NDIS Issues Register – July 2018IssuePricesProviders rank the short-fall between prices and costs as the greatest impediment to their capacity to supply services.1 Of the several levers available to manage NDIS costs, the NDIA has made disproportionate use of pricing. This has resulted in significant financial pressure on service providers and a heightened risk that the gap between market supply and demand for services will grow.

Some of the assumptions that underpin the one-to-one support price (for personal care and community participation) are unrealistic and untested with evidence. NDS is not alone in raising concerns. Employers, workers and their unions are all questioning NDIS prices. A research paper published by the University of NSW in July 2017 (commissioned by three unions: HSU, ASU and United Voice) draws heavily on the views and experiences of disability support workers. It reads, in part:

"Prices for disability support work set by the NDIA according to the 'Reasonable Cost Model' do not enable minimum Award conditions to be met, and prevent employers who offer above-Award conditions from meeting their legal obligations. Prices do not account for what is required to deliver high quality services, and arrangements are not fully enabling disability support workers to deliver services which are personalised, coordinated, responsive or safe. Quality is likely to diminish in the process of NDIS expansion."

An Independent Pricing Review (IPR), undertaken by McKinsey & Company, focused on complexity, thin markets, provider efficiencies, and provider returns. It promises some relief, but not enough. The report finds that, while some providers can operate profitably at current prices, many are struggling. It recommends adjusting a range of prices and introducing a modest broad-based temporary supplement. Unfortunately, the report does not accept that the standard one-to-one support price is based on flawed assumptions.

The Australian National Audit Office has raised the question of whether the NDIA has a conflict of interest in being both a price setter and a funder. In its recent report on NDIS costs, the Productivity Commission recommends that price-setting be transparent, evidence-based, responsive to regional differences and regulated only

1 NDS State of the Disability Sector Report 2016

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when and where necessary. It recommends that price-setting be transferred from the NDIA to the new National Quality and Safeguards Commission.

What NDS is seeking

Revise the assumptions underpinning the Reasonable Cost Model for 1:1 support and community participation

Fund the user cost of capital for day centres Set prices that reflect jurisdictional and geographical differences Pilot outcomes-based approaches to pricing Extend price deregulation Maintain the temporary support for overheads’ price supplement of 2-3 per cent on the

standard hourly rate until the Agency has fully reformed its systems and processes Supported Independent Living (SIL) quotes are approved in a timely manner

Status

New payment requirements require providers to include additional information in the payment request, including the claim type and cancellation reason, if applicable – Read NDS news update.

The 2018-19 SDA Price Guide will be released shortly. SIL quotes that were approved without indexation will be indexed. The NDIA national provider payment team (NPPT), will expand in July. This team

will also centralise approvals for SIL quotes. NDIA will soon release two provider self-help guides on how to address

payment problems and a one-page payment issues template to assist providers and expedite payments. NDS provided feedback on these resources.

Active service bookings at 1 July were adjusted in line with indexation. NDIS price for one-to-one support increased by 7.64% – Read the NDS news

update for an analysis of the 2018/19 Price Guide and download the NDIA summary of updated pricing arrangements. NDS continues to argue for a substantial and permanent increase to the one-to-one attendant care support price, which is essential to reduce the risk of market failure.

NDS survey on community participation and centre-based supports raises questions about growth - 30 per cent of community participation providers and 50 per cent of centre-based providers are planning to cease, shrink or not grow their services under NDIS prices, according to the results of an NDS survey – Read the NDS news update.

The 2018-19 Federal Budget provides $64.3 million to establish an NDIS Jobs and Market Fund to stimulate growth and investment – Read the NDS news update and download the NDS Factsheet and NDS member webinar: Budget Briefing with Ken Baker.

The final evaluation report on the NDIS, led by researchers at Flinders University, echoes concerns raised by NDS that “the supply of disability supports is not

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growing sufficiently to meet the additional demand created by the NDIS.” The greatest concerns about inadequate pricing were directed at prices for one-to-one community participation, mental health services, group services and people with complex needs – Read the NDS news update.

AbleInsight published the first public report from the newly established Disability Service Providers’ Benchmarking Function.

Ken Baker’s Dialogue provides further analysis of the IPR recommendations. The IPR final report, released on 2 March 2018, includes 25 recommendations

that have been accepted in principle by the NDIA Board, with specific implementation timeframes - Read the NDS news update and NDIA response.

NDS’s financial sustainability report signals the need for better pricing. The Productivity Commission’s final report on NDIS costs was released in

October - Read NDS’s submission and NDIA’s response to the Position paper.

IssuePlanningThere is major pressure on the NDIS to accelerate the development, approval and activation of plans as the scheme expands from 151,970 participants with approved plans, and a further 10,253 children supported in the ECEI gateway - which is 70 per cent of the estimate until 31 December 2017 (78 per cent of the bilateral estimate from July 2013)2 - to approximately 460,000 at full scheme. The pressure to meet ambitious intake targets is putting planning processes under considerable strain. As the Productivity Commission observes:

“In the June 2017 quarter, the NDIA approved about 15,000 plans or roughly 165 plans a day. In 2018-19 (the final year of transition), the NDIA will need to approve about 500 plans a day, while also reviewing hundreds more.”3

The quality of planning by the NDIA and Local Area Coordinators (LAC) is inconsistent and often requires substantial effort by participants, their families and providers to correct plan. Plan quality is impaired by three structural factors:

Ambitious NDIS implementation targets agreed in the intergovernmental agreements are driving rapid high-volume processing of participant plans. The Productivity Commission concludes that “the performance reporting framework does not have a strong enough focus on reporting on quality, including the quality of participant plans.”4

Planners have limited information about the services people entering the scheme received from state and territory-funded systems, at times causing them to omit essential supports in plans.

2 Q3 of Year 5 Report to COAG Disability Reform Council 2018/19, page 3-43 Productivity Commission, Report on NDIS Costs, October 2017, page 114 Productivity Commission Study Report, October 2017, page 429

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Newly-recruited LACs may lack experience and knowledge of disability services. The NDIA dictates that LACs generally cannot be disability service organisations based on a potential conflict of interest.

Providers continue to report the following concerns: First plans are often missing essential supports, such as supported

independent living (SIL) and equipment Funding for quotable items in plans are often delayed Significant reduction of supports in some plans

Since the Scheme’s inception there has been 757 appeals to the AAT.5 In addition, there were 4,146 complaints made to the NDIA, making a total of 17,352 since the Scheme began.6

Too few plans include employment supports. Only 5.4 per cent of funds in plans for participants aged 15 to 24 years, and only 2.1 per cent for participants aged over 25 years, are for employment supports.7

People with complex conditions should have support coordination in their plan, particularly people whose condition is changing and who need to combine NDIS supports with other services.

