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“Dear Ask DSC,
I have a concern that might be a bit controversial. I am seeing more and more participants switching to unregistered providers who have cheaper prices. Many of these people are now using unregistered providers for personal care and other high risk supports. I am worried these providers might be dodgy, as they hardly have any quality and safeguarding requirements. Should I warn participants against using them? Am I, working for a service provider myself, even allowed to do that? Moreover, how is it fair that these providers are able to keep their costs down by not complying with quality and safeguarding requirements, whereas providers doing the right thing are pretty much punished?”
This is a great question. It’s an emotive one and a complicated one to answer, but here goes…
If a person’s supports in their plan are plan or self-managed, they can generally use both unregistered and registered providers. Though some supports can only be delivered by registered providers, such as Specialist Disability Accommodation, behaviour support and support that involves the use of restrictive practices. But for most supports, the choice of provider and registration status is flexible. This means an increased risk, yes, but it also means increased freedom. You might like to read Todd Winthers’ great article on this topic.
For many people, the option to be able to use unregistered providers is really important to exercising their choice and control.
Now, it’s not as simple as registered provider = good, unregistered provider = bad. Technically speaking, any Australian company could be operating as an unregistered provider. For example, if you self-manage your consumable funding, you might choose to buy continence aids from the local pharmacy. If the pharmacy is not registered with the NDIS, technically, they are an unregistered provider. This kind of flexibility about who can supply goods and services can be really handy when you’re just living your life.
As you point out though, there are also unregistered providers that deliver personal care and higher risk supports. This worries a lot of people, including the NDIS Minister Bill Shorten who has alluded to reviewing who can deliver personal care supports going forward.[1] Just between us though, it’s difficult to see how mandatory registration would be implemented for all supports given the significant workforce shortages and thin markets the NDIS already faces. One solution could be for the NDIS to subsidise the cost of registration, but look, we haven’t seen that option on the table as yet, and the government doesn’t seem to be looking to spend more money on the NDIS.
There’s a lot of commentary in the media about the unregistered provider market, but registration status itself does not necessarily determine whether or not a provider is “dodgy”. It is an important consideration, though, for each individual to understand and weigh up when they are choosing the right provider for them. By engaging a registered provider, a participant has assurance that the provider is subject to a third-party audit against quality standards and that it needs to meet a number of compliance obligations, such as reportable incidents and worker screening contained in the rules. For some people, this is a really important safeguard. For others, it’s not so important.
There are many reasons a provider might choose to remain unregistered, including:
- The time and costs associated with meeting compliance requirements.
- Some professionals are already subject to industry specific oversight beyond the NDIS and don’t see value in the registration process.
- The NDIS is just a very small part of their business, and the cost outweighs the benefit.
- Some unregistered providers choose to implement quality and safeguarding systems that could meet the requirements of the practice standards without going through the audit cost.
- Providers want to charge above the NDIS Pricing Arrangements and Price Limits.
There will also be providers who operate with few safety and compliance protocols in place. Supporting participants to understand why a prospective provider has chosen not to register may be useful in making decisions.
We also need to recognise that registration is a tool but not the silver bullet. Ann-Marie Smith’s service, Integrity Care, was a registered NDIS provider, demonstrating that registration status alone does not guarantee quality and safety. Though it should be noted that additional mechanisms have been put in place since her tragic death to prevent registered provider services being delivered by a sole worker.
So, what can you do to help the people you support navigate this complexity? Because it is so complex (too complex if you ask me).
Weigh up the risks
Rather than warning people, your role might be to support them to understand the pros and cons of working with the unregistered market. This enables people to make informed decisions about the risks, including any additional safeguards they may wish to put in place.
Access the provider register
This page contains information about the status of NDIS providers who are registered with the NDIS Commission. There is also a list of actions that have been taken against NDIS providers, including those that are not registered. You could make sure your participants know about this page and how to use it.
Use the NDIS Code of the Conduct
It’s also important to recognise that despite popular belief, unregistered providers are not unregulated providers. The NDIS Quality and Safeguards Commission (NDIS Commission) regulates all providers in the NDIS market, and anyone can make a complaint to them about a provider. All providers, registered and unregistered, need to meet the NDIS Code of Conduct. So, if you become concerned about the quality of supports provided by an unregistered provider (or a registered provider for that matter) you can report this to the NDIS Commission to investigate.
Encourage worker screening
Another condition of provider registration is that workers in risk assessed roles undergo an NDIS Worker Screening. While not mandatory for unregistered providers, NDIS participants should know about the worker screening and can require their workers to have this check if they wish. Some participants may not be aware that they can be linked to their sole trader workers in the NDIS Worker Screening database, which is another really important safeguard. See the NDIS Commission website for more details.
In terms of the fairness of it all… look, we hear you, it’s not a perfect system. But if you’ve developed a quality system for your organisation that keeps people safe, helps you do your job and drives quality improvement, then we reckon that’s a pretty good investment, and we know that quality services are in very high demand in the NDIS. Keep sharing information with the people you support to help them assess and weigh up risk because, ultimately, often the most important safeguards are the ones we put in place for ourselves.
