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Since its last progress report, the committee continued to receive
information from participants, families, carers and service providers on their
experience of the implementation and performance of the NDIS to date.
This section covers the key issues raised in evidence, which have not
been covered in the other parts of this report.
Disability workforce issues
The committee examined workforce readiness as part of its Market
readiness for provision of services under the NDIS inquiry. The report
provided an overview of current workforce shortages and needs, as well as an
overview of the barriers to grow the workforce identified by submitters.
Barriers to grow the workforce included employment conditions, NDIS pricing
structure, and training and professional development.
The committee has continued to receive similar evidence around the
current barriers to growing the workforce, which reinforce the findings of the
Market Readiness inquiry.
For example, Ms Philippa Angley, Head of Policy at National Disability
Services, reported that despite the McKinsey IPR report recommending raising
the pricing for allied health assistant services, the pricing has not changed
resulting in the inability to find and employ staff in this field:
A very fundamental issue is the pricing of allied health
assistance. [...] So we've got a situation where some therapists would quite like
to use allied health assistance, but under the current pricing structure you
cannot attract even a skilled disability support worker to do that work.
Loss of skilled workforce
During the Market Readiness inquiry, the committee had heard that the
transition to market had been disruptive both for service providers and
disability workers, resulting in skilled staff leaving the disability sector
for adjacent sectors, including Aged Care, Child Protection, Education and
At the roundtable in February 2019, submitters stressed that skilled
workers continue to leave the disability sector. Key reasons identified by submitters for skilled workers leaving the sector
- the closure of Commonwealth, state and territory governments
disability support programs;
- the NDIS pricing structure making it unviable for providers to
operate under a fee-for-service model, especially in rural and remote areas; and
- the registration and audit requirements under the NDIS Quality
and Safeguards Commission is driving a number of providers to choose not be
registered under the NDIS;
For example, the committee heard that there was an 'exodus' of skilled
workers from the mental health sector due to the imminent closure of key
Commonwealth, state and territory government funded programs, and the
difficulties associated with working under the NDIS.
Similarly, Dr Jennifer Fitzgerald, CEO of Scope, a large service
provider of Early Childhood Intervention services, told the committee that
organisations were considering laying off their workforce due to funding and
transition uncertainties. She emphasised that, in the current environment, 'it
was hard to plan and understand what the workforce demand will be'.
Dr Jim Hungerford, CEO of The Shepherd Centre, explained that some
specialised providers in the hearing services sector have actually stopped
operating due to inadequate pricing under the NDIS and delays in payment.
Mr Tom Symondson summarised his views on the negative impacts of the
transition to a fee-for-service model on the workforce in rural areas:
I really think we're damaging the workforce of now and
pushing people out of the system, hoping that they will be replaced by a group
of backpackers who, frankly, won't have the skills that we need to support our
Negative impacts on quality of
services and safety for participants
The loss of a skilled workforce is impacting on the quality of supports
delivered to participants. For example, Mr Angus Clelland, CEO of Mental Health
Victoria, expressed his concerns about having to rely on 'staff who are not
qualified and don't have mental health training'.
Mr Patrick McGee from the Australian Federation of Disability
Organisations (AFDO) reported that the emergence of workers with no formal
qualifications and limited training employed by agencies to provide disability
supports increases the risk and occurrence of incidents:
a medication mix-up resulted in the guy I am guarding for
ending up in hospital with a couple of seizures.
Similarly the Victorian Healthcare Association contended that in the
mental health sector 'qualified and experienced workers are being replaced by inexperienced
and underqualified workers with no mental health training, creating safety
issues for workers and participants'.
The committee is concerned by the numerous reports of skilled and highly
experienced disability workers continuing to leave the disability sector
despite an obvious need to grow the workforce. This strongly indicates that
working conditions have dramatically deteriorated under the NDIS, making it an
unattractive and uncompetitive sector to work in. Indeed, during the Market
Readiness inquiry, the committee had heard that a rise in underemployment and
insecure work arrangements, inadequate wages and no prospect of professional
development opportunities were contributing factors to people choosing to leave
the sector and significantly impeding the growth of the workforce.
