Post by bear on Feb 13, 2021 11:17:20 GMT 7
Redesigning the complex disability services system
NDIS boss Martin Hoffman is taking his $21 billion agency back to its original vision.
More than 4 million people in Australia have a disability.
“The expectation that was created in the sector through the wonderful people who have advocated for this over many years of their lives as advocates and representatives – often people with disability themselves – was huge. And so the expectations are high,” says Hoffman.
Faced with ongoing complaints, the scheme was struggling and the government committed to a legislated service guarantee that aims to bring a consistent set of standards to more than 50 different service features the agency has committed to meet.
At the same time, the heavily rule-bound program has seen costs balloon as participants push for greater access to service entitlements – especially better-off participants who have the resources and savvy to navigate the complex application and review processes.
Annual scheme costs are budgeted to rise by close to $7 billion to over $24 billion between 2019-20 to 2022-23.
Cultural shift
This leads to what Hoffman admits is a radical change in the underlying program design, a shift away from “welfare rationing culture” where the NDIS micro-manages entitlements line by line.
“The big change we want to take the organisation is really going back to this concept of what is a personal budget, and what is actually means because it’s really quite a radical concept ... a genuine belief that the person themselves or their family knows best what’s best for them.”
Knowing that this scheme is going to keep working in the right way is really important for sustainability.
“If you’ve got a similar functional capacity and similar life circumstances, you’re going to get a similar budget,” Hoffman said.
Hoffman came to the job after he was plucked from the NSW government where he oversaw the sprawling finance and services portfolio – the home of Service NSW – and before that, he had risen to be deputy secretary at the Commonwealth Department of Industry.
Refreshingly frank about the challenges of working as a leader in the public service, Hoffman is a rare beast in the highly insular senior levels of the federal bureaucracy, having worked in the private sector, broadly in the digital media world for nearly two decades.
A 2019 review by former finance secretary David Tune laid out a suite of operational and legislative changes to improve participant experiences and bring some statutory flexibility to the program everyone acknowledges is still maturing.
Not surprisingly Hoffman’s initial focus has been to bring some operational discipline to the tyro agency. For the first six months, he chaired a weekly meeting to review actual performance against a “trajectory forecast” managers created based on a clear understanding of the resources and productivity of workers.
“The trajectory is not just a wish where you have the classic hockey stick curve and you say it is all improved. It’s backed up by actual analysis that says if we do this and this and this, then we can expect the trajectory lines look like them. And then you plot the actual against that.”
‘The fight never finishes’
The Tune review had already prompted significant improvements in access decision times and plan assessments but the relentless weekly focus on operational metrics has seen clear improvements.
Every access decision in the most recent reporting quarter (September 2020) was made within 21 days, compared with 74 per cent one year ago. In the complex world of disability, many of these decisions are contested which leads to further delays and administration. In the same report, 99 per cent of reviews of reviewable decisions were completed within a 90-day timeframe, compared with 60 per cent nine months ago.
“The fight never finishes, but at least you’re on par, and you can try and maintain it and hold the line,” Hoffman said.
Hoffman says a new app is being developed that gives participants easy access to their plan on their mobile phones. He is also pushing through a bunch of basic service improvements Tune called for that include giving reasons for decisions and putting names of people on letters rather than just the name of the agency.
The aim is to roll out piece-by-piece improvements that can be specifically tracked as a part of a service guarantee.
But the big game-changer is the move to streamlined access plans where independent assessors determine an overall budget based on common standards.
“We’ve done the first bit of it, which was we no longer give the money to the providers and commission them to go out and deliver services. We genuinely give the money into individuals plans.”
“But what happened is that we set that budget line by line, support by support. And that leads to a sort of a welfare rationing culture, mindset where we say ‘yes you can have this much of that’, but ‘no, you can’t have that much of this.’”
Of particular concern is the distortion this has created in payment budgets and Hoffman said public data showed plans for people from the top socio-economic decile are 13 per cent higher than the bottom.
A personalised system
Central to this approach will be a new real-time payments system that enables controls to be embedded into the system, but enable participants to choose within the suite of services available—similar to the HICAPS system for private health care benefits.
The shift to giving participants more choice and control includes independent assessments to determine budgets based on a consistent set of information about the functional capacity of the person.
“We get criticised because people say, how will an independent person who I haven’t met know all my needs and all my supports. And our point is, they’re not trying to do that. We are trying to use very well established tools to understand the functional capacity to enable us to set up a reasonable budget.
“And that’s when you start on your specific needs and your specific supports and work your ongoing therapists or practitioners to actually work out what you’re going to do. And that’s the point we’ve got to keep trying to communicate.”
The push to redesign how personalised budgeting works in practice is also being driven by the need to ensure the long-term financial sustainability of the scheme.
For Hoffman, the certainty that the scheme will be there is critical for the scheme’s overall success.
