August 18, 2024 • 57 mins
Welcome to part 1 of our 2-part news special! Yes, we have slacked off in getting into the latest happenings and changes in the NDIS world, so here we are. This conversation was recorded a few weeks before release, and sooo many extra news items have come up since, so we will be back next episode for part 2. Stay tuned for that!
This episode sees us reach a new record for f-bombs dropped (with many more being edited out!), so as always if you listen to your podcasts with kids in the car you have been warned!
Here are the links to two of the items we cover this week:
https://everyaustraliancounts.com.au/ndis-amendments/
If you want to get in touch with us, you can:
Contact the podcast whatinthendispod@gmail.com
Contact Hannah hello@plandecoders.com.au
Contact Sam sam@rosenbaum.consulting
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
We acknowledge the original owners of the land on which we podcast,
(00:03):
whose stories were told for thousands of years. Today we are recording in Mianjin.
We pay our respects to elders past and present who may be listening.
Sovereignty was never ceded.
This episode of What in the NDIS Now is brought to you by Astalti.
Astalti is the software solution for NDIS professionals built by NDIS professionals.
(00:28):
Astalti is my go-to software and Astalti is trusted and loved by hundreds of other NDIS providers.
I love how easy it is to use and how it keeps all my participant information,
notes and invoicing all in one place available to me anytime from any device.
(00:49):
Sign up now for your 14-day free trial. Head to Astalti.com.au to sign up now.
See for yourself how much easier managing all your NDIS business needs are by using Astalti.
Thanks again to Astalti for sponsoring today's episode.
A quick note before we get started that there may be some swearing in today's podcast.
(01:14):
If you don't like swearing or usually listen with children in the car, you have been warned.
You're listening to What in the NDIS Now, a podcast where I, Hannah Redford, and my friend,
(01:38):
Sam Rosenbaum, interview participants and providers about all things NDIS.
Welcome listeners to part one of our two-part news special on What in the NDIS Now.
Yes, we have been slack and haven't covered the happenings and changes for a while, so here we are.
(02:02):
Part one of this two-part special was recorded a few weeks ago.
And I must warn you, it's a bit loose and sweary.
But so many announcements and news drops have happened since that we will be back next episode
with part two. Part two will include discussion about the recent what is and is not a support.
(02:29):
A little more on the pricing arrangements and price limits document, a chat about,
and I'm using air quotes here, the response to the Disability Royal Commission, and much, much more.
So stay tuned for our follow-up part two next episode.
(02:51):
And until then, enjoy some swearing punctuated with the NDIS news up until a few weeks ago.
Hi, Sam. How are you going?
Yeah, good. Thanks, Hannah, yourself?
Yeah, I'm doing well.
Mid-year.
Yes, and we're back. We just had a mid-winter break.
(03:12):
It's been very blasty, very cold.
Yes. So, Sam, I came across something on Twitter that I wanted to share with you,
which is also funny because it's actually a picture, which is great for an audio medium.
But what are you going to do? We'll explain.
Audio descriptors inserted here.
(03:32):
Yeah. So I'll show you. So this is a photo of a sign that is on a lift that is next to a set of stairs.
So sometimes you see these little lifts that are like almost like a cage,
and you sort of put yourself, wheel yourself onto it,
(03:53):
and the platform moves up to meet the upper on the side of the stairs.
They're purposely designed to help people with mobility issues get up those like four or five
stairs that you see in maybe the RSLs or out front of some hotel buildings where they don't have ramps.
Yeah, exactly. So this is a sign that is on one of them, and it says,
(04:16):
notice, to use the disabled lift, please come upstairs to the buffet and notify a member of
staff so that we can turn the power on. Thank you.
Yes, that's very accessible friendly.
Yes. So first up, what I think is, I mean, obviously this is daft,
(04:40):
and the people that it should have gone through it clearly didn't go through to be produced.
But the first bit that makes me laugh, slash, what the fuck?
Yeah. Is that it says it's a disabled lift.
Now, when you say a particular object is disabled, usually someone has done something to stop it
(05:08):
working. So I think that's not what they meant. But anyway.
No.
So that's funny. So also what this is saying is that if you are in a wheelchair.
Just get up the stairs, go to the buffet, find a staff member and ask them to come back down
(05:29):
and turn the power on for you. It's just simple.
But that means that you shouldn't leave the house without a support person to go up to the bar for
you. Why are you leaving your house without a support person? Why would you be independent?
The audacity of people thinking that even with physical limitations, that they should have the
(05:51):
right to go to the buffet and be able to get into and access public places. Baffling.
So it was just, I thought it was funny in a dark humour way. And I wanted to share that with you.
Sounds like a good restaurant or a hospitality venue that our good old friend Dan should
(06:16):
hit up to maybe engage with his app.
Yes. Yes. Like it's such an epic fail on so many levels.
Yes. Well, we're seeing a lot of those epic fails. And one of those epic fails is the
newly released updated on the pricing arrangements and pricing limits.
(06:37):
Oh yeah. What a shit show, Sam.
Yes. That's definitely a term for it.
So the day when we get our pricing and limits and price arrangements document is the biggest day of
the year for everyone in the NTIS sector.
Or provider world anyway. Yeah.
Yeah. So, but they were late with releasing it. And a bunch of us sat in our computers going
(07:04):
refresh, refresh, refresh on the website until it popped up. But what did it pop up with, Sam?
It did, Sam. So let me tell you, they did increase some services.
Well, that's useful.
Yeah. So in early June, the Commonwealth government announced a 3.75% increase to minimum wage,
(07:32):
which is great. And that also affects everyone on the Shads Award, which is disability support,
includes disability support workers. So the NDIS had to increase their cap,
but they increased it by just slightly less than that, which is 3.19%. So yay?
(07:58):
Yeah. This is not great. Historically, we and providers in the sector are
struggling to maintain operational and viability, essentially, or profitability,
although we don't necessarily like using that word in the sector. But that's what business
(08:21):
owners need to ensure that we can reinvest into our staff, into our service, into our operations.
So then we can increase our quality, increase our service deliverables and offerings to our
participants and ultimately serving the participants that we work with. But we are seeing more and more
doors close, more and more service, biggest service providers as well, kind of stepping out of
(08:48):
SILs, SDAs, support coordinations are dropping off. Yeah, it's a bit of a rocky road and having the
the increase on certain services, less than what the actual increase for award wages is,
is not a good thing for business profitability and viability. Because if we're going to talk
(09:11):
about sustainability, which is the big thing about sustainability, if we don't have sustainable
baselines in businesses, those businesses are going to close the door and where the fuck does
that leave stability and where the fuck does that leave sustainability for participants to actually
receive the supports they need. Let's not even, and that's just in main geographical locations,
(09:35):
so like big cities, let's not even, let's not even talking about your remote, your regional areas
that are struggling, that don't have staffing in there in the first place. And a lot of those
people actually have to increase their pay rate quite substantially more to make that more
attractive. Yes, there are some benefits and perks for doing so, but it's still a fucking shit show.
(09:58):
Yeah. So they also increased the cost for psychology, nursing and behaviour support.
So that's weird. What they left with no increase for the fifth year in a row, people.
Hold up. No, you're not going to say the words out of your mouth because they wouldn't hold that back
(10:23):
for a fifth year. For the fifth year in a row, they have left support coordination at the same
price. They have left plan managers at the same price. They have left allied health professionals
at the same price. There are so many allied health professionals as well that are finding it
(10:51):
harder and harder. It is becoming really silly. The last big company I saw decide to close their
doors on support coordination is the Benevolent Society, who have hundreds of support coordinators
and they're ceasing their support coordination service. They're keeping the rest of what they
(11:14):
do, but they're ceasing support coordination because there's no more viability in being a
support coordinator. No. I've got a peer down in South Australia in the Adelaide region called
Brendan Gale. He does a lot of work in this area and he is a super smart person with figures.
(11:40):
He's done this really interesting insight and kind of a cost analysis of support coordination,
breaking it down as to how much it costs per award. The allocation funding is per hour and how a
business kind of would break that out. He's kind of come up with the figure of that to actually
(12:01):
run a support coordination service and providing by the hour is actually $113 an hour, which is a
$12.87 deficit. That gets for anyone that's actually interested in numbers and how it all
kind of break down. The cost per hour worked is allocated at about $65.20. Non-chargeable time,
(12:26):
this includes team meetings, supervision, learning and development, business development,
pro bono work, which let's face it, I'm pretty sure this is a very conservative number here.
Breaks, thinking time, because let's face it, when we get stuck on a participant, it does take up
quite a lot of time to actually sort of go stop, take a break, step back and think of a solution
(12:49):
for that issue that that participant is having. That brings it up to $79.73 an hour. That brings
the total wage cost per support coordination chargeable hour to $79.73. Now we get into
overheads, which is everything else the business needs to run, including our IT services, admin,
(13:12):
compliance, HR, finance. That then brings it up to $104.85. I reckon this number is a very
conservative number when you think about the different pricing in IT and different operational
components. So yeah, at $104.85, now we want about the agency kind of has a 8% margin point on that.
