Ageing Disability and Home Care

Governance and Assurance

Prepared by KPMG

Prevention of abuse and safeguarding mechanisms in Ageing, Disability and Home Care

21 January 2013

ABCD

Family and Community Services

Distribution
Governance and Assurance
Chief Executive Ageing Disability and Home Care

Disclaimer

Inherent Limitations

This report has been prepared as outlined in the Introduction Section. The services provided in connection with this engagement comprise an advisory engagement, which is not subject to assurance or other standards issued by the Australian Auditing and Assurance Standards Board and, consequently no opinions or conclusions intended to convey assurance have been expressed.

The findings in this report are based on a qualitative study and the reported results reflect a perception of the NSW Department of Family and Community Services (FACS) but only to the extent of the sample surveyed, being a FaCS-approved sample of management and personnel. Any projection to the wider management and personnel is subject to the level of bias in the method of sample selection.

No warranty of completeness, accuracy or reliability is given in relation to the statements and representations made by, and the information and documentation provided by, FACS management and personnel consulted as part of the process.

KPMG have indicated within this report the sources of the information provided. We have not sought to independently verify those sources unless otherwise noted within the report.

KPMG is under no obligation in any circumstance to update this report, in either oral or written form, for events occurring after the report has been issued in final form.

The findings in this report have been formed on the above basis.

Third Party Reliance

This report is solely for the purpose set out in the Introduction Section and for FaCS’ information, and is not to be used for any other purpose or distributed to any other party without KPMG’s prior written consent.

This report has been prepared at the request of FACS in accordance with the terms of KPMG’s engagement letter/contract dated 6 July 2012. Other than our responsibility to FACS neither KPMG nor any member or employee of KPMG undertakes responsibility arising in any way from reliance placed by a third party on this report. Any reliance placed is that party’s sole responsibility.

Reference to review

Reference to ‘review’ throughout this report has not been used in the context of their view in accordance with assurance and other standards issues by the Australian auditing and assurance standards board.

Contents

1 Introduction 1

1.1 Purpose of this review 1

1.2 Project objectives 3

1.3 Project methodology 4

1.4 Structure of this document 5

2 Recommendations 6

2.1 Current strengths of the system 6

2.2 Recommendations for improvement 6

3 Summary of findings 10

3.1 The current operating framework 10

3.2 The nature of the care and support role 11

3.3 The nature of the disability support workplace 11

3.4 Workforce management 12

3.5 Reporting and responding to abuse and neglect 14

3.6 Practice management 17

3.7 Ombudsman proposals 18

ADHC Prevention of Abuse and Safeguarding Mechanisms

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ABCD

Family and Community Services

1  Introduction

Australia is a signatory to the United Nations Convention on the rights of the Person with a Disabilities Protocol which states that people with a disability have the right to ‘freedom from exploitation, violence and abuse’.[1] Responsibility for ensuring that these rights are safeguarded rests with governments, communities, and all citizens.

In light of sexual and physical abuse allegations that have arisen in Victoria, the NSW Minister for Disability Services asked the Chief Executive of Ageing, Disability and Home Care (ADHC), a division of the NSW Department of Families and Community Services (FACS) to initiate a review of the handling of matters relating to the abuse and neglect of people with a disability in NSW.

KPMG was commissioned to undertake a review of the prevention and response to abuse and neglect occurring as a result of the conduct of ADHC employees. While the focus was on ADHC’s capacity to prevent, and respond to, abuse and neglect in relation to the conduct of its employees, KPMG was also requested to engage with the NSW Ombudsman around proposals to strengthen current safeguarding arrangements more broadly, recognising that this is an issue of broader community concern.

1.1  Purpose of this review

ADHC is responsible for providing services and support to older people, people with a disability, and their families and carers, throughout NSW. ADHC regulates, funds and provides a range of disability support services, including:

·  Community access and therapy intervention

·  Supported accommodation including in home support

·  Respite

·  Attendant care

·  Home and community care

·  Monitoring of licensed boarding houses.

The core purpose of the review was to ascertain the adequacy of current safeguarding provisions, identify areas that may need to be strengthened and make appropriate recommendations.

The review was commissioned at a time of significant policy reform at the state and national levels and there is a need to consider the implications of these reforms from a safeguarding perspective.

1.1.1  Wider reform context of disability services in NSW

Person centred approaches seek to provide people with a disability with meaningful choice and control over the supports and services they use, how they are provided and by whom and this translates to autonomy and independence in daily life and is considered fundamental to self direction and the empowerment of people with a disability.[2]

NSW has made a key reform commitment to introduce individualised funding from 2013. Individualised funding attaches funds to a person, rather than a service and provides for direct payment for those who wish to manage a funding allocation.

The introduction of individualised funding in NSW will shift the dynamic between service providers and their clients. The level of control a person wishes to exercise may vary, but the option for self direction and management of a funding allocation will be available for those who wish that degree of control.

In parallel, at the national level, reforms to create a National Disability Insurance Scheme (NDIS) are being progressed.[3] The NDIS will utilise a social insurance approach to fund the long-term care and support needs of people with a disability in Australia. Similar to NSW person centred approaches, the NDIS is being designed around the concept of individualised support packages, potentially delivered as individualised funding allocations. While it is not yet clear how the NDIS will operate in practice, it has significant implications for the support and service landscape, including likely major changes to the role of states and territories in disability support and service provision.

