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Joint Standing Committee on the National Disability Insurance Scheme

CORTIS, Dr Natasha, Senior Research Fellow, Social Policy Research Centre, University of New South Wales

VAN TOORN, Dr Georgia, Postdoctoral Fellow, University of Sydney

Evidence was taken via teleconference—


CHAIR: Welcome. Thank you for appearing before the committee today. Information on the procedural rules governing public hearings has been provided to you and is also available from the secretariat. I invite you to make some opening comments.

Dr Cortis : My research is about workforce issues in community services. One of the things I've been trying to do through my career is to build good quality data for the community services sector and, in particular, to build evidence that recognises that frontline workers and the ways that their work is organised in communities matter to quality and outcomes for the people who use services. I do this in a way that recognises the history of community services and the undervaluation of female-dominated work. I also do it in a way which tries to be sensitive and build sensitivity in research to the specificity of work in different areas of community services systems and their histories and resource models, because there has been a tendency to kind of lump community service workers together as a homogenous group.

I am a lead author on this report, Working in new disability markets. This is very much part of this strategy of unpacking the specificity of community service work in different service areas. This was commissioned by the three unions that represent workers in the disability industry, and it was co-authored with Dr Georgia van Toorn. This is the main report from a survey that we ran earlier this year. I'd just like to note that there is a companion report generated from the survey, called The disability workforce and COVID-19. We collected data during March, when the pandemic was unfolding, but we thought it was expeditious to separate that material and report that more quickly, given the urgency of circumstances. But the work that we're talking about today, Working in new disability markets, is the main report from that study. What we set out to do was provide a comprehensive picture of how workers see the NDIS as working in early 2020; what is needed for high-quality service delivery; and how the workforce is faring in terms of workers' experiences and perceptions of things like working time arrangements, pay, supervision, job security and other issues. We needed to do this because there's a serious lack of information about the disability workforce and how workers are faring under the NDIS—and, in my view, this lack of information about the workforce is a factor that's holding the NDIS back. On the one hand, the scheme is premised on having a workforce that can respond to the diverse needs of people with disability and can work in person-centred ways. But, on the other hand, the scheme is operating with a very thinly resourced market-based model, and that is placing pressure on the time that workers can spend with people that they support and it's placing pressure on service quality and workforce capacity, and placing the sustainability of the system at risk. In my view, we need data about workers' experiences and about workers' needs and priorities in order to assess and really understand whether and how the NDIS is operating and whether it is operating in accordance with a person-centred ethos. This work set out to fill that gap.

The three NDIS unions commissioned us to work with them to design, analyse and report on a survey of workers, and it's a kind of partnership that follows a tradition in international care work scholarship whereby research is often conducted in collaboration with workers' representatives. In this case, we found it a really helpful partnership for the research, because it enabled us to engage with very diverse groups of staff who were dispersed across many different types of organisations and many different disability workplaces. It also worked really well for the research that the study was independent of employers and providers and of the scheme itself, and that we gave workers confidentiality. If you flick through the report, you'll see there's a high degree of frankness in the comments, and the information is on topics like how workers see quality; their satisfaction with different aspects of their work, including pay; and the unpaid work they're doing—information it just wouldn't be plausible to collect via provider focused studies. So the research is unique in the way it captures workers' perspectives and in the way it reflects their priorities. The way we recruited participants—via union networks—enabled us to engage very high numbers of workers. The tradition in care-work research, for a long time, has been to do research with small qualitative samples, but this study is very large in terms of our sample size. We had 2,341 responses, which makes it the largest survey of disability workers in Australia.

While the approach that we took has many strengths, the method also has some limitations. In this case, there were some limitations in our approach to sampling, which means that the information is probably a bit skewed towards the better end of the industry. Because we recruited through unions and we were working to quite a short deadline, there are some groups of workers who are a little underrepresented—workers new to the industry; younger workers; workers in smaller workplaces or working alone; workers in private homes; and workers with very short hours, in casual roles or with a more marginal attachment to the industry. So the findings are likely to depict working conditions at the better end of the industry because workers who have benefited from a union presence in their workplace are overrepresented in the sampling.

