Public hearing 25 - The operation of the NDIS for First Nations people with disability in remote and very remote communities, Alice Springs - Day 5
CHAIR: Good morning, everyone. Welcome to the fifth and final day of Public hearing 25, which is addressing the operation of the NDIS for First Nations people with disability in remote and very remote communities. I thank everybody who has made arrangements at the last minute to start at 9.30 instead of 10, including our witnesses for today. I will ask Commissioner Mason to make the Acknowledgment of Country.
COMMISSIONER MASON: Thank you, Chair. We acknowledge the Arrernte people as the original inhabitants and traditional owners of the lands on which we gather today, Mparntwe, also known as Alice Springs. We acknowledge their ongoing spiritual and cultural connection to Mparntwe. We acknowledge and pay our deep respect to elders past and present. We extend that respect to all First Nations people and acknowledge their enduring connection to land, sky, seas and waterways. Finally, we pay our deep respect to First Nations people here today and who are following this Public hearing online, on the mainland and on islands, including in the Torres Strait, especially elders, parents, young people and children, so with disability. Thank you, Chair.
CHAIR: Thank you, Commissioner Mason. Yes, Mr Griffin.
<SCOTT McNAUGHTON, RECALLED
<KITSA PAPADOPOULOS, RECALLED
MR GRIFFIN: Good morning, Mr McNaughton and Ms Papadopoulos. I want to pick up this morning with looking at a document called the Thin Market Interim Evaluation report. It appears in Hearing Bundle C at tab 65 and has the reference, CTD.8000.0032.0596. Can you indicate, Ms Papadopoulos, are you familiar with that report?
MS PAPADOPOULOS: Yes.
MR GRIFFIN: And is it the case that that report was produced by the NDIA?
MS PAPADOPOULOS: That's correct.
MR GRIFFIN: And, in particular, by the Research and Evaluation branch.
MS PAPADOPOULOS: Yes.
MR GRIFFIN: And it is dated November 2021.
MS PAPADOPOULOS: Yes.
MR GRIFFIN: From my reading of that report, it appears to take an approach of trying to address market failures by looking at three possible options, which I wish to discuss with you. And they are, firstly, market facilitation; secondly, coordinated funding proposals, known as CFPs; and, thirdly, direct commissioning.
MS PAPADOPOULOS: That's correct.
MR GRIFFIN: Can I take you to market facilitation. In plain English, what does that mean?
MS PAPADOPOULOS: Market facilitation means helping markets behave the way that we hope they would naturally. So, it's about on what we call the demand side, which is the people who have the money to spend, making sure that they are supported to be effective consumers, so they understand their plan, they understand the options available to them as to what to purchase, they are supported by support coordinators or others to be able to operate that way in the market.
And then, on the supply side, working with the provider network to make the opportunities clear in that in that particular location, which can be about sharing data and highlighting, for example, the number of people in a particular place who need a certain type of support, and packaging up that opportunity and sharing it and encouraging providers to to be open to that opportunity, to understand that opportunity.
And, finally, it's about connections between different players in the market. So, for example, we create networks of support coordinators to meet each other and establish relationships with each other so they can work better together for their own participants and to share opportunities across groups of participants. We establish relationships between support coordinators and providers in the market, including providers from adjacent markets nearby. So, we try to help everybody get to know each other, and, through those sorts of connections, we often see that the market is able then to more naturally match supply and demand.
MR GRIFFIN: Thank you. So, a successful market facilitation would improve the connections between providers and participants?
MS PAPADOPOULOS: Yes.
MR GRIFFIN: That's almost in a nutshell what you hope to achieve?
MS PAPADOPOULOS: Yes.
MR GRIFFIN: What is coordinated funding proposals? CFPs?
MS PAPADOPOULOS: A coordinated funding proposal is a method that we developed within our branch. It involves identifying a group of participants in a particular place who all have a similar need for a similar type of support, and we work with the support coordinators who represent that group of people. And we we enable the support coordinators to lead a process where they write up a request for quote which will say, for example, "There are 20 participants in Katherine who will need an orthotics assessment and ongoing supports. We are looking for a provider with these particular characteristics."
And they invite usually three or four providers of their choice who might be coming from the nearest regional centre, for example, to submit a quote as to how they would deliver those services to those people, including the service delivery model, how many times they visit, how many hours they would spend, but also the cost. And the support coordinators can also specify other requirements, which they usually do, for example, around cultural competency, experience working with particular kinds of participants and so on.
And then support coordinators, in consultation with the participants who they represent, will make a choice as to which provider or providers to engage and go ahead with that particular quote, and then when the providers deliver the services, they actually draw down from plans in the normal way.
MR GRIFFIN: So, in effect, if you’ve got multiple participants with similar need – in the case you described, an orthotic device – their support coordinators can pool the funding in order to purchase those services or products?
MS PAPADOPOULOS: Yeah. It appears as if the funding is pooled. So, for example in describing or setting out in the request for quote how many participants there are and the funding that they have available in their plans, the providers can see the opportunity as an aggregate opportunity. However, when it comes to the service delivery, they – the funding is not physically pooled. It is drawn down from plans in the normal way.
MR GRIFFIN: Yes. And is it hoped by adopting that approach that those participants will get the service product they require more quickly than might otherwise be the case?
MS PAPADOPOULOS: Yes.
MR GRIFFIN: And it might be cheaper, because there are multiple people receiving the product or service, than it would be if it was done on the individual basis?
MS PAPADOPOULOS: Certainly that’s the case around travel, because travel can then be split among the participants involved.
MR GRIFFIN: For coordinated funding proposals to work, it seems that the support coordinator is the crucial person or persons?
MS PAPADOPOULOS: Yes. In the – in the CFPs that we have run so far, we have always worked with support coordinators. But that doesn’t mean that others couldn’t use the technique. And we are in the process of hoping to release a toolkit. And that could be used by parents or participants themselves or other community groups or anybody who wants to represent the group of participants to follow that process.
MR GRIFFIN: So, if there were three families in a remote community that thought that members of their family had a similar requirement, the NDIA would assist them to understand how this process of CFPs would work?
MS PAPADOPOULOS: Yes. And that’s part of what we’re thinking through with our communications around releasing this toolkit, how might it be used and how can we make sure that people who want to use it, that we can adequately support them. We would really like to just be a light touch enabler of it. We would like it to be fairly self-explanatory.
MR GRIFFIN: What is a toolkit in that context? What does it look like?
MS PAPADOPOULOS: It has a step-by-step guide as to how to put together a CFP. So, for example, it explains step 1, identify who the group of people are and what the support is that you’re looking to purchase. Step 2, you know, decide what the roles and responsibilities will be, who will make the assessment and so on. And then – and then how to choose the providers that you want to approach and what’s involved in assessing and so on. And it also includes some templates for the various documents.
MR GRIFFIN: So the first stage would be making that toolkit accessible to people?
MS PAPADOPOULOS: Yes, that’s what we’re working through at the moment.
MR GRIFFIN: What happens if the target audience aren’t able to sufficiently understand the toolkit? What assistance can they seek to better understand what this is all about?
MS PAPADOPOULOS: Well, this is why we haven’t rushed into releasing it, because I wouldn’t want to create an expectation around a process that’s available, but I don’t have sufficient resources within the agency to support that to happen. So, we’re being pretty careful with being prepared for that before we roll it out.
MR GRIFFIN: I won’t hold you to any specific dates, Ms Papadopoulos, but what’s your expectation of the rollout of the program you’ve just described?
MS PAPADOPOULOS: I’m hoping before the end of this year.
MR GRIFFIN: And to reiterate the point you just made, you’re very conscious, to use my words, of making sure that it’s carefully thought through and designed before release?
MS PAPADOPOULOS: Yes.
MR GRIFFIN: And is one of the reasons because you would expect that there might be a demand on the NDIA for resources to understand how to operate that toolkit?
MS PAPADOPOULOS: Yeah, I mean –
MR GRIFFIN: And you want to have those in place?
MS PAPADOPOULOS: It’s a consideration that we have with any policy change, practice change or new initiative that we release to ensure that the implementation will be smooth. At the moment, my team facilitates all the CFPs that we’ve run, which is about a dozen that we’ve run so far. And the support coordinators who we have worked with to date have, in the main, really liked the process, and some of them have taken that toolkit and are independently doing it themselves the second time because they’ve learnt the first time. So, I think there’s a lot of potential for a broad appeal of the toolkit, but some support will be needed from us.
MR GRIFFIN: And did I understand from your evidence that the cost to the NDIA of providing support for people that are trying to use the toolkit would be a budgetary cost which would have to compete with all the other budgetary demands of the NDIA?
MS PAPADOPOULOS: I – that’s a very – sorry, it’s very likely that it could be met within the existing budget of my team. We would just have to be able to forecast the likely impact on our resources in our team.
MR GRIFFIN: And, finally, in relation to the toolkit, will it be delivered in different languages? Particularly in relation to First Nations communities?
MS PAPADOPOULOS: Look, I think the learnings from this – this week’s evidence and other – other cultural discussions, cultural competency discussions we’ve been having internally, yeah, certainly means we have to think about the accessibility of all our materials, and this – this would be one of, you know, similar – subject to the same considerations.
MR GRIFFIN: So in listening to the evidence being given this week, has it been impressed upon you, at least, that the question of language and cultural considerations in certain circumstances are the difference between a program such as this being effective and not being effective?
MS PAPADOPOULOS: Yes, it’s a really key part of effectiveness. I would agree with that.
MR GRIFFIN: To what extent has your group thought through issues of language and culture as of today in respect to the proposed toolkit?
MS PAPADOPOULOS: I – the last version I saw of the draft communications plan was really around who – who might the potential audiences be and how do we imagine our users might use this and who are we – who are we actually pitching it to. And so we’re still talking about that. And if we do think it’s appropriate that the toolkit is used directly by families or people in Aboriginal and Torres Strait Islander communities who don’t have English as a first language, then absolutely language would – language translations would become important.
But, at the same time, I would hesitate to commit that – that it’s an appropriate toolkit for the participants themselves. I don’t want to, again, offer something that seems too complex. So, it’s only if we could simplify it to the point and make sure – and test and consult so that – to make sure that it’s an appropriate toolkit to offer to that – that audience group before we would then go into how to make that work.
MR GRIFFIN: If I can come back to the Thin Markets Evaluation Report. I mentioned there were three approaches. The third approach was direct commissioning.
MS PAPADOPOULOS: Yes.
MR GRIFFIN: What does that mean?
MS PAPADOPOULOS: Direct commissioning in the NDIS context means, similar to CFPs, when we identify a group of participants who all have an unmet need of some kind, but instead of a CFP, we actually take it a step further and we can – we can actually physically pool the funding and procure a provider or a group of providers to deliver – to deliver the service through a contract with the NDIA, and the money for that support comes out of the plans and is used to pay the contract.
MR GRIFFIN: So as the words “direct commissioning” imply, that’s a contract between the NDIA and a provider or a group of providers?
MS PAPADOPOULOS: Yes.
MR GRIFFIN: How is direct commissioning different, if it is, from block funding?
MS PAPADOPOULOS: How is direct commissioning different from block funding? It is closer to block funding than individualised plans. So, in many ways, it seeks to mimic many of the benefits of block funding. In our –
MR GRIFFIN: Just pausing there, what do you say the benefits of block funding are?
MS PAPADOPOULOS: Yes. Certainty of funding. Certainty of a time – timeframe for delivery. So, these contracts are usually multi year contracts. And also more certainty around the numbers of participants and the profile of service delivery.
MR GRIFFIN: And when you say “certainty”, is it also the case that block funding provides some security? People know what’s going to be there for a certain period of time?
MS PAPADOPOULOS: Yes.
MR GRIFFIN: I interrupted what you were saying previously.
MS PAPADOPOULOS: No, you didn’t. No, that’s fine.
MR GRIFFIN: Do you want to continue with that as to talking about the differences between direct commissioning and block funding?
MS PAPADOPOULOS: So, in our first two trials of direct commissioning, one in Tasmania and one in the ACT, the arrangements were not – not that similar to block funding. It did address many of those areas of certainty, for example, how many participants and where they were, but it – each – the terms of those two contracts, the providers agreed that each request for service essentially would come participant by participant as they were ready, and we would offer the – the job package essentially for that participant to the provider and they would accept it and commence service delivery for that person. And they may or may not get a certain number of participants.
So, we didn’t necessarily commit to that. And that was appropriate in both of those settings, and that was really a suitable model for the providers who we worked with there. In contrast, in the APY Lands, which is the third place that we’ve trialled direct commissioning, we have – we have set up a different kind of funding model which more appropriately meets the needs of that situation.
MR GRIFFIN: In what particular respects in the NPY Lands did you decide to have a different approach?
MS PAPADOPOULOS: We – we had consulted a lot in terms of the design of that commissioning model. So, we understood the needs of providers in that area, and we worked really closely with the community and with all our stakeholders to design something that was going to work in that area. And that was really important, because there – we didn’t want to have a high risk of going out to procurement and not having an offer that was attractive enough essentially.
So, the funding model that we came up with there actually worked – started from the position of what would the service look like. And, in this case, it is a service for social, community and civic participation supports which is, for example, people participating in activities – so whatever they’re interested in. Hunting, fishing, sewing, helping them with their daily lives. And we knew that a drop-in centre style approach would be most appropriate and we – so we worked backwards from a costing model of how much would it cost to run a service that looks like that for this many people for an average number of hours, and then we split that into how much is the effective contribution from each person’s plan.
MR GRIFFIN: And in respect to the NPY Lands, have you done any preliminary evaluation as to whether the approach you’ve adopted has been successful?
