Thin markets and emerging service gaps
4.1
This chapter discusses the issues of thin markets and Provider of Last
Resort (PLR) arrangements as well as emerging gaps in services. Service gaps
identified are resulting in lack of provision of advocacy supports, outreach
services and support coordination for Participants.
4.2
The chapter also explores the challenges faced by people from culturally
and linguistically diverse (CALD) backgrounds and Aboriginal and Torres Strait
Islanders in engaging with the NDIS and accessing culturally appropriate
services.
Thin markets
4.3
The move to individualised funding under the NDIS requires providers to
have sufficient economies of scale in order to operate sustainably, which can
be difficult to achieve in rural and remote communities and in areas of thin
markets.
4.4
Many submitters contended that thin markets will persist for the
following groups of Participants:
-
People living in rural and remote areas;
-
People with complex needs or with very challenging behaviours;
-
People experiencing homelessness;
-
People involved with the criminal justice system;
-
People from CALD background; and
-
Aboriginal and Torres Strait Islanders.[1]
Rural and remote areas
4.5
The Municipal Association of Victoria is of the view that 'the situation
for rural councils and their communities is particularly concerning as there
are not necessarily viable options in existence for service provision for
citizens, other than local government, in many cases'.[2]
4.6
In rural and regional areas, and some outer urban areas, VCOSS members
reported that there are not enough local services to provide people with the
funded supports, let alone a choice of providers.[3]
Costs of delivering services
4.7
The high costs of delivering services in rural and remote areas are
contributing to the lack of availability of service providers. For example,
submitters stressed that the cost of travel in rural and remote areas is such
that it is becoming unviable to provide services in those areas under the
current NDIS pricing.[4]
4.8
Northern Territory PHN noted that transport and accommodation expenses
associated with service delivery in remote areas remain exceptionally high, and
continue to need to be factored in as a key cost.[5]
4.9
National Disability Services believes that the methods for funding supports
in rural and remote areas need to be revised to reflect the full impact of
local conditions.[6]
People with complex needs
4.10
Mr Terence Cleary, Executive Manager, Community Care and Access,
Anglicare NT, explained that market failure is not just happening in the
Northern Territory because of its remote areas but also elsewhere, where people
with complex needs are not receiving appropriate services:
These are not just issues in relation to the Territory—market
failure is happening in Western Sydney, where people with complex needs are not
having their needs met either because the services aren't there or because the
nature of their issues are so complex that the market can't respond at the
moment.[7]
4.11
Dr Adrienne McGhee, Principal Policy and Research Officer at the Office
of the Public Advocate (Queensland), expressed their concerns:
We're particularly concerned about what supports are being
provided to individuals who have disability and complex needs who are currently
residing in government operated facilities and whose transition to the NDIS
will be largely dependent on how proactive these agencies are in supporting
them to become participant.[8]
4.12
Ms Rachel Stephen-Smith, the ACT Minister for Disability, Children and
Youth believes that there are issues with pricing of support for people with
complex needs:
The potential for market failure for people with high and
complex needs. That does partly relate, I think, to adequate pricing. There are
also potential cherry picking issues in the pricing models that are chosen, but
I think, from the feedback we've had from providers, there are genuine issues
with the appropriate pricing of support for people with high and complex needs.[9]
4.13
Other submitters raised concerns about the inadequate pricing of support
for people with complex needs.[10]
For example, Catholic Social Services Australia (CSSA) stated:
CSSA also has significant concerns about the availability and
consistency of services where insufficient price caps could lead to market
failure for particular services or for Participants with complex needs.[11]
4.14
Submitters argued that inadequate pricing may lead to providers choosing
not to accept clients with high needs.[12]
For example, VCOSS is of the view that 'the NDIS risks creating disincentives
to assisting Participants with complex needs or those perceived as ‘difficult’,
such as people displaying challenging behaviour'.[13]
Funding approach
4.15
Overwhelmingly, submitters recommended that alternative funding models,
including fixed or block funding must be made available in areas of thin and
failing markets.[14]
4.16
Victorian Healthcare Association proposed models that could be
considered:
-
The introduction of price guide flexibility whereby additional
funding could be allocated on a sliding scale to meet client needs and build
capacity in services and communities. This could be achieved using the current
quote based system that the NDIA already has in place.
