4.1
This chapter examines financial matters associated with the implementation and performance of the National Disability Insurance Scheme (NDIS), including:
financial sustainability considerations;
pricing of services and supports;
funding for support coordination; and
paying family members for supports.
4.2
Committee views on each of the issues noted above appear throughout the chapter.
Financial sustainability considerations
4.3
The National Disability Insurance Scheme Act 2013 (NDIS Act) requires regard to be had to 'the need to ensure the financial sustainability of the [NDIS]'. The National Disability Insurance Scheme (Supports for Participants) Rules 2013 require the Chief Executive Officer (CEO) of the National Disability Insurance Agency (NDIA), in 'administering the NDIS and approving each plan…[to] have regard to objects and principles of the Act, including the need to ensure the financial sustainability of the NDIS'.
4.4
The committee heard that there are concerns as to how the NDIA considers financial sustainability in making decisions about reasonable and necessary supports. In this respect, the Public Interest Advocacy Centre (PIAC) raised concern that there is no guidance from the NDIA about how it has 'regard to' financial sustainability in practice.
4.5
The PIAC also argued that—based on the NDIA's approach to Administrative Appeals Tribunal (AAT) and Federal Court matters—the NDIA appears to be 'inappropriately relying on broad-based actuarial evidence' to determine that supports which would otherwise be considered reasonable and necessary would not be funded due to financial sustainability considerations for the NDIS as a whole. As an example, the PIAC noted that in one AAT case, the NDIA had:
…relied on actuarial evidence to show the 'worst case scenario' where 'every person, male or female, married or unmarried, who suffered from multiple sclerosis, and certain other disabling diseases, sought a sex worker'. The evidence did not refer to data as to the extent to which people with multiple sclerosis or other disabilities might wish to use a sex worker, [or] the frequency with which such requests would otherwise meet the criteria for 'reasonable and necessary support' under the NDIS Act.
4.6
According to the PIAC, the NDIA also appears to be making a (new) argument that it has 'residual discretion' to refuse funding based on—among other matters—the need to ensure the financial sustainability of the NDIS. This is even where the support satisfies the reasonable and necessary criteria in the NDIS Act. According to the PIAC, this would make NDIA decisions 'even more opaque and less accountable than is already the case'.
4.7
The PIAC recommended that the NDIA publish guidelines on how it considers the financial sustainability of the NDIS in funding decisions, and the way that financial sustainability is determined. According to the PIAC, these guidelines should be informed by the following principles:
The preparation and approval of a participant's plan must take place through a 'participant-centric' decision-making approach.
The 'financial sustainability' of the NDIS should be given effect through the application of the reasonable and necessary supports criteria under section 34 of the NDIS Act, and not be a stand-alone ground on the basis of which the NDIA can refuse to fund a support.
Consideration of broader financial implications of funding a support in relation to other potential participants undermines the 'participant-centric' approach and should not be relevant to the assessment of 'reasonable and necessary' supports for an individual participant.
NDIA position
4.8
In relation to how the NDIA considers financial sustainability when making decisions about reasonable and necessary supports, the Planning Operational Guideline states:
In applying the value for money criteria in the NDIS Act and Supports for Participants Rules, the NDIA will, to the extent is permissible under the NDIS Act and Rules, consider the cost of any available in-kind supports and the impact on the sustainability of the NDIS if supports which are already available in-kind are instead purchased by paying cash.
The NDIA is considerate of the fact that funding supports that do not represent value for money has the potential to undermine the financial sustainability of the NDIS (section 3(3)(b))…
Importantly, whilst one of the objects of the NDIS Act is to promote the provision of high quality and innovative supports (section 3(g)), innovation, of itself, does not displace the requirement that a support must be effective and beneficial, having regard to current good practice…
This requirement also reflects the need to have regard to the financial sustainability of the NDIS which is likely to be undermined if funding for supports whose effectiveness and benefits are largely unknown.
4.9
In its submission, the NDIA noted that a number of pressures may impact on the financial sustainability of the NDIS, including increased participant costs due to inflation and ageing; and NDIS coverage, with interface issues between the NDIS and other service systems 'testing the boundaries' of who can access the NDIS and what constitutes 'reasonable and necessary' supports. The NDIA asserted that it had implemented the following measures—among others—to monitor risks that could impact the financial sustainability of the scheme:
Ongoing analysis of costs and quarterly reporting on financial sustainability by the NDIA Scheme Actuary.
