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Good food for thought on the NDIS

The Productivity Commission and the NDIS

John Homan

091015

The author:

The author has served a more than thirty year ‘apprenticeship’ in the disability sector. First as the father of Amanda, who was disabled from birth, later at a strategic level:

  • he was a member of management committees of several disability service providers,
  • served as a Community Member on the (first) Disability Services Council of Queensland,
  • was co-author with Sandy Paton of “Learning with Amanda”[1]
  • wrote four submissions to the Productivity Commissions inquiry into Disability Care and Support, and
  • made two presentations to the Productivity Commission, and         
  • is a member of the Management Committee of the Capricorn Community Development Ass. Rockhampton

Introduction

The introduction of the National Disability Insurance Scheme (NDIS) is probably the greatest advance in social policy in Australia since Medicare in 1975.

The NDIS is underpinned by the Productivity Commission (PC) report following its inquiry into “Disability Care and Support” (31July, 2011) Dr Bruce Bonyhady[2] stated that:

“The main goal of the NDIS is to support people with disabilities and their families to live ordinary lives. The vision is to maximise independence and social and economic participation”.[3]

That objective has not changed, however how to get there has been, and still is, a learning process. It is complex and to many confusing. This confusion, is leading to much speculation, frequently incorrect, and misleading. The NDIS has recently been referred to as: ‘just another funding model’, and also as: ‘just the department by another name’.

That type of observations is not only not helpful, but harmful as they hide the true nature of the NDIS. They create prejudices and falsehoods that will inhibit beneficiaries, support workers, service providers and the community at large from getting the best outcomes from the scheme.

The objective of this paper is to highlight the documented aims of the NDIS, and to suggest to potential customers and other stakeholders how they may assist in getting the best outcomes. It is based on research, the author’s experience and also his opinions.

A good life

The end in mind for all of us is to live a ‘good life’. A good life is different for all of us, but has common elements. It is about having choices that enable us to realise our life and dreams, to have respectful and loving relationships, to be respected and valued in a welcoming community, to live in an environment that encourages and supports us to reach our potential, to live in a society where we are all equal.

[1] Paton S., Homan, J., Learning with Amanda, presentation at the International Conference for Community Engagement, Brisbane, 2005

[1] Dr Bruce Bonyhady is the Chairman of the National Disability Insurance Agency (NDIA) He has initiated, inspired and driven the establishment of the NDIS.

[1] Dr Bruce Bonyhady, Address at the National Press Club luncheon, 090714

These are some elements, common in most of our lives, but not in the lives of people with disabilities. They have been regarded as ‘factory seconds’. They have had things done for them, at them and to them, but rarely with them. Up till now they have been largely spectators in their own lives.

The key issue that an effective NDIS must address is relationships. The NDIS’s principal role is not about money. Although money is important, it will not drive the paradigm shift that is called for. More money with the old failed system, is just the old failed system with more money. It is clear that it will take much more than money to remove stigma, disadvantage, discrimination, social isolation, and marginalisation of people with disabilities.

The Productivity Commission (PC) makes the social justice case for a new balance in disability support, in which community has a much more prominent role. Jim Moore[4] makes the same case on economic grounds.

The PC understood that funding was an important, but not the only objective for the NDIS when it stated that:

“The NDIS would have other roles (than funding services). It would aim to better link the community and people with disabilities. “People would have much more choice in the proposed NDIS. Their support packages would be tailored to their individual needs. People could choose their own provider(s), ask an intermediary to assemble the best package on their behalf, cash out their funding allocation and direct the funding to areas of need (with appropriate probity controls and support), or choose a combination of these options”[5]

Money by itself can not achieve this. People with disabilities do not only need financial support, but – equally important – need social support.

The current system is top down: the funder delegates authority to service providers, who then decide what services to provide, to whom, how much, and when. The paradigm shift is the creation a direct relationship between the NDIA (the operating arm of the NDIS) and its customers, through its Local Area Coordinator. This transforms the hierarchal relationships into a triangular one where the customer, the NDIA, and the service providers sit at the same table as equals.

Systems

To achieve these core objectives of social and financial support the PC proposed to combine two (well proven) existing systems.

  • Local Area Coordination (as developed and practiced in West Australia), which builds capacity with key aims of self-determination and self sufficiency. Rather than just providing a service to fix a problem. It asks: “What is a good life?” versus “what services do people need”.[6]
  • inControl is a British system in which “Personal budgets and self-directed services mobilise the intelligence of thousands of people to get better outcomes for themselves, and  more value  for public money”.[7]

Changing lanes

The change to the NDIS will not be an overnight affair, but will be slow and often traumatic! It will take a lot of time, confusion, navel gazing, and changes in values and attitudes. It will not be easy, but a worthwhile challenge!

