Introduction
2.1
This chapter provides a background to the NDIS and an overview of the planning process, highlights some of the key activities undertaken by the National Disability Insurance Agency (NDIA) and other relevant organisations since the committee's last report, and outlines a number of issues relating to NDIS planning that were raised during the 45th Parliament.
Background to the National Disability Insurance Scheme
2.2
The National Disability Insurance Scheme (NDIS) provides support to people with disability, their families and carers. It is jointly governed and funded by Federal, state and territory governments. The NDIS became operational on
1 July 2013, with the commencement of trial sites. From 1 July 2016, the NDIS began the transition to full scheme on a geographic or age basis. The transition to full scheme is guided by Bilateral Agreements between the Commonwealth, and State and Territory governments.
2.3
The NDIS is a new model of funding and delivering supports for persons with disability. It is insurance-based, and moves from the previous system of block funding to a fee-for-service, market-based approach. It is based on the premise that people with disability each have different support needs and should be able to exercise choice and control in relation to their supports.
2.4
The main component of the NDIS is individualised packages of supports to eligible people with disability. When fully rolled out, the NDIS is expected to serve over 500 000 people aged under 65 who have a permanent and significant disability, with funding for supports and services.
The National Disability Insurance Agency
2.5
The NDIA is an independent statutory agency responsible for the governance and administration of the NDIS. Its core functions include delivering the NDIS in a way that maximises choice and control for participants and promotes access to high quality supports, and managing, advising and reporting on the financial sustainability of the scheme.
Legislative framework for the NDIS
2.6
The NDIS is established pursuant to the National Disability Insurance Scheme Act 2013 (NDIS Act). The NDIS Act also establishes the NDIA, and sets out the agency's functions and governance arrangements.
2.7
Relevantly, the NDIS Act sets out the objectives of the NDIS, which include:
supporting the independence and social and economic participation of people with disability;
providing reasonable and necessary supports, including early intervention supports, for participants;
enabling people with disability to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports;
facilitating the development of a nationally consistent approach to accessing, planning and funding of supports for people with disability; and
promoting the provision of high quality and innovative supports for people with disability.
2.8
The Act further provides for: how a person may become a participant in the NDIS; how a participant's plan is prepared and reviewed, including how the NDIA approves funding for supports; how a provider can become a registered provider of supports; and the processes for reviewing decisions.
National rollout of the NDIS
2.9
National rollout of the NDIS began on a progressive basis from July 2014, with the majority of jurisdictions beginning the transition in July 2016. It is expected that the full rollout of the NDIS will be completed by July 2020.
2.10
As of 30 September 2019, all jurisdictions except WA have transitioned to full scheme. The NDIS is providing services to over 314 000 people across all jurisdictions, as outlined in the table below.
Table 2.1: Number of people benefiting from the NDIS compared to bilateral estimates as at 30 September 2019
|
|
|
|
|
New South Wales
|
108 261
|
141 957
|
|
Victoria
|
84 049
|
105 324
|
|
Queensland
|
55 577
|
91 217
|
|
South Australia
|
29 538
|
32 284
|
|
Tasmania
|
7 027
|
10 587
|
|
Western Australia
|
20 165
|
39 097
|
|
Australian Capital Territory
|
6 988
|
5 075
|
|
Northern Territory
|
2 622
|
6 545
|
|
Total
|
314 247
|
432 086
|
2.11
In 2019–20, the Australian Government has budgeted for expenditure of $16.3 billion on supports for NDIS participants. Government proposes to spend $20.9 billion in 2020–21, following the full rollout of the scheme. This is comparable to the expected cost of $22 billion for the scheme. The Australian Government has published a range of factsheets for participants and providers that set out key elements of the scheme.
Background to NDIS Planning
2.12
This section provides an overview of NDIS planning, including the principles that guide the planning process, a description of the plan, and an outline of the planning process and plan review. This reflects the committee's understanding of the NDIS planning process, based on information published by the NDIA and relevant legislation and supplemented evidence given to the committee during the inquiry.
2.13
Each NDIS participant must have a plan, prepared in conjunction with the participant and approved by the NDIA. The planning process seeks to identify participants' goals and to determine the informal, community, mainstream and NDIA funded supports needed to realize those goals.
