12.1
This chapter outlines other issues raised about planning, in addition to those discussed in previous chapters in this report. These issues included:
Planning meetings, including their location, whether they should take place via phone, and their length.
Plan lengths and automatic plan roll-over.
Plan implementation and utilisation.
Excluding participants from planning meetings.
National Disability Insurance Agency (NDIA) surveys on participant satisfaction.
12.2
The chapter concludes with a final committee view and recommendations to address some of the issues outlined in this chapter.
Timeliness and delays
12.3
The committee was informed that wait times for National Disability Insurance Scheme (NDIS) participants to have a planning meeting, receive a plan, and have their plan reviewed, was a major issue when submissions were lodged to the inquiry in 2019. In particular, evidence suggested that wait times were particularly problematic for the following:
Participants in rural and remote areas.
Participants who are young children.
Participants in hospital settings.
Participants awaiting assistive technology approvals and access to funds following approvals.
Home modifications approvals.
Replies from the NDIA to emails and phone calls from participants.
12.4
For example, Mr Douglas Herd, who had been ‘part of the Senior Executive Service leadership team that launched the NDIS in 2013’ and previously worked for the NDIA as a branch manager in its Communications and Engagement team, reported that he had submitted his ‘access request and medical evidence to become a participant with the NDIS on 6 January 2019. Eight months later I am still waiting for my first plan to be issued’. He argued that the ‘delays I have encountered are not uncommon, not new and not unknown to the NDIA Executive, the NDIA Board, [and the relevant] State, Territory and Commonwealth Ministers’.
12.5
One submitter, who self-managed the plans for her son and her sister, argued in response to the time that reviews take that ‘[w]e just wait, and wait, and wait, and hope for the best’. Wait times, she argued, ‘can have such devastating consequences, like a great worker, who we spent nearly 18 months to find, can’t wait around while we wait for a new plan’ which may not have the requested funding in it anyway.
12.6
Ms Linda Bone, the mother of a participant, described a change of circumstances review as a ‘relentless process that took eight months to get a review meeting, after continually calling [the] call centre, going into [the] NDIA office, sending emails to complaints and feedback’.
12.7
The committee learned that the NDIA did not have set timeframes in place for responding to requests, in the second half of 2019. In some instances, such as requests for unscheduled plan reviews, evidence suggested that the NDIA was not acknowledging the request or responding for months, if at all. The issue of communication with the NDIA is discussed separately in Chapter 11.
12.8
Family Advocacy suggested that many participants and their families were contacting their local MPs to speed up the review process:
Many families have shared that they have had to contact their local Federal Member of Parliament (MP) for assistance in relation to NDIS matters due to sheer frustration from time delays, not receiving any response, not having a particular person they can contact due to the lack of transparency…[A]fter significant delays with no responses, assistance from their MP seemed to speed up the process.
It seems unnecessary to overload MPs’ offices with NDIS complaints.
12.9
Noah’s Ark Inc provided an example of a family requiring major car modifications. The family intended to buy a van but did not want to purchase it until the NDIA approved the modifications. However, the NDIA refused to approve the modifications until the car was purchased. Under NDIA rules, a car had to be less than three years old. Noah’s Ark argued that ‘Families have waited too long for approvals and then the car has been too old and not approved based on this’.
12.10
In some instances, the committee learned, funding delays can lead to
long-term negative impacts on participants. For example, Intervention Services for Autism and Developmental Delay argued that ‘delays to receipt of funds in the case of young children with autism have serious consequences in terms of the long-term outcomes of the therapy’ and can also ‘result in higher costs as therapy will need to be continued for longer’, because the earlier the age that Early Intensive Behavioural Intervention commences, the shorter the time period needed to achieve therapy goals.
12.11
Several submitters also suggested that the review process could be much more ‘streamlined and effective’ if reviews were carried out by local NDIA offices rather than the national office, as these may have a better understanding of local issues and can ensure that the reviews ‘are not lost in the system’.
12.12
Ms Karen Clifford called for ‘defined, reasonable and accountable targets for completion of requests for review’. She further proposed ‘an issue tracking and escalation system…accessible to participants/nominee and an NDIA staff member assigned and available to be contacted by [the] participant/nominee’.
12.13
Every Australian Counts outlined the following recommendations from its stakeholders:
Enough staff to implement key processes within set timeframes.
Accountability measures that would hold staff to account for failing to deliver processes within those timeframes.
Online tracking of applications, approvals, reviews and complaints so participants can log in and see where they are in the queue.
12.14
The 2019 Review of the National Disability Insurance Scheme Act 2013 (NDIS Act) led by David Tune AO PSM (Tune Review) argued that ‘participants can and should expect to have certainty about when they will be able to access their NDIS supports’ and called for the Government’s proposed Participant Service Guarantee to have a timeframe within which the NDIA must approve a plan.
12.15
The Australian Government supported the Tune Review’s recommendation that the Participant Service Guarantee have timeframes for plan facilitation and approval, and stated that the Participant Service Guarantee will include ‘timeframes for the NDIA to make decisions or undertake administrative functions, including planning, plan approval and review processes’. The Participant Service Guarantee, it confirmed, will be given effect through specific legislative amendment.