(13:37):
So that's $8.39. So bringing that up to be a viable point of $113.24, which is not what the amount is.
Yeah. And it has meant a real world cut to how much you can pay support coordinators
and everyone else who didn't get a raise, the plan managers, the allied health professionals.
(14:02):
Because there's inflation and cost of living issues. And for the fifth year in a row, it hasn't moved.
No. So they're not just squeezing support coordinators, they're squeezing a whole bunch,
a whole big sector of the scheme. Yes. And hopefully where the powers at be are continually
(14:29):
listening to this, but it does bring in a great uncertainty, a lot of confusion. And let's not
even start to talk about how the agency themselves is handling support coordination within plans.
Because that's a different, completely different conversation. And I'm not even sure that half the
planners or the agency staff really know what they're going on. Because from what I'm hearing
(14:49):
from my clients that I work with in the support coordination field, there's polar opposite
information coming from the agency from, yep, cool, here's a nice plan, a healthy plan for support
coordination and healthy service provisions, or to be outrightly flat out told by an agency delegate
that support coordination will never be considered in this person's plan prior to them actually
(15:13):
making decision on the plan in the first place. Yeah. It's a total and utter shit show. It seems
like no one at the NDIA gets training anymore because they've just, they seem to have put out
a communication to planners that just says cut support coordination as much as humanly possible,
(15:38):
even for people who still absolutely need it. Because part of the issue is that LACs don't go
out to people's homes. Or really have a sit down face to face anymore. No, it's not.
We'll discuss this at this point as well many a times throughout some of the past episodes. And
(15:58):
we're still not seeing any of this change. Even though we've got the whole NDIS review, the NDIS
review, the Disability Royal Commission, we've had lots of reviews happen. And now we've got an act
as well that's come out recently that is all of this is so contradictory. And then the actions
(16:21):
of the agency, the ministers and government officials that are ultimately decision makers
in this whole entire process still can't even come out and tell us what they're accepting from
any of those reviews in the first place. It's like, let's get some more task force going. Let's get
some more input going. Let's have co-design and co-facilitation with peoples with a disability.
(16:42):
But at the same time, we're going to get those advocacy's in to consult on those pieces of work,
get them to sign a non-disclosure agreement and have everything handed out at five o'clock
on a Friday afternoon and expect there not to be backlash. That's true. But let's get back to the
PAPL. So there's been a slight change to short notice cancellations. So if you have a support
(17:04):
worker, the short notice cancellation is still seven days. So they didn't change on that,
which I find a little bit annoying because no one knows if they're going to be sick in seven days.
It's just frustrating. So the new rule that has come in is that allied health professionals
only have a two day window. So you have to give them them two days notice. That's where the change
(17:31):
is. So anyone who's under capacity building now only has two day cancellation, whereas they used
to have the whole seven days like support workers. But that's changed. There has been the removal of
the TTP. Finally, which needed to happen. Condensed price guide. Yes. And it's so much easier to read.
(17:59):
It's so exciting. For those non-providers out here and non-provider listeners, the TTP item is a line
item that used to be used in from the when the NDIS first got introduced to help those providers
that were initially providing supports before the rollout to transition their funding mechanisms from
(18:21):
what we used to be called originally block funding into the NDIS model. And there was a bit of a gap
between that. So those providers kind of needed to be able to essentially be enticed to jump over
is ultimately the point. Let's face it. So then they were able to use those TTP guidelines to
sort of move into the NDIS. And that was a very long time ago and made the pricing arrangements
(18:45):
and pricing limits a very confusing document to read sometimes and try and find exactly which line
you're wanting. Because there was a lot of like irrelevant lines that actually only applied to a
very small handful of providers there. Yeah. So I'm glad it's gone. Plans will be indexed to allow
for the higher cost of support work. However, it may take time. So just don't yell at your plan
(19:15):
manager just yet. Just give it a couple of months. And if you still not seeing your plan indexed, then
talk to the NDIA. But the idea, what they've said is they will absolutely be indexed.
So indexation, Hannah, what are we talking about here?
(19:37):
So that means that if you, for example, you were funded for eight hours of support a week. Now,
they still want you to have those eight hours of support a week, but the price of those eight hours
has increased. So they are going to put that amount of money that you're going to now pay
(20:02):
the extra amount of money into your plan. Yeah. So essentially you're not losing out on the
support hours that were originally within the intent of your plan at the starting point when
it was created. So that's just to help with those smaller changes from the provider fees, which
weren't around when your plan may or may not be first created.
(20:22):
Now, Sam, as a support coordinator or, you know, previous support coordinator, but probably always
a support coordinator in my heart, you may or may not have noticed that meal preparation is a weird
bit of the pricing arrangements and price limits document.
(20:44):
It's never been something that's been explicitly clear. And I have seen it used in so many different
ways, shapes and forms, and probably not within the right guidelines in the first place. But what has
changed? So for a little while, because of those people who were maybe not using it correctly,
(21:08):
it went to a stated line item. So what that means is it had to then be stated in your plan that this
was a thing you could have. Then there was a lot of backlash. So they decided to make it not a stated
item. So then anybody who had core funding, provided you had enough budget for all the things
(21:32):
you wanted to do, you could have meal preparation. Now, the main thing is that you can't just
now they've put the caveat in that bit of the papal that says that while it's not a stated item,
it must be stated in your plan to be able to use it. Which means it's a stated item.
(21:57):
Yes. So, da fuck?
Like, just make it a stated item then, like it makes no sense.
Well, it goes, oh, we got backlash. So we're going to change something, but we're not going
to fundamentally change it in any way, shape or form. And the problem with this specific point
is that there are lots of planners that don't actually do a great intent statement on the core
(22:24):
budget in the first place with the idea of what they're meant to be using. Some are fantastic at
it. Some give you like a dot by dot point of what they intended on how they came to that figure.
Now, some are like half a sentence. And with removing it from a stated support,
kind of removes that thought or the onus on the plan and to go, what are we going to add in on
(22:48):
from stated supports in it? And so that's removed, removed like that kind of process internally
there. So they've got to actually be proactive or a participant has to be proactive in insisting
that it's there in the first place.
Yes, because plan managers are refusing to pay it because it doesn't state explicitly in the plan
(23:11):
that this is that meal preparation was considered when they made up the funding.
Yes. Well, good job, NDIA.
Painful.
So that takes us to the bill.
Oh, yes. Yes, yes, yes.
So the wonderful NDIS bill amendment, which is apparently meant to be getting the NDIS
(23:36):
back on track following the NDIS review and everything else and public consultations.
But as I said earlier, at the start of it, there wasn't much open public consultation.
In fact, the people that were consulted on it, as I said, were instructed to have to sign
non-disclosure agreements, meaning that they could not say anything to anyone about anything
(23:57):
up until the point it got released. For anyone who'd been hiding under a rock for the last
four months, it has had the biggest shit show of effect nationwide, not just within the sector,
but on the national scale of how we go about treating people with a disability.
(24:19):
And let's not forget the talking points of the minister, which is the grand old line,
nothing, we won't do anything without you or nothing for us without us, that he keeps on
emphasising that it's all about co-design, that it's all about ensuring that nothing is going to
happen that's going to have a detrimental impact. But...
(24:41):
So Every Australian Counts is a grassroots campaign to bring on the NDIS. So years and years and years
ago. Nowadays, Every Australian Counts is a body of primarily participants and families
(25:03):
who try to make representations to the minister about things they think are wrong or right,
these sorts of things. So I went on to the Every Australian Counts website, and they have broken
down some of their concerns with the bill. So the first one is with the co-design that you have
(25:26):
spoken about. The bill now requires the minister to consider co-design principles, but it doesn't
make this a legal requirement. So they could just sit there and go, I considered it, and I
decided against it. Let's go have a cup of tea while we consider it and we'll come back and
(25:47):
do nothing about my consideration. Yeah. So that's the first concern they have with this,
because Every Australian Counts is looking at the long-term effects of this bill and knowing that
the government can change and government ideas can change with new governments, even in like,
(26:12):
you know, 20, 30 years time. And so having it explicitly stated in the bill that they must
do co-design rather than just consider it is a big concern.
Because with the amendments that are being proposed, it opens a floodgates for a lot of
(26:36):
things to be set in rules. And rules are not necessarily legislation like the NDIS Act,
it's supporting documentation in how to operationalise and implement parts of the Act.
In some of these rules, what we've got in this amendment is references to lots and lots of rules
(27:01):
that is all, those rules are meant to then kind of engage with community, engage with people with
a disability, engage with advocates on co-design on those rules. But that only needs to be considered
based on that point that we've just discussed. And if you consider what we had previous, for the
(27:26):
seven years prior to the current government, that's concerning AF.