What NDS is seeking

Focus on the quality of plans, not just the volume Use providers’ knowledge about existing supports to inform plans and reviews Allow service providers to undertake planning if participants choose them Adopt an ‘employment first’ approach to NDIS planning for participants of

workforce age Enable minor plan amendments without triggering a plan review Timely response to authorising quotes (e.g. SIL and equipment) Always include support coordination in plans for participants with complex conditions

(e.g. people with psychosocial disability and progressive neurodegenerative diseases) Allow providers to access NDIS plans, prior to an active Service Booking, with

consent from the participant

Status

Backlog of reviews shows a system under distress – Read the NDS news update . The final evaluation report on the NDIS, led by researchers at Flinders University,

found that while the majority of participants feel better off than before the NDIS, a

5 Q3 of Year 5 Report to COAG Disability Reform Council 2018/19, page 436 Q3 of Year 5 Report to COAG Disability Reform Council 2018/19, page 197 Q3 of Year 5 Report to COAG Disability Reform Council 2018/19, National Dashboard

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third feel about the same and 10 - 20 per cent feel worse off – Read the NDS news update.

NDS welcomes the NDIA announcement of a Participant Pathway Review (April 2017). Latest news is available on the NDIS website.

A number of inquiries focus on the poor quality of planning, including:o The Federal Parliament's Joint Standing Committee on the NDIS Progress

Report and inquiries into: Transitional arrangements for the NDIS - Read the NDS submission. Market readiness – Read the NDS submission.

o The Productivity Commission’s final report on NDIS Costs - Read the NDS news update and NDS submission on the draft report.

Bruce Bonyhady, the outgoing Chairman of the NDIA, acknowledged plan quality is a key challenge facing the Agency in implementing the NDIS.

IssueEmergency ResponsePeople with disability and their families need to be able to draw on immediate disability support when emergencies arise, such as when a family under stress relinquishes responsibility for the care of their child late at night; or when an elderly mother caring for an adult son with severe disability is hospitalised and can’t be left alone.

Under state and territory-funded disability systems, arrangements exist for organisations to respond when emergencies arise at any time, regardless of whether the person is in the service system or in receipt of funding. Under the NDIS, there is no national 24/7 response system in place, and accessing funded support is limited to people with an NDIS plan.

During the NDIS trial, providers delivering support coordination extended their hours of operation based on the expectation that they were available around the clock. This was inefficient and the response to a participant emergency comes with no guarantee that the support will be funded retrospectively.

As the Local Area Coordination role is being established across Australia, funding for support coordination is being limited to only some people with high and complex needs. In the current NDIS pricing framework, providers will likely not have the capacity to take on additional unfunded activities without appropriate remuneration.

What NDS is seeking

Establish an emergency response service during transition in NDIS sites that:o Provides emergency support irrespective of NDIS eligibility status;o Is accessible via a national 24/7 phone line;o Prioritises plan reviews or NDIS eligibility on the next business day; and

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o Is tested and refined for full scheme.

Status

NDS’s submission to the Federal Parliament’s Joint Standing Committee on the NDIS inquiry into   market readiness  emphasised the need to clarify provider last resort arrangements, including crisis accommodation. A report is due in August.

The Federal Parliament's Joint Standing Committee on the NDIS report into the transitional arrangements for the NDIS echoes concerns raised in the NDS submission that the “Provider of Last Resort arrangements remain unclear and incomplete”.

NDS provided the NDIA with an emergency and crisis response paper in 2016.

IssueNDIA PortalThe Department of Human Services developed a new ICT system, called ‘myplace’, which was scheduled to be phased in over three years, with the foundations operational from 1 July 2016. Sitting alongside the participant and provider portals will be an e-market, an electronic marketplace where providers and participants can interact. $143M has been committed for the system over four years. 

Although the portal is working better now compared to when it was first launched, its functionality is far less than optimal, which imposes an administrative burden on service providers. Providers are not able to change service bookings without intervention from the NDIA, and there is an unacceptably high number of claiming errors arising from:

Plan dates and/or funding on the portal does not match the participant’s plan; Plan reviews which may include variations to support type and funding

allocation without notification to the provider; and Delayed SIL quote approvals and application of SIL and SDA Service Bookings.

NDIS Payment failures spiked at 12.2 per cent in September 2017 and have remained around 7 to 9 per cent per week since November – based on the NDIS Weekly Payment Summary (the acceptable rate is approximately 4 per cent).

The Agency posted information about portal changes that allow providers to access participants’ information (with participant consent) for people with whom they have active service bookings. However, only Support Coordinators and Plan Managers are able to view the NDIS budget and basic plan details, which leaves many providers at risk.

What NDS is seeking

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The Independent Pricing Review recommendation of a temporary support for overheads’ price supplement of 2 to 3 per cent on the standard hourly rate should not expire before the Agency has fully reformed its systems and processes

An alert function to providers when a plan has been approved/reviewed A reporting function for providers to identify participant plan review date Prices to be auto-populated to reduce data input time and minimise errors Review of the remittance advice format to allow for easier reconciliation Adequate notice to providers regarding portal updates Clarity on the scope and functions of the government’s proposed e-market

Status

The NDIA has advised NDS that they are planning to reinstate the ‘edit service booking’ function. We anticipate this will be available early in the first quarter of 2018/19. NDS will alert members when it is available to providers. 

NDS has provided feedback on portal functionality enhancements being considered.

The NDIA engaged PricewaterhouseCoopers (PwC) to undertake a payments process redesign and implementation project from January – June 2018. NDS met regularly with PWC and the NDIA during this project.

NDIA published information about the provider payments team. If NDS members are experiencing cash flow issues, contact stephanie.worsteling@nds.org.au.

IssueTransport

Without access to transport, many NDIS participants would be isolated and denied opportunities for social and economic participation. The NDIS experience shows tensions between individual transport payments, participant choice, limited or non-existent accessible public transport, utilisation of sector vehicles and coordination of community transport.

The allocation of transport funds needs to consider where participants live and their choice of supports, while applying a ‘reasonable and necessary’ test.

Unresolved questions include: How much funding should be provided by the NDIS to assist participants with transport if they cannot use public transport? What responsibility do state and territory governments have in providing accessible transport for residents with disability, including in regional areas?

The transport issue is complex but requires urgent resolution. Service providers are considering divesting their transport fleets because NDIS funding in individual plans is insufficient to cover ongoing operational costs. If this occurs, participants would be

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severely disadvantaged - or their expenditure on transport would substantially increase.

What NDS is seeking

A solution that includes: Participant transport funding that reflects individual needs and circumstances; funding to cover the cost to providers of maintaining and operating vehicles for specialist transport; continuation of state taxi subsidy schemes; increased effort by state and territory governments to make public transport accessible; and coordination among service providers to increase the utilisation of vehicles – a transport pilot could test different models.

Status

NDS has finalised a Transport Issues Paper (PDF | Wo rd ). An inquiry is underway as to how supported school transport should be provided

for children who are NDIS participants – Read the NDS news update. The NDIA has clarified the flexibility of transport funding within core supports in

the NDIS Q&A 15 January: You can generally use Core Budget funds allocated against one support category to purchase supports under another support category (e.g. transport) unless funds have been set aside for a specific purpose such as periodic payments for transport.

NDIA lost an appeal in a test case for transport funding (the McGarrigle case). It will be returned to the Administrative Appeals Tribunal (AAT) for reconsideration.

