The roll-out of the National Disability Insurance Scheme (NDIS) in NSW commenced on 1 July 2013 with a three year ‘launch’ in the Hunter region. The scheme is due to be mainstreamed by 2018.

By Enis Jusufspahic

Evidence base for a National Disability Support System

In its final report on the National Disability Insurance Scheme (NDIS, the Scheme) released in 2009, PriceWaterhouseCoopers projected a steady increase in the number of people with severe and profound disabilities from 1.4 million to 2.9 million over the next 40 years.  The report also highlights ageing of the informal carer population as a pivotal issue, as unpaid carers provide far more support than formal paid care workers.[i]

In the current system, the funds are usually held by the service provider, who is required to meet output targets.  The process of changing service providers is difficult, as the service user/client needs to find a suitable service in their area which has capacity and is able to meet their needs. In many areas, there are few agencies that have capacity to accept new clients without extended delays.  In this way, the person with disability effectively becomes tied to a service.

In the current system, the worker is seen as the expert and the person with disability as a sub-ordinate client; the assessment of a person’s needs is based on what the person is not able to do and how we can best fit the person’s needs within the existing service system.  This contradicts the United Nations Convention on the Rights of Persons with Disabilities, whichacknowledges that the person with disability is the expert on their own needs and capabilities by recognising “the importance for persons with disabilities of their individual autonomy and independence, including the freedom to make their own choices”[ii].

Under an NDIS, the focus shifts to the person’s needs, strengths, aspirations and goals, and the system works with the person to achieve those goals a step at a time.  Instead of outputs, the new system is about achieving outcomes for the individual: gaining independence, promoting wellbeing and social connections. Indeed, the NSW Government had already recognised the need for person centred approaches through Stronger Together, its ten year plan for funded disability.  Family and Community Services, Ageing, Disability and Home Care (ADHC) has been working to prepare the current system to be ready for the NDIS by providing person centred supports and individual funding arrangements that enable choice and control for people with disability.[iii] 

The NDIS: rationale & function

The NDIS is part of a larger disability reform process which took shape under the National Disability Agreement in 2009, which set some new government priorities in relation to people with disabilities and their families including strategies for increased choice, control and self-directed decision-making as well innovative and flexible support models for people with high and complex needs.[iv]

The new National Disability Reform Agenda will build on these priorities by introducing national tools to identify service benchmarks;  plan for changing needs;  identify people at risk;  and work towards program and service delivery consistency across jurisdictions.^[v]

The NDIS is an “entitlement based” national system, which means that there is no financial means testing.  This ensures that there is no disincentive for people with disabilities to earn, save and contribute to their society.^[vi]  The NDIS was introduced in order to streamline all supports a person may be eligible for into one flexible package that reflects their needs and aspirations.  The NDIS is being designed to encompass all permanent functional impairments such as psychiatric disability and acquired brain injury.

The NDIS is being rolled out across the country at various launch sites to make the national roll?out of the full system run more smoothly.  In NSW, the NDIS commenced in the Hunter Region on 1 July 2013; it is a three year process covering the three major local government areas in the region.  The NDIS is expected to be introduced to the rest of the State from 2016 to 2018.[vii]

Eligibility – becoming a participant of the Scheme

The NDIS targets people ages 0 to 65. Those who turn 65 while they are participants of the NDIS will have the option of going into aged care or staying with the NDIS. People who are over 65 and seek support from the NDIS for the first time will have their needs met through the aged care system.

In order to become a participant of the Scheme an individual needs to have an impairment that is, or is likely to be, permanent (including impairments that are permanent but episodic). The National Disability Insurance Agency (NDIA) which administers the NDIS may require medical evidence before a determination can be made as to whether the impairment is permanent or likely to be permanent.

The impairment needs to result in substantially reduced functional capacity to undertake activities such as communication, social interaction, learning, mobility, self-care, self-management without assistive technology, equipment or home modifications; or the person usually requires assistance from other people to participate in the activity or to perform tasks or actions required to undertake or participate in the activity. The person needs to demonstrate that they are likely to require support under the NDIS for the duration of their lifetime.[viii] 

Assessment and Management of Plans

In order to register for the NDIS one needs to call the NDIA, drop in to their regional office or complete an online registration form called the MyAccessChecker.  This registration form asks for basic information about your capacity to carry out tasks of daily living.