Well, exactly right. And that's why Every Australian Counts is raising this as a concern.
And then the next few. So the next point is about a whole of person approach.
The bill may not fully account for people with multiple and interrelated disabilities,
(27:54):
which could lead to inadequate support. So at the moment, the NDIS is supposed to,
and I say supposed to because very often they don't, it's supposed to consider the whole person
and all of their disabilities when people have multiple disabilities. But this amendment says,
(28:17):
don't worry about that. We're just going to focus on the primary disability, which is ridiculous.
But wait Hannah, wasn't there conversation at the start of all this that primary and secondary
disabilities were going to be scrapped? Well, you know, I think Bill Shorten talks a good game,
(28:47):
but he doesn't walk that walk. It's not.
From what I've seen. No. And when the NDIS review dropped, I was
cautiously optimistic, but very positive about it with the caveat that my biggest concern
was the implementation. And I think my concerns are, concerns are starting to become more
(29:13):
concerning than what they were initially, especially with what we've discussed so far.
More so now that Bill Shorten is going after the rights of people with a disability to engage
with sex work. Even though Bill Shorten initially opposed the changes that Peter Dutton and the
(29:39):
then government were trying to do when they were wanting to squash this. And let's not even,
and let's not even, like from what I understand, it's a 0.12%.
Yeah. It's something like 104 people in the whole of the scheme accessing sex workers with
their funding. Yeah. The minister is just really convoluting everything at the moment, throwing
(30:04):
stuff around like about this, let's get rid of it. Going after support coordination, going after
dodgy providers and blank, broad spectrum blanketing it. Like it's almost back a year and a half ago
when we had the ledger boat yacht problem. Just what is going on?
(30:27):
Well, my dear Sam, it gets worse. So the next one is about the right to a new assessment.
So the bill lacks a clear provision for participants to challenge or replace needs assessments they
find inappropriate. So what they're going to do is bring in these needs assessments, which are-
(30:50):
And it's not the independent assessment, is it?
They absolutely are. It's an independent assessment. It's just called a needs assessment
this time. And you can still review and appeal the funding that you get, but you cannot appeal
(31:11):
and refute the actual needs assessment itself. That will be set in concrete. And what if you
just happen to have someone who is incompetent or didn't quite understand what you meant?
Or didn't care to understand in the first fucking goddamn place.
(31:32):
Right. So to me, not being able to challenge what is put in the needs assessment is a huge problem.
And I think we absolutely need to fight this. I mean, we need to fight all the points,
but to me, this is a very scary one.
(31:53):
100%. And anyone that lived through the independent assessment days, we're bringing back
severe trauma-inducing mechanisms that were heavily fought against.
Yeah.
Heavily fought against. I was listening to an episode of Reasonable and Necessary where
(32:20):
we had, where Dr. George had Senator Steelejohn on the podcast and talking about these exact
points as well. And this is probably the biggest frustration point that Senator Steelejohn had
about all the amendments. And quite frankly, he couldn't actually give a, there was about
a two minute pause where Dr. George asked Senator Steelejohn if he liked anything about the act.
(32:44):
It was quite the uncomfortable, awkward silence of arms and arms. And there really isn't anything
that sounds good, looks good or feels good about any of this. And so much so about the assessment
points, because as we said, we might have the assessor could be having a bad day. The assessor
(33:10):
could be a complete and utter dimwit. There's nothing good about this.
No.
Fuckity fuck, fuck, fuck. Honestly, there's really not much more to say on it. Besides,
what's the next fuck you're going to throw at me?
Yeah. It's going to be information requests. The NDIA still has broad powers to request
(33:35):
information and mandate medical assessments, which could be problematic.
Yes, because isn't this meant to be about disability, not medical?
Yes. Well, absolutely. That's one thing I'm confused about.
Is that kind of like my insurer asking if I've got any pre-existing conditions that might
(33:57):
affect my ability to get insurance or have a lower premium rather than paying exponential amount?
Well, it's funny you say that because it is an insurance scheme.
Well, yes, it is. But in the insurance world, they actually have prohibited insurers from being
(34:18):
able to use some of this information to grade how they provide their coverage. So what is the
minister and the rest of the pen pushing bureaucrats and red tapery think that that
would be appropriate if they're saying no to insurers doing this on one hand, but hey,
we're running an insurance scheme. Maybe we should take a leap of what we're telling everyone not to
(34:43):
do. The other thing is that you have to supply so much information to them when you apply to get on
the NDIS. So at what point have you supplied enough information to the NDIA? At the point that maybe
the delegate opens up the folder that all your documents are in and maybe actually read one of
(35:08):
them in the first place, not just ask you for another document that has already got the same
information on a document they've already got, but that would imply some foresight on the agent's
views behalf to actually read the fucking information they have in the fucking goddamn
first fucking place. Well, yes.
Although, mind you, I will say I don't necessarily disagree with the timelines on this.
(35:30):
Where there's some precaution and understanding that maybe there's not everyone a doctor is going
to be able to see everyone in the short term, but at the same time, there are people that are
outrightly using and abusing the scheme for ill-content. Sure. So go after them. Yes.
Like the problem is that the number of people doing that is so minuscule that it doesn't
(35:57):
warrant being heavy-handed to everybody just because of a tiny, tiny fraction of people
who are doing the wrong thing. It's really not like the media would have us believe that it's
so widespread and it's so ridiculous and everyone's buying drugs with their NDIS.
(36:20):
Everyone's getting hookers and escorts.
It's just not happening. That's not the...
I can see some of the validation from a compliance and legislative point of view as to have actual
timeframes. Because if where the agency asks a provider for information, they have timelines
(36:44):
on it. If the provider's not... If we're coming up to registration and providers come up to
registration and they can't be bothered to call an auditor and book in a date, then they
don't necessarily deserve to get their registration renewed because they're clearly not following
their requirements to be a provider in the first place. At the same time, if a individual
is wanting to access the scheme, then there is an onus on them to get the documentation
(37:09):
together in a timely manner. Though at the same time, I would really like to see those
timelines kind of reverse back and increase the customer... The participant guarantee from
the agency on timeline reviews and maybe actually fucking hit the benchmark in the first goddamn
place before you go putting the onus on participants to get stuff in on time when the agency can't
(37:32):
follow their own timelines in the first place. Yeah, when they're taking, you know, 9, 10
months to get reviews through at the moment, it's... That's if they were even considerable.
Yeah. OK, last point on this bill is limits on support and spending. The bill gives the
(37:53):
NDIA wide authority to control how participants use their supports and funding, raising concerns
about participant autonomy. When I first started reviewing the Act or the amendment, sorry,
this... There was a line that was the biggest concern out of everything, which I don't have
(38:19):
it in front of me, so please forgive me, I'm not going to be able to get this word for
word. But essentially, the idea was that the decision maker could state the service provider
and the person to deliver that support. So if someone was on such a tangent that they
wanted to... Or a power trip within the agency, they could go to Joe Blow and go, hey, Joe,
(38:44):
we're going to give you all of this support, but you can only receive this support from
this one person, no one else, or from this explicit provider, which ultimately kills
choice and control, kills autonomy, as you said, and limits and restricts an individual
choice on who they receive the support that they're needing to live their everyday life
(39:08):
and improve it. Which to me is... There are lots of words and I don't know which one to
choose, but it's a fucking joke. The audacity of the government to think that they have
the right to decide not only what constitutes an NDIS support in the first place, well,
(39:33):
look, there could be arguments on how to deal with that because there are a lot of providers
that call themselves NDIS providers that is very questionable if it's actually a disability
support or not, but that's beside the point. If I need physiotherapy, I should be able
to go to any physiotherapist and receive that support. I should not be told that I have
to go to physiotherapists are asked and go see Janine physiotherapist for my support,
(39:59):
and that's all I'm allowed to do because that's so ridiculous of a thought that it's not funny.
And then my question would be is how did Jane physiotherapist actually get in through the
pockets to try and get that kind of leverage in the first place? Or what does the planner
(40:22):
know about Jane that they think they have a right to make me go see Jane if I'm getting
supports from a physiotherapist? Yeah, and it's very paternalistic. The government
thinks that all people with disabilities need someone to be over them and making decisions
for them because people with disabilities can possibly make their own decisions and
(40:47):
make the right decisions. Well, it almost starts to look when you put it in this kind of context
that they might as well just write it as in the new way that the government's going to
become guardians and administrators for everyone on the NDIS sector. It's not good.
No. So one thing, another document I found in recent days is that the Disability Intermediaries
(41:15):
Association has put out a joint statement with the National Disability Service, Allied Health
Professionals Australia and the CEO CoLab to discuss the concerns about the disability
sector and the market failures. So I'm going to read this to you and you tell me what you think.
