Laura O'Reilly, co-founder of Hireup, and Fighting Chance, gave the keynote speech at Tuesday's Australian Disability Service Conference in Sydney. Here's what she said:
Good morning everyone. Thank you for having me this morning, it's an honour to be here.
My name is Laura O’Reilly, and I’ve been working as a social entrepreneur in the disability sector for the last 11 years. In that time I have co-founded two organisations with my brother Jordan - Fighting Chance and Hireup. Both of which I’m proud to say are working to bring new approaches to traditional service models for Australians with disability, particularly in the 1:1 attendant care, day program, transition to employment and supported living spaces.
But despite working for more than a decade in a sector where I see huge opportunity for innovation, for service improvement and reform across the board; in which the NDIS has created a vibrant market mechanism for new services to grow and thrive, my observation since 2016 has been that our sector has generally struggled to seize the opportunity of the moment and rethink traditional service models which so many people with disability reply on.
One of my favourite authors Jane Austen wrote that “it isn’t what we say or think that defines us, but what we do”. This sentiment largely captures where we find ourselves as a sector when it comes to innovation and transformation.
What we often say as a sector, is that we are focused on person centricity and quality outcomes. What we do, however, is despite ripe conditions for innovation and entrepreneurship, there have only been a few new and transformative service models enter the sector in the last few years. There are some exceptions to this statement of course, and many very talented innovators join us in this room today. But that does not change the broad reality that for many thousands of people with disability right across Australia, and some 6 years after the roll out of the NDIS nationally, the services on offer today for most people have little changed since before 2013.
If we’re being really honest about what we do - well in many cases, the truth is that day programs are largely still day programs, ADE is still ADE, DES is still DES. The funding for group homes might have changed, but if you have no real choice over the time you get up, or what you eat on a day-to-day basis, what does it matter if the funding is block or SIL? As program design has little changed, so too have outcomes, such as the stagnant rates of employment among people with disability.
My challenge to you all today, both to the service providers in the room who have so much power over the complexion of frontline services, and to government decision makers whose choices about policy settings shape the way that frontline service models evolve and develop, is to align what we do to what we say when it comes to frontline service design and quality. The NDIS is one of the most important social reforms in Australia’s history, and it will fail to live up to its potential if we as a community are not supporting the emergence of a vibrant services landscape for people with disability in which there is variety, quality, specialisation - and which facilitates lives of unbridled opportunity for all.
Before elaborating further on this topic, I wanted to begin by sharing with you a little of my story, and the path that brought me to this work and to the passion I have for innovation and service transformation in the disability sector.
My story starts in 1989, when I was three and a half years old. My youngest brother Shane was born prematurely. Complications in the weeks after birth led to brain damage, which led to cerebral palsy, and consequently Shane would grow up with a profound physical and moderate intellectual disability. Although Shane’s disability was severe, that was the least of who he was as a person. He had these blue eyes that sparkled when he said something witty; he had a terrific memory, a relentlessly positive outlook, and the ability to make a whole room of people burst out laughing. He loved computers and technology, and with the support of our parents, Shane was someone who refused to be defined by his disability.
I love this photo which I think really captures the essence of who Shane was, and also the environment my parents created for him as he grew up. This is a picture of my profoundly disabled brother, who needed assistance with pretty much every aspect of his daily life, mowing the lawn. He was enabled to do that by the inventive eye of my dad, who strapped together an old power wheelchair and a mower with a belt around Shane’s legs. This combined with the control Shane had over his index finger, enabled him to contribute to the family chores and mow the lawn in mostly straight lines.
Skip forward to 2011, it was the person and the spirit in this photo that led me and my second sibling, Jordan, to set out on the unlikely journey of building different kinds of services for people with disability in Australia.
Shane was of course the immediate catalyst for the work we would go on to do, and particularly his experience finishing school and graduating into a services landscape that, pre NDIS, left so much to be desired. Although Shane wanted to work, he was afforded no opportunity to do so. He tried an ADE but didn’t have the dexterity for the manual work on offer, and that was the end of that. Despite a long waiting list, he eventually joined a day program, where he passed his time doing a range of recreational activities he only partly enjoyed. He also wanted to move out of home, but was told that the emergency waitlist for accommodation was 15 years. Suffice it to say, watching someone we loved engage with such a limiting range of options for their adult life set a fire in us to see things done differently.
