Public hearing 32 - Service providers revisited - Day 5

CHAIR: Good morning, everybody. Welcome to the fifth and final day of Public hearing 32 dealing with service providers revisited. We commence today, as always, with an Acknowledgement of Country. We acknowledge the Jagera people and the Turrbal people as the Traditional Custodians of Meanjin, Brisbane, the land on which we are gathered for the purposes of this hearing. We pay our respects to their Elders past, present and emerging. We also acknowledge First Nations people who are participating in this hearing, including those who may be following the hearing either in person or via the livestream. Now, I understand that there are some further appearances to be announced today. 

MR LUKE: Yes. If the Commission pleases, my name is Luke. I appear for Mable. 

CHAIR: Yes. Thank you very much. 

MS WHITELEY: If the Commission pleases, my name is Whiteley. I appear for Hireup. 

CHAIR: Thank you, Ms Whiteley. And no other appearances? In that case, Ms Dowsett, yes. 

MS DOWSETT: Thank you, Chair. So, as you have said, we begin this morning with a panel on digital platforms, and I understand the witnesses have all made their oath or affirmation before we came in this morning, so we are right to begin. 

<PETER SCUTT, CALLED 

<LAURA O'REILLY, CALLED

<JACI ARMSTRONG, CALLED 

CHAIR: Thank you very much. Thank you very much to each member of the panel for coming this morning. I understand that you may have been travelling from interstate this morning, at least some of you, so thank you. Thank you to the airlines for getting you here. We appreciate your assistance. I shall now ask Ms Dowsett to ask you some questions. 

<EXAMINATION BY MS DOWSETT 

MS DOWSETT: Thank you very much. If I can begin with you, Ms O'Reilly. You are a co founder of Hireup, and you are an advisor to the board. 

MS O'REILLY: I am a co founder of Hireup, alongside my brother Jordan, and I'm also co CEO for the business. I've been in that position since January of last year. 

MS DOWSETT: And Jaci Armstrong. Ms Armstrong, you are a director of Hireup. 

MS ARMSTRONG: I am, yes. 

MS DOWSETT: And the final member of our panel, Mr Scutt, you are co director   co founder and executive director of Mable? 

MR SCUTT: That's correct. 

MS DOWSETT: Now, just to give some context to this panel, I just want to read very briefly from Hireup's annual report 2020 2021. Hireup says: 

Along with at least seven others, we are part of a seismic shift in how support work is being organised and performed. We are doing away with traditional rosters and giving more flexibility and choice, both to people with disability and to their support workers. 

Now, I see that you are nodding. You agree that that's what the digital platform is doing in this disability service sector? Mr Scutt, do you agree, from Mable? 

MR SCUTT: Yes, no, I broadly agree with that. 

MS DOWSETT: Okay. Have you been following this week's hearing? 

MS O'REILLY: Yes. 

MS DOWSETT: So you will understand we begin with some general questions about corporate structure and the people to whom you provide services. So if I can begin with Hireup, and I will direct my question to you, Ms Armstrong, but, Ms O'Reilly, if you want to add something, then please do. 

MS O'REILLY: Sure.

MS DOWSETT: But the current corporate structure is that you have seven directors. 

MS ARMSTRONG: Yes. 

MS DOWSETT: And of those, how many are people living with disability? 

MS ARMSTRONG: I am the sole director who lives with disability. I am blind and have a guide dog. My twin sister also has cerebral palsy. But there are also other directors on our board with lived experience with disability. 

MS DOWSETT: And Hireup has, in January 2021, launched an observership program for its board of directors. How many participants have you had through that program? 

MS ARMSTRONG: We have had three so far. We are about to have our fourth and fifth this year. 

MS DOWSETT: And do you know, have any of those observers gone on to board roles? 

MS ARMSTRONG: I couldn't tell you if they have gone on to board roles at the moment, but we have provided a strong foundation through formal training, external training, and they are also remunerated during their time on Hireup's board. 

MS DOWSETT: Thank you. Turning to you, Mr Scutt, from Mable. There are eight current directors? 

MR SCUTT: Seven current directors. 

MS DOWSETT: Seven. And are any of those people with disability? 

MR SCUTT: The chairperson is a parent of a child with a disability, but no people on the board that have lived experience of a disability. We have been in conversation with somebody for the past nine months around taking a board role, because the board is in agreement that we should have it, at governance level, a person with a disability, and we hope to have a landing on that shortly. It's just been other work commitments that have prohibited that. And in the meantime, we work closely with an independent disability advisory council, of which the chair of Mable and I attend. 

MS DOWSETT: Turning then to your service users, and I will stay with you, Mr Scutt, for the moment. Mable tell us in its response to a notice from the Royal Commission that, in September 2022, Mable   sorry, 9,897 support workers delivered 383,624 hours of support to 14,899 clients. 

MR SCUTT: That's correct. I think we also clarified that of those clients, about 58 per cent were people with NDIS funding. 

MS DOWSETT: And so doing the maths, that's slightly in excess of 8,500 NDIS participants in the month of September 2022. 

MR SCUTT: That's correct. 

MS DOWSETT: Is that indicative of Mable's service user population generally? You have about that many NDIS participants? 

MR SCUTT: That's right, as of September. It would be more than that today, but I don't have the exact numbers. But very much consistent with the sorts of scale that Mable operates at. 

MS DOWSETT: And turning to Hireup, you tell us in your response that you have 7,476 individual disability service users? 

MS O'REILLY: So Hireup has about 26,000 people with disability who are active on the platform. About 11,000 of those were, on average, active per month in the last year. 

MS DOWSETT: And how many of those active participants are NDIS participants? 

MS O'REILLY: The vast majority of Hireup's client base are NDIS participants. We only provide services to people with disability, and most of our participants come through the NDIS. 

MS DOWSETT: And some of those come as individuals, some come through a support coordinator, and some come to you through other providers. 

MS O'REILLY: Correct. 

MS DOWSETT: I want to turn now to ask you for a very brief overview of how your platforms operate. So I will stick with Hireup. You have clients and support workers, and they have profiles. People need to build a profile. 

MS O'REILLY: Yes, that's correct. 

MS DOWSETT: And the profile for a participant includes details about them, their interests, their support needs and a photograph. 

MS O'REILLY: That's correct, yes. 

MS DOWSETT: Right. In what circumstances can those profiles of participants be seen   so who sees those profiles and when? 

MS O'REILLY: So Hireup is a sort of   you can think of it as a gated community. So our support workers and our clients come through an extensive onboarding process to be able to get access to the Hireup sort of community. Our support workers in particular go through extensive checks before they are approved to be able to use the platform, and it is at that point that both parties, clients and support workers, are approved, that they are able then to look at each other's information, look at each other's profiles and start, you know, finding opportunities to work together. 

MS DOWSETT: Right. And you operate on that   on the Hireup platform something called a job board where clients outline their requirements, and support workers can look at the job board and elect to take or not take the particular job. Is that correct? 

MS O'REILLY: Yes, that is correct. So there are a number of ways that Hireup   Hireup's fundamental purpose is putting people with disability in control of their support workers. 

MS DOWSETT: Can I just ask you to slow down a little. 

MS O'REILLY: Sure. We have two key ways that we connect parties. One is through search, so the ability to search for key terms, character traits, qualifications, et cetera, to find support workers. And then there is the jobs board, as you mentioned. But one important thing to point out is that Hireup is   uses an online platform. It's a big part of what we do. But we are also an NDIS registered service provider, and we also offer our community other supported ways to connect. So an example of that is our team builder service. It's a person in our team who can help our clients build their team if they are not able to use the digital platform. 

MS DOWSETT: Is that like a support coordinator or actually a support coordinator? 

MS O'REILLY: It's not like a support coordinator or actually a support coordinator. The team builder function is a sort of one off. The client will tell us what they need, and our team will help to find the right worker. And that reflects the fact that Hireup is all about choice and control and trying to support our community to access support the way that works for them. For some, the jobs board is perfect; for others, some people need a bit more help, and we cater to all of those support needs. 

MS DOWSETT: We will get into training in a little more detail later. But just now, in this setting up of the relationship in the platform, your support workers undergo client specific training before they commence to deliver services to a participant. Is that correct? 

MS O'REILLY: Yes, that's correct. So Hireup has five mandatory trainings that we require all of our support workers to undertake before they are able to deliver services. Critical to this Commission is our module on preventing abuse and neglect. We also require our support workers to hold a valid first aid or CPR certificate. And all of our support workers mandatorily undertake the NDIS Worker Orientation. We then have a very individualised training system after that, but those are the baseline mandatory trainings, and we pay our workers to undertake those trainings. 

MS DOWSETT: Thank you. So, Mr Scutt, turning to Mable, again, you’re a digital platform and people have profiles. So we will start with support workers. If a support worker wanted to be on the Mable platform, they sign up and create a profile. 

MR SCUTT: That's correct. 

MS DOWSETT: And then they have to go through what's called a verification process. 

MR SCUTT: That's correct. 

MS DOWSETT: And you have set that out on page 3 of the response, but if you could just perhaps talk us through the key checks that form part of that verification process. 

MR SCUTT: Yes. So, broadly, it's about   the worker screening is built on police checks and identification checks and certain qualification checks, depending on the services being offered. So for high risk services, like personal care, you need a Cert III or a Cert IV equivalent qualification to be able to offer that service. If you want to offer nursing services, you will need your AHPRA registration, which we will check with the AHPRA database. Similar for allied health. Reference checks are part of that screening process as well. 

MS DOWSETT: Right. And so once a support worker has gone through the verification process, then they go through onboarding. And can you   this is where they acknowledge   so a support worker will be bound by the Mable code of conduct and the NDIS code of conduct? 

MR SCUTT: That's right. 

MS DOWSETT: And then they are prompted to undertake the NDIS Worker Orientation Module. 

MR SCUTT: That's right. They are made aware of their obligation to abide by the code of conduct, and they are prompted to undertake the training in multiple places. 

MS DOWSETT: But it's not compulsory for them to undertake that training? 

MR SCUTT: It's not compulsory, but we have had a high take up of support providers on the platform doing that training. 

MS DOWSETT: I think you tell us that 53 per cent of support workers share their certificate completion? 

MR SCUTT: That's right. If they share their certificate of completion, it's identified on their profile as having completed that training. And when you look at the 53 per cent in relation to the 58 per cent of people on our platform that have NDIS funding, and also the fact that a lot of people work on Mable that may work for a provider or may work on other platforms, we believe that many more people have completed that training than have provided their certificates. 

MS DOWSETT: Right. So that's your support workers, independent contractors, in the Mable platform. For service users, is it similar to what we heard through Hireup, that they create a profile in which they give details of their biography, their interests, their support needs, what it is that they are looking for? 

MR SCUTT: They do create a profile that articulates much of that, but they also can   as we talked about, through search and job posts, a lot of the job posts are quite detailed in terms of, you know, what they are looking for and who they are. They can be very specific in terms of communicating that to prospective support workers. 

MS DOWSETT: And when is the service user profile visible and who is it visible to? 

MR SCUTT: It's visible to support workers that have entered into an agreement with the client. So it's not visible broadly. It's visible when they enter an agreement and the person with the disability can share their profile with a prospective worker. So  

MS DOWSETT: So during the job search phase, you only see the details of the job for the service user; you don't see their broader profile? 

MR SCUTT: No, they are able to communicate during the process of meet and greets, whether it's a virtual meet and greet by the platform or a phone call or a meet and greet in a café. They are able to have more direct discussions around who they are and their needs in both parties assessing whether this is a suitable relationship, and that's part of the process of determining is it the right support for each party. 

MS DOWSETT: Right. Can I ask you what   to describe the nature of the services that Mable support workers provide. What is it that people are doing on your platform? 

MR SCUTT: So I think it's a variety   it's a really diverse set of services that I think respond to people's desire to live independently and be included socially and economically, and I think one of the things that's always stuck by me is a person with a disability saying, you know, "The old system was about support to live, the new system is about support to live a life   a good life.” And so the nature of support work is changing, that it needs to be much more diverse. So I think people can engage the   you know, really tailor and build a team around their goals and their sort of vision of independent living and inclusion. So everything from   various services to support that independent living, from help around the house, help with shopping, meal preparation, through to personal care, nursing services, allied health services. But they might be finding somebody to help them learn the skills of resume writing or preparing for a job, for example, or learning the skills to live independently. 

MS DOWSETT: Are you able to tell us what proportion of the work that's done through the Mable platform is the   what might be described as intimate personal care? So looking after somebody in their home, helping them with those daily intimate personal care. 

MR SCUTT: I might have to take that proportion on notice to give you an answer, but I think it's going to be a number like 25 per cent. 

MS DOWSETT: Right. Would you   what would you say to the proposition that it   it may appear that the work of the nature performed on the platforms could contribute to a creaming off the easier work, doing the nicer gentler things like community engagement, going out for coffee or engaging somebody for resume writing, but less of the hard stuff? 

MR SCUTT: I think I would go back to the fact that I think support needs are very diverse, and it's not just about personal care being hard and the rest of it being simple. I think there is a need for lots of people with various life experience to come into the sector with lots of capabilities to be able to support people to live an ordinary life. And so I think one of the things Mable is doing is opening up the diversity of people coming to the sector to offer those services. So I wouldn't accept that that's the right characterisation. 

MS DOWSETT: And if I could put that same proposition to Hireup, how would you respond to it? 

MS O'REILLY: Hireup has quite a different approach to Mable. As I mentioned, we are an NDIS registered service provider, and we employ our support workers. And we do that because I think   I agree with your proposition, that it is important, I think, for service providers to be able to provide, you know   to go with our clients to the more complex parts of their life where they need support. So on the Hireup platform, we   again, we can clarify the exact number, but it's probably closer to 75 per cent of the supports delivered through Hireup are the more complex end. 

That's   we are registered to be able to deliver services under a number of complex categories in the registration process. So an example of one of the supports that we provide is behaviour support. We have a large complex support team in Hireup who provide additional services to our clients over and above the platform, up to and including behaviour coordinators, who, for example, help with the process of training support workers in the client's behaviour support plan. So, yes, we actively try to provide more complex supports to our clients. 

MS DOWSETT: If I could move on to workforce. So Hireup tells us that it has   and I think you may have given the number a little while ago, Ms O'Reilly. But you tell us in your response that you have 26,965 workers, which includes office staff and support workers. 

MS O'REILLY: Yes. 

MS DOWSETT: And you have this concept of an approved support worker. This is somebody who has passed all of the aspects of Hireup registration, all of the checks. And in that category, you have people who are casual, part time and full time. 

MS O'REILLY: Yes. 

MS DOWSETT: And the casual is 26,550. So the vast proportion is casual. 

MS O'REILLY: Mmm. 

MS DOWSETT: You tell us that you have offered eligible casuals the opportunity to transition to permanent employment, but less than two per cent take that up. 

MS O'REILLY: Mmm. 

MS DOWSETT: You have given us a monthly attrition rate for your workforce. Do you have annual attrition rate figures? 

MS O'REILLY: I don't have that to hand. We can   we will need to provide that. But the way that the   the way that the Hireup platform works is that support workers are really in charge of what supports they want to deliver and which work they want to do. So we look at churn monthly because we look at how many workers are active in one month compared to the prior month. And we know - 

CHAIR: Can I remind you just to speak a little more slowly? 

MS O'REILLY: Apologies. 

CHAIR: Thank you. 

MS O'REILLY: We know that about 40 per cent of workers who churn in any given month resume within the next three months. So it's   and recently saw numbers that we have   people resume on the platform who haven't used it for many years. So it's quite tricky in the context of being a platform to have those annual numbers. 

MS DOWSETT: How does the casualised and that transient nature of the workforce that you are describing   how does that affect Hireup's capacity to provide continuity of care to its customers? 

MS O'REILLY: It's a really important feature of the Hireup approach that we employ our support workers. So all of our workers are employed. As you mentioned, many are casually employed, but they are still, of course, entitled to all of the entitlements under the SCHADS award, superannuation, workers’ compensation, back to work supports, et cetera. So that's a really important part of what we do. In terms of the casual   

MS DOWSETT: Slow down. 

MS O'REILLY: In terms of the casual workers on the platform, what we see is that the Hireup model offers an interesting combination of both flexibility and control. Often when we talk about casualisation being a challenge in the sector, it's because employees don't have much control, roster to roster, of how they are going to be working. On Hireup, what we see is our workers are totally in control of how much work they will take on and when they want to work. 

So I think the Hireup value proposition is an interesting combination of that flexibility and also control. And for that reason, we see many people seek to join the Hireup platform. And as you mentioned, although we offer casual conversion, and the opportunity for our workers to be permanently employed, when we first sent out 2,000 invitations to eligible workers offering them that opportunity, only 50 responded and wanted to take it up. So we see that, yes, there's   it's the attractive proposition, I think, to many workers. 

MS DOWSETT: And you tell us that 55 per cent of the active support workers use Hireup as a secondary source of income. 

MS O'REILLY: That's correct, yes. 

MS DOWSETT: Turning to you, Mr Scutt, and to Mable. So your workforce is comprised of contractors   individual contractors? 

MR SCUTT: Yes, people that are choosing to be self employed. 

MS DOWSETT: Right. And you also have a number of organisations who have joined the platform, and you have provided us some information about that in the response to the notice, but I have received information you would like to make a correction to that. So would you like to explain how organisations fit into the Mable model? 

MR SCUTT: Yes. So I think, you know   and keeping in mind, I guess, one of the differences between what Mable is doing versus Hireup, is, you know, we operate more at that self directed end of the disability support marketplace. So people using Mable are self managing and client managing. We are not having people who are agency managing with more complex needs coming to the platform. In terms of, you know, the vision of Mable, it's really about, you know, connecting people with people. That's the vision, how do we connect people that need support with people that can offer their support within their community. 

Whether the people are self employed workers or potentially employees of an organisation, you know, our long term vision is we are agnostic around that, and what we really want to do is offer the opportunity for organisations to be on the platform, for their employees to be on the platform, so people can build a team of support around choosing the right people and less about, you know, how people choose to engage in employment in the sector. 

CHAIR: But you wanted to correct something? 

MR SCUTT: Sorry. Yes. So the correction was we   

CHAIR: I was trying to work out what it is you are correcting. 

MR SCUTT: So what I am correcting   sorry, a bit lost in that answer. But, yes, what we were correcting is that we have a pilot underway. I had originally submitted that there were six organisations. It's actually five organisations, three of which are onboarded and two of which are in the process of onboarding. 

