Yesterday was one of those days I never believed would actually happen....
2023 was consumed by three sagas that tested me intellectually and emotionally. A fight with one of the Big Four banks for compensation related to appalling and misleading practices plus, at times, a total lack of coherent information. That ordeal lasted three months. After I submitted this tale of woe to the Australian Financial Complaints Authority (AFCA), suddenly ANZ wanted to resolve this issue. Before any action by the Ombudsman could be taken, we were awarded what I consider to be a fair amount for the extreme mental and financial stress that the ANZ and its subsidiaries had caused. And I am far more knowledgeable about the jargon and the structures within ANZ that are designed to bamboozle their customers.
The other seemingly never-ending story concerned the NDIA (National Disability Insurance Agency). After Alex became a participant in the NDIS (National Disability Insurance Scheme) in October 2019, I thought this organisation would be a godsend for families like us. Supports tailored to individual needs, inclusivity and the chance to live as "ordinary" a life as possible were such noble ideals. We all grasped eagerly at these opportunities.
Alas, the reality has been somewhat different. The NDIA has a language all of its own creation. They are masters in misleading not only their participants, but those who work within the constraints of this juggernaut. For example, our Local Area Coordinator (LAC) believed the NDIA had added Alex's diagnosis of Acquired Brain Injury to his profile, after she had uploaded all the required information. The NDIA do not believe Alex's ABI is disabling enough to warrant recognition as a second diagnosis to Autism.
Since 2019, every single NDIS Plan for Alex has been unsatisfactory. When I complained that Alex does not understand his Plans, I was reminded by a delegate that was my role to translate the contents. When I pressed the issue, explaining I had difficulties comprehending all the separate funding terminology, I was met with silence.
I also believe the NDIA engages in obstructive behaviour. We have experienced roadblock after roadblock when dealing with the NDIA. Funding for air-conditioning for his well-being refused, with excuses of lack of medical information and that we had missed an unknown deadline. Delays with review after review. Demands for further evidence to be scruntinised by the NDIA and then either dismissed or rejected.
in March 2023, Alex was diagnosed with Severe Obstructive Sleep Apnoea. He needed a CPAP machine immediately. Which we purchased as he would never have been able to afford one. Yes, there were significant health benefits but we concentrated on presenting his CPAP device as an instrument of well being. Alex's improved sleep quality would lower his anxiety, improve his daily functionality and allow him to participate in life without being exhausted. We were confident of reimbursement. Needless to say, the NDIA disagreed.
We have fought this decision for the last eleven months. Given the NDIA's propensity for smoke and mirrors, we kept appealing this decision, wasting time on internal reviews. I understood we needed to undertake three internal reviews within the NDIA before we could apply for an independent review by the Administrative Appeals Tribunal (AAT). This is not so. I could have applied to the AAT after the first decision by the NDIA. This information was never made clear, with contradictory advice given to Alex's LAC, his Support Coordinator and us.
The reimbursement for Alex's CPAP machine was never about additional funding. We just wanted to have permission to use some of his existing funding for this purpose.
Some time ago, a crusty senior GP insulted us to our faces. He berated us - "people like you are why the NDIS is going broke". We swiftly cut ties with that practice. I doubt that ignorant and prejudiced doctor will ever change his views. If other medical professionals are spouting comments like this to vulnerable NDIA participants and families, God help us all. What his remarks did cause was creeping doubt and disillusionment in ourselves and in our quest for a better outcome for Alex and us.
We finally applied to the Administrative Appeals Tribunal (AAT) for an independent decision late last year. With help, we secured an advocate from People with Disabilities (PWD), who warned us that the process may take 12 - 18 months. I was prepared to trust the Tribunal and wait for its decision.
The NDIA offered us complete reimbursement almost immediately after we applied for an independent decision by the AAT. The payment was finally released into our account yesterday.
Not surprisingly, the action was entirely economically based. I would have loved to say the NDIA had an epiphany of conscience, but they would have worked out the cost of a lawyer for a day before the AAT would cost far more than reimbursing us for Alex's CPAP machine.
I have been told by the AAT that I can share the following information publicly. Families or NDIS participants can apply to the AAT if their internal review has been rejected once. Not twice, not three times. The AAT is entirely independent. Often an application to the AAT will result in a positive outcome as the cost of the service/device may be cheaper than a lawyer contesting the case in court. Good to know...