It was also the spirit in this photo which drove the kind of work we sought to do. Jordy and I came to our work in the disability sector with a belief, set in childhood experiences like watching Shane push a lawn mower up and down the garden, that things can be different if you think outside the square, harness the power of technology, and are resourceful. That the potential of our brother, and of all people, can be unleashed by creative service design. Since 2011 our goal in working in the disability sector has been, not just to deliver services, but to create them. Not just to see what is there today, but push towards what should be there tomorrow.
10 years later we have built two organisations in that image, of which I’m really proud.
Fighting Chance is a non profit organisation we started in 2011 that exists to build social enterprises that move the dial for people with disability. Under the Fighting Chance umbrella we have built 3 social enterprises - Avenue, Jigsaw and Base - which are working to transform the day program, transition to employment and Supported Indepent Living spaces respectively. From the most humble beginnings in our mum’s garage, today FIghting Chance has grown to be supporting over 1000 people with disability, across 14 sites in four states. We strive to align what we say, and what we do.
And of course Hireup, an online platform we founded in 2015, which exists to put people with disability at the centre of decision making about their support workers. Hireup harnesses technology to enable our clients to find, choose and manage their own support workers, without having to negotiate the rosters or middle-man role of the agency. Hireup today has over 150,000 registered users right across Australia and has facilitated more than 72,000 support connections, provided more than 9.3 million hours of 1:1 support, and has saved Hireup clients over $87 million in their NDIS funding, funds they can redirect to more and better supports.
While Hireup and Fighting Chance work in different parts of the sector, what we say is that the service areas we work in need to be reformed, and we strive to align that with what we do.
So for me, innovation and social entrepreneurship are concepts about which I am deeply passionate, and I believe that the future of our sector lies in rethinking the traditional approaches I saw under-serve my brother. And while there are undoubtedly pockets of interesting innovation across the disability service landscape, as I said at the start of my presentation, my experience has been that this is not the norm. I think that at this stage in the rollout of the NDIS, it should be.
So what is it that we need to do to invite more creativity and innovation into the disability sector and rethink traditional service models?
Providers
- For providers, firstly, I think that more attention needs to be given by boards and senior leadership teams to the challenge of frontline service quality. In many cases organisations have been focused in recent years on the administrative and organisational consequences of the NDIS, rather than dedicating resources to service innovation and redesign.
- Secondly, providers should be scrutinising the services they are offering, and if the competitor up the road runs the same service model in largely the same way; or if the drop down menu on the “Our Services “section of their site reads like the NDIS price guide, perhaps these are signs of a failure to sufficiently differentiating the offering, or contribute something fresh and new to the services landscape which will create opportunities that do not otherwise exist.
- Thirdly, more specialisation is needed in the design of service options, not less. The old way was doing a range of services, prescribed by the government on a tender application form, to an average standard. The pathway ahead is doing fewer services magnificently and creatively.
- Fourthly, it is absolutely critical that people with a disability themselves are fully engaged in the process of designing new service approaches, and that user feedback is regularly sought to check that the service you are offering is meeting the needs of the community.
- But finally, and very critically, it cannot be the approach of the organisation just to ask users what they want. I see that often in the approach providers take to innovation; we’ve asked our clients what they want and sought to build versions of that for each person. Had someone asked anyone in this room what they wanted the future of TV to look like in 1999, not many of us would have said Netflix. Of course organisations need to engage the client in the innovation process, but at the end of the day organisations need to set risk and failure tolerances to allow innovation to happen, to make the choice to be bold and to experiment; and critically, entrepreneurs with the ideas of the future need to step up.
Government
But it is not just providers who have a critical role to play in creating the conditions precedent for innovation and service delivery innovation; government also has an enormous role to play in ensuring that the policy environment is conducive to the flourishing of a rich services landscape. Government also needs to appreciate Jane Austen and align what we say, AND what we do, by creating:
- policy settings which support, rather than inadvertently constrain, the kind of transformative outcomes we seek.
