5.1
This chapter considers issues facing current and prospective National Disability Insurance Scheme (NDIS) participants in the following cohorts:
People with psychosocial disability.
Aboriginal and Torres Strait Islander peoples.
People from culturally and linguistically diverse (CALD) backgrounds.
People with disability in school settings.
People with disability in criminal justice settings.
People with disability experiencing homelessness.
Children in the Early Childhood Early Intervention (ECEI) cohort.
young people in residential aged care.
5.2
The chapter also outlines recent National Disability Insurance Agency (NDIA) initiatives to address some of these issues, and includes the committee's views and recommendations.
Psychosocial disability
5.3
According to the NDIA's most recent quarterly report, 12.8 per cent of participants who received a plan in the quarter to 30 September 2020 had a psychosocial disability. Further, as at 30 September 2020 there were 40 508 active participants with psychosocial disability. This represents approximately 10 per cent per cent of total NDIS participants.
5.4
Psychosocial disability differs from other types of disability in fundamental ways, and accordingly requires a unique approach in terms of NDIS policy and practice. The Mental Illness Fellowship of Australia (MIFA) stated that:
Psychosocial disability associated with a mental health condition 'is the result of the complex interactions between limitations in activity (related to impairments associated with usually severe mental health conditions) and the environment in which people live'…
[T]he uniqueness of psychosocial disability is that, rather than physical barriers, participants primarily experience cognitive, social and motivational barriers to activities of daily living, which can have a severe impact on daily functioning. These barriers can stop people with psychosocial disability from engaging in education, training, employment, cultural activities and social activities.
5.5
MIFA also noted that psychosocial disability correlates with complex support needs, stating that psychosocial support providers have the highest proportion of clients with complex behaviours (34.4 per cent, compared to 16.7 per cent for other providers), and people with psychosocial disability are more likely to:
have multiple community, mainstream and health service system stakeholders at different times in their lives;
experience greater isolation from the community as a result of their severe and complex mental health conditions and loss of connections to family, friends and loved ones;
experience fluctuations in their mental health stability and heightened periods of crisis, which may result in an increased need to access wrap-around support services or be admitted to hospital;
need a 'safety net' during periods of vulnerability, particularly where an individual has limited informal and/or formal supports in their life; and
have changing support needs over time, with variations in the quantity and type of supports needed in an NDIS package from year to year.
5.6
Evidence before the committee indicates that—despite recent improvements to the NDIS—people living with psychosocial disability continue to experience challenges accessing the scheme and obtaining supports.
5.7
For example, Making Connections Together (MCT) noted that the NDIS access and planning processes do not work well for people with psychosocial disability and mental illness, stating:
These participants are systematically disadvantaged by processes which present barriers to them and planners who don't understand mental health. People with co-morbidities or co-existing psychosocial and other disability are the worst affected, as the NDIS notion of a primary and secondary disability does not give a true picture of their situation.
5.8
Mrs Marie Johnson provided a detailed account of the challenges faced by her daughter—who has a psychosocial disability—when seeking to access the NDIS. The account raised concerns about the conduct of NDIA staff processing Mrs Johnson's daughter's application; about the NDIA losing applications and associated medical documents; and about deficiencies in NDIS systems and processes. Mrs Johnson also asserted that the NDIS 'does not have the culture nor the capability to manage the psychosocial caseload', stating:
The complex needs and circumstances of people with psychosocial disability are being processed and examined by NDIS staff who have no experience or professional background in this area.
Our family experience and evidence is that over a protracted period of time, the NDIS psychosocial support team and NDIS psychosocial pathway processes simply do not exist.
5.9
Mr Tony Stevenson, Chief Executive Officer (CEO), MIFA, asserted that the NDIS is not meeting its targets as regards access to the scheme for people with psychosocial disability. Mr Stevenson queried whether the NDIS is reaching the 'right' people, noting that:
Ten thousand people who were participants of the previously funded Commonwealth programs are still in transition. They're still in limbo. Certainly the Department of Health is working on a process to continue that transition, but we're very concerned because those transitional programs are only in place until [June 2020].
5.10
Mr Stevenson also noted that connecting people with psychosocial disability to the NDIS may involve engaging with people who have regular contact with this cohort—such as local police officers and hospital emergency departments.
5.11
The committee also heard that people with psychosocial disability continue to experience service gaps between the NDIS and other sectors. For example, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) stated that psychiatrists have reported 'instances where referrals to previous mental health services have been rejected as, with the advent of the NDIS, they are no longer available to people over 65'. The RANZCP argued that this gap 'is of significant concern to psychiatrists and should be addressed'.
5.12
Advocacy for Inclusion (AFI) recommended that existing programs for people with psychosocial disability should not end 'until all clients have their plan enacted in the NDIS or have transitioned to another program'. AFI also stated that transitions from existing programs 'must be monitored to ensure [that] individuals are not left without community support' when they access support from clinical services or acute care.
5.13
Submitters and witnesses recommended that additional steps be taken to address the needs of people with psychosocial disability in NDIS service design and delivery. For example, MIFA recommended that the unique needs of people with psychosocial disability be acknowledged and considered as part of NDIS service system design and development. It also recommended that NDIS system design principles enable appropriate levels of flexibility in the type, range and length of supports offered to people with psychosocial disability, to address the fluctuating needs of individuals over their lifetime.
5.14
In addition, MIFA noted that regular, genuine consultation between the NDIA, people with psychosocial disability and representative organisations is essential to understanding the unique needs of participants with psychosocial disability, understanding psychosocial disability in the NDIS context, and identifying areas for improvement within the scheme.
5.15
The RANZCP asserted that NDIS processes must reflect the fluctuating nature of psychosocial disability and support a recovery-based service model. The RANZCP stated:
Ensuring NDIS processes best reflect the fluctuating nature of psychosocial disability and support a model of recovery is essential for providing positive experiences for NDIS participants with mental health conditions.
Providing medical professionals with dedicated communication resources could better assist streamlining access for people with disability especially given the important role medical professionals play in providing evidence and facilitating access to the NDIS.
Acknowledging the intersection between health and disability is imperative in improving the experience of people with disability with the NDIS.
Ensuring long term disability support services are available and easily accessible to vulnerable groups and to those who are not eligible for NDIS assistance.
Australian Government position
5.16
The NDIS offers Temporary Transformation Payments (TPPs) to providers of attendant care and community access to help them with costs transitioning to the NDIS in the form of loading for items claimed.
5.17
The Australian Government in March 2020 announced that from 1 July 2020 it would invest an additional $28.4 million for remaining clients of the National Psychosocial Support—Transition measure to 30 June 2021. This program 'provides targeted support to people who were previously accessing…services through ceased Commonwealth community mental health programs…to test eligibility' for the NDIS. Clients in the program are able to access psychosocial supports during the process. Those found ineligible for the NDIS will be able to access support through the Continuity of Supports (CoS) program.
