Introduction
3.1
Planning is fundamental to the operation of the National Disability Insurance Scheme (NDIS). As noted earlier in this report, the plan sets out the goals of the NDIS participant, and the funded supports that will assist the participant to realise those goals. The plan determines – in large part – a person's experience of the NDIS.
3.2
This view was shared by many submitters to this inquiry. For example, Mr Drew Beswick from Alliance20, an organisation representing 21 of Australia's largest disability service providers, described planning as the 'gateway to the NDIS':
Fixing plans and the planning system will help sort out some of the issues that we are seeing emerge with service provision and allocation. Plans unlock services and support. Planners and local area coordinators provide information, assist with entry to the scheme and help guide participants through the process. They are pivotal to the success of the scheme.
3.3
Given the significance of the plan and the process to the NDIS, it is crucial that planning is effective, and meets the needs of all persons with disability who are supported by the scheme.
3.4
Despite the significance of the plan and the planning process to the NDIS, the committee has heard from numerous submitters and inquiry participants that there are significant issues with the operation and implementation of the NDIS, particularly in relation to the planning process. Still more concerning is that a number of these issues are not new, and have been raised by submitters to previous inquiries. In this respect, Ms Deane, Campaign Director at Every Australian Counts, the grassroots campaign that advocated for the introduction of the NDIS, has titled the submission by Every Australia Counts 'Groundhog Day', noting that:
…people with disability and their families feel like they're trapped in some NDIS version of Groundhog Day where they keep saying the same things over and over and over again about what the problems are and what the potential solutions are but they wake the next morning to find that very little has changed. If I could summarise our submission it would to make a plea to the committee, to say that the problems with the NDIS are well known and the solutions are well known—what we're really missing is action.
3.5
The committee considers that there is an urgent need for action to improve the operation of the NDIS, and in particular to improve the planning process to ensure that people with disability are fully supported to achieve their goals.
3.6
This chapter examines a number of areas associated with planning in relation to which submitters have raised concerns, and makes recommendations to improve the planning process in the shorter term.
3.7
As previously noted, this is an interim report. The committee will give further consideration to the issues raised in this chapter, as well as to the issues highlighted in Chapter 4, in the coming months, before tabling a final report in relation to NDIS planning in 2020.
Draft plans
3.8
A number of submitters raised concerns that plans frequently contain errors and omissions, and do not adequately involve NDIS participants in the planning process. For example, the Brotherhood of St Laurence stated that many participants found the planning process 'disempowering and opaque', with little communication or transparency between the NDIA, Local Areas Coordinators (LACs) and participants. It also noted that NDIA planners often base decisions about the inclusion supports on Typical Support Packages (TSPs), rather than on the individual circumstances of the participant.
3.9
ConnectAbility Australia, a service provider in the Hunter Region, stated that approximately 50 per cent of plans have incorrect basic data (for example, names and addresses), and noted that the process to correct these errors is onerous, cannot be billed and is a cost to both providers and the NDIS.
3.10
One submitter spoke directly to how these issues impact participants, families and carers, explaining that:
…as parents of a 29 year old woman with severe autism, we have never been sent a draft plan for our daughter. Instead, some time after a plan review meeting, a finalised plan suddenly appears in the “Participant Portal”, and we receive a printed plan in the mail a week or two later.
As our daughter has been a participant since the start of the Scheme, and her case is complex, she has had numerous plans. In most if not all cases, plans sent to us have needed to be reviewed, as either they have not reflected correctly what had been agreed our daughter needed, or there have been other mistakes – some absolutely horrendous. We believe this is a common experience.
3.11
However, submitters and witnesses were concerned that drafts are still not given to participants as part of the NDIS planning process. For example, Family Advocacy expressed concern that 'the NDIA is not listening to families about the importance of seeing a draft plan', noting that:
The NDIA is making decisions unilaterally rather than it being a consultative process. There is a significant imbalance of power being experienced in this process. A person with disability ought to have the power to correct an administrative error without going to review and all the delays and stress this causes even if it means allowing a longer period of time for the final plan to be completed.
3.12
Every Australian Counts provided a succinct overview of the current planning environment, noting that:
[E]veryone would like to be able to see a draft of their plan. This would allow people to correct simple mistakes and make sure it accurately captures the information they have provided. But the draft plan has become the unicorn of the NDIS—a magical mythical creature that everyone would love to see but so far no one has.
Support for draft plans
3.13
The overwhelming majority of submitters supported the provision of draft plans as a means of addressing the issues outlined above. In this respect, a number of submitters noted that draft plans could increase participant involvement in the planning process, build trust, and ensure that errors in plans are corrected before plans are finalised—thereby reducing complaints, disputes and costly plan reviews.
3.14
The committee heard numerous examples of where errors and oversights may be more effectively addressed if participants are provided with a draft plan. For example, the Northern Territory Office of the Public Guardian noted that draft plans may be beneficial in the following instances:
where there are discrepancies between what is discussed during the planning meetings and what is outlined in the support packages;
specific funding for supports is discussed or agreed, but does not appear in the plan;
matters discussed during planning conversations are not properly captured;
plans received have been found to be illogical; and
planners indicate that additional information is being sought and this is not followed up and not provided in the plan.
3.15
The Office of the Public Guardian further noted that the introduction of draft plans could provide an opportunity to ensure plans reflect the real needs of participants, and could ensure that complex matters discussed at meetings can be effectively followed up.
3.16
Idenditywa, a West Australian agency supporting people with disability and their families, noted that providing the opportunity to review draft plans could help eliminate errors and help reduce disputes, complaints and requests for reconsideration.
3.17
Ms Van Poppel from Women with Disabilities Victoria also noted that draft plans would allow participants to review plans and ensure that matters are not omitted. Ms Van Poppel further stated that allowing participants to review draft plans ahead of planning meetings could empower participants to raise important issues in planning meetings:
For women with disabilities in particular, I think that's a really important step—having that ability to pause, relook at something and have permission to raise something that you might not necessarily have felt comfortable raising in a planning meeting. When we've been running these planning workshops and NDIS information workshops with women across the state, we've asked them what gender issues they see coming up in the NDIS, and almost always the first thing that they say is, 'I don't feel comfortable to speak up'.
3.18
Autism Spectrum Australia also noted that participants often lack the confidence to raise important issues during planning meetings, and asserted that draft plans would 'help participants have confidence their plans will successfully outline their situations and include the goals that are a priority for the participant and family'.
3.19
Mrs Tiffany Heddes, a member of Assistive Technology Suppliers Australia, emphasised the importance of allowing participants to review draft plans before they are finalised, stating that:
The NDIS is about choice and control, but, if you're not able to see your plan, how is that choice and control? If you're able to see your plan before it's implemented, you know things can be picked up. We could always suddenly flag, 'Oh, I know that wheelchair is going to need service, so I need to go back and ask them to put maintenance fees in there. I need to ask them to put rental fees or trial fees in'—all these different things. In the long term, that will save the NDIS so much money. It will save parents and everyone in the industry so much heartache and frustration.