Just before I hand over to Georgia, who will outline some of the key findings, I wanted to draw the committee's attention to the neglect of disability workforce research in Australia. Other community service areas have had large robust studies in place, which have been used for workforce monitoring for many years and which have been supported by government. For example, in aged care, the Department of Health commissioned a very robust aged-care census which providers are obliged to participate in and that links, at the organisation and outlet level, that material with information from workers. There is also a regular census of the workforce in early childhood education and care commissioned by the Commonwealth, and the Commonwealth, in recent years, has also commissioned workforce surveys in domestic and family violence services. I'm sure there are other examples.

When we look overseas, England has a longitudinal care worker study which has helped equip them to understand changes in the social care workforce and the impact of reform. It is now allowing them to monitor the impact of the pandemic. England also has an national minimum dataset for social care, which includes information about workers and which incentivises providers to participate. Over the years, that's been really helpful in generating research in the UK and in helping government manage the workforce there. I am not sure why disability has not had that kind of investment in Australia, especially given the massive changes involved in moving to the NDIS and the central role of the workforce in the scheme. I wanted to mention that before handing over, just to underline the particularity of the way the NDIS has developed and expanded without having a large-scale initiative to engage workers in research about the scheme. I suppose it is also helpful to note that all these other initiatives exist. That gives a resource that could be drawn on in developing disability-focused worker research.

In the meantime, we really hope that the working in new disability markets report will be used to help take stock of the industry and help plan for the future and serve as a reminder of the way marketised social care can push costs and risks onto workers and also that workers, including workers' voices, can be part of the solution and can help point to ways to improve services.

Dr van Toorn : As I mentioned, I am a postdoctoral fellow at the University of Sydney. When Dr Cortis and I did this research, I was based at the social policy research centre at UNSW. My area of research, broadly, is the political economy of disability and care work. I study the ways in which social care is organised and delivered in marketised social service sectors, such as disability. My PhD looked in particular at the NDIS. I would like to highlight today some of the key findings from our main report that came out of our study, which is the largest of its kind in Australia, with a sample of 2,341 workers, as Natasha mentioned.

The report really paints a picture of working conditions and job quality in the disability sector in 2020. It highlights some major issues and challenges for workers that are undermining the development of the disability workforce, which is, as we know, so critical to the success of the NDIS. Many of these challenges and issues stem from the NDIS's market-driven approach combined with its pricing arrangements, which combine to create strong incentives for providers to casualise their workforce and to cut costs associated with things like training, supervision and professional development of the workforce.

With the shift from block funding and grants to an individualised funding model, where providers are paid for billable hours, disability service providers face high levels of instability in their revenue flow. We found that these new risks and responsibilities are being passed onto workers and this really come through strongly in the data that we collected. I will run through this briefly now and can elaborate further.

Our study found that disability workers are concerned about the quality of the services that their clients are receiving. Only one in five workers believed that the NDIS had been positive for them as a worker and only one in three believe that the NDIS has been positive for the participants of the scheme—their clients. An interesting finding to come out of the study was that the more experienced the workers were, the more likely they were to be concerned about service quality compared to new recruits who had not worked in the sector for as long. Workers felt that the quality of services had suffered due to problems related to unstable and inconsistent work-time arrangements, understaffing, lack of training and supervision, and unpaid work.

Workers reported high levels of instability in their paid work hours due to rostering that is more haphazard and liable to change quite suddenly. Many workers work across multiple sites and employers in the disability sector and so spend time travelling, for which there are not paid. Nor are workers paid for time spent writing case notes, doing things like communicating with their colleagues and supervisors, reporting safety concerns and safety incidents and other tasks associated with the handover of clients to colleagues. We found unpaid time constituted around seven per cent of the total time worked in the previous week.

Workers also described feeling high levels of stress and pressure to do more in less time. More respondents disagreed than agreed—44 per cent versus 40 per cent—that there are enough staff in their service to get the work done. Contrary to the person centred ethos of the NDIS, we found that two in five workers—40 per cent—said that they work under pressure to meet KPIs regardless of the actual needs of the people they support. Interestingly, 64 per cent said that they were worried that clients aren't getting what they need from disability services.

Work in the disability sector is also characterised by low pay and income insecurity. A minority of respondents, 37 per cent, said that they were satisfied with their take-home pay. Satisfaction with pay was higher amongst workers in their first year of work in the disability sector, but that fell very quickly with experience, and we found that that stayed low through disability workers' careers. This is related to the fact that pay structures don't tend to reward an increase in experience and skills.

