Tune Review Recommendations Released!

David Tune, a former senior public servant, was enlisted in 2019 to review the Scheme itself and the way the NDIA is managed. Tune has taken a look at the current stay of play with the NDIS participant experience, consulted widely and reviewed the legislation. His report, released this morning, has 29 key recommendations to cut delays, reduce complexity and improve services. These will form a new Participant Service Guarantee to be implemented from 1 July 2020.

While Tune’s report is, at this stage, just recommendations and not yet changes to the legislation, the Federal Government is expected to respond formally by the end of the week. Here we take a look at the recommendations and interpret what they really mean.

Update: read the government’s response to the Tune Review recommendations here.

REASONABLE AND NECESSARY

The Tune Review is recommending a few small tweaks to the reasonable and necessary criteria that could impact the way they are interpreted and implemented. Hugely important is the recommendation to clarify in the NDIS Act that when a mainstream service does not provide a support, it’s not automatically the default responsibility of the NDIS. This was pretty much the assumption that the NDIS was operating under until this AAT case threw it all into question . This clarification is going to be disappointing to many participants and families, as it ultimately exposes many service gaps between the NDIS and other systems, and there will be fears of continual buck passing. But, we can hope, that it will place pressure on mainstream services to improve the supports they provide to people with disability.

Other recommendations include:

The NDIA publishing more information, in accessible formats, that explains how they make the decision as to whether a support is reasonable and necessary (and honestly did they really need an independent review to tell them this might be a good idea?).
The Disability Reform Council (DRC) to work out some of those pesky mainstream interface issues, and then to adjust the NDIS (Supports for Participants) Rules accordingly. They are also urging the DRC to clarify the distinction between NDIS supports and ordinary living costs.

The report emphases that the intention is not to narrow the scope of the NDIS, but to provide clearer boundaries between the NDIS and other services. Clearer boundaries would definitely make everyone’s job a lot easier, but it is the gaps between boundaries that we need to keep an eye on.

PLANNING IN-HOUSE

The Tune Review seems to have got the memo that the planning process is unnecessarily complicated and results in a disconnect between the person who engages with the participant and the person who ultimately has the decision-making power. They’ve recommended that the NDIA trials writing and approving all plans in-house. This would be a major change and would be more in line with how the Productivity Commission originally envisioned the planning process. In this trial, the LAC and ECEI Partners would return to their original mandate of supporting participants to implement their plans and connect with services.

As it currently stands, the LAC or ECEI partner develop a plan, and then send it to an NDIA delegate to either approve or adjust. The NDIA has been trailing Joint Planning Meetings which involve the LAC Planner, NDIA delegate and participant all meeting to discuss the plan before it is approved. However, the Tune Review states that joint planning could just add another step to the already long planning process and result in delays.

The Review also recommends making 3-year plans available to some people. Currently, the maximum is 2 years.

PARTICIPANT SERVICE GUARANTEE

The Tune Review was asked by the government to explore the creation of a Participant Service Guarantee. Tune reports that there is a need to strike a balance between the quality and the speed of planning. In other words, if they are too prescriptive on timeframes for getting plans done, they are potentially placing participants at risk by rushing them through and doing a shoddy job. His recommendation, on this basis, is that there is not a timeframe for every interaction a prospective participant or participant may have with the NDIA.

The proposed Guarantee will set timeframes for NDIA decision making, hopefully resulting in the much-needed conclusion to the current saga of never-ending wait times. Here are some of the timeframes the Review recommends:

21 days for the NDIA to begin the planning process once a person has been accepted into the Scheme.
From July 2020, 70 days for a plan to be approved following an access decision. From July 2021, this should go down to 56 days.
From July 2020, the NDIA to have 90 days to make an internal review decision. Then 60 days from July 2021.
21 days for a plan implementation meeting to be held after the plan has been approved.
90 days for people seeking access to the Scheme to provide supporting evidence. This is up from the current 28 days, which puts a lot of pressure on potential participants to gather evidence in a very short amount of time.
21 days for the NDIA to decide whether to undertake a unscheduled plan review. Once they have decided to do a review, they will have 42 days to make a decision from July 2020, and 28 days from July 2021.
28 days for the NDIA to implement an AAT decision.

