The NDIS model relies on informed participants making decisions in their
own best interests. Consequently, participant readiness is central to the
success of the Scheme.
As described by the Productivity Commission, the outcomes of the Scheme
are directly linked to how ready participants are to access and enter the NDIS,
to get plans that meet their needs, to find supports and services, and to
self-manage their plans if they wish to.
Throughout the inquiry the committee heard that most participants are
not ready to confidently engage and navigate the market.
As one submitter put it to the committee:
In general, participants and families are overwhelmed,
confused and anxious about the market and how to engage with the NDIS, let
alone navigating to a new service provider.
The chapter explores the current challenges and issues faced by NDIS
participants to access quality services, navigate the marketplace and exercise
choice and control. It discusses:
the adequacy of support and funding in plans;
activating and managing plans;
finding providers and the infrastructure in place to access
information and facilitate transactions;
the overall capacity of NDIS participants to exercise choice and
the need for resources for capacity building.
Adequacy of plans
Adequate provision and calibration of funding are fundamental to create
a participant enabling environment.
Of concern is that submitters continue to raise issues around adequacy
of plans and ability of participants to activate and manage plans.
These issues are not new and have been discussed in past inquiries undertaken
by this committee.
Similar to previous inquiries, submitters raised concerns about the lack
of understanding and knowledge of disabilities; supports required, as well as
therapies and intervention options from planners or Local Area Coordinators
Some submitters also contended that, despite the NDIS being based on an
insurance model, a focus on containing costs rather than making early
investments to achieve quality and long-term outcomes has been also affecting
the quality of participant plans.
For example, the Public Service Research Group noted:
The NDIS promises participants choice and control in planning
their care, but their options for support are bounded by cost-benefit analysis
and discretionary decision-making on the part of the Scheme's care planners.
Support coordination in plans
The importance of including support coordination in plans was raised on
many occasions during the inquiry.
As described by the NDIA, support coordination assists participants to
understand, activate and implement their plans, including helping participants
to choose and connect with service providers.
Support coordination is not available to all participants. The majority
of participants do not have funding for support coordination in their plans
because it is allocated in plans for participants who have less capacity to
actively manage their affairs, including those with complex and high support
At 30 June 2018, 38 percent of active participants have support
coordination in their plans.
Inquiry participants argued that support coordination should be more
systematically included in participants' plans as it plays a critical role in
For example, Queenslanders with Disability Network (QDN) identified the
role of support coordination in providing the information required to activate,
access and choose providers:
It is critical that support coordination fulfils the need to
better assist people with disability through practical and accessible
information to understand how their plans work, what services are available in
their local area and how they can navigate the new market.
Mental Illness Fellowship of Australia (MIFA) stated:
It is widely considered by the sector that support
coordination should be an essential and ongoing part of plans. To readily
participate in the market, participants must be adequately informed and
One of the reasons put forward by submitters to increase access to
support coordination to more participants is that the lack of support
coordination in plans contributes to underutilisation of funds in plans and the
inability for participants to navigate the market.
Similar evidence was received by the committee during the Transitional
Arrangements for the NDIS inquiry.
Many submitters recommended that support coordination be offered as an
ongoing part of plans.
The NDIA has undertaken work to address planning issues. From April to
October 2017, the NDIA undertook the NDIS Pathway Review to redesign and
enhance the experience of participants throughout their NDIS journey, including
at implementation phase.
The NDIA made a number of commitments to improve the pathway experience
in response to the findings from the review, including:
face-to-face engagement as the default for all NDIS plan
a single point of contact for most participants;
a stronger focus on the broader ecosystem of supports; and,
communication that is clear, consistent and available in
The new participant pathway was piloted from December 2017 to April 2018
in a number of local government areas in Victoria.
Following this initial pilot that focused on the planning phase, some pathway
enhancements have now been implemented with further improvements scheduled to
roll-out across Australia in the second half of 2018.
In its most recent website update on pathway improvement, the NDIA
There are also some challenges, including managing the
logistics around the pilot planning approach and continuing to build the skills
and capabilities of planners.
