IAC advice to the NDIA Board and Agency response

Overview

The National Disability Insurance Scheme (NDIS) Independent Advisory Council (IAC) was established in July 2013 by section 143 of the NDIS Act 2013. The role of the IAC is to provide advice to the National Disability Insurance Agency (Agency) Board on how the Agency is delivering the Scheme.

In 2014 the IAC pursued an ambitious work plan and contributed to a range of Agency consultative processes. The IAC’s activities culminated in two major pieces of advice:

  1. In December 2014, the IAC provided advice to the Board on how the Agency should approach the provision of ‘reasonable and necessary’ supports to NDIS participants. This advice consisted of five separate advice papers considering the concept of ‘reasonable and necessary’ supports in the following contexts:

    • the participant lifespan

    • families

    • planning

    • independence, and

    • self-management

  2. In January 2015, the IAC provided advice on implementing the NDIS for people with disability related to mental illness (psychosocial disability). This advice included the completion of a literature review.

The Board is required to inform the Council of Australian Governments (COAG) Disability Reform Council (the Council) of the advice it receives from the IAC and to advise the Council of the Agency’s response. This document represents the Agency’s formal response to the Council.

The Agency welcomes the IAC’s advice and accepts all of its recommendations. The Agency would like to formally recognise the significant work undertaken by the IAC in developing this advice. The advice will act as a useful reference for full scheme design and will benefit the people at the centre of the NDIS: people with disability, their families and carers. By accepting the IAC’s recommendations the Agency is continuing to reinforce its commitment to a culture of continuous improvement.

A summary of the IAC’s recommendations and the Agency’s response is presented below.

Advice on implementing the NDIS for people with psychosocial disability

The IAC identified improving the Scheme’s responsiveness to people with psychosocial disability as a priority. In developing its advice, the IAC focused on opportunities for improving engagement with the mental health sector and mainstream services, understanding existing demand (and predicting and meeting future demand), and consistency in the assessment of severity and permanency in the determination of reasonable and necessary supports.

The IAC emphasised the importance of supporting people with psychosocial disability in their transition to the NDIS. The Agency agrees that this transition requires careful planning, and in this respect strongly supports the IAC’s recommendation for the development of a five-year ‘NDIS Mental Health Implementation Plan’.

This will be actioned by building upon the existing NDIA Mental Health Work Plan (the Plan). The Plan will be progressively broadened to create a five-year plan which will serve as a statement of the Agency’s directions and priorities in improving how the NDIS responds to people with psychosocial disability.

As proposed by the IAC, committing to the plan will assist the Agency to appropriately adapt the NDIS for people with psychosocial disability and address associated concerns in a focused and timely manner.

The IAC recommended that the Agency report annually to the Board on progress. Two existing reporting processes will be utilised to report to the Board on the implementation of the Plan: Annual Report on Scheme Data and the NDIA Mental Health Work Plan Report. This will occur from October 2015.

In reflecting on the IAC’s advice, the Agency acknowledges that some of the Scheme’s original design elements in relation to access, functional assessments, severity indicators and outcome measures may not have adequately reflected the needs of people with psychosocial disability and current practice in the mental health sector. In response, the Agency is committed to developing evidence-based definitions and guidelines related to mental illness. This is being progressed through the Agency’s existing Operational Review of Access for Psychosocial Disability, and also a newly scoped work program to develop reference packages.

The IAC proposed that many of the design and operational issues identified in its advice could be addressed by establishing a specialist mental health/psychosocial disability team at the NDIS National Office. The Agency agrees and is already implementing this recommendation.

The 12 design and operational issues identified by the IAC articulate a clear vision for the five-year plan, and the Agency supports the IAC’s proposed strategy for each. The Agency agrees that the following critical issues identified by the IAC should be the focus of the five-year plan:

  • developing definitions and guidelines on what constitutes severe and permanent disability related to mental illness
  • building a nationally consistent approach to reasonable and necessary supports for psychosocial disability
  • predicting and influencing future demand, and responding to variations in support needs
  • funding of mental health specific support items, and
  • building participant capacity and specific consideration of mental health in the design and implementation of the Information, Linkages and Capacity Building policy (ILC; formerly known as Tier 2).

