Chapter 4Co-design

Introduction

4.1Co-design is a participatory process whereby the government works collaboratively with people and key stakeholders on the design of policies and services. Implementing genuine co-design offers several benefits, including:

generating more innovative ideas;

ensuring policies and services match the needs of those they are designed to serve;

increasing economic efficiency by improving responsiveness;

building cooperation and trust; and

increasing support for change.[1]

4.2Co-design principles are central to the NDIS, and fulfil the mandate of the National Disability Insurance Scheme Act 2013 (NDIS Act) that people with disability should be involved in decision making processes that affect them.[2] By implementing co-design, the National Disability Insurance Agency (NDIA) enacts its mandated commitment to work collaboratively with the disability community to design and implement improvements and changes to the scheme. It draws on the lived experience of participants and expertise of stakeholders 'to understand experience from a variety of perspectives, to find and test solutions, and to manage competing values or priorities.'[3]

4.3The NDIA states that 'co-design needs to be understood in its broadest sense that includes various ways of co-working'. It is therefore more than just consultation. In the NDIA Engagement Framework, the agency outlines five key aspects of working collaboratively with the disability community:

co-planning, involving making decisions about values, direction, ambition, resources and approach;

co-design, involving making decisions about the detailed form of an interaction, service or policy;

co-delivery, supporting people with lived experience and professionals to collaborate to enable change for others;

co-evaluate, supporting participation in the judgement of existing situations and development of recommendations for action; and

co-governance, involving collaborative oversight, within the legislative framework of the NDIS.[4]

4.4The committee has discussed co-design in many previous reports. For example, in its 2021 Independent Assessments Final Report, the committee analysed the key principles of co-design for governments and tracked the evolution of the NDIA's commitment to co-design from 2015 to 2021.[5] More recently, in its Capability and Culture of the NDIA Final Report, the committee recommended that the NDIA improve its engagement with peak organisations representing marginalised groups, with the goal of improving co-design and access to culturally appropriate services.[6]

4.5Other bodies have adopted or recommended co-design principles. The Disability Royal Commission published a research paper which recommended a co-design approach to foster inclusion and cultural safety for marginalised people with disability.[7]

4.6The NDIS Review also took a co-design approach, mandated in its terms of reference to:

… co-design directly with participants, carers and their families, and providers and workers, and prioritise potential reforms to improve the responsiveness and capability of the NDIS and the NDIS market to ensure they deliver for Australians with a disability and their families and carers, and society more broadly.[8]

4.7Co-design is needed at all levels of the scheme; and should be implemented at all stages of policy development, from the broad design of the legislative framework, to the structure of plans for individual participants. This section considers co-design with four main groups of stakeholders:

key representative bodies;

individual NDIS participants;

family members and carers of people with a disability; and

disability service providers.

4.8Evidence to the committee over ten years indicates that harnessing the lived experience of NDIS participants and their family members and carers, including their detailed knowledge of how the scheme operates in reality, is essential for the effectiveness of the scheme. Genuine co-design engages comprehensively with participants and their family members to define problems, avoid harm, and design solutions that meet participants' needs.

4.9The committee has described in previous reports various problems that have arisen from deficiencies in co-design. For example, in its 2021 report on independent assessments, the committee noted that a lack of co-design and appropriate consultation had led to an overall failure of the policy development process, which eroded trust in the scheme and its decision makers. Researchers who co-authored the evaluation report on the second trial of independent assessments noted that:

There is a severe lack of trust in the people who matter in government policy making and a disbelief that they are genuinely interested in the experiences and views of people with disability and their supporters.[9]

4.10The committee is of the view that government should actively support people with disability to act as facilitators, designers and policy shapers. This should include training, mentoring and opportunities to gain experience, to express their views and advocate effectively within co-design processes. The Independent Advisory Council must continue to be empowered to provide independent advice that is frank and fearless. It should be noted that members of the Advisory Council are often part of co-design processes.

Co-design with key representative bodies

4.11The NDIS was built through extensive co-design with people with disability, their families and carers, and representative organisations. This section outlines how the NDIA implements its commitment to co-design when implementing improvements to the NDIS. The agency states that this commitment is expressed by consulting and working alongside people with disability, representative organisations, and other interested groups.[10]

4.12Co-design is implemented through a series of working groups, including the Co-design Advisory Group (CAG), the Independent Advisory Council (IAC) and the Disability Representative and Carer Organisations Forum (DRCO Forum).

Co-design Advisory Group

4.13The primary purpose of the CAG is for the Independent Advisory Council (IAC), Department of Social Services (DSS) and the disability sector to provide strategic advice to the NDIA on the development, focus and implementation of co-design and engagement processes within the disability community.