NDS has raised concerns around transport through various reviews, including:o NDS submission to the Joint Standing Committee on the NDIS: Market Readinesso NDS response to the Department of Social Services consultation paper on

NDIS Market Oversighto NDS submission to the Joint Standing Committee on the NDIS:

Transitional arrangements for the NDISo NDS submission to the Productivity Commission Position Paper on NDIS Costs o NDS submission to the 2017 Price Controls review by the NDIA.

IssueContinuity of supportIn 2016, the Commonwealth Department of Health (DoH) wrote to providers outlining the Continuity of Support (CoS) arrangements for older people with disability who are ineligible for the NDIS. To be eligible for CoS, a client must be receiving specialist disability services at the time CoS is implemented in their region. About 8,500 people will enter the CoS program. The transition will be completed by June 2019.

The most significant change for service providers is that they will have a contract with DoH for the delivery of supports for eligible people over 65 years.

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The bilateral agreements between the Commonwealth and the states and territories provide a continuity of support guarantee for people under 65 years. Lack of detail about how this guarantee will be delivered is causing anxiety among some current service recipients. Announcements have not yet been made about if and how these supports will be funded at full scheme.

Regarding the boundary between the mental health system and the NDIS, the Productivity Commission comments: “It is unclear what supports will be available for people with a mental illness who do not meet the NDIS eligibility criteria. This should be clarified as a matter of urgency.”

What NDS is seeking

Clarity around the detail of continuity of support arrangements and assurance that funding will be adjusted according to individual needs. This should include arrangements for people in Commonwealth programs – such as Supported Employment, Personal Helpers and Mentors and Partners in Recovery – and people in relevant state and territory programs.

Renewal of the CoS guarantee in bilateral agreements for full scheme.

Status

The 2018-19 Federal also contained some other NDIS related funding measures, including $92.1 million to ensure continuity of support for those not eligible for the NDIS – Read the NDS news update.

The transition to the Commonwealth’s CoS program for seniors with disability who have been accessing direct cash budgets under state disability. Schemes began on 1 January this year, with those in NSW and SA joining first.

In October 2017, Community Options Australia, a not-for-profit specialising in case management and assessment, was appointed by the DoH to deliver the direct funding model under the CoS program. The department estimates 120 clients nationally will be supported under the direct funding model.

In July 2017, the DoH invited tenders to manage the CoS Individual Support Packages Direct Funding Model from January - Read the NDS news update.

The Federal government outlined a new Commonwealth CoS program for aged care and specialist disability services for people aged 65 years and over – with Indigenous Australians aged 50 and over. There are Programme Guidelines (July 2016) and a Programme Manual (April 2017) for people over 65 years.

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IssueRural and remote regions

Ensuring that services in rural and remote areas are sufficient and culturally appropriate is important but difficult. Pricing, economies of scale, climate, geography, culture, workforce shortages, safety and social issues, acute and critical needs all contribute to the complex challenges. Pricing and market failure sound like dry abstract topics until you think about the real life consequences.

The NDIA’s decision-making is centralised, but Australia is a diverse country. Local knowledge and flexibility are critical to implementing the NDIS well in rural and remote regions. The Productivity Commission lists participants who live in outer regional, remote or very remote areas as among those most at risk from market failure: “In the absence of government intervention, there will be greater shortages, less competition, and ultimately poorer outcomes for participants.”8

In its recent report on transition to the NDIS, Federal Parliament’s Joint Standing Committee on the National Disability Insurance Scheme expressed concern about “the lack of services and providers operating in rural and remote areas … the committee acknowledges that the transition to a market based system brings new challenges for delivering services in rural and remote areas. Arrangements to deal with thin markets need to be considered to ensure Participants can access the services they need.”9

The Independent Pricing Review (IPR) final report recognises that “there are cohorts of participants for which supply shortages are high-risk due to the increased cost of service provision and limited availability of workforce”, including people living in outer regional, remote and very remote areas, participants with complex needs, those from CALD backgrounds, Indigenous Australians and people with acute and critical needs.10

The Modified Monash Model (MMM) is used to define areas that attract NDIS price loadings for remote (MMM6) and very remote areas (MMM7). The definitions that determine access to the loadings are so narrow that they exclude a large proportion of regional Australia.

What NDS is seeking

Adequate pricing for rural and remote services, particularly recognising the cost impact of travel and ‘no shows’

Testing of alternative funding and support models for some rural and remote areas, such as bulk purchasing

8 Productivity Commission, Report on NDIS Costs, October 2017, page 369 Joint Standing Committee on the National Disability Insurance Scheme, February 2018, ‘Transitional Arrangements for the NDIS final report, page 2910 McKinsey & Company, Independent Pricing Review final report, March 2018

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Sufficient flexibility to allow local decision-making, without compromising the core design principles of the NDIS

Status

The 2018/19 Price Guides for Remote and Very Remote have been released.

Providers should refer to support price limits based on where the support is delivered, which is not necessarily where the participant lives. The NDIA may enter into arrangements (and at times contracts) with specific providers for provision of services to more remote regions – refer to the 2018/19 Price Guide.

Therapy travel recommendations that will benefit providers will also be introduced from 1 July 2018 (i.e. allowing providers to charge up to 45 minutes of travel time in rural areas). Travel cost arrangements for remote areas can still be claimed, subject to explicit agreement by the participant in advance – refer to the summary of updated price arrangements for 2018/19.

The IPR final report , released 2 March 2018, provided recommendations for rural and remote service provision – Read the NDS news update. Overall, the IPR gives too little attention to the challenges of providing supports in remote regions. Further work is needed to develop feasible initiatives.

The NDIA is establishing tailored planning pathways to meet the unique needs and circumstances of participants, including Aboriginal and Torres Strait Islander communities and remote and very remote communities. 

NDS has raised concerns and recommendations around rural and remote issues through various reviews, including:

o NDS submission to the Joint Standing Committee on the NDIS: Market Readiness. For example, the market oversight function should have a mechanism to respond to planned and unplanned withdrawal of services.

o NDS response to the Department of Social Services consultation paper on NDIS Market Oversight. For example, less disruptive ways to introduce NDIS principles in some remote areas such as block funding or direct commissioning.

o NDS submission to the Joint Standing Committee on the NDIS: Transitional arrangements for the NDIS. For example, further investment in sector development to support small and medium-sized providers, those operating in thin markets, and those providing services to Indigenous people and people from culturally diverse backgrounds; and clarity on the arrangements to manage an emergency or crisis response.

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o NDS submission to the Productivity Commission Position Paper on NDIS Costs

The Rural and Remote Strategy 2016-2019 and Aboriginal and Torres Strait Islander Engagement Strategy have been released.

IssueSupports for people with psychosocial disabilityAt full scheme, about 64,000 people with significant and enduring psychosocial disability will be eligible for the NDIS. This is a small proportion of people who receive services for a mental health condition each year.

During the trial, providers identified a range of uncertainties, including eligibility, planning, pricing, design of supports, workforce, interface with mainstream services and Information, Linkages and Capacity Building (ILC), and continuity of support. 

