Key issues arising from the NDIS and proposal for trial

Key issues arising from the NDIS and proposal for trial A discussion paper from Disability Employment Australia

Table of Contents Table of Contents... 2 Background... 3 The challenge in integrating two unlike systems... 3 Assessment... 3 Career development... 3 Concurrent participation in ADEs and DES... 4 Less than 8 hours work capacity... 4 DES is not consumer directed... 4 Summary of the problem... 5 Two ideas to help address the problem... 5 Proposal 1 Trial of consumer directed services... 5 Proposal 2 Making the systems work together... 7 Conclusion... 8 2

Background Employment goals are central to the NDIS. Employment is a key human right and is an important way of ensuring social inclusion. Increasing employment participation of people with disability underpins the long term financial viability of the NDIS and will contribute to national prosperity. The Productivity Commission has recommended, and to date Governments have accepted, that Disability Employment Services (DES) sit outside the NDIS. This recommendation is based on a view that employment assistance is a mainstream program provided as part of the Government s universal service obligation to all citizens. At the same time, the Productivity Commission has acknowledged that some employment related support will be provided through NDIS. Supported employment (Australian Disability Enterprises) is a major example but some specialised services such as the NSW Transition to Work program are also included. The challenge in integrating two unlike systems A major challenge in implementing the NDIS will be providing seamless assistance to achieve employment. Some obstacles that may arise from the way the DES program has been designed are in the areas below. Assessment Disability Employment Services has its own assessment system. It identifies the number of hours a person is capable of working so that their participation requirements can be met. It also identifies the barriers to work so that the level of difficulty in securing employment and the fee payable can be determined. A key goal of the NDIS is to provide one-off assessments to avoid repetition of information. The new NDIS assessment will be able to identify the level of support needed to participate in daily life, community and employment. However, tension exists between these two approaches to assessment, as well as the basic problem of having two assessments. We understand that DEEWR may consider adopting the NDIA s assessment. However, is the assessment fit for purpose in the context of a DES program that focuses on rapid engagement in work rather than maximising life choices? Career development When people who are working at or above their assessed benchmark hours approach DES, they are not eligible for assistance such as career advancement unless their job is in jeopardy and they want assistance to move to a new job. However, evidence shows that even once work has been secured, people with disability tend to be employed in lower skilled and waged jobs. Factors such as poor education that impact on workforce participation of people with disability continue to limit job mobility and advancement over their life spans (2007 Mavromaras et al). Continued assistance with career development and advancement is 3

needed to address this gap and maximise economic independence and social inclusion. DES is not currently designed to address this need. Concurrent participation in ADEs and DES People employed in Australian Disability Enterprises and working at or above their benchmark hours must resign before they can access DES. This creates a critical obstacle. Employees are forced to accept loss of employment or reduced engagement in the hope of finding something better. They lose income and networks they reduce their employability by becoming unemployed. This problem must be addressed if we are to provide a pathway to economic independence for those who can achieve it. Less than 8 hours work capacity People who have been assessed as having less than 8 hours work capacity are generally ineligible for DES services unless the Job Capacity Assessor thinks that, with the assistance of a DES provider, they will be able to exceed that benchmark in the future. This requirement is likely to exclude some NDIS clients from accessing DES services. It also highlights an apparent mismatch between the strengths-based assessment conducted by the NDIA and the assessment conducted by Job Capacity Assessors which focuses on the extent that work capacity is impeded by disability. DES is not consumer directed While each DES participant is entitled to an individualised service, decisions about how to allocate resources across a diverse caseload rest with the provider. The Productivity Commission has pointed out that this funding arrangement cannot be described as consumer-directed. While the following comment in the Commission s report refers to Job Services Australia, it is equally applicable to DES: The person can switch service providers, but does not have much freedom about what they can spend or do at any given service provider. The Government makes payments to a Job Services Australia provider based on a fee and outcome basis, with no veto by the client if they are unhappy with the performance of the provider (Productivity Commission 2011 D.1). In addition to managing resources for organisational viability, the provider must maximise its performance regarding the Key Performance Indicators in the contract and reflected in Star Ratings for each site. Poor performance against KPIs reflected in Star Ratings may lead to reduced referrals of clients or ultimately, loss of contract. Performance is measured at the aggregate level across a whole caseload not whether individual client s goals are being met. These features of the practical operation of the DES contract may give rise to challenges and requests for NDIS assistance to address a gap in assistance provided by DES. For example: Individuals may consider specific forms of support necessary to meet aspirations such as preparation for university while providers may consider that there are cheaper, faster means of achieving the six month employment outcome on which their performance is based. 4

