The National Disability Insurance Agency (NDIA)
While there have been many issues identified in the performance of the NDIA, ranging from timeliness and responsiveness of the agency through to their way of doing business, this report concentrates on matters that bear directly on safeguarding.
It is clear that the NDIS is a most welcome innovation in Australia — a universal, national, insurance-based view of disability that enshrines respect for the individual participant and their ability to exercise choice over such matters as “who provides services” and to exercise control over precisely how those services are delivered. These are intrinsic rights founded on the United Nations Convention on the Rights of Persons with Disability (2006), of which Australia is a signatory, and people with disabilities rightly demand that they are not lost. A drive to “safeguarding at all costs” could lead to loss of autonomy, denial of the ordinary risk-taking that all citizens enjoy and even a return to institutionalisation (even if that is virtual through such things as electronic monitoring).
We need to be careful that people don’t lose trust in the NDIS and the good things that it has done and also that we don’t portray every person with a disability as needy and vulnerable.
For the majority of NDIS participants the current model of service delivery works well, at least it will work well when all the administrative and organisational problems of the NDIA are worked out. For a smaller group of participants the NDIA approach is inherently risky because a lack of support around their learning, physical, and communication needs can make them more vulnerable to neglect and abuse, including coercion.??
The prevention of abuse, neglect and exploitation starts with the NDIS Plan
Anne Gale, Public Advocate
The NDIA has not had a clear, transparent concept of “vulnerability”. However, during the COVID 19 pandemic the NDIA identified over 5,000 NDIS participants, in SA who are “vulnerable” and these people have had welfare checks conducted by the NDIA.
The cohort for the COVID 19 vulnerability strategy included participants:
- receiving certain levels of core daily activities supports;
- already in the NDIA’s Complex Support Needs Pathway;
- receiving disability related health supports, including community nursing, assistive technology for personal care/safety, diet management;
- receiving behavioural supports;
- aged over 55 years and with aged carers;
- in indigenous communities; and
- living in Supported Independent Living (SIL), Specialist Disability Accommodation (SDA), Younger People in Residential Aged Care (YPIRAC) or specific housing segments such as boarding houses or hostels.
This welfare checking initiative conducted under COVID 19 needs to be built on when considering criteria of “vulnerability” and measures to address the associated risks. It is salutary to note that Ann Marie met none of these criteria for vulnerability so would not have had a welfare check. “Living alone” is a criterion that needs to be added.
The NDIA has avoided the concept of “case management”, due to concerns that it leads to disempowerment and condescension. Instead, it has created numerous players with different roles that make perfect sense to the framers in the NDIA but make precious little sense to many participants or their families. So, the NDIA has the following cast of players:
- The Local Area Coordinator (who works with the participant to get their plan together and assists in navigating access to the wider community) - the role of supporting people to access the wider community and mainstream services has been impacted by the rate of the roll out of the NDIS, placing a focus on getting people on to the scheme rather than connecting them with their community,
- The NDIA Planner who signs off on the participant’s plan and may not have sufficient information about the participant to make an assessment of risks and vulnerabilities – for participants in the Complex Support Needs Pathway the NDIA Planner is the closest role to that of the traditional case manager,
- The Plan Manager who pays the participant’s bills from service providers, if the participant so-chooses who may not have met the participant or be involved in aspects of their life, and
- The Support Coordinator who will only be included in the plan if the participant meets strict complexity guidelines and is usually only funded temporarily while the participant needs help to engage service providers. There is frequently no opportunity for a long-term relationship to develop a rapport, as funding may not continue year to year. Support is time-limited and considered capacity building and inappropriate for ongoing lifelong support. Less than 40% of NDIS plans include funding for support coordination and this is flagged by the NDIS as expecting to drop as time goes on.
As well as this cast of players there is an array of functions they perform — from local area coordination, support connection, support coordination, specialist support coordination, plan management and planning. If that sounds confusing and unnecessarily complex it is because it is. Many a participant or their nominee (usually a family member) is totally overwhelmed by this abundance of players and functions and they end up doing all the advocacy, lobbying, chasing-up and coordination themselves (that is, case management hasn’t been done away with — it has lobbed back with the participant and/or their families, to their detriment).
Potentially vulnerable individuals are those with complex support needs (including communication difficulties), cognitive challenges, poverty, domestic violence or lack of connection to family/friends/services. For individuals with any number of these vulnerabilities, putting together their services can be overwhelming and they may not know who to go to for help.
Task Force members were at pains to emphasise that just because you have a disability that does not mean that you are therefore vulnerable. Some people may be vulnerable due to not being aware of what they need and what support is available to them.