12.16
The NDIA argued that it ‘is committed to communicating effectively with participants’, including through its recently published NDIS Participant Service Charter, which contains timeframes for the NDIA to respond to individual needs and circumstances. These timeframes in relation to planning and plan reviews, as at 30 June, were:
Planning
21 days to start preparing a plan, after an access decision has been made.
70 days to approve a participant’s plan, after an access decision has been made.
90 days to approve a plan for an Early Childhood Early Intervention (ECEI) participant, after an access decision has been made.
Plan reviews
56 days to commence facilitating a scheduled plan review, prior to the scheduled review date.
21 days to decide whether to undertake a participant requested plan review, after the request is received.
42 days to complete a participant requested review, after the decision to accept the request is made.
Reviewable decisions
90 days to complete an internal review of a reviewable decision, after a request is received.
28 days to implement an Administrative Appeals Tribunal (AAT) decision to vary a plan, after receiving notification of the AAT decision.
Plan variations
28 days to vary a plan, after the receipt of information that triggers the plan amendment process.
50 days to vary a plan, after receipt of information relating to a complex quote that triggers a plan amendment process.
7 days to provide a copy of the plan to the participant, after the plan is amended.
Planning meetings
12.17
Issues raised about planning meetings included the location; the appropriateness of planning meetings taking place via phone; and the length of planning meetings.
12.18
Some submitters indicated that they would prefer planning meetings to take place in their home. For example, Huntingtons Queensland proposed that planners should attend participants’ homes if the participant has complex, degenerative disabilities, instead of relying on office appointments, written material and phone calls to assess the participant’s needs.
12.19
The Queensland Office of the Public Guardian noted that in some instances, planners and LACs were willing to hold meetings at a participant’s home, while others refused to.
12.20
Conversely, Ms Kirsten Deane from Every Australian Counts raised the issue of the appropriateness of planners asking participants if they are happy where they live, in front of the people with whom they live. She suggested that such a situation would offer ‘no opportunity to say, “Hey, I don’t really like the people who I live with”’.
12.21
Others questioned whether planning meetings taking place via telephone were appropriate for some participants. For example, Huntingtons Queensland highlighted that phone planning meetings may be problematic for participants with Huntingtons disease because many ‘have speaking or swallowing issues which mean they cannot form words clearly, or…may take a very long time to process a question and formulate an answer’.
12.22
Similarly, the Deafness Forum of Australia, Deafblind Australia, Audiology Australia, Able Australia, Senses Australia and Neurosensory outlined that they knew of:
…examples of people with hearing loss being told by the NDIS that communication with them must be done by telephone. While some people with hearing loss are able to communicate by telephone, many are not. When the NDIS staff have been asked to use alternative communication methods the person has been told that the contact must be by telephone. This is not acceptable.
12.23
Carers Victoria also outlined concerns that phone meetings had occurred with participants who have ‘significant mood and thought disorders and cognitive impairments’, with some being unaware that the phone call was a planning meeting.
12.24
Noah’s Ark Inc reported that it was aware of several families who had not known that a telephone conversation was a planning meeting until they had received a plan.
12.25
Services for Australian Rural and Remote Allied Health (SARRAH) submitted that telephone meetings may be ‘culturally inappropriate’ for rural and remote Aboriginal and Torres Strait Islander participants, and called for face-to-face meetings, ‘preferably with locals who have established relationships within the community’. This issue is outlined further in Chapter 9.
12.26
The Community and Public Sector Union (CPSU) raised concerns that most ‘planning conversations are now taking place over the phone using questionnaires…administered by call centre employees with no prior knowledge or experience with disability’. The CPSU suggested that this was taking place ‘to increase the number of new plans approved due to the high number of plans that are required to be completed’. Other evidence alleged that telephone planning meetings were being offered to participants even where they preferred a face-to-face meeting.
12.27
However, Services for Australian Rural and Remote Allied Health noted that telephone or online planning meetings may be ‘part of the required mix for rural and remote areas’, and called for additional training for planners so that they would be better carry out this type of planning.
12.28
Other submitters indicated that at the time of the committee taking submissions (September 2019), the NDIA had phased out phone planning meetings. However, the NDIA indicated that during the COVID-19 pandemic, this had changed. This is discussed at the end of this section.
12.29
Several submitters expressed their concern about the length of planning meetings. People with Disabilities WA asserted that the current time allocated to planning meetings, of an hour and a half to two hours, ‘is not conducive to families bringing their family members to the planning meetings’. It gave the following example:
[A] family that was supported to attend their child’s planning meeting was ushered out of their planning meeting after 1.5 hours as there was another planning meeting booked. This participant has extremely complex needs with multifaceted supports required and the family was told the planner would use the documentation to complete the plan…The final plan had the participant portrayed as able to do a number of things independently, which was completely incorrect and resulted in an internal review. This review process was undertaken 3 times before a plan was developed to reflect the child’s complex needs.
