The interface of NDIS and mainstream services
This chapter examines the boundaries and interface of NDIS service
provision and mainstream services and discusses the transitional issues
reported by those who contributed to the inquiry.
In particular, it explores the interface between the NDIS and the
following services: health; aged care; education; transport; housing and
Principles to Determine the
Responsibilities of the NDIS and Other Service Systems
The interactions between the NDIS and mainstream services are guided by
the Principles to Determine the Responsibilities of the NDIS and Other
(the Principles) agreed by COAG in April 2013 and updated in November 2015. The
Principles form part of the Bilateral Agreements for Transition to the NDIS,
and Operational Plans commit jurisdictions to work with the NDIA to develop
working arrangements for operationalising the Principles.
However, the committee heard the Principles are subject to
interpretation and lack clarity. This is resulting in boundary issues and
funding disputes, which can lead to reduced or no access to services for both
NDIS Participants and people with disability not eligible to the NDIS.
For example, the Queensland Government stated:
During transition it has become evident that different
interpretation of the Principles is resulting in individual plans not including
supports that Queensland considers should be included. This is most evident in
relation to health supports, but also transport assistance and education support.
In its submission, the Tasmanian Government noted that 'the NDIA’s
operational documents for interpreting the COAG Principles have not yet been
finalised, which contributes to the uncertainty in this area'.
The ACT Government reported that 'over time the ACT has experienced a
cost pressure associated with the fact that what is "in scope" for
the NDIS has moved'.
The NSW Government is of the view that 'extensive further work is
required by the States and the Commonwealth to scope, agree and communicate
The need for improved clarity between the NDIS and other government
services has also been identified by the NDIS Board as a priority area under
the recently refreshed NDIS Corporate Plan for 2017-21.
In its submission, the NDIA 'acknowledges the challenges associated with
the operational application of the COAG Applied Principles'
and makes the following statement:
The NDIA will continue to work with governments on
operationalising the Applied Principles, and suggests consideration be given to
additional clarification of these principles via a Rule, as well as the
inclusion of tangible targets and outcomes to ensure accountability on all parties-
potentially via the NDS.
The current transition of Commonwealth, state and territory programs to
the NDIS is discussed throughout the chapter as it is contributing to emerging
service gaps and the lack of clear delineation of funding responsibility
between the NDIS and state and territory services.
Dr Adrienne McGhee, Principal Policy and Research Officer at Office of
the Advocate (Queensland) described how 'health and disability are
interconnected. Yet, for the purposes of determining which government agency
pays for what, we're finding that they're being artificially separated out,
which is adding complexity and delays transitioning of people with disability.'
Many submitters found that the delineation between the services to be
provided by the NDIS and those provided by mainstream health services has not
been made sufficiently clear.
Ms Ellen Dunne, Director at the Office for Disability with the ACT
Government acknowledged the complexity of the interface between the NDIS and
I think it's really important that we recognise that there is
still a lot of complexity about the interface between eligible supports for the
NDIS and mainstream services—in particular, with the health system.
As a result of the lack of clarity, Ms Dunne stated that 'there is still
a lack of understanding about what should be paid for by the health directorate
and the ACT government and what should be paid for by the Scheme.'
The Victorian Healthcare Association is concerned 'that the poorly
defined interface between the NDIS and health services may result in people
losing access to community-based disability services and requiring more costly,
acute health services leading to poorer outcomes for people with disability'.
Mr Tom Symondson, CEO of Victorian Healthcare Association explained:
There is a very, very disturbing lack of clarity of the
interface between NDIS and health. As providers of both, we see that
consistently and it is causing very perverse outcomes for individuals, and
obviously services are having to navigate that as well. That also brings about the
issue of who is responsible for what. When you are somebody who is receiving
supports under the NDIS but you also have health issues, you tend to fall in
this very, very large grey zone in between the two systems. It is the health
provider or the NDIS provider who end up trying to work out who is going take
that cost, and it is the individual who is receiving services that suffers.
As a result of the poor interface between NDIS and mainstream health
services, the Allied Health Professions Australia is of the view that 'there is
significant scope for failures in the handover process between services and
resulting in safety risks for Participants'.
Discharge from hospital
Submitters reported that transition out of hospital into the community
for patients with disability can be problematic.
Issues reported concerned people in the process of applying for a NDIS Plan as
well as people with existing NDIS Plans.
Protracted hospital stays are a concern to the Victorian Government
because of the timeframes associated with NDIS access, planning and plan
implementation for people who require an NDIS Plan to support hospital
Ms Kim Peake, Secretary at the Department of Health and Human Services,
Victoria also raised this issue during a public hearing in Melbourne:
[...] on occasions, delays in the planning process are really
impacting on discharge of people from health services, and that has a corollary
in terms of the relationship with aged-care services in particular but also
into access to housing in the community.
Occupational Therapy Australia noted that 'hospitals cannot continue to
care for people simply because their NDIS Plan has yet to be finalised and
Inadequate supports in Plans are causing delays in release from
hospital. For example, Mrs Carmel Curlewis, an NDIS provider and Accredited
Practicing Dietitian reported:
[...] I found across the eastern seaboard that, after speaking
to 200 dietitians mainly from hospitals, it wasn't uncommon to have NDIS Participants
in hospital for six months, often 12 months—and, at the worst-case scenario, 18
months—waiting for enough money in their NDIS plans to get out of hospital.