4.14CAG members work together to:

ensure disability community perspectives on issues facing the NDIS are represented

gather feedback on the co-design priorities and approaches with peers and members and

provide and receive strategic advice on the design, implementation and evaluation of co-design and engagement.[11]

Independent Advisory Council

4.15Under the NDIS Act, the IAC has a statutory function to advise the NDIA Board on key issues affecting participants, families and carers. Their advice aims to improve the scheme, participant experience and outcomes.[12]

4.16The IAC has four reference groups that provide advice on matters relating to specific themes, including:

children, young people and families;

equity and inclusion;

home and living; and

intellectual disabilities.[13]

4.17The committee received evidence that the NDIA may benefit from establishing an additional reference group to improve co-design of the scheme, for example, a neurological reference group.[14]

Disability Representative and Carer Organisations Forum

4.18The DRCO Forum is a means by which the NDIA brings together senior representatives from key disability sector organisations to engage, discuss, collaborate and co-design with the agency.[15]

4.19The 27 DRCOs who comprise the Forum were chosen for reasons including:

experience representing people with disability at the Australian Human Rights Commission and the United Nations;

significant involvement in the formation of the NDIS and National Disability Strategy and contribution to the UN Convention on the Rights of People with Disability;

extensive knowledge on specific policies that affect people with a disability and expertise in accessible consultation and person-centred engagement; and

strong established connections to large networks of people with a disability across Australia.[16]

4.20In January 2023, the government provided an additional $1.42 million to 27 Disability Representative and Carers Organisations (DRCOs) to support their participation in co-design activities. The total amount paid to DRCOs to participate in co-design is $2.84 million since the funding commenced in early 2022.[17]

Other advisory groups

4.21The NDIA also engages with other sector reference groups to develop reforms in specific areas. These groups include:

Autism Advisory Group

First Nations Advisory Council

Industry Chief Executive Forum

NDIA Mental Health Sector Reference Group

Pricing Reference Group

Specialist Disability Accommodation (SDA) Reference Group

4.22The NDIS Review implemented its mandate for co-design through extensive engagement with participants and other key stakeholders. The reviewers travelled to every state and territory, including remote and regional areas, and met with thousands of people. The review received 3976 submissions. The review's co-design approach included:

inviting submissions to the Review in different formats: written, verbal by phone, video, Auslan, artwork and poetry;

hosting workshops and meetings where people were invited to share their experiences and discuss ideas;

partnering with disability representative and carer organisations so they could engage in depth over months on key topics of interest with the communities they represent;

attending events and forums hosted by the disability community, providers and others;

engaging in hundreds of meetings to hear directly from individuals and organisations;

collaborating closely with small groups of people with lived experience and other disability expertise, who helped test and improve ideas for improving the participant experience of the NDIS and on better ways to support children and families; and

drawing on the evidence, perspectives and insights of previous reviews.[18]

4.23The government has outlined reforms to the NDIS, which it intends to develop through co-design with people with disability and their representative organisations. These initiatives include:

Addressing workforce capability to improve the consistency of access and planning decisions. This includes increasing the number of specialised planners.

Processes to support participants around better planning to manage their funding.

Implementing a lifetime planning approach so plans are more transparent and enable flexibility for life events.

Improving the consistency of supported independent living decisions.

Helping participants understand and access evidenced-based supports.

Supporting staff to detect, respond to, and reduce provider fraud and non-compliance.[19]

Co-design with participants

4.24The NDIA Engagement Framework establishes the agency's commitment to co-design with the disability community. It is informed by the principle that the people who are impacted by NDIS processes or decisions have a right to be involved in how those processes are designed and implemented, and the decisions made. When the framework is not adhered to, participants feel frustrated and devalued.

4.25The committee has heard that there can be a conflict between the NDIA's published commitment to co-design with participants, and the agency's actual practice. For example, the Summer Foundation told the committee that:

Though the NDIA state that participants are at the heart of everything they do, participants have reported not feeling listened to by the NDIA and frustration at not being seen as experts in their own lives. There appears to be a culture within the NDIA of a lack of trust in participants and an assumption that many ask for more than what is reasonable and necessary.[20]

Communication with applicants and participants

4.26The way that the NDIA communicates with participants does not always appear to reflect what participants have told the agency they need. The 2019 Review of the National Disability Insurance Scheme Act 2013 (Tune Review), discussed problems with the way the agency communicated with participants:

A significant number of people with disability who participated in the consultations indicated the information they could access about the NDIS was not disability-friendly or available in alternative formats, such as Easy Read, Auslan, Braille or languages other than English. Others stated that the NDIA assumed participants had a high degree of digital literacy and that, instead of responding to queries directly, would direct them to the NDIS website, which proved too difficult to navigate.[21]

4.27Since 2019, despite some efforts to provide information in Easy English, little appears to have changed in terms of clear communication with participants.