5.18
The Department of Health website states that the CoS program provides continuity of support to older people with disability who previously received state-managed disability services when the program was implemented but are not eligible for the NDIS. The program will be replaced from 1 July 2021 by the Disability Support for Older Australians program.
5.19
Since July 2020, the NDIA has made available psychosocial recovery coaches to support participants with psychosocial disabilities. It has also committed to developing a national framework for recovery-oriented psychosocial disability services in the NDIS, to be released in 2021. The NDIA stated that it has identified the following areas for improvement in the ways in which it addresses psychosocial disability:
Improving the NDIS access process
Better responses to the episodic nature of psychosocial disability
The introduction of evidence-based psychosocial disability supports into the NDIS to improve social and economic participation for persons with psychosocial disability.
5.20
Chapter 4 also discusses the introduction of psychosocial recovery coaches in greater detail.
Committee view
5.21
The committee heard that people with psychosocial disability continue to experience challenges accessing the NDIS and obtaining safe, quality services and supports. Evidence indicates that these issues may be driven by systemic deficiencies in the NDIS (such as the complexity of processes and the conduct of some NDIA personnel); gaps between the NDIS and mainstream service sectors; and a lack of understanding of psychosocial disability and mental health within the NDIA, partners in the community, and service providers.
5.22
The committee considered issues facing people with psychosocial disability in the final report for its inquiry into NDIS Planning. Among other matters, consideration was given to the use of expert reports; the skills and expertise of NDIA staff and community partners; and service gaps between the NDIS and the mental health sector.
5.23
In addition, the committee considered issues facing people with psychosocial disability in the interim report for its inquiry into the NDIS Workforce. In particular, it considered training needs of disability support workers and allied health professionals; and whether NDIS prices are set at a level that enables the workforce to deliver safe, quality supports to people with psychosocial disability within a recovery-oriented model of care.
5.24
The committee also notes that the NDIA has progressed a number of initiatives to support people with psychosocial disability, including further investment in programs to support transitions to the NDIS and the introduction of the psychosocial recovery coach.
5.25
In light of the measures progressed by the NDIA, and the consideration given to relevant issues in the committee's other inquiries, the committee proposes to maintain a watching brief in relation to issues facing people with psychosocial disability. However, irrespective of these matters, the committee considers that the NDIA should regularly consult with the psychosocial disability sector, to better understand and address the issues facing people with psychosocial disability seeking to access the NDIS and obtain reasonable and necessary supports. The committee also strongly encourages the NDIA to incorporate any feedback from this engagement in policy and program design.
5.26
The committee recommends that the National Disability Insurance Agency regularly and systemically engage with people with psychosocial disability and representative organisations to better understand the needs of people with psychosocial disability and mental illness.
Aboriginal and Torres Strait Islander peoples with disability
5.27
According to the NDIA's most recent quarterly report, 9.1 per cent of participants who received a plan in the quarter to 30 September 2020 identified as Aboriginal and Torres Strait Islander. This is the highest percentage of any quarter. As at 30 September 2020 there were 27 112 active participants who identified as Aboriginal and Torres Strait Islander peoples. This represents 6.6 per cent of total NDIS participants.
5.28
A consistent theme of scrutiny by this committee has been access to, and the provision of, NDIS services to Aboriginal and Torres Strait Islander peoples, particularly in remote areas. The committee continued to hear evidence about the challenges facing Aboriginal and Torres Strait Islander peoples throughout the present inquiry. For example, some Aboriginal and Torres Strait Islander peoples may have little knowledge of the NDIS or the supports for which they may be eligible. Further, the NDIS is very complex for some Aboriginal and Torres Strait Islander peoples in remote and very remote communities, who do not speak English as a first language, do not have access to a computer, or have limited computer literacy.
5.29
This section outlines some of the major issues outlined in evidence that may arise for Aboriginal and Torres Strait Islander participants, including:
investment in an Aboriginal Community Controlled service sector;
uptake of the NDIS in remote and very remote Aboriginal and Torres Strait Islander communities.
Investing in an Aboriginal Community Controlled service sector
5.30
Submitters and witnesses observed that greater investment is needed to create and develop an Aboriginal Community Controlled service sector and an Aboriginal and Torres Strait Islander workforce.
5.31
For example, Ms Polly Paerata, CQI and Policy Coordinator, Aboriginal Health Council of South Australia, asserted that service delivery in remote Aboriginal and Torres Strait Islander communities should be provided by organisations that are already embedded in the community. This is to ensure the cultural competency of service provision and to build relationships of trust between community members and service providers.
5.32
Ms Paerata provided an example of a remote community in South Australia that had experienced difficulties providing services under the NDIS model:
The only service that they have there at the moment is a health service, and everyone else is a fly-in fly-out service. So, in those instances, the health services provide care for disability clients or disability participants under their aged care model. They do that because the community itself does not have the capacity to deliver disability services…[I]t doesn't have the capacity internally to build the business models to provide a sustainable NDIS service to its community.
5.33
The First Peoples Disability Network (FPDN) acknowledged that there have been some investments in building the Aboriginal Community Controlled sector and strengthening the Aboriginal and Torres Strait Islander workforce. However, the FPDN expressed concern that there appears to be an assumption in the NDIA and across Government that existing community controlled organisations have sufficient knowledge, skills and experience of the social model of disability and human rights. In this respect, the FPDN stated:
Whilst [Aboriginal Community Controlled] organisations (many of them health based) may be best placed to reach out and provide services and support in their local community, lived experience and knowledge of disability in an Aboriginal context must be acknowledged as expertise in and of itself. This expertise should be sought out, and resourced to work in partnership and build intersectional capacity and capability amongst the Aboriginal Community Controlled disability workforce.
5.34
The FPDN recommended that the NDIA:
establish a formal First Peoples Advisory Committee consisting of representative organisations of First Peoples with disability, and Aboriginal Community Controlled organisations;
work with this Advisory Committee to identify and fill data gaps in relation to agency functions and workforce, and the interactions with, and participation of Aboriginal and Torres Strait Islander peoples with disability within the NDIA;
build an Aboriginal and Torres Strait Islander unit in the NDIA, to ensure that a cultural overlay is implemented in all procedures and policies; and
support the provision of training for Aboriginal Community Controlled Organisations, to develop knowledge, skills and experience of the social model, human rights approach to disability.
5.35
The FPDN also recommended that the Government invest in Aboriginal community-led education programs that build individual and community knowledge, capacity and confidence around rights and entitlements.
Cultural competency
5.36
An ongoing concern for Aboriginal and Torres Strait Islander peoples with disability seeking to access the NDIS and obtain supports is a lack of cultural competency within the NDIA, its community partners, and service providers. The committee continued to hear evidence about this matter during the present inquiry. For example, the Australian National University’s Law Reform and Social Justice Research Hub (LRSJ Research Hub) emphasised the importance of cultural competency, stating:
Where culturally competent practices are in place community engagement tends to be more effective. Aboriginal and Torres Strait Islander peoples are more likely to engage with programs where they know they will be treated respectfully, fairly and appropriately. Moreover, cultural competency can improve policy outcomes within the NDIS. By improving health workers awareness, knowledge and skills, we can better prepare workers to interact in complex, cross-cultural environments.
