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Inclusion Tree Submission
The questions below were taken from the DSS Taskforce submission page to help guide our responses.
The Taskforce will provide advice to the Minister on key design elements and implementation of new regulatory arrangements, including a Provider Risk Framework.
The Taskforce will provide the Minister with a report in 2024 setting out advice on:
The Taskforce wants to hear from us, and we have used the questions below to help guide our submission.
Inclusion Tree provides human-centred support services, in most all States and Territories of Australia. Our services are individually tailored, strengths-focused, trauma-informed, and inspired by leading edge practices and social innovations.
We enjoy compassionately inquiring together to co-create solutions that make a difference to the people experiencing disability and mental health.
We know that investing in our people and acknowledging their gifts is what makes our business grow. We are committed to nurturing the personal and professional development of all our staff through an intentional culture of growth and learning, based on ‘We-Flow’ principles and practices.
We do this through providing Support Coordination, Capacity building and allied health services to NDIS participants. We support 560 participants of which 63% manage their own supports through independent workers and ‘service for one’ models.
We actively participate in industry working groups, events, roadshows, as well as policy and consultation sessions, advocating tirelessly for the rights of individuals to maintain control of their lives.
We are not supportive of Industry mandatory registration and enrolment at all.
We acknowledge that change is needed to reduce fraud, increase compliance and improve the quality-of-service delivery to NDIS participants. We agree that participants have and still are experiencing substandard practices, unfair and discriminatory pricing structures, neglect and abuse. Significant evidence indicates that many of these risks and abuse incidents against NDIS participants have been perpetrated by registered providers. Therefore, we do not believe that registering and enrolling all service providers will solve these issues.
Mandatory registration will not improve the lives of people with disability, nor will it guarantee a safer environment or better outcomes, it will actually disadvantage people with disabilities by consequentially limiting the number of professional services available. Suggestions that mandatory registration will solve the problem of financial exploitation and fraud in the Scheme and will keep people safe are unfounded.
We recognise that compelling individuals to select service providers exclusively from a preselected pool of providers restricts participant’s autonomy and limits decision-making, undermining the fundamental principles of self-direction and determination, as well as the cornerstone values of choice and control inherent in the NDIS framework. This practice not only restricts individuals’ freedom to tailor their support services according to their unique needs and preferences but also undermines the essence of empowerment and inclusivity championed by the NDIS.
A compulsory registration mandate does not guarantee the delivery of high-quality services or ensure the safety of individuals. Studies indicate that people with disabilities experience greater safety and well-being when integrated into their communities, surrounded by supportive networks. Establishing a segregated system for people with disabilities risks further isolation from their communities, and contradicts the principles of inclusion and social integration.
Research shows:
There is concern that the accreditation and audit approach would have potential negative effects by focusing organisation attention, resources and efforts on compliance process activities rather than frontline implementation of person-centred best practices and focus on outcomes for those being served (Hough 2021; Smith “Paper Safe: The Triumph of Bureaucracy in Safety Management 2018).
We are also concerned that the recommendations of the Royal Commission have not been adequately considered. Although this issue was addressed in a recent interim report, the fundamental principles outlined in the review recommendations remain unchanged.
Risk-proportionate modeling can be detrimental to participants if it is not implemented carefully or if adequate independent safeguards are not in place. While the concept of managing risk proportionally to an individual’s preferences and abilities is intended to promote autonomy and independence, there are potential serious issues to consider.
There is the potential for exploitation or abuse, particularly if participants are not fully informed or empowered to make decisions about the level of risk they are comfortable with. In some cases, caregivers or service providers may prioritise their own convenience or interests over the safety and well-being of the participant, leading to situations of neglect or exploitation.
Additionally, risk-proportionate modeling would likely inadvertently restrict participants’ opportunities for growth and inclusion by setting overly cautious limits on their activities or experiences. If certain risks are deemed unacceptable solely based on a participant’s disability status or service delivery type it could reinforce societal stereotypes and perpetuate discrimination, ultimately hindering their ability to fully participate in community life.
Therefore, while the concept of managing risk proportionally has its merits, it must be implemented carefully to ensure that participants are not unduly limited in their opportunities for independence, decision making and ability to lead a fulfilling life.
The suggestion of categorising participants into classes of disability not only oversimplifies the complex spectrum of disabilities, but also undermines the inherent dignity of individuals by reducing them to mere classes. This approach fails to recognise the unique strengths, challenges, and aspirations of each person and their informal networks removing their agency and autonomy in defining their own identity, support needs and risk mitigation strategies.
Enforcing strict 1:3 ratios of support is perilous on several fronts. Firstly, it undermines the principle of individualised care by imposing a rigid structure that fails to account for the diverse needs and capabilities of NDIS participants. This one-size-fits-all approach not only neglects the unique circumstances of each individual but also limits their autonomy and agency in determining their own support requirements and ability to manage risk.
