From 1 July 2016, Queensland began transitioning to the National Disability Insurance Scheme (NDIS). The scheme is progressively rolling out across Queensland, with full implementation by 30 June 2019.
The NDIS will transform the way community mental health services are delivered in this country.
NDIS is a seismic shift away from block funding of services to individualised funding packages. This requires a major change to how services are set up and delivered.
We’re in a brave new world that brings both challenge and opportunity for consumers, carers and service providers alike.
It’s time to think creatively, laterally and rationally about where we go from here.
A consumer-carer perspective
If implemented well, the NDIS has great potential to bring positive benefits for people with psychosocial disability. It will give them more choice and control over the services they receive, and who delivers them.
Many of the teething problems with the scheme relate to communication, accessibility and planning for the unique needs and broader support requirements of each participant.
These were outlined in the Productivity Commission’s report National Disability Insurance Scheme Costs, October 2017.
The National Disability Insurance Agency (NDIA) has moved to address many of these issues, including:
- piloting a new participant pathway
- eliminating phone planning
- enhancing training for planners, particularly on psychosocial disability, including new access tools
- linking better with government services such as health, housing, employment and justice
- changing the NDIS portal to simplify and enhance navigation, including the development of a psychosocial gateway
- providing applicants with a consistent contact
- reviewing the price guide
- establishing a Safety and Quality Commission.
Beyond the NDIS the broader question remains: what about the people who do not receive a package? What services will they be able to access, as most Commonwealth and state programs are cashed out into the NDIS? And what of support services for carers—who will fund those?
Queensland has done well by cashing only 50 per cent of funding into the NDIS—particularly the Housing and Support Program (HASP).
There is a lot of work yet to be done to ensure that the scheme, and alternatives, provides a net benefit for people with mental illness and their carers.
Some bumps for community mental health
The National Disability Services State of the Disability Sector Report 2016 outlines some of the challenges faced by service providers under the NDIS. Apart from the rate of change and growth required to meet consumer demand under the NDIS, some 58 per cent of providers had NDIS clients leave for another provider, and 22 per cent made a loss (and this before full roll-out).
Providers are also reporting concern about the current NDIA-set prices, believing this may impact service quality or result in withdrawal from the scheme. There is hope that a review of the NDIS price guide will better reflect the cost of services and offer relief.
NDIS touches every aspect of the community mental health sector’s business. Many organisations are spending reserves on external expertise to help re-engineer financial, human resource and customer relationship management systems. They’re restructuring, undertaking complex financial modelling and projections, and enhancing marketing and rebranding. Some are recruiting new board members and CEOs with business acumen.
While the road ahead has some bumps for the sector, successful organisations are already ahead of the game. They’ve been improving these aspects of their business for many years now. They know the key to success is developing the right culture for the NDIS—one that marries commercial acumen with mission and core values.
Evidence suggests that when there is a major shift in the external environment, internal stability and agility is critical. Don’t forget culture eats strategy for breakfast!
Finding the silver lining
Astute service providers are successfully adapting and innovating in the new NDIS environment.
Some are considering mergers and acquisitions. Others are exploring ways to pool back office functions to reduce costs. This extends to considering pooling the workforce and sharing recruitment, induction, personal development and training costs.
Some are diversifying income streams and moving into other or new markets, such as aged care, employment and child safety. In a similar vein, some are trying to supplement income through social enterprises and social bonds—but up-front costs can be prohibitive.
The challenge for service providers is to become or maintain their status as provider, employer and partner of choice. This is the best strategy for achieving growth, sustainability and successfully transitioning.
There are challenges and benefits for the public system too
Sections of the public mental health system would argue they have been in constant reform over the past 20 years, and that the NDIS is just another change.
Even though the NDIS will not have the same impact on the public system as it is having on the NGO system—the impact is substantial and integrally linked.
To cope with the NDIS, the public mental health system has had to establish dedicated positions within services to support staff and consumers with NDIS processes; train staff and change operational process.
There is some evidence the NDIS has:
- increased workloads for psychiatrists and allied health staff who are required to provide information on diagnosis, treatment and functional impairments
- required staff to focus on functional impairment rather than diagnosis/treatment
- shifted the focus of therapies towards building capacity and skills for the person to live and participate in their community
- highlighted the need to work effectively with NGOs, local NDIA planners and local area coordinators
- increased unfunded staff hours spent supporting the person preparing for their NDIS assessment
- increased frustration among public sector staff as a result of providing inconsistent advice
- increased pressure on hospital-based services due to cumbersome NDIS processes, resulting in costly blockages to discharge, budget pressures for health services, and a negative impact on patient recovery
- inadequate plans being approved and lengthy waits for review decisions because public mental health staff are unable to access and check a client’s draft NDIS plans.
But there are also some tangible positives from a public mental health system perspective. The NDIS has enhanced relationships with the NGO sector, with greater recognition by hospital and health services of the important role of NGOs. The NDIS has also improved their efforts to engage and communicate with the local NDIA office.
Importantly, hospital and health services can see that a consumer’s life is greatly enhanced when they receive an NDIS package.
Advocacy: The Commission’s ongoing role
Many of the recommendations in our Submission to the NDIS Parliamentary Inquiry are reflected in changes implemented by the NDIA.
As Queensland moves towards full implementation of the NDIS, the Queensland Mental Health Commission and its counterparts around the country will continue to advocate for further improvement to the scheme.
The NDIS is a key issue for mental health commissions, and a standing item at our regular Commissioner meetings. Importantly, we have membership on the NDIS National Mental Health Sector Reference Group—a key forum to effect further change.
Ultimately, we must keep people with a mental illness at the forefront of everything we do, including ensuring ongoing support for those who will miss out. After all, this scheme is designed to improve the lives of a large proportion of these people.
I believe we still have many hurdles to overcome, but I also believe that collectively we can implement the NDIS successfully, and I look forward to working with you in achieving this.
Queensland Mental Health Commissioner
Editor’s note: This viewpoint piece is based on speeches delivered by the Queensland Mental Health Commissioner at the Queensland Alliance for Mental Health Mind the Gap NDIS Workshop, and the National NDIS Conference in Sydney in November 2017.