The rules governing how providers and workers will register in the NDIS after 2018-19 is one step closer.
The Coalition of Australian Governments (COAG) Disability Reform Council (DRC) recently released the NDIS Quality and Safeguarding framework (dated 9 December 2016) which provides some further insight into the national governance requirements that will take effect at full roll out of the scheme. Whilst the framework is high level policy at this stage it provides some insight into how the fully implemented system may operate. If there is one consistent theme throughout the document, it is a “risk-based approach” as those words appear on almost every second page.
The principles underpinning quality and safeguards…
The framework is founded solidly on the fundamental principles of the NDIS, especially choice and control, human rights and national consistency, and adopts a risk based approach allowing participants to decide, within certain boundaries, the level of risk they wish to take regarding how they procure their supports.
The framework also expands on the methods in which the NDIS will provide participants with the tools and information to make informed judgements about quality and suitability of providers. The framework relies heavily, in places, on ILC to provide participants with the capacity and capability to take control of their own plan supports which given the status of ILC is the first point of concern with respect to the implementation of the framework into practical everyday application.
The framework creates at least three new roles
There are a number of important roles that will be created by the framework in the form of national regulatory elements. These include the introduction of the following roles and responsibilities:
An NDIS Complaints Commissioner to facilitate the resolution of complaints regarding providers of NDIS-funded supports and investigate both serious incident reports and potential breaches of NDIS Code of Conduct.
An NDIS Registrar to register providers, oversee provider compliance, establish policy settings for nationally-consistent worker screening and take the lead in monitoring the effectiveness of the NDIS market.
A Senior Practitioner to oversee approved behaviour support practitioners and providers, review the use of restrictive practices and follow up on serious incidents.
There will also be new documents governing provider behaviours
During the current transitional period the state based requirements remain in force with the focus on the development of the following documents which will be a nationally consistent bench mark for all parties operating within the NDIS:
the draft Legislation
Practice Standards (7 in total)
A worker Code of Conduct. The NDIS Code of Conduct will apply to everyone within the NDIS, even non-registered providers working with self-managing participants.
It is likely that these newly created responsibilities will be co-located within an existing government agency in each state however the detail on this is not known at this stage.
What the framework means for providers
Within the framework there appears to be a lessening of regulation for those who chose to self manage their plan, albeit, with some tighter risk based assessment as to whom can initially be approved to manage all, or portions, of their plan supports.
Persons self managing will be able to continue to buy certain supports from non-registered providers, unless they are determined as high risk supports, and the non-registered providers will not be required to meet Quality Assurance requirements and therefore are not required to be audited.
In the current NDIS environment where self management is being promoted this has the potential to expose some participants to greater risk however the development of the service standards may address this, in part.
High risk supports can no longer be delivered by unregistered providers
The NDIS Code of Conduct will apply to everyone within the NDIS, even non-registered providers working with self-managing participants.
High risk supports which are likely to include allied health services will need to be registered with AHPRA or the NDIS registrar. Early childhood supports are also likely to be required to be registered across the board as they also appear to be included within the high-risk category within the framework.
With this in mind, self managing participants currently utilising non NDIS registered allied health providers may need to ensure their provider registers in the future or at a minimum keep a close eye on the requirements as the develop.
Worker screening across the country
Another important aspect of the framework is the introduction of Risk Based Worker Screening. This will be implemented by worker screening units which will be state based and overseen by the NDIS registrar.
The minimum screening requirements depending on supports the worker is providing and the time they spend on the front line with participants. There will be a compulsory orientation module for all registered providers to complete. Unregistered providers do not need to complete the orientation module however they will be encouraged to do so as a possible point of differentiating themselves within the market.
Much discussion and debate was held during the development of the framework surrounding minimum qualification requirements and it does not appear that qualification requirements will be specified, at this stage.
The framework also outlines the planning processes in more detail and highlights a risk based approach to plan management considerations with some supports not being able to be self managed due to the high risk of issues such as behavioural support as an example as well as allied health as previously mentioned.
Market information is seen as a foundation of the safeguarding framework
Access to current, easy to read, accurate, information for participants and providers has also been identified as a requirement within the NDIS market. The Framework discusses the development of an eMarket which would be an integrated, online information portal where participants could access information on providers and may even extend to providing the ability for booking of initial consultations and to buy supports.
If implemented, this would be a highly valued outcome based on feedback from many participants to date. The framework document also acknowledges the value that private online sources have added to the NDIS community and will continue to add in the future. DSC is certainly one of those online sources of real world information and current issues within the NDIS.
More compliance and auditing costs for providers?
The release of the framework has also raised concerns from many providers with respect to the ongoing quality assurance auditing costs as these are not specifically funded by the NDIS. In addition the training and workforce development activities expected within the framework do not appear to be specifically funded.
Whilst the sector development fund appears to be heavily relied upon to provide such support, in reality, it is falling short for many providers. Careful attention to these workforce development issues will be required throughout the framework development process if the NDIS hopes to achieve anything near the skilled workforce projections required to service the full scheme activity level.
The key phrase: moving to a risk-based approach
As mentioned in the first paragraph the words “risk based approach” appear frequently, some may say too frequently, throughout the document. Risk based approach is a modern take on attempting to identify and prioritise the key issues, or risks, that a particular undertaking may face.
In the context of the NDIS a Risk Based Approach may work in some areas such as worker screening, however it is difficult to see how it is going to applied to any useful extent within the context of assessing risks associated with participants and supports / services. For example, it appears that allied health services have already been identified as high risk which for many smaller practitioners, and their clients, will come as a surprise. And not a pleasant one. It is difficult to understand how a weekly Physiotherapy session to relieve the ravages of high tone in a cerebral palsy patient could be seen as high risk. Hopefully sanity will prevail as time progresses.
Where to next?
This article touches on only several of the key elements that DSC are aware of as areas of significant concern for both providers and participants at present. DSC will monitor all the elements of the framework including SDA, which has largely been ignored within the framework at this stage, as the translation of the framework into implementation occurs and provide regular updates.