NDIS Review Conversation Series: Paper No. 16
- For the NDIS to systematically build capacity to deliver the hoped-for impact, it needs an approach to design that imcorporates not only co-design but process design
- Coordinated change management will be needed to orchestrate complex system change
- The NDIA will need to draw a line in the sand on congregate and segregated service models, if it is to authentically advance the goal of social and economic participation
- Fairer and more equitable systems will mean difficult decisions for some Scheme participants whose individual budget might be lower as a result, but this contrast effect can be offset by giving participants greater flexibility in how they can use their budgets
In the preparation work for each paper we produced, the issue of transition emerged with increasing regularity. Four key imperatives emerged. First, the drama is always in the detail of any design, and therefore the design work needed to be sufficiently methodical, detailed, and connected.
Second, for a system as complex as the NDIS, there will likely be a range of projects running concurrently and these must be carefully and mutually coordinated to ensure an integrated implementation.
Third, if the Scheme is to authentically move away from congregate and segregated models of support, it will need be clear about this so can begin redirecting funds into more inclusive support arrangements.
Fourth, in transitioning to a more successful and sustainable Scheme, it is likely there will be refinements about who is eligible for the Scheme and how their individual budget is resolved, and this might mean delivering some difficult messages to Scheme stakeholders.
The remainder of this chapter contemplates each of the above transition imperatives.
Designing for strong Scheme outcomes: the importance of Process Design
For the past two years the NDIA has undertaken a sincere approach to codesign, seeking ways to involve people from the disability community in its policy and practice considerations. This effort has helped strengthen the relationship between the NDIA and the disability community and other stakeholders.
One of the benefits of codesign, when undertaken with sincerity and intention, is it brings key beneficiary voices to the table, and this can help ensure the subsequent design has the best chance of delivering good outcomes to the beneficiary group. Involvement of those voices in the decisions about design is key to this.
However, for more complex issues it is not unusual for codesign to struggle to deliver a workable design, or for codesign participants to become frustrated at the slow pace. When this happens, as has been the case on occasion with codesign work at the NDIA and elsewhere, it is not because of a lack of sincerity or effort. Rather, it’s because the codesign process is missing a key methodology: process design. Process design is a methodology that, in general terms, systematically moves from identifying and quantifying the presenting problem and its underlying causes, to the development of solution design elements, the quantification of expected benefits, the build process, the testing of the build elements, refinement, and then scaling up via a rollout plan. When this type of methodology is missing, the design work can struggle to move from expressing the presenting issue at a high-level to a corresponding high level aspirational view of how things could be. When this happens, participants (including the sponsoring agency) can struggle with the limited progress.
The use of a process design methodology, and careful facilitation of it by an accountable party, will be key to the NDIA’s work in leading transition to a more effective set of Scheme arrangements. There are plenty of different flavours of process design methodology, and plenty of agencies offering them. Therefore, it is key that the NDIA, or whichever government agency commissions the work, opts for a process design methodology that is accessible, avoids gimmicks, isn’t expensive, and where the process design supplier/facilitator is held properly accountable for the quality of the deliverables.
Navigating complex system change: the importance of change program management
In commencing service deinstitutionalisation in 2004, SA agency Julia Farr Services ran over 70 concurrent projects to deliver integrated change. It was a similar story with mental health reform in New Zealand in the 1990s. Complex system change means there will be a significant number of component projects running concurrently.
There is no doubt the NDIA and other government agencies already know this. However, we make this point here because the NDIA’s efforts to improve the Scheme over the past decade have not appeared integrated. It has not always been clear how different active projects are related to each other, and sometimes a project appears to be running in isolation, even though its own success might be critically dependent on the prior resolution of other matters outside the project scope.
Therefore, assuming it is the NDIA leading the post-Review transition to a stronger Scheme, we recommend a Change Program office be established, to identify the range of required projects, to map the milestones and timelines for their work and, critically, to map and manage the interdependencies. The Change Program office will also need to run a proactive, transparent, and highly inclusive communications program with stakeholders.
Inclusion vs congregation: drawing a line in the sand
Segregated and congregated services do not support people into inclusive lives in the way well-orchestrated inclusive services do. Proper inclusive education is better than segregated special education at positioning students for an inclusive adult life. Mainstream employers with an appreciation of workforce diversity offer more inclusive and fairer-waged employment than Australian Disability Enterprises. Housing that reflects what most Australians have, is better than group houses at positioning the occupants for ordinary community relationships.
If there is to be a successful transition to a Scheme committed to inclusion, to social and economic participation, the NDIA will need the courage, and the support, to draw a line in the sand, to set a date after which no participant will receive funding to enter congregated or segregated arrangements. This does not mean existing participants in congregated and segregated services need to be forcibly removed, because they and their families may have come to rely on those arrangements, however suboptimal such arrangements are at lifting people into good lives. Such services can be classified as heritage services, but not be permitted to receive new NDIS-funded clients into those services.