Operational responses to address identified cost pressures.
Committee view
4.10
The committee notes that the Planning Operational Guideline already provides detail about how the NDIA considers the financial sustainability of the NDIS when making decisions on funding supports. This information appears to have been published as part of the NDIA's commitment to make its operational guidelines public.
4.11
The committee welcomes this action, and encourages the NDIA to take further steps to increase transparency in how its delegates make decisions that balance funding reasonable and necessary supports for participants with the need to ensure the financial sustainability of the NDIS. The committee otherwise proposes to maintain a watching brief in relation to this matter.
Pricing of services
4.12
Several submitters and witnesses raised concerns that NDIS pricing does not enable service providers to operate profitably, or to recruit and retain staff with the skills and qualifications to deliver safe, quality supports.
4.13
For example, the Illawarra Disability Alliance (IDA) observed that price points for one-on-one supports, coupled with the 'transactional' nature of service delivery, mean that its members often have difficulty operating profitably. The IDA noted that many providers are seeking to leave the personal care market over time, or are reducing their service offerings. This limits support options for participants with higher or more complex needs. Compounding this issue is the difficulty in recovering payments for services (discussed below).
4.14
Mind Australia asserted that the transactional nature of service delivery, coupled with low price caps, means that organisations must decide between providing a service at a financial loss or refusing to provide services at all. Mind Australia provided an example to illustrate its concerns:
The NDIS…requires Group Activities to be delivered at a cost of $56.81 per group (i.e. if there are 10 people in a group, they would be charged $5.68 each). Mind estimates the actual cost of providing this service is approximately a loss of $150 per hour to the organisation, due to the administration of the pricing and the changes required to service agreements, effectively making the provision of this support unviable.
The loss of this service is of significant concern for Mind as we know the benefits that clients gain from talking and spending time among their peers in a safe space. Feedback from participants and carers is that they feel that relationships are monetised, rather than therapeutic.
4.15
The Mental Illness Fellowship of Australia (MIFA) observed that psychosocial disability support does not fit into current pricing structures, stating:
The sector has developed responsive recovery-oriented models of support over many years and has developed a workforce that is appropriately qualified and skilled to deliver this support. However, there is a mismatch between the supports people with psychosocial disability need and the types of supports provided in NDIS packages, and between the pricing of the supports and the true cost of service delivery.
4.16
Mr Matthew Paul recommended that price caps be increased for all supports funded under the NDIS, noting that providers are 'inundated and running at a loss' despite growth in the sector. According to Mr Paul, providers also report that they are putting in 'countless hours' above billable hours to assist participants to navigate complex NDIS systems. Yooralla similarly suggested that prices be increased to reflect the payment of superannuation on annual leave loading, increased penalty rates for casual staff, and the cost impact of portability of long service leave.
4.17
The Queensland Law Society (QLS) stated that its many of its members have raised concerns about the NDIS Price Guide, asserting that an urgent review of the guide is required for 'transparency, improvement and accountability purposes'. According to QLS, the review should include markers for financial and social appraisal of the price guide in comparison to the Medicare price guide—including its formulation and auditing processes.
Psychosocial recovery coach
4.18
A new item in the NDIS Price Guide 2020–21 is the psychosocial recovery coach (recovery coach). This support has been developed in response to feedback on integrating recovery-oriented practice into the NDIS. A recovery coach is an NDIS-funded support worker with mental health knowledge, who may also have lived experience of disability. Responsibilities of the recovery coach include:
developing recovery-enabling relationships, based on hope;
supporting the person with their recovery planning;
coaching to increase recovery skills and personal capacity, including motivation, strengths, resilience and decision-making;
collaborating with the broader system of supports to ensure supports are recovery-oriented;
supporting engagement with the NDIS, including support with plan implementation; and
documentation and reporting.
4.19
The recovery coach is billed at $80.90 per hour during the day on weekdays.
4.20
Submitters and witnesses expressed qualified support for the new recovery coach role. For example, Mind Australia welcomed the introduction of the recovery coach, noting that the support recognises the value of a lived experience workforce. However, Mind Australia expressed concern at the low pricing of the item relative to its specialist nature, noting that it will be difficult to deliver the supports at the current price once the cost of employing suitably qualified workers is taken into account.
