Promoting self-direction in the National Disability Insurance Scheme

Introduction

Experience of Hunter residents moving from the NSW self-managed Community Participation program to the NDIS

Barriers to self-direction

Limitations of NDIS plan management

Disincentives to self-manage under the NDIS

The prevailing view that self-direction is too hard

Enablers of self-direction

Retain and strengthen the benefits of state enabled self-directed support

Assist people with disability and families to direct their own support

Alternative framework describing the continuum of self-management

Recommendations

References

Introduction

The National Disability Insurance Scheme (NDIS) provides a unique opportunity for people with disability in Australia to have the support they need to live the lives they choose. A number of core elements differentiate the NDIS from state and territory schemes. First, eligible individuals are able to identify personal goals and aspirations and receive reasonable and necessary supports to complement informal, community and mainstream services. Second, the funding is allocated to the participant to support independence and social and economic participation and to enable the exercise of choice and control to the full extent of the participant’s capacity. Self-directed funding that gives participants control over major decisions related to the nature and delivery of their support is a critical element in making the legislative aspirations a reality.

Architects of the NDIS understood the value of self-directed funding and support drawing on the evidence of its association with improved health and wellbeing. A significant body of research consistently reports that self-directed funding and support is associated with greater satisfaction levels, perceptions of greater power and control over life decisions, improvements in quality of life, spending time with people, taking part in the community, feeling safe and secure at home, personal dignity, economic wellbeing, increased social networks and the perception of improved quality of supports.

The research quoted by the Productivity Commission in Appendix E of its report Disability Care and Support[1] draws on studies with different management arrangements facilitating self-direction. Differences are related to variations on two critical issues: who holds the funds and associated administrative arrangements and who controls the funds through planning and managing the package. Some studies reported on direct payment and the majority reported on mechanisms in which a service provider shared control with the individual. Positive impacts of self-direction are consistent irrespective of whether the individual manages the funding or the responsibilities are shared with a service provider.

In fact, the beneficial impacts of self-direction are reported by the Productivity Commission to extend to the service system. These include reducing the demand for formal services, costing less than other alternatives and partly addressing staffing shortages.

Research demonstrates that people with self-directed support have more active social networks, increased social, economic and community participation and improved wellbeing. These factors are also associated with less dependence on the formal service system. The Productivity Commission argued that there is enough evidence from diverse sources to suggest that self-directed funding is likely to be less costly than alternative service models.[2]

The Productivity Commission also argued that self-directed funding and personal planning may partly address the shortage of staff because it will draw the so-called ‘grey’ market of family, friends and neighbours into the pool of people who can provide support to people; it will reduce the number of administrators responsible for contracting and managing frontline workers by shifting that responsibility to people with disability and their families and it will shift away from specialist services to mainstream services (for example, joining a local scouts group or a gym).

The Independent Advisory Council (the Council) believes that the NDIS unnecessarily limits the recognition and support for self-direction thereby reducing positive impacts for individuals as well as the NDIS. The Council believes that the NDIS definition of the term self-management is unnecessarily narrow and fails to recognise and support the multiple systems and services mechanisms across Australia that enable people with disability and families to have significant control over the way they manage their supports.

This paper will outline barriers to self-direction drawing on first-hand experience of people with disability, families and services in the Hunter as people transition into the NDIS. These barriers include the lack of clarity of language, limitations of plan management provisions of the NDIS, unintentional disincentives to self-management and prevailing attitudes that self-management is ‘too hard’.

The paper will then outline enablers of self-direction including recognition of state and territory shared management options, recognition of and support for quality plan implementation support, incentives to retain and strengthen the positive aspects of self-direction and strategies to assist people to self-direct. A proposal for adjustments to the current plan management approach will be outlined to provide clear messages to enable and support people with disability to direct their own support.

Experience of Hunter residents moving from the NSW self-managed Community Participation program to the NDIS

The New South Wales (NSW) self-managed Community Participation program provides day program support for young people with a disability with moderate to high support needs who need an alternative to paid employment or further education in the medium or longer term.

The program operates under a shared management approach where a service provider is the fund holder and participants and their parents are able to negotiate the level of responsibility they want in relation to planning, staffing, support coordination and financial management. The funding from NSW includes 12 per cent for service and financial administration costs.

Self-managed Community Participation has been available in NSW since 2009 and a significant group of the early adopters now undertake all the life planning, staffing and support coordination functions. Some participants enjoy the control self-managed Community Participation gives them over lifestyle decisions, but prefer to retain the quality plan management support. Others continue to look to the service for assistance in staff recruitment and training, support coordination and the life planning required for moving from aspirational goals to real life outcomes.