The issue of job security is another major concern for plans to grow the disability workforce to double 2015 levels in order to meet demand. A third of those employed casually had worked in disability services for 10 years or more, only 31 per cent of respondents felt that they had good prospects for career advancement and a quarter said that they did not intend to work in the disability industry in five years. This constant churn amongst the disability workforce—along with the precariousness of work and low pay and the nonrecognition of skills and experience—is likely to hamper the development of a much larger workforce that's necessary to achieve the goals of the NDIS.

Finally, workers reported a lack of adequate supervision, support and training. Reflecting the lack of funding to pay for necessary supervision and training, only 36 per cent of respondents said that they get the time they needed with their supervisors. This was perhaps unsurprisingly lower for casuals, at 26 per cent. Over half of the supervisors themselves—53 per cent—agreed that they were unable to provide proper supervision due to lack of time. Training was another major area of concern, with a quarter of respondents—26 per cent—receiving less than one day of training in the previous 12 months.

This gives you just a snapshot of our findings, which points to some serious concerns being raised on the frontline of disability service delivery and the need for further research, as well as planning and investment in the quality of skills and the stability of the workforce into the future. I'll leave it there for now.

CHAIR: Thank you. In addition to what you've covered, was there any opportunity for the respondents who were surveyed to make suggestions about how things could be improved?

Dr van Toorn : We didn't ask that question explicitly, no. But I think many of the respondents felt that they needed more support from their employers and that there were a number of basic supports that needed to be in place, including things like paid supervision time and paid time to do case management tasks, share information with their colleagues and engage in team meetings and training opportunities—those sorts of things. Those were the main things that the workers really pointed to in terms of improving the quality of services that they are able to provide.

CHAIR: Was there any comparison made by respondents between the system that now operates under the NDIS and what had operated under the previous state and territory governments' systems?

Dr van Toorn : I think, as I mentioned, we found that the more experienced workers that had worked in the previous system found that they were much more likely to be concerned about the quality of services that their clients were receiving. That was a result of the issues that I was mentioning around that individualised unit pricing structure of the NDIS and how that structure isn't able to provide funding for the very things that contribute to quality service provision—things like training, supervision and case management that aren't built into the funding model of the NDIS as they were in the previous system. Many respondents did point to that as a key difference between the current and the previous system, especially the more experienced workers that had worked in both and could compare them.

Ms COKER: Thank you very much for sharing your expertise with us today. In your presentation, you said that your research has revealed that there are 'new risks and responsibilities being passed on to NDIS workers'. I was wondering if you could expand on that for me.

Dr van Toorn : Sure. To take the area of risk, for example, we found that workers had a quite common experience of feeling quite alone and isolated in their work, particularly community based support workers. They would be working often without close contact with their supervisor and their colleagues, they were not getting paid for communication and contact with the other team members and their supervisors and they were not able to contact their supervisors easily and get quality time with them. So that's an example of how the risks of a unit pricing funding model being passed onto the worker has meant that they are now feeling that they are solely responsible for a client. Often they are working with clients with very high complex support needs, and the workers described being placed in sometimes highly challenging and dangerous workplace contexts. They felt they didn't have the support that they needed in order to deal with those challenges that came up. So that's an example of a sort of workplace risk that's associated with the nature of their work and the individualised funding model.

Ms COKER: These are quite serious concerns that you're raising, particularly with COVID and the impact on this workforce in terms of the workers' own mental health. Have you got any suggestions about what could be done to, I suppose, reduce this level of risk amongst the workforce?

Dr van Toorn : As I said before, I think a level of planning, an increased investment and maybe a separate form of funding needs to be invested into overhead costs associated with workers feeling more supported, qualified and able to perform their job to the highest degree. I think also staff training and supervision, particularly support around reporting incidents where workers feel like they were put at risk or their clients were put at risk. We found that workers, even if they did have the time to report incidents, often felt concerned about or were unable to navigate the reporting system adequately, were not paid sufficiently—they didn't have any paid work time to do that reporting—or they would report issues of concern but those issues were not followed up seriously by management within the organisation. It was a very common concern that safety concerns were not followed up adequately and it was a disincentive to report around various forms of risk, whether it be risk to the worker, risk to the client or health and safety concerns that may arise around COVID, for example.