We have won cases with ANZ and the NDIA. I was tempted to give up so many times, such was the emotional turmoil caused by their deliberate and merciless excuses and delays. I had hellish days of doubt and misery. I had to pull myself out of the abyss and fight on because we believed we were in the right ...
The final hangover from 2023 can't be discussed publicity. Once again, our integrity and honesty is under fire. So, I shall don my invisible protective armour and prepare to engage the enemy once more. Michael is accompanying me and I am better prepared than last time.
Wish us luck..
I discovered the following document when I Googled " NDIA Obstruction". Although the document is written about the experience of South Australian NDIS participants with high needs, the findings are relevant to the operation and structure of the NDIA in 2024. Note the date this document was submitted...Wordy but vital that this document is read and made public.
"General issues around the implementation and performance of the NDIS Submission 97 - Attachment 1
NDIS Solutions Paper
This paper is to be read as Appendix 1 to ISSUES PAPER ON THE OBSERVED OUTCOMES OF THE
NDIS by Alister Morton undated paper - file saved 21/3/2021. It should also be understood in the
context of the cohort of people primarily with Intellectual Disability and who are accommodated
in Supported Residential Facilities or Community Supported Housing with predominantly 24 hour
supports.
KEY POINTS
1. Older persons in South Australia with congenital or life-long disability ARE the most
vulnerable citizens as they are mostly without significant Advocacy support from family or
significant others. Solution – Independent Advocacy provided routinely for persons who require nominee or legal
guardian.
2. NDIS funding is not objective and equal or consistent across Participants in the program.
Solution – NDIS funding should be standardised and commensurate with diagnosis and objective
functional status of the participant.
3. NDIS funding is open to Political bias rather than individual Participant need.
Solution – NDIS funding should not either require strong advocacy or action based on Political
complaints or intervention – an agency separate from Government should administer the system
4. NDIS has discrimination inbuilt at core – Agency Managed Participants DO NOT have access
to providers of choice as Self and Plan Managed Participants do.
Solution – All Participants should have equal freedom for Providers of choice. NDIS Quality and
Safeguards and Provider Registration should be disbanded as had been ineffective and wasteful
and obstructive.
5. NDIS funding is determined by largely non-clinical NDIA Planners
Solution – All determinations and assessments should be carried out or informed by Qualified
Professionals with Specific Qualification in Disability or Health as situation requires.
6. NDIS Planning Meetings are provided often without true Multi-disciplinary collaboration and
meetings are not minuted – minutes are not provided to Participants / Nominees as a true
record of Planning Meetings.
Solution – All Planning Meetings or formal determination meetings should be minuted and
accepted by all parties. Planning meetings should provide proper opportunity for Multidisciplinary
input.
7. NDIS Plans including Participant Profiles and Goals are quite often false or at least poor
constituting effective fraud on behalf of a Commonwealth Officer.
Solution – Plans should be developed by a person who has direct face to face knowledge of the
individual and their circumstances and should reflect minuted Planning meeting minutes
(currently none).
8. Many Participants in SRF’s have had effective funding reduction limiting access the same
amounts of funding for Accommodation Support, Day Options / Programs and Therapy.
Solution – Urgent review of pre-transition funding and services and comparison with current
funding and services. Key funding areas must be reported if Plans are assessed year after year and
cannot be reduced except for where a person’s disability has improved. The system needs toGeneral issues around the implementation and performance of the NDISSubmission 97 - Attachment 1
properly understand the needs of the majority of it’s population and not concentrate primarily on
the younger developmental cohort.
9. Most Participants (almost all) have lost the standard yearly Respite / Holiday away from the
SRF due to insufficient funding for specialling or respite staffing
Solution – All participants should have adequate staffing SIL funding to enable individual activities
on a weekly basis and at least yearly respite from the principal place of residence if appropriate.
10. Participants in the Govt and NGO sector have had an effective cut in Support Coordination
funding of about 75% per person as well as Service Coordinators being more disconnected.
Solution – All participants who cannot act for themselves should have at least 12K Support
Coordination – ideally this should be undertaken by a Key person acting as a Local Area
Coordinator according to the original principal. This equates to only approx. 1 day of active
coordination per month. This was the approximate level of Program Service Coordinator funding
provided prior to transition in Govt and NGO Accommodation Services for this cohort.
