Review of Quality and Safeguarding Framework

In October 2022, NDIS Minister Shorten announced a Review of the design, operation, and sustainability of the NDIS. An overarching goal of the Review is to put people with disability back at the centre to help restore trust, confidence, and pride in the NDIS.

As part of this, the Review has been tasked with looking at the adequacy and effectiveness of the NDIS Quality and Safeguarding Framework (NDIS Q&S Framework). This Framework was published in 2016 and sets high-level policy for quality and safety in the NDIS. Many people contributed to the development of the Framework, including people with disability and their families, service providers, advocacy groups, and professional organisations. We are now six years into its implementation and the NDIS Review says the Framework needs a refresh to ensure it remains fit for purpose in the evolving NDIS market.

What’s changed?

A lot has changed since the Framework was first published, including:

The establishment and national roll-out of the NDIS Commission.
Higher rates of self and plan-management than originally envisioned (around 88% of participants as at 31 December 2022).
Significant and unexpected growth in the unregistered provider market, with over 130,000 active unregistered providers.
New services which have entered the market, including intermediaries and the emergence of platform providers.
It has become more apparent how the unique experiences of First Nations, culturally and linguistically diverse, and LGBTIQA+ people can impact risk of violence, abuse, neglect, and exploitation.

Framework domains

The Framework includes developmental, preventative, and corrective measures focused on NDIS participants, workers, and providers, with measures intended to be mutually supporting and reinforcing. The independent Review is concerned that the implementation of the Framework has focused more heavily on preventative and corrective measures, with less focus on developmental strategies. For those not familiar with these measures, here is an overview:

Developmental domain measures are intended to strengthen the capability of people with disability, the workforce, and providers. While these are not regulatory functions, they are fundamental to quality and safeguarding and enable people to protect themselves. Examples include supporting people to build friendships and community connections, ensuring choice and control over support, and making sure information is accessible.
Preventative domain measures are intended to prevent harm and ensure that quality services are delivered to people with disability. The NDIS Worker Screening Check, risk assessments, and audits are all preventative safeguarding measures.
Corrective domain measures are intended to resolve problems, identify improvements to prevent those problems from recurring, and provide oversight of the system. This includes responding when things go wrong, such as action taken as a result of incidents and complaints or addressing audit non-conformities.

Investment in the developmental and preventative domains was intended to prevent adverse outcomes so that fewer corrective actions would be required.

Balancing risk

The Framework suggested that developmental, preventative, and corrective initiatives would work together. Individual risk management was to be supported through developmental capacity building for participants. While systemic risk would be supported by preventative and corrective measures. However, the Review states there has been insufficient investment in participant capacity building, information provision, developing natural safeguards, supported decision-making, and advocacy initiatives. Similarly, there has been insufficient focus on developmental strategies to improve the quality and performance of providers and workers.

At the same time, the unanticipated growth of the unregistered provider market has reduced the impact of preventative strategies which are largely achieved through registration. This has shifted quality and safety responsibilities back to participants without the requisite investment in developmental strategies that support and enable informed decisions about risk.

Patchy approach to quality and safeguarding

The Review is concerned that the Framework is not currently delivering a long-term, whole-of-Scheme approach to quality and safeguarding. Despite a national Framework, there are still differences across jurisdictions in areas such as restrictive practice authorisation and the implementation of NDIS worker screening arrangements. The Framework fails to identify and link the various overlapping standards and frameworks in Australia (including Australia’s Disability Strategy), resulting in significant gaps, inconsistencies, and confusion.

The Review says that is not clear that the Framework directly guides the work of the NDIS Commission or other stakeholders. It is also only applicable to NDIS-funded supports. The expectations of intermediaries such as plan managers, support coordinators, and local area coordinators are particularly ill defined, and not everyone is aware of the role split between the NDIS Commission and the NDIA. A more comprehensive framework needs to look at the role played by NDIS participants, providers, workers, intermediaries, natural supports, DSS, the NDIA, the NDIS Commission, and the states and territories in quality and safeguarding.

Ensuring regulation is fit for purpose

Progress has been made in implementing nationally consistent regulation of providers and workers under the Framework. However, there are still concerns about the proportionality and effectiveness of the current approach. The Review has heard that regulation is duplicative and costly and may act as a disincentive to providers entering or remaining in the market. This is particularly concerning for communities with thin markets.

The growth in the unregistered provider market raises questions about how risk is managed for people who are not relying on preventative registration measures. Some have argued that more providers should be registered and undergo worker screening due to the risk profile of the services they provide. While others advocate that the unregistered market plays an essential role in enabling choice, control, and flexibility. Some unregistered providers suggest that not being subject to the NDIS Pricing Arrangements and Price Limits gives them the freedom to be more innovative and invest in quality improvements. While some registered providers have raised concerns that the lack of a “level playing field” between registered and unregistered providers disincentivises registration.

The Review has heard that the regulatory approach of the NDIS Commission should be more proactive in identifying and addressing potential concerns about risks to participants, rather than waiting for complaints and reportable incidents. However, the NDIS Commission’s lack of visibility of unregistered providers, amongst other factors, is identified as a barrier to more proactive identification of issues.

Promoting quality

While the Framework seeks to build quality and best practice through developmental and preventative measures, the implementation has tended to focus on establishing and enforcing minimum safety standards. Consideration is being given to how the NDIS Commission as a regulator should lead strategies to promote a positive culture of quality, or whether these roles should be performed by different organisations.

Participant Safeguarding Proposals Paper

The NDIS Review has also just released a Participant Safeguarding Proposals Paper. This paper outlines three complementary ideas about how safeguarding in the NDIS could be improved. The first idea is creating an NDIS-wide strategy on participant safeguarding, so that everyone has a clear idea of how to support the safety of participants. The second is to explore options for how participants and their supporters can communicate about risks and safeguards, and develop a proactive plan of supports and actions to manage the individual risks they face. The third idea is to have a better variety of safeguards available that prioritise building and strengthening natural safeguards.

Where to from here?

There is certainly a lot to unpack here, and we encourage everyone to read the NDIS Quality and Safeguarding Framework issues paper. You can have your say on this important piece of NDIS infrastructure by visiting the NDIS Review website. Consultation on the NDIS Quality and Safeguarding Framework is open until 29 May 2023 and feedback on the Participant Safeguarding Proposals Paper closes 19 June 2023.

And don’t forget to come say hello and bring all your questions to the Review co-chairs at DSC’s Annual NDIS Conference in just a few short weeks!