NDIS Review 2023

Undoubtedly, the 2023 Q4 Review of the NDIS and its ensuing recommendations are poised to be regarded as a pivotal milestone in the scheme’s history.

During this initial phase, uncertainty remains regarding the acceptance, scope, and frameworks of the recommendations. Given the expansive nature of the NDIS, meticulous considerations are vital to ensure coherence across its various components.

Minister Bill Shorten, MP, the Minister for the National Disability Insurance Scheme of Australia, emphasised during a recent address at the National Press Club that a comprehensive assessment of all recommendations will be conducted. He stressed the imperative of crafting a clear and precise plan to progress these recommendations, acknowledging the significant groundwork essential for their practical implementation.

Mr. Shorten consistently expressed gratitude to those leading the NDIS, acknowledging their efforts in establishing a robust platform rooted in care and respect for individuals with disabilities in Australia. Furthermore, he reiterated his commitment to prioritising the disadvantaged, placing them at the core of his decision-making process, while encouraging others to do the same.

History of The NDIS Review

In October 2022, Minister Shorten initiated a comprehensive Review aimed at tackling significant NDIS issues. These encompassed various concerns such as participant dissatisfaction, NDIS interaction with other government sectors, market management, quality assurance, Scheme sustainability, erosion of trust, and virtually any NDIS-related challenge identified.

The review’s terms encompass two main parts:

• Part 1: focuses on NDIS design, operations, and sustainability, aiming to enhance participant experiences, manage costs, rebuild trust, and prioritise people with disabilities within the Scheme. It also assesses the Scheme’s effective-ness, financial sustainability, governance, interactions with other governmental sectors, and impacts on services out-side the NDIS.
• Part 2: delves into fostering a sustainable market and workforce by improving pricing systems, ensuring access in less served areas, developing a capable workforce, guaranteeing disability accommodation and supports, enhancing consumer information, reinforcing quality services, and strengthening monitoring and compliance measures.

NDIS Review: A Five-Year Transition Period

Immediate recommendations encompass foundational support enhancements, updated access guidance, and workforce measures. They emphasised the imperative nature of a collaborative process involving individuals with disabilities and underscored the need for a seamless transition for current Participants.

Looking ahead, longer-term outcomes are anticipated to be unveiled in 2024. During question time following his Nation Press Club Address, Mr. Shorten MP acknowledged the uncertainty surrounding the timeline for individual changes, expressing a need for clarity in the upcoming months. He highlighted that significant changes, like those in Plan Management potentially superseded by technological implementations, might extend over the entire five-year transition period due to their complexity. For more information click here.

Create a Cohesive Support System For Individuals With Disabilities

Foundation Supports

There are two categories of foundational supports:

General Foundational Supports

Universal services available to all individuals with disabilities, comprising information, disability employment provisions, systemic advocacy, peer support and advisory services

Targeted Foundational Supports

Specialised foundational assistance is provided to individuals under 65 years old who do not meet the eligibility criteria for NDIS. These services encompass home and community support, such as household errands or aids for individuals requiring less intensive assistance.

Furthermore, tailored aid is aimed at enhancing the capabilities, self-reliance, and everyday life skills of adults with psychosocial disabilities. Additionally, early intervention is available for families and children encountering emerging developmental issues, while transitional support aids young individuals in gearing up for employment and self-sufficiency.

These services are precisely tailored to meet the specific needs of individuals.

Enhancing Mainstream Services For Individuals With Disabilities

• An agreement for intergovernmental collaboration on disability matters should replace the Applied Principles and Tables of Support (APTOS). For more information click here.

• The National Injury Insurance Scheme should undergo expansion in accordance with the design proposed by the Productivity Commission.
• Children with disabilities should experience enhanced educational outcomes.
• To ensure comprehensive consideration, Disability Impact Assessments should be adopted across all government sectors.
• Unified and contemporary disability rights, inclusion, and discrimination legislation should be collaboratively developed by the Commonwealth, states, and territories—an alignment with the Disability Royal Commission’s call for a Disability Rights Act.
• Upon reaching 65, NDIS Participants could access funding simultaneously from aged care and NDIS services.
• A strategic initiative aimed at bolstering the support system for First Nations people with disabilities is crucial.
• The use of ‘in-kind’ arrangements within the NDIS should be discontinued.