At 31 December 2017, 7 per cent of NDIS participants had a psychosocial disability11, which is less than expected. There are concerns about inconsistent plan quality, inadequate support coordination and a limited scope of supports for people with psychosocial disability from ILC-commissioned projects. Some providers are not extending supports to new clients with psychosocial disability due to inadequate pricing.

What NDS is seeking

A clear definition of what constitutes ‘complex’ and how the higher intensity loadings are applied

Prices that reflect the costs of supporting people with complex needs Funding for outreach workers to identify and assist people with psychosocial

disability who are likely to be eligible for NDIS Psychosocial disability expertise among planners Support coordination in all plans for people with psychosocial disability Clarity on continuity of support arrangements for people who are not eligible Evaluation of the NDIS interface with mainstream services (e.g. health,

emergency departments) to understand whether people with psychosocial disability are presenting more or less following the introduction of the NDIS

Status

NDS has been meeting with the NDIA and McKinsey and Company to discuss the implementation of the Independent Pricing Review (IPR) including on how complexity is defined.

11 Q3 of Year 5 Report to COAG Disability Reform Council 2018/19, National Dashboard

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Tailored planning pathways are being established to meet the unique needs and circumstances of participants, including participants with complex needs and participants with psychosocial disability.

NDS submission (November 2017) to the Joint Standing Committee on the NDIS inquiry into the transitional arrangements for the NDIS (Answers to Questions on Notice), which highlights the implications for all stakeholders (participants, providers and hospitals) that arise when NDIS participants go to hospital, based on a range of case studies.

The Department of Social Services released a guide (September 2017) to assist Commonwealth mental health providers to understand the NDIS and how to assist people with psychosocial disability to access the NDIS.

The Joint Parliamentary Standing Committee on the NDIS released a report - ‘Provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition' (August 2017) – Read the NDS submission.

NDIA published Mental Health Sector Reference Group communiques until August 2017.

While the Coalition of Australian Governments has agreed to the Principles to Determine the Responsibilities of the NDIS and Other Service Systems, their application has generated areas of dispute and uncertainty.

IssueMoving from block grants to cash claimsSome intergovernmental agreements have imposed complex and burdensome transition arrangements on providers. The move from block grants paid in advance to individualised payments in arrears can cause cash-flow problems for some providers. This is exacerbated when state funding for existing clients decreases prematurely in relation to the commencement of NDIS funding.

Many providers only become aware that a person who they are supporting has transitioned to the NDIS (with an approved NDIS plan) when state or territory funding for that participant ceases. Providers need to be informed when a participant has an approved NDIS plan so they align the supports they are providing with the plan and start claiming for NDIS supports. Unaware of the approved NDIS plan, the provider continues to provide services which may no longer be funded and be difficult to recoup. Consent from participants to inform their current providers should be required during the planning process.

What NDS is seeking

Improved arrangements between state and territory governments and the NDIA on how block grants are reduced as people transition to the NDIS

Measures to reduce financial risk to providers

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In-kind contributions from governments should not continue into full scheme; they should be cashed out

Status

NDS is working with state governments to address issues associated with funding from state government ceasing before the provider is aware that the person has an NDIS plan.

NDS has requested that the NDIA advises the provider when a plan has been approved, with permission from participants.

IssueEmployment supportsTo view a register of the latest unresolved issues surrounding disability employment support, visit the NDS Disability Employment Issues Register .

IssueFuture Funding In the first year of full implementation, the NDIS will cost around $22B; 55 per cent of which will come from the Australian Government and the remainder from state and territory governments. A 0.5 per cent increase to the Medicare Levy, introduced in 2014, will collect money quarantined for the NDIS well in advance of that money being spent. In the longer term, governments will need to find significant new funding for the NDIS in conditions of fiscal restraint.

The 2018-19 Federal Budget secures funding for the NDIS for the foreseeable future. It commits $43 billion of Commonwealth money over the next four years. This is just over half the $83.2 billion total cost of the scheme over this period, consistent with the Commonwealth’s share.

"Funding for the NDIS is in place", says the Government, "and always will be, ensuring that Australians living with disability can access the lifetime care and support they need." Over the coming year, state and territory governments will benefit from the transfer of almost $3.4 billion from the DisabilityCare Australia Fund. This Fund was established in 2014 to assist governments to implement the NDIS and currently holds more than $10 billion. Distribution is contingent upon certain NDIS milestones being reached.

Nothing in politics is ever completely certain and the disability sector will need to continue to maintain a vigilant eye on the future funding of the NDIS to ensure that this, and future governments, maintain their commitment. The NDIS must be financially sustainable; however, it cannot deliver on its promise unless the disability service sector is also sustainable, dynamic and growing.

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The Productivity Commission’s (PC) report into NDIS Costs (October 2017) concludes that the NDIS is operating within its budget, but there are cost pressures on the scheme which need to be managed carefully.

NDS is seeking

Passage of the Bill to secure a revenue stream to fund the NDIS into the future A clear commitment to fully fund the NDIS in the forward estimates of all

governments

Status

NDIA released a Cultural and Linguistic Diverse Strategy 2017-19 – visit the NDIS website for more information.

The 2018-19 Federal Budget secures funding for the NDIS for the foreseeable future. It commits $43 billion of Commonwealth money over the next four years. This is just over half the $83.2 billion total cost of the scheme over this period, consistent with the Commonwealth’s share – Read the NDS news update , and NDS media release and download the NDS Factsheet and NDS member webinar: Budget Briefing with Ken Baker.

The NDS submission to the 2018 Federal Budget focuses on building a strong and dynamic disability support market, expansion of employment opportunities and increased access to housing and education for people with disability.

The PC report recommends that price-setting be transparent; based on evidence; independent; and timely. It should be responsive to regional differences and only regulated where there is a clear case in terms of inflationary effect or harm to participants. To achieve this, the PC recommends:

o The NDIS Quality and Safeguards Commission monitor, review and report on price caps from mid-2018 (when it begins operation) and set prices form mid-2020, with progress towards price deregulation considered by the next independent review of scheme costs in 2023.

o Continued funding of NDS research on the financial sustainability of providers. The NDS submission to the 2017 Federal Budget focused on ensuring the

implementation of the NDIS is sustainable. The 2016 Federal Budget saw the deposit of $2.1B in a special savings account

to fund the future of the NDIS – Read the analysis in the NDS news update.

IssueParticipant deathMany deaths occur suddenly and without warning. There is an anomaly in the NDIS Act 2013 relating to payments of outstanding NDIS amounts following a participant’s death. Section 182 (2) states that:

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“A person is taken not to have been entitled to the payment of an NDIS amount if the payment should not have been made for one or more of the following reasons: … (c) the participant died before the payment was made.”

While the NDIA does pay for services that were delivered prior to the person’s death, this does not cover the costs of necessary and often mandatory tasks that providers undertake following the death of a participant.

What NDS is seeking

Adequate funding to compensate providers for undertaking necessary tasks following a participant’s death

Status

The NDIA is working on a resolution regarding the financial implications for Supported Independent Living (SIL) providers, related to both the participant who has passed away and the shared living funding in other resident plans.