It's just a ridiculous situation. 
The Summer Foundation also found that inadequate supports in Plans and
poor coordination between the health system and disability supports have also
led to increased hospitalisation of people.
Withdrawal of services and boundary
Submitters reported issues of withdrawal of services by the health
system. For example, the Victorian Council of Social Services (VCOSS) reported the
case of a patient who upon applying for an NDIS package saw the hospital
withdrawing services on the basis that the NDIS would cover the supports he
needed, including a wheelchair. This occurred before the patient received his Plan.
Multiple Sclerosis Australia stated that there are now instances where
health services are no longer accepting responsibility for supporting safe
discharge from hospital back into the home if the person is an NDIS Participant.
For example, it reported the case of a hospital in Queensland refusing to provide
any wound care once a Participant was discharged from hospital because the
person had an NDIS Plan.
At a public hearing in Canberra, Dr Ken Baker, CEO of National Disability
Services, provided the example of a funding issue arising when an NDIS Participant
with complex disability needs hospitalisation:
[...]an example from health is where a person with complex
disability, who may be nonverbal, who may have a severe intellectual
disability, needs hospitalisation. In practice it is traditionally the case
that a support worker or a disability support worker would accompany that
person into hospital and assist that person with disability to communicate with
the health practitioners within the hospital. [...] But under the NDIS it is a
matter for dispute as to who should pay for that support worker, if that
support worker is inside the hospital. I think it's not clear who should pay
for that person.
And, Dr Baker summarised the position of the NDIS:
Essentially the position of the NDIS is that, once that
support worker enters the hospital, the health system should be paying the
support worker, or the support worker should stop at the door and hand over
that person to the health practitioners.
In answers to a question on notice on boundary disputes, National
Disability Services provided a series of case studies illustrating the issue of
responsibility and funding for support workers when a person with complex needs
requires hospitalisation. In one case study, a non-verbal patient allegedly passed
away due to his support worker not being present and unable to interpret the
patient's non-verbal communication and explain the history of his condition.
Equipment and services
In Appendix 1 of the NDIA Operational Guidelines: Planning, the
NDIA states that the following supports may be funded by the NDIS:
Where this is required because of the participant’s
functional impairment and integrally connected to the participant’s support
needs to live independently and to participate in education and employment
(e.g. supervision of delegated care for ongoing high care needs, such as PEG
feeding, catheter changes, skin integrity checks or tracheostomy tube changes).
However, some submitters provided examples of NDIS Participants having
reduced or no longer access to these types of services and equipment because of
the NDIS arguing these supports should be met by the health system.
For example, Miss Grace Poland, an NDIS Participant with cerebral palsy
told the committee:
So, since February 2016, my access to services and equipment
has been limited. I have stopped receiving funding for orthotics, compression
stockings, podiatry services and lymphatic drainage therapy, all of which I
need to manage high muscle tone spasticity and chronic pain. Mercy Health, who
used to provide my compression stockings, told me that the NDIS would be
responsible for this funding in future, but this has not been the case.
Carers NSW reported that the NDIA has refused to fund in Plans supports
such as enteral and parenteral nutrition equipment and supplies; products to
support the use of continence aids; and nursing support on the ground these
supports are health specific. However, the health system has either disagreed
with this judgment or not had the funding available to provide this support. As
a result, this has left families 'in limbo, and often in crisis'.
The question of whether 'equipment is disability related and funded
under the NDIS' or 'medical and funded by the health system' was raised by
Occupational Therapy Australia, who submitted that there is a grey area,
particularly in terms of assistive technology.
Multiple Sclerosis Australia reported the funding of supra-pubic
catheters as an example of jurisdictional dispute between the NDIS and health
Changes of supra-pubic catheters (SPC), by registered nurses,
under the NDIS using ‘Individual Assessment and Support by a Nurse is no longer
being funded in a number of regions across NSW, Victoria and the ACT. Until
earlier this year Participants in the Hunter and Barwon trial sites had
received this funding across multiple plans. The message ‘vaguely’ being put
out by some planners is that this support is to be funded by the relevant
health service, however, a number of area health services are pulling out
stating that they have had their HACC funding removed and are therefore no
longer able to provide this service. This lack of clarity and consistency of
message to Participants is creating stress and without appropriate and timely
catheter changes, places Participants at a high risk of requiring
hospitalisation due to complications from infections caused by retention of
urine, and the triggering of an MS exacerbation due to such an infection increasing
core body temperature.
Similarly, in Queensland, with the transitioning of Queensland's
Community Care program some people with NDIS Plans are no longer able to access
wound care and catheter changing as neither the health system nor the NDIS
believe it is their responsibility to fund such services.
The Dietitians Association of Australia (DAA) reported that planners
are frequently denying the inclusion of dietetic services in Participant
packages. Planners are directing Participants to seek access to dietetics
services through the health system and Medicare CDM items. Allied Health
Professions Australia (AHPA) believes this approach is inappropriate when the
nutrition issues of Participants are grounded in their disability, and
therefore access to Accredited Practicing Dietitian services is reasonable and
Mrs Carmel Curlewis, an NDIS provider and Accredited Practicing
Dietitian, told the committee that some NDIS Participants have to stay in
hospital for extended periods of time because their Plans do not meet their
needs for dietetic services:
[...] we've got Participants in the health system who cannot be
discharged because they can't have enough dietitian hours and consumables
funding in their NDIS packages to discharge them from hospital.