Feedback from some people who have moved from self-managed Community Participation to the NDIS in the Hunter Trial Site suggests that they are not satisfied with the transition. The main reason appears to be the perception that the NDIA only pays for direct support and makes no active provision for aspects of service provision they relied upon in shared management such as:

  • life planning from aspirational goals to the micro-steps required to achieve an outcome
  • capacity to select staff individually
  • support coordination, and
  • professional development of staff.

In theory, an NDIS registered plan management provider could undertake some of these functions as part of its service intermediary role. However, given that no participants have used a plan management provider, it can be deduced that this avenue of sourcing supports has not been accessed.

There is a fear that if the value of life planning, assistance with staffing, and support coordination are not recognized and funded, the functions will not be there in the future.

Most people with disability and families in the Hunter trial site have not been aware that these are services they need to request. They believe they are asking for the ‘self-managed Community Participation’ under the NDIS and that the professional assistance they have taken for granted will be part of the package. When they realise it is not, they are faced with uncomfortable conversations with service providers who inform them that coordination supports need to be written into the plan, or that additional money will not be provided to advertise to replace staff if they leave.

Case study

The family of a gentleman with autism believed that his 23 hours of direct support per week had been transferred from a NSW self-managed funding program to the NDIS. He remained with the same provider but experienced a most significant change, namely that instead of being able to select his own staff when his staff moved on, he was forced to use allocated agency staff and over a period of months went from having 3 staff to 9 staff. In addition, he was forced to change the times at which he received assistance to fit in with staff timetables.

Case study

The mother of a young woman with very high and complex needs has found that the flexibility she and her daughter valued so highly has reduced. Previous lifestyle choices such as having a massage and support to attend a concert in Sydney (requiring an overnight stay) are now not permitted. Under state provision, the young woman had a budget determined by her support needs and she was free to use it as appropriate. This has been replaced by the payment of direct support for NDIA approved line items significantly reducing the person centred nature and flexibility of her support and lifestyle.
Issues around staffing are also of great concern. The requirement to use the agency staff when her staff leave has been exacerbated by the fact that one highly trained support worker that the family selected and trained is now no longer available to them because she is being used by ‘people in greater need’. The mother reported that she feels she has lost the anchor she experienced through the supportive relationship with the service especially the ‘sounding out’ conversation that she valued. She is not sure where that type of support will come from in the future.
Finally, the mother reported that there was no real discussion about plan management. She undertook to self-manage a small part of her daughter’s package and the NDIA planner assumed that the Agency would manage the rest.

Anecdotal evidence suggests that where people have been primed to ask for coordination, they have only been successful where they can argue their needs are complex for which they have received 10 hours per year for this assistance. This provides less assistance than they have been used to.

These case studies reflect a serious reduction in self-direction. The capacity to select staff is central to having a lifestyle of choice; especially for people with cognitive impairment for whom paid support has the capacity to facilitate valued roles and lifestyle. Only staff that truly know the person and are committed to their goals will promote relationships in ways that fade out the role of paid staff.

Barriers to self-direction

Confusion of language

The term ‘self-management’ is not used consistently across Australia and this is causing confusion for people with disability, families, service providers and government. The term is not defined in the glossary of the NDIS Quarterly Reports but operationally, it refers to individuals who directly receive all or part of their funding and are responsible for all aspects of implementation and reporting of their NDIS package. Limiting the definition in this way does not represent the intent of self-management as it suggests that individuals who choose to have varying involvement with the administrative processes are not taking control of their lives, their supports and their funding.

The following table lists the terms associated with self-management and defines their current usage within Australia.

Table 1 Terms and definitions associated with individual funding in Australia
Term

Common usage

Use in other contexts

Self-directed support

An approach that gives people with disability greater control over their support and their lives. Often described as self-directed planning, self-directed funding and self-directed support.

Self-directed support can be managed through a service provider, a financial intermediary or via a direct payment.

Most of the literature on self-directed support refers to arrangements in which a service provider is the fund holder (i.e. shared management)

Consistent meaning across jurisdictions.

Self-managed

Self-managed ‘support’ is used in NSW to describe arrangements whereby a service provider holds the funds and the participant takes the desired level of responsibility for life planning, recruitment, training and support of staff, and for support coordination.

Service provider is the employer.

