Fran Connelley delves into the difficulties involved in implementing the fraught National Disability Insurance Scheme – for all stakeholders.

Fran Connelley delves into the difficulties involved in implementing the fraught National Disability Insurance Scheme – for all stakeholders.

 

ndisIn the 11 months since I released my book, How to Thrive under the NDIS, the National Disability Insurance Scheme (NDIS) has become a political minefield.

To say it’s been a tough year for everyone in the sector is an understatement. Earlier this year providers were left unpaid by the new MyPlace portal. People were unable to access services. Some parents were harassed by debt collectors.

In October, founding Chair Bruce Bonyhady was replaced and the Minister, Christian Porter, announced a shakeup of the National Disability Insurance Agency (NDIA) board. New headlines concerning implementation ‘glitches’, payment delays and the surge in new autism participants are appearing weekly.

This week, a Geelong family represented by Victoria Legal Aid, is taking the NDIA to court to challenge its decision to only partially fund their son’s transport costs. It’s the first time a package will be tested in the federal court.

So it’s time to step back and take stock of things.

The scale of the NDIS

The NDIS is the most significant social reform since the introduction of Medicare. Decades of block funding had created an unfair, inefficient and outdated sector characterised by lengthy delays in essential equipment and heavy administrative costs. The system wasn’t working.

The NDIS redirects funding away from the organisation and distributes it directly to people with disabilities. Sector spending is planned to increase from $7 billion to $22 billion by 2020 while the number of people supported will increase from 220,000 to 460,000.

This is visionary stuff. The NDIS is a universal insurance scheme framed around the rights of people with disability to exercise ‘choice and control’ over their supports.

A tough year

By September 2016, the NDIA had committed $3.3 billion and 37,721 people had received approved packages.[i]

In its first two months, the NDIA received over 2,000 complaints about the ICT system and within a few months the Federal Government had initiated independent reviews into the viability of the scheme.[ii] One review by PwC Australia found the NDIS was: under resourced and under prepared.

The issues for people with disability

There remains considerable confusion for people with disabilities, their families and carers. However, some early evidence is positive. A colleague, the sister of a man with complex intellectual and physical disabilities, recently told me her brother was much better off with his new NDIS plan. Yet she admitted it was another example of her mother’s heroic persistence in navigating the bureaucratic hurdles to reach this outcome.

If the person has the necessary skills for form filling and interviews (or access to a carer with those skills), the results of an NDIS package can be positively life-changing.

But there are clearly many issues still to be addressed:

Low awareness and understanding A recent NSW State Government survey found 62% of people with a disability have still not heard about how to access the scheme and 57% are unaware of when the program starts.[iii]

Plan inconsistencies, errors and delays Currently, the plans on the portal are, in many cases, very different to the plans the participants actually receive from their planner. There are also lengthy delays in the process, with some plans taking up to eight weeks.

Poor communication There have been many cases of hasty planning meetings held over the phone. In some instances, local area coordinators have had no prior disability experience. For the clients and their carers these issues only add to the confusion and stress.

Financial distress In July, people who chose to self-manage their NDIS plan could no longer obtain their money in advance. Previously, a float of one month’s funding had been available. Many families, without assistance, have had to pay upfront for services.

The issues for providers

There were always going to be implementation issues, but they have been so widespread and all-consuming that they are diverting CEOs from tackling the major strategic challenges presented by the NDIS.

The key challenge facing providers is the NDIS pricing model. A recent Curtin University, WA, study of 180 disability groups found 42% of providers were generating a profit of less than 3%. For many, the risk of financial collapse is very real.[iv]

The volume of plan errors is adding to the cash flow issue. In New South Wales, the Department of Ageing, Disability and Home Care (ADHC) ceases to fund the provider at the time of plan approval, even if that plan is incorrect and requires review.

One charity CEO advised that 80% of its clients’ NDIS plans required review due to incorrect information and communication issues between the local area coordinators and the NDIA planners. This places them in the position of delivering services without payment for those clients waiting for their plan to be reviewed.

Another major challenge relates to the workforce. The focus on outcomes and the need for new marketing and business development skills creates a cultural challenge for many providers. The conflict of ‘the mission versus the market’ is difficult to balance with an increasingly casualised workforce that must also become ‘customer centric’.

So what’s ahead?

The sector can expect:

Increased market concentration Providers of all sizes are forming alliances and partnerships to achieve scale prior to the entry of the larger corporates circling the sector. Severe cash flow issues will result in many smaller providers closing their doors.

New business models As more private providers enter the market, we can expect to see greater sophistication and innovation in online business models.

Smarter marketing Australian Unity, Northcott and Cerebral Palsy Alliance are leading the way with brand awareness campaigns, innovative service offerings and a customer centric approach to service delivery.

Insufficient capacity An Australian National Audit Office report tabled in November revealed a significant shortage of supply in the workforce required to meet the NDIA targets saying, It will take at least a decade for the right number of disability workers and businesses to come online.[v] The CEO of a large private organisation specialising in providing casual staff to the sector told me 15 years is a more realistic timeline.

More questions How will the NDIS support participants to gain and keep employment? How will it handle the increase in autistic participants? How will the NDIS assess the participant with an episodic mental health issue? How will it address the chronic shortage in affordable housing and the underfunded Information Linkages and Capacity Building program?

Beyond the politic

The politically driven timeline of the NDIS has increased the errors and the complexity of the scheme, and continues to threaten its viability.

The vision of the NDIS is world class but its implementation is revealing cracks that go beyond ‘glitches’. There are fundamental issues to be addressed.

Over the next three years, 430,000 Australians are still being transitioned into the scheme, which is still tracking relatively on budget.

It was always going to be a massive undertaking to implement a scheme of this scale. We have a unique opportunity to learn from the events of 2016 and apply the strong, carefully considered leadership required to ensure the NDIS lives up to the hopes of the thousands who fought for it.

Fran Connelley

Fran Connelley, MFIA, is a strategic marketer who specialises in the nonprofit sector and is Director of FC Marketing. Her book, How to Thrive under the NDIS – A Pathway to Sustainability for Service Providers, was released in February 2016 and has sold out three times. To order a copy visit bit.ly/1POkfwH.

 

Notes

[i] NDIS Quarterly Report, 2016-17- Quarter 1, COAG Disability Reform Council, Quarterly Actuarial Report, v1, Oct 2016.

[ii]NDIS problems continue despite costly investigation’, The Sydney Morning Herald, 2/11/16

[iii]How Siobahn Daley became the public face of the NDIS’, The Sydney Morning Herald, 7/11/16

[iv]NDIS rollout: Research finds disability groups face collapse’, The Sydney Morning Herald, 7/9/16

[v] ANAO Report No.24 2016–17 Performance Audit, National Disability Insurance Scheme—Management of the Transition of the Disability Services Market, 9/11/16

 

Image courtesy of drpnncpptak at FreeDigitalPhotos.net.

 

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