3.1
This chapter provides background to the National Disability Insurance Scheme (NDIS) workforce, including its size, composition, employment profile and future growth needs. It also provides an overview of initiatives to support workforce development at the Commonwealth, state and territory levels.
Size of the workforce
3.2
The Department of Social Services (DSS) estimated that, in 2019, there were around 138 000 full-time equivalent workers (FTE) in the NDIS workforce. This contrasts with the estimate of 100 000 FTE in the disability sector in the DSS Growing the NDIS Market and Workforce Strategy.
3.3
This discrepancy may be explained by the fact that the NDIS workforce not only includes those workers who provide supports (such as disability support workers and allied health professionals), but also workers who perform a variety of other functions which are essential to the operation of the scheme. As noted by Ms Romola Hollywood, Director, Policy and Advocacy, People with Disability Australia:
[T]he NDIS workforce is not just about disability support workers but also fundamentally includes workers in mainstream services such as education, health, housing, transport and justice, particularly in those agencies that are run by state and territory governments. It also includes the partners in the community such as local area coordinators, NDIS staff and, in particular, planners.
…Then we have the whole disability support workforce. Advocates also play a fundamental role; this includes staff who work in the area of supported decision-making, which we think needs a lot more focus in the new workforce strategy. Then we also have allied health professionals and also medical practitioners. So we have a really broad suite of workers who make up what we see as the NDIS workforce.
3.4
A lack of reliable workforce data also makes it difficult to estimate the size and composition of the NDIS workforce, or to predict future demand. This issue is taken up in subsequent chapters.
National Disability Insurance Agency workforce
3.5
According to its 2019–20 annual report, at 30 June 2020 the National Disability Insurance Agency (NDIA) workforce was 11 550 staff. This included 4396 Australian Public Service employees, 1692 contractors and consultants, and 5462 employed by NDIA partners. This represents a 4.4 per cent increase on 2018-19.
Workforce composition
3.6
According to the Western Australian Government, in 2019 there were around 91 000 disability support workers in the NDIS workforce (66 per cent of the total workforce), and around 14 000 allied health professionals (10 per cent of the total workforce). The remaining 33 000 workers (24 per cent) comprised 'other' workers, including coaches; counsellors; fitness instructors; wholesalers; tradespeople; manufacturers; and importers and exporters.
Disability support workers
3.7
Disability support workers assist people with disability with various physical and emotional tasks, including personal care; cooking and cleaning; shopping; programs for community activities; and emotional support and friendship. Supports vary from low to high intensity.
3.8
Support workers typically hold certificate-level qualifications obtained via Vocational Education and Training (VET) providers.
3.9
Depending on the capabilities of the worker and the nature of the relationship with the person they support, support workers may be called on to assist with basic first aid, swallowing, mealtime support, and administering medication. However, disability-related health supports—while funded under the NDIS—are often delivered through the health system (for example, in a hospital by a medical practitioner or nurse practitioner).
3.10
Disability support workers are often distinguished from carers—noting that carers also provide personal care, support and help to a person with disability, but are not engaged as a paid or voluntary worker. Further, support workers do not provide therapeutic or clinical interventions. In the disability context, these are typically delivered by allied health professionals.
3.11
Purpose at Work (PaW) highlighted the unique nature of disability support work, emphasising that it involves significant emotional labour. PaW noted that job satisfaction is frequently high in professions with a high degree of emotional labour, noting that this may be explained by the longer, more established relationships between support workers and clients.
Allied health professionals
3.12
'Allied health' describes a range of professions involved in providing health services outside of emergency, medical, dental and nursing care. According to the Australian Allied Health Leadership Forum, allied health professions have:
a direct patient care role, with application to public health outcomes;
a national professional organisation with a code of ethics or conduct, and clearly defined membership requirements;
clearly articulated national entry level competency standards and assessment procedures;
a defined core scope of practice; and
robust and enforceable regulatory mechanisms.
3.13
Several allied health professions are registered under the National Registration and Accreditation Scheme (NRAS), such as physiotherapists, medical radiation practitioners, pharmacists, osteopaths, psychologists, occupational therapists, podiatrists and optometrists. Others operate under self-regulation, including dietitians, social workers, audiologists, physiologists, orthoptists,
speech pathologists, orthotists, prosthetists and sonographers.