Enhancing The Participant Experience in The NDIS: A Comprehensive Approach

“On 18 October 2022, the Minister for the NDIS started an independent review to put people with disability back at the centre of the NDIS. The purpose was to restore trust, confidence and pride in the Scheme”.

The motivation behind the NDIS Review stemmed from numerous reports of subpar experiences among individuals with disabilities within the NDIS. The NDIS Review has proposed several adjustments to the Participant pathway, encompassing:

• Criteria for Access and Eligibility within the NDIS: Implementing more standardised and reliable procedures to determine eligibility, evaluating functional capacity more consistently, and introducing a revised access form along with comprehensive guidance materials.
• Redesigned Assessments: Introduce an updated assessment methodology aimed at accurately appraising an individual’s support requirements. Under this new structure, assessments would be administered by a qualified “NDIS Needs Assessor”, possessing expertise in allied health, social work, or relevant disability specialisation. These designated assessors would hold the authority to make funding decisions. Crucially, these assessments would offer flexibility without time constraints, affording Participants the opportunity to share their perspectives on the assessment results. This approach aims for a personalised strategy in addressing Participants’ specific needs and requirements.

NDIS Budget Planning

• Budget Allocation in the NDIS: The NDIS budgets should be established holistically, considering the complete range of an individual’s needs, instead of itemising each specific support requirement. This approach aligns with the original scheme’s intention. The primary focus of budget determination should prioritise the intensity and nature of the support needs, as ascertained in the prior assessment phase.
• To ensure clarity and continuity, Participants ought to receive information about the budget outcomes from the same professional who conducted the assessment. This integrated approach aims to maintain consistency and transparency throughout the process for Participants.
• The plans will consist of three components: a flexible budget determined by assessments, provisions for home and living, and one-time allocations for assistive technology and capital needs.
• According to Our reform Blueprint: “Once the budget has been set, Participants and their families should receive more help creating a real plan of action, using their funds to achieve their goals. Detailed planning should be undertaken once the budget is set. This should have much more flexibility in how funds are spent than now.

The NDIA should take a trust-based approach in how Participants use their budget and make it easy for participants to comply with rules. Compliance should be encouraged through guidance and support, with more hands-on interventions used where there are serious risks or history of issues.”

Introducing Alternative Support Structures: Exploring Alternatives to Support Coordinators, Local Area Coordinators (LACs), and Psychosocial Recovery Coaches (PRCs).

One of the major recommendations in the Report involves phasing out existing Support Coordination, Local Area Coordination (LAC), and Psychosocial Recovery Coach (PRC) services, replacing them with a revamped ‘Navigator’ role. This proposed Navigator function serves as a cornerstone for various other recommendations, emphasising heightened support for individuals outside the NDIS realm compared to our current intermediary roles. Here are the proposed features:

• Navigators would assume responsibility for tasks such as aiding NDIS Participants and other individuals with disabilities in accessing mainstream services, facilitating NDIS applications, assisting in the execution of NDIS plans, and providing additional support as needed.
• Specialist Navigators would have the role of assisting individuals with more intricate life circumstances, offering tailored support and guidance to address their specific and complex needs.
• These Specialist Navigators would be contracted and financially supported directly by the NDIA, independent of participant plans, typically through a tender process. This approach aims to enable a more adaptable support system, where the level of assistance can dynamically adjust based on individual needs, diverging from the current model that predefines fixed hours of support in advance.
• In addition to their primary functions, Navigators would also extend their services to encompass psychosocial support and assistance in navigating aspects related to home and daily living for individuals requiring such support.
• Each NDIS Participant would have the opportunity to access a Navigator for support and guidance as part of the proposed restructuring.
  “Where appropriate, Navigators should operate out of locally based ‘hubs’ with other relevant services and be able to share information on support quality and opportunities for greater community inclusion.” – NDIS Review
• Navigators would operate autonomously from other service providers and possess nationally standardised governance, branding, online services, information management systems, monitoring mechanisms, and training protocols for consistency across regions.