[1]Jim Moore, Chief Executive of the Department of Family and Community Services NSW

[1] PC disability Care and Support, Overview, Key Points, p2.

[1] Co-Production and Personalisation in Social Care, Jessica Kingsley Publishers, 2007.

[1] Leadbetter, C., Making it personal, Demos, 2008. http://www.demos.co.uk/publications/makingitpersonal

When changing to the NDIS lane, the stated aim for people with disabilities to become equal members of our community, with the same rights and obligations we all have, with the same opportunities to reach our potential, and dream of and live a good life. To be no longer out of step with the world around us.

When we walk into the butcher, the baker or candlestick maker, or any other establishment, we expect that people will treat us with courtesy and respect. We expect that they will address our wishes and concerns as best they can, and facilitate and advise us so we have the best information on which to base our decisions. The disability world is not like that, people with disabilities, and often their families and carers have lived, and are living in a world in which their needs and wishes are largely ignored. The NDIS is designed to change this and give people with disabilities the right and authority to direct their own lives, to meet their needs, their wishes, realise their dreams.

When people with disabilities become part of the triangular relationship, where the NDIA and service providers take the other two seats at the table, the big change is that the other two parties, are there to facilitate, to help and guide, not to make the decisions, and control. As in ‘normal’ society, the people with disabilities, the customers, are assisted in making the best possible decisions.

Do it yourself guide

This guide to changing lanes is based on the author’s personal understanding of what we should expect from the NDIS, and how we can all help make it work.

This guide is in three parts:

  1. The customer,
  2. The Local Area Coordinator, and
  3. Service providers.

1.The customer is you, the person with a disability, and your supports..You are the customer, and you are the one who in the end makes the decisions. Your support team is there to help you get it right.

It is important to understand that you are no longer a charity case under the old system, but that you occupy an equal place at the table and - like the others - have rights, and obligations.

Where thinking in the past has been about fixing problems, in the new lane we think about what we need to make our life a good life. You will have the deciding voice in what will be a good life for you, and how you will use your funding to help make it happen.

Making lists is a useful starting point. A list of the basic tasks you need help with, like bathing, feeding, transport, and other household tasks. Then a list about your quality of life. The things that make for a good life, relationships, inclusion in community, hobbies, other passions and more.

Overseas experience has shown that when people have the freedom to design their own care packages, they make sensible and mature choices that improve their quality of life and keep them safe. The shift in power, towards users and away from professionals brings responsibilities for users to assess and manage risks and to account for how resources are used. Users generally welcome these responsibilities.[8]

A comforting thought is that help is at hand to assist you in making the choices that will give you the best outcomes. There is also a readily available review process, in case a choice should prove not the right one, or to adjust your package when circumstances change.

[1] Leadbetter, C., Making it personal, Demos, 2008. http://www.demos.co.uk/publications/makingitpersonal Services NSW

[1] PC disability Care and Support, Overview, Key Points, p2.

[1] Co-Production and Personalisation in Social Care, Jessica Kingsley Publishers, 2007.

[1] Leadbetter, C., Making it personal, Demos, 2008. http://www.demos.co.uk/publications/makingitpersonal

The help at hand is your co-driver on this journey to a good life. Your Local Area Coordinator (LAC) will hold the map and help you negotiate the barriers, road blocks, and potholes on your way.

Your LAC will come early in your life to establish your eligibility for NDIS support, and once this has been established, to give you an indication of how much money will be in your budget.

It is not the money that will make the LAC an important person in your life. The LAC is important as a respectful and trusted friend. The LAC stands beside you and your family, initially to gain an understanding of your particular vision for a good life, and then to contribute to the realisation of this vision. The LAC is your companion on this journey, there to help and facilitate, never to control.

Once the money has been allocated, you have to decide how to manage it. This is a basic book keeping exercise, and you have several choices. You can do it yourself, or farm it out for someone else to do. There are a number of agencies, service providers, accountants, and others who will do this for a fee. Shop around, as fees can vary quite a lot! Getting someone else to do the book work does not mean that you relinquish control over how the money will be used.

How the money is used is an exercise in how you can fit ‘a quart into a pint pot’. How to fit what is on your lists into your budget. This will be an ‘interesting’ exercise in determining priorities. What can I do without? What is essential? Also what will it cost, and who will provide the services? You can do this yourself, however again help may be useful. This is where your LAC can be very helpful.

The freedom you have is that you are no longer tied to a single service provider. You can go shopping for support with specialist organisations or community ones, and if you cannot find what you want, you can start your own supports and hire your own support workers! This can be particularly useful in the bush, where services are few and far between.

