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Joint Standing Committee on the National Disability Insurance Scheme - 13/03/2015 - National Disability Insurance Scheme oversight

HOPPER, Mr Lincoln, Chief Executive Officer, Multiple Sclerosis Society of Queensland


CHAIR: And now we welcome Mr Lincoln Hopper from the Multiple Sclerosis Society of Queensland. Information on parliamentary privilege and protection of witnesses and evidence has been provided to you. I now invite you to make a short opening statement, and invite members of the committee to address questions, as we do.

Mr Hopper : Thank you for the opportunity. Similar to the last guest, I have been in my role for a couple of years, but I wear a couple of hats. One is as the CEO of MS Queensland, and the 3½ thousand or so people who live with MS in this state. But I am also the Chair of the Queensland Progressive Neurological Disease Alliance, which is an informal group of organisations working together to try to make a difference for our clients. They include other diseases such as Huntington's', epilepsy, motor neurone, Alzheimer's and Parkinson's'.

Just touching on the main points: we would say that amongst people living with progressive neurological conditions in Queensland there is a highly variable NDIS-readiness state at the individual, organisational and systems levels. For example, within the multiple sclerosis cohort, half our clients would not see that they actually have a disability and therefore do not understand the relevance of the NDIS to them, which clearly sets up a dynamic of challenge for organisations wanting to impart information and to support those people.

We would suggest that therefore a state-wide strategy is required to increase immediately the base level of awareness, knowledge and understanding of the NDIS, and its relevance to those 35,000 people living with progressive neurological disease in Queensland. We would also say that systems based approaches to health, housing, education, employment, community, disability and aged care are creating serious gaps and confusion for people living with PND—progressive neurological disease—particularly because they are large users of all those systems. We contend that community-based organisations are best positioned to support increasing the wellness and readiness of specific participant cohorts, to promote the readiness from within the sector and, particularly, to deliver a better front end for the scheme—assisted by deploying the skills, knowledge and relationships of the community sector.

We believe that the proposed NDIS ILC function will be critical to increasing individual-, organisational- and systems-level readiness, both now and ongoing, especially when considering the unique and disparate challenges of rapidly or relapsing-remitting episodic conditions. Successful application of ILC will delay or allow a significant number of people affected by PND to remain appropriately out of Tier 3, and reduce the need for intensive and costly services prematurely—or, in some cases, at all.

We would suggest that consideration should be given to piloting the implementation of ILC to determine how it will be optimised, and to work through any potential teething issues at this stage of the scheme. We would also say that ILC must be implemented in Queensland ahead of the NDIS Tier 3 rollout, and that a community based ILC approach will allow the community sector to continue its unique and expert role viably, and to demonstrate leadership and partnership with the NDIA and other sector agencies.

Ms MACKLIN: We have not had this proposition put to us before—that there should be a trial of tier 2 or ILC anywhere prior to the rollout of the full NDIS. Why do you say that and how do you think that would help?

Mr Hopper : It is suggested that 80 per cent of the PND cohort will actually spend their time mostly in that ILC phase. Therefore getting that right for them is possibly the most important thing. Indeed, an effective ILC has significant benefits to later phases of the scheme. We also believe it would really cement the foundation for the scheme in people's minds and that that would be well understood well before those other phases and, therefore, streamlining people into and out of those phases would be more effective. In a state where there is no trial, as you know, it made sense to us to therefore test some of the ILC concepts which could then be used in other cohorts and possibly other states as well.

Ms MACKLIN: Given that the NDIS is going to start in Queensland next year and so there is not going to be a trial of the ILC separately or before—

CHAIR: Maybe, because—

Ms MACKLIN: What? To start it now—

CHAIR: Well, here. But the policy is to have a trial before the—


CHAIR: No, a trial. It could be part of this. So who knows?

Ms MACKLIN: No, but the point that Lincoln is making is to trial the ILC—

CHAIR: I understand that.

Ms MACKLIN: before the other starts and, at the moment, the agreement is to start the NDIS either by trial or fully—

CHAIR: The Labor policy was to have a trial before.

Ms MACKLIN: Well, that may be so, but there is a signed agreement. I hear what you are saying. You want to get this right. So I am asking you how you might do some of the things you want to do within the current agreed framework.