2.14
The NDIS Act sets out principles relating to plans. Relevantly, the Act provides that that the preparation, review and replacement of a participant's plan, and management of funding for supports, should so far as reasonably practicable:
be directed by the participant;
where relevant, consider and respect the role of family, carers and other persons who are significant in the life of the participant;
be underpinned by the right of the participant to exercise control over his or her own life; and
maximise the participant's choice and independence.
2.15
These principles are set out in addition to the general objectives and principles for the NDIS (outlined above).
2.16
The NDIA's operational guidelines further state that the planning process should result in the NDIA gaining a 'rich understanding of the participant's support needs'. The guidelines emphasise that, to maximise choice and control, process should be led by the participant and use goal-based planning and strength-based approaches to increase participant independence.
What is a plan
2.17
According to the NDIA's operational guidelines, a plan is a document which outlines the environmental and personal context of an NDIS participant, along with the specific supports which will be provided to or funded for the participant to enable them to effectively move towards their personal goals, objectives and aspirations.
2.18
The plan must include:
a statement of goals and aspirations. This must specify the participant's goals, objectives and aspirations, as well as the environmental and personal context of the participant's living (including living arrangements, informal and other community supports and social and economic participation).
The statement of goals and aspirations is prepared by the participant. The NDIA must have regard to the statement of goals and aspirations when deciding whether to include a support in a plan. Before including any support in a plan, the NDIA must be satisfied that the support will assist the participant to pursue the goals, objectives and aspirations included in the statement of goals and aspirations;
a statement of participant supports. This must specify (among other matters) the general supports that will be provided for or in relation to the participant, the reasonable and necessary supports that will be funded by the NDIS, and how funding for the supports is to be managed. When approving a statement of participant supports, the NDIA must have regard to a range of matters set out in the NDIS Act, including the participant's statement of goals and aspirations.
The statement of participant supports is prepared with the participant and approved by the NDIA. The NDIA must comply with the statement of participant supports.
2.19
The statement of participant supports will also set out the date by which, or the circumstances in which, the NDIA must review the plan, and how the funding of supports under a participant's plan will be managed.
Planning process
2.20
Under the NDIS Act, when a person becomes a participant the NDIA must facilitate the preparation of a plan in accordance with the NDIS Rules. Where the rules do not require the NDIA to commence facilitating the preparation of a plan within a prescribed period or in prescribed circumstances, the NDIA must facilitate the preparation of the plan as soon as reasonably practicable.
2.21
NDIA guidance states that when a person becomes an NDIS participant, an NDIA representative will contact the person to arrange a planning meeting. The representative may be an NDIS Planner, Local Area Coordinator (LAC) or Early Childhood Early Intervention (ECEI) Coordinator.
2.22
At its public hearing in Canberra, the committee heard that originally the role of the LAC was to provide information to potential participants, but now the LACs are – in approximately 80 per cent of instances – doing the majority of the planning or plan building for participants. The NDIA confirmed this, noting that:
In [the trial phase of the NDIS] we didn't have LACs to speak of, except some like positions within the agency. But when we started to look at our model as we scaled up, we acknowledged that around 80 per cent of participants fall into a category that we call 'general' or 'supported'. They don't have the same complex needs that perhaps the other 20 per cent of participants may have.
…
[B]ecause of the way that LACs are nestled within the communities and understand the connections between the community and mainstream and often had relationships with some of these participants through other means, they were best placed to deliver the general and supported preplanning and…develop the information that would generate a plan. Then what happens is that the plan is pushed through the system to the agency delegate, who then makes the decision. So the LAC planner isn't the delegate.
2.23
Before the planning meeting (also referred to as the 'planning and assessment conversation'), the NDIA will review the participant's access request form, any available evidence of disability (for example, reports from clinicians and other medical practitioners), the statement of goals and aspirations, and any other information provided by the participant. By reviewing existing information, the NDIA seeks to reduce the overall assessment burden for the participant by minimising the number of times that information needs to be provided.
2.24
During the planning meeting, the NDIA and the participant will discuss the participant's goals and aspirations, and identify any specific supports which would assist the participant to achieve them. The NDIA will also talk to the participant about their preferred option for managing the funding of supports under their plan. The NDIA's website notes that planning meetings are conducted either in person or over the phone between the participant and the NDIA representative. Participants are also able to bring a family member, friend or advocate (or anyone else) to the planning meeting.
2.25
Generally, the planning meeting (or meetings, where necessary) will be based on the participant's statement of goals and aspirations. However, if a participant has not prepared a statement of goals and aspirations ahead of the planning meeting, the NDIA can support the participant to prepare their statement as part of the planning meeting.
