1.1
The Joint Standing Committee on the National Disability Insurance Scheme (the committee) was appointed by resolution of the House of Representatives on 4 July 2019 and the Senate on 22 July 2019. The committee is composed of five members and five senators. It is tasked with reviewing:
(a)
the implementation, performance and governance of the National Disability Insurance Scheme (NDIS);
(b)
the administration and expenditure of the NDIS; and
(c)
such other matters in relation to the NDIS as may be referred to it by either House of the Parliament.
1.2
The resolution establishing the committee requires the committee to present an annual report to the Parliament on the activities of the committee, in addition to reporting on any other matters it considers relevant.
Purpose of this report
1.3
The committee's inquiry into general issues related to the implementation and performance of the NDIS (General Issues inquiry) provides an ongoing opportunity for the public to present important evidence to the committee related to the NDIS, including its implementation, performance, governance, administration, and expenditure. From time to time, the committee also conducts inquiries into specific elements of the NDIS. These inquires commence on a certain date and conclude with the tabling of a final report.
1.4
This is the committee's first report of the 46th Parliament for the General Issues inquiry. It examines issues raised in evidence to the General Issues inquiry and provides an update on the committee's recent activities.
1.5
This report pays specific attention to independent assessments, and to issues arising during the COVID-19 pandemic. It also considers matters relating to financial sustainability, funding and pricing; issues affecting specific cohorts of people with disability; and other key issues relating to the implementation and performance of the NDIS. The report makes 10 recommendations which aim to improve the operation of the NDIS for participants, providers and other key stakeholders.
1.6
The committee thanks all those who contributed to the inquiry by making submissions, providing additional information, or expressing views through correspondence. The committee is also grateful to those who gave their time to give evidence at hearings.
Structure of this report
1.7
This report outlines the committee's recent activities and reviews key issues raised in relation to the General Issues inquiry, as follows:
Chapter 1 (this chapter) provides an overview of the committee's activities, outlines other relevant inquiries, and provides background information about the NDIS.
Chapter 2 examines the proposed rollout of independent assessments for current and prospective NDIS participants.
Chapter 3 examines the effect of the COVID‑19 pandemic on people with disability and the NDIS.
Chapter 4 examines key issues relating to financial sustainability, pricing and funding.
Chapter 5 examines key issues affecting particular cohorts of people with disability.
Chapter 6 examines other key issues related to the implementation and performance of the NDIS.
Committee activities
1.8
During the 46th Parliament the committee continued the work of committees in previous parliaments, overseeing the important work relating to the NDIS. As this is the committee's first general issues report since March 2019, there is a considerable amount of committee activity to report.
1.9
The committee published 66 submissions for its General Issues inquiry over the course of the current Parliament. These submissions are listed at Appendix 3. The number of submissions received for other inquiries is listed in the table below.
1.10
The committee has held 17 public hearings during the 46th Parliament, some of which focused on certain inquiries. Several were held via teleconference or videoconference in response to the COVID‑19 pandemic, or in accordance with witness requests. The dates and locations of the hearings are as follows:
8 October 2019 in Brisbane.
9 October 2019 in Sydney.
28 October 2019 in Hobart.
7 November 2019 in Melbourne.
19 November 2019 in Adelaide.
21 November 2019 in Canberra.
13 February 2020 in Canberra.
23 June 2020 in Canberra (via teleconference).
30 June 2020 in Canberra (via teleconference).
14 July 2020 in Canberra (via teleconference).
28 July 2020 in Canberra (via teleconference).
18 August 2020 in Canberra (via teleconference).
8 September 2020 in Canberra (via teleconference).
29 September 2020 in Canberra (via teleconference).
12 October 2020 in Canberra (via teleconference).
13 October 2020 in Canberra (via teleconference).
17 November 2020 in Canberra (via videoconference).
1.11
Transcripts from all the hearings listed above, together with submissions and answers to questions on notice, are available on the committee's website. Witnesses who appeared at the hearings are listed in Appendix 4.
1.12
The following table summarises the inquiries undertaken by the committee during the 46th Parliament.
Table 1.1: Committee inquiries during the 46th Parliament to date
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|
|
|
|
|
Supported Independent Living
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1 August 2019
|
51 submissions
|
May 2020
|
|
NDIS Planning
|
1 August 2019
|
157 submissions
|
December 2019 (interim report);
December 2020 (final report)
|
|
NDIS Workforce
|
6 February 2020
|
52 submissions
|
December 2020 (interim report)
|
|
NDIS Quality and Safeguards Commission
|
23 June 2020
|
71 submissions
|
Expected to report in 2021
|
|
General Issues
|
See resolution establishing the committee
|
66 submissions
|
December 2020 (this report)
|
1.13
The following sections briefly outline the committee's inquiries into Supported Independent Living; NDIS planning; and the NDIS workforce.