(41:43):
Tell me what you think. So this is the joint statement. An alliance of peak bodies and
organisations across Australia representing all parts of the disability service sector
is calling on the NDIA and government to take urgent and immediate action to ensure
services for people with disability can continue as evidence mounts of a catastrophic market
(42:08):
failure in the NDIS. Withdrawal of services will most affect participants who have the greatest
need for supports, those with complex high intensity or behavioural support needs and those
in regional and remote Australia. Following the recent announcement of a totally inadequate
(42:33):
annual pricing review by the National Disability Insurance Agency, provider representative
organisations are raising the alarm that providers of quality and responsive disability services
are already reaching breaking point. Since the pricing announcement, an increasing number of
(42:56):
providers are saying that they will not be able to continue providing supports to people with
disability. The wellbeing and safety of people with disabilities must come first, but inadequate
funding for quality services is putting this at risk. Quality providers are committed to ensuring
(43:17):
services remain available to people with disabilities but can no longer afford to subsidise the costs.
Financial reserves often built up over decades with the support of local communities are dwindling
as providers struggle to make ends meet. The NDIA's approach to pricing is undermining the ability
(43:42):
of registered providers to deliver quality, sustainable disability services and is undermining
NDIS reform. The organisations called for immediate steps to address the crisis in the disability
service sector, including increasing prices for support coordination level 2 and 3 and therapy at
(44:07):
least in line with wage increases in the disability support worker cost model. Reinstate high
intensity payments for behaviour support. Oh yeah, that was something we forgot when we discussed
the PAPL was that they've changed, you know how we've got standard and then high intensity.
(44:28):
So now you can't charge high intensity just because of behaviour. There has to be something
else that's happening to charge high intensity. Yeah, because that always happens.
Which decreases the number of people who want to provide supports to people who have extreme
(44:51):
behaviours because now they don't get the compensation that they potentially need
because also there's a lot of training that goes into those support works.
There is so much training, not to mention the regulation and paperwork on this because
generally speaking you've got restrictive practices in there which then has a work to do with
(45:13):
a world of pain for a provider dealing with implementation, reporting and handling that.
Not to mention the rate of turnover for staff in these sectors. I feel sorry for any parent
with a child that has high needs on the spectrum or any kind of non-physical
(45:36):
attachment to this because I work with quite a number of providers that deal with really
challenging behaviours that are borderline about to be thrown into the child care system,
child protective services. Not because the parent doesn't want to be the parent there,
it's because the behaviours are so intense that the parent can't be a parent.
(46:01):
Yeah. And these support providers are the last stop gap before throwing a child
into the juvenile justice system and throwing them into a world of pain for the rest of their adult
life to hope and dumbfounding. Yeah, it's pretty fucked. They want to implement a loading for all
(46:27):
registered providers of at least 1% which is kind of bringing back TTP but...
Look, it would settle a bit of the argument on why registered versus not registered providers
and have a bit of, I don't know, silver lining at the end of the tunnel for some providers that
(46:50):
have forked out tens, twenties, lots and lots of thousands of dollars to build a system
that has determinable metrics around how you define quality, how you ensure safe provision of
safe services, building your staffing up. Because it, although mind you, non-registered providers
should be doing that in the first place as well, but sometimes I see it as not a necessary thing
(47:18):
if they're not registered. So my concern is that even when the TTP was first introduced,
even when the TTP was a thing, the NDIS often said no, they wouldn't give extra funding just
because you're with a provider that charges TTP to cover that extra because they're like,
(47:42):
but it's a choice of you to go to them. So to me, that doesn't encourage people to go
use registered providers if that's what the NDIS is hoping that people will do.
Well, we need to point out that this is from the group, not necessarily from the agency. So
my concern in that would be, as you said, how that actually gets implemented, whether or not
(48:06):
there is kind of a bit of an adjustment for it. And then the other question would be is,
is it only restricted to agency managed participants or is it available to a self-managed
participant that's using a registered provider and then does it get at Kelo? But this isn't from,
this is just advocating for it. Right, right. This is that joint statement from the DIA,
(48:34):
NDIS, AHPA and the CEO CoLab. So just remembering this isn't our thoughts either, this is just
something from this joint statement, but it is interesting to think about and consider
these thoughts. They go on to say, these first steps are essential to getting the NDIS on the
(48:57):
pathway towards a financially sustainable model of service provision. Statements attribute to
supporting organisations. The NDIA's pricing decision is simply indefensible, keeping price
limits fixed for half a decade. Despite inflation, award wage increases and operating cost pressures
(49:20):
is irresponsible and reckless. This pricing decision has already resulted in the closure
of safe quality and skilled service providers. Mr Jess Harper, Chief Executive Officer of Disability
Intermediaries Australia. We knew the impact of the annual pricing review would hit the sector
(49:40):
hard, but the feedback we've received from providers shows that it's been catastrophic.
NDIS has been overwhelmed with providers saying they are reconsidering their future in the sector.
Laurie Lee, Chief Executive Officer of the National Disability Service. We know that our speech
(50:03):
pathologists, occupational therapists and many other types of allied health professionals are
deeply committed to supporting NDIS participants to live the best lives they possibly can to the
extent of personally absorbing some of the costs the NDIS refuses to pay for and the increased
(50:24):
expenses due to the cost of living. But after five years of not even so much as indexation
of therapy support pricing against inflation, our sector has reached breaking point.
Bronwyn Morris Donovan, Chief Executive Officer of Allied Health Professionals Australia. The CEO
(50:45):
CoLab is extremely concerned by the recent annual pricing review, seeing this as the major loss for
participants and registered providers and forcing many reputable providers to cease services.
We call for the reinstatement of high intensity payments for participants with complex behaviour.
(51:07):
There you go.
Well, I think that neatly re-illiterates my tangent at the start quite well. But then again,
with those organisations involved, you would certainly hope there was a lot more literacy to it.
Yes. They say it so much more eloquently.
(51:28):
Yes. Well, I am a bit of a self-progressed bogan, so fuck it.
Sure. But yeah, it's a very perplexing time in the sector. And I just don't understand
(51:50):
how we've gone through four years of royal commissions and disability independent reviews.
And reviews into support coordination and reviews into plan managers and reviews into
supports. And like, we've had the reviews, it is now time to like just do it. And they're not,
(52:14):
they're not even saying their responses.
This is when one of the town halls at the start, just after the review, I think it was the
Brisbane town hall with Bill Shorten. He was that that was his point. Let's stop the reviews. Let's
get into doing it. And it's like he started to get into doing it, but decided to forget everything
(52:35):
about that was actually in the reviews that came out about the disability review,
the royal commission and making people making choices about group homes.
Absolutely. And that's that's my concern. And that's my problem with what he's doing,
because he hasn't even come out and said, Yes, we're accepting this recommendation or that
recommendation. He's just gone off half cocked to say these dumb things.
(52:59):
Under the guise of, oh, we need to have this amendment done so we can actually implement
the stuff in the in the review in the first place. But I'm not going to tell you what we're
going to accept. And we're not going to actually wait for any state government to come out and say
what they're going to accept. We're not going to wait until we actually have an official statement.
Let's just get the ball rolling and get in and do it because we've had enough of reviews.
(53:24):
Minister Shorten, have you actually listened to anything that came out of the reviews in
the first fucking goddamn fucking place? Because we do not see it.
Not that exactly.
We want to and go back to the episode just after the NDIS drop, because I was all supportive for
this. But fuck it all. Eat my words.
(53:48):
Yes. And I had to fight you on it because I was like, no, man, this is not good.
I am very upset. Not well, I'm disheartened.
Yeah.
Because there was so much work done by so many people with such good intentions.
I'm not too sure about some of the chairs on the NDIS review, because quite frankly,
(54:11):
some of the language seems like they were roped into this idea from the very beginning.
And Minister Shorten was being a little bit backstabby in trying to force this point
from the get go.
Yes.
But there were a lot of people that were involved in it that really,
fundamentally, truly hoped for some. And look, a lot of the recommendations out of the review
are actually fundamentally quite good. Not all of them.
(54:34):
I said some.
Yes.
I said some, Hannah. Not all. There are some good things out of the review.
But with our understanding what our government is actually accepting in the first place.
And fundamentally more, and this is our shout out to you, Sue Grier,
how they're balancing the disparity between the NDIS, sorry, the Disability Royal Commission,
(55:00):
and their response and recommendations around group homes versus the Bruce Bonahady NDIS review,
practically forcing us into it.
Yeah. Yeah.
I can understand Professor Bonahady's kind of logic and the math behind what he's saying.
Sure. That's paper. What we heard out of the Royal Commission, and if anyone has actually
(55:28):
gotten their hands on the Royal Commission and go through the volumes of supporting documents and
the testimonials, the shit in that is fucking heartbreaking.
Yeah.
And how have we not listened to it? Is gobsmackingly,
pulsatingly, infuriating and saddening. And I don't know if I can say it in any other words.
