Today's post by Jim Simpson, Senior Advocate for the NSW Council for Intellectual Disability, examines hurdles the NDIS faces in NSW in offering people with disabilities - particularly those "on the fringe" who are vulnerable and marginalised - choice and control over the services and support they need. This piece was originally published on the NSW CID blog.
Current NDIS implementation
Transition of existing NSW disability service clients to the NDIS started in July 2016. 36,000 people are transitioning in 2016-17 and a further 36,000 in 2017-18. From numerous sources, NSW CID has been receiving very mixed reports about the first six months of transition. People report that:
- The process for their first NDIS plan was very rushed and often led to unsatisfactory plans.
- They have experienced a major reduction in the level of their disability support.
- There have been many instances of people with intellectual disability not getting the opportunity to exercise choice and control.
- Families are being discouraged from pursuing self-management of plans, even when they have already been self-managing in NSW.
Moving 36,000 people into the NDIS in a year was always going to be extremely challenging. However, there seems to be major issues with the skills and workloads of local area coordinators and NDIS planners and the system for deciding what funding an individual gets.
NSW Government exit from service provision
Parallel with the implementation of the NDIS, the services currently provided by ADHC are being tendered out to the non-government sector. While people with disability and their families are having some input into this process, the bottom line is that individuals are not getting to choose their new provider. The new provider will be the successful tenderer for a large parcel of ADHC services. Choice and control is being delayed for people receiving ADHC services.
There are also major issues around whether the non-government sector will be willing and able to meet the needs of people with complex challenging behaviour. This concern is increased by the NDIS not yet having systems in place to make sure there is an adequate supply of services for this group including to fill the provider of last resort role that ADHC has historically filled. (See NSW CID blogs.)
Health services funded by ADHC
NSW Health’s Framework to improve the health care of people with intellectual disability was produced in collaboration with ADHC and NSW CID. The Framework calls for an improved focus on people with intellectual disability across the health system and a statewide network of specialised intellectual disability health services to backup mainstream health services.
At a time when NSW Health’s implementation of the Framework has been largely confined to three small pilot services, there is great danger of a major backward step in intellectual disability health services. ADHC has funded some vital health services for people with disability including, for example, a network of specialist nurses to assist good health care of ADHC clients and regional specialist psychiatry clinics.
Logic says that these services should be taken over by NSW Health. However, the funding for them is going to the NDIS and the NDIS is not responsible for funding health services.
If the roles of the ADHC health services are not maintained, the health and wellbeing of the people who use them will suffer. There are likely to be many preventable deaths.
People in trouble with the law
In 2001, NSW CID and the Intellectual Disability Rights Service (IDRS) published The Framework Report. This report was funded by the NSW Government and spelt out the service needs of people with intellectual disability who have contact with the criminal justice system. Over the following years, the NSW Government took some major steps towards filling this gap including funding the Community Justice Program (CJP) in ADHC and funding the Criminal Justice Support Network (CJSN) of IDRS.
The CJP provides supported accommodation for up to 400 people with major histories of offending. With the closure of ADHC and implementation of the NDIS, there are major questions about future disability support not only for the current clients of the CJP but also for many other people with intellectual disability who get into major trouble with the criminal law. The NDIA is tending to take a narrower view of its role in relation to this group than did the CJP – providing less support to help people keep out of trouble.
Also, the future of the CJSN is up in the air. Its funding will go to the NDIS but there is no indication that the NDIS will fund the CJSN. If the CJSN closes, people will be left unsupported in dealing with the police and courts leading to injustices for individuals, lost opportunities for linking people into the NDIS and cost and inefficiencies in the justice system.
People on the fringe
From early in the development of the NDIS, NSW CID has taken a central role in advocating for equal access to it by people who will not naturally approach the scheme – people living isolated lives on the fringes of society. This group includes, for example, parents who have intellectual disability as well as people who get into trouble with the criminal justice system due to a lack of disability support. (See our position statement.)
A small amount of disability support can make an enormous difference to the lives of many people who live on the fringe. In the Hunter trial site, the NDIS has provided this support to a small number of people on the fringe who have been assisted by advocacy and mainstream agencies to access the scheme but most people on the fringe have remained unsupported.
The NDIA corporate plan 2016-2021 emphasises the need for the scheme to focus especially on people who are vulnerable or marginalised. However, the NDIA has not yet developed any systems for this focus to occur. In particular, the NDIS needs systems to reach out to people on the fringe and support them to access the scheme.
Why is it so?
What we should be seeing from the NDIS implementation is much more real choice and control, and the development of specialised support services for people who need them. But currently this is not what we are seeing and there are inherent issues and challenges impeding the process. There are many factors that may be contributing to these current issues and challenges, including:
- The very high numbers of people who are transitioning from NSW funding to NDIS funding over the current two years.
- Inadequate staff levels in the NDIA due to a Government limit on operating costs. This limitation is impeding the NDIA developing good systems and having the staff needed at the coalface.
- The skills, experience, training and workloads of local area coordinators and planners.
- The methodology being used to finalise plans including the reference/typical support packages that are being used for this.
- The NSW Government’s determination to exit from service provision and to do this by 2018.
- The NSW Government having agreed to transfer all of its disability budget to the NDIS for participant plans without deductions for important services that the NDIS will not provide, for example the ADHC health services and the Criminal Justice Support Network. The NSW Government must find funding for these services!
- Inadequate action on the National Disability Strategy which is aimed at lifting the capacity of mainstream services to respond to people with disability.
NSW CID will continue to advocate vigorously on these issues with the NDIA and the Commonwealth and NSW Governments. We will report on our progress.