Moreover, such strict ratios risk perpetuating a disempowering environment reminiscent of congregate care models from the past. By enforcing a ratio of 1:3, it inadvertently promotes a system that resembles institutionalised settings, where individuals are grouped together solely based on their disability status rather than their personal preferences, aspirations, and abilities. This regressive approach takes us back to an era where people with disabilities were segregated from mainstream society, deprived of their autonomy, and denied the opportunity to lead fulfilling lives within their communities.
Furthermore, enforcing rigid ratios disregards the potential for innovation and flexibility in service delivery. It stifles creativity and inhibits the exploration of alternative, person-centered approaches to support that could better meet the diverse needs and preferences of NDIS participants. In essence, strict 1:3 ratios not only pose dangers to the well-being and empowerment of individuals with disabilities but also represent a significant regression towards outdated and exclusionary models of care which are incredibly dangerous.
A significant amount of service providers and health practitioners who support NDIS participants also support the general mainstream public, the latter are primarily their ‘target audience’. These non-disability specific service providers must already be registered with their industry regulator and must comply with strict governing service obligations and industry practice standards.
Creating another registration requirement, in addition to their already cumbersome industry registrations, to only ‘allow’ them to support NDIS participants will become prohibitive, and is reasonable to assume this additional administrative burden with little to no financial return will simply see them saying no.
In-demand specialty services and businesses that provide high quality services to the ‘general’ public usually have extensive waitlists by nature, therefore they are even less likely to register as their demand is already high and can forego NDIS participants as they will usually only be a small percentage of their business today. This gap will easily be covered by their extensive waitlist.
For example; a participant wants to go to their local trusted physiotherapist for treatment. They usually have a waiting list of 4-6 months, there is little to no incentive for this physiotherapist to be ‘registered’ with the NDIS as they are already well over capacity and will receive little return to the additional cumbersome and costly administrative overhead to support NDIS participants. It is likely that this physiotherapist will simply not register as the return is not worth the effort, meaning this participant will need to find another specialist and start the process again.
Physio’s are already registered with Australian Health Practitioner Regulatory Agency (APHRA) and must comply with their strict practicing, quality and compliance standards in order to operate. Why are we recreating and duplicating another regulatory body?
People must not need to trade their dignity of risk, for another bureaucratic, closed and limited ecosystem of providers, cast in the veil of ‘keeping people safe’.
By introducing an additional layer of ‘registration and compliance’, you are segregating people with disabilities from the ‘general’ population, instead we want to help people with disability become more visible and included, who have a right to access the same services and supports available to the mainstream public.
If you increase the administrative overhead for mainstream practitioners and providers, it’s highly likely that they will simply say no. We already have a shortage of health professionals in Australia, demand already far exceeds capacity and thus can serve the ‘general public’ with far less administrative overhead with less ongoing compliance obligations and inherent costs, general customers who have a lower cost to serve and therefore a higher profit margin. Therefore, again making NDIS participants a sub-class of clientele, who is less attractive to service and support, and could well be de-prioritised in favour of more profitable ‘easier’ general public customers.
Reducing the number of ‘available’ quality health professionals has an immediate effect on the health and wellbeing of NDIS participants. Waitlists are already extensive, often between 4 and 6 months for an initial consultation, waitlists will continue to increase as the provider pool decreases. This is heightened further in rural and remote areas where people may only have access to 1 or 2 options today. Participants may have to wait longer and travel further just to be seen by a ‘registered’ practitioner, all at a higher cost to the Scheme and the participant themselves.
Accordingly, people with disability using mainstream services for disability-specific support should be enabled, encouraged and assisted where necessary, to access the existing services, protections, safeguards and remedies available to all other consumers. At the same time, mainstream regulatory bodies must become skilled in how to engage with and respond to people with disability in any matters that affect them.
It is highly likely that participants will lose access to key services and supports they rely on in their existing trusted support network today. If their existing professionals and non-disability specific providers choose not to register and only focus on their easier non-NDIS customers, participants will then need to re-source and again build up a new trusted network which usually takes months, years, sometimes even a lifetime to build. Restarting this process comes with the real risk of emotional and demoralising strain, risk of financial exploitation, and risk reduced service quality. This would further increase costs to government in unnecessary and premature assistance, resulting in higher and more intensive health supports, and other associated costs often for the remainder of their lives.
We are concerned that mandating registration for all providers will lead to the departure of many skilled and experienced professionals from the sector. A significant number of NDIS participants opt for plan management or self-management to gain access to a broader range of service providers who are better suited to meet their specific needs. This option must be maintained.
Prioritising a co-designed NDIS underscores the imperative for changes that genuinely cater to the needs of people with disabilities, rather than advancing a bureaucratic agenda. This approach emphasises inclusivity and empowerment, ensuring that individuals have a significant voice in shaping policies that directly impact their lives.
Criticism arises from the fact that these recommendations have not been co-designed, neglecting the invaluable perspectives and insights of individuals with disabilities, therefore missing crucial nuances in understanding people’s true needs and experiences.
At the inception of the NDIS, the original idea was that the market would drive innovation and assure quality through natural market competition. The NDIS is still in its infancy, even 12 years on. We need to iterate to innovate, and not close off NDIS participants to supports and return to a bureaucratic, service provider led environment of the past. Participants chose to use plan managers or self-manage to expand their options and increase their chances of receiving quality services that better suit their needs, options that the general public are afforded the luxury.