5.37
The LRSJ Research Hub also stated that the NDIS should update guidelines with respect to cultural competency and implement a process by which NDIA staff and contractors can have their cultural competency reviewed.
5.38
The FPDN expressed concern that the intersection of Aboriginality and disability is not understood within the NDIS workforce, in addition to the compounding impact of racism and ableism over the course of a person's life. The FPDN stated that the NDIA should require all staff and contractors to undertake mandatory training in cultural awareness and disability rights, developed and delivered by First Peoples with disability and their representative organisations.
5.39
The FPDN also recommended the NDIA work with representative and community controlled organisations to establish cultural safety accreditation standards for service providers.
Uptake of the NDIS
5.40
The committee heard that low uptake of the NDIS in remote and very remote Aboriginal and Torres Strait Islander communities is often due to a focus on meeting basic needs such as food and shelter, which must take priority over disability supports. For example, Ms Kim McRae, Tjungu (Disability & Aged Care) Team Manager, NPY Women's Council, stated that:
People out bush are largely concerned about food, shelter and safety, and some items—things like swags and blankets—which are considered to be not reasonable and necessary under the NDIS, are the things that people want. So we find that our families often don't engage with the scheme because of that.
5.41
Ms McRae also observed that that NDIS is not properly adapted to how care is provided in Aboriginal and Torres Strait Islander communities, stating that:
That brings me to the other issue around individualised funding when people live very much communally out in community, where individuals in the family all contribute to the wellbeing of the family through the resources they have access to, so families often think that what's in that plan will benefit all of the family.
If…the family hasn't got access to food, then clearly, when there's a plan there with $140,000 in it, it seems pretty counterintuitive to the family that they can't draw down on it, they can't access that money, for basic needs.
5.42
Similar matters were raised during the Senate Community Affairs References Committee's inquiry into effective approaches to prevention, diagnosis and support for Fetal Alcohol Spectrum Disorder. For example, Dr Lauren Rice, Research Fellow, University of Sydney Brain and Mind Centre, stated that:
The NDIS is designed for the Western world, not for an Aboriginal community. There are people out in Yakanarra who have a disability, and they have extended family members who aren't working so that they can care for them, but because they're related to the person they're not allowed to be funded.
So there are people in Yakanarra who have a $150 000 plan that can't be used because a non-Aboriginal person or a non-family-member has to go into the community to provide the services. There are cultural reasons why Aboriginal people don't want to care for people outside their family, so you can't just say, 'Why doesn't someone from another community an hour and a half away come in and care for them?'
5.43
The issue of family members not being funded to care for a participant is discussed further in Chapter 4.
NDIA position
5.44
The NDIA stated that it is committed to ensuring Aboriginal and Torres Strait Islander peoples are supported to access the NDIS and utilise their plans. It stated that it is working closely with a range of stakeholders—particularly Aboriginal Community Controlled Organisations—to develop approaches to service delivery that are culturally appropriate and utilise local capacity and capability wherever possible.
5.45
Further, in 2019–20 the NDIA's Individual Capacity Building Program grant round committed over $105 million to 105 organisations to facilitate access to peer support and other skill-building for people with disability, carers and families. Fourteen grants totalling $14.6 million were provided to organisations that targeted Aboriginal and Torres Strait Islander peoples.
5.46
The NDIA held a series of roundtable discussions with representatives from the National Aboriginal Community Controlled Health Organisation, Aboriginal Medical Services and other stakeholders in WA, Queensland and the NT. Discussions focused on local issues regarding Aboriginal and Torres Strait Islander peoples accessing the NDIS, and the challenges organisations face when registering as NDIS providers.
5.47
The NDIA noted that in May 2019, the Government committed an additional $20 million to expand the NDIA's Community Connectors Program to more locations to support four identified communities to navigate the NDIS: Aboriginal and Torres Strait Islander peoples; CALD communities; parents caring for children with disability; and people with psychosocial disability. According to the NDIA, from July 2020 a further 187 Community Connectors will be employed across Australia to support the four targeted communities.
Committee view
5.48
The committee heard that Aboriginal and Torres Strait Islander peoples continue to face challenges accessing the NDIS and obtaining reasonable and necessary supports. The committee heard that there is limited support to assist Aboriginal and Torres Strait Islander peoples to understand complex NDIS processes, and limited investment in building the capacity of Aboriginal and Torres Strait Islander communities and organisations.
5.49
The Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability (Royal Commission) also heard that the NDIS does not adequately cater to some Aboriginal and Torres Strait Islander peoples with disability:
First Nations people have told the Royal Commission they find the NDIS difficult to navigate and understand and, when they do, it lacks the flexibility to support their cultural wellbeing.
5.50
Evidence before the committee indicates that a driver for some of the ongoing challenges experienced by Aboriginal and Torres Strait Islander peoples with disability is a lack of opportunity for input at the policy and service design level by Aboriginal and Torres Strait Islander communities and peak bodies. The committee supports the recommendation by the FPDN that the NDIA establish a First Peoples Advisory Committee, comprising representative organisations of First Peoples with disability and Community Controlled organisations. As noted by the FPDN, the NDIA should work with this committee to identify and fill data gaps in relation to agency functions and workforce, and the interactions with, and participation of, Aboriginal and Torres Strait Islander peoples with disability within the agency.
5.51
The committee acknowledges that the NDIA has established advisory groups within certain jurisdictions (for example, the Northern Territory), with broad representation from local stakeholders, Aboriginal and Torres Strait Islander organisations and consumer representatives. However, the committee considers that there would be merit in establishing an advisory committee within the NDIA, to provide input to national policy and program delivery.
5.52
The committee also considers that a First People's Advisory Committee may assist the NDIA to understand and address issues associated with the low uptake of NDIS services in remote communities, and to address service gaps between the NDIS and other service systems with a specific focus on Aboriginal and Torres Strait Islander peoples.
5.53
Further, the committee notes that in the interim report for its inquiry into the NDIS Workforce, it recommended that Government develop, publish and implement a strategy for the Aboriginal and Torres Strait Islander workforce, co-designed with Aboriginal and Torres Strait Islander peoples, community leaders, Community Controlled Organisations and other key stakeholders. The committee considers that establishment of a formal First Peoples Advisory Committee could form part of or sit alongside such a strategy.
5.54
The committee recommends that the National Disability Insurance Agency establish an advisory committee, consisting of representative organisations of Aboriginal and Torres Strait Islander peoples with disability and Aboriginal Community Controlled Organisations, to provide input to national policy and program delivery.
5.55
The committee also appreciates the need for investment in the development of an Aboriginal Community Controlled disability sector—including the funding of peer-led initiatives to support Aboriginal and Torres Strait Islander peoples with disability build their capacity to navigate the NDIS, understand rights and entitlements, and ultimately obtain culturally safe, appropriate and high quality disability supports.