2.26
The NDIA will use information gathered during the planning meeting, as well as other information relevant to the participant, to develop and approve the statement of participant supports. In preparing the statement, the NDIA may also request that the participant, or another person, provide additional information that is reasonably necessary for the purposes of preparing the statement. The NDIA may also request that the participant undergo additional assessments and/or psychiatric or medical assessments. Where the NDIA has requested that the participant undergo assessment or examination, the NDIA will provide assistance, including financial assistance where appropriate.
2.27
The NDIA must decide whether or not to approve the statement of participant supports as soon as reasonable practicable, including what is reasonably practicable having regard to any requests for information, examination or assessment that have been made by the NDIA.
2.28
A participant's plan will come into effect when the NDIA has received the statement of goals and aspirations and has approved the statement of supports. The plan ceases to be in effect when it is replaced by another plan, or when the person to whom the plan relates ceases to be a participant.
2.29
The NDIS Act requires the NDIA to provide a copy of a participant's plan to the participant within seven days of the plan taking effect. The NDIA states that the plan will be available via the NDIS myplace portal about 24 hours after it has been approved. The participant will also receive a copy of the plan in person or by mail in the participant's preferred format and language.
Plan review
2.30
NDIS plans are routinely reviewed by the NDIA as part of the planning cycle. Plans may also be reviewed on an ad hoc basis following a request from a participant or on the NDIA's initiative. According to the NDIA, the plan review is an opportunity to check whether supports are working effectively and are helping the participant to realise their goals.
2.31
A scheduled plan review takes place as part of the normal planning cycle. As noted above, the statement of participant supports must specify the date by which, or the circumstances in which, the NDIA must be review the plan.
2.32
The NDIA's operational guidelines state that the NDIA generally ensures that plans have a minimum duration of 12 months, and will specify a plan review date of four to six weeks before the plan comes to an end. However, in some cases the NDIA may specify a longer or shorter plan review date to accommodate the preparation of a new plan at a time that is more appropriate for the participant.
2.33
An unscheduled plan review may take place where the NDIA decides to review the plan at the participant's request, or where the NDIA decides to conduct a plan review on its own initiative.
2.34
A participant, or their nominee, may request that the NDIA conduct a review of their plan at any time. This generally occurs when a participant's circumstances have changed, and their current plan no longer meets their needs. Where a participant makes such a request, the NDIA must decide whether to conduct the 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 the decision.
2.35
The NDIA may also decide to conduct a review of the participant's plan at any time. The operational guidelines note that it may be appropriate for the NDIA to conduct a review of this kind where there are, or are expected to be, significant changes to the participant's circumstances, or a significant event has occurred. The NDIA may also decide to initiate a review of a plan where a participant changes their statement of goals and aspirations, or in light of information obtained during the NDIA's feedback and monitoring activities.
2.36
Where the NDIA conducts a review of a participant's plan, this will involve the NDIA developing a new plan for the participant, having regard to the same matters and using the same approach employed when preparing the current plan. However, it is noted that reviews of a participant's plan will vary in length and complexity depending on the circumstances of the participant, and the circumstances that triggered the review.
2.37
Similarly to developing a plan, the NDIA may request additional information from a participant, or request that the participant undergo assessments and/or examinations, as part of the plan review process.
Varying a plan
2.38
Relevantly, a participant's plan cannot be varied after it comes into effect. It may only be replaced following a plan review process.
Internal and external review
2.39
It is important to distinguish plan reviews (both scheduled and unscheduled) from internal reviews of decisions under the NDIS Act.
2.40
Plan review is a process by which the NDIA re-assesses a participant's support needs, and prepares a new plan on behalf of the participant.
2.41
By contrast, internal review involves an NDIA officer (who was not involved in the original decision) considering the factual, legal and policy aspects of a decision and determining if the decision was correct or preferable. A number of decisions under the NDIS Act may be subject to internal review. Relevantly, these include a decision not to approve a participant's statement of supports, and a decision not to conduct an unscheduled plan review.
2.42
Where a person is not satisfied with the outcome of an internal review process, they may seek further review of the decision by the Administrative Appeals Tribunal.
NDIA Activities
2.43
This section briefly lists some of the NDIA's key activities since the committee tabled its last progress report in March 2019.
