Social Development Committee: NDIS Inquiry

Ms WORTLEY (Torrens) (11:44): I move:

That the 46^th report of the committee, entitled 'Inquiry into the impact of the National Disability Insurance Scheme (NDIS) on South Australians living with disability who have complex needs and are, or are at risk of, residing for long periods in inappropriate accommodation', be noted.

I would like to take the opportunity to acknowledge and thank all those involved in the Social Development Committee inquiry and especially the individuals who shared their stories of living with disability and the families and carers of the individuals who shared their journey through the NDIS system. Thank you for giving the committee the insight into what you have had to endure. Your evidence was invaluable. I also wish to thank the secretariat for their work, Robyn Schutte and Mary-Ann Bloomfield, and also the committee members: the Hon. Ian Hunter MLC, the Hon. Irene Pnevmatikos MLC, who has recently left the other place, the Hon. Robert Simms MLC, the member for Frome, the member for Unley and the member for Chaffey.

As a result of this inquiry, the committee has made 53 recommendations to the government of South Australia through the Minister for Human Services. In tabling its 46^th report today, the Social Development Committee notes that there has been a lot of work done to improve the NDIS for some 600,000 people across the country who receive supports through the scheme. It is important to note the Social Development Committee has not been alone in considering the NDIS and the broader circumstances of people with disability. Since the committee completed its work, the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability handed down its final report, totalling more than 6,000 pages with 222 recommendations.

Throughout 2023, Professor Bruce Bonyhady AM and Ms Lisa Paul AO PSM also conducted a review of the first decade of the NDIS, and it is expected the review will be released in the not too distant future. I refer to these other pieces of work because the Social Development Committee's report touches on many of the same issues, and its recommendations will no doubt need to be considered in the context of that other work that has been carried out around the nation.

Our committee heard that the NDIS has been a life-changing scheme for many Australians, yet for some of the most vulnerable in our community it has not delivered the promise of an ordinary life. Some participants have been forced to live in situations that have caused them harm or with service providers unwilling or unable to provide adequate care and support.

The committee acknowledges that some of the work needed to address the issues which have arisen during the inquiry and which are referenced in the report has already commenced as a result of previous inquiries in other jurisdictions. The committee acknowledges the work of the South Australian government to address the ongoing housing crisis and the work it has done to improve the availability of short to medium-term accommodation for participants exiting hospital, such as the Regency Green facility.

The committee received evidence from people living with a disability, NGOs and advocates that South Australians who live in rural and remote areas face additional challenges in accessing specialist disability accommodation (often referred to as SDA) and the support services that they need. To that effect, regional and rural participants have less opportunity to exercise their choice and control. This is even more the case for Aboriginal and Torres Strait Islander people, whose needs are not being met because a market-based approach fails in regional, remote and outback locations.

The committee heard there are other gaps in the system that need to be filled and that there will continue to be an ongoing need for the mainstream services that support people with disability even if they have an NDIS package. This presents unique opportunities for the government of South Australia to step in and fill these gaps and to work with people with a disability and other stakeholders to develop and implement innovative and novel solutions.

This inquiry has also shown—and what we know from the stories of participants and their advocates—that it is essential that the Australian government work with the South Australian government to address the accommodation needs of South Australians with disability and complex needs. There also needs to be renewed commitment to closing the gap in the accommodation opportunities for Aboriginal South Australians.

The committee has made a recommendation that the government of South Australia implement a co-design process to update the state's housing strategy, Our Housing Future 2020-2030, including a focus on housing that will be accessible to people living with disability. The committee has also made several recommendations that the South Australian government work with the Australian government to improve safeguarding mechanisms for children and young people, in particular Aboriginal and Torres Strait Islander children and young people with disability and complex needs, and that the NDIS Quality and Safeguards Commission be given greater powers to investigate breaches.

A well-functioning disability support system means that people get appropriate care and do not end up in inappropriate settings like hospitals or, even worse, the justice system. The committee received evidence during this inquiry that, between 1 January 2021 and 30 June 2022, at least 71 NDIS participants presented to a public hospital for a non-health related admission. There was also concerning evidence about the amount of time that NDIS participants were spending in hospital when they were medically ready for discharge.

The committee heard about discharge delays, totalling 67,188 days between June 2019 and December 2021, related to 830 NDIS participants in SA hospitals. While I understand and am pleased that work over the past year has seen the number of NDIS participants ready for discharge from hospital reduced by around half, I hope the committee's recommendations can help that to improve even further.

Part of what makes the NDIS so unique is a participant's right to exercise choice about many aspects of life. Specialist disability accommodation (SDA) is a funding stream under the NDIS home and living supports program, which can provide opportunities for participants to exercise choice and control. Despite this, the committee received evidence that decisions about a participant's home and living arrangements could not be made without any face-to-face contact by NDIA staff. The NDIA is charged with an incredible responsibility, and it was troubling to learn that such important decisions were at times being made in such impersonal circumstances.