12.30
Mr Sean Redmond from the AEIOU Foundation suggested that families perceived that planners in planning meetings were too focused on the process and not interested in hearing about the family’s needs:
[T]here’s not a lot of understanding of individual needs. The planners will be sitting there and going through the motions. They’re going through their own stages and domains. The family want to tell their story, but they very rarely ever get to. I’ve been in hundreds of meetings, and this is the same throughout all of them. They don’t get to tell their story. They will try to do that, and the planner will then turn around and say, ‘No, let’s go back to this,’ and start talking about a domain. All they are thinking about is their process: step 1, step 2, step 3.
12.31
Amaze suggested that, for some autistic people, ‘it may be more effective to run a series of shorter planning meetings, rather than one, long session’. It noted that some were finishing planning meetings quickly because of their difficulties with social communication, or being too anxious to continue the planning process.
12.32
Through its recently implemented participant check-in process, the NDIA stated, participants ‘will have the opportunity to decide if they want to have their plan review meeting face-to-face, or over video/phone at a time that best suits them’.
12.33
In its June 2020 Quarterly Report to disability ministers, the NDIA stated that during the COVID-19 pandemic, ‘planning meetings were conducted via phone (or video-conference) or face-to-face at the preference of the participant.
12.34
Mr Martin Hoffman, the Chief Executive Officer (CEO) of the NDIA, informed the committee at the hearing on 12 October 2020 that because of a ‘substantial environmental shift’ arising through the COVID-19 pandemic, there had been:
…a significant shift in how we operate and how participants plan and receive their supports. Participants now receive more services in teleconference and videoconference format, and they are more willing to engage with the agency in these formats as well.
Throughout this period of change, our focus has nevertheless remained squarely on ensuring a high-quality participant and planning experience. We’ve embodied that commitment in our Participant Service Charter and our Participant Service Improvement Plan, released in August this year…
The COVID-19 pandemic has fundamentally changed how the agency interacts with participants and the way participants use their plans.
Plan lengths and automatic plan roll-over
12.35
One impact of short plans, the committee learned, was the need for participants to go back on waiting lists. The parent of one submitter reported that her daughter was given a plan for six months and spent six months on the waiting list for a specialist. Early Start Australia informed the committee that some children were being issued short plans of as little as three months, meaning that they are waiting 6–8 weeks to access a service and then having only a few weeks of support before being asked to start planning again. In the interim, they may lose their therapy place, and experience wait times again to access a service. Early Start proposed that early intervention plans should not be shorter than 12 months and that plans should commence once participants start to access supports.
12.36
A further impact concerned participants’ mental health, with one participant informing the committee:
My next NDIS review is a year away but I am already anxious about it, worrying about what questions they will ask and if they will take away my eligibility again. My psychologist attended my last planning meeting to have input into an appropriate plan for me. She strongly advocated for a three year plan as the review process causes me such extreme anxiety and distress for several months that she is unable to do any therapeutic work during that time. She has to use psychology sessions to help manage my distress. We were given a two year plan.
12.37
Other evidence concerned the ability of providers to complete reports where plans were subject to reviews earlier than expected. Ms Shayna Gavin, a practising physiotherapist, reported that she knew of families being asked to do plan reviews at the nine month mark, with a week’s notice. She argued that:
- this does not give time to complete reports to support the review process
- we have been typically commencing reassessments for reports in the 9th or 10th month of the plan so they are ready when reviews come around. To start this even earlier means we are reporting on only partially achieved goals.
12.38
Most submitters and witnesses were in favour of automatic roll-over of plans and longer plans, if a participant’s circumstances and needs have not changed. Several submitters proposed that this only be applied to subsequent plans, not first plans, to ensure that the range of supports has been tested for relevance and suitability. Roundsquared suggested that plan-rollover and longer plans would be particularly welcomed for many participants in rural and regional areas where travel for a planning meeting may mean travelling a considerable distance.
12.39
Some of those in favour of longer plans proposed the following conditions:
Children receive shorter plans.
Safeguards be implemented to ensure that vulnerable participants who are less able to assert their needs have the opportunity to ask for changes.
That parts of plans that are meeting a participant’s needs be rolled over, while other parts be subject to review.
12.40
However, one suggested that ‘some participants have accepted a two-year plan only to find they have the same funding as their one-year plan’.
12.41
Some submitters called for certain groups of participants to be excluded from automatic plan roll-overs, such as children. Allied Health Professions Australia suggested that it may be possible to identify key points when changes are likely to be required in a participant’s plan, such as the following:
At key developmental stages for children.
When assistive technology needs replacing.
When there are significant changes in functionality.
12.42
Some in favour of automatic plan roll-over suggested that this should be subject to the following conditions:
The previous plan should have a surplus of a certain amount.
Mechanisms introduced to ensure participants are not avoiding reviews because of the process being traumatic or stressful.
That consideration be given to the episodic needs of participants with psychosocial disability.
Better processes be put in place for participants to initiate a plan review if needed.