-
A trial of the multipurpose services (MPS) model, which is used
in the aged care sector, as a solution to market failure in rural and remote
areas. The model is based on the principle that MPS’ can pool funds from
previously separate Commonwealth and State aged care and health programs to
provide a more flexible, co-ordinated and cost effective framework for service
provision.[15]
4.17
Ms Noelene Swanson, State Manager, Northern Territory with National
Disability Services, believes that some guarantee of demand for providers is
required in rural and regional areas:
The other thing we would like to recommend is the need for
providers to enter into rural and regional areas is some guarantee of demand. [...]
To overcome that would be consideration of block funding or hybrid based
funding until that demand has reached a point where it can be sustained.[16]
4.18
The Victorian Government argued that 'the most effective way to address
thin markets is to ensure adequate pricing that takes into account the real
cost of service delivery in these markets'.[17]
4.19
The Royal Australian College of General Practitioners (RACGP) pointed
out that because primary health and disability services have areas of overlap,
there is opportunity for cost savings by avoiding duplication:
Integrating health and disability services would benefit
rural communities, in which GPs have a wide reach. We see an opportunity for
the NDIA, RACGP and other bodies involved in providing services to patients
with disability to work together to identify areas of duplication and encourage
sustainability.[18]
Provider of Last Resort
4.20
As market steward, the NDIA is responsible for the Provider of Last
Resort (PLR) arrangements. In the circumstances of insufficient market supply
with no provider available or in the event of provider failure, the NDIA may
directly commission and procure disability supports for Scheme Participants.
4.21
However, as stated in the NDIS Market Approach Statement of
Opportunity and Intent, during transition, states and territories continue
to lead as PLR and will continue to do so for providers that they fund during transition.
Over time, the NDIA will lead an integrated response jointly with states and territories
as transition leads to full Scheme.[19]
4.22
The Northern Territory is the exception. Under Schedule K of the
Bilateral Agreement between the Commonwealth and the Northern Territory, the
NDIA is the responsible entity for ensuring provider of last resort services
are in place for all Participants in the NT during transition.
4.23
Overall, submitters found that the Provider of Last Resort framework
remains unclear and incomplete.[20]
For example, Victoria Legal Aid argued that 'in Victoria, provider of last
resort measures or any real solution to address the very serious effects of
market failure remain opaque, unclear and incomplete'.[21]
It pointed out that the Victorian bilateral agreement is silent as to what will
occur in the event of market failure and the Operational Plan provides no
practical framework and only states:
...the NDIA will lead on identifying and developing approaches
to ensure that a provider of last resort is available, as well as support for Participants
in crisis.[22]
4.24
The Victorian Government also identified a lack of clarity on the
Provider of Last Resort arrangements and called for additional information
about how these arrangements will function both during transition and under
full Scheme.[23]
4.25
The Tasmanian Government submitted that the NDIA's Provider of Last
Resort arrangements have not yet been negotiated with Tasmania.[24]
4.26
Mr Terence Cleary, Executive Manager, Community Care and Access with
Anglicare NT stated:
The bilateral agreement between the Australian government and
the NT government on the transition of the NDIS is unique in that it's the only
bilateral agreement that specifically refers to market failure, thin markets
and this notion of a provider of last resort. So for the two or three years
since we've had that in place, at every meeting I reckon I've just about got up
and said, 'Could someone articulate for me and for us this framework of the
provider of last resort?' And still, two to three years later, there's been
nothing articulated at all. It was very heartening to see that the Productivity
Commission in its latest papers has been calling for recognition of that.[25]
4.27
The Office of the Public Guardian NT recommended that 'the development
of a clear framework for the Provider of Last Resort be prioritised to ensure Participants
in remote and thin markets are protected'.[26]
Similar recommendations were made by Victorian Legal Aid[27]
and the Queensland Government.[28]
4.28
In its NDIS Costs Study Report, the Productivity Commission recommended
the NDIA publicly release its Provider of Last Resort policy as a matter of
urgency.[29]
Committee view
Thin markets
4.29
The lack of services and providers operating in rural and remote areas
is not new or unique to the NDIS. However, the committee acknowledges that the transition
to a market based system brings new challenges for delivering services in rural
and remote areas. Arrangements to deal with thin markets need to be considered
to ensure Participants can access the services they need.
