Quality & Safeguarding
NDIS Commission Inquiry into Support Coordination and Plan Management
There has been so much happening in the NDIS of late you might have missed the latest Own Motion Inquiry into Support Coordination and Plan Management (intermediaries). Unlike other Own Motion Inquiries this one appears to have commenced on the down-low, with the Part 1 report being published at the same time the Inquiry was publicly announced.
About the Inquiry
The Inquiry is being conducted in two stages:
Part 1 has been completed and examined complaints and reportable incidents received by the NDIS Commission relating to support coordination and plan management to identify:
Quality and safeguarding concerns raised in support coordination and plan management; and
Positive contributions that good support coordination and plan management is making to quality and safeguarding in the NDIS.
Part 2 of the Inquiry will examine whether the NDIS Commission should make any changes to how it regulates intermediaries. This stage will not be conducted until the Disability Royal Commission and NDIS Review hand down their final reports in coming months.
Part 1 Findings
45% of active NDIS participants have support coordination in their plans. Around 85% of support coordination payments (by value) were made to registered NDIS providers in the March 2023 quarter.
The NDIS Commission examined complaints and incidents made since 1 January 2022 which included:
460 complaints about support coordinators.
40 complaints made by support coordinators to the NDIS Commission raising concerns about a participant’s other supports; and
1,507 reportable incidents involving support coordination (excluding unauthorised restrictive practices).
On the face of it, these statistics surprised me. Surely support coordinators would be involved in raising more than 40 complaints in this period? But when you get into the details, the report suggests support coordinators may be raising their concerns about other service providers through the reportable incident channel. Or informing the provider of the incident or allegation which then prompted that provider to notify the NDIS Commission of a reportable incident. The data is difficult to follow, unsurprising given the confusion around who is responsible for submitting a reportable incident and to whom. You have to look hard through the NDIS Commission’s website to find clarification buried in pages 29-30 of this Reportable Incidents Guidance:
A registered NDIS provider is only required to notify the NDIS Commission of reportable incidents that are connected to the service they are providing. If a registered NDIS provider (such as a support coordinator or allied health professional) witnesses an incident or conduct involving another NDIS provider this should be raised as a concern of ‘provider non-reporting’ to the reportable incidents team of the NDIS Commission by phone or email. A reportable incident form is not required.
To make matters more confusing, the Incident Management Systems Detailed Guidance indicates that these manual reports should be directed to the Complaints team.
Despite these two pieces of advice, we often hear support coordinators are encouraged by the NDIS Commission contact centre to make a reportable incident and then the NDIS Commission will determine if it is indeed reportable.
Reportable Incidents and Support Coordinators
Anyway I digress. So how many of the 1,507 reportable incidents occurred in connection with the provision of support coordination services?
The majority of these cases were where the support coordinator reported a participant’s death that was unrelated to the provision of support coordination. Of the remaining incidents there were:
108 notifications containing allegations against a support coordinator.
181 notifications where the support coordinator informed another provider of an incident or allegation, which then prompted that provider to notify the NDIS Commission of a reportable incident.
170 notifications where the support coordinator was recorded as taking action to assist the participant in responding to the incident or allegation. For example linking a participant with appropriate health services, helping to find alternative living arrangements or reporting abuse to police following an incident.
So in most instances, support coordinators actually appear to play a positive role in incident management by supporting the participant to access available safeguards and support. The NDIS Commission recognises this positive contribution in its report.
So what about the remaining 108 incidents where the support coordinator was at the centre? These allegations included:
Fraud - invoicing participants for support coordination services that were not provided.
Neglect - failing to arrange necessary supports for the participant.
Crossing professional boundaries - entering into a personal relationship with the participant.
Coercion - coercing a participant into engaging their support coordination services; and
Abuse - where the support coordinator allegedly verbally abused, bullied or berated the participant.
These themes are similar in nature to the issues raised through the additional 460 complaints made against support coordinators. These matters are all very concerning, but it must be said, we don’t know how many were substantiated.
Complaints against Support Coordinators
43% of the 460 complaints made to the NDIS Commission about support coordinators since 1 January 2022 raised integrity concerns, including conflicts of interest, denying participant’s choice and control, coercion, sharp practices and crossing professional boundaries.
This shouldn’t surprise anyone, conflict of interest appears in just about every inquiry into the NDIS like that badly behaved drunk friend that just won’t stay in bed. Conflict of interest complaints arose in situations where providers delivered both support coordination and other support to the participant, and when the support coordinator is alleged to have acted in their personal interests at the expense of the participant.
87% of complaints raised care and skill concerns, including inadequate supports, poor communication, errors in relation to NDIS requirements, overcharging, inadequate or inappropriate responses to concerns raised, depletion of the participant’s NDIS funds, cessation of support coordination supports and other matters. Phew. You don’t need to be a mathematician to notice that these complaints do not add up to 100% - this is presumably because many complaints capture multiple issues.
In one alarming complaint, the support coordinator had also started working as the participant’s disability support worker. It was alleged that the support coordinator encouraged the participant to move into the support coordinator’s home, saying this would make it easier to provide the participant’s supports. After a disagreement, the support coordinator evicted the participant, leaving the participant homeless and without supports. When the participant sought assistance, it became clear that all of their support coordination funding and almost all of their funding for other supports had been used.