Self-managed ‘funding’ is used by the NDIS to refer to payment of the entire package directly to the participant (or nominee) who is responsible for all aspects of administration of the package.

Direct payment

States and territories use this term to refer to an arrangement whereby the payment of the entire package is made directly to the participant (or nominee) who is responsible for all aspects of administration of the package.

NDIS refers to this as self-managed funding.

Shared management

Agreed sharing of funding and service management responsibilities between the person with disability and their family and a disability service provider who holds the funds. The participant takes the desired level of responsibility for micro planning, recruitment, training and support of staff, for support coordination and in some states for employment and payment of staff.

In NSW this is referred to as self-management.

Some of these functions are undertaken by a plan management provider under the NDIS

Plan management

NDIS term defined as ‘managing the funding for supports in a plan’ and includes purchasing the supports, receiving and managing funding from NDIA and acquitting funding provided by NDIA.

No known usage of this term nationally.

Limitations of NDIS plan management

The NDIS (Plan Management) Rules and Operational Guidelines deal with issues of management of funding under the plan.

Information sheets for participants identify plan management options (self-managed, registered plan management provider, the NDIA or a combination) and describe a registered plan management provider as an individual or organisation that manages the funding of support in a participant’s plan. The role of a service intermediary is introduced and includes:

  • assisting participants develop skills in this area
  • negotiating and coordinating the provision of supports
  • sourcing providers
  • negotiating method and timing of delivery of supports, and
  • negotiating individual requirements as part of the support management.

The service intermediary role can only be undertaken in conjunction with the financial intermediary role.

There are a number of significant limitations of the NDIS plan management framework. Firstly, many people are confused about the concept of plan management. To most people with disability, a plan consists of much more than the money. The plan is the document linking aspirations with supports to achieve outcomes and people want to own the plan as a symbol of ownership of their lives. Conversely, the term ‘plan management’ suggests that the participant’s aspirations and lifestyle are being ‘managed’ and this is contrary to the philosophy that the NDIS provides participants with the opportunity to learn how to take increasing control of their packages and their lives.

Secondly, the Council believes that the assistance anticipated in the service intermediary role is not an optional extra if an individual is to move from having a paid friend to using paid support in ways that complement and extend informal support. It appears that most NDIS participants are currently funded for direct support but without the infrastructure of a service intermediary role, most participants will not maximise their opportunities.

Thirdly, the service intermediary role as described by the NDIS may be too limited. Under shared management, favoured by many under state and territory programs, the service intermediary provides quality plan implementation support, assisting participants with life planning involved in moving from aspirational goals to implementation of outcomes. Examples of this include having friends, having a job, moving into a house, staff recruitment, training and coordination support, as well as employment and payment of staff.

For most participants, these functions are undertaken in a capacity building manner that leads to an increased readiness to take responsibility. However, some participants seek ongoing service involvement and choose the shared management option for the authority it affords in choosing lifestyle and ensuring supports are implemented to achieve outcomes in ways consistent with NDIS values.

Finally, the fact that the service intermediary role is not identified in the Rules or Operational Guidelines and can only be undertaken in conjunction with the financial intermediary role has led it to be little understood, and consequently not utilised. One provider described this linking as a fatal flaw for the service intermediary role.

Table 1.3.1 of the NDIS Quarterly Report to the Council of Australian Governments (COAG) Disability Reform Council (March 2014) demonstrates that the option of using a plan management provider under the NDIS is not understood. Across the trial sites, the majority of plans are agency managed. Only a small proportion of plans are solely self-managed and no participants are using a plan management provider.

Table 2 - Usage of Plan Management
State Agency Managed Combination Plan Management Provider Self-Managed

NSW

68%

30%

0%

2%

SA

83%

12%

0%

5%

TAS

66%

31%

0%

3%

VIC

71%

29%

0%

1%

Average

72%

26%

0%

2%

In summary, the Council believes that under current NDIS plan management processes, the valued assistance found in state and territory shared management has been lost. This represents a loss of technical assistance critical to building the capacity of people with disability and families to maximise the opportunities enabled under the NDIS and a loss of recognition and valuing of options to attain self-direction.

Disincentives to self-manage under the NDIS

There is no reward to the individual (other than control over their supports) for taking on the additional responsibilities related to self-management. For example, in NSW, eligible people receive a package of support based on their assessed need. The size of the package is based on the cost of gaining the required support with a service provider taking 12 per cent for administration. Where a person uses a financial intermediary (at a cost of 5 per cent of their package), the person gains the benefit of being able to use additional hours of support from their package. Where a person uses self-management, further additional hours of support accrue to the individual.