The Specialist Disability Accommodation (SDA) Rules 2016 refer to funding for an additional period in circumstances when vacancy arises due to participant death (Part 6.3):

“Funding for additional period in certain circumstances when vacancy arises if … the SDA dwelling for the participant is enrolled to house two to five residents and … the participant dies”

The Independent Review of the NDIS 2013 Act did not address the issue of provision of funding following a participant death. Decisions by Government on legislative changes are likely to be required in order to progress this issue – Read the NDS submission.

Issue Expansion to full scheme

Full scheme roll out commenced in July 2016, supporting the transition of an estimated 430,000 participants. This rapid expansion of the scheme will require the supply of services to grow at a substantial rate, with sufficient diversity to respond to demand among participants.

A patchwork approach to significant, high risk and scalable reform will have consequences. Service providers need a clear plan and coherent investment strategy from government to support the sector’s development and transition to the National Disability Insurance Scheme (NDIS) market. Such a plan shouldn’t be developed without significant input from the non-government sector.

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The operating environment is presenting obstacles for providers and participants – from the malfunctioning of the NDIS portal to inadequate pricing and workforce shortages. The NDIS cannot deliver on its great promise to people with disability and their families unless there is a strong and sustainable disability services sector.

The Market Position Statements and Market Analysis Dashboards, which the NDIA published in 2015 and 2016, were a welcome step forward; but they have not been updated since then and are now insufficient to provide reliable population estimates and assessments of market depth and concentration as the NDIS expands. 

What NDS is seeking 

Market data made available to providers to inform current and future supply, including:o Trends in purchasing supports and productso Market gaps and areas of unmet needo Patterns of demand based on state government registers and waiting lists

Problems identified during the trial and transition resolved before the NDIS expansion to full scheme

Investment in sector development to boost provider capacity

Status

The date for the completion of the full transition to the NDIS in South Australia has been extended to the end of December 2018 – Read the NDS news update. NDS will continue to speak with governments about whether any other jurisdiction is likely to extend the date for full transition to the NDIS.

The final evaluation report on the NDIS, led by researchers at Flinders University, had a mixed report card - Read the NDS news update.

The NDIA published an Assistive Technology Market Insight paper. Governments signed a bilateral agreement on local delivery of NDIS in WA -

detailed in a NDS news update. NDS released a policy paper ‘How to get the NDIS on Track’, outlining 24

recommendations to improve the operation and implementation of the NDIS. The NDIA Quarterly Reports to the COAG Disability Reform Council now

provide national and jurisdictional dashboards. Three independent reports: PricewaterhouseCoopers, Robyn Kruk and the

Australian National Audit Commission (ANAO), highlighted problems with the capacity of the Agency to scale up at a pace to meet the targets in the bilateral agreement, and the capacity of providers to meet the rapid growth in demand.

The ANAO report says that the DSS should produce and publish a disability workforce action plan that includes specific actions, timeframes, accountabilities and monitoring arrangements. It also highlights the need for government to

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consult service providers in developing an action plan for the NDIS market, sector and workforce.

The COAG Disability Reform Council Communiqué in September 2017 stated, “The Council also expressed concern at broader operational problems and the flow on effect of myplace portal issues leading to a slowdown in the rate of plan approvals for the large number of people that have been deemed eligible for the NDIS since 1 July 2016.”

The NDIA has released Market Position Statements for NSW, Victoria, Queensland, ACT, SA, NT and Tasmania. 

The Intergovernmental agreements are available on the NDIS website.

IssueSector development

Critical to realising the vision of the NDIS is the growth of a dynamic, sustainable and values-driven disability sector. Without this, people with disability and their families will not have the choice and quality of support that the NDIS promises. Existing providers transitioning to the NDIS need to develop new organisational capabilities and make significant changes and innovations to their systems and process.

“A substantial proportion of exiting service providers are unlikely to operate effectively in the new environment without significant transformation… Providers long accustomed to block funding will require support to transition to business models responsive to individualised funding, and to diversify their service offerings to meet the support requirements of NDIS participants”.12

The Australian National Audit Office report on the Transition of the Disability Services Market (November 2016) concluded that the scheme’s implementation is outpacing the preparatory work needed (and also highlighted the absence of a national workforce action plan). The growth in demand for NDIS services will severely test the capacity of the market. Inadequate NDIS systems and processes, an uncertain policy environment and a very tight pricing regime combine to discourage providers from investing in growth.

Service providers need a clear plan and coherent investment strategy from government to support the sector’s development and transition to the NDIS market. Such a plan shouldn’t be developed without significant input from the non-government sector.

The 2012 Federal Budget allocated $122.6M to a Sector development Fund (SDF) which expires in June this year, 2018 (with all funding committed, if not expended). The SDF has sponsored many good initiatives, such as the NDIS Provider

12 Sector Development Fund Strategy and Operational and Guidelines, Department of Social Services, December 2015

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Readiness Toolkit. However, broad sector development is still required to enable the sector to prepare for and grow in response to the rapid escalation of demand as the NDIS roll out continues to 2020. Poor coordination across the activities and initiatives in which the SDF and state governments have invested risks national duplication of effort.

What NDS is seeking 

Market data made available to inform current and future supply, including:o Trends in purchasing supports and productso Market gaps and areas of unmet needs

NDS supports recommendations by the Productivity Commission, including:o Prioritise the implementation of an e-market to improve information flows o Publish market position statements with additional information o Fund the ABS to regularly collect detailed information on the disability workforceo Increase government focus on the NDIS and mainstream interfaces o Increase the funding for ILC to $131M for each year of transition, during which

time a review should be undertaken Continuation of highly successful initiatives that have demonstrated the value of

nationally consistent data collection for service providers and for Government, including the NDS National Financial Benchmarking and Workforce Wizard

Better coordination of federally and state funded initiatives, especially in relation to data collection, to inform a cohesive national view of sector transition

Successful projects funded by state governments made available nationally

Status

In a welcome move, the 2018-19 federal Budget provides $64.3 million over three years to establish an NDIS Jobs and Market Fund to stimulate growth and investment – Read the NDS news update.

NDS’s submission to the Federal Parliament’s Joint Standing Committee on the NDIS inquiry into   market readiness  urges Government to “commit additional funding (over the next four years) to assist providers with the demanding changes required of them as they transition to the NDIS.

The final report by the Federal Parliament's Joint Standing Committee on the NDIS for the inquiry into the transitional arrangements for the NDIS highlights the effectiveness of the Sector Development Fund and Innovative Workforce Fund as “valuable ways to ensure a ready and appropriately skilled workforce” (p55) - Read the NDS submission.

Three independent reports (Price Waterhouse Coopers, Robyn Kruk and the Australian National Audit Commission) highlighted problems with the capacity of the Agency to scale up at a pace to meet the targets in the bilateral agreement, and the capacity of providers to meet the rapid growth in demand.

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The ANAO report says that the Department of Social Services should produce and publish a disability workforce action plan which includes specific actions, timeframes, accountabilities and monitoring arrangements.

