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NDIS Updates: Complexity and the NDIS

Disability symbol on a computer keyboard

15/10/2018

The Office of the Public Advocate (OPA) brought into focus the issues faced by people with complex needs with the release of its report The Illusion of Choice and Control.

The report highlighted that people with complex support needs experience a number of barriers in obtaining the supports that they need under the NDIS, including:

  • Achieving NDIS-approved status and receiving adequate plans at the earliest opportunity;
  • Engaging and retaining suitably-qualified providers and workers; and
  • Finding and retaining appropriate accommodation.

The report included a number of participant stories that detailed the impact on participants of the NDIS interface with mainstream services, the lack of adequate services and NDIS planning processes and plans. In most stories, participant human rights were found to be infringed or limited.

The report recognised that a number of strategies are being implemented to address some of the issues, however the OPA maintained that further work is required and lists a series of recommendations. Ultimately, the report calls on the NDIS to identify and resource an appropriate crisis response (i.e. provider of last resort) to ensure participant plans have contingency funding to respond to crisis and to implement strategies to develop a suitably qualified workforce.

Members that attended NDS's Outside the Box conference this year highlighted similar concerns as those detailed in the ‘Illusion of Choice and Control’. In particular, they spoke of the need for an appropriate provider of last resort strategy - one that would ensure that participants are adequately supported in the event of an emergency.

The NDIA has responded to the report by detailing a number of national improvements to the participant experience which will be implemented from October 2018. These include:

  • A complex support needs pathway
  • Clear links to other service systems such as housing, education, employment and health systems to ensure that people are adequately supported
  • Stronger connections between NDIA planners and Local Area Coordinators
  • Ongoing work with Mental Health Australia to implement a psychosocial disability service stream

NDS welcomes these improvements. The work being undertaken by the NDIA and Commonwealth, State and Territory governments to improve participant experience and ensure that participant needs are met, is vital for the success of the NDIS. Further, a more detailed and practical understanding of the responsibilities of the NDIS and other service sectors to support individuals is absolutely necessary to ensure that people do not fall through the gaps. Greater transition planning and early engagement is required where participants are moving between service systems (e.g. the disability services system and the justice system) to ensure that their needs are met and human rights are upheld.

The NDIS Quality and Safeguards Commission also recently released the 'NDIS Practice Standards: Skills descriptors' for providers delivering high-intensity supports. This document details the types of skills and training a support worker is required to have under the NDIS Quality and Safeguards Commission to be capable of delivering specific activities under high-intensity supports. These include complex bowel care, enteral feeding and management, tracheostomy care, urinary catheters, ventilation, subcutaneous injections and managing diabetes. The skills descriptors also include support activities that require training but can be undertaken as part of a general support role such as high risk of seizure, pressure care and wound management, mealtime preparation and delivery, and stoma care. Auditors will rely on the skills descriptors to determine whether NDIS participants are being provided supports in a safe environment.

The skills descriptors identify a number of training requirements for staff that are absolutely necessary to ensure that participants are being supported in a safe environment. The extensive training requirements do however raise a number of questions regarding the adequacy of the high-intensity supports price. Analysis of the base price indicates that there is an assumption that approximately 95 per cent of paid time is spent with clients. This assumption does not necessarily enable providers to undertake extensive and regular training with staff required to meet the obligations mandated by the NDIS Quality and Safeguards Commission.

‘The Illusion of Choice and Control’ report can be found here.

For the NDIA’s full media release see here.

Contact information
Pascale Dreyer, NDIS Transition Advisor, 03 8341 4320,