Five key things the disability sector needs

Hireup takes a deep dive into the issues impacting the disability sector with National Disability Services CEO, Laurie Leigh.

The National Disability Insurance Scheme (NDIS) turns 10 this year. Those in the sector would say the scheme’s birthday marks a decade of great change as disability service providers adjust to new ways of funding and working in a system that is constantly evolving. Throw a global pandemic into the mix plus a nationwide worker shortage, and it’s easy to see why the sector is operating on a heightened state of alert. 

National Disability Services (NDS), the peak body for providers, took the sector’s pulse in November last year. The survey’s findings, just released, indicate widespread concerns about workforce challenges, pricing problems, and onerous administration to name a few. This will come as no shock to providers, who’ve long voiced concern over these problems.

Hireup sat down with NDS’s CEO, Laurie Leigh, to take a look at some of these challenges - beginning with worker shortages. In its most recent State of Sector survey (released November 2022), 83 percent of NDS members reported having “moderate to extreme” difficulty recruiting disability support workers. The federal government estimates the sector needs 83,000 more support workers to meet demand by next year. And Allied Health Professionals Australia says a chronic lack of therapists is leading to lengthy waiting lists across the country.

Leigh says workforce issues have been gradually going from “bad to worse” and have been exacerbated by the pandemic.

“[It] definitely [got worse] the last couple of years with COVID [due to] the reduced migration which we know is a significant proportion of the disability workforce. Plus all of the difficulties of working amid COVID in human services - there’s burnout - and the exhaustion this has brought has really meant that it's impacted significantly on the size and the capability of the workforce that we have.”

Leigh says, lately, service providers are even finding it difficult to fill corporate roles like finance and human resources positions. Plus, the problem is made worse by high staff turnover.

“We have a 25 to 30 percent turnover within the sector every year. So even if you can get enough workers in, you lose a quarter of them every year. And so if we can make it more appealing for people to stay, then that will actually make a huge difference to the workforce issue as well.”

Leigh says creating career pathways and increasing worker benefits will go a long way toward attracting and retaining staff. Unions are calling for the sector to have portable leave and training schemes that are recognised across the country. The NDS chief says it’s a good idea but one that has to be administered by the government as providers are already overwhelmed by paperwork.

“My only real concern about the idea of portable training and entitlements is that providers are already under quite a lot of regulatory and compliance burden. So whatever system is put in place, it needs to be something that doesn't add to the reporting that providers are doing already. 

“You wouldn't want a scheme where providers are having to report all of their hours that each worker has had every week to a central body. You’d want to see if you could be smart about it and do it through the back end, for example through Australian Tax Office records or something like that, that shows how much somebody has worked overall.”  

Pricing is another issue Leigh is passionate about, with many providers struggling to cover costs under the pricing model set by the National Disability Insurance Agency (NDIA). More than a third of respondents to NDS’s 2022 survey expect to make a loss this financial year, despite price increases announced by the agency in June.  

Leigh says part of the problem is that the NDIA both sets the price and pays the bills, leading to a conflict of interest. It’s why she’s calling for an Independent Pricing Authority (IPA), similar to the one for the health system and slated for aged care.  

“It won't be a panacea,” she says. “It won't mean that providers are rolling in money because that's not what's happening in health and it's not what's going to happen in aged care. But it takes away that conflict of interest, and puts in place a more independent mechanism for looking at pricing systematically without the overlay of an organisation that's trying to keep its budget as low as possible.” 

The NDS called for an Independent Pricing Authority as part of its submission to the NDIS review which is currently underway. Sustainability is a key part of its brief, with the review’s independent panel charged with finding ways to build a robust scheme, workforce and marketplace.

That’s no small task, considering the complexity of the challenges both the scheme and sector are facing. We asked Leigh for the top three things the disability sector needs.

She gave us five. 

Increase investment in ‘Tier Two’ services

A lack of so-called tier two supports (read our explainer of these here) has created an ‘NDIS or bust’ situation for people with disability needing assistance. Leigh argues investing in these supports will take considerable pressure off the scheme. She says this means providing “reliable, ongoing funding for tier two services, be that through states and territories, local council governments, the NDIS or linkages grants, so that there is - for the whole sector - a thriving environment for people with disability to access”. 

An Independent Pricing Authority 

The NDS CEO returns again to this issue, saying that currently the NDIA has “a political incentive to make sure the budget is as tight and as low as possible” and that the effects of this “[end] up spilling costs over to providers without them being given adequate funding to be able to deliver their services”.

Separate funding for training and development 

In order to attract and, crucially, keep workers, Leigh says career pathways need to be created. She argues that funding for this needs to be provided on top of the existing pricing model.

“I would like to see a training and development component pulled out of the disability support worker cost model. It would be a piece of funding that providers get ring-fenced for training and development of their workforce. I think that would really go a long way to helping the workforce issues.” 

Cross-sector data sharing

Leigh says creating cross-sector systems in which providers share information might reduce some of the duplication that providers are finding especially onerous. “I'd like to see more data sharing, particularly in that quality and safeguarding space, so that there are multiple reports and reporting going forward that make it administratively easier for providers.” 

Clarity regarding registration

In February, Leigh appeared at the Disability Royal Commission, which was conducting a second public hearing into disability service providers. When asked about provider registration she famously said “for non-registered providers, there are not even basic screening requirements for their workers. So, somebody could have murdered somebody and be convicted for that and still work as a disability support worker the next day”. This is why she believes a national registration process plays a role in setting standards and safeguards for people reliant on the sector. Leigh told Hireup she’d like to see “movement” on this.

“An NDS position is that there are some services that are quite high risk by the very nature of the service. For example, personal care - when you're in somebody's house alone providing personal care to them, those are probably services that should be registered. There are some services right at the other end - lawn mowing is often given as an example of something which probably shouldn't be registered. But there needs to be a bit more clarity about [this].” 

Despite the difficulties providers are facing, Leigh says there is renewed optimism in the sector. The NDIS review, a new minister plus a significant change of leadership at the NDIA has given providers hope. And with co-design being a central theme guiding where we go from here, she hopes those at the helm will harness the collective experience of the sector as the NDIS heads into its second decade.