The implementation of this new approach will involve a phased transition, incorporating extensive consultations within the sector, pilot programs, and initiatives aimed at transitioning the current support coordination and LAC workforce to this updated model.

Enhancing Decision-Making Support

The Review strongly advises enhancing support for individuals with disabilities in their decision-making processes. This involves ensuring accessible information and robust capacity-building assistance. Additionally, it suggests comprehensive training for plan nominees and increased supervision to monitor their decisions effectively.

Revamping NDIS Support For Children

The Review stresses the importance of enhancing support specifically designed for children in their familiar surroundings. It emphasises the urgency of establishing a seamless network of aid for children dealing with disabilities and developmental hurdles, emphasising its crucial status for all governing entities. In Bill Shorten’s Press Club speech in December 2023, he pointed out the unexpected prominence of focusing on children and the related expenses in the NDIS, a trend largely unforeseen by the scheme’s founders.

Essentially, comprehensive support is essential for children, as the report includes recommendations for nationwide developmental monitoring and screening to reduce the need for expensive assessments. Additionally, it emphasises the integration of children into early childhood education, care settings, and schools to create an inclusive environment.

Upon this foundational structure, fundamental supports are designed to enhance family capabilities and deliver evidence-informed, best-practice aid. Specialist NDIS support remains accessible to those with higher assistance needs, now facilitated through a fairer and transparent access mechanism.

The Review emphasises the allocation of children’s budgets based on their unique support requirements, as determined by assessments focusing on the individual child rather than solely on diagnosis. This recommendation resonates with numerous accounts in the public domain about misinterpreted diagnoses and the necessary support sought by parents from a system often employing standardised analyses of diagnoses within specific cohorts, neglecting the individual impact of the diagnosis on a person’s life. This proposed change aims to integrate greater parental input into the support determination process.

The Report emphasises that early intervention support for children must be grounded in evidence-based practices that offer children and families the most effective path toward a better life. It recommends:

• Ensuring the adoption of best practices, the Report suggests registering all capacity-building support Providers within the early childhood framework. This registration would be coupled with a uniform method for continuous monitoring and assessment of the efficacy of early intervention measures for children.
  Assistance for Individuals Affected by Psychosocial Disabilities

The Review has proposed alterations in the NDIS approach towards aiding individuals with psychosocial disabilities, emphasising a shift towards prioritising personal recovery and independence. During the Press Club event, Minister Shorten underscored the ongoing support for individuals with psychosocial disabilities within the NDIS framework.

• When individuals with psychosocial disabilities engage with the NDIS, they typically begin with a specialised early intervention path. As their needs evolve, they transition to more comprehensive “lifetime supports” tailored to their circumstances when it’s deemed appropriate.Enhanced collaboration and alignment with public mental health care services
• Psychosocial support Providers will now require registration and adherence to a newly introduced, specialised Practice Standard. This ensures compliance and standardised quality across services.

Transformative Revisions in Home & Living

The Review proposed several alterations to Home and Living, some of which have already been quietly introduced in recent times. These recommendations encompass:

• The NDIA, in partnership with states and territories, ought to oversee the construction of Specialist Disability Accommodation (SDA) when the private market fails to address specific needs. Additionally, all governments should collaborate on devising a strategy for ‘upgrading or repurposing’ aging SDA stock owned by states and territories.
• Introducing a New Practice Standard: Mandating Housing and Tenancy Separation.
• Altering the budget setting process aims for greater consistency and sustainability. The suggestion proposes that individuals needing around-the-clock support should typically receive funding based on an average shared support ratio of 1:3.
• Establishing a mechanism enabling individuals sharing support to collaboratively make decisions and combine their funds.
• Funding for independent living without shared support should be confined to specific circumstances, such as situations where there are documented risks to oneself or others in shared settings, individuals caring for dependent children, and those with particularly intricate needs. Additionally, there is a proposal to introduce a trial process allowing individuals to experience different living arrangements before making a formal commitment.
• The review underscores the elimination of the Improved Livability Specialist Disability Accommodation (SDA) design category while reassessing the other categories. Furthermore, it proposes the creation of a new, specialised SDA category catered to individuals living in shared accommodations who don’t meet the criteria for existing categories.