4.28Eastern Access Community Health submitted that participants they serve have faced multiple communication issues including:

letters to clients from the NDIS varying significantly in clarity and usefulness of information, including reasons why a person may have failed to meet the requirements to access the scheme;

questions remaining unanswered;

medical confidentiality being breached in correspondence; and

timeframes being too brief for medical professionals to verify documents.[22]

4.29The committee has also received evidence that the NDIA may choose forms of communication that do not adequately meet participant needs. For example, Allied Group noted that during the period of Covid-19 restrictions, NDIA staff could only be contacted by phone, a practice which has continued despite the lifting of restrictions on other forms of contact. Allied Group suggested that this may indicate a risk that planners may not be meeting participants face-to-face in order to properly determine their support needs.[23]

Documentation requirements

4.30Participants have repeatedly told the NDIA and the committee about the extensive, often onerous, requirements to document and justify their experience of disability, to establish their eligibility for the scheme and for particular supports in the planning phase. The committee has also heard that documentation requirements can impact time-poor medical practitioners.

4.31People with disability are the experts in their own lived experience of disability and are best placed to identify 'reasonable and necessary' supports they require to live full lives and participate in their communities. However, participants have often felt that the NDIA had not operated with an understanding of these principles and required exhaustive documentation to justify access to the scheme and provision of reasonable and necessary supports. At times even assessments and clinical recommendations made by specialists who know the participant are disregarded.[24]

4.32National Legal Aid explained its concerns about the application and planning processes, noting the significant complexity of relevant terminology:

Establishing eligibility for the NDIS is often technical and often relies on prospective participants and their practitioners understanding NDIS terminology and having the resources to provide extensive information. It can be difficult for prospective participants to meet the NDIA's requests for specialist reports, particularly in rural and regional areas... Often, it's clear the prospective participant meets the access requirements, but the issue is terminology or wording, or an incorrect application of the meaning of permanency.[25]

4.33The committee is aware of other evidence regarding the NDIS planning process that suggests the process may not sufficiently consider the specific needs of each participant. People with Disability Australia (PWD), for example, reported that:

the NDIS focuses on diagnostics rather than function, meaning that a person with severe functional impairment who is not in a specific list of disabilities might struggle to get support;

plans are not adequate to support needs, meaning services are withdrawn or are not supplied to begin with, leaving people at risk of harm; and

appeals regarding both access and funding/supports go unanswered for long periods of time.[26]

4.34The NDIS Review also found that the scheme's access requirements were 'complex to complete', and that 'proving eligibility can be a burdensome, intensive exercise'. The review also noted additional barriers to access for people from culturally and linguistically diverse backgrounds, First Nations people, people from lower socioeconomic backgrounds, applicants with low levels of literacy, applicants who don't have family or informal supports, and people with cognitive or psychosocial disability.[27]

4.35The need to provide the requisite evidence to support participant plans can be time-consuming, repetitive and exhausting. For instance, The Australian Association of Psychologists Inc. (AAPi) submitted that the burden of proof and level of documentation required for access to the NDIS and for planning purposes is inappropriately high.[28] MND Australia submitted that participants with MND often feel that despite the burden of supplying costly supporting documentation from neurologists and allied health professionals, the information is neither understood nor considered by NDIA decision-makers:

Understanding this material is essential to the care and well-being of the participant, as early interventions as soon as possible after diagnosis can sometimes slow the progression of disability and thus potentially the number of services required … There is an inequitable emphasis on self-advocacy; people without a support network and those with cognitive and behavioural challenges do poorly in NDIS assessment processes … It is imperative that the NDIA adopts clearer and more timely communications to participants about decision-making processes, timelines and expectations. This includes general information provided on the NDIA website and plain language and multilingual communications with individual applicants and participants.[29]

4.36One participant described dealing with the NDIA as being 'like having a full-time job'. Despite his GP providing a 30-page report, they did not 'have the knowledge on how to fill in the forms correctly as how the NDIA people wanted them', and the NDIA repeatedly requested more evidence. Even though the applicant was eventually granted access to the scheme, he described it as feeling like he was 'continually chasing [his] tail'.[30]

Draft plans

4.37Participants, carers and service providers have consistently argued for the provision of draft plans, because an iterative process of plan development would allow plans to be corrected in case of error, or easily adapted where circumstances change over time.