Hiring staff brings risks, and hence needs to be done with caution. There is a very useful guide, approved by the NDIS, that – when meticulously followed – will make it a lot easier, and reduce risk. [9] www.myplace.org.au/engagingyourownsupports.

2.The Local Area Coordinator

“Local Area Coordination can be described as a generalist or eclectic approach.  It exhibits elements of individual coordination, personal advocacy, family support, community development and direct funding.  The unique quality, and much of the advantage, of Local Area Coordination derives from the mixing and blending of activities and approaches of each of these human service orientations as well as the intentional design of an ongoing personal relationship”.[10]

The relationship you, as the coordinator, develop with the customer is the customer’s relationship with the NDIA. To the customer you are the NDIA, and so to help achieve the best possible outcomes for the customer, you will need to be the best coordinator you can be!

You can only help in achieving good outcomes if you have an insight into the goals and dreams of your customer, and he will only share these with you if you have a respectful and trusting relationship with him and his family.

For the relationship to work it must be a relationship between equals. As the customer has decision making powers, you can not be merely a messenger speaking on behalf of others. You too need to

[1] A Guide to Engaging your own Support Workers.  www.myplace.org.au/engagingyourownsupports.

[1] Bartnik, E., Chalmers, R., It’s about more than the money, Local Area Coordination Supporting People with Disabilities, ‘Co-Production and Personalisation in Social Care’, 2007

age:EN-AU;mso-fareast-language:EN-US;mso-bidi-language: AR-SA'>[1] Co-Production and Personalisation in Social Care, Jessica Kingsley Publishers, 2007.

[1] Leadbetter, C., Making it personal, Demos, 2008. http://www.demos.co.uk/publications/makingitpersonal

have the authority to make decisions on behalf of the NDIA. Your authority needs to match your responsibilities.

Developing, growing and maintaining these relationships is the key to good outcomes. Don’t be fooled by the idea that personal relationships are un-professional, or a conflict of interest. That is old, 18th century institutional thinking. Personal and professional relationships can co-exist, provided certain boundaries are observed.

Your authority to make decisions enables decisions to be made close to and in consultation with the customer. You are in the best position to capture, not only the factual information, but also the abstracts, and nuances that get lost in the written report, but should be factors in the decision making process. Written reports only capture a small part of this, and much is lost on its way up the organisational chain, and with it the quality of decisions made.

It’s about more than the money! The money is just a tool, but not the end in mind. Your relationship with the customer, his family and other supports, is the critical factor in the customer empowering himself, and reaching his potential.

Everybody has natural abilities and capabilities and strengths. Collectively they are his assets, his capital. Everybody has these assets in various degrees, for instance: Personal Capital, Knowledge Capital, Social Capital, and Material Capital. It is your job as coordinator to walk beside your customer and be his friend, and guide and encourage him to grow this capital, so he can become empowered and reach his potential.

Your reward is to see your customer take his place in community, respected as an equal, with the confidence and knowledge to address his own issues, manage his risks, and be well and safe.

  1. The Service Provider

Funders tend to relate principally to agencies rather than the people served and, hence, these agencies see themselves as the “agents of those they serve”.[11] Funder and service provider tend to become co-dependent. The funder purchases a series of services, defined by a service agreement, from the service provider. The service provider is accountable to the purchaser, usually in inputs, sometimes outputs, rarely outcomes. The service provider controls services delivered, when and to whom. Service users have little influence or choice, and become virtual spectators in their own lives.

The system has been characterised by a ‘one-size-fits-all’ approach in which there is very little choice or flexibility, and where programs and services are built around organisational and system needs rather than the needs of clients”. [12]

It has led to an ‘armchair culture’, reactive rather than strategic, risk averse and inward looking. Many organisations have neglected relationships with their customers and their families, as they are seen as a nuisance rather than an asset.

In the new lane everything changes! The NDIS does not consider its customers to be ‘factory seconds’, it values them as people who may be different and have different needs, but are equal human beings. People who need to be respected and valued. People who must be included in our communities as equals.

To enable this to happen, power is transferred from the service providers to the customer, so he can take ownership over his life, and make the decisions that will make his life a good life. To

[1] Kendrick, M., When people matter more than systems, 2000

[1] Shut Out, National People with Disabilities and Carer Council, 2009 (p2)

than the money, Local Area Coordination Supporting People with Disabilities, ‘Co-Production and Personalisation in Social Care’, 2007

age:EN-AU;mso-fareast-language:EN-US;mso-bidi-language: AR-SA'>[1] Co-Production and Personalisation in Social Care, Jessica Kingsley Publishers, 2007.

[1] Leadbetter, C., Making it personal, Demos, 2008. http://www.demos.co.uk/publications/makingitpersonal

facilitate but not control this process the NDIA, through its facilitators, aims to develop strong long term relationships with the customer.