MS DOWSETT: Chair, for your information, that's on page 3 of the Mable response. 

CHAIR: Thank you. 

MS DOWSETT: So these are five businesses who have registered their organisation on the platform so then that organisation and all of its employees are coming through the platform, able to be searched by people seeking services? 

MR SCUTT: So, at the moment, it's a pilot. So it's a bit of a hybrid where the organisation is visible via the platform and its employees are visible via that organisational log in. But the long term goal is to create visibility over people that are employed in the sector by organisations, and you will be able to search for people based on your criteria and look across who is available, including people that are self employed or employed by providers. 

CHAIR: Can I understand something a little more about the verification process that you have described on page 3 of your response. Does Mable actually meet - in person - anybody who wishes to become a service provider through your portal, as it were? 

MR SCUTT: No, we don't. 

CHAIR: There are, then, people who will be able to perform services for NDIS participants whom you haven't met and who have no formal qualifications. 

MR SCUTT: So if they are providing high risk services, like personal care, they have to have a Cert III or a Cert IV. 

CHAIR: I understand that, but there are some who will be available for services that do not require any qualifications. 

MR SCUTT: That is correct, in the sense that for lower risk services that is the case. And then people with a disability are able to assess whether they are the right people for them. So there's a lot of transparency around the qualifications for the individuals that are offering services in their local area, and the person is able to judge: is a qualification important for this particular service or are other qualities more important for this particular service? Subject to   

CHAIR: Yes. Alright. You included as a dot point "reference checks". What does that involve for somebody who wishes, in effect, to become a participant in your structure? 

MR SCUTT: Yes. So it depends on the services they are offering. But if it was a high risk service, it would be a professional reference check that we would be doing as part of that process. And if it was people new to the sector offering low risk services, we would be looking at both personal and professional references. 

CHAIR: Like what? 

MR SCUTT: So, for example, one of the people that I have spoken to that became a support worker was somebody who had been working at a major   you know, Woolworths for a long part of their career and was changing careers, and that person was looking to enter the sector offering social support and domestic assistance. We would look at reference checks that may be relevant to somebody that she's worked with at Woolworths, for example. 

CHAIR: I notice that you provide for   we have got insurance coverage. You say on page   I think it's 8: 

All services logged on the platform are covered by a suite of insurances, public liability, professional indemnity and personal accident cover. 

How is that intended to work? 

MR SCUTT: Yes. So one of the features of Mable is providing safeguards to all parties that engage, and insurance has been part of that safeguard since the beginning, in 2014. So we have a suite of insurances through Berkshire Hathaway Speciality Insurances today across public liability, professional indemnity and personal accident cover. So for services that are delivered that are delivered by the platform and logged by the platform. Then there's automatic coverage for the workers providing those services on the platform that also can be accessed by clients. 

CHAIR: What about coverage for the clients if the people you provide don't do what they are meant to do or engage, in the worst case, some form of abuse? 

MR SCUTT: Yes. So the clients would be able to take action against the insurances that cover the service providers on the platform. 

CHAIR: The client would take action, on that hypothesis, against the actual service provider? 

MR SCUTT: That's right. 

CHAIR: Not against your organisation? 

MR SCUTT: Well, I think it depends on if our organisation, I think, is at fault around the things that we do. I think it's important to understand the respective roles, that we are a facilitator of connections, and the safeguards around that connection we take very seriously, and we talk a lot about the multi layered safeguards. I think if we are failing to do what we say we do around the safeguards or we are aware of   

CHAIR: I understand that, but I'm just trying to understand what safeguards there are for the clients in the event of something going wrong. So do the insurance policies name, either by name or in some other way, the actual service provider as a beneficiary of the policy   of the indemnity policy? 

MR SCUTT: I might have to take that very specific question on notice, and I'm happy to come back to you with a real clarity on that. 

CHAIR: That's a rather important question. 

MR SCUTT: Yes. Understood. 

CHAIR: Yes. Thank you.

MS DOWSETT: Thank you, Chair. Just picking up on that question of safeguards, and you said that you take that issue very seriously. Once the person is through the verification process, there's no ongoing quality assurance by Mable, is there? There's no supervision? 

MR SCUTT: Well, I think there's, you know, I would say, a multi layered approach to that quality assurance. I think supervision is a challenge for providers in the sector because the services are delivered inside homes and inside communities. And so there's not a person that has a direct line of sight in a supervisory role generally. One of the things we think about is that the best person to actually understand the experiences is the person receiving that experience and for people via Mable. 

MS DOWSETT: Can I just pause you there. So you put the onus on the service recipient to be doing all of the supervision and quality assurance? 

MR SCUTT: I think our service recipients using Mable want to have that direct relationship with the service providers. They want the service providers to be accountable to them and express what's important to them, and they are able to judge whether that's a suitable service in a relationship and empowered to discontinue that relationship if it's not working. But then we have a whole process of collecting non invasive continuous feedback on that quality experience. So whether it's ratings and reviews that people can provide around their experience with specific workers or post engagement surveys or NPS surveys. 

But also, you know, part of the whole co design process of Mable is we are constantly listening and talking to our community. We have a small batch research happening all the time. So one of the things about Mable is it's set up to be a human centred design solution and a co design solution. So our feedback is   loops are pretty constant, including incidents, complaints frameworks as well, and making it easy for people to lodge complaints and incidents. 

MS DOWSETT: So if a service user lodges a complaint with Mable, you have said you have this complaints framework. What's the outcome that can occur, other than the person leaves as a bad review or is removed from the platform? What else do you do? 

MR SCUTT: Yes. And, you know, I think also as part of that process, the person with a disability is empowered to make a decision whether they want to continue in that relationship. But where they are providing feedback around a complaint, it could be around the operations of the Mable platform, it could be around the engagement with our team, but it could be in relation to the behaviour of another party. And, you know, what we will do is seek to understand the nature of that complaint by speaking to both parties and look at ways where we can help them resolve it. 

And that may be doing things like pointing them to training on the Mable learning hub. We have a Mable learning hub with 170 courses from subject matter experts. It's not Mable training, but it's expert training from the Council of Intellectual Disabilities through to Cerebral Palsy Alliance, NDS, Enabler gamified training. There is a large library there of courses that the person could be pointed to to actually understand more the expectation of their client. 

MS DOWSETT: Is it fair to say that the Mable business model relies upon other providers having trained a worker to reach a sufficient level of competence to begin providing services? You need people to come in with a base level of skill? 

MR SCUTT: I don't think that's the case. I think if they are providing high risk services, they need to evidence their qualifications. I think when it comes to people that work in the sector, historically that are working on Mable, I think in many respects I see that as a part of a career path that is important in the sector, that in this sector people working in it can have the career path of starting their own small business. We've had people become sole trade that have gone on to incorporate and start to employ others, and that's a career path that's available in most sectors of the Australian economy. 

But we are also bringing in a large number of people new to sector, and they might be coming in to do important work, supporting people in their community, a regional community, a cultural community. They are offering low risk services initially. They are engaging directly with their clients. And in that case, there is pathways to upskilling. And one of the things that we are conscious of is that Cert III is   about 35 per cent are completed and the rest are abandoned. And one of the things we think about is people coming into the sector being able to access that training and invest in themselves is important. 

MS DOWSETT: Under the   you have told us in your response that Mable has a minimum contractual hourly rate of $32 an hour. Is that for all categories of work? 

MR SCUTT: It's essentially a level of protection that exists on the platform. You can't contract below that rate. But people contract directly and agree the rates with their client. So the average rates for personal   

MS DOWSETT: No, I'm sorry. You are not answering the question. Does the minimum contractual rate, $32 an hour, apply to any category of work done through the platform? 

MR SCUTT: Any work done through the platform. 

MS DOWSETT: And you have told us that there are platform fees that independent contractors pay. And so once that platform fee is removed, that minimum contractual rate becomes $28.80 an hour? 

MR SCUTT: That's correct. 

MS DOWSETT: How was that rate determined? 

MR SCUTT: It's determined to approximate the minimum wage, allowing for superannuation and platform fees. 

MS DOWSETT: The minimum base rate or casual rate? 

MR SCUTT: The minimum casual rate. 

MS DOWSETT: And how often is it reviewed and updated? 

MR SCUTT: So we tend to look at it annually or if new information becomes available. It's something we will review around the middle of this year. 

MS DOWSETT: If I can turn back to Hireup. I'm sorry, I have left you sitting there for a while. You tell us that your workers are paid under the SCHADS award, the Social, Community, Housing Care and Disability Services Industry Award. And on page 16 of the response, you say that the base level for shifts over two hours is above SCHADS level 3.2. 

MS O'REILLY: Correct. 

MS DOWSETT: Given that phrasing, that the base level for shifts over two hours, is it the case that Hireup have shifts under two hours? 

MS O'REILLY: Yes. So this was an interesting challenge for us with changes to the SCHADS Award last year, where there were the introduction of minimums. We pay our workers for two hours, but we do allow our clients to book for one hour. And that is our attempt to balance entitlements and the rights of our workforce, but also the need amongst many people with disability to just access an hour of support perhaps for   you know, for a shower or for personal care. So on those shifts, Hireup makes a loss. We carry the cost of that, but that is a very important part of our approach to enabling our workers to achieve their entitlements under the award but also meet the needs of our clients. 

MS DOWSETT: And you reference that   the minimum rate of a SCHADS level 3.2, but do you mean Schedule B, which is the Social and Community Services Employees Schedule, or Schedule E, the Home Care Employees Schedule? 

MS O'REILLY: Home Care. 

MS DOWSETT: I'm just conscious of the time, so I'm trying to keep this on. In its response, Hireup have told us that it sees that there are some positives to the worker screening approach, but there are also some challenges. And you reference the delays, the turnaround times and inconsistency between various jurisdictions. You have said that you would   that   sorry, Hireup supports a national worker screening process. Would you like to explain why you would support that and what you would like that to look like? 

MS O'REILLY: Absolutely. So Hireup very much supports that   this move to a situation where all workers who are working in the NDIS, who are providing direct supports, personal care supports in particular, but direct supports to people with disability, should have to undergo minimum checks and to check that people are fit and proper. As we heard Laurie Leigh say in this place on Wednesday   

CHAIR: Remember   remember, nice and slow. 

MS O'REILLY: I apologise. Slow is not my strength, I apologise. As we heard Laurie Leigh say on Wednesday, it is currently the case that it is possible for someone with a conviction for murder to get an ABN and to be able to work in the NDIS. And we think that that is an unacceptable situation and that all workers should have to undertake worker screening, and certainly we ensure that all of our workers are thus screened. 

MS DOWSETT: And back to you, Mr Scutt. Now, I acknowledge that these are independent contractors. They are not Hireup employees. But you have said in your response that Hireup would like to   sorry, Mable. I apologise. Mable would like to have more of   more registered NDIS providers on its platform. Why would you like that and what are you doing to achieve that? 

MR SCUTT: Yes. So I think it's more a broad point, that people that are self managing and plan managing have a choice about who they engage. It could be registered or unregistered. Predominantly we have had unregistered providers on the platform historically, but, you know, we would like to be a market facilitator that gives them access to registered providers, whether they are sole traders or employees that register providers. You know, it's not because we are attempting to broaden the demand side of the platform to agency managed clients, but we just want to expand the level of choice and control that people have in terms of determining the right support for them. So having registered providers on our platform increases the level of choice and control they have. 

CHAIR: What information does the client or potential client get about the appropriate rate that should be paid for the particular services that are being offered? 

MR SCUTT: So I think one of the things I think Mable does is support   is   what's the right word   support people in making informed decisions by being able to search locally for the service that is available, who is providing and what their qualifications are, other characteristics, and including indicative rates that are able to very transparently - 

CHAIR: Sorry. Does Mable itself provide information to the potential client as to, for example, the average rates that are set out on page 7 of your document, or is this left to the client to work out on an individual contracting basis with whatever information the client is able to glean? 

MR SCUTT: I think the clients using Mable want that level of self direction and control to be able to agree the rates with the people they are engaging, and that is one of the hallmarks of Mable, that parties agree directly on those rates. And the rates, you know, on average, are above award and have been increasing over time, and you find different approaches to that. Some people with a disability really value, obviously, their support and then wanting to pay them very well. 

CHAIR: The assumption is that every client is able to negotiate freely and with all necessary information. 

MR SCUTT: Well, I think part of our   

CHAIR: Could you direct your attention to the question? 

MR SCUTT: Sorry. That's right. So I think that with either having the capacity themselves or with a supported decision maker, or there is certainly capacity building information around what to think about when engaging supports, that they are empowered to be able to make those decisions via Mable. And, of course, if they don't feel comfortable with that, then there are many other alternative ways to engage support. 

CHAIR: Thank you. 

MS DOWSETT: I want to move now to the topic of supervision. And so this is really directed towards Hireup. You give us some information on pages 26 and 27 of your response about how   how the supervision works. And you say in that response, very much like Mr Scutt has been saying, that the best person to know what they need out of their support   I'm paraphrasing, not quoting. But empowering the person with disability to exercise choice and control, to be that frontline supervisor of the work that's done for them. 

But in addition to that, Hireup has a supervision structure that sits behind that, somebody who is supporting the support worker to know what's required of them and keeping a check in on how things are going. And one of the things you say is that the Hireup support is there if it's needed or if things become more complex and that "more active" supervision approaches are available for clients and/or support workers who need it. The question is, who decides who needs more active supervision? 

MS O'REILLY: There is a partnership approach we take with our clients and our support workers to answering that question. And there's a different answer in each case. But certainly there are times when our clients will reach out to us and say. "I need more support. I would like to engage, for example, a Hireup relationship manager," who is a person that walks with the client on their journey and supports them with that. There are other times that the client   that an incident will happen. For example, after every shift, we ask our support workers, "Did an incident happen on this shift?” And if the support worker tells us that something has happened, that's a trigger for us to intervene. 

We also use significant proactive detection in our platform to be scanning constantly for signs that things might be going wrong. And so it's a combination of the client is able to ask that support from us   we advertise and publicise that it's available   but we also   as a registered provider, we consider it our responsibility to make sure that the ecosystem is safe. And so we will always step in if the support worker lets us know, if the client lets us know or if our systems let us know that something is going wrong. 

MS DOWSETT: Is there a base level of check in? So some of these services, perhaps many of these services, are provided in the home, perhaps by one support worker. Is there a standard level where somebody from the supervision structure will check in with the person receiving the support how things are going, is everything okay? 

MS O'REILLY: Yes. So there's a combination of human involvement in that process and technology involvement in that process. So as an example, after every shift   every new shift   every new connection between a client and a support worker, we will ask the client digitally, "How did it go? Did anything happen?” And we direct the client to our community support team, to our incident management process, if they need to raise something with us. 

For clients with more complex support needs   so, as an example, clients with behaviour support needs   we proactively allocate a behaviour support coordinator to every client, who will then proactively reach out, check in, see how things are going. So it's a really combination approach. But I think   the magic, I think, of Hireup being combining the technology and the   you know, all responsibility approach that we take, is that we are able to really flex and shift the response of the ecosystem based on the client, their profile, their needs. 

MS DOWSETT: And is that check in that you are describing   so, for example, the behaviour support. Is that in person or is that also digital, somebody sends you an email, sends you a message through the app? 

MS O'REILLY: It is absolutely in person. That can be over the phone. But that is   there are also many cases where that is physically in person. A behaviour support coordinator will go out and, for example, undertake training with a group of workers face to face. So it sort of depends where the client is, of course. But it's not digital, it's not an email; it's a person on the phone or reaching out in   physically in person. 

MS DOWSETT: And just to provide you the opportunity to answer the question too, Mr Scutt, that because of the nature Mable's platform   and you are a very different entity to Hireup   you don't have that one on one check in with your service users. Is that correct? 

MR SCUTT: So that's right. We operate more at that self directed end, although those service users would have support coordinators that they would be working with that might be checking in separately. But what we want to do is make it very easy, through a channel of choice, to provide that feedback. And we proactively seek it, as I said, through, you know, post engagement surveys, ratings and reviews, net promoter score surveys, et cetera. We are constantly collecting feedback about the quality of the experience. 

MS DOWSETT: This Royal Commission has heard in a number of hearings that there isn't   that support coordination isn't something that everyone has in their plan, and even if they have it in their plan they might not have a lot of funding for it. If you have got one of those people who doesn't have a support coordinator, is there anyone in the model checking in on the person individually? 

MR SCUTT: Not separate to the feedback   constant feedback loops we have. And I think that reflects the fact that people with a disability are diverse and choose what's the right model for them. And the people coming to Mable are those that are much more wanting to be self directed, either having the capacity themselves or with the support of decision makers. 

MS DOWSETT: Thank you all very much for coming along today and for sharing your evidence with me. Those are my questions. I will now hand you to the Chair. 

CHAIR: Thank you. I will ask Commissioner Bennett first. 

COMMISSIONER BENNETT: Just very quickly, understanding the difference, quite different models the two of you have. And Hireup is a NDIS provider   registered provider, and you are not. Mr Scutt, is it more   are you more like Airtasker than a disability service provider? 

MR SCUTT: So that's right. We are not   we are not the provider of disability support. We are the conduit or the market facilitator of those connections. Airtasker is somewhat analogous in the sense that the parties engage directly. I think what's quite different about Mable as a solution is there are ongoing needs, not one off tasks, and the relationship that forms between people around all the needs and preferences of both parties becomes critical. 

COMMISSIONER BENNETT: So it's like a dating site. 

MR SCUTT: It has   I wouldn't say it's like a dating site either, but it has advanced matching capability where you can actually reconcile the diverse needs and preferences and locations of people that need support versus people that are offering support. And it's actually helping them form relationships of choice that are really important to outcomes for both parties. 

And I think the other important difference is that we have heard a lot about the need to raise the capacity of the workforce in this sector and the important work they do, and I think one of the pathways of bringing into this sector people that aspire to be self employed and are willing to take on that level of responsibility is actually   I think we are raising the quality of people entering the sector through also having a pathway to self employment. And I think we should celebrate the fact that there's diverse models. I think that's exactly what people with a disability need and people that want to work in the sector need, is diverse ways of getting support and offering support. 

COMMISSIONER BENNETT: Thank you. 

CHAIR: Commissioner McEwin? 