3.20
Disability Council NSW also emphasised the importance of participant choice and control, asserting that NDIS participants and their carers should have access to draft plans as the information in those plans is directly relevant to them and concerns their welfare as NDIS participants. Occupational Therapy Australia raised similar matters, and recommended that draft plans allow for 'easy adjustment' of the plan to accommodate changes identified as reasonable, necessary and/or desirable.
3.21
Submitters also noted that the provision of draft plans could help address communication issues between participants, providers and the NDIA that are undermining the planning process and resulting in poorer outcomes for participants and increased work for providers. For example, Allied Health Professions Australia (AHPA) stated:
AHPA is aware of numerous examples of errors in plans that resulted in the need for plan reviews and which could have been more effectively addressed through the use of draft plans. This could significantly reduce the volume of plan reviews resulting from plans not resembling the identified needs of participants and their families. AHPA also argues that it would be appropriate to allow participants to nominate a support person, including a provider, as not every participant is able to review a plan appropriately. We also note that a more collaborative process may involve providers having a role in reviewing draft plans, particularly in more complex areas such as in relation to assistive technology with significant benefits in reducing the incidence of planning errors.
3.22
Other submitters noted that the provision of draft plans may allow service providers to have input into the planning process, and to identify potential deficiencies and funding shortfalls before the plan is finalised. For example, Mr Tom Ballantyne, Maurice Blackburn Lawyers, noted that:
With the draft plan, I think that's an opportunity to perhaps overcome this gap in expert evidence. For a participant who does have a relationship with an occupational therapist, it's an opportunity to show it to them, and perhaps that's also a way of moderating this conflict of interest. It's not that the occupational therapist is there saying in a planning meeting, 'You need XYZ, and I should be doing it,' but at least they're in the background, informally advising and saying, 'Well, they've approved a prosthetic limb, but they have not approved funding for all the capacity building you need to actually use that,' and pointing out those sorts of deficiencies.
3.23
The National Rural Health Alliance similarly suggested that draft plans be circulated to both providers and participants, noting that providers may have a role in reviewing draft plans—particularly in complex areas such as assistive technology.
Potential to reduce unscheduled plan reviews
3.24
Usually, a plan is established for twelve months and plan review occurs as part of the planning cycle. However, a plan may also be reviewed following a request from a participant or at the initiative of the NDIA. Currently, any changes to a plan require a full plan review.
3.25
Submitters to the inquiry expressed concern at the frequency of unscheduled plan reviews, noting that such reviews are often required due to the omission of an important supports from the participant's plan. For example, Mr Mark Tonga, Chair of the NSW Disability Council, stated that:
I had to keep going back to lead the questions with the planners. There was discussion with the planners and everything was hunky-dory, and then I got a frightening surprise when I got my plan. I had to go back 13 times to review my plan and ask for the things that I need. They weren't specialist things. They were repairs to my wheelchair, a shower chair—things I really needed. I thought there was a clear understanding with my planner, but I think there was a breakdown in communication.
3.26
Submitters also observed reviews may be burdensome or traumatic for participants. For example, Mrs Parkinson-Cumine, Li-Ve Tasmania, noted that:
Participants are scared of reviews too. We've had participants who've gone for a new commode chair and all of a sudden their community access has been slashed by $20,000, completely unlinked. So you've got a group of participants who are terrified to go back, even though their plans don't meet their needs, because of the negative experiences they've had. Then they've had to go back for another review. So I think anything we can do to help participants work with the planners to get the plan right from the get-go would be a huge advantage.
3.27
Submitters asserted that draft plans would reduce the need for reviews. For example, the Australian Orthotic Prosthetic Association (AOPA) observed that:
Draft plans would decrease the likelihood of plans omitting orthoses/prostheses and ongoing services and supports crucial to their orthosis/prosthesis, all of which result in internal plan reviews.
The introduction of draft plans for participants with complex support needs would support the principles of choice and control and decrease the need for plan reviews associated with misinterpretation and communication issues during the planning process.
3.28
The Office of the Public Guardian (Queensland) noted that draft plans would reduce the need for formal plan reviews, as well as contributing to better plan outcomes and supporting the development of longer-term plans.
3.29
The Royal Australasian College of Physicians (RACP) noted that developing draft plans could result in improvements to the accuracy and suitability of plans and reduce the number of unscheduled plan reviews.
Potential risks associated with draft plans
3.30
Although there was general support for draft plans, some submitters expressed concern that any changes to the current planning process should not cause further delays for people with disability to access supports.
3.31
For example, the Northern Territory Office of the Public Guardian highlighted that 'plans may sit unresolved for long periods of time…which would not be positive for participants'. Mr Tom Ballantyne, Maurice Blackburn Lawyers, noted that the 'flipside' to the benefits delivered by draft plans are potential delays to plan approvals and participants receiving their necessary supports.
3.32
The Office of the Public Guardian (Tasmania) similarly stated that while draft plans could 'potentially be a good means of checking for feedback before finalising a plan, and of providing parties the opportunity to ask questions of the planner', it would not support draft plans if they would result in further delays for participants.
3.33
Submitters therefore emphasised the need for timeliness if draft plans are to be introduced. In this respect, Syndromes Without A Name (SWAN) Australia noted that a draft plan should:
[allow] for participant feedback that can be addressed in a timely manner and…improve the current disconnect in the system between the participant needs and planner funding decisions.
3.34
In order to ensure that the introduction of draft plans does not cause unnecessary delays, some submitters recommended setting a timeframe for participants to consider draft plans. For example, Identitywa suggested that:
individuals, their decision-makers and support organisations [be] provided with an opportunity (perhaps 7 working days) to…provide factual information on draft plans prior to them being made active. This would reduce additional hold-ups, plan disputes and complaints.
3.35
Early Start Australia similarly suggested setting a timeframe for participants to respond to draft plans. It also stated that draft plans were a routine part of NDIS trials from 2014 to 2016, and were effective in ensuring that errors and omissions could be identified and resolved in a timely manner. As such, Early Start Australia argued that:
Effectiveness of draft plans has been proven and is proven to have little impact on the timeframe of delivering a finalised plan. Include draft plans as routine and standard operation in the plan review process.
3.36
Submitters also observed that the draft planning process should involve participants in a meaningful way. The Mental Illness Fellowship of Australia (MIFA) noted that this is particularly important to ensure that people with psychosocial disability receive optimal supports:
For there to be true participant involvement in the planning process, planners must work with participants to review their draft plans in a streamlined and timely manner to minimise any uncertainty or undue delay. Individuals with severe and complex mental illness may have already undergone a lengthy access process, so it is important that any draft planning process is sensitive to the needs of people with psychosocial disability and the additional barriers to access that they face.
3.37
The National Aboriginal Community Controlled Health Organisation (NACCHO) noted that although 'draft plans' are made available in certain circumstances, there is little scope for consultation before the plan is finalised:
[T]he NDIA does not tend to enter into any discussion about the supports included in the plan and the ‘draft plans’ are most often finalised with no opportunity for adjustments. This can lead to inadequate plans for the participant with limited options to adjust the plans.