MS PAPADOPOULOS: The APY Lands direct commissioning is only really starting service delivery over the last few months. So, it’s too early.
MR GRIFFIN: It’s too early to tell.
MS PAPADOPOULOS: Yeah.
MR GRIFFIN: Before I leave the evaluation report, we’ve gone through market facilitation, coordinated funding proposals and direct commissioning. They were the three approaches that were adopted to deal with market failure. Did you consider other approaches and reject them, and, if so, can you tell the Commission what the other approaches you considered were?
MS PAPADOPOULOS: The material that was available to my team as we started to develop our operational approach essentially came down to those three methods. So, there’s – there’s a number of more policy style documents: Our market approach document, our market enablement framework and some – some reports that we worked on with DSS in 2019 that aimed to cover the spectrum of all the different levers that we can use. And that was really important. But the task of my branch was to turn that into an operational approach with processes and methods, and so those three methods essentially summarise much of what you will see in the more theoretical material that precedes it.
MR GRIFFIN: So, you looked at all the options available and did you then reduce them down to these three approaches, largely?
MS PAPADOPOULOS: Yes.
CHAIR: Can I ask, please, when you allocate the cost of the pooling arrangement to individual plans, how is that done?
MS PAPADOPOULOS: The average cost per participant per –
CHAIR: I’m thinking about the APY Lands.
MS PAPADOPOULOS: Yeah, so that average cost is worked out per participant and then we have a look at the plans. In the APY Lands example, most of the participants already had sufficient funding in their plans to cover that effective contribution. The ones that didn’t had their plans adjusted up so that they would make that contribution, and others who had more than that contribution retain whatever is left over in their plan.
CHAIR: And what information was conveyed to the participants themselves or their nominees or families about what was happening?
MS PAPADOPOULOS: We used all the community resources available to us in that community. So, Remote Community Connectors, NPY Women’s Council, so the support coordinators to talk to participants, and any participant who wanted to opt out has been able to opt out. There were a handful who did.
CHAIR: And did anybody opt out?
MS PAPADOPOULOS: Yeah, I think there were around three or four.
CHAIR: And how many plans were involved in the pooling, in the end?
MS PAPADOPOULOS: 33.
CHAIR: 33. And a total cost of?
MS PAPADOPOULOS: I’m not sure of the total cost. But I can take that on notice.
CHAIR: Thank you.
MR GRIFFIN: In the NDIA’s consideration of what approach to take to remote and very remote First Nations communities, has the organisation undertaken various projects and trials?
MS PAPADOPOULOS: Yes.
MR GRIFFIN: And those trials were essentially thin market trials looking at what policy settings would be – where you could use incubators, things such as that?
MS PAPADOPOULOS: I have never heard the term incubators used as part of our work.
MR GRIFFIN: Okay. Well, there were policy considerations taken into account?
MS PAPADOPOULOS: Yes.
MR GRIFFIN: How did you go about designing the trials that the organisation undertook?
MS PAPADOPOULOS: Yes, so I will just clarify, the term “trials” in this context, we used to refer to the group of projects that was agreed as a result of the Disability Minister’s decision in December 2019, where all states and territories agreed that we should try a more innovative approach to market intervention and they all nominated a number of places, usually one or two per state or territory. So, they are officially called our DRCC market trials. And beyond that, my team has our own additional program of market interventions. Sorry, was there something else about that question?
MR GRIFFIN: Particularly as to how you design the trials, what factors you take into account and, whilst I’m asking the question, did those factors vary in different parts of Australia?
MS PAPADOPOULOS: Yeah, it was a very consultative approach with the states and territories, and they brought to us what their particular concerns were. So, for example, in ACT, the concern was around behaviour supports because that’s a very new support that’s available in the market with several barriers to entry and a lot of different regulation and a lot of people still learning how to use that. So, they were really interested in developing that market. But, obviously, the ACT context is a very metropolitan market, so it’s got – it’s got healthy characteristics in many ways, but for that particular support, that’s something they wanted to boost. And in other areas such as the APY Lands, we were – we were dealing with very remote communities who – which needed market development across all supports.
MR GRIFFIN: Is it proposed to conduct those trials in respect to each and every remote or very remote community or are you doing a cross-section and then going to draw conclusions from that?
MS PAPADOPOULOS: The initial round of projects agreed with states and territories is a distinct group of projects. So, we won’t be adding anything to that particular list. However, as I said, the ongoing work of my branch is to monitor markets and then we prioritise internally with our feedback that we get from – from everywhere, from states and territories, from service providers, from our intermediaries, our partners in the community. So, using all of that information, we have an ongoing program of prioritising which markets we want to intervene in.
There are only a limited set of projects that are actually included in the evaluation. The evaluation doesn’t only include those DRC state and territory thin market trials, but it includes some of the other NDIA initiated projects that we had commenced around a similar timeframe.
MR GRIFFIN: From the work you’ve done to date, is it likely that you will develop a certain number of models and then apply them to particular communities, or will you look at each individual community and apply a bespoke model to it? Are you able to indicate what the current thinking is about that?
MS PAPADOPOULOS: Yes. Certainly. I definitely would say that our approach is to look at each community as a stand alone situation. Every community is different, as we’ve heard this week as well. But – but it’s about understanding and taking the time to understand what the particular factors are in each community. But they will – they will usually run along particular themes. So, we have a lot of operating guidance as to how we do our work. It’s very systematic. We have a list of factors that we look for and identify, and then we will match the intervention to that. So, it’s about having as much – as much clarity of process and options but with a lot of flexibility as to how to use those appropriately.
MR GRIFFIN: What are the primary factors you would look for in any community?
MS PAPADOPOULOS: So, on the demand side, which is what’s happening with the participants themselves and their plans, we have a look at the high-level data, what’s the utilisation, what’s the activation. So, people who might not have used their plans ever. What – what types of supports are really low. So, if people and not receiving core daily activities, that’s risky and something that – that we would need to address more quickly and more urgently, and – and then we get to know the individual plans.
So, we get to understand the participant’s story through their plans. We meet their support coordinators, and we try to understand what their circumstances are. Some of the things that we see are certainly people not understanding the NDIS, people not understanding their plan. We see people with very difficult personal situations which, again, we’ve heard about this week, where prioritising getting their disability supports – yes, that that might not be a priority for them.
So, we learn a lot about the participant stories and that – that helps guide us as to – as to what we might want to do on the provider side for it. So, for example, if you’ve got a lot of participants who are not ready to start receiving supports, it’s no use going into the provider market and trying to attract someone to come in because they – those participants won’t be ready. So, we spend a lot more time with our planning teams, our Remote Community Connectors and so on to build that while, at the same time, starting to build those networks between support coordinators, getting support coordinators to meet providers, starting to share data with providers. And that’s the facilitation approach generally.
But then if we find a group of participants who really are keen to use supports – so Berri Barmera is great example. It’s not a remote or a very remote market. But it’s an example where we had people not accessing social, community, civic participation supports, and it was because the market wasn’t offering things they were interested in. So, we had a couple of expos and providers were able to hear from participants, “Hey, this is what I would really like to do.” For example our young people interested in online gaming programs and things like that. And providers have responded to that really well and are now changing their service offering. So, every market is different.
MR GRIFFIN: Mr McNaughton, is there anything, to your knowledge, in the overriding legislation governing the scheme that would inhibit the NDIA from taking a bespoke approach which would include a higher than previous level of flexibility and discretion?
MR McNAUGHTON: No. And, in fact, there were some, Counsel, some changes in the most recent update in the legislation to allow us to do that even more easily. So, it doesn’t limit it. Obviously, there are the overriding principles of participant centred approach, funding the reasonable and necessary supports a participant needs. But there are some other – I think they are chapter 1 or chapter 2 powers that allows us to commission external agencies to help deliver the scheme.
And that was – there were some improvements made to that, I think out of the Tune Review recommendation in the legislation that just recently passed. So, that should give us even more flexibility to help implement what Kitsa is talking about as well.
MR GRIFFIN: And so, as far as you’re aware, it’s largely a question of looking at policy and amending it accordingly because you have a sufficient degree of discretion within the legislation to do that?
MR McNAUGHTON: Yes. Yes. That’s – and that also goes across all of our operational guidelines, not just in relation to – to the market intervention that Kitsa is talking about.
CHAIR: Ms Papadopoulos, with the APY Lands and the program that’s being trialled, what is the outcome you would be looking for as far as the participants in the APY Lands are concerned? How would this program, assuming it’s implemented more generally, what would it mean for each individual participant in the APY Lands and, for that matter, those First Nations people with disability who may be eligible for the plan – for the scheme but are not yet on it. What would be the practical outcome?
MS PAPADOPOULOS: The practical outcome is people with disabilities to be able to spend their days doing things that interest them, more than what they are able to do now. So, the reason we targeted this kind of support is because we surveyed participants in the APY Lands and we asked them what would you – what’s your priority, what would you like to do most with your plan, and overwhelmingly it was around that – that day to day, give me something to do.
And then the provider, part of the terms of their contract is that they spend the first phase working with participants to talk to them and ask them what kinds of activities you would want to do. We’ve got a great recent outcome from that process, where there’s a group of women who have all said that they would like to learn sewing. So, the provider is now getting some sewing machines and setting – setting up that activity for those women. I also assume there will be things like hunting, fishing and other things, but it’s also about just taking – taking people and helping them with whatever tasks they need to do that day. They can drop in and have someone work with them and help them with that.
CHAIR: And what about the health services that are not presently available because there aren’t providers – health services in the broadest sense – and other supports. How does this program alter facts on the ground as far as the availability of those services and affecting, in a favourable way, the ability of people to access services in their own communities or at least very close to their own communities?
MS PAPADOPOULOS: Look, I would say it’s one more step in the development of a market in the APY Lands and the development of more providers delivering supports. I can’t say that there will be a direct impact on health services. Hopefully, health outcomes. If people are healthier, getting out every day and doing what they like to do, hopefully, there are health outcome benefits. But in terms of allied health and other services, we – we are seeing the entry of some new allied health providers. They are fly in fly other or drive in drive out, I think.
But, look, anything that means there’s more presence of NDIS providers in the community creates a place, perhaps, where other providers might be able to join in and find participants gathered in a certain place. All of those things are really important to slowly build a more robust service system. So, it’s step by step.
CHAIR: But do I understand from that answer – and there may be very good reasons for this – that at the moment, the program really isn’t directed towards ensuring more services available within local communities? Apart from the ones you are talking about to enable people to do the things on a daily basis that they have expressed a preference for?
MS PAPADOPOULOS: The APY Lands project that we’ve been running for a couple of years actually is not just about direct commissioning. So, there are a few other things that we did. Initially, it was about managing the transition of the South Australian Government services out of the APY Lands. So, one of the major early wins was that we secured an external provider to run the independent living centre at Amata where we had four NDIS participants living there and receiving care initially from South Australian Government.
There’s now a non-government provider running that service. And for all the reports we are getting back, those people are receiving better and more services than what they were – that’s acknowledged by the South Australian Government. They see it as a success story as well. So, that’s working really well. We also transitioned over 100 participants to receiving meals and linen services from a non-government provider, and we’ve created a network of support coordinators which is being facilitated by Marathon Health. And, yeah, the direct commissioning builds on that.
We’ve also got a CFP that NPY Women’s Council mentioned earlier in their evidence this week for 10 children to receive functional assessments. And as a result of just the general market facilitation, that’s why we are seeing the entry of some more allied health providers, but we see ourselves staying in the APY Lands, you know, for the next few years, and we hope to just keep building what’s possible there.
CHAIR: And how would this address the kind of situation we heard about Boyzie and the problems he had in getting a licence and the neurological assessment in Perth and so on and so forth?
MS PAPADOPOULOS: Look, I can’t comment specifically on what kind of assessment he needed and whether it would be possible on Country. It sounds like there were some machinery or something that he might have needed testing facilities that might only be available in Perth. So, I’m not sure.
CHAIR: Sorry, Mr Griffin, again for my interruption.
MR GRIFFIN: If in a case like the NPY Lands you identified two or three potential providers, who makes the final decision as to which provider is selected?
MS PAPADOPOULOS: For coordinated funding proposals, the support coordinators work with participants to make a choice.
MR GRIFFIN: Yes. And what about – is there any model where the NDIA would decide the provider as opposed to the community?
MS PAPADOPOULOS: No. Only in direct commissioning. That’s a panel – a panel of assessors.
MR GRIFFIN: I want to take you both now to the Ngukurr report. And the reason I’m doing that is that we don’t have sufficient time to go through all the trials being conducted and, to my way of thinking, it appears the Ngukurr report raises a lot of issues which have been raised this week. But as a preliminary to that, can I ask for the Top End map to be brought up. While that’s happening – it’s there now. Can you see that’s a map of the Top End? You see Darwin, Katherine and then east of Katherine, slightly south, is Ngukurr.
MS PAPADOPOULOS: Yes.
MR GRIFFIN: Ngukurr, I understand, was formerly known as the Roper River mission, because it is on the Roper River, which isn’t shown on the map, and is about 330km away from Katherine. Has a population in excess of 1,000 people, is my understanding. That report appears in Hearing Bundle C at tab 64. For the record, has the reference CTD.8000.0032.0348 and is entitled A Better NDIS at Ngukurr Report – June 2021. Have you both had the opportunity to read that report recently.
MR McNAUGHTON: I have.
MR GRIFFIN: You have.
MS PAPADOPOULOS: I have when we were working with that team a few months ago.
