Providers Speak: Transport Under the NDIS
As the scheme rolls out across Victoria, providers continue to struggle to provide economically viable transport services under the NDIS. In order to better understand the implications for providers and the way they run their organisations, NDS distributed a survey to Victorian disability transport providers in September 2018.
Following the survey, NDS spoke to several respondents about their answers and how transport services fit into the broader picture of running a disability service under the NDIS. An overview of the findings is available here.
NDS spoke to three CEO's, Monica Provan from CODA, David Martin from Murray Valley Centre, and Julie Amor from Kyeema about their transport experiences. Although the conversations varied, several themes appeared.
The following draws on these conversations.
Payment, funding and costs
All three providers noted that the NDIS rollout limited their ability to continue cross-subsidising their transport service provision as they had done previously. This is consistent with survey findings in that almost half (46 per cent) of respondents said they cross-subsidised their transport supports before the NDIS. Similar to survey findings, all three providers were absorbing transport costs and, in some cases, asking clients to do so as well.
For CODA, clients’ transport funding was often used up in getting them to and from services, for other outings, at nights and on weekends, CODA was being forced to invoice clients directly, particularly towards the end of plan cycles. Murray Valley runs a successful black-tie ball to raise fund to purchase vehicles for their fleet. Their CEO noted that this is unsustainable, the takings are unpredictable and that it has only covered the cost of half a vehicle. For all three, the cost of running, maintaining and (when required) replacing fleet vehicles was not being met by the funding received through transport service provision and could not be absorbed elsewhere in the way it had been previously.
Fleet size and intentions
Similar to the survey findings, all three providers were making a loss on their fleets. Nonetheless, two of the three planned to maintain their fleet size over the next three months; one planned to increase. For all three, this was because transport provision was their clients’ way of accessing their services and they did not believe sufficient alternatives existed. This echoed a common sentiment from survey results that while transport is often thought of as peripheral to service provision, it is essential for it. Kyeema planned on increasing the size of their fleet despite making a loss, in order to keep up with increasing client demand and also in an attempt to reduce the amount of staff vehicles used, many of which are not fit-for-purpose.
That 38 per cent of survey respondents planned on maintaining the size of their fleet may seem somewhat encouraging, however interviewed providers highlighted the significant cost which comes with fleet upkeep - not the least of which is vehicle replacement. While a number of providers may intend to remain in the transport space in the short term, several noted that they do not have the funds to replace their fleets and so, as vehicles age and require replacement over time, many of those who intend to maintain fleets may fail to do so over the medium term.
Mission-led mentality and tensions
Several of those interviewed spoke about the tensions which exist between their organisation's mission to support people with disability wherever they were able, and making tough decisions as to who they could support while remaining financially viable. Amor noted, “Our mission is to support people, so we find it hard to say ‘no’ but we are probably going to have to in the future. We find it particularly hard to decline those who live deep in the country and have already been refused support by other providers”. CODA's CEO spoke about a 40-year history of providing services to their community as an organisation created by families who wanted a different option to institutions, and wanting to ensure clients had as many options as possible.
All providers spoke about difficulty with deciding when to deny clients services and how distance and geography were factors in this process. At CODA, the survey didn’t capture the number of prospective clients they had turned away before service commences, and the CEO noted that the NDIS needs a new mindset: if providing support to a client is not going to cover costs, they are forced to either refer them out or decline to provide services. Previously, CODA would support anyone who came to their services, as long as they could do so safely. That is no longer the case. CODA now has a process that when clients come to their organisation and assessed on the cost of providing support. If it will result in a financial loss but the impact on the client, who otherwise would not receive support, is significant enough to justify it, the case is taken to the organisation's board for consideration. This process results in an average of one or two clients a year being supported at an overall loss.
When asked how they would have acted differently with regards to transport under the NDIS, all three providers said they had more or less prepared the best they could. Amor noted that, despite the amount of research done pre-NDIS rollout, prioritising transport would have been beneficial - especially including it in service agreements and ensuring families were well informed and agreeable to its inclusion.
David Martin noted that despite being in a favourable position financially due to owning their fleet, property and buildings, there is nonetheless a need for cashflow, and that this is something transport service provision detracts from, rather than contributes to. The organisation researched outsourcing their transport services, however, it wasn't financially viable - bolstering both anecdotal and quantitative evidence that transport service provision is not a financially viable service, given the current pricing structure.
As all three providers interviewed operated outside of greater Melbourne, the question of whether adequate alternative transport options existed was paramount. All said that it didn’t: most noted that public transport was limited, often routes were not comprehensive and in many cases it was not suitable for the providers’ clients. Indeed, providers’ continued provision of transport services at a loss is perhaps the clearest indication that alternative options are not available to their clients.
The survey findings suggest a fundamental shift to a landscape where providers are taking on extra costs to compensate for inadequate transport funding and as a way of maintaining their core service provision. There is a marked lack of certainty regarding providers’ transport service provision over the next 12 months. This was supported by the recent NDS State of the Disability Sector Report where travel and transport service provision is the top area providers across the country are considering exiting in the near future.
Common themes include that organisations are making extremely tough decisions regarding who they provide services to. For many, this conflicts with their mission-led mindset to provide fundamental support to those who need it. For some organisations, part of these considerations included the lack of alternatives in the region clients could rely on.
Ultimately, whilst providers continue to navigate difficult processes, new administrative procedures, a changing landscape, a growing workforce, and myriad other issues, there is an ongoing a tension between their role as providers of services, as financially viable businesses, and as mission-led organisations with an obligation to their communities. This tension is multiplied by working under inadequate NDIS pricing - felt particularly, but by no means exclusively, in the area of transport service provision.
NDS continues to advocate on behalf of service providers for improvements to transport under the NDIS. A report on the findings from the survey and with recommendations has been provided to government. NDS thanks providers for their support in completing the survey, and in particular Monica Provan, David Martin and Julie Amor for taking the time to speak to NDS about their transport services.
NDS welcomes your feedback: if you have any questions or comments about the above, please contact Henry Newton on the details below.
The full report is now available, here.