4.30
The committee is concerned with reports of people with complex needs not
being provided with adequate services. It appears that inadequate pricing may
lead to service providers choosing not to accept clients with complex needs. The
committee is troubled by the growing evidence of service providers 'cherry
picking' clients, potentially leaving some of the most vulnerable NDIS
Participants with no access to adequate services.
4.31
Greater clarity is required on how the NDIA intends to intervene in
areas of thin markets. The committee recommends the NDIA develops a strategy to
address thin markets. The committee will undertake further work on the issue of
thin and failing markets within the context of its inquiry into market
readiness.
Recommendation 17
4.32
The committee recommends the NDIA develop and publically release
a strategy to address thin markets.
Provider of Last Resort
4.33
The committee is concerned that Provider of Last Resort arrangements still
remain unclear and incomplete. It appears that negotiations between the NDIA
and state and territory governments around Provider of Last Resort arrangements
have not yet progressed. It appears that the NDIA will be responsible for these
arrangements at full Scheme, so the committee urges the Agency to consider
these arrangements well before transition is complete. Chapter Two of this
report discusses the Provider of Last Resort arrangements with regard to the
provision of crisis accommodation, and recommends that the responsibilities are
clearly set out in bilateral and other agreements.
4.34
The committee also reiterates recommendation 18 of its report into the provision
of services under the NDIS for people with psychosocial disabilities related to
a mental health condition.
Recommendation 18
4.35
The committee recommends the NDIA publically release its Provider of
Last Resort policy as a matter of urgency.
Service gaps
4.36
Inquiry participants reported that the transition to a market-based
system combined with the transition of Commonwealth, state and territory
programs have resulted in emerging service gaps in important areas.
Advocacy
4.37
As discussed in chapter 3, individual advocacy plays an important role
during pre-planning, the planning process and at plan reviews. As described by
VCOSS, advocacy is particularly important for people with complex needs or
facing disadvantage, or those with limited informal supports or networks.[30]
4.38
Systemic advocacy is also critical to ensure the inclusion and full
participation of people with disability by identifying and addressing issues on
a larger scale than with individual advocacy.[31]
4.39
A recent cost-benefit analysis of independent disability advocacy showed
that for every dollar governments invest in independent advocacy it saves $3.50
on systems. For examples, advocates do get people of hospital quicker and help
keep people out of jail.[32]
4.40
Ms Mary Mallett, CEO of Disability Advocacy Network Australia, pointed
out that 'advocacy is not funded by the NDIS' and 'was not designed to be'.
However, state and territory funding for disability advocacy is being rolled
into the NDIS as part of the bilateral agreements.[33]
4.41
On 9 August 2017, the Australian Government announced $60 million in
funding to continue support for disability advocacy services. The Australian
Government also called for states and territories to commit to ongoing support
for advocacy both under the NDIS and outside the NDIS. The media release
stated:
This substantial Commonwealth commitment ensures disability
advocacy services will now continue to be funded until 30 June 2020. [...]A
national system of disability advocacy support also requires ongoing investment
from states and territories to ensure their citizens can resolve issues with
state-run services, and advocates can participate effectively in state-based
planning.[...] The Commonwealth calls on other states and territories to meet
their commitments to people with disability through the NDS by committing to
ongoing support for advocacy under the NDIS.[34]
4.42
This announcement was welcomed by a number of submitters as it brings
some certainty to the sector and ensures that some advocacy work can continue
at least until June 2020.[35]
However, funding for advocacy at state and territory levels is uncertain beyond
transition.