MR GRIFFIN: Okay. That project, if I can call it that, was initiated after NDIA Connectors, the Connectors branch manager, visited that community in June of 2020.
MR McNAUGHTON: That’s correct.
MR GRIFFIN: And the NDIA became aware of potential issues with poor performance of the scheme and instructed the branch to investigate and develop better arrangements?
MR McNAUGHTON: That’s correct.
MR GRIFFIN: And the idea was, it was hoped to achieve improved outcomes for participants in that community.
MR McNAUGHTON: Yes. Yes.
MR GRIFFIN: The NDIA, I understand, had received feedback from the Northern Territory service delivery organisations and did an initial desktop analysis.
MR McNAUGHTON: Yes, we did.
MR GRIFFIN: And that desktop analysis indicated that participants were not receiving enough of their reasonable and necessary supports?
MR McNAUGHTON: That’s correct.
MR GRIFFIN: But there were insufficient numbers of providers entering the Ngukurr NDIS market?
MR McNAUGHTON: Yes.
MR GRIFFIN: That the providers in the market were not providing quality supports.
MR McNAUGHTON: Yes.
MR GRIFFIN: And the longer-term cost to the NDIS may continue and/or escalate due to participants not achieving their outcomes.
MR McNAUGHTON: That’s correct.
MR GRIFFIN: So, Mr McNaughton, effectively, the desktop analysis indicated that it might cost the NDIS more money for a poorer return if it was allowed to continue in its current form?
MR McNAUGHTON: That’s correct. It goes to some of the comments that Kitsa mentioned around if people aren’t accessing their supports and they are not connecting in those important social community connection with Country, the health outcomes may, in fact, not improve and go backwards. And then they may need more support in the long term.
MR GRIFFIN: And that’s quite a sophisticated analysis because it tries to project consequential costs if the situation isn’t improved?
MR McNAUGHTON: That’s correct. Yes.
MR GRIFFIN: But the bottom line, even for an economic bean counter, is that it might cost you far less dollars by adopting a fresh approach than continuing with the old one?
MR McNAUGHTON: Yeah, and that’s exactly what we are trying to do with the Ngukurr community.
MR GRIFFIN: And that report on page 7, said in part:
“The situation is unlikely to improve without the active assistance of the NDIA.”
MR McNAUGHTON: That’s correct.
MR GRIFFIN: Ms Papadopoulos, was that because, in market terms, there was close to a failure within that community?
MS PAPADOPOULOS: The Ngukurr project was really led by the Connectors team, and I understand they were looking at a range of factors, not just the market itself, but also the community, community development type of thinking. What’s happening with plans be and other things. So, that was – that was a conclusion that they reached. And we – we supported with offering a CFP a little bit later on in the process. But all that analysis was done by that team.
MR GRIFFIN: Mr McNaughton, my understanding is a team of NDIA representatives from Katherine went to that community to undertake the work which is reflected in the report.
MR McNAUGHTON: Yes, that’s correct. Also, also the remote team out of Darwin and some of our Connector – they also had some support from research teams in our national office pulling that report together.
MR GRIFFIN: I’m not going to go through the report in detail, but I just want to pick out some highlights and get your comment. You were looking at the impacts on mainstream services as part of that analysis. And I understand – and correct me if I am wrong – that evidence emerged that mainstream institutions such as the local school and the police and the health clinic were experiencing the impact of the inability of participants to access and utilise what supports may otherwise have been available to them.
MR McNAUGHTON: Yes. Yes, that’s correct. I think Kitsa’s point was really important. It goes to the Commissioners’ point yesterday about this was probably one of our first genuine community – a whole of community approach, not just a market intervention, but what’s the entire impacts of the NDIS on the community and what needs to improve outcomes. So, the mainstream service, the school, the police, the health centres are all involved in work, which is probably one of the first of its kind for us.
MR GRIFFIN: Because adopting this approach at Ngukurr enabled you to move outside the confines of a strict economic market analysis.
MR McNAUGHTON: It did. It focused much more, Counsel, on the community needs and the community situations.
MR GRIFFIN: Was that a challenging exercise for your staff to undertake?
MR McNAUGHTON: It has been. It’s been quite a long journey. COVID impact as well in the middle of that too, of course. But lots of conversations building those understandings – community yarning round tables, they’ve called them. And there is still a lot more to go, but it – and it – it requires a lot of wrangling of all the mainstream service providers into those conversations too. It’s not just the disability mob here again to talk about NDIS. It’s about who needs to be around the table to have those conversations. So, it took a lot of effort to get to that point.
MR GRIFFIN: And did that involve liaison with a number of Territory agencies?
MR McNAUGHTON: Yes, absolutely. The Northern Territory government actively involved in that process with us. Which was – which was really important.
MR GRIFFIN: And you looked at the performance of the Sunrise Health Services within that community. And I think it’s fair to say that there was sustained criticism of their performance, particularly a lack of professionalism or community focus and various other matters. Is that a fair overview?
MR McNAUGHTON: Yes, that was feedback from other members of the community. We actually have engaged Sunrise to provide our Remote Community Connector supports and they have been able to increase their local staffing to help with that. And that’s been a really important initiative as part of the whole of community approach. So, Sunrise has been doing a lot of good work for us as Remote Community Connectors.
MR GRIFFIN: But is it fair to say that the – I will call it anecdotal evidence from community members was borne out when it was more closely looked at in this study?
MR McNAUGHTON: Yes, yes. That’s correct.
MR GRIFFIN: And because it’s sometimes, Mr McNaughton, suggested that individuals, when criticising, don’t represent anything other than their own particular circumstance, and this report would suggest that when one looks at it closely, you may well find that those individual complaints are reflective of a much wider issue?
MR McNAUGHTON: Yes. And that’s – that’s, Counsel, exactly what the team were doing. Interviewing local participants, community members about their experience within the NDIS, which then opened up a range of other mainstream issues that came through, including access to health systems or education. So, that’s why we took a much broader lens to the engagement.
MR GRIFFIN: And it supports the notion, doesn’t it, that face-to-face discussions with people in community can be enormously valuable?
MR McNAUGHTON: They are priceless, Counsel. Absolutely.
MR GRIFFIN: And when you say “priceless”, what do you mean by that?
MR McNAUGHTON: I wish I had more resources to do lots more of them, to be very frank with you. But, yeah, absolutely, everything we get, the feedback from the remote planning team, when we get to go to community, spend time, build trust – in fact one of my remote planters told me you’ve to visit a community at least eight times to be recognised, 15 times to be trusted. So, even – the ability to continue to go out to be present to invest in that is so important for us.
MR GRIFFIN: And that’s also a question of building rapport with people.
MR McNAUGHTON: Absolutely, yes.
MR GRIFFIN: So what you found in that study was that the NDIS support needs were not being met for a variety of different reasons. To what extent did it emerge that people didn’t understand their plans or what their entitlements may be?
MR McNAUGHTON: There was certainly an aspect of that too. Obviously, our analysis looked at, as Kitsa mentioned, when you look at the funding types that aren’t being utilised in people’s plans, for a participant, it’s quite often what – what’s my connection to Country. What’s my daily activities I can do. So, we broke it down into funding types that actually community members needed to get their therapy, they needed to have community daily activities. So, they were the sorts of themes that emerged. But very much – and that’s come through quite strong from this hearing, that we need to do more to make it easy for people to understand their plans.
MR GRIFFIN: Can I pick up an issue at this point. And let’s deal with requiring assistive technology by way of, say, a wheelchair.
MR McNAUGHTON: Yes.
MR GRIFFIN: You might recall that, during my opening, I indicated that a wheelchair suitable for the streets of suburban Melbourne, Sydney or Brisbane doesn’t do well on the Outback gravel. That’s accepted, isn’t it.
MR McNAUGHTON: Absolutely.
MR GRIFFIN: The second issue is the time in which it takes, on occasions, for people to either receive a wheelchair, or to receive a replacement wheelchair, or to have it repaired. Some of the stories told in the Ngukurr report suggest, for example somebody having to wait two years for a wheelchair. There doesn’t appear to have been any dispute that their need and entitlement was there. What did this study reveal about that issue?
MR McNAUGHTON: Yeah, it – and this – we heard some examples earlier in the hearing as well around people waiting far too long to get access to their supports, especially when the supports are funded. We’ve made a decision that that person needs those supports. So, they’re in the person’s plan, the fundings for them. What we’ve identified through this work and others is that we need to be able to get the right assessments done much more quickly for people. So, the allied health assessments in community.
Virtual allied health assessments are a good stopgap but don’t work for all complex situations. So, the ability to get allied health professionals in or occupational therapists to do those assessments is critical. Then the second part, Counsel, is where are the available all terrain or robust wheelchairs available in the country and how can we get them there as quick as we can. So, they are the two bits of the puzzle we have been doing a lot of work on to try to condense that time, because it was taking far too long.
MR GRIFFIN: Let’s assume that there’s no dispute that the person is entitled to a wheelchair.
MR McNAUGHTON: Yes.
MR GRIFFIN: From a logistical point of view, it’s difficult for us who aren’t involved in the work you do to understand how that isn’t a simple logistical exercise. Source the product, deliver the product. Amazon does it hundreds of thousands of times every day. The Army does it, albeit in a different circumstance. Why can it happen that somebody would wait two years for something that is indisputably required?
MR McNAUGHTON: I mean, those wait times are simply not good enough, and there’s been a lot of work. So, there’s two things we have done to try and really break the back of this situation, because it’s just not good enough that it’s taking so long. The first thing was, in March this year we changed our policy settings to remove the need for quotes for wheelchairs or assistive technology up to $15,000. And what this happened, it was – quotes were going back and forth and back and forth, and that was just adding time. And then a quote would expire after 60 days, and you had to get another quote.
So, it was really inappropriate in some of those delays. So, we have removed the need for that altogether. So, that now allows any of the sort of treating specialists of the person, disability technology advisors to say, “This person definitely needs a wheelchair. It’s in the plan. We don’t need any more quotes.” So, that’s taken out a huge amount of the steps and timing in the process. The second bit is, as you said, it’s the supply chain, for want of a better term, of how you can then find that piece of equipment.
Some pieces of equipment are available to providers in Darwin, others are quite bespoke and need to be manufactured to suit the height and growth. And a lot of those manufacturers are in the big cities, on the eastern seaboard and then we need to get the trucking company to take it up there. We’ve just released earlier this year a new national database. It’s called Ask NED, the National Equipment Database. And we have got every single assistive technology provider we can who can do robust all terrain to put what’s available on the shelf and what they can build as well as the delivery times. And every support coordinator knows they can tap into that.
If you can’t get the right assessment, there is an online allied health assessment national network now, for this product – for products as well. And, again, we have been able to try and get that into place to try – as you said, we need to – we need to really close the time it’s taking for those things. And I think those two things are starting to make a difference now.
MR GRIFFIN: What happens when the support coordinator fails to do their job properly and that contributes to delay? Is there any way you can intervene in those circumstances?
MR McNAUGHTON: We do a lot – a lot of work engaging with – because one of the things we can obviously see with utilisation, if we are seeing high levels of utilisation of support coordination but not much utilisation of other parts of the plan, there is often a conversation with the support coordinators saying what’s going on here? Because you can see you’re drawing down the plan; we are not seeing many other supports being drawn down. So, our teams and Kitsa’s teams will have conversations with support coordinators about what do we need to do here to help what’s happening, what else – what else is happening in this participant’s life or this community that needs to be done. So, we do a bit of intervention there. But Kitsa might want to add to that. She looks after the support coordinators nationally.
MR GRIFFIN: Before you do, Ms Papadopoulos, what’s your current expectation on that simple example? I am in Ngukurr. Everyone agrees I need a wheelchair. In July of 2022 what are your expectations of delivery?
MR McNAUGHTON: We have some service guarantees, internal key performance indicators now. We would like those in 60 or 90 days from them being identified in someone’s plan to be delivered.
MR GRIFFIN: Although better than the example, it still seems a long time. Let’s say – if you say 90 days was in accord with your expectation, upper end, think of the situation where I’m in this remote community, my whole lifestyle and enjoyment of life is suddenly changed because I have no mobility. That’s a very long time for someone in that situation.
MR McNAUGHTON: I guess it depends, Counsel, if it is – as I said, if it’s a real – if there’s been a catastrophic spinal injury, the person would be in hospital in Darwin. We would be working on their exit from hospital to have that equipment for them. Because that’s – if someone’s mobility is decreasing over time, they have a wheelchair, and that wheelchair needs to be replaced, we would be working on the replacement of that wheelchair through their plan.
If it’s a more of a standard wheelchair, that doesn’t need any sort of customisation, those things are quite readily available, and we expect them to be there much quicker than those timeframes. If it is a very bespoke build of a wheelchair, just the time to actually construct, to get the fittings done and then to get it delivered there can – can take a period of time, even – but that’s kind of the most extreme, I would think, example.
MR GRIFFIN: So on the –
COMMISSIONER MASON: We have heard evidence this week about the failure of the hoist, external and internal. The wheelchair and the commode. Just listening to the evidence this week and the impact that it had on that family, what needs to change with allied health providers in the way that they are selecting equipment? Because their external – or outdoor hoist failed at the first go.
MR McNAUGHTON: Commissioner, it was a really harrowing story, wasn’t it, that we have got an allied health professional prescribing this sort of equipment and getting it delivered and it was the wrong sort of equipment. You know, they’ve all got their own professional standards and others that they should be working to, but you do – your mind goes to do we have to have some more bespoke providers of remote robust all terrain type of allied health and specialist equipment? I mean, assistive technology equipment.