Inquiry into Supported Independent Living
1.14
Between August 2019 and May 2020 the committee undertook an inquiry into Supported Independent Living (SIL). Key issues examined in the committee's report included:
the approval process for access to SIL;
living arrangements for SIL participants—including issues associated with choice and control and ensuring compatibility between residents;
concerns associated with vacancy management;
other issues, including the provision of SIL and other supports in regional, rural and remote areas; provider of last resort arrangements; decision support and advocacy; service quality; and coordination between the NDIS and state and territory services.
1.15
The committee tabled a final report for its inquiry into SIL on 13 May 2020. The report made 45 recommendations to improve the SIL process. These focused on maximising choice and control for participants and reducing unnecessary financial burden for providers.
1.16
The Australian Government provided its response to the committee's report in August 2020. The Government supported, or supported in principle, 25 of the recommendations made by the committee. The Government noted the other 20 recommendations, drawing attention to 'ongoing reforms to the provision of SIL being progressed by the [National Disability Insurance Agency (NDIA)]'. It also stated that the NDIA is developing an overarching Home and Living policy, and will consult widely on changes to SIL and the wider policy over the coming months. A table setting out the Government's response to recommendations in the SIL report is included in Appendix 1.
National Disability Insurance Agency actions since the committee's SIL report
1.17
In its submission to the General Issues inquiry, the NDIA stated that it has made a number of specific improvements to SIL since the committee's final report for the inquiry into SIL, including:
strengthening guidance to planners on how to increase participants' involvement in the planning process, such as by including participants in developing and endorsing rosters of care before they are approved;
amending the quoting tool to address errors and simplify calculations; and
simplifying and clarifying internal and external guidance and operating procedures.
1.18
The NDIA also stated that it is developing a new policy position on a future model for SIL, which seeks to increase clarity, transparency and understanding throughout the SIL process. This will include a formal external consultation process. The NDIA will also continue to develop the market and alternative models of care, such as individual living options (ILOs), to provide participants with greater choice of living arrangements. The NDIA will take into consideration the recommendations of the committee's SIL inquiry as part of future improvements to SIL.
1.19
In September 2020 the NDIA released a consultation paper on SIL, seeking submissions by 19 October 2020. The consultation focused on how the NDIA proposes to improve short-term operational, equity and cost challenges for participants receiving SIL. A second consultation paper, to be released at the end of 2020 or early 2021, will lay out the NDIA's long-term vision for home and living options, including how the NDIA proposes to strengthen support for participants to make independent decisions.
1.20
The Supportive Families and Friends Association Inc provided the committee with a submission made to the NDIA's consultation paper on SIL. The submission outlined several concerns regarding the funding and delivery of SIL supports, drawing on the experiences of residents in group homes in Victoria. Key concerns included the following:
Under the state-managed disability support framework, state governments had a duty of care for residents in SIL homes. As state governments progressively withdraw from disability support roles, duties of care are becoming 'blurred'.
Residents in SIL homes live in a 'confusing and complex environment', and are expected to negotiate agreements with NDIA staff, partners in the community, and various support providers.
People with complex needs often require a third party to advocate for them. However, funding for independent advocacy is often unavailable.
While NDIS documentation stresses the need for residents and families to be included in the development of the roster of care, this may not occur in practice.
SIL funding is often provided on a 'one size fits all' basis, and does not take into account the higher support needs of participants with a cognitive impairment or other severe disability.
1.21
Noting that the committee tabled its report on SIL in May 2020, and that the NDIA is progressing a number of measures that aim to improve the operation of SIL for participants and providers, the committee proposes to maintain a watching brief in relation to SIL. If further evidence indicates that stakeholders continue to have concerns about the funding and delivery of SIL supports, the committee may consider this matter in more detail in the future.
Inquiry into NDIS planning
1.22
The committee recently conducted an inquiry into NDIS Planning. The interim report, tabled December 2019, contained 14 recommendations covering matters such as planner training, draft plans, plan reviews, plan gaps, and standardising terminology.