3.38
This issue was also highlighted by National Disability Services (NDS), which noted that
the current planning process includes showing the participant a draft plan at the conclusion of the planning meeting but does not give it to them to take away to consider…Unfortunately, the draft plan shown to the participant during the…meeting may not be the same as what gets funded (the planner needs to submit the draft to a delegate for approval).
3.39
NDS noted that, 'in an ideal world, [the participant] would be given a draft plan to take away to consider'.
3.40
Other submitters raised similar issues in relation to the relationship between the participant, the planner and the NDIA delegate. For example, Disability Advocacy Victoria submitted that the delegate should 'meet participants and LAC to see if participants have questions regarding their draft plan'. This issue is explored further below.
3.41
Finally, some submitters noted that while draft plans may improve planning for NDIS participants, they are not a panacea for all issues associated with the planning process. For example, Northcott pointed out that:
the real issue is ensuring that planners are properly trained and experienced to guide and assist customers so that the first submitted plan is the right one and meets their needs.
Joint planning
3.42
A number of submitters raised concerns about lack of communication between participants, planners and NDIA delegates, and lack of transparency in the planning process. In particular, concerns were raised that participants frequently do not have the opportunity to meet face-to-face with the NDIA delegate who makes the final approval decision.
3.43
In this regard, the Brotherhood of St Laurence provided the following quote from an NDIS participant which—in its view—reflected the views expressed in a study that the Brotherhood conducted in 2018:
You talk about a rapport…you [the participant] have a two-hour meeting with a person [LAC staff]. You never see them again, so really the rapport building is quite minimal…They [LAC staff] then put together the plan based on that. It then goes into the behemoth of the NDIS to a planner who has never seen you or anybody else. You don’t know who this person is. There’s this huge brick wall there. Even the LACs don’t have access to whoever the planner is, and they then make all the decisions, so the LAC, from my understanding, can really write whatever they want, but they’re not the ones making the decision.
3.44
Until recently, it had been the committee's understanding that the planning process was typically conducted with the participant and an NDIA delegate. However, at the committee's public hearing in Canberra, the committee heard from the NDIA that, in the majority of cases, it is the LAC who conducts the planning and plan building process. Ms Vicki Rundle, Deputy Chief Executive Officer, advised the committee that:
…currently it would be around 20 per cent of our planners who look after our complex participants would do both the planning and also would do the plan approval with that complex participant, because the remainder [approximately 80 per cent] of participants generally would be dealt with by LACs, and then the delegate would receive the plan for approval.
3.45
The NDIA indicated that it is working towards ensuring that participants are able to meet face-to-face with planners. However, it also noted that 'planners' may refer to either the LAC who is involved in plan development or the NDIA delegate in more complex cases:
We mean whichever group you would expect to have the planning conversation with the participant , be it an LAC in the first group I talked about—that 80 per cent—or the complex cases.
3.46
Submitters noted that having the LAC prepare the plan, before sending it to an NDIA delegate with limited if any involvement in the planning process is resulting in poor outcomes for participants. For example, Ms Fordyce, Amparo Advocacy, observed that:
Even if you do have a good LAC who's put together, with the help of others, some good information, the planner who makes the final decision has never met the person with a disability, has never met the family and has not heard from the advocate or the person themselves as to what their life experiences are and what their needs are.
…
Consequently, you get plans that are poor and lack support coordination, which will never be implemented, so then we have to go for a review. I don't think the two-tier process of having an LAC doing the planning and someone else designing the final plan is working. People need to meet the individual. I think it's really fundamental to meet the person and hear their story.
NDIA joint planning proposal
3.47
In its submission, the NDIA advised that joint planning is an example of how the NDIA is working towards a collaborative and transparent planning experience for participants. The NDIA noted that since 6 May 2019, it had been conducting a 'soft launch' of joint planning meetings in Southern Adelaide, with the intention to roll it out more broadly following a detailed evaluation. The NDIA explained the process as follows:
In the joint planning meeting, a participant engages with their LAC and assigned NDIA planner delegate to discuss their NDIS plan before it is finalised. This occurs following the pre-planning meeting and prior to plan implementation. This meeting gives the participant an opportunity to ask questions to better understand their NDIS plan and includes supports before the plan is approved. In most cases, the participant will leave the joint planning meeting with an approved plan and will be able to access their supports immediately.
3.48
At the committee's hearing in Adelaide, the NDIA provided further detail on joint planning:
Before the joint plan meeting the participants will have what we call a plan summary statement without the funded support. It will talk about the goals and what the outcomes are. At the joint planning meeting they actually have what we call a working version of the plan. Once the plan is explained they can actually take that plan with them at the end of the meeting.
…
At the joint planning meeting, when [the participant is] happy with the plan then the plan is approved. The local area coordinator then sits with the participant or the carer and explains how to use the funds, which is what we call a plan implementation meeting.
3.49
The NDIA further explained that:
The draft plan, as the plan summary, is at the end of the pre-planning conversation. So when the local area coordinator has the pre-planning meeting with the participants, they understand the needs and wants of the participant. What we are envisaging now is to actually introduce that plan summary statement without funded support. That gives them the outcomes, the goals and what's actually in the plan. When they come through the joint planning meeting is when the funded supports are actually loaded into the actual goals and outcomes set in the plans. Part of the joint planning is then reassurance and reconfirming that this is what they've told us, this is what's been recorded and this is…the funded support actually…included in the plan. Part of the joint planning is actually to make sure that if there are any further changes required, then we'll make the changes on the spot. If not, then this gives an opportunity for us to approve the plan on the spot so that the participants know that the plan is actually approved without any further delay.
3.50
The NDIA noted that, as part of the joint planning trial, joint planning was offered to 347 participants in South Australia from May to December 2019. Of those 347 participants, 223 were involved in the joint planning trial. 203 plans were approved at joint planning meetings.
3.51
While the NDIA noted that a fully costed draft plan is not currently provided to participants ahead of the joint planning meeting, it stated that there is no technical impediment to providing participants with a costed draft plan ahead of joint planning meetings.
3.52
At the committee's public hearing in Canberra, the NDIA also indicated that it would consider providing costed draft plans, in conjunction with draft plan summaries. However, it also highlighted some information security issues associated with LACs giving draft plans to participants:
At the moment, the only way the LAC could print out a draft plan would be to send that plan to their email—not an NDIS email—and print it out for a participant, which of course [is] not something that we'd encourage because then we know that it's been sent to an unsecure email.
Stakeholder views on joint planning
3.53
Aside from organisations directly involved in the joint planning trial, the majority of witnesses at public hearings were unaware of joint planning meetings or the NDIA's intention to roll out joint planning on a national basis. However, stakeholders generally supported joint planning as a concept.
3.54
In this respect, National Disability Services (NDS) advised that while some of its members were participating in the joint planning trial, the organisation itself had not been involved in the trial or been contacted by the NDIA. However, representatives of the NDS did note that the NDS 'would embrace the trialling of any approaches to planning which have the capacity…to improve what has been happening to date.'