Once a person with disability becomes a participant in the scheme, that is they become eligible for funded supports from the NDIS, the person meets with a plan manager employed by the NDIA to develop an individual plan.  The plan comprises two parts:  a statement of goals and aspirations prepared by the participant which outlines the person’s goals, objectives, aspirations and context;  and the statement of participant’s supports which is prepared with the participant and approved by the Agency that sets out the supports that will be funded by the NDIS.[ix]

Individual plans are based on goals (for example being able to use public transport) and funded supports (which need to be reasonable and necessary) are timed limited and tied to the specific goal.[x]  The NDIA understands “necessary supports” as supports needed to address the impact of a person’s disability on their participation in the community or employment. The Agency determines what is reasonable by taking into account value for money and efficacy of the support, balanced against relevant community standards such as what support it is reasonable to expect of families and carers.

Once a plan is in place, an individual with a disability can choose their own support providers and whether to manage their funding themselves or to appoint an advocate (carer, service provider or the NDIA) to manage some or all of their funding.[xi]

Transitioning Existing Clients and Service Providers to the NDIS

Under the NDIS, the service provider needs to bill the “fund holder” for the services provided to the person with a disability.  Services are expected to bill the package holder through the NDIS Provider Portal.  If the person chooses to manage the funding themselves then they are to receive the invoice.  Services are only able to claim for supports rendered which are in line with the Agency’s price list.  For example, an hour of house cleaning is $33.92.[xii]

Only approved providers are able to provide services to indivuals with disability if the NDIA is the fund holder. In the NSW context, this means that the service provider will, in the medium term, need to meet the Disability Service Standards, including Third Party Verification, in order to deliver services under the NDIS.

Most disability specific government funded programs are transitioning to the NDIS.  At the NSW launch site, the transition is occurring by client according to the program that that person is funded by.  For example, a younger person with disability may be on an Attendant Care Package from organisation A and Life Choices from organisation B.  In this case, both organisations will need to transition as the person is transitioning.

There may be a period of time during which current service providers will provide supports to people with disability under existing contracted funding arrangements as well as under the NDIS. In cases where the provider contract to provide services has not expired, representatives of ADHC will make arrangements with the provider for the remaining period.

Who is responsible for safeguards and quality assurance?

The NSW Ombudsman is to monitor and review services provided to NDIS participants.  In turn, the participants will be able to make complaints to the NSW Ombudsman.  Official Community Visitors will be able to visit the NDIS participants living in an accommodation service if in full-time care of a service provider.[xiii]

A person with a disability may seek a review of a decision by the CEO of the NDIA relating to assessment and eligibility, the provision of reasonable and necessary supports, a decision to become a registered provider of supports and other matters.  Alternatively, application can be made to the Administrative Appeals Tribunal for a review of the CEO’s decision.[xiv]

Current limits of the NDIS

In order to fund the NDIS the NSW Government has committed all State disability services funding under the Heads of Agreement with the Commonwealth on the NDIS.[xv] This has further been elucidated in the National Disability Insurance Scheme (NSW Enabling) Bill 2013,which authorises and facilitates the transfer of the State’s public sector disability services assets and employees to the non-government sector by 2018-19, when the NDIS is expected to be rolled out across the State.[xvi]

Under the National Disability Agreement, the states and the Commonwealth agree to fund services that assist families and carers in their caring role and services that assist people with disability to live in stable and sustainable living arrangements. As it stands now, the NDIS does not provide services directly to carers, although respite is provided indirectly;  for example, when the individual with disability attends day activities or participates in community activities.  However, this is not true respite, which is responsive to the person’s informal care arrangements.

A disability service provider advised that they had been engaging in long term goal based planning with the people they support for some years. Most clients identified that they wanted to live independently in a unit of their own or to share with other people. It difficult to access supported accommodation and/or group homes in NSW as demand is high and supply is limited.

The NDIS does not provide funding for the capital costs of housing, but provides funding for reasonable and necessary supports for an individual with disability to live independently if that is indeed their goal.

Conclusions

The Disability Service System is undergoing the most significant reform process since the inception of government funded disability services.  Funding of the sector is expected to grow from approximately $3 billion in 2013-14 to $12 billion in 2019/20 (see graph).

Government, together with the non-government sector, needs to ensure the future stability and viability of supports for the people with disabilities.  This can be achieved through adequate resourcing and continuing to support local services and development initiatives.  It is especially important as many organisations are looking at their operations and planning for the future by seeking to better respond to client needs and position themselves in a changing industry.

[i] Disability Investment Group – National Disability Insurance Scheme – Final Report, Price Waterhouse Coopers, October 2009 www.dss.gov.au/sites/default/files/documents/05_2012/pwc_ndis_report_2009.pdf