A question of balance

Good afternoon, everybody. My name is Lisa Paul.

I'm one of the co-chairs of the Independent Review of the National Disability Insurance Scheme, and I'm absolutely delighted to be with all of you today.

I'd like to start by acknowledging the traditional owners of this beautiful land. We are broadcasting our webinar from the lands of the Awabakal and Worimi Peoples in the Newcastle area, and pay my respects to elders past, present, and emerging.

It's wonderful to welcome webinar attendees from all the different lands across our country.

I would particularly like to acknowledge any First Nations Peoples that have joined us for the webinar today. I'd also like to acknowledge people with disability who are joining today, and their families, and loved ones, and supporters.

Welcome to NDIS Providers Webinar.

Although the Panel is in Newcastle today, the webinar is being attended by providers right across the country.

I'll introduce my fellow Panel members and then I'll hand over to the amazing Bruce Bonyhady for your address.

So it gives me terrific pleasure to introduce Professor Bruce Bonyhady who actually needs no introduction.

You all know Bruce. Without Bruce, there wouldn't be an NDIS.

He is one of the architects of the NDIS, maybe the architect of the NDIS, and fought hard as you did for the creation of the wonderful, wonderful scheme that we love.

Other Panel members joining you today.

We have here in person, online, in person, online, whatever, Professor Kirsten Deane, who many of you would recognize from her work leading the Every Australian Counts campaign, which was also so instrumental in campaigning for the NDIS.

And online, online, is versus online, in-person, online, online, is Dr Stephen King, another one of the Panel members, and he is a productivity commissioner.

So I always like to say something like, "We forgive him for being an economist," but it's very important to have someone with Stephen's skills on the Panel.

A couple of our Panel members aren't here.

So Kevin Cox was a former human rights commissioner in Queensland, and he's not able to join us today; the amazing Judy Brewer who has campaigned long and hard for people with autism; and Dougie Herd, who is a CEO of a provider and a person with lived experience.

So everyone on the Panel pretty well is a parent of someone with a disability or has lived experience of disability.

It's a wonderful Panel and it's been a great privilege to be part of it, but I also wanna pay tribute to our fabulous Secretariat folk who support us so, so well in every way in everything that we do.

They're based in the Department of Prime Minister and Cabinet, but several of them are with us today, which we really appreciate.

So just a bit of housekeeping.

Keep your cameras and microphone off unless asking questions.

You can ask questions in the Question and Answer Panel on the right side of your screen.

This is being recorded, I think, and put up on our website.

And we did a session this morning with participants where we were sort of half and half online and here in Newcastle in person.

And we had some media there, so I imagine there'll be some media interest today as well.

We really value your expertise. We value... Let's face it. Without providers and the workers that support people with disability, there would be no scheme.

You are the heart of the scheme in your support to participants.

We've met with hundreds of providers.

We will have heard from thousands of workers.

We've heard from thousands of participants and the people that love them.

We've received more than two and a half thousand submissions.

It's just been a great privilege.

It's great to be here in Newcastle as the base for this webinar today because it was one of the first two trial sites way back in 2 But the important business for today is to hand over to Bruce to start outlining what we are thinking about the future of the scheme.

So to give you a sense of the future of the scheme, I'd now like to hand over to Professor Bruce Bonyhady.

Thanks, Bruce.

Thanks very much, Lisa.

I would like to acknowledge the traditional owners of the lands on which I am today, which is the Awabakal and Worimi Peoples here in Newcastle.

And I pay my respects to their elders past, present, and emerging.

I also want to thank everyone, particularly service providers and support workers, for taking the time to tune into this webinar.

I also know that many participants and family members are watching today, and so my comments are addressed to you as well.

After all, every market has two sides, the supply side and the demand side, the providers or workers and the consumers or clients.

The purpose of this session is to brief you on the work of the NDIS Review with a particular focus on markets and what is and what is not working, share the emerging views of the Independent Review Panel, and answer questions about future directions of the NDIS Review.

With that in mind, let me take you back to October 2022 last year.

Last October, the NDIS Minister, the Honourable Bill Shorten, established the NDIS Review to evaluate the design, operations, and sustainability of the NDIS.

He wanted us to improve the outcomes for participants and families and improve their experience, ensure the NDIS is sustainable, and restore trust and confidence in the scheme.

Since then, the Review has received more than two and a half thousand public submissions and heard directly from many thousands of Australians with disability.

We've also travelled to every state and territory to listen and learn firsthand about what is and is not working.

The overwhelming message we have received is that the NDIS is life-changing.

It is uniquely Australian and something Australians are deeply proud of.