5.56
The committee supports the FPDN's recommendation that the Government—including via the information, linkages and capacity-building (ILC) program—invest in community-led programs that build individual and community knowledge, capacity and confidence around rights and entitlements. The committee agrees that this investment should be long term, and specifically targeted to Aboriginal and Torres Strait Islander community-led organisations.
5.57
The committee recommends that the Australian Government commit to long-term investment in Aboriginal community-led education programs to build individual and community knowledge, capacity and confidence around rights and entitlements associated with the National Disability Insurance Scheme and disability supports.
5.58
The committee is also strongly of the view that all people working within the NDIS—including NDIA staff, community partners and service providers—should have a minimum level of cultural competency.
5.59
The committee notes that the Aboriginal and Torres Strait Islander Engagement Strategy (Engagement Strategy) states that the NDIA will provide cultural competency training to its staff and partners, informed by advice from the cultural competency expert reference group. According to the Strategy:
Training will be tailored with localised input to ensure responsiveness and reflect the uniqueness of the many Aboriginal and Torres Strait Islander peoples with disability, their families, carers and communities.
5.60
The committee strongly encourages the NDIA to ensure cultural competency training is co-designed and delivered by Aboriginal and Torres Strait Islander peoples with disability, representative organisations and peak bodies.
5.61
The committee also acknowledges that the Engagement Strategy states that the NDIA will 'support the cultural competence expert reference group to develop a framework of cultural competency for use by NDIS funded services that provide reasonable and necessary supports to Aboriginal and Torres Strait Islander Scheme participants'. However, the committee considers that there would be merit in developing clearer standards for cultural competency, co- designed with Aboriginal and Torres Strait Islander people with disability and representative organisations.
5.62
The committee therefore supports recommendations by the FPDN that the NDIA work with representative and community controlled organisations to establish standards for cultural safety accreditation. Noting the NDIS Quality and Safeguards Commission is generally responsible for ensuring the quality of services delivered by providers, the committee considers that the Commission should have an active role in the development of such standards.
5.63
The committee also notes that in the interim report for its inquiry into the NDIS Workforce, the committee recommended that the Government review options for a national registration and accreditation scheme for disability support workers—including national benchmarks for skills, qualifications and competencies reflecting the diversity of people with disability. The committee considers that accredited cultural competency standards could sit within or complement such a scheme.
5.64
The committee recommends that the National Disability Insurance Agency and the NDIS Quality and Safeguards Commission develop, publish and implement cultural safety accreditation standards for providers, co-designed with Aboriginal and Torres Strait Islander representative organisations and Aboriginal Community Controlled Organisations.
5.65
The committee also received evidence concerning provision of services for Aboriginal and Torres Strait Islander peoples during the COVID-19 pandemic. This evidence is discussed in further detail in Chapter 3.
Culturally and linguistically diverse people with disability
5.66
According to the NDIA's most recent quarterly report, 10.5 per cent of participants who received a plan in the quarter to 30 September 2020 were from CALD backgrounds. Further, as at 30 September 2020 there were 38 263 active participants from CALD backgrounds. This represents 9.3 per cent of total NDIS participants.
5.67
Evidence before the committee indicated that people with disability in CALD communities often face difficulties accessing the NDIS and obtaining supports. In some cases, these difficulties arise from cultural barriers that prevent people with disability from CALD background from accessing disability support. Further challenges are associated with systemic issues with the NDIS—such as complex language and bureaucratic processes—which are compounded by CALD-specific challenges such as language barriers and gaps in the cultural competency of serviced providers.
Cultural barriers
5.68
Evidence suggested that cultural attitudes to disability often prevent CALD communities from accessing the NDIS.
5.69
People with Disabilities (WA) Inc provided the committee with the report of a co-design project between people with of disability and service providers on improving experiences of the NDIS (the PwDWA Report). The project involved engagement with people with disability from CALD communities. The PwDWA Report noted that people from CALD backgrounds may conceal disability due to fears of discrimination or judgment. Psychosocial disability in particular is a sensitive matter for CALD communities. It also noted that cultural norms may require family members to care for people with disability, and consequently CALD communities may be reluctant to accept government support. The PwDWA Report provided the following example:
A family originally from the Middle East indicated that accepting government funding/formal services is a sign that they have failed to take care of their child which is not a good feeling as a parent. 'My husband will work hard to raise the funds that we need for the therapy of our child, and my husband's family will also help with funds from their business'.
Language barriers
5.70
Other evidence indicated that people with disability from CALD communities often face difficulties understanding the NDIS due to language barriers, and that there may be insufficient support available to support people from CALD communities to overcome these challenges.
5.71
For example, the Ethnic Disability Advocacy Centre (EDAC) noted that CALD families are often confused by NDIS terminology, stating that local area coordinators (LACs) and planners often fail to recognise the level of difficulty participants may face in navigating NDIS systems. EDAC also expressed concern that some clients are instructed to contact providers directly—without support—even though there may be literacy issues in both the clients' first language and English.
5.72
The PwDWA Report noted that issues related to language barriers that participants from CALD backgrounds may experience include:
the terminology used by the NDIS, including words such as 'goals';
the NDIS not offering further explanation of particular terms; and
words used in the NDIS having a different meaning to their use in previous state-funded disability support frameworks.
5.73
Submitters and witnesses also expressed concern at the lack of interpreting services available to CALD participants. For example, Ms Christine Grace, Manager, Advocacy Services, EDAC, stated:
[O]ne of the most significant issues for EDAC in relation to advocacy and referrals received is the fact that accredited interpreters are not being used in the process of planning and implementing NDIS plans. I often find that bilingual local area coordinators or friends are being used as alternatives to accredited interpreters.
The impact of that for our clients is that they are missing out on supports that they really need, because the communication can't be guaranteed to be correct in relation to what is interpreted or what the client understands is being asked of them.
5.74
EDAC also argued the following points in relation to interpreters and how the NDIA, planners and LACs involve them:
It is often assumed that interpreters are not needed where a participant has a working knowledge of English or has a friend or family member who can provide language support.
There is little understanding that interpreting involves more than strict word for word translation, with some languages not having specific terms for medical conditions or therapies.
Time should be built into planning meetings to allow interpreters to explain particular terms and situate concepts within a participant's cultural context.
5.75
Submitters expressed related concerns about translation of plans. For example, EDAC noted that translation is generally not offered unless requested, and it is not common knowledge among NDIA staff or partners in the community that plans can be made available in languages other than English. EDAC also suggested that there appears to be little awareness in the NDIS that there is a difference between interpreting and translating—with assumptions made that interpreters can simply read out a plan and the participant will understand.
5.76
Submitters and witnesses argued that translation of plans should be offered to all participants from CALD communities, including, where relevant, family members who are the primary decision-makers for a child.