3.14
Allied health professionals are required to hold nationally accredited tertiary qualifications of at least Australian Qualifications Framework (AQF) Level 7 (Bachelor Degree), typically obtained through faculties of medicine, education, health science, social science and rural health. These enable membership of national self-regulating organisations or registration with national boards.
3.15
Also forming part of the allied health workforce are allied health assistants. Assistants perform duties that facilitate care, and deliver components of clinical care that assist with treatment but do not entail clinical reasoning. Generally, assistants require supervision by an allied health professional in the initial stages of patient care, and while establishing a care plan. However:
….once established, many experienced [allied health assistants] are fully able to deliver services continuing therapeutic care to participants without the immediate presence of the supervising [allied health professional], thereby enabling increased access to and consistency of services and extending the reach of the…practice.
3.16
Allied health assistants are trained by VET providers, and typically hold a Certificate IV-level qualification including a specialisation in disability-related services.
Gender makeup of the workforce
3.17
The National Disability Services (NDS) Australian Disability Workforce Report for July 2018 (NDS Report) indicates that—as at March 2018—approximately 70 per cent of disability support workers were women. According to the report, the gender ratio is roughly the same in all states and territories, and has been stable for the 11 quarters to March 2018.
3.18
The NDS report also states that—as at March 2018—approximately 93 per cent of allied health professionals were women. However, there are variations in gender ratios across the allied health professions. Ms Claire Hewat, Chief Executive Officer, Allied Health Professions Australian (AHPA) observed that:
Professions like…physiotherapy will have a lot more males in them, whereas speech pathology is 97 per cent female, occupational therapy is 98 per cent female and dietetics is 94 per cent female. So [the workforce is] very much…impacted by being a female dominated area where a lot of people do take time off from the workforce and only come back to work part-time.
3.19
This is consistent with a recent survey of the NDIS workforce by the University of New South Wales (UNSW) Social Policy Research Centre: Working in new disability markets: A survey of Australia's disability workforce (UNSW Report). According to the UNSW Report, 66 per cent of survey respondents identified as female and 32 per cent as male. 2 per cent identified as another gender or stated that they preferred not to disclose a gender identity.
Age of the workforce
3.20
The NDS Report noted that the disability support workforce is older, on average, than the Australian workforce as a whole. At March 2018, between
40 and 49 per cent of support workers were aged over 45 years, while people over 45 years made up around 34 per cent of the total Australian workforce.
3.21
According to the NDS Report, around 70 per cent of allied health workers were aged 25 to 44 at July 2018, with around 21 per cent aged over 45 years.
3.22
The UNSW Report noted that two per cent of respondents were aged 24 years or under; 12 per cent were aged 25 to 34; 16 per cent were aged 35 to 44; 28
per cent were aged 45 to 54; 34 per cent were aged 55 to 64; and 5 per cent were aged 65 or over. Two per cent of respondents were reported 'age unknown'.
Workforce participation—people with disability
3.23
People with disability often face barriers to employment, variously including discrimination from employers during recruitment; misconceptions about the nature and impacts of disability in the employment context; transport and accessibility issues; and a lack of formal support structures and pathways into employment. These barriers also limit the extent to which people with disability are able to access meaningful work and equitable fair pay.
3.24
Additional barriers exist for Aboriginal and Torres Strait Islander peoples and culturally and linguistically diverse (CALD) peoples with disability. These include racial discrimination; systemic disadvantage; language barriers; and different understandings of work and caring. For some Aboriginal and Torres Strait Islander communities, remoteness may be a barrier to employment.
3.25
Participation rates for people with disability are lower than for people without disability. Australian Bureau of Statistics (ABS) data provides that, in 2018:
53.4 per cent of people with disability were in the labour force (employed or seeking employment) compared with 84.1 per cent of people without disability;
10.3 per cent of people with disability in the labour force were unemployed, compared with 4.6 per cent of people without disability;
the median gross income for a person with disability aged 15 to 64 years was $505 per week, compared to $1016 for a person without disability; and
the rate of full-time employment is almost two times higher among people without disability than among people with disability.