(56:00):
I'm actually pretty sure there's a lot more forceful words I could say.
All the swear words.
I think we've hit the new record of F-bombs and other words in this.
Yes.
But yeah, hopefully we might have some good news on our coming forward on our next news episode,
but I think it's definitely a watch this space.
(56:20):
Yes, absolutely. But thank you so much for listening, and we hope you got something out of
this informative episode.
And I won't be signing off this episode with my normal line, but let's just keep our,
the good line of let's keep our thoughts and prayers.
(56:41):
And we'll see you later. Bye.
We acknowledge the original owners of the land on which we podcast,
(00:03):
whose stories were told for thousands of years. Today we are recording in Mianjin.
We pay our respects to elders past and present who may be listening.
Sovereignty was never ceded.
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(00:28):
Astalti is my go-to software and Astalti is trusted and loved by hundreds of other NDIS providers.
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(00:49):
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A quick note before we get started that there may be some swearing in today's podcast.
(01:14):
If you don't like swearing or usually listen with children in the car, you have been warned.
You're listening to What in the NDIS Now, a podcast where I, Hannah Redford, and my friend,
(01:38):
Sam Rosenbaum, interview participants and providers about all things NDIS.
Welcome listeners to part one of our two-part news special on What in the NDIS Now.
Yes, we have been slack and haven't covered the happenings and changes for a while, so here we are.
(02:02):
Part one of this two-part special was recorded a few weeks ago.
And I must warn you, it's a bit loose and sweary.
But so many announcements and news drops have happened since that we will be back next episode
with part two. Part two will include discussion about the recent what is and is not a support.
(02:29):
A little more on the pricing arrangements and price limits document, a chat about,
and I'm using air quotes here, the response to the Disability Royal Commission, and much, much more.
So stay tuned for our follow-up part two next episode.
(02:51):
And until then, enjoy some swearing punctuated with the NDIS news up until a few weeks ago.
Hi, Sam. How are you going?
Yeah, good. Thanks, Hannah, yourself?
Yeah, I'm doing well.
Mid-year.
Yes, and we're back. We just had a mid-winter break.
(03:12):
It's been very blasty, very cold.
Yes. So, Sam, I came across something on Twitter that I wanted to share with you,
which is also funny because it's actually a picture, which is great for an audio medium.
But what are you going to do? We'll explain.
Audio descriptors inserted here.
(03:32):
Yeah. So I'll show you. So this is a photo of a sign that is on a lift that is next to a set of stairs.
So sometimes you see these little lifts that are like almost like a cage,
and you sort of put yourself, wheel yourself onto it,
(03:53):
and the platform moves up to meet the upper on the side of the stairs.
They're purposely designed to help people with mobility issues get up those like four or five
stairs that you see in maybe the RSLs or out front of some hotel buildings where they don't have ramps.
Yeah, exactly. So this is a sign that is on one of them, and it says,
(04:16):
notice, to use the disabled lift, please come upstairs to the buffet and notify a member of
staff so that we can turn the power on. Thank you.
Yes, that's very accessible friendly.
Yes. So first up, what I think is, I mean, obviously this is daft,
(04:40):
and the people that it should have gone through it clearly didn't go through to be produced.
But the first bit that makes me laugh, slash, what the fuck?
Yeah. Is that it says it's a disabled lift.
Now, when you say a particular object is disabled, usually someone has done something to stop it
(05:08):
working. So I think that's not what they meant. But anyway.
No.
So that's funny. So also what this is saying is that if you are in a wheelchair.
Just get up the stairs, go to the buffet, find a staff member and ask them to come back down
(05:29):
and turn the power on for you. It's just simple.
But that means that you shouldn't leave the house without a support person to go up to the bar for
you. Why are you leaving your house without a support person? Why would you be independent?
The audacity of people thinking that even with physical limitations, that they should have the
(05:51):
right to go to the buffet and be able to get into and access public places. Baffling.
So it was just, I thought it was funny in a dark humour way. And I wanted to share that with you.
Sounds like a good restaurant or a hospitality venue that our good old friend Dan should
(06:16):
hit up to maybe engage with his app.
Yes. Yes. Like it's such an epic fail on so many levels.
Yes. Well, we're seeing a lot of those epic fails. And one of those epic fails is the
newly released updated on the pricing arrangements and pricing limits.
(06:37):
Oh yeah. What a shit show, Sam.
Yes. That's definitely a term for it.
So the day when we get our pricing and limits and price arrangements document is the biggest day of
the year for everyone in the NTIS sector.
Or provider world anyway. Yeah.
Yeah. So, but they were late with releasing it. And a bunch of us sat in our computers going
(07:04):
refresh, refresh, refresh on the website until it popped up. But what did it pop up with, Sam?
It did, Sam. So let me tell you, they did increase some services.
Well, that's useful.
Yeah. So in early June, the Commonwealth government announced a 3.75% increase to minimum wage,
(07:32):
which is great. And that also affects everyone on the Shads Award, which is disability support,
includes disability support workers. So the NDIS had to increase their cap,
but they increased it by just slightly less than that, which is 3.19%. So yay?
(07:58):
Yeah. This is not great. Historically, we and providers in the sector are
struggling to maintain operational and viability, essentially, or profitability,
although we don't necessarily like using that word in the sector. But that's what business
(08:21):
owners need to ensure that we can reinvest into our staff, into our service, into our operations.
So then we can increase our quality, increase our service deliverables and offerings to our
participants and ultimately serving the participants that we work with. But we are seeing more and more
doors close, more and more service, biggest service providers as well, kind of stepping out of
(08:48):
SILs, SDAs, support coordinations are dropping off. Yeah, it's a bit of a rocky road and having the
the increase on certain services, less than what the actual increase for award wages is,
is not a good thing for business profitability and viability. Because if we're going to talk
(09:11):
about sustainability, which is the big thing about sustainability, if we don't have sustainable
baselines in businesses, those businesses are going to close the door and where the fuck does
that leave stability and where the fuck does that leave sustainability for participants to actually
receive the supports they need. Let's not even, and that's just in main geographical locations,
(09:35):
so like big cities, let's not even, let's not even talking about your remote, your regional areas
that are struggling, that don't have staffing in there in the first place. And a lot of those
people actually have to increase their pay rate quite substantially more to make that more
attractive. Yes, there are some benefits and perks for doing so, but it's still a fucking shit show.
(09:58):
Yeah. So they also increased the cost for psychology, nursing and behaviour support.
So that's weird. What they left with no increase for the fifth year in a row, people.
Hold up. No, you're not going to say the words out of your mouth because they wouldn't hold that back
(10:23):
for a fifth year. For the fifth year in a row, they have left support coordination at the same
price. They have left plan managers at the same price. They have left allied health professionals
at the same price. There are so many allied health professionals as well that are finding it
(10:51):
harder and harder. It is becoming really silly. The last big company I saw decide to close their
doors on support coordination is the Benevolent Society, who have hundreds of support coordinators
and they're ceasing their support coordination service. They're keeping the rest of what they
(11:14):
do, but they're ceasing support coordination because there's no more viability in being a
support coordinator. No. I've got a peer down in South Australia in the Adelaide region called
Brendan Gale. He does a lot of work in this area and he is a super smart person with figures.
(11:40):
He's done this really interesting insight and kind of a cost analysis of support coordination,
breaking it down as to how much it costs per award. The allocation funding is per hour and how a
business kind of would break that out. He's kind of come up with the figure of that to actually
(12:01):
run a support coordination service and providing by the hour is actually $113 an hour, which is a
$12.87 deficit. That gets for anyone that's actually interested in numbers and how it all
kind of break down. The cost per hour worked is allocated at about $65.20. Non-chargeable time,
(12:26):
this includes team meetings, supervision, learning and development, business development,
pro bono work, which let's face it, I'm pretty sure this is a very conservative number here.
Breaks, thinking time, because let's face it, when we get stuck on a participant, it does take up
quite a lot of time to actually sort of go stop, take a break, step back and think of a solution
(12:49):
for that issue that that participant is having. That brings it up to $79.73 an hour. That brings
the total wage cost per support coordination chargeable hour to $79.73. Now we get into
overheads, which is everything else the business needs to run, including our IT services, admin,
(13:12):
compliance, HR, finance. That then brings it up to $104.85. I reckon this number is a very
conservative number when you think about the different pricing in IT and different operational
components. So yeah, at $104.85, now we want about the agency kind of has a 8% margin point on that.
(13:37):
So that's $8.39. So bringing that up to be a viable point of $113.24, which is not what the amount is.
Yeah. And it has meant a real world cut to how much you can pay support coordinators
and everyone else who didn't get a raise, the plan managers, the allied health professionals.
(14:02):
Because there's inflation and cost of living issues. And for the fifth year in a row, it hasn't moved.
