Quality & Safeguarding

Royal Commission explores Quality and Safeguards

Team DSC

Safeguards and quality services are key areas of inquiry for the Royal Commission into Violence, Abuse, Neglect and Exploitation (Royal Commission). Whilst the full report is not due to be handed down until September 2023, there are plenty of updates, reports, and transcripts published on the Royal Commission’s website that provide insight into the critical issues in focus.

Late last year, the Royal Commission circulated the Safeguards and Quality Issues Paper. The Royal Commission asked the public to share its views about how people with disability experience safeguards, what promotes quality in services, and how these may prevent and reduce exposure to violence, abuse, neglect, and exploitation. The Royal Commission received 48 responses from people with lived experience, professionals, disability representative organisations, peak bodies, services providers, and government agencies. It has now produced a summary of those responses. It is important to note that the summary does not state the position of the Royal Commission. Rather, it summarises what the Royal Commission was told in response to the issues paper.

The issues paper posed ten questions, although respondents were not limited to answering those questions. Here is some of what respondents had to say:

  • Identifying at-risk individuals and situations – There is a need to identify factors that place individuals at higher risk of abuse, including through the planning process.

  • Balancing choice and control with safety – There is a need to ensure safeguards are balanced with dignity of risk, that they are not overly intrusive or limiting to a person’s freedom, choice, and control.

  • Promoting natural safeguards - Unpaid, freely entered relationships, connection, employment, and being part of the community are the strongest safeguards against abuse.

  • Supported decision making as a safeguard – Supported decision making is not only an important measure to enhance choice and control over living arrangements and life plans but is also a safeguard that reduces risk.

  • Assuring quality and safety in service provision – The critical importance of a culture that respects human rights and does not tolerate violence. The need for strong governance, including risk management, quality monitoring, incident and human resource management, and an understanding of risk and abuse by the governing body. Important operational elements, such as recruiting and retaining a skilled workforce, consistent screening requirements, focussing on practice (not just compliance), and good supervision.

  • Reporting, investigation, and response – Fear of retribution, complex complaints processes, and lengthy timeframes were all cited as barriers to people with disability. Another critique of complaints-based systems is that they rely on articulate, assertive, and empowered complainants to be effective.

  • Oversight and independent monitoring of services – Concerns about the level of oversight of services, the infrequency and rigour of audits, and the importance of community visiting were raised, as was the lack of oversight for people with disability who are not on the NDIS.

  • Role of the NDIS Quality and Safeguards Commission and operation of NDIS in safeguards – The issues that were raised include that the system is unnecessarily complex, that the NDIS Commission should take a more stringent approach to providers that don’t meet standards, and that new providers with little NDIS knowledge are entering the market with off-the-shelf policies.

  • Implementing OPCAT as a safeguard in closed settings – It was proposed to expand the application of the United Nations Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT) to all closed settings affecting people with disability (this safeguard is currently applicable in some jurisdictional detention settings).

Respondents to the issues paper proposed a raft of changes for the Royal Commission to consider. The Royal Commission summarised these proposed changes as follows:

Natural Safeguards

  • NDIA and relevant sectoral partners conduct a national conversation around ‘natural’ safeguards including what natural safeguards are, and how they afford protection against abuse while also NDIS planners or other appropriately skilled professionals routinely assess NDIS participants at the time of plan development as to what relationships they have beyond a paid support worker, and what activities in the wider community they are accessing.

  • Community organisations and appropriate funding bodies increase access to ‘circles of support’ - this being most pressing for those who are at higher risk and with lower personal and social capital (i.e. most living in group homes).

  • Community organisations and appropriate funding bodies ensure better access to promising supported decision-making mechanisms not currently NDIS-registered, such as Microboards.

  • States and territories develop culturally safe Community Visitors Services, and introduce ‘cultural brokers’ and other means of getting better individualised planning for First Nations people with disability.

  • Support connection with advocacy groups and peer networks through NDIS packages to build capacity round choice and control, and rights awareness.

Formal Safeguards

  • Identify at-risk individuals and situations using a nuanced risk assessment framework taking into account a range of relevant factors that would potentially catalyse appropriate safeguards and support coordination, in consultation with the person with disability.

  • Develop nationally consistent Community Visitors Programs, without losing local knowledge and connections in operational service delivery.

  • NDIS Quality and Safeguards Commission take a more proactive role to ensure appropriate safeguards exist for at-risk individuals, and more effective enforcement of service provider standards.

  • Extend enforceable practice standards to non-NDIS service providers.

  • Provide more stringent and frequent auditing of group homes, including spot checks.

  • Extend the National Preventative Mechanism of OPCAT beyond detention settings to the closed setting of group homes.

  • Develop a supported decision-making legal and policy framework to help build independence for the person with disability.

Quality in service provision

  • Encourage wider uptake of the NDS Zero Tolerance Framework by service providers.

  • Recruit and retain a skilled high quality workforce committed to the rights of people with disability through proper remuneration and training.

  • Impose and sustain strict screening of disability support workers, especially those supporting people with complex needs.

  • Develop a quality ratings system for group homes.

  • Service providers ensure better direct supervision of staff in group homes and other support delivery settings.

  • Ensure enhanced preparation for NDIS planners around cultural difference and participant choice.

  • Streamline registration for service providers and professionals to remove disincentives for renewal of NDIS registration.

  • Strengthen the role of consumers and carers as key partners in service design, delivery, governance, and evaluation matters as this will lead to quality services.

  • Provide training for service provider Management Committees/Boards such that members are trained in their accountabilities and governance requirements.

Complaints, reporting and responding

  • Establish an independent and impartial oversight body with broad statutory jurisdiction.

  • Ensure that there is a ‘no wrong door’ approach to facilitate and support people raising their concerns with the most appropriate agency.

  • Complaints agencies, in particular the NDIS Commission undertake more outreach activities, and establish a designated outreach team or person as this may assist with community perceptions of being accessible and trustworthy.

  • Service providers and complaints agencies change their culture around complaints away from an adversarial approach and towards a positive reporting culture that values complaints.

  • Commonwealth, states or territories develop legislation/policy on whistle blowers protections for this context.

  • Complaints agencies ensure diverse staff teams in complaints bodies and adopt flexible processes to meet individual needs.

  • An appropriate independent body evaluate accessibility of disability complaints mechanisms, in consultation with people with disability, inquiring into the reasons for unresponsiveness and delays in complaints mechanisms, particularly in urgent matters. [1]

[1] Issues Paper Overview of responses to the Safeguards and quality Issues paper p.15-17.