3.55
The Tasmanian Government also supported the introduction of joint planning meetings, and called for 'a more rapid roll out of these meetings to ensure Tasmanian participants receive their approved supports and services as soon as possible'. The Tasmanian Government considered joint planning meetings had the potential to address delays in plan activation, noting that:
The COAG Disability Reform Council (DRC) Quarterly Performance Report 30 June 2019 shows a clear delay between a participant’s plan approval and plan activation (plan activation is defined as the time from a participant’s initial plan approval to when the participant first uses plan supports). In Tasmania, 68 per cent of plans are activated within 30 days of plan approval and 85 per cent within 90 days. This means participants do not access their approved reasonable and necessary supports for significant periods of time post plan approval.
3.56
Some submitters to the Tune Review also expressed support for joint planning, but noted that more should be done to communicate relevant process changes to NDIS participants and their representatives. For example, Carers Australia observed that it only became aware of the NDIA's intention to introduce joint planning through the NDIA's submission to this inquiry, noting that:
If we don’t know, then it is unlikely that many participants and their representatives will know about these process changes. Nevertheless, the changes identified appear to be heading in the right direction.
3.57
Carers Australia also noted a lack of clarity around timeframes for the national rollout of joint planning, as well as the extent to which joint planning would overcome the key issues identified by participants and their carers. In this regard, Carers Australia recommended that:
all participants should be able to see their plans before they are finalised; and
the national rollout of joint planning meetings be expedited
3.58
However, despite general support for joint planning, evidence received from NDIS participants and carers involved in joint planning indicated that while joint planning as a concept is supported, in practice the joint planning process is not meeting expectations. For example, Ms Kate White, a carer of a participant, described her experience with joint planning as follows:
I can see the concept [of joint planning] is really good, but in that instance I could not see the purpose of them being there. To everything I said—'I was hoping to get this, that or the other'—they said, 'Is it reasonable or necessary?' And they thought that it was unreasonable of me to be asking for the things I was asking for my child.
My child has just started occupational therapy. With most things, when you learn a new skill, you want to go per week—weekly sessions. They thought it was unreasonable and unnecessary for us to be asking for weekly sessions. That really upset me. They said: 'Well, you can make more of it. You can go every second week. You can go with your child.' I said: 'You're making assumptions here. You're making the assumption that I'm not working. You're making the assumption that the provider can provide a time when I can attend. You're making the assumption that we can do it after hours. You're making all these assumptions without even discussing it with us.'
3.59
Ms White further noted that the 'draft' plan presented at the meeting was essentially given on a 'take it or leave it' basis, expressing concern that this approach could result in additional challenges and worsened outcomes for vulnerable participants and carers. She also emphasised the importance of having a draft plan prior to the meeting, noting that:
I think having a look at it beforehand would make a huge difference—because then I could come prepared, looking like an adult instead of a person bursting into tears—and also expectations about what, if any, changes would be considered and what aren't: this is within the purview of this meeting and this is outside it. I really didn't have an understanding of what changes may or may not be. I got the impression from it that it was: 'This is what you've got.' I think that would make it easier.
Committee view
3.60
As noted above, the committee was surprised to hear that around 80 per cent of plans are developed by LACs before being approved by an NDIA delegate, and is concerned that participants often have no contact with the delegate who is responsible for approving their plan. Given that it was originally envisaged that the key role of the LAC would be to provide plan implementation and support coordination services, the committee is also concerned that the new emphasis on planning may detract from LACs' other roles. The committee will consider this matter further in the coming months, and intends to seek additional information from the NDIA and its contractors.
3.61
In light of these matters, the committee strongly supports the introduction of joint planning, and welcomes the Minister's announcement that joint planning will be rolled out nationally from April 2020. However, the committee notes that joint planning is in its trial phase. Until joint planning is rolled out, a risk remains that participants will not have the opportunity to meet face-to-face with the NDIA delegates who are responsible for approving their plans.
3.62
The committee considers face-to-face meetings with NDIA delegates to be an essential part of the planning process, as a means of ensuring that participants have the opportunity to communicate their goals and required supports, and can challenge planning proposals that do not meet their needs. The committee notes that work is underway to ensure that participants are offered face-to-face meetings with LACs as part of the Pathways program. The committee calls on the NDIA to ensure that this measure is implemented as soon as possible, and that it is extended to capture face-to-face meetings with NDIA delegates.
3.63
It is also unclear to the committee whether joint planning, on its own, will be an adequate substitute for providing fully costed draft plans to participants. In this respect, the committee reiterates that the majority of submitters to the inquiry strongly supported the provision of draft plans as a means of enhancing choice and control for participants, addressing errors in plans, and reducing the incidence of unscheduled plan reviews. The committee has also heard from those involved in the joint planning soft launch that the current process for joint planning may not be sufficient to ensure that participants and their representatives are adequately prepared for planning meetings and feel able to advocate for the supports and funding necessary to meet their needs.
3.64
The committee therefore considers that, in addition to the introduction of joint planning, participants should be provided with a fully costed draft plan ahead of joint planning meetings (or any planning meeting that precedes approval of the plan). In this respect, the committee notes that it previously recommended the introduction of a mechanism, such as a draft plan, that would allow participants and their representatives to view, comment, and rectify any errors in their plan before the plan is finalised. The committee has also heard from the NDIA that there is no technical impediment to providing draft plans.
3.65
The committee recommends that fully costed, detailed draft plans be made available to participants at least one week prior to their meeting with the official with the authority to approve the plan, and that at the meeting the participant have the opportunity to rectify the plan.
3.66
The committee recommends that the National Disability Insurance Agency ensure that participants are given the opportunity to meet face-to-face with an official with authority to approve a plan before the plan is approved.
Plan review processes
No process to review only parts of plans
3.67
As noted earlier in this report, a participant may request that the NDIA conduct a review of their plan at any time. The NDIA has indicated that such requests are generally made where a participant's circumstances have changed and the current plan no longer meets their needs, or where a participant wishes to make a change to how their plan is managed.
3.68
Where the NDIA conducts a review of a participant's plan, the NDIA must facilitate the preparation of a new plan with the participant. At present, there is no process to review only part of a plan. Further, a plan cannot be varied once it comes into effect. It can only be replaced.
3.69
A number of submitters observed that current arrangements for plan review are causing significant burden and distress for participants. Submitters also noted that participants were often reluctant to challenge minor errors or seek minor changes to plans due to the threat of having to engage with a full review process. For example, Ms Kirsten Deane, Every Australian Counts, noted that:
…if people decide to go to review they're often told that their whole plan will be reviewed. So you risk perhaps getting a cut in funding and other areas of the plan while you challenge the area that you would like to challenge. People find that unconscionable, because it sounds very much like a threat: don't go to review, because you might lose support elsewhere. So people say that if they put in for a review they would just like the bit that they don't agree with reviewed, not the entire plan. But once they have put in for review, as you would well know, the whole plan is up for grabs. People have to weigh that up with a big concern about getting other areas of the plan cut while they challenge a particular decision.