The committee acknowledges the recent work undertaken by the NDIA to
improve the participant pathway. It is too early to comment on the
effectiveness of the new measures for a number of reasons. Firstly, the
implementation of the new participant pathway has only started to be rolled-out
nationally. Secondly, it is unclear how the NDIA intends to build on the
lessons learned from the pilot to make further improvements. Thirdly, as
acknowledged by the NDIA, building the skills and capabilities of planners
remains a challenge.
The committee is of the view that working towards improving the planning
process remains critical to ensuring adequacy of plans and provision of
information about services to participants. To this effect, building the skills
and capacities of the planners should be a key priority for the NDIA. Indeed,
many of the issues raised by inquiry participants are directly related to the lack
of knowledge and expertise of planners. The committee believes that the NDIA
should ensure that training on how participants access services and implement
their plan is included in the ongoing training of all planners.
The committee recommends the NDIA ensure that training on how
participants access services and implement their plan is included in the
ongoing mandatory training for all NDIA staff and contracted Partners in the
Community involved in the development and approval of plans.
In the Transitional Arrangements for the NDIS report, the
committee discussed the importance of support coordination in the enactment and
implementation of participants' plans, especially for people with high and
The committee remains concerned with reports of participants not knowing
how to use their plans or underutilising their plans because of a lack of
funded support coordination in their plans. The committee agrees with
submitters that support coordination is vital to ensure that people can, over
time, build their capacity to understand and navigate the market.
The committee recommends the NDIA implement the Transitional
Arrangements for the NDIS recommendation 21 in relation to support coordination
funding in plans. The committee notes that the Government supported this
The committee recommends the NDIA implement the Transitional
Arrangements for the NDIS Recommendation 21 in relation to support coordination
The committee recommends the NDIA ensure support
coordination is adequately funded in Plans to meet Participants' needs and not
limited to a fixed period.
Plan implementation and engaging providers
Depending on the participant's circumstances, there are supports
available to activate plans:
The NDIS can work with you to put your plan into action, and
depending on your situation there are a range of people who can help you
implement your plan and support you to start receiving supports. These would
have been discussed with you during your planning process and may be a Local
Area Coordinator or an Early Childhood Partner. Some people may also have a
Support Coordinator funded in their plan to help them get started. You can
start your plan by yourself if you are self-managed.
As stated by the NDIA, the role of Local Area Coordinators (LACs)
includes helping participants to find and start receiving services as well as
self-directing or self-managing their plans.
Similarly, Early Childhood Early Intervention (ECEI) Partners are also tasked
with assisting participants and families to connect with providers.
Feros Care, a Partner in the Community delivering LAC services,
explained at a public hearing their role in helping participants through the
activation and implementation of their plans:
During the planning and implementation phase, we are able to
point participants towards possible service providers, as well as assisting
them on how to navigate the portal, interact with service providers and other
skills they may require.
However, the committee heard that some participants lack support to
activate and implement their plans.
For example, Mr Rowe from Aged and Disability Advocacy Australia stated:
Even when we're getting plans through, people don't know what
to do with that approval and so they're sitting on it. While we tick one box to
say they've got a plan, people still haven't got a service. So we're no better
Similarly, the Queenslanders with Disability Network (QDN) reported:
This participant readiness has focused on front end access
and pre-planning. However, once people register for the Scheme, Queenslanders
with disability are reporting that they do not know how to activate their
plans, what options are available for managing their plans; and how to access
the right supports, aids and equipment.
Additionally, QDN reported that people expressed confusion around the
role and responsibility of LACs in plan activations:
...people expressed confusion around 'new language and roles'
including how difference roles fit into plan activation e.g. Supports
Coordinator, Local Area Coordinator, Service Provider, Plan Manager.
Knowledge of relevant services
Prior to navigating the market to find providers, it is important that
participants and their families know what types of supports best meet their
needs so they can make informed decisions.
However, submitters reported that in many cases, participants and their
families did not have the relevant information or the knowledge to choose
supports and services that adequately met their needs.
