Feedback on the Consultation Paper: Proposal for a National Disability Insurance Scheme

Feedback on the Consultation Paper: Proposal for a National Disability Insurance Scheme Quality and Safeguarding Framework

Response from the ADHC Policy and Practice Team, and ADHC Statewide Behaviour Intervention Service

Feedback on the Consultation Paper: Proposal for a National Disability Insurance Scheme Quality and Safeguarding Framework. ADHC Policy and Practice Team, and ADHC Statewide Behaviour Intervention Service

Contributors to this feedback document:

Name / Position
Trudi Cusack / A/Senior Policy Officer, Behaviour Support Unit, Clinical Innovation and Governance
Val Lehmann-Monck / Practice Leader - Occupational Therapy, Clinical Innovation and Governance
Alison Chung / Practice Leader - Physiotherapy, Clinical Innovation and Governance
Carol Hannaford / Senior Project Officer – Clinical Innovation and Governance
David Doyle (and team) / A/Team Coordinator Adult team Statewide Behaviour Intervention Service (SBIS)
Tara Carthy (and team) / Team Coordinator Specialist Training And Resource team, SBIS
Lesley Whatson (and team) / Team Coordinator Children’s team, SBIS
Michelle Henwood / Manager SBIS
Ruth Pappas / A/Snr Project Officer SBIS

Document approval

The Feedback on the Consultation Paper: Proposal for a National Disability Insurance Scheme Quality and Safeguarding Framework (ADHC Policy and Practice Team, and ADHC Statewide Behaviour Intervention Service) has been endorsed and approved by:

______
David Coyne
Executive Director
Clinical Innovation and Governance
Approved: April 2015 / ______
Peter Goslett
Director, Policy and Practice
Clinical Innovation and Governance
Approved: April 2015

Document version control

Distribution: / Internal to CIG, and external via
Document name: / Feedback on the Consultation Paper: Proposal for a National Disability Insurance Scheme Quality and Safeguarding Framework (ADHC Policy and Practice Team, and ADHC Statewide Behaviour Intervention Service)
TRIM Reference: / AH15/
Version: / Version 1
Document status: / Final
File name: / Feedback on the Consultation Paper: Proposal for a National Disability Insurance Scheme Quality and Safeguarding Framework
Authoring unit: / Clinical Innovation and Governance
Date: / April2015

Table of contents

1.Background

2.Part 1: Proposed Quality and Safeguarding framework for the NDIS

2.1Building participants’ capacity

2.1.1What kind of information would best help participants to select a provider?

2.1.2How can we ensure that everyone has access to information about providers of supports in their local area?

2.1.3What approaches to delivering information, such as web-based information, peer review sites and consumer expos, might best meet participant information needs?

2.1.4What would be the benefits and risks of being able to share information publically, such as through online forums, consumer ratings of providers and other means?

2.1.5Are there any others ways of supporting people to build natural safeguards that the NDIS should be considering?

2.1.6How can the NDIS better support people with disability who are isolated or have few, or no, people in their lives — to help ensure they are safe and their rights are protected?

2.1.7What initiatives would help providers of supports ensure they offer safe and high-quality services?

2.1.8Are there additional ways of building natural safeguards that the NDIS should be considering?

2.1.9What can be done to support people with a limited number of family and friends?

2.1.10What kind of support would providers need to deliver high-quality supports?

2.1.11Should there be an independent oversight body for the NDIS?

2.1.12What functions and powers should an oversight body have?

2.2Monitoring and oversight

2.2.1Should reporting of serious incidents be mandatory under the NDIS?

2.2.2If so, what kinds of incidents should be reported? To whom should they be reported?

2.2.3Should there be an independent oversight body for the NDIS? Why or why not? If so, what powers and responsibilities do you think an oversight body should have?

2.2.4Should there be community visitor schemes in the NDIS and, if so, what should their role be?

3.Part 2: Detail of key regulatory elements of the Quality and Safeguarding framework

3.1NDIA provider registration

3.1.1Considering the options for registration, which option would provide the best assurance for providers?

3.1.2Considering the options for registration, which option would provide the best assurance for participants?

3.1.3Should the approach to registration depend on the nature of the service?

3.1.4How can the right balance be reached between providing assurance and letting people make their own choices?

3.2Systems for handling complaints

3.2.1How important is it to have an NDIS complaints system that is independent from providers of supports?

3.2.2Should an NDIS complaints system apply only to disability-related supports funded by the NDIS, to all funded supports, or to all disability services regardless of whether they are funded by the NDIS?

3.2.3What powers should a complaints body have?

3.2.4Should there be community visitor schemes in the NDIS and, if so, what should their role be?

3.3Ensuring staff are safe to work with participants

3.3.1Who should make the decision about whether employees are safe to work with people with disability?

3.3.2How much information about a person’s history is required to ensure they are safe to work with people with disability?

3.3.3Of the options described above, which option, or combination of options, do you prefer?

3.4Safeguards for participants who manage their own plans

3.4.1Should people who manage their own plans be able to choose unregistered providers of supports on an ‘at your own risk’ basis (Option 1) or does the NDIS have a duty of care to ensure that all providers are safe and competent?