Cultural competency
5.77
The committee heard that levels of cultural competency within the NDIS are insufficient, and that this negatively impacts on the ability of participants from CALD communities to obtain the supports they need.
5.78
EDAC asserted that the lack of cultural competency within the NDIS must be addressed as a matter of urgency, noting that lack of cultural knowledge manifests in a variety of ways. EDAC provided the following examples:
Example 1: A planner thought a Burmese client was Chinese and booked an interpreter for the wrong language. The planning meeting needed to be rescheduled; the delay meant the client had no access to supports.
Example 2: assumptions are made that all Muslims speak Arabic, all people from Myanmar speak Burmese.
Example 3: Carer asked can the client hold a knife and fork when these are not the implements used in their culture.
5.79
The LRSJ Research Hub stated that the lack of cultural competency training within the NDIS (including NDIA staff and partners in the community) is concerning, as is the lack of empirical metrics to measure cultural competency. It recommended that the NDIS update its guidelines with respect to cultural competency, and implement a process by which NDIA staff and contractors can have their cultural competency reviewed.
Other issues facing CALD communities
5.80
Other issues raised about issues facing participants from CALD communities included the following:
Difficulty in obtaining the medical evidence needed to access the NDIS and appeal NDIA decisions due to cultural or linguistic barriers and high costs.
The need for information provided to general practitioners to be designed to accommodate the experiences of people from CALD and non-English speaking backgrounds with disability, their families and carers.
Some participants not having access to a computer or the skills to use it, and as a consequence are unable to use the NDIS portal, send emails, or use the NDIS website as a resource.
NDIA position
5.81
The NDIA stated that it is committed to ensuring people with disability from CALD backgrounds are supported to access the NDIS and engage supports. The agency has implemented a number of improvements to facilitate access to the NDIS for people with disability from CALD backgrounds, and to ensure CALD people with disability achieve outcomes via the NDIS on an equal basis with the wider population. The NDIA has also introduced mandatory training for staff to increase their knowledge and understanding as to how to have respectful conversations with people from CALD backgrounds.
5.82
The NDIA further noted that the Language Interpreting Services page on its website helps people understand the interpreter services the NDIA offers. This page also has translated resources in 12 languages other than English, and translations of the CALD Strategy and the NDIA Glossary in Easy English—to support registered providers and participants to implement NDIS plans.
5.83
The NDIA also commented that its CALD Strategy, released in 2018, was developed through extensive consultation with an external advisory group including peak bodies, advocates and service providers representing CALD communities and the disability sector. The Strategy sets priority areas for:
engaging with communities and making information accessible;
increasing community capacity and broadening consumer choice; and
improving the NDIA's approach to monitoring, evaluating and enhancing cultural competency within the NDIA and its partners.
5.84
According to the NDIA, the Strategy will guide the agency's engagement with CALD communities and future initiatives to support diverse participants to access the NDIS and obtain supports.
5.85
The University of Notre Dame and the Multicultural Disability Advocacy Association NSW noted that, despite the CALD Strategy, research shows that people from CALD backgrounds experience difficulty accessing the NDIS.
Committee view
5.86
The committee heard that people with disability from CALD communities face a number of barriers to accessing the NDIS and obtaining reasonable and necessary supports. These include cultural barriers to accessing government services; systemic issues with the NDIS; and challenges specific to CALD communities such as language barriers and gaps in the cultural competency of NDIA staff, partners in the community and disability service providers.
5.87
The committee notes that the NDIA has developed and published a CALD Strategy, which includes principles and priority areas for engaging with CALD people with disability. The NDIA has also implemented measures to increase the cultural competency of staff and community partners. However, evidence suggests that these measures may be insufficient to address issues experienced by people with disability from CALD backgrounds seeking to access the NDIS.
5.88
In the final report for its inquiry into NDIS planning, the committee also noted that the CALD Strategy appears to be out of date, given that the goals of the Strategy were intended to be achieved by 2019. The committee recommended that the NDIA review the CALD Strategy, and update it to address the issues raised in the NDIS Planning final report. The committee encourages the NDIA to implement that recommendation. The committee considers that, as part of this process, the NDIA should address the issues outlined above.
5.89
The committee otherwise proposes to maintain a watching brief in relation to issues facing CALD communities, and may consider these issues again in a subsequent report.
People with disability in school settings
5.90
Submitters and witnesses gave evidence that there are barriers facing people with disability—including NDIS participants—seeking to access a safe, quality and inclusive school education. Evidence indicated that these barriers may stem from a lack of appropriate strategies to support people with disability in school settings, and by a lack of clarity around the interface between the NDIS and the education system.
5.91
Ms Mary Sayers, CEO, Children and Young People with Disability Australia (CYDA), observed that:
[T]the NDIS should…work in concert with…education to really promote and ensure [an] inclusive environment. So all efforts and funding that are NDIS supports should be focussed on that inclusion rather than on taking children out of schools during hours to focus on individual therapy. The evidence is very clear that this is not the best-practice approach.
5.92
Ms Sayers also noted that there are inconsistencies across jurisdictions as to how the rights of people with disability are articulated in education, stating that state and territory education systems 'need to work much more closely to ensure rights are upheld'.
5.93
In answers to questions on notice, CYDA stated that greater support is needed around key transition points for students with disability—such as the move from primary to high school, or the final years of high school and transition out of school.
5.94
The Queensland Law Society (QLS) expressed concern that the NDIS and 'school-generated support services' operate in silos and do not collaborate, noting that this leads to disadvantage for students with disability. QLS stated that strategies should be implemented in schools and government departments to improve the relationship between the NDIS and the state school system, and to streamline communications between schools, parents and NDIS providers.
5.95
In its submission to the committee's inquiry into the NDIS Workforce, the Disability Council NSW asserted that 'education is a huge area that needs to be overhauled'. The Disability Council NSW further stated that:
There are too many therapists in the schools that do not link in with the school or the child's learning in any way. The NDIS needs to re-think that therapists cannot support education (this is the main goal for children). Could be a limit of 2-3 of any type of therapists in a school...[who] should build a relationship with the school and be aware of the routine and the children in that setting. They should be required to communicate with the teacher and parents about what they are doing in the session at the school.
…If parents are not happy with the 2-3 therapists at the school, they can take the child to see any therapist they like - out of school hours - that is their choice.
5.96
The Tasmanian Government expressed some similar concerns, noting that it is aware of situations where external providers request access to students during school hours. According to the Tasmanian Government, this can result in students being away from school for significant periods.
Support workers on campus
5.97
In its submission to the committee's inquiry into the NDIS Workforce, the Australian Tertiary Education Network on Disability (ATEND) noted that the tertiary education sector has experienced an increase of support workers on campuses who lack the capacity to support students with disability.
5.98
During one of the committee's public hearings, Mr David Swayn, Committee Member, ATEND, noted that key issues in this space include:
maintaining student independence in a tertiary education environment;
understanding campus life and academic integrity;
understanding health and safety rules on campus; and
understanding the meaning of 'reasonable' in the education context.