The committee is deeply concerned that the loss of skilled and
experienced workers is potentially compromising the quality of care and
supports offered to participants. Importantly, this can lead to serious safety
issues for both workers and participants. It also means that the loss of
qualified workers is potentially impeding participants to reach their full
potential. Not investing in quality care is counterproductive and not aligned
with insurance scheme principles. The committee is of the view that the issues
raised in evidence around loss of skilled workers are directly related to the
NDIS pricing structure and operating environment. The State of the Disability
Sector Report for 2018 released in November 2018, highlighted key issues for
the sector, including unrealistic pricing and costly red tape which is driving
up the cost of doing business. As a result, recruitment and retention of
qualified and experienced staff remained a significant challenge for service
providers as well as ensuring quality of services under current pricing. It suggests that under the current regime service providers cannot afford to
employ highly skilled staff that command higher wages.
The committee recommends the NDIA consider how to better reflect in its
pricing of supports the additional administration and professional development
costs associated with operating in the NDIS environment as part of the next
annual NDIS pricing review.
Quality and Safeguards Commission
NDIS Quality and Safeguards
Commission certification and audit requirements
On 1 July 2018, the NDIS Quality and Safeguards Commission (the
Commission) became responsible for the registration of all NDIS service
providers in NSW and South Australia. From 1 July 2019, it will also be
responsible for the registration of NDIS service providers in Victoria,
Queensland, Tasmania, ACT and NT. The Commission will provide nationally
consistent regulation, with operations starting in Western Australia, from 1
Registration requirements under the NDIS Commission and the NDIS
Practice Standards are designed to be proportionate. Smaller providers are not
expected to present the same evidence as a large service provider with a large
workforce and many participants.
Providers will need to be audited against the NDIS Practice Standards to
apply for or renew registration with the NDIS Commission. An independent
auditor will assess NDIS providers against the relevant components of the NDIS
Practice Standards. This will either be a ‘verification’ or ‘certification’
quality audit. Verification audits are a lighter touch desktop audit, while
certification audits are a more detailed process.
Providers delivering more complex supports must get third-party quality
assurance certification against the NDIS Practice Standards. Certification
audits must be done by an approved quality auditor, and might include document
reviews, site visits, and performance assessment based on the experience of
The committee heard from a number of organisations representing various
types of therapists and service providers on the cost impost of regulation,
particularly auditing, will have on their members. The issue was first raised
with the committee during its inquiry into Assistive Technology, and reiterated
in various submissions to the committee's ongoing General Issues inquiry.
The Australian Orthotic Prosthetic Association expressed their concern
that the additional regulatory requirements would act as a barrier for their
We are concerned that the imposition of additional
certification requirements and the introduction of the NDIS Quality and
Safeguards Commission will present further barriers to workforce development
and impact on service accessibility.
Assistive Technology Suppliers Australia (ATSA) reported that typical
reported audit fees are well over $8000 per annum without factoring in travel,
time and accommodation costs.
ATSA also commented on whether the proportionality of the system was actually working as intended.
In their submission they contend that while the lighter touch audit that is
dependent on structure rather than turnover may work well for 'sole traders',
it works less well in their industry where there is a prevalence of small
The intention is to apply a quality system that is
“proportionate” to the size and risks of the businesses supplying NDIS
participants, one that is based on a structure of sole trader or company, not
on turnover. In this sector there are few if any “sole traders” but often they
are small family businesses, 2 to 5 staff, i.e. SMEs. Due to this, most
providers of AT supports fall outside the definition of a business eligible for
the simplified ‘verification’ audits.
Occupational Therapy Australia (OTA) and other submitters also raised
concerns about the prohibitive cost of the certification audit. According to OTA, the high cost of certification audit is resulting in
providers choosing not to register, and families having to request plan reviews
to change their funding arrangements to self-managing plans to enable them to
see unregistered providers.
Similarly, ATSA reported that some allied health professionals are
choosing not to become NDIS registered providers. Victorian Mental Illness Awareness Council also reported that many therapists
acting as sole providers are choosing not to take part in the Scheme as the
Commission's regulatory costs are too high:
A lot of those people are saying that it's just not worth
their while. If you're an individual psychologist, is it worth your while to
pay an extra $6,000 to be audited on top of the auditing that's already done to
be a psychologist? It disadvantages the small providers who are probably the
ones who are more likely to support people. So there are some real barriers in
this space that need to be addressed.
Assistive Technology Suppliers Australia (ATSA) is of the view that the
provider registration audit requirements duplicate other quality system
processes and noted:
The provision of AT under State/Territory funding schemes and
the Department of Veteran’s Affairs does not require such audits. They
recognise the important regulatory roles played by the Therapeutic Goods
Administration coupled with Australian Standards testing for AT, along with the
ACCC. They also understand the value of occupational therapists’ oversight of
AT trials, scripting, delivery and setup.