Scope Australia, a not for profit organisation that supports children
and adults with developmental delays and disabilities reported:
We are aware of several instances where people with severe
and multiple disabilities with dysphagia (swallowing difficulties), have had
their request for funding to develop safe meal time profiles rejected by the
NDIS as this is considered a health department responsibility. The health
department in return, does not have the resources, capacity or expertise to
provide this service and is not able to include it within their service
Similarly, Speech Pathology Australia (SPA) identified that 'the most
problematic interface between mainstream health and NDIS services relates to
the provision of speech pathology services to people with a swallowing
disability and the provision of mealtime management supports'.
The National Disability Insurance Agency (NDIA) has recently
informed Speech Pathology Australia that the NDIS will not fund meal time
supports as part of individualise plans into the future – the rationale being
that this support is primarily to prevent a health risk (pneumonia or choking)
and therefore the Health sector should finance it.
[T]his ignores the important role eating, drinking and
sharing a meal play in family and social life for people with disability. It
also fails to acknowledge the fact that day-to-day provision of supports for
mealtimes is part of the responsibility of disability support workers, often as
part of provision of specialist disability supports.
SPA also stated that 'there are currently no alternative funding streams
for meal time support services provided by a speech pathologist (or
multidisciplinary team) for people with disability through the health systems.
Current MBS item numbers for speech pathology services are not structured
appropriately or adequately to fund this service'.
Having raised this issue with relevant federal, state and territory
ministers, SPA reported that the general view of all governments, (except
Victoria) is mealtime support 'should remain under Disability for funding and
provision of supports i.e. funding should continue to be included in NDIS
participant's individual plans'.
The lack of clarity and delineation of supports and funding is also
affecting other services such as sexual health. Ms Ee-lin Chang, Senior Health
Promotion Officer at Family Planning NSW reported:
We are concerned about the gap between Health and the NDIS in
meeting the reproductive and sexual health needs of people with disability. In
particular, we are concerned that people who have sexualised behaviours of
concern or who require additional support to enable them to make decisions
regarding their reproductive and sexual health will fall through the gap
between NDIS and Health.
Many submitters reiterated the concerns raised during the committee's
inquiry into the Provision of services under the NDIS for people with
psychosocial disabilities related to a mental health condition
about the transition of existing programs to the NDIS resulting in emerging
gaps in services for people with psychosocial disability ineligible to the
For example, Mr Tom Symondson, CEO of Victorian Healthcare Association
raised the issue of community-based mental health services transitioning to the
NDIS in full and how this is affecting people not eligible to the NDIS and
We have a Victorian specific issue—and we accept this—around
community-based mental health. I think I'm right in saying, we're the only
state that committed all of our community-based mental health funding to the
NDIS. We didn't keep anything back. That means that, because of the
differential eligibility for NDIS versus the existing state-based mental health
system, there is the threat of a number of people—a swathe of people—who won't
be eligible for NDIS funded community mental health, who currently are, and
we're very concerned about what impact that will have on those individuals, and
also on the rest of the service system trying to pick up that strain.
Ms Elinor Heard, Sector Reform Lead at Mental Health Council of Tasmania
also expressed the sector's concerns about the transition of services to the
Our sector remains concerned that the rolling over of
Commonwealth funding to the NDIS and the resulting decrease in community-based
services will lead to more episodes of crisis for individuals with a mental
health condition and an increase in complex presentations to emergency
departments and hospitals.
Catholic Social Services Australia summarised the issue:
As the committee has heard previously, the boundaries between
NDIS and non-NDIS services are particularly unclear in the area of psychosocial
disability support. There is confusion about which services are included in the
NDIS and how the mental health and disability sectors interface. Clarity is
needed as soon as possible on how mental health services for people who are not
eligible for the NDIS will continue to be funded.
Interface between the NDIS and
The committee understands that people with disability may also
experience a range of complex health support needs secondary to, but
intertwined with, their disability. In some cases, it remains unclear where the
line is, or should be, drawn between the health system and the NDIS for Participants.
For example, the evidence received by the committee about issues regarding enteral
and parenteral nutrition equipment and supplies; continence aids; and wound
care demonstrates the lack of clarity and delineation of responsibilities
between the NDIS and mainstream health systems. It appears that the quantum and
types of supports to be provided for NDIS Participants by either the NDIS or
health services are subject to interpretations and not consistently applied. It
is impacting negatively on access, quality and delivery of services for NDIS Participants
who require these supports. People are clearly missing out on necessary
supports, which can lead to increased and longer costly hospitalisation. These
issues are not new and must be resolved. Establishing clear and robust
boundaries between the NDIS and health services is essential.