Pathways Review
2.44
In 2017, the NDIA commenced the NDIS Pathways Review (the Review), to address concerns from participants, families, carers and providers that the NDIS was not meeting their expectations. In particular, the Review was a response to stakeholder concerns that the use of telephone planning did not promote the development of an informed relationship about a person's needs and requirements.
2.45
Throughout the Review, the NDIA heard from more than 300 participants, providers and other stakeholders. Generally, feedback was that participants wanted more transparency and to feel engaged, understood and supported throughout their engagement. Participants also emphasised the need for easy-to-understand, clear and accessible communications.
2.46
According to the NDIA's submission to the current inquiry, key improvements arising out of the Review include:
three specific pathways: the NDIS Participant Pathway, Complex Support Needs Pathway, and Early Childhood Early Intervention (ECEI) Pathway;
streams for psychosocial disability and hearing, to deliver targeted support and tailor the participant experience to specific disability needs; and
service enhancements to meet the communication and engagement needs of people from diverse backgrounds or areas, including Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse peoples, remote and very remote communities, and people who identify as LGBTIQA+.
2.47
The submission also notes that by June 2019, baseline service improvements to the NDIS Participant Pathway were rolled out nationally, and states that these improvements include:
a stronger focus on community, government, informal and employment supports during pre-planning, to assist participants, families and carers;
a consistent point of contact for participants;
enhanced planning communication products in a variety of formats;
face-to-face pre-planning and plan implementation meetings at the discretion of the participant; and
improved linkages between NDIA planners and LACs, and improved training for NDIA planners and LACs.
2.48
The NDIA has also published an update on progress as at June 2019, which broadly supports their submission to the inquiry. Relevantly, the update also refers to the rollout of additional disability training for NDIA staff; improved support coordination; and the rollout of joint planning meetings.
Joint planning soft launch
2.49
Many submissions to the inquiry recommended the introduction of draft plans in the planning process (or noted instances where draft plans would be useful), to ensure participants have meaningful input during the planning process and to understand their approved plans.
2.50
The NDIA's submission states that the NDIA understands the importance for participants to have meaningful input into the planning process, and of ensuring that participants understand their approved plans. The submission notes that this reflects consistent feedback from the pathway review.
2.51
The submission further notes that the joint planning meeting is a key example of how the NDIA is working towards a collaborative and transparent planning experience. In this respect, the submission states that since 6 May 2019, the NDIA has been conducting a 'soft launch' of joint planning meetings in southern Adelaide. The joint planning soft launch began with four LACs and four NDIA planners at the NDIA St Mary's and partner Mission Australia's Clovelly Park sites. The submission explains the soft launch process and associated proposals for joint planning 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.
This work builds on previous joint planning trials, which took place during the 2018 Pilot 1 (new plans) and Pilot 2 (plan reviews) as part of service improvements for the new participant pathway. This work also builds on the roll out of service improvements to the new participant pathway, particularly the delivery of plan alignment and plan implementation meetings, and stronger connections between LACs and planners. The NDIA will roll out joint planning more broadly, following a detailed evaluation of the ‘soft launch’. The rollout of the joint planning process will be supported by the introduction of an Appointment Booking Tool that will electronically capture and schedule the required meetings between the participant, their LAC and NDIA planner delegate.
2.52
The NDIA provided further detail on the joint planning process at the committee's public hearing in Adelaide:
Basically, the joint planning in South Australia involves the local area coordinator and the participant as well as the [NDIA] delegate who approves the plan. The process involved is that the local area coordinator initially has a conversation with the participant as part of the pre-planning. They build the plan and then the local area coordinator and the delegate come together and agree on what's to be included in the plan and what needs to be done. Once they've formalised that, they ask the participant to come to what we call a joint plan. It's a three-way conversation with the participant. The participants also have a choice to bring their carers, if need be. Anyone who supports them can come into that meeting. Then they have the local area coordinator and the delegate.
Part of the process is to give them a working version of the plan. We say, 'This is what's in your plan. This is what's included in the plan. Are you happy with the plan? Is there anything you'd like changed?' If there are any changes, if they are able to make the changes on the spot, the delegate will make those changes and approve the plan. As soon as the plan is approved the delegate usually leaves the meeting. The local area coordinator will continue the conversation with the participant, explaining what's in the plan and how to use the plan. That's the remit of what we did in South Australia.
2.53
The NDIA stated that it offered joint planning to 347 participants, and held joint planning meetings with 223 participants. It further noted that 203 plans were approved at the joint planning meetings, representing around 91 per cent of the plans that were considered as part of the joint planning soft launch.