No. So they're not just squeezing support coordinators, they're squeezing a whole bunch,
a whole big sector of the scheme. Yes. And hopefully where the powers at be are continually
(14:29):
listening to this, but it does bring in a great uncertainty, a lot of confusion. And let's not
even start to talk about how the agency themselves is handling support coordination within plans.
Because that's a different, completely different conversation. And I'm not even sure that half the
planners or the agency staff really know what they're going on. Because from what I'm hearing
(14:49):
from my clients that I work with in the support coordination field, there's polar opposite
information coming from the agency from, yep, cool, here's a nice plan, a healthy plan for support
coordination and healthy service provisions, or to be outrightly flat out told by an agency delegate
that support coordination will never be considered in this person's plan prior to them actually
(15:13):
making decision on the plan in the first place. Yeah. It's a total and utter shit show. It seems
like no one at the NDIA gets training anymore because they've just, they seem to have put out
a communication to planners that just says cut support coordination as much as humanly possible,
(15:38):
even for people who still absolutely need it. Because part of the issue is that LACs don't go
out to people's homes. Or really have a sit down face to face anymore. No, it's not.
We'll discuss this at this point as well many a times throughout some of the past episodes. And
(15:58):
we're still not seeing any of this change. Even though we've got the whole NDIS review, the NDIS
review, the Disability Royal Commission, we've had lots of reviews happen. And now we've got an act
as well that's come out recently that is all of this is so contradictory. And then the actions
(16:21):
of the agency, the ministers and government officials that are ultimately decision makers
in this whole entire process still can't even come out and tell us what they're accepting from
any of those reviews in the first place. It's like, let's get some more task force going. Let's get
some more input going. Let's have co-design and co-facilitation with peoples with a disability.
(16:42):
But at the same time, we're going to get those advocacy's in to consult on those pieces of work,
get them to sign a non-disclosure agreement and have everything handed out at five o'clock
on a Friday afternoon and expect there not to be backlash. That's true. But let's get back to the
PAPL. So there's been a slight change to short notice cancellations. So if you have a support
(17:04):
worker, the short notice cancellation is still seven days. So they didn't change on that,
which I find a little bit annoying because no one knows if they're going to be sick in seven days.
It's just frustrating. So the new rule that has come in is that allied health professionals
only have a two day window. So you have to give them them two days notice. That's where the change
(17:31):
is. So anyone who's under capacity building now only has two day cancellation, whereas they used
to have the whole seven days like support workers. But that's changed. There has been the removal of
the TTP. Finally, which needed to happen. Condensed price guide. Yes. And it's so much easier to read.
(17:59):
It's so exciting. For those non-providers out here and non-provider listeners, the TTP item is a line
item that used to be used in from the when the NDIS first got introduced to help those providers
that were initially providing supports before the rollout to transition their funding mechanisms from
(18:21):
what we used to be called originally block funding into the NDIS model. And there was a bit of a gap
between that. So those providers kind of needed to be able to essentially be enticed to jump over
is ultimately the point. Let's face it. So then they were able to use those TTP guidelines to
sort of move into the NDIS. And that was a very long time ago and made the pricing arrangements
(18:45):
and pricing limits a very confusing document to read sometimes and try and find exactly which line
you're wanting. Because there was a lot of like irrelevant lines that actually only applied to a
very small handful of providers there. Yeah. So I'm glad it's gone. Plans will be indexed to allow
for the higher cost of support work. However, it may take time. So just don't yell at your plan
(19:15):
manager just yet. Just give it a couple of months. And if you still not seeing your plan indexed, then
talk to the NDIA. But the idea, what they've said is they will absolutely be indexed.
So indexation, Hannah, what are we talking about here?
(19:37):
So that means that if you, for example, you were funded for eight hours of support a week. Now,
they still want you to have those eight hours of support a week, but the price of those eight hours
has increased. So they are going to put that amount of money that you're going to now pay
(20:02):
the extra amount of money into your plan. Yeah. So essentially you're not losing out on the
support hours that were originally within the intent of your plan at the starting point when
it was created. So that's just to help with those smaller changes from the provider fees, which
weren't around when your plan may or may not be first created.
(20:22):
Now, Sam, as a support coordinator or, you know, previous support coordinator, but probably always
a support coordinator in my heart, you may or may not have noticed that meal preparation is a weird
bit of the pricing arrangements and price limits document.
(20:44):
It's never been something that's been explicitly clear. And I have seen it used in so many different
ways, shapes and forms, and probably not within the right guidelines in the first place. But what has
changed? So for a little while, because of those people who were maybe not using it correctly,
(21:08):
it went to a stated line item. So what that means is it had to then be stated in your plan that this
was a thing you could have. Then there was a lot of backlash. So they decided to make it not a stated
item. So then anybody who had core funding, provided you had enough budget for all the things
(21:32):
you wanted to do, you could have meal preparation. Now, the main thing is that you can't just
now they've put the caveat in that bit of the papal that says that while it's not a stated item,
it must be stated in your plan to be able to use it. Which means it's a stated item.
(21:57):
Yes. So, da fuck?
Like, just make it a stated item then, like it makes no sense.
Well, it goes, oh, we got backlash. So we're going to change something, but we're not going
to fundamentally change it in any way, shape or form. And the problem with this specific point
is that there are lots of planners that don't actually do a great intent statement on the core
(22:24):
budget in the first place with the idea of what they're meant to be using. Some are fantastic at
it. Some give you like a dot by dot point of what they intended on how they came to that figure.
Now, some are like half a sentence. And with removing it from a stated support,
kind of removes that thought or the onus on the plan and to go, what are we going to add in on
(22:48):
from stated supports in it? And so that's removed, removed like that kind of process internally
there. So they've got to actually be proactive or a participant has to be proactive in insisting
that it's there in the first place.
Yes, because plan managers are refusing to pay it because it doesn't state explicitly in the plan
(23:11):
that this is that meal preparation was considered when they made up the funding.
Yes. Well, good job, NDIA.
Painful.
So that takes us to the bill.
Oh, yes. Yes, yes, yes.
So the wonderful NDIS bill amendment, which is apparently meant to be getting the NDIS
(23:36):
back on track following the NDIS review and everything else and public consultations.
But as I said earlier, at the start of it, there wasn't much open public consultation.
In fact, the people that were consulted on it, as I said, were instructed to have to sign
non-disclosure agreements, meaning that they could not say anything to anyone about anything
(23:57):
up until the point it got released. For anyone who'd been hiding under a rock for the last
four months, it has had the biggest shit show of effect nationwide, not just within the sector,
but on the national scale of how we go about treating people with a disability.
(24:19):
And let's not forget the talking points of the minister, which is the grand old line,
nothing, we won't do anything without you or nothing for us without us, that he keeps on
emphasising that it's all about co-design, that it's all about ensuring that nothing is going to
happen that's going to have a detrimental impact. But...
(24:41):
So Every Australian Counts is a grassroots campaign to bring on the NDIS. So years and years and years
ago. Nowadays, Every Australian Counts is a body of primarily participants and families
(25:03):
who try to make representations to the minister about things they think are wrong or right,
these sorts of things. So I went on to the Every Australian Counts website, and they have broken
down some of their concerns with the bill. So the first one is with the co-design that you have
(25:26):
spoken about. The bill now requires the minister to consider co-design principles, but it doesn't
make this a legal requirement. So they could just sit there and go, I considered it, and I
decided against it. Let's go have a cup of tea while we consider it and we'll come back and
(25:47):
do nothing about my consideration. Yeah. So that's the first concern they have with this,
because Every Australian Counts is looking at the long-term effects of this bill and knowing that
the government can change and government ideas can change with new governments, even in like,
(26:12):
you know, 20, 30 years time. And so having it explicitly stated in the bill that they must
do co-design rather than just consider it is a big concern.
Because with the amendments that are being proposed, it opens a floodgates for a lot of
(26:36):
things to be set in rules. And rules are not necessarily legislation like the NDIS Act,
it's supporting documentation in how to operationalise and implement parts of the Act.
In some of these rules, what we've got in this amendment is references to lots and lots of rules
(27:01):
that is all, those rules are meant to then kind of engage with community, engage with people with
a disability, engage with advocates on co-design on those rules. But that only needs to be considered
based on that point that we've just discussed. And if you consider what we had previous, for the
(27:26):
seven years prior to the current government, that's concerning AF.
Well, exactly right. And that's why Every Australian Counts is raising this as a concern.
And then the next few. So the next point is about a whole of person approach.
The bill may not fully account for people with multiple and interrelated disabilities,
(27:54):
which could lead to inadequate support. So at the moment, the NDIS is supposed to,
and I say supposed to because very often they don't, it's supposed to consider the whole person
and all of their disabilities when people have multiple disabilities. But this amendment says,
(28:17):
don't worry about that. We're just going to focus on the primary disability, which is ridiculous.