12.43
Calling the Brain’s Bluff, in a submission written by a participant, stated that ‘I don’t trust the NDIS to do the right thing by me if they automatically roll over my plan’, and argued that automatic plan roll-overs and longer plans could lead to many participants not having supports they may need.
12.44
On 18 November 2019, the Minister for the NDIS, the Hon Stuart Robert MP, announced that participants will have the option to request longer plans of up to three years:
The longer term plans, of up to three years, are designed for participants who are in a stable situation with their support needs unlikely to change, are confident in using their funding to achieve their goals and are focused on longer term goals such as learning new skills, moving into or maintaining employment or becoming more active in the community.
Participants will still have the option to review the plan at any time if their circumstances change.
12.45
The NDIA informed the committee that it now conducts participant check-ins via phone to ask if their circumstances have changed or if they would like a plan review, in which case the NDIA would proceed with a review. It further reported that participants can request plans for periods of up to three years.
Plan implementation and utilisation
12.46
The committee was informed that there may be multiple reasons why participants do not utilise the supports provided in their plans. For some, it is because ‘they feel overwhelmed, do not know where to start and do not have the confidence to do so’. Further reasons included a lack of understanding of budgets or how to spend the money provided for supports, as well as time spent in hospital, specialist services not being available, not having a support coordinator and being on long wait lists for services. Carers Victoria suggested that planners are not ensuring that participants who do not have capacity to organise their own supports have formal or informal supports to implement their plan, leading to plan underutilisation.
12.47
Uniting Vic. Tas also suggested that where LACs are responsible for connecting participants to support providers, ‘often participants go for long periods of time before they hear from the LAC, and it can take a very long time before they are connected to services’—with in some instances participants not being connected with any support services.
12.48
Services for Australian Rural and Remote Allied Health suggested that underutilisation of supports ‘may reflect (to a substantial degree) the inclusion of supports that are of little interest to, unable to be accessed by or not available to the participant’. It also noted that plans ‘may include allied health services that are not accessible or available in the participants’ community or region–so go unused’. The issue of a lack of service providers for participants from rural and remote communities is discussed in further detail in Chapter 9.
12.49
Ms Kirsten Deane from Every Australian Counts, observed that once participants ‘have the plan, there is very limited help for people to actually get it into action’. She noted that although LACs are expected to help participants enact their plans, ‘the reality is they don’t’. She stated that she had heard:
…multiple stories of people whose plans sat on the kitchen bench for months because they just didn’t know what to do next and no-one helped them through it. I have also had stories of people who didn’t realise that they had plans. Their plan was sitting in the portal and nobody had notified them that it was actually there. People need assistance in implementing their plans. This is a new scheme and a very complicated system, and there is no-one there to help them get their plans into action.
12.50
Mr Peter Tully from Every Australian Counts told the committee that ‘most people really struggle to engage once they’ve got their first plan’ because they need to choose between engaging their existing service providers for everything funded in their plans, or go to the marketplace to find new providers:
Most people, including myself with my experience and knowledge, have no idea where to start. I was one of those people who was on the waiting list for 25 years for two hours of support in the middle of the day just so I could have lunch, go to the toilet and have a hot cup of tea without having to pre-plan that. To all of a sudden have a plan [that] allowed me to get personal care in the morning and in the evening, and support in the middle of the day. It was like: ‘Whoa, what do I do now? Where do I go?’ I didn’t do a great job at all with my first plan; I was under 20 per cent. But I’m pleased to say that my third plan is well and truly on track now, because I’ve got that experience.
I guess my comment to you is: once people have got their plan, we can’t assume that the job is done. We have to continue to make it simple. We have to continue to have simple, basic supports in place, whether that is support coordinated or peer-to-peer advocacy.
12.51
Submitters made the following suggestions to address plan under-utilisation:
The NDIA to examine data at a regional level to understand if plan utilisation is dependent on thin markets.
Planners to explain to participants at planning meetings how to implement their plans.
The NDIA contact participants at regular intervals to determine whether plans were being implemented.
12.52
Chapter 3 examines the issues of funding for support coordination and reduced funding in subsequent plans, including because of plan underutilisation, separately.
12.53
The NDIA, in its 2018–19 Annual Report, stated that it shares ‘states and territories’ concerns that participants are constrained in their ability to utilise their plans’ and it is currently undertaking detailed analysis on the nature and causes of low plan utilisation. This has included examining the extent to which underutilisation in each jurisdiction and each region is caused by the following issues (among others):
Pricing issues, particularly in remote and very remote areas.
The proportion of participants with first versus subsequent plans, with plan utilisation rising from an average of 47 per cent for a first plan to 75 per cent for a later plan.
The extent of support coordination of a participant’s plan.
The nature of LAC and ECEI providers’ assistance to help participants utilise their plans.
How well participants can understand their plans based on the simplicity of the document.
Issues associated with gaining timely access to assistive technology, from NDIA approval to delivery of the item.
12.54
The Tune Review suggested that there ‘is merit in requiring planners to offer a plan implementation meeting following the approval of a participant’s plan’, with this requirement being included in the Government’s legislated Participant Service Guarantee. This meeting, it suggested, could include information on how to spend funded support, how to provide service providers, how to make agreements with providers and how to use the participant portal.