11. Govt Accommodation Services or NGO’s who were primary advocates for many Participants
are now reduced to a position of conflict of interest in being the ‘Service Provider’
Solution – Independent Advocate to be provided.
12. Participants do not have easy and User-friendly access to NDIA support – the LAC system
that was meant to be incorporated into the NDIS seems to have diminished.
Solution – LAC system rediscovered and reintroduced to deliver person-centred, direct,
accountable, Case-management style coordination.
13. Access is difficult and impersonal for contact with NDIA Agents (Planners etc.)
Solution – Eliminate the Centrelink style Federal system and provide a Local, Accessible,
Contactable scheme.
14. NDIS Satisfaction rating is possibly skewed toward those who have capacity to provide
feedback. Experience and dialogue with participants would suggest that the advertised
satisfaction rate is highly inflated either by demographic, method, or reporting. An overall
satisfaction rate approaching 90% seems incredulous and inconsistent with participant
feedback.
Solution – Urgent review of data collection and reporting. Equal weighting for participants without
ability to feedback, and review with professionals how to reasonably gain true feedback about the
system where a person cannot do this themselves. Ensure a method for staff to make confidential
complaints about loss of services or treatment for participants.
15. NDIA Quality and Safeguards has failed to provide reasonable outcomes and has not faced
any known consequences in the wake of the Annie Smith affair.
Solution – Disband Quality and Safeguarding as stands as it has failed to provide. It has to my
knowledge not sought to measure or appreciate any loss in Quality or safety in the provision of
services. Community Visitor Scheme should be massively upgraded and States (or perhaps even
local Councils) should be funded to monitor and report on the performance of the Commonwealth
(if it is to remain a federal system).
16. Govt COS Program Participants have extreme limitation with services only able to be
delivered by one specific provider under agreement with SA Govt. The COS unit is somewhat
obscure with very limited ease of contact and information to Participants.General issues around the implementation and performance of the NDISSubmission 97 - Attachment 1
Solution – All Participants irrespective of funding relationship should be provided with equal
access to personal choice and freedom of provider in a truly ethical fair system.
17. NDIS Finance Committee has failed to appreciate market forces in relation to Therapy and
the function and efficacy of Allied Health Assistants.
Solution – Allied Health Assistant rates should be dramatically increased to reflect the real cost of
delivery of these services and to appreciate the benefit of delivering more services for less. Why
not motivate a market that looks for more cost effective options rather than providing incentive
for increased professional and more expensive input. This also helps to increase employment and
status of lowest paid workers (essentially paid commensurate with Personal Support Workers).
An Allied Health Assist may cost $55/hr to retain their services and NDIS funds at $48 if under AHP
direct supervision and $86 if under indirect supervision. Employees may make 70% billable KPI
which means there is a slimmest of margins even for an AHA level 2. An AHP (PT) may cost $75 /hr
to retain and NDIS funds at $224 / hr. Once billable potential taken into account the margin here
might be 50% ($112 / hr). Why would an employer faced with this reality look at increasing it’s
workforce / capacity with a larger number of personnel that bring little or no margin? AHA level 1
rates should be deleted as the same skill set and employee cost is most often required whether
the Physiotherapist is providing direct supervision or not and the Assistant is paid no less because
they are assisting the Therapist directly with a complex participant. AHA rates should be increased
to $120 / hr. Higher PT rates should be reviewed as this causes market forces that may alter
preference for therapist for similar work e.g. AT provision by OT rather than PT.
18. NDIS has failed to recognise the benefit of Govt and large NGO Agencies in promoting the
rights and programs for people with a disability, for developing links and providing
opportunities for tertiary education and research in disability, and for the progression of
ethic driven behaviours, education and training in the disability sector.
Solution – NDIS Price Catalogue should be reviewed with better appreciation of market forces and
Larger Organisations should be provided with a surcharge ability or receive some bulk / … funding
to appreciate that they carry larger overheads. The current model is selective for the benefit of
sole traders or smaller businesses with few overheads.19. NDIS’ fiscal focus has resulted in wholescale changes and loss of morale and ethic across the
disability sector where it was understood the objective was to provide a Person-Centred
Approach rather than a fiscal centred approach.