4.21
Mr Bill Gye, Chief Executive Officer (CEO), Community Mental Health Australia (CMHA), expressed concern that the recovery coach may be seen as a replacement for support coordination, stating that:
…the recovery coach is a positive but a qualified positive at the same time. It is a positive in that it provides an opportunity for organisations to employ people at a slightly higher level than they do for their primary core supports. But organisations have historically been depending upon a proportion of support coordination pricing, which is a level II at about $102 an hour. The recovery coach comes in at $80 an hour, which is certainly better than the $60 to $65 an hour for the core supports there.
The problem is that the recovery coach is now being seen as a replacement for the support coordination level 2 role which means that the advantage that used to present in terms of the daily rate being offset by the fact that the recovery coach at $80 an hour is lower. The offset of the offset is that there may be more hours that are contracted for the recovery coach.
4.22
Mr Gye also observed that the price cap for the recovery coach item is set too low, relative to the level of skill required to support people with psychosocial disability within a recovery-oriented framework.
4.23
In its submission to the committee's inquiry into the NDIS Workforce, the Australian Psychological Society (APS) observed that it was not consulted in the development of the recovery coach item. It also stated that the roles and responsibilities of support coordinators, local area coordinators (LACs) and recovery coaches must be clearly defined. In addition, the APS emphasised that recovery coaches must not deliver interventions under the NDIS, as they do not possess the required qualifications, experience or capacities.
NDIA position
4.24
In its submission to the inquiry, the NDIA stated that 'setting price regulation is part of the NDIA's commitment to build confidence and certainty for the provider market, while balancing the need for NDIS participants to obtain reasonable value for money'.
4.25
The NDIA also noted that the Minister for the NDIS released the results of the 2020–21 NDIS Pricing Review on 3 June 2020. The review examined, through research and consultation with industry, community and government stakeholders, whether the existing price control framework and other market settings under the NDIS continue to be appropriate or should be modified. According to the NDIA, important updates arising out of the review include:
introducing psychosocial recovery coaches to support participants with psychosocial disability;
improving clarity on the way prices are set for Supported Independent Living (SIL);
new features to provide opportunities for participants access to alternative living arrangements as part of independent living options (ILOs);
driving innovative opportunities for participants in employment;
improving the Disability Support Worker Cost Model (DSW Cost Model);
clarifying definitions of time of day and day of the week (such as weekdays, evenings and public holidays);
introducing Programs of Supports to improve choice and control for participants, and to provide more certainty for providers when delivering supports; and
improving the definition of some locations throughout Australia to regional, remote or very remote to ensure continued service and reach by providers.
4.26
The NDIA also stated that it is 'committed to the continuous improvement of the methodologies underpinning the NDIS price regulation framework', and that it has recently commenced a review of the DSW Cost Model—particularly its applicability to supports delivered in SIL settings.
Committee view
4.27
As this committee has noted in previous inquiries, appropriate price controls for NDIS supports are vital to ensuring market growth and the sustainability of the sector. The committee remains of the view that service providers must be able under NDIS pricing to deliver high quality services to participants without compromising their financial sustainability.
4.28
Throughout this inquiry, the committee continued to hear evidence that NDIS prices are set too low to enable providers to operate profitably, or to recruit, train and retain staff with the skills and qualifications to deliver safe, quality supports to people with disability.
4.29
The committee notes that it gave detailed consideration to the impact of NDIS price controls in its interim report on the NDIS Workforce, recommending that a comprehensive review of the funding model for the NDIS be undertaken, with a focus on ensuring that prices reflect the true cost of delivering safe, quality supports to people with disability. The committee will continue to consider the impacts of NDIS pricing as part of its ongoing inquiry into the NDIS Workforce. It will also consider NDIS pricing, as appropriate, as part of its other inquiry processes.
4.30
The committee welcomes the introduction of the psychosocial recovery coach item as a means of developing a lived experience workforce and integrating recovery-oriented care into the NDIS. However, the committee encourages the NDIA and its partners in the community to ensure that the item is not used as a replacement for support coordination or allied health expertise. The committee also encourages the NDIA to consider whether the price cap for the coach should be set at a higher level, to reflect the skill needed to deliver effective recovery-oriented support for people with psychosocial disability. Noting that the recovery coach is a new item which has not been fully tested, the committee proposes to maintain a watching brief in relation to this matter.