COMMISSIONER MASON: I’m aware of minimum standards of housing design on the APY Lands, for remote housing. It seems practical and sensible to have a minimum standard for equipment in remote and very remote areas as a minimum standard, rather than off the shelf that seems suitable for anywhere in Australia, because the impact is incredible.
MR McNAUGHTON: Yes, I agree, Commissioner. And I’m not – I’m not actually right across all the standards of the allied health professional industries, but having providers who understand what is all terrain or robust is really important, and service providers to be able to go to those specialists so that what it gets there it’s durable for unsealed roads or unpaved roads and those sort of conditions are really important.
COMMISSIONER MASON: I was surprised that even the hoist that was used internally, in the house, actually was too big. It felt like there was no effort to even look at the house.
MR McNAUGHTON: Yes. Well, if – I agree. I don’t understand how an occupational therapist could not have measured the width of the house for the hoist that was being built down the house. So, you know, that’s something we have to look into around that.
COMMISSIONER MASON: Thank you.
CHAIR: Mr Griffin, I’m not sure whether you propose to draw out some of the points that are made in this report. Do you intend to do that? I mean, specific matters such as only three of the 24 participants interviewed knew something about the NDIS.
MR GRIFFIN: I do intend to go to those matters.
CHAIR: Right, I shall leave it.
MR GRIFFIN: But before I do, if I can adopt the language of former Prime Minister Keating that in a two-horse race, back self-interest every time. Have you ever considered building in an incentive to the providers of the wheelchair to get it there more quickly? Give them some incentive to make it happen, given the fact that you’re comparing the cost to you on the one hand and the wellbeing and lifestyle of the participant on the other?
MR McNAUGHTON: I’m not aware that we’ve considered that. But I think it’s – it’s not an unreasonable consideration, actually, Counsel. So that might be something we can take away and give some thought to.
CHAIR: Or a penalty if they don’t deliver.
MR McNAUGHTON: Yes. That’s true.
MR GRIFFIN: The research at Ngukurr also revealed that all six of the support coordinators lived in either Katherine, 321km away, or Darwin, 635km away. And it concluded:
“... which makes delivery of the above services very difficult if not impossible.”
Is that accepted by the NDIA?
MR McNAUGHTON: Yes. I think we have heard a lot – even from the witnesses from the Fitzroy saying that the ability to have a local support coordinator is really, really important.
MR GRIFFIN: I won’t go through all of the matters revealed, but it indicated that 83 per cent of the participants did not know who their support coordinator was. Rhetorically, I ask how can that happen?
MR McNAUGHTON: Yeah, well, again, that’s concerning, isn’t it. That’s why we need to do some more. I think one of the interventions was to look at the support coordination model.
MR GRIFFIN: Are either you or Ms Papadopoulos able to take that answer further by saying, “Yes, it’s concerning but it happened for the following reason and what we are going to do to make sure it doesn’t happen in the future”?
MR McNAUGHTON: I can start with what we are doing with the trial in Ngukurr in support coordination. I think, as the report goes to, there was – if my memory serves me correct there was around 350 or 400 thousand dollars a year of support coordination going to that community. But I might be misquoted there, but it was a reasonable sum of money. There were multiple support coordinators supporting participants in that community, and, as the report found, not everyone had a strong connection with their support coordinator.
So, what’s the better way of looking at intervening in a market like that where we can have a support coordinator who is trusted, understood, and accessible for the local community members and, you know, that’s the work we are continuing to do. We’ve seen some good examples of that outstanding of Ngukurr where we’ve been able to build local support coordinators for the ACCHO sector, for argument’s sake, which has made a significant difference in some of those communities.
MR GRIFFIN: Of the 20 people spoken to in this study, only five when prompted with the actual name of the support coordinator were able to recognise who you were talking about.
MR McNAUGHTON: Yeah, that’s correct.
MR GRIFFIN: Is it always under consideration to, wherever possible, to have the support coordinator in the same geographical location as the community?
MR McNAUGHTON: That would – that would be the ideal. Absolutely. Obviously, that doesn’t cover every single community of the entire country, but there is a lot of merit in having access to your support coordinator and we heard some evidence of that earlier this week around support coordinators in Perth and only speak to them on the phone every now and then. So, the ability to have local organisations providing support coordination obviously has a lot more benefit to participants.
MR GRIFFIN: The report then deals with lack of knowledge and effectiveness of the NDIS in that community. It indicates, amongst other things, that only three of the 24 participants interviewed knew something about the NDIS. The remaining 21 had little to no knowledge of what the scheme did.
MR McNAUGHTON: And that’s – that’s partly – obviously why we need to do more in Ngukurr, and we didn’t have a presence there at all through Remote Community Connectors before the – our work with the Ngukurr community started. And I think that’s probably a testament to that too, where people had obviously met with our planners, they’ve done their plans, hadn't had much connection through the support coordinators, and we had no local Community Connector who was the navigator on the ground.
MR GRIFFIN: So what precisely does the NDIA propose to do to deal with that issue of such an extraordinary lack of knowledge about the scheme?
MR McNAUGHTON: In Ngukurr?
MR GRIFFIN: In Ngukurr.
MR McNAUGHTON: Yes, so, there's obviously, the whole of community approach is still underway, Counsel, but there's been a couple of initiatives already that have been done. We the NDIA team, supported with Kitsa's team, continue to have community yarning and roundtables. We now have Sunrise Health providing on-the-ground Remote Community Connector presence there in a full time capacity, which is really important for us. We have been working on a coordinated funding model for proposal for Ngukurr as well.
And we continue to support the Ngukurr community, we have the elders group, we have Sunrise, we have the Northern Territory government and the other mainstream providers all at the table now looking at some of those local solutions, and Kitsa can talk about the work that they are doing around the coordinated funding proposal, if you would like, Counsel.
MR GRIFFIN: Before we do that, a PowerPoint presentation entitled Draft Ngukurr Community Analysis, which appears in Hearing Bundle C at tab 69, identified three particular issues. I will raise those with you. Firstly, an absence of a culturally appropriate engagement and communication strategy when consulting with the community. Secondly, the language used to communicate agency information is not culturally appropriate, which leads to misinformation, confusion, and potentially mistrust.
And, thirdly, consultation with the community is not taking into account the cultural appropriateness of engagement with Aboriginal and Torres Strait Islanders people. That was conclusions reached by the work done by your organisation. How does the organisation intend to tackle those issues, with reference to Ngukurr to give us some concrete examples?
MR McNAUGHTON: Yeah. Thank you. And we have those those emerging themes have been consistent throughout the course of this hearing too. And the need for us to do more culturally appropriate information about the NDIS in community, in language, so that people can from First Nations people in remote can understand what the scheme is and how they can use their plans more flexibly. I think that's come through really strongly.
There is a whole range of work underway in terms of supporting Remote Community Connectors to build out better more appropriate language products around the around the NDIS. So, that's one of the first things we are doing. We are reviewing our remote and very remote strategy at the moment. The review found very similar themes across areas of focus, and one of those is that we need to do more around our communications to tailor communications much more appropriately for First Nations people in remote communities. So, there's another piece of work the agency is progressing around that.
MR GRIFFIN: Will that involve engaging First Nations people with expertise in this area?
MR McNAUGHTON: Most definitely.
MR GRIFFIN: And to what extent, in that work let's take Ngukurr. What's your timeframe in terms of addressing the issues raised in the report? Do have your milestones in line that you want to achieve?
MR McNAUGHTON: So, there are there are various milestones around things like implementing the coordinated funding proposal, which is around that access to supports that is currently underway. We had a target around getting the Remote Community Connector in situ in place, which we have been able to do now. And then it's the ongoing I think there's another community yarning round table booked in for the next few weeks where the teams and the Northern Territory government and other entities will be there for the next of those community gatherings to continue the dialogue.
MR GRIFFIN: One of the final conclusions on page 16 of the report is the traditional mainstream model is not and will not work at Ngukurr or in other remote areas. Does the NDIA accept that proposition?
MR McNAUGHTON: Yes, our own findings from our first iteration of the remote and very remote strategy review was that we need to do more to design some of our policies and practice that are more tailored and fit for purpose for remote communities.
MR GRIFFIN: What will your new approach look like, as contrasted to your previous approach? What are the main characteristics of the change in approach?
MR McNAUGHTON: Well, without pre empting that, because it's there's work in progress and we're just assembling the external stakeholder references groups, as June mentioned yesterday. There's some preliminary meetings around that. But, clearly, the themes of flexibility, more tailored approaches for remote communities and at making the scheme easier to access and understand would be some overriding principles, and then the work that the the great work Kitsa's team and her are doing around improving the supply of services so people can access the funding in their plan will be a really important component of that too.
CHAIR: Mr McNaughton, I'm not quite sure that you answered directly the first of the series of questions that Mr Griffin asked. Namely, does the NDIA accept the proposition stated at page 16 of the report that the traditional mainstream NDIS model is not and will not work at Ngukurr and or other remote areas.
MR GRIFFIN: With respect, Chair, he did answer the question in the affirmative.
CHAIR: He did. I'm sorry. I didn't hear.
MR GRIFFIN: Yes, which is why I didn't proceed any further in the issue.
CHAIR: I see. The word "yes" was responsive to that. You accepted that proposition.
MR McNAUGHTON: Yes, I did.
CHAIR: I'm sorry. I didn't I missed that. Thank you.
MR GRIFFIN: It seems to flow from what we've been discussing that there needs to be a whole of government approach involving both the NDIA, any Commonwealth agencies and any state or territory agencies?
MR McNAUGHTON: Yes, I would agree with that, Counsel. I think a lot of the evidence throughout the course of the week were around other elements that impact communities, of which access to the NDIS is one. So, some of these issues are really I mean, one of things that even that I struggle with or my team struggle with is finding housing for my staff into these remote communities. We have been trying to recruit staff into Fitzroy for two years, and we can't get them there because there's no housing. So, these things are quite deep issues we need a whole of government response to. So, yes, I agree.
MR GRIFFIN: Another conclusion appears to be that key to achieving sustainable improvements is to enable First Nations communities to develop solutions for themselves.
MR McNAUGHTON: Yes.
MR GRIFFIN: Does your organisation accept that proposition in this context?
MR McNAUGHTON: Yes, they have to be community led solutions and I think that's the you know, some of Kitsa's examples about working with the community in APY and other places like Palm Island have really demonstrated that.
MR GRIFFIN: And do you accept
CHAIR: Sorry, I'm sorry to interrupt again. But the observation at page 16 of the report seems to place in focus an issue that has arisen over the last few days. And that is whether the response or the responses to the difficulties that we have heard about and that are reflected in this report, this report based on consultations and discussions in about April 2021 reveals what could only be described, I think, as a disastrous situation in this community.
What you're engaged in and let me accept it's a good faith attempt, even if a bit belated to try and address these problems, what you are trying to do is to address these problems by a communal approach of the kind Commissioner Mason has spoken about on a number of occasions, within a framework of an individual approach. And I'm just wondering whether this is trying to adapt a program, a structure, a scheme that really isn't capable of being reformed in the way that is required to address the needs of First Nations people with disability in remote areas with the best will in the world.
Do we not need to contemplate a different model all together for those communities which are unique in a range of respects? In other words, can this be done within the framework of the NDIS?
MR McNAUGHTON: Well, Chair, we think it can, with the flexibility the new legislation has provided around the commissioning. But I I do think it is a good and timely opportunity to raise that issue as part of Minister Shorten, our new minister, has announced a bring forward of a review into the NDIS. He's also announced a focus on improving as part of the review, improving the service delivery into remote. And I think those very macro issues you are suggesting need to be on the table for that review and that consideration. In the meantime, we need to continue doing all we can to improve outcomes for First Nations people in remote, and we will continue to do that within the current legislation.
CHAIR: Bearing our Terms of Reference, we might need to do it as well. Yes, Mr Griffin.
MR GRIFFIN: The analysis document at tab 69, sums up by saying:
"This will mean a change to the overall policy and service delivery architecture through structural reform to transfer accountability and decision making to communities."
Stripped from the bureaucratic jargon, how does that look in Ngukurr in the next 12 months?
MR McNAUGHTON: It's the ongoing approach through the community led the community roundtable conversations where the community are much more empowered to look at solutions around the NDIS. And those other mainstream service systems we have at the table as well. So, I think that's the principle of empowerment at the community level, Counsel, and our role in trying to facilitate that.
MR GRIFFIN: That's referred to in part, I think, in paragraph 143 of your statement?
MR McNAUGHTON: Yes.
MR GRIFFIN: The work you have been doing in Ngukurr commenced in around 2020? Is that correct?
MR McNAUGHTON: That's correct, yes.
MR GRIFFIN: We're now in the middle of 2022. How do you assess the progress over that period of time?
MR McNAUGHTON: As I mentioned, we do need to there were quite significant COVID restrictions accessing communities remote communities. Quite rightly, for a significant period of time, Counsel, so that meant we weren't able to physically visit there for some period, which put things on hold. We have since been able to visit and reconnect more regularly, which has been good. We're close to the you know, and Kitsa can talk through the coordinated funding proposal, if so you need that too, Counsel.
And those key themes in place around so we've been really pleased to be able to get the Remote Community Connectors up and running and having the presence on the ground. We've been really pleased to have the roundtables and getting the other mainstream service systems at the table. But it is a journey. These things take time, to build rapport, as you said, and build trust, that they don't happen quickly, and they do take time.