4.43
For example, the NSW Government will cease advocacy funding after June
2018.[36]
Ms Mary Mallett, CEO of Disability Advocacy Network Australia explained the
situation:
The immediate critical area is in New South Wales. The
funding of advocacy by states and territories has always been part of their
disability funding. It makes sense—it's for people with disability. It got
rolled into their bilateral agreements to fund the NDIS. That funding has been
signed over and will disappear as the NDIS fully rolls out. In New South Wales
$10.9 million annually of advocacy funding will disappear at the end of June
next year, plus another couple of million which is for disability peaks that
represent the voice of people with disability.[37]
4.44
Physical Disability Council of NSW (PDCN) argued that the Commonwealth
funding guaranteed until June 2020 is only for organisations currently funded
under the National Disability Advocacy Program (NDAP) and this will leave a
majority of NSW state funded organisations under or completely unfunded after
June 2018.[38]
4.45
PDCN also stated:
PDCN’s opinion is that continued funding for peak
organisations to provide systemic advocacy, independent information and
representation for people living with disability in New South Wales is
essential to meet the objectives of the NDIS.[39]
4.46
The situation varies in other states. During transition, the Victorian
Government is increasing its funding for advocacy through the Disability
Advocacy Innovation Fund. This year, it provided an additional $1.5 million on
top of its base investment in advocacy, which is $2.9 million, recognising a
need to build the capacity of people with disability to navigate the Scheme.[40]
4.47
However, the Victorian Government identified the need for greater
clarity on how systemic and legal advocacy will be delivered in a national
consistent way.[41]
4.48
In light of the loss of advocacy funding because of the transition of
state and territory funding to the NDIS, People With Disability Australia 'urges
the Committee to draw attention to the critical gap in advocacy services that
will be left after state funding ceases'.[42]
4.49
VCOSS recommended ongoing funding for independent advocacy so every NDIS
participant can access advocacy support to navigate the system and obtain the
right support in their Plans.[43]
4.50
Ms Mary Mallett, CEO of Disability Advocacy Network Australia also
called for action:
This week the Productivity Commission's report came out.
Everybody's paying attention to that. It says advocacy is important. The first
annual report of your joint standing committee said that advocacy is important
and must be fixed. [...]We're pleading with your committee to take it seriously
and to do whatever you can and to use whatever levers are available to get the
state governments to take their responsibility.[44]
Assertive Outreach
4.51
The issue of assertive outreach has been explored by this committee in
its inquiry into the Provision of services under the NDIS for people with
psychosocial disabilities related to a mental health condition. The
committee found that with the transitioning of Commonwealth, state and
territory funded programs, there is a risk of emerging gaps in outreach
services.[45]
4.52
In its submission, Mental Health Australia reiterated the concerns
raised by the sector during the inquiry into the Provision of services under
the NDIS for people with psychosocial disabilities related to a mental health
condition about the future of funding for assertive outreach under the
NDIS:
In the long term, without specific new policy and funding
arrangements, there is a major risk assertive outreach for people with severe
mental illness and complex needs will no longer be delivered at all, either
through the NDIS or elsewhere.[...] the lack of a strategy for funding specialist
assertive outreach is a critical loss to the system of supports for people with
psychosocial disability and a major concern for mental health stakeholders.[46]
4.53
VCOSS called for dedicated funding for assertive outreach to help locate
and connect people experiencing isolation or disadvantage with the NDIS.[47]
4.54
Refugee Council of Australia recommended increasing assertive outreach
programs to help people from refugee and CALD backgrounds, stating:
These programs should be designed to help them understand
changes to the disability support sector in the transition to the NDIS and what
this means for their individual situation, including services both in and
outside the NDIS and the interface between these two sectors. This support
would include accessible information about individuals’ rights and
responsibilities as an NDIS participant or as a user of ILC services.[48]
Support Coordination
4.55
Anglicare highlighted the importance of support coordination to assist
Participants in understanding and enacting their Plans.[49]
The Office of the Advocate (Victoria) also observed that 'support coordination
is one of the key determinants of the successful implementation of an NDIS
plan'.[50]
4.56
Can:Do Group is of the view that the traditional coordination role has
been lost with the introduction of the NDIS:
[...] service providers have stepped back and are only
providing what they are being asked to provide by the family as they are only
being paid for that service. This negates the importance of coordination,
collaboration and navigation alongside families – yet outside of most initial Plans
which do have some support coordination no one is being paid for this, nor has
resourcing to do so at no charge, so it is not being done.[51]
4.57
Many submitters reported that the lack of funded support coordination in
Plans is resulting in Participants not knowing how to use their Plans and
delays in Plan implementation.[52]
4.58
Mrs Leanne Varga, Systemic Advocate and Campaigns Manager with Family
Advocacy told the committee that 'people are asking for support coordination or
plan management and they are not receiving it'.[53]
4.59
Anglicare believes that the lack of funding for support coordination is
contributing to Plan underutilisation, and is creating hidden costs to the
Scheme.[54]