Solution – Unsure of a solution – a personalised funding model will inevitably force it to be about
the money and not about the person. The previous Block funding model meant that finance
wasn’t necessarily individualised or decisions of support were not based on this but on need and
clinical priority. Some people simply missed out on services as others presented with higher
priority. Now what determines service is funding not need or priority and sometimes funding is
mismatched with need and priority and requires too much bureaucracy to administer making it
untimely, inefficient and poor. Except for removing the funding based model unsure of how to
solve this tendency.
20. Clinical Funding was previously prioritised by therapists familiar with the participant who
would determine hours provided according to need at the time. Now Clinical prioritising is
effectively approved by an NDIS Planner without Clinical registration (AHPRA) who in many
cases has never met the Participant, and through a process that creates delay and increased
risk to the Participant.
Solution – Clinical decisions should be made by a Clinician with direct assessment of the
Participant. Funding in many cases is a Clinical decision – not an administrative one.
21. Rather than 1 CSTDSA battle per year and Each Provider battle with Disability Services for
block funding each year the NDIS has reduced funding to thousands of individual battles
with each Participant or their nominees
Solution – Disband the NDIA as a scheme which has failed to realise the expected efficiencies of
the 2008 DIG Report. Go back to a sustainable model before all the Providers have been
irreversibly damaged. This may already be too late. The only other option is a funding model that
is decided through true independent assessment – not assessment tendered and responsible to
the NDIA. Then again, the relevance of having an NDIA is the question.
22. NDIS has increased the stress and understanding of many families, carers, nominees of
people with a Disability who are mostly themselves limited or tired. It creates a system
which is complicated and uses terminology and processes that is often confusing. It would
be worth looking at family separation rates in this cohort.
Solution – The system needs to be Objective, Determinable, Consistent, Stable and non-
adversarial. It must provide a reliable and ongoing source of funding without constant review for
those whose disability does not significantly change and there needs to be again a personable,
local, direct assessment process by suitable person who is also responsible for the outcomes.
Research should be conducted into the stress for families and relationship to the NDIS.
23. NDIS has resulted in an overall decline of Lifestyle Planning, Care, and Support for many
across the sector, especially those who lack advocacy.
Solution – Proper Local Area Coordination to deliver fully funded effective Support Coordination /
case Management. Independent Advocacy and Community Visitors to check on care.
24. The OPA in South Australia fails to appreciate in writing in its Annual report the overall
negative impact of the NDIS and although listing concerns provides descriptions that are
slightly misleading and not clearly representing the issues.
Solution – the OPA should not report findings of the NDIS but should make their own assessments
about the effectiveness and safety of the Scheme. The OPA should understand that the cohort of
currently between 900 – 1200 individuals they hold in cases reflects only a small portion of the
number of people who cannot advocate for themselves in South Australia. The OPA should seek to
find information about unmet advocacy need in South Australia.
25. The Majority of younger Participants have nominees that are dissatisfied with the processes
and inconsistencies or injustices of the system. Some have seen significant increase in
support however acknowledge that the process creates considerable increase in stress in
families where there is already considerable pressure.
Solution – The scheme needs to be adjusted so that it is more standardised and less subjectively
inconsistent. It should not be as is commonly stated whether you get a good Planner or not.
26. The NDIS has failed to enable the full utilisation of allocated funds resulting in $6B returned
to Treasury and not utilised where it was assessed that it was needed in the last financial
year.
Solution – All unallocated funds for the scheme should be returned to the scheme in Capital
funding type projects or business supplement projects as unallocated funds usually occurs because
there was insufficient providers or resources. There should not be an incentive to Government to
not spend the NDIS allocated funding.
27. Many Disability Organisations both GOVT and NGO have lost asset base / income and
suffered significant financial pressure as direct result of overall decreased funding through
NDIS compared with the previous Block funding. This has resulted in significantGeneral issues around the implementation and performance of the NDISSubmission 97 - Attachment 1
rationalisation of services and training resulting in decreased quality of services and also
increased risk to Participants.
Solution – Some form of business surcharge or block funding for large providers to enable
competing with small concerns with few overheads.
28. Financial pressures on larger organisations have resulted in staff pressure and turnover, and
specifically professionals leaving and operating as sole traders and managing the overheads
that larger organisations can not mange.
Solution – As for 27
29. NDIS focuses on the younger cohort and with the term ‘Maintenance’ not being supported
in essence. NDIS considers it’s role is to increase function rather than maintain it. Clinicians
with long term experience in the disability sector acknowledge that the majority of Therapy
in the older person’s context is about maintaining function and capability not about
“Capacity Building’. This leads to a ‘disingenuous’ attempt for Professionals to have to build
programs and reports around the construct of development rather than maintenance. NDIS
must recognise the concept of maintenance.