3.70
In light of these matters, submitters recommended that participants be permitted to review only parts of plans, particularly where changes are minor or routine. For example, Occupational Therapy Australia (OTS) observed that:
under the current planning process, it is usual for a plan review to be triggered if there is a change required to a plan. Participants could be spared the onerous and lengthy process of a full review if plans had the capacity for additional supports to be considered and included via a review of just a section of a plan.
3.71
Speech Pathology Australia similarly noted that:
Straightforward changes to plans should not have to go through a full review process. It would save time and participant frustration to distinguish between reviews which are 'significant' and those which are less complex. For example, changing the way a plan is being managed should, in most cases, be a simple process and quickly implemented but it seems that this change request is just put on the list and addressed in date order. Plan errors, such as funding being placed in the incorrect category, should also be managed.
Delays in unscheduled plan reviews
3.72
As noted above, a participant may request that the NDIA conduct a plan review at any time. This is referred to as an unscheduled review. The NDIS Act requires the NDIA to decide whether to conduct the plan review within 14 days of receiving the request. If the NDIA decides to conduct the review, it must commence the review within 14 days of making that decision. However, there is currently no statutory timeframe within which the review must be completed.
3.73
A number of submitters raised concerns regarding delays in the plan review process. For example, the Rights Information and Advocacy Centre noted that:
delays in review processes lead to decline in mental health and faith in the NDIS process, to disengagement and continuity of supports and significant out-of-pocket expenses for necessary supports;
delays are often outlasting the expiration of NDIS plans; and
delays disrupt the flow of the plan, often leading to the inefficient use of funds and disruption to the provision of services.
3.74
The Community and Public Sector Union (CPSU) noted that requests from participants to have their plans reviewed are increasing, with over 10,000 reviews waiting to be actioned. The CPSU further noted that hundreds of unscheduled reviews are 'dropping off' because the scheduled review is taking place before the request for an unscheduled review is actioned. The CPSU further noted significant levels of distress and anger among participants about lengthy delays in the review process, and provided the following account from a NDIA planner:
It's distressing when you have to call someone you know has been left in an awful situation for a long time. There's a lot of anger from participants and their carers. I shake every time I go to make a call.
3.75
The Commonwealth Ombudsman noted that it had published a report into the NDIA's administration of reviews, which highlighted a backlog of around 13,000 outstanding review requests—some of which were up to nine months old. The Ombudsman further noted that:
…there is still significant work for the NDIA to address timeliness in completing reviews to ensure the backlog does not continue to grow. Indeed, complaints about reviews continue to represent 33 per cent of complaints to the Office about the NDIA.
3.76
To address some of these issues, submitters recommended implementing legislative timeframes for review processes and dedicating more staffing and resources to ensure that reviews can be addressed in a timely manner.
Delays in conducting internal reviews
3.77
As noted earlier in this report, the NDIS Act provides that a person may request that the NDIA conduct an internal review of particular decisions made under the NDIS Act. Relevantly, these include a decision to approve the statement of participant supports in a plan, or a decision not to conduct an unscheduled plan review.
3.78
The NDIS Act provides that the person conducting the internal review must confirm, vary or set aside the relevant decision as soon as reasonably practicable. However, there is no specific timeframe within which the review must be completed. By contrast, a person affected by a reviewable decision (for example, a participant) must make a request for internal review within three months of being notified of the relevant decision.
3.79
Submitters to the inquiry raised concerns about the significant delays in conducting internal reviews of decisions under the NDIS Act. For example, Advocacy for Inclusion (AFI) noted that:
It is common for a participant to wait 6 months or more. During this time, the participant is often without adequate support, funding or services.
3.80
AFI observed that key drivers of these delays—and a cause of significant concern for participants—is the lack of a statutory requirement to complete internal reviews within a specific timeframe, and the lack of formal processes within the NDIA to record and respond to review requests. AFI observed that:
[T]here remains no clear definition of what defines a 'reasonably practicable' amount of time as to when the NDIA needs to complete an internal review. Plans are expiring before the NDIA is reviewing them, which applicants are worse off without the support [for which] they are eligible…[T]he NDIA advised that it does not have formally documented procedures or a timeliness standard for acknowledging review requests.
3.81
National Legal Aid (NLA) highlighted similar issues with internal review processes, and recommended that a time limit be set for the review to be completed— noting that this would increase certainty for participants. NLA also recommended greater communication between NDIA officers responsible for conducting reviews and participants and their representatives.
If the NDIS Act provided a set time limit for a review to be completed and an explicit provision that a failure to complete the review within that time would give rise to a deemed decision, participants would have certainty and a clear avenue for review…NLA would welcome an amendment of this sort, which would remove a…barrier to meaningful review.
3.82
In relation to timeframes for completing reviews, Maurice Blackburn Lawyers noted an imbalance between the requirement for participants to file a request for internal review within three months, and the absence of a corresponding requirement for the NDIA to complete reviews within set timeframes:
While participants must file a request for review within three months of receiving notice of the decision, there is no timeframe imposed on the Agency to actually complete the review. Many participants report waiting months for any response, by which time their current plan may have expired, whereupon the process has to start again.
Publishing settlement outcomes
3.83
Some submitters to the inquiry noted that while a high number of external reviews of NDIS decisions—that is, decisions reviewed by the Administrative Appeals Tribunal (AAT)—are resolved by settlement, there is no information available to participants on settlement outcomes.
3.84
In this respect, the Public Interest Advocacy Centre noted that while around 96 per cent of cases before the AAT involving the NDIS were finalised through settlement, the details of these settlements remain private. The Centre argued that the lack of transparency around settlement outcomes:
leads to a lack of accountability within the NDIA in ensuring that funding decisions are made correctly; and
hinders the ability of participants to understand the supports and levels of funding that are provided to others in similar situations.
3.85
In light of these issues, the Centre recommended that the NDIA publish information around AAT settlement outcomes in a manner which balances privacy with accountability. The Centre noted that the release of information around settlement outcomes would not be unique to the NDIA, and suggested that the NDIA could use the approach adopted by the Australian Human Rights Commission as a model.
3.86
At the committee's public hearing in Sydney, representatives from the Public Interest Advocacy Centre noted that the Centre had recommended publication of settlement outcomes to the NDIA, and the NDIA was 'actively considering the issue'.
3.87
Other submitters to the inquiry also indicated their support for publishing (de-identified) settlement outcomes as a means of increasing transparency and accountability for participants and planners.
Committee view
3.88
The committee is concerned that requiring a full plan review in all the circumstances where a participant wishes to make changes to their plan—even where the changes are minor or routine—is causing significant distress for participants and may limit their ability to effectively advocate for reasonable and necessary supports.
3.89
In this respect, the committee notes that submitters to previous inquiries have raised concerns that the rigidity of the NDIS review process, as well as long delays for accessing reviews, do not allow for responsive plans and limit the supports that can be put in place for participants in crises or emergency situations. The committee previously recommended that the NDIA develop an approach to allow minor adjustments to be made to plans without triggering a full plan review. However, this has not been implemented.