COMMISSIONER McEWIN: Thank you. Thank you all of you. Just my one issue is we have heard this week   and I'm sure have you been watching some of the hearing   is suggestions about a national registration scheme for registering disability support workers. Briefly, could you tell me if either of you have a view on that and, if so, what that view is. 

MR SCUTT: So I think a lot of our view is informed by our community and the people we are talking to   sorry. It's okay   yes. Sorry. A lot of it is informed by our community   the Disability Advisory Council and our community. And I know when the Victorian Government introduced that scheme   and we have actually supported awareness of it. It was actually a Mable worker that - 

CHAIR: Can I suggest you direct attention to Commissioner McEwin's question and answer the question. 

MR SCUTT: Yes.

CHAIR: I think he asked you whether you are in favour of a national registration scheme. So let's find that out first and then you can give briefly your reasons for whatever view you have. 

MR SCUTT: So I think what we hear from people with a disability is they would like the scheme to be voluntary rather than mandatory, I think is what was the feedback to the Victorian Government, is that mandatory registration may reduce choice and control and may reduce access to workforce and may not be what all people with a disability value in terms of who they engage. And so the strong message to the Victorian Government was we support the scheme, but let's make it voluntary. Workers can decide to be engaged, consumers can decide whether that's an important safeguard for them. 

COMMISSIONER McEWIN: Thank you. Hireup? 

MS O'REILLY: Hireup's view is very much in favour of the notion of a national registration for workers. We would like to, of course, see the detail of any proposals. But I think it's important to point out that there is already a form of mandatory registration that registered providers are subject to. The employees of registered providers are required to be screened, are required to do the orientation. And so I think the issue is more about making sure that everybody is asked to comply to the same standards and closing down the very significant loopholes that exist now, that workers who are essentially a support worker but are doing so as an ABN contractor are not obliged to adhere to the same standards. And I think that is actually the flaw in the system that we should seek to close down. 

COMMISSIONER McEWIN: Thank you. And thank you again for your contribution. 

CHAIR: I'm not entirely clear how your employees get paid. How do they   what do they get paid for? Is it based on some hours worked, and how is that determined? 

MS O'REILLY: Yes, absolutely. So our employees are paid per the hour that they work. It is determined in alignment with the SCHADS award. So depending on the hour of the day, the time of the day   

CHAIR: But the starting point is they have to be selected by a client to work. 

MS O'REILLY: Yes. Correct. The relationship is formed between the client and the support worker. Both parties agree to work with each other. 

COMMISSIONER BENNETT: And they invoice you and then you send them money? 

MS O'REILLY: No, there's no invoicing. It's all through the system. So when the booking is created, let's   you know, "I would like you to come for two hours on Saturday.” That tells the worker you get two hours at the Saturday rate, depending on the time of day. Once the client says, "Yes, that shift happened," and approves it, and the worker approves that the shift happened, the worker is then automatically paid. 

CHAIR: By who? 

MS O'REILLY: By Hireup. And, importantly, we offer a surety of pay. So we pay our workers every fortnight for the shifts that they have performed, irrespective of whether we have been paid by the client. 

COMMISSIONER BENNETT: And then you claim that from the  

MS O'REILLY: Correct. Correct. From the NDIA.

COMMISSIONER BENNETT: For that client number? 

MS O'REILLY: Yes. So if the client is NDIA managed, we directly invoice the NDIA for those hours. If the client is plan managed, we send the invoice to the plan manager. If the client is self managed, we send the invoice to the client themselves. 

CHAIR: Thank you. That clarifies it. Thank you very much to each of you for joining the panel today and for giving us the benefit of your experiences and the way in which your respective enterprises work. Thank you very much. 

MS O'REILLY: Thank you. 

MR SCUTT: Thank you. 

<THE WITNESSES WITHDREW

CHAIR: Do we take a break, or do we proceed directly to the next panel? 

MS DOWSETT: Just a very   maybe two minute adjournment so we can do our reconstituting. 

CHAIR: Yes. We will take a very brief adjournment. 

<ADJOURNED 10:23 AM 

<RESUMED 10:34 AM 

CHAIR: I understand we have been having certain technical difficulties. What is the current position?

MS DOWSETT: They have all been overcome, Chair. The panel is ready to begin. 

CHAIR: We are ready to go. 

<ADAM SCHICKERLING, CALLED

<DI WINKLER, CALLED

<WENDY BROOKS, CALLED 

CHAIR: Very good. In that case, thank you very much for coming to the Royal Commission, for those of you who have come to the Royal Commission, and for Dr   is it Dr Winkler? 

DR WINKLER: Yes. 

CHAIR: Dr   yes. Well, thank you too for joining us remotely, and I'm pleased to say that we can see you very clearly. So that demonstrates that the technical issues have been resolved. Thank you for your contributions to the Commission, and I will now ask Ms Dowsett to ask you some questions. 

<EXAMINATION BY MS DOWSETT

MS DOWSETT: Thank you, Chair. I will just begin with some brief introductions and then move on to my questions. So, Adam Schickerling, you are the National Director, Strategy and Engagement for Synapse. 

MR SCHICKERLING: That's correct. 

MS DOWSETT: And Synapse was introduced by Ms Eastman on Monday as part of the human rights panel, so I won't go over what she said. But just to confirm, that Synapse supports and advocates for people with brain injury, and its areas of practice include the provision of supports and services to NDIS participants. 

MR SCHICKERLING: Correct. 

MS DOWSETT: How many members of the board   sorry. Excuse me. Could you tell us the composition of Synapse's board by reference to how many members are people with disability? 

MR SCHICKERLING: So the Synapse board currently consists of one person with a disability, a number of others that have connection to people with disability.

MS DOWSETT: One out of how many, may I ask? 

MR SCHICKERLING: Out of six. 

MS DOWSETT: And how many NDIS participants does Synapse support? 

MR SCHICKERLING: So that varies a little because of the nature of the work that we do. So we do a large number of information and referral type services across the country where people don't necessarily identify individually. So I think our engagement numbers are around 120,000 a year. But of those particular individuals that are funded through NDIS supports, probably about 600 and around about a thousand or so people that have other funded supports that are not NDIS. 

MS DOWSETT: And the range of services provided by Synapse include housing, direct support, personal support and support coordination. 

MR SCHICKERLING: Yes, that's correct. In an NDIS context, yes. 

MS DOWSETT: So for today's panel, I would like you to focus on   specifically on Synapse's Cairns Community Living Initiative, or CLI. And just briefly, CLI is four duplexes, so eight homes. And are they fully occupied at the moment? 

MR SCHICKERLING: They are, yes. 

MS DOWSETT: And they are sole occupancy or shared occupancy? 

MR SCHICKERLING: Sole. 

MS DOWSETT: And Synapse has provided a response to this Royal Commission. Commissioners, you have that in Bundle K at tab 1. If I could turn to you, Dr Winkler. You are the chief executive officer, founder and executive director of Summer Foundation. 

DR WINKLER: Yes. 

MS DOWSETT: And you are also a director of Summer Housing? 

DR WINKLER: That's right. 

MS DOWSETT: Summer Foundation is a not for profit research and advocacy organisation focusing on resolving issue   the issue of young people living in disability   people with disability living in aged care? 

DR WINKLER: That's right. 

MS DOWSETT: And can you tell us the size of Summer Foundation's board and how many of those are people with disability? 

DR WINKLER: Yes. Good question. So 50 per cent of the Summer Foundation board are people with disability. So I think there are eight board members, but I   yes. 

MS DOWSETT: And Summer Foundation wants to see a wider range of housing types within Specialist Disability Accommodation, SDA, and non SDA markets. And you have pioneered what we will refer to today as the 10 plus 1 model. 

DR WINKLER: Yes. 

MS DOWSETT: And just to be clear, the Summer Foundation works with SDA providers but is not an SDA provider itself? 

DR WINKLER: No. 

MS DOWSETT: And Summer Foundation has provided a response to the Royal Commission, which you have at Bundle K, tab 3, on 24 November 2022. We also have Summer Foundation's February 2023 report, Re imagining Shared Housing and Living, which is at tab 4. 

Finally, Ms Brooks, you are a board member of Summer Housing. And it was established in 2017 to replicate and scale up the 10 plus 1 model. And although there is the crossover of two directors with the Summer Foundation, Summer Housing is a separate entity. 

MS BROOKS: That's correct. 

MS DOWSETT: And can you tell us the number of people on the board and how many of those are people with disability? 

MS BROOKS: Yes. Yes, there are seven board directors. I'm a founding board director. When I was appointed as a board director for Summer Housing, I had   already had 17 years of lived experience with disability, having used a wheelchair for most of that time and then mobility aids. And I still live with a disability. I have peripheral vision loss. But my mobility is much better now. But I definitely have a lived experience and understanding of the incredible barriers to people living with disability. And there is another board director as well who uses a wheelchair and has a similar condition to me and has MS. 

MS DOWSETT: And Summer Foundation told us in its response that in the 12 month period ending November 2022, it supported 172 people with disability. 

MS BROOKS: That's Summer Housing. 

MS DOWSETT: Summer Housing. Yes. 

MS BROOKS: Yes, that's correct. 

MS DOWSETT: I want to now ask you   I will begin with you, Mr Schickerling. I want to ask you about your model, so the CLI for you, and I would like you to tell us briefly, if you can, what's different about your offering? Why is it innovative? Were you seeking to fill a gap or do something better? And can you also speak to how much co design of people with disability was involved. I know it's a big question. Just a brief overview. 

MR SCHICKERLING: I'm not so good at brief. As   before I start, first can I please pass on acknowledgment to the Traditional Owners of the country that we are on today, as well as country upon which the activities we are talking about relate. That's a really, obviously, important part of the work that we've done. And I also need to take the opportunity to say that the information and the discussion we have today is done with the consent of Elders involved in the work that we are doing. So with that said, starting with the idea of need and probably the start of co design, the initial work that we started doing with the Community Living Initiative was really based off work we had done many years ago around the issue of young people in residential aged care and uncovering, unsurprisingly, the ridiculous amount of people that were living in inappropriate settings, particularly Aboriginal and Torres Strait Islander people. 

In that case, for example, there was a number of people that had literally been living in the Cairns Base Hospital for a number of years due to not being able to go back home to their communities due to lack of services, lack of housing in Cairns, lack of service providers, all those sorts of things. So that's really where the discussion around this emerged from and starting to understand what those barriers were for Aboriginal and Torres Strait Islander people. It's at that point, 10 years prior to its commencement, the conversation started with community and with Traditional Owners about what would that look like if it was different. Why is that happening? What are the challenges? And the initial work started   started at that point. So that was 10 years prior to start. 

MS DOWSETT: So I don't mean to rush you, but we don't have time to come through the 10 years of development. So I know I asked a really broad question. I will focus it now. What's different? 

MR SCHICKERLING: So the difference is   so there's three core components to it, I guess. The first is cultural design in the built environment, a critical issue in terms of how the living spaces are created to be culturally safe. And when I say that, which you may touch on later, I talk about cultural safety not only for people receiving services but for the workforce that you expect to keep there. So that's one critical component. The second is then the capacity to deliver culturally informed support and services, which requires the leveraging of that environment, and different cultural knowledge and skills that the workforce brings. And the third is the broader understanding of service model and where it sits within community, not in terms of physical address but the connections with community. 

MS DOWSETT: Thank you. If I could turn to you, Dr Winkler, speaking on behalf of the Summer Foundation who pioneered 10 plus 1 one. So the model is about 10 apartments being peppered or sprinkled through a larger residential model with a   the plus 1, another apartment, being reserved for the service provider. So can you tell us what   what was the gap that Summer Foundation was seeking to fill in pioneering this model? 

DR WINKLER: Sure. So my background is I am an occupational therapist. So I worked for years with people with very severe brain injuries who often wanted to live on their own or with their partner or with their children but were unable to do so because of the level of support that they received. And so often people with really severe brain injury, the only model available was a predominant model, which is a group home, which doesn't really take into account that you might have a partner or children that you want to live with, or that you want to   you might acquire a disability and your goal is to get back to the same living situation (audio dropout). 

MS DOWSETT: I want to move on now to   sorry. I didn't mean to cut you off. We might have had a break in the - 

DR WINKLER: That's okay. I saw this model in Canada probably 30 years ago when Australians didn't live much in apartments, and I remember looking at the model going   thinking, that would be perfect for some of the people that I work with that want to live more independently. 

MS DOWSETT: Right. And we understand from your response, Ms Brooks, that Summer Housing has delivered 300 apartments through the 10 plus 1 model. 

MS BROOKS: Yes, I think we are up to 444 now. And there are some under construction. There was a gap due to COVID, but some are under construction now. 

MS DOWSETT: And geographically, they are in Victoria and New South Wales, or you have spread out beyond   

MS BROOKS: No. We are spread out. I think the only state and territories that we are not in now are Tasmania and the Northern Territory. But every other state and territory in Australia. 

MS DOWSETT: I want to turn now to the question of how your models fit within the funding framework and, specifically, the NDIA/NDIS framework. So, Mr Schickerling, in Synapse's response, you talk at paragraph 33 about seeking to engage with the NDIA about the funding model to be applied. Can you tell the Royal Commission why Synapse was seeking a different funding model? 

MR SCHICKERLING: Yes, absolutely. I think it goes back to my earlier response in recognising that there are very different skills and knowledge and environment that needs to be created to deliver culturally relevant support. And the traditional models and the way that they have been funded historically don't align with that. So we certainly proactively tried to engage with the agency well before transition to try and safeguard the cultural integrity of the model. Importantly, recognising for providers like Synapse, our obligation is to community who have been part of that design. So we have an obligation to not have it compromised. I would say that it doesn't particularly fit the way that the NDIA funds those environments, though. 

MS DOWSETT: And you have told us in your response that Synapse was told you have to use the SIL funding model. And you go on to say: 

The failure to allocate funds differently prevents an evaluation of the actual impact of the services delivered. 

How does the funding model affect evaluation of services? 

MR SCHICKERLING: Largely   so there's a number of aspects to that. Primarily, one of the key elements, as I said earlier, is not understanding the impact of cultural design and not understanding the impact of culturally informed support and how that's provided, who it's provided by. All has a really significant impact on the way that resources can be allocated through something like supported independent living. And so this idea of a very traditional group based approach, particularly in this environment where we have eight individual dwellings, it's not a group or a shared living arrangement, but that funding model is being applied to it regardless. 

MS DOWSETT: Thank you. Dr Winkler, in Summer Foundation's statement to the Royal Commission, you talk on page 3 about the SDA tenant outcomes research that's been undertaken. And on page 11, you provide us with the conclusion. And you say in part that: 

The way the scheme currently funds housing support and support coordination perpetuates the power of traditional group home providers at the expense of NDIS participants. 

How could the funding model be adapted or changed to address that conclusion? 

DR WINKLER: So I think we need new frameworks for funding support where people are co located. So I guess the model was set up to maximise choice and control. And so there needs to be a shared support element so that there's kind of the   you get the efficiency of people being co located. But then we also want people to be able to kind of choose to have their   choose their own support workers and support providers for one on one. 

There is   so the model has been around since 2016, and only recently has the NDIA put a line item in which really accounts for people being able to share support when they are co located. But I think that's just the first step. We need a whole kind of framework so we can kind of set   help set expectations with tenants before they move in so they can make an informed choice and understand what's the shared support element and also, you know, how the one on one support works and what the responsibilities are of the shared support provider versus the one on one provider and the SDA provider. 

So it's a new model, and I think a lot of providers and also some people within the agency just see it as a different version of a group home. But that, I guess, reverts to a kind of more institutional model where we want   I guess the whole   the point of the model was for the support provider to get to know each individual person and understand how they want to live and, therefore, when they need support. And then once they get to know everybody, then be able to look for efficiencies and see where there can be some shared support, rather than, I guess, come in with a SIL kind of framework and thinking around providing similar to a group home. 

MS DOWSETT: So if we can just dig in a little to this shared support notion. This is for unplanned supports. So I will ask you first perhaps, Ms Brooks. How does that work? What is happening in the unplanned supports? Is that a question you can address? 

MS BROOKS: I'm not exactly sure what that question refers to. Can you give me an example of what you are talking about?

MS DOWSETT: So Dr Winkler has just been describing that there is the one on one supports - 

MS BROOKS: Yes. 

MS DOWSETT:   that are provided in the model  

MS BROOKS: Yes.

MS DOWSETT:   and then there's the plus 1, the unplanned or shared support. 

MS BROOKS: Yes. 

MS DOWSETT: What   what's the value in the shared support? What are they doing? 

MS BROOKS: Absolutely. Well, in our 10 plus 1   and, of course, I will ask Di to jump in if I miss something here. But the 10 plus 1 model is a very good model when you have people living in individual apartments, so they are living by themselves in apartments peppered in a large apartment block. And the plus 1 is another apartment where we can have, and we do have, 24/7 supports. Someone living there providing 24/7 support to those people living on their own so that they feel they have the comfort and the confidence that they can   they don't have to have their one on one support worker with them, but that they are not alone, they are not isolated, that they can call on the 24/7 support worker in that   in that situation. And that's a very important part of our model. 

MS DOWSETT: And Dr Winkler was just describing that relatively new line item, the online shared support, that's now in the price guide. So residents in the 10 plus 1 model can use their NDIS funding to tap into that   the plus 1 if they need something during the day   during the 24 hours. 

MS BROOKS: Absolutely. Absolutely. At any time. At any time. That's correct. 

MS DOWSETT: Switching tack just a little bit, I wanted to explore the tenants' rights of the people who live in these models. So I will stick with you, Ms Brooks. How do the people who live in the 10 plus 1 model   what are their rights as tenants? 

MS BROOKS: Yes, that's very important. Of course, the tenancy Acts are different in each state and territory, but we have   we have had to work with variations in the law. We have agreements, tenancy agreements, with every one of our tenants. And they must be NDIS participants with an SDA package   approved package. Their rights are to work with us to modify the apartment so that it's customised to really maximise their ability to live independently, as independently as possible. So lowering bench tops, making sure that they can open blinds automatically, open doors automatically, that doors are not too heavy for them to open if they are using wheelchairs. 

All of these things are challenges and barriers that I have faced myself, and I know how difficult that can be. You know, a small step getting out on to the deck on your apartment or the porch on your apartment can be a barrier that means you can't go out there. So we work with our tenants to make sure those modifications are made and that it's really well set up and they are feeling comfortable. They have absolutely the right to choose their own support workers, and that's completely separate from us. We don't provide the support   the home care support or any other supports. That's for the tenant to choose. Now, we can assist the tenant in identifying and finding those supports, but that's   that's all within the choice and control of the tenant. 