12.55
The NDIA in answers to questions on notice provided in October 2020 stated that it ‘supports participants to ensure they understand their plans and how to access and use supports to pursue their goals’, along with booklets and information on the NDIS website to help participants understand how to use their funded supports. It stated that after plan implementation, it ‘monitors participants’ plans until plan review’, which may include contacting the participant, providers and, if relevant and if the participant consents, informal, community and mainstream services. Plan monitoring, it asserted, ‘involves regular review of the plan budget, service bookings, payment requests and periodic payments’.
12.56
The NDIA further stated that if supports have been under-utilised, it discusses the reasons for this and how to address them in a new plan.
12.57
The NDIA’s Participant Service Charter, as at 30 June 2020, guarantees that it will offer to hold a plan implementation meeting as soon as reasonably practical after the plan is approved. The NDIA guarantees to hold the plan implementation (if the participant requests it) within 28 days, and to provide a copy of the plan to a participant within 7 days after the plan is approved.
Self-management
12.58
Some evidence that the inquiry received concerned the complexity involved in self-managing plans. For example, Family Advocacy suggested that planners and LACs have ‘a large vacuum of knowledge about self-management’ and highlighted several instances of LACs and planners discouraging participants from self-managing their funding, or giving incorrect information about
self-management. It called for improved training for NDIA staff on self-managing funds.
12.59
Every Australian Counts noted that ‘self-management offers participants the most flexibility’, but many people reported that moving into self-management was ‘too big without more support. They would like more tools and help to be available so more people can take advantage of the opportunities
self-management offers’.
12.60
Family Advocacy called for more resources to be offered to participants on how to self-manage their plan. Similarly, Disability Council NSW proposed that:
…more training be provided to NDIS participants and carers who wish to self-manage their plans. Self-management is an attractive option to many given the flexibility and control it can give them in managing their NDIS plans; however, many find that unfamiliarity with its processes and complexities are a barrier to taking up the option of self-management. Training could diminish this obstacle.
12.61
The Tune review recommended that the NDIS Act be ‘amended so a participant who requests to “plan manage” their NDIS funding be subject to the same considerations that apply when a participant seeks to
“self-manage”‘. The Australian Government supported this recommendation, stating:
The Government supports amending the NDIS Act to extend risk assessment processes as it applies to all forms of self-managed funding, including those where an intermediary is involved. This will ensure the capacity building supports desired or required to enable a participant to successfully self-manage their NDIS funding are identified, and to minimise any real or potential risks to the participant.
Pre-planning
12.62
The committee heard that pre-planning is usually carried out by LACs in the lead-up to a planning meeting with a planner.
12.63
Multiple submitters informed the committee of the benefits of pre-planning for participants. The Victorian Office of the Public Advocate (Vic OPA) suggested that a single planning meeting ‘does not provide participants with the opportunity to understand and collect, for example, all the necessary assessments and documentation’ needed to support their claims. It argued that pre-planning ‘should form an integrated and distinctive step in the planning process’, noting that ‘simple things, such as grasping the terminology of the scheme, can make a noticeable difference in the quality of the plan’.
12.64
As noted in Chapter 8, AMPARO Advocacy suggested that pre-planning may be especially helpful for participants from culturally and linguistically diverse backgrounds, as many people from this group may attend planning meetings with little understanding of what they are able to access.
12.65
The Vic OPA noted the pre-planning checklist available on the NDIA’s website but argued that it is ‘light touch’ and ‘does little to proactively prepare participants or to recognise the iterative nature of the planning process’. It further contended that the ‘information is not necessarily presented in a format that is accessible to participants with cognitive impairment’.
12.66
The Aboriginal Health Council of South Australia (AHCSA) argued that ‘there is minimal pre-planning support available to participants’ at present. Although some of its services had been able to obtain Information, Linkages and Capacity Building funding to fill this gap, it submitted, ‘there is great concern about the sustainability of pre-planning support into the future’.
12.67
Ms Val Johnstone suggested that the NDIA send participants at least three weeks before a planning meeting a ‘Getting to Know You’ questionnaire, containing questions on the participant’s living situation, relationships, health connections, community access, activities, and ways in which they need support.
12.68
The Vic OPA also submitted that the phrase ‘pre-planning’ may have been used in a ‘misleading way’. Participants had been invited to ‘pre-planning meetings’, it argued, ‘only to realise after the fact that the pre-planning meeting was to be the only meeting that would take place’.
12.69
In February 2018, the Joint Standing Committee on the NDIS in the 45th Parliament, in its report into transitional arrangements for the NDIS, noted that at the time, some state governments were funding pre-planning. The committee made the following recommendation:
Recommendation 10
The committee recommends the NDIA ensure that across all jurisdictions people with disability can access pre-planning supports.
12.70
The Australian Government in its response to the committee’s report stated its support for this recommendation and gave the following examples of
pre-planning initiatives it was taking in 2018:
The NDIA is currently piloting the first phase of a new participant pathway, which focuses on a range of improvements to the pre-planning, plan development and plan implementation stages of the pathway...
