(image via Consumers Health Forum of Australia)
Back in July, challenges associated with the rollout of the National Disability Insurance Scheme (NDIS) were on display as a computer glitch saw providers unable to claim payments associated with the program after the system went live on July 1.
Whilst those problems related to technology, more important questions surround ensuring that participants are not disadvantaged or even harmed as the rollout gathers momentum and are able to reap full advantage from what the scheme has to offer.
Toward this end, the National Disability Insurance Agency (NDIA) recently published a quality and safeguarding framework which outlined measures needed to manage risk across a range of areas.
- Supporting and empowering individuals through assisting people to make decisions, building necessary supports, having safeguards and advocacy services in place and responding to complaints and serious incidents.
- Building a safe and competent workforce though the screening and monitoring of workers and ensuring that workers have the skills and qualifications required for specific roles.
- Working at the provider level to ensure a diverse and sustainable provider market, introducing quality requirements and investigating potential breaches of unsatisfactory conduct.
Overcoming challenges in these areas will be difficult. According to the framework document, the number of people employed within the disability services sector, for example, will have to grow from 74,000 in 2015 to 162,000 in 2019-20 when the scheme is in full swing in order to meet demand. Doing this whilst ensuring that suitable background checks are undertaken and that workers have the right skills, knowledge and attitudes to support participants and to prevent and detect abuse and neglect will be hard.
Dr Jessica Cadwallader, Advocacy Project Manager, Violence Prevention at People With Disability Australia acknowledges the work of the NDIA in preparing the framework but says balancing the need for regulation and protection with that to enable people to make independent decisions about services they receive is not easy. This is especially given the history and prevalence of violence and abuse which people have suffered within disability services, she says.
According to Cadwallader, a particular area of concern revolves around self-management and the ability of participants through the scheme to directly hire support workers without going through a service provider. Whilst this may empower people to hire those with whom they feel comfortable, Cadwallader says, it also raises concerns surrounding the performance of background checks and the ability of participants to assess the suitability of the worker’s qualifications against participant needs.
Another issue involves the division in ownership and responsibility between state and Commonwealth governments. Whilst concerns about the use of restrictive practices on patients in mental health facilities have been raised in the framework, Cadwallader says further issues relate to how the reportable incidents scheme under the NDIS will interact with state based reportable conduct schemes.
In addition, Cadwallader says an important lesson from trial sites surrounds the need to include risk management plans in overall plans. She says an area which should not be forgotten is the role of social supports in protecting those who have disabilities from abuse. But far and away, Cadwallader said, mistreatment and abuse are more likely to occur in environments where victims are isolated and have fewer people to whom they feel they can safely disclose what is happening.
Finally, whilst the framework will cover NDIS participants (expected to comprise around one in every ten people who have disabilities), Cadwallader says violence against people with disability requires an urgent response across the board. On that point, advocacy groups have reacted angrily to a federal government decision not to hold a Royal Commission into violence and abuse against disabled people.
Cadwallader says the most significant challenges will occur during the implementation of the scheme.
“It’s a definite step forward and we are glad that with the scheme rollout charging full ahead that this has come out…,” Cadwallader said, referring to the framework.
“But implementation will be where a lot of the real issues are nutted out.”
Australia has an opportunity through the NDIS to improve supports offered to those who have serious and permanent disabilities.
Whether this is realised depends upon how well or otherwise the scheme is implemented and risks are managed.