But wait Hannah, wasn't there conversation at the start of all this that primary and secondary
disabilities were going to be scrapped? Well, you know, I think Bill Shorten talks a good game,
(28:47):
but he doesn't walk that walk. It's not.
From what I've seen. No. And when the NDIS review dropped, I was
cautiously optimistic, but very positive about it with the caveat that my biggest concern
was the implementation. And I think my concerns are, concerns are starting to become more
(29:13):
concerning than what they were initially, especially with what we've discussed so far.
More so now that Bill Shorten is going after the rights of people with a disability to engage
with sex work. Even though Bill Shorten initially opposed the changes that Peter Dutton and the
(29:39):
then government were trying to do when they were wanting to squash this. And let's not even,
and let's not even, like from what I understand, it's a 0.12%.
Yeah. It's something like 104 people in the whole of the scheme accessing sex workers with
their funding. Yeah. The minister is just really convoluting everything at the moment, throwing
(30:04):
stuff around like about this, let's get rid of it. Going after support coordination, going after
dodgy providers and blank, broad spectrum blanketing it. Like it's almost back a year and a half ago
when we had the ledger boat yacht problem. Just what is going on?
(30:27):
Well, my dear Sam, it gets worse. So the next one is about the right to a new assessment.
So the bill lacks a clear provision for participants to challenge or replace needs assessments they
find inappropriate. So what they're going to do is bring in these needs assessments, which are-
(30:50):
And it's not the independent assessment, is it?
They absolutely are. It's an independent assessment. It's just called a needs assessment
this time. And you can still review and appeal the funding that you get, but you cannot appeal
(31:11):
and refute the actual needs assessment itself. That will be set in concrete. And what if you
just happen to have someone who is incompetent or didn't quite understand what you meant?
Or didn't care to understand in the first fucking goddamn place.
(31:32):
Right. So to me, not being able to challenge what is put in the needs assessment is a huge problem.
And I think we absolutely need to fight this. I mean, we need to fight all the points,
but to me, this is a very scary one.
(31:53):
100%. And anyone that lived through the independent assessment days, we're bringing back
severe trauma-inducing mechanisms that were heavily fought against.
Yeah.
Heavily fought against. I was listening to an episode of Reasonable and Necessary where
(32:20):
we had, where Dr. George had Senator Steelejohn on the podcast and talking about these exact
points as well. And this is probably the biggest frustration point that Senator Steelejohn had
about all the amendments. And quite frankly, he couldn't actually give a, there was about
a two minute pause where Dr. George asked Senator Steelejohn if he liked anything about the act.
(32:44):
It was quite the uncomfortable, awkward silence of arms and arms. And there really isn't anything
that sounds good, looks good or feels good about any of this. And so much so about the assessment
points, because as we said, we might have the assessor could be having a bad day. The assessor
(33:10):
could be a complete and utter dimwit. There's nothing good about this.
No.
Fuckity fuck, fuck, fuck. Honestly, there's really not much more to say on it. Besides,
what's the next fuck you're going to throw at me?
Yeah. It's going to be information requests. The NDIA still has broad powers to request
(33:35):
information and mandate medical assessments, which could be problematic.
Yes, because isn't this meant to be about disability, not medical?
Yes. Well, absolutely. That's one thing I'm confused about.
Is that kind of like my insurer asking if I've got any pre-existing conditions that might
(33:57):
affect my ability to get insurance or have a lower premium rather than paying exponential amount?
Well, it's funny you say that because it is an insurance scheme.
Well, yes, it is. But in the insurance world, they actually have prohibited insurers from being
(34:18):
able to use some of this information to grade how they provide their coverage. So what is the
minister and the rest of the pen pushing bureaucrats and red tapery think that that
would be appropriate if they're saying no to insurers doing this on one hand, but hey,
we're running an insurance scheme. Maybe we should take a leap of what we're telling everyone not to
(34:43):
do. The other thing is that you have to supply so much information to them when you apply to get on
the NDIS. So at what point have you supplied enough information to the NDIA? At the point that maybe
the delegate opens up the folder that all your documents are in and maybe actually read one of
(35:08):
them in the first place, not just ask you for another document that has already got the same
information on a document they've already got, but that would imply some foresight on the agent's
views behalf to actually read the fucking information they have in the fucking goddamn
first fucking place. Well, yes.
Although, mind you, I will say I don't necessarily disagree with the timelines on this.
(35:30):
Where there's some precaution and understanding that maybe there's not everyone a doctor is going
to be able to see everyone in the short term, but at the same time, there are people that are
outrightly using and abusing the scheme for ill-content. Sure. So go after them. Yes.
Like the problem is that the number of people doing that is so minuscule that it doesn't
(35:57):
warrant being heavy-handed to everybody just because of a tiny, tiny fraction of people
who are doing the wrong thing. It's really not like the media would have us believe that it's
so widespread and it's so ridiculous and everyone's buying drugs with their NDIS.
(36:20):
Everyone's getting hookers and escorts.
It's just not happening. That's not the...
I can see some of the validation from a compliance and legislative point of view as to have actual
timeframes. Because if where the agency asks a provider for information, they have timelines
(36:44):
on it. If the provider's not... If we're coming up to registration and providers come up to
registration and they can't be bothered to call an auditor and book in a date, then they
don't necessarily deserve to get their registration renewed because they're clearly not following
their requirements to be a provider in the first place. At the same time, if a individual
is wanting to access the scheme, then there is an onus on them to get the documentation
(37:09):
together in a timely manner. Though at the same time, I would really like to see those
timelines kind of reverse back and increase the customer... The participant guarantee from
the agency on timeline reviews and maybe actually fucking hit the benchmark in the first goddamn
place before you go putting the onus on participants to get stuff in on time when the agency can't
(37:32):
follow their own timelines in the first place. Yeah, when they're taking, you know, 9, 10
months to get reviews through at the moment, it's... That's if they were even considerable.
Yeah. OK, last point on this bill is limits on support and spending. The bill gives the
(37:53):
NDIA wide authority to control how participants use their supports and funding, raising concerns
about participant autonomy. When I first started reviewing the Act or the amendment, sorry,
this... There was a line that was the biggest concern out of everything, which I don't have
(38:19):
it in front of me, so please forgive me, I'm not going to be able to get this word for
word. But essentially, the idea was that the decision maker could state the service provider
and the person to deliver that support. So if someone was on such a tangent that they
wanted to... Or a power trip within the agency, they could go to Joe Blow and go, hey, Joe,
(38:44):
we're going to give you all of this support, but you can only receive this support from
this one person, no one else, or from this explicit provider, which ultimately kills
choice and control, kills autonomy, as you said, and limits and restricts an individual
choice on who they receive the support that they're needing to live their everyday life
(39:08):
and improve it. Which to me is... There are lots of words and I don't know which one to
choose, but it's a fucking joke. The audacity of the government to think that they have
the right to decide not only what constitutes an NDIS support in the first place, well,
(39:33):
look, there could be arguments on how to deal with that because there are a lot of providers
that call themselves NDIS providers that is very questionable if it's actually a disability
support or not, but that's beside the point. If I need physiotherapy, I should be able
to go to any physiotherapist and receive that support. I should not be told that I have
to go to physiotherapists are asked and go see Janine physiotherapist for my support,
(39:59):
and that's all I'm allowed to do because that's so ridiculous of a thought that it's not funny.
And then my question would be is how did Jane physiotherapist actually get in through the
pockets to try and get that kind of leverage in the first place? Or what does the planner
(40:22):
know about Jane that they think they have a right to make me go see Jane if I'm getting
supports from a physiotherapist? Yeah, and it's very paternalistic. The government
thinks that all people with disabilities need someone to be over them and making decisions
for them because people with disabilities can possibly make their own decisions and
(40:47):
make the right decisions. Well, it almost starts to look when you put it in this kind of context
that they might as well just write it as in the new way that the government's going to
become guardians and administrators for everyone on the NDIS sector. It's not good.
No. So one thing, another document I found in recent days is that the Disability Intermediaries
(41:15):
Association has put out a joint statement with the National Disability Service, Allied Health
Professionals Australia and the CEO CoLab to discuss the concerns about the disability
sector and the market failures. So I'm going to read this to you and you tell me what you think.
(41:43):
Tell me what you think. So this is the joint statement. An alliance of peak bodies and
organisations across Australia representing all parts of the disability service sector
is calling on the NDIA and government to take urgent and immediate action to ensure
services for people with disability can continue as evidence mounts of a catastrophic market
(42:08):
failure in the NDIS. Withdrawal of services will most affect participants who have the greatest
need for supports, those with complex high intensity or behavioural support needs and those
in regional and remote Australia. Following the recent announcement of a totally inadequate
(42:33):
annual pricing review by the National Disability Insurance Agency, provider representative
organisations are raising the alarm that providers of quality and responsive disability services
are already reaching breaking point. Since the pricing announcement, an increasing number of
(42:56):
providers are saying that they will not be able to continue providing supports to people with
disability. The wellbeing and safety of people with disabilities must come first, but inadequate
funding for quality services is putting this at risk. Quality providers are committed to ensuring
(43:17):
services remain available to people with disabilities but can no longer afford to subsidise the costs.