3.26
The committee heard that challenges for people with disability wishing to be employed in the NDIS workforce are likely to be similar to those faced by people with disability in the workforce generally. Consistent with this view, the UNSW Report noted that four per cent of respondents identified as having a disability.
Workforce participation—Aboriginal and Torres Strait Islander peoples
3.27
Aboriginal and Torres Strait Islander people are underrepresented in the NDIS workforce, as well as in the disability and health sectors. Indigenous Allied Health Australia (IAHA) noted that although Aboriginal and Torres Strait Islander peoples comprise 3 per cent of the population, they comprise just 0.5 per cent of the allied health workforce.
3.28
The underrepresentation of Aboriginal and Torres Strait Islander people in the workforce is a particular concern as a sustainable, community-based workforce is a critical factor in ensuring access by Aboriginal and Torres Strait Islander people to quality, safe, culturally appropriate services.
Geographic distribution
3.29
The UNSW Report observed that the workforce is distributed relatively evenly across capital cities and regional centres, with substantially fewer workers in rural and remote areas. Forty-nine per cent of respondents worked in capital cities, 45 per cent in regional towns, and 6 per cent in rural or remote areas.
3.30
Further, the committee heard that there is substantial maldistribution of allied health professionals across Australia—heavily skewed to major cities and inner regional areas. This is reflected in data collected by the Department of Health (DoH), set out in the table below.
Table 3.1: Distribution of allied health professionals by remoteness (2018)
|
|
|
|
|
|
|
|
Medical radiation practitioners
|
11 167
|
2 160
|
719
|
73
|
32
|
|
Optometrists
|
3 986
|
790
|
241
|
24
|
17
|
|
Osteopaths
|
1 756
|
393
|
56
|
NP
|
NP
|
|
Occupational therapists
|
14 322
|
2 851
|
1 169
|
137
|
57
|
|
Physiotherapists
|
22 003
|
3 665
|
1 314
|
171
|
109
|
|
Podiatrists
|
3 544
|
883
|
251
|
37
|
15
|
|
Psychologists
|
22 528
|
3 274
|
1 044
|
122
|
52
|
Employment profile
Casual vs permanent employment
3.31
According to NDS, in December 2019 approximately 60 per cent of disability support workers were employed on a permanent basis, 34 per cent were employed casually and six per cent were employed on fixed-term contracts. This trend has remained fairly constant since December 2015, with a recent fall in casual employment and a corresponding rise in permanent employment—as reflected in the figure below.
3.32
Data on the allied health workforce is less current. However, the NDS Report indicates that, as at March 2018, around 80 per cent of allied health workers were employed on a permanent basis, with around 17 per cent employed on fixed-term contracts and three per cent employed casually. These trends have remained fairly constant since December 2015.
Part-time vs full-time employment
3.33
According to the NDS Report, as at March 2018 around 80 per cent of permanent support workers were employed on a part-time basis. Around half of permanent allied health professionals were employed on a part-time basis.
Turnover
3.34
According to NDS, casual disability support workers have consistently higher turnover rates than workers employed on a permanent basis. Surveys show that, from December 2015 to June 2019, quarterly turnover for casual support workers was between six and nine per cent, while for permanent workers the quarterly turnover was between 4 and 7 per cent.
3.35
The period June 2019 to December 2019 saw a significant increase in turnover, with the turnover rate for permanent workers rising to 10 per cent and the rate for casual workers rising very substantially to around 28 per cent. This is reflected in the figure below.
3.36
The NDS Report indicates that, as at March 2018, the quarterly turnover rate for the allied health workforce was approximately five per cent.
Hours worked per week
3.37
According to NDS, recent workforce surveys indicate that, over the period to December 2019, disability support workers worked on average 29.2 hours per week. There has been a recent rise in the number of hours worked per week among disability support workers.
3.38
The NDS Report indicates that, as at March 2018, allied health professionals worked on average 28 hours per week.
Growth required to meet demand
3.39
The committee heard that substantial workforce growth is needed in the NDIS and the disability sector to meet future demand, particularly when considering retirement and exits; competition between sectors; and increasingly onerous standards for new entrants. If workforce demand remains unmet, there will be significant adverse consequences for people with disability.