The Australian Rehabilitation and Assistive Technology Association
(ARATA) concurred, commenting that many professions that under currently
operating under AHPRA, require to also be regulated by the Commission, with the
potential to impact negatively on the provision of services:
[T]he regulatory overlay that the new NDIS Quality and
Safeguards Commission has put onto a number of professions that are already
registered professions, that are operating under AHPRA, is so significantly
burdensome that NDIS participants are losing a really skilled workforce...
The committee has welcomed the establishment of the NDIS Quality and
Safeguards Commission which has the capacity to bring national consistency to
the delivery of disability services, while providing the necessary safeguards
for those in receipt of services.
In previous discussions with the NDIS Quality and Safeguards
Commissioner the committee was assured that the regulatory burden on providers
would be commensurate with the risks associated with the delivery of services,
and proportionate to the size and structure of those providing services.
However the committee reports from mainly therapists, although other groups
also expressed concerns, that the imposts that regulatory costs imposed by NDIS
Quality and Safeguards Commission were excessive and placed a significant
financial burden on small providers.
Furthermore, the committee heard that many if not all of these small
providers are already regulated either through AHPRA, and/or through their
The committee acknowledges that the purpose of the Commission is to
provide regulatory certainty and consistency to the sector, and safeguard
recipients of the disability services, however this must be done is an
appropriate and proportionate way. The dual impact of high costs and duplication
of regulation are reportedly acting as a disincentive to many professionals and
small organisations who are desperately needed for the NDIS to function.
The committee recommends that the NDIS Quality and Safeguards Commission
urgently review the impact of its regulatory requirements on sole providers and
small to medium sized businesses providing disability services and report to
the parliament on its findings.
NDIA communication with participants
In its 2017 Progress Report as well as other inquiries, the committee
received much evidence around poor NDIA communication and engagement with
previous inquiries, submitters raised issues around the lack of clarity,
consistency and accuracy of information provided by the NDIA; the difficulties
to contact the NDIA and obtain information; and a lack of timely responses to
In a bid to improve its communication with participants, the NDIA has
transitioned to a new website in January 2019. The NDIA indicated to the
committee, 'it is planning further enhancements to the website to ensure its
content is accessible, current, clearly dated, and fit-for-purpose'.
In April 2018, the NDIA engaged Serco Citizen Services Pty Ltd (Serco)
as its NDIS Contact Centre (NCC). In the latest NDIS Quarterly Report 31
December 2018, the NDIA stated:
Participants are now benefiting from significantly improved
services following the switch to Serco in June 2018. The average phone call
answer is now 28 seconds, versus 4 minutes 16 seconds previously; abandonment
rates have decreased from 17.5 percent to 1.5 percent; and email resolution for
the first response has risen from 70 to 80 percent.
In recent times, the committee has mostly heard about issues around the
clarity, quality and consistency of information provided to participants.
Mr Max Jackson and Ms Margaret Ryan reported that the NDIS Contact
Centre (NCC) provided limited information and help, contending that 'using a
call centre as a first response does not necessarily establish good customer
service, and in fact can exacerbate frustration'.
Ms Kirsten Deane, Executive Director of the National Disability and
Carer Alliance explained that every time her organisation talks to people with
disability and their families, 'poor communication out of the NDIA is one of
the top issues that come up'.
She acknowledged some improvements, particularly on the website, but
stressed that the complexity of the language and the inconsistency of information
provided to participants remained problematic:
[...]There are a number of cheat sheets floating around in the
sector that translate how the NDIA speak with everyday language that the rest
of us would use, which is necessary so that people can translate what is on the
NDIS website, what might be on the NDIA portal, what might be in people's
plans. [...] The other issue is consistency. Our record at one of our forums was
a woman who had called the NDIA call centre seven times and got seven completely
difference answers to the questions.
Similarly Every Australian Counts stated that one of the issues most
commonly raised by participants and their families is that 'communication is
unclear, inconsistent and full of bureaucratic jargon that no one understands'.
The Multicultural Disability Advocacy Association of NSW (MDAA) reported
that the 'complex jargon' used by the NDIA and planners in both written and
verbal communication made it difficult for people from CALD backgrounds to
navigate their NDIS journey.
Ms Sam Petersen, an NDIS participant, who shared with the committee her
difficult experiences with the NDIS, mentioned on several occasions the
inconsistency of information provided by the NDIA and her planner. For example,
The inconsistency of information provided by the NDIA is
endless – I have been so misinformed on almost anything, in so many ways.