3.90
In light of these matters, the committee supports the recommendations made by submitters that the NDIS Act be amended to enable participants to review only part of a plan, or to vary a plan. This review process should be subject to the recommended timeframes below.
3.91
The committee recommends that the National Disability Insurance Scheme Act 2013 be amended to enable participants to review only part of a plan, or to vary a plan, in appropriate circumstances.
3.92
The committee is also concerned that significant delays in the plan review process, as well as delays in conducting internal reviews of decisions, are causing undue burden and distress for participants, limiting participants' ability to access supports (including disrupting continuity of supports), and undermining effective administration of the NDIS.
3.93
The committee has heard from a number of submitters that the NDIA should be required to complete unscheduled plan reviews within a statutory timeframe. The committee strongly supports this recommendation, and notes it has previously recommended that the NDIA dedicate additional resources to reducing delays at all points of the scheme, particularly for plan approval, activation and review.
3.94
The committee recommends that the National Disability Insurance Scheme Act 2013 be amended to require the National Disability Insurance Agency to complete an unscheduled plan review within 45 days of receiving a request from the participant.
3.95
The committee recommends that the National Disability Insurance Scheme Act 2013 be amended to require the National Disability Insurance Agency to complete internal reviews of decisions within 45 days of receiving a request to conduct the internal review.
3.96
Finally, the committee notes that some submitters have recommended that the NDIA publish settlement outcomes arising from appeals to the AAT. The committee strongly supports this recommendation as a means of increasing transparency and accountability for participants and planners. However, the committee emphasises the importance of ensuring the privacy of participants (and other parties to proceedings). Consequently, the committee considers that only de-identified details should be published.
3.97
The committee recommends that the National Disability Insurance Agency publish settlement outcomes relating to external review by the Administrative Appeals Tribunal, in de-identified form.
Standardised language
3.98
A number of submitters to the inquiry indicated that communications from the NDIA are often complex and bureaucratic, and do not use terminology in a consistent manner. For example, Every Australian Counts emphasised that 'communication from the NDIA needs to be simple and consistent', and that:
Often things that participants and their families need to know are still lost in complicated jargon. The NDIS must use language everyone can understand. They need to use consistent language [on] the website, the plan, the portal and…price guide. And they must make sure they give consistent answers regardless of who asks the question…or answers it.
3.99
Ms Deane, Campaign Director with Every Australian Counts, reiterated these issues at the committee's hearing in Brisbane, noting that communication from the NDIA is:
…not timely…not focused on the participants and their families, and it still remains confusing complex and incredibly bureaucratic. People have had to learn a whole new language with the NDIS. They often talk about magic words; if you don't use the magic words…you don't get what you need.
…
If we want people with disability and their families to be the informed, active, in control participants that the scheme expects them to be, they need really good, clear, simple communication.
3.100
Concerns relating to miscommunication and inconsistency were also raised during the committee's public hearing in Canberra, particularly in relation to the terminology associated with the planning process. In this respect, committee members noted that the committee had understood 'planner' to refer to the NDIA delegate with authority to make plan approval decisions. However, it emerged that the term was also used to refer to other persons and bodies (in particular, LACs) involved in the planning process.
3.101
The NDIA acknowledged that it had contributed to exacerbating some of these issues. Ms Vicki Rundle told the committee that:
I think we haven't helped that clarity at all, because over time we have used the terms interchangeably ourselves. We need to think through how we distinguish the roles of the agency, the planner, the delegate and the LAC.
Committee view
3.102
Evidence presented to the committee indicates that information disseminated by the NDIA is often overly complex and bureaucratic, and that the NDIA often fails to use consistent language. The committee is concerned that this is creating an additional burden for participants and other stakeholders seeking to navigate what is already a complex scheme, and compounding the challenges faced by people with disability.
3.103
The committee notes that the NDIA is working to harmonise and simplify the language it uses on its website and in published material as part of its ongoing Pathways work. However, evidence received during the inquiry suggests that a number of communication issues persist, and that more needs to be done to improve access and facilitate greater understanding for NDIS participants, providers and other stakeholders.
3.104
The committee therefore considers that the NDIA should use standardised, clear and unambiguous terminology to refer to all matters associated with the NDIA. In particular, the committee considers that the language the NDIA uses in all of its material should clearly delineate between LACs who are planners, NDIA officers who are planners, and NDIA officers who are decision makers.
3.105
The committee also considers that the NDIA should expressly define key terms associated with the planning process, include those definitions in published material (for example, on the NDIA's website and in guidance documents). Examples of terms that the committee considers should be defined include 'Local Area Coordinator (LAC)', 'Planner', 'Delegate' and 'Review'.
3.106
The committee recommends that the National Disability Insurance Agency standardise the terminology it uses to refer to persons, processes and other matters associated with the NDIS.
3.107
The committee recommends that the National Disability Insurance Agency (NDIA) clearly define key terms associated with the NDIS, and with the planning process in particular. Where a term refers to a person, organisation or other body, the committee recommends that the NDIA clearly define that entity's role, functions, responsibilities, limitations and accountability.
Training
3.108
A number of submitters raised concerns regarding the experience, expertise and qualifications of planners. In particular, submitters noted that planners may lack an understanding of particular disabilities and the broader disability sector, and often lack the skills and qualifications needed to assist participants with complex disability support needs.
3.109
In this respect, Allied Health Professions Australia noted that:
…ongoing member feedback [indicates that] there is significant variation in the experience, expertise and qualifications of planners. It is clear from the reported experience of allied health disability providers that there are very real differences in how well individual planners are able to understand the needs of individual participants. It is also clear that the extent to which planners sufficiently understand the disability sector and the individual roles and contributions of different allied health professions varies with direct consequences to those services in participant plans.
3.110
Submitters also observed that planners may lack the training and experience necessary to support participants facing intersectional challenges. For example, Women with Disabilities Victoria noted that one of its concerns is that planners in the NDIS do not have sufficient training in recognising and responding to family violence, emphasising that:
Women with disabilities need staff at the NDIA and in Local Area Coordination to be equipped in understanding, recognising, responding and referring women to appropriate agencies such as family violence, legal and sexual assault services.
3.111
Submitters also noted that NDIA representatives involved in the planning process may lack the necessary training or qualifications to deliver culturally appropriate services to Aboriginal and Torres Strait Islander participants and participants from culturally and linguistically diverse (CALD) backgrounds.
3.112
In this regard, the Aboriginal Health Council of SA (ACHSA) Ltd noted that many of the communities it represents continue to experience culturally inappropriate services, with the result that many Aboriginal people have disengaged from the NDIS. ACHSA further noted that:
…there have been failures in the ability of Planners to understand the complex needs of Aboriginal People and their families…Planners are either too rigid in their questioning/interviews or simply do not have the understanding and ability to support in these complex situations.
3.113
The National Aboriginal Community Controlled Health Organisation (NACCHO) echoed these concerns, and recommended that all planners and NDIA staff be required to complete a minimum level of cultural awareness training, with an accredited certificate being NACCHO's preferred option.