For example, Occupational Therapy Australia (OTA) raised the issue that
'some participants may not possess the requisite knowledge and skills to choose
supports that adequately meet their (often complex) needs'.
Similarly, Speech Pathology Australia pointed out that prior to finding
a service provider, participants will require to understand the intervention
With regard to speech pathology services, our members have
reported that Participants need a greater depth of information about the types
of intervention that may be appropriate for them than what is currently
available [...] so that participants are able to make informed decisions.
According to some submitters, Planners and ECEI Partners are not always
able to assist as they, themselves have limited knowledge of some disabilities
and interventions' options.
Finding service providers
As described by the NDIA, LACs and ECEI Partners can help participants
to find and connect with service providers. However, it appears that LACs and
ECEI Partners are not systematically fulfilling this role due to their current
focus on getting participants in the Scheme.
Brotherhood of St Laurence pointed out that 'for participants who do
receive funded supports, the significant focus on planning and gaining access
to the scheme has meant that the LAC has limited time available to assist
participants to navigate the marketplace and implement their plans'.
As a result, participants and their families have mostly to rely on
information provided on the NDIS website, the NDIS portal and through the NDIS
However, as the Federation of Ethnic Communities Councils of Australia
Placing information on a website and expecting consumers to
access it will not be sufficient to enable participants in the NDIS to be
informed about the services available to them.
Digital literacy and accessibility
Occupational Therapy Australia reported that 'concerns have been raised
that the NDIA's perception of a participant being ready to navigate new markets
is very much focused on one's computer literacy'.
Submitters reported that some participants and their families are not
equipped to deal with the ICT side of the NDIS as they often do not use or own
a computer. 
For example, Ms Kim McRae from the NPY Women's Council stated:
There's an issue around portal access. The assumption with
the NDIS that every family can access information through the portal has proven
to be incorrect for our families out on the APY Lands. People don't have
computers in their homes. Some families just do not have access to IT, for a
range of reasons, or they don't have internet access out there.
The Benevolent Society noted that accessibility of information and
digital literacy is an issue affecting participants' ability to navigate the
The NDIS is based on the assumption that participants can
navigate the system digitally and electronically, which in many instances is
not the case. The NDIS is also heavily dependent on written communication,
which is not accessible for all people with disability. There is a long way for
service providers and the NDIA to go to prepare and disseminate information in
a wide variety of formats and modalities to ensure it is accessible for all
Overall, inquiry participants found the NDIS IT system and NDIS website difficult
to navigate and not user friendly.
As Sunnyfield pointed out, without an NDIS user friendly system 'it is
hard for many to even contemplate shopping around for different support
providers to exercise greater choice and control of supports'.
NDIS participant portal
The NDIS participant portal is a secure website for participants or
their nominee to view their NDIS plan, request payments and manage services
with providers. It also features a provider finder tool to enable participants
to find providers and services in their preferred location.
The requirement to have a MyGov account to access the NDIS participant portal
has proven impractical as some participants have no access to a mobile phone
and email account.
Some submitters also reported that the search function for providers on
the NDIS portal is inadequate and ineffective.
In its submission, the NDIA stated that the 'Provider Finder tool is
currently being enhanced to provide better information to participants on the
location and nature of services offered by registered providers, with stage one
completed in December 2017'.
More recently, on 23 July 2018, the NDIA has launched further Provider
Finder enhancements, which the NDIA claims is:
making it easier to find providers, their location and hours of
making it easier to find the right service in a participant's
providing a mapping tool to give a more precise search response
and show location;
allowing participants to search for providers beyond the current
50km limit; and
improving usability and accessibility through the roll out of a
new visual design and guided help text.
Meanwhile, those who are digitally literate are turning to social media
as they 'feel that this is the only effective communication channel available
In total, there are almost 100 NDIS Facebook sites with a membership of
nearly 90 000 people.