3.40
DSS has estimated that an additional 90 000 FTE may be required for the NDIS workforce by 2024, stating that:
[T]he NDIS is expected to be one of the largest job creation opportunities in Australian history, with up to an additional 90 000 full time equivalent employees (FTE) needed over the next five years. This will include a mix of highly skilled positions and a large number of roles that do not require formal qualifications. The NDIS will thus become the main supplier of funds for the employment of disability care professionals.
3.41
Taking account of working hours and exit rates, around 173 000 new workers (by headcount) may be required by 2023, as reflected in the figure below.
Growth for specific cohorts
3.42
DSS stated that to meet required levels of workforce growth, the disability support workforce in the NDIS must grow by around 7.8 per annum, while the allied health workforce must grow by 9.6 per cent per annum. According to the WA Government, this equates to an additional 31 000 disability support workers, and 7000 allied health professionals, between 2019 and 2023.
3.43
Some submitters highlighted the need for additional workers to serve specific cohorts. For example, the Australian Psychological Society (APS) observed that, in light of the projected number of NDIS participants with mental illness, the demand for psychology interventions will continue to be significant.
Challenges in growing the workforce
3.44
The committee heard that there will be substantial challenges to growing the workforce to meet demand. For example, NDS observed that in a 2019 survey, the majority of providers had substantial difficulties recruiting and retaining staff across a range of professions. Difficulties were also reported in relation to NDIA staff, including planners and LACs. This is reflected in the table below.
Table 3.2: Recruitment and retention difficulties, by employment category
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|
|
|
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Psychologist
|
84%
|
45%
|
|
Occupational therapist
|
83%
|
46%
|
|
Speech therapist
|
80%
|
48%
|
|
Physiotherapist
|
79%
|
43%
|
|
Dietitian
|
69%
|
45%
|
|
Manager/supervisor
|
64%
|
28%
|
|
Support worker
|
62%
|
34%
|
|
Planner/LAC
|
54%
|
38%
|
|
Support coordinator
|
54%
|
30%
|
Workforce development initiatives
NDIS Jobs and Market Fund
3.45
The NDIS Jobs and Market Fund (JMF) provides targeted funding to support jobs and market growth in the disability sector. It was announced in the
2018–19 Budget, and includes $64 million in funding over four years.
3.46
The JMF includes $45.6 million for projects to grow the market and workforce. Projects that may be funded include developing an e-marketplace; initiatives to support Aboriginal and Torres Strait Islander peoples and organisations to provide NDIS services; developing delivery models for rural and remote areas; developing of training resources; and programs linking jobseekers with NDIS career opportunities.
3.47
According to DSS, the JMF will build on the success of the Sector Development Fund (SDF), which has funded projects totalling over $110 million to support people with disability, providers and the workforce to transition to the NDIS.
Boosting the local care workforce
3.48
As part of the 2017–18 Budget, $30 million in SDF funding was transferred to the Boosting the Local Care Workforce (BLCW) program. The BLCW aims to develop the capacity of disability and aged care providers to operate effectively and expand their workforce—with a particular focus on boosting local job opportunities in rural, regional and outer suburban areas.
3.49
The BLCW program includes the following measures:
appointment of 25 regional coordinators to help local organisations build sustainable businesses and grow their workforce under the NDIS;
creation of a free 'readiness assessment', for organisations to self-assess their systems, processes and overall readiness to become a registered NDIS provider or to sustain or expand their services as a register provider; and
creation of new data analytics tools such as the NDIS Demand Map. The map uses de-identified NDIS and other data to provide information on current and expected numbers of participants by postcode, anticipated spending per participant, and number of workers required to meet participant needs.
3.50
In addition, the BLCW program hosts a number of events around the country to assist providers to better understand and respond to workforce needs.
3.51
Some submitters and witnesses commented on the effectiveness of the BLCW program. For example, AHPA observed that it is unclear whether the program has been effective in addressing workforce issues impacting the allied health sector. However, it noted that a large amount of research was undertaken as part of developing the program, and expressed hope that this research will support future policy responses. NDS noted that while the Government has invested significantly in the BLCW program, there a lack of information about whether initiatives under the program have been successful.