Mandatory registration will reduce innovation by locking the sector down and limiting options to primarily disability-specific and disability-only service providers. This does not support a competitive marketplace and it creates additional barriers of entry for innovative and progressive providers.
Innovative providers are rarely disability-only providers. Providers who bring innovative solutions to the disability sector often originate from diverse fields such as technology, healthcare, academia, fintech, and pharmaceuticals. Having successfully developed and refined their products in other markets, they leverage their expertise to support and assist individuals with disabilities. We should welcome and incentivise these services, products and providers so we can all benefit from these products and services, not restrict and deincentivise providers from doing so.
We need to attract business and innovation to our sector. We are traditionally generations behind due to it being ‘too hard’ to build, develop, sell then iterate specifically to people with disability. This naturally drives up costs for innovative products and services due to the limited competition in the market. Businesses can make 80% of the money with 20% of the effort in the ’mainstream’ markets, which will make it more difficult for people with disability to benefit from progressive technology and innovative services and products, this will be worse if the costs of entry are increased. People with disability will be left even further behind, though they are the very people who should benefit the most.
The current registration process is fraught with issues. The current registration process is cumbersome, tiresome, expensive, stressful and labor-intensive, and that’s just to pass the initial audit. The time it takes for registration to be assessed and approved is outrageous. The NDIA quote themselves “anywhere between 6 months and 2 ½ years to receive a registration outcome’’. This is not a scalable solution, nor is it reasonable to expect the 180,000 non-registered service providers to follow.
We are deeply concerned that some of the proposed changes designed to address particular specific problems and issues will be applied to the NDIS universally. This will serve to significantly erode the key features of the NDIS Act 2013, namely the focus on the individual; customised responsive supports; strengths-based approach; choice for the person with disability involving what supports would benefit them and who would provide them; control of how and when the supports are provided; assistance to access mainstream services that were previously unavailable to people with disability.
Below, we’ve outlined several essential features that, while not necessarily directly tied to the proposed model, are vital and must continue to be integral to any structural, policy, and procedural changes.
A new model will need to be developed. It MUST be co-designed from the ground up with people with Disability, their supporters and seasoned advocates. This will ensure that the needs of people with disability are met, service providers are kept accountable for quality of services delivered, improve the flow of information and support available to people both within the NDIS and using mainstream services.
As stated above, introducing mandatory registration for providers is not a reasonable or feasible expectation, it will only create a further segregated community. It will not promote people with disabilities to be fully valued citizens in the community, if anything it will keep participants further detached.
Embarking on a genuine co-design approach to design and implement changes, rather than mere consultation, with people with disabilities would mark the crucial initial stride toward establishing a truly person-centered scheme. This approach is essential for nurturing inclusivity, understanding, and empowerment within the framework of disability support.
Self-managed service delivery such as ‘services for one’ and ‘Micro-boards’ need to have the opportunity for exemptions from any registration process, and develop its own risk assessment to ensure people are safe and families are supported in conducting this role and operations.
It can’t. This model represents a significant regression in disability support, diminishing autonomy and agency, and compelling people with disabilities to lead isolated, segregated lives, under the guise of paternalistic oversight, which imposes subjective judgments on perceived risks to participants and potential risks we might pose to the system.
This degree of control is excessively authoritarian and demeaning, contradicting the principles upheld by the UNCRPD, the Human Rights Commission, and the values embraced by ‘everyday’ Australians, stifling the empowerment and self-determination which is crucial to empowering the lives of people with disability.
There are already mechanisms in place that could be tweaked to ensure providers remain compliant and provide quality outcomes;
We advocate for a person-centered regulatory approach to ensure safety and quality in delivering disability supports. Emphasising service delivery to participants and their quality-of-life outcomes, rather than solely focusing on agency systems and processes, is crucial. This distinction is vital because the frontline interaction with participants ultimately determines the success or failure of safety and quality measures from an individualised person-centered standpoint. Therefore, the primary objective is to devise a regulatory framework that appropriately monitors the frontline service interaction with participants and service providers, and implements evidence-based regulatory strategies to effectively impact this interaction.
We must strengthen mainstream systems to safeguard people with disabilities e.g. Australian Competition and Consumer Commission and Australian Health Practitioner Regulations, rather than creating an insular and segregated disability ‘eco system’.
We must work together to establish an appropriate risk framework to ensure individuals in closed settings have access to the necessary support and mechanisms in their NDIS plan, enabling them to explore alternative living arrangements and support options.
Thank you for providing us with the opportunity to share our insights and concerns regarding the proposed changes.
Should further discussion be possible, we eagerly welcome the opportunity to continue our engagement and contribute to the ongoing refinement of policies that uphold the rights and well-being of people with disability.
Submission end
We acknowledge the connections of First Nations People of Australia to the land, sea and community on which we live and work. As custodians of this sacred land we respect and acknowledge Elders, past, present and emerging.