MS DOWSETT: Just sticking with the residential tenancy agreement for now. So there's an individual agreement between Summer Housing  

MS BROOKS: Correct.

MS DOWSETT:   and each of the people that you provide an apartment for. 

MS BROOKS: Correct. That's right. Which   in Victoria, that   that tenancy agreement incorporates the SDA agreement. But in other states, that hasn't been the case, so we have had to have two agreements. 

MS DOWSETT: Right. And, Mr Schickerling, in the CLI model, what is the tenant's right there for the people occupying those accommodations? 

MR SCHICKERLING: So the same again. So we have standard tenancy agreements that are in place. Tenancy and property management are outsourced to another provider that have that agreement direct with the individual tenants. 

MS DOWSETT: So Synapse doesn't have the agreement with them. That's an outsourced provider. 

MR SCHICKERLING: Yes, that's right. 

MS DOWSETT: New topic, unfunded supports. So this is something that you have both raised in different   that, sorry, Summer Housing and Synapse have raised in their responses. I would like to understand, if I could, what the nature of those supports are. What is it that Summer Housing is doing that you describe as these unfunded supports? And have you had any conversations with the NDIA about trying to get them funded? 

MS BROOKS: Yes. Yes, that's a good point. I mean, there are some   there are some supports that we provide that I feel are completely unnecessary to have funded because there shouldn't be issues in the first place. For example, in most instances when tenants apply for an SDA package and they are NDIS participants and they are applying for an SDA package, in the first instance, that   in most instances, the application will be denied and then they have to go on to appeal. And this has been an incredibly difficult and, I think, cruel and unusual punishment for people living with disability, to know that they then have to face possibly a 12 month appeal process. 

We know that if that appeal process occurs, that almost all of the appeals are settled. So   so why put that barrier there in the first place for people who are disadvantaged   extremely disadvantaged, who are looking to improve their   looking to improve their living conditions? Why put that barrier in their way? So Summer Housing has stepped in, with the support of Summer Foundation often too, to work with our tenants to ensure that they go through the appeal process with support and that they do get a settlement that's agreeable and they do get a package to enable them to live independently. 

MS DOWSETT: So that's the kind of support that you were saying you don't think should be funded because it shouldn't happen. But what about things that once the person has their SDA funding and they are in? 

MS BROOKS: Yes. Yes.

MS DOWSETT: Is there anything there that you are providing that you think should be funded or should be done by somebody else? 

MS BROOKS: Yes. Yes. Look, I think there are ways that we could collaborate much better with the NDIA. And, you know, for example, with the 10 plus 1 model, if the NDIA provided a coordinator, one person who could work with the 10 tenants and us, to ensure that they were properly placed in their apartments, that they had the modifications done that they needed, that they got the supports that they required, that  coordination could really fast track and improve the outcomes for our tenants. We do a lot of that   what I would call   we are like curators. We are like facilitators. And it takes a huge amount of resources and time. We could really benefit from a far more collaborative approach by the NDIA. 

MS DOWSETT: Mr Schickerling, is there anything you would like to add on that topic of unfunded support, the work that is being done? 

MR SCHICKERLING: Yes. I think, importantly for us in the work we do, we would refer to what we are doing around really about enabling community, not providing housing. So they are very, very different concepts. And so there potentially is two elements to that, that issue of what is unfunded support versus what is the cost of delivering something differently. And they are not necessarily the same thing, of course. We would say certainly that we have   by way of one example, we have independent mentoring   cultural mentoring that is part of the model. The most critical part of that is that is something we provide to all people that are engaged or that are part of the work that we are doing, whether they are a tenant or an employee. Of course, we can look at how some of those things might be funded under an NDIS package. But in terms of workforce and cost of workforce, that's not something that fits the current pricing. 

There is many other things, of course, in the way that we deliver services where relationships and family relationships will be such that we have obligations to a whole range of different things for families of tenants as well as staff. They are not things that are funded for in an individual package, but the organisation cannot operate if we don't do those things. That could be as simple as someone passing away and a whole   a whole bunch of the team needing to attend Sorry Business with that family. The NDIA is not funding a team of 10 people to do that, but it's an obligation. It's not an optional extra. So I think we often come at this from the angle of saying that in the work that we do, culture leads the decision making   it's not a mainstream service response   and then we consider culture on top of that, which is generally how the system works. 

MS DOWSETT: Thank you. Dr Winkler, I want to turn to you for the final theme I'm going to address today, which is the transition out of or away from the group home model. As I said at the beginning, we do have the February 2023 report, Re imagining Shared Housing and Living, and you have set out in that report the six key recommendations from this research. And I will just read, like, the headlines, if I can: better data; funding allocation; living and design; governance models; provider capability; and collaboration. So they are areas in which you have made some recommendations based upon workshops that were held with people who currently live in group homes. I assume that it's too early to say if you have had any responses to these recommendations, it being only 17 February. 

DR WINKLER: Yes. So, look, we have some providers who are interested in working with us to kind of progress to a demonstration project, but it's very early days. 

MS DOWSETT: Are you aware of research or work that's being done in relation to the non SDA housing market? What opportunities for innovation and transition exist in that part of the sector? 

DR WINKLER: Good question. So   and on the Housing Hub that we list both SDA and non SDA, but I'm not   not aware of any innovation around   specific to disability housing in non SDA. 

MS DOWSETT: Yes. 

MS BROOKS: Can I just comment on that. As someone who has used a wheelchair and mobility aids for many, many years and had to   and continued to work full time right through that period too, I only felt like I had a disability when I faced the built environment obstacles. And until we have a building code that provides for universal access, we are always going to face the discrimination for people living with disabilities. And, you know, we are a poorer society for that too. So I think we really do need to address the building codes in all states and territories and insist on much better standards of accessibility. 

Because if people can't get out and about, how can you see people with disabilities? How can they   how can they function and be included in society? How can they be employed and work? It's a huge battle. And so these   these little experiments that we are doing with Summer Housing, our small contribution, it's just a tiny part of saying to society we have to wake up. We have to say   this society has to stop segregating people living with disabilities and include them and make for a richer society for us all. 

MS DOWSETT: Thank you very much. Thank you for coming and being on the panel today. Those are my questions for you. I will now hand you over to the Chair. 

CHAIR: Thank you very much. Commissioner McEwin? 

COMMISSIONER McEWIN: My one question is for the Summer Foundation and/or the Summer Housing, is, just briefly, when you work with property developers and with the construction   building construction industry, are you seeing positive signs that they actually do understand universal design or the point that you just raised? Do you see some breakthroughs? 

MS BROOKS: Yes, I think that's a great question. We certainly do see that they see the value in universal design   universal access in design. Would they sacrifice profit to implement universal design? I know that they wouldn't. You know, you cannot   we cannot rely as a society on commercial forces to solve social issues. And this is why we need organisations like Summer Housing, Summer Foundation, as not for profits, to lead the way. We are not dependant on profit, but we can actually enter into partnerships with the commercial sector, with our investors   hard nosed investors like Macquarie   and we can say to them, "Partner with us and we will show you the way to make for better access.” 

COMMISSIONER McEWIN: Thank you. Dr Winkler, did you want to add anything to that? 

DR WINKLER: Just I guess I'm very thankful that we've   that access to premises standards has been in for a decade. So that means that there is universal design in all the common areas of, say, apartment buildings. So I think that developers are used to that. And I think that we have worked with a lot of the kind of key major developers and, yes, they are much more kind of aware of the need for accessible design than they were. Yes. 

COMMISSIONER McEWIN: Thank you. 

CHAIR: Commissioner Bennett? 

COMMISSIONER BENNETT: I just want to ask Summer Foundation or Summer Housing, do you   in the 400 and something dwellings that you constructed, do you have any information of people that may have moved from a group home into your dwellings? 

MS BROOKS: Yes. Yes. Yes, I would love to tell you a brief story, if I could. We had a young adult, [redacted]   I mean, we have many stories. I will just give you one. A young adult who was   left home and went into a group home   his parents were very concerned about it   in Victoria. The support worker was also controlled by the landlord. So the group home and the support worker were one and the same. So he couldn't and the parents couldn't make any complaints about the deteriorating   his deterioration over a number of years because they were worried that he would lose his access to the group home if they complained about the supports. 

You know, simple things like, because of his disability, he couldn't make himself a cup of coffee or he couldn't access the fridge or because benchtops are all made   for occ health and safety requirements made for able bodied people, not for people living with disabilities. His weight declined to 39 kilograms, and he stopped speaking   completely stopped speaking. Then he   the family found Summer Housing, and [redacted] moved into one of our apartments to live independently. And in a very short space of time, he started speaking in full sentences, he put on weight again and he was so happy at being able to live an independent adult life. And they say   the parents say, "We now treat [redacted] like an adult instead of a deteriorating child.” 

COMMISSIONER BENNETT: Thank you for that insight. But do you know the numbers? Because it's been put to us that lots of people don't want to leave their group homes, and I'm just trying to get a sense. 

MS BROOKS: Yes.

COMMISSIONER BENNETT: Is that because they have never had another alternative or another experience? And so I'm trying to see if you   if that is one of your feeder cohorts, or is it mainly new generational change looking for different options? 

MS BROOKS: Yes. We have people coming into our accommodation from nursing homes, we have people coming from group homes and we have people coming from hospital and long stay hospitals. Some   sometimes we have cases of people who have been in hospital for three   you know, as you said, three years or more. So we have a combination of all. I'm not sure what the breakdown is. Maybe Di has that information. But I think   I do want to add, when people live in group homes and have been in group homes, it's a form of institutionalisation. And it really affects people, and it affects their aspiration and their willingness to risk trying something different. 

And I think for many of the carers and families and support workers of people living with disability who are in group homes as well, they are not so sure   you know, they don't live in brand new apartments. They have probably never seen inside a brand new apartment. They are also very wary about, what is this going to be like? Is the person I love going to get the supports that they need? Is this going to be something that's   are they aiming too high? 

You know, we have been giving a message to   in our community that people with disabilities are defective. They are not worthy. So when we provide excellent accommodation that's customised, people don't really feel that they should be aspiring to that. And, of course, then if they have to spend a year appealing through the SDA process, then, of course, it's a huge barrier as well. But I think there's a fundamental barrier for people, that they don't actually feel worthy of these new buildings. 

COMMISSIONER BENNETT: Dr Winkler, do you have a sense of the percentage that are coming from those congregated or segregated environments into   

DR WINKLER: I don't have it at hand, but I'm happy to provide it. I will just add to what Wendy was saying, is I think a lot of people living in group homes aren't aware that they have SDA in their plans, even if it's kind of a legacy level, and they are not aware of what the alternatives are. And so they really need patient expert and independent support to be able to explore housing options and make a choice. 

One concern I really have is that the data that the NDIA provides at the moment is largely around where people are living at the moment, and we have no visibility about where people want to live, their needs and preferences. And I am really concerned that, you know, we might build social infrastructure that we are going to be left with for the next 30 years which is kind of not based on good quality data. 

So I just think there's an urgent need for what I call demand activation, which is supporting   building the capacity of people with disability to make an informed choice about their housing options, how they receive support and then documenting that and aggregating that and making that available to the market so that we can actually build, you know, housing and new models of support that are kind of based on people's needs and preferences. 

COMMISSIONER BENNETT: Thank you. I would appreciate the figures if you have - 

MS BROOKS: Yes.

COMMISSIONER BENNETT: Thank you.

MS BROOKS: Thank you.

MR SCHICKERLING: Could I make one brief comment on that? 

CHAIR: Yes.

MR SCHICKERLING: Is that okay? I would just like to highlight, I think it's really important in the context of the work we do that we need to be quite careful as a broader system in how we refer to this notion of group homes or what might be considered congregate living. And the layering that we put over that, about if it is or isn't good, is not culturally informed. So we just need to be very careful that when we make these generalisations, that it refers not necessarily to being a culturally validated opinion. And in many cases   and we would advocate very strongly for this   in the work we do, it's actually a far more appropriate and relevant way for people to remain connected. And people often will identify with culture, not with disability. 

COMMISSIONER BENNETT: And certainly we have heard this   people from CALD backgrounds would like to live with their   I think that's a different nuance than the criteria just being the disability congregation that I was trying to make. But thank you very much for reminding me of that. 

CHAIR: Summer Housing, are all the tenants in your accommodation NDIS participants? 

MS BROOKS: Yes, they are. That's   that's a condition of us being SDA providers, that we   our tenants have an NDIS package and   or our participants, and that they have an SDA package within their   

CHAIR: What happens when they get to 65? 

MS BROOKS: I might hand that question over to Di. I hope they are still with us whether they are 65. But Di - 

DR WINKLER: Yes, it's a really good question. I understood that people would not be kind of   could continue. But I guess it kind of remains to be seen how that happens. I guess the other issue is   yes, as   like, people with disability do age prematurely. So, yes, I am not sure. 

CHAIR: I imagine that's a problem you are going to have to address at some stage. 

MS BROOKS: Yes. Yes, you are correct. 

CHAIR: Yes. This may be connected with Commissioner Bennett's questions, but do you have a breakdown of the sources of the people who come to your accommodation? Some will come from group homes, and I Commissioner Bennett asked you whether some had never been in group homes. But you mentioned also that some come from long stays in hospitals. 

MS BROOKS: They do. 

CHAIR: How would they come to you? 

MS BROOKS: Well, they   they are in hospital for a long time. A long time   I have got a few stories, but   

CHAIR: Because there is no other accommodation or because they have got a long term condition or what? 

MS BROOKS: Yes. Yes. Yes. So, you know, they may have a particularly complex   you know, one case that I can talk about is a man who had   who developed quadriplegia and required ventilation. And so his partner couldn't manage that at home, and they couldn't find anywhere where he could go. He was three years in hospital. He was only 34. And then they heard about Summer Housing. And it was by applying to   through the NDIS for NDIS support, and they are trying to see if they could manage this at home and how could it work. And the support worker told them that Summer Housing had properties and they might like to apply and apply for an SDA package. 

At that stage   we are only in   it is only recently that shared living was possible through an SDA package. So it wasn't possible when they applied two years ago, and   but they thought it was better than him staying in hospital. So they applied and he moved into a Summer Housing accommodation, but he couldn't go with his wife. And then, only recently, the SDA enabled shared living. And so his wife is now living with him, and they have got a shared villa. One of our new innovations where   we are trying some townhouses as well, some villas, where you could have shared accommodation. 

CHAIR: Thank you very much. Thank you to each of you for your contributions today. We very much appreciate the experiences you have had, and you have been prepared to share. So thank you very much. 

MS BROOKS: Thank you.

<THE WITNESSES WITHDREW

CHAIR: Ms Dowsett, shall we now take 15 minutes adjournment?

MS DOWSETT: Yes. 15 minutes is the morning tea adjournment. So we will have a quick morning tea. 

CHAIR: We will resume, then, at 11.30 or 11.32. 

<ADJOURNED 11:18 AM 

<RESUMED 11:35 AM 

CHAIR: Yes, Ms Eastman. 

MS EASTMAN: Our next witness is Tracy Mackey, the NDIS Quality and Safeguards Commissioner. 

CHAIR: Ms Mackey, thank you very much for coming to the Royal Commission to give evidence today. We appreciate your assistance and the rather detailed statement that you have provided, which we have had the opportunity to read. Has Ms Mackey taken the affirmation? No. In that case, would you be good enough to follow the instructions of my associate, who is sitting directly opposite you, and she will administer the affirmation. Thank you. 

<TRACY MACKEY AFFIRMED 

<EXAMINATION BY MS EASTMAN SC

CHAIR: Yes, Ms Eastman. 

MS EASTMAN: Thank you. Ms Mackey, I think we have introduced you on a number of occasions for the Royal Commission, and thank you for joining us. You have prepared two statements for this Public hearing, one dated 15 November 2022. Do you have a copy of that? 

MS MACKEY: Yes, I do. 

MS EASTMAN: And a second statement of 3 February this year, 2023. 

MS MACKEY: I also have that. 

MS EASTMAN: Are there any corrections to the statement? 

MS MACKEY: No, there are not. 

MS EASTMAN: And are their contents true and correct? 

MS MACKEY: Yes, they are. 

MS EASTMAN: So I want to turn initially to the recent publication of what is described by you as an Own-Motion Inquiry. That was an inquiry into seven service providers, and it involved a review of the reportable incidents notified by those service providers to examine a range of factors. Why   to start with, why did you decide to initiate this Own-Motion report? What was the reason for it? 

MS MACKEY: So this Own-Motion Inquiry was initiated by the former Commissioner and then the implementation occurred   

MS EASTMAN: Can I ask you just to slow down, please. There is no rush today. 

MS MACKEY: Sure. And then the Acting Commissioner, between Commissioner Head and I. So this Own-Motion Inquiry has taken quite a long time to come to fruition, and we have learned a lot about how to undertake an Own-Motion Inquiry as a result of that. There was a number of causes to why Commissioner Head committed to undertaking the Own-Motion Inquiry, and I believe he presented some of those at a former hearing of this Commission. 

MS EASTMAN: So can I bring it forward to the publication of the report. And if you   have you got a copy of the report with you? 

MS MACKEY: Yes. 

MS EASTMAN: Page 4 sets out the findings, and they are identified by way of dot points at the bottom of page 4 over to page 5. And I don't want to focus on all of them, but there seem to sort of be a fairly key set of themes emerging. One was the need for specific regulation of the group home setting to enhance quality and safety of those settings for people with disability. And then related to that were a range of issues: greater engagement with people living in group homes; the attitude and aptitude of the workforce; interaction of supported independent living and disability accommodation arrangements   so the SIL and the SDA arrangements   working better; a need to better understand the supported accommodation market and how people interact with it by improving collection monitoring and analysis of relevant data; and an interface with health and supported accommodation systems not being very effective for people in the setting. So those are the overarching findings of the inquiry. You also say in the preface to the report that: 

One of the key aims of the inquiry was to identify models of best practice for the delivery of supported accommodation that can inform the NDIS Commission's capacity building work with providers, and the development of relevant practice standards and quality indicators. 

So the report, are we right in understanding, brings together the findings and also seeks to identify a way forward? Is that right? 