4.38A 2017 Productivity Commission report recommended the NDIA implement a process for allowing minor amendments to plans, without triggering a bureaucratically onerous full plan review.[31] The 2019 Tune Review noted that 'the participant experience would be improved if full draft plans were made available to participants prior to the NDIA delegate approving the plan', which would also reduce the incidence of unscheduled review requests, appeals, or difficulties in implementing plans.[32]

4.39The committee's NDIS Planning Interim Report recommended in 2019 that participants be provided with fully costed, detailed draft plans one week prior to their plan review.[33] The Australian Government supported this recommendation in principle, and undertook for draft plan summaries to be provided to participants from April 2020.[34]

4.40Yet participants continued express their frustrations to the committee with being denied drafts of their NDIS plans. Therefore, the committee reiterated its recommendation that participants be provided their draft plans in its NDIS Planning Final Report in December 2020.[35]

4.41Again, the government recognised the importance of providing participants with access to information about their plans prior to their planning meeting, noting in its response to the committee report that:

Having a draft plan in advance is an important mechanism to ensure decision-making processes are transparent and for keeping the participant at the centre of the planning process, enabling the participant to consider how they might best use their plan funding to meet their goals and aspirations.[36]

4.42However, in May 2023, NDIS Chief Executive Officer MsRebecca Falkingham was asked why draft plans had still not yet been implemented. Ms Falkingham advised the Community Affairs Legislation Committee that the NDIA was aware of calls for draft plans and confirmed that the new PACE system could be configured to produce draft plans. Despite the committee's repeated recommendation that draft plans be provided to participants, MsFalkingham noted that the agency would wait until the completion of the NDIS Review process before taking any action on draft plans.[37]

4.43The call for draft plans has been expressed for at least 5 years, yet little progress has been made by the NDIA. Exercise and Sports Science Australia (ESSA) expressed the views of many when it submitted that the agency's delay in implementing draft plans has:

… deprived participants of the opportunity to review and provide feedback on their plans, thereby limiting their ability to effectively advocate for their needs and preferences.[38]

4.44The committee continues to receive evidence calling for draft plans.[39]

First Nations people with disability

4.45The committee has received significant evidence regarding difficulties faced by First Nations people in accessing the NDIS and community health services, especially for those living outside major cities.

4.46Approximately 62000 or 7.2 per cent of Aboriginal and Torres Strait Islander people have a severe or profound disability, almost twice that of the non‑Indigenous population.[40] This compounds other disadvantages faced by First Nations people, such as other health morbidities and shorter life expectancy, making the disability support required 'so much more complex as compared to other Australians'.[41]

4.47Growth in NDIS participation has been slower amongst First Nations communities, but it is growing. As of September 2023, the proportion of new entrants to the scheme identifying as First Nations people had increased to 10per cent, and the total proportion of First Nations participants in the scheme had increased to 7.8 per cent.[42]

Cultural safety

4.48The South Australian Office of the Public Advocate (SA OPA) submitted there was 'further work to do to ensure that Aboriginal people with disability access the NDIS', and that it was an 'assumption that Aboriginal people and communities will identify disability and will engage with the NDIS':

There is more work for many communities around the stigma related to disability, building trust and a safe place. It also needs to be acknowledged that the concept of 'disability' does not resonate in Aboriginal communities, especially when programs try to define functional impairment as a result of trauma and illness as the responsibility of the State health system and only functional impairment that is significant and ongoing as the responsibility of the NDIS.[43]

4.49Dr Adam Heaton from the Australian Institute of Aboriginal and Torres Strait Islander Studies proposed that the NDIS give more funding to Aboriginal Community Controlled Health Organisations, who are known and trusted by First Nations communities, to 'better coordinate their primary healthcare offerings and achieve holistic health and wellbeing outcomes'.[44]

4.50The NDIA submitted that it had established a Co-Design and Engagement Branch to work across internal teams and with external stakeholders to deliver a best practice co-design approach for strategic projects, including a 'strategy refresh' project for Aboriginal and Torres Strait Islander peoples.[216]

4.51The committee welcomes the recent launch of an NDIS Aboriginal and TorresStrait Islander Strategy and establishment of a First Nations Advisory Council and the Co-Design and Engagement Branch, and will continue to monitor the participation of First Nations people in the NDIS.[45]

Culturally and linguistically diverse (CALD) people with disability

4.52The NDIA anticipated in its 2018 Cultural and Linguistic Diversity Strategy that, by 2022, around 20percent of participants would be from CALD backgrounds.[46].