Funding for transport
4.31
Participants often require transport to access supports and services. Under the NDIS, participants may access funding for transport assistance if they cannot use public transport without substantial difficulty. Funding takes into account relevant taxi subsidy schemes, and does not cover assistance for carers to transport family members with disability for everyday commitments.
4.32
Through this inquiry, the committee continued to hear that transport funding may not be sufficient to enable participants to access the supports they need. The committee notes that much of the evidence was provided to the committee in late 2019 to early 2020. Since then, the NDIA has taken steps to address concerns associated with transport funding (outlined below).
4.33
For example, the IDA noted that price controls in the NDIS Price Guide 2019–20 effectively require participants to fund transport costs from 'Category 2' funding, provided such funding is included in their plan. Where there are insufficient Category 2 funds in a plan, the participant will not be able to access services or activities unless they can meet transport costs from their personal finances. This is a particular concern for participants in regional, rural and remote areas, where the costs of accessing services can be prohibitive.
4.34
The IDA also expressed concern that the NDIS Price Guide 2019–20 contradicts advice from senior NDIA officials that individuals are able to use their plans flexibly across core supports in relation to transport.
4.35
One submitter raised concern that—at the time of the submission—transport was 'severely underfunded', noting that:
My daughter has to use a taxi for transport and the current level of funding for transport doesn't even cover half of that cost. I should also be able to use my core funding for transport if the current level of transport funding is inadequate.
4.36
Another submitter similarly stated funding for transport is insufficient, stating that transport funding 'doesn't allow me to do anything or go anywhere'.
4.37
Michael Hansen of Making Connections Together noted that thresholds for obtaining transport funding under the NDIS are higher than thresholds for obtaining Mobility Allowance, and raised concern that NDIS participants cannot access Mobility Allowance. Mr Hansen stated that:
If you have a car and don't use public transport you won't get transport allowance [under the NDIS] but would be eligible for Mobility Allowance —this is not fair especially if people have been on the mobility allowance and this has assisted with all types of transport.
4.38
A report from People with Disabilities (WA) (PwDWA Report) stated that funding for transport must be individually tailored to participants' circumstances, providing the following case example of:
…[a] participant who has visual impairment and lives in Perth's Northern suburbs being allocated a LAC who works at the Northam Office (approximately 100kms distance) and needing to use taxi service both ways.
4.39
The report also emphasised that safety must be paramount when considering travel allowances, expressing concern that 'taxi fares are being removed and/or reduced in plans and yet some participants do not have the confidence or feel safe to travel using public transport without a Support Worker'.
NDIA position
4.40
In its submission, the NDIA stated that the NDIS can fund transport supports for a participant where it is reasonable and necessary, and the supports relate to the impact of their impairment(s) on their functional capacity. Generally, transport supports funded by the NDIS include:
training and support to use public transport;
modification to private vehicles, driver assessment and training; and
some costs associated with the use of taxis, private transport or innovative transport options for participants who cannot travel independently or use public transport.
4.41
According to the NDIS website, there are three levels of funding for transport assistance, which are used to provide a transport budget for participants:
Level 1: up to $1,606 per year for participants who are not working, studying or attending day programs but are seeking to enhance their community access.
Level 2: up to $2,472 per year for participants who are currently working or studying part-time (up to 15 hours a week), participating in day programs and for other social, recreational or leisure activities.
Level 3: up to $3,456 per year for participants who are currently working, looking for work, or studying, at least 15 hours a week, and are unable to use public transport because of their disability.
4.42
Participants may also receive higher funding if they have either general or funded supports in their plan to enable their participation in employment.
4.43
In its submission, the NDIA indicated that it has made progress on initiatives to improve funding arrangements for transport. It stated that it has been working with the Department of Social Services (DSS) and states and territories through the Senior Officials Working Group (SOWG) Transport Working Group, to better understand how transport supports provided through the NDIS sit alongside other transport services. DSS and the NDIA are also working to develop a new long-term approach to planning for transport supports, to be considered by Ministers in December 2020.