MR GRIFFIN: In the draft report at tab 64, it purports to define the success of the project. And what I'm going to ask you is whether these factors are the factors that the NDIA is going to measure its performance against: All participants have tailored and accurate plans. Secondly, the service model and supports for all of the funded supports are attractive accessible, culturally appropriate and effective. Thirdly, the participants and their families or carers understand their own plans. And, fourthly, the arrangements are socially, culturally and financially sustainable. Are those aspirational targets or are they targets, based on your experience of doing this project, achievable?
MR McNAUGHTON: In a way, they're both. They're also targets that we have spoken to the community about. In different terminology, but, you know, these are things that are important for the community. They're important for the agency, and we're going to do all we can to progress those. So, they might sound aspirational, but actually we think they are really important targets to aim for.
MR GRIFFIN: My hope is they're not merely aspirational, which is why I asked the question. The gist of my question is, based on your experience to date in this project, is, really, are they achievable in circumstances of Ngukurr?
MR McNAUGHTON: I think they are. I think they are. And we're already seeing that. If we can start to get the better coordinated funding for those supports, the therapy supports the support coordination, the social and community participation, all of a sudden we start to go from a community that had very, very low utilisation and access to services, to start to get those therapy supports. To start getting social and community participation activities in community. To have a local Community Connector who can help with the activities on the ground. Those things are really powerful outcomes for those participants and those communities.
COMMISSIONER MASON: Mr Griffin, can I ask a question about the Ngukurr work. We heard this week about the importance of family and the informal supports that family provide to their family members with disability. In the Ngukurr experience, are family members now participating in the service systems, so to speak, or are they still seen as are they still participating as informal supports?
MR McNAUGHTON: Commissioner, do you mean are we have we got paid family members or are you talking about informal?
COMMISSIONER MASON: Yes.
MR McNAUGHTON: I'm not aware of any paid family members as part of a person's plan. I'm not sure if any family members are working now in the broader service system. I don't know that, sorry.
COMMISSIONER MASON: That seemed to be a fundamental building block raised by peak organisations this week and also family members who have given evidence. And I think if that question is not given attention to, then we will continue to have that as a solution raised. But it seems like it's not a priority in activating workforces in these remote areas. So, I'm keen to know if the NDIA is interested in that question because, yes, there are complexities about it, but managing those complexities, I think, is critical if we want to activate local workforces.
MR McNAUGHTON: Thanks, Commissioner. There's two bits. We are supporting some work the department is leading around building local workforces where we are trying to get working with the ACCHO sectors and others around having more community members to be trained up and engaged to be part of the NDIS service system. The other broader policy issue that's come up a few times this week, as you mentioned, is around the scheme's ability to pay family members. Which obviously needs a lot more policy attention, based on the outcomes of this week. There is policy now around that in the agency where we do it in exceptional circumstances and mainly where there are no other viable options available.
I think, Chair, you raised a couple of times this week around the risk overlay and what are the policy parameters. We need to think that through. We would need to talk through that with key stakeholders, I think, to make sure that we are getting those policy settings right. It's not a quick thing. We just need to engage with the right people, I think, Commissioner.
COMMISSIONER MASON: And the last comment I make, is and Pat Turner in her evidence or in that panel that we had yesterday talked about the Aboriginal health worker, critical as a frontline worker connecting the services offered by Aboriginal health service and working with individual members who come in for services. And also they work with families. There you have the model.
MR McNAUGHTON: Yes.
COMMISSIONER MASON: Here in Alice Springs, that's the model. Aboriginal people from this community working in Aboriginal-controlled community organisations working with their family members. So and that's the model in remote communities. So, it's the economic, the social, the cultural benefit is there. And it would be it would be transformative, if this issue could be resolved. Because it seems to me, from the Ngukurr experience, that even at the family level, the the value proposition of the NDIS as an insurance scheme is not understood by Aboriginal people in remote communities.
It feels like the section of the scheme that is the direct benefit is talked about with clients and families, but actually the value proposition of it in terms of the Australian Government and the Australian community is not understood. So, what that means is we need more local people working in the system and being part of the governance and service delivery model to have more of an understanding. And I am sure you understand this, but there needs to be more of a critical mass of workers.
MR McNAUGHTON: Yes.
COMMISSIONER MASON: So in those local communities. Thank you, Mr Griffin.
CHAIR: That just leads me to ask this very specific question: The Sunrise Health service that is referred to in this the report, is that an Aboriginal-controlled organisation?
MR McNAUGHTON: Yes.
CHAIR: It is?
MR McNAUGHTON: Yes.
CHAIR: And yet its performance was said to be not terribly good. Does anybody know or analysed why that was the case?
MR McNAUGHTON: I'm not sure of the actual issues. I understood they were from some interviews with other community members around their access to the service and it wasn't open every day of the week.
CHAIR: I don't want to engage in speculation about it. Yes, thank you, Mr Griffin.
MR GRIFFIN: As Commissioner Mason raised the issue, can I come to the question of funding of family members. Mr McNaughton, at paragraph 115 of your statement you state that:
"The NDIA does not have specific guidance on how the 'exceptional circumstances' threshold applies to funding First Nations families in remote and very remote areas to provide services."
Can I assume from that that there is no prohibition on funding family members?
MR McNAUGHTON: That's right.
MR GRIFFIN: Under the current scheme?
MR McNAUGHTON: That's correct, yes.
MR GRIFFIN: But can I take it that there would be legitimate concerns when considering whether to fund family members? Based on your experience, what would be the types of concerns you would have when faced with a proposal to fund a family member?
MR McNAUGHTON: It's a it's a bit of a challenging policy space because of the issues around participant safety and risk. We have seen some horrific situations where a person had one carer in their life and there was some pretty tragic outcomes. And we're conscious of participant safety and risk as part of that model. Also for the ability for participants to exercise choice and control over who provides that personal care, and sometimes people may not want it to be a close family member. So, that's really important.
Having said that and, COVID, we did relax the exceptional circumstances a little bit because the workforce mobility and people that were severely immunocompromised where they weren't able to have other workers come into the house, and so we did relax it a little bit in COVID.
MR GRIFFIN: Can I ask you at that point, did COVID give your organisation any insights in relation to this issue?
MR McNAUGHTON: It did because we did we did specifically update the policy and slightly relax the exceptional circumstances to respond to the pandemic. Interestingly, counsel, there was less than 10 requests that certainly come across my desk for it. Because people still wanted to have an appropriately trained support worker come into their house. And that's the other thing, the level of training and regulation that and oversight that is in place.
Having said that, we have heard very strongly, as the Commissioner said, this week, that is an area that needs some more attention from policy. We just want to make sure we are doing it in the right cultural but risk overlay as well.
MR GRIFFIN: Without any in depth analysis, it would appear from the evidence of Marmingee and Geoff that, on the face, they would seem to be the sort of people that could provide an exceptional level of service without any apparent concerns for risk. Was that your impression from their evidence as they gave it?
MR McNAUGHTON: Yes, I thought they they were very good witnesses, and it was a really powerful insightful account of the supports they provide. The the other the other consideration we have to make in accordance with decisions like this, Counsel, and without sounding too bureaucratic, but under the Act, section 34, I think it is, (e), talks about when we provide funding in someone's plan, we need to take into consideration what is reasonable for the family, parents or community to provide.
So, there is that element we have to take into consideration, as well as their other payments such as carer pensions and things like that. That also come into play. So, that is a factor we need to given it's in the Act we need to be very mindful of.
MR GRIFFIN: Are there any other specific risk factors that the NDIA considers when deciding whether or not to fund a family member?
MR McNAUGHTON: The exceptional circumstances are I mean, they are quite limited in terms of cultural and also have we have we explored the possibility that other there is available support workers for the participant. Support workers who are trained, who are registered, who have the appropriate safeguards in place. If all of those things don't exist and there's a risk to the participant of not getting any support, then that that could be a factor for us to consider that.
MR GRIFFIN: I think you indicated that the level of application from family members is quite low.
MR McNAUGHTON: It is quite low, yes.
MR GRIFFIN: And have you explored why that is?
MR McNAUGHTON: Not not to my knowledge, sorry, Counsel, no.
MR GRIFFIN: There seemed to be, from some witnesses, a belief that they wouldn't be eligible. And certainly Geoff gave evidence to the effect that he wished it were otherwise, but he didn't regard he and Marmingee as being eligible. Is that simply a case of them being mistaken as to how the scheme currently operates in terms of eligibility to make an application?
MR McNAUGHTON: It could be. I am not part of, obviously, detailed into their planning meetings or what's been discussed. But that could be part of that.
MR GRIFFIN: Does it flow from what you've said that, in analysis of an application by a family for support, that the family are seen as the last resort? If they are seen as the last resort, they are more likely to be treated as exceptional circumstances?
MR McNAUGHTON: We probably, Counsel, plan the other way around. So, when we are planning for the participant, we're building their reasonable and necessary supports, taking into consideration what's already provided as informal supports, as I mentioned previously. And then if there are no available so who are then are the available support workers to support that participant? Who is available to provide personal care or therapy or any of the other supports that person requires?
If in the conversation it comes up that there is no supports available at all for the person and there's a risk, then that's when we could consider it, if that was a if that related to that participant's specific situation.
MR GRIFFIN: And is that the point where you could characterise that as building capacity within the family and, hence, the community?
MR McNAUGHTON: Yes. And it almost goes part of Commissioner Mason's really important point was, we can we can build family members to then even become trained support workers and register with an ACCHO. All of a sudden, they get the sort of support of an organisation as well. So, that type of building a local workforce is is a really important aspect of that too, where we can.
COMMISSIONER MASON: Mr Griffin, I was going to ask that question, is because if we're talking about a family member or families becoming part of the workforce, there's a really important understanding of responsibilities and the opportunity to even be auspiced by an Aboriginal community-controlled organisation or to be registered, as you said. My thinking was not that they would be working in isolation to accountability, or transparency or monitoring, supervision, case management.
MR McNAUGHTON: Yes.
COMMISSIONER MASON: Because there is also there's necessity of what does it mean to be in the workforce. And we heard that evidence from NPY Women's Council, who started services in the 1990s and is still saying that level of supervision and support and case management of workers is still critical. In fact, their model is the Malparara way of working which is an non-Indigenous and a Anangu worker working together using their expertise, because of that low educational attainment but higher level of cultural and family expertise. So, and I think I also wanted to make that point as well.
MR McNAUGHTON: Yes, I think it's an incredibly important point too, and it also having the support of an organisation for your own sort of development and peer learning and all of those aspects is really important, but the other thing too is if the family member was sick for a week or so the organisation might be able to have someone else come in and support the participant with their needs as well. So, those things are really important, Commissioner, I agree.
MR GRIFFIN: Before I proceed any further, can I indicate in response to, Chair, your question about Sunrise.
MR GRIFFIN: On page 9 of the report at tab 64, which is the A Better NDIS at Ngukurr Report, I won't go into detail, but it says:
“Performance of Sunrise Health Service and as NDIS and primary healthcare provider ..."
And it outlines on page 9, going over to page 10, the sources of information which indicated that their performance was not up to standard.
CHAIR: Yes, I was aware of that. I was just wondering whether it was an Aboriginal controlled organisation or external.
MR GRIFFIN: Thank you.
CHAIR: Yes. Thank you.
MR GRIFFIN: And finally, Mr McNaughton, on this topic, you heard evidence from Geoff talking about how he gave up his job to take care of Tristan, help him develop the business, created the Men's Shed equivalent and thought that the idea of a mentor program might be enormously valuable. Without me going through his evidence, did you see merit in the suggestions he was making in looking at a mentor model in some communities?
MR McNAUGHTON: Yes, I mean, I thought his evidence was fantastic. What they're obviously doing with the local football and Men's Shed and peer peer mentoring, and the employment program they've got with the landscaping business, I think all of those things are very, very good. We we have some funding opportunities within the scheme around peer learning and mentoring and coaches, actually, for people who have psychosocial disability and other mental health type conditions.
So, we have coaching type roles, peer coaches for for participants. It's a it's a funded support type that can be put in place. So, there are some options there. I'm not sure about what other funding streams there may be for that type of peer learning and Men's Shed things. I'm sure there are other sorts of funding sources for great initiatives like that.
MR GRIFFIN: And, in particular, he said based on what he had learnt in assisting Tristan, that he thought, within their community, a well-trained person in mentoring could perhaps then mentor up to five other young people, and, hence, you suddenly have the potential with 20 mentors to be providing support to 100 young people in those communities. Did you see merit in what he was suggesting?
MR McNAUGHTON: I certainly did. I think I think there's a lot of value and evidence that mentoring is a fantastic type of support model. Whether that's within the construct I'm not sure if all those people are NDIS participants or others, so whether it's an NDIS funded program or otherwise, I'm not sure. But definitely merit in the program, Counsel, for sure.
MR GRIFFIN: I don't expect you to commit yourself publicly to this, but would be the sort of proposal which would be considered, if put before the NDIA?
MR McNAUGHTON: I think it's things we would have to look at. Again, are the participants the ones being mentored? All those sorts of things, Counsel, but yes.
MR GRIFFIN: Yes. But you would be open to considering it.
MR McNAUGHTON: Yes, yeah, they are the sorts of community-led initiatives I think that should come through.
CHAIR: Mr Griffin, we have been going, I think, for an hour and three quarters.
MR GRIFFIN: Yes. We are right on the break. I was going to suggest 11.15?
CHAIR: So, should we have a break for 10 minutes, quarter of an hour?
MR GRIFFIN: 10 minutes. And then
CHAIR: 10 minutes, I think that would be appropriate. It is now 11.15. We will resume at 11.25 Central time. Thank you very much.
