Practical Tips for Managing Support Coordination Conflict of Interest

When we talk about providers with a conflict of interest, we’re not talking about bad people doing bad things. We’re talking about ordinary people being compromised by difficult situations. A conflict of interest is a situation where a person or organisation has competing interests or loyalties. 

When a Support Coordinator is employed by an organisation that  offers a range of NDIS funded services, they have a conflict of interest. Most organisations expect staff members (whatever their role) to be ambassadors for the organisation. But it is a Support Coordinator’s job to support people to make choices about what is best for them, without bias or receiving incentives.

The recently published Tune Review (the legislative review of the NDIS) explored the issue of Support Coordination conflict of interest in some detail. It included a recommendation that: 

“The NDIS Rules be amended to outline circumstances in which it is not appropriate for the providers of Support Coordination to be the provider of any other funded supports in a participant’s plan, to protect participants from providers’ conflicts of interest”.

Kind of vague right? At this stage, it is only a recommendation. We are still waiting to hear the government’s response, along with more information about what the recommendation would actually mean in practical terms. However, the details in the Tune Review do give us some idea about what they are thinking. They note that there may be a case for “requiring Support Coordination to be independent from other service provision” but that “this would not be appropriate in all cases.” Particularly, the Review acknowledges it may not be practical to separate the providers if people live in communities where there is limited choice or have specific cultural safety needs. It also notes that Support Coordination should not be provided independently if that would be against the person’s wishes or if it meant the person could no longer live in their community (for example, if a person had to choose between their Support Coordinator or continuing to live in their SIL home). 

But in most circumstances, the Tune Review expressed the opinion that a person’s Support Coordination provider should not be providing them with other funded supports. They want legislative changes that mitigate the risk of conflict of interest. One possible practical way of approaching it, they suggest, would be for the NDIA to actively undertake risk assessments during the planning process. 

Regardless of what ends up happening with the Tune Review recommendation regarding Support Coordination, registered providers have an obligation to put processes in place to mitigate conflict of interest and support choice and control. The NDIS Terms of Business, with which all registered providers must comply, state: 

“Registered Providers must act in the best interests of Participants, ensuring that Participants are informed, empowered and able to maximise choice and control. A Registered Provider must not (by act or omission) constrain, influence or direct decision making by a person with a disability and/or their family so as to limit that person’s access to information, opportunities and choice and control.” 

The NDIS Provider Toolkit clearly conveys expectations for managing conflict of interest when delivering support coordination in conjunction with other supports. It requires that providers retain documentation of:

• Organisational arrangements in place to keep information separate between teams. A best practice approach to keeping information separate may involve separate management for Support Coordination and other service teams within the organisation with discrete lines of reporting from the executive level down to the front line.  I encourage providers to have separate client database systems to make sure information on Support Coordination clients is only viewable within the Support Coordination team. It would also be advisable for Requests For Service (RFSs), that now come through to the provider’s primary portal, to be diverted directly to the Support Coordination team and not via other service managers.

• A Participant’s options for their coordination of supports. This means a Support Coordinator should keep records on the options presented to people when comparing and selecting supports. Support Coordinators may use 1-page bios of providers to help people compare and select their preferred option. Each bio could include a wide range of criteria, ranging from the availability of easy read service agreements to the price per hour of service. 

• Documentation that there is no remuneration provided to Support Coordination staff for participant volume. This requires evidence that Support Coordinators are not rewarded for internal referrals to the other services offered by the organisation.

• Documentation confirming that there are no trailing commissions or percentages on funds managed. Same as above.

• Confirmation that the conflict of interest and above information is disclosed to the people receiving supports. Support Coordinators who work for providers offering a range of NDIS funded services must show evidence of having discussed the implications of this with the people they support. In my training, I suggest Support Coordinators set a clear agenda for their initial meeting with new clients (this is increasingly important as the average hours of Support Coordination allocated in plans is decreasing and each hour must be used wisely). The agenda should include discussing conflict of interest.

Conflict of interest is not the act of doing something wrong. It is just a state of being that arises when Support Coordinators are not completely independent. But, with the right systems and processes in place, the risk that a conflict of interest will disadvantage a Participant can be mitigated. 

Image: James MacSporran, 2 Pixels, 2019, gouache, ink and paint pen on paper, 38.5 x 56 cm

Courtesy of the artist and Arts Project Australia