4.53In its first report to disability ministers of 2023–24, the NDIA advised that 8.6 per cent of participants were from a CALD background. The NDIA's analysis indicated that although it is likely that CALD participants are joining the NDIS, they have not been identified as CALD in the data collected. The agency suggested that, with the introduction of a new ICT system, the opportunity to collect improved data on participants will enable better identification of CALD participants.[47]

4.54In the 2018 strategy, the agency also recognised that people from CALD backgrounds face additional challenges in accessing the scheme.[48] The committee continues to receive evidence that people with disability who are from CALD backgrounds face additional barriers to accessing information about the scheme, receiving culturally appropriate supports, and accessing legal information and representation.[217]

4.55AMPARO Advocacy submitted that:

Whilst service systems should be designed to deliver good outcomes for individuals regardless of cultural or linguistic backgrounds, the NDIS is a complex specialist disability service system that is extremely difficult to access and navigate and it has not been designed to respond well to language and cultural differences of individuals.[218]

4.56The SA OPA drew the committee's attention to a report it prepared with the South Australian Disability Advocate in 2021, in which it identified several barriers for people from CALD communities seeking to access the scheme and offered suggestions for change. The report found:

stigma around disability in CALD communities needs to be addressed before the NDIS is even considered;

the NDIS is not the first priority for new migrants (who are looking for jobs, schooling and accommodation);

information about the NDIS needs to be provided in a range of accessible formats;

better education and clearer information about the NDIS is required for CALD communities and mainstream services;

NDIA staff and LAC partners need to be culturally aware;

interpreters need to be engaged at all stages of the NDIS process, including appointments with a GP;

the NDIS process is not always culturally appropriate, e.g. the information is not provided in a person's own language, NDIA staff do not always demonstrate cultural competence, and questionnaires may ask inappropriate questions; and

the NDIA should work with national peak bodies such as National Ethnic Disability Alliance and Federation of Ethnic Communities' Council of Australia to better engage with people from CALD communities.[49]

4.57In its most recent quarterly report, the NDIA noted that it was co-designing a new CALD Strategy for 2024–28 and a corresponding action plan. According to the agency:

The CALD Strategy and Action Plan will enable the NDIA to work to ensure that people with disability from CALD backgrounds, families and carers, can access and use the NDIS. An External Advisory Group (EAG) has provided support, advice, and guidance in developing the CALD Strategy and Action Plan. The EAG comprises representatives who work with and represent people with disabilities from CALD backgrounds.[50]

4.58The committee looks forward to considering these measures as part of its inquiry into the NDIS participant experience in rural, regional and remote areas.

Psychosocial disabilities

4.59Participants with psychosocial disabilities may experience difficulty in engaging with co-design processes. The National Mental Health Consumer and Carer Forum (NMHCCF) questioned whether the agency was engaged in genuine co-design with people with psychosocial disabilities, observing that consultation is not the same as co-design:

The NMHCCF welcomes the numerous processes underway to enhance the operation of the scheme, but has witnessed some processes labelled as co-design which are in fact consultation. This speaks to the current culture of the agency to override the expertise of those it exists to serve … Facilitating more opportunities for genuine co-design with people living with psychosocial disability would enhance the operation of the agency for this population. Where genuine codesign is not considered possible by the Agency, this should be plainly stated.[51]

4.60Allied Group noted that when participants with psychosocial disabilities have applications for home and living supports rejected, they may be exposed to extremely unsuitable and unsafe living environments. Many participants experience negative health and wellbeing outcomes as a result. Allied Group therefore called for the NDIA to proactively seek the perspectives of people with psychosocial disability in upcoming NDIS Home and Living co-design process:

These participants will not be recruited for participation by social media or email call-outs for volunteers–as many do not have access to online information, due to their living circumstances; disability; or capacity. Disability representative organisations, and allied health peak bodies, must be included in co-design alongside a broad spectrum of participants who require a home and living response.[52]

Co-design with service providers

Communication with service providers

4.61Service providers are affected by communication issues with the NDIA, and have called for significantly more consultation and co-design with the sector in the policy development stages. For example, NDS noted a 2022 survey of disability sector organisations showed that 64 per cent of those surveyed 'disagreed' or 'strongly disagreed' with the statement that the NDIA was working well with providers, with only 11 per cent supporting the statement that the NDIS was working well.[53]

4.62Occupational Therapy Australia (OTA) encouraged the NDIA to engage with allied health professionals and their peak organisations more proactively to co-design policies from the outset, rather than implement changes and seek feedback on the results. OTA also indicated that when changes to policy are implemented, the NDIA's communication with providers is deficient. OTA suggested that, despite policy changes being made with good intentions, they can often have unforeseen clinical consequences for the scheme, participants and providers.[54]

4.63Medical practitioners and allied health professionals submitted that unclear or insufficient guidance from the NDIA made it difficult for them to support participants by providing acceptable evidence of disability and need for supports.