1.23
The Australian Government tabled its response to the committee's interim report in March 2020. The Government supported seven recommendations, supported five recommendations in principle, and noted two. A table setting out the Government's response to the recommendations in the NDIS Planning Interim Report is included in Appendix 2.
1.24
The committee tabled its final planning report in December 2020. The report contained 42 recommendations intended to bring greater transparency, consistency and accountability to how the NDIS is administered and implemented. It covered a broad range of issues related to planning, including:
informal supports and the role of families;
overlap with other systems;
planner training and expertise;
planning for particular groups;
planning in rural and remote areas;
appeals in the Administrative Appeals Tribunal (AAT); and
communication, including by the NDIA, in relation to plans.
1.25
On 25 November 2020, just prior to the tabling of the final planning report, the NDIA announced potential changes to the planning process. The committee did not have an opportunity to thoroughly examine these potential changes, nor receive evidence from the NDIA about them.
1.26
Reflecting the connections between planning and other elements of the NDIS, there were various issues in evidence to the general issues inquiry that were examined in the planning report. These include:
funding for transport, particularly in rural and regional areas;
concerns for people with psychosocial disability with planning processes;
the role of local area coordinators;
how NDIA delegates determine what is 'reasonable and necessary';
the NDIA not providing reasons for decisions;
the length of plan reviews, meaning participants may not have sufficient funding for services;
lack of published information about typical support packages;
flexibility to use plan funding across core, capacity-building and capital supports;
the interface between the NDIS and other service systems; and
Inquiry into the NDIS Workforce
1.27
On 6 February 2020, the committee decided to undertake an inquiry into the NDIS Workforce. The committee tabled an interim report for this inquiry in December 2020. The report contained 14 recommendations covering NDIS pricing; worker training and accreditation; employment opportunities for people with disability; maldistribution of allied health professionals; growing the Aboriginal and Torres Strait Islander workforce; and securing reliable workforce data to support workforce planning and policy development.
1.28
Reflecting the connections between the NDIS workforce and other elements of the scheme, some issues raised in evidence to the General Issues inquiry were also examined in the interim report. These include ensuring the workforce is able to support participants with psychosocial disability, developing a lived experience workforce, and NDIS pricing.
Inquiry into the NDIS Quality and Safeguards Commission
1.29
The committee's inquiry into the NDIS Quality and Safeguards Commission (the Commission) is ongoing. In addition to the 71 submissions published on the committee's website, three of the public hearings listed above (those on 29 September, 13 October and 17 November 2020) directly related to the inquiry into the Commission.
1.30
The committee expects to table a report for this inquiry in 2021.
1.31
Some issues raised in submissions to the General Issues inquiry also appeared in submissions to the committee's inquiry into the NDIS Quality and Safeguards Commission. These include:
oversight of service quality and safety;
the role of the Commission in providing advice and recommendations to the NDIA about matters impacting the health, safety and wellbeing of participants with psychosocial disability;
registration, auditing and reporting obligations for registered providers;
oversight of unregistered providers;
the application and operation of worker screening arrangements; and
the application of the NDIS Code of Conduct.
Inquiries by other bodies
1.32
Various other bodies are conducting, or have recently conducted, inquiries that relate to the NDIS or people with disability. Some key inquiries are briefly summarised below. Evidence presented to these inquiries has been used to inform this report, as well as other work of the committee.
Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability
1.33
The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with a Disability (the Royal Commission) was established with the issuance of letters patent on 4 April 2019. The letters patent set out the terms of reference for the inquiry and appointed six commissioners. Amended letters patent were issued on 13 September 2019 to add one commissioner, bringing the total number to seven.
1.34
The Royal Commission released a first progress report in December 2019, a second progress report in August 2020, and an interim report in October 2020. The interim report provides a summary of the Royal Commission's work from its establishment to 31 July 2020.
1.35
The interim report identified a number of key issues of particular interest to this committee. These include: group homes and other living arrangements, health care, the NDIS, the justice system, and responses to the COVID-19 pandemic. The Royal Commission has also paid particular attention to matters relating to Aboriginal and Torres Strait Islander peoples and people from linguistically and culturally diverse backgrounds. Some key themes emerging from the evidence relate to the following matters:
Attitudes towards disability.
Segregation and exclusion.
Access to services and supports.
Advocacy and representation.
Oversight and complaints.
1.36
The original letters patent required the Royal Commission to present its final report by 29 April 2022. A media statement by the Royal Commission on 30 October 2020 (the date the interim report was published) stated that the Chair, Ronald Sackville AO QC, 'is expected to request a 17‑month extension of time to present the Royal Commission's final report to September 29, 2023'.