For example, Multiple Sclerosis Australia and Physical Disability Council of
NSW also reported that some Participants do not know how to activate and use
theirs Plans due to not having any support coordination to assist them.[55]
4.60
Additionally, Anglicare Australia identified that lack of funded support
coordination in Plans needs to be addressed, as currently service providers are
picking up this cost.[56]
Loss of funding for support
coordination
4.61
Multiple Sclerosis Australia reported that some Participants are losing
their support coordination funding at plan reviews.[57]
Making Connections Together also noted that 'support coordination is considered
irrelevant after the first 12 months of a plan'.[58]
4.62
In its study report on NDIS Scheme Costs, the Productivity Commission
also found evidence that support coordination is being provided to Participants
for only a fixed period of time and is of the view that 'the NDIA should
allocate support coordination based on need, rather than time'.[59]
Guidelines and funding
recommendations
4.63
Some inquiry participants believe the guidelines for support
coordination are unclear. Family Advocacy stated:
Currently, the NDIS website does not provide clear guidelines
as to when a participant is eligible for support coordination. For this reason,
greater transparency is required in relation to the eligibility for support
coordination.[60]
4.64
The Victorian Government is of the view that 'there has been
inconsistent information about the expectations of support coordination as well
as limited training of support coordinators to support people with complex and
specialist needs'.[61]
4.65
The Office of the Public Advocate (Victoria) argued that the current
format of support coordination is too limited and that the NDIA should
introduce 'intensive support coordination' as a funded service based on the
traditional comprehensive case management model.[62]
4.66
The Summer Foundation believes that 'proactive, effective and ongoing
support coordination should be provided when required to respond to complex and
changing needs'.[63]
Committee view
4.67
The transition of Commonwealth, state and territory funded programs into
the NDIS as well as the transition to individualised funding for NDIS
Participants have disrupted the way advocacy, outreach and support coordination
services were historically funded and delivered. The committee is cognisant of
the service gaps in these areas through previous inquiries, including the Provision
of services under the NDIS for people with psychosocial disabilities related to
a mental health condition.
Advocacy
4.68
The committee is concerned that state and territory governments are not
putting strategies and resources in place to address the identified gaps in
funding for advocacy. Overall, it is unclear how individual advocacy will be
funded beyond transition. This issue must be urgently addressed. The committee
recommends the Council of Australian Governments (COAG) Disability Reform
Council work with the Department of Social Services to address the expected
funding shortfalls for advocacy services beyond transition.
Recommendation 19
4.69
The committee recommends the Council of Australian Governments (COAG)
Disability Reform Council work with the Department of Social Services to
address the expected funding shortfalls for advocacy services beyond
transition.
Assertive outreach
4.70
During its inquiry into the Provision of services under the NDIS for people
with psychosocial disabilities related to a mental health condition, the
committee identified that the Department of Social Services and the NDIA needed
to collaboratively develop a plan outlining how assertive outreach services
will be delivered beyond transition to ensure people who are hard-to-reach can
effectively engage with the NDIS and other support programs. The evidence
received during this inquiry reinforces the urgent need for such a plan.
Recommendation 20
4.71
The committee recommends the Department of Social Services and the NDIA
develop and publically release a plan outlining how assertive outreach services
will be delivered beyond transition to ensure people with disability who are
hard-to reach can effectively engage with the NDIS and / or other support
programs.
Support coordination
4.72
The committee is of the view that support coordination plays a major
role in the enactment and implementation of Participants' Plans, especially for
people with complex needs. The committee is concerned with reports of
Participants not knowing how to use their Plans because of a lack of funded
support coordination in their Plans.
4.73
The committee also recognises that support coordination should not be
limited to a fixed period as some Participants may need ongoing support
coordination. The committee agrees with the Productivity Commission's view that
the NDIA should allocate support coordination based on need rather than time.
Recommendation 21
4.74
The committee recommends the NDIA ensure support coordination is adequately
funded in Plans to meet Participants' needs and not limited to a fixed period.
People from CALD backgrounds
4.75
People from culturally and linguistically diverse (CALD) backgrounds
make up the second largest group of people living with disabilities. Yet, they
are significantly under-represented in disability support services, and had
very low NDIS participation rates during the NDIS trial phase.[64]
4.76
The Public Advocate (Queensland) shared the concerns of AMPARO Advocacy
about the current NDIS participation rates of people with disability from CALD
backgrounds being significantly below what some groups in the CALD service
delivery sector have anticipated.[65]
4.77
VICSERV and others drew the attention of the committee on issues around
engaging with the NDIS for people from CALD backgrounds.[66]
Provision of interpreter services
4.78
One of the reasons put forward for the low engagement of people from
CALD backgrounds is the lack of interpreter supports. Queensland Advocacy Inc.[67]
and other groups[68]
argued that the NDIA will not fund interpreters. The Office of the Public
Advocate (Queensland)[69]
said that Plans do not consistently address interpretation and translation
needs.
