NDIS COMMISSION OWN MOTION INQUIRY

Pleasingly the NDIS Commission has recognised the issue around conflict of interest, something that DIA has been championing for some time. On Page 11 of Part one the NDIS Commission looks at this issue in the context of SRS (Supported Residential Services) in Victoria.

“Participants’ experiences in SRS and the NDIS Commission’s actions in responding to complaints and incidents brought into sharp focus:

– the risks of having support coordination and plan management supports provided by the same entity that provides other NDIS and non-NDIS supports to the participant, or a person or entity closely associated with them; and

 

-the benefits of having support coordination and plan management provided independently of a participant’s other NDIS and non-NDIS supports so that the support coordinator and manager can support participants to identify any shortcomings in their other supports, to raise concerns and to consider whether their other providers are delivering the supports they need to achieve their goals.”

This is something that DIA sees on a regular basis and has continued to call on government to take a stronger and nuanced stance, like DIA has in our Professional Standards of Practice, on conflict of interest and independence of service.

– The NDIS Commission has focused primarily on the ‘Top 10’ Largest Providers, 9 of whom are DIA Members.

– The NDIS Commission received 384 complaints around Plan Management from 1 July 2018 to 9 May 2023 of almost 5 years.

– The 10 largest Plan Managers serviced over 157,200 NDIS Participants over the same period.

– The 384 complaints over almost 5 years represents less than 0.24% of NDIS Participants serviced by the Top 10 Plan Managers.

– DIA is pleased to see the NDIS Commission recognise the positive roles that Plan Managers have in supporting NDIS Quality and Safeguarding.

– Many of the complaints appear to be about issues where this is significant policy gaps around the roll of a Plan Manager, particularly around weather a support can be claimed for under the NDIS.

It is not lost on DIA that in one instance a NDIS Participant complained that a Plan Manager would not pay for a support without the approval of the NDIA (likely as it was not in line with their plan). However then opposite is also complained about with Local Area Coordinators raised concerns that plan managers were paying for items that were clearly not within the relevant participant’s plan and were not reasonable and necessary supports.

So which is it – does the NDIS Participant have the choice and control to direct a Plan Manager to claim for everything and anything they request or is a Plan Manager a gate keeper that has to determine if a support is in line with a NDIS Participants Plan and reasonable and necessary.  Talk about a rock and a hard place.

-There are many other examples of policy gaps that are causing our sector significant issues. Themes including:

• • conflicts of interest
  • denying participants’ choice and control
  • coercion and sharp practices
  • crossing professional boundaries.

– The NDIS Commission has reviewed a total of 460 Complaints from 1 Jan 2022.

– Over the same period of time Support Coordinators delivered services to 282,640 NDIS Participants.

– The 460 complaints over the year represents less than 0.16% of NDIS Participants serviced by Support Coordinators.

– DIA was pleased to see the NDIS Commission recognise the positive roles that Support Coordination has in supporting NDIS Quality and Safeguarding.

– DIA is disappointed that the Volume of NDIS Participant Funding for Support Coordination was not explored. The Own Motion Inquiry assumes that all key roles are delivered by a Support Coordinator, this not the case, the NDIA determines the volume of funding a Participant will receive for Support Coordination and this intern limits / dictates what support a Participant will engage a Support Coordinator for.

– The NDIS Commission has broken down the complains into two key areas a) Integrity Concerns and b) Care and Skill Concerns. As will Plan Management above DIA notes that much of the areas raised speak to existing policy gaps with in the NDIS. Themes include:

• • inadequate supports being provided
  • poor communication
  • errors in relation to NDIS requirements
  • overcharging
  • inadequate or inappropriate responses to concerns being raised
  • depletion of the participant’s NDIS funds
  • cessation of support coordination supports
  • other matters including breaches of privacy, verbal abuse and exclusion of informal or other supports.

Anyone who is involved with any type of complaints mechanism will tell you that there are always more unreported complaints as those reported, however the numbers being report are extremely low considering the scale of NDIS participants utilising Plan Management (376,855 NDIS Participants) and Support Coordination (282,641 NDIS Participant).