From a linear hierarchal funder to service providers to customer relationship we now move to a triangular, level playing field. Suddenly service providers have become shop keepers, not gate keepers.  They are now a participant in a market providing niche services, and their – potential – clients are people with disabilities who are trying to get the best care, support, and quality of life that their money will buy!

Service providers have to adjust to user demand and shift from a mass, centralised form of service provision towards more networked and personalised services. Can they develop the respectful and trusting relationships with their clients? Can they become innovative, and manage, rather than avoid risk? Can they learn to focus on outcomes and strategies to improve them, rather than mere accountability in inputs? These are huge challenge for service providers, and not all will succeed.

  • “It is not the strongest of the species that survives, nor the most intelligent: it is the one most adaptable to change.” Charles Darwin.
 

[1] Paton S., Homan, J., Learning with Amanda, presentation at the International Conference for Community Engagement, Brisbane, 2005

[2] Dr Bruce Bonyhady is the Chairman of the National Disability Insurance Agency (NDIA) He has initiated, inspired and driven the establishment of the NDIS.

[3] Dr Bruce Bonyhady, Address at the National Press Club luncheon, 090714

[4]Jim Moore, Chief Executive of the Department of Family and Community Services NSW

[5] PC disability Care and Support, Overview, Key Points, p2.

[6] Co-Production and Personalisation in Social Care, Jessica Kingsley Publishers, 2007.

[7] Leadbetter, C., Making it personal, Demos, 2008. http://www.demos.co.uk/publications/makingitpersonal

[8] Leadbetter, C., Making it personal, Demos, 2008. http://www.demos.co.uk/publications/makingitpersonal

[9] A Guide to Engaging your own Support Workers.  www.myplace.org.au/engagingyourownsupports.

[10] Bartnik, E., Chalmers, R., It’s about more than the money, Local Area Coordination Supporting People with Disabilities, ‘Co-Production and Personalisation in Social Care’, 2007

[11] Kendrick, M., When people matter more than systems, 2000

[12] Shut Out, National People with Disabilities and Carer Council, 2009 (p2)

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Capricorn Community Development Association Inc.

National Disability Insurance Scheme

Local Area Coordination: The engine room of the NDIS

John Homan

151215

The organisation:

The Capricorn Community Development Association Inc. (CCDA), is an unfunded volunteer, community development organisation. Its purpose is to support the community in solving its own problems. CCDA acts as a mini-peak body for the region and inputs a Central Queensland perspective to state and national forums.

CCDA is a member of: The Queensland Futures Forum; The Controlled Income Management Group; The Queensland Anti-Poverty Week State Steering Committee; QCOSS; Peak Care; CCFSN, The Community Services Industry Partnership and is a foundation member of the Community Services Industry Alliance.

Activities include: Advocacy; Information dissemination; A monthly newsletter; Community information events and activities; Networking opportunities; Input to strategic forums and networks.

The author:

John Homan is a member of the CCDA Management Committee, and is the father of Amanda who was intellectually disabled from birth. He has served a more than forty year ‘apprenticeship’ in the disability sector, at an operational level, and a strategic one:

  • he was a management committee member of several disability service providers,
  • served as a Community Member on the (first) Disability Services Council of Queensland,

  • wrote four submissions to the Productivity Commissions inquiry into Disability Care and Support, and
  • made two presentations to the Productivity Commission.
  • was co-author and presenter of “Learning with Amanda” at the International Conference for

Community Engagement, Brisbane, 2005

Introduction

The National Disability Insurance Scheme has been rightly hailed as the greatest social reform in Australia since the introduction of Medicare. It now has become clear that this ‘greatest reform’ is poorly understood, within the sector, and the community. The proposal to outsource Local Area Coordination (LAC) reflects traditional style welfare thinking: fiddling to make the old system better, while staying inside our comfort zone, and with what we are familiar.

 

The reality is that what we knew and understood of disability care and support is no longer relevant. We have to un-learn most of our culture, knowledge, practices, and understanding. We need to clear the decks so we may understand and embrace the new thinking. For many this will be traumatic, but in not making the transition there is the real danger of snapping back into the old welfare model, which not only failed people with disabilities, but also is unaffordable.

This paper is an attempt to shine a light on the systemic changes proposed by the Productivity Commission when it reported on its inquiry into Disability Care and Support. The Productivity Commission’s perspective was subsequently supported by federal legislation in 2013.

The new thinking is about changing relationships between stakeholders, and changing systems of supporting people with disabilities. The discussion around outsourcing Local Area Coordination clearly demonstrates confusion about the proposed practice framework.

