What we can learn from complaints data

The NDIS Quality and Safeguards Commission (NDIS Commission) has published a ‘Market Spotlight’ report on complaints. The report provides a high-level analysis of complaints data themes, in a sample of 1,500 randomised complaint records for the period of 1 October 2023 to 31 December 2023.

Why does this data matter? Because complaint themes offer insight into issues participants are concerned about and in which types of services. It helps providers identify opportunities to improve the quality of their services and satisfaction of their clients. Moreover, data like this often informs regulatory action, so it helps to understand what’s informing the government’s priorities and where we might be going. The NDIS Commission has run several Own Motion Inquiries off the back of complaints.

So what did the analysis find?

Of the complaints sampled in the review, 68% were about services delivered by support workers. 40% of these were related to daily and community supports and 28% in home and living. Support coordination and plan management accounted for 17% of complaints. The NDIS Commission flags this as disproportionate given these intermediaries only represent around 6% of the market.

Let’s take a take at the themes across the different support types in more detail.

Daily and community supports

40% of complaints were about daily and community supports. These complaints were categorised as:

Poor quality practice, process, and workforce (45%)
Violence, abuse and neglect (23%)
Scheme integrity (25%)
Participants’ rights and scheme principles (7%)

These supports accounted for a significant proportion of complaints containing allegations of worker misconduct, violence, abuse and exploitation. The NDIS Commission says the themes highlight some of the challenges associated with a workforce with no training requirements. Complaints related to poor role clarity, lack of training and no market entry barrier or oversight. These themes are quite consistent with what the NDIS Review and Provider and Worker Registration Taskforce reported and will likely be something the new registration model will want to address.

Specialist Disability Accommodation (SDA) and Supported Independent Living (SIL)

25% of complaints were about SDA and SIL supports. These complaints were categorised as:

Poor quality practice, process, and workforce (46%)
Violence, abuse and neglect (31%)
Scheme integrity (13%)
Participants’ rights and scheme principles (10%)

Allegations inferred some SIL and SDA providers lack the necessary leadership, processes, practices, oversight, workforce and training to provide high quality services. SIL and SDA had the highest prevalence of neglect across all support types. Critically, conflicts between participants and their in-home support providers often led to housing instability. This is one of the reasons the NDIS Review and Disability Royal Commission (DRC) both recommended separating support and housing in SDA. In its response to the DRC recommendations, the government has committed $49.7 million for design and consultation to support better home and living options, including targeted compliance and education to ensure SDA providers meet their conflict of interest obligations. It also includes funding to explore the legal separation of SDA and SIL.

Last year the NDIS Commission completed an Own Motion inquiry into supported accommodation and is now progressing its action plan which includes reviewing and updating practice standards and the formal separation of SIL and SDA. The government has also just announced that all SIL providers will be required to be registered.

Short Term Accommodation (STA)

4% of complaints were about STA supports. These complaints were categorised as:

Scheme integrity (47%)
Poor quality practice, process, and workforce (34%)
Violence, abuse and neglect (19%)

Financial integrity and exploitation were the most common concerns raised about STA. Complaints included overcharging, establishing inappropriate STA arrangements, failing to properly inform participants about costs, and altering costs after supports were delivered.

These themes are unsurprising given the current public scrutiny facing STA providers- we have new workshop on understanding STA in the NDIS to assist providers to navigate this complex support.

Support coordination

13% of complaints were about support coordination services. As mentioned above, the Commission flagged this as disproportionate given the market share of these services. These complaints were categorised as:

Poor quality practice, process, and workforce (41%)
Scheme integrity (36%)
Participants’ rights and scheme principles (17%)
Violence, abuse and neglect (6%)

The NDIS Commission says that these complaint themes demonstrate a lack of provider understanding of the role of support coordination. It also observed how poor-quality practices impact other NDIS supports. This includes participants not being supported to understand or use their NDIS plan, delays in accessing supports, accessing inappropriate supports, or disruption to other NDIS supports.

These themes are reasonably consistent with the NDIS Commission’s Own Motion Inquiry into Support Coordination and Plan Management which found 43% of complaints raised integrity concerns. These included conflicts of interest, denying participant’s choice and control, coercion, sharp practices and crossing professional boundaries. 87% of complaints raised care and skill concerns, including inadequate supports, poor communication, errors, overcharging, inadequate or inappropriate responses, depletion of the participant’s NDIS funds, cessation of support coordination supports and other matters. The figures between the Own Motion and Market Spotlight summary look somewhat different. However, this could be explained by the Market Spotlight summary assigning each complaint to one category, whereas the Own Motion Inquiry identified multiple themes in one complaint. In case you missed it, the government has since announced that all Support Coordinators will be required to be registered.

Plan Management

4% of complaints were about plan management. Complaints were about:

Poor quality practice, process, and workforce (65%)
Scheme integrity (30%)
Participants’ rights and scheme principles (5%)

The NDIS Commission says that plan management complaints were concentrated in poor quality practice, processes, and workforce and scheme integrity. They say this reflects a lack of clarity and consistency in plan management expectations. Though it’s not clear who is lacking the clarity – whether it is providers, participants, the Commission or the Agency?

These themes appear reasonably consistent with the aforementioned Own Motion Inquiry. It reported 61% of complaints made about the top 10 plan managers raised payment concerns, including non-payments, wrong payments, late payments and overpayments. 22% of complaints raised concerns of sharp practices, including inducement, provisions in service agreements and denying participants’ choice and control. Similar concerns were raised in complaints about other plan managers (outside the top 10), however complaints relating to conflict of interest and sharp practices were markedly higher in smaller providers. This is unsurprising given the Commission has identified those smaller providers are more likely to provide other services on top of plan management.

Therapeutic supports

6% of complaints were about therapeutic supports. Complaints focused on:

Scheme integrity (48%)
Poor quality practice, process, and workforce (46%)
Participants’ rights and scheme principles (6%)

Complaints against therapy supports raised concerns about providers charging for additional hours or imposing unfair terms on participants. The NDIS Commission reports that financial integrity issues often stem from the inappropriate application of the NDIS Price Guide by providers, as well as workforce and training deficiencies. Participants were sometimes charged more because less trained workers took longer to conduct assessments and complete reports. This critique is consistent with some of the current messaging from the Minister about unfair pricing.

In Summary

The analysis found that across all support types, a high proportion of complaints were about poor quality, processes and practices, as well as workforce issues. However, there were significant variations in the types of complaints between support types. For example, there was a higher prevalence of complaints about violence, abuse and neglect in daily and community supports and SIL and SDA, compared to more scheme integrity concerns raised in capacity building supports. This makes sense given the different scopes of the roles and highlights how organisations really need to tailor their approach to what they do to reduce complaints.

It is important to note that the analysis had a number of limitations (detailed in the report), including that it didn’t investigate whether the allegations were substantiated. The report is available on the NDIS Commission website. It goes into a little more detail on the sub-themes - plus, there’s charts!