The National Disability Insurance Scheme (NDIS) needs a good dose of risk and compliance

Some background

The NDIS is a healthcare program initiated by the Australian Government for Australians with a disability. The Bill was introduced into Parliament in November 2012 by then Prime Minister Julia Gillard, and passed in March 2013.

The recent 2017 Budget announced the government’s intention to fully fund the NDIS with a 0.5% increase in the Medicare levy from July 2019. This would increase the levy to 2.5%, resulting in $8.2 billion to be raised across the budget period.

Federal Treasurer Scott Morrison indicated that this new approach of plugging the funding gap reflected the belief that funding the NDIS is the responsibility of all Australians.

“An NDIS will give all Australians with a significant disability the peace of mind to know that their care and support needs will be addressed, no matter where they live or how they acquired their disability” (then PM Julia Gillard)

NDIS should heed the lessons of the “pink batts” scheme

A major government initiative that involves handing out large chunks of funding would certainly attract the attention of service providers, including ill-qualified “wannabes”.

Like the “pink batts” scheme (the government’s Home Insulation Program), the NDIS involves putting substantial funds into a supplier market with inadequate capacity to meet demand. Further, it relies on existing state regulatory programs to ensure oversight of quality assurance and safety standards.

The problem

The problem is summarised here:

  • Supply (service providers) possibly insufficient to meet demand (NDIS participants).
  • NDIS’s great attraction (via it’s massive funding injection) will result in many service providers jumping onto the bandwagon (making it hard to spot the ill-qualified and unsuitably-resourced providers).
  • Relatively low barriers to entry may result in service providers without the appropriate skills and experience getting into the system.
  • The governance and control framework at the national level to ensure safety and quality standards are met is not yet fully in place and will take a while to get embedded.
  • The transition to full Scheme (i.e. NSW by July 2018 and the last batch of states by July 2019) means that some aspects are to be handled by the states and some (national) aspects by the federal government within the transition period. States will need to ensure there is sufficient funding for them to sustain an adequate level of oversight within the transition period.

A great step forward – NDIS National Quality and Safeguarding Framework

On 3 February 2017, the Council of Australian Governments (COAG) Disability Reform Council released the National Disability Insurance Scheme (NDIS) Quality and Safeguarding Framework.

This Framework sets out the key functions of the national quality and safeguards system to be implemented for the full scheme NDIS, including roles and responsibilities. The transition to a full scheme NDIS in NSW will be completed by July 2018. Transitional quality and safeguards working arrangements (states) will apply during the transition period.

Implementation of the Framework is overseen by the National Disability Insurance Agency (NDIA).

Governance is needed on both the demand and supply sides

Demand side – properly qualifying applicants to ensure funding goes to the people who need it most and thereby, controlling the demand.

Supply side – a robust process to onboard service providers and to ensure they have an adequate safety, risk and compliance framework to ensure the above-mentioned Framework is duly met and an ongoing oversight of their compliance and performance is conducted.

A horrific story

I heard on a radio breakfast show a week ago that an intellectually and physically impaired lady in Sydney was sexually assaulted by a middle aged man of foreign descent. She was cared for by four NDIS carers and when she told them about the incident, they failed to report it. Unfortunately, stories like this make NDIS participants highly vulnerable and issues may never come to light.

Separately, I heard the former Prime Minister Tony Abbott on the Ray Hadley breakfast show on 2GB this morning talk about NDIS. Specifically, Mr Abbott emphasised the need for robust governance on both the supply and demand sides.

NDIS needs a good dose of Risk and Compliance to be successful

In terms of supply-side compliance, a successful implementation will need to involve the following (List is not exhaustive):

  • States’ Transitional Quality Assurance and Safeguards Working Arrangements – Clearly communicated to service providers. (and further down the road – a clear and well-planned transition from state to national arrangements).
  • An accreditation process properly implemented to ensure only suitably-qualified service providers are on-boarded onto the NDIS program.
  • New and existing service providers seek expert help to ensure their processes are compliant with the standards stipulated by the above Working Arrangements and the state (and later national) quality and safety framework. For instance, a readiness review should occur for new service providers to ensure they can meet all key obligations upon commencement of their operation.
  • Service providers to engage compliance experts to continually self-assess the effectiveness of their controls to ensure they remain in compliance and key risks are mitigated. Where issues are found, they should be rectified in a timely manner.
  • Service providers to have a robust recruitment, induction and training program to ensure the carers are (and remain) well qualified to discharge their duties at all times.
  • Service providers to have an effective incident management process in place to ensure incidents are detected, reported, assessed and followed through. It would also be best practice to ensure near-misses are logged and rectification measures to be taken where required (e.g. staff training).
  • Service providers to maintain a complaints register to ensure participants / customers’ complaints are appropriately handled and done so on time.
  • Service providers to ensure there is adequate record keeping at all levels (e.g. in the field with customers) to ensure any history or facts are kept for future reference and can aid in any investigations where required.

Final comments

The NDIS is a truly noble initiative by the government to ensure care and support is given to Australians who have a significant disability and cannot adequately care for themselves. It also serves as a prudent economic management measure.

Risk and Compliance professionals can play an important part in making the Scheme a well-run, well-governed and well-delivered program; one that will have a significant contribution to the community and society.

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