Solution – NDIS must recognise and support the notion of “maintenance therapy”. Every person in
society can help maintain their fitness, well-being, and function and so Participants must be
provided with reasonable and necessary supports to maintain their Capacity. Capacity Building
Supports to be renamed simply Capacity Supports – if we must retain categories!
30. NDIS had failed to understand the intersect with Health. It is important that significant
health and Rehabilitation supports can be provided by disability specific and experienced
providers rather than that provided through normal SA Health programs.
Solution – Additional funding should be provided for Health-related Incidents and Rehabilitation
for a person with a disability to be provided by people who are trained in Disability. It is
unreasonable to expect that a person suffering a health related issue such as an ankle fracture
cannot be supported by their principal provider / therapist who knows the person best. Again a
true Local Area Coordinator should be accessible and able to assess the persons immediate need
and respond with delegated authority to approve additional funding. NOTE – This would also solve
the current SA issue of hospital beds being held by NDIS particpants awaiting accommodation or
change of circumstance funding processes and stop the building of hospital wards to fill with
people who are not truly SA health patients but find themselves in SA Health system as a ‘service
of last resort’.
Additional points from consultations with other Providers
31. Experienced provider estimates that split families rate is higher (potentially double normal
statistic) in the disability sector and this raises issues for “duplication of supports”. NDIS
needs to understand that equipment may need to be provided for multiple residences for a
child participant and also modifications to vehicles may be required to more than one
vehicle as it unreasonable to expect that one guardian would have to take all transport
responsibility.
Solution – Assess causes of stress for families supporting people with a disability. NDIS to
appreciate living arrangements of the individual and that duplication of supports may be
reasonable and necessary.
32. Previous system was a “wrap around” system which meant that family issues were
addressed with Social work and Psych. Current system is participant / child focussed and can
ignore the needs of families / parents.General issues around the implementation and performance of the NDISSubmission 97 - Attachment 1
Solution – A true Local Area Coordinator Model like a Case Worker or Key Worker with adequate
funding to properly engage a multidisciplinary team. NDIS and States need to assess what was
provided prior to NDIS transition and compare with what is provided now and test whether it
meets the “no worse off” clause of the Act.
33. Interface with Health has been stated as an issue but also the interface with education and
DCP and Housing has ongoing and exacerbated issues as a result of the NDIS.
Solution – NDIA need to review issues of responsibility and barriers created by jurisdiction
arguments and eliminate these through proper agreement and management.
34. Old systems created Capacity Building – NDIS creates Dependence. One provider feels that
limitations in funding previously promoted maximising building capacity around the person
whereas a fiscal system flooding the market in some areas creates dependence and
increased use of therapy hours.
Solution – Unsure – NDIA have been fiscally reckless in many cases potentially in order to help
transition and acceptance of the scheme and then have to find ways to limit funding in subsequent
plans. Research of overall Plan trends for cohorts should be published.
35. State V Federal funding responsibility conflicts. Example Housing HSA refuses to do home
mods as “it is a disability issue”. Before NDIS some mods ok but now it is a problem with
changes noted 6-12 months ago. Provider believes that HSA has obligation as does
Education DECD to provide Disability specific access / needs and it is not necessarily a NDIS
responsibility.
Solution – Age old problem when more than one person responsible – similar is happening even
within people’s Plans with lots of inefficiencies and duplication of roles with Support Coordinators,
Plan managers, Planners, LAC’s, SSC’s, Therapists, Nominees, Providers. Often lots of talk and no
action. Key solution is accountability and responsibility – a team decision and action list that is
minuted. A Key person (LAC) who holds responsibility.
NDIS should not continue to state its goal is to make Disability Funding Affordable or the Scheme
affordable. The NDIS Act should be ensure that a Reasonable and Necessary Support system is fully
Funded.
Alister Morton
21/9/2021
Physiotherapist B.Ap.Sc. APAM _ Morton Health, based in Adelaide, South Australia - office@mortonhealth.com.au
"Advocacy, not adversary - Insurance, not welfare -Connection, not confusion
NDIS reform - we need it now"
No comments:
Post a Comment