But at the same time, we've been dismayed by some of the things we have heard and seen.

Perhaps the best way to explain is to summarize a speech I made this morning.

That speech was delivered here in Newcastle at a community event for NDIS participants and their families.

I deliberately chose to give the speech in Newcastle because it is here that then Prime Minister Kevin Rudd officially launched the NDIS on the 1st of July, 2 In essence, I said, that unless significant action is taken, the future of the NDIS will sooner or later be endangered.

That is why every part of the disability sector, from people with disability, to families, to carers, to providers, along with governments, has a responsibility to take action to protect the NDIS for future generations.

We need to reign in the growth in costs.

We need to tackle systemic inequity and to deliver better outcomes.

We need to start being much more innovative and improve quality.

This morning, I outlined the five key challenges faced by the NDIS.

It's an oasis in the desert for people with disability.

Its fundamental purpose, delivering reasonable and necessary supports has become unbounded, and therefore some service demands and types are increasingly unreasonable and/or unnecessary.

It supports far more children than projected, its markets are not working.

And as a consequence, its sustainability is being questioned.

Those five challenges are not news.

They were detailed in the NDIS Panel's Interim Report.

What we have heard.

What is news is the air of unreality that seems to surround the NDIS.

Some people seem to believe that rising costs are not as significant as we have been told.

I'm here to tell you that they are, and they're very serious, and we must change.

What I said this morning was that we all need to stop treating the NDIS as though it is a limitless magic pudding.

And when I say we, I mean governments, service providers, participants, and families, even the NDIA itself because since this review commenced, everyone has been saying that the NDIS must do much more.

Much, much more.

But unlike the magic pudding, the NDIS is finite.

And due to unmet and still unrevealed demand, the scheme is in danger of overshooting its target of containing expenditure growth at 8%.

And we have a responsibility to both this and future generations of Australians to get the NDIS back in balance.

That, in essence, is what I said this morning.

Right now, what I want ask you is this.

Are you prepared to work with us to get the NDIS back in balance? Because since 2 the disability sector has swung like a pendulum from one extreme to another.

We've gone from a situation where before the NDIS was introduced, almost everything was regulated to a situation where a decade after the introduction of the NDIS, most of the growth is in unregulated services.

We've gone from an unacceptable situation where before the NDIS was introduced, everything was rationed and block funded to a situation a decade after the introduction of the NDIS, where the demands for supports to be individually funded on a one-to-one basis, continue to grow seemingly without limit.

I believe this headlong drive for more and more supports has been fuelled by the market settings.

Instead of primarily driving up innovation, those market settings have largely driven up demand and costs.

Instead of primarily driving inclusion and participation, those market settings have led to new forms of segregation and exclusion and, in the worst cases, abuse and exploitation.

In addition, social and community capital has been eroded.

And what outcomes, in return for all this expenditure, have these market settings delivered? Have they delivered services to people with disability living in remote communities? Have they prepared for the demand surge that will come when age carers are no longer able to support family members with disabilities? Have they helped children with disabilities to be supported in early childhood settings and schools? Have they delivered innovations that give people with disability real choices and the best value to them and taxpayers? While there have been pockets of innovation, and interesting, some of the most innovative supports are unregulated, overall, they have not.

As I said, things are out of balance.

How then, should we, rather than swinging back the other way, bring the pendulum into balance and secure the future of the NDIS? The best way to answer that question is to outline the future directions currently under consideration by the NDIS Review in relations to markets and the workforce.

Let me start with pricing and payments.

It's clear that the conditions for deregulating prices do not exist, but price caps are not working because they're based on poor or incomplete data and not transparent and do not reflect market realities.

This is undermining confidence.

That is why we're considering how service types, participant needs, location, and other relevant data should inform the setting of price caps.

That's why we want price caps to reflect the additional costs of delivering services to participants with complex needs, as well as in regional and remote areas.

That's why we're considering how the administrative margin, which is now included in all prices and has fuelled the shift to unregistered providers and price caps should be set.

That's why we're considering payment approaches other than fee for service that deliver better outcomes for people with disability.

And that is why we're considering market reforms that would enable participants to make informed choices, give them voice, reduce information asymmetries, improve quality, foster innovation, and give governments a more active role in stewarding the NDIS market.

Since the Review commenced, the constant feedback and evidence from service providers, particularly traditional providers, is that NDIS prices are not high enough and that many providers are teetering on the edge of solvency.

the Review recognizes these pressures.

However, we've also heard that many providers are overcharging and overservicing, that there is collusion, and, in some cases, outright fraud.