Based on research, experience, and other evidence, this paper aims to demonstrate that outsourcing Local Area Coordination is a bad idea, that it may cause the National Disability Insurance Scheme (NDIS) to fail, and may return us to the current system that the Productivity Commission referred to as:

underfunded, unfair, fragmented, and inefficient, and gives people with a disability little choice and no certainty of access to appropriate supports. The stresses on the system are growing, with rising costs for all governments”.1

NDIS Core activities

The Productivity Commission’s documented objective through its 2010 inquiry into Disability Care and Support was to enable all people with significant disabilities to build and pursue their goals and dreams for a good life, and also to ensure the scheme is sustainable

To realise these objectives the Productivity Commission identified two core sets of activities: Firstly: to fund services to people with disabilities,

Secondly: to assist people with disabilities in achieving a good life, and to make the scheme financially sustainable.

To align social benefit: a better life for people with disabilities, with economic benefit: an economically sustainable system, is revolutionary!

Profit and Loss

The costs of funding services by Australian governments since the 1990s have increased at between 7 and 8 per cent per annum in real terms, which clearly shows that the old welfare model is not sustainable. The ‘welfare’ model of funding disability care and support has always been a cost. It is not sustainable for several reasons, and will be less so in time to come. People living longer and natural increases of the population, drive increasing demand and increasing cost. Cost will exceed growth in government revenue.2 As the Productivity Commission pointed out, it would require tax increases or reducing other services to become sustainable.3

The major change introduced by the Productivity Commission, is that people with disabilities are funded directly. They are allocated a budget, and can choose the services they need or want, to achieve a good life. Funding is no longer filtered, and controlled by service providers. This system is based on a well proven British system “in Control”. 4

Even with these changes, funding continues to be a cost; no different from the current, traditional welfare model.

  1. PC disability Care and Support, Overview, Key Points, p4.

  1. Moore, J., address to National Disability and Carer Congress, 2011

  1. PC disability Care and Support, Overview, Key Points, p4.

  1. Leadbetter, C., Making it personal, Demos, 2008.  http://www.demos.co.uk/publications/makingitpersonal
 

Changing from a welfare model to an insurance model makes the alignment of social and economic benefit, the PC’s second objective, achievable.

An insurance model factors in expenditure over the life of an individual, and the scheme’s sustainability is measured by calculating the total future costs of all those who are insured. This approach creates an incentive to make short term investments that maximise lifetime opportunities and reduce long-term costs.5

This long term investment strategy aims to make the person more independent, more skilled, more confident, more included in community, and possibly more employable. Reducing dependence on the NDIS through building capacity and independence, reduces cost to the NDIS; and that will make the system sustainable.

Benefits

The insurance model of investment in people not only makes the NDIS sustainable, but is projected to make a profit!

The Productivity Commission found that the NDIS would result in an additional 320,000 people with a disability and 80,000 carers being employed, and boost Gross Domestic Product by 1 per cent by 2050. National expenditure on disability services is projected to increase by 0.5 per cent as a result of the NDIS, but in return, the economy is projected to increase by 1 per cent.6

Other Benefits are:

  1. Because the NDIS applies Australia wide, to all people with significant disabilities, around 410 000 people would receive funding support.7

  1. People with disabilities will have buying power that enables them to shop for the services they want and need, and standards of service will improve.

  1. This growth in the sector will create significant economic growth, particularly in states like Queensland, where funding per person has been as low as 55% of the national average.

  1. Increased demand for support services, both not for profit and for profit will generate major growth in the sector.

  1. The increase in services to people with disabilities will create a major demand for skilled support workers, as well as people employed by the NDIS.

  1. This will also create opportunities for training and mentoring organisations, and other allied services.

  1. It may even stimulate the growth in demand for assist dogs which offer great social and economic benefit.

Relationships

A better life for people with disabilities and sustainability of the system do not just happen.

The NDIS, as an insurance system, aligns social and economic outcomes. As the economic outcomes flow on from the social ones, the primary focus of the National Disability Agency (NDIA) (the operating arm of the NDIS) is on improving the quality of life of people with disabilities. Economic benefits and sustainability will follow!

Noted social researcher and thinker Charles Leadbetter observes that a full life comes from having a number of significant and fulfilling relationships that support you and give your life purpose, someone to share experiences with, good and bad. And also that significant, fulfilling relationships, which provide us with care, recognition and purpose are vital to leading a full life.8

  1. Bonyhady, B., Address at CEDA luncheon, Brisbane, 051115

  1. Bonyhady, B., Address at CEDA luncheon, Brisbane, 051115

  1. PC disability Care and Support, Overview, Key Points, p2.

  1. Leadbetter, C., With Relationships and The Public Good, 2008.

 http://www.charlesleadbeater.net/NotaBlog/blog-2008.aspx

 

The Productivity Commission shared Leadbetter’s insights about the critical importance of relationships to bring about change. The PC completed what it had started with the direct funding model and set about creating direct, equal, respectful, and trusting relationships with people with disabilities.