<ADJOURNED 11:15 AM
<RESUMED 11:30 AM
CHAIR: Yes, Mr Griffin.
MR GRIFFIN: Thank you, Chair. What I propose to do now is to deal with some discrete issues. Can I start with the question of support coordination and particularly plan utilisation. If a participant has a plan which contains $100,000, and only $10,000 is used in the relevant time, does that create a flag within the NDIA?
MS PAPADOPOULOS: It creates a flag for my team through our market monitoring work. Not so much with regard to one individual, but with regard to patterns in places of numbers of participants not using their plans.
MR GRIFFIN: So your unit takes a macro approach, but you can divide it by geographical location when you look at utilisation rates?
MS PAPADOPOULOS: Yes.
MR GRIFFIN: Let's assume in Location X, 10 participants each had a plan for $100,000 and, on average, they had only used $10,000, what would that cause you to do in your part of the NDIA?
MS PAPADOPOULOS: In that market was identified as a high-risk market through our monitoring, we would take a deeper look into that market. So, we would consider things like how long has that place been in the scheme. So, for example, Western Australia has transitioned to the NDIS more recently than other states and territories. So, there might be an explanation why that's still taking time to get going. But for markets that have been in the NDIS for many years, we would certainly be very concerned about that.
We would talk to the relevant state manager, so the planning teams in that place, and ask them do you know what's happening in this area, what's your what are your reflections on what's happening in that place. And we would have a look at the plans themselves as to what what's in that 10 per cent that they're drawing down. And we would go from there as to whether to prioritise it as a market to working further.
MR GRIFFIN: Would you expect feedback from the state manager along the lines of that person having discussed the issue with support coordinators?
MS PAPADOPOULOS: We when we talk to the planning team, we talk to them about what we see being used. So, if that 10 per cent, for example, is support coordination but nothing else, or low levels of other supports, we would certainly be looking to that support coordinator as a key person that's accountable for what is happening in that plan. And we would go to support coordinators directly. If we're seeing people, on the other hand, who have support coordination on their plan but haven't been connected to a support coordinator, then we would go back to the planning team and ask for that connection to be made.
MR GRIFFIN: Is any person or unit within the NDIA responsible for assessing the performance of support coordinators?
MS PAPADOPOULOS: My team leads market stewardship of the support coordination market. The support coordination market is is regulated by the National NDIS Quality and Safeguards Commission with regard to practice standards, registration requirements and so on. So, a lot of the issues around quality and capability fall within the responsibility of the Quality and Safeguards Commission. However, we share that market stewardship role with them, and there are other things that we can do on our side as well.
MR GRIFFIN: Based on your experience, is it fair to describe the Quality and Safeguards Commission approach as to being primarily complaint led?
MS PAPADOPOULOS: No. There's there's a large element which is around the regulation. So, the registration requirements are really important, but also the code of practice that applies to any provider operating within the NDIS, registered or unregistered. So, that creates expectations around quality of services, which then the complaints system complements by giving people a way to follow up.
MR GRIFFIN: National Support Coordinator X has been in that role for two or three years. How does the organisation or the Quality and Safeguards Commission form a view as to whether they are discharging their obligations to the standard you expect? What do you take into account?
MS PAPADOPOULOS: If the support coordination organisation is registered, they will do audits on a regular basis, and that is how the NDIS Quality and Safeguards Commission will satisfy themselves around that.
MR GRIFFIN: And when you say, "they will do audits", who is "they"?
MS PAPADOPOULOS: The provider pays for their own independent audit, and the documentation of that is provided into the Commission.
MR GRIFFIN: Is one of the factors taken into account with support coordination with First Nations people whether or not the coordinator is culturally competent?
MS PAPADOPOULOS: That's a really important quality that a participant should be looking for, and in the system that we have, it's about the participant being connected to the right kind of support coordinator that meets their needs. That might be their needs might be specifically around cultural competence but, for others, there might be other support coordinators who specialise in other kinds of disability or other things, for example, that might suit them.
MR GRIFFIN: Who ultimately decides whether the coordinator is up to the task?
MS PAPADOPOULOS: The regulatory regime that's administered by the NDIS Quality and Safeguards Commission can ultimately investigate complaints or investigate the results of audits, for example, and it has mechanisms where it can deregister certain providers or ban them from operating under the NDIS.
MR GRIFFIN: From some previous public hearings of this Commission, there has been a strong suggestion that the QSC is very much complaints driven rather than what I would describe as proactive. Do you have any experience in relation to that issue?
MS PAPADOPOULOS: I don't have a view of what whether they have got the balance right. I understand that they have a number of functions, and they have teams responsible for each of those functions. And and I know that they have recently funded some proactive work specifically around support coordination. So, I have seen them with some recent relevant initiatives that have been proactive.
MR GRIFFIN: This is addressed to both of you, based on your experience. If one judged the performance of a support coordinator on the basis of their complaint history, that would be a very crude measure, wouldn't it?
MS PAPADOPOULOS: I think it would be an important piece of information for a consumer to understand.
MR GRIFFIN: I accept that. But it would ultimately be a crude measure, if that was the factor you looked at?
MS PAPADOPOULOS: Perhaps it the providers would feel it gave a skewed perception of their overall performance. Yes.
MR GRIFFIN: Let me go back a step sorry, Mr McNaughton, did you want to add anything there?
MR McNAUGHTON: No, I don't.
MR GRIFFIN: Okay. Let me go back a step. The provider has to be audited; correct?
MS PAPADOPOULOS: If they are registered.
MR GRIFFIN: If they are registered. Who selects the auditor?
MS PAPADOPOULOS: I think the provider themselves selects auditor.
MR GRIFFIN: Is there an inherent weakness in that approach?
MS PAPADOPOULOS: First of all, I can't confirm that's accurate. It's just my understanding of generally how regulatory regimes work, where self-auditing is really common in regulation across Australia. There are, as I understand it, then a number of safeguards around the appropriateness of the auditors that can be chosen. So, I assume there's some level of regulation of who the auditors are in the first place and then some examination of the quality of the reports that are coming through into the regulatory authority as well.
MR GRIFFIN: Mr McNaughton, do you have any further knowledge on that subject?
MR McNAUGHTON: No, no.
MR GRIFFIN: Can I ask you to take on notice the question of whether or not the auditors are selected by the provider, and could you, via your legal representatives, provide to the Commission subsequent to this hearing details of any safeguards that surround that process.
MS PAPADOPOULOS: Yes, sure. We will work with the Quality and Safeguards Commission to prepare that.
MR GRIFFIN: Thank you. Can I move to the topic of that arose in relation to Emily Carter and Lauren Rice from the MWRC at Hearing Bundle A tab 63. They say at paragraph 79 that:
"Following the Lililwan project, none of the 21 children who were diagnosed with FASD have received any formal disability support, including NDIS supports."
Firstly, were you, Mr McNaughton, present when that evidence was given?
MR McNAUGHTON: Yes, I was.
MR GRIFFIN: Do you have any knowledge in relation to that topic?
MR McNAUGHTON: Of those individual 21 cases or FASD generally?
MR GRIFFIN: Let's deal with those 21 initially.
MR McNAUGHTON: Not personally the 21, no, sorry.
MR GRIFFIN: So can I ask, on notice, whether the NDIA has taken any steps to ensure that the children diagnosed with FASD as a part of that particular Lililwan study, who may be eligible for NDIS, have NDIS plans? And, likewise, ask your legal representatives to collate any information in respect to that. On a more general issue, Mr McNaughton, does the NDIS recognise Fetal alcohol syndrome as a condition relevant to disability?
MR McNAUGHTON: Yes, we do. Fetal alcohol spectrum disorder is on our sorry.
MR GRIFFIN: Just pause, because I wanted to draw a distinction between Fetal alcohol syndrome, FAS and Fetal alcohol spectrum disorder, FASD. Do I take it from the answer you're commencing that FASD is now recognised as well?
MR McNAUGHTON: Yes.
MR GRIFFIN: When did that occur, do you know?
MR McNAUGHTON: My understanding is there was a there was a Joint Parliamentary Committee into Fetal alcohol spectrum disorder in 2019 20. There was a series of recommendations out of that, one of which was for us at the agency to look at how we recognise Fetal alcohol spectrum disorder in the scheme. It has subsequently been added to our list of different disability types. It's in our List B, which means we identify it as a permanent condition, and so it meets the permanency test of the NDIS Act. And then what we need to do is get the information around the level of functional impact the disability has, given it's a spectrum disorder that can vary per person.
MR GRIFFIN: And do you know whether the other condition, Fetal alcohol syndrome, had previously been recognised?
MR McNAUGHTON: I'm not sure of that, Counsel. I know that part of our approaches recently is to use what we've been advised from the sector is more contemporary language, is to use Fetal alcohol spectrum disorder as part of eligibility.
MR GRIFFIN: So is it your understanding that the original descriptor, Fetal alcohol syndrome, has been replaced by FASD as far as the NDIA is concerned?
MR McNAUGHTON: That's my personal understanding, yes.
MR GRIFFIN: And, once again, if that understanding is not correct, can you let us
MR McNAUGHTON: I will come back to you.
MR GRIFFIN: Thank you for those answers. Can I move to the issue of return to Country. You would have heard quite a lot of evidence during the course of the week about that issue. Under the current scheme, a First Nations person who leaves the community for whatever reason to be in another location, and wants to return to Country, do they have any entitlement to support him doing that?
MR McNAUGHTON: Yes, they do. If if that obviously, the participant may have had to move off Country for whatever the reasons, as you mentioned, if part of their goals within their plan is to keep connected to Country, we can and do provide funding for return to Country trips. There's a lot that goes into the not only the eligibility, as you said, but putting that in the person's plan, but there is and I think Beth Walker mentioned this earlier in the week, around the logistical coordination that we often work with the participant and the providers on.
Can I give you an example, Counsel? Would that be useful? I was talking to my service delivery director in Darwin recently about an example of a participant who had moved into into Darwin. They were in a supported independent living. They were in a wheelchair, and they were required registered nurse care most of the day, and they were going back to Country for ceremony. We had to work with the registered nurses, a chartered flight because it was it wasn't a drivable making sure the wheelchair can fit on the plane, supports for the registered nurse when they are back in community for a period of time, so servicing accommodation and return trip.
So, we actually had to build out a quote for that. It was somewhere in the vicinity of 20 to 30 thousand dollars for a return to Country trip like that. So, that's just some of the complexities that our team will work with to make sure that we can support those return to Country trips where they do where they are part of the the participant's goals. It is an area that certainly my my team here in the Northern Territory said it would be good to have some better policy clarification from us on that. And I think that's come through the hearing a bit this week also.
MR GRIFFIN: Can I take you to that, because I was intending to go there. Let me go back a step first.
MR McNAUGHTON: Sure.
MR GRIFFIN: You've heard the evidence we've been referring to. I won't repeat that. The reasons for having a return to Country seem to fall into the category of spiritual reasons, family reasons, cultural reasons, health and medical, psychological. And there might be permutations of all of those. I take it from your evidence that the NDIA accepts as a general proposition that there is great benefit for certain participants returning to Country.
MR McNAUGHTON: Yes.
MR GRIFFIN: Is that acceptance to the level that that is an entitlement, or is it something that will be a case-by-case basis?
MR McNAUGHTON: We don't internally use the word "entitlement" in the agency. We will use "reasonable and necessary for the participant." So, where it's reasonable and necessary based on their goals and their situation, that is certainly something that we should be funding in the plan.
MR GRIFFIN: And the expression "reasonable and necessary" suggests to a lawyer discretion. What's reasonable, what's necessary. And you were elaborating on some of the factors you take into account. There are some situations where the cost of a single trip to Country is very large, as you just indicated.
MR McNAUGHTON: Yes, that's correct.
MR GRIFFIN: Presumably, there are other people with disability that don't require all the ancillary support. Is cost a factor when determining?
MR McNAUGHTON: Sorry, Counsel, there is a value for money aspect to reasonable and necessary decision making as well. So, you think about a return to Country trip that might cost 20 or 30 thousand dollars, what's the value for money, how many trips per year would a policy setting provide for that, because there could be quite a lot of ceremony. So, that and we have to take all of those things into consideration. One of the other key considerations is if a person is in has a behaviour support specialist and funding in their plan for that, can we be assured in community that those right supports are put around the participant as well in case, so there's no risk to the participant or community. So, we have to work and get approval from the behaviour support specialist to make sure that that's supported when they go back to Country for a period of time as well.
MR GRIFFIN: Just take two examples. Participant A, the dollar cost of a return to Country trip, $500. Participant B, $30,000. Ideal world, you might want four trips a year. You're dealing with $120,000 compared to $2,000. How does your organisation manage that analysis when you're confronted with those two hypothetical applications for inclusion in a plan?
MR McNAUGHTON: Yeah. There's a lot of complex fact that go into those individualised decisions. We use our senior directors and my senior director in the Northern Territory, she's a great Larrakia woman and very, very experienced with these sorts of matters, and she will be actively involved in talking to the participants and the communities around those sorts of decisions people would need to make and the trade offs.
We would also need to is it feasible for the person to go to Country four times a year and leave their SIL supports in Darwin, for argument's sake, and what risk might that provide to their health, if they are not getting those. So, there's a range of factors that need to be considered in all of those examples. Of course, if if the person, say, in the the example, say, in Alice Springs, people might have moved in from community and it's a four wheel drive trip.
It's not it's much easier for them to go back to Country, and, in fact, they can go do an overnight camp and go do some shooting or hunting. We can fund that through the social community participation rather than a return to Country trip.