Let’s turn to Plan Management now.
60% of active participants in the NDIS use plan management and it’s on the rise (up from 49% over the past 2 years). The plan management market is dominated by a small number of large providers, with a large number of much smaller providers. Although there are more than 1,100 plan managers, the 10 plan managers that support the largest number of participants hold almost 40% market share. The ‘top 10’ are generally plan management specialists and provide virtually no other NDIS supports. By contrast, plan management represents a smaller proportion of the NDIS revenue for many of the smaller providers, many which provide other services in addition. As part of this Inquiry the NDIS Commission has examined:
384 complaints relating to the 10 largest plan managers made since 1 July 2018;
65 complaints relating to plan management provided by smaller plan managers made to the NDIS Commission since 1 July 2022; and
285 reportable incident notifications made by the 10 largest plan managers since 1 July 2018.
Reportable Incidents and Plan Managers
Like support coordinators, plan managers appear to make positive contributions to quality and safeguarding, including by making “third party” reports of incidents or allegations occurring in connection with other NDIS services. This makes up almost all reportable incidents by plan managers. Since 1 July 2018, the top 10 have notified the NDIS Commission of 285 reportable incidents. 229 of these notifications were in relation to a participant’s death that did not occur in connection with plan management. The remaining cases were mostly instances where the plan manager had on-reported concerns about abuse or neglect of participants as well as financial abuse and fraud identified through invoices and claims. The few cases where the plan manager was at the centre of the report - was when they had refused to pay invoices. In these cases the plan manager has notified the NDIS Commission of these complaints as allegations of abuse.
Complaints and Plan Managers
61% of the 384 complaints made to the NDIS Commission about the top 10 raised payment concerns, including non-payments, wrong payments, late payments and overpayments. 20% of complaints raised issues of participant supports and NDIS funds, including participants being left without adequate supports, depletion of funds and under-utilisation. 22% of complaints raised concerns of sharp practices, including inducement, provisions in service agreements and denying participants’ choice and control. 67% of complaints raised other quality concerns, including issues with communication, complaints handling, invoicing and accounting practices.
Similar concerns were raised in complaints about other plan managers (outside the top 10). Complaints relating to conflict of interest and sharp practices however, were markedly higher for the smaller guys (38%). This is unsurprising given the Commission has identified those smaller providers are more likely to provide other services on top of plan management.
It is also not surprising that the majority of complaints relate to plan managers refusing to pay invoices. The NDIA’s guidance on the role of the Plan Manager in determining reasonable and necessary is quite the contradiction.
As my colleague Rob Woolley pointed out last year the NDIA Guide to Plan Management says, in black and white, “the role of a plan manager does not extend to determining whether supports or services which have been purchased are reasonable and necessary.” But in the same paragraph, that same Guide to Plan Management says, “the plan manager’s role is to ensure that the plan is being implemented as intended, which includes ensuring that funds are spent in accordance with the plan.” So, plan managers are excluded from determining R&N but are expected to uphold it?! How does that work, exactly?
The irony is, other complaints related to plan managers paying for items that others believed were not consistent with the plan. Oh to be a plan manager - can you really win?
NDIS Commission concerns
The NDIS Commission says although the data and analysis in the report focuses on more recent complaints and reportable incident notifications, broader concerns about support coordination and plan management have emerged and grown since 2020. Since then an increasing number of complainants raised concerns about conflict of interest, sharp practices and patterns of unscrupulous behaviour. The NDIS Commission draws particular reference to recent investigations into a number of Victorian Support Residential Services (SRS). In many cases it became apparent that the independence of support coordination and plan management could heavily influence whether participants were safeguarded or exposed to increased risk and exploitation. The Commission stating that in a number of cases, participants who had support coordinators who were associated with the SRS proprietor and providers of their other NDIS supports, found it very difficult to raise concerns. Whereas the SRS participants with independent support coordinators were able to raise concerns far more effectively.
Moreover, when the NDIS Commission received SRS complaints, it found many plan managers were able to supply relevant invoicing and payment information quickly. However, it did not appear that plan managers had clear or consistent arrangements in place to ensure that participants were only paying for supports that they actually received.
So what does all this tell us?
The report provides some insight into the role that intermediaries can play in safeguarding the rights of participants from abuse and exploitation, particularly if they are independent. While the overwhelming majority of reportable incidents do not relate to the conduct of intermediaries, the data highlights some consistent and concerning themes that perhaps invite a policy response. Complaints about plan managers not paying invoices is something that could surely be addressed by clear guidance from the Agency? Concerns that support coordinators are failing to provide support with care and skill might be targeted through stronger role clarity and training underpinned by an ethical framework. The support coordination role is a new and evolving one and we cannot expect it to professionalise overnight without guidance and serious government investment. Finally, it is difficult to foresee how complaints around integrity and conflict of interest will decline while providers continue to be permitted to provide both intermediary services and other funded supports. Particularly in the absence of a strong policy framework. We await with bated breath to hear what the NDIS Commission proposes in Part 2 of its Inquiry and whether it will make any changes to how it regulates support coordination and plan management. You can read the full report here.
Artwork by Belinda Parrish