Two pilots of this first phase were launched in Victoria in January 2018.
Future pilots will focus on the early stages of the pathway, including learning about the NDIS and how to access the scheme, as well as improvements to the annual plan review process.
During the pre-planning stages of the new pathway, participants will meet their Local Area Coordinator (LAC), typically face-to-face, to prepare for planning…
The NDIA has also developed a new pre-planning resource, which is currently being trialled in this pilot phase. This new resource will support participants in their pre-planning preparation.
The evaluation of the initial pilot, as well as recommendations for further rollout, are anticipated to be finalised by June 2018. These evaluations will help inform the national rollout of the new NDIS participant pathway.
12.71
However, the Vic OPA stated that it was ‘not aware of pre-planning occurring with a LAC, as intended in the new pathway that was alluded to in the government’s response’. It repeated its support for the previous committee’s 2018 recommendation in its submission to the inquiry in this parliament.
12.72
The NDIA in responses to questions on notice provided to the committee in October 2020 stated that its website has ‘a range of information to help participants, their families and carers understand the NDIS’, including a factsheet and a checklist to help participants prepare for their first plan. The website, it argued, also contains participant booklets which ‘are a practical tool to help people with disability, participants, their families, carers and the wider community to…prepare for a planning meeting and to implement their plan’. The participant booklets are also available in hard copy.
Excluding participants from planning meetings
12.73
The inquiry received evidence from multiple sources that expressed concern that some planners excluded participants from planning meetings. For example, Carers NSW reported cases where participants had been excluded from planning meetings, ‘either because the planner has told the carer that they do not need to be there, or because appropriate communication aides have not been implemented’. In other instances, carers had been excluded, while supporters and advocates, including practitioners and service providers, had been deterred from participating. Carers NSW argued that ‘carers and participants should be considered experts in their situation and needs’, and failing to include them in planning was likely to lead to increased need for plan reviews.
12.74
The Housing Connection reported that in one instance, a planner asked specifically for a participant not to attend a plan review meeting. The Housing Connection argued that having ‘a person present is critical, for at least part of the time, to understand who the person is and what their support needs are’, particularly for adults with intellectual disability and participants with complex support needs.
12.75
Leadership Plus expressed concerns that some participants with acquired brain injury were missing ‘planning meetings due to their disability, and because of low planner numbers, plans are simply developed without any input from the person’.
12.76
People with Disabilities WA also noted ‘a trend for [the] NDIA to not engage with a participant if there is a legal guardian involved, or where the person is younger, e.g. 16–25 and has a parent supporting them’. It proposed that efforts should always be made to make sure that a participant is present at planning meetings, particularly because a participant’s preferences may differ from their family, and in ‘many cases where the younger person has complex needs, we are seeing better results where the planner has met the younger person face-to-face’.
12.77
Even where participants are present at planning meetings, however, their involvement may be ‘superficial and patronising’, according to the Tasmanian Office of the Public Guardian. It called for planners to be ‘mindful and skilled’ when engaging with participants. The National Rural Health Alliance similarly noted that some participants were ‘often not included in the plan and even when in the room, are not included in the conversation’. It reported that in some instances participants who were not verbal but able to use speech generated devices were often still excluded from the planning process. The National Rural Health Alliance suggested that ‘some planners were not aware or mistaken about the cognitive abilities’ of some participants.
12.78
In other instances, however, some participants may not want to attend their planning meeting. Mrs Corinne Pisanu, the mother of a participant, reported that her son by choice preferred ‘to discuss his goals and the elements and direction of his plan in meetings with myself and his coordinator of supports prior to the planning meeting’ and not participate in the meeting.
12.79
The Queensland Office of the Public Guardian suggested that in some regions, recent improvements had led to planning meetings not proceeding unless the participant was present.
12.80
On some occasions, the committee heard, planners did not involve other people who participants brought with them to planning meetings. Kelmax Disability Services noted that some LACs and planners were refusing to allow a support coordinator to communicate on behalf of a participant.
12.81
People with Disabilities WA provided an example of a planning meeting where the planner had directed all questions to the participant and excluded his family’s input. Uniting Vic. Tas also suggested that LACs may ignore support workers or treat them ‘as if the information they provide is not relevant’.
The NDIA’s position
12.82
The NDIA in its Participant Service Improvement Plan 2020–21 stated that it wants ‘to support and promote children and young people’s voice in their own plans; while also working closely with parents carers’.
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In its response to questions on notice provided in October 2020, the NDIA stated that ‘it is critical a participant attends a planning meeting, either in person or over the phone to ensure relevant information can be collected to support quality plan development’. The NDIA asserted that it ‘does not have a policy to exclude participants, their carers, supporters or advocates from attending planning meetings’ and acknowledged ‘the important role families and carers play in the lives of people with disabilities, including their involvement in planning meetings’.
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Mr Martin Hoffman, the CEO of the NDIA, told the committee that the NDIA has no policy to exclude people from planning meetings but to ‘the greatest extent possible, we should be hearing from the participants themselves—their wishes, their needs—rather than others speaking for them’.