MR GRIFFIN: A $30,000 example I gave you and I hesitate to use the word sounds like a very complex analysis, or, to use a neutral word because of your aversion to complex, Mr McNaughton, a complicated process.
MR McNAUGHTON: Sorry.
MR GRIFFIN: You accept, I think, from what you've said that there is a lack of guidelines that are available to a participant who's seeking that sort of support in their plan. That right?
MR McNAUGHTON: In those more I hate to use that word but complex examples, yes. Where it's social and community participation, it's and it's quite easily, it's a lower cost item, it's more regularly available because there's plenty of four-wheel drives that can do Country trips as part of community participation. It is an area and speaking to my staff, that they would welcome some more wraparound policy thinking of this too.
MR GRIFFIN: And have you accepted the suggestion that that would be useful?
MR McNAUGHTON: Yes, absolutely.
MR GRIFFIN: And what's your timeline to prepare some guidelines in relation to this issue?
MR McNAUGHTON: We will start that over the coming months. We also need to talk to the sector. People like, you know, Beth Walker and the Public Guardian, other people who are quite experienced in this in this space. We there's a few people we would like to involve in some of that policy thinking.
MR GRIFFIN: Do you recall that part of Beth Walker's evidence where she reported NDIA's staff regarding the return to Country as a "holiday"?
MR McNAUGHTON: I did hear that reference.
MR GRIFFIN: What was your reaction? Let's assume that that was an accurate reporting of what was said to Ms Walker. What would be your reaction to your staff returning to return to Country as a holiday?
MR McNAUGHTON: I don't think that's appropriate.
MR GRIFFIN: Why not?
MR McNAUGHTON: It's certainly not how I think of it. I think we've heard the benefits very strongly this week around why that connection to Country and community is really important.
MR GRIFFIN: And you accept that those benefits may be hard to quantify, but they are nonetheless quite powerful?
MR McNAUGHTON: Very much so. Yes.
CHAIR: Is there room for some pooling, perhaps, if, for example, there are several people from the same remote community who may be in a regional centre or perhaps even in two separate regional centres? Might there not be an opportunity, if it would cost $30,000 for one trip, to combine two or three? Obviously, there's some logistical issues but are those sorts of issues being considered?
MR McNAUGHTON: Yes. Yes. It's a really good point, Chair. Where we can, because there might be some community members all in Darwin who have to go back to Country for the same ceremony, we will try to work out options for that where it's possible. It's a good point.
MR GRIFFIN: There was evidence given this week and I think from Emily talking about social supports. Put in the context that some support is, to use my term, very tangible and almost measurable because it relates to an aspect of the disability, but some other supports are much less tangible, aren't they, in terms of where the support and benefit is.
MR McNAUGHTON: Potentially. I'm not sure of the line of questioning here. Sorry. In Emily's evidence?
MR GRIFFIN: Let me just get that up for you. In the NDIA interaction records, a planner told Emily that the NDIA would not fund Emily to go to Alice Springs to go shopping for new clothes because:
"It is a holiday, and the NDIS does not fund holidays."
Assuming that evidence to be accurate for purposes of this question, when one goes to the NDIA's social and recreational supports operational guideline, which appears at Hearing Bundle C, tab 87, it states:
"Social and recreation activities can include things like going out to the movies or going places for fun such as shopping."
Do you accept that's what the guideline says?
MR McNAUGHTON: Yes, yes.
MR GRIFFIN: And appreciating that all circumstances are different, it was within the guidelines as they stood that her application should have been treated within that guideline, wasn't it?
MR McNAUGHTON: Without knowing the exact details, the that could be the case, yes.
MR GRIFFIN: So do you have any idea where the idea came for staff to say, "We do not fund holidays"?
MR McNAUGHTON: Yeah, so there are within the NDIS rules and operational guidelines, the concept of everyday expenses. So, the NDIS funds the reasonable and necessary disability supports the person needs, but not for everyday items. That is you know, so a good example, Counsel, is we won't buy a person a car. But we will fund the modification of the car because the car can be considered an everyday expense. We may support a person to go to a football match at the MCG or wherever, but we won't pay for their ticket to get into the game. We will fund the support worker to get them there and take them home.
So, they are the sorts of everyday items that we regularly fund, is your support to engage in that activity, but, for some people, the cost of the activity may be an everyday item. So, we may support you to go to the supermarket to do your shopping, but the cost of your groceries is an everyday item. That's not funded out of your NDIS plan.
MR GRIFFIN: So you support the accessibility
MR McNAUGHTON: Yes.
MR GRIFFIN: to the activity but not the cost, necessarily, of the activity itself.
MR McNAUGHTON: Yeah, in some I hope I've made that reasonably clear in those examples but, yes, that's what we usually fund.
MR GRIFFIN: And so in the example of Emily, you would support Emily's transport costs to Alice Springs because there was no other transport available? Is that the general idea we are looking at?
MR McNAUGHTON: Yeah. So, Emily, because of her disability, isn't able to drive herself, so the disability is the factor. So, we would support her in the transport that she needs so she can engage in those activities. But when she's in Alice Springs, obviously, the shopping is something she would support herself.
MR GRIFFIN: To that extent, it's not simply a question of shopping because, depending on the community where someone comes from, there just may not be available the everyday goods and services that are available in the bigger areas.
MR McNAUGHTON: That would I'm not aware of the items in every single community, but that might be some other I'm sure people in remote communities will come into Alice Springs or Tennant Creek or Darwin to get some essential services and supports at times, Counsel, yes.
MR GRIFFIN: Can I ask you about the question of utilisation of plan funds. We have discussed under utilisation in one respect. It has been suggested in some of the evidence that, to use my term, use it or lose it. If something provision is in a plan over one or two plans and it's not spent, some people have been told that if they don't spend it, it will be withdrawn. I was wondering if we could have a discussion about that, in a more sophisticated way, how you treat that issue and whether it does ever get to the point of use it or lose it.
MR McNAUGHTON: Happy to have a conversation around that. Use it or lose it is not a term in any of our guidance or policies.
MR GRIFFIN: I appreciate that. I just try to use simple English, Mr McNaughton.
MR McNAUGHTON: I just just for the Commission's experience, it's not something that we consider. In fact, over the last two years, we have seen some pretty significant impacts on plans because of inability to access supports due to COVID. And we've been really conscious of that, so where participants have come to a point and said, "I know I couldn't access all these supports because during COVID for four months, in Melbourne, access to my day program stopped."
So, all of those things are very well aware, and we are very attuned to those. Those things continue be funded in each subsequent plan where it stays reasonable and necessary. It's certainly not a, "Because you didn't access that support, we are going it take away from you." Kitsa needs the supports in the plans to sort of generate, you know, the demand for the market. So, we fund what is required. If there is an issue in that fund not being sourced, that becomes a market issue not a reasonable and necessary decision in an individual's plan. And we're quite clear in our guidance around that.
MR GRIFFIN: Ms Papadopoulos, do you have anything to add to that?
MS PAPADOPOULOS: Yeah, I would agree with Scott that the plan the plans are made on the basis of what's reasonable and necessary for that participant, and it's really important for us to understand the need to see what what is in the plans in terms of reasonable and necessary supports. And and I would agree that we it would be not good practice to remove something from someone's plan if they live in a community where those supports have not been available to date. It's not their fault that they couldn't access it, and, further to that, it removes a source of information for us about what they actually need. So, yeah, I would I would hope that that's not happening.
MR GRIFFIN: In respect to support coordinators and planners, it seems that, on many occasions, they are operating from locations quite remote from where the participant lives. Put aside the question of COVID. Should not there be a requirement that any support coordinator or any planner have visited the particular community and spoken face to face with the participant on a reasonably regular basis?
MR McNAUGHTON: I will start with the planners. Kitsa might talk about support coordination. Yes, ideally, we would like to have a much better national presence across multiple locations. We have planning teams in Thursday Island, Weipa, Tennant Creek, Broome, here in Alice, and many regional towns. Mount Isa I'm going to miss them all. But we don't have every single community covered, of course, Counsel. There's about 85 planners across the national network who service specifically remote.
Some are based in those towns, and some are like a big team in Alice and a big team in Darwin who service the various communities. And they will factor their visits in around wet seasons and availability and other things. So, they might do more community visits in a condensed period of time in the northern parts of the country in the dry season, and then do more in the southern parts outside of the in the wet season, for argument's sake, so they will manage their team.
We would like to have more staff in locations. In Nhulunbuy, where we have got a presence, the only way we could keep the staff staff members there was to actually subsidise housing, rental. It's so expensive, there is limited properties, so we actually rent a subsidise a rental property for our staff there. We are struggling to maintain staff in Broome because of the private rental market there. It's $800 to $1,000 a week for a basic property.
And if you're in a you know, a level APS 4 or 5 level planners, that's a lot of your disposable income going to rent. So, there are challenges around housing that we face, like everyone faces. As I mentioned, we've tried to recruit into Fitzroy for about two years, Fitzroy Crossing, Fitzroy Valley. And we've been unable to maintain a staff member there because of it's a very tough labour market, and there's not a lot of housing supply.
So, we're at the we're at those other factors as well. We are continuing to look at identified positions in locations where we would like to increase our footprint of remote planners. And that's something that we're very conscious of trying to grow that team over the coming year to do that. We absolutely agree the importance of having planners who visit communities, who understand communities, who work with our Remote Community Connectors as an important part of the of the NDIS way.
MS PAPADOPOULOS: And with regard to support coordinators, yes, similarly, it would be ideal if support coordinators could live and work near the participants who they represent, it helps to build trust, build relationships and would allow enable the support coordinator to do a better job, I think, of what monitoring participant's plan and connecting them to supports and understanding their circumstances and the situation in that market.
So, that that is ideal. And we do see support coordinators generally as one of the healthier aspects of our remote and very remote markets in terms of availability of local support coordinators. Many times, that's because it's been one of the areas where Aboriginal community-controlled health organisations have first commenced NDIS service delivery. Many of them start with support coordination as a nice first step and so that's been great.
It's also important that there are options that are not local to help meet demand from if there's not enough local support coordinators, that it is the kind of service that can be delivered over video or phone call. It might not be ideal, but it's possible, and there are many great high quality support coordinators who can offer still a great service in that way. And so the important thing is the participant has a choice around who they engage, and if that support coordinators is not meeting their needs, they can look around and get advice from other people, other participants, and try another service until they find something that suits them.
MR GRIFFIN: You've heard evidence from Joan and others to the effect that, in their view, support coordinators should take a more case management role. Do you have any views about that proposition?
MS PAPADOPOULOS: Case management is not a concept that we use in the NDIS.
MR GRIFFIN: What would be your equivalent which would describe the activities involved with case management?
MS PAPADOPOULOS: We we wrap a number of supports around a person. So, we start from the needs and wants of the particular individual and then we look at what what are their risk factors and what supports do they need to help them achieve their goals in life. And, so, for for most people, you know, they for many people, they might only need some minimal support or some informal supports. Others could benefit from a bit of support coordination or a lot of support coordination, and that reasonable and necessary decision is made for them.
But for our participants with the most complex needs, we do have a complex support needs pathway in the NDIS where planners work more intensively and more closely with a person's support coordinator to manage risk around that person's circumstances. And there are also three levels of support coordination that can be can be included in someone's plan. So, level 2 is the most common. Level 1 is quite uncommon. But level 3 is a specialist support coordinator, and for someone who has complex needs or some complex circumstances, we can certainly bring in a level 3, and that person will work more like a case, manager although we don't call it that.
MR GRIFFIN: If a support coordinator is helping a participant in relation to housing issues or general health issues, are they eligible to make a claim for the time they spend doing that?
MS PAPADOPOULOS: Yes, as long as the activity that they're claiming for has been agreed by the participant and relates to that participant's disability, then that's appropriate, yes.
MR GRIFFIN: At a fundamental level, what's the philosophical justification for having a planner and a support coordinator? Why can't those roles be one and the same?
MS PAPADOPOULOS: The scheme design includes roles for intermediaries. So, the planner is there to take the person up to that point of where they have a plan and they they have a plan that includes enough supports and funds to meet their reasonable and necessary needs. And then the design of the scheme then fundamentally is about that person then going out into the market and connecting with all the supports that they need.
So, in the idea of intermediaries was included because it was recognised that not every participant will be able to do that on their own and they might need some support in order to connect to NDIS and other supports, in order to monitor and manage their plan and for someone to help broker supports for them. So, we have a number of intermediaries. We have local area coordinators which are funded by the NDIA. We have early childhood, early intervention service, also funded by the NDIA.
And then we have plan managers, support coordinators and psychosocial recovery coaches, who can all be purchased by the person through their plan, and they make a choice about who they engage. So, they can find someone who suits them and who they can have a good relationship with.
MR GRIFFIN: The designation of those different roles you describe, is the principle behind that that there is otherwise a conflict of interest or some risk to the participant if those roles were combined in a single individual?
MS PAPADOPOULOS: I I don't know that it's about conflict of interest. I think it's more about going back to the original principle of the scheme, which is about individual choice and control to to purchase, access, whatever meets your own needs without necessarily someone from the government walking alongside you or being part of that with you. You know, and if and many of our participants wouldn't wouldn't want that. They do just want to take their plan and go away and and spend it and use it as as they need to.
MR GRIFFIN: Ms Papadopoulos, if we are dealing with a First Nations person in a remote community and they don't have face-to-face contact with their coordinator, is it not likely to be very confusing, having a multiple of people involved, from their perspective? Whereas, having a single person would provide at least a level of clarity about who they were dealing with?