To put these percentages into some level of perspective, adjacent sectors experience (Health and Finance etc) significantly higher levels of complaints at between 2.0 to 5.0%.

There is always room for further work to be undertaken to lift the quality of service within Plan Management and Support Coordination. DIA is at the forefront of this work and will continue to drive the sector to deliver a high-quality professional service to NDIS Participants.

DIA notes that 10 years on from the launch of the scheme there is still currently no or very limited day to day operational Policy Framework for Plan Management and Support Coordination under the NDIS, outside of DIA’s Professional Standards of Practice. After 10 years the NDIA has only published a simple ‘Guide to Plan Management’ and a paper on ‘Improving Support Coordination’ which has had little impact on the way the sector operates given that it basically defined what the sector was already doing.

So to only have the scale of complaints that currently exists is a credit to the amazing work the most Plan Management and Support Coordination Providers and Practitioners delivery on a daily basis.

DIA was disappointed that information about the NDIS Commissions responses to the complaints, even at an aggregated level, was not supplied or analysed. The NDIS Commission has a range of responses to complaints ranging from No Action all the way up to strict Compliance and Enforcement measures (such as fines, revocation of registration and banning orders.

Part 1 of this own motion inquiry sates in both the Plan Management and Support Coordination sections that “participants and other interested parties are raising a range of serious integrity and quality concerns”. Given this, what are the outcomes or responses the NDIS Commission has taken to address these serious integrity and quality concerns?

The response to complaints provides a clear view of the scale and impact of complaints – i.e. extremely serious complaints should be met with the strongest response, in contrast complaints with no / little merit should be closed with no action.

DIA is disappointed to see complaint examples within the report without any comment or viewpoint of the provider or comments as to the action/response taken by the NDIS Commission. Without the inclusion of this information the reader can wrongly assume that each of these complaints resulted in compliance responses, which may simply not be the case.

DIA is disappointed that the price freeze for both Plan Management and Support Coordination for now 4 years, was not explored as part of this Own Motion Inquiry. Current NDIA price limits do not include any funding specifically in recognition of the quality and safeguarding expectations being put onto Plan Managers and Support Coordination. Such funding has been clearly called out for other disability supports that fall under the NDIA’s Disability Support Worker Cost Model.

DIA has been warning the NDIS since 2020 that the quality of intermediary supports across the sector would be negatively impacted given the price freeze (which is a price cut in real terms). So it is no surprise that the NDIS Commission has experienced an increase in complaints about Plan Management and Support Coordination since 2020.

1. The data around complaints is welcomed and will underpin further work to drive sector quality by DIA. There are both positives and areas the sector needs to work on.
2. DIA is disappointed that:
   • This work has been done in secret, without consultation or opportunity to provider input (as seen with the other Own Motion Inquiry).
   • The lack of analysis on the response measures for the complaints and notifiable incidents, particularly given some of the complaints date back to 2018.
   • Allegations against Plan Managers and Support Coordination Providers were summarised without context and in most cases with no outcome or response. So what happened to these complaints?
3. DIA was pleased to see that Plan Management and Support Coordination conflict of interest continues to be highlighted as a significant policy gap. DIA’s own Professional Standards of Practice are leading the way and well ahead of the requirements of the NDIA or NDIS Commission.
4. DIA was pleased to see a recognition that Plan Managers and Support Coordinators are marking report to the NDIS Commission about issues they are seeing. However, DIA notes that our Plan Management and Support Coordination members often receive very little feedback or response to these complaints which actively discourages them from continuing these.
5. DIA is disappointed that the price freeze for both Plan Management and Support Coordination for now 4 years, was not explored as part of this Own Motion Inquiry. Current NDIA price limits do not include any funding specifically in recognition of the quality and safeguarding expectations being put onto Plan Managers and Support Coordination. Such funding has been clearly called out for other disability supports that fall under the NDIA’s Disability Support Worker Cost Model.
6. DIA will engage heavily in Part 2 of this Inquiry, which will commence following the outcomes of the NDIS Review and Royal Commission.
7. DIA will invite the NDIS Commissioner to our upcoming Market Update member webinar series to present on this Inquiry.