4.44
Since 1 March 2020, participants have been able to use funds allocated to their core supports budget flexibly for transport costs. Further, the CEO of the NDIA told the committee in October 2020 that, under forthcoming changes to the NDIS planning process, 'most funds will be completely flexible for participants to use on the supports they need when they need them'.
Committee view
4.45
The committee heard evidence that transport funding may not be adequate to ensure that participants are able to access necessary supports and services. However, the committee notes that many of these concerns were raised in late 2019 and early 2020. Since that time, the NDIA has progressed a number of measures to enhance access to transport funding, increase funding amounts, and increase flexibility in how funding may be used.
4.46
The committee notes that it also considered issues related to transport funding in the interim report for its inquiry into the NDIS Workforce, and the final report for its inquiry into NDIS Planning.
4.47
In light of these matters, the committee proposes to maintain a watching brief in relation to transport funding. If further evidence indicates that transport funding is of concern for participants or other stakeholders, the committee may consider the issue in more detail in a subsequent report.
Funding for support coordination
4.48
Support coordination is a funded item in a participant's plan. According to the NDIS website, support coordinators assist NDIS participants to understand and implement the funded supports in their plans, and link participants to community, mainstream and government services.
4.49
Concerns about the lack of funding for support coordination—particularly for participants with limited informal supports—were raised by a number of stakeholders. For example, one submitter outlined ongoing difficulties with accessing support coordination services that met her needs:
There should be very trusted, well trained Support Coordinators that are knowledgeable about the supports available in my area who can help put us in contact with immediate care. Or at least so people aren't waiting 6 weeks to go to the shops like I have been.
4.50
In a supplementary submission, the submitter noted that after 17 weeks on the NDIS, the only supports being provided were ones that the participant had put in place herself (plan manager, support coordinator and transport from a company that she had used previously). The submitter went on to argue that:
The NDIS needs to change the way that support coordinators are paid. If a SC [support coordinator] does badly and clients need to complain via email like me, the SC gets paid more for sorting things out. The longer they take to sort it out, the more they get paid.
4.51
The committee also heard that there are concerns about the conflict of interest that may arise where support coordination and plan management services—and sometimes also support services—are delivered by the same entity. For example, Support Management Solutions (SMS) stated that:
There have been occasions where participants are coerced into leaving a plan manager in order to join another plan manager that is associated with the support coordinator's organisation. The conflict of interest issue is not discussed with the participant, rather the dual activities are promoted as a benefit. There are also occasions where organisations offering both services charge participants against the support coordination budget for items that are the responsibility of the plan manager.
4.52
Another submitter stated that there are conflicts of interest where a support coordinator is also involved in the delivery of other supports, noting that this is of particular concern in SIL settings. The submitter expressed concern that some support coordinators may be focussed on maximising plan budgets, rather than on helping the participant to achieve their goals.
4.53
Much of the evidence provided to this inquiry highlighted the importance of support coordination for specific cohorts, including participants who are homeless, Aboriginal and Torres Strait Islander participants, and participants from culturally and linguistically diverse (CALD) backgrounds. Other issues affecting these cohorts are also discussed in Chapter 5.
Support coordination for participants who are homeless
4.54
The Hutt St Centre, a specialist homelessness organisation in South Australia, observed that while support coordination has been 'marketed' by the NDIS to support people with difficulties in self-management, communication and learning (among other challenges), it is often overlooked, underfunded, or not approved in final NDIS plans despite being advocated for in planning meetings. The Hutt St Centre also noted that inadequate funding for support coordination impacts the ability for people with disability experiencing homelessness to transition to the NDIS—despite their housing and case management goals being met.
Support coordination for Aboriginal and Torres Strait Islander participants
4.55
The committee received evidence concerning support coordination for Aboriginal and Torres Strait Islander participants. For example, the First Peoples Disability Network (FPDN) asserted that support coordination must be funded in the first plans of all Aboriginal and Torres Strait Islander participants as an affirmative action by the NDIA, stating:
Dedicated funding should be earmarked to ensure…appropriate support coordinators can be identified, and involved with the development and finalisation of first plans. Appointing the support coordinator after a plan is approved does not provide the opportunity to build trust and better understand when and how support coordinators can contribute, as well as enabling participants to agree and be clear on their expectations of this role. Support coordinators should also have a proportion of funding earmarked to contribute to plan reviews.
