2.1
This chapter provides background to the National Disability Insurance Scheme (NDIS), and highlights issues related to the NDIS workforce raised in previous inquiries and review processes. In addition, the chapter briefly outlines the recent review of the National Disability Insurance Scheme Act 2013 (NDIS Act), and introduces the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (Royal Commission).
Background to the National Disability Insurance Scheme
2.2
The NDIS is a model for funding and supports for people with disability, families and carers. It is insurance-based, and moves from the previous state‑based system of block funding to a 'fee-for-service', market-based approach.
2.3
The main component of the NDIS is individualised packages of supports for eligible people with disability. The scheme 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.
National Disability Insurance Agency
2.4
The National Disability Insurance Agency (NDIA) is the 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 National Disability Insurance Scheme
2.5
The NDIS is established under the NDIS Act. The Act also establishes the NDIA, and sets out the agency's functions and governance arrangements.
2.6
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 NDIS participants;
enabling people with disability to exercise choice and control in the pursuit of their goals and in 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.
2.7
The NDIS Act further provides for how a person may become a participant in the NDIS; how plans are prepared and reviewed; how the NDIA approves funding; how an entity can become a registered provider of supports; and the processes for reviewing decisions.
National rollout of the National Disability Insurance Scheme
2.8
The NDIS became operational on 1 July 2013 with the commencement of trial sites. National rollout of the scheme began on a geographic and age basis from July 2014, with the majority of jurisdictions beginning transition on 1 July 2016. The transition to full scheme was guided by bilateral agreements between Commonwealth, state and territory governments.
2.9
National geographical rollout of the NDIS was completed on 1 July 2020, with Christmas Island and the Cocos (Keeling) Islands joining the scheme. As at
30 September 2020, the NDIS was providing services to 412 543 participants, as set out in the table below.
Table 2.1: Active NDIS participants compared to bilateral estimates as at 30 September 2020
|
|
|
|
|
NSW
|
130 118
|
141 957
|
|
VIC
|
111 210
|
105 324
|
|
QLD
|
78 811
|
91 217
|
|
SA
|
36 712
|
10 587
|
|
WA
|
34 751
|
32 284
|
|
TAS
|
9 358
|
39 097
|
|
ACT
|
7 909
|
5 075
|
|
NT
|
3 636
|
6 545
|
|
Other territories
|
34
|
-
|
|
National
|
412 543
|
432 086
|
2.10
As at 30 September 2020, there were also 8 639 children in the Early Childhood Early Intervention (ECEI) gateway.
2.11
According to the 2020–21 Budget, expenditure on the NDIS is expected to increase from $18.7 billion in 2019–20 to $23.4 billion in 2020–21. The budget papers state that this 'reflects a higher number of people with a disability entering the [NDIS] under transition arrangements with the states and territories'. Subsequent expenditure is approximately $25.5 billion in 2021–22, $25.6 billion in 2022–23, and $25.7 billion in 2023–24.
Relevant Senate inquiries
Market readiness for provision of services under the NDIS
2.12
From December 2017 to September 2018, the committee undertook an inquiry into market readiness for provision of services under the NDIS (Market Readiness inquiry). Among other matters, the inquiry considered workforce demand and shortage; policies and initiatives to grow the workforce; and barriers to workforce growth.
2.13
Relevantly, the committee noted a 'critical shortage' of disability workers and allied health professionals, with a majority of submitters reporting significant challenges recruiting qualified staff to meet demand. Evidence indicated that this supply gap would continue to widen, with significant implications for the quality of care under the NDIS and for participant choice and control.
2.14
The Market Readiness inquiry also highlighted several barriers to growing the workforce, including changing working conditions with the transition to the NDIS; casual work and low hours; NDIS pricing structures; and a lack of qualification pathways and opportunities for professional development. In view of these matters, the committee observed that:
There are currently virtually no incentives to choose a career in the disability support sector. Submitters who have worked for a very long time in the sector described how working conditions have dramatically deteriorated under the NDIS. In short, they reported a rise in underemployment and insecure work arrangements, inadequate wages and no prospect of professional development opportunities.
Under these conditions, it is hard to imagine how to retain highly experienced and qualified workers and attract new workers, including young people entering the workforce.
2.15
The committee expressed concern that that there was a lack of reliable data on the NDIS workforce, noting that this makes it difficult to develop solutions to workforce issues. It also emphasised the importance of qualified staff to safe, quality care, stating that a range of qualifications should be available across the university and vocational education and training (VET) sectors.
2.16
The committee made 29 recommendations. Relevant to the present inquiry, the committee recommended that:
the Australian Bureau of Statistics (ABS) should regularly collect and publish data on the qualifications, age, hours of work and incomes of those working in the disability sector;
the Department of Social Services (DSS) should develop and publically release a national workforce strategy;
the Australian Skills Quality Authority consult with the industry, and with state and territory governments, on the adequacy of VET programs in disability care;
the NDIS Quality and Safeguards Commission should review options on how to ensure the NDIS workforce can access funded training, including considering the introduction of a portable training entitlement system;
the NDIA and the Commission should ensure that consistent and clear information is provided about the provider registration process; and
the Government should allocate resources to the Commission to establish a strategic unit responsible for monitoring and review of NDIS prices with the aim of transferring responsibility for pricing to the Commission in 2020.