Participants reported having tried to contact the NDIA or LACs in the
first instance but were unable to get a timely response. Participants also
found that the website does not easily provide the information they are
seeking. As a result, they use social media to get a wide range of information:
Questions posed on social media can be broad such as how
plans are managed and how can the plan budget be spent, to questions about
specific compliance issues such as whether receipts need to be kept, how to
employ a staff member, how to implement a service agreement, whether a provider
needs an ABN, managing the portal, or where to seek a specific assessment to
prove disability if this is no longer being provided by the local state service.
The Health Issues Centre pointed out that 'relying on social media to
answer technical questions risks people receiving inconsistent or false
Overall, the committee is concerned that some participants are
struggling to activate and implement their plans. It appears that the resources
and supports put in place by the NDIA to help participants activating and
implementing their plans are not reaching some participants and their families,
leaving them unable to navigate the marketplace to find and engage providers. More
generally, these supports appear to be insufficient or ineffective to assist
participants and their families. The rise in use of social media to find answers
to simple technical questions strongly indicates that the NDIS systems and
communication tools are not meeting the needs of participants.
LACs and ECEI Partners
In theory, the role of LACs and ECEI Partners includes helping
participants to enact their plans and find suitable service providers. However,
evidence received by the committee shows that LACs and ECEI Partners are not
systematically fulfilling this role. Some participants seem even to be unaware
of the role and responsibility of LACs and ECEI Partners in plan activation.
The committee believes that, because of the need to meet bilateral
estimates, LACs and ECEI Partners have been focusing too much on planning-related
activities. As a result, they have not been able to assist participants with
plan activation and implementation.
The committee is of the view that especially during 2018-19, the largest
transition year in terms of scheduled intake of participants, the NDIA needs to
urgently and clearly direct more resources towards plan activation and
implementation. The committee is aware of the recent announcement made on
24 August 2018 by the Minister for the Department of Social Services that the
NDIA, over the next 12 months, will hire additional staff to support participants
with the development and implementation of their plans.
The committee recommends the NDIA urgently allocate more staff
and support to assist participants with plan implementation.
On a more general note, the NDIA has recently committed to implement
significant reforms to improve participant readiness as well as market
readiness for providers.
The committee is of the view that the NDIA should monitor the adequacy of its
staffing levels to ensure it has the capacity to implement any reforms in a
The committee recommends the NDIA monitor and report on the
adequacy of its staffing levels on an annual basis.
Knowledge of relevant services
The committee is concerned that some participants have no sufficient
information about the types of supports and interventions that can best meet
their needs. This is particularly affecting specific cohorts, including people
who are deaf and hard of hearing; children and people with complex needs. The
committee has discussed this issue in previous inquiry reports and made
recommendations to create relevant pathways to facilitate access to appropriate
intervention and support options.
The committee understands the NDIA has undertaken work to develop
tailored pathways to ensure the NDIA has the right response for all
participants including participants with complex support needs, children aged
zero to six, participants with psychosocial disability, participants from
culturally and linguistically diverse (CALD) backgrounds, Aboriginal and Torres
Strait Islander communities, Remote and very remote communities, and LGBTQIA+
This work includes ensuring participants are provided with relevant information
about relevant intervention options and service providers. The committee
understands that this work has now been 'underway' for over a year. The
committee urges the NDIA to expedite this work and start implementing the
The committee recommends the NDIA urgently implement the tailored
pathways designed to support:
participants with complex support needs,
children aged zero to six,
participants with psychosocial disability,
participants from culturally and linguistically diverse (CALD)
Aboriginal and Torres Strait Islander communities,
remote and very remote communities, and
The committee heard that many participants and their families have come to
rely on online resources to get information, including about NDIS registered
providers. The committee is concerned that the lack of digital literacy and /
or ability to access computers can be a significant barrier for some participants
and their families. Additionally, submitters also reported that the NDIS ICT
system, including its website and MyPlace Portal are not user friendly.
The committee agrees with submitters that finding relevant information
on the NDIS website is not easy and, at times, confusing. Overall, participants
find the navigation difficult and the design confusing. The committee is of the
view that the NDIA must urgently improve the user experience of the NDIA's
The committee is aware that the NDIA is working on improving the
participant Portal, including the Find a Provider Tool. The committee is
currently undertaking a new inquiry focusing on NDIS ICT systems. This includes
examining the appropriateness and effectiveness of the portal and its impact on
the implementation of the NDIS. The committee will report on this matter in the
The committee recommends the NDIA urgently undertake work to
improve its website, including its design and navigation; and the quality and
accessibility of its content.