It has become apparent that the operationalisation of the COAG Applied
Principles requires urgent work to clearly define roles and responsibilities of
the NDIA and the state and territory health systems. The COAG Health Council in
collaboration with the COAG Disability Reform Council should undertake work to
address how health services interface with NDIS services. This works needs to
focus on refining the COAG Applied Principles and agreeing on service
The committee recommends the Council of Australian Government (COAG) Health
Council in collaboration with the COAG Disability Reform Council urgently undertake
work to address current boundary and interface issues between health and NDIS
NDIS operational issues
Poor planning process and delays in Plan approval and implementation are
also contributing to delays in hospital discharge. This situation needs to be addressed.
The committee urges the NDIA to continue its work and effort in addressing
planning issues and chronic delays, and gather and publish the numbers of Participants
in this situation. The committee sees merit in establishing a unit to focus specifically
on this cohort of Participants.
The committee recommends the NDIA establish an NDIA unit specialising in
dealing with Participants who are hospitalised to ensure a smooth transition
from hospital and avoid delays in hospital discharge and to avoid discharge to
Transition of Commonwealth, state
and territory programs to the NDIS
As the provision of services to people with disability remains a shared
responsibility between all levels of government, it is imperative that
governments do not systematically and prematurely withdraw services during the
transition period. The committee received compelling evidence that the
transition of Commonwealth, state and territory disability support services to
the NDIS is resulting in emerging service gaps for both NDIS Participants and
people with disability ineligible for NDIS services. The committee has
identified the need for a national audit and mapping of all Australian, state
and territory disability support services transitioning to the NDIS to ensure
service gaps are detected and addressed accordingly.
The committee recommends the Council of Australian Government (COAG) Disability
Reform Council conduct immediately a national audit of all Australian, state
and territory disability support services transitioning to the NDIS, to identify
and address emerging service gaps.
The committee remains deeply concerned about the lack of clarity on how
the Australian, state and territory governments intend to provide services and
funding for people with psychosocial disability beyond the supports provided
through the NDIS. The committee reiterates recommendation 13 of its report on
the Provision of services under the NDIS for people with psychosocial
disabilities related to a mental health condition.
A number of submitters raised concerns about the ability of the aged
care sector to adequately support people over 65 years of age with
Many consider aged care services unsuitable and inappropriate for people with a
One of the issues is that aged care programs funding are capped. For
example, Spinal Cord Injuries Australia reported:
The most support anyone can expect through the My Aged Care
Gateway is a level four Home Care package which is currently valued at less
than $50,000. There are some small supplementary programs as add-ons to this
but eligibility is for such things as dementia care as an example. This level
of funding is woefully inadequate for anyone with a significant disability.
The Australian Blindness Forum believes the aged care sector does not
meet the specialised needs of people who are blind or vision impaired and over
the age of 65:
These people do not have the same generic aged care needs as
others in the sector as their needs are specialised. The boundaries between
disability services and aged care services are now blurred and there is no
clarity around the promised continuity of support for all people with
disability who are not eligible for the NDIS and who now are part of the aged
The Macular Disease Foundation argued that 'the key area of inequity
between the NDIS and the aged care system is that the aged care system provides
limited and inconsistent access to specialist disability support services,
whereas the NDIS provides full access to these services.
AMIDA explained that people over 65 with disability are being moved in
aged care accommodation despite their needs being better met in Specialist
Disability Accommodation (SDA):
In our experience people in SDA who turn 65 are often moved
into aged care despite their needs being better met in Specialist Disability
Accommodation. Ratio of staff to client in SDA is at most, 1 to 5 whereas in
aged persons’ accommodation it can be 1 to 30, which reduces the opportunity
for specialist disability needs to be met.
Spinal Cord Injuries Australia also reported that people are being
discharged from hospital to aged care facilities due to 'an inability to find
appropriate services to support people on discharge'.
The committee is concerned that people with disability over 65 years of
age are not receiving adequate supports and are potentially disadvantaged
compared to NDIS Participants. The committee believes that the Department of Health
in collaboration with the Department of Social Services should undertake work
to map the needs and gaps in funding and services for this cohort ineligible to
NDIS services, with the view of developing a strategy to address current
shortfalls in supports. The committee noted that the Productivity Commission
also considered that these issues need to be addressed. The Productivity
Commission did put forward some of the policy options it considers worth
exploring, including removing the NDIS entry cut-off age altogether and better
aligning the aged care and NDIS systems.
The committee recommends the Department of Health in collaboration with
the Department of Social Services undertake a review of current supports and
funding available for people with disability over 65 years of age, with the
view to developing a strategy to address current funding and support
The allocation of roles is relatively straightforward when it comes to
the education system. The NDIS funds 'supports that enable Participants to
attend school education, where these supports are required by the participant
to engage in a range of community activities'.
This includes assistance with self-care care at school, specialist transport,
equipment and specialised support to transition between schools, or from school
to post-school options.
The education system has responsibility for assisting students with
their educational attainment, including through teaching and educational
The Department of Education and Training summarised responsibilities of
the NDIS, the Commonwealth and state and territory governments:
In summary, a student with a disability would use the NDIS
for supports associated with the functional impact of the student’s disability
on their activities of daily living, such as personal care, transport to and
from school. The NDIS will not be responsible for personalising either learning
or support for students that primarily relate to their educational attainment
(including teaching, learning assistance and aids, school building
modifications and transport between school activities). (...) Australian
Government funding informed by the NCCD is one element of the support made
available for students with disability within the school setting. State and territory
governments are the primary funders of students with disability in the
government sector, and in the non-government sector schools and systems use
resources from all sources to meet the needs of their students.