MS MACKEY: It does. And as a part of the delivery of the report, not only do we have the core report, but we also have additional information, including that of Professor Christine Bigby who provided quite a detailed literature review around best practice with quite detailed examination of what that best practice looked like. 

MS EASTMAN: Well, her literature review, in terms of distilling what the research said   and if I put it in a slightly layperson's perspective   of what makes it good to live in a group home, in effect, was around 10 factors. But she identifies active support as a sort of key aspect of that. In terms of what you have seen across the providers who were part of this inquiry but more broadly, do you think active support is widely used across service providers? 

MS MACKEY: I would say that we still have a long way to go on the take up of active support. We can certainly see it evident in some services and in some providers, but it is one of the areas where we would like to see a lot more commitment and investment go into active support in practice. 

MS EASTMAN: That still sounds, from what you say, as a fairly soft approach to encouraging service providers to adopt active support. From what you have seen in your time as the Commissioner, do you think there needs to be a stronger approach to active support by way of a practice standard so that it becomes mandatory in the way in which service providers deliver services? 

MS MACKEY: As part of releasing the Own-Motion Inquiry report, we also at the same time as the Commission released an initial action plan. And that was very deliberate because we are very much committed to the Own-Motion Inquiry informing what we do as the regulator in the space. There are a number of, if you like, streams or groupings of actions that we are either already taking and will accelerate or advance on, as well as new actions. Some of those are around that educative or capacity building that you have just mentioned, but others are around ensuring compliance across providers of this ilk. So we are in the   at present developing up a campaign around compliance action for all SIL providers, and that's both registered and unregistered. And part of that design is looking at where we will focus our attention. So we want to be assured of what's being delivered and the real practice of what's being delivered. So we will certainly be looking at the approach that providers take. 

On the question of practice standards, we have also committed to developing a practice standard for SIL. And we don't want to pre empt where that might take us in terms of the design of that standard, because the very first step we want to take is to engage people with disability who live in supported accommodation to scope out the design of that standard. So we are still very much in the phase of implementing the report that's coming   that has just come out. I'm still in the phase of meeting with chairs, CEOs and boards about   of those seven providers. And so we are trying to move on the implementation of our action plan at the same time, but it will take us a little while to get there. 

MS EASTMAN: Do you get a sense that as service providers think about active support, that much of the focus is very much on the frontline delivery and the management of support workers and less on understanding frontline practice leadership that requires there to be very sound corporate governance structures and accountability in place in organisations? So I suppose what I'm saying is that there is two parts to this. The first part is improving the capability and the quality of work at the support worker level, but also where the back end fits in. So not the front of house but back of house, but particularly in that corporate governance leadership area. 

MS MACKEY: It was very insightful in the Own-Motion Inquiry to look quite deeply at all of the arrangements across those seven providers. And what we found across the seven was the arrangements, even in terms of, for example, governance, varied significantly. 

MS EASTMAN: Well, these are   sorry to interrupt. These are the seven large providers that, in a sense, capture perhaps the largest revenue but also a very sort of diverse service model. Is that right? 

MS MACKEY: That's right. So they were chosen very carefully as a reflection of the size, you know, the volume of people that they support, but also the differing arrangements that they had. So those characteristics are defined in the report. Each of the organisations has a number of different takeouts from the work that we've done in the Own-Motion Inquiry. 

MS EASTMAN: We have heard over the course of this week that there is interest in some areas in having uniformity of practice and standards. But when you dig a little bit deeper in terms of the way in which the service providers wish to deliver the services, their sense of their corporate or organisational culture and their wish to be able to manage things like support worker training or the disciplinary functions that might arise under the way complaints are, that they want to do it their own way. 

Have you seen any tensions in trying to give the service providers sufficient freedom and autonomy to do things their way? Like, we have even seen mission statements like The Melba Way or The Afford Way in the past. But at the same time, needing to have a coherent and uniform set of standards so that, as a regulator, you can work to enforcing standards and not try to do the sort of checks and balances around all of the different forms of complaint handling, training, administration. 

MS MACKEY: I would agree that, given the arrangements in place at the moment, it's important for us as a regulator to do two things. The first is that we continue to build the capability of the sector and invest in that capability, and the standards are a good way of reflecting what the minimum expectation is. Not where they should be aiming, but the minimum. We are at pains to point that out regularly. 

MS EASTMAN: So we are at the lowest common denominator here, and that shouldn't be what you aim for. 

MS MACKEY: That's right. So when I visit a service, I'm really interested to understand what they are doing to go beyond. So, you know, if you are meeting the practice standard, what's on your agenda about continuing to understand the feedback from those you are providing supports to? Understanding the feedback from your workforce, looking at best practice. So I'm interested in, you know, what they are doing as the next phase of evolving. 

MS EASTMAN: Are you seeing much in terms of innovation and evolving to the next phase, which I assume means ongoing continuous improvement in the delivery of quality and safe services? 

MS MACKEY: I certainly have seen examples where people are going beyond and where   you know, sometimes they are quite small things that appear very obvious but are very rare. And so   

MS EASTMAN: Can you give me an example? 

MS MACKEY: So   

MS EASTMAN: Without naming a service provider, but just what do you mean by of something of that nature? 

MS MACKEY: Sure. So I was meeting with a service provider in the last couple of weeks, and they were talking about the house rules that the participants set up, not facilitated by the workforce. It's their home, what are they seeking to achieve in that home. And they were talking about how one of the rules that   as they wanted a set of house rules. One of those rules was that all workers and all people from   who visited that weren't the residents or their families or friends had to enter the premises via the back door. 

So, you know, that was their rule. It was a very simple rule, but they were actually being guided by the people that lived in that house and, you know, treating it as their home rather than a workplace, where it's automatic that if you are the CEO, you come in the front door and you just enter that because your workforce are in there. So it can be quite simple. It can also be much more sophisticated and nuanced in terms of trying to meet particular needs of the participants in various service types. 

MS EASTMAN: So a lot of what you have to do in responding to complaints and incidents is very much focused on how a service provider might respond to a particular or isolated incident. Have you found that the exercise of using the Own-Motion power and the work that you've done for this report has given you an opportunity to do a deeper analysis as to the nature, extent and causes of violence, abuse, neglect and exploitation in   and the focus of this one was group homes. 

MS MACKEY: The Own-Motion Inquiry has given us an enormous and very helpful and insightful guide about where to prioritise our resources and how we can continue to evolve all of the functions we do. So not only complaints and RIs, but also how we continue to evolve, for example, the capability framework. So what are those practical things that we can do as the regulator, as well as how we deliver the core functions. 

MS EASTMAN: Do you feel in that respect that   and I mean no disrespect to anybody before your time   that using this Own-Motion power   and I know Mr Head started this   has really allowed the NDIS permission to evolve in showing the broader community, service providers and people with disability how you are going to approach your work? Given   do you think it's given a greater sense of transparency in how you do what you do? 

MS MACKEY: I think on this particular one it has, but one of the reasons it's been able to do that is we've had a number of years of data to be able to draw on, which would have been very difficult to do much earlier in the life of the Commission. It is   and I believe I expressed this when I was here last time. It is a commitment that I have, and the executive team have at the Commission, to continue to use the Own-Motion Inquiry power. We publicly announced another Own-Motion Inquiry. 

MS EASTMAN: I'm just about to ask you about that one. 

MS MACKEY: Yes. 

MS EASTMAN: So you very recently, I think earlier this week perhaps, announced an Own-Motion Inquiry into platform providers operating in the NDIS market. And I don't know if you have been present today or in the room where we have had some evidence from at least two organisations that do that. The Terms of Reference indicate that   just tell me if I'm right in this, that the purpose of this is to get a better understanding in the way in which platform providers work and their operations, but it's also a recognition that people with disability can and should, to the greatest extent possible, determine how services are best delivered to meet their needs and who should be delivering them. So that's from the Terms of Reference. 

MS MACKEY: So that's a reflection of   it is pleasing to see that one part of the market is changing. So the establishment of platform providers has given rise to additional choice for quite a large number of NDIS participants. What we are seeing is as more and more people choose to go down that path, we want to make sure that all of the core functions of the Commission are able to be flexible and agile enough to respond to those differing service delivery arrangements. 

MS EASTMAN: Well, part of this Own-Motion Inquiry also give consideration to the extent to which the use of platform providers is contributing to the fragmentation of the way in which services are delivered and the impact on the way in which the disability support worker workforce is operating. Will you be looking at that? 

MS MACKEY: That may be something that comes out of the inquiry. We are just   obviously having announced it on Monday, we are in the very early stages. So I'm not at liberty to talk about, you know, where we are heading to. Certainly issues of workforce are raised with us through our complaints process, and we will make sure that we cover off any trends that we are seeing and look into those issues. But it would be way too early for me to suggest where we might go to in terms of outlining those particular ones. 

MS EASTMAN: I just want to touch on a few topics that have arisen during the course of this week and many which you have addressed in the statement, and the first one is the registration of service providers. So you set out at paragraph 12 in your statement the   which statement? I think it's the November statement. In the November statement, the criteria for registration and the registration process. At the present time, you as a regulator are in an interesting role where you have registered providers and unregistered providers. 

And depending on the particular requirements that mean somebody has to operate their business as a registered provider, it's, in effect, voluntary as to whether or not providers will register. One of the issues that has been raised during the course of this week is whether or not this should be uniform and that all service providers should be registered. There have been some suggestions that there could be tiers of registration, so a registration light approach. But do you have a view that all service providers should be registered, particularly from a regulator's perspective? 

MS MACKEY: So fairly early on in my tenure, registration was   it was obvious to me that that was one of the key issues from a participant point of view, as well as from a provider point of view. And I did hold a roundtable to discuss a whole range of issues around registration. And we have made public a discussion starter paper for that, as well as a write up of the issues that were canvassed at that roundtable. I understand that many people want to go to everything's registered or not registered, but I believe there are quite a number of issues that need to be unpacked and that it's not as simple as doing a "yes" or "no" answer. And, you know, there are a range of examples that you can think about. So one would be around allied health. Many allied health professionals, not all, are registered by another regulator. But looking at how you can draw on that regulation. Similarly in early childhood, many   early intervention services are also registered around early childhood regulators. 

So looking at some of those duplicative arrangements and how you can link into some of those. And then thinking about not distorting the market. So if somebody wants to choose a local service provider to do their lawns, you want to be able to have them choose someone from the community. And, in fact, that goes to the heart of the NDIS, which was, you know, giving people choice in their own community, to remain connected to their own community. So we don't want to preclude a range of service provision. Having said all of that, there are also currently   I wouldn't quite characterise the current arrangements as voluntary. I understand why that   why it might appear that way. 

MS EASTMAN: Let me put it that it is a perception that it's a voluntary thing . 

MS MACKEY: Yes. But there are currently criteria around who is required for certain service types and then also in terms of the way in which the plan funds are managed. So there are currently arrangements around that, and part of what we explored as doing the registration work was whether or not those settings are right. So have we taken, for example, a risk based approach? Which   when these arrangements were put in place, there was no history to draw on in terms of complaints and reportable incidents. Now there is, and I think that would be useful in looking at the definitions of who may or may not need to be registered. We have certainly provided all of the information and the work that we've done around registration to the NDIS Review, and I anticipate that they will look closely and deeply at these issues. 

MS EASTMAN: You have touched on the fact that there are other regulators in the area, and you have addressed this at paragraphs 38 and 39 of the November statement. And it highlights some complexity that depending on who registers as a service provider for NDIS purposes may have implication around the various regulatory arrangements that arise in relation to charities, corporations law, fair work laws, work health and safety laws and then all of the national health regulation as well. 

We asked some questions of the service providers this week about how they manage it in terms of the various regulatory arrangements around them, and we focused mostly only on the national or the Commonwealth regimes. For the most part, the large service providers said that they were managing those different regulatory requirements. We didn't have the opportunity of asking, for example, a sole trader who might employ one or two people to assist them to do their work. Have you seen any issues arise that create additional burdens or the red tape for the smaller providers or the sole traders? 

MS MACKEY: I think we have certainly been made aware through some of the peak bodies and also directly from some service providers of varying scale   I wouldn't say it's inclusive to the sole operators or the smaller ones   about the challenges they see around what they might call regulatory burden or duplication. And, in fact, one of the   one of the things that's been on my mind to progress   and I'm happy to make the commitment that we will do it this year   is I want to do a much more expansive review of where that duplication and where that burden sits. Because when we get asked for examples, often it relates to the systems. 

So we have got   you know, we would be the first to acknowledge that our system is not necessarily user friendly, and the ability of our system to connect to systems that providers have, or use is non existent. So if some of those things play out, then that will help inform what we do in terms of further investment around data and digital. But it will also then illuminate where there are particular opportunities. I think, you know, there are already plans in place to try and address some of the things in advance. So, for example, the aged care legislation around worker screening is mirroring the work that   the arrangements that we have in the NDIS space, and they are using the same arrangements so that it makes it easier to be able to sit across both of those sectors. 

MS EASTMAN: Is that   will that work involve working, for example, with the Small Business Commissioner and look at the way in which small businesses operate? 

MS MACKEY: I would certainly be open to engaging with the Small Business Commissioner. 

MS EASTMAN: The next registration topic is support workers, and we had the opportunity to hear from Dan Stubbs in terms of the Victorian model. And you may be aware that we have asked service providers during the course of this week about their workers, the qualifications required, the interaction with the NDIS Capability Framework and NDIS screening. And so the issue is, is there an appetite to move from just a Victorian model but to replicate a model of that kind to operate on a national basis? And do you think that there would be value in having a national registration scheme for support workers to enhance that regulatory arrangements to achieve quality and safety for people with disability receiving services in the NDIS? 

MS MACKEY: I have been hearing   or listening to some of the hearing this week about this particular issue. As you suggest, I believe the Commission is quite well placed given that we are responsible for worker screening and we have the Capability Framework. What we often hear from workers is that they would love some kind of portal where they could, you know, see the training and development that they have done and just be able to build on it over time. So having some kind of central repository around even that element appears to be very attractive for workers in this sector. 

If the government was to want to implement worker registration of some kind, certainly the Commission would be supportive of that being a national approach. I have   we do work quite closely with the Victorian scheme. We have noted that it's difficult for workers in Victoria given the overlap of arrangements and understanding where they need to go for what. So that the easier we can make it for disability support workers to engage in the space, I think the better. And lastly, I would say we would need to do quite a lot of work on defining who is a disability support worker. We often use it quite generically, but really understanding, you know, who are we targeting around this particular type of initiative. 

CHAIR: Sorry. May I ask some questions? That's an important point. I take your point about the person who wants to have someone come and mow the lawns. I don't suppose we are terribly interested in that situation as to whether the person has a particular certificate, as long as they know how to operate a lawn mower. But if we are talking about personal care for people who are on the NDIS, that's a rather different thing. The concept of choice and control is obviously very attractive, and it's the foundation of the NDIS. It reminds me, in some ways, of the principles underlying freedom of contract that operated under the common law of the 19th century. 

It assumes an awful lot about the capacity of people, not just people with disability but the capacity of people to make decisions in their own interests. And that's because of the difficulties associated with freedom of contract. That's why we now have Unfair Contracts Act. We have rules against misrepresentation. We have principles relating to the unconscionability of agreements. And I just wonder whether choice and control, insofar as it allows an unregulated market of service providers for personal care, is running some of the risks that materialise with the theory of freedom of contract over 150 years ago. Do you see the point? 

MS MACKEY: Absolutely. And I think probably the next place I would have gone was the choice and control issue. So we know that there's a tension between choice and control and regulation for people. You know, many NDIS participants fought very hard for the NDIS to be very much in their patch to be able to make these choices. And I'm certainly aware and have spoken with participants who make choices about their   the disability support workers they have that are doing that personal care that you reference and have chosen not to have people who necessarily have qualifications and they choose not to, for example, use worker screening. 

Now, they are very difficult, I think, issues for us to begin to unpack, and that's why I think part of what we need to do is really think about who we are talking about in that disability worker space. I think we have now got with the Commission   you know, more than four years in, we have got a lot of data that we can mine to actually help us understand where risk lays, where there are some thresholds around safeguarding and where it might be important for people as a consumer   because really we are talking about their right as a consumer to make a choice. But we all make choices as consumers every day around a whole different range of sectors, and we equally make some assumptions about the protections that sit for us as a consumer. So I think that's possibly where we need to take that conversation around, well, what's the expectation without impinging on that choice and how do we do it in a way that's respectful and ensures the rights of the person with a disability front and centre. 

CHAIR: Thank you. Yes, Ms Eastman. 

MS EASTMAN: I will just finish my questions in relation to the registration of support workers. So if there was a national registration scheme and a regulator in relation to support workers, would that sit, do you think, well with the NDIS Commission or does it need a different body? 

MS MACKEY: Certainly that would be a decision for government. As I've mentioned, I think the Commission would be well placed given we do worker screening, and we have the capability framework. And what we hear again and again from participants, from workers and providers is that we need to try and make this really complex system as simple as possible for people to engage with. So what I do know is in jurisdictions where there are multiple regulators that have overlapping responsibilities to the Commission, that's where we get the most feedback about how difficult it is for them to understand who they go to for what. So if we can take that out of the equation, I think that would be very helpful. 

MS EASTMAN: What would be the cost consequences to the scheme if there was a national registration scheme for support workers? Would that be something that would need to be carefully considered before any recommendations would be made? 

MS MACKEY: Absolutely. 

MS EASTMAN: And so that would be doing some modelling in relation to the impact of the cost if the NDIS Commission was to become the regulator of support workers through a registration process. 

MS MACKEY: Regardless of whether it was the Commission or any other agency, there would need to be detailed work done on the arrangements and the resourcing required and the impact in terms of costs to participants. 

MS EASTMAN: Can I put it this way: if, for example, there was to be a national registration for support workers to sit within the NDIS Commission without any additional funding or resources to meet such a scheme and the administration of that scheme, that that would have some serious viability issues? 

MS MACKEY: We would have to take decisions about what core functions we, you know, either reduced or ceased to be able to take on an additional significant core function of that ilk. 

MS EASTMAN: Well, on the topic of your work on complaints, at paragraph 97 of your statement, you say that: 

The NDIS's Commission current complaint handling processes and systems are unable to deal with the volume of complaints that it receives. 

That statement, I think, is a fairly significant perhaps admission as to the NDIS struggling to meet the demands in responding to complaints. Is that right? 