Mr Hopper : I think there are potentially lighthouse opportunities where there are coalitions of organisations. I represent one, for example—the NeuroCare Network. That grouping of organisations supports people with progressive neurological disease. I think there are opportunities that could potentially be supported as lighthouse trials or even pre-trial trials, to get that learning flowing. It is significantly important that we get the ILC componentry right in the short, medium and long term, particularly for people who have episodic conditions. Therefore, I think it is about looking to some existing opportunities that may be presenting themselves in various states and testing those ideas. We believe learning from, recognising, encouraging and supporting the things that are working well is vital to a successful rollout of the entire scheme.

Ms MACKLIN: Have you had any discussions with the state department or the commonwealth to suggest this?

Mr Hopper : We have.

Ms MACKLIN: How is that progressing?

Mr Hopper : It has been cautious.

Ms MACKLIN: That is very polite.

CHAIR: It was; very nicely put.

Ms MACKLIN: I can see what you are getting at—

CHAIR: Did you get into specifics or just a generality? Did you say how you felt it could work?

Mr Hopper : Yes, we did. We mapped out what we believe would be a framework to be able to test these concepts.

CHAIR: Would you be able to provide that to us at some stage?

Mr Hopper : I certainly can.

CHAIR: That would be great, thank you. Do you just want to quickly outline how you brought 10 groups together and what you have achieved from that? I think the committee would be interested to hear that.

Mr Hopper : Colloquially we call ourselves the NeuroCare Network and it is a group of 10 organisations, eight of which have actually self-funded a real-life project to see if we can establish new opportunities and new innovations in service in our target groups. We are at the halfway point of a feasibility study that is investigating establishing a 24-hour state-wide information, advice, support and referral network as well as a community based network for all people living with progressive neurological disease in Queensland. Through that design—through collaboration and scale efficiency, most importantly—we are hoping to improve access to those things for those people. One of the unique challenges within the progressive neurological disease organisational setting is that many of these organisations are small. They have abundant speciality but struggle to be able to get to scale. This NeuroCare Network offers the opportunity for them to pool their resources, share what works and be efficient around that as well as preserving the individual specialty of each organisation.

CHAIR: Are you prepared to put a couple of numbers to them as we have previously about the projected savings across the 10 organisations by having instead of each individual organisation having a referral centre or referral numbers, for arguments sake, and the examples of going to places like Toowoomba with two cars trundling up the range?

Mr Hopper : Certainly. As I mentioned, we are halfway through this more dedicated feasibility project and the numbers are being produced by that, so it is difficult for me to comment on that. I will simply say that the initial concept that birthed the project itself showed that five of our organisations literally pass each other on the road going to certain communities. It would well make sense of sharing resources—and we all saw the benefits very quickly—and indeed understanding that potentially 80 percent of what we need to do for people with these conditions is quite similar. So pooling our resources, working quite collaboratively but also preserving the uniqueness of that 20 percent is something that we certainly want to try and achieve through this particular program.

CHAIR: That has continued to progress well, as in the relationships between 10 very separate organisations?

Mr Hopper : Yes, it has. People are focused on the outcome of better service delivery for their clients. They realise that the environment we are in—as you have heard earlier—is a challenging one and these organisations see the benefits to their clients of working collaboratively. Also, the sector itself is best placed at the front end working across the sectors to deliver these types of services, so we see that we are not only achieving efficiencies for ourselves but in fact the front line of delivery in that respect to our client group.

CHAIR: Excellent. We have no further questions. Thank you, very much, for presenting. We appreciate it and the good work that you are doing.

Proceedings suspended from 12:11 to 13:02

APELT, Professor Linda, Chief Executive Officer, MontroseAccess

CHAIR: I welcome our next witness, Professor Linda Apelt, from MontroseAccess. Information on parliamentary privilege and the protection of witnesses and evidence has been provided to you. I now invite you to make a short opening statement. At the conclusion of your remarks, the committee would like to ask some questions.

Prof. Apelt : Thank you. I have tabled for the committee a statement for the record, and what I would like to do now is make a very brief opening statement. First of all, I would like to say a little bit about MontroseAccess. We have got over 80 years of history of supporting young Queenslanders with physical disabilities. We currently provide respite services, physiotherapy, speech pathology, family support and occupational therapy. We have four service centres in the south-east corner and we also provide outreach throughout the rest of Queensland. We have an operating revenue of $8 million and we have 600 unique clients.

Our key points of difference: we provide services for rare neuromuscular conditions to those people without any other supports. We are family-centred, we are community based and we have an interdisciplinary team approach, to ensure that each client is supported appropriately.

We have an NDIS transition plan that is being developed and in the process of implementation at the moment. We have a forward-looking strategic plan that anticipates a new, client-centred environment and balances commercial reality with our charitable posture. With that, we have redefined our charitable purpose and our financial strategy going forward. We are in the process of implementing new ICT systems, a customer relationship management system and also new finance and back-end corporate systems. We have a new enterprise agreement that is under negotiation at the moment. We are in the process of reengineering all our business processes from front- to back-end so that we are able to operate within a fee-for-service environment and provide greater access to our services for people in the community. Staff training and cultural change in professional practice and business processes is happening across the organisation. There is a new branding and marketing strategy, strengthened governance and also business partnerships.

However, we can have a great plan, but there are a number of issues that I would like to raise with the committee today that our clients and also the staff of MontroseAccess had sought some clarification on. The first issue is having certainty about the rollout in Queensland. As I mentioned, we have got a good plan but, without the certainty around time lines, the nature of trials and potential cohorts, it is very, very difficult for us to put in place, with the degree of certainty that is necessary to ensure that we will be as responsive as the NDIS requires, and can ensure that we set up sustainable business operations for the future.

The second area that our client groups, particularly parents, and also our professional staff have been asking about is the priority placed on the services provided by professional social workers going forward. The model of service delivery that MontroseAccess provides, and our clients are telling us is the type of service delivery that they believe best meets their needs going forward, has social worker support integral from the time that a family has a diagnosis of a disability through to each of the key lifestyle changes that our client groups go through. For example, when a child moves from being on their feet to a wheelchair, when they change schools, when other physical functions change within their body, the social work support is actually very much hand in glove with all other supports that are provided directly to the client. There seems to be a lack of clarity about the ability for our client groups to include a price value of a holistic social work support within tier 1 of NDIS funding. I recognise that the broader community support in tier 2 will obviously include social work support and other general family support. But I do think this is an area of clarification that would be very helpful for families going forward.

The third area which I have been asked to bring to the committee's attention today relates to the NDIS pricing schedule. I am sure that this is an issue that is universal across the trial sites and also for us here in Queensland. If it is that the NDIS pricing schedule is designed to be a contribution to the price of service or the market price of service or a realistic price, then that needs to be made transparent and we can plan accordingly.

CHAIR: Do you want to extrapolate on that, please?

Prof. Apelt : The evidence to date suggests that, across the pricing schedules, in some instances, even in the most ideal, efficient market environment, the pricing, in some ways, is about 25 per cent off what would be considered to be a realistic price. I know that there are qualifications around that in that quality or breadth or depth of service can be pruned back within a price envelope. But in terms of working on the assumptions about what is considered to be good practice in quality service provision; I think that there is still room—and presumably that is part of the purpose of the trial sites—to really test what in effect is a realistic, efficient price schedule.

CHAIR: Let us drill on a little bit further. You are talking about the actuarial figures.

Prof. Apelt : Yes.

CHAIR: Are we talking about it for, say, occupational therapy options? Can you give us an example?

Prof. Apelt : From my point of view it is predominantly the therapy options and in particular when we are drawing upon specialist therapy expertise, which Montrose does predominantly.

CHAIR: This is actually quite different to some of the other evidence that we have heard at different places. So, rather than talk about that, could you talk about the specific type of intervention that you are referring to or therapy and what the dollar values are at the moment? Obviously you are saying it should be roughly 25 per cent to meet the market. Is that correct?

Prof. Apelt : What I am saying is that I think that this is an area that should still be open for discussion in Queensland.

CHAIR: Can you give us an example of a particular service, if I am not putting you on the spot?

Prof. Apelt : I am reluctant to say a specific price at the moment because I do not have the material in front of me. But I am receiving feedback from my colleagues that are members of the AFA—Ability First Australia—organisations that are in the process of trialling the NDIS implementation in other states and territories. Feedback that they are giving us is that there are still instances where plans are being put together that are considered to be plans that meet the need of clients where the pricing schedule is difficult for organisations to meet. I think the question there is around definitions on what is an efficient price, and I believe the dialogue still needs to be open and the evidence shared.

CHAIR: We will leave that one there. Thank you.

Prof. Apelt : The other area is an operational area. We have some research as to how other organisations are handling issues such as missed appointments in a billing strategy. Another area is the cost of travel for outreach. That is an example in the pricing schedule that people are bringing to my attention—which, once again, goes to specialist therapist provision for very rare conditions. This is an area of operations that we are working through in a textbook sense and a theoretical sense as to how that will be managed within a more demand-driven environment.

The other area that a number of our parents and our therapists have brought to our attention is seeking clarity around the funding arrangements. The vast majority of our young clients receive clients from Montrose within the school environment. I think people would appreciate greater clarity around what is considered to be still able to be funded as an NDIS disability support service within the school environment rather than something that might be the responsibility of another jurisdiction such as the education department. We can work out what we believe should occur, but it is a question that continues to be raised with us and I think people would benefit through getting greater clarification.

The last one, which I am sure you have heard all around Australia, is that we can provide people with the funding to provide supports within funding but, without adequate supply of appropriate housing, this remains a very difficult issue, and it is something that Montrose is coming up against increasing because fortunately our young clients are living longer and, while traditionally we at Montrose had a cut-off point at 18 years, we have now opened the doors to clients and have said, 'You can stay with us as long as you need to.' So we have an increasing cohort of young adults and, as you would be fully aware, it is very challenging to find appropriate housing for these young people.

CHAIR: Thank you, Linda.

Ms MACKLIN: Do you have a view about the best way to fund that housing and deliver it?

Prof. Apelt : I believe that the mechanisms around partnering with specialist housing providers and disability support providers in Australia at the moment is probably our best opportunity. Obviously, there has been a range of government policies around increasing supply of affordable housing, but where I am coming from here is highly specialised supply of housing. For example, if you visit some of the housing where our young people are supported at the moment, we are talking about anything up to a million dollars for a share-house accommodation, because of the range of additional supports that go into the design of that housing. My best advice at this stage is that the specialist housing providers—for example here in Queensland we have got the Brisbane Housing Company and Horizon and a number of those—increasingly have a role to play to work hand in glove with the disability service providers. They are already supplying in this space, but obviously they still rely upon a capital provision in order to make that service.

Ms HALL: Housing has been mentioned by just about everyone who has spoken today. You have identified a couple of areas that can be addressed in the shortage. But what will the shortfall be if it addressed through those areas? What is the shortfall that exists now?

Prof. Apelt : Quite a few studies have been done about housing need and housing affordability. For example, Swinburne are very good at documenting this material. Talking specifically about MontroseAccess, of the 600 unique clients that we provide services to at the moment, we have supported accommodation, three houses, and provide housing support for four clients per house. The vast majority of our young adults live at home with their ageing parents, desperate for Montrose to be able to provide additional respite services and activities for these young adults. We are increasingly having to look at making sure that those services are stimulating and age appropriate. Our history has been with children, but now, as we are servicing more and more adults, the housing issue is raised time and time again by parents and the young adults. As soon as their children reach 18, it is an issue. Families do planning with us and with our social workers, and we spend a lot of time doing that. Other people better qualified than I have researched this very well but, when it comes to housing supply and the level of need, all I can say is that it is the tip of the iceberg that is being serviced at the moment, and largely through the social housing programs.

Ms HALL: You identified school and community involvement as being important.

Prof. Apelt : Yes.

Ms HALL: I am just wondering whether you are concerned about how education, health and NDIS will all come together, where those sorts of silos exist. Do you see that as a problem? If so, how do you see that that can be circumvented?

Prof. Apelt : It does not need to be a problem, but it potentially is if we do not have very clear guidelines for people about how the funding will work. I am sure we have all seen examples where staff basically get into argy-bargy about who is responsible for paying what and whether it is an educational expense, a health expense or whatever. From my point of view, it could be simplified in that, if a young person with a disability who qualifies under the NDIS requires support to be within a school environment, it is an NDIS expense.

It all comes from the government at some point in time. It simplifies it for the parents and the young people, but also the service providers if the supports are built into the plan and there is one stream of funding for that. It is inevitable that when you get close to the ground the argy-bargy starts to happen. People are obviously protective of their individual sources of funding, for good reason.

CHAIR: We have a little chuckle about that, because we deal with this one on a regular basis.

Prof. Apelt : Yes, I know.

CHAIR: There are answers; it is just a case of whether people wish to adopt those answers. We have no further questions. Thank you, very much, Linda, and thank you very much for the work you are doing. We appreciate your evidence today and we will keep in touch.

Professor Apelt : Thank you, very much.