And the plan management and support coordination are not always playing the roles that were intended.

That's why the Review will be recommending a major investment in scheme integrity, which will ensure efficient administrative processes, transparency of payments, better data to underpin analysis of scheme performance, and reduce risks of exploitation and abuse.

The NDIS workforce is another area we have under consideration.

The NDIS workforce has doubled over the past decade and delivers a wide range of critical services.

The biggest change is the growth in unregistered providers, which now sit at around 140, This is an area where the Review has received very strong feedback, with the unregistered market attracting strident critics and passionate defenders.

the Reviewers also heard that overall, the workforce is struggling.

People are burnt out.

Pay does not always reflect the difficulty of the work, or experience, or qualifications.

Workers using an ABN can receive almost twice the pay for taking a participant shopping under the guise of community inclusion, then providing complex personal care to a person who have behaviors of concerns or needs specialized feeding.

Currently, there are almost no training incentives.

In addition, training courses are not fit for purpose.

We should, therefore, not be surprised that we have high staff turnover and a skill shortage.

Not only that, it's estimated that the scheme will need another 128, workers by mid-2025.

A key requirement for an effective NDIS is a well-trained workforce. The Review would, therefore, like to see more micro-credentials and a portable training allowance, which would grow and travel with workers who are employed casually.

It's also essential for the NDIS to have integrity.

For the sake of integrity, we need an effective, quality, and safeguard system that has visibility of workers and businesses.

Currently, though, around 140, and small businesses are flying under the radar of the quality and safeguard system.

That's not good enough.

Tomorrow, my co-chair, Lisa Paul, will be speaking at an ASU conference and will have more say on these important issues.

The bottom line is that the NDIS cannot reach its social and economic potential without a skilled and engaged workforce, which contributes to quality outcomes and a sustainable NDIS.

In conclusion, let me come back to the purpose of the NDIS.

The scheme is, as Minister Shorten has said, a monumental socioeconomic reform on a par with Medicare.

It has transformed the lives of hundreds of thousands of Australians with disability and their families and carers. And its impact will only grow in the decades to come.

In fact, the biggest social and economic gains from the NDIS are ahead, rather than behind us.

The challenge before us is to ensure that future is fully realized.

To do this, we must put an end to magic pudding thinking.

Every person with disability, every family member, every carer, every service provider, and all governments have a role to play in this change.

After all, it was the United Disability Sector that gave Australia the NDIS.

Disability service providers were part of that campaign.

You supported the Every Australian Counts campaign and stood side by side with people with disability, their families, and carers.

I think it's very important to remember what we achieve together.

That's why I want to thank you most deeply for that solidarity.

We would not have the NDIS without you.

I also understand your fears and anxiety, as well as the fears and anxieties of your staff.

However, now more than ever, we need to remain united and resolute.

We need to restore balance because only then through our united efforts will the future of the NDIS be secured.

Thank you very much.

That was awesome, Bruce.

Thank you so much.

That was a wonderful speech and much appreciated and really well sets out some of our directions.

So we've got some questions coming through online, which is great.

In fact, there's quite a few coming through.

Now, by the way, to everyone watching this, if we don't get to your questions today, this is all going up on our website, which is ndisreview.gov.au, and we'll try to do...

We'll try to answer some questions, even if it's thematically, that we don't get to today.

So I'm going to throw to Kirsten first, and our questions come through, which says, "What systems are in place to improve outcomes for participants who have no assistance in navigating the NDIS?" - Thanks, Lisa.

Well, what systems are in place at the moment? Not too many.

And so we've heard that really clearly from participants, their families, but also those who support them, that not only is the NDIS incredibly confusing, incredibly complex to navigate, but also that there's limited support in how to make your way through what has become a maze.

So what we are thinking about is a few different things.

First of all, we are thinking really deeply about what kinds of information people need not just to navigate the NDIS, but make sure that they can get all of the support that they need not just through the NDIS, but through other service systems.

What information do they need so that they can do that? So that's what kinds of information they need to help them navigate they were through.

But also make informed choices about those things.

So we're thinking about what kinds of information people need, and then we are thinking about where they might get that information 'cause we've heard very clearly and very strongly from people with disability and their families that they want it to get from folks that they trust.

So anonymous government website, not so much, more about getting it from trusted sources.

So from peers, from organizations that they know and trust.

So what kinds of information do people need to help them make choices? Where they might get that information and where the best place is that people trust.

And then the third set of issues is if they have those things, what other kinds of help do they need to help work their way through the NDIS? And the last thing that we're thinking very deeply about is that the majority of participants on the NDIS have a cognitive disability.

