How to improve the working relationship between NDIA and disability service providers?
National Disability Services (NDS), the peak body for non-government disability service organisations released its annual State of the Disability Sector Report in November 2018. Part of the report is an annual market survey conducted by the Centre for Social Impact, in collaboration with NDS’ Centre for Applied Disability Research. In excess of 600 disability service providers responded to the survey representing providers of all shapes and sizes, and with 90% currently providing services under the NDIS.
A detailed report of the survey was published last week. It reveals a sentiment that we have witnessed over the two years while supporting close to 100 South Australian disability service providers in their NDIS transition. In the survey only 15% of service providers agreed or strongly agreed that the NDIA is working well with the sector to implement the NDIS. Also, only 15% agreed or strongly agreed that the NDIA has a high level of respect for service providers. Respect, trust, open communication and effective engagement should be part of any working relationship.
The disability sector is undergoing a complex and difficult reform for the benefit of all people living with significant and permanent disabilities. It aims to create a system that is fair, equitable, efficient and sustainable. People with disability can receive individualised supports and flexibility to manage their supports, yet this will only work if supports are accessible and available for everyone and in any location. Disability service providers have been and will always be part of this support network. All providers that we have worked with genuinely care for the people they serve and want the best outcomes for each of them.
Disability service providers would like to focus on delivering quality services and less on NDIS systems and processes that continue to be frustrating. Almost three quarters of the survey respondents disagreed or strongly disagreed that the systems and processes of the NDIS are working well. The majority of surveyed providers (80%) agree or strongly agree that the NDIS policy environment is uncertain. Keeping on top of changes is time consuming and challenging for staff. New rules require implementation yet providers receive little or no support. Getting consistent and helpful answers remains difficult. Setting up quotes, interpreting rules, hiring and training staff, supporting clients, establishing service agreements and chasing payments takes time and resources that providers do not have and are not reimbursed for. The administrative burden and price pressure impacts on services. Over half of the respondents agreed to the statement that ‘in order to provide the services at the prices being offered by the NDIA, the quality of care would have to be reduced’. The concerns varied by provider size. Small and medium sized providers ($1m- $20m annual income) were more likely to agree that the quality of service will be impacted by the current prices.
Higher prices for high intensity supports
The recent introduction of higher prices for high intensity supports in February 2019 was welcomed by the sector. The new pricing tier however is linked to the wage of the worker and the complexity of the support which has caused widespread confusion. The prices have already come into effect while providers are still working out how they can be applied, how this will impact on their operation, scheduling of staff and filling of shifts, quoting and service agreements. It is unknown if participants’ plan budgets will be sufficient when service agreements will be recalculated. It is also unclear how the rule will impact on participants wanting to choose a support staff member irrespective of pay rate.
The new definition of high intensity ‘standard’ supports appears to be an oxymoron and it is unclear why these supports are paid at the same rate as standard supports. Training and supervision needs are usually higher for staff working with participants with high intensity supports needs. Some participants require positive behaviour support and providers in SA and NSW must comply with the new requirements under the NDIS Restrictive Practices and Behaviour Support Rules introduced in July 2018, which impose additional reporting, training and auditing requirements irrespective of the staff members’ pay rate. There is an argument that high intensity supports should be provided by more qualified staff members, yet this may not reflect current practice, staff availability or participant choice.
The NDIA is under immense pressure and several improvements for participants and providers were introduced last year. The increase of the agency’s staff cap has likely provided some relief. However, adding more resources and more time does not necessarily lead to better outcomes or greater trust and respect between providers, participants and the NDIA. Disability service providers bring many years of experience, expertise and strong relationships with people with disabilities and their families and carers. NDS has called for a stronger inclusion of the sector in the development and review of policies and processes. Changes should be tested before they are introduced and implications for participants and providers should be analysed. Finding better solutions to complex problems in collaboration with the sector will sustain quality services and benefit participants, providers and the NDIA – because we are all in it together.
Carey, et al. 2018 ‘How is the Disability Sector Faring?’ A report from National Disability Services’ Annual Market Survey, Centre for Social Impact, UNSW Sydney, access here
National Disability Services 2018, State of the Disability Sector Report 2018, access here
The Hon Dan Tehan MP 2018, ‘Improved experience for NDIS participants and providers’, 25 August 2018, access here