This transition from the current, top down, relationship between funder, service provider and people with disabilities, to a relationship where the three parties sit around the table as equals, is the paradigm shift that creates the empowering environment that drives better lives and sustainability.

Local Area Coordination (LAC)

Local Area Coordination was the system chosen to bring change. Local Area Coordination is about relationships. It was tested in Albany (WA) in 1988, and has been developed, slowly and methodically, since. It now covers all of West Australia. The Western Australian model of Local Area Coordination is community development by a different name and includes some elements of case management.

The West Australian system of LAC met the objectives of creating a direct link between the NDIA, the funder, and the person with a disability for two reasons. It was a proven system, and regarded as

‘core business, and was never outsourced. Eddie Bartnik and Ron Chalmers observed that ‘Local

Area Coordination has been retained within government throughout the past eighteen years. At key decision points during this period it has been determined that LACs play a pivotal role in connecting individuals and families with the policy and program systems of government and that this should not be lost in exchange for any benefits which may ensue from privatisation’.9

Using this model, Local Area Coordinators are not mere messengers. To their customers they are the NDIA. They can make decisions with the customer on behalf of the NDIA, as their authority matches their responsibility. Local Area Coordination, and direct funding have created the dynamic where the person with a disability, the NDIA through the LAC, and service providers are now equals at the table. Ownership of decisions made is shared.

As there is not a single discipline that encompasses a LAC’s skill set under this model - individual coordination, personal advocacy, family support, community development and direct funding, are some – in Western Australia they were drawn from a wide range of backgrounds and professions (eg social work, psychology, education, therapy, nursing and community work).10 LAC’s, in spite of their wide diversity of backgrounds are expected to demonstrate some key qualities: a contemporary values base, they must be self-aware, be able to listen and hear, have imagination, people skills, ability to think strategically and operationally, be innovative and able to manage risk. Wherever possible, LACs are recruited from their local communities.

With the LAC as his mentor, and, the person with a disability controlling his funding, he can leave the

‘filling in time between meals’ type of service behind, and embark on a journey to his potential, and a good life.

The LAC builds his knowledge and understanding of the local community as a basis for promoting inclusion and to expand the potential support base for people with disabilities. LACs work with children and adults of all ages and stay with people across the major transition points of life. It is the nature and quality of this ongoing relationship, and having one point of contact for local people that is reflected consistently in satisfaction ratings with the LAC program.11

Stehlik and Chenewith suggest that a long term trusting relationship enables the Local Area Co-ordinator to be seen as a "co-driver" on the journey, the person holding the map, while assisting and supporting the client to move forward himself. The barriers, road blocks, and

  1. Bartnik, E., Chalmers, R., It’s about more than the money, Local Area Coordination Supporting People with

Disabilities, ‘Co-Production and Personalisation in Social Care’, 2007

  1. Bartnik, E., Chalmers, R., It’s about more than the money, Local Area Coordination Supporting People with Disabilities, ‘Co-Production and Personalisation in Social Care’, 2007

  1. Bartnik, E., Chalmers, R., It’s about more than the money, Local Area Coordination Supporting People with Disabilities, ‘Co-Production and Personalisation in Social Care’, 2007
 

potholes that are constantly in the way are therefore potentially smoothed by this partnership, thus enabling the journey to be taken by others as well. 12

Under the Productivity Commission’s proposed model, the core function of Local Area Coordinators is to protect, and build on, the NDIS’s investment by guiding and mentoring people with disabilities, so they will get the best possible quality of life, and the best ‘bang for their buck’.

When the NDIS introduced individual funding, it turned service providers from gate keepers into shop keepers. Service provision became a bazaar where people with disabilities can shop for the services they need, or want. It is a competitive, self-regulating market, open to all enterprises, specialist or generic, that believe they have a product someone may want to buy. No longer are service providers accountable to the funder. They are now accountable to the buyer of their product or service. This open market exposes buyers to considerable risk. Are sellers motivated by ‘doing good better’, or making a quick profit?

This unregulated market system was an NDIA creation, and so the responsibility for protecting people with disabilities from snake oil salesmen and carpet baggers, is a clear NDIA responsibility. It is an intrinsic part of the Local Area Coordinator’s mission to ensure that people with disabilities get the best possible quality of life, and the NDIS the best possible return from its investment.

