July 1st 2016 has come and gone, and most places in Australia now know when the full roll-out of the NDIS is scheduled to commence. Of course, rumours abound, and nothing this big ever works perfectly, but it seems close to certain that tens of thousands of people with a psychosocial disability will receive NDIS packages before 2020. Most consumers, carers and service providers are happy about that, even though questions and concerns persist; notably:
Pricing — I move around Australia more than most, and I am yet to meet a provider who says they can truly break even on what the NDIA pays them. Full cost recovery with the leanest providers of quality services costs around $60-$65 an hour. Getting the average hourly rate in a package much above $50 is an art form understood by a few organisations, but the gap remains—usually disguised by subsidies from other block-funded programs, and reserve funds. These are temporary fixes that cannot endure.
Choice and control — while the amounts available for total packages are often substantially more than any previous offerings, the trend to ‘reference packages’ has meant that experienced mental health NGOs find themselves sitting down with an NDIA-referred client to begin from scratch finding out what the client actually wanted – all too often very different from what the NDIA planner has suggested. This is unsurprising – the NDIA staff are largely new to the game and under pressure to implement packages – but it is a bit hard to swallow the rhetoric that choice and control has now replaced our allegedly ‘menu-driven’ approach. Let’s hope sooner rather than later we get to mutual respect between the funder and providers, that delivers genuinely new opportunities for recovery and quality of life.
Eligibility — We have known all along that no more than 25% of the clients of public clinical mental health services will get a package. We can’t be so definitive about mental health NGOs, although most of us are certain it is less than 50%. But in mid-2016, we still know almost nothing about how the funding gaps caused by transfer of funds to the NDIS will be filled. The tight definition of those most in need –the ‘57,000’–that was suggested by the Productivity Commission in 2012 has never been explained in practice, despite repeated requests. So consumers, carers, service providers and other funders don’t know who might be in or out of the Scheme. Public and NGO providers have many years of experience in identifying this group, but are kept out of the loop by the NDIA. Problems with pricing and choice inside the Scheme will be resolved with time and patience, but the gaps in service outside the Scheme remain the greatest concern.
It is now more than three years since the first trial sites began assessing people with psychosocial disability for packages. Much progress has been made on the content of packages, on the efficiency of assessment and payments systems and collaborative working relationships. But these issues inside and outside the scheme continue to cause uncertainty and stress where we should all be rejoicing in the new opportunities generated by a major injection of public resources. Let’s hope that can happen sometime soon.
David Meldrum will be speaking on ‘Getting to where we want to go’ at the Mental Health Reform conference this November. Book your place by August 26th to save $400 on ticket prices.