Committee view
5.99
The committee has heard that there are a number of challenges facing people with disability in school settings. Evidence indicates that these challenges stem from a lack of understanding of disability, disability rights and social inclusion within school settings, and a 'siloing' of responsibility between the NDIS and the mainstream education system.
5.100
The committee notes that the Royal Commission has conducted a preliminary inquiry into the issue of education for people with disability, and has identified a number of areas of concern for further inquiry, including:
gatekeeping practices (for example, refusals to enrol children with disability or offering only part-time enrolment or enrolment in segregated classes);
mistreatment by school staff and other students, including bullying;
the use of restrictive practices;
a lack of adjustments, supports and individualised planning;
low expectations of students with disability;
misuse of disciplinary measures, including suspensions and exclusions;
poor communication and complaint handling;
insufficient teacher training for students with disability;
the adequacy of data collection; and
challenges faced by students with disability from Aboriginal and Torres Strait Islander and CALD communities.
5.101
The Royal Commission will continue to consider how education systems can contribute to, or reduce, violence, against, and abuse, neglect and exploitation of, students with disability, including in public and private education sectors, as well as in special/segregated education and mainstream settings.
5.102
In light of the issues outlined above and the work of the Royal Commission, the committee proposes to maintain a watching brief in relation to challenges facing people with disability in school settings, and may consider the issue in further detail in a subsequent report.
People with disability in criminal justice settings
5.103
People with disability are overrepresented in the criminal justice system. For example, SECCA noted that people with disability account for 18 per cent of the Australian population, but almost 50 per cent of people entering prison. This percentage is higher for people with disability experiencing intersectional disadvantage. For example, Aboriginal and Torres Strait Islander peoples with disability are approximately 14 times more likely to be imprisoned than the general population.
5.104
Evidence before the committee indicated that NDIS participants and other people with disability often fall into service gaps at the interface of the NDIS and the criminal justice system. Often, this is due to a lack of clarity at an operational level about divisions of responsibility. For example, according to the Public Interest Advocacy Centre:
[G]aps between the NDIA and mainstream service systems create situations where people with disability are either unable to get the support they need from the appropriate system, or unable to navigate the process to determine which system ought to provide the support.
5.105
The RANZCP stated that people with intellectual and developmental disability (IDD) in forensic services 'can often face…difficulties when attempting to access the NDIS', with the justice system 'expected to provide all necessary supports to those held in forensic and custodial facilities'. It called for mechanisms to prevent 'people with intellectual and developmental disability leaving forensic services without obtaining a…plan before release'. According to the RANZCP, these should include 'appropriate housing and ongoing, culturally safe mental health care and support'.
5.106
Victoria Legal Aid (VLA) observed that, despite some welcome initiatives to address gaps between the NDIS and mainstream service systems, there remain interface issues and lack of service coordination for clients in youth crime and criminal justice settings. As an example, VLA noted that due to the loss of NDIS-funded services when entering custody, one of its clients was denied bail because his accommodation and supports failed. This person also lost access to his support workers when he entered custody, as the NDIA stated that the NDIS was not responsible for funding supports once he was remanded.
5.107
Evidence before the committee also indicated that criminal justice settings may not be equipped to support people with disability. The RANZCP stated that:
In Australia, when challenging behaviours for people with IDD result in involvement with the criminal justice system, there is a dearth of secure, therapeutic community options. Once in prison, people with IDD often struggle to receive the care they need due to a lack of staff awareness and training on disability and mental health.
5.108
AFI similarly noted a lack of supports for people with disability and mental health concerns in the criminal justice system, noting that this may lead to people with disability being 'trapped in a constant cycle of recidivism'.
5.109
SECCA stated that a major reason that people with disability become involved with the criminal justice system is lack of support and education—particularly for people with intellectual disability. SECCA called for funding for targeted programs that reduce interaction with the criminal justice system, including protective behaviours and other preventative education services.
NDIA position
5.110
According to the NDIS website, the NDIS funds reasonable and necessary supports for participants in custody 'on the same basis as all other people in relation to a person not in custody', while the justice system funds supports to ensure justice services are accessible for people with disability.
5.111
In its submission, the NDIA noted that it has introduced 17 Justice Liaison Officers (JLOs) for custodial settings in all jurisdictions, 'to improve understanding of the NDIA's operational processes and streamline pathways for prisoners with a disability into the NDIS'. The next stage of this program will focus on:
developing a collaborative, best-practice approach to improve planning for release and transition of NDIS participants from justice settings;
providing clarity between offence-related' behaviour and behaviour that is a direct consequence of disability; and
working with states and territories to develop formal data sharing arrangements to improve the experience for NDIS participants moving into and out of justice settings.
Committee view
5.112
The committee heard that people with disability often fall into gaps between the NDIS and the criminal justice system—often due to a lack of clarity around the division of responsibility between these service systems. In addition, the committee heard that people with disability are not adequately supported while in custodial settings, and continue to be overrepresented in the criminal justice system due to a lack of appropriate support and education.
5.113
Similar evidence was presented to the committee during its inquiry into NDIS Planning. In the final report for that inquiry, the committee recommended that the Commonwealth, states and territories 'consider the appropriate division of responsibility for the funding of supports for participants in the criminal justice system'. It also recommended that the NDIA develop a strategy for ways to engage with participants in custody.
5.114
In light of the recommendations in its NDIS Planning inquiry, the committee proposes to maintain a watching brief in relation to the issues facing people with disability in criminal justice settings. If further evidence indicates that this matter continues to be of concern for stakeholders, the committee may consider the issue in more detail in the future.
People with disability experiencing homelessness
5.115
According to the Hutt St Centre, a specialist homelessness organisation in SA, people with disability are a growing sub-population of people accessing homelessness services:
Since the full roll out of the NDIS in South Australia in 2018, there has been an increasing and emerging need for specialist homelessness agencies to assist and advocate with clients to access the NDIS and navigate its related processes.
5.116
Other submitters and witnesses noted a number of challenges for people with disability experiencing homelessness, and called for measures to assist this cohort to access appropriate accommodation and disability supports.
5.117
Ms Paige Armstrong, CEO, Queenslanders with Disability Network (QDN) told the committee that people who are transient or homeless need a way to obtain necessary assessments to meet NDIS criteria, and 'some form of hands-on assistance to walk them through an access process'.
5.118
Ms Armstrong also highlighted the 'Getting on the Grid' project as an example of an initiative supporting people with disability who are transient, homeless, leaving the child safety, criminal justice or juvenile justice system, or from the LGBTQIA+ community, to access the NDIS. Ms Armstrong explained that:
Being a member driven organisation, our project was co-designed, co-led and facilitated with a group of peer leaders who were people who…have experienced homelessness, people who have been a part of the child safety system et cetera. So we had a group of 10 peers who worked with us and we tailored our approaches according to settings. We went into the hostels and boarding houses and did 'NDIS bingo' with lucky door prizes—because that was the way to get people in the room and have a conversation about the NDIS and what's in it for them without having the active conversation about 'this is the NDIS'.