Such a line in the sand provides clarity of purpose and signals an authentic commitment to delivering true inclusion in Australia.
Managing the contrast effect: dealing with the impact of a better-calibrated Scheme
In psychological terms, the idea of the contrast effect is when our perception of a thing becomes heightened when set in contrast with something that is different. For example, a dark square might seem darker when set within a lighter square. For further example, a sale price for a household item might seem more attractive when set alongside the previous higher price for that item.
In the NDIS, the adoption of new assessment and budget-setting arrangements will bring much needed clarity to the business of being fair and equitable across a participation population of over 600,000 people. Such a move will also bring about the contrast effect. For some participants it might be a pleasant contrast effect, where their individual budget is increased compared to what it was before.
However, there will be other participants for whom the contrast effect will be less palatable because, by establishing stronger fairness and equity across the 600,000 participants, their individual budgets are reduced, or not topped up should they consume all the resources before the end of the budget period.
Because of this contrast effect, those participants may react more adversely to their revised budget than if those were the budget circumstances in the first place. Even though to a neutral bystander the updated budget arrangements might seem fair to the person’s circumstances, the contrast effect will be there for the participant.
This adverse contrast effect may also emerge from the shadows for a participant whose NDIS budget is reduced because they have made good progress from the use of their previous budget, and as a result their circumstances have changed for the better, which may mean in some cases the participant is allocated a smaller budget.
As a result of the contrast effect, it is entirely possible some affected participants or their allies may stimulate activity in the appeals process and in the public domain. This will likely feel very uncomfortable for the NDIA and its stakeholders. However, if the Scheme is to be fairer and more equitable, these contrast effects and consequences seem inevitable and perhaps unavoidable if we wish to see a stronger, fairer Scheme.
This presents the NDIA with a difficult challenge. However, there are at least two options we can think of that can help. First, we encourage the Scheme to deeply involve key stakeholders like the disability representative organisations (DROs) and similar organisations in the design work and the change program coordination. The NDIA has already built momentum in its relationship with DROs. This can help properly test the emerging design and its impact on participants, provides important transparency, and increases the chances of a public discourse that recognises the extent of fairness in the changed arrangements.
Second, based on what we saw in the UK experience of individualised budgets 10-15 years ago, we think there is merit in maximising the amount of flexibility participants have in how they can make the best use of their budget. The people we met with in the UK at that time who were budget recipients, talked much more about the importance and value of flexibility in how they used the budget, rather than whether the budget was exactly the right amount.
On that basis, we suggest that the positive contrast effect of greater flexibility in how to use the budget can help counter the negative contrast effect of a reduced budget.
The Scheme needs to grow into its original promise, which is to advance and sustain Scheme participants in social and economic participation, or what we term meaningful and fulfilling lives as valued members of the community.
To deliver this promise, there is need for a range of well-designed, interconnected initiatives that lead to a genuine transformation in disability supports. It is going to take courage, but that is what Australia needs if it is to create a world-leading and highly impactful disability support system.
For this to happen, there needs to be sustained, values-driven, collaborative leadership, not just at the NDIA but also across all government stakeholders, in partnership with people living with disability, their families and allies, and with community leaders committed to inclusion.
► Join the conversation at our To The POint webinar
Tell us what you think about managing transition, share your ideas for reform, and help raise expectations about what the NDIS Review can deliver at our final To The POint webinar on Wednesday, 11 October at 1pm ACDT (that is, 1:30pm AEST and 11:30am in the West). The webinar will run for 1 hour and feature Robbi Williams, CEO of JFA Purple Orange, discussing this Paper. Attendees will have the opportunity to ask questions and provide their feedback on issues in the NDIS market and how they can be solved.
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► Our NDIS Review Conversation Series
With the NDIS Review underway, JFA Purple Orange is publishing a series of papers to help stimulate conversations about the future of the Scheme. Each fortnight, we will tackle a different topic of reform that we think is critical to the work of the NDIS Review. We strongly believe that the NDIS is an essential component of ensuring that Australians living with disability get a fair go at what life has to offer, but it must be strengthened and sustained. We are committed to playing a constructive role in developing ideas for reform that ensure the Scheme delivers on its original promise.
► About us
JFA Purple Orange is an independent social profit organisation based in South Australia that undertakes systemic policy analysis and advocacy across a range of issues affecting people living with disability and their families. We also host a range of peer networks for people living with disability including people living with intellectual disability, physical and sensory disability, younger people, people from culturally and linguistically diverse backgrounds, and people in regional South Australia. Our work is characterised by co-design and informed by a model called Citizenhood.
► Media enquiries
If you would like to republish this paper or interview Robbi Williams, CEO of JFA Purple Orange, about it, please contact Marissa on (08) 8373 3833 or email email@example.com.
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