Financial reserves often built up over decades with the support of local communities are dwindling
as providers struggle to make ends meet. The NDIA's approach to pricing is undermining the ability
(43:42):
of registered providers to deliver quality, sustainable disability services and is undermining
NDIS reform. The organisations called for immediate steps to address the crisis in the disability
service sector, including increasing prices for support coordination level 2 and 3 and therapy at
(44:07):
least in line with wage increases in the disability support worker cost model. Reinstate high
intensity payments for behaviour support. Oh yeah, that was something we forgot when we discussed
the PAPL was that they've changed, you know how we've got standard and then high intensity.
(44:28):
So now you can't charge high intensity just because of behaviour. There has to be something
else that's happening to charge high intensity. Yeah, because that always happens.
Which decreases the number of people who want to provide supports to people who have extreme
(44:51):
behaviours because now they don't get the compensation that they potentially need
because also there's a lot of training that goes into those support works.
There is so much training, not to mention the regulation and paperwork on this because
generally speaking you've got restrictive practices in there which then has a work to do with
(45:13):
a world of pain for a provider dealing with implementation, reporting and handling that.
Not to mention the rate of turnover for staff in these sectors. I feel sorry for any parent
with a child that has high needs on the spectrum or any kind of non-physical
(45:36):
attachment to this because I work with quite a number of providers that deal with really
challenging behaviours that are borderline about to be thrown into the child care system,
child protective services. Not because the parent doesn't want to be the parent there,
it's because the behaviours are so intense that the parent can't be a parent.
(46:01):
Yeah. And these support providers are the last stop gap before throwing a child
into the juvenile justice system and throwing them into a world of pain for the rest of their adult
life to hope and dumbfounding. Yeah, it's pretty fucked. They want to implement a loading for all
(46:27):
registered providers of at least 1% which is kind of bringing back TTP but...
Look, it would settle a bit of the argument on why registered versus not registered providers
and have a bit of, I don't know, silver lining at the end of the tunnel for some providers that
(46:50):
have forked out tens, twenties, lots and lots of thousands of dollars to build a system
that has determinable metrics around how you define quality, how you ensure safe provision of
safe services, building your staffing up. Because it, although mind you, non-registered providers
should be doing that in the first place as well, but sometimes I see it as not a necessary thing
(47:18):
if they're not registered. So my concern is that even when the TTP was first introduced,
even when the TTP was a thing, the NDIS often said no, they wouldn't give extra funding just
because you're with a provider that charges TTP to cover that extra because they're like,
(47:42):
but it's a choice of you to go to them. So to me, that doesn't encourage people to go
use registered providers if that's what the NDIS is hoping that people will do.
Well, we need to point out that this is from the group, not necessarily from the agency. So
my concern in that would be, as you said, how that actually gets implemented, whether or not
(48:06):
there is kind of a bit of an adjustment for it. And then the other question would be is,
is it only restricted to agency managed participants or is it available to a self-managed
participant that's using a registered provider and then does it get at Kelo? But this isn't from,
this is just advocating for it. Right, right. This is that joint statement from the DIA,
(48:34):
NDIS, AHPA and the CEO CoLab. So just remembering this isn't our thoughts either, this is just
something from this joint statement, but it is interesting to think about and consider
these thoughts. They go on to say, these first steps are essential to getting the NDIS on the
(48:57):
pathway towards a financially sustainable model of service provision. Statements attribute to
supporting organisations. The NDIA's pricing decision is simply indefensible, keeping price
limits fixed for half a decade. Despite inflation, award wage increases and operating cost pressures
(49:20):
is irresponsible and reckless. This pricing decision has already resulted in the closure
of safe quality and skilled service providers. Mr Jess Harper, Chief Executive Officer of Disability
Intermediaries Australia. We knew the impact of the annual pricing review would hit the sector
(49:40):
hard, but the feedback we've received from providers shows that it's been catastrophic.
NDIS has been overwhelmed with providers saying they are reconsidering their future in the sector.
Laurie Lee, Chief Executive Officer of the National Disability Service. We know that our speech
(50:03):
pathologists, occupational therapists and many other types of allied health professionals are
deeply committed to supporting NDIS participants to live the best lives they possibly can to the
extent of personally absorbing some of the costs the NDIS refuses to pay for and the increased
(50:24):
expenses due to the cost of living. But after five years of not even so much as indexation
of therapy support pricing against inflation, our sector has reached breaking point.
Bronwyn Morris Donovan, Chief Executive Officer of Allied Health Professionals Australia. The CEO
(50:45):
CoLab is extremely concerned by the recent annual pricing review, seeing this as the major loss for
participants and registered providers and forcing many reputable providers to cease services.
We call for the reinstatement of high intensity payments for participants with complex behaviour.
(51:07):
There you go.
Well, I think that neatly re-illiterates my tangent at the start quite well. But then again,
with those organisations involved, you would certainly hope there was a lot more literacy to it.
Yes. They say it so much more eloquently.
(51:28):
Yes. Well, I am a bit of a self-progressed bogan, so fuck it.
Sure. But yeah, it's a very perplexing time in the sector. And I just don't understand
(51:50):
how we've gone through four years of royal commissions and disability independent reviews.
And reviews into support coordination and reviews into plan managers and reviews into
supports. And like, we've had the reviews, it is now time to like just do it. And they're not,
(52:14):
they're not even saying their responses.
This is when one of the town halls at the start, just after the review, I think it was the
Brisbane town hall with Bill Shorten. He was that that was his point. Let's stop the reviews. Let's
get into doing it. And it's like he started to get into doing it, but decided to forget everything
(52:35):
about that was actually in the reviews that came out about the disability review,
the royal commission and making people making choices about group homes.
Absolutely. And that's that's my concern. And that's my problem with what he's doing,
because he hasn't even come out and said, Yes, we're accepting this recommendation or that
recommendation. He's just gone off half cocked to say these dumb things.
(52:59):
Under the guise of, oh, we need to have this amendment done so we can actually implement
the stuff in the in the review in the first place. But I'm not going to tell you what we're
going to accept. And we're not going to actually wait for any state government to come out and say
what they're going to accept. We're not going to wait until we actually have an official statement.
Let's just get the ball rolling and get in and do it because we've had enough of reviews.
(53:24):
Minister Shorten, have you actually listened to anything that came out of the reviews in
the first fucking goddamn fucking place? Because we do not see it.
Not that exactly.
We want to and go back to the episode just after the NDIS drop, because I was all supportive for
this. But fuck it all. Eat my words.
(53:48):
Yes. And I had to fight you on it because I was like, no, man, this is not good.
I am very upset. Not well, I'm disheartened.
Yeah.
Because there was so much work done by so many people with such good intentions.
I'm not too sure about some of the chairs on the NDIS review, because quite frankly,
(54:11):
some of the language seems like they were roped into this idea from the very beginning.
And Minister Shorten was being a little bit backstabby in trying to force this point
from the get go.
Yes.
But there were a lot of people that were involved in it that really,
fundamentally, truly hoped for some. And look, a lot of the recommendations out of the review
are actually fundamentally quite good. Not all of them.
(54:34):
I said some.
Yes.
I said some, Hannah. Not all. There are some good things out of the review.
But with our understanding what our government is actually accepting in the first place.
And fundamentally more, and this is our shout out to you, Sue Grier,
how they're balancing the disparity between the NDIS, sorry, the Disability Royal Commission,
(55:00):
and their response and recommendations around group homes versus the Bruce Bonahady NDIS review,
practically forcing us into it.
Yeah. Yeah.
I can understand Professor Bonahady's kind of logic and the math behind what he's saying.
Sure. That's paper. What we heard out of the Royal Commission, and if anyone has actually
(55:28):
gotten their hands on the Royal Commission and go through the volumes of supporting documents and
the testimonials, the shit in that is fucking heartbreaking.
Yeah.
And how have we not listened to it? Is gobsmackingly,
pulsatingly, infuriating and saddening. And I don't know if I can say it in any other words.
(56:00):
I'm actually pretty sure there's a lot more forceful words I could say.
All the swear words.
I think we've hit the new record of F-bombs and other words in this.
Yes.
But yeah, hopefully we might have some good news on our coming forward on our next news episode,
but I think it's definitely a watch this space.
(56:20):
Yes, absolutely. But thank you so much for listening, and we hope you got something out of
this informative episode.
And I won't be signing off this episode with my normal line, but let's just keep our,
the good line of let's keep our thoughts and prayers.
(56:41):
And we'll see you later. Bye.
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