Employment outcome payments and star ratings are driven by achieving employment at the individual s assessed maximum capacity measured in hours as judged by a Job Capacity Assessor using secondary material. However, individuals may look at employment opportunities in terms of their capacity to provide a higher wage, a pathway into an industry or occupation of interest, or other factors. Consumers may not be able to get assistance to achieve these outcomes if they don t also meet the requirements of the provider s contract KPIs. Similarly, while the NDIS recognises that consumers should have choices about how key aspects of their ongoing assistance are provided, this currently does not apply to Ongoing Support provided through DES or to work-based personal assistance. As the NDIS rolls out, the differences between its consumer-directed approach and the contract/provider-driven approach of DES will become more evident. Summary of the problem Disability Employment Australia strongly supports the implementation of the NDIS and the centrality of employment to its objectives. However, there will be considerable challenges to providing an integrated employment service that arise from the design of the DES program. While the NDIS is based on need, DES is rationed. While the NDIS is consumer-directed, DES is directed by providers who seek to achieve KPIs set by the Government. One foreseeable challenge will be that individuals assessed as having less than 8 hours work capacity and ineligible for DES will have no choice but to seek employment support through the NDIS. There is also a strong possibility that consumers and carers wanting to develop a pathway to work, by marshalling resources across a range of support systems including ADE and DES, will find themselves thwarted by program barriers. Failure to address these challenges will lead to reduced effectiveness of both systems and frustrate consumers. Two ideas to help address the problem Proposal 1 Trial of consumer directed services Implementing the NDIS across multiple launch sites provides an opportunity to trial a different, consumer-directed approach to provision of employment assistance. Disability Employment Australia proposes that a trial of consumer-directed employment assistance be established in two or more launch sites. The trial should include: Access to one year of employment assistance through the NDIS instead of DES for 50 Tier 3 NDIS clients. The clients should be people who are not currently participating in DES, 5

include some who have an assessed work capacity of less than 8 hours, and others who are eligible for but not participating in DES; Local DES and ADE providers who volunteer to participate. The volunteer providers should work with the relevant LACs to develop assistance packages, and participate in evaluation of the trial. They should also be excluded from performance ratings or market share; Consumer advocates who assist in the development and education process, and the trial s evaluation; A national steering group that includes NDIA, DEEWR, FaHCSIA, consumers, Disability Employment Australia and NDS. The trial evaluation should include: Comparison of outcomes with similar cohort in mainstream services including employment / participation outcomes and consumer views of value/quality of assistance; Comparison of costs and benefits; Feedback from providers / LACs and other stakeholders; Recommendations of adjustments to DES and/or the NDIS. What are we trying to test? There is a view among some that employment assistance for people who are accessing NDIS for care and support, such as those in Tier 3, should be provided through the NDIS rather than through DES or JSA. The arguments for this include: It would enable provision of employment assistance to be fully integrated. For example, a disability support organisation could work with a person to develop a pathway that included day services, career counselling, transport and transition to employment. Once people can exercise consumer control over services within NDIS, they will demand control over other aspects of service. It is inconsistent to be able to control care provision at home but not Ongoing Support at work. The principle of self-determination should be applied to employment assistance given its fundamental place in people s lives. Tier 3 clients are often poorly served by the current system. Apart from people who are excluded such as those who have work capacity less than 8 hours per week, individuals that have intensive ongoing needs tend to get marginalised in a system with a strong emphasis on rapid attainment of independence and other Departmental objectives. Individualised funding provides direct accountability for outcomes and quality of service to the people accessing the service. Bringing employment into the NDIS would resolve the tension between accountability to the individual and accountability to Government for delivering KPIs. On the other hand, there may be risks in seeking the including of employment services in the NDIS. These could include: Fragmentation and loss of scale in sector. While it is expected that less than one third of DES-ESS clients are likely to fall into Tier 3 of the NDIS, the removal of these clients from the DES program could have serious implications for some services, particularly certain specialists, and for the program as a whole. If individualised funding leads to a loss of critical mass in the disability employment services sector, it could come at the cost of investment in 6