“We know that one of the scariest thoughts for parents who are getting elderly, who may have spent a lot of their life looking after a child who might now be in their 40’s, is what’s going to happen to their son or daughter when they are not here. ”
“Knowing that this scheme is going to keep working in the right way is really important for sustainability. And so, sustainability is also challenged in the sense of financial sustainability.
There is a lot of historic catch-up in the scheme’s expenditure, but the growth has been rapid. Hoffman says in the September quarter annualised spend per participant was $52,000.
“In the September quarter in 2017 it was that $35,000 so that’s sort of 50 per cent growth in three years.”
“The way the current act works, it encourages this line-by-line, additional support. So people coming in for a plan review say I’d like this or that support now. Is it ‘reasonable and necessary’ - yes or no. If yes then it becomes an extra cost.”
According to Hoffman, this is a key strategic shift that is critical for the agency to make while building a strong economy of providers – many of which are co-branded as NDIS suppliers – to actually deliver the services participants need.
“There are two ways the scheme will go. Either we will keep doing it the way we do it now and we will get an ever bigger rulebook of yes/no decisions. Yes, we will fund this, no we won’t fund that, you get this much of this and this much of that.
“Or we go in a radically different way, which is exciting, to say, no, we’re going to actually have fewer rules but stronger and more consistent,
overall total budgets.”
“We can forecast those well, they are consistent across functional capacity, life environment, age and socio-economic outcomes.
“And then we can deliver a better result from that plan for the person with greater choice and control.”
www.afr.com/politics/federal/redesigning-the-complex-disability-services-system-20210113-p56tq4
Disability scheme to end ‘welfare rationing mindset’
The administrator of the $21 billion National Disability Insurance Scheme is moving to simplify the development of personal budgets, to speed up plan approvals and better control costs.
NDIS boss Martin Hoffman is taking his $21 billion agency back to its original vision.
More than 4 million people in Australia have a disability.
“The expectation that was created in the sector through the wonderful people who have advocated for this over many years of their lives as advocates and representatives – often people with disability themselves – was huge. And so the expectations are high,” says Hoffman.
Faced with ongoing complaints, the scheme was struggling and the government committed to a legislated service guarantee that aims to bring a consistent set of standards to more than 50 different service features the agency has committed to meet.
At the same time, the heavily rule-bound program has seen costs balloon as participants push for greater access to service entitlements – especially better-off participants who have the resources and savvy to navigate the complex application and review processes.
Annual scheme costs are budgeted to rise by close to $7 billion to over $24 billion between 2019-20 to 2022-23.
Cultural shift
This leads to what Hoffman admits is a radical change in the underlying program design, a shift away from “welfare rationing culture” where the NDIS micro-manages entitlements line by line.
“The big change we want to take the organisation is really going back to this concept of what is a personal budget, and what is actually means because it’s really quite a radical concept ... a genuine belief that the person themselves or their family knows best what’s best for them.”
Knowing that this scheme is going to keep working in the right way is really important for sustainability.
“If you’ve got a similar functional capacity and similar life circumstances, you’re going to get a similar budget,” Hoffman said.
Hoffman came to the job after he was plucked from the NSW government where he oversaw the sprawling finance and services portfolio – the home of Service NSW – and before that, he had risen to be deputy secretary at the Commonwealth Department of Industry.
Refreshingly frank about the challenges of working as a leader in the public service, Hoffman is a rare beast in the highly insular senior levels of the federal bureaucracy, having worked in the private sector, broadly in the digital media world for nearly two decades.
A 2019 review by former finance secretary David Tune laid out a suite of operational and legislative changes to improve participant experiences and bring some statutory flexibility to the program everyone acknowledges is still maturing.
Not surprisingly Hoffman’s initial focus has been to bring some operational discipline to the tyro agency. For the first six months, he chaired a weekly meeting to review actual performance against a “trajectory forecast” managers created based on a clear understanding of the resources and productivity of workers.
“The trajectory is not just a wish where you have the classic hockey stick curve and you say it is all improved. It’s backed up by actual analysis that says if we do this and this and this, then we can expect the trajectory lines look like them. And then you plot the actual against that.”
‘The fight never finishes’
The Tune review had already prompted significant improvements in access decision times and plan assessments but the relentless weekly focus on operational metrics has seen clear improvements.
Every access decision in the most recent reporting quarter (September 2020) was made within 21 days, compared with 74 per cent one year ago. In the complex world of disability, many of these decisions are contested which leads to further delays and administration. In the same report, 99 per cent of reviews of reviewable decisions were completed within a 90-day timeframe, compared with 60 per cent nine months ago.
“The fight never finishes, but at least you’re on par, and you can try and maintain it and hold the line,” Hoffman said.
Hoffman says a new app is being developed that gives participants easy access to their plan on their mobile phones. He is also pushing through a bunch of basic service improvements Tune called for that include giving reasons for decisions and putting names of people on letters rather than just the name of the agency.
The aim is to roll out piece-by-piece improvements that can be specifically tracked as a part of a service guarantee.
But the big game-changer is the move to streamlined access plans where independent assessors determine an overall budget based on common standards.