Under the NDIS, this incentive of extra value for money does not accrue to the individual. The Agency argues that people are allocated reasonable and necessary supports and that it would be inequitable to advantage people who take the additional responsibilities of self-management. This reflects a disincentive when compared to current state and territory service systems.

In addition, the NDIS fee structure does not sufficiently differentiate service offerings of ‘technical’ assistance that people value under shared management. This includes offerings such as additional time for life planning, support to recruit, select, train and supervise staff and support coordination. If the fee structure differentiated these offerings, more people would be interested to purchase assistance with self and shared management, making the task easier.

The prevailing view that self-direction is too hard

The uptake of self-directed services in the United Kingdom (UK) varied enormously, more than could be accounted for by chance. Analysis indicated that differences in the attitudes and support given by local authorities, varying animosity from public sector unions, and variations in voluntary sector advocacy for direct payments significantly affected the adoption of consumer-directed payments (Hasler and Stewart 2004, Rankin 2005, Riddell et al. 2005, Glasby and Littlechild 2009, pp. 47ff, Davey et al. 2007, reported in Glasby 2007).

This is reflected in a recent Australian study by Rees (2013) where study participants believed it was critical to challenge the attitudes of funding bodies and organisations that place barriers that inhibit the take up of self-management. This means stopping the prevailing message that self-directing or self-managing is too hard’ and something to be feared.

Enablers of self-direction

Recognition of, and support for, shared management as an option with which people are familiar

State and territory systems have used shared management structures for many years. The service provider is the fund holder and employer of staff, and responsibilities for aspects of service management are delegated to people with disability and families reflective of their capacities and wishes at any time. The intermediary roles are highly valued, providing ‘technical assistance’ which is crucial in assisting people to increase their capacity to direct their own support. They have provided a training ground for people who want to self-manage their funding.

Other participants want the service provider to retain a role but choose the shared management option because they want to ensure that the support is used to develop the chosen lifestyle in ways that are consistent with family values. Offerings provided through self-management and NDIA managed services do not afford participants this level of choice over management for service delivery.

Recognition of, and support for quality plan implementation support

Effective service provision under shared management offers participants much more than direct support. Services provide quality plan implementation support, helping people to plan, develop skills and orient staff to enable the direct support to go from an outing with a paid friend to facilitation of opportunities to develop relationships, build informal support and remove the paid support aspect. This is not the natural orientation of direct support workers and if direct support is the only aspect of service provision funded, opportunities inherent in individualised support will be missed.

Many people who use disability supports to complement informal support have gained the knowledge and skills to do so from quality plan implementation support provided by skilled and experienced people.

More recent participants who have not had the experience of shared management models may not recognise the need to seek this professional assistance and will then flounder in moving toward their real life goals.

Quality plan implementation support leads to more cost effective support because it produces the development of informal support that can improve both quality of life (because it leads to an increase in real relationships) and reduce the amount of paid support over time. Quality plan implementation support needs to be recognised and funded by the NDIA as a standard part of service delivery.

Retain and strengthen the benefits of state enabled self-directed support

Strengthen the person centred nature of NDIS plans and supports

Many individuals and families consider the reduction in flexibility as a shortfall that is directly related to the NDIS attempting to fit participants’ lifestyle choices into prescribed fields. The Council believes it is important to provide maximum flexibility in how people use their reasonable and necessary support, as long as the requirements of value for money and not duplicating the supports available from other systems are met.

For example, when an adult with disability chooses to use funding to pay the rent for house sharers who provide significant informal support, the Council believes that the Agency should recognise the use as value for money rather than preventing the practice on the general provision that rent is a private expense. The Agency should consider that this particular example is one of an innovative use of support funding - the participant pays his own rent from personal income but uses his reasonable and necessary support to pay (or subsidise) the rent of the house sharers as a strategy to establish a home living with friends who do not have a disability in a way that is cost effective.

For example, when an individual with significant physical disability uses their funding to purchase a massage, the Council believes that the Agency should recognise this as a value for money approach to health and wellbeing that reduces muscle tension and the likelihood of decreased mobility. The fact that people without disability pay for a massage from personal income is not the issue.

Retain and strengthen capacity for participants to select their own staff

Service providers in the Hunter have argued that the unit cost of service provision is insufficient to enable people to advertise for their own staff. Certainly, people who have been prevented from recruiting and selecting their own staff (after moving from shared management in NSW to the NDIS) relate this directly to the unit cost from the NDIA compared to the unit cost from the NSW government.