Minister's announcement
2.54
On 14 November 2019, the Minister for the NDIS, the Hon Stuart Robert MP, announced the government's plan to improve the NDIS and to ensure its future sustainability. According to the minister, the plan has been developed with advice from the NDIS and the Department of Social Services (DSS), and has six core elements:
quicker access and quality decision making;
increased engagement and collaboration;
market innovation and improved technology;
a financially sustainable scheme;
equitable and consistent decisions; and
improving long-term outcomes.
2.55
Relevantly, the Australia Government's plan includes a number of initiatives to improve NDIS planning. For example, the minister announced that:
from April 2020, the NDIA will commence the national rollout of draft planning meetings, and the provision of draft plan summaries;
from July 2020, the government aims to remove the distinction between core and capacity building funding, so that participants and their families can use plan funding more flexibly on supports that meet their needs; and
the government remains committed to finalising the review of the NDIS Act and legislating changes for the commencement of the NDIS Participant Service Guarantee in July 2020 (see below).
2.56
The Minister also announced that he will continue to work with state and territory governments to monitor the implementation of decisions made by the Disability Review Council in relation to transport 'to ensure they provide clarity and good outcomes for NDIS participants'.
Review of the NDIS Act – Tune Review
2.57
The Australian Government has promised to develop an NDIS Participant Service Guarantee, to support positive participant experiences with the NDIS. The Guarantee will set new standards for the time it takes for key steps in the NDIS process. This means that there will be shorter, agreed timeframes for people to receive a decision on whether they will be covered by the NDIS, to receive an NDIS plan, and to have a plan reviewed. A particular focus of the Guarantee is participants needing specialist disability accommodation and assistive technology. The review will complement work being implemented by the NDIA to improve planning.
2.58
To develop the Guarantee, the government commissioned a review of the NDIS Act and associated laws, led by Mr David Tune AO PSM. The review will consider what changes may be needed to the legislative framework for the NDIS to support the Guarantee and to set new standards into law. This may involve amendments to the NDIS Act and associated legislation, but will not change the design or intent of the NDIS.
2.59
Government held public consultation on the review from 26 August 2019 to
31 October 2019. People with disability, family members, carers, advocates and providers from around Australia shared experiences and ideas in community workshops, the online survey and submissions.
2.60
Mr Tune is expected to hand down recommendations by the end of 2019, to support the proposed rollout of the Guarantee from 1 July 2020.
Disability Reform Council Activities
2.61
The COAG Disability Reform Council (the Council) provides a forum for member governments to discuss matters of mutual interest and progress key national reform in disability policy including the NDIS. The Council oversees implementation of the NDIS, as well as a broad range of reforms implemented through the National Disability Agreement and National Disability Strategy to support people with disability, their families and carers.
2.62
The Council is chaired by the Minister for the NDIS, and consists of state ministers within disability and treasury portfolios, as well as representatives from the Australian Local Government Association.
2.63
In its last progress report, this committee identified a number of actions relating to the NDIS which were agreed to by the Council between 1 July 2017 and 31 December 2019. According to its reports, the Council has since:
welcomed the incoming Commonwealth Minister for the NDIS, the Hon Stuart Robert MP, as Chairperson of the Council;
agreed to a range of disability-related health supports that will be provided through the NDIS. The Council also circulated a fact sheet which clarifies which health supports are, and are not, funded through the NDIS, and how funding is to be provided;
agreed to the Hospital Discharge Delay Action Plan, which will promote timely discharge of participants from public hospitals;
discussed progress and next steps on the proposed establishment of an NDIS Reserve Fund. The Council agreed that actuarial advice on a Reserve Fund will be provided to states and territories by the end of October 2019;
agreed to an approach to improve the access and experience for NDIS participants with psychosocial disabilities, and to address interface issues between the NDIS and mainstream mental health systems;
agreed that the NDIA will introduce Justice Liaison Officers in each jurisdiction, to deliver a coordinated approach to supporting NDIS participants in youth and adult justice systems;
endorsed an approach to improve the provision of transport services under the NDIS, including interim measures to increase transport funding for participants who are significant users of taxi subsidy schemes;
requested that implementation of an integrated and holistic framework for critical supports be expedited, and that further refinement of the framework be undertaken by the NDIA, states and territories;
agreed to work collaboratively on implementation of the Information, Linkages and Capacity Building (ILC) Strategy and grant programs, to review the allocation of funding, monitor risks and implement mitigation strategies, and ensure greater local knowledge;
agreed to consider amendments to the Specialist Disability Accommodation (SDA) Pricing and Payments Framework and SDA Rules to bring the rules into line with regulatory best practice, clarify policy settings and afford SDA participants greater flexibility in their choice of living arrangements; and
agreed to ongoing discussions to ensure and report on the long-term financial sustainability of the NDIS, with a proposal to be considered at the Council's next meeting.
