can be fully utilised to achieve long term life improvements for participants. Alliance20 has suggested solutions ranging from addressing the interface with health responsibilities through to changes to pricing and planning arrangements.

9. Improving NDIS specialist disability accommodation (SDA)

This necessary and potentially positive initiative has been implemented, with only very limited funds allocated to establish Specialist Disability Accommodation (SDA). A key issue is that participants are often initially eligible for SDA funding, but that this is withdrawn at the time of plan review or when participants chose to move provider. SDA provisions are overly complex and do not provide certainty for investors and this is impacting the development of partnerships and the roll out of specialist disability accommodation in the interests of NDIS participants with specialist needs.  It is also limiting the choice and control essential for participants who are dependent of specialist accommodation.

Alliance20 has a range of suggested solutions that range from changed rules and policies to different stakeholder engagement arrangements.

10. Building effective quality and safeguarding arrangements

Alliance20 members fully support the Quality and Safeguards Commission.  An independent and effective oversight mechanism is seen as essential to a flexible market which maximises choice and control for people with disability without sacrificing quality and care.  However, concern remains about the relationship between the NDIA and the Commission and the cost to providers of serving people with disability.

Alliance20 is seeking to engage with the Commission to provide input and experience in the development of its systems and policies.

11. Ensuring strong and effective emergency and crisis responses

Crisis responses should reduce as the National Disability Insurance Scheme (NDIS) is fully rolled out across Australia and matures.  However, the need for the right crisis responses for participants with disability will continue. Such crisis responses will continue to require close liaison with other agencies and services, including at federal and state government levels. These relationships were well established in state-managed systems but are at risk of fracturing under the NDIS.

Alliance20 is proposing an emergency response service available nationally to address this risk and which can utilise providers to enable emergency costs to be distributed across health and human service agencies rather than be restricted to the NDIS.

12. Pricing to secure and sustain the NDIS

The most significant and immediate issue facing providers is pricing. Pricing impacts providers’ ability to provide supports required by participants. That is why sustainable pricing is required to secure and sustain a successful implementation and operation of the National Disability Insurance Scheme (NDIS). To date, pricing limitations have impacted on organisations’ ability to provide innovative services and to invest in new service options. For some service types, pricing limitations have affected the viability of services or outlets.

Alliance20 welcomes the new pricing arrangements announced in late March 2019 for therapy, attendant care and community support services. While some of the increases are temporary and other pricing issues are yet to be addressed, Alliance20 members believe that there is still a lack of transparency and complexity around how the NDIA process are set.

13. Creating the industry needed to achieve NDIS goals

The shortage of qualified staff is a well-documented issue with obvious implications for participants.  What is less obvious is the limitations on the capability to deploy the staff to make the NDIS effective.  The entities that currently employ the staff delivering NDIS services are characterised by deep experience in service delivery but virtually non-existent balance sheets reflecting historical funding arrangements where surpluses (profit) were not allowed by governments.  They cannot absorb the risks of upscaling and innovation required by the NDIS.  Other entities who may have the balance sheets to do so do not have the depth of experience of working with people with disability to achieve improved life outcomes.

These are areas where Alliance20 members can assist in developing new workforce and industry development strategies. Collaboration with government and other sectors is required with enhanced leadership from both Commonwealth and state government agencies.  These collaborations can produce an effective sector that delivers better services and outcomes for people with disability at lower overall costs to governments and communities.

14. Support Coordination

Support Coordination is a critical role in assisting participants implement their plans. It is a new role in the disability service system under the NDIS. As a new function, support coordinators need to be skilled in assisting people understand plans and seek and review service options.

Similar to Local Area Coordinators and Planners, experienced and skilled staff need to be available to fill these roles. Support coordinators also need direct and clear access to information about types of services, different providers and NDIA pricing and process arrangements.

Alliance20 members are able to assist with the full establishment of this new service using our vast experience and resources.