The capacity to select staff is an aspect of self-direction most valued by participants who are prepared to take considerable time and effort to ensure a good fit with the person assisted. NDIA facilitation of opportunities for participants to be able to select their own staff will provide a very strong incentive to the uptake of self-direction.

Assist people with disability and families to direct their own support

The move to self-directed support must come from the individual. The NDIA can, however, set in place strategies under which moves to self-direction are more likely to occur. Some strategies include:

Provide clear information to assist people to use self-directed and self-managed options

This should be achieved by:

  • offering training
  • developing online resources, and
  • developing a telephone advice line that provides information necessary for the smooth and successful management of a support package, e.g. wage rates, insurance, and occupational health and safety information.

Build the capacity of individuals

Rees (2013) asked people who were self-managing their packages (i.e. had a direct payment) what type of assistance they believed would be valuable in assisting others think about self-management. They identified factors critical to success including:

  • proactive thinking about what a good life might look like, including assistance to develop a vision and strengthen informal support
  • the opportunity to connect with others who are self-managing, and
  • having clear information about what self-management entails, including from personal, financial and administrative perspectives.

The NDIS needs provide incentives for skill development, particularly for participants using self-managed and self-directed options. The availability of systemic strategies that build capacity of people with disability and families (tier 2, now referred to as ILC) as well as enabling individual participants to have capacity building funds within their package (tier 3) would be of value.

Facilitate the development of user-led organisations that supports people to self-manage

Glasby and Duffy (2007) reported that where direct payments have been taken up enthusiastically, the biggest successes have often come where there is a user-led ‘Centre for Independent Living’ to provide advice and peer support for people thinking about such an option and starting to test out whether it is for them. Steps should be taken to encourage the development of user-led, Disability Support Organisations as obvious sources of peer support.

Embed supports for people who face multiple disadvantages

It could be argued that use of shared management is an option that affords increased flexibility, and so accommodates individual circumstances for people of Aboriginal and Torres Strait Islander (ATSI) and Culturally and Linguistically Diverse (CALD) heritage and people in rural and remote areas. This is because shared management gives people the opportunity to develop a lifestyle and support that is very individual and therefore more closely aligned to their values, cultural practices and lived experience. However, the challenge is that few people experiencing multiple disadvantages use self-directed options because they lack the knowledge and skills to negotiate the system.

Additional targeted assistance will be required if people experiencing multiple disadvantages are to have greater uptake of self-directed options. It is anticipated that such steps would increase participant engagement and satisfaction with the NDIS as well as increase the empowerment of participants. Experience in self-directed options could provide a stepping-stone to the use of self-management.

Alternative framework describing the continuum of self-management

The limitations of the NDIS plan management framework could be overcome by either replacing the role of the plan management provider with that of shared management, or ensuring that the functions of shared management are fully incorporated in the role of the registered plan management provider. Shared management is a term understood by people with disability, families, service providers and governments across Australia and more clearly delineates the roles and responsibilities intended. The use of the term as part of the articulated functions in planned management would be an advantage. Further work to develop the continuum of self-management, including exact functions and their appropriate fees, would be beneficial.

Continuum of self management

  1. Agency Managed
    • Agency pays bills
    • Participant selects providers and certifies that supports have been provided
  2. Shared Management
    • FINANCIAL INTERMEDIARY holds funds and manages risk on behalf of participant
    • TECHNICAL ASSISTANCE enabled through a broader SEVICE INTERMEDIARY role assists with recruitment, training support and employment of staff
    • SUPPORT COORDINATION
  3. Self Mamangement or direct funding
    • Individual receives funding package directly
    • Responsibility for entire package
    • Recruits and pays staff and manages all human resources issues
    • Individual manages risk and insurance
    • Accountable to NDIA

Recommendations

1. Develop a glossary to assist people across Australia to discuss the issues around individual funding

The states have been delivering a variety of individual funding models and have developed their own terminology and definitions. The development of a national glossary is essential and will facilitate the inclusion of valued options from states and territories as well as comparisons between the NDIA experience and international experience.

The Council recommends that the Agency work with state and territory governments to develop a glossary.

2. Clarify plan management options to either:

a. incorporate shared management functions into registered plan management providers, or

b. replace the concept of registered plan management providers with the concept of shared management.

The role of plan management providers has not been understood and the fact that the service intermediary role can only be undertaken in conjunction with the financial intermediary role has inhibited its use. In addition, the service intermediary role as currently structured does not appear to provide the depth of assistance provided in share management options.