4.79
However, at a public hearing in Brisbane, Mr Yuu Matsuyama, Senior Legal
Officer, Office of the Public Advocate provided some encouraging news about
interpreter supports:
Our office was part of a consortium of agencies that
advocated strongly on the issues of interpreter supports for people with
disability from CALD backgrounds so that they can communicate with local area
communicators, planners and service providers to enact their NDIS Plans. We've
been advised since that the NDIS signed a memorandum of understanding with the
Commonwealth government's Translating and Interpreting Service to assist Participants
from CALD backgrounds with implementing their Plans. The Queensland government
has also committed to continue to provide interpreter services to Participants
with disability from CALD backgrounds until 30 June 2019. On that front, the
Public Advocate congratulates both the Commonwealth and the Queensland
government for responding to that issue.[70]
4.80
The Office of the Public Advocate (Queensland) warned that 'by not
implementing policies supporting the provision of interpreter services and
other mechanisms for people from CALD backgrounds to overcome barriers
accessing the NDIS the NDIA, and its disability provider partners, are
vulnerable to complaints of racial discrimination'.[71]
4.81
VCOSS recommended employing CALD workers and resourcing and working with
local CALD communities to develop engagement strategies, undertake outreach,
and deliver services, could help increase NDIS access and participation for
people from CALD backgrounds.[72]
Data collection
4.82
In a letter to the NDIA dated 3 April 2017, the Public Advocate
(Queensland) recommended that accurate data about participation of people from
CALD backgrounds, including countries of origin, be collected for the following
reasons:
Failure to collect adequate data about this group will impact
on the NDIA’s ability to monitor the participation rates of people from CALD
backgrounds, inform targeted strategies with diverse communities, and ensure
effective policy development and planning.[73]
4.83
In its reply to the Public Advocate, the NDIA explained the current
limitation of data collection:
With regard to CALD data; as recognised in the report to the
Council of Australian Governments Disability Reform Council for Quarter 2 of
Year 4 of the NDIS, there are some current limitations to the data available in
relation to the proportion of Participants that are culturally and
linguistically diverse. This is due to the data warehouse of the new Customer
Relationship Management (CRM) system being under development. Ongoing
enhancements to the CRM, data warehouse and business practices will address
these issues.[74]
CALD strategy
4.84
The Public Advocate (Queensland) pointed out that the NDIA is yet to
release the NDIS CALD strategy.[75]
The Queensland Government believes that the delay in releasing the NDIS CALD
strategy poses the risks of continued underrepresentation of people from CALD
backgrounds in the NDIS.[76]
4.85
In a letter to the Public Advocate (Queensland) dated 22 May 2017, the
NDIA stated that the 'NDIA is developing a CALD Strategy to articulate how the
NDIA will ensure the needs of people from culturally and linguistically diverse
backgrounds with disability are met in the design, development and
implementation of the NDIS'. It indicated the 'the Strategy will be endorsed
and published mid to late 2017'.[77]
Committee view
4.86
The committee is concerned with reports that the current NDIS
participation rates for people with disability from CALD backgrounds are
significantly below what some groups in CALD service delivery sector have anticipated.
The committee notes the lack of data being collected and made publically available
about the participation rates for people from CALD backgrounds. This impedes on
the NDIA's ability to monitor the participation rates of people from CALD
backgrounds and develop targeted strategies. The committee recommends the NDIA ensure
its Customer Relationship Management (CRM) system is modified to enable
collection of accurate data about participation of people from CALD
backgrounds.
Recommendation 22
4.87
The committee recommends the NDIA ensure its Customer Relationship
Management (CRM) system is modified to enable collection of data about participation
rate of people from CALD backgrounds.
4.88
The committee was pleased to hear that progress has been made toward the
inclusion of interpreters' services in people's Plans. However, the committee
believes that more needs to be done to ensure that people with disability from
CALD backgrounds can fully engage with the NDIS. For example, the committee
notes the recommendation to employ CALD workers to increase NDIS access and
participation. The committee understands that the NDIA has been working on the
development of a CALD Strategy for some time and anticipated to publically release
it by mid to late 2017. The CALD strategy is yet to be published.