At a public hearing, the NDIA Regional Manager for Queensland North
summarised the options for plan management:
But, depending on the person's individual preference or the
family's preference, they can choose to manage their plan in a number of
different ways. They can be entirely invested in the management and have entire
control over the management of how that plan is implemented, or, at the other
end of the scale, they can vest the management in the agency, in their affairs.
Self-managing means that participants are responsible for requesting and
paying the invoices related to the supports received in their plans.
Self-managing also gives the participants the opportunity to purchase supports
from suppliers that have not registered with the NDIA.
At 30 June 2018, 12 percent of participants were fully self-managing
their plans and another 12 percent were partly self-managing their plans.
According to the NDIA, self-management of funds maximises choice and
control, promotes innovation in support purchasing, expands the workforce
beyond the traditional disability sector and is a key mechanism for Scheme
The NDIA's view of market success for participants includes 'plans being
The NDIA Board has committed to achieve 30 percent of participants
self-managing at full Scheme in 2020.
Queenslanders with Disability Network (QDN) noted the low take-up of
self-managed plans in Queensland. QDN believes this indicates the lack of
participants' confidence and readiness in managing their own supports and
navigating the market.
One Door reported that there has been a lack of information and 'conflicting
or changing indications about how self-management works'.
Submitters reported that families who are self-managing say that the
process is very confusing and that very little support is provided by the NDIA
or their partnering LAC and ECEI organisations to build their capacity to
understand the complexities of self-managing plans.
Family Advocacy contended that LACs and ECEI partners are discouraging
family members from self-managing their NDIS plans as the process is too
confusing and overwhelming for most people.
The NDIA says it has established a project team dedicated to maximising
participant opportunities afforded by the option to self-manage NDIS fund. So
far, work underway includes:
designing and implementing enhanced operational policy of
self-management of NDIS funds;
implementing robust staff practice guidance and training through
the new participant pathway work;
development and publication of practical participant-facing
products to better describe and promote self-management; and
implementation of an NDIS Self-Management Regional Network to
build staff capacity in facilitating self-management.
The committee believes the NDIA Board's commitment to 30 percent of
participants self-managing their plans by 2020 will not be realised unless more
information, support and capacity building activities are available to participants
and their families.
People who are self-managing their plans have the opportunity to engage
service providers which are not registered with the NDIS. In theory, it gives
self-managed participants a wider range of choices of services. For the NDIA, having
more participants self-managing may also be a way to overcome some of the
challenges associated with shortages of NDIS registered providers.
Overall, the committee has not heard of the benefits of self-managing.
During this inquiry, the committee heard no evidence that, at this stage,
people are seeing self-management as a way to expand their choices of supports
and find quality services. It is likely that it will take time before
participants feel confident to explore the full range of service options. The evidence
received around self-management further points to the lack of participant
readiness to manage their own supports and navigate the market.
Capacity to exercise choice and control
Participant choice and control is a core feature of the Scheme's design.
However, many submitters are of the view that some participants and their
families have not yet the capacity to exercise choice and control and that the
supports and resources currently in place are not conducive to build their
capacity to do so.
Transition to a market-based system
Prior to the introduction of the NDIS, most participants never had to
navigate support services in the marketplace, which is why the majority of
participants and their families are finding the new system very challenging.
As described by People With Disability Australia, 'the role of consumer
of disability services, as opposed to recipient, is relatively new for many
people with disability'.
For example, Merri Health noted that 'many individuals and families have
had limited experience with choice, i.e. they took what was available
Ms Mullins from Independent Advocacy in the Tropics described the
situation to the committee:
There's another group of people who want to navigate the
market but don't know how. It's all too much for them. They were block funded
before. They like the fact that now they have choice, whereas before they had
no choice. They had to take what they were given. But at this stage they do not
have the skills to navigate the market on their own.