- An operating environment where the playing field is level and certain, and all organisations working in this sector are held to the same rules, so that positive innovations, rather than detrimental ones, can thrive.
To elaborate on what I mean by this, I would like to give two brief examples from my work, where we see that the settings and policies imposed on government either support or stifle service innovation and transformation.
The first example I would like to give is of Jigsaw, one of Fighting Chance’s social enterprises, that sits at the intersection of DES, SLES and ADE. Built on the concept that ‘people prepare best for work, through work’, Jigsaw has developed a unique work-based training program that trains, employs and transitions people with disability into open employment.
At the heart of the model is a thriving document and data management business which trades in order to support job seekers with disability to build skills in a work-based environment, experience their first job at award wage, and when the candidate is fully prepared, deliver a supported transition into open employment.
Where the DES system typically sees around 10% of job seekers successfully hold their role beyond 12 months, the Jigsaw model is seeing success beyond 12 months at a rate of 74%.
Jigsaw is not alone in proving that social enterprise, and work-based training programs, can generate long-term employment outcomes at rates which surpass the traditional DES system. However, despite the promise of the social enterprise approach, the growth and proliferation of such models has been limited in recent years by the DES contract which actively stifles such innovation or out-of-the-box thinking, and by the lack of a payment by outcome mechanism to pay, not for a way of supporting people into employment, but for the outcome of the placement.
If the upcoming DES reform is able to lean into a more flexible contract and payment mechanism (such as payment by outcome), this will allow specialist providers who deliver strong employment outcomes for the cohorts they serve, to enter the market, and as a consequence of such a policy shift I think we could reasonably expect to see an explosion of innovative approaches to the challenge of unemployment in years to come. If nothing in the policy settings changes, then the opposite could remain the reality.
A second key role that government must play in supporting widespread service transformation relates to the vital importance of the level playing field and regulatory certainty to drive innovation, and the Hireup story is a good example of how important such regulatory fairness and clarity is. When we founded Hireup back in 2015 we made a number of values-based decisions about the kind of organisation we wanted Hireup to be, and consequently we took the decision to both employ our workers, and to register as a provider under the NDIS. While I’m extremely proud of the decisions made in these regards, years later we are seeing other platforms take more Uber-style approaches to the structural aspects of their operating model, choosing to remain unregistered, and instead engage their workforce as contractors. The ability of organisations that do hundreds of millions of dollars of NDIS-funded service provision annually to opt out of being registered and held to basic quality standards; the ability of organisations who facilitate ongoing employment-like relationships between people with disability and support workers to opt out of taking responsibility for their workforce or paying minimum wages and entitlements, is a gap in the policy landscape that I’m concerned will undermine quality and innovation in the long run.
What's more, there is a very real unintended consequence that people with disability could be “deemed” the employer as a result of these Uber arrangements, resulting in huge fines, back pay and liabilities for Australians using the NDIS.
For organisations to thrive, and be innovative, we have to ensure that meeting basic standards are not optional, and that organisations which try to do the right thing in their application of innovative ideas are not disincentivized from doing so by higher costs and burdens of regulation, which currently apply to some but not all.
So my call out to the policy makers in this room is that we must have the courage to change decade-old approaches which have shown over time that they do not generate the outcomes future generations deserve; and instead invest into newer, more creative approaches that do. In the pursuit for new approaches we need to close down loopholes and apply the rules around quality and standards equally to all, not just those who choose to opt in. Because innovation cannot come at the expense of quality, standards and workplace conditions.
I would like to finish this morning where I started, with the wisdom of Jane Austen. “We all have a better guide in ourselves, if we would attend to it, than any other person can be”. I think what Austen was telling us here is that we cannot look outwardly for moral courage or character, but must find it within ourselves. And so, as a sector, must we look within for the courage and the inspiration to build innovative frontline services, and by their design to pursue better outcomes for the people with disability we seek to serve. With the support of government, to create the policy settings and playing field on which innovation can thrive, my hope is that the decade to come will see a flourishing of new approaches to traditional service delivery, and that young people like my brother Shane will have richer and more opportunities than ever before.