Recommendation 23
4.89
The committee recommends the NDIA urgently publically release its NDIS
CALD Strategy.
Aboriginal and Torres Strait Islander communities
4.90
At a public hearing in Darwin, Mr John Paterson, CEO of Aboriginal
Medical Services Alliance of the Northern Territory (AMSANT) provided some
background information about Aboriginal and Torres Strait Islanders and
disability:
In 2016 Census data showed just how significant the issue of
disability is for Aboriginal and Torres Strait Islander communities. At least
60,000 Aboriginal and Torres Strait Islanders across Australia live with a
severe or profound disability, which is at least twice the prevalence rate of
other Australians. In 2014-15, six per cent of disability service users were
Aboriginal and Torres Strait Islander people, with 84 per cent of those aged
under 50. Disability is often compounded by other challenges in Aboriginal
communities, such as lack of cultural competence of mainstream services,
poverty, comorbidities and, for remote people, a serious lack of access to services.[78]
4.91
The Australian Medical Association (AMA) explained that 'the high
prevalence of disability within Indigenous communities is due, in part, to poor
health care and nutrition, an increased exposure to violence and psychological
trauma'.[79]
4.92
Mr Paterson acknowledges that the NDIS could offer some real
opportunities but holds 'serious concerns that these opportunities will not be
realised without significant reforms to the current NDIS framework'.[80]
Engagement with the NDIS
4.93
Community Mental Health Australia (CMHA) identified that 'Aboriginal and
Torres Strait Islander people are the least engaged in the NDIS and
experiencing particular challenges'.[81]
4.94
Dr Nick Collyer, Systems Advocate at Queensland Advocacy Inc. reported
that knowledge of the NDIS rollout is poor amongst Aboriginal and Torres Strait
Islander communities and stressed the importance of pre-rollout conversations
rather than distribution of written materials to raise awareness about the NDIS
in these communities.[82]
4.95
The Office of the Public Guardian NT found that Participants, their
families and service providers are not well prepared to understand and interact
with the new Scheme. It recommended:
[...] resources be allocated for culturally-appropriate
pre-transition preparation initiatives to ensure families and carers are able
to provide the necessary support to Participants throughout the planning
process.[83]
4.96
Submitters described poor planning practices and outcomes in
communities.[84]
For example, AMA drew the committee's attention to anecdotal reports about
inconsistent and unacceptable NDIS planning practices occurring in Aboriginal
and Torres Strait Islander communities:
The AMA has been told of instances where Indigenous people
have been ‘assessed’ from a car parked outside a residence. We have heard of a
person with otitis media whose forms were ‘lost’ and the young man and his
family forced to travel 500 kilometres to a specialist to provide the correct
medical paperwork.[85]
Culturally appropriate pathways
4.97
AMSANT[86]
and the Office of the Public Guardian NT[87]
raised concerns about the cultural competency embedded in NDIS systems and NDIA
staff who are unaware of culturally respectful ways of engaging with Aboriginal
and Torres Strait Islander people.