The Guarantee also outlines principles for the NDIA’s engagement with people with disability. The standards they suggest are that the NDIA is transparent, responsive, respectful, empowering and connected.

In other words, just being better at their jobs.

The Government has indicated that they are planning to enact the Guarantee by July 2020.

SUPPORT COORDINATION

The Review was told loud and clear by people with disability and their families that they want more funding for Support Coordination to help them navigate the implementation of their plans. However, the Review questioned that this might be a symptom of LACs not having the time to undertake their original responsibility of supporting people in this capacity. So, the Tune Review recommends that the government provide more funding to support people to navigate the NDIS. This feels like a bit of a cop out, as it is not clear whether they envision this extra funding is going to LACs or Support Coordinators.

They also recommend that the NDIS Rules be amended to outline circumstances where it would be a conflict of interest for a provider to provide support coordination in addition to other supports for the same participant. This would be huge if it happens and has been a concern for many from the outset. Further, they recommend the Rules provide clear guidance about when the NDIA will fund Support Coordination.

PLAN FLEXIBILITY

Since the Minister’s Press Conference last year, we have known that the NDIA’s plan is to make Core and Capacity Building funds flexible from July 2020, so this recommendation does not come as a huge surprise. However, the Review does recommend that plans provide some details about the intended outcome of this funding so there’s a mutual understanding of what the funding will be working towards.

PLAN MANAGEMENT

The Review recommends abridging plan management to become a form of self management. This would mean that requests for plan management would be subject to the same risk assessments as requests to self-manage. While this has the potential to build capacity and increase autonomy, there is a risk it could result in more people being forced to agency manage, and therefore being unable to use unregistered providers, meaning less choice.

ACCESS

The report acknowledges that people with psychosocial disability particularly struggle to access the Scheme. To erode some of these barriers, they propose that the NDIA provides more guidance around when a psychosocial disability is considered permanent in the context of the NDIS. And, importantly, they suggest the NDIA takes into account that mental health conditions can be episodic and fluctuate.

The Review also notes that the cost of gathering the necessary evidence, such as allied health and specialist reports, is a significant barrier to access for many people. As such, they recommend that the NDIS funds independent functional assessments for people seeking access.

EARLY CHILDHOOD EARLY INTERVENTION (ECEI)

Many families told the Review that they were struggling to get what they need from the NDIS to continue to provide support for their children with a disability. Particularly, it was noted that young children often do not receive much funding for core supports because it is believed that this is the role of all parents and is therefore not defined as reasonable and necessary.

The bad news for parents is that the Tune Review does not recommend any specific changes to address this issue. However, it does suggest that the rules be amended to acknowledge that parents of children with disability often have to provide additional support that parents of children without disability do not have to provide.

The Review also acknowledged the importance of “respite-like” supports. Though it was acknowledged that the word “respite” does incorrectly suggest that the person with a disability is a burden to their family.

THIN MARKETS

The Review feels that the NDIA needs the power to respond to thin markets with alternative funding models. This would be a “defined power” which can only be acted upon in a particular set of circumstance, which will be outlined in the Rules.

While we do not know yet what those circumstances might be, it is acknowledged that this might be a good solution for regional and remote communities which require more innovative approaches to ensure adequate service provision.

ISSUES ON THE AGENDA

The Tune Review also recommends that following issues be put on the DRC’s agenda to be solved ASAP:

The treatment of chronic illnesses under the NDIS.
The role of guardians, plan nominees and other supported decision-making mechanisms under the NDIS, and how these intersect with state and territory legislation.
The role of the NDIA and Quality and Safeguards Commission to undertake fraud detection activities.
How compensation works with the NDIS.

The report is a massive 224 pages long, so naturally we have not been able to cover all the exciting suggestions and observations made. However, we will be exploring them in DSC articles in the coming months. We will also be back in your inbox as soon as we know how the government plans to respond to these recommendations.

You can read the full report here.

Photo by Beatriz Pérez Moya on Unsplash