Review of the NDIS Act (Tune Review)
1.37
In June 2019 the Australian Government commissioned a review of the National Disability Insurance Scheme Act 2013 (NDIS Act). The review was led by David Tune AO PSM, and is known as the Tune Review. The terms of reference for the review focused on 'removing legislative impediments to positive participant and provider experiences and supporting the implementation of the Participant Service Guarantee' (PSG). The review's report, released in December 2019, examined issues concerning consistency, transparency and timeliness in decision-making by the NDIA. It made 29 recommendations to address these issues.
1.38
The Government Response to the Tune Review was released in August 2020. The Australian Government supported or supported in principle all of these recommendations, noting that implementation of its response—including legislative amendments—had been delayed due to the COVID-19 pandemic. However, the Government stated that 'the NDIA has agreed to commence operationalising the [PSG] and public reporting against its timeframes and service standards…from 1 July 2020'.
1.39
The NDIA has published the PSG on its website. The PSG includes timeframes for a number of NDIS processes, including access decisions; approval of plans; plan reviews; and complaint resolution.
Australian National Audit Office report
1.40
The Australian National Audit Office (ANAO) undertook a performance audit in the NDIA and published a report on 29 October 2020 titled Decision-making Controls for NDIS Participant Plans. The report concluded that the NDIA 'does not yet have appropriate controls to ensure supports in participant plans are reasonable and necessary'. It also found that:
While an appropriate control framework had been established, the effective implementation of the controls will provide the NDIA with greater assurance that the supports approved in participant plans are reasonable and necessary.
1.41
The ANAO made three recommendations to the NDIA relating to the NDIA's policies and processes. The NDIA agreed to each of the recommendations.
Inquiries relating to Ms Ann Marie Smith
1.42
On 6 April 2020, Ms Ann Marie Smith tragically died in her home in Adelaide, South Australia. Ms Smith was an NDIS participant. Reports have asserted that Ms Smith's death followed a prolonged period of neglect, and that Ms Smith had been left in 'squalid and appalling circumstances'.
1.43
The committee is aware of several inquiries that relate to Ms Smith, including the following:
On 21 May 2020 the SA Minister for Human Services, the Hon Michelle Lensink MLC, established the Safeguarding Task Force 'with responsibility to examine and report quickly on gaps and areas that need strengthening in safeguarding arrangements for people with disabilities living in [South Australia]'. The task force delivered an interim report to the minister on 15 June 2020 and a final report on 31 July 2020. The South Australian Government published the final report on 3 August 2020, and accepted all seven recommendations.
In May 2020 the Quality and Safeguards Commissioner, Mr Graeme Head, appointed the Hon Alan Robertson SC to review issues relating to Ms Smith's death. Mr Robertson's report, dated 31 August 2020, was released by the Commission on 4 September 2020.
The Minister for the National Disability Insurance Scheme, the Hon Stuart Robert MP, said in May 2020 that the circumstances of Ms Smith's death are being investigated by South Australian Police and the South Australian Coroner. SafeWork SA also confirmed that it is 'making enquiries' in in relation to Ms Smith's death with the NDIS provider responsible for Ms Smith's care.
1.44
The inquiries relating to Ms Smith's death identified a number of gaps in the policy and legal framework for NDIS supports and services. In particular, the Safeguarding Task Force identified 14 'safeguarding gaps' covering matters such as the scope of the NDIS quality and safeguarding framework and its application to unregistered providers; conflicts of interest where a support coordinator also delivers NDIS supports; and a lack investment in and access to advocacy to assist people with disability to navigate services systems.
1.45
The committee will give further consideration to quality and safety matters for NDIS participants as part of its inquiry into the NDIS Quality and Safeguards Commission.
Inquiries by the Commonwealth Ombudsman
1.46
The committee's work continues to be informed by the Commonwealth Ombudsman's inquiries and reports. Two recent reports should be mentioned here.
1.47
First, in February 2020 the Ombudsman reported on its investigation into the actions of the NDIA in relation to Mr C. The report considered matters relating to the provision of disability supports to Mr C upon his release from prison. The Ombudsman's report acknowledged that the NDIA had already made some improvements, but also included five recommendations for further work by the NDIA. The NDIA agreed with all these recommendations.