5.119
Ms Kim Barker, Public Guardian, Tasmanian Office of the Public Guardian, stated that without stable, suitable accommodation, participants are unable to benefit from supports and services funded in their plans, which are aimed at building capacity and autonomy and realising personal goals'.
5.120
The RANZCP noted that the NDIA is 'looking at making inroads' in the area of homelessness, but the logistics of transience, poor health and difficulty accessing health care 'can make it difficult for this group to access appropriate services more generally'. It called for the Australian Government to provide further funding to the homeless sector, to ensure people who are homeless can access support to find housing, and to facilitate better access to the NDIS'.
5.121
The Hutt St Centre noted 'disproportionate systemic, environmental and personal barriers' to accessing the NDIS for people with disability who are homeless, stating that this cohort likely needs 'significant assistance, as well as both individual and systemic advocacy…to achieve equitable outcomes'. Particular areas of concern that the Hutt St Centre noted in relation to people experiencing homelessness applying for the NDIS included:
the need for high level self-management, literacy and self-advocacy skills;
limited access to information about disability and healthcare;
costs associated with assessments needed to access the NDIS;
limited awareness or contact with LAC services, which may not be able to provide the level of support needed to assist this group;
few, if any, informal supports;
co-morbidities, such as brain injury, which are difficult to separate from disability in terms of their functional impact on daily life;
limited or no funding for support coordination; and
homelessness services prioritising immediate needs for safety and housing.
5.122
The Hutt St Centre called for the NDIS to fund case management to support people experiencing homelessness to transition to the NDIS, and for the NDIA to 'proactively consult with people with disability who have lived experience of homelessness' and homelessness services. It further proposed that the NDIA develop 'a Community Liaison Role for the Housing and Homelessness Sector' similar to current JLO and Health Liaison Officer roles, to:
improve NDIS access for people experiencing homelessness;
build relationships between homeless service workers and NDIA staff; and
assist homelessness organisations to work with clients who are experiencing barriers to accessing the NDIS.
Government position
5.123
In November 2018, the (then) Assistant Minister for Social Services, Housing and Disability Services, the Hon Sarah Henderson, announced the rollout of the NDIS Complex Support Needs Pathway. This pathway is intended to provide support to participants who 'need a higher level of specialised supports in their plan', including because they experience other challenges because of homelessness and involvement in government service systems.
Committee view
5.124
The evidence provided to this inquiry suggests that an unknown, but significant, number of people with disability experiencing homelessness may not be accessing the NDIS, or may be struggling to meet access requirements because of their lack of documentation, informal supports and involvement with the allied health sector which could provide evidence to support access requests. This group of people is especially marginalised, with limited existing supports to introduce them to the NDIS in the first instance, and to help them with an application and support them once they have been approved. Without access to housing and basic needs, there may be challenges for these participants in accessing and implementing supports.
5.125
The committee therefore considers that, at a minimum, the NDIA should develop a strategy to engage with people with disability who are homeless, and to work with them once their access requests have been approved. The NDIA should consult with the sector and with participants who have experienced homelessness in the development of this strategy. Further, the NDIA should introduce Homelessness Liaison Officers to help coordinate services for this group, modelled on existing JLOs. The committee recognises that the Complex Support Needs Pathway goes some way towards providing specialist planners for participants who are homeless, but liaison officers would take this initiative a step further by coordinating with existing homelessness services who may already have a pre-existing relationship with the participant and may be able to provide specialist advice.
5.126
The committee recommends that the National Disability Insurance Agency develop a strategy to engage with people with disability who are homeless and to work with this cohort or participants once their access requests have been approved.
5.127
The committee recommends that the National Disability Insurance Agency introduce Liaison Officers to work with homelessness organisations and related services to facilitate improved National Disability Insurance Scheme (NDIS) access and planning for people with disability who are homeless and eligible for the NDIS
The Early Childhood Early Education (ECEI) pathway
5.128
The NDIS offers an Early Childhood Early Intervention (ECEI) pathway for children under seven with developmental delay or disability. According to the NDIA, the ECEI pathway is 'designed to provide timely support' to this group of children, 'to improve their functional outcomes and build the capacity of their family to support their child's development'. Further, the ECEI pathway 'focuses on family-centred practice, delivered in a child's natural settings, within the context of family and community life'. The ECEI pathway does not guarantee automatic access to the NDIS once a child turns seven.
5.129
In the 45th Parliament, this committee tabled a report on the provision of services under ECEI pathway. The commitee made 20 recommendations to address areas such as lack of clarity about access points and eligibility criteria, the limitations of assessment tools, and underfunding in plans for children with ASD. The Australian Government agreed to 13 of the committee's 20 recommendations (noting that implementation for some was already underway); partly agreed to one; agreed in principle to four; and noted two.
5.130
The committee has continued to hear concerns about the ECEI pathway in this inquiry. These concerns included:
the need for the ECEI pathway to assist parents to support their children;
the rigidity of the age requirement for children to transition from the ECEI pathway to the NDIS;
lack of communication about how to transition from the ECEI pathway to the NDIS;
early intervention plans not including funds for social or community support, capacity building, peer group learning or support for family members and carers;
the need for a separate pathway for children until their mid-teens, with planners who have expertise in this area; and
hearing services (discussed separately below)
NDIA position
5.131
The NDIA acknowledged that wait times for the ECEI pathway have 'presented a challenge' to the agency and its 18 Early Childhood Partners, due to the volume of children presenting to the scheme and the thin markets for ECEI specialists currently available. However, it argued that because of recent initiatives, 'wait times for access for all participants have been significantly reduced and issues relating to plan gaps have been largely eliminated'. Further, 'the NDIA has supported more children than ever through the Early Childhood Early Intervention Gateway'.
5.132
The NDIA also highlighted its ECEI Remediation Program, announced in June 2019, which includes six month $10,000 NDIS plans 'to children who were experiencing, or likely to experience, wait times of greater than 50 days between access and having a plan approved'. As a result, there had been a '56 per cent reduction in wait times for children and families to receive ECEI supports from 1 April 2019 to 31 March 2020'. The NDIA further emphasised that the average wait time for children to meet NDIS access, as at 31 May 2020, was three days, and the average wait time for children awaiting a plan had reduced from 104 days in June 2019 to 44 days by 31 March 2020.
5.133
The NDIA stated that it reviewed its ECEI Partner agreements in early 2020, with these 'being adjusted to reflect volumes for next financial year to ensure ECEI Partners have appropriate funding to meet…demand'. It also noted that recommendations from this committee in its report in the 45th Parliament into the ECEI pathway had 'been central to the ongoing enhancements being delivered by the NDIA to strengthen the delivery of ECEI supports', with these recommendations being included in the NDIA's review of the pathway.