MS MACKEY: That's correct. So the Commission was provided funding when we were established. As we know, over that time, the number of participants has increased beyond what was forecast. The Commission is not a demand based funding model, so therefore our capacity to deliver against how we are funded is quite challenging and we   I continue to work with government on that. 

MS EASTMAN: Well, it seems just from hearing the evidence this week is that the approach to what might constitute a complaint or a reportable incident to the NDIS Commission is when in doubt, just make the notification, and that rather than the Commission being a place of last resort or the place where there is no other avenue for addressing the incidents and complaints, that they are coming to your Commission. Is that what   is that the reason that you are seeing such an increase and being unable to meet and deal with the volume of complaints? 

MS MACKEY: So we have seen an increase in complaints, as I've mentioned, because we've got a larger number or population of people who are NDIS participants. We have also seen the diversification of the market. We have also seen quite a number of reviews occur across the NDIS. I believe, when I started, it was somewhere around 18 in number. And we have also had, for example, the likes of the Royal Commission. All of those are giving us information and seeking for us to respond in an increasing way. And so when there hasn't been that increase, that is when the challenges arose. 

At the same time, we have seen the maturity of the market around regulation. So if we just look, for example, at reportable incidents, we now have more reportable incidents from more providers, and that's because people are beginning to understand the requirements and are much more compliant around reporting what they need to. We are also getting   well, streamlining, as much as we can, all of our arrangements around things like reportable incidents. So we've done a major review. And as part of doing that, we look at trends. So we can tell if a provider is overreporting or underreporting given their size and scope of activities that they undertake. So we do very much engage with them. So I wouldn't necessarily say that it's because there is a lot of overreporting that that's where the challenge is arising from. 

MS EASTMAN: With respect to complaints, is one way to address the issues that   or the burdens that arise for the Commission is that the providers themselves have more robust and effective complaint handling systems that operate at a local level? 

MS MACKEY: We certainly know from our complaints team, which has undertaken a significant reform process over the last six months or so, that a very significant proportion of the resolutions to complaints is that we basically facilitate communication between the provider and the participant or the provider and their family. So we   

MS EASTMAN: Should that really be your function? 

MS MACKEY: Look, it should if people are not comfortable or feeling like they don't have the ability to raise issues directly with the provider. But it also tells us that we have got more to do around building that capability of providers to give people an opportunity to raise things that might not   you know, when we say "complaints", it can be anything from something very significant and severe to actually people wanting to express a preference and not having an opportunity to do that. So we need to find ways in which we can build the capability of providers to offer those opportunities, not just in their complaint handling processes but also in the way they engage with everyone they support. 

MS EASTMAN: Should the overall objective here be, yes, we encourage people to make complaints so that there's a culture of raising concerns or issues as you need? 

MS MACKEY: Absolutely. 

MS EASTMAN: But essentially, it's not building very elaborate pathways to   and processes in relation to those complaints; it's really about using the complaints that are coming to identify what could be done at a preventive level and keep that focus on prevention, rather than build very elaborate complaint handling systems with elaborate investigative teams and elaborate processes for investigating and elaborate report writing. And we have seen that the investigation process sort of takes over what the sort of primary purpose of the complaint might be. Is that a concern that you have seen and, if so, what do you think service providers might like to turn their minds to in relation to their complaint handling systems? 

MS MACKEY: So I think the Own-Motion Inquiry for us really bore out some of those issues. So of the seven providers, we saw some with more mature and, you know, really person centred arrangements around complaints, and we saw others that certainly had room to improve. For those that have those processes that we thought were more fit for purpose, they were around doing two things with every complaint: one, resolving the complaint as quickly as possible, with the person front and centre in mind, not with the organisation's risk in mind; and, second of all, that their   you know, using the data that they gather from complaints to inform the way they deliver services, the way they engage with participants, the way they develop policies. So they have got those two pronged things always occurring. 

MS EASTMAN: One follow up question from our discussion at PH26, which was the homelessness hearing, is I asked you on that occasion whether or not you had turned your mind to whether the powers in the Act would empower you to order a provider to make redress in certain circumstances. And my recollection is you said that you were getting some advice and considering that. Can you give me an update on where you are on the question of redress? 

MS MACKEY: I can. So I'm pleased that as we've been doing the work around improving the way we handle complaints and we respond to complaints, that it is now very much a feature in the way in which we are working to resolution of complaints, that if a participant or the complainant, for example, would like an apology, would like a refund, would like services reinstated, whatever that might be, that that is absolutely part of the process that is considered. And so that's become sort of part of the way we work in that space. 

The other thing that we are pursuing is I have asked my new general counsel to look at the use of enforceable undertakings. It's not a tool that the Commission has yet used, yet we have the ability to put in place enforceable undertakings. It is certainly my experience in previous regulator roles that they can be incredibly effective, including making sure that there is the right arrangements around reflecting the impact that has occurred, as well as preparing for future arrangements of the same ilk. So we are currently working in that space as well. 

MS EASTMAN: The next topic is community visitors, and you have addressed this in the statement at paragraph 222 and following. And at paragraph 224, you say that you support a national community visitor scheme that sits within the Commission, but you say that ultimately this is a question for the Australian Government, which I think reflects Mr Head's evidence at Public hearing 14, from my recollection. 

MS MACKEY: That's correct. 

MS EASTMAN: Some jurisdictions at a state level have community visitor schemes that have been operating over a long period of time. One feature of those community visitor schemes is that they are not limited to NDIS participants and that they may capture a sort of broader area in terms of people with disability. What, in your view, needs to be considered in moving to a national scheme, first, and then, second, how do you ensure that a move to the national scheme that would have predominantly a focus on NDIS participants addresses the circumstances of other people with disability who are not participants who may well benefit from community visitors in relation to their engagement in their particular settings or with particular individuals? Have you thought through that? 

MS MACKEY: We have done some limited work in the space, and Commissioner Head certainly commenced that work during his time at the Commission. In developing up things like our regulatory strategy over the last 12 months and thinking about how we continue to evolve, particularly as we want to think about putting the rights of people with disability front and centre in our decision making and informing even our approach to what we do, it's clear to me that one of the elements that is not as strong as in other regulatory systems is the ability to monitor. So the way in which we monitor is a proxy through complaints and RIs, rather than a program of monitoring. That would often be a significant element of that   you know, other regulatory systems. By doing monitoring, you could certainly look at and engage with   undertake a version of a visitor scheme or outreach, and there's a range of other terms people are using in that space. 

I do think, having had engagement with community visitors arrangements across the states and territories that do have those arrangements, that it would be helpful for participants and for stakeholders, you know, advocates and disability representative organisations, to have a nationally consistent approach in this space. Hence why we have held the view that it would be helpful for the Commission to step into that space. I fully acknowledge that there are a range of schemes that have been around for a very long time. I would say that they have differing levels of ability to able to fulfil what we would view as a monitoring arrangement and, indeed, there are attributes of some of those schemes that seem to work better than others. 

MS EASTMAN: Do you think if there was a national community visitor scheme that a piece that would work well with community visitors is also a clear national approach to supporting and funding advocates? And I don't know if you heard the evidence earlier this week, on Monday, from the advocates about the great demands for advocacy services and those demands not being met. 

MS MACKEY: I didn't hear the evidence on Monday, but I was given some briefing from the team about it. And advocates have   I've certainly been in a number of forums where advocates have raised issues. We had an advocacy forum in November last year with more than 200 advocates. And despite us not being the funder for advocacy, we are certainly conscious of the significant role that advocates can play. We work closely with our colleagues in the Department of Social Services around what those requirements are. And indeed, at present, I'm talking to a particular advocacy organisation because we found there are some niches that are just not covered for or provided for at the moment, where we can see would be incredibly helpful for those supports to be in place. 

MS EASTMAN: Coming back to the questions that I asked you about complaints and the overwhelming number of complaints, would you agree that effective advocacy and support for people with disability with an advocate could well be something that might minimise the number of complaints that then have to make their way to your Commission and, if so, would that not be a very significant investment by government in terms of managing the number of complaints? 

MS MACKEY: That is possibly the case. But not having particularly looked at the numbers in that way, I would be hesitant to say it is. 

MS EASTMAN: Do you know in government whether there has been any modelling in looking at what might be the investment in advocacy to assist people use the NDIS, assist people in the resolution of complaints and concerns? Do you know if there's been any modelling in looking at the effectiveness of good advocacy into the scheme? 

MS MACKEY: I don't know if I would describe it as modelling, but I'm certainly aware of work that has been occurring. And our colleagues in DSS are   

MS EASTMAN: So that's the DSS work that's happening. 

MS MACKEY: It's a DSS - 

MS EASTMAN: Okay. Now, I want to ask you one question about restrictive practices. And the data provided to the Royal Commission has indicated a significant increase in the use of authorised restrictive practices between 20 21 and then 21 22. So just if I give you the raw numbers   you might want to have this in front of you   is in terms of the total numbers of the use of restrictive practices in the period July 2020 to 30 June 2021, there was 3,677,132 restrictive practices recorded in your data. For the following financial year, it's 5,579,139 practices recorded. 

Over those years, there is also an increase in the number of participants recorded in the order of about 1,400. I've just rounded that up. So assuming that there has been an increase in participants, but the number is between   again, I will round up   around three and a half million up to five and a half million use of restrictive practices   and these are authorised restrictive practices   can you give the Royal Commission any sense as to why this is occurring and what are the reasons for the increase? 

MS MACKEY: Can I just check the document that has those figures? I have written the figures down, but I just want to make sure   

MS EASTMAN: So it's in response to an NTG, but I don't have the number of the NTG. Is it the February one? I will turn that up for you. I'm just got the raw numbers. 

MS MACKEY: Okay.

CHAIR: You said the increase in number of participants recorded was in the order of 1,400. That doesn't sound right. 

MS EASTMAN: This is actually in your statement. Sorry.

MS MACKEY: Okay.

MS EASTMAN: It's given the number without that reference. So if you turn to your statement from February. 

MS MACKEY: February. Yes. 

MS EASTMAN: Sorry about that. It's at page 40. 

MS MACKEY: 136?

MS EASTMAN: Yes. 

MS MACKEY: Yes. Okay. 

MS EASTMAN: And it's the chart that accompanies paragraph 135. So it's the top of the page on page 40. 

MS MACKEY: Okay.

MS EASTMAN: So the question is, can you give us an explanation for that, what seems to be a significant rise? 

MS MACKEY: So during the period of time between 2020 and 2022, we saw the full transition of states and territories to come under the arrangements that the Commission has. So there's a growth in participant numbers in real terms and, therefore, the number of people that will be subject to restrictive practices as part of a behaviour support plan. At the same time, we also know that we have an increased number of plans being lodged with the Commission. So we have got visibility of these figures. We also know that we've got a much higher level of compliance from providers around reporting these arrangements, which we don't have early on. So it takes some time even when states transition. So we are still working, for example, with providers in Western Australia who seem to be lagging with the reporting around a range of things, including restrictive practices. 

So these increase in numbers, although quite significant, as you point out, are not necessarily related to an increase in use; rather, an increase in number of participants and increase in the reporting of those. And having said that, I don't at all want to down play the significant issue that we have across this country around the use of restrictive practices, whether authorised or unauthorised. We are doing a range of things to try and reduce that number. And certainly in all of my conversations with other government agencies and state and territory governments is around how we work together to reduce these restrictive practices. 

MS EASTMAN: So my last question is really to give you an opportunity, if you wish, to respond to what a number of service providers have said over the course of this week, and that is that they would like to see more guidance material from the NDIS Commission on best practice, on how certain aspects of their management of their workforce might be addressed and also the suggestion that there needs to be some central repository. We did hear from Ms Leigh and the work that NDS is doing for its members. Some of that material NDS is doing is free and publicly available, but others it's available to members only. 

Do you have a view as to whether the QSC becomes akin to a centre of excellence in building a repository of best practice material and guidance material and, in effect, that will be building on the work that you've done with Professor Bigby in terms of the active support and her review? So I just   you may not be able to answer that, but I got a strong sense that there was the service providers looking to the QSC as, "This is the place that should give us all of the information and the answers and guidance on what we should do.” Do you have a view about the role of the QSC in that? 

MS MACKEY: So I think there is an opportunity for the Commission to play a role in identifying and sharing good practice, not to the point where we are templating what needs to happen. Because if we do that, we are not respecting the fact that there are around 580,000 NDIS participants, all of whom have different rights, different choices that they make. So in stepping into the space, one of the things that we are about to kick off later this month is we are going to do a very regular update around good practice. We've got a couple of ideas for the first edition. We are going to be very sharp and sharp, and we are sharing that with everyone that we have communication with. 

We have also already got an enormous amount of information on our website, which we did upgrade last year to make it easier to navigate. So not only is there is the Capability Framework, but even in the Capability Framework there are lots of additional resources around research, around good practice and examples of good practice. And equally, in our behaviour support space, there's an enormous volume of resources. 

We also have the opportunity to fund grants. We have done quite a few with NDS, as you mentioned. They are usually the free resources that are provided. So, for example, we have done grants around supported decision making. So when we do those grants, it is our expectation that they will be provided free of charge to the sector or to participants, to whoever it is they are targeted at. We do recognise that in now doing that grant process for a number of years, we probably need to be the repository of that information. So we tried to look at the arrangements in place initially by letting a range of the grantees provide it separately, but we now know we need to also provide that ourselves. 

MS EASTMAN: If you did that, does that also provide a real opportunity for developing co design and inclusive design and bringing people with disability in to work on those standards and guidelines so that very much comes from the perspective of the people receiving services, rather than what the organisations or providers need to do to make sure that they limit their risk or limit their exposure to liability? Would there be an opportunity in the way in which you would do that that brings the voice of people with disability in but also engages and builds the capability within the disability sector that people have those opportunities? 

MS MACKEY: It would absolutely be my expectation if   as we do more and more in this space, that it's clear that we are engaging with and responding to what participants are telling us and asking us and requiring in terms of the services and supports they receive. 

MS EASTMAN: Right. Ms Mackey, thank you. I feel like I have done a rapid fire at you of about 10 different topics, but I'm grateful for your evidence today. Thank you. 

CHAIR: Commissioner McEwin, do you have any questions? 

COMMISSIONER McEWIN: One question. Thank you, Ms Mackey. In relation to the question Ms Eastman asked about advocacy support, do you agree with the proposition that advocacy support is important for disabled people, particularly those who may not have family or informal support and that that support should be adequately or appropriately funded? 

MS MACKEY: So certainly advocates play a key role for many participants, and sometimes they are of the cohort that you have just mentioned and other times they can have quite different characteristics. So we certainly value   and that's why we do the   the advocacy forum and do quite a lot of work with advocates throughout the year. 

COMMISSIONER McEWIN: Thank you. 

CHAIR: Commissioner Bennett?

COMMISSIONER BENNETT: Thank you but no thank you. 

CHAIR: Can you help interpret that chart on page 40 of your February statement. It refers to   if you look at the column in the first chart following photograph 135 on the right hand side, the number of participants is 8,242 and occasions of use 5.3 million. Does that imply that for each participant there was an average of six or seven hundred per annum? 

MS MACKEY: So for some participants, for example, with the use of chemical restrictive practices, there might be three or more uses of a chemical restraint each day. So the volume of restrictive practices can be very significant for one individual. What we do find   and we've done some targeted work around restrictive practices where we have looked at those participants that are subject to the most regularised restrictive practices. 

CHAIR: Yes.

MS MACKEY: We looked at the   it's called the group of 200, and we have worked our way through that group. We are now working through the next group. So there are   there is significant use of restrictive practice across Australia. 

CHAIR: Yes. We can see that in the next table where we see that the chemical restraint in 2021 to 2022, there were 5,430 participants and nearly three million occasions of a use, which rather suggests between 500 and 600 per person. 

MS MACKEY: That's right. 

CHAIR: But then when we go down to the next one, we see that mechanical restraint, 1,266 and 279,000. So that rather suggests something like 230 uses of mechanical restraint per person per annum. What's a mechanical restraint that gets into that column? 

MS MACKEY: So our senior practitioner is probably best placed, and I believe he's provided quite detailed information to the Commission, and I'm happy to. 

CHAIR: We have probably had the information previously  

MS MACKEY: Yes.

CHAIR:   but it just struck me looking at the table. 

MS MACKEY: Yes. When you look at all of them, they are quite stark. And, unfortunately, what we also find is the same participant is likely to be subject to multiple restraints very regularised. But we do have a table that's quite easy to understand that talks about each of the different types of practices and examples of those which might be quite helpful. 

CHAIR: Thank you. I'm in favour of simple tables. Thank you very much for your assistance. We very much appreciate it. And the very detailed information, again, that you have given and that we have received in the past from the NDIS Commission. So thank you very much. 

<THE WITNESS WITHDREW

CHAIR: Ms Eastman, shall we resume at 1.30?

MS EASTMAN: Yes. Thank you. 

<ADJOURNED 12:37 PM 

<RESUMED 1:35 PM

CHAIR: Yes, Ms Eastman. 

MS EASTMAN: Our final witness for this hearing is Gerrie Mitra, and she is the General Manager, Provider and Market Development at the NDIA. I think you need to do your oath or affirmation. Is that right? 

MS MITRA: That's right, yes. 

CHAIR: Ms Mitra, thank you very much for coming to the Royal Commission again to give evidence, I think. We appreciate your assistance. If you would be good enough to follow the instructions of my Associate, who is seated opposite you, she will administer the affirmation. Thank you. 

<GERRIE MITRA, AFFIRMED 

CHAIR: Ms Eastman will now ask you some questions. 

<EXAMINATION BY MS EASTMAN

MS EASTMAN: So good afternoon, Ms Mitra. Thank you for joining us. You have prepared a statement for this Public hearing dated 19 December. You have a copy with you? 

MS MITRA: I do. 

MS EASTMAN: And you have provided us with corrigendum, and that is dated 14 February. And there are some amendments to paragraph 17 and also just replacing a typographical error in paragraph 134. Is that right? 

MS MITRA: That's correct, yes. 

MS EASTMAN: And other than those amendments, the contents of your statement are true? 

MS MITRA: Yes, that's right. 

MS EASTMAN: And I understand that you have been following some but perhaps not all of this Public hearing. Is that right? 

MS MITRA: Yes, that's correct. 

