Conflict of interest in Support Coordination
Support coordinators wield significant influence over the services participants select. In an ideal world, the only interest support coordinators have is the well-being of the participants they support. However, the real world is messy, making us all susceptible to conflicts of interest. Whether actual, potential, or perceived, these conflicts can jeopardise the safety and autonomy of participants, undermining choice and control in the NDIS.
Conflict of interest is receiving increasing attention in the support coordination space. It is one of the biggest challenges in delivering genuine choice and control for participants. While we’ve all heard the horror stories, many smaller conflict of interest breaches occur day to day. Most of us are trying to do the right thing but don’t always know how to navigate the important questions about ethics, transparency, and the well-being of NDIS participants.
The Current Landscape
Recent reports, such as the Australian National Audit Office (ANAO) Performance Audit Report, have underscored the pressing need to address conflict of interest both broadly within the NDIS and specifically within support coordination. The NDIA has also signposted this desire in their new PACE reporting templates, which require support coordinators to identify and manage real or perceived conflicts. Additionally, the NDIS Independent Review recommended replacing the support coordination role with Navigator roles, and recommend that organisations delivering navigation be barred from offering other NDIS-funded services altogether.
Key Forms of Conflict of Interest
Support Coordination providers delivering other types of services: This is generally the first type of conflict of interest that comes to mind for many support coordinators. When support coordination providers also offer other services, there is often a concern that they will favour these services when supporting participants in selecting providers.
Business-related relationships between providers: We don't need to work for the same organisation as another service to feel pressure around referrals. Many providers feel pressure from other organisations due to either formal business relationships or informal pressures (such as another service being a major source of referrals).
Working for multiple providers: With an increasingly casualised workforce, it is becoming more common for people to work for multiple NDIS providers. This can lead to similar pressures (both explicit and implicit) faced by support coordinators working at single providers who deliver multiple services.
Personal Relationships: Support coordinators may have personal relationships with individuals working for other providers. This can create real or perceived pressure, leading to a conflict of interest.
Real vs. Perceived Conflicts of Interest
Even if we are confident that we prioritise the interests of the people we support when making decisions, we must still consider the issue of perceived conflicts of interest. In other words, we must also instil confidence in the people we support that we have their best interests at heart. So, how do we do this?
Be Independent: The simplest way to avoid the type of conflict of interest that arises from delivering multiple services is to offer support coordination exclusively. This also clearly signals to participants that conflict of interest is a priority. If the transition to navigators goes ahead as recommended by the 10-Year Review, this will be how all intermediary services are delivered. Why not get a head start?
Have a Conflict of Interest Policy: All registered support coordination providers who also deliver other services are effectively required to have a conflict of interest policy outlining how they will navigate this inherent conflict. Additionally, given the various other forms of conflict of interest relevant in this space, even unregistered and independent support coordinators should have a clear conflict of interest policy in place.
Read, understand and explain your conflict of interest policy: OK, I’m kind of cheating by calling this one a separate recommendation, but be honest, have you read all of your organisation's policies to the point you would be comfortable explaining them to each of the people you support?
Transparency: When a conflict arises, it's crucial to be transparent with anyone affected, especially participants.
Report Serious Breaches: Serious breaches, such as providers offering cash incentives for referrals or using high-pressure tactics to compel participants to engage multiple services from them, should be reported to the NDIS Quality and Safeguards Commission.
Client Capture: Conflict of Interest at Its Worst
The ANAO report has highlighted "client capture" as a significant risk to participants, but what exactly is client capture? In short, it refers to participants who receive all their services from a single provider. While this may be requested by some participants for the sake of a number of reasons, providers rarely explain the risks to participants. All the risks that participants face from providers, including poor service delivery, financial abuse, and fraud, are significantly increased when there is only one provider in their lives. As capacity-building support, we must take responsibility for explaining these risks to participants.
You may be thinking, "But what about choice and control?" Of course, this should be a primary driver of everything we do as support coordinators. However, given the risks associated with client capture and the breadth of providers available, client capture is rarely a sign of a person being supported to make informed choices and exert control over their lives.
What to Look Out For:
Client capture manifests in various forms, all aimed at steering participants towards receiving more services from the same provider. Some are more overt, like high-pressure marketing tactics or only offering some services if a participant receives another service from them, to more subtle forms such as referral partnerships or utilising internal assessment tools to identify participants for additional services. These may not be easy for you to detect from the outside, so working closely with participants is the key to detecting unethical practices. Some useful strategies include:
Investing time in capacity building with participants and their supporters about risks of client capture.
Speaking to participants who receive multiple services from a provider about the process they went through to select that provider. Sometimes, this will be the result of careful consideration, in which case there may not be a problem, but other times these conversations can raise red flags.
Where to From Here:
There are a few key takeaways for support coordinators:
Understand and follow your organisation’s conflict of interest policy.
Work with participants to build their capacity to understand conflict of interest.
Beware of your own conflicts of interest and take steps to mitigate them.
Keep an eye out for other providers acting in conflicted and unethical ways.
Do not offer, request, give, or receive incentives that may influence decision-making.
As with everything, take good case notes.
And finally, remember that choice and control is one of the core reasons the NDIS exists. To demonstrate the scheme’s value, we must deliver genuine choice and control. To demonstrate genuine choice and control, we must get on top of conflict of interest.