3.114
AMPARO Advocacy further noted a 'vast difference in the competency of planners', and raised concerns that many planners appeared to have little or no experience in working with people from CALD backgrounds with disability, with many planners having no knowledge of how to work effectively with qualified interpreters. At the committee's public hearing in Brisbane, AMPARO elaborated on these issues, noting that:
The NDIA has improved their processes, we're really pleased to say. Unfortunately they've done almost nil to promote those processes. We still have LACs, NDIA staff, early-intervention staff, service providers and support coordinators contacting us. Through discussions, we find out that they think that an interpreter isn't available or that somebody's got to pay for the interpreter.
Committee view
3.115
The committee considers that rigorous, comprehensive and ongoing training is essential for all persons involved in the planning process, to ensure that the varied and complex needs of participants are fully understood and to ensure that participants receive the supports they require to achieve their goals.
3.116
The committee acknowledges that work to improve training for NDIA staff is underway or has been completed, and notes that this training aims to improve officers' understanding of different disability types and to ensure that staff are able to deliver better services to participants from Aboriginal and Torres Strait Islander communities and from CALD backgrounds. This work has also been acknowledged by a number of submitters to the inquiry.
3.117
However, evidence before the committee indicates that additional training remains necessary to ensure that planners understand the diverse experiences of NDIS participants—particularly those with complex support needs, and to ensure that service delivery is consistent, effective and culturally appropriate.
3.118
The committee recommends that the National Disability Insurance Agency (NDIA) ensure that additional training and skills development is provided to all persons involved in the planning process (particularly NDIA officers and LACs), to ensure that all such persons:
are familiar with a range of disabilities experienced by participants, and develop specialisation in particular disability areas;
are familiar with allied health expertise;
understand the specific needs of Aboriginal and Torres Strait Islander participants, and participants from culturally and linguistically diverse backgrounds, to ensure that they are able to deliver culturally appropriate services; and
receive training in domestic violence awareness.
Plan gaps
3.119
A number of submitters to the inquiry raised concerns in relation to the incidence and severity of 'gaps' in participants' plans. Submitters held various views on what may constitute a 'gap' in a plan, noting that a gap may occur where a plan comes to an end prior to a scheduled plan review, where funding under a plan is exhausted prior to the plan review date, and where additional funding cannot be secured following a change in circumstances.
3.120
In relation to some of the causes of plan gaps, Ms Parkinson-Cumine, on behalf of Li-Ve Tasmania, noted that:
…unscheduled plan reviews and review of reviewable decisions are subject to long delays, with participants waiting over three months, and often longer, for assessment. Scheduled plan reviews often do not proceed in a timely manner, creating plan gaps where there are no current plans or where plans have been extended without appropriate funds being added. Payments are then requested from provider payments, with payments taking months to be made.
3.121
With regard to the frequency of plan gaps and their impact on participants, the Office of the Public Guardian (Tasmania) observed that:
…there are plan gaps between nearly all participants' plans for whom we are appointed as guardian. Invariably, the review process starts just a few weeks before the end of the plan and the subsequent plan is rarely completed and in place until at least a month after the previous plan has expired. This is particularly the case for expensive plans that need higher level approval.
…
NDIS service providers are reluctant to provide service without a plan in place and a guarantee of payment; and there are no processes in place for providers to claim payment for service during periods where there is no plan and therefore no current service agreement in place.
3.122
Occupational Therapy Australia (OTA) observed that the incidence of plan gaps may be even higher (around 75 per cent). OTA further noted that plan gaps may occur for a number of reasons, including the unavailability of planners, unavailability of participant or support coordinators, or approval delays following a planning meeting.
3.123
The NDIA submitted that 'gaps' in plans have generally resulted from the original design of its Business System, which did not cater for situations where a new plan was not approved prior to the review date of an existing plan. The NDIA noted that there was a risk of participants' supports being discontinued during these 'plan gaps', as the Business System did not allow providers to claim for supports delivered in the plan gap period until the new plan was approved.
3.124
The NDIA's submission states that enhancements have been made to its Business System to address this issue:
A business system enhancement was implemented on 1 August 2019 to automatically apply 28 days of funding when the new plan has not been approved at the plan review date in certain circumstances. This enables the participant and NDIA additional time to undertake a plan review and minimises the incidence of plan gaps.
Plans that had expired prior to 3 July 2019 were not included in the auto-extension as generally these participants were unable to be contacted to undertake a plan review. As the ability to provide funding for supports during the gap period remained, the NDIA initiated a process to make contact with the participant to undertake a plan review, rather than automatically increasing their funding to mitigate the risks to the NDIA.
On the 31 August 2019, a further enhancement was implemented to remove the exception cases so all participants and providers will now be able to claim for all supports delivered in accordance with their plan while waiting for their plan review.
3.125
The NDIA asserts that the enhancements mean that plan gaps should no longer be an issue for participants and providers.
3.126
Other submitters acknowledged this work, but noted that it did not appear to address issues associated with whether a plan is appropriate. For example, the Commonwealth Ombudsman noted that:
…the automatic extension to plans does not address concerns about whether the plan is appropriate. Given the short period since the implementation of this process, we will continue to monitor these changes and any impact on complaints made to the Office.
Committee view
3.127
Throughout this inquiry, the committee has heard a substantial amount of evidence regarding the incidence and severity of plan gaps, which appear to be limiting the ability of participants to accessing necessary supports, reducing choice and control, and undermining the proper administration of the scheme.
3.128
The committee acknowledges that the NDIA has implemented enhancements to its Business System, to extend funding for a further 28 days in circumstances where a new plan has not been approved at the plan review date. The committee welcomes these improvements, and considers that they may go at least some way to ensuring continuity of supports for NDIS participants.
3.129
However, in light of the evidence presented to the committee regarding delays in plan approvals and review processes, the committee considers that a 28 day extension of funding may not be sufficient to ensure that funding for supports remains in place until a new plan is approved. Further, the extension of a plan may not address concerns regarding whether funding remains appropriate.
3.130
The committee considers that where a new plan has not been approved by the plan review date, funding under the existing plan should be automatically extended until the new plan is approved. The committee is also mindful of ensuring that the NDIS does not take a 'set and forget' approach to planning, particularly in relation to participants who have complex support needs or where there is potential for further capacity-building. The committee therefore considers that a plan review should be conducted, and a new plan should be approved, as soon as possible after the plan review date.
3.131
The committee recommends—in circumstances where a new plan has not been approved at the plan review date—that:
the National Disability Insurance Agency continue to provide funding under the existing plan until the new plan is approved; and
ensure that a plan review is carried out within 45 days of the review date set out in the existing plan.
First plan approvals
3.132
Throughout the inquiry, the committee heard evidence regarding delays in the approval process, particularly in relation to the approval of first plans. The evidence suggested that while steps have been taken to address the issue, approval timeframes are still not meeting the expectations of participants, their carers and families.