MS EASTMAN: So I want to ask you a few questions arising from your statement but reflecting what the Royal Commission has heard over the course of the week. The first issue is the growth of the workforce. When the NDIA   sorry, NDIS commenced, there was an expectation that there would need to be a significant growth in the workforce to support people with disability as we move to the models of support under the NDIS. To what extent has the NDIA done ongoing research and modelling to think about the workforce demands into the future? 

MS MITRA: The NDIA works closely with DSS, who has been responsible for developing the workforce strategy for the care sector and in particular for the disability workforce. So we have worked alongside DSS to understand some of the modelling. They have led mostly, though, in that work. 

MS EASTMAN: So does it remain the case that even at this stage of the life of the NDIS and the establishment of the NDIA, that for the most part the policy work concerning the NDIS remains with the department or DSS? Is that right? 

MS MITRA: That's correct, particularly for workforce. Yes. 

MS EASTMAN: I want to turn to another issue which was raised towards the beginning of the week, and that was the issues concerning the disability workforce and what work is funded and what work is not funded. So I don't know whether you heard Ms Riddell's evidence at all? 

MS MITRA: I only heard part of that. 

MS EASTMAN: So she told the Royal Commission that support workers don't get any funding for non direct care hours. And she said: 

When the NDIS prepare the roster of care, only supervisors get admin hours, and all workers are funded for the hours precisely from when the residents are awake, at home or needing support. 

And she said: 

If the person with disability does not need direct support in those hours or are away from their home, then the support workers don't get funded for the hours. 

And she said: 

This means that you have to choose between the administration work that you have to do and the requirements of your job when the resident is there. 

So she made that observation about being able to perform the duties that include administrative requirements and administrative work, but the implications in terms of being funding. So she addressed that. That's page 106 from line 18 in the transcript and in her statement at paragraph 28 and 29. Now, Mr McFarland also, in his statement at paragraph 17 and 35, said that: 

The NDIS Cost Model and pricing cap is based on award minimum pay and conditions, and that there was funding only up to the cap identified in the award. The combination of these two things meant that there is a very tight arrangement that needs to be made in the way in which support workers do their job. 

Now, am I right in understanding, looking at your statement, if you turn to   starting at paragraph 14. And then when we get to paragraph 19, you say: 

For the time spent on general training and upskilling of staff, as well as administrative activities, the NDIS price limits include an allowance for overheads of these items. 

But you say: 

As such, they would not be deemed claimable under the current settings. 

So I just want to understand, based on what you say in the statement, is to what extent is the administrative work, the form fillings required of support workers, the documentation in relation to what the activities might have been for somebody during the course of the day   is that work unfunded from the NDIS perspective? 

MS MITRA: So in short, no, it's not unfunded. And there's probably two points that might help to clarify that, if that's helpful. The first is that the price limits are a fully loaded hourly rate. So they are not based on the minimum wage of the SCHADS Award; they are actually based on   and I've got this in one of my attachments, which is the Disability Support Cost Worker Model. So you do have all of this for you. But they assume the SCHADS classification of 2.3, so not at the bottom. 

MS EASTMAN: But   just only at 2.3, but not above that? 

MS MITRA: So that's an average. So we pay   the hourly rate that we   or the price limit for the hourly rate is the same for everything. So we are not   

MS EASTMAN: Regardless of whether somebody is in a casual position, part time or full time? 

MS MITRA: No. No, no. All of the loadings for casual and all of the loadings for different shifts at different times of the day are included. But I think what's probably important to understand in terms of the overhead component is that   so if you take, for example, the lowest hourly rate, $32.36, that a worker at that level would be paid, and then you add on all of the things that are required to be paid under the award for leave and other things, takes us up to $43.86. And our price limit is actually $62.17, which includes 26 per cent   I'm sorry, 21.6 per cent for operational overheads. So for every hour worked, another $9 is paid to the provider for operational overheads. And then there is another amount of 12 per cent for corporate overheads and another two per cent for margin. 

MS EASTMAN: Alright. And in terms of what then seems to be the disparity in what you've described and the experience of the unions through its members and for Ms Riddell's experience, is   how do you account for that? What do you think is going on? 

MS MITRA: It's a good question, because I think the other   I think perhaps understanding what we are paying for, we are expecting that a provider who is operating efficiently is employing a qualified worker or somebody who is capable of doing the job   a competent worker is probably a better way of putting it   

MS EASTMAN: Okay. So pause there. 

MS MITRA: Yes.

MS EASTMAN: So I know you are in mid sentence, but what do you mean? Do you mean, by qualified or competent, somebody with a particular qualification or Cert III? 

MS MITRA: No. No, that they are capable of operating at that level, providing the appropriate work. 

MS EASTMAN: And for capable, do you expect that somebody would have the skills to meet the NDIS capability worker frameworks?

MS MITRA: They would have the skills to be able to perform the job that the participant is buying for their support. 

MS EASTMAN: And to have that capability, do you accept that they would need training to develop those capabilities? 

MS MITRA: So we think that the amount that the funding model allows for is enough for them to maintain their skills. 

MS EASTMAN: On what basis do you say, "We think that's enough"? 

MS MITRA: Based on the work we have done with   well   so based on the work that we've done assessing and understanding the kinds of operational and corporate overheads that organisations pay. So we pay   we do pay the base amount that   you know, what the award requires a provider to pay their worker. And then on top of that, we have loaded the hourly price limits so that people   the organisations have enough to pay for their operational overheads, which includes training and maintaining skills, as well as enough to manage the corporate overheads, things like claiming, and then on top of that a margin. 

MS EASTMAN: There is also, is there not, an expectation that the capability and skills of workers will improve and increase over time? But the funding model doesn't match the increase and the increased level of skill and capability. Would you agree with that? So let me put it this way: if I was looking at it just through the lens of the award, I might say at an entry level   if we work at that level of   I think you said 2.4. 

MS MITRA: 2.3. 

MS EASTMAN: 2.3. That you would hope, as a person learns on the job, undergoes training, undergoes performance evaluation, builds the skills in terms of performing their duties, that the approach is that they would then increase their pay point level as they go through. 

MS MITRA: Yes. 

MS EASTMAN: But because you are applying an average, it brings everybody down. So it doesn't create an incentive, does it, in increasing and improving capability of skills? 

MS MITRA: So there is probably a couple of ways to explain that, and I really appreciate it is   it can come across quite complex. So when we say we pay an average for, this is the sort of lowest rate that we pay. Because there is a second rate, the higher intensity rate, and there's also an opportunity to claim for non face to face time in particular circumstances. But we are not saying that the employer should be paying at that rate; we are saying that's the average we pay. If they have a beginning staff member who is on the level 1 of the SCHADS Award, they might pay that. Others they might be paying 2.4. So it's an average in the sense that, across their workforce, the most that they can claim would allow for that, and that's part of the work that we do with our financial benchmarking. And our consultation with the sector helps us to set those rates. 

MS EASTMAN: Can I ask you just what you mean in paragraph 21 where, as you say: 

The NDIA does not have a direct relationship, contractual or otherwise, with providers as it relates to the agreed provision of supports and services. 

And then you say this: 

Any non face to face activity should be negotiated and agreed between the participant and the provider as part of a service agreement in line with the pricing arrangements. 

So you see that? 

MS MITRA: Yes. 

MS EASTMAN: Are we right in understanding that what sits in that assumption is, one, a capacity for the participant and the provider to negotiate; secondly, that the participant would have knowledge about where the skills gaps would be within the provider and the training required to be done by the support worker who the provider will organise for them? It seems to   it seems to put a lot of expectation on the participant having a very comprehensive knowledge of the provider to know the deficiencies at the provider end   and I don't mean in a pejorative way, but the deficiencies at the provider end   and then negotiate almost on behalf of the provider so that the provider will be able to do the training, do the supervision, do the admin work and the like. Is that the assumption that lies behind that sentence? 

MS MITRA: No. It might be perhaps better if I explain it in a different way. So this is additional non face to face time on top of the hours that somebody works, and it is for particular unusual circumstances that may have occurred. So, for example, somebody might need some additional training. Their   the way their services are being delivered needs to change. There is some additional requirements and, therefore, non face to face time can be claimed on top of the face to face time that   

MS EASTMAN: But how do you work out whether you need to claim something on top of? 

MS MITRA: So this would occur as part of the planning process where a planner would work with and understand the complexity of the person, their needs and their likelihood for additional support. It could be, though, for example   and all that the participant needs to do is agree that from time to time there may be the need for non face to face activities. But it could be, for example, that there's been an incident during the day and a worker needs to share information with a second worker, and the provider at that point can claim for both workers to have that time to work through whatever has happened through a day. So those are sort of the irregular supports. The reason we say that it must be agreed between the participant and the provider is that there is an agreement that from time to time there may be a need to claim for additional hours that are not face to face. But that's not what's included in the fully loaded rate, which is for the general ongoing maintenance of skills. 

MS EASTMAN: Do you think there needs to be greater clarity and guidance on these areas which are   might be the sort of exceptions or the add ons? 

MS MITRA: We have been doing a lot of work over time to simplify the pricing arrangements and to try to make sure that they are well understood by both providers and participants. 

MS EASTMAN: From listening to the evidence that you have over the course of this week, do you think that that is the case, that it's well understood? 

MS MITRA: From listening to the evidence this week, I think there will be an opportunity for us to continue to explain how the pricing guide works   or the pricing limit works. 

MS EASTMAN: Alright. So this takes me to support coordination. I don't know whether you followed the evidence of Mr Harper this week. 

MS MITRA: Yes.

MS EASTMAN: And you have addressed support coordination at paragraph 92 of your statement. And you say in paragraph 92: 

As part of the commitments under the Participant Service Improvement Plan, the NDIA committed to be clearer about support coordination services and what participants should expect. 

So you see you have said that to us? So that suggests that this is another area where there might not be the clarity in understanding the role and the responsibilities of support coordinators and the nature of support co coordination. Do you agree with that? 

MS MITRA: So we have   again, this is an area where we have our paper that we have got on our website published and we have done a lot of training on it, which is about supporting support coordinators to understand their role. So we think we have done a lot more work on making that clearer. It is true that at the last annual price review, a recommendation was made that we need to further clarify roles and responsibilities. It's an area that's grown rapidly, and we do get anecdotal feedback from participants about the variable quality of the support coordination. 

MS EASTMAN: So is part of the challenge that the role of the support coordinator and the boundaries of the responsibility are not necessarily clear or agreed? So, for example, that there may be an expectation that the support coordinator also has to be the person's advocate and has to advocate on their behalf? 

MS MITRA: No, I think we are very clear on that. The support coordinator is an NDIS provider and are not able to be an advocate for the participant. 

MS EASTMAN: But my question is do you think, though, in terms of what's actually happening out there in the broader world, that that clear distinction or that boundary as to responsibilities is not so clear and that the expectation of support coordinators, and in some cases support coordinators themselves, step in and take on an advocacy role? 

MS MITRA: I can't speak to how many are actually doing that, but I think this is an area where we are very clear in all of our documentation and in our training that support coordinators should not step across into the role of advocate. And we have done quite a bit of work to educate support coordinators on that. 

MS EASTMAN: How do you regulate that, then? 

MS MITRA: Well, again, we don't   we   the regulation of that may happen   well, wouldn't happen, obviously, through us. Through   it would be through the Commission, if somebody has overstepped the boundary. We do include on our website a series of questions for support coordinators to sort of help them consider are they stepping over the line. Because it's   you know, it is something that would be relatively straightforward to occur. 

MS EASTMAN: Alright. I want to now turn to an issue which was touched upon this morning but has been an issue that the Royal Commission has considered throughout its life, and that is particularly with   and I will just use the shorthand "group home model"  

MS MITRA: Yes.

MS EASTMAN:   is whether, in a contemporary Australia and an Australia that is focused on promoting the rights of people with disability, that the traditional group home model is right to be phased out? So this is a question that's been raised in the course of the Royal Commission's work, and we asked you about that as question 4. So it's page 11 of your statement. And your response to us is to tell us about the NDIA Corporate Plan 2022 to 2026, and you referred to what you describe as a number of aspirations that relate to a market transition away from traditional group home models in support of newer and more innovative service models. And then you set out the aspirations in the balance of that paragraph. And in paragraph 73, you say: 

The NDIA recognises that some participants face a number of challenges to achieve their home and living goals. 

So just sort of setting the scene there. When you say that there are these aspirations, are there any targets in terms of achieving the aspirations during the period of the corporate plan, 2022 to 2026? 

MS MITRA: Not yet. Not yet in terms of a set target. We are in the process of finalising, through an extensive co design process, which I have outlined in my statement   we are in the process of designing a framework and an implementation plan to support that framework, and I anticipate that we will then establish some targets and timelines for some of the things that we intend to do. 

MS EASTMAN: And what are some of the things that you intend to do? 

MS MITRA: So I have outlined those here as well in terms of working closely with participants to better understand how to support people to make more choices into contemporary living. We have got   

MS EASTMAN: What does that   sorry. What does that actually mean? Is the focus on, in a sense, building capacity in the people with disability to say what they want or is the focus actually on saying, "Let's provide a wide range of options for people with disability, and we need to start developing them sooner rather than later"? 

MS MITRA: Yes, I think it's probably both, although I might word the first slightly differently. It is supporting people to consider what options are available and to think about what sorts of choices they might want to make. 

MS EASTMAN: Let me put it another way. That seems to have very much a focus on what's the present arrangement and thinking about people who are presently living in group homes. And Ms Riddell made a comment about this in her evidence, that for some people who have known nothing but institutional living and living in a group home, that they may not be the cohort of people who are looking at other options. But isn't the very nature of the work that you need to do is thinking about the future? So what about our 10 year olds, our 16 year olds, our 20 year olds, young people with disability and what they want? How have you started to think about the future for young people, not just responding to those who are immediately in   have lived in group homes? 

MS MITRA: Yes.

MS EASTMAN: That's what I'm trying to get to. 

MS MITRA: Yes, no. And  

MS EASTMAN: Tell me, where is the future and the innovation in this? 

MS MITRA: Absolutely. The future is on designing new models that provide choices. And in particular, I'm taking a life stages approach, which is, I think, what you are referring to with those young people who are 16, 17, 18, looking to explore what options are there to move out of home. So  

MS EASTMAN: But a 16 or 17 or 18 year old probably says, "Right. I might be with my parents for a while. Then I might actually like support to live at a college at university. So that will be my home.” That's not a group home. And then they might want to live with friends. And then they might want to live by themselves. 

MS MITRA: Yes.

MS EASTMAN: So trying to understand how is this broad thinking actually reflecting the life course of a person with disability rather than just thinking about what the sort of bricks and mortar might look like. 

MS MITRA: Yes.

MS EASTMAN: So what work are you doing in that regard? 

MS MITRA: Yes. So the co design on the framework is a key part of that, because that's exactly what we've heard through that process. The individualised living options that we have been working through and introducing is another part, which definitely provides a very individualised mechanism to enable people to think about the kinds of places that they might want to live and who they might want to live with. That's particularly so for people who want to share with a housemate, and that is a completely different way of thinking about a service. And in the attachments, we have also referred to the work that the Independent Advisory Council have done on looking and considering about the many different options that are there. 

MS EASTMAN: How has a human rights perspective influenced the way in which this work, the consultation, the thinking, the planning   how has that influenced that work? 

MS MITRA: I think very much so. It is   very much been about a person's right to choose for themselves where they will live and who they will live with. 

MS EASTMAN: Have you, in the course of that work in the NDIA, given consideration to the guidelines on deinsitutionalisation published by the committee overseeing the Convention on the Rights of Persons With Disability that was released on 9 September 2022? Are you aware of that? 

MS MITRA: I'm not specifically aware of that document, no. 

MS EASTMAN: So those guidelines suggest that state parties should abolish all forms of institutionalisation, end new placements in institutions and refrain from investing in institutions, and that institutionalisation must never be considered as a form of protection for persons with disability, or "a choice", and the notion of institutionalisation is not just being in a large institution, but it picks up the way in which a person lives, and the extent to which congregate living or shared arrangements or paternalistic approaches to service provision or supervision in living arrangements would be the features of institutionalisation. Is that something that you have looked at? 

MS MITRA: I haven't specifically looked at that document. 

MS EASTMAN: Right. So that's   for reference, it's called the Guidelines on Deinstitutionalisation, Including Emergencies, and it was released by the committee on 9 September. And its CRPD reference number is CRPD/C/27/3. Alright. Can I move to another topic, and that is the effective monitoring and information sharing for NDIS participants who are at a heightened or elevated risk of violence, abuse, neglect and exploitation. This is a topic that we have asked the NDIA about on a number of occasions, including Mr Hoffman's evidence at Public hearing 14. Can you give us an update on what approach the NDIA is taking to effectively monitoring and any information sharing for participants who are at a higher or elevated risk of violence, abuse, neglect and exploitation in the   as recipients of services? 

MS MITRA: Yes. So, since Public hearing 14, we have worked with the Commission to develop a new operational protocol to better identify and jointly identify participants who are vulnerable and at risk. That protocol was signed off last July, and there is a group working and meeting regularly to work through and the sort of implementation process of that. In addition to that, we have developed a safeguarding policy, which is just working its way through board approval process and will soon be published, which will have a further implementation plan sitting underneath it. And since Mr Hoffman's statement, we have also finalised the work on real time access to the Commission to access data on participants and providers so that they don't need to go through a process of making a request. 

Can I also say that the other thing that's happening with regards to identification of participants who are vulnerable and at risk is our new business system, which is currently being trialled in Tasmania and will then be rolled out once that trial is finalised and we have made any adjustments necessary. But that gives us the ability now to capture in one place all of the data that we have about somebody. So it allows us to better identify risk and then flag for outbound participant check in calls. So it will allow us to be quite proactive, including picking up the things that were in the Robertson statement   review around people who live alone and people who have a sole provider. 

MS EASTMAN: One aspect of people who may be characterised as in that vulnerable participants framework are people who have found that they require a guardian to be able to navigate and work with the NDIA or their support coordinators or service providers. This is an issue that we addressed at Public hearing 30 with Mr McNaughton and Dr Bennett. And one of the issues there was the extent to which the NDIA has a role in supporting practices around good supported decision making with respect to it being able to engage with the NDIA, whether it be in understanding agreements, in the forms of communication and the way in which the choice and control can be exercised in practice. 

MS MITRA: Yes.

MS EASTMAN: Are you able to give us an update on the work of the NDIA in relation to supported decision making guidelines or assistance for the broader community but service providers in particular? 