NDS maintains that the Integrated Market, Sector and Workforce Strategy , developed by the Commonwealth, states and the NDIA, lacks an action plan and that an industry plan is required to provide direction to federal and state investment in the further sector development.

NDS was funded to develop and deliver national projects: NDIS Provider Toolkit, Community Inclusion Initiative, and the NDIS IT System Selection Program.

IssueInformation, Linkages and Capacity BuildingInformation, Linkages and Capacity Building (ILC), formerly known as ‘Tier 2’, is a key component of the NDIS insurance model. It will contribute to the sustainability of the NDIS by building the capacity of the community, people with disability, their families and carers, and greater community inclusion. Over time, it is intended that these developments will reduce the demand for, and level of specialist disability support required by many people with disability.

ILC is being piloted in the ACT, which commenced in July 2017, and will start in SA and NSW from July 2018 and Tasmania, Victoria, Queensland and NT from July 2019. Funding for ILC will reach $132M by 2019 to 2020, not including Local Area Coordination (LAC). 

Essential services, expertise and social capital could be lost in the transition to the NDIS if the NDIA does not provide ongoing block funding for some activities, such as volunteer coordination and information services. 

It is disappointing to see the NDIA persist with very short-term contracts, contrary to the Productivity Commission’s recommendation that the standard contract period for community service grants be set at seven years.

The ambitious timeframe for implementing the NDIS has forced LACs to prioritise planning at the cost of providing assistance to connect people with community or mainstream services. Often, this responsibility has fallen to providers who have not been funded to undertake it.

What NDS is seeking

An ILC program that builds on existing effective community organisation activities that promote greater community inclusion

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Longer-term ILC contracts Bulk purchasing (block funding) of some services Sector involvement in co-designing the ILC Framework

Status

The LAC and ECEI partners in Northern Territory will commence in July 2018 – Read the DSS media release.

The results of the latest ILC  national  and  jurisdictional  grants round have been released, allocating $56 million to an array of projects over the next two years.

Providers with programs that engage volunteers will be pleased to see a recommendation from the Productivity Commission final report for the NDIA to fund the initial costs of connecting participants with volunteers and the ongoing costs of volunteer management. Without funding, valuable programs will be lost.

The final report by the Federal Parliament's Joint Standing Committee on the NDIS for the inquiry into the transitional arrangements for the NDIS raises concerns that “the current grant funding approach for ILC activities may result in service gaps for some essential services and has potential to disadvantage some cohorts because of their type of disability or geographical location.” (page 9.) - Read the NDS submission. It recommends:

o The Australian Government increase funding for ILC to the full Scheme amount of $131 million for each year during the transition (recommendation 15)

o The NDIA monitor the effectiveness of the current ILC grant funding model, with the view of introducing other types of funding, including block funding if required, to ensure appropriate and quality services are delivered across all jurisdictions (recommendation 16)

The NDIS website provides ILC program guidelines, a Toolkit, Outcomes Framework discussion starter, and FAQs.

Phasing dates for LAC and ECEI are detailed in the NDIS Partners in the Community Program Guidelines (page 5).

The LAC for each jurisdiction is summarised on the NDIS website.

IssueNDIS and mainstream servicesThe ILC Framework will play an important role in facilitating referral and linkages to and from mainstream service systems for people with disability. While the COAG has agreed to the principles that govern the interaction between the NDIS and mainstream services, their application has generated areas of dispute and uncertainty. Developing effective interfaces between the NDIS and mainstream services is a work in progress. More clarity is required for interfaces with health, education, transport, child protection and mental health.

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If these interactions are poorly-managed, NDIS participants and support providers will be disadvantaged. Keeping state and territory governments engaged is critical, particularly in relation to the interface of mainstream services and the NDIS, and where there are risks associated with programs/initiatives being lost during the transition.

What NDS is seeking

NDS supports the draft recommendation in the Productivity Commission’s position paper on NDIS Costs (June 2017, Page 57) to include:o A standing item on the agenda of every COAG Council that has

responsibility for a service area that interfaces with the NDIS. This would foster regular discussions to resolve uncertainties about service gaps, responsibilities and other boundary issues.

o Review points of National Agreements and National Partnership Agreements should include specific commitments and reporting obligations consistent with the National Disability Strategy (including how boundary issues are being dealt with).

Practical protocols between the NDIS, health, aged care, education and other service systems to ensure the availability of coordinated support, particularly for people with complex needs.

Clarity on and timely resolution of interface issues to enable people with disability to get the most effective combination of support.

Status

The Summer Foundation, in partnership with two regional hospitals and the NDIS, is working towards testing new approaches to discharge planning as part of its Hospital Discharge Project.

The Nepean Blue Mountains Local Health District (NBMLHD) is undertaking a project to develop a formal agreement on the role of disability support workers in NBMLHD Hospitals.

The Joint Parliamentary Standing Committee on the NDIS released a report on transition to NDIS focused on emerging service gaps, including those with the mainstream interface. The recommendations align with what NDS has been advocating for at a national level - Read the NDS submission. An additional NDS submission (Answers to Questions on Notice), highlights the implications for all stakeholders (participants, providers and hospitals) that arise when NDIS participants go to hospital based on a range of case studies.

Factsheets from the Department of Health have been updated and provide clarity to providers and participants regarding young people in residential aged care. Under the NDIS arrangements, if the younger person in a residential aged

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care home requires additional support above the residential care subsidy and supplements for that person, this funding will be provided through the NDIS.

A Senate Committee reported on the delivery of outcomes under the National Disability Strategy 2010-20 – Read the NDS submission.

The Federal Parliament's Joint Standing Committee Progress Report noted that “The Commonwealth has entered into Bilateral Agreements with State and Territory Governments to delineate the types of services to be provided and funded by the NDIS and mainstream services. The boundary issues are yet to be tested.”

IssueQuality and Safeguards

The NDIS Quality and Safeguards Commission (NDIS Commission) will commence in 2018 and gradually bring together the nine systems operating across Australia, providing a single nationally-consistent approach for regulating the NDIS across the country. It will begin to regulate providers in New South Wales and South Australia from July 2018.

NDS’s main concerns about the new quality and safeguards framework are: the ‘unlevel playing field’ among providers, with some being unregistered; problematic definitions of ‘sharp practices’; costs of compliance; transition to the new system; and uncertainty about the Commission’s intentions regarding education and awareness raising.

Considerable support during the Framework consultation period was given to a community visitor function within the NDIS, but questions were raised over how such a program would fit within the changing system. During the NDIS transition, existing state and territory community visitor schemes will continue. An evaluation of the community visitors programs will be undertaken, the results of which will inform future decisions.

There is less regulation for NDIS participants who choose to self-manage their package. They will be able to purchase supports from unregistered providers. Unregistered providers will not have to meet Quality Assurance auditing requirements or be compelled to report serious incidents to the NDIS complaints commissioner. Given that the NDIA is promoting self-management, this gap in the Framework will potentially expose an increasing number of participants to risk.

NDS has raised concerns with the Department about providers having to bear the cost of QA auditing, particularly in the context of tight NDIA pricing. The Department of Social Services (DSS) is giving consideration to this matter.

