Restoring simplicity and choice to the NDIS participant pathway
“Currently nine governments fund, organise and, to a varying extent, directly supply supports to people with disability and their carers. The Commission is proposing a simpler approach…”
These are the words of the Productivity Commission in its 2011 report on disability care and support in Australia. Recognising the complexity of the previous arrangements, as well as the dominance of top-down block funded services, the Productivity Commission set simplicity and individual choice as core foundational principles in how it, and indeed, the disability community, imagined a new national disability scheme could take shape.
Yet, as the new approach was designed and implemented, complexity increasingly took hold. Opportunities for authentic individual choices shrunk in the face of cumbersome processes, ill-defined roles, unclear boundaries, and a regrettable regression to block funding models in some support areas. With the 10-year Review of the National Disability Insurance Scheme (NDIS) underway, now is an opportune time to revisit the original vision and principles of the Scheme and develop new approaches in some critical areas.
We acknowledge that the National Disability Insurance Agency (NDIA) has a difficult task in delivering a fair and equitable method of investing in changing the life chances of Australians living with disability. Without doubt, achieving authentic inclusion is a challenging quest. In any reform of the size and magnitude of establishing the NDIS, it can be difficult to avoid complexity creeping into systems and processes. However, the first rule of thumb is to establish simplicity as the key anchor point. System elements and process steps tend to snowball in complexity through the development stages, but if they have a sound provenance back to simple, compelling principles, then the system is more likely to establish and retain coherence.
The current NDIS participant pathway is too complex and there is a lack of calibration between the decisions made by different NDIA staff. The pathway often involves a lot of inefficient back-and-forth wrangling between the NDIA, Local Area Coordinators (LACs), participants, and their supporters. The clear articulation of authentic choices is often lost to overwhelming complexity, rushed meetings, and delayed decisions. All of these factors routinely produce inconsistent or unsuitable outcomes and can lead to costly reviews and appeals.
Many NDIS participants highlight the importance of ‘speaking NDIS’ to the resulting budget allocations within their plans, as if there is a special language or dialect required to navigate the Scheme. Similarly, participants tell us that obtaining medical and therapy reports that are written in a particular way and having access to advocacy supports, or even a local member of parliament, can make a significant difference to access decisions and budget settings. When these factors influence outcomes, consistency and equity are lost.
Each of these common experiences of the current complicated participant pathway does not fulfil the original vision of the NDIS. This is the first topic we would like to focus the collective minds of the disability community on as part of our NDIS Review Conversation Series. Below, we kick off the conversation by presenting an alternative approach to Scheme access and planning and invite debate.
A simple participant pathway
A simple pathway based on a conceptual framework of ‘Indicate – Calibrate – Evaluate’ would improve the participant experience, produce greater consistency in decision-making, and lower the administrative burden. Via a simple, non-clinical, upfront assessment process that maps the consequences of disability, a participant would receive an indicative budget considered reasonable and necessary to change those consequences. Then, the participant (or parent/guardian of a child) builds a draft plan that focuses on what is important for them. The participant chooses who supports them in developing their draft plan or they may opt to do this themselves.
Once a plan is drafted, an NDIA delegate works with the participant to calibrate it so that the components are relevant and reasonable and fit within the Scheme’s parameters. The plan is then signed off. At the end of the plan’s term, the NDIA delegate and participant evaluate how it went, to look at what worked, how well, and what this means for the participant’s next budget. This data also helps the NDIS evolve, by identifying what types of investment produce the best outcomes, for example, in terms of mainstream employment, inclusive housing, and authentic membership in community and economy.
Participant choice and plan authorship
Each NDIS participant should be the ‘author’ of their plan. It should reflect their authentic choices based on their individual goals. However, the current complex participant pathway generates NDIS plans that are largely ‘owned’ by the NDIA. Complexity in the NDIA’s processes inevitably increases its control while restricting the participant’s choices.
In contrast, the proposed simple participant pathway, outlined above, facilitates the individual authorship of plans, allowing a person to draft their own plan based on an indicative budget. They can also decide if they would like assistance in developing their goals and articulating their support needs from others, such as a family member, friend, or LAC.
Another way that the current approach is eroding participant choice and individual plan authorship is through a shift back to the group consumption model; that is, the antithesis of the original vision for the NDIS. Block-funded, shared group services are continuing to be included in plans, particularly for participants with higher support needs, on what appears to be an unspoken basis of reducing costs in line with a misinformed Scheme sustainability narrative. A plan that includes block-funded supports may be the result of insufficient ‘individualisation’ within the pathway (for example, when residents of a group home are, in effect, assessed in the context of living with other people), and/or because limited choices have been made available to the participant, and/or because the participant has not been supported to change their expectations about what might be possible in their lives. In these ways, the plan does not pass muster as an ‘individual plan’, as it does not adequately reflect authentic, informed, individual choices in pursuit of personalised goals.
Clear roles with defined boundaries
Each role attached to a simple participant pathway should be clear and the boundaries between them well-defined. But currently these roles and boundaries are unclear, with LACs bogged down in the planning process and completing tasks that would be more appropriate for the NDIA delegate.
Consequently, who the LAC role is intended to serve is confused and conflicted. Does the LAC represent and work on behalf of the Scheme, or does the LAC represent and act in the best interests of the participant? This conflict is untenable for a well-functioning participant pathway and should be urgently addressed as part of the NDIS Review.
As stated above, the participant should be the ‘author’ of their plan. The NDIA delegate should be the agent of the Scheme upholding its values and parameters. And the LAC should be an agent of the participant, if a participant elects to access the support of one. The role of the LAC should be to stand alongside the person, supporting them to access information, make decisions, and connect to their community. To avoid conflicts and confusion, there should not be any overlap or duplication between the roles of the NDIA delegate and the LAC.
We believe that reform of the participant pathway is the first step toward unlocking the currently complexity across the whole Scheme. By restoring simplicity, upholding the principle of choice, and clearly defining roles and boundaries, a reformed participant pathway can underpin the efficient sustainable functioning and broader success of the NDIS in achieving its original promise of advancing the life chances of participants.