3.133
With regard to this matter, the NDIA's most recent Quarterly Report states:
first plans are being approved more quickly after an access decision has been made. First plans completed in the September month were completed in 88 days on average compared with 133 days in June 2019. Further, outstanding first plans have been in progress for an average of 79 days at 30 September 2019 compared with 155 days at 30 June 2019.
Committee view
3.134
The committee appreciates that steps have been taken to improve the planning process, and that the timeframes for plan approval have been reduced relative to the last quarter. However, the committee remains concerned that NDIS participants are still experiencing delays in plan approval, which may be creating barriers to accessing reasonable and necessary supports.
3.135
The committee notes that in June 2019, the Minister for the NDIS, the Hon Stuart Robert MP, announced an initiative to resolve delays and backlogs for children with disability in accessing Early Childhood Early Intervention (ECEI) supports through the NDIS. A key aspect of this initiative was the provision of a standardised, six-month interim plan for participants who have been waiting 50 days or longer for plan approval, with the interim plan replaced by an individualised plan within six months. Participants with complex support needs would also be immediately streamed to an NDIA Early Childhood specialist to develop their plan and appropriate funding package.
3.136
The committee considers that it would be appropriate to implement similar measures in relation to all NDIS participants, to ensure that participants are able to access the supports they need as quickly as possible. As outlined above, the committee heard evidence at its Canberra hearing that participants with complex support needs are assisted by an NDIS official, while participants in other cohorts are generally assisted by an LAC. The committee considers it appropriate for participants with complex support needs to continue to be supported by an NDIA official.
3.137
The committee also reiterates that all NDIA representatives involved in the planning process must receive the training and skills development necessary to support participants with complex needs.
3.138
The committee recommends, where a plan is not approved within 45 days of receipt by an National Disability Insurance Agency (NDIA) delegate, that:
the NDIA immediately approve a typical supports package (TSP) for the participant as an interim measure; and
the NDIA replace the TSP with an individualised plan no later than 45 days after the TSP is approved.
3.139
The committee recommends that all participants with complex support needs be immediately streamed to an National Disability Insurance Agency delegate to develop their plan and appropriate funding package.
Children with acquired injuries and complex care needs
3.140
Some submitters to the inquiry raised concerns that delays in accessing the NDIS and plan approvals were having a particular impact on children with complex care needs and children with acquired injuries.
3.141
In this respect, representatives from the South Australian Child and Adolescent Health Community of Practice recommended that children should be 'treated within a slightly different system within the NDIS', noting that:
There are so many critical points of a child's development that are being missed at the moment. I'm really concerned about this cohort of children in our current environment in terms of the delays that we're seeing for their development and the impact on this group of children going forward.
…
I think the other issue with children is the complexity. With adults it is probably quite clear what their underlying disability is, but for children, particularly at a young age, it's not that clear. I think it makes it quite clear the difficulties that planners have in that they have to understand really very complicated situations with children, where you have a whole host of issues that are impacting.
3.142
The Community of Practice also noted that processes to transition persons with disability from the state disability sector to the NDIS focussed on children with existing disability, and that children with newly acquired disability had been required to 'join the queue'. Representatives from the Community of Practice stated that:
For many years we have advocated that children who have a newly acquired disability be treated as a priority…and yet we had absolutely no inroads into considering the option that they would be able to come up the queue or come up the priority order.
…
[T]he delays have been felt the entire time. There has been no improvement in the time frames of being made eligible for the scheme. We have a number of examples where a child with severe brain injury has taken three or four months to even get accepted onto the scheme and then had to wait another month or two to actually get a planning meeting.
…
[I]n terms of the health service, the pressure is on length of stay and ensuring that children are exiting hospital and not in hospital once they've become medically stable…the priority is to get them home and into their home environment, but, if they need home modifications or changes to their home due to the change in function that they've had, the delays that we're experiencing are significant and it is backing the system up. These children are being held in hospital far longer than they need to be.
Committee view
3.143
The evidence before the committee indicates that children with acquired disability, and children with complex needs, are underserved by the NDIS, and that delays in accessing the scheme and obtaining plan approvals may be limiting access to reasonable and necessary supports.
3.144
In light of these matters, the committee considers that a mechanism is required to prioritise these cohorts in appropriate circumstances, particularly to avoid lengthy stays in the hospital systems and to ensure that they are able to access supports as quickly as possible.
3.145
The committee recommends that the National Disability Insurance Agency develop and implement a mechanism to prioritise access decisions, plan meetings and plan approvals for children with complex needs and/or an acquired disability.
Transport
3.146
A number of submitters to the inquiry noted that funding for transport under the NDIS was not meeting the expectations of participants, particularly with regard to participants in regional or remote areas. For example, the submission by the Tasmanian Government noted that:
The NDIS assessment of need in relation to transport supports has, for many Tasmanian participants, resulted in a reduced capacity to travel: to work or place of study; to access funded supports; and to participate in community events or recreational activities. This has greatly affected participants' quality of life and has been the cause of significant dissatisfaction both within the Tasmanian disability sector and the broader community in Tasmania.
3.147
Participants noted that the difficulties associated with transport often resulted from a lack of flexibility in plans regarding how funding may be used, as well as from a lack of funding for transport more generally. For example, Mr Matt Law, Chief Financial Officer, Cara, noted that:
There are situations where a customer or participant has sufficient funding in their core for the supports that they require but, because there is no flexibility to use it for transport, they can't use a component of that funding to get where they would receive the supports, so they end up not accessing the supports at all. Yes, they would lose some of that element that was for supports if they had to use that money for vehicle costs and transport but at least they would be accessing the supports.
3.148
Mr Law recommended both that flexibility in plans be increased to enable participants to use core funding for transport costs, and that funding for transport be increased.
Committee view
3.149
In light of the evidence before it, the committee is concerned that the current NDIS may not be giving participants adequate access to transport services, and that this is leading to difficulties accessing other reasonable and necessary supports and participating fully in community activities. The committee acknowledges that this is a particular problem for participants in rural and regional areas, who may need to travel longer distances to access services.
3.150
As noted earlier, the COAG Disability Reform Council (the Council) has endorsed an approach to improve provision of transport services under the NDIS, including measures to increase transport funding for participants who are significant users of taxi subsidy schemes.
3.151
The Minister for the NDIS, the Hon Stuart Robert MP, noted that he will work with his state and territory colleagues to monitor the implementation of the Council's decisions, to ensure they provide clarity and good outcomes for NDIS participants. The minister also noted that government would aim to remove the distinction between core and capacity building funding in plans from July 2020, so that participants and their families could use plan funding more flexibility on the supports that best meet their needs.
3.152
The committee welcomes these measures, and is optimistic that they will help improve the provision of transport services under the NDIS. However, the committee remains concerned that the measures proposed by government may not be sufficient to ensure the NDIS meets the transport needs of participants in the shorter term. The committee therefore considers that the NDIA should implement a mechanism to allow participants to pay for transport out of core funding as a matter of urgency.
3.153
The committee recommends that the National Disability Insurance Agency immediately implement a mechanism to allow participants to pay for transport out of core funding.