And up until now, it's the Panel's view that they haven't had sufficient choice and voice in the scheme.

And so we are thinking really deeply about what else that we might need to do to make sure that participants have the support that they need to take choice, to stop choice just being a word, but actually enabling them to genuinely have choice in their lives and what kinds of support they need to make those kinds of decisions.

So the NDIA recently released a support for decision-making policy.

10 years in the making, but it's here now.

So what the Panel's thinking about is: What have we gotta do to make that policy sing? What have we gotta actually do to make sure that people have what they need so they can genuinely direct their lives? So they're the kinds of things that we are thinking about at what's not working now, but what would good look like in the future? That's what we're really grappling with.

Absolutely.

We sure are.

Now, I've got a question for...

Thank you, Kirsten.

I've got a question for Stephen who's joining us online.

Next question's for you.

What's the Review thinking about improving service delivery in rural and remote Australia? - Okay, thanks Lisa.

We've heard time and again in our travels around the country about the lack of services in rural and remote areas and the naivety of the current system, which provides a budget for participants and then leaves them in a situation where they can't find the services to be able to use that budget to get the services that they need to live a good life.

And that has to be addressed. It has to be addressed in different ways and it will be addressed in different ways across the country, I think.

So the sort of things that we're looking at the moment is thinking about in the rural and remote areas, what are the alternative ways that the NDIA can help steward the market to ensure that the services are there? And in some cases, that may be a nuancing, as Bruce mentioned during his talk, it may be a matter of nuancing the prices, to change the incentives, to make sure that there are some incentives for service providers to be in less populous areas.

But quite frankly, out in a lot of parts of rural and remote Australia, that's not gonna be enough.

That might work for some of the outer suburbs of our major cities, but in rural and remote Australia, we're probably going to have to think about a more hands-on approach from the stewardship function.

For example, it might be the case that in some areas, there has to be what we call a contestable market, a process whereby the NDIA puts out tenders and says, "Well, who will be the service providers in these markets? Who's willing to do it? What are the prices going to look like?" So in a sense, NDIA, the system underwriting to make sure that there are service providers available, and where possible, obviously, still giving choice to participants.

But again, in some areas, that may not be possible.

Populations, particularly in remote areas, may not be enough to support multiple providers.

In those areas, what we are thinking of is that there may need to be much more work with the community to have the authorities working with the community to say, "Well, what services does the disability community in this area need? And how can we best provide them? How can we make sure that we getting the services there?" And that may mean that we need, for example, more focus on peer workers, more focus on community services, rather than simply a, "Well, let the market try and solve it." So they're the sort of ways that we're looking at.

I suspect it's going to need all of those levers to be pulled because the variants across Australia is huge.

But certainly at the moment where we have what seems to be a bit of a cruel joke where you say to somebody, "Well, here's a budget, but there's no services available to spend it on." That has to be overcome.

But we think there's a range of different ways that we can start doing that.

- Thank you, Stephen.

And Bruce, do you wanna add to that? - Sorry, the question on- - Well, I'm just wondering if you want to talk about your travels to Northern Territory, actually, because we're talking about...

Stephen's question was about rural and remote.

Yeah.

And you did some amazing travels up North.

Yeah.

So you wanna talk about that and then I'll throw you another question? - Yeah, well, I thought you were about to jump to the next question.

Oh, sorry.

That's all.

Yeah, look, it's all under control here, folks, it really is.

That's okay.

(Lisa laughs) So, the Review made a very important trip from Darwin to Alice Springs via Maningrida, Grote Island, Tennant Creek, and Ali Curung.

And if you wanna see where the NDIS is not working, you need to go to remote parts of Australia.

The visit to Ali Curung and Tennant Creek was particularly symbolic 'cause that's where the NDIS first rolled out in a remote area eight years ago.

And to visit Tennant Creek, but particularly to visit Ali Curung, which I'd visited eight years earlier and find that almost nothing had changed, really brought home how little the NDIS has achieved in these remote communities.

For people in those communities, the NDIS is confusing to navigate.

It's very difficult to navigate.

They may have a support coordinator, but they not don't have services.

And so the key issue that the Review's looking at is whether there should be an alternative way of commissioning services in those communities initiated by those communities.

So the communities come together to commission those services.

And if that can be achieved, it will be an enormous achievement because it would contribute to closing the gap by creating permanent jobs in those communities.

But it will also need closing the gap because closing the gap is gonna be necessary for the good governance of those services.

And so that actually raises a really important point about the NDIS that to date, in many ways, it's operated as an island separate from these other service systems.