Technological Advancements: Empowering Individuals With Disabilities

The recommendations highlight the need for technological advancements within the NDIS. This includes proposals for a centralised support-finding platform and the development of a comprehensive electronic payment system enabling users to pay all service providers, regardless of their registration status.

Plan Management Challenges Ahead

The Review proposes that the implementation of the digital payments system will gradually diminish the necessity for Plan Managers, suggesting a future where their role might become obsolete once the system is fully established. This development holds significant implications for Plan Management providers. However, it’s crucial to emphasise that the Review clarifies these changes won’t occur abruptly; they require careful coordination and proactive, transparent communication over time.

NDIS Pricing: Revising Pricing Models Within The NDIS

The primary recommendation regarding pricing entails the transfer of pricing oversight from the NDIA to the Department of Social Services and the Independent Health and Aged Care Pricing Authority (IHACPA). The Review refrained from making explicit suggestions regarding the price ceiling for any supports.

For a thorough overview providing broader context in this area, you can access the comprehensive update through the following link here.

The Review proposes that these entities create an updated pricing and payments structure that moves away from a uniform approach, aiming to more accurately mirror the expenses linked to supporting individuals with varying complexities, diverse regional settings, group-based interventions, staff training, workers’ compensation, liability insurances, and other indirect labor expenses.

Transforming Provider Requirements in The NDIS

The newly proposed approach would mandate that all Providers must either be registered or enrolled to operate within the NDIS framework. If put into practice, here’s how it will function.

NDIS Enrolment

This emerges as an alternative to registration, offering a straightforward, minimal online procedure tailored for providers offering the least risky supports, thereby ensuring comprehensive market visibility. Minister Shorten emphasised in December that the objective is to have all service providers accessible to the NDIA and NDIS Commission. The Review proposes this approach for supports where the general protections provided by Australian Consumer Law are deemed adequate, encompassing items like consumables, equipment, technology, and home and vehicle modifications.

Basic Registration

This is recommended for lower-risk supports, implementing less stringent registration prerequisites akin to the current verification pathway. However, this revised scope encompasses a broader range, including sole traders, smaller organisations, social and community participation services, and those with limited one-on-one participant interaction. The Review proposes a basic registration process centered on self-assessment and attestation of compliance with Practice Standards, relieving smaller entities from audits and potentially easing compliance for these stakeholders.

Generic Registration

Targeting medium-risk supports, this category employs graduated regulatory approaches based on risk assessment, involving a mix of observational and/or desktop auditing. Instances include high-intensity daily personal activities and supports involving substantial one-on-one contact with participants.

Higher Level NDIS Registration

At the uppermost level of regulatory standards, advanced registration applies to supports deemed high-risk or demanding advanced technical expertise. This includes services rendered in high-risk settings like group homes. Providers falling into this category would undergo observational audits to assess compliance with both general and support-specific standards.

NDIS Worker Screening

The current system mandates worker screening solely for employees in risk-assessed roles within registered providers. In the proposed NDIS 2.0, this screening requirement would persist for all Registered Providers, now encompassing a broader range across three distinct categories. Additionally, it would extend to workers of enrolled Providers directly delivering specified services or having more than incidental contact with individuals with disabilities.