The role of LACs
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Mr Douglas Herd, an NDIS participant, suggested that the NDIA out-sourcing to LACs ‘a significant proportion of NDIS plan preparatory work (including the development of my first plan) diminishes the possibility that I can genuinely exercise choice and control of my plan’s development’. He argued that it ‘is almost impossible to believe that whatever plan I finally receive’ from a ‘delegate who has never met me could be genuinely “individualised”’ or directed by the participant, as outlined in section 31 of the NDIS Act. He called for LACS to ‘be restored to being local area coordinators, not
quasi-planners’.
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Mr Herd also noted that ‘currently NDIA enforced rules prohibit me from seeing or receiving a copy of whatever is sent from the LAC to the real decision-maker, the NDIA delegate’.
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The Disability Reform Council, in December 2019, agreed that the NDIA will develop a new evidence-based Information, Linkages and Capacity Building Strategy, to also include the role of local area coordination, with an evaluation by the end of 2020.
Surveys on participant satisfaction
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One submitter drew the committee’s attention to surveys carried out by the NDIA that determined very high levels of participant and family satisfaction with the NDIS:
YES the planner was lovely; YES we felt we had input, YES we felt they understood, YES we felt listened to.
So in the stats we are amongst those 90% YES’s erroneously reported as satisfied with NDIS. But no…The research methods do not pass scrutiny. Has the NDIS helped, yes or no? Of course you must say yes, however minimal the support. Questions are asked to elicit the response that favours NDIA.
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The Tune Review also discussed how the NDIA surveys participant satisfaction, noting that ‘participants disagree with the way the NDIA is measuring satisfaction’ and that participants may feel that the survey ‘is not an accurate reflection of their experience’. The Review proposed that the NDIS Independent Advisory Council develop a new independent participant satisfaction survey, and the results of this survey be included in the NDIA’s Quarterly Reports to the Disability Reform Council.
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The Australian Government in its response to the Tune Review’s recommendations stated that it supported ‘considering opportunities to strengthen existing survey metrics’ and that the ‘NDIA has also been working with the Independent Advisory Council to strengthen the focus on outcomes when obtaining data and is reporting on participant satisfaction quarterly’.
COVID-19 and arrangements for planning
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Evidence gathered for this inquiry mostly concerned planning before the COVID-19 pandemic impacted the NDIS landscape. As such, the committee only received a small amount of evidence concerning issues arising during COVID-19 in relation to planning. The committee’s report into general issues around the implementation and performance of the NDIS will examine COVID-19 arrangements in further detail. Relevant measures the NDIA has put in place include the following:
Offering alternatives to face-to-face planning meetings for participants.
Extending NDIS plans for up to 24 months for participants in Victoria.
Allowing flexibility for participants to use funds to purchase low cost assistive technology that will help participants continue with supports via telehealth and telepractice, such as smart devices and fitness equipment.
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The NDIA also informed the committee that during the COVID-19 pandemic, the NDIA has ‘delivered a more flexible approach to plan reviews, simplified where possible, to ensure participants could continue to access their funding to get the supports they needed’. A further initiative includes participant check-ins, in which a planner or LAC asks participants whether they would like a new NDIS plan with the same supports, a new plan with minor changes to current supports, or a full plan review. The CEO of the NDIA, Mr Martin Hoffman, stated at the hearing on 12 October 2020 that according to feedback, ‘some short-term initiatives put in place during the pandemic may provide ongoing benefit, such as participant check-ins, plan extensions and rollovers, and light-touch reviews’.
Other issues raised
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Further issues raised to the inquiry included the following:
The suggestion that the same planner should be provided to families with multiple NDIS participants.
NDIS systems not adequately taking into account a person with multiple disabilities and the complexity when additional disabilities exist.
Some participants with autism listing intellectual disability as their primary disability because they expect to get a fairer NDIS plan as a result.
Capacity building being removed from plans after the first year.
Plans not commonly including supports to enable workforce participation, including in subsequent plans where a participant has not yet found a job.
Planners over-relying on Typical Support Packages, rather than creating individualised participant plans.
Participants having their eligibility be reviewed as part of their annual plan reviews.
Irrelevance of questions asked in planning meetings to determine how a participant’s quality of life can be improved, when the participant has a degenerative disease.
The accuracy of disability assessments involving multiple-choice questionnaires.
The need for better escalation pathways for finance and reimbursement of items.
Providers not being told when a new plan takes effect.
Contracted planners (through the NDIA’s Partners in the Community programs) having conflicts of interest because of their involvement in direct care
Committee view
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The committee recognises that participants, their advocates, disability advocacy organisations and providers may experience inquiry fatigue, with Every Australian Counts summing up the position of many:
We are all trapped in some NDIS version of Groundhog Day where we keep identifying the same problems and potential solutions... And while we want to acknowledge the NDIA’s commitment to listening and responding, and the changes they have made through their pathway program, we feel compelled to say that progress on the ground is agonisingly slow.