Peters and Waterman from the McKinsey Institute stated in 1982 that: “Without exception the dominance and coherence of culture proved to be an essential quality of the excellent companies. Moreover, the stronger the culture and the more it was directed toward the marketplace, the less need was there for policy manuals, organization charts, or detailed procedures or rules. In these companies, people way down the line know what they are supposed to do in most situations because the handful of guiding values is crystal clear”.13

A nationwide organisation like the NDIA needs a strong and coherent culture across the entire organisation. Not a ‘one size fits all’ culture, but one grounded in common values and objectives. The complexity of the NDIA makes it difficult, if not impossible, to achieve consistent outcomes through the rule book. However, this consistency may be achieved through its shared values.

Outsourcing?

Outsourcing is a risky business. There are many examples in the community services sector to confirm this.

Much history of failures of outsourcing, relevant to the disability, and other sectors of community services seem either lost or ignored. It would therefore be prudent to seriously pay attention to George Santayana’s warning that "Those who cannot remember the past are condemned to repeat it"14

The Disability Services Act of 1986 was a federal act. Then in the early nineties the Federal Government ‘outsourced’ disability (except for employment) to the states. Different states responded differently. West Australia invented, developed and grew Local Area Coordination statewide; while in Queensland its government did not initiate a system of identifying people with disabilities until 2000.

The political decision to outsource disability to the states in the early nineties, generated the current system which - as previously noted - the Productivity Commission described as: ‘‘underfunded, unfair, fragmented, and inefficient, and giving people with a disability little choice and no certainty of access to appropriate supports. The stresses on the system are growing, with rising costs for all governments”.15

In its report the Productivity Commission strongly advised against repeating the outsourcing of the nineties, when it said that the Commonwealth should be the sole funder of the NDIS, and then referred to an ‘outsourced’ or federated model:

“The third and most inferior option would be a ‘federated’ NDIS. In this model, the

  1. Stehlik, D., Chenoweth, L., Flexible funding as an underpinning to community resilience, 2001

  1. Peters, T. J., Waterman Jr, R. H., In search of excellence, 1984,  (P5),

  1. George Santayana (1905) Reason in Common Sense, p. 284, volume 1 of  The Life of Reason

  1. PC disability Care and Support, Overview, Key Points, p2.
 

Australian Government would provide additional disability funding to state and territory governments and stipulate some common national features, but would otherwise leave state and territory governments in control of their own systems”.

Then it warned against the dangers of an outsourced NDIS:

“…such an arrangement could easily revert to the current dysfunctional and unfair system, with ‘agreements’ breaking down into disputes about relative contributions, special variations and carve-outs.

A federated scheme would not offer people the assurance of high-quality long-term care and support”. 16

This warning, although related to funding, may be interpreted as a general warning about the dangers and risks of repeating history through the instrument of outsourcing.

If economic forces are the same all over the world, as Economist Professor Joseph Stiglitz17 observes, why are outcomes markedly different? Stiglitz gives the answer when he says that this clearly shows that differences in outcome are greatly affected by policy and politics”.18

Stiglitz referred to the big global picture, however there is no reason to believe that this rule does not apply at different scales. Outsourcing disability to the states, and the warnings against the federated funding model by the Productivity Commission, are clear examples. The next question is “If we outsource Local Area Coordination, is it immune?”

Professor Anna Yeatman19 observes that outsourcing peripheral activities enables an organisation to focus better on its core activities.20 This raises the question whether giving control over a core activity, like Local Area Coordination, is worth the money it may save.

As previously mentioned, in West Australia outsourcing Local Area Coordination was considered in the nineties, and was rejected. It was decided that “LACs play a pivotal role in connecting individuals and families with the policy and program systems of government and that this should not be lost in exchange for any benefits which may ensue from privatisation”.21 The WA Disability Services Commission judged Local Area Coordination to be a core activity.

Further considerations:

Outsourcing Local Area Coordination to NGO’s or for profits creates a clash of cultures. Growth and expansion is a primary objective of most organisations, get bigger and better. Local Area Coordination, in alignment with community development principles, has an exit strategy. Its aim is to reduce its clients’ dependence on the NDIA by taking them on a journey to their potential, independence and community inclusion, and with it reducing cost, and make the NDIS economically sustainable. It seems unlikely that these conflicting philosophies can co-exist!