Having a process to identify potentially vulnerable participants is key and having a single locus of responsibility vis-a-vis the participant is essential for good practice. The concept of vulnerability needs to be assessed on a case-by-case basis and is not static. That is to say a person may be independent and or well connected for the majority of their life, but if these circumstances change, they may find themselves more vulnerable. Conversely, people can become less vulnerable over time. This assessment must occur in person so that nuances can be identified. It is critical that the participants or their families know where to go to for help, with a single point of contact who is responsible for looking out for the vulnerable participants and ensuring their needed supports. The best entity in the NDIS system to perform such functions is probably “support coordination”, but it needs to be ongoing and it needs to be timely and responsive to need.
There are people who require case management FULL STOP! and there is no place for that in the scheme as it stands today
Support Coordination also needs to be automatically inserted into the plan of any potentially vulnerable participant. The participant must be supported by the Local Area Coordinator (LAC) or NDIA to find and engage that service as a starting point. In addition, the support coordinator needs to ensure that all aspects of the participant’s plan that are listed are implemented. The support coordinator provides an essential second pair of eyes to ensure good things are, and bad things are not happening in a participant’s life.
Case Management is so missing and most of those people are not aware that they can get support coordination in their package.
Any support coordinator that is employed by an agency that also provides other services for that participant is not an independent pair of eyes. Therefore there is conflict of interest. This was identified in the 2019 review of the National Disability Insurance Scheme Act 2013 — Removing Red Tape and Implementing the NDIS Participant Service Guarantee, David Tune OA PSM.
“The NDIS Rules are amended to:
a) set out the factors the NDIA will consider in funding support coordination in an NDIS participant’s plan
b) outline circumstances in which it is not appropriate for the provider of support coordination to be the provider of any other funded supports in a participant’s plan, to protect providers from a conflict of interest.”
Tune Recommendation 16
Support Coordination and Core Supports must be separated, they must almost never be provided by the same provider. I am not saying that they should not do support coordination but they should not do it for the same client with few exceptions.
This issue of the separation of the role of support coordination from other service provision is a fraught one and we have been challenged on this matter. There is no point casting the role of honest broker on to the support coordinator if they do not know the participant well, if they see their role as mechanistically providing service provider options, or if they have little knowledge of disability matters as they affect the lives of a potentially vulnerable participant.
Often the best support coordinators come from the service provider agency because they understand the disability and they know the participant.
Peter Hoppo, NDS
To not separate the roles invites conflicts of interest and in the wrong hands participant capture. To separate the roles, requires that support coordinators can perform some, at least, of the functions of a quality case manager and that they know the participant well.
Looking at the NDIS from the perspective of the participant, they not only look for administrative efficiency (that is, returned phone calls, answered emails) but also who to go to for help. There is too much navigation through a complex web expected of the individual participant. To get this right is not disempowering the participant – quite the reverse – it gives them the information and contact to exercise choice and control and take possession of their own lives.
The NDIA is the agency with oversight of funding and system design. It is the agency that partners with LAC, which helps participants to better connect with their community. The NDIA has redirected LAC to expedite the transition of people into the Scheme to meet their key performance indicators. It also funds support coordination which connects an individual to the services they need. The NDIA needs to define the alerts for when a vulnerable participant is in difficulty. Comments have been made about the perceived lack of understanding of disability within LAC and further disability awareness training delivered by people with disabilities is required.
The NDIS, built on choice and control and insurance principles, has not seen itself as the case manager ultimately responsible for safeguarding vulnerable participants. This has to change and COVID 19 has started this process.
Safeguarding Gap 1
Potentially vulnerable participants are not routinely identified and assigned ongoing support coordination in their NDIS plan.
Safeguarding Gap 2
The support coordinator can be from the same agency that provides other core services for the individual, creating a conflict of interest.
Support coordinators need good familiarity with participants, their wishes and their disabilities and they need to be available when the participant is in strife. If, pragmatically, the best support coordination is available from the service provider agency then, as the Tune Review recommends, there needs to be explicit mechanisms to handle the conflict of interest.
Safeguarding Gap 3
Participants are not routinely linked to community activities so they are often isolated.
Assisting with access to the community has been the designated role of Local Area Coordination, but it has taken a lower priority than plan development during transition from state schemes to the NDIS.
Safeguarding Gap 4
Participants are not identified as potentially vulnerable by the NDIA and prioritised by LAC when carrying out the community connection role.
Safeguarding Gap 5
NDIS plans do not routinely include strategies to minimise participant risk, for example, coordination of health care (including dental, sexual and mental health), technology to aid independence and safety, capacity building for asserting rights, and recognition of cultural matters.
Plans need to be developed with participants being involved (with support if needed) and plans need to be fully implemented and the funding fully expended. The utilisation of plans need to be monitored closely by the NDIA.Page last updated : 14 Jul 2021