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Government commitment to subsidise the significant cost of quality assurance in the new system does not extend beyond organisations operating in ‘thin markets’.

What NDS is seeking

A national system, co-designed with the sector, which recognises that:o Minimum standards and reporting requirements should apply across all

providerso Regulation has a minority role in promoting quality and safeguardso Individual planning is a means of managing risko Choice is a necessary but insufficient driver of qualityo NDIS prices should incorporate the cost of compliance

Clear criteria to guide the selection of organisations over which the NDS Commission will have prudential oversight

NDIA to establish a mechanism for planned and unplanned withdrawal of services Government investment in building the sector’s capacity to embed human rights-

based cultures and prevent and respond to abuse and neglect

Status

A new NDS webpage provides the latest information on NDIS Quality and Safeguards and a NDS webinar which covers the roles and functions of the NDIS Commission and the operational implications of the new Framework for providers.

New Rules tabled in Federal Parliament outline requirements for providers under the new NDIS Commission – Read the NDS news update.

The 2018-19 federal Budget allocated $43 million to establish the NDIS Commission. This funding will establish the national office and a regional office for NSW and SA – operating from July – with a total staff of 164.

The Disability Reform Council will soon consider a market stewardship framework, which will ideally clarify information requirements, responsibilities across government agencies, market interventions and the circumstances under which government would intervene. The NDS response to the DSS consultation paper on NDIS Market Oversight emphasises the need to define the responsibilities of several government agencies that have a role in NDIS market stewardship.

Graeme Head has been appointed the inaugural NDIS Quality and Safeguards Commissioner. He began work with DSS in early 2018 in preparation for the three-year appointment from July 2018. Other positions announced include: o Sam Taylor, Registratrar (previously at NSW Department of Family and

Community Services) o Miranda Bruyniks, Complaints Commissioner (previously at Victorian

Disability Services Commission)

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o Dr Jeffrey Chan, Senior Practitioner (previously held Senior Practitioner roles in Victoria and Queensland)

The NDIS Quality and Safeguarding Framework was released in February 2017 - Read NDS news update for the Framework regulatory components.

The Australian National Audit Office (ANAO) NDIA Fraud Control Program focuses on assessing the efficient and effective implementation of government programs. The ANAO is due to table a report in September 2018.

The NDIS Commission released three factsheets: One for providers and participants and a general overview. The NDIS Provider Toolkit Section 2.7 has been updated to reflect this information.

NDS’s submission into the draft NDIS Code of Conduct recommends that separate Codes be developed - One for workers and one for employers.

A Bill to establish the national NDIS Commission was tabled in Parliament – A NDS news update summarises its function and authorities.

NDS’s Zero Tolerance Initiative offers practical free resources for frontline workers, supervisors and boards of management.

IssueHousingUnless action is taken soon, more than 100,000 NDIS participants could be without access to adequate, accessible, affordable housing by 2020. The need to stimulate accessible and affordable housing for non-eligible NDIS participants remains.

The NDIS has an annual recurrent budget of $700M for Specialist Disability Accommodation (SDA) at full scheme, which will support about 28,000 (6 per cent) of NDIS participants. Current national supply is 14,000. National growth is estimated at 500 units annually rising to 900 in 2019 and back below 500 in 2022. To connect demand with supply within this small market is very difficult. Developers need sophisticated demand information to make investment decisions that are compatible with participant needs and preferences.

Balancing choice with reasonable and necessary and value for money can have significant financial implications. For example, if five NDIS participants requiring high physical support accommodation decided to live in a two-bedroom apartment instead of a group home, it would cost the NDIS more than $300,000 extra per annum extra.

In-kind arrangements restrict participant choice and tilt the market in favour of filling vacancies in government-run accommodation before NGOs. This is inconsistent with competitive neutrality. Despite important assurances from David Bowen, the former NDIA CEO, in-kind arrangements should not continue beyond the NDIS transition. David Bowen stated that the NDIA will not enforce the separation of the landlord and disability support roles beyond separate service agreements. This is not in writing.

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What NDS is seeking

Greater certainty of SDA prices beyond 2021 SDA market profile data to stimulate new innovative housing Nationally consistent approach to vacancy management Nomination rights that ultimately sit with the participant Effective use of the NDIA housing fund to leverage the growth of accessible and

appropriate housing in a timely fashion A commitment and action plan from governments to address broader issues

around housing access and affordability for non-NDIS participants; for example, legislating a minimum access provision for all new residential housing.

Status

NDS’ submission to Review of the Specialist Disability Accommodation (SDA) Pricing and Payments Framework recommended the number of categories be reduced.  In November, the Disability Reform Council agreed the review would be undertaken in its third year of operation (1 July 2018 to 30 June 2019). Outcomes of the Review will be considered in September 2018 – Read the NDS news update

A new SIL quoting tool, soon to be released, includes more automated features. It will be explicit about the need to include an indexation adjustment. Providers are reminded to quote for 53 weeks. As SIL funding is based on a quote, the Price Guide no longer lists benchmark prices for these supports. The temporary support for overheads (TSO) adjustment does not apply to SIL prices. The NDIA is also planning to release a one-page SIL Quoting Template to streamline plan reviews for participants with little or no change to their support needs.

The NDIA released the SDA Provider and Investor Brief to provide a clear explanation of SDA to prospective investors and providers. The Brief is explicit about the fact that only a small number of SDA-eligible participants will receive SDA funding to live alone – Read the NDS news update.

The Summer Foundation published a ‘SDA Market Insights’ report based on a national study.

NDS published a SIL Quoting Practical Guide. Providers continue to report ongoing issues related to the SIL quoting process

and template. NDS provides regular feedback to the NDIA regarding issues associated with the SIL quoting process and template and SDA payments.

The Summer Foundation and PricewaterhouseCoopers released a report — NDIS Specialist Disability Accommodation: Pathway to a mature market. Other SDA resources are available on the Summer Foundation website.

The SDA Rules 2016 are summarised in an NDS news update. SDA operational guidelines provide guidance in relation to the preparation and

review of a participant’s plan when SDA is to be considered. Registrations opened for providers of SDA in June 2016. Registration

information and dwelling enrolment for SDA is available on the NDIS website.

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The SDA Pricing and Payments Decision Paper (1 June 2016) sets out the NDIA’s final decisions in relation to initial SDA Benchmark pricing and payments.

IssueWorkforceA skilled, sufficiently large and diversified workforce is central to the NDIS’s promise to deliver choice and quality services for people with disability. To meet the demand for services, the disability support workforce will need to double in size and be capable of providing high-quality support.

NDIA pricing is currently one barrier to this, as it underestimates the time and costs associated with high-quality disability work. Existing industrial arrangements are another key challenge to transitioning services to the NDIS – balancing attractive and fair employment conditions with flexible service delivery, under lean prices and growing demand for workers.

In mid-2017, a report prepared for the Health Services Union, Australian Services Union and United Voice highlighted the link between NDIS prices, working conditions and the quality of services. The ‘Reasonable, valued and necessary’ report found, in short, that “the current NDIS can’t provide decent jobs”.