4.64For example, Disability Advocacy NSW suggested that medical and health professionals were often overwhelmed with the evidentiary requirements of the NDIA, with little guidance or support available to enable them to write technically specific reports that satisfy the NDIA's evidentiary requirements. This 'places a burden on time-poor and under resourced practitioners/clinicians operating in [rural, regional and remote] areas.'[55] Furthermore, when requests are made for further information, it may not be clear as to exactly what additional evidence is required.[56]

4.65Similarly, Speech Pathology Australia (SPA) submitted that a lack of transparency from the NDIA about what it needed to make a decision placed a burden on its members when preparing assessments. Further, NDIA staff often did not demonstrate good knowledge of processes and the evidentiary requirements.[57]

4.66The committee received evidence from providers that changes to processes and platforms were not adequately communicated, which increased barriers to access. For example, National Disability Services (NDS) highlighted unintended consequences of changes to NDIS ICT systems, saying:

The My NDIS provider portal and tools have been criticised for creating significant administrative burdens for providers, including understanding the new system and training staff. The NDIA has created guides on using PACE on their website, but in-house training and changes remain significant and unfunded. The new My NDIS portal should be accessible to all participants, including those with specific communication requirements, reduced digital literacy or access, or those from a CALD background. Participants must be supported to adjust to the new system, as they risk missing out on essential services and being exposed to fraud.[58]

Opportunities for co-design

4.67Several service provider organisations outlined opportunities for the NDIA to implement co-design with providers. NDS noted that, while the recommendations of the NDIS Review and Disability Royal Commission were a once-in-a-lifetime opportunity for reform, the capacity of the sector to implement the changes was limited by available funding:

NDS State of the Disability Sector data (2023) shows that while disability providers are focused on improving productivity (94 per cent), 82 per cent received service requests they could not fulfill and 62 per cent are worried about their ability to adjust to reforms. More than half report that leadership teams find it difficult to develop strategy in the current environment.

Achieving reforms will require transformation across most aspects of service delivery.Co-designing the roadmap with providers is critical.

Funding is needed for structural adjustment. This could assist with the introduction of new navigation models and supports for homes and living, managing vacancies, investing in/divesting infrastructure, new regulatory and training requirements, delivering trauma informed supports and adapting to new systems, including enhanced incident reporting, digital platforms and e-markets.[59]

4.68Neurological Alliance Australia called for the government to promote effective and efficient delivery of innovative services by introducing an independent pricing mechanism and working closely with providers to co-design any trials of new systems.[60]

4.69The Australian Physiotherapy Association (APA) submitted that service provider peak bodies could provide better, more targeted contributions to co-design processes than generalist consultancies. The APA recommended that the NDIA:

works with therapy provider peak bodies to co-design information, education processes and content that are targeted and fit for purpose;

 ensures that advisory groups have wide and diverse representation; and

contracts physiotherapists as paid consultants to provide advice on internal reviews, projects, guidelines – instead of contracting big generalist management consulting firms.[61]

4.70Allied Health Professions Australia gave evidence that better outcomes could be achieved if co-design could be conducted jointly with participants and providers, rather than placing the two groups into an adversarial relationship:

At the moment, there is often a separation, particularly between participant led co-design and then sector co-design, so it would be helpful to actually have everybody in the same room and able to have an opportunity to discuss these issues with both—not sides, because I don't actually see it as sides; I think everybody is working towards the same goal. Providers want what is best for people with disability, they want to help them to build capacity and improve their lives.[62]

4.71The principles of co-design are well founded and essential for informing policy development. Co-design with service providers is therefore vital, as providers are well placed to give advice on policy design and service delivery.

Role of the committee

4.72In its role as the only permanent oversight body for the NDIS, the committee will continue to monitor the NDIA's reforms to co-design of the scheme, individual policies, and the participant experience.

4.73Drawing on evidence provided to the committee in relation to co-design at every stage, and with participants and other stakeholders including service providers, the committee will continue its oversight of these changes.

4.74In particular, the committee recognises the importance of:

simplifying documentation requirements for access to the scheme;

improving communications with participants and service providers;

the take-up of opportunities or genuine co-design with service providers and participants to improve pricing, policies and guidelines, as the NDIS is reformed;

progress towards implementing draft plans; and

co-design of the new First Nations Strategy and action plan, and the new CALD Strategy for 2024–2028.