…The issues are well known. The solutions are well known. What’s missing is some action.
If we sound fed up it’s because we are. If we could make a single plea to the committee it would be to state that the time for talk has well and truly passed – in fact it passed long ago. It is now time for some action.
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In particular, the committee wishes to express its thanks to participants and organisations that made submissions and appeared at public hearings in spite of the inquiry fatigue that some may be experiencing.
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The committee considers that the recent reforms, outlined in the recently published NDIS Participant Service Charter and Participant Service Improvement Plan 2020–21, to a considerable extent address many of the
long-standing issues that participants, their support networks and providers have outlined to multiple inquiries, including those initiated by this committee. In particular, the committee anticipates that the participant service guarantees to improve timeliness, along with recent changes to plan lengths, the decisions to allow participants the option of automatic plan roll-over and plan implementation meetings, will lead to positive changes overall in the planning experience.
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Nonetheless, the committee does wish to address the matter of the length of plan meetings. Participants and their supporters should never feel rushed or under pressure in planning meetings to tell a planner everything they feel the planner needs to know, particularly if, for example, they experience communication difficulties, anxiety or require an interpreter. Providing participants and their support networks with enough time in joint planning meetings to articulate their needs will be more important than ever with longer plans and automatic plan roll-over. The committee recommends that the NDIA allocate more time for joint planning meetings than is currently the case, once the national roll-out of joint planning meetings recommences following the NDIA’s response to COVID-19.
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The committee recommends that the National Disability Insurance Agency ensure that it provides participants and the people they bring with them to joint planning meetings with sufficient time to articulate their needs in those meetings.
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The committee acknowledges that the NDIA publishes information for participants, their families and carers on the NDIS website, including a factsheet and checklist, to help them prepare for their plan meetings. However, the committee is of the opinion that more is needed. The NDIS website should include a clear diagram of the planning process and a more detailed checklist of what participants can provide as evidence for the supports they are requesting, such as medical reports and quotes, where appropriate. Planners should refer to this checklist in planning meetings.
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The committee recommends that the National Disability Insurance Agency develop and publish a clear diagram on the NDIS website of the planning process.
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The committee recommends that the National Disability Insurance Agency develop a more detailed checklist of documents participants can provide before their planning meeting as evidence for the supports they request. This checklist should be published on the NDIS website and be referred to by planners in planning meetings.
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Further, on the issue of pre-planning, the committee considers that the NDIA could re-purpose its recent participant check-in approach to contact participants (or their nominees) at least three weeks before their first planning meeting. This would ensure that participants understand what the meeting will involve and what they need to do to prepare.
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The committee recommends that the National Disability Insurance Agency contact new participants and their nominees at least three weeks before their first planning meeting to ensure that they understand what the meeting will involve and how they need to prepare for it.
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The committee was concerned by allegations made to this inquiry that planners were deliberately excluding participants from planning meetings, or not involving participants during the planning meetings. The committee is of the opinion that the NDIA should develop guidance for planners and delegates about ways to ensure participant involvement in planning meetings, including guidance around the involvement of advocates, parents, carers and family members.
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The committee recommends that the National Disability Insurance Agency develop and implement detailed guidance for planners and delegates about how to engage with participants appropriately during planning meetings and the involvement of third parties including advocates, parents, carers and family members.
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The committee notes the recommendation of the Tune Review that the NDIS Independent Advisory Council develop a new participant satisfaction survey, with the results of this survey to be included in the NDIA’s Quarterly Reports to the COAG Disability Reform Council.
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The committee also shares the concern of the Tune Review that the current metrics system is not a reliable system of measuring participant satisfaction and may, in fact, be geared towards generating outcomes that put the NDIA and the NDIS in a favourable light—particularly given the considerable number of concerns raised by a broad range of witnesses and submitters to this inquiry, who represent the disability sector and participants as a whole. As such, the committee recommends that the NDIA consult with participants and advocacy organisations about how to develop a new, more accurate way of measuring participant satisfaction. To remain with the current system would be contrary to the NDIA’s stated commitment to transparency in its Participant Service Charter and Participant Service Improvement Plan, and would suggest that the NDIA is in fact not interested in publishing participant feedback that may present it negatively in the public domain.
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The committee recommends that the National Disability Insurance Agency co-design new metrics for measuring participant satisfaction with people with disability and advocacy organisations.
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Finally, the committee recognises that the COVID-19 landscape has changed the way planning is carried out, in some ways for the better. Throughout 2020, the committee has maintained a close eye on how COVID-19 has impacted participants and how the NDIA is responding to the challenges of the pandemic, including through the planning process. The committee will continue to observe this space as the pandemic continues.
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As a closing note, the committee reaffirms its commitment to holding the NDIA to account so that the current and promised reforms in the planning space will lead to the benefits that participants and their support networks need and have requested for so long. These reforms, along with the recommendations outlined in this report, will lead to real and lasting positive change in the NDIS, and ensure that it remains a world-class insurance-based scheme for people with disability.
Hon Kevin Andrews MPSenator Carol Brown
ChairDeputy Chair