What NDS is seeking 

Revision of the assumptions underlying the Reasonable Cost Model (client-facing time, supervision ratios, employment entitlements and classifications).

Testing and building innovative, workable solutions that balance market, workforce and service-user interests.

Status The final evaluation report on the NDIS, led by researchers at Flinders

University, notes the pressure to casualise the workforce and the difficulty of employing experienced skilled staff with tight NDIS pricing - Read the NDS news update for some early insights into the workforce.

The second edition of NDS’s publication, the Australian Disability Workforce report , released on 2 March 2018, describes trends over ten quarters of data collection.

In December 2017, the Department of Social Services (DSS) awarded the $33 million Boosting the Local Care Workforce Strategy to consultants Ernst and Young, partnering with Serendipity employment services provider and the Community Services Industry Alliance.

NDS’s Workforce Hub continues to add resources in four focus areas: Building, Optimising, Knowing and Developing your Workforce. A set of resources about costing working time are the most recent additions. The Analysing Time guide

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and related templates are available as part of the Understanding Workforce Costs area, with workshops taking place in some states.

The Australian National Audit Office report says that DSS should produce (in consultation with service providers) and publish a disability workforce action plan which includes specific actions, timeframes, accountabilities and monitoring arrangements.

The Modern Award Review is coming to an end after over four years. Both ‘common issues’ relevant to all industries and SCHADS-specific issues were the subject of conciliations and hearings in 2016 and 2017. The Fair Work Commission is determining these gradually, with the latest – a variation to Clause 10.3 which sets out conditions for part-time work - released in December.

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IssueResearchPolicy and practice-relevant research is essential to support the implementation of the NDIS and the National Disability Strategy. The NDIS’s basis in insurance principles and the long-term benefits of early intervention needs to be underpinned by the best available evidence, effectively mobilised to people with disability, their families and carers (to support informed choices), and the service providers they choose (to support evidence-informed practice and innovation).

Research and data are essential to assist service providers to make investment and expansion decisions and to inform the government’s market stewardship function. NDS’s Federal Budget Submission identifies investment in research and data collection as one of seven priorities.

NDS is concerned about the lack of reliable, timely and accurate data to support service planning. This concern is echoed in the Productivity Commission’s recent report on the NDIS, which underlines the connection between data and research and effective government stewardship: “The release of timely, market-relevant data [is]…needed urgently ... A better evidence base would enable a deeper understanding of the market and in turn, inform risk-based market stewardship responses.” The Productivity Commission recommends that the NDIA “make public the details of the data it holds and consult with stakeholders on how best to provide access to this data”.

The 2014 Audit of Australian disability research concluded that the current disability research base is ‘not fit for purpose’ for the reform agenda and is fragmented and diversified across topics and study designs. In particular, there is an absence of timely, relevant and practical research for immediate use to policy makers, providers and consumers. 

What NDS is seeking

The establishment of a national disability research entity to drive service innovation and quality improvement. Its objectives would be:o Better coordination and collaboration among researchers, providers,

consumers and government agencies around agreed research priorities;o The efficient co-ordination of disability research activities, expertise and

spending, including better connection between existing funded projects from various sources (ARC, NHMRC, CRC programs);

o Building knowledge of outcomes from interventions or supports;o Building capacity and capability of research end-users; and

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o Facilitating system-wide innovation, including exploration of the potential of Assistive Technology to stimulate sector development.

Increased support for providers to develop their applied research capacity and evaluation evidence, including translating high-quality research into sector practice.

Status

The NDS Centre for Applied Disability Research (CADR) released a series of Research to Action (R2A) Guides. These free resources have been developed to support evidence-based practice, informed choice and, more broadly, innovation in the disability sector.

The NDIS Population Estimates Tool ,  developed by NDS, has been updated with data from the 2016 Census and 2015 Survey of Disability Ageing and Carers, which enables NDS members to estimate the eligible NDIS population in any combination of Local Government Areas. For enquiries about disability statistics and population data, contact Lesley Reid, Senior Researcher/Data Manager, on (08) 9208 9820 or at lesley.reid@nds.org.au.

NDS continues to offer benchmarking services for disability service providers to generate evidence for advocacy on policy and effective market stewardship, including:o Workforce metrics – via Workforce Wizard. For enquiries about workforce

data, contact Caroline Alcorso, National Manager of Workforce Development, on (02) 9256 3180 or at caroline.alcorso@nds.org.au.

o Financial Benchmarking . For enquiries about the NDS Financial Benchmarking project, contact Gordon Duff, General Manager of Sector Development and Research, on (02) 9256 3117 or at gordon.duff@nds.org.au.

CADR assisting providers to increase their ‘research mindedness’ through initiatives including the Disability Knowledge Clearing House, the ‘Lines of Inquiry’ email news service and Research to Action publications and one-day forums.

The NDIA has specialist reference groups including early intervention, autism, Indigenous and rural and remote service delivery and mental health. 

IssueChildren & Young People

The NDIS commitment to early intervention support funding in the first few years of a child’s life is fundamental. Improved access to therapeutic supports and assistive technology will help prevent or arrest problems in a child's early life and will ultimately boost their capacity to participate in education, employment and to live a good life in their community. It will also reduce the need for long-term support services and ongoing assistance from families and carers.

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The Early Childhood Early Intervention (ECEI) approach was announced in February 2016 has been established longest in the Nepean Blue Mountains. In 2016, the NDIA introduced the Early Childhood Partners for children aged 0 to 6 years to see whether some children can be assisted with relatively low levels of support (for example, connecting them to a local community health centre or playgroup; providing short-term early intervention; or requesting NDIS access and helping the family to develop an NDIS plan). This would divert them from becoming participants of the scheme.

For children with disability, the interaction between the NDIS and mainstream services such as health, education and early childhood services must work well. Shared planning across service systems would improve outcomes and simplify arrangements for families and children.

Delays with assistive technology are impacting on the benefits of early intervention for children due to waiting lists for assessment and delays with funding approval. Some programs previously funded by state government, such as Host Families, need to be considered as they doesn’t easily translate under the NDIS Pricing Framework because it is a payment to the carer or family providing respite.

What NDS is seeking

A trial of joint planning between the NDIS and mainstream services (such as education and health)

An evaluation of the ECEI Partners program Continual release of beneficial evidence-based interventions (and the level of

intensity) for children with particular disabilities Acknowledgement that, for some children, standard transdisciplinary support is

insufficient and higher initial investment is required Monitoring of access to therapeutic supports

Status

The NDIA has asked McKinsey & Co to lead a further consultation process with a range of provider and participant stakeholders specifically about Therapy Price Controls, seeking views on the proposed tiering definitions and price levels, and the best ways of implementing the changes. NDS urged interested NDS National Committee members to participate in the consultation.

NDS has raised concerns about the differentiated prices proposed in the Independent Pricing Review final report (March 2018) for therapy with the NDIA – Read the NDS news update.

The Joint Standing Committee on the NDIS published the report on the Federal Parliamentary inquiry into the   NDIS Early Childhood Early Intervention (ECEI) approach in December 2017 - Read the NDS submission.

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