The Mental Health Sector Reference Group will be consulted as a key resource in the development and implementation of all aspects of the Plan. This group was established to develop a robust working partnership between the mental health sector and the Agency. The group held its first meeting in December 2014 and is already contributing to the draft NDIA Mental Health Work Plan. The IAC is has two members on this group.

This renewed approach as prompted by the IAC will ensure the Agency is better placed to support the needs of people with a psychosocial disability.

Advice on the provision of ‘reasonable and necessary’ supports to achieve an ‘ordinary life’

The IAC’s advice considered ‘reasonable and necessary’ supports throughout the participant lifespan. It also applied the concept of ‘reasonable and necessary’ in the specific context of families, independence, self-management and planning. The advice has been influential in the redesign of the NDIS for full scheme transition.

In considering the concept of ‘reasonable and necessary’, the IAC developed guidance on how this could be applied to support people with disability to strive for and achieve ‘an ordinary life’. The IAC defines an ordinary life as one which includes positive relationships, a sense of belonging, autonomy, active involvement in decision-making, and opportunities for challenge and contribution. This is consistent with a Scheme priority which is to promote economic participation and many of the concepts referred to in the IAC’s definition of an ordinary life are achieved through participation in employment, where this is possible. The IAC recommended the concept of an ordinary life underpin decision-making in relation to ‘reasonable and necessary’ support. The Agency reflects this in its vision which is to optimise social and economic independence and full participation for people with disability.

The IAC advised that the NDIS could better support the realisation of an ‘ordinary life’ for people with disability. The IAC’s recommendations to achieve this and the Agency’s response is summarised below.

The planning function

The Agency agrees that planning is crucial to facilitate the opportunities presented by the NDIS. In its advice, the IAC highlighted that currently a great deal is required of the planning process and of planners. The planning function must guide a person through the process of thinking about their goals and aspirations, and operationalise them into strategies ultimately recorded as a statement of supports.

The key finding of the IAC was that the current planning process may not be the best way to maximise participant outcomes. The IAC recommends that the Agency reconsider the planning process in the context of the full participant pathway through the NDIS.

The Agency agrees and is re considering the planning role in the context of Local Area Coordination (LAC) and ILC. A revised planning model which includes the life planning component as described by the IAC, and reconfigures the planning process so that a participant’s first experience with the NDIS is not one centred on funding, will be devised for full scheme. The Agency agrees that focusing on the enablers of an ‘ordinary life’ in planning conversations will provide for better participant outcomes.

A critical component of the IAC’s advice focused on participants and their families having the appropriate guidance and support to build a participant’s vision for an ‘ordinary life’ in the planning process. It recommended a number of improvements in this area.

In response, the Agency is already consolidating and improving planning and guidance documents. These changes link the participant led plan and an ordinary life to the context of the participant’s life stage. A full review of the key guidance document for planners, the Cluster and Pricing Guidelines, will be completed in June 2015.

The exploration and development of an enhanced support co-ordination function as a feature of each plan will also provide the necessary support to continually amend, update and reconsider plans as circumstances change and the participant’s confidence in their goals and aspirations increases. The Agency also aims to develop a more flexible approach to the many variations of plan management and financial management in a market driven NDIS.

Capacity building for participants and families

The IAC made a number of recommendations aimed at building the capacity of participants and their families. This included urgent implementation of the Disability Support Organisation (DSO) initiative and the co-design of national capacity building infrastructure.

The DSO initiative is critical to the Agency’s capacity building strategy. This initiative is now in place and DSOs are developing their work plans, and over the next two months will incorporate trial site feedback as a first stage of setting up local support groups. The Agency will continue to monitor the development of the DSO network.

The Agency is committed to ensuring participants are supported adequately, with a focus on building individual capacity and skill. Key to this is the development and implementation of ILC strategies and LAC. The ILC policy framework will be consulted on by governments in early 2015. Agency staff have met with the IAC as part of the ILC policy consultation process.

The Agency will continue to implement strategies that promote a participant’s capacity to direct their own supports and that promote active involvement by participants in all decisions in relation to their plan. Building capacity to encourage self-management and ensuring it is an accessible option for more participants is an important contributor towards the goals of independence and choice and control. The Agency has already implemented self-management workshops in a number of trial sites, and has begun to include ‘support coordination’ in participants’ plans. The Agency will also hold a co-design workshop to ensure its approach to self-management meets the needs of participants.