The Public Service Research Group (PSRG) reported the observations made
by a participant, which highlights how a lot participants and their families are
not yet equipped to fully exercise choice and control:
A lot of families of people with disabilities didn't really
seem to know actually what they want to do because they're not practiced at
making choices, or making real choices. They’re practiced at making choices
from what's available, but not necessarily saying 'I don't like anything that
you've got available for me, this is what I want 'cause that's what will make a
difference to my quality of life.
Dr Jim Stanford, Director at the Centre for Future Work, is of the view
that a market based delivery system does not necessarily lead to choice and
The assumption is often made that, if you have a market and
the person has a voucher and they can choose where to spend it, that gives them
choice and control, and that is not necessarily the case, depending on how the
market is functioning, how much awareness and information they have and how
much power they have to negotiate a market based system. So I would not see the
provision of services through a market based model, as is contemplated under
the NDIS, as in and of itself being synonymous with choice and control.
The Dietitians Association of Australia argued that it will take time
for participants to become informed and confident consumers:
Some participants and their families will need time and
support to build their capacity and confidence as consumers, partly because
they have had poor access to products and services previously.
Similarly, the Multicultural Disability Advocacy Association of NSW is
of the view that 'the idea of shopping around for services will take a significant
period of adjustment and support to perform'.
The NDIA recognises that 'for many participants, this is their first
opportunity to exercise choice and control over their supports, and it may take
time and a more mature and vibrant market for them to feel confident to
explore, negotiate and change providers'.
The PSRG undertook research, which highlighted that factors that are
well-recognised as driving inequalities such as age, gender, socioeconomic
status, residential location and household structure are further constraining
potential for choice and control for some NDIS participants.
Catholic Social Services Australia (CSSA) and it members are very
concerned that the system is producing 'significant inequalities between participants
who have the capacity (or support) to navigate the market system and those who
In particular, participants with 'complex needs or without informal support are
being left behind'.
Flinders University also pointed that that there is 'a real risk of
cumulative disadvantage and inequity despite the principles of the NDIS' as
some participants or their families do not have an understanding of the range
of interventions and services.
In this context, directing more resources towards capacity building is
vital to enable participants to exercise choice and control and engage with the
Family Advocacy recommended that 'the NDIA put more resources into
supporting family members and participants to engage in the marketplaces of
In order to do this, 'stronger capacity building for participants to pursue
these opportunities and to understand the process of self-management is
Similarly, Brotherhood of St Laurence is of the view that 'further
investment in capacity building and awareness building should be a focus of the
NDIS, through LACs and ECEI services, and through continuous investment in
building peer support and advocacy networks'.
The Community and Public Sector Union (CPSU NSW) is of the view that
defunding of advocacy has decreased the ability of participants to be able to
navigate existing and new disability markets.
In light of the evidence received to date, it appears that exercising
choice and control is far from being realised for many participants. The
committee acknowledges that the transition to a new market-based system is a
radical change for participants. There is no doubt that it will take time for
some participants to become confident and informed customers. However, there is
a clear lack of direct support and assistance available to participants to
build their capacity to engage in and benefit from the new system. Indeed,
simply having access to a market does not equate having choice and control. Market
access alone is not sufficient to allow participants to make informed choices.
Intervention is therefore required to create a participant enabling
environment and enable people to exercise choice and control. To date, the NDIA,
despite its lead role as market steward, has mostly failed to put in place the
appropriate infrastructure and systems to create a participant enabling
environment, especially for the more vulnerable and disadvantaged cohorts. This
is creating a concerning rise in inequalities between participants. Alarmingly,
this can also result in some people being left without access and provision of
the necessary and reasonable supports they are entitled to.
The NDIA must ensure that, through its Partners in the Community and the
more systematic inclusion of support coordination in plans, supports and
advocacy are available to all participants throughout their entire NDIS
journey. The recommendations made by the committee in this chapter would assist
in creating a participant enabling environment and ensure that the transition
to a market-based system does not leave anyone worse off.
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