And one of the big findings from the Review is the need for the NDIS to work much more in partnership with other service systems.

There's, as many of you know, a set of applied principles, which apply to what the NDIS should fund and what other service systems should fund.

The overwhelming evidence to this review is that those principles, which are called APTOS, are not working effectively.

These systems need to work together in harmony, rather than have hard boundaries, which is where they are today.

So Lisa, can I chime in on it too? - Of course.

So, while the trip to the Northern Territory was very disappointing in terms of not seeing enough change over the eight years since the scheme had been operating, we did have the chance to see some awesome services that were operating in these communities.

And what they had in common was that they were community-led.

And as a result, they were genuinely responsive to the needs within the community and well, what the community wanted, and they were incredible.

And so while it was very disappointing to see what hadn't happened, it was awesome to see those genuinely innovative and different kind of services.

But what they had in common was that community-led part.

And so what we were left with thinking is: How can we get more of that good stuff and not so much of the other stuff? (Lisa laughs) - Yeah, absolutely.

That's what we're trying to distil, isn't it? The special sauce into the Review.

So Bruce, next question is for you.

What changes can be made to make it easier for providers to improve outcomes for participants? This is something very close to my heart, isn't it? - Yeah, well, I was- - I always go on about outcomes.

Yeah, well, you might get a chance to add something at the end of it.

Can I just say, what a great question.

Because outcomes and quality are a key focus for the Review.

And we often talk about the sustainability of the NDIS, and sustainability, of course, has got two sides.

There's the cost side, but also the benefit side.

And this question about outcomes is exactly what we need to focus on in order to improve the benefits of the NDIS.

So when it comes to improving outcomes for participants and how service providers can do better in that area, I think there are a number of things that need to happen, which the Review is thinking about.

Partly, it relates to the ecosystem and the dynamics that sit around the NDIS at the moment.

But partly, it also relates to providers.

So I think the first point I would say in relation to outcomes is that prices need to be set with outcomes in mind.

And so we've already indicated that we think that pricing needs to be more transparent, it needs to take better account of costs, and of course it needs, as part of that, we also need to think about and improve the quality of the workforce.

And so, training of workers is something that we're also giving great attention to.

But I think the real point I want to make over and above that is: What is a good outcome for a person with a disability? Is it more services or is it an inclusive life? And what it is an inclusive life? And so the big challenge is how do service providers work with participants to ensure and support an inclusive life, rather than further the demand for more specialist disability services? How do we make sure that people with disability are included in neighborhood centers, a part of community, and a full citizens? And so I think it is really that shift, it's a cultural shift away from doing for people with disability to doing it with people with disability and helping them to be full citizens to be included in community.

And so they're the big changes that we're thinking about as part of this review, Lisa.

Well said, Bruce.

Well said.

Not much more to add, except that I was really surprised when we started the Review to find that it wasn't possible to put my hands on the number that says how much the scheme is contributing to the economy.

Not in a totally credible way.

And yet it was easy to put my fingers on the numbers of what's being spent on the scheme.

And so we've got the input number, which is how much the scheme costs, but we don't have the outcomes.

And yet we know.

We know that the scheme is changing lives.

We know the scheme is changing so many lives for the better.

We know the scheme.

I mean, we hear every day how the scheme has helped someone get into employment or have a more inclusive life, as Bruce says, or just have an improved quality of life.

And even though each plan has goals and so on, they're not kind of incentivized, if you like.

We don't incentivize or reward providers well enough in my view to get really good outcomes.

And we don't kind of aggregate them.

So we don't really know about them.

And it's not right because we know this scheme is having fantastic outcomes.

So I'm really interested to look at ways that we can reward providers that are getting incredibly good outcomes for participants in ways that Bruce describes of achieving an inclusive life.

And let's face it, for everyone who's able to find some employment to some level, there's a nobility in employment that can't be denied.

My next question is for Kirsten.

Somebody is saying, "Kirsten, there's too much reliance on core supports.

And will the Review recommend a shift towards more capacity building supports, especially for psychosocial disability?" - Okay, great.

Great question.

So we have been thinking a lot more about the ways that the scheme can respond better to people with psychosocial disability.

So there's a little part about me that is sort of uncomfortable in calling out a particular disability 'cause I think a lot of the commentary around the scheme has been super unhelpful about focusing on particular diagnosis.

So I just wanna say that kind of upfront.

But at the end of that sentence is, but we have heard really strongly from participants and their families and providers that the scheme needs to approach supporting people with a psychosocial disability in a different way, particularly when it comes to a focus on recovery.