1.48
Second, in August 2020 the Ombudsman reported on the NDIA's handling of requests for assistive technology. The Ombudsman commenced its investigation to complement the committee's earlier inquiry into the provision of assistive technology under the NDIS, for which the committee tabled a final report in December 2018. The Ombudsman's report included 14 recommendations to the NDIA. The NDIA agreed with 12 of these recommendations and disagreed with two.
Queensland Productivity Commission inquiry into the NDIS market
1.49
In April 2020 the Queensland Government asked the Queensland Productivity Commission to inquire into issues related to the NDIS market in Queensland. The inquiry will examine the transition to the NDIS and market development in Queensland, including:
the efficiency and effectiveness of the NDIS market;
structural, regulatory or other impediments to the efficient operation of the NDIS market;
factors affecting specific markets or market segments, including in rural and remote areas; and
options for improved policies and measures to ensure the NDIS market meets the needs of participants now and in the future.
1.50
On 22 June 2020, the Queensland Productivity Commission released an issues paper to assist submitters. The Commission is due to provide a final report to government by 30 April 2021.
Productivity Commission review of the National Disability Agreement
1.51
The National Disability Agreement (NDA) was endorsed by the Council of Australian Governments in February 2011. In January 2019 the Productivity Commission reported on its review of the NDA. It found that 'the disability policy landscape has changed markedly since the NDA commenced a decade ago, and much of what is in the NDA is now outdated'. In particular, the Commission found that the NDA does not reflect the NDIS.
1.52
The Productivity Commission also made a number of recommendations, including that Commonwealth, state and territory governments 'develop and enter into a new [NDA] by the beginning of 2020'. While this has not yet occurred, work has commenced on a new strategy.
Update on the National Disability Insurance Scheme rollout
1.53
The NDIS is a model of funding and supports for people with disability, families and carers. It is insurance-based and moves from the previous state‑based system of block funding to a 'fee-for-service', market-based approach. The scheme is based on the premise that people with disability each have different support needs, and should be able to exercise choice and control in relation to their supports. The main component of the NDIS is individualised packages of supports for eligible people with disability.
1.54
The NDIS was progressively rolled out on a geographic and age basis. It was first implemented in 2013 in seven trial sites across Australia. The NDIA has reported that at 30 June 2020 the scheme was available to all Australians, regardless of where they live. All states and territories have completed transition to the NDIS except Western Australia, where transition is scheduled to conclude on 30 June 2023.
1.55
As set out in the table below, the NDIS currently supports 412,543 people with disability. It is projected to serve approximately 500,000 participants once the transition to full scheme is complete.
1.56
As at 30 September 2020, there were also 8,639 children in the Early Childhood Early Intervention (ECEI) gateway.
Table 1.2: Active NDIS participants compared to bilateral estimates as at 30 September 2020
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|
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NSW
|
130,118
|
141,957
|
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VIC
|
111,210
|
105,324
|
|
QLD
|
78,811
|
91,217
|
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SA
|
36,712
|
32,284
|
|
WA
|
34,751
|
39,097
|
|
TAS
|
9,358
|
10,587
|
|
ACT
|
7,909
|
5,075
|
|
NT
|
3,636
|
6,545
|
|
Other territories
|
34
|
-
|
|
National
|
412,543
|
432,086
|
1.57
According to the 2020–21 Budget, expenditure on the NDIS is expected to increase from $18.7 billion in 2019–20 to $23.4 billion in 2020–21. The budget papers state that this 'reflects a higher number of people with a disability entering the [NDIS] under transition arrangements with the states and territories'. Subsequent expenditure is approximately $25.5 billion in 2021–22, $25.6 billion in 2022–23, and $25.7 billion in 2023–24.
Note on terminology and references
1.58
References to submissions in this report are to submissions accepted by the committee in relation to the general issues inquiry, unless otherwise stated. References to Committee Hansard are to official transcripts of this committee's hearings, unless otherwise stated.
1.59
The committee aims to use respectful terminology in this report. Consistent with the United Nations Convention on the Rights of Persons with Disabilities, this report generally uses person‑first language such as 'people with disability'. The committee recognises that while some people with disability prefer this kind of terminology, others hold different preferences. When quoting a person who gave evidence to the committee, the committee endeavours to reproduce that person's preferred terminology.
1.60
The committee acknowledges that there are a variety of terms used to reflect the diversity of Aboriginal and Torres Strait Islander cultures and identities. In this report, the term 'Aboriginal and Torres Strait Islander peoples' is used, with respect. When quoting a person who gave evidence to the committee, the committee endeavours to reproduce that person's preferred terminology.