From a safeguarding perspective, reforms to disability support and service provision, through the introduction of individualised models of support (state-based person centred approaches in NSW and/or the NDIS), have the potential to influence the risks and vulnerabilities experienced by some people with a disability. While the intent of the reforms are to advance the rights of people with a disability, there is potential in this environment of reform for the emergence of new risks and the need for additional safeguarding strategies to be developed. An obvious area of risk relates to the provision of individualised funding packages to be managed by people with a disability. While the risks are not yet fully known, it is timely for ADHC to review the current safeguarding arrangements in the context of these reform directions, and consider the need for any adjustments to improve safeguarding arrangements in light of the proposed new ways of providing support to people with a disability.

1.1.2  Protecting children and young people

The protection of children and young people from abuse and neglect – including children and young people with a disability is addressed through the state’s child protection system. Community Services (a division of FACS) the lead agency in this system, with statutory responsibilities for such matters.

The child protection system in NSW has defined roles and responsibilities for the agencies involved, and clear guidelines on how to report incidents, and suspicions of abuse and neglect. To report an allegation of abuse and neglect, a mandatory reporter or member of the public has to report a matter to the Child Protection Helpline. Reports are prioritised and allocated to a Community Services’ case worker.

If a reporter is unclear as to whether a situation necessitates reporting, there are support options available outside of the Helpline. The online Mandatory Reporter Guide (MRG) provides reporters with a process that can determine the level of risk that a child or young person may be in depending on the information provided to the tool and, as such, the necessity for reporting. For specific Government agencies, child well being units can be contacted to discuss whether a case should be reported, and the outcomes of using the MRG for a case. Individual agency protocols and procedures can also be referred to.[4]

Significant aspects of the reforms to the child protection system in NSW focused on supporting changes to the threshold of risk for reporting – only cases where there is a significant risk to a child or young person are required to be reported. Incidents of abuse and neglect that do not meet the minimum risk threshold would not be reported.

1.2  Project objectives

The objectives of this project are to:

·  Gain an understanding of current activity related to the prevention of abuse for people with a disability

·  Consider contemporary safeguarding practice to prevent, identify and respond to allegations of abuse with a focus on vulnerable individuals and environments

·  Explore opportunities for immediate improvement from a policy, procedures, information and education, skill and capability perspective

·  identify new or additional vulnerabilities that will require safeguarding mechanisms

·  Understand current screening procedures and their adequacy

·  Explore key findings from prior investigations that may inform policy and practice improvements for identifying and responding to allegations of abuse

·  Provide a report documenting key findings and providing recommendations for improvement to the existing system and advice on potential safeguarding mechanisms to support prevention of abuse.

1.3  Project methodology

The methodology for this project included:

Stage 1 - Desktop review:

·  Targeted scan of contemporary literature on the nature of abuse and neglect of vulnerable people, and safeguarding approaches and practices within Australia and selected international jurisdictions.

·  Review of ADHC’s organisational documentation relating to the prevention and handling of allegations of abuse and neglect of people with a disability, across the full range of ADHC operated services.

Stage 2 - Consultation:

·  In depth (one on one) interviews with key ADHC business units and individuals, with an understanding of the current settings and practice around the prevention and handling of allegations of abuse and neglect.

·  ADHC stakeholders were nominated by the FACS project sponsor and include:

-  ADHC Divisional staff

-  ADHC regional directors and regional program managers

-  Businesslink

-  NSW Ombudsman

-  Peak disability organisations.

Stage 3 – Analysis

·  Analysis of the information obtained through Stages 1 and 2 to inform the overall findings and formulation of recommendations.

Stage 4 – Reporting

·  Preparation of a report to bring together the key themes in order to make relevant recommendations for adjustments or improvements, including any new or additional mechanisms that may need to be considered as part of a broader safeguarding framework developed in the context of person centred reforms and the implementation of a NDIS.

1.3.1  Limitations of the methodology

As part of this engagement, KPMG conducted interviews with a number of ADHC staff and a limited number of external stakeholders selected by the project sponsor.

The stakeholders consulted comprised senior ADHC executives, senior ADHC staff drawn from a number of policy and program areas, ADHC staff with experience in service delivery and staff management. The external stakeholders selected by ADHC for interview included the NSW Ombudsman and a representative of the National Disability Services, the Disability Council of NSW and the NSW Council for Intellectual Disability.

The comments and views expressed during the consultations are recognised as the perspectives and opinions of individuals. The consultations did not include people with a disability who receive ADHC services, family members and carers, frontline ADHC disability support workers or home care staff, ADHC supervisors and/or team leaders. The scope for the project did not include wider consultation with the non-government sector or peak advocacy and interest groups. While the role of the NSW Police Force is referenced in the comments made during the consultations, no representative of the NSW Police Force was consulted in relation to the project.

1.4  Structure of this document

The report is structured as follows:

·  Section 1 provides the project overview and purpose.

·  Section 2 provides the key recommendations

·  Section 3 outlines the key findings of the review

2  Recommendations

2.1  Current strengths of the system

A consistent theme during the consultations was a recognition by key stakeholders that the current protections in the system – from screening of staff, to induction processes, to the implementation of operational policies to performance monitoring and review – are reasonably robust ensuring the likelihood of staff being involved in acts of abuse and neglect are subsequently minimised.

ADHC has consistently worked to improve its policies, procedures and practices in response to abuse and neglect towards people with a disability. During the consultations, stakeholders commented that where abuse and neglect has been identified, ADHC responds in a structured and considered manner.

A range of mechanisms are in place to prevent, mitigate and respond to the perpetration of abuse or neglect across these domains and settings as a result of the conduct of ADHC employees. These include:

·  a comprehensive suite of policies, procedures and operating practices that govern the conduct and recruitment of individual ADHC employees