So while as a Panel and as a review, we are wary about focusing on a particular disability or diagnosis 'cause we think a lot of the commentary about that has been incredibly unhelpful.

I do recognize that when it comes to psychosocial disability, we do need to think about things differently in terms of a recovery framework.

And so the other thing that we kind of heard really strongly is that it's awesome that the NDIA now has the Recovery Framework, but we need to do more to actually lift that off the page and make it kind of happen in practice.

And one of these things is, as the question rightly points out: How can we make sure that we step things up and step things down depending on where people are and how they're traveling? So how can we make sure we give people the right levels of support, bit more support when they're not doing so well, and then step it back and let them kind of take the reins when things are going well.

And the distinction between core and capacity building isn't terribly helpful there.

Actually, what we're talking more about is: How do we make sure that we wrap around people when things aren't awesome? And then how do we make sure we kind of rightly step back when things are going well? And so I think that's more of what we're trying to grapple with.

Yeah, because I also think we have to give people the next scheme, the continuation of this scheme, has to give people confidence that it's okay, that they can trust that it's okay to get lots and lots of support from the scheme when they need it and not so many supports when they don't need it.

And then lots and lots of supports when they do need it and not so many when they don't.

And I think that's true particularly of people with psychosocial disability, but I actually don't think it's exclusive to them.

So that's why I kind of... I hesitate with this focus on diagnosis.

But yeah, I do think it is a group. So yes, we are grappling with that and thinking about how that could work better.

Yeah 'cause now, the people feel, "Okay, I've got all my supports when I really need them, but now I don't need them but I'm frightened that I'll never get them back." And so we've gotta give that confidence that, "Yes, you will get it back if you need it." - Yeah, and the kind of perverse incentive to kind of...

And again, this has been a comment that we've had not just from participants with psychosocial disability but across is that, "I'm afraid to go to the NDIS and tell them that I've achieved my goal or things are going well 'cause I don't want them to strip support." So it's kind of this weird situation where actually, you end up doing the thing you want to do, but you don't wanna tell anybody about it because you might lose support.

So we don't want that.

That's just the wrong... It's the wrong way around, wrong way around.

Hey, I've got a question for Stephen.

It's so long, Stephen, that it fills the entire screen that's in front of me.

So, good luck with this.

(Lisa laughs) We have two related questions about registration process for providers.

Number one, will there be a source of information for service providers who are trying to find their way through the system to register? And number two, can you please let me know how urgently the NDIS is treating the registration process and how it actively disadvantages registered providers? I think that's more about how the...

I would take that as how the Review is dealing with registered v unregistered.

Okay, thanks for the question.

And it's an issue Bruce again mentioned in his talk.

This has come up over and over again in our discussions with providers.

Just the... fact that the scheme at the moment sort of has these two buckets.

One side, there's registration, which is complex, it's onerous, it's costly, but provide safeguards and safeguards for participants.

At the other end, you've got unregistered providers, which there is literally no information going back to the NDIA, to the NDIS, to the system, about what those providers are doing, what services are being provided, where they're being provided, and so on.

So you've got this dichotomy currently, which really makes almost no sense.

And we get it, it is driving... Probably some of you in the room, it is driving some of you in the room who wanna do the right thing, who wanna be registered, it's driving you bankrupt because you have costs that you're simply not able to get back through the price caps and you're not able to get back in competition with the unregistered providers.

We need a much more nuanced approach. So we are thinking about how to do that. How do we make sure that there's at least a minimum level of two things.

Firstly, the data going back to the system, but also the safeguards for participants.

And how do we make sure that you start at that minimum level and then you're able to ratchet up in a risk-based approach so that for high-risk services and high-risk participants, yes, there are checks and safeguards in place 'cause we need to make sure that those participants are getting not just high-quality services but safe services.

How do we make sure that's there for the relevant services without onerous, over-the-top levels of bureaucracy that the providers have to go through? This sort of approach, it's easy to sort of say risk-based, and it's sometimes called risk-based regulation or risk-based approaches.

It's easy to say, "We are thinking about how that can be put in practice." Hopefully, we'll get to some recommendations that mean that it's much easier for providers to work out, "Ah, okay, this is the level of registration that we need.

This is the level of risk that is being provided for on particular services for particular participants.

And we need to make sure that we satisfy the requirements to minimize that risk." While at the same time not throwing the baby out with the bath water.

We do see innovation from the unregistered providers, we do see some flexibility from the unregistered providers.

As Bruce mentioned we've had some participants who have said, "For God's sake, don't get rid of them." So we need to try and do that balance.

It is not going to be easy, it's not going to satisfy everybody.