Productivity Commission Report
2.64
In the Heads of Agreement between the Commonwealth, State and Territory governments on the NDIS, it was agreed that the Productivity Commission (the Commission) would undertake a review of NDIS costs in 2017, to inform the final design of the full scheme prior to its commencement.
2.65
On 20 January 2017, the (then) Treasurer, the Hon Scott Morrison MP, requested that the Commission undertake a review of NDIS costs. The terms of reference required the Commission to address a number of matters in the Heads of Agreement for the NDIS, and to consider:
Commonwealth and state funding and governance arrangements for the NDIS, including financial contributions and risk-sharing;
the interaction with, and role of, other services in meeting reasonable and necessary support for people with severe and profound disability; and
whether there are any issues associated with the scheme's design, including the application of market and insurance principles, in ensuring the best possible outcomes for persons with severe and profound disability.
2.66
The Commission delivered its final report on 19 October 2017.
2.67
The Productivity Commission emphasised that good planning processes are essential for the success of the NDIS and its long-term sustainability, noting:
the challenge for the planning process is finding the right balance between individualisation and good outcomes for participants on the one hand, and ensuring equity among participants and the financial sustainability of the scheme on the other.
2.68
However, the Commission noted that as at October 2017 the planning process was not operating well, and was often failing to meet participants' needs. In this respect, the Commission noted that:
planning conversations with scheme participants are said to be rushed and superficial. Most plans are prepared by phone, which limits engagement with participants and can mean that planners do not get the ‘full picture’;
the planning process is not clear, transparent or accessible, and processes are not sufficiently inclusive or flexible to accommodate differing needs, particularly for participants with complex needs and participants from culturally and linguistically diverse (CALD) backgrounds; and
there is variability in planner skills, experience and training. Planners often lack knowledge about different types of disability, which can hinder their ability to formulate a good plan.
2.69
Evidence submitted to the present inquiry suggests that these issues persist. For example, Maurice Blackburn Lawyers noted that:
There seems to be an increasing number of complaints from participants and their families/carers about delays in receiving an NDIS plan, the lack of experience and expertise of NDIS planners, the lack of communication about the proposed plan, and also the content of the plans themselves.
Issues raised in the 45th Parliament in relation to planning
2.70
The committee conducted 8 inquiries during the 45th Parliament. The following section provides a brief overview of some of these inquiries, and highlights issues and recommendations relating to the NDIS planning process.
2.71
It is noted that while government agreed (or agreed in principle) with the majority of the recommendations made by the committee, only limited progress had been made on implementation as at 30 March 2019.
Provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition
2.72
Between November 2016 and August 2017, this committee undertook an inquiry into the provision of services under the NDIS for people with psychosocial disabilities, reporting in August 2017.
2.73
Key issues raised by submitters and other stakeholders related to: eligibility criteria for the scheme, including lack of clarity and guidelines leading to inconsistency in outcomes; access to the NDIS; training of NDIS staff; the adequacy of plans; continuity of supports for people not eligible for the NDIS; provider of last resort arrangements, including for people in indefinite detention; and access to NDIS support services for people in custody.
2.74
The committee recommended that the NDIA implement a number of measures to improve planning processes and deliver better outcomes for participants. In this respect, it recommended the NDIA:
develop and proactively market resources and training for primary health professionals about the NDIS, especially in regards to access to the scheme and planning processes;
develop an approach to improve flexibility in plans to respond to the fluctuating needs of participants with a psychosocial disability, including allowing minor adjustments to be made without the need for a full plan review; and
report on the level of engagement of carers in the planning process.
2.75
Many issues highlighted in the committee's August 2017 report persisted as at March 2019, including inconsistencies in eligibility and planning outcomes, limited progress in developing a standardised assessment tool, and continuity of support and funding of services outside the NDIS. These issues were also raised by a number of submitters during the current inquiry.