2.17
The Government supported 14 of the recommendations, supported 12 in principle, and partially supported one. It noted or did not support two.
General issues around the implementation and performance of the NDIS: Progress Report 2019
2.18
In March 2019, the committee tabled its second progress report for the 45th Parliament, in relation to its ongoing inquiry into General issues around the implementation and performance of the NDIS. The report covered the period from 1 July 2017 to 30 December 2018.
2.19
The committee continued to hear evidence around barriers to growing the workforce, including employment conditions, price settings, and training and professional development. It heard numerous reports of skilled, experienced workers leaving the sector despite a clear need to grow the workforce to meet demand. The committee concluded that workforce conditions had dramatically deteriorated under the NDIS, making it an unattractive and uncompetitive sector.
2.20
The committee observed that these issues appeared to be largely driven by unrealistic pricing and unnecessary red tape. It recommended that the NDIA consider how to reflect the additional administration and professional development costs associated with operating in the NDIS environment in NDIS pricing, as part of the (then) next annual pricing review.
2.21
The committee also expressed concern that the NDIA continues to provide inconsistent information to participants, and asserted that the NDIA should develop guidance and training materials to ensure its staff and contractors provide clear and consistent information to participants, families and carers.
Senate inquiry into violence, abuse and neglect of people with disability
2.22
In February 2015, the Senate referred an inquiry into violence, abuse and neglect of people with disability (2015 Inquiry) to the Senate Community Affairs References Committee. The inquiry reported on 25 November 2015.
2.23
Relevantly, the 2015 Inquiry identified several systemic and workforce-related issues that may cause or exacerbate violence, abuse or neglect, including:
the institutional nature of disability service provision;
low pay rates, contributing to high levels of staff turnover;
high rates of casualization;
lack of career development and training;
lack of appropriate pre-employment and ongoing worker regulation;
poor workplace culture; and
lack of appropriate risk management and reporting processes.
2.24
The 2015 Inquiry made 30 recommendations to address the identified issues. Relevantly, these included establishing national training requirements; ensuring Australian Bureau of Statistics (ABS) data is inclusive of people with disability; and collecting specific data on Aboriginal and Torres Strait Islander peoples with disability. It also recommended that government consider several specific matters in rolling out the NDIS, including increased training for planners and the impact of pricing structures on incidents of violence, abuse and neglect.
2.25
The Government noted 24 of the recommendations made in the 2015 Inquiry, agreed with one, agreed in principle with four, and did not agree with one.
Review of the National Disability Insurance Act 2013 and the
Participant Service Guarantee
2.26
In June 2020, the Government commissioned a review of the NDIS Act, led by Mr David Tune AO PSM (Tune Review). The review sought opportunities to streamline NDIS processes, and to address legislative barriers to positive participant and provider experiences. It also considered a Participant Service Guarantee (PSG) to set standards and timeframes for NDIA decision-making as it affects NDIS participants, their families and carers.
2.27
The final report of the Tune Review was published in December 2019. It made 29 recommendations to improve the experience of participants, and to support the introduction of the PSG.
2.28
The Government Response to the Tune Review was released in August 2020. Government supported, or supported in principle, all 29 recommendations. Implementation of the response, including amendments to the NDIS Act and NDIS Rules, was delayed due to the COVID-19 pandemic. However, the NDIA has agreed to commence operationalising the PSG and public reporting against its timeframes and service standards, from 1 July 2020. The Ombudsman will similarly report against the NDIA's implementation of the PSG in 2020–21.
2.29
The NDIA has published the PSG on its website. The PSG includes timeframes (in days) for a number of NDIS processes, including access decisions; approval of plans; plan reviews; and complaints.
The Tune Review and the NDIS Workforce
2.30
The Tune Review did not have a specific focus on the disability workforce. However, the Review acknowledged that building market capacity is critical for participants to draw benefits from NDIS funding, noting that the ability to exercise choice first relies on there being a sufficiently robust market offering that is responsive to participant needs and preferences.
2.31
The Review also acknowledged the need for rapid expansion of a workforce capable of implementing NDIS processes, and a need to improve the capability and capacity of the NDIA workforce, including partners in the community.
Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability
2.32
The Royal Commission was established by Letters Patent issued in April 2019. The Royal Commission may inquire into and report on:
(a)
what governments, institutions and the community should do to prevent, and better protect, people with disability from experiencing violence, abuse, neglect and exploitation, having regard to the extent of violence, abuse, neglect and exploitation experienced by people with disability in all settings and contexts;
(b)
what governments, institutions and the community should do to achieve best practice to encourage reporting of, and effective investigations of and responses to, violence against, and abuse, neglect and exploitation of, people with disability, including addressing failures in, and impediments to, reporting, investigating and responding to such conduct;
(c)
what should be done to promote a more inclusive society that supports the independence of people with disability and their right to live free from violence, abuse, neglect and exploitation;
(d)
any matter reasonably incidental to a matter referred to in paragraphs
(a) to (c) or that you believe is reasonably relevant to [the] inquiry.
The Royal Commission and the NDIS Workforce
2.33
Evidence before the Royal Commission routinely touches on issues affecting the NDIS workforce and the capacity of the workforce to deliver safe, quality supports. The Commission also expressed specific interest in understanding experiences of people with disability in and seeking employment, stating that:
People with disability can face barriers to employment that may prevent financial independence and other benefits associated with work, including dignity, a sense of purpose and social connectedness.
Having a meaningful job with fair and equitable pay can promote the inclusion and independence of people with disability and support their right to live free from violence, abuse, neglect and exploitation. While not the only factor, financial independence may reduce the risk of violence, abuse, neglect and exploitation of people with disability.
2.34
Some of the evidence before the Royal Commission may be used to inform the committee's views regarding the NDIS workforce, and may be reflected in the interim and final reports for this inquiry.
Disability Reform Council Activities
2.35
The (former) Council of Australian Governments (COAG) Disability Reform Council (DRC) provides a forum for governments to discuss matters of mutual interest and to progress reforms in disability policy. The DRC oversees implementation of the NDIS, as well as a broad range of reforms to support people with disability. These are implemented through the National Disability Agreement and National Disability Strategy.
2.36
The Prime Minister announced in May 2020 that COAG will be replaced by the National Federation Reform Council, and that the Australian Government was 'looking to consolidate and reset' the DRC. The DRC has also noted that the National Cabinet has announced a review of former COAG Councils and Ministerial Forums, led by Mr Peter Conran AM. While the review was underway, disability ministers were to continue to meet to discuss 'critical issues of national significance', in accordance with agreed protocols and the NDIS Act.
2.37
The activities of the DRC in 2020 have largely focussed on ensuring that people with disability and the disability support workforce are protected during the ongoing COVID-19 pandemic, and on ensuring that people with disability can continue to access the services and supports they require.
2.38
As part of its 11 May 2020 meeting, the DRC thanked the disability workforce for their commitment during the COVID-19 pandemic, noting that support workers play an essential role and deserve ongoing support. It stated that ministers are working with the NDIA, Commonwealth, state and territory health agencies, and the disability sector, to ensure the workforce is supported and informed during the COVID-19 pandemic—including by ensuring access to personal protective equipment (PPE).
2.39
The DRC also noted scenario modelling on potential workforce shortfalls should COVID-19 infections increase significantly, and stated that ongoing workforce monitoring will be undertaken, along with the development of measures to ensure actions can be taken if major workforce shortages arise.
2.40
The DRC further noted 'considerable steps' taken by the Commonwealth and state and territory governments to support the workforce, including:
removing visa restrictions on international students working in the sector;
fast-tracking worker screening processes in jurisdictions;
online job matching tools to assist the disability sector to connect with job seekers; and
developing new, accessible online training programs to assist displaced workers to retrain for critical sectors, such as the care sector.
2.41
During its 24 July 2020 meeting, the DRC agreed to continue monitoring the NDIS support market, and to work together to finalise an NDIS workforce plan later in 2020 in light of COVID-19.
Productivity Commission report
2.42
In the Heads of Agreement between the Commonwealth, State and Territory governments on the NDIS, it was agreed that the Productivity Commission (PC) would undertake a review of NDIS costs in 2017, to inform final design of the full scheme prior to its commencement. On 20 January 2017, the (then) Treasurer, the Hon Scott Morrison MP, requested the PC undertake a review of NDIS costs. The PC delivered its final report (PC Report) on 19 October 2017.
2.43
The PC Report noted that the disability care workforce would need to double from 2014–15 levels to meet demand for NDIS supports at full scheme. According to the report, this means approximately one in five new jobs (net) created in Australia over the transition period would need to be in disability care. The PC Report observed that the workforce was unlikely to meet this target under the policy settings at the time. It also highlighted a number of barriers to workforce growth, including:
finding sufficient workers to meet demand at particular times of day;
ensuring a sufficient supply of qualified workers; and
increasing rates of retirement of workers from the sector as they age.
2.44
In addition, the PC Report observed particular regional challenges, noting that the workforce may need to double or triple to meet demand in some areas.
2.45
The PC Report stated that, in the long term, roles and responsibilities for workforce policy must be clarified to ensure a coordinated approach to workforce development within the NDIS. It also stated that building the evidence base on the number of workers in the sector, their conditions and working arrangements, would be a sound investment to develop effective workforce policies in the future.