Your Guide to the NDIS Independent Review – Final Report

Last week, the Independent Panel released its long-awaited final report of its review of the NDIS (find the full report here). The review was at the request of Hon Bill Shorten, the Minister for the National Disability insurance Scheme back in October 2022. 

There were three overarching objectives of this review:

1. To put people with disability back at the centre of the NDIS

2. Restore trust, confidence, and pride in the NDIS

3. Ensure the sustainability of the scheme for future generations

The Independent Review panel received almost 4,500 submissions – including from people with disability, NDIS participants, their families, and carers, as well as the providers and workers who support them.

There were 5 key challenges that the review panel highlighted in its interim report released in June.

1. Why is the NDIS the only option out there for people with disability?

2. What does reasonable and necessary mean?

3. Why are more children on the scheme than expected?

4. Why aren’t NDIS markets working?

5. How do we ensure that the NDIS is sustainable?

The report makes 26 recommendations with 139 actions. The recommendations are a guide to renewing the NDIS and getting it back on track to deliver a more inclusive Australia. The focus is humanising the NDIS for a better participant experience as well as making sure the Scheme is there for the future. When the NDIS works it truly changes lives. Now, unfortunately it isn’t working for everyone.

It is important to note participants, supporters and the disability community will not see any immediate changes. There is no need to worry about your current supports and NDIS services, a lot has to happen before any recommendations are put in place.

The NDIA are working on the 2023 Federal Budget reforms with disability representatives, independent advisers and NDIS participants.

The NDIA will expand this work overtime to include NDIS Review outcomes once governments have considered the recommendations (The Australian Government will release its response to the 329-page report in 2024).

The NDIA will be guided by good plans and important people. They will take time to:

• consider all recommendations

• co-design any reforms with people with disability and the disability community

• make changes in a measured and considered way.

The final report is 329 pages long and contains a lot of information. The recommendations cover almost every aspect of the current scheme. To make things simpler we are going to break things down into 9 major areas that have been flagged for improvement, change and action.

Early Childhood approach

1 in 5 children in Australia has a disability or developmental concerns, making this a mainstream issue. The only option for families at the moment is the NDIS. The number of children on the scheme was not expected when the scheme was being created.

It is recommend creating a connected system of support including accessible and inclusive mainstream services, more foundational supports and individual funding available through the NDIS.

• New early intervention pathways for children with higher levels of need.

• More support for families.

• Regular check ins to make sure supports are working.

• Ensure children whose needs are better met with mainstream services and foundational supports are assisted to move gradually towards these and out of the NDIS.

Foundational Supports

Mainstream supports must be made more accessible and inclusive, and accessible in one’s community. At the moment the lack of mainstream supports is putting pressure on the NDIS and letting down those that aren’t eligible for the scheme.

“Foundational” supports should be available to people on the NDIS, and people under the age of 65 who are not eligible for the NDIS. Money will be put in by the commonwealth as well as the states to fund these foundational supports.

General foundational supports would include programs and activities like information and advice, individual and family capacity building, peer support, self-advocacy, and disability employment supports.

Targeted foundational supports are supports available for people aged under 65 with disability who are not eligible for the NDIS. These should include:

• home and community support for people with less intensive support needs

• target supports for adults with a psychosocial disability to build capacity, independence and daily living skills.

• supports for families and children with emerging developmental concerns.

• transition supports for young people preparing for employment, and independent living.

• foundational supports designed to meet individual needs particularly First Nations people, Culturally and Linguistically Diverse people, LGBTQI + SB, and people who live in rural or remote areas.

Navigation

A common theme was the difficulty people and families had when trying to navigate the NDIS. Currently there are multiple roles that are meant to be supporting participants, mainly Local Area Coordinators, Early Childhood Partners, Support Coordinators and Psychosocial Recovery Coaches.

The report recommended introducing navigators, a role that would take over old roles to help people navigate both the NDIS as well as foundational supports.

Navigators should have good local knowledge and help people on the NDIS, as well as those that are not eligible.

There should be different types of navigators:

• general navigator (provide information, and to support access to mainstream and foundational supports, support NDIS participants to develop an action plan to use their budget, book and coordinate services where needed, and check-in frequently to see how things are going.)

• specialist navigator (provide higher level of support to NDIS participants with more complex support needs and circumstances, where multiple service systems are involved)

• psychosocial recovery navigator (help people with psychosocial disability – both NDIS participants and those not eligible for the scheme, For those eligible for the NDIS, the navigator should help with the application process, help set and achieve goals, identify the right supports and connect with mental health, primary care and housing services)

• housing and living navigator (should work with NDIS participants to identify and trial housing and living options, then help negotiate with chosen providers)

• share support facilitator navigator (a specialist role who would work with participants who share housing and living supports, y they should be independent of the support provider and property manager)

• lead practitioner navigator (for children and their families. They should identify needs, connect to appropriate foundational and mainstream supports and provide information, advice and coaching to support the child’s development. Lead practitioners who work with NDIS participants should also coordinate NDIS funded services to build a supportive team around the child and family.)