4.56
The FPDN also stated that it supports the recommendation of the NDIA's Independent Advisory Council that support coordination must be separated from the provision of SIL supports. However, the FPDN observed that this is often 'extremely challenging' for Aboriginal and Torres Strait Islander peoples with disability due to the lack of culturally competent services—particularly in regional and remote areas. In addition, the FPDN observed that while
41 per cent of participants are currently receiving support coordination from a provider of other supports, there is no data on the proportion of these individuals who identify as Aboriginal and Torres Strait Islander.
4.57
The FPDN also expressed concern that artificial separation of the often overlapping LAC, support coordinator and planner roles creates confusion and distress for many Aboriginal and Torres Strait Islander peoples with disability—particularly in remote areas where employees are limited and initiatives to develop a skilled workforce are ‘just beginning’.
4.58
The Senate Community Affairs References Committee heard that in some instances support coordination services carried out for remote Aboriginal and Torres Strait Islander communities in Western Australia may be inappropriate. For example, Dr Lauren Rice, Research Fellow, University of Sydney Brain and Mind Centre, stated that:
The support coordination is being done from Broome or Perth… The support coordinators come out. They are youngish people who turn up and knock on the door of a person who has an intellectual disability and other health problems and is going through extreme trauma. They aren't going to open the door to some random figure… The other issue is that the support coordinators are people who have no understanding of the culture.
Support coordination for participants from culturally and linguistically diverse backgrounds
4.59
The Ethnic Disability Advocacy Centre (EDAC) expressed concern that it continues to see cases where support coordination is not included in its clients' plans. It asserted that support coordination is vital for CALD participants—particularly those with refugee backgrounds or with low English proficiency—as this cohort often requires a significant level of long-term support to access services and implement plans. EDAC stated that failures to include support coordination in plans lead to its clients missing out on crucial services. EDAC provided the following illustrative example:
A single parent (Humanitarian Entrant) with six children, three of them with autism. Only one of the children was provided with Support Coordination in their NDIS plan, with an assumed expectation that the Support Coordination would be "bundled" and used for all three children, and that the level of funding allocated to one child would be sufficient to coordinate supports for all three children, who had significantly different support needs.
4.60
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 (PwDWA Report). The project involved engagement with people with disability from CALD communities. According to the Report, the WA Metropolitan Migrant Resource Centre (MMRC) indicated that there is insufficient or non-existent support coordination included in CaLD participants' plans. As a consequence:
[T]here is no assistance available to help them unpack the NDIS plan or to choose service providers or assist in negotiating with service providers for fair charges on the services. There are indications that CaLD individuals with approved NDIS spend some weeks before starting to receive the services because they struggle to get into the market to search for the services.
Case management
4.61
Some submitters highlighted the absence of funding for case management—a service that existed in some jurisdictions before the introduction of the NDIS. For example, Ms Kim Barker, Public Guardian, Office of the Public Guardian Tasmania, argued:
Many NDIS participants for whom we act as guardian have multiple disabilities, sometimes on the back of past trauma, with significant intersecting impairments. Some of this cohort are included in the NDIS's complex planning pathway, and we want to acknowledge the improved service coordination and service provision for those participants involved in that pathway. However, the NDIS's failure to fund case management services for complex and challenging participants, who have numerous service providers plus multidisciplinary care and treatment teams, poses a real gap in coordination and communication between providers.
4.62
The Hutt St Centre observed that the importance of case management continues to be highlighted by difficulties its clients experience in accessing the NDIS and using their plans. It stated:
While homelessness services can undoubtedly provide short to medium term case management for clients with complex needs and disabilities, our service delivery with clients is often prioritised by meeting more immediate needs for safety and housing.
[C]ase management within the NDIS would be better placed to assist clients with high service needs to be adequately supported through the process of transitioning to the NDIS. Case management through the NDIS would…[also] provide a more streamlined approach to continuity of care, as well as greater opportunities for hand over between homelessness services and the NDIS.
Australian Government position
4.63
The 2019 Review of the NDIS Act led by David Tune AO PSM (Tune Review) recommended that the Australian Government amend the NDIS Rules to 'set out the factors the NDIA will consider in funding support coordination in a participant's plan'. The Government supported this recommendation, stating that it 'supports reinforcing the active consideration of support coordination' when developing participants' plans.