Mandatory NDIS Practice Standards

The NDIS Practice Standards outline the quality benchmarks that Registered NDIS Providers must meet in delivering supports and services to NDIS Participants. Complementing the NDIS Code of Conduct, these standards inform NDIS Participants about the expected quality of service from Registered NDIS Providers. When renewing registration, the NDIS Commission will inform organisations of the specific NDIS Practice Standards applicable to their registration group(s) and their organisational legal structure (e.g., individual, partnership, or body corporate). This determines the type of quality audit required for compliance.

Presently, all Providers must adhere to the NDIS Code of Conduct. However, under the proposed changes, adherence to the NDIS practice standards would become mandatory for all Providers.

Minimising and Eradicating Limiting Measures

The Review emphasises the urgent need to decrease and eradicate the utilisation of restrictive practices.

• The Review emphasises the necessity for exploring alternative funding models for Providers to create and implement behavior support plans. This exploration aims to secure timely access and sufficient funding, ensuring the delivery of quality behaviour support services.
• Key priorities involve collaborating with behaviour support practitioners and Providers to urgently enhance the quality of behaviour support plans, ultimately improving Participants’ quality of life and eradicating inadequate provider practices.
• Urgent action is urged to facilitate information sharing, establish nationally consistent authorisation processes, prohibit restricted practices, and enforce stricter compliance measures against Providers inappropriately or unlawfully employing restrictive practices.
• The Review advocates for a collaborative government initiative aimed at enforcing corrective measures against Providers employing restrictive practices. Additionally, it proposes a comprehensive review of potentially harmful practices, aligning with the National Framework for Reducing and Eliminating the Use of Restrictive Practices in the Disability Service Sector.

Proposed: “The Need for a Unified Disability Support Ecosystem Safeguarding Strategy”

The Review advocates for a Disability Support Ecosystem Safeguarding Strategy to harmonise and oversee safeguarding endeavors across the entire disability support system, encompassing foundational supports. This strategy emphasises robust links with mainstream regulators for comprehensive oversight.

To learn more about the Safeguarding Strategy, click this link for additional information.

• The proposal suggests expanding the NDIS Quality and Safeguards Commission into a National Disability Supports Quality and Safeguards Commission, tasked with regulating all Australian Government-funded disability supports.
• The recommendation calls for the establishment of a Disability Supports Quality and Safeguarding Framework to supersede the 2016 NDIS Quality and Safeguarding Framework, aiming to offer comprehensive oversight.

Collaborative Approach Among Governments

To optimise the allocation of disability funding and ensure meaningful benefits for individuals with disabilities, the Review recommends a significant revamp in the collaborative approach among governments. This includes proposing the establishment of a new Disability Intergovernmental Agreement (IGA), designed to:

• Set up an independent entity and procedures mirroring the Closing the Gap initiative, involving individuals with disabilities to track government commitments’ progress and the advancement toward an inclusive Australia, particularly for First Nations people.
• Establish shared responsibilities aiming for an inclusive and accessible Australia in line with the UN Convention on the Rights of Persons with Disabilities (UNCRPD).
• Define clearer funding structures through a new multilateral Federation Funding Agreement, reinforcing collective responsibilities for mainstream services, foundational supports, and the NDIS.
• Develop a dedicated timetable illustrating how governments will prioritise and uphold commitments to First Nations people under the National Agreement on Closing the Gap and the UN Declaration on the Rights of Indigenous Peoples (UNDRIP).
• Establish a performance reporting framework designed to gauge agreed-upon performance targets within the Disability Support Outcomes Framework.
• Adjust incentives, roles, and responsibilities across governments to ensure a shared distribution of risk and investment.

A proposed Disability Outcomes Council would serve as an independent entity responsible for holding all levels of government accountable regarding investment, service delivery, and outcomes. This council aims to provide individuals with disabilities assurance that necessary supports will be available when required.

Final Word: NDIS Review

The Review urges all governing bodies to increase investment in research, evaluation, and knowledge translation. This strategic initiative intends to showcase the value of the NDIS to governments and taxpayers, while simultaneously enabling Participants to achieve their objectives through innovative, evidence-based support mechanisms.