However, many submitters raised concerns about the lack of clarity around
the provision of supports in the school environment and how the implementation
of the NDIS in educational settings is currently working.
For example, Allied Health Professions Australia is concerned that 'there is
insufficient clarity around the split between NDIS and mainstream education
Prader-Willi Syndrome Australia is of the view that there are some 'grey
areas' and 'a lack of clarity for who will be on the spot' to address risks for
students with Prader-Willi Syndrome.
Vision Australia and the Australian Blindness Forum argued that the
interface between the NDIS and education 'is not always appropriate as it
prevents families and communities from obtaining a holistic approach to a
child's needs while they are of school age'.
Personal Care in Schools (PCIS)
The Department of Premier and Cabinet, Victoria reported that COAG
agreed that, under the NDIS, Personal Care in Schools (PCIS) will be funded by
the NDIS when full scheme commences on 1 July 2019. However, some issues have
yet to be resolved and include:
reaching agreement on the 'in scope' personal care supports that
will be funded by the NDIA versus ‘reasonable adjustments’ that schools will
continue to fund; and
identifying an agreed process for assessing, costing and
delivering NDIA funded supports in schools.
The ACT government listed the following key issues, which remain to be
clarified around the scope of PCIS:
how to measure and cost the provision of PCIS;
whether it is viable for PCIS to be delivered through
individualised NDIS funding packages; and
how might NDIS funding of PCIS impact on school operations – will
there be an expectation for families to exercise choice and control over who
provides PCIS for their child? Will this mean external providers delivering
PCIS? How does this affect a school legal responsibility for duty of care for
In its submission, the Queensland Government pointed out that 'the
section covering Personal Support in Schools remained unfinished when the Principles
were approved by COAG in December 2015'.
The Victorian Government Department of Education is currently leading a
national project to provide a stronger evidence base around PCIS options and
future operational arrangements.
Access and provision of therapies
Occupational Therapy Australia and other submitters
raised the issue of access to schools for provision of therapy services:
Currently, the provision of therapy services is determined by
a state or territory education department policy regarding access to its
schools or by a given private school’s willingness to allow access. It is
important to note also that therapy can involve facilitating a student’s work
in the classroom and/or participation in extra-curricular activities.
Speech Pathology Australia stated that 'there is now widespread reports
of schools across Australia restricting all access to NDIS providers to
students during core learning times, school hours and in some cases on school
Ms Heidi Limareff, Deputy Chief Executive at Can:Do Group explained the
current lack of consistency to the committee:
The role of school therapy is up in the air. Some schools
don't allow any NDIS work. Some say it's okay, but then supply their own goals
for us to work on when in the schools. Some schools have had no changes
whatsoever. Some allow us in because they know us and other times they don't
allow us in because they know us and want new people coming in to try new
Occupational Therapy Australia pointed to inequities of access to
therapies between jurisdictions:
For example, children with a disability living in Queensland
have vastly improved access to school based occupational therapy services
compared with those living in Victoria. Such inequity needs to be addressed via
a national disability scheme.
As a result of reported confusion and difficulty surrounding whether or
not NDIS funded supports can be accessed at school, Family Advocacy recommended
that guidelines for access to therapies in school hours be produced between the
NDIA and state education departments.
Personal Care in Schools (PCIS)
The committee understands that the Victorian Government is leading a
national project on PCIS and future operational arrangements. The committee
believes this should assist in finalising the Principles in relation to
The committee recommends the Australian, state and territory governments
clarify and agree on the scope and process to deliver Personal Care in Schools
(PCIS) under the NDIS.
Provision of therapies in schools
With the transition to individualised service provision, evidence
suggests that decisions to allow NDIS service providers to deliver therapies in
schools are made on a case by case basis and heavily rely on internal school
policies. The committee is of the view that the NDIA should develop guidance on
best practices for provision of therapies in school settings based on lessons
learnt during NDIS trials and rollout to date.
The committee recommends the NDIA develop guidance on best practices for
provision of therapies in school settings based on lessons learnt during NDIS
trials and rollout to date.
The provision of transport services for NDIS Participants attracted
substantial criticism from government, stakeholders and Participants.
National Disability Services stated that 'transport in the NDIS needs
and raised the following issues:
Unresolved questions include: how much funding should be
provided by the NDIS to assist Participants with transport if they cannot use
public transport? What responsibility do state and territory governments have
in providing accessible transport for residents with disability, including in
regional areas? Should the transportation of children with disability to school
be the responsibility of the NDIS? Where does the funding responsibility lie
for transporting people with disability to and from medical appointments?
The Department of Premier and Cabinet, Victoria reported that 'several
states and territories share Victoria’s concerns that NDIS Participants are not
receiving adequate transport support'.
The Department of Social Services reported that 'administrative
differences between state and territory service systems pose a challenge to applying
a consistent national approach to addressing some transport system issues,
especially in developing a national approach to NDIS and mainstream funding for
taxi and private transport costs for NDIS Participants not able to travel
Taxi subsidy scheme
The Office of the Public advocate (Queensland) reported that the taxi
subsidy scheme in Queensland ceased with the introduction of the NDIS but was
reinstated in July 2017.