4.64
The NDIA in its submission noted that it has developed a Market Enablement Framework (MEF) 'to address market issues' and provide guidance on market interventions if needed, with the MEF examining markets by region and by support type (such as support coordination).
Committee view
4.65
The committee notes that the support coordination market is limited in some areas, and that—as the Tune Review recognised—increases in funding for support coordination would require market development to ensure that the market for support coordination is sufficient to meet participants' needs.
4.66
The committee echoes the Tune Review's call for the NDIA to build the support coordination market, and acknowledges that the NDIA has its MEF in place to examine issues related to thin markets. The committee encourages the NDIA to critically examine the support coordination market, to ensure that there are sufficient providers who offer a quality service.
4.67
The committee also encourages the NDIA to consider the issue of support coordination for particular cohorts, with particular regard to:
offering support coordination in all first plans for Aboriginal and Torres Strait Islander participants and participants from CALD backgrounds;
increasing the cultural competence of support coordinators, and 'matching' support coordinators to participant cohorts so far as possible; and
increasing funding for support coordination as necessary and appropriate.
Paying family members for supports
4.68
Some evidence concerned how the NDIA makes decisions on whether family members should be paid to provide care and support services to participants.
4.69
At present, the NDIA's Operational Guideline on sustaining informal supports states that funding 'a family member to provide supports to a participant can be detrimental to family relationships'. Family members will only be funded to provide supports in 'exceptional circumstances', such as when:
there is a risk of harm or neglect to the participant;
there are religious or cultural reasons for funding a family member to provide supports; or
the participant has strong personal views, for example in relation to their privacy or dignity.
4.70
The Operational Guideline also states that 'the NDIA will consider the circumstances of each case, any wishes expressed by the participant and also take into account what is reasonable to expect others to provide'.
4.71
Queensland Advocacy Incorporated argued that 'there have been instances of the NDIA making decisions in circumstances in which they do not have authority' under the NDIS Act to do so.
4.72
The QLS expressed concern about reports of participants who sought paid support for family members in accordance with the Operational Guideline, and who were advised by their plan manager or support coordinator that this is 'not permitted'. The QLS argued that the Operational Guideline 'do[es] not have the authority or operation of primary legislation', asserting that decision-makers relied on the guideline 'to assert decision-making authority on an issue which is not captured by the NDIS Act'.
4.73
Evidence provided to other Senate inquiries also indicated that NDIS funding arrangements may not be appropriate for certain cohorts—particularly for some Aboriginal and Torres Strait Islander peoples with disability. For example, Dr Lauren Rice, a Research Fellow from the University of Sydney's Brain and Mind Centre, told the Community Affairs Reference Committee that there 'are cultural reasons why Aboriginal people don't want to care for people outside their family'.
4.74
The Senate Select Committee on COVID-19 heard that the NDIA had in at least two instances allowed family members to be paid for supporting participants during the COVID-19 pandemic. The CEO of the NDIA, Mr Martin Hoffman, explained that:
For family members caring for a person with disability, the more appropriate general system of service delivery or support is the various carer payments and carer allowances…
That is the approach for payment to family members providing care to people with disability... However, the basis of the NDIS is to attempt to be individualised and customised to particular circumstances. In the range of things that we consider, basically, is are there alternate options that can provide the support service, alternate providers who can provide the support service? If that is not the case, and there have been a couple of those, as I've mentioned, then, for a limited period, until those supports are available in this COVID period, we have agreed to it.
4.75
Mr Hoffman also noted that the decision to fund a family member to care for a participant 'depends upon the training capability of the family member' and whether them caring for a participant 'is going to be safer or in the best interests of the person'. The operational guideline states that 'the NDIA will not fund a family member to provide…care or community access supports unless all other options to identify a suitable provider…have been exhausted'.
Committee view
4.76
The committee notes that during the COVID-19 pandemic in particular, the question of whether a family member would be better placed to provide supports to a participant may be especially relevant if there is a health risk to a participant, paid services are unavailable because of movement or health restrictions, and family members have to take time off work to care for a participant because of the absence of safe alternatives.
4.77
The committee considers that the NDIA operational guidelines appear to provide clarity about the circumstances in which the NDIA will decide to fund family members to provide supports. However, the committee encourages the NDIA to provide participants with reasons for a decision not to pay family members to provide supports in writing (or another accessible format, as appropriate).