NDIS scrimps on quality
My last blog post generated some interesting feedback around the NDIS (National Disability Insurance Scheme). I have been accused of being a NDIS Fan-boy, and for ignoring the negative aspects of the new funding model.
I am certainly in favour of a national insurance scheme for addressing disability within Australia. Most people are. And I also believe that a national system has the potential to not only give customers more choice and control over their services, but also to reduce the stigma traditionally associated with disability. I wrote:
â€œBecause the reach of the NDIS is so aspirational and expansive, it dilutes rather than aggravates the stigmatisation traditionally attached to the label of disability.â€
Many Australians donâ€™t understand hard-core disability issues like social role valorisation, consumer choice and self-directed services. But they do understand superannuation, insurance, and Medicare. The normalisation of disability services â€“ as just one of many other social servicesâ€“ should lead to the normalisation of disability itself which, in turn, should generate more awareness, greater acceptance and increased inclusivity of people with disability.
It seems churlish, then, to criticise the NDIS. But there is a major flaw that needs to be addressed, and addressed urgently.
When considering the effectiveness of the NDIS, we must consider the breadth, depth and quality of its services. The NDIS will certainly help more people from more places receive more support. So it has great breadth. The NDIS appears to be matching the individual packages of existing customers and allowing more targeted supports. So it has good depth. But the NDIS is not funding Service Providers adequately, and this jeopardises the actual quality of service provision.
Service delivery rates are benchmarked by the NDIS. This means that THEY (not Interchange, not the customer) set the hourly rate that service providers can charge. If the rate is set too high, the breadth and depth of services will be diminished to compensate. But if the rate is set too low – then service providers wonâ€™t be able to offer a quality service. In fact if the rates are set too low, then many service providers wonâ€™t be able to offer a service at all.
Interchange currently charges around fifty dollars an hour for providing 1:1 support in the community or at home. But the equivalent NDIS rate is around forty-two dollars an hour. That means Interchange is losing about eight dollars an hour on every person supported under the NDIS. This is clearly unsustainable.
How can service providers reduce costs by 15%, when over 80% of our costs are in staffing? You do the math. We are either going to have less staff, or less quality staff. And the last thing people with disability need is untrained and disinterested staff without the qualifications and experience necessary to help them set, track and meet real life goals.
So at the very least – the current NDIS rates would inevitably result in a cheaper, more transient, and less qualified workforce with a reduction in planning, case-management, training and supervision time. Strategy, Governance and Safety would also suffer.
At the very worst â€“ the current NDIS rates will lead to an increase in centre-based services, segregated transport, more clustering â€“ and the gradual de-professionalisation of the entire disability workforce.
In short: the NDIS risks spoiling everything that Interchange stands for. So much for being an NDIS Fan-boy!
Fortunately there are two NDIS models being trialled in Perth: the national system currently operating in the Midland/Hills area; and the Western Australian system being rolled out in the Cockburn/Kwinana area. The West Australian system is called NDIS My Way, and addresses the needs of local providers and recipients alike based on organic improvements to what was already a successful, individualised and person-centred funding model.
The NDIS promises to individualise all funding to provide more choice and control for people with disability, through better planning toward real outcomes. But Western Australia started doing this over ten years ago. Hence the best aspects of the NDIS have already been introduced to WA via an historically more progressive State Government.
The My Way model builds on this experience and ensures sustainability for service providers, whereas the NDIS model is more of a blunt instrument: improving funding in the Eastern States but stripping it back here in WA.
Both models improve the breadth and depth of services to people with disability. But the NDIS model fails because it scrimps on quality. The funding to service providers is so low that it diminishes our capacity to recruit, train and supervise a professionalised workforce. This is why the State-mediated My Way model must be chosen as the best way of providing services to people with disability here in WA.
For if the NDIS model is chosen, disaster looms. We will not just be replacing a working model with a faulty one, but destroying twenty years of capacity-building, social infrastructure and service innovation made possible by successive and sympathetic State Governments here in the West.
The whole sector is getting nervous, even impatient. We acknowledge that the NDIS is a huge initiative unrolled in difficult economic times. We accept there will be teething problems in trial sites. We are even willing to absorb the uncertainties around competing models and new systems. But the NDIS just has to get its funding levels right. Service providers, like Interchange, are simply unable to absorb funding cuts of over ten per cent to our essential services. Quality must suffer. And if quality suffers â€“ so will the people we serve.
We need to get it right, and to get it right soon. The NDIS is a great initiative from the federal government but for Western Australia – My Way is Our Way and the Only Way forward.