Human services have moved on from input to output accountability, and are now moving to accountability on outcomes, based on evidence. This is no longer a ‘tick the boxes’ exercise. The Economist Professor Joseph Stiglitz’s22 theory says that: “If economic forces are the same all over the world, outcomes are markedly different because outcomes are greatly affected by policy and politics”.23

  1. PC Overview and Recommendations Disability Care and Support  - Overview,  p 38

  1. Joseph Stiglitz, professor of economics at Columbia University,  Nobel Memorial Prize in Economic

Sciences

  1. Joseph Stiglitz, The Price of Inequality, Sydney (NSW) Town Hall, 080714

  1. Anna Yeatman, Professorial Research Fellow Whitlam Institute, University of Western Sydney

  1. Yeatman, A., Competitive Tendering and Public Values, 1997

  1. Bartnik, E., Chalmers, R., It’s about more than the money, Local Area Coordination Supporting People with Disabilities, ‘Co-Production and Personalisation in Social Care’, 2007

  1. Joseph Stiglitz, professor of economics at Columbia University,  Nobel Memorial Prize in Economic Sciences
  2. Joseph Stiglitz, The Price of Inequality, Sydney (NSW) Town Hall, 080714
 

Stiglitz’s theory throws into doubt the capacity of different organisations to produce valid and compatible evaluations. Zifcak illustrates Stiglitz’s rule when he makes the point that service contractors have a clear interest in retaining their contracts and that if policy functions are contracted out, inevitably there will be a tendency for a contractor to provide the advice for which it is paid. Advice based on a commitment to public service or to some wider conception of the public interest is therefore less likely to be heard.24

Professor Yeatman also makes the point that trusting the dynamics of competition between privately oriented providers to provide the best results is a counter-intuitive thing to do. Whether we consider the work of private consulting firms undertaking review and evaluation of areas of government funded service or the work of non-government organisations in the community services sector, or the work of higher education institutions, a reliance on commercially-based incentives for good work in service to public values, is highly problematic.25

The productivity Commission’s stated objective is for the NDIS to be a national scheme with national standards and entitlements that would cover people with significant disabilities arising from non-accidents.26 An outsourced system will threaten ‘national standards’ because of the real risk that oranges are not compared with oranges, but with apples and many other fruits.

The NDIS is an insurance, not a welfare, scheme. Insurance, to be viable and sustainable, relies on vast amounts of data. The data coming in from outsourced systems may not be compatible, and be an actuary’s nightmare, and may cause the NDIS to fail.

There are other reasons not to outsource Local Area Coordination:

  • LAC is a core strategy, identified by the PC, and enshrined in the legislation. Outsourcing it will make it non-core, and will bastardise the NDIS.

  • Stakeholders and the community at large have a poor understanding of the NDIS. Outsourcing one of its two core activities will indicate its lesser importance and will add to the current problems of confusion and misinformation.

  • Where the NDIS is based on direct relationships between the NDIA and the customer through the LAC, outsourcing LAC will return the NDIS to the old, failed, top-down system. It places a ‘middle man’ in the relationship between the NDIA and the customer, which will recreate all the complexities of authority, responsibility, and accountability that has marginalised people with disabilities over many decades/centuries.

  • LAC as a part of the NDIA, is a responsible autonomy. It is an organic system, built around relationships and trust. Organisation members have a set of compatible, and shared values. This enables an empowering culture to grow, with shared objectives and motives. When outsourcing LAC to NGO’s and for profits, it is most unlikely that this common culture will be realised. The host organisation’s culture may be expected to be dominant.

  • Experience has shown that most NGO’s, for profits and government departments are managerial in their governance. They are not community developers, nor do they understand community development, and so will most likely fail Local Area Coordination. It makes it inappropriate for them to host LAC.

  • Unavoidably LAC’s employed by NGO’s and for profits will have a conflict of interest, or create a perception of conflict of interest. Do they speak for the organisation that pays them, or do they represent the NDIA and speak for the customer? This will be a question that will keep being asked.

Conclusion

Local Coordination has proved itself in West Australia over more than 25 years. The Productivity Commission strongly supports this model to achieve its second core objective: to assist people with disabilities in achieving a good life, and to make the scheme financially sustainable.

  1. Zifcak, (1997, 116), quoted  Yeatman, A., Competitive Tendering and Public Values, 1997

  1. Yeatman, A., Competitive Tendering and Public Values, 1997

  1. PC disability Care and Support, Overview, p11
 

The WA Disability Service Commission made the decision – based on 18 years’ of experience - that LACs play a pivotal role in connecting individuals and families with the policy and program systems of government and that this should not be lost in exchange for any benefits which may ensue from privatisation’.27

Comparing the benefits of LAC, as proposed by the Productivity Commission, with the identified risks of outsourcing, clearly demonstrates that the risks of the NDIA failing many thousands of people with disabilities and their families through outsourcing, presents an unacceptable risk.

The risk that, rather than people with disabilities achieving a good life, and the NDIS economic sustainability, we once again are trapped in a system that is “underfunded, unfair, fragmented, and inefficient, and gives people with a disability little choice and no certainty of access to appropriate supports”.28

 

  1. Bartnik, E., Chalmers, R., It’s about more than the money, Local Area Coordination Supporting People with

Disabilities, ‘Co-Production and Personalisation in Social Care’, 2007

  1. PC disability Care and Support, Overview, Key Points, p2. 

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