professional development of sector workers or other things such as employer partnerships for which critical mass is needed. Ultimately, the loss of Tier 3 clients might weaken arguments for retaining a separate DES program. Poor value services. There is a risk that organisations or individuals with little experience or expertise in providing employment assistance for people with disabilities might start to market these services. Some types of employment assistance such as assistance into a job are short term so there is no opportunity to learn which services are better than others. Some consumers will be short changed. Lack of employment incentives. It is not clear if performance ratings or financial incentives for performance in the DES program are to be applied to organisations delivering employment assistance funded through the NDIS. There is a risk that the gains made in moving towards a stronger outcome focus will be lost. Cost / cost pressure. Currently, the cost of disability employment services is constrained by the contract and managed on a day-to-day basis by providers. There is a risk that giving consumers greater control could increase demands for expenditure which might, in a tight fiscal environment, lead to pressures elsewhere in the system. Equity. Some argue that the benefits of consumer-directed services are greater for those who already have advantages in the labour market. A trial of consumer-directed services funded by the NDIS could help identify the benefits and risks of offering employment assistance via the NDIS as well as what might be done to address issues that arise. There are other reasons to suggest a trial. The NDIS is a large and complex reform. Both the Productivity Commission and experts in the field have urged careful planning and consideration of change. Also, the DES market and program have undergone considerable change in the last few years. Before more changes are considered, it makes sense to try to understand the impacts they might have on consumers, providers, Government, employers and other stakeholders. While the NDIS principles are sound, we won t know how well they work until we see them in practice. A trial would show us if it is a good idea to move employment into the NDIS, and for whom, how and when. A trial would be useful not only to understand what would happen if employment assistance were to be provided from within the NDIS, but also to highlight the differences between this approach and retaining a separate system. Accordingly, our second proposal is to see how well we can, through a collaborative approach, make DES and the NDIS work together. Proposal 2 Making the systems work together While we are keen to see how an integrated system might work, it is also particularly important to look at other options and consider how the NDIS and DES program might be managed to deliver integrated assistance. Disability Employment Australia seeks Government support to establish local arrangements to identify and address issues arising out of the interface between the NDIS and DES. We also want to ensure that employment issues are specifically addressed in evaluations of the launch site experience. 7

In each of the launch regions, a local group consisting of key stakeholders should be established to identify and address problems as they arise. This could include finding rapid solutions to problems such as disagreements between a provider and the NDIA over who should pay for a service. The aim would be to solve problems for clients while ensuring that issues are identified and addressed at a systemic, contract-wide level. We expect that the local groups would generate ideas about how the services can best be integrated. For example, they might agree that NDIS clients should be offered a single employment advisor to work alongside the LAC to develop an integrated assistance package incorporating DES and NDIS funded services. These ideas can be used to signpost future strategies for the full NDIS roll out. We envisage that the NDIS launch may have implications for future thinking about DES. Disability Employment Australia proposes a specific evaluation process of the arrangements for employment in the launch regions. The evaluation process should actively engage stakeholders and provide a basis for ongoing discussion of the best way to realise the employment aspirations of people with disability. Conclusion Employment is a major aim of the NDIS it underpins its long term success and sustainability. There are tensions between the principles on which the NDIS is based and the way that the DES program works in practice. These cannot be ignored. Nor can we wait to see how they play out. Disability Employment Australia proposes active steps be taken to deliver the best possible employment assistance in the launch regions, harnessing resources and expertise across both systems. This includes a trial of employment service provision through the NDIS, alongside local collaborative strategies to join up resources. In each case, we are proposing that the evaluation of the quality and effectiveness of employment assistance be conducted with key stakeholders including most importantly, users of the services and their advocates. 8