Person Centred Planning within the NDIS: Current Limitations—Prospective Opportunities

Abstract

The National Disability Insurance Scheme (NDIS) has been a universally accepted initiative. It represents a very significant policy in terms of numbers of people prospectively impacted (about 460,000 at full roll out), in terms of complexity, and in terms of the cost (the current funding envelope is set at $22 billion). Adding to this complexity, the roll out of the scheme is intended to be implemented over a relatively brief period ending in 2020 so that the risk related to the establishment of the NDIS is increased as a result. Because a central tenet of the scheme is for participants (service users) to have choice and control over the services they receive, Person Centred Planning (PCP) is a core element of the NDIS. Every person deemed eligible for support is intended to have a plan that outlines the goals to be achieved, defines the “reasonable and necessary” supports to which they are entitled and which are funded by the NDIS, together with the total amount of funding allocated to spend on those supports. The PCP is then implemented by the participant’s preferred provider. Notwithstanding their considerable experience and capacity, the National Disability Insurance Agency (NDIA) prevents service providers undertaking the planning process and so most plans are completed by NDIA personnel. There is concern that providers might focus on developing plans that are more financially rewarding or more aligned with their service provision systems than aligned with the goals of the participant. The NDIA is also seen to have a potential conflict in that scheme sustainability is central to that agency’s responsibility and the PCP process is one way the NDIA can maintain control of costs because the plan sets out the funded services amongst other things. However, significant concerns have been raised with respect to the PCP process suggesting that, because of the sheer size of the scheme and the shortage of appropriately qualified and experienced NDIA planners, amongst other things, the process results in: (1) poor quality plans being developed; (2) delays in services being provided; and (3) for participant health and welfare to be put at risk. It is also an expensive process with $1.76 billion being allocated to this process for the roll out period and an ongoing cost of between $900 million and $1 billion being the ongoing expected annual cost. These costs are increased when plans need to be rectified. This report results from a project examining the anecdotal concerns raised by all stakeholders involved in the service provision process—NDIA, peak bodies and service providers—via semi-structured interviews and evidence evaluation processes. The project considered the evidence and put to stakeholders three alternate options that could be used to support the PCP process: (1) the status quo; (2) a risk-based proportionate response allowing for both provider and NDIA planning activities but focused on ensuring regulatory resources were applied where the level of risk warranted them; and (3) a model including providers as planners for all situations and with the NDIA providing assurance over the plans developed. We identified that there is support for the development of a risk-based approach to the planning process (i.e. option 2) so that service providers can assist in planning where appropriate and so that the NDIS only applies its scarce resources to supervise, regulate and/or plan where appropriate in order to reduce the average cost of a plan. Such a strategy is likely to mitigate the perceived problems associated with conflict of interest or bias, increase the quality and timeliness of plans and reduce the costs of the PCP process to the NDIA. Indeed, potentially, costs may be reduced to the NDIS by around $400 million, which can be applied to service delivery.