Ms COKER: You talk about serious neglect in Australia of disability workforce data in comparison to other countries. Other presenters have also mentioned a lack of data. Has your research identified the kinds of data that would be most useful for workforce planning and development or data that is most lacking in the current policy environment?

Dr van Toorn : That wasn't a question we asked the respondents directly. That may be something that Dr Cortis could comment more on. But no, that was not something we covered in the survey directly.

Dr Cortis : I suppose the survey was designed with a view to what the information gaps are. In designing it, we looked at other data sources and thought about what we really need. The survey set out to fill the gaps in research and to ask about unpaid time spent working, because we don't know that from the provider focused information that we had. We were looking at how workers navigate or experience incident reporting, because, while employers can tell us about the systems in place, we don't know how workers perceive them, use them or why they may not be working. That issue of gaps was something that we addressed, not in the survey but, I suppose, in the design of the survey and in the process we went through before it went out.

Ms COKER: I think it is very revealing what you have said in the data. There is a lot we need to work on. We really appreciate your presentation today, thank you.

Senator CAROL BROWN: I had a little bit of trouble hearing, so if you have answered this question just let me know. In your work, what skills and qualifications do you find most lacking in the disability workforce?

Dr Cortis : We didn't actually ask about the skills/qualifications or the field of study but we did look at the level of training people had. We asked lots of questions about whether they thought their skills were well matched to the work that they were asked to do but we didn't go into detail about the exact skill sets that were needed. What I found really interesting in there was that, often, a certificate IV is considered a reasonable level of training, but we found that many workers actually don't have that. That's especially apparent among new entrants to the workforce. So those who have been working in disability services for less than two years or less than one year are less likely to have a certificate IV or above. I thought that was interesting in terms of lack of skills. People are coming into the industry without a level of skill that's considered reasonable. But I think your question was more about the skill sets that are needed, and I don't think we can get that from the data that we have.

Senator CAROL BROWN: We have had some submitters suggest that microcredentials—that is, shorter courses on specific skills and competencies—would be effective in ensuring that those training for disability work would be able to respond to the diverse needs of people with disability. Would you support this approach to workforce training?

Dr Cortis : I don't know from the data that I have, apart from some comments left by workers about the inadequacy of short online courses. Workers doing them didn't find them particularly helpful, and senior workers looking at their junior colleagues doing them didn't find that they were really building skills. So there were some comments that were quite critical of that kind of approach, and the online approach, to training people for disability support work.

Senator CAROL BROWN: Right. In your opening remarks, you gave us a snapshot of your work in putting this data together and the assistance given to you by the unions that represent those workers that you were able to speak to—was it 3,200?

Dr Cortis : It was 2,341.

Senator CAROL BROWN: What strategies should governments use to better capture workers' perspectives when they are putting together policy and seeking to implement policy in regard to the NDIS?

Dr Cortis : There are different approaches that could be taken. Working through union networks worked really well. In this research that we did, we were able to very quickly access a large network of workers who were willing to make very frank comments. Many of them were extremely experienced and had seen the process of change occur. Another approach would be to take a statistically representative approach, but the difficulty in doing that is that there isn't really a list of every disability worker in the country that a sample could be drawn from that was completely statistically representative. But, certainly, there are ways to engage workers through their representatives, through registered providers. The thing with research in other countries is that it incentivises providers to participate—for example, in the UK, in the minimum dataset developed there.

Senator CAROL BROWN: Yes. Are you aware of the announcements made by the government regarding the participant service guarantee and independent assessments?

Dr Cortis : I'm aware of the announcements, but I don't have expertise in that field that would enable me to comment personally. I'm not sure about Georgia.

Senator CAROL BROWN: I was just wondering whether you would see any workforce issues arising from those proposed changes.

Dr Cortis : I don't know that I can comment on that, sorry.

Dr van Toorn : I don't think I can comment on that either, I'm sorry.

Senator CAROL BROWN: Alright. Thank you for your presentation.

CHAIR: Dr Cortis and Dr van Toorn, I believe that's exhausted our questions. Thank you for joining us in this important discussion. Certainly, it will assist us in this inquiry, so thank you very much.