3.4.2What kind of assistance would be most valuable for people wanting to manage their own supports?

3.5Reducing and eliminating restrictive practices in NDIS-funded supports

3.5.1Who should decide when restrictive practices can be used?

3.5.2What processes or systems might be needed to ensure decisions to use restrictive practices in a behaviour support plan are right for the person concerned?

3.5.3Are there safeguards that we should consider that have not been proposed in these options?

3.5.4For providers, what kinds of support are you receiving now from state and territory departments that you think would be helpful if it was available under the NDIS?

3.5.5Would you support mandatory reporting on the use of restrictive practices? Why/Why not?

3.5.6If you support mandatory reporting on the use of restrictive practices, what level of reporting do you believe should occur (based on one, or a combination of, the three options described)?

2.Additional comments

1.Background

Clinical Innovation and Governance provides practice leadership for therapy and behaviour support services and delivers a range of specialist services, policy and research, and practice improvement for services to clients with complex needs and challenging behaviour.This includes support in specialist placement and recruitment

The role of Clinical Innovation and Governance is to:

Establish and review policy and practice standards for the support of adults, children and young people with complex needs and challenging behaviour.
Provide practice leadership in the areas of Behaviour Support, Physiotherapy, Speech Pathology, Psychology, Occupational Therapy and Nursing and Health Care.
Establish and review policy, guidelines and training for working with clients who have patterns of offending behaviour.
Monitor and report on the use of Restricted Practices approval mechanisms across the disability sector.
Provide oversight of provision of services to people with an intellectual disability and a mental health issue.
Provide leadership and support related to student placements for relevant disciplines
Manage the operation of the Statewide Behaviour Intervention Service and the Integrated Services Program.

Clinical Innovation and Governance welcomes the opportunity to provide comment on The Consultation Paper: Proposal for a National Disability Insurance Scheme Quality and Safeguarding Framework as per (February 2015).

This is a significant proposal and highly relevant to our work. We recognise and value the effort taken by the National Disability Insurance Agency (NDIA), Disability Reform Council and Department of Social Services in undertaking to develop this framework for a nationally consistent quality and safeguarding system for participants in the National Disability Insurance Scheme (NDIS).

Our comments have been summarised on the following pages based on the questions posed in the consultation paper. The views contained within this feedback reflect our desire to represent the interests of people with disability, particularly those with intellectual disability.

Further, Clinical Innovation and Governance prepared a paper “Practice Leadership and working with people with complex support needs in an NDIS environment”. This is attached.

For further information please contact:

Val Lehmann-Monck, Practice Leader - Occupational Therapy

Clinical Innovation and Governance, Ageing, Disability and Home Care, Department of Family and Community Services NSW

Email:

2.Part 1: Proposed Quality and Safeguarding framework for the NDIS

2.1Building participants’ capacity

2.1.1What kind of information would best help participants to select a provider?

We recommend two categories of resources. Bothideallydeveloped and maintained by a government department or organisation that has no vested interest with any of the service providers.

One: A centralised database of service providerswhich is easily accessible for a wide range of people with disability and in plain English. This should include:

Clear details of what a service will provide,including costs.
Clear details of what a service will not provide(if relevant).
Geographical coverage of a service.
Funding arrangements of the organisation / provider if relevant, e.g. private business, charity, government.
Presentation of two different types of appraisal: a formal annual report and numerical score of an official accreditation (including reporting on formal complaints received), alongside a matching current numerical score of collated user reviews (and links to testimonials/full reviews). User reviews would need to be moderated by the site host. If providers’ quality standards are checked by the NDIA, it would be useful to make this information available in a somewhat similar fashion as the familiar school-based NAPLAN scores. Alongside this is a star rating (allowing comparison across service providers) – creating a simple yet familiar mode of service reviews (see popular example of a similar measure of quality ratings). The strength of a formal accreditation review alongside user reviews provides very powerful and useful information to participants and controlling bodies.
Information regarding complaints procedures and quality assurance processes and structure for each provider listed.
Qualifications/accreditation/professional registration of the relevant providers.
Providers must update their changing circumstances as it occurs and also in a periodic manner.

Two: A website thatpresentsother useful information, alsoeasily accessible for people with disability and in plain English. This should include:

Evidence based practice approaches. This information needs to help people understand the difference between evidence based and non evidence based interventions.
Guidance about how to select a provider, including what questions to ask providers, such as the Clinical Innovation and Governance fact sheets on choosing a private therapist:
accessible format
for children
for adults
Where to get help to manage packages.
Qualifications/accreditation/professional registration – specific to the various types of support e.g. behaviour support.
Relevant local government and state government links.
A frequently asked questions source.
Local lists of generic community based supports/networks.

Some of the above information should also be available in hard-copy e.g. pamphlets and information flyers.These should be readily available at relevant locations such as schools, Centrelink, health services, non-government organisations, migrant advocacy services.

Information should be available in a variety of formats: easy English augmented with pictures, translation services, vision supports, voice over / closed caption options.