5.134
On 25 November 2020 the NDIA announced various potential changes related to the ECEI pathway. The committee did not have an opportunity to thoroughly examine these potential changes, nor receive evidence from the NDIA about them.
Committee view
5.135
The committee notes that a number of the concerns outlined above about the ECEI pathway were raised in evidence in late 2019 and early 2020. Since then, the NDIA has progressed several initiatives to ensure that children in the ECEI pathway are able to obtain funding for reasonable and necessary supports in a timely manner. According to the NDIA, wait times for participants in the ECEI pathway have been significantly reduced, and issues relating to plan gaps have been largely eliminated.
5.136
In addition, the committee notes that in its final report on NDIS Planning, it recommended that the NDIA 'improve its wait times for children, particularly the time taken to produce a plan following an access decision and to approve assistive technology'. The committee also recommended the NDIA develop 'templates or guidelines to ensure that plans for children and young people take into account key developmental stages and life transition points'.
5.137
The committee proposes to maintain a watching brief in relation to issues concerning the ECEI pathway, noting that in late November 2020 the NDIA announced potential changes and a public consultation process relating to the ECEI pathway. If the committee receives further evidence indicating that concerns about the ECEI pathway persist, it will consider these concerns in a future report.
Hearing services in the ECEI pathway
5.138
The ECEI approach streamlines applications to help children receive supports earlier. The Hearing Support Program (HSP) funds hearing services for children with a confirmed hearing loss including the testing and fitting of hearing devices, and will support them to connect with the NDIS. Hearing Australia is the sole HSP provider for the under seven age group. The NDIS also funds additional supports, which may include early childhood intervention or other assistive technology that is not funded under the HSP.
5.139
In the 45th Parliament, this committee tabled a report on the provision of hearing services under the NDIS. The report recommended that the NDIA contract Australian Hearing as the national ECEI Partner for early intervention hearing services for families of deaf and hard-of-hearing children. The government partially supported this recommendation.
5.140
During this inquiry, the committee learned that some submitters and witnesses were concerned about the possibility that Hearing Australia would no longer be the exclusive provider of Hearing Services for children under seven. For example, at the hearing in Adelaide in November 2019, Dr Jim Hungerford from First Voice expressed concern that Hearing Australia was likely to lose exclusive role as provider of paediatric audiology services for young people from July 2020. He argued that the lack of a structured system that ensures children with hearing loss received an appropriate plan would negatively impact their outcomes. Audiology Australia raised similar concerns.
5.141
Deafness Forum of Australia, Deafblind Australia, Audiology Australia, Able Australia, Senses Australia and Neurosensory raised concerns about Hearing Australia potentially losing exclusivity for referrals, including that:
it is unclear how the process would be managed after July 2020 when the NDIS was due to cease the in-kind arrangements with Hearing Australia;
these changes could impact the timeliness of audiological services, with concerns that any delay in the hearing rehabilitation program would be likely to have an adverse impact on a child's development; and
the market would be unable to offer the same level of service especially to those who live in rural and remote areas.
NDIA position
5.142
The NDIS website states the future of hearing services in Australia is assured due to an approach adopted by the NDIS and HSP, which 'will work together to ensure that high quality hearing services continue to be available to people of all ages'. The NDIA has also announced that from 1 July 2020:
Hearing Australia will continue to be the sole provider of HSP services for eligible children and young people under 26. This ensures that quality safeguards remain in place for this age group.
Committee view
5.143
The committee welcomes the decision of the NDIA to continue to use Hearing Australia as the sole provider of HSP services for eligible children, noting that this appears to be the position the committee suggested in its communication with the NDIA to address issues raised in evidence. The committee proposes to maintain a watching brief in relation to this matter.
Younger people in residential aged care
5.144
In its submission to this inquiry, the NDIA stated that it is committed to supporting younger people in residential aged care to live in a setting of their choice. It also noted that the number of people in residential aged care under the age of 65 has decreased in recent quarters, and that less people under the age of 65 are entering aged care. This is supported by the NDIA's most recent quarterly report, which states that:
The number of people in residential aged care under the age of 65 years has decreased in recent quarters from 6,243 at 30 June 2017 to 4,860 at 30 June 2020 (a 22% decrease).
Also, less people under the age of 65 years are entering residential aged care—536 people under the age of 65 years entered in the June 2017 quarter, compared with 247 in the June 2020 quarter (a 54% decrease).
5.145
The NIDA's submission notes that in March 2019, the Australian Government announced an Action Plan to reduce the number of young people in residential aged care. In November 2019, the Government announced new targets for the Action Plan and the establishment of a Joint Agency Taskforce (JATF)—in response to the interim report of the Royal Commission into Aged Care Quality and Safety. The revised targets seek to ensure there are:
no people under the age of 65 entering residential aged care by 2022;
no people under the age of 45 living in residential aged care by 2022; and
no people under the age of 65 living in residential aged care by 2025.
5.146
The JATF has been established between DSS, the Department of Health and the NDIA to develop a new strategy that builds on the YPIRAC Action Plan and to take action to ensure these new targets are met. Actions include:
investigating the reasons why individuals under the age of 65 continue to enter residential aged care;
building a team of 80 specialised NDIA planners to support NDIS participants in aged care, or at risk of entering aged care, to find age-appropriate accommodation, if this is their goal;
working with industry to identify all available Specialist Disability Accommodation across the country to develop a database of existing and new housing options available now and in the future; and
developing an implementation plan that commits to further actions to meet the goals set out in the new strategy.
5.147
In September 2020, the Australian Government released the Younger People in Residential Aged Care Strategy 2020-25 (YPIRAC Strategy). The strategy includes four priority areas: understanding younger people and systems; improving the system; creating options; and supporting change. The YPIRAC Strategy will:
…guide concrete actions to reduce the number of younger people entering residential aged care and support those already living in residential aged care to move into age-appropriate accommodation with the supports they need. The Strategy builds on the 2019 YPIRAC Action Plan and will extend and improve upon previous initiatives.
5.148
The NDIA's most recent quarterly report also states that in September 2020, the NDIA published a new Operational Guideline for YPIRAC, providing greater transparency on how the NDIA supports younger people in residential aged care. In addition, the NDIA is completing streamlined assessments of housing supports for younger participants in residential aged care, to enable those participants to access alternative accommodation sooner.
Committee view
5.149
The issue of younger people in residential aged care continues to be an area of concern for the committee. The committee strongly believes that people aged under 65 years should not enter or remain in residential aged care settings unless they choose to do so.
5.150
The committee notes that Government has implemented a number of measures to support younger people to exit aged care settings if they choose to do so, and to ensure people exiting residential aged care can access NDIS supports. Some of these measures have been announced in recent months. In addition, the committee notes that the number of younger people in residential aged care settings continues to decrease.
5.151
The committee encourages the Government to continue to progress measures to support younger people to exit residential aged care settings, with a view to meeting the current targets in the YPIRAC Strategy. The committee otherwise proposes to maintain a watching brief in relation to this matter.