“We’ve done the first bit of it, which was we no longer give the money to the providers and commission them to go out and deliver services. We genuinely give the money into individuals plans.”
“But what happened is that we set that budget line by line, support by support. And that leads to a sort of a welfare rationing culture, mindset where we say ‘yes you can have this much of that’, but ‘no, you can’t have that much of this.’”
Of particular concern is the distortion this has created in payment budgets and Hoffman said public data showed plans for people from the top socio-economic decile are 13 per cent higher than the bottom.
A personalised system
Central to this approach will be a new real-time payments system that enables controls to be embedded into the system, but enable participants to choose within the suite of services available—similar to the HICAPS system for private health care benefits.
The shift to giving participants more choice and control includes independent assessments to determine budgets based on a consistent set of information about the functional capacity of the person.
“We get criticised because people say, how will an independent person who I haven’t met know all my needs and all my supports. And our point is, they’re not trying to do that. We are trying to use very well established tools to understand the functional capacity to enable us to set up a reasonable budget.
“And that’s when you start on your specific needs and your specific supports and work your ongoing therapists or practitioners to actually work out what you’re going to do. And that’s the point we’ve got to keep trying to communicate.”
The push to redesign how personalised budgeting works in practice is also being driven by the need to ensure the long-term financial sustainability of the scheme.
For Hoffman, the certainty that the scheme will be there is critical for the scheme’s overall success.
“We know that one of the scariest thoughts for parents who are getting elderly, who may have spent a lot of their life looking after a child who might now be in their 40’s, is what’s going to happen to their son or daughter when they are not here. ”
“Knowing that this scheme is going to keep working in the right way is really important for sustainability. And so, sustainability is also challenged in the sense of financial sustainability.
There is a lot of historic catch-up in the scheme’s expenditure, but the growth has been rapid. Hoffman says in the September quarter annualised spend per participant was $52,000.
“In the September quarter in 2017 it was that $35,000 so that’s sort of 50 per cent growth in three years.”
“The way the current act works, it encourages this line-by-line, additional support. So people coming in for a plan review say I’d like this or that support now. Is it ‘reasonable and necessary’ - yes or no. If yes then it becomes an extra cost.”
According to Hoffman, this is a key strategic shift that is critical for the agency to make while building a strong economy of providers – many of which are co-branded as NDIS suppliers – to actually deliver the services participants need.
“There are two ways the scheme will go. Either we will keep doing it the way we do it now and we will get an ever bigger rulebook of yes/no decisions. Yes, we will fund this, no we won’t fund that, you get this much of this and this much of that.
“Or we go in a radically different way, which is exciting, to say, no, we’re going to actually have fewer rules but stronger and more consistent,
overall total budgets.”
“We can forecast those well, they are consistent across functional capacity, life environment, age and socio-economic outcomes.
“And then we can deliver a better result from that plan for the person with greater choice and control.”
www.afr.com/politics/federal/redesigning-the-complex-disability-services-system-20210113-p56tq4
Disability scheme to end ‘welfare rationing mindset’
The administrator of the $21 billion National Disability Insurance Scheme is moving to simplify the development of personal budgets, to speed up plan approvals and better control costs.
National Disability Insurance Agency chief executive Martin Hoffman told The Australian Financial Review the shift to having independent assessments of participants capacity and circumstances would bring better consistency and standardisation.
“The big change we want to take the organisation is really going back to this concept of what is a personal budget, and what it actually means because it’s really quite a radical concept ... a genuine belief that the person themselves or their family knows best what’s best for them,” he said.
“If you’ve got a similar functional capacity and similar life circumstances, you’re going to get a similar budget.”
Once participants have an agreed budget they will then be free to use the marketplace of charitable, government and for profit partners the NDIS uses to deliver disability support services to the more than 430,000 people already on the scheme.
Mr Hoffman said entitlements had previously been determined by an ever-increasing rule book that had led to “a welfare rationing culture mindset where we say ‘yes you can have this much of that’, but ‘no, you can’t have that much of this’.”
Mr Hoffman said this had also led to distortions where better off and more savvy participants were able to gain better entitlements, and public data showed plans for people from the top socio-economic decile were 13 per cent higher than for those at the bottom.
The seven-year-old scheme took over from a patchwork of state and local government services, but a 2019 review by former finance secretary David Tune found the speed of the shift and complexity of the changes had led to major frustrations about delays and inequities.
Mr Hoffman was appointed to the NDIA in late 2019 after running the NSW Finance and Services department – home of Service NSW – for four years.
Legislation to lock in service guarantees and to enable more flexibility in the administration of the scheme is being developed by the Department of Social Services for federal parliament to consider this year.
The scheme has seen large cost increases with annual scheme budgets to rise by close to $7 billion to over $24 billion between 2019-20 to 2022-23.
www.afr.com/politics/federal/disability-scheme-to-end-welfare-rationing-mindset-20210211-p571he
www.afr.com/politics/federal/disability-scheme-to-end-welfare-rationing-mindset-20210211-p571he
Cheers bear