Indeed, due to concerns raised by stakeholders about transport supports
provided in NDIS Plans not meeting Participant needs, the Queensland Government
reinstated the taxi subsidy scheme for NDIS Participants until transition is
completed in June 2019.
Similarly, the Tasmanian and Victorian governments have decided to fund
taxi subsidies to NDIS Participants to ensure people are not disadvantaged
during the transition period.
The Victorian Government 'holds concerns that the NDIS may not be
providing adequate transport support to Participants'.
As a result, it is currently paying taxi subsidies to NDIS Participants as well
as making its agreed contributions to the NDIS under its bilateral agreement
with the Commonwealth.
Similarly, Tasmania stated that 'this gap in support effectively means
that the Tasmanian Government is paying twice for this cohort of NDIS Participants'.
At a public hearing in Hobart, the Tasmanian Government further
In November 2016, in response to stakeholder concerns, the
Tasmanian government established a temporary taxi subsidy safety net for
approximately 130 NDIS Participants who were former members of the state's taxi
subsidy program and who reported that their NDIS plans do not provide adequate
funding for transport supports. That's 130 individuals who signed a form in
which they declared that NDIS plans do not provide adequate funding for
transport supports. I think it's significant that people were willing to
actually make that declaration. The gap in support effectively means that the
Tasmanian government is now contributing twice for this cohort of NDIS Participants.
Given the lack of consistency in access and funding for taxi subsidies
across jurisdictions, Spinal Cord Injuries Australia recommended that clear
policy 'be put in place across the entire country on how taxi subsidies are to
be applied to Participants to ensure continued equity and access for all people
At a public hearing in Canberra, Ms Jennifer Grimwade, Executive Officer
of the Australian Blindness Forum raised the issue of the uncertainty of future
We are concerned that taxi subsidy schemes will be wound down
in the future and that will also have a great impact on people who are blind or
The Australian Medical Association (AMA) is concerned that the growth of
ridesharing platforms, such as Uber, may threaten the ongoing viability of
mobility taxis and further restricts the availability of transport options for
people with disabilities. It provided the example of San Francisco where the
introduction of private ridesharing operations resulted in a significant drop
of wheelchair accessible vehicles available in the city.
The provision of transport for Participants to and from school is an
ongoing issue for the Scheme. COAG agreed that transport to and from school
will be funded by the NDIA at full Scheme.
To address risks of inadequate design of NDIS funded school transport,
the Victorian Government is working in collaboration with the Commonwealth
Government, the NDIA and other jurisdictions to develop a new model for NDIS
funded student transport.
The Queensland Government reported that it had not been able to agree
with the NDIS 'on the administrative, operational or in-kind arrangements for
the delivery of specialist school transport'.
Mr Andrew Rayner from the Department of Premier and Cabinet, Tasmania,
explained that on a number of service areas, including school transport, clear
arrangements were not in place when transition commenced:
In Tasmania, it's the status quo until the government is
convinced that there's something developed that's workable and that will
continue to provide that essential service for those children. That's an
open-ended commitment. For school transport, a number of service areas and
policy areas were still being worked on at the point that transition commenced.
That's an artefact of the speed with which the NDIS is being built. School
transport is one of those. We signed on the transition agreements in full
knowledge that there wasn't a model for how school transport would work under
the NDIS. I know that the NDIA is working on it.
The committee agrees with submitters that transport in the NDIS needs
urgent attention. Transport issues have been consistently raised throughout
this inquiry and other inquiries conducted by the committee.
The committee has received substantial evidence over a long period that NDIS Participants
tend not to receive adequate supports in their Plans.
Taxi subsidy scheme
The committee notes that the Queensland, Victorian and Tasmanian Governments
have temporarily reinstated taxi subsidies for NDIS Participants to ensure
people are not disadvantaged during the transition period. In effect, it means
that these states are paying taxi subsidies to NDIS Participants as well as
making their agreed contribution to the NDIS under their bilateral agreements.
The committee is concerned that the current NDIS funding levels for
transport supports for adults is not meeting participants' needs, or matching
funding supports accessible through state and territory taxi subsidy schemes. This
is leaving Participants worse off under the Scheme. State governments have
apparently recognised this disadvantage and have been forced to temporarily reinstate
taxi subsidies but the future remains uncertain beyond transition. The
committee recommends that the NDIA undertake a review of its current
operational and funding guidelines for transport supports with the view of
ensuring it meets Participants' needs.
The committee recommends the NDIA review its operational and funding guidelines
for transport supports to ensure NDIS Participants' needs are met.
The committee believes that there is still considerable work to be
undertaken to achieve a suitable NDIS funded student transport model. The
committee understands that the Commonwealth, state and territory governments
and the NDIA have established a working group to develop a new model for NDIS
funded student transport. The committee welcomes this initiative, but is of the
view that ensuring choice and control for each individual student should not
hamper efforts to provide a crucial service for all students to get to and from
AMIDA argued that there is a well-known shortage of housing options,
especially for people with complex needs.
Accommodation was the subject of an inquiry by this committee in 2015-2016 and
it remains a critical issue.