4.98
AMA pointed out that there is no Aboriginal and Torres Strait Islander
representatives on the NDIS Independent Advisory Council (IAC). Given the
prevalence of disability amongst Aboriginal and Torres Strait Islander people
and the current challenges faced by this cohort with the transition to the
NDIS, the AMA believes there is a need to have an Aboriginal and Torres Strait
Islander person appointed to the IAC.[88]
CMHA made a similar recommendation stressing that 'it is vital that the formal
structures advising the NDIS process reflects this diversity and the associated
challenges'.[89]
Service gaps and funding approach
4.99
Significant service gaps exist in many communities and submitters
reported that purely market based models simply will not provide the stability or
support required to improve the lives of people living with a disability in
Aboriginal and Torres Strait Islander communities.[90]
4.100
AMSANT recommended that changes be made to the criteria for NDIS
providers to make it more feasible for the Aboriginal community controlled
health sector and other Aboriginal organisations to become providers.[91]
Aboriginal disability workforce
4.101
The Queensland Government believes that 'the employment of appropriate
Aboriginal or Torres Strait Islander people (male and female) by the NDIS would
facilitate the integration of NDIS into the community and is likely to lead to
improved outcomes for clients'.[92]
VCOSS made a similar observation and recommended employing Aboriginal workers
and working with Aboriginal organisations to deliver services.[93]
4.102
Ms Noelene Swanson, from National Disability Services, believes there is
an opportunity to grow a local Aboriginal workforce:
We have a real opportunity here: we have the youngest people
in Australia living in rural and remote areas. We have a workforce capacity
that is now equivalent to the age of the industrial revolution. So there's a
real opportunity to grow a local Aboriginal workforce as well as businesses and
services.[94]
4.103
Mr John Paterson, CEO of AMSANT, expressed concerns 'about the lack of
real strategy for the development of an Aboriginal disability workforce'[95]
and subsequently recommended 'that an Aboriginal workforce strategy be
developed by the NDIA in consultation with Aboriginal organisations and the
Aboriginal community controlled health sector as a priority action'.[96]
Initiatives to increase engagement
and improve outcomes
4.104
State governments have put in place initiatives to engage with
Aboriginal and Torres Strait Islander people and communities. For example, the
Queensland Government described how the Queensland’s participant readiness
initiatives, augmented by Sector Development Funding, have increased the rate
of participation of Aboriginal and Torres Strait Islander people over the last
two quarters, particularly in North Queensland. Aboriginal and Torres Strait
Islander peoples represent 4.22 per cent of Queensland’s population and now
represent 9.5 per cent of Queensland NDIS Participants with approved Plans.[97]
4.105
At a public hearing in Melbourne, Mr Arthur Rogers, Special Adviser NDIS
with the Department of Premier and Cabinet, Victorian Government, explained
that the Victorian Government's workforce plan includes promoting employment
within the disability sector for groups that are underrepresented, including
people from Aboriginal and Torres Strait Islander backgrounds.[98]
4.106
The NDIA has acknowledged the challenges of delivering ILC activities in
Aboriginal and Torres Strait Islander communities. The NDIA indicated it is
'currently preparing to undertake a grants round that primarily targets remote
areas, including Aboriginal and Torres Strait Islander communities, to build
the foundations required for ILC to be delivered in those areas from 2019–20 when
ILC is rolled out nationally'.[99]
Committee view
Engaging with the NDIS
4.107
The committee is aware that Aboriginal and Torres Strait Islander people
are experiencing additional challenges to engage with the NDIS. The committee
believes that pre-rollout and pre-planning engagement activities are essential
and must be prioritised by the NDIA. The committee noted the Queensland
Government's efforts to increase engagement and the rate of participation of
Aboriginal and Torres Strait Islander people. The committee encourages other
jurisdictions to undertake targeted initiatives.
Recommendation 24
4.108
The committee recommends the NDIA ensure culturally appropriate
pre-rollout and NDIS engagement activities are in place in Aboriginal and
Torres Strait Islander communities at least six months before rollout date.
Cultural competencies
4.109
The committee is concerned about reports of lack of cultural
competencies of NDIA staff when engaging with Aboriginal and Torres Strait
Islander people. Given the prevalence of disability amongst Aboriginal and
Torres Strait Islander people and the current lack of engagement of this cohort
with the NDIS, the committee agrees with the recommendation made by submitters
that an Aboriginal and Torres Strait Islander representative be appointed to
the NDIS Independent Advisory Council (IAC).
Recommendation 25
4.110
The committee recommends the Minister for Social Services appoint an
Aboriginal and Torres Strait Islander representative on the NDIS Independent
Advisory Council (IAC).
Workforce and services
4.111
The committee sees growing the disability workforce in Aboriginal and
Torres Strait Islander communities as a priority to ensure supply of services.
The committee understands that the First People's Disability Network is working
with Aboriginal and Torres Strait Islander communities, employment agencies,
training organisations and other local stakeholders to increase the number of
Aboriginal and Torres Strait Islander people working in the disability sector.[100]
However, the committee believes that a comprehensive Aboriginal and Torres
Strait workforce strategy would benefit the sector.
Recommendation 26
4.112
The committee recommends the NDIA develop, in collaboration with
Aboriginal and Torres Strait Islander organisations and the Aboriginal
community controlled health, an Aboriginal and Torres Strait Islander Workforce
Strategy.
Hon Kevin Andrews MP
Chair
Senator Alex Gallacher
Deputy Chair
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