Support for NDIS Providers Program
3.52
The Government has committed $17.6 million over four years from 2018–19 to assist providers to meet obligations in providing safe, quality supports to participants. The Supports for NDIS Providers Program (SPP) is a four-year grants program managed by the Quality and Safeguards Commission, which is intended to support national information and education to grow a quality market in the NDIS, 'emphasising compliance obligations through the lens of people with disability accessing NDIS supports and services.'
3.53
According to DSS, the SPP is designed to:
drive a nationally consistent, responsive and effective market regulation;
support registered NDIS providers to meet the conditions of registration and operate in accordance with registration obligations;
maintain and stimulate strong and diverse markets for supports and services, including in rural and remote areas of Australia, for activities that have limited supply and those supporting Aboriginal and Torres Strait islander and CALD participants; and
stimulate continuous improvement amongst NDIS providers to deliver higher standards in quality and safety of supports and services.
Workforce development strategies
3.54
A number of workforce strategies have been developed by the Federal Government, or are in development at the time of tabling this interim report. These strategies include:
the Growing the NDIS Market and Workforce strategy, and the development of a National Workforce Plan;
the NDIS Thin Markets Project and the work of the National Rural Health Commissioner;
the NDIS Participant Employment Strategy; and
the NDIS Workforce Capability Framework.
3.55
Each of these is relevant to one or more aspects of workforce development, and is discussed in Chapters 6, 7, 8 and 9.
3.56
Other initiatives at the state and Commonwealth levels that are relevant to the NDIS workforce include the following:
The Closing the Gap Framework and initiatives to increase health, education and other outcomes for Aboriginal and Torres Strait Islander peoples.
State-based initiatives such as the ACT Community Services Industry Strategy 2016-2026, the Northern Territory Human Services Plan 2019–2029, and the WA Social Assistance and Allied Health Workforce Strategy.
Various reviews and initiatives aimed at reforming the policy environment for mental health and psychosocial disability, including the National Mental Health Workforce Taskforce; Vision 2030 for Mental Health and Suicide Prevention; and a Review of the National Mental Health Policy.
Appointment of a Chief Allied Health Officer
3.57
Some submitters called for or supported the appointment of a Chief Allied Health Officer (CAHO) to help address system-wide workforce concerns.
3.58
On 9 July 2020, the Ministers for Health and for Regional Health, Regional Communications and Local Government announced the appointment of
Dr Anne-Marie Boxall as CAHO. The media release states that Dr Boxall's appointment supports the Government's Primary Healthcare 10-Year Plan, health workforce reforms and $550 million Stronger Rural Health Strategy.
Committee view
3.59
The NDIS is one of Australia's most significant public policy initiatives, and is currently supporting 412 543 people with permanent disability to access services and supports. The number of participants in the scheme is expected to grow, with the Minister for the NDIS estimating that the NDIS will deliver supports to over 500 000 Australians.
3.60
Meeting the needs of NDIS participants requires a sizeable workforce with the skills and training to deliver safe, quality services. It has been estimated that the workforce will need to grow by approximately 90 000 FTE by 2024. The scale of this workforce growth is significantly larger than other national policy projects. As one submitter to this inquiry noted:
[T]he rollout of the National Broadband Network required a workforce increase of 25 000 staff and the Building the Education Revolution Program of 2007–2010 required 22 971 additional staff…The additional 90,000 staff required for the NDIS to meet its demand when fully rolled out this year poses a very substantial challenge.
3.61
The committee acknowledges that a number of initiatives have been implemented, or are in development, to increase the size of the workforce and to ensure that workers possess appropriate training, qualifications and expertise—including the development of a national workforce plan. However, the committee has heard that the NDIS continues to experience significant challenges in attracting and retaining a sufficient number of qualified workers to meet demand, and ensuring that the workforce is equipped with the skills and qualifications to effectively support people with disability.
3.62
Potential reasons for these challenges, along with the committee's preliminary views on how they may be addressed, are discussed in subsequent chapters. The committee proposes to consider these issues in greater detail—including seeking further evidence from stakeholders—before presenting its final report.