Information should also be available via a central telephone hotline and via direct face-to-face meetings. Provision of case managers or support workers would assist people who are unable to access a computer database due to their disability.

There should be the option to access advocacy or a support person when making decisions about providers – particularly in cases where the carer or parent also has a disability. This would allow unbiased third party support.

Much of the content here refers to information prior to the provision of service. There is an equally important process of information provision that must occur throughout service provision from providers to participants, on anongoingbasis from the NDIA to participants and providers – especially as the scheme grows and changes in the early years.

Information specific to behaviour support services would be essential, especially at the planning stage as this may impact on the success of other supports the person chooses e.g. holidays, employment.

2.1.2How can we ensure that everyone has access to information about providers of supports in their local area?

See the above response regarding provision of information to help participants to select a provider.

Information needs to be promoted through a whole of population education, including media campaigns, to reach people not already well connected with services

Many people with intellectual disability will require face to face support over a period of time rather than being able to use social media, internet, reading, audio information alone. There should be some provision for individual or group information sessions that are not just one-off events. This would ideally be supported by practitioners with a range of skills in communicating with people with intellectual disability (in particular speech pathologists). Many people with intellectual disability have developed their own idiosyncratic communication systems. Generic communication approaches will not necessarily reach these people in a meaningful way. Site visits could be one way to engage with people in a meaningful way and provide information tailored to their needs through the support of those in their network. Information provision with people with intellectual disability is not just a one-way process. The process of checking understanding is equally, if not more, critical than the provision of the information itself. This cannot be done easily through pamphlets and internet information provision but should be considered across all proposed delivery modes.

To ensure correct targeting of information, the system needs a good profile of the providers in the local area and a good profile of the communication or information needs of consumers and their carers (i.e. how the info needs to be presented).

Access to the right information and the right specialist information will be determined to some extent by the skills of the local planners, this will require a program of ongoing training and development as practice and services evolve and change.

2.1.3What approaches to delivering information, such as web-based information, peer review sites and consumer expos, might best meet participant information needs?

See the above responses regarding provision of information to help participants to select a provider, and ensuring that everyone has access to information about providers of supports in their local area.

Each of these approaches have their merits, however there are many ways to deliver the information, it also about making sure that the information is consistent and constantly being disseminated.

Knowing the profile of people with disability and their carers in a local area is important so that information can be targeted appropriately. For instance, predominantly web based information is inappropriate if the local population don’t have access to computers (e.g.in remote areas) or the skills to access the internet.

Feedback and access patterns overtime will also support the information providers to align it with peoples’ needs.

2.1.4What would be the benefits and risks of being able to share information publically, such as through online forums, consumer ratings of providers and other means?

We recommend a well designed and moderated presentation of two different types of appraisal (a formal annual report and numerical score of an official accreditationincluding reporting on formal complaints received, alongside a matching current numerical score of collated user reviews with links to testimonials/full user reviews). User reviews would need to be moderated by the site hostto prevent hacking or vexatious complaints.

If providers’ quality standards are checked by the NDIA, it would be useful to make this information available in a somewhat similar fashion as the familiar school-based NAPLAN scores. All reporting should be by geographical area.

Alongside this is a star rating (allowing comparison across service providers) – creating a simple yet familiar mode of service reviews. The consumer ratings may be able to provide a good way of tracking organisational or systemic issues which can then be addressed by an oversight body or the organisation themselves.

The strength of a formal accreditation review alongside user reviews provides very powerful and useful information to participants and controlling bodies. This public rating system could provide a better idea of what services the organisation does and does not provide, minimising possible misrepresentation by the service. It is also potentially a good way of tracking if the organisation is engaging in best practice.

There are,however, risks around consumer ratings relating to accuracy, right of reply and the professional restrictions around the use of testimonials. These risks need to be mitigated through good planning. Consumer ratings would need to be carefully designed, administered and analysed.

Benefits include:

Transparency;
Compliance with service agreements;
Ensuring consumers make decisions based on accurate and timely information, as well as understanding the risk they take by using one provider over another;
More people know about positive experiences and good services that they might not have otherwise been unaware of.

Risks include:

Building a culture of competitiveness amongst providers resulting in the publication and presentation of information that highlights only positive outcomes, and hiding/masking problems and risks. In areas of limited competition, ie rural and remote locations bad consumer ratings may reduce access to a service.
Reviewers might be malicious and provide incorrect damaging information (moderator role would mitigate this, but needs to take into account freedom of speech and fair reporting);
Possibility that the system will be so complex that vulnerable populations would be unable to access it;
Risk of loss of service user privacy by tracking online activity and targeted promotion of services, including direct approaches by services;
It may leave providers exposed in the case of conflict or differences in opinion therefore the availability of objective, verified information about organisations is important to counteract incorrect information;
Service user may refuse to access support when the provider’s reputation/reportageis negative whether accurate or not;
One service could attempt to discredit another in order to seek a market advantage;
This could become an inappropriate public forum for complaints lodging;
Satisfaction is one but not the best marker of quality service, therefore needs to be balanced with a more official accreditation report.

2.1.5Are there any others ways of supporting people to build natural safeguards that the NDIS should be considering?