Disability Service Providers

The review found that the current NDIS market is not working. Market settings have encouraged a focus on the number of supports provided and have not given enough attention to quality or outcomes, as well as a lot of over-charging, over-servicing, and fraud in some cases. Regulation of providers is inconsistent and is not proportionate to the risk of the activity delivered. A number of solutions were offered to help fix the current market.

• A risk proportionate and graduated approach to the regulation of all providers delivering NDIS and foundational supports:

1. Advanced registration for all high-risk supports (such as behaviour support and daily living supports in formal closed settings).

2. General registration for all medium risk supports (such as high intensity supports that may require additional skills and training like complex bowel care).

3. Basic registration for all lower risk supports (such as supports with limited 1:1 contact such as specialist transport).

4. Enrolment of all providers of lowest risk supports (such supports covered under general consumer law protections like equipment and technology).

• an online platform that provides real time information on providers so participants can search and select providers.

• A benchmarking system for providers to understand how their services stack up against others, to learn what is and what isn’t working.

• Better incentives for continuous improvement.

• A streamlined registration process for all providers.

• Improve access to supports for First Nations participants.

• Improved workforce training, capability and ensure the workforce is of sufficient size for the growing scheme.

A change to pricing structures

Price caps were intended to ensure “value for money” and prevent providers from driving up prices. However, the process is blunt and not transparent. Providers have little incentive to compete on price or quality, with caps acting as a “price anchor” instead of a “price ceiling”. The review has called for the transition of responsibility for advising on NDIS prices from the NDIA to the Independent Health and Aged Care Pricing Authority, to enable transparency, predictability and better alignment of prices across the care and support sector. A new approach to pricing and price caps is recommended.

Access, support needs assessment and budget setting

The review found the current NDIS access and planning process is complicated, unclear, unfair, and focuses on a diagnosis not on support needs. It requires multiple professional reports that are expensive and sometimes not even used to inform decisions. It found it can be a traumatic and degrading experience and doesn’t help participants understand how to spend funds or find support.

Recommendations were made to make this experience simple, clear, and fair.

• Separating the current planning process into stage: access, disability support needs assessment, and setting and using your budget.

• a new Access Request Form developed which explains what information is needed.

• Any extra reports requested by the NDIA are paid by the government.

• Local navigators assist people, helping to get information to make an NDIS access request.

• While applications are being processed, navigators help find mainstream services and foundational supports in the community, so you have support while you wait.

• If accepted onto the NDIS you meet with a skills needs assessor, they do a comprehensive needs assessment.

• Your budget is created by the person doing your needs assessment and is based on the results of the needs assessment.

• Budgets are easy to understand, flexible (with only a few limitations, such as home and living supports).

• Your navigator helps you understand your budget and how you use it. They should help you find mainstream services, foundational supports and disability specific services to meet your needs and achieve the outcomes that are important to you.

Disability Support Workers

The review found multiple issues with disability support works, from both the perspective of participants as well as from the workforce itself. Participants find it hard to find and keep disability support workers with the right skills for their needs. From a workers perspective there is not enough information or guidance about how to deliver high quality supports, and good quality support is not recognised and rewarded. Some recommendations to help the disability support workforce are:

• Improved worker screening.

• minimum online training to ensure workers understand their obligations.

• trialing portable leave across the sector.

• Targeted strategies to increase the workforce.

Housing and living supports

The review found many people still live in large or small group homes where they can’t choose their housemates or their service providers. Planning decisions don’t seem to consider housing and support in a connected way – and decisions are not always clear and consistent.

Housing is currently a big issue for the NDIA, the review suggested the below to help the current situation participants find themselves in:

• Once a budget has been set, a specialist housing and living navigator should help people find options that work for them.

• Participants who need 24/7 living supports would generally be funded at a 1:3 support ratio. This won’t always be the case, some participants will need more support because they have higher individual needs.

• Participants who share their home with other people will have access to a new shared support facilitator, whose job will be to help everyone to have a say in how the house and support is organised.

• SDA categories and design standards should be reviewed to ensure they meet needs, remove the “Improved Liveability” category and create a new “Shared Living Support” category.

• SDA and living supports should be from separate providers.

• State and territory governments should agree to upgrade or repurpose ageing SDA accommodation.

Please know, no one will be forced to move from their current living arrangement. The panel also strongly recommended that people with disability, their families and representative organisations should be closely involved in designing and testing changes to make sure they work well.

Transition period

The panel have stated the recommendations should be considered and implemented as a package over a five-year transition period. During this period, implementation should be sequenced strategically to address critical dependencies, manage risks, and mitigate or minimise disruptions for participants, providers and workers.

Implementation of some recommendations should be prioritised in the short-term to make immediate improvements to the participant experience, such as foundational supports, updating guidance for making access requests and strengthening the workforce.

The review states implementation should ensure all groups with a stake in the NDIS have a genuine voice in the process. This should be reflected in design with people with disability, their families, carers, Disability Representative Organisations, workers, and disability service providers.