Footnotes

[1]Dr Emma Blomkamp, 'The promise of co-design for public policy', Australian Journal of Public Administration, vol. 77, no. 4, p. 729.

[2]National Disability Insurance Scheme Act 2013, subcl. 5(a).

[3]National Disability Insurance Agency, NDIA Engagement Framework, 31 March 2022, p.6, ndis.gov.au/media/4150/download?attachment (accessed 30January2024).

[4]National Disability Insurance Agency, NDIA Engagement Framework, 31 March 2022, p.6, ndis.gov.au/media/4150/download?attachment (accessed 30January2024).

[5]Joint Standing Committee on the NDIS, Independent Assessments Final Report, October 2021, pp.123–125.

[6]Joint Standing Committee on the NDIS, Capability and Culture of the NDIA Final Report, November2023, p.xii.

[7]Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, Violence, abuse, neglect and exploitation of LGBTQA+ people with disability: a secondary analysis of data from two national surveys, p. 9, disability.royalcommission.gov.au/publications/violence-abuse-neglect-and-exploitation-lgbtqa-people-disability (accessed 30 January 2024).

[8]NDIS Review, Final Report, Terms of Reference, p. 298.

[9]Joint Standing Committee on the NDIS, Independent Assessments Final Report, October 2021, pp.120–121, citing Jen Smith-Merry and Mary-Ann O'Donovan, 'The NDIS is fighting a trust deficit. Its future depends on putting this right', Croakey Health Media, 14 July 2021, croakey.org/the-ndis-is-fighting-a-trust-deficit-its-future-depends-on-putting-this-right (accessed 16 July 2021).

[10]National Disability Insurance Agency, Co-design update, ndis.gov.au/news/7976-co-design-update (accessed 28 January 2024).

[11]National Disability Insurance Agency, Co-design Advisory Group, ndis.gov.au/co-design-advisory-group (accessed 28 January 2024).

[12]National Disability Insurance Agency, Independent Advisory Council, ndis.gov.au/about-us/governance/independent-advisory-council (accessed 30 January 2024).

[13]National Disability Insurance Agency, Submission 98, Inquiry into the Capability and Culture of the NDIA, p. 9.

[14]See for example, MS Australia, Submission 26, p. 3; Neurological Alliance Australia, Submission 36, p. 11; MND Australia, Submission 44, p. 4.

[15]National Disability Insurance Agency, Community participation, ndis.gov.au/community/community-participation (accessed 28 January 2024).

[16]National Disability Insurance Agency, Co-designing reform, ndis.gov.au/community/have-your-say/co-designing-reform (accessed 30 January 2024).

[17]Ms Rebecca Falkingham, Chief Executive Officer, National Disability Insurance Agency, Letter to the committee regarding Submission 137 to the Inquiry into the Capability and Culture of the NDIA, 11July2023.

[18]NDIS Review, Final Report, p. 23.

[19]National Disability Insurance Agency, Co-designing reform, ndis.gov.au/community/have-your-say/co-designing-reform (accessed 30 January 2024).

[20]Summer Foundation, Submission 34, Inquiry into the Capability and Culture of the NDIA, p. 9.

[21]Mr David Tune AO PSM, Review of the National Disability Insurance Scheme Act 2013, dss.gov.au/sites/default/files/documents/01_2020/ndis-act-review-final-accessibility-and-prepared-publishing1.pdf (accessed 28 January 2024), p. 54

[22]Eastern Access Community Health, Submission 37, p. 4.

[23]Allied Group, Submission 3, p. 5.

[24]AEIOU Foundation, Submission 33, [p. 6].

[25]National Legal Aid, Submission 41, p. 8. On the challenges of obtaining specialist reports to support an eligibility assessment see South Australian Office of the Public Advocate, Submission 42, p. 27.

[26]People with Disability Australia, Issues to do with the NDIS, 2023, pwd.org.au/disability-rights/policy-areas-and-position-statements/issues-to-do-with-the-ndis/ (accessed 4 October 2023).

[27]NDIS Review, Final Report: Supporting analysis, pp. 217–220.

[28]Australian Association of Psychologists incorporated, Submission 25, p. 7. AAPi described a case of an applicant with a psychosocial disability and autism where two access request forms were required, with supporting documentation for both aspects of their disability

[29]MND Australia, Submission 44, pp. 2–3.

[30]Quoted in Disability Advocacy NSW, Submission 5, p. 7.