Support coordination is known to be important for people with complex support needs, yet the committee was informed that many support coordinators lack essential skills expected of them. The committee heard there is a need for increased scrutiny over these roles, and that means an increase in the minimum standard of training for anyone providing support coordination services. The committee has recommended that this be mandated at the national level.

Access and equity issues were raised in relation to the adequacy of the resources available for hard-to-reach cohorts, such as people facing homelessness, CALD communities, people with experience of the criminal justice system and Aboriginal and Torres Strait Islanders. The committee also heard that the local area coordinators (LACs), whose role it is to provide support to people trying to access the NDIS or mainstream services, need to have a redefined role. The committee heard in some instances there were cases of LACs having no real understanding or experience with disability and with people with complex support needs.

The committee heard case management is not funded, nor is it part of an NDIS model of support. However, some submissions evidenced a need to reintroduce case management services for some participants who have very high needs. The committee has recommended the government of South Australia work with the Australian government for the NDIA to implement case management for the small percentage of participants with complex support needs.

One of the key concerns highlighted during the inquiry was that the NDIA has been taking a cost-saving approach to its assessments and taking excessive time to make decisions. Some submissions made by advocates commented their organisations had witnessed participants being rejected for funding because it would not be value for money for the NDIS.

Another issue that emerged was that the NDIA started to place an even bigger burden on families and carers by assessing familial relationships as automatic formal support, hence reducing the amount of funding approved. The committee has recommended the state government work with the Australian government to urgently develop a policy and procedure to allow for flexibility to be built into NDIS plan structures to respond to the fluctuating needs of children and young people.

Evidence provided to the committee by Housing Hub shows times frames for SDA applications for NDIS participants in hospital can take from 60 days to 90 days, or even longer. The NDIA has been working on improving SDA decision time frames and a lot of work has been done within the agency following the 2019 David Tune review which saw the implementation of the NDIS Participant Service Guarantee. But there is still work to do, especially when a person is in crisis.

The welfare of younger South Australians in residential aged-care facilities was also raised as a significant and ongoing issue during the inquiry, where delayed decision-making is having negative impacts. For people under 45 years of age who exited residential aged-care facilities, approximately one in seven (14.3 per cent) returned to the community while 37.1 per cent exited due to health.

The committee has recommended the government of South Australia work with the Australian government to urgently integrate the housing outcomes and targets of the National Agreement on Closing the Gap and Australia's Disability Strategy in developing all future housing policies and frameworks, including those under the NDIS and South Australia's Disability Inclusion Plan. The committee has also recommended that both governments urgently address achieving the Younger People in Residential Aged Care targets in response to the Royal Commission into Aged Care Quality and Safety.

For some participants who were successful in their SDA application, the committee heard this is not the end of the road in terms of gaining appropriate accommodation; rather, it can be the beginning of an even longer journey. Participants and disability advocates described the toil it takes to locate, apply for and win SDA in a market that has not expanded as envisaged.

Witnesses provided evidence that SDA supply is inadequate for NDIS participants in South Australia. To provide some insight into the numbers, in the quarter to 31 March 2023 there were 2,316 South Australian participants with approved SDA funding in their plans and only 1,287 SDA-enrolled dwellings. There were also 621 South Australian NDIS participants seeking an SDA dwelling. The notion that an SDA market would be created out of demand from participants with SDA funding has clearly not worked.

Housing for people who have a disability requiring very high support demands urgent attention from government. The committee would like to see, and has recommended:

the government of South Australia continue to develop and implement a plan to address the shortage of long-term disability housing supply in South Australia;

the government of South Australia work with the disability community to design and build more public disability housing that can meet the diverse needs of South Australians with disability, including for people with a disability and complex support needs; and

the government of South Australia continue to fund, develop and implement sustainable state-based service systems to assist both NDIS participants and non-NDIS participants who have no other housing options available to them or where other service systems break down.

The committee has further recommended that the government of South Australia work with the Australian government for the NDIA to develop a comprehensive market and workforce strategy with short and long-term measures specific to the South Australian context.

The committee heard numerous stories from participants and advocates that the NDIS has the ability to significantly benefit the lives of South Australians living with disability who have complex support needs, including having a positive impact on their wellbeing. However, the evidence shows in some cases system failures have caused detrimental outcomes for NDIS participants. Accordingly, the impacts on the wellbeing of participants who experience living in inappropriate accommodation can include a deterioration in mental health, an increase in behaviours of concern, an impoverished quality of life, and an unreasonable burden of care on family carers.

The committee heard it is vital that participants have access to NDIA advice and the availability of service providers outside of regular business hours. The committee understands, as the evidence shows, one of the things that can improve the application and planning process and serve to benefit participants is personal advocacy. For some participants, being able to have a one-to-one interaction with the person making the decision on their support can also go a long way. I seek leave to continue my remarks.

Leave granted; debate adjourned.

Mr ODENWALDER: Sir, I draw your attention to the state of the house.

A quorum having been formed: