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Joint Standing Committee on the National Disability Insurance Scheme
National Disability Insurance Scheme oversight

CHALMERS, Dr Ron, Director General, Disability Services Commission

MASSEY, Mrs Robyn, Executive Director, My Way Implementation, Disability Services Commission

SPENCER, Ms Simone, Executive Director, Full Scheme Planning, Disability Services Commission

TOSTER, Mrs Pamela, Director, Reform Implementation, Disability Services Commission

Committee met at 09:01

CHAIR ( Mr Brough ): I declare open this hearing of the Joint Standing Committee on the National Disability Insurance Scheme. This is an all-party joint Senate and House of Representatives standing committee. We are made up of six coalition members, five Labor members and one Greens member and yesterday we were joined by Western Australian Senator Linda Reynolds. Our approach to this is generally bipartisan. Our aim is to add value to an incredibly important program. We understand the challenges and, by being able to provide an opportunity for people to express their hopes, desires, concerns and beefs and bouquets, we are able to make recommendations to all levels of government that hopefully will gain what we all are striving to achieve. Western Australia is the last of the states we are visiting. The only trial site that we have not yet visited is the Northern Territory. Yesterday we were down in Busselton at the My Way program and we heard some extremely positive stories down there from participants.

I welcome representatives of the Western Australia government NDIS My Way Program as part of our first session. Information on parliamentary privilege and the protection of witnesses and evidence has been provided to you. I remind witnesses that the Senate has resolved that an officer of a department of the Commonwealth or of a state shall not be asked to give opinions on matters of policy and should be given reasonable opportunity to refer questions asked of the officer to superior officers or to a minister. This resolution prohibits only questions asking for opinions on matters of policy and does not preclude questions asking for explanations of policies or factual questions about when and how policies were adopted. I invite you to make a short opening statement. At the conclusion of your remarks, I will invite members of the committee to put questions to you.

Dr Chalmers : Thanks for the opportunity to say a few things about the NDIS model trial. I am keen to focus in two areas. Firstly, I will give a bit of an update on how the trial is proceeding in the lower south-west—and you got a flavour of that yesterday. I would then like to make a few comments about preparations for the second part of that trial, in Cockburn-Kwinana, which kicks off officially on 1 July this year.

We were very pleased back in August 2013 with the decision that was taken to have a two-trial approach here in WA. It did provide us with the opportunity to build upon the positive features of our existing disability service system here and to trial a model that we believed would be an appropriate operational model for the NDIS here in this state. After nine months operation of the trial in the lower south-west, I think it is fair to say that it is progressing very smoothly and according to the plan that we developed for that trial. As we reach the end of the third quarter, we have over 700 people now in the trial with fully developed plans and the vast majority of those plans are fully operational. So it is delivering for people on the ground. After nine months, I think that is a statement as much about the model and being able to deliver on those plans. I think that is a very positive feature to date.

Stakeholder feedback remains very positive. You got a flavour of that yesterday. It is fair to say that that is not atypical, that we have had no complaints or appeals reported in the first three quarters. So on that level, we are very happy as well. It was touched on yesterday the number of people in that 700 with psychosocial disability and we now have over 70 people in the scheme. Again, the model is working for those people. As we near the end of that third quarter, it is clear that the average package cost is below the national average. We predicted that that would be the case, again because of the model and the nature of the model. While it will be interesting to see how that pans out in Cockburn and Kwinana, we still anticipate to be under that national average package cost when the trial is fully rolled out.

A significant proportion of those plans require no dollars in them. A proportion of those plans are people who at this point in time do not require dollars to activate the strategies that are making their lives as they want their lives to be. Again, the My Way coordinator's role in all of that is critical. We have, at the moment, 30 per cent of approved plans that are in that self-managed domain. A proportion of those, though, still have in-kind contributions, if you like, and we are still like every other state and territory teasing out and trying to move away from that in-kind issue as quickly as we can. It was mentioned yesterday that the number of service providers operating in that lower south-west area has grown significantly from nine to 35. It will be interesting to see whether all 35 remain in there, but at this point in time that is comforting to know that we have a broad range of service providers for people down there.

I think it is also safe to say that we have a very strong partnership relationship between ourselves and the disability sector, the not-for-profit sector. That is a feature of how we do business here in this state and that has served us very well, including in the design of this trial. One example of that is around the pricing model that we have here. We do not fix prices. For the past half-decade we have moved away from actually dictating what price structures will be. We think that the pricing framework that we have in place is a sound one, but again we are in trial mode and we will see how that pans out. We are also working very closely with mainstream agencies—again, you got an example of that yesterday. That is across housing, mental health, health generally and education. While there are still issues and we are still teasing out interface issues that seems to be progressing well.

If I could turn to a couple of structural issues. We also have retained the services of a national actuary, Taylor Fry, to continue the focus on the sustainability of the model here in Western Australia. They run the ruler across this on an ongoing way but very much at the quarterly reporting periods, and to date Taylor Fry are saying that we are looking good.

CHAIR: Can you give the committee an outline of the difference between the two. How does your My Way—

Dr Chalmers : The two models?

CHAIR: Yes. Clearly there have been some big statements which I am sure we will want to drill into, but could we have a baseline on the fundamental differences so that we clearly understand how the agency's program is working around the country.

Dr Chalmers : Yes. I get asked this question an awful lot. It falls into two domains. Firstly, there are structural differences. You heard yesterday that we pay organisations in advance rather than paying on invoice. We do not fix prices. We have, I believe, a more mature approach to how you get the true price for service rather than—

CHAIR: Can you drill into that a bit more. What do you mean by that? We understand that there is the actuary and the list of prices that have been worked to in other states. How are you doing that?

Dr Chalmers : About five or six years ago this state across the whole of the community services sector moved away from dictating to not-for-profits what the prices would be—that is, government saying, 'That is the price for the service. You take it or you leave it.' We moved to a very different approach that says, 'Let's drill down and find out what the true cost of delivering that service is.' Two and a half years ago now, we went out and open tendered the whole of our disability services sector and re-contracted the lot based on prices that people wanted to come to us with within a competitive sense across the whole sector. Then, in a procurement sense, we arrived at what the range of prices would be for certain service types. We did that in a partnership arrangement with the sector, and we were fortunate to be able to use all of those prices to then use a framework of what we believed were reasonable prices for the different services. That framework, which has bands of pricing in it, has been the framework that we have used for the lower south-west. We used a similar approach in developing a framework for Cockburn and Kwinana. That will be the framework that rolls out from 1 July this year.

Ms MACKLIN: Do you happen to know the prices compared to what is paid here, for example?

Dr Chalmers : It is a difficult question to answer, but I think, as a summary headline statement, they are slightly more generous than what the NDIS is paying in the Perth Hills.

Ms MACKLIN: That must be able to be quantified.

Dr Chalmers : It depends on each person's individual plan.

Ms MACKLIN: Sure, but nevertheless we talking about only 700 plans, so it must be able to be quantified. I would have thought as part of the evaluation that would be an important piece of information.

Dr Chalmers : It is, because—

Ms MACKLIN: Is that going to be made available?

Dr Chalmers : Absolutely.

Ms MACKLIN: Can it be made available to the committee?

Dr Chalmers : It is not available yet, because that is what the evaluation is all about. The first report of that comparative evaluation is due in October this year.

CHAIR: Is it fair to say, to fully understand this, that you have basically the same service? You deliver the two individual plans but in different locations they may be getting a different dollar value per hour of service. It is not just uniform.

Dr Chalmers : That is right.

CHAIR: It could be lower or it could be higher, but it is not dictated.

Dr Chalmers : Yes.

Ms MACKLIN: You said that, in the main, it is more generous than what the NDIA pays, but you also said that the average package cost is lower. How do you explain the lower—

Dr Chalmers : The model.

Ms MACKLIN: What about the model? What is it about the model that makes it a lower cost?

Dr Chalmers : We do not drive people towards funded services. The model itself, as you heard yesterday, has a heavy reliance on engagement, relationship building, flexibility and staying close to people. It relies on trying to strengthen informal support networks and accessing community based support and low-cost support rather than having as the starting point a plan and pushing people towards funded, high-cost services.

Ms MACKLIN: But why do you say that is the NDIA plan?

Dr Chalmers : I cannot comment about the NDIA.

CHAIR: Maybe we can put it another way.

Ms MACKLIN: But you are commenting. You are saying that that is what they do in comparison to you. This is obviously a very important issue.

Dr Chalmers : It is.

Ms MACKLIN: I know the NDIA is here, so we will ask them to put their view about this. Certainly when we are in other parts of Australia people do not describe the NDIA in the way that you just have. I think Mal's question at the start was the right one. We are trying to get to what the differences are. I get the point about paying in advance. The band of prices may be a little more generous, but it does not sound like that is the fundamental reason that the average package cost is lower. You are saying, then, that the reason the average package costs are lower is that people do not use as many funded services. Is that correct?

CHAIR: Before you answer that, is it fair to say that your presumption, at this point anyway, is that, when you do your evaluation, your expectation would be that there would be more money and resources in the My Way plans being provided to services that link people, advocate on their behalf and create networks, as opposed to actual payment for individual services? Is that your expectation at this stage, between the two models, rather than saying something about the NDIA model?

Dr Chalmers : Yes, it is, and it gets back again to the role that the NDIS My Way coordinators will be playing in this scheme. The question was asked yesterday: is there a role statement for the NDIS My Way coordinators? The answer is yes, there is, clearly articulated. But right from the start, going back to 2011, when we were involved in discussions around the country with this—because we have been on the whole journey—we said it did not make terribly much sense to start compartmentalising different roles within a bureaucracy, with planner, local area coordinator and a raft of different people whom people have to interface with. By having an NDIS My Way coordinator being on the journey with the individual and staying close to them over the period of time, that in itself—and I think the evaluation will show this—will deliver a tangibly different support arrangement that includes, in the first instance, those informal networks and community based supports without necessarily a heavy reliance first up on funded supports. We believe that that will be the outcome of the evaluation and we have evidence so far that it is the case.

Ms HALL: I want to pick up on this issue. You indicated that the cost was lower because of informal arrangements. Yesterday we heard that there is not a lot of therapy being included in the packages or plans that have come into play. Does informal mean the parents, the neighbours and the friends providing that support as opposed to support being given by therapists or other people or organisations?

Dr Chalmers : I will start with the therapy. Yesterday, you were getting issues related to the transition.

Ms HALL: Yes, I understand that.

Dr Chalmers : It is not that people are getting less therapy; it is just that the mainstream platform of health is delivering that therapy. We are still in the process of transitioning that in-kind effort into individual plans.

Ms HALL: But we also heard that people are paying for it themselves.

Ms MACKLIN: They are getting less than they need.

Dr Chalmers : Sure, and, as they transition in, that planning process will identify that and up the effort and up the dollars that are in there as well.

Ms HALL: I do not think we can bypass that fact, but go ahead. Answer the rest of the question.

Dr Chalmers : But I would still say that people will not be getting any less therapy than they are getting anywhere else in any other trial site.

Ms HALL: They will not be, but they are currently.

Dr Chalmers : In transition. The alternative there was to say: 'We won't transition you in until we get all of that sorted.' At the moment, we transition them into the scheme, but that bit is still transitioning, if you like, as part of those packages in review of individual plans.

Ms HALL: Would it be informal—the path that is identified? Is that parents and neighbours? We heard yesterday that neighbours were picking up—

Dr Chalmers : No, not necessarily. It is friendship networks. It is all the stuff that we have been pushing for about 20 years here in WA. I think it has been a strength of our model here that local community based supports are linking people into their local community. The plans that we gave you have examples of how that actually works with people on the ground, rather than saying, 'You have to go to a service provider and get all of your needs met from a funded service as such.' I think the evidence is out there at the moment. It works.

CHAIR: To drill into that a bit further, there was a group in my old electorate which used to take people with mental illness. They were basically a friend who help them to go to shopping centres et cetera. The organisation received some small amount of funding from whomever—it did not really matter—but, if you relay that to your situation here, that would typically be some sort of funding. You would probably call it tier 2 in this system. Your coordinators and your planners are connecting them with that service, which is enabling them to go shopping, do more socialising et cetera, but there is not a direct cost, other than the time spent in connecting the two. Is that a reasonable assessment?

Dr Chalmers : It happens all the time. Even outside of that, you are able to link people up and strengthen their friendship networks. Instead of having to pay an agency to take someone out for some structured recreation activity, you have someone linked with two or three friends who can take them to a pub on a Friday night to engage with other people. That is the essence of what we are on about here. It is a focus not on hours of support with a funded support worker; it is all of the other richness that comes from building those informal networks that I think drives down the total package cost.

Ms HALL: With the informal networks of going to the pub or going for a drive with Aunt Mary, what sort of guarantee is in place that that will be delivered all the time and that it will not be an ad hoc arrangement?

Dr Chalmers : I draw again on 20 years worth of experience to say that, firstly, there are many people who would prefer that type of arrangement to be in place than having to rely on the fellow yesterday who did not have the support worker turn up on the second day in his plan. Those informal networks are very attractive to people and they would prefer to be supported it that way, a more natural way, than just saying, 'I am totally dependent on a funded service.'

Ms HALL: As somebody who worked in that area for a very long period of time, one of the complaints that I heard was that—definitely in New South Wales— these informal arrangements did not always deliver and placed stress on the families. I thought that with the NDIA we were trying to get away from that stress on family and friends . That is the thing that worries me a little bit about the My Way model.

Dr Chalmers : We developed local area coordination here in Western Australia about 25 years ago, so we have had a quarter of a century worth of using this model. The feedback that I get consistently is that this is a far more reliable approach for people and it builds a better life for people than simply relying on some funded support agency to turn up at a particular time on a particular day. New South Wales has not had that level of development around local area coordination over that period of time or it has had a patchy history around that.

CHAIR: You are drawing on experience to say it has that level of reliability.

Dr Chalmers : We get the feedback all the time from individuals and families. I got an email from a family member last night when I got home telling me just how wonderful the supports are. I get that all the time. It is tangibly different than just saying, 'We need to get you linked with a service provider with a roster of support.' Many people need that and many people will access that, but I think it is the starting point for thinking. It is not a dollar-driven solution; it is a lifestyle-driven solution.

Senator REYNOLDS: Yesterday we heard from a number of providers about the time of getting the package developed. Those who are on the trial sites said that the NDIS took about a month and My Way generally took about three months. The discussion was that My Way was a more comprehensive approach, up-front, for the individual and their families and to really work out what is required. There were a number of passes to that, to get it right.

From what the discussion has been this morning, is that part of this process, of taking longer up-front, to get it right but to also engage the family and community support first rather than just relying on a service provider? Am I correct to draw a linkage between the two?

Dr Chalmers : You may not have been there yesterday afternoon when we heard some family examples of how this works. We are very respectful of what the individual or family want, by way of this planning process. If someone has a physical disability they have a very clear view of how they want supports delivered. They can engage in the planning process. That can be done in the blink of an eye. But if people want to have a longer period of time and they want to test out certain support arrangements—they do not want to lock things in early—and the clock is not kicking and going, 'We have to have this done by a certain time,'—we heard yesterday from some of the examples in the afternoon that people have wanted to come back, over a period of weeks, and have other conversations and chat with therapists and others. That is what we want and that is what we are seeing is working very effectively for people.

Senator REYNOLDS: I know in other evidence we have had in this and other inquiries that quite often people up-front do not know what they need or what they want, because they have never been asked. It takes time, because they have an intellectual disability or they have been institutionalised and have not really thought about what they want. Have you found, in your experience, giving them the time and working through it iteratively with them and their extended network of supporters is a better outcome?

Dr Chalmers : We are keen for individuals to have whoever they want around the table during that planning process. Right from the start we realised that trying to exclude disability-service providers, that families might have long connections with, did not make sense to us. Excluding people and having the artificiality of that exclusion, I do not think was helping anyone. The individual and the family, I believe, need to make those decisions about who is going to be involved. Clearly, people will say there will be self-interest from service providers. We have no evidence of that, that people are there trying to ramp-up the dollars and ramp-up what they are going to get out of the service at all. We have no evidence of that here. I do not know if you want to add something, Robyn?

Mrs Massey : I would just make a comment, and there is a bit of diagram of how it works in your packs there. The front-end, where the My Way coordinator connects and then explores those possibilities, is what takes the time. If you come and meet a planner who says: 'What are your needs and we'll come up with a plan?' at first meeting, that is not an opportunity to explore what is possible. Quite often, people—particularly people with an intellectual disability—have no idea of the possibilities that are out there. It is getting to know the person, getting to know the community and then doing that exploration. You cannot do that in one meeting.

Dr Chalmers : I would just add that the reassurance of knowing that you will deal with the same person for a period of time and are not just coming back into an office and getting another person you have never met before, picking up the story from that point, is critical too. Over 20 years, the strongest feedback that we get is that the continuity of support and knowing who you are dealing with is valued very highly.

Senator REYNOLDS: Over that time, have you found that by including—it is really about quality of life too, isn't it? Including somebody in there, with their family networks, their community networks, and engaging them in a much better quality of life rather than, conversely, pushing them to funded services, which almost sound like trying to institutionalise them and disengage people from community, have you had any feedback on that?

Dr Chalmers : Everyone is different. For some people it is very clear that they would need full-on 24/7 support from a reputable and high-quality service provider. There is no doubt about that. I would not want to give the impression that this is some sort of folksy 'round the kitchen'. It is choice but, for many people, this works very well. If we were to try and push those people into a short time-frame for plans, structured supports and what have you, the stories you heard yesterday would not have emerged.

Senator REYNOLDS: It is not necessarily a good outcome for them.

Dr Chalmers : Absolutely.

Ms MACKLIN: Continuing with the same theme, yesterday we drilled down to the issue of whether or not either of the sites has a specific time limit, and it was clear that neither does. But you also said earlier in your comments this morning that there is something about the model that has delivered 700 plans, suggesting that more plans have been developed and more quickly here, under the My Way approach, than at the alternative site, which seems contradictory. You seem to be suggesting you have been able to deliver more quickly than the alternative system has. Is that true?

Dr Chalmers : Not more plans approved but actual services and supports being delivered to people on the ground.

Ms MACKLIN: And why do you think that is? You said before that it was because of the model that you had 700 plans—what is the word you used, if it is not 'approved'?

Dr Chalmers : Activated. Yes, they are up and running. They are effectively up and running, rather than just having a paper plan in place and ticked off, and services not being provided.

Ms MACKLIN: They are approved, though?

Dr Chalmers : Absolutely, and they are funded—the ones that are funded.

Ms MACKLIN: But you were suggesting that that is something to do with the model.

Dr Chalmers : Yes.

Ms MACKLIN: What is it about the model? If it is not that things get done more quickly, what is it?

Dr Chalmers : The My Way coordinator actually takes an active, proactive role in linking people to services, linking people to their community, setting up the plan, rather than there being a disconnect between the planner saying, 'Here's a plan,' and what happens beyond that, where there is a bit of a gap. So it is by being on the journey and seeing it as the responsibility of the My Way coordinator not just to approve the plan and have it in the system but to actually make that plan a reality for the individual.

Ms MACKLIN: It sounds like it is about the difference in the role of the local area coordinator. I think it would be really useful for us to get a better understanding of that. That seems to be the real difference; am I right?

Dr Chalmers : Absolutely. Right from the start, we did not break up the roles, compartmentalise those roles, across a range of different bureaucrats, if you like. Why? Because we have a long history of knowing that that does not work—or it does not work in Western Australia; I can only talk for this state. By having the person on the journey and them really being responsible for making that plan activate is, I think, critically—

CHAIR: But you hold them responsible, basically, for not only the building of the plan but also the implementation of that plan?

Dr Chalmers : Yes.

CHAIR: That leads to a question which you may not be able to answer right now: if the NDIA has each planner looking after, just as an example figure, 10 people, you must have each planner—to use that term, or coordinator—looking after five or some lesser number because they have a deeper role. There is a lot of head-shaking here! On the face of it, you have expanded the role and it is getting great results, which is fantastic. But it would seem, therefore, there would be more time needed—

Ms MACKLIN: and more of them.

CHAIR: and therefore you would need more of them.

Ms MACKLIN: Is that true?

Dr Chalmers : The maths would tell you that. There are a couple of other things that are relevant here. The team—

CHAIR: But that is not the case? Or do you want to get to that?

Dr Chalmers : I want to get to that and I will get to it very quickly. You also have to see this in the context of who else we have in that team of people in the lower south-west. In that team, we have allied health capacity and we have technical support capacity for people who want to self-manage—manage their own plans—and need assistance and so on. So it is not solely reliant on a formula of a My Way coordinator for this number of people. We have run a ratio here in this state, over the journey, over the years, of one local area coordinator to about 50 individuals. That will reduce significantly because of this expanded role, but it will not be down to five or 10; we are still looking at a ratio of probably one to 40 people.

Ms MACKLIN: What is it in the south-west?

CHAIR: Roughly?

Dr Chalmers : Well, we are still in this trial process.

Mrs Massey : It is between one to 40 and one to 50. I think the important bit there is acknowledging that there are people with a physical disability who come in and meet with their My Way coordinator, do their planning and off they go. They now have the resources because it is an NDIS with additional resources. They will go off, run their lives independently and then come back in 12 months wanting a bit of a review—or if their situation changes. At the other end of the spectrum are those people who require lots of support, right from really investigating the possibilities, developing up a plan, linking people into—

Ms MACKLIN: Sure, but on average the ratio is pretty much—

Mrs Massey : One to 40 to one to 50.

Ms MACKLIN: They still have between 40 and 50 clients.

Mrs Massey : Yes.

Ms MACKLIN: So it has not changed much.

Dr Chalmers : No, and again we are in a trial. We will test out and see where the dust settles on that one.

Ms MACKLIN: How does that compare to this site, here?

Dr Chalmers : I do not know.

CHAIR: We will ask them.

Ms MACKLIN: We will put that to the NDIA later.

CHAIR: But clearly it is not just apples and apples; we understand that.

Dr Chalmers : The model is different.


Ms MACKLIN: But that is what we are trying to understand: how is it different?

Dr Chalmers : Sure, but I cannot help you with their model.

Ms MACKLIN: So it is one to 50 or one to 40—somewhere between 40 and 50—and of course we understand that people are different; that is no different to anything else. But I still do not think we have got to the essence of the difference.

CHAIR: I think I have.

Ms MACKLIN: Have you?

CHAIR: Yes, seriously, and we should have a chat about it. Rachel?

Senator SIEWERT: I wanted to go back to the issue of informal supports and look at how that is maintained, so I will come back to that. But firstly: what percentage of people's plans in the My Way site would have an informal component, and what component of the plan is it? Dr Chalmers?

Dr Chalmers : There is a small proportion of people with plans in the lower south-west now who are supported entirely by those networks and community-based supports. There will be other people who will have a combination of those and funded, structured services. There will be other people who are right now relying totally on funded supports. So it varies. Everyone is different.

Senator SIEWERT: What sort of funding is available to those who are relying on informal supports?

Dr Chalmers : Those people can, at any time they wish, come back to us and say: 'We need some additional supports that might require funding added into those plans.' This is the flexibility that you picked up yesterday in some of those examples, where they are not static and it is not, 'Sorry, you are locked in for 12 months or six months.' If people want to come back and, through changing circumstances or for whatever reason come back, access funded supports, they can do that at any time.

Mrs Massey : Can I just add there that we have actually provided some examples of a few plans in the package you have got there, and you will note that included in that conversation is identifying those informal supports that are working now. They are actually captured in the plan. So, if the point comes when it is too much of an impost on a family member, it is, 'Come back and have a bit of a chat,' and it might need additional resources or whatever. So it is not as if people are locked into providing a support and are obligated to do that. It is what is working really well for someone. But it is identified as a strategy in the plan, even though it does not have funding attached to it. So we put equal importance on those strategies.

Dr Chalmers : I would add that it is the same dynamic for self-management, shared management or totally agency-driven—the people will want to self manage. Our experience is that they will want to self manage for periods of time and then—like the woman you heard from yesterday—

Senator SIEWERT: Like Penny yesterday—

Dr Chalmers : Absolutely.

Senator SIEWERT: who had self managed and then came back and said, 'No, I do not really want to'?

Dr Chalmers : Yes—total flexibility.

Ms MACKLIN: That self-management point is an important one because one of the things that we were impressed with yesterday was how many people were self managing. Somebody said that the proportion of plans that are self managed is around 30 per cent. I think we have got an unusual cross-section, because most of the people who came were self managed, but nevertheless. And the 30 per cent, I think, is comparable to the figure elsewhere, but I would have to say that our experience, listening to people elsewhere, is that they do not have as much freedom as the people yesterday seemed to have. So is that your understanding as well—that people are able to self manage; they get a whole bucket of money; they are not restricted to self managing within particular lines of funding? Is that true?

Mrs Massey : Absolutely. Can I go back to the 30 per cent? That is actually unique, nationally; there is no other site where that number of people actually self manage their funding. Again, based on the history in Western Australia, I think we have had a history of self managing.

Dr Chalmers : That is the point I was going to make: that, for many, many years now, we have had people self managing their own arrangements—not because we force them to but because they see this as their preferred option. I was on the record—

Ms MACKLIN: Is it right that they are self-managing within one whole bucket; they are not self-managing within particular lines of funding?

Dr Chalmers : It is not program streams or anything.

CHAIR: Is it not even into three categories? There are three buckets now. When the NDIA first started, the evidence we received as a committee was it was just line after line after line. That was early on. The agency developed from that and there are three separate line items and there is flexibility within those. So the model that you are applying here is that, no, you basically use your global budget and you have some guidelines around that, I presume. Basically, it is not into three separate clusters.

Mrs Massey : If I am reading you right, I am thinking that you are saying that people can have an amount of money—so they get an amount of money that seems reasonable and necessary—and they may say: 'I'm going to use part of that funding to engage with an organisation and that will be organisation managed. I will have some of my funding which will be self-managed because I think I can manage that bit quite nicely and then—


Dr Chalmers : I think I understand where you are coming from. During the planning process, if someone says, 'I need support with daily assistance, showering, and what have you, I need support with recreations' and if it is clearly identified in the plan, can the individual just shake that all up and say, 'I'm going to spend it all on just one area and I can ignore what is in the plan'? No, because there has to be integrity in the plan, otherwise it becomes, 'I'll spend all that money on the overseas trip that I want to make.'

Mrs Toster : I think you are referring to the flexible amount in the NDIA plans and the fixed budget—is that right?

CHAIR: Not quite. The agency can articulate it better than I can. Basically, you have gone from having dozens of line items having to be spent. Just to go back, it might be saying you can have socialising—whatever the term is—between 10 and two on a Tuesday. That is how prescriptive it was originally. That then became more flexible and then a range of things came that dealt with socialising. There was flexibility within a budget but you could not pull from another part of the budget and there were three separate components of the budget that had been developed. We heard yesterday what appeared, at least, to be an even greater level of flexibility when they are managing that money. We are just trying to get an understanding of where that sits in comparison to what we have heard previously.

Dr Chalmers : The flexibility still needs to be within the integrity of the original plan. It cannot be totally laissez-faire.

Ms MACKLIN: Take the example you were just giving a minute ago of personal care, social activities and maybe going to work. The person is able to manage their own arrangements and change their personal care arrangements, for example, within the bucket of money that they have. If they want to change going out on Wednesday night to going out on Friday night, or whatever, they can just do that themselves; they do not need to talk to you about it?

Dr Chalmers : No, they do not. If their circumstances change significantly or their goals change significantly then I guess the model allows them to come back immediately to have that discussion back with the My Way coordinator.

Ms MACKLIN: But they do have to come back?

Dr Chalmers : Yes.

CHAIR: If it is a big change, yes. If it is around the edges, you are not too fussed—is that right?

Dr Chalmers : That is basically it, yes.

Mrs Massey : The Commonwealth catches it. In our pricing framework, we have clusters of support. There is accommodation, daily living and wellbeing. If people want to make a change within their daily living and how they do that, they can use that amount of funding. But it still needs to be used for the purpose of daily living but they may change the night they do it, the support person and how they do it. But they still need to remain within those clusters of support.

Ms MACKLIN: It sounds similar.

CHAIR: I have a question from yesterday from one of the participants. Their concern was that at the end of the financial year, or whatever else, they have X amount of dollars and they cannot carry it over. It is not the case that their whole life has changed and they do not now need it; they are doing things within that program. They did not say it was black or white; they were interested in an answer.

Mrs Massey : Sure. It is a new program so people do not quite understand that all the funding is reviewed at the end of the 12-month period. If somebody's life has not really changed and it is really working for them, it might be a light-touch review and they will continue basically with the plan that they had in the last year, and their funding would continue on. People cannot carry over their funding. The whole idea is you have a 12-month plan. If it is working really well, you will get that same level of funding again for another 12 months. But I think there is still that doubt in people's minds that this is an ongoing program where they are guaranteed ongoing support.

CHAIR: Their concern is like the analogy about departments that get towards the end of a financial year and say, 'Let's go and buy a whole heap of new furniture because next year we will not get the funding.' So I think it is really important from a communications perspective that participants understand how that works so they do not do stupid things as well.

Dr Chalmers : You cannot bank the money over four years and say—

CHAIR: Like departments do.

Dr Chalmers : I know that only too well.

Senator SIEWERT: I want to follow-up on two other areas. One was the self-management issue. We had evidence that people were using zero and that they felt they did not have guidelines about how they should account for their money and provide those accounts back to you. Has that been picked up to assist people so they do not have to reinvent the wheel?

Dr Chalmers : Again, we have been working in this self-management and shared management space for a long time. Six, seven or eight years ago we helped establish an organisation here called WA's Individualised Services. That organisation has become, in many respects, a national expert on self-management and shared management. It has done an awful lot of work around all of the different components that were being talked about yesterday—from taxation, insurance, superannuation, risk management, recruitment of staff to people who are self-managing. The tools that it now has available are extensive and I would say are probably the best going in the nation. They are available to anyone who wants to share manage or self-manage.

Senator SIEWERT: Can you provide that information. It was obvious yesterday that a number of people were not aware of that and were, in fact, reinventing the wheel, by the sounds of it.

Dr Chalmers : In the conversation I had at the end of the day with the woman who was raising that issue in particular I linked her back to WaiS. She said, 'I need to talk with them.' She has taken her own accounting package and tailored that for her own particular needs when, in fact, those tools were already available there.

Senator SIEWERT: I appreciate what you have just said. The point then is that there is miscommunication. I would have thought that, if someone is going to self-manage, surely you would give them a package of information that—

Mrs Massey : There is that acceptance of grant. It is making sure that people have the safeguard of knowing what they are responsible for when they self-manage. We do put quite a bit of work into it. This particular lady is particularly skilled and was pretty keen to do a lot of her own stuff. But I agree that we need to make that happen. We have actually already discussed the idea of WaiS running some family workshops down in the lower south-west to give people those tools.

Another thing we do is offer technical support. We have someone in the local team down there who is specifically the go-to person for anyone who wants to self-manage. They are a bit of a conduit there if people need a little bit of extra support around that.

Senator SIEWERT: I want to go to the psychosocial issue that came up yesterday with Lamp in terms of the approach that they are saying they cannot take. I would suggest that is not the first time you have heard that concern given your level of involvement on the ground. How are you responding to that? Is the psychosocial funding in the same boat as therapies? Is the funding for that coming out of the transitioning health bucket or is that separate again?

Dr Chalmers : I will start with the last question first. It is separate. That is not tied up with a therapy bucket at all. People with psychosocial disability found eligible for NDIS My Way are going through the same basic eligibility planning process as other people are.

Senator SIEWERT: So it is not part of therapies that are transitioning; it has already transitioned—is that right?

Dr Chalmers : Yes, that is right. The Lamp issue is complex. It is tied in with funding through Commonwealth government mental health programs. It is complex. We want Lamp to be a provider of service, and they are a provider of service. They are actually an endorsed service provider in the lower south-west and they are providing support to people in NDIS My Way, so they are in the game. Without putting too fine a point on it, they have an interest in what they have done in the past—centre based, block funded types of arrangements where they deliver this and people come to that. I think it has been a source of tension for them to start moving away from that into more individualised type approaches. I am being diplomatic here.

Senator SIEWERT: I understand that and I understand the issue about block funding. We have heard a lot about block funding. And I understand the issue around centre-based care and when people do their plans and they signal that they actually want that. I understood from the evidence yesterday that some people had actually said that they find it really valuable and that is what they want to do. How are you working through that process?

Mrs Massey : People can absolutely choose, and they are choosing, to access support from Lamp. That is part of the process. They come along and they identify Lamp and then that funding goes to Lamp to provide the service. So it is happening in plans.

Senator SIEWERT: Even through the centre?

Mrs Massey : Yes, absolutely.

Senator SIEWERT: So the issue that then arises is the pricing.

Dr Chalmers : Yesterday there was a reference to $18 an hour. Again, what we will not be doing in NDIS My Way—and I suspect NDIA will not be doing it either—is to say to Lamp or other organisations, 'Here's a million dollars and you just cut your cloth within that million dollars for whoever happens to come and choose you in your plan or have you built into the plan.' We will not be building into plans $53 per hour for an individual who is heading along with a group option where there might be 10 others who are also getting $53 per hour built into their plans. We will not be doing that. I think we are on a similar page with NDIA, and that is where the $18 came in—that is, if you are there with six people, that is more than enough money to support whatever centre-based initiative you want to do.

Senator SIEWERT: So they build into their plan that they want to do centre-based support?

Mrs Massey : Yes.

Dr Chalmers : That is right, and they are funded appropriately.

Senator SIEWERT: So they actually then have to put in their plan what sort of support they want and whether it is centre based or some other form of support?

Mrs Massey : They will actually choose that program. Part of the planning process is people come in and say, 'This is what I would like to do,' and they might say, 'I want to go along to here; this is the strategy here.' At that point they would put that into their plan, because they have already chosen that they want to go along to Lamp to the centre based, and that is then built into their plan and the funding flows. So they choose it right back there when they are actually choosing the activity.

Senator SIEWERT: If people want to change they come back and then seek a change to the plan?

Mrs Massey : Yes.

Ms HALL: One of the things that we have heard quite frequently is that programs are block funded and then those programs are no longer being funded and people move towards individual programs and services. We are supportive and that is the way the NDIS has been designed. Do you think there is still a role for some group funded programs, particularly at tier 2 level? How do you think that they should be funded? What are the options around that area? It seems like there is maybe a little bit of a void developing in that area.

Dr Chalmers : I will put a bit of context here. Western Australia was the first state in the nation to individually fund people. Over 90 per cent of our funding here in WA is individualised. We have very, very few block funded arrangements in place here in WA. So it is not like other states and territories, where we are having to disaggregate a whole heap of block funding arrangements. We did that back in the mid-nineties. The component of our sector that is block funded is very small.

Ms HALL: What will happen to that component?

Dr Chalmers : A couple of things. We are not wedded to the notion that nothing will be block funded. I think the work that is being done now across the nation on the old tier 2 stuff will be instructive on this. That is still very cloudy at the moment, and I do not think it is going to be clearer by April. It is still very cloudy at the moment, but we were not there. The fact is that we have very, very little block funding here. We moved away from it 15 years ago.

Ms HALL: It is not an argument for block funding; I am just worried—

CHAIR: Did you say 95 per cent of your services—

Dr Chalmers : Well over 90 per cent of our services are individualised. We have very, very few block funding arrangements.

Ms HALL: My question is not around whether block funding is best or individual funding is best; my question is probably linking more to tier 2, as I said when I asked the original question. What is going to happen in that area; how do you think that should go; and what is your opinion? Should I ask your opinion? Maybe not.

Dr Chalmers : We still have an open mind in terms of exactly what needs to be retained within a block-funding-type arrangement. We heard yesterday from Claremont Therapeutic Riding Centre—

Ms HALL: Absolutely.

Dr Chalmers : who want to say that the stuff they do is really valued and so on, and they believe it does not lend itself to highly individual—I am not convinced about that, by the way, but we still have an open mind on how this will settle within a tier 2, ILC type environment.

Senator SIEWERT: Can I jump in there. I have heard some arguments from providers saying that in rural and regional areas you need more block funding. That is an argument that I have heard basically across Australia. You are obviously working in this space in the south-west. I understand the horse-riding issue you have raised, and that has actually come up elsewhere as well interstate. What is your feeling coming out of your experience to date with My Way?

Dr Chalmers : We have very little block funding in regional WA or remote WA. We are highly individualised.

Senator SIEWERT: Because we have already moved to the individualised?

Dr Chalmers : And it works.

Senator REYNOLDS: Hopefully then you have more flexibility in the price range so that, if you do need to provide services to someone in rural or regional areas, they get a higher rate for it to cover the extra costs.

Dr Chalmers : We are not operating in any red-dirt territory at the moment, although some people in the lower south-west would feel they are remote at times. That is still to be tested out. I imagine the pricing framework that we would establish in the mid-west would be very different to the pricing structure that we establish—

Senator REYNOLDS: That is one of the advantages: you have the ability to do that.

Dr Chalmers : Yes. The other issue there is about transport costs. We are still grappling to try and find the optimal way of being fair and reasonable to organisations around the transport costs for moving people around the lower south-west.

Senator REYNOLDS: Thank you.

CHAIR: We would love to continue, but we are very mindful that we have run over time. You have a few other things that you would like to add that we would like to hear.

Dr Chalmers : One minute, just to project into the Cockburn-Kwinana area, might do us. We have put a lot of work into Cockburn-Kwinana over the past 12 months, knowing that this was coming, to the point where we now have 600 individuals who are basically in the scheme even though formally they are not in the scheme. The majority of those people also have well-developed plans. We do not want to wait until 1 July to be able to start operationalising that part of our trial site. We have also got a good, skilled team of people in place in Cockburn-Kwinana, and we have infrastructure in place, a new office facility, so the nuts and bolts of the scheme are looking very good.

Later this month we will go with a media and information campaign using TV, radio, billboards and press and talking about NDIS My Way so that we are getting the message out to people whom we may not be linked with already to make sure that people are aware that this is kicking off in Cockburn-Kwinana. So we are pretty confident that we will be as successful in Cockburn-Kwinana as we have been in the lower south-west and as the composite trial arrangement. I might leave it there.

CHAIR: I need to ask you one final question. It is an opinion, and it is a serious point. Leaving aside what the Western Australian government's decisions may be into the future, drawing upon your knowledge of other jurisdictions and the way in which they have been operating for a very long time in comparison to the 25 years that you have referred to here, it would seem to me that there is a very different starting point for the introduction of an NDIS in WA to other states, even though many of the other states have individualised packaging and have had for some time. With the agency looking at what you are doing here, and this committee looking at what you are doing here and what works best et cetera, do you see risks of taking, I guess, a superficial look at some of the things that you are doing that appear to be different and getting even a better result, on the face of it, without having the complexity and the changes that you have already experienced over 25 years that do not exist elsewhere? Is that a risk if you just take this element of it—if you like, the topping—without the changes that have been implemented over a long period of time? Is that even close to being clear?

Senator SIEWERT: I understand it.

CHAIR: Well, that is one! Let me try again. It is a very serious point, without labouring it. I sense that there has been a lot of work done over a long time, which means that what we are rolling out here and expanding upon has as its basis a different starting point than perhaps the other states, even though the other states have personalised packages. So, if we were to look, or the agency were to look, at just the role, for argument's sake, of your planners-cum-local-coordinators and say, 'Wow, if we do it like that, we can achieve other results,' I am sensing that would not be the case at all. I am just seeking an opinion. I am getting a couple more heads nodding in the crowd as well as up here. Are you any closer to understanding what I am saying?

Dr Chalmers : Without going into territory that I do not need to go to: we said at the start of this whole business back in 2011-12 that we felt we had a good disability service system here in WA. It was underfunded, but it was a good system that worked well operationally for the Western Australia context—regional and remote and in metropolitan Perth as well. Our view has not shifted on that. So the NDIS My Way model has been built on those fundamentals.

It is not that we have ignored what has happened in other states and territories. We have been very, very close to those. In fact, I am not sure that LAC would have emerged in the NDIS model if it had not been for us pushing that way. I am not sure that there would have been such a strong focus early on individualised funding models if we had not pushed for it early. I was at the table from day one around this stuff.

This is not just about saying that WA is all different to the rest of the world. The fundamentals work here in this place operationally. Part of that, which we have not touched on today, is local decision making. I do not think we would ever welcome a scheme where we were having to defer important decisions to thousands of kilometres away. That needs to be said as well. Nothing since 2011 has changed our view on that fundamental model here as well. Your bit about 'can we take'—

Ms MACKLIN: Just on that: what decisions do you think would be made thousands of kilometres away, compared to decisions that would be made in Perth—compared to what might be made thousands of kilometres away in the north-west of WA? It is a serious point. What are the differences in the freedoms that your model gives compared to what you are concerned about?

Dr Chalmers : I am happy to answer this because this is a response that our minister gives regularly here as well. You are going to have to ask the NDIA about their level of autonomy here locally about decisions. I do not want to speak for them.

Ms MACKLIN: But you just made the assertion that, under the NDIA, decisions will be made thousands of kilometres away that would impact on you in a different way to how the My Way approach operates. What are those?

Dr Chalmers : Service providers have access to me. Individuals and families have access to me if they want it. So local decision making at individual plan level, right the way through to more fundamental things that are happening within a community, still rests within our system here. We do not have to defer to the east for micro, middle level or major level issues.

CHAIR: Now I understand. It is not actually from Kununurra to here; it is actually to Geelong.

Ms MACKLIN: The real issue is whether or not whoever is operating in the far north-west would have a level of autonomy greater or less than they have now. I guess that is something that we are interested in teasing out too. Essentially, your point is a fair one: the greater the autonomy for a region, the more likely you are to get a better result. We are trying to get to the practical differences. We do not have time now, but if you could come back to the committee, and it is not about whether or not people have access to you; it is about what the actual controls are that you put on people operating thousands of kilometres away compared with the NDIA approach. This is a really important point.

CHAIR: Just take that one on notice.

Dr Chalmers : I will.

CHAIR: Linda did you want to finish up?

Senator REYNOLDS: I want to come back to the chair's last question to Dr Chalmers. Would it be fair to take from your answer—and I think the word you used was 'system'—that this My Way pathway is a system and, to pick up the chair's question, if you take one part of it, it will not work without the rest. Is what really what you were asking, Chair?

CHAIR: Yes. Thank you. You did that far better than me.

Senator REYNOLDS: You cannot just take one bit out of it. You have got to take the whole process.

Dr Chalmers : Could I give one quick example. I mentioned before that local area coordination started here many years ago. Attempts have been made over that journey of 25 years to import it in other states and territories, with variable success. I think that is because people pick little bits of it and say, 'We can use it for this purpose or that purpose.' It loses its original potency because it loses the full impact.

Senator REYNOLDS: It works with all the elements of it.

Dr Chalmers : That is right.

CHAIR: That will do. Thank you very much for your time and your patience. We appreciate it and I am sure we will come back to you with some more questions and points in the time to come.

Dr Chalmers : Thank you.

Proceedings suspended from 10:06 to 10 : 20