The IAC recommended better support and flexibility for families. The Agency agrees that resilient families are a critical factor in ensuring the long-term sustainability of the Scheme. The Agency will continue to develop a more flexible approach to plan development and address the limitations currently experienced through the catalogue of supports. This will be enhanced by emerging natural supports and increased capacity created by the ILC strategies. This work will commence in 2015, as part of a range of strategies to provide flexibility in the choices for participants and their families.

Co-design and inclusiveness for all participants

The Agency is committed to a co-design approach that incorporates the views of participants. It agrees with the IAC that the complexity of issues related to determining reasonable and necessary supports for certain cohorts warrants a specialised body of work. The Agency has recently taken steps to ensure the co-design approach incorporates the views and experiences of all potential participants, including people from rural and remote areas, Aboriginal and Torres Strait Islander and culturally and linguistically diverse (CALD) backgrounds.

A Rural, Remote and Aboriginal and Torres Strait Islander Reference Group has been established to provide overarching, advice and guidance for the development of the Agency’s Rural and Remote Strategy and an Agency Strategic Direction for Indigenous people. A CALD Reference Group will also be established in 2015 to provide guidance on the development of the Agency CALD Action Plan. In accordance with the IAC’s recommendations, the Agency will consult with the IAC on the work of these groups and the development of relevant strategies.

The Agency recognises the importance of developing a culturally aware workforce and is considering recruitment and retention strategies for people from diverse cultural backgrounds, cultural awareness training and representation of diversity groups in governance arrangements. The Agency will work to ensure that NDIS staff member competencies include the knowledge and skill sets necessary to understand and interact with CALD people with disability in family and community settings and have the attitude to develop relationships based on mutual respect.

Reasonable risk and independence

The IAC recommended the Agency take the lead in adjusting conservative attitudes to risk in service provision, and promote opportunities for reasonable risk-taking. The Agency strongly agrees that participants should have opportunities to exercise an appropriate level of risk in order to participate in the community and further their life aspirations. The Agency recognises that this is directly connected to the goals of the NDIS.

The Agency will continue to provide input into the development of the Quality and Safeguarding Framework, which is being led by the Department of Social Services (DSS). The IAC has already been consulted by DSS on the initial draft framework. The Agency continues to work through the interfacing principles to develop improved practice models to ensure reasonable approaches to participant risk. This will include a strong focus on efforts to reduce the negative impact of existing risk management approaches on choice and control for participants.

The Agency’s outcomes framework, when finalised, will address many of the issues raised by the IAC in relation to independence. The outcomes framework considers participant needs over their life span and incorporates changes on a continuum towards independence. The Agency will continue to develop the outcomes framework and will incorporate the key features as outlined in the IAC’s guide to independence in major life domains.

The Agency agrees that further work can be done to promote independence and to respect the participant’s right to choice and control in the services they receive. This needs to occur through provider learning and capacity building. The Agency is working to promote person centred approaches that respect the right of the individual and promotes practice that has enablement as a key feature. This work will occur in the context of market and sector development, linked to provider registration and ongoing provider capacity building.

In building an appropriate workforce for the NDIS, and in undertaking further work on the efficient price, the Agency will consider how targeted training can be provided to staff that require a specific understanding or skill in order to meet the support needs of a participant. Provider readiness and sector development work will include staff training and capacity building for participants.

The IAC also recommended that the Agency consider innovative ways supports can be provided, particularly in promoting independent and varied living arrangements. The Agency will work in collaboration with all jurisdictions to develop flexible innovative living arrangements for participants. The Agency will continue to monitor the impediments faced by participants relating to accommodation choices. It will liaise with the IAC on further work in this area.

Conclusion

For people with disability, their families and carers, the NDIS represents a lifetime journey which demands an agile and flexible system capable of responding to participant needs across the lifespan. This is the model the Agency is working towards, through the approach of co-design and learning from trial site experience.

The fundamental premise of the NDIS is that people with disability, their families and carers are at heart of the Scheme, exercising choice and control to put in place the structures and supports necessary for them to live the life they envisage. The implementation of the IAC’s recommendations will further the Agency’s pursuit of these aims.

The Agency will closely monitor the implementation of the IAC’s recommendations and will provide progress reports to the IAC and the Board.