[31]Productivity Commission, National Disability Insurance Scheme Costs - Study report, October 2017, pc.gov.au/inquiries/completed/ndis-costs/report/ndis-costs.pdf, p. 198. See Recommendation 5.1.

[32]Mr David Tune AO PSM, Review of the National Disability Insurance Scheme Act 2013, dss.gov.au/sites/default/files/documents/01_2020/ndis-act-review-final-accessibility-and-prepared-publishing1.pdf (accessed 28 January 2024).

[33]Joint Standing Committee on the NDIS, NDIS Planning Interim Report, p. vii.

[34]Australian Government, Australian Government response to the Joint Standing Committee on the National Disability Insurance Scheme: NDIS Planning Interim Report, p. 3.

[35]Joint Standing Committee on the NDIS, NDIS Planning Final Report, p. xvii

[36]Australian Government, Australian Government response to the Joint Standing Committee on the National Disability Insurance Scheme: NDIS Planning Final Report, p. 3.

[37]Ms Rebecca Falkingham, Chief Executive Officer, National Disability Insurance Agency, Senate Community Affairs Legislation Committee Hansard, 31 May 2023, pp. 98-99.

[38]Exercise and Sports Science Australia, Submission 27, p. 7.

[39]For example, JFA Purple Orange advocated for a revised, iterative planning model, that included provision of draft plans and a stronger element of co-design between LACs and participants: Submission 6, pp. 4–5.

[40]Dr Adam Heaton, Submission 4, p. 1.

[41]Dr Adam Heaton, Submission 4, p. 1; see also Australian Institute of Health and Wellbeing, 'Indigenous health and wellbeing,' 7 July 2022, aihw.gov.au/reports/australias-health/indigenous-health-and-wellbeing (accessed 9 October 2023).

[42]National Disability Insurance Agency, NDIS Quarterly report to disability ministers, 30September2023, ndis.gov.au/media/6468/download?attachment (accessed 28 January 2024), p.16.

[43]SA Office of the Public Advocate, Submission 42, p. 20.

[44]Dr Adam Heaton, Submission 4, pp. 1-2.

[216]National Disability Insurance Agency, Submission 98, Inquiry into the Capability and Culture of the NDIA, p. 10.

[45]National Disability Insurance Agency, First Nations Strategy, 4 July 2023, ndis.gov.au/about-us/strategies/first-nations-strategy (accessed 13 October 2023).

[46]National Disability Insurance Agency, Cultural and Linguistic Diversity Strategy 2018–22, ndis.gov.au/media/316/download?attachment (accessed 28 January 2024).

[47]National Disability Insurance Agency, NDIS Quarterly report to disability ministers, 30September2023, ndis.gov.au/media/6468/download?attachment (accessed 28 January 2024), p.12.

[48]National Disability Insurance Agency, Cultural and Linguistic Diversity Strategy 2018–22, ndis.gov.au/media/316/download?attachment (accessed 28 January 2024).

[217]Queensland Advocacy for Inclusion, Submission 26, Inquiry into the Capability and Culture of the NDIA, p. 7.

[218]AMPARO Advocacy, Submission 178, Inquiry into the Capability and Culture of the NDIA, p. 2.

[49]South Australian Office of the Public Advocate, Submission 42, p. 21.

[50]National Disability Insurance Agency, NDIS Quarterly report to disability ministers, 30September2023, ndis.gov.au/media/6468/download?attachment (accessed 28 January 2024), p. 72.

[51]National Mental Health Consumer and Carer Forum, Submission 11, Inquiry into the Capability and Culture of the NDIA, [p. 8].

[52]Allied Group, Submission 3, p 3.

[53]National Disability Services, Submission 39, p. 4.

[54]Occupational Therapy Australia, Submission 2, p. 5.

[55]Disability Advocacy NSW, Submission 5, p. 7. See also MS Australia, Submission 26, p. 6.

[56]Disability Advocacy NSW, Submission 5, p. 3; see also Eastern Access Community Health, Submission 37, p. 2.

[57]Speech Pathology Australia, Submission 103, Inquiry into the Capability and Culture of the NDIA, p.8.

[58]National Disability Services, Submission 39, p. 17.

[59]National Disability Services, 2024–25 Federal Budget Submission, nds.org.au/media/com_ndssync/2024-25%20Federal%20Budget_NDS%20submission.pdf (accessed 20January 2024).

[60]Neurological Alliance Australia, Submission 36, p. 14.

[61]Australian Physiotherapy Association, Submission 121, Inquiry into the Capability and Culture of the NDIA, p. 6.

[62]Ms Erin West, Allied Health Professions Australia, Committee Hansard, 18 November 2022, p. 19.