But if we don't get that balance right, then the scheme won't be sustainable going forward.

Thanks heaps.

And did you wanna add to that, Bruce? - Look, I think the only thing I would add is that, as Stephen correctly pointed out, that the registration process is incredibly complex and expensive to work through, except there are providers who are effectively buying their registration guides and all that sort of stuff off the shelf.

And then the audit process is not really checking as to whether their services are meeting the appropriate standards.

And so we have a fundamental problem of an expensive safeguard system and where registration doesn't necessarily equal quality.

And so we've sort of got the worst of all worlds.

And so I think as Stephen rightly pointed out, it's all about how we get a proportional system in place that balances risk, and cost, and all those other factors.

Yeah, I think that...

Well, and that's actually as it happens, a perfect segue to the next question, which actually was pinned to you anyway, which is, "How will the quality and safety concerns that exist today be addressed by the Review?" - Okay.

Look, we've put out what I think is quite an important paper on quality and safeguards that identified three or four key issues from the Review's perspective.

The first is that the Quality and Safeguards Framework that was put in place in 2 was really designed for the transition to the full scheme.

We're obviously now at full scheme, and we now need to revisit that Quality and Safeguards Framework and make sure that it is the appropriate framework for a fully functioning national scheme.

I think the second issue is that a key element of the original Quality and Safeguards Framework was a focus on three types of safeguards: developmental safeguards, preventative safeguards, and corrective safeguards.

And preventative safeguards have been put in place to some degree.

But the bigger mission to date has been the lack of investment in developmental safeguards.

Because the best way to help people with disability to protect themselves is to build their own capacity and their social networks, and to make sure that they're in open environments, rather than closed environments. And that part of the Safeguarding Framework has just not been implemented sufficiently.

So we think that is extremely important. We also think that programs like Community Visitors have a very important role to play. In fact, the overwhelming feedback from this review is that those Community Visitor programs need to be strengthened, and particularly in jurisdictions which currently don't have them.

And then the fourth really important point that has come out is that the safeguarding system that protects people with disability is a multifaceted system.

It doesn't just sit with the NDIS Quality and Safeguards Commission, it involves state regulators.

And so we need a much better system of information sharing between the different parties because at the moment, what's happening is that privacy considerations are trumping information sharing.

And timely, accurate information sharing is absolutely central to an effective quality and safeguard system.

The final point to note is to link this question to the earlier discussion about foundational supports.

At the moment, the NDIS, or NQSC, is the NDIS Quality and Safeguards Commission. It was never intended to be just focused on the NDIS. It needs to be a national quality and safeguards system covering the entire ecosystem.

So covering foundational supports and also just in the same way as we're saying service systems need to reach into each other and link. The Quality and Safeguards Commission needs to link to these other systems.

The final point to make. I've heard about three final points, I realize this, but the

It's like John Farnham. 

This is important, which is that- - It's all important.

Yeah.

Of course it's important.

Is that in any system where you have quality and safeguards sitting side by side, there is always a risk that safeguards trump quality.

And so we are thinking about how the quality elements can be enhanced in the system. And it comes back to the whole purpose of the NDIS, which is to invest in people with disability. And that requires quality, it requires quality workforce, it requires quality management, it requires quality systems, and it requires information sharing and best practice... communities of practice working together. Because ultimately, what we want to do here is we want to lift all boats.

We want the quality right across the system to improve so that people with disability get quality outcomes, know what they're purchasing when they purchase those services, and can be confident of the outcomes that will follow.

Thanks, Lisa.

Oh, I thought that was fantastic, Bruce, actually.

I think that's an absolutely wonderful exposition of this incredibly important area, and I think hopefully you've now got a really good sense of the sort of considerations we are making in the Review on quality and safeguarding.

'Cause in one way, there's nothing more important than keeping people safe, so thank you.

I'm gonna move to Kirsten and change gears a wee bit.

How are we going to get the NDIS to work effectively with education and the justice systems? Small question.

Will there be a bigger focus in education? - Thanks, Lisa.

So for those folks who weren't able to join in on the session this morning, Bruce, in his speech, talked about the Panel's emerging thinking about trying to get a more joined up, an ecosystem of which the NDIS will only be one part.

So what Bruce said this morning was that the Panel is thinking about whether the construction, the idea about Tier 1, Tier 2, Tier 3, keeping people in silos has actually not been terribly helpful.

And whether we need to kind of screw that up and put it in the round filing cabinet.

And whether we need to actually instead think about kind of a joined-up ecosystem, where, as Bruce just said, the systems reach in and into each other from the perspective of the person with disability.