2.76
Relevantly, the committee noted that feedback from stakeholders during its February 2019 roundtable indicated that there is still inadequate flexibility in plans for participants with psychosocial disability, and that any change to a plan—even a minor change—is triggering a full plan review.
Provision of services under the NDIS Early Childhood Early Intervention Approach
2.77
Between June and December 2017, this committee undertook an inquiry into the provision of services under the NDIS Early Childhood Early Intervention (ECEI) Approach, reporting in December 2017.
2.78
Key issues raises by submitters and other stakeholders related to: access to the NDIS; the planning process, the adequacy of plans and delays in the plan approval process; underfunded plans for children with Autism Spectrum Disorder (ASD); and the costs of delivering services for service providers.
2.79
Relevant to the present inquiry, the committee recommended that:
the NDIA provide ongoing and targeted training to planners creating ECEI plans for children to ensure that they are equipped with the most up to date knowledge, expertise and resources in their decision making;
the NDIA ensure that provision of funding for assessments in plans is based on participant needs, and not arbitrarily restricted to a yearly assessment;
the NDIA urgently address issues of scope and level of funding in plans for children with autism with a view to ensuring that recommended evidence-based supports and therapies are fully funded; and
funding be made available in plans for interpreters, including funding an interpreter to communicate with the participant's parents or carers.
2.80
By early 2019, stakeholders acknowledged that there had been improvements through the development and implementation of the ECEI pathway. However, there were a range of issues that still needed to be urgently addressed, including: delays in provision of services; significant challenges in addressing the needs of children with ASD; and the lack of a clear, national strategy around the ECEI approach under the NDIS.
Transitional arrangements for the NDIS
2.81
From June 2017 to February 2018, this committee undertook an inquiry into transitional arrangements for the NDIS, reporting in February 2018.
2.82
Key issues raised by submitters and other stakeholders related to: the interface between the NDIS and mainstream health services; delays in accessing the scheme; plan approvals, plan activations and access to services; funding levels and associated service gaps; the lack of clarity on how the NDIA intends to intervene in thin markets; provider of last resort arrangements; service gaps; and a lack of culturally appropriate services for CALD persons and Aboriginal and Torres Strait Islanders communities to engage with the NDIS.
2.83
Relevant to the present inquiry, the committee recommended that the NDIA:
ensure that across all jurisdictions people with disability can access pre-planning supports;
urgently finalise and start piloting tailored pathways for people with psychosocial disability; children; people from Aboriginal and Torres Strait Islander communities; those from CALD backgrounds, and participants with more complex needs;
focus all necessary resources and efforts on reducing wait times at all points of the scheme, specifically for plan approval, activation and review; and
ensure support coordination is adequately funded in plans to meet participants' needs and not limited to a fixed period.
Progress report 2017
2.84
In September 2017, the committee tabled its first progress report for the 45th Parliament, covering the period from 1 July 2016 to 30 June 2017. The report provides an overview of activities related to the implementation, performance, governance, administration and expenditure of the NDIS over the reporting period. It also considers issues raised in evidence to the committee's inquiry into general issues around the implementation and performance of the NDIS.
2.85
Key issues raised by submitters and other stakeholders focussed on: the NDIA's planning process; lack of transparency and responsiveness; reductions to plan funding; development of non-contextual pricing for services; portal issues; transport market design; and the early intervention pathway.
2.86
Relevantly, the 2017 progress report raised a number of issues relating to the NDIS planning process. In particular, participants, their families, carers and service providers expressed dissatisfaction with plans being developed over the phone; the skills and competence of planners; inconsistency in planning decisions; delays to plans and reviews; and the NDIA's lack of transparency.
2.87
The committee made a number of recommendations to address the issues associated with NDIS planning. Relevantly, the committee recommended that:
the NDIA provide an opportunity for participants, and those who support them, to view, comment, and rectify any errors in their plan in advance of it being finalised and implemented; and
the NDIA ensure that only criteria underpinned by terminology set out in the NDIS Act and associated rules are used in the assessment of appropriate supports.
Conclusion
2.88
The committee acknowledges the work that has been progressed in recent months to improve the NDIS planning experience and outcomes for participants, providers and other stakeholders.
2.89
However, as discussed in subsequent chapters, issues with the planning process persist and the committee's previous recommendations have not necessarily been implemented by the NDIA. To address this concern, the committee makes a number of recommendations to improve the planning process in Chapter 3, and in Chapter 4 the committee highlights other issues that it will continue to examine in the coming months.