The NDIS is not responsible for the provision of housing. However, the
NDIS can fund supports in relation to housing and independent living. The NDIS
factsheet Mainstream Interface-Housing provides some information about
the supports funded by the NDIS. Supports include:
home modifications to the participant’s own home or a private
rental property and on a case-by-case basis in social housing;
the NDIS may also contribute to the cost of accommodation in
situations where the participant has a need for specialised housing due to
their disability. The NDIS will only assist with this cost where it is higher
than the standard rental cost that the participant would otherwise incur.
Additionally, the NDIS can fund:
support that builds people's capacity to live independently in
support with personal care and help around the home where the
participant is unable to undertake these tasks due to their disability, such as
assistance with cleaning and laundry.
With the transition to the NDIS, new issues are emerging, including in
Special Disability Accommodation;
residential aged care facilities;
short-term accommodation and respite;
and crisis accommodation.
Specialist Disability Accommodation
In July 2016, the NDIS started to include Specialist Disability Accommodation
(SDA) funding in Participants' plan. SDA funding is for the dwelling itself,
and is not intended to cover support costs (such as Supported Independent
Living), which are assessed and funded separately by the NDIS.
Submitters reported a shortage of Specialist Disability Accommodation
The Summer Foundation acknowledges that 'there is a real promise in the SDA or
specialist accommodation framework' but reported implementation issues.
At a public hearing in Melbourne, Dr George Taleporos, Policy Manager
at the Summer Foundation, further explained some of the current issues which
impend on housing development:
The issue, however, is that we are not seeing people
receiving SDA payments in their plan. The only people who are receiving SDA
payments in their plan are people who are currently in in-kind housing funded
by the state governments. Developers, investors and people who want to build
housing are not seeing that there's a market for this housing, because no-one
has SDA in their plans. Our sister organisation, Summer Housing, is providing
housing for eight people, and not even they have SDA in their plans.
Dr Taleporos stressed that until payments start appearing in people's Plans,
'there will be very few developers who will actually take the risk and build
The SDA pricing framework guarantees funding for five years. The Summer
Foundation believes investors need a longer period of price certainty to feel
confident about developing housing options.
Residential Aged Care
As described by Dr George Taleporos, the lack of housing has resulted in
people 'currently trapped in residential aged-care facilities'.
He also pointed out that with the withdrawal of state services, people are
finding themselves in 'funding limbo', which is 'particularly concerning' for
young people in residential aged care.
At a public hearing in Melbourne, Ms Kym Peake, Secretary of Department
of Health and Human Services with the Victorian Government acknowledged the
increased number of young people in residential aged care facilities and
advised the committee that the Victorian Government is undertaking some work in
Ms Peake reported that 'approximately 1569 young people are in
residential aged care in Victoria, and in 2016 there was an increase of about
100 extra young people'.
Dr George Taleporos told the committee that one of the reasons for the
increase in people in residential aged care under the NDIS in Victoria is that
when a person is in hospital, the state government is no longer taking
responsibility for finding a suitable solution and the NDIS is yet to be more
Ms Natalie Siegel-Brown, the Public Guardian in Queensland noted that a
contributing factor to young people remaining in aged care is that nursing
homes are failing to register people for the NDIS. Through an informal survey,
the Office of the Public Guardian found that 'nursing homes have no idea that
the young people in their homes are eligible for NDIS'.
Short-term accommodation and
Mr James O'Brien, President of the Prader-Willi Syndrome Association of
Australia reported that the NDIS pricing guide for special disability
accommodation is ambiguous in relation to respite, emergency or temporary
accommodation and this is resulting in short-term facilities closing down:
My reading is that short-term stays are not funded under SDA.
There is currently insufficient funds for short-term facilities to meet the
demand and existing respite providers have indicated to me that they will be
closing due to a lack of funding under the new system.
National Disability Services reported that because NDIS funds the user
cost of capital for long-term housing (SDA) but not for short-term
accommodation, there is a risk of respite houses being converted to long-term
At a public hearing in Canberra, Dr Ken Baker acknowledged the work
currently undertaken by the NDIA to respond to 'the looming crisis in
short-term accommodation and respite services by announcing its intention to
introduce a new pricing structure from the end of the month'.
Following consultation and feedback from Participants and providers, the
NDIA increased price limits for short term accommodation and the changes took
effect on 30 October 2017.
The new price limits per night for short-term accommodation now include
increased price limits for weekend and public holidays, as well as for high
Submitters drew the attention of the committee on the issue of some
tenants with complex needs in group homes who are being given notice to vacate
and are at risk of becoming homeless due to lack of Provider of Last Resort.
The Office of the Public Advocate (OPA) in Victoria reported that 'in a
pre-NDIS world, the Victorian Department of Health and Human Services (DHHS)
could be relied upon to ensure that especially vulnerable people with
disability (and complex needs that threatened tenancy arrangements) did not
However, the OPA is of the view that, 'since the introduction of the
NDIS, DHHS can no longer be depended on to provide this safety net in regions
where the NDIS has been rolled out'.
The OPA pointed out that 'the transitional arrangements are largely
silent on who will provide and fund crisis accommodation for people whose
behaviours threaten their tenancy. Neither the Victorian Bilateral Agreement nor
the Operational Plan refer specifically to crisis or temporary accommodation or
its provision to people with disability'.