The committee acknowledges the recent initiatives undertaken by the NDIA
to improve access to information through the development of the new NDIS
website and the production of a range of new factsheets. The committee strongly
encourages the NDIA to continue reviewing and improving its publications to
ensure clarity and consistency of language and information.
The committee is concerned that inconsistent information continues to be
provided to participants by NDIA staff, planners and NCC staff. As recommended
by the committee on many occasions, the NDIA should develop additional guidance
and training materials to ensure its staff and contractors provide clear and
consistent information to participants, their families and carers.
The Australian Government supported Recommendation 3 of the NDIS ICT
Systems report, which recommends the NDIA create specialised NCC teams based on
common types of issue raised by end-users, and co-design with end-users a
fit-for-purpose chatbot for the website and portals. The committee is of the view that swiftly implementing this recommendation will
alleviate some of the communication issues raised by submitters.
NDIA engagement with service providers and peak organisations
In February 2019, roundtable participants reported that the NDIA has
improved its level of communication and engagement with service providers and
However, roundtable participants expressed doubts about NDIA willingness
and / or capacity to take into account the views and recommendations of the
sector to inform their decision-making process.
For example, Ms Yvonne Keane, Executive Officer at Early Childhood
Intervention Australia, explained to the committee that increased NDIA
engagement does not necessarily translate into changes and actions:
The ECIA has close, regular communication with staff in the
NDIA – in particular, the early childhood team. We are in regular contact with
them. However, their capacity to effect changes is probably quite limited. The
changes that are required go beyond their remit.
Similarly, Mr Tom Symondson, CEO of the Victorian Healthcare
Association, reported that the NDIA is better engaging with his organisation
and some of its membership. However, he noted that 'it doesn't translate
through to the issues being taken seriously' and that 'the resolution ability
Ms Stephanie Gotlib, CEO of Children and Young People with Disability
Australia, remarked that NDIA engagement with stakeholders often comes too late
and therefore inputs from the sector cannot inform new initiatives or changes:
Sometimes you think you're going to stakeholder engagement
and it's actually a briefing, an often those things are too late –'Give us your
feedback, but we're working on a timeline, so it's not going to be able to
Ms Catherine Olsson, Senior Adviser Disability at Speech Pathology
Australia, explained that in the context of resolving interface issues with the
health system, the NDIA needed to recognise that the sector could greatly
assist with the provision of advice and be part of the solution. She concluded:
A greater willingness to engage with the sector, and greater
trust that the sector is an ally rather than an enemy, would be a useful thing
to take forward.
Additionally, roundtable participants reported that while communication
has improved with peak organisations, it remains challenging for service providers
on the ground. For example, Mrs Andrea Douglas reported:
I would suggest that, at peak-body level, we certainly have
had an increased engagement with the NDIA, and that has been very much
appreciated, but that, from my grassroots provider level, it's still very
challenging. [...] You can get very varied responses, and certainly not timely
Similarly, Mr David Moody, Acting CEO of National Disability Services,
We have direct lines of communication with key
decision-makers within the Agency. But I certainly would have to concede the
point that many of our providers are challenged, in terms of their engagement
with the agency, at various levels on various key issues [...]
The committee acknowledges the recent efforts made by the NDIA to
increase its engagement with the disability sector, especially with peak
organisations. However, based on the evidence received by the committee, the
engagement appears to be, at times, tokenistic. The committee has heard on
several occasions that stakeholders are asked for feedback too late in the
decision-making process, limiting opportunities for changes and inputs from the
The committee noted that the NDIA has established sector reference
groups, which provide advice and suggestions to the NDIA on a number of topics,
including mental health, autism and Special Disability Accommodation. In theory, establishing such sector reference groups can be an effective
mechanism for the NDIA to work closely with experts, service providers and
people with disability to improve systems or address the challenges associated
with the implementation of the Scheme. However, these groups appear to meet far
too infrequently to provide a genuine platform for collaborations and
developing solutions. The committee is of the view that the NDIA should more
systematically utilise the expertise of the sector to inform the development
and review of its operations and guidelines. This would significantly assist
the NDIA in developing initiatives to strengthen the effectiveness of the
The committee recommends the Australian Government consider adding to
the Guiding Principles of the NDIS Act, a further principle aimed at ensuring
that the NDIA systematically engage and collaborate with the disability sector
and people with disability in the development and review of its operational
plans and guidelines.
Andrews MP Senator Alex
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