MS MITRA: Yes. So, again, that's the work that Dr Bennett has been leading and a significant piece of co design work undertaken by the agency. The supported decision making policy is also now in final stages. The board, I think, has actually approved that one, and it will move to publication shortly. So very recent piece of work in terms of finalising it, a very strong piece of work that we are looking forward to producing. 

MS EASTMAN: One other issue which we have raised with the NDIA over time is who is the provider of last resort and where State Governments and Territory Governments have stepped away, in many cases, from being the provider of last resort. I'm interested to know whether, for example, the NDIA has worked on recommendations made by the Senate committee on autism. And in its report released in December 2022, it made two recommendations relevant to the NDIA. One of the recommendations was addressed at the effectiveness of the NDIA's response to previous recommendations in relation to support of autistic people in the justice system and that issue of last resort for people making their way through the justice system and then leaving the justice system. So you might be aware of the Royal Commission's work following Public hearing 11 and Public hearing 15. Is that a recommendation that the NDIA proposes to act on, do you know? 

MS MITRA: I don't know, and that's not a part of the business that I'm involved in. 

MS EASTMAN: And recommendation 80 was a recommendation that: 

The NDIA publish the findings of its review into the Complex Support Needs Pathways and Maintaining Critical Supports Framework, including its policy on provider of last resort arrangements. 

Are you aware of that recommendation? 

MS MITRA: No, I'm not aware of that recommendation. 

MS EASTMAN: Has there been any steps taken by the NDIA to publish the findings of its review of the Complex Support Needs Pathway? 

MS MITRA: I'm not aware whether or not that has been published. 

MS EASTMAN: And publishing the Maintaining Critical Supports Framework? 

MS MITRA: I do know that the Maintaining Critical Supports Framework is no longer a current document and that there are other   other pieces of work that we have done instead of that framework. But that's now superseded. 

MS EASTMAN: Would we be right in understanding that the NDIA, with respect to proposed changes to the Complex Support Needs Pathway and related initiatives, will be published as updates to service   as service models are finalised and endorsed? 

MS MITRA: I'm not aware whether or not that will happen. The Complex Support Needs Pathway does continue, is active, but I'm not aware of what we intend to publish. 

MS EASTMAN: And I assume by that, you're also not able to tell us when any publication may be available. Is that right? 

MS MITRA: No, that's correct. 

MS EASTMAN: Okay. So my last questions really relate to some issues arising from the panel this morning. Were you here and had the opportunity to hear Dr Winkler's evidence? 

MS MITRA: I was here for the panel this morning. 

MS EASTMAN: So a range of issues raised   if I summarise them, I think it might be issues in terms of the funding model and a perception that there may be a lack of innovation in how the NDIA thinks about the future. I have really paraphrased the evidence this morning. Is there anything you want to say in response to the evidence this morning? 

MS MITRA: I think what I would say is we work very closely with Dr Winkler and others. There are many people doing research and considering how we move forward, particularly with some of the older models of supports and housing. And we continue to work closely together on those. We've done a lot of work ourselves, as you will see from my statement, in terms of an evidence review responding to the independent   to the   our own advisory council. And we continue to consider the funding models and how they can be most effective at this point for this particular cohort. So it is an area of key focus. 

The co design work   the work that we have done on home and living is a significant way of understanding what participants want and, as you said earlier, that some of them   some people do end up staying because it's all that they know. So there are a number of actions that I think will come out of that. And the other thing that has just happened this week is that as we've reshaped under our new CEO, a new leadership team, there is a change in functions to highlight home and living as a key piece of work for the agency this year. So it's an area that we are focused on, doing a lot of   putting a lot of effort into it and want to move forward as the discussion came out of this morning, as was said. 

MS EASTMAN: One question which I omitted to ask you a little earlier, and we talked about group homes and their future. The other is the area of day programs and in terms of the way in which we conceive of and understand what day programs might mean in the future. 

MS MITRA: Yes.

MS EASTMAN: Does the NDIA have a view on the maintenance of day programs in the form that are currently delivered as being an appropriate or viable option into the future? And my question relates to that same   that 10 year old, that 16 year old, that 20 year old is   

MS MITRA: Yes.

MS EASTMAN: Should they   those young people have an expectation that their lives, in terms of day programs, will be in the same form and the same   delivered in the same manner that they presently are? 

MS MITRA: Yes. No, I don't think they should have that expectation at all. We have changed the way we fund. It's much more individualised. A lot of the   a relatively small amount of the funding that goes into community and social participation is in day programs. And the way we now are funding day programs   the intent of that was to ensure that it was a more integrated approach. So I don't think that young people should anticipate that that's the only option for them in the future. 

MS EASTMAN: Ms Riddell gave the evidence of there being less opportunity to spend that time with their clients and the people they support in terms of building independence and participation in the community. And I think she said if that's funded for somebody to be taken to a park for six hours and that's the only nature of the activity, then that doesn't seem to be a particularly good alternative option to a congregate day program. So what really needs to be done in thinking and re visioning the way in which people with disability have the opportunity to participate in the community on a day by day basis, assuming that they are not otherwise in employment  

MS MITRA: In employment.

MS EASTMAN:   and that's what they would like to do. 

MS MITRA: I can tell you that our new Chair and our Board, which has recently been refreshed, is very focused on ensuring that we are funding for independence, not dependence, and for outcomes and to achieve their goals. And certainly the access to the community is one of the key   key opportunities for the scheme to make a real difference. The way we fund, the way we support and the way we encourage our market to arise, it gives people many opportunities to be independent. 

MS EASTMAN: And in the same way that I have referred to the CRPD committee's guidelines on institutionalisation for homes, would you agree that the same features of institutionalisation should be eradicated from the way in which day programs or models of that kind should be developed into the future? 

MS MITRA: I would agree that the vision for day programs in the future needs to be much more integrated and supporting people to achieve their goals. 

MS EASTMAN: Thank you for answering my questions. 

CHAIR: Yes. Thank you very much. I will ask my colleagues if they have questions for you. Commissioner Bennett? 

COMMISSIONER BENNETT: Just two questions. You have   Kate Eastman went into the work   and you describe the work that you are doing in national consultation about looking at innovation in homes. There is no sense of timing when you have said, "We are now   we have had big consultations and now we are going to develop a framework.” Is there any sense of timing? We know that providers are still building large multi resident dwellings, or acquiring them, so there needs to be a point of stop. And when might that be?

MS MITRA: Yes. So a couple of things. I missed the opportunity, perhaps, to talk about our home and living demonstration pilots which are currently underway. So that's in my witness statement as well. We are about to roll out a second round of those, which is, again, about funding organisations to put forward their innovative ideas about what's new. We have changed our funding so we are not funding   providing any capital funding any more for large institutions and homes. And we are currently actively working all the time on different ways, including our individualised living options   so that's happening now. So there are a number of things that are happening now, and more will come as we focus on this work. 

COMMISSIONER BENNETT: So when do we expect that more will come to be very clear about the deinstitutionalisation arrangements we have talked about? 

MS MITRA: Yes. There are already today more opportunities for people to move into individualised living options. Those pathways, the funding, is available for them already now. 

COMMISSIONER BENNETT: So there will not be a plan that says at this point there will be a ceasing over the next decade or   

MS MITRA: So we have already got a plan to cease providing capital funding for anything that is six and above. So you will see that in my statement. So that's already happening now. We   that was a sort of transitioning out. So anybody who is running a home with six bedrooms won't receive capital funding as that funding transitions out. So that's  

COMMISSIONER BENNETT: But they still receive funding to support services? 

MS MITRA: Well, again, I think over time it will happen. Because we have given individualised funding, what's actually happening is that people are not choosing to go into vacancies. So as people move out, those homes are finding it increasingly difficult to find anyone else to move in. And we are finding that there are many other options now in the market for people to go into. 

COMMISSIONER BENNETT: Something more concrete would have been helpful. And that goes to day programs. Will there be a plan that has very clear ceasing of that congregated arrangement which we have heard predominantly many of those day programs are run by the same people, organisations that run the group homes? 

MS MITRA: Yes. We haven't yet done the work with participants to work through what those alternatives would look like. So that is something, I think, that will happen in the next year. We are looking at the pricing already to sort of start to deincentivise large day programs. And then I think the next focus for that will be a co design process to work through what are those alternatives. So that piece is a little earlier. The housing piece, I think, is more progressed. 

COMMISSIONER BENNETT: Thank you. 

CHAIR: Commissioner McEwin. 

COMMISSIONER McEWIN: Thank you. My only question is, could you clarify what you meant when you responded to Ms Eastman's question about day program funding? And you said funding is more individualised. What did you mean by that? 

MS MITRA: So, effectively, it is easier for somebody to take their funding and use it in different settings. So we have kind of worked through with the sector on what that looks like so people's funding enables them to move from one place to another, rather than block funding day programs. 

COMMISSIONER McEWIN: Okay. Thank you. 

CHAIR: Ms Mitra, thank you very much for coming back to the Commission and giving evidence. We appreciate your assistance. Thank you. 

<THE WITNESS WITHDREW

CHAIR: Ms Eastman, I think there is some directions that have been agreed? 

MS EASTMAN: Chair, that concludes the evidence for this hearing, and we have provided you with some directions which we have circulated to the parties. So my understanding, unless there is some late options, are these directions are agreed. 

CHAIR: Thank you very much. On that basis, these are the directions that I will make. If any party has any disagreement, they should say so at the end of the reading out. Otherwise, they will be the directions that are made.

(1) As directed by me on Wednesday of this week, Sunnyfield and Afford should provide the Office of the Solicitor Assisting the Royal Commission with their written submissions in response to the propositions I put to their counsel. They should do this by 22 February 2023. 

(2) Any witness who took a question on notice during this hearing may provide their response in writing to the Office of the Solicitor Assisting by 24 February 2023. Any such responses may be tendered into evidence by Counsel Assisting the Royal Commission. 

(3) Counsel Assisting will tender into evidence any additional document she considers necessary in chambers by 3 March 2023. 

(4) By 31 March 2023, Counsel Assisting will prepare written submissions on the hearing. These submissions will be provided to parties with leave to appear and may be provided to witnesses on a confidential basis. 

(5) Any written responses to Counsel Assisting's submissions should be sent to the Office of the Solicitor Assisting by 21 April 2023. 

In the absence of any objections to those directions, they are the directions then that I make. Thank you. Ms Eastman, is there anything else from you?

MS EASTMAN: No, that concludes the hearing. And I'm sure the Commissioners will be happy to adjourn now. Thank you. 

CHAIR: I will make some short comments. This is the last long hearing this Royal Commission will conduct. There will be opportunities later to thank all of those who have contributed to the Royal Commission's work in hearings and in the many other forms of engagement over a period which now is just short of four years. As Ms Eastman has explained, this has not been a hearing which has focused on the voices of people with lived experience of disability, but the hearing commenced with pre recorded evidence from Sam Petersen, to whom we are very grateful for their willingness to return to the Royal Commission. We are also grateful to everybody else and all the institutions who have given evidence at this hearing. 

I do want to take this opportunity to say what a privilege it has been for me and for the other Commissioners in the course of 32 Public hearings and more than 150 hearing days to have heard the stories and the aspirations of so many people with lived experience of disability. It is very clear from our Public hearings that people with disability are not a homogenous group. We have heard from people with many different forms of physical disability. We have had evidence from people with intellectual disability, people with cognitive impairment, people with psycho social disabilities, people with autism, people with Down syndrome. 

We have heard from people with disability experiencing multiple forms of disadvantage, such as First Nations people, both Aboriginal and Torres Strait Islander people; people from culturally and linguistically diverse communities; people from the LGBQTI community. We have heard from people with disability who are famous and from those who have previously never told their stories in public. Some of our witnesses have been very polished performers, used to speaking to or communicating with an audience. Most have never given evidence or recorded their experiences in public. For many of those witnesses, it required very great determination and fortitude to give their evidence, even in cases where their identities were not revealed. 

One of the prime responsibilities of the Royal Commission has been to avoid re traumatising witnesses who have experienced deep trauma in their lives. That responsibility has extended to the support necessary to ensure that people with disability could give evidence safely and as comfortably as possible. We owe a great debt to our counsellors who have done a magnificent job supporting witnesses throughout the life of the Royal Commission. 

In addition to our Public hearings, we have received almost 8,000 submissions. 52.5 per cent of those have been from people with disability themselves, that is, with lived experience. Many more were from families and supporters of people with disability. And, of course, we received large numbers of submissions from disability representative organisations. Up to date, the Royal Commission has conducted, through the Commissioners, 1,587 private sessions. Of these, 1,012 or 64 per cent have involved participants who are people with lived experience of disability. A very significant number have never previously recounted their experiences to anyone except possibly their own families or very close friends. 

Every single person who has engaged with the Royal Commission or has recounted individual experiences has done so in a way that is very important to them and very important to the Royal Commission. I do want to refer very briefly to a number of witnesses, not to suggest that some experiences are more important than others but merely to illustrate the diversity of experiences that have been the subject of evidence over the course of the Royal Commission's life. 

Quaden Bayles is a young First Nations man with disability who gave evidence with his mother at Public hearing 7. Quaden's evidence included his experiences of bullying and insufficient supports at school. When asked about the message he would like to give to children who do not understand how their comments can hurt him, Quaden answered, "Just don't be rude to kids who have disabilities. Just be kind and be nice." 

Colin Hiscoe is the president of Reinforce, a self advocacy organisation for people with intellectual disability. He gave evidence at Public hearing 3 and spoke about the difficulties that advocates have accessing people with disability in closed settings and made observations that many people with disability, particularly those who have been institutionalised, have no knowledge of their human rights and are denied the opportunity to exercise their rights. Mr Hiscoe said: 

Why is it so hard? Why is it so damn difficult to be able to get into those closed residential units or the group homes? Why is it so difficult for people with disability to have the same basic human right as anybody in this room or in the community? Why is it that we can't have the same basic things? You are allowed to get married; I might not be because I've got a disability. 

Mr Uli Cartwright gave evidence to the Royal Commission, first in a panel at Public hearing 5, on the experiences of people with disability during the ongoing COVID pandemic, and he gave evidence again at Public hearing 30 on guardianship substituted and supported decision making. Mr Cartwright shared his experiences of being subjected to a financial administration order. He said: 

I wouldn't have gone through any of this if I didn't have a disability. If I didn't have a disability, I could have blown all my Centrelink payments the same day I got paid. I could have spent it on whatever I wanted. The difference between me and someone who has the freedom to make really bad financial decisions is that I have an intellectual disability. And, somehow, that automatically means that I'm not capable of any financial decisions at all. 

Sophie gave evidence at Public hearing 20, which examined the two case studies involving Life Without Barriers, and we heard about that during this week, and we have heard about changes to the organisation and its practices since that hearing. Sophie gave very personal evidence about her experiences while living in group homes operated by Life Without Barriers, including experiences of violence, abuse and restrictions on her right to have personal intimate relationships in her own home. 

Fiona Strahan is a woman of short stature who gave evidence at Public hearing 28 about violence and abuse of people with disability in public places. When asked about how Australia could become a more inclusive society, she said: 

In terms of what needs to change, society won't change if we are not visible in a whole variety of roles, you know, and that our visibility as an equal and as a colleague. And when I look at the skills of people with disability, the number of people with disability receiving DSP, the Disability Support Pension, who have, you know, degrees   master's degrees, PhDs, and still not kind of working. It's as though we are not working hard enough. We are so working hard enough. 

And finally, I mention Kylie Scott, a disability consumer representative for the Sydney Local Health District, a former Australian Special Olympian and a person with Down syndrome. Ms Scott gave evidence at Public hearing 4, which examined healthcare and services for people with disability. Ms Scott gave evidence about her experiences with doctors where Ms Scott had difficulty in being heard and having her needs properly considered. This was one element that led to the evidence of that hearing about diagnostic overshadowings. 

Again I stress that the experiences related to us by every person with disability are of equal importance. I have just given those illustrations to show the range of people, the range of disabilities that have come to our attention and the range of issues, therefore, with which we have to deal with. 

As I have often remarked, preparing for and conducting each Public hearing has required an enormous effort from many people. The frontline Counsel Assisting the Royal Commission, led by Ms Kate Eastman SC, have done a superb job over the life of the Royal Commission, marshalling and presenting evidence and drafting thousands of pages of Counsel Assisting's submissions to the very many hearings. Counsel have invariably conducted the hearings in a trauma informed manner so as to ensure that witnesses have felt safe and supported and do not run the risk of re traumatisation by virtue of appearing at the Royal Commission. 

Counsel have always been very ably assisted by the various teams from the Office of Solicitor Assisting, who have done an enormous amount of essential background work in compiling and analysing information from a variety of sources and then assisting with the onerous task of writing submissions and other reports. 

This hearing is a prime example. We have heard from 38 witnesses, either individually or in panels. A total of 22 parties were granted leave to appear. The Office of Solicitor Assisting issued 28 notices to produce, to 24 service providers, and received many hundreds of pages of written responses and annexed documents. Witnesses came from many parts of Australia to give evidence in the hearing room. Apart from the noise from construction activity on one day, all proceeded remarkably smoothly. 

Thanks are due to Ms Eastman, Ms Dowsett, Ms Doust and Ms Beattie for their tireless work and for maintaining the highest standards of professionalism. We thank the Office of Solicitor Assisting, the team led by Lorna Davidson and Annick Wain, for their dedicated and meticulous preparatory work, support to Counsel Assisting and support to the Commissioners sitting on the hearing. 

We thank the policy branch which has provided invaluable assistance for all of our Public hearings, as well, of course, as conducting and supervising a very wide range of research and writing of reports. These hearings would not be possible without all the logistical work done by the corporate branch of the Royal Commission. They have a complex task, and it is a great credit to them that the hearing has proceeded as smoothly as it has and as so many other hearings held by the Royal Commission have proceeded. 

We owe a great debt to our magnificent interpreters, who cope with the rapidity of speech remarkably well. We are very grateful to them for the work they have done over the life of this Royal Commission, and I'm sure Commissioner McEwin endorses that comment. Our thanks to Law In Order for the technical support that they have provided. 

And our thanks to everybody else who has contributed to these hearings, that I at least hope will provide a permanent record of the work of the Royal Commission and be a valuable source for many, many years to come on issues associated with people with disability and the need to ensure that their human rights are protected and that they are free from violence, abuse, neglect and exploitation. Thank you to everybody. We will now adjourn. 

<ADJOURNED 2:33 PM