The OPA noted:
Under the NDIS there are no provisions available for
alternative accommodation – no additional ‘crisis’ funding from the NDIA and no
one responsible for providing a bed. This situation was recognised and
addressed in the recently released Productivity Commission Position paper on
NDIS Costs, and NDIA’s response to that paper. NDIA has stated that they are
currently developing a ‘Market Intervention Strategy’ and are prepared to
ensure market supply and act as provider of last resort in cases of ‘thin
markets’ and market failure including in crisis care and accommodation
situations and service gaps for Participants with complex, specialised or high
intensity needs, or very challenging behaviours.
Specialist Disability Accommodation
The committee is cognisant of the ongoing shortage of Specialist Disability
Accommodation (SDA). The committee has received anecdotal evidence that Participants
are not receiving SDA funding in their Plans. Because it has not been available
for long, the committee believes it is too early to comment on the
effectiveness of the introduction of SDA funding in Participants' Plans. The
committee is aware that the Disability Reform Council has asked the NDIA to
consider mechanisms through which private investment in SDA could be
encouraged. The committee understands that the NDIA has engaged McKinsey &
Co to progress this work and expects to publish new information on SDA by the
end of March 2018.
The committee will undertake work in this area during the course of its new
inquiry on market readiness.
The introduction of SDA payments in plans will not address the chronic
lack of housing for people with disability. The committee acknowledges that
housing remains the responsibility of mainstream services and believes that the
Australian, state and territory governments need to develop and introduce new
initiatives to address the shortage of accommodation for people with
disability. This should include considering options of land release and
adapting existing housing stock.
The committee recommends the Council of Australian Government (COAG)
Disability Reform Council consider the provision of housing stock and
infrastructure for people with disability.
Young people in residential aged
care and crisis accommodation
The committee is concerned with the reported increase in young people in
residential aged care facilities since the introduction of the NDIS. The
committee noted that the Victorian Government is undertaking some work in this
area to address the issue. The committee also noted that one of the reasons put
forward for this increase is that state and territory governments are no longer
responsible at time of hospital discharge to find a suitable accommodation
solution. The committee is of the view that Provider of Last Resort
arrangements should be put in place to ensure no Participants end up in
residential aged care facilities when discharged from hospital. The issue of
Provider of Last Resort is further discussed in chapter 4 of this report.
The committee is concerned with the lack of arrangements for provision of
crisis accommodation. This is increasing the risk of people with complex needs
becoming homeless. The committee agrees with the Productivity Commission's
finding that it is unclear whether the NDIS or state and territory governments
are responsible for funding emergency supports for accommodation.
In the committee's view this is because the responsibilities are omitted in the
majority of bilateral agreements, and subsequent operational plans. The
committee believes that the Australian, state and territory governments and the
NDIA need to work together to clarify roles and responsibilities of the state
and territory governments and the NDIA in relation to provision of crisis care
The committee recommends that the Australian, state and territory
governments and the NDIA work together urgently to include crisis accommodation
and Provider of Last Resort arrangements for housing in their respective
bilateral agreements and operational plans.
The lack of integration between the NDIS and the justice system was
reported by inquiry Participants.
The committee reported on this issue in its recent inquiry into the Provision
of services under the NDIS for people with psychosocial disabilities related to
a mental health condition.
Issues raised by submitters relate to diminished access to supports
under the NDIS; lack of and/or inability to find service providers and
unresolved Provider of Last Resort arrangements.
For example, VCOSS members reported two cases of NDIS Participants
having support cut as a result of moving to the NDIS on the grounds that these
supports were related to offending behaviour. VCOSS explained:
In both cases, the individuals were receiving funding through
their Victorian Individual Support Packages for psychological services to help
reduce offending related behaviour and promote pro-social behaviour and broader
life skills. The NDIA has ruled this support is not ‘reasonable and necessary’
on the grounds it relates to offending behaviour. However, the COAG principles
states the NDIS will cover 'supports to address behaviours of concern (offence
related causes) and reduce the risk of offending and reoffending such as
social, communication and self-regulation skills...' Some service providers
specialising in forensic support services to people with disability have also
been informed they cannot provide this support under the NDIS. It is unclear if
they will continue to receive state-based funding. Without these support these
people risk becoming entrenched in the criminal justice system.
Victoria Legal Aid reported cases of clients unable to be released from
custody because they are not able to attract service providers.
Victoria Legal Aid is of the view that 'urgent and immediate solutions must be
developed to address circumstances where the continued detention of our clients
with complex disabilities is directly linked to the failure of the market to
provide disability services under the NDIS'.
They called on the NDIA and the Victorian Government to 'urgently allocate
clear and transparent responsibility for immediately providing services to his
vulnerable cohort of clients'.
In its submission, the NDIA stated it is working on a number of projects
to improve interface issues at the jurisdictional level, including a project on
'improvements in criminal justice system intersection with the Victorian
The committee believes it is imperative that the interface between the
NDIA and the criminal justice system works effectively. As discussed in Recommendation
23 in its report on the Provision of services under the NDIS for people with
psychosocial disabilities related to a mental health, the committee
supports the proposal of establishing an NDIA unit specialising in the
interaction of the Scheme with the criminal justice system.
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