Clarification on the way to proceed is a critical decision for the Council on this issue. In any case, it is essential that any barriers to its utilisation be removed.

3. Collect statistics on participants using shared management/plan management providers in the cohort of participants who self-direct under the NDIS.

The current NDIS measure of people self-managing their plan is taken as a symbol of the extent to which the NDIS is facilitating choice and control. The level of choice and control anticipated to result from the revision to the responsibilities in recommendation 2 means that these participants should also be recognised for the independence and self-direction they will demonstrate.

4. Strengthen the enablers of? self-direction through the following actions:

a. Recognise and support quality plan implementation support

Quality plan implementation support that provides skilled advice and facilitation for life planning, staffing, and the development of role and support coordination is a critical part of individualised service provision aiding direct support to go from an outing with a paid friend to the facilitation of opportunities to develop relationships, build informal support and eventually remove paid support.

The Council recommends that quality plan implementation support is viewed as an essential element of support and built in individual packages.

b. Retain and strengthen the state enabled benefits of self-directed support including:

i. Strengthening flexibility

The Council acknowledges the improvement in flexibility that will result from the bundling of supports. However, some of the flexibility enabled under state provision has been lost as a result of having individuals’ lifestyle choices filtered through an NDIS assessment.

The Council recommends a re-examination of the state enabled options that are prohibited under the NDIS (e.g. a personal trainer, a massage, payment of rent for a house sharer) and enable them if they represent value for money.

ii. Strengthening capacity for participants to select their own staff

The capacity for participants to select their own staff is an aspect of self-direction most valued by participants. It is considered essential if participants are to develop valued roles and informal support.

The Council recommends participants who are not using their support in a grouped environment be enabled to select their own staff.

iii. Assisting people with disability and families to direct their own support

The move for participants to self-direct support must come from the individual. However, the Agency can also establish strategies to maximise the likelihood that participants will want to self-direct.

The Council recommends that clear information is provided about self-directed options including challenging the view that self-direction and self-management is too hard, that resources are devoted to build the capacity of individuals to direct their own support (through allocations in their packages as well as through ILC funding, and that steps are taken to facilitate the development of user-led organisations, which is associated with increased uptake of self-directed options in the UK).

5. Implementing the recommendations in one trial site

The Council is mindful of the significance of recommendations that alter the infrastructure of the NDIS. In the context of a learning environment, it is considered sound to implement on a small scale and review impacts and outcomes prior to wider implementation.

The Council recommends that the recommendations of this report are trialled in one of the total population launch sites.

6. Cultural change around the concept of ‘registered plan management providers’

The Council recommends that concept of ‘registered plan management providers’ as contained in the National Disability Insurance Scheme Act 2013, be culturally changed to reflect the roles and responsibilities found in state and territory ‘shared management’ providers (for example, through the operational guidelines, engagement and other explanatory material).

References

Carr, S, Enabling Risk, ensuring safety: Self directed supports and personal budgets, SCIE, 2010

Duffy, S, Designing the NDIS: An international perspective, Centre for Welfare Reform, 2012

Fisher, K, Gleeson, R, Edwards, R, Purcal, C, Sitek, T, Dinning, B, Laragy, C, D’Aegher, L, & Thompson, D, Effectiveness of individual funding approaches for disability support, Occasional Paper No. 29, SPRC, 2010

Fisher, K, Attendant Care Program Direct Funding Pilot Evaluation for Department of Ageing, Disability and Home Care, 2008 SPRC Report 11/08

Glasby, J, & Duffy, S, Our health, our care our say: What could the NHS learn from individual budgets and direct payments (PDF 217KB), University of Birmingham Joint HSMC and IN Control, 2007 discussion paper.

Rees, K, Gitana Consulting and Training Services, It’s not just about the support: Exploring the ways in which family members and people with disabilities evaluate their self-directed/self-managed arrangements, Practical Design Fund, April 2013

Productivity Commission Inquiry into Disability Care and Support, 2011 Appendix E

Robinson, S, Gendera, S, Fisher, K. R, Clements, N and Eastman, C, Evaluation of the self directed support pilot second report, SPRC Report 10/11, 2011, prepared for the Department of Communities, Disability and Community Care Services Queensland.


Footnotes

[1] Productivity Commission Report Disability Care and Support, August 2011, Appendix E.

[2] Productivity Commission Report Disability Care and Support, August 2011, p.E.5.