And then, so what we're talking about is universal services, mainstream services doing their bit.

Then we have foundational disability-specific support sitting on top of that that will be available for all people with a disability.

And then sitting on top of that, we have folks who would be eligible for an individual funding package.

Now, how are we going to make that happen? One of the things that the Panel is considering is a new intergovernmental agreement that would make all those things happen and would hold governments to account when they don't do their bit in the universal services or the foundational supports.

And so while... And I say this very respectfully, Lisa, as a non-bureaucrat, while an intergovernmental agreement doesn't really sound all that sexy, I think having...

The Panel's thinking is an overarching agreement that contains both the Australian Disability Strategy and the NDIS is the way to really make that sing and hold governments to account when they are not doing their bit.

And there is nothing that burns my crumpets more than the education system. So that's sort of what we are thinking.

Could not agree more.

And it doesn't sound exciting, an intergovernmental agreement, but actually, it's huge.

You think about the focus that all governments have taken quite seriously on measuring, on closing the gap for Aboriginal and Torres Strait Islander peoples.

And there's not that incredibly high-level, high-status perspective on people with disability and how inclusive Australia is right across the nation.

And so I'm with you.

We definitely will be wanting to recommend ways of raising the status of disability issues, raising the status of people with disability, and looking at every system like education.

I think there's nothing worse than... And education's my own background, as you know.

It's a tragedy if a student with disability comes out of school with low expectations of what they can achieve, and there's kind of... the schooling system's done that to them.

So we will absolutely be looking at all the other areas that governments focus on 'cause this is about government policy, like education, like housing, like health.

And having our say in what that should mean, what all those areas should mean for the human rights and the social justice for people with disability.

Because our terms of reference said, "What are we gotta do to fix the NDIS?" Paraphrased, and it's the Panel view, is that we can't fix the NDIS unless we fix all of the things around it.

That's it.

That's it.

We need a more inclusive Australia, as you were saying.

So Bruce, I'm gonna give you the final word.

We've only got time for one more question, but it is a rather large one, and you covered it beautifully this morning, but for here, we haven't heard it.

How is the Review looking at early childhood? - Thanks, Lisa.

Look, early childhood is an area of great importance to this review.

The areas that we're particularly looking at are: How do we ensure that children with developmental concerns, developmental delay and disabilities, can be supported in their communities? And so how do we ensure that those first developmental concerns are picked up as soon as possible in maternal and child welfare centers, in integrated child and family centers, in early childhood education settings, wherever these children are, so that they can get early intervention supports delivered in those settings as early as possible so that when their brains are at the most plastic, they're getting the supports they need.

We know that in many cases, evidence of disability emerges over time. And so the NDIS then needs to be ready if those children get to the point where they need an individualized package that they can receive that package.

But one of the things that we've heard through the Review is that the supports that children are receiving, in many case, is not aligned with best practice.

So they don't involve a key worker, they're not being delivered in those natural settings. And so we'd like to see a significant change in that area as well. And the other part of it, of course, is that children thrive and do best in families that are well-supported. So the NDIS needs to do much more to support families so that their child can thrive.

And so in many ways, what we've been told is that the NDIS has taken an adult-centric approach to children.

We need to recognize that children need to feel supported in their families, in natural settings, and then with the supports and early intervention that align with best practice. And if we can do that, we'll get much better outcomes for those children. Early intervention is an investment, and at the moment, we're not making the most of that investment. And I think it's a broader comment that applies to the NDIS We got the earlier question, Lisa, about capacity building.

This scheme is an investment in Australians with disability, and we need to make sure that every dollar counts. And so that goes beyond sort of eliminating some of the things that shouldn't be going on to a positive side about: How do we make sure that every dollar counts, that every person with a disability, every child with a disability gets the same opportunities as other Australians? That was what this scheme was all about. And so that's what we now need to make sure happens from the earliest of years of a child's life right through adulthood.

Oh, thanks Bruce.

That's fantastic.

Can I please draw this to a close? Can I thank Dr Stephen King, Professor Kirsten Deane, Professor Bruce Bonyhady? Can I thank the wonderful Secretariat that have been supporting us, our amazing Auslan interpreters, the captions people, which has actually done by a person today, not by AI, our camera people, the people that have been supporting us online, It's been great to join you.

In particular, though, I most of all want to thank everyone who's been online participating today.

And thank you for sending in your questions.

Quick reminder.

Submissions close this week.

Submissions close on Friday the 25th of August.

So, gotta be in it to win it, right? Please put in your submissions if you haven't already.

I thank everyone and that's the end of our webinar.

Thank you.