MS PAPADOPOULOS: Yeah, look, we would see a support coordinator in that situation as being the key person in that person's life. They generally wouldn't speak to the NDIS or to the planners on a regular basis. Generally, that would be around plan reviews. And so that once the person has their plan, the NDIA itself generally takes a step back and the person is supported by their support coordinator. And we would really expect that a support coordinator takes the time to get to know that person, build a relationship, build trust and so the person knows that they can go to that support coordinator for anything they need.
MR GRIFFIN: Would it be your experience that if there was a single person, that would be most appropriately an ACCO or an ACCHO in those communities?
MS PAPADOPOULOS: ACCOs and ACCHOs are very, very well placed to provide support coordination because they have an existing footprint, they know the community, they know the individuals, they have cultural competency, and it's fantastic that we are seeing, as I said, many ACCHOs and ACCOs entering that part of NDIS service delivery. But we also see diversity and choice as really important, and so I I like to see healthy markets where there are choices for people as to who their support coordinator is, and that I think that keeps the existing support coordinators on their toes, because if they are not providing a good service, there is that that option for participants to go and choose somebody else.
MR GRIFFIN: And that involves choice, I appreciate, but, of course, if a coordinator is inept, you have to assume the participant can recognise ineptness.
MS PAPADOPOULOS: Yeah, I think that's absolutely right, and a lot of our work needs to go into empowering participants to understand what they should expect from their support coordinator. And some of our recent work in my team in the last few months has been about that. We've had we've released a paper end of last year around what the expectations are of a support coordinator, their four roles and addressing other issues.
We have released a lot of information on the web, and we have also held workshops for providers, support coordinators, partners and participants which were really well attended. And we've got some great follow up that we have got planned with participants. In addition to that, in the market interventions that my team work on in remote and very remote markets, we recognise how important support coordinators are to make as a as a key player in that market to make sure that participants are receiving the supports they need, and, therefore, we work really closely with support coordinators.
We recognise usually there are some great ones but others who really could benefit from development, and we put a lot of investment into each of our projects into building the capability of support coordinators, so that they can better meet expectations of the participants.
MR GRIFFIN: But looking from the perspective of the participant, what do they measure performance against?
MS PAPADOPOULOS: The participant should be thinking about what is it that I want out of this person. And support coordinators over the last few years, their exact role has been a little bit unclear. We've had a lot of feedback from our consultation about what really is the support coordinator to do. And understandably, then, it is hard for a participant to know what they should be expecting. But we have been remedying that through our recent work, as I explained.
MR GRIFFIN: It's more than hard. I suggest that, in those circumstances, it's impossible. Let me give you an example unrelated to this inquiry. When I started in legal practice, there was scales of fees for lots of work done by lawyers. That meant that an ordinary person on the street, unsophisticated in the law, would know generally what a service would cost, how much a conveyance would cost. Then we came to the age of cartels and anti-competitive behaviour and ACCCs who said, "You can't do that, because that's against the public interest."
For benefit of my colleagues behind me, I am grossly oversimplifying this. And we now have a situation where somebody off the street has no idea what a lawyer should charge them. Aren't we in a similar situation here, where most participants in these remote communities have no capacity to determine whether the services provided by the coordinator are up to scratch or not? They have no benchmark or experience to measure against?
MS PAPADOPOULOS: Look, a few things there. Firstly, we do have pricing arrangements and price limits in place for support coordination. Secondly, I I think from the evidence that I have heard this week and the consultations that I've done through my team over the last couple of years, people know when it's not working. That's for sure. They know when they're not getting their needs met, and we've had examples of witnesses this week talking about, "I thought my support coordinator was supposed to be helping me get this wheelchair, but I wasn't sure."
So you can you can understand that they are dissatisfied. I think the problem is about that, because the support coordinator is can be the key person in their life that's helping them navigate the NDIS, I'm not sure that they know how to remedy it or how to talk to that support coordinator about that issue.
MR GRIFFIN: And even if they had concerns about the performance of the support coordinator, what do they do about it? It's obvious that they can seek another one, but what skills or knowledge do they have to firstly realise that they can change, and, secondly, not end up with somebody similarly inept?
MS PAPADOPOULOS: Yeah, the planner, when they are setting up the participant with their plan, if they have allocated support coordination funding in the plan, the planner will explain to them, "You now need to choose a support coordinator. Here are the kinds of things you might want to look for and here are some support coordinators who we know about in your." The planner doesn't choose for them. The planner doesn't recommend. The planner will show them options, and then the participant will nominate, "Okay, I think I am interested in you know, support coordinator A, and then after that support coordinator B and support coordinator C. " They kind of rank them. And our system sends out a request for service to make sure that that connection happens.
MR GRIFFIN: So is that one of the roles of the planner?
MS PAPADOPOULOS: To to help educate the participant about how to connect with a support coordinator.
MR GRIFFIN: Thank you. Mr McNaughton, can I raise a separate issue. There's been reference during the week about registration of service providers and various providers choosing to not seek registration. What does the NDIA see as the benefit of registering providers?
MR McNAUGHTON: So, there's a couple of aspects to that. One is registered service providers then come under the regulator in terms of the National Quality and Safeguards Commission. So, that affords participants the protection, in a way, of the regulator for registered service providers. And the registered service providers will also operate within our price guide, which gives participants certainty and choice. So, that's one of the main benefits of registered service providers where we see it, the protection for participants around price and quality and safeguarding.
MR GRIFFIN: That's based on a general consumer protection model of regulation in other aspects of the community?
MR McNAUGHTON: Yes
MR GRIFFIN: And, yet, under the scheme, unregistered providers are entitled to certain roles with some limitations. Why does the NDIS believe that it's acceptable to have unregistered providers, given your view about the value of registration?
MR McNAUGHTON: Yes. So, many of our unregistered providers have also got other registrative regulations they comply with. So, if you are a speech pathologist and you're not registered with us, you have got other regulatory bodies that you must comply with anyway. And so a range of allied health providers may choose to operate as not an NDIS registered service provider because they have got their own professional bodies that they remain registered with anyway.
Some other type of disability care activities might be home maintenance or gardening services where those providers choose to not go through the process of registration because it's quite a light touch service. They can operate within plan management or self management.
MR GRIFFIN: In a nutshell, if you're running a mowing service, you probably won't cause much risk to the participant? Is that right?
MR McNAUGHTON: Yes. That's right.
MR GRIFFIN: Those that have remained unregistered that have given evidence in this inquiry have pointed to two overarching factors: (1) the cost of registration and auditing, and (2) their perception it gives them less flexibility in providing the services. Can I deal first with the question of cost. Does the NDIA monitor the overhead cost of obtaining registration and maintaining it?
MR McNAUGHTON: Counsel, I'm going to go way outside my area of focus here because those questions are for the Commission who look at regulation. I don't actually know the costs involved in that or what requirements providers have. So, I had best not give an answer to that because I'm not sure.
MR GRIFFIN: Well, we certainly heard from some witnesses the idea of spending $7,000 on an audit before they've even got a client. Ms Papadopoulos, do you have any knowledge of that area?
MS PAPADOPOULOS: It is through our pricing annual pricing reviews, we review a range of overhead costs that providers in the NDIS have, and I would assume that the cost of registration is covered in that in that calculation of overheads and then feeds into, ultimately, the price limit that is set. However, recognising that not all providers are registered, I'm not sure to what extent that's taken into account.
MR GRIFFIN: And the second issue, the perception that being unregistered gives the provider more flexibility in how they provide their service. Do you have any observation on that?
MS PAPADOPOULOS: The main flexibility it offers is that it allows them to provide services to all kinds of participants. So, whether they are self managed, plan managed or agency managed. Sorry registration offers you registration means you can offer services to all three types of plan management, but if you are if you are a participant who is agency managed, you can't access registered providers it's unregistered providers. You can only access registered providers.
So that's certainly a consideration of a provider who is deciding whether they should register or not. They would look at certainly what's a common type of plan management with the kinds of participants in the market that they wanted to service.
CHAIR: What requirements are there for a support coordinator?
MS PAPADOPOULOS: Support coordinators have to be registered to provide level 3 support coordination, but not for level 1 or level 2. But we level of registration for support coordinators, I believe, is around 70 per cent or so that are choosing to be registered.
CHAIR: But are there any criteria that must be satisfied for a support coordinator who is not registered?
MS PAPADOPOULOS: They must comply with the code of conduct. So, any provider who is providing services under the NDIS and claiming from plans must comply
CHAIR: No, but I'm talking about threshold criteria, not standards you have to adhere to once you are a support coordinator.
MS PAPADOPOULOS: Not in terms of threshold criteria, in order to enter the market. However, when you are claiming from plans, you there's a range of requirements as to how you bill and what you bill for. That yeah, that provides some structure around how they're operating and what they are what they're offering.
MR GRIFFIN: What proportion of participants in these remote communities are plan managed as opposed to agency managed?
MS PAPADOPOULOS: I believe it's in the 70 more than 70 per cent, is my understanding, as compared to 44 per cent of people
MR GRIFFIN: 70 per cent are?
MS PAPADOPOULOS: Yeah, plan managed.
MR GRIFFIN: Plan managed, and the remainder agency managed?
MS PAPADOPOULOS: The remainder would be largely agency-managed and there are some who would be self managed.
MR GRIFFIN: Yes. And in respect to planners and support coordinators, do they have to undertake any mandatory training in relation to the communities in which they are providing their services?
MS PAPADOPOULOS: Support coordinators?
MR GRIFFIN: Mmm.
MS PAPADOPOULOS: No mandatory training. If they're registered, they have to do some mandatory modules which might include some general aspects of cultural competency. I'm not sure what the content is. But with regards to a particular community, no, that would be a provider's prerogative in order to promote to participants the quality of the service that they offer. They they should be incentivized to do that for themselves.
MR GRIFFIN: So, in those terms, if they had that sort of expertise or training, that would be a selling point that they could use?
MS PAPADOPOULOS: Absolutely.
MR GRIFFIN: Ms Papadopoulos, when people mention "learning modules", I become a little sceptical. Are we talking about somebody going online for 45 minutes and going through some slides, followed by a few questions at the end? Or are we talking about a system where they are being tested in a real sense as to their understanding of what they have seen?
MS PAPADOPOULOS: I haven't undertaken it myself. I haven't seen it. But it's a requirement of the Quality and Safeguards Commission. I understand the modules set out the expectations but also set you know, link, I think, to the audit that you undertake. So, it becomes foundation of what your quality regime is and what you will be audited against.
MR GRIFFIN: In respect to the NDIA practice guide, in relation to assisting communications this may be a matter for Mr McNaughton, it says in broad terms that NDIA staff are responsible to find a First Nations interpreter/translator in certain circumstances. How does one determine whether or not that guideline is being followed?
MR McNAUGHTON: So, I will give you an example. Our remote planning team in the Northern Territory here based out of Darwin and Alice Springs, they have to get what's called their remote passport, which is an internal term. And it means your you have the right credentials to go into remote communities. It covers things like four wheel drive training, first aid training. There is a in addition to our generic cultural awareness, cultural competency training, there's a more detailed cultural competency learning that is delivered by our First Nations staff in Darwin.
And that goes into a lot more of the detail around communities and the communities that they will be servicing. What we then do is if you're going to a community I will say if you are going to a Wadeye or Nhulunbuy, you will engage with the local community representatives to understand what is happening in community at that point of time: Is there any ceremony, is there any Sorry Business, Men's Business, and so then we relay that back to the team before they go.
And so that and then who are we going to see in community for in visit? Who needs interpreters? Many of my staff speak multiple languages. Or if not, is the Remote Community Connector available who will interpret, or do we need to get a local interpreter and pay for that for the trip. So, we prepare all that well in advance before the team go. There's a lot of safety and cultural protocols that go into visiting communities. And that becomes part of the remote team out of Darwin who will support that and also in Alice Springs. Just to give you an example about before we go to community how we plan for that.
MR GRIFFIN: Thank you.
COMMISSIONER MASON: Can I can ask a question. We have heard a lot about cultural competency training, including the consortium from the Kimberley where local people do that training for 45 minutes. Has there been any thinking done within the NDIA or if you know or are aware of certified cultural capability training in the Commonwealth?
MR McNAUGHTON: Commissioner, it's I'm not aware of any certified training that you refer to, but it's certainly something that we've been thinking about with our First Nations employees staff developing a much stronger curriculum for us internally. That might involve different external agencies to help with the delivery of that. I think that's exactly where we would like to go for our staff, as well as our partners in the community.
COMMISSIONER MASON: I'm just thinking about, for example, in the in legal services and they might do community legal education.
MR McNAUGHTON: Yes.
COMMISSIONER MASON: And they often are done by lawyers. People who have got training.
MR McNAUGHTON: Yes.
COMMISSIONER MASON: Recognised in the profession. And yet you've got Aboriginal and Torres Strait Islander people who have lived experience who worked in organisations, worked in the field and I'm not dismissing their experience, but there's a sliding scale of quality, probably, across Australia. And they seem these training programs seem to pop up constantly in the Commonwealth, but, for example we have got the Australian Institute of Company Directors.
Now, you know, if someone who carries that recognition, there is a an understanding of the compliance and the quality of that person in the business community. And it does concern me that there seems to be a a kind of more of an informal learning as opposed to these are really these are really serious topics that have serious implications on someone who's not Indigenous going into remote communities, and online learning or even an in house learning may not necessarily be ideal in mitigating risks to First Nations people who are receiving that service from someone who may not have a lot of experience.
So, clearly monitoring and making sure that people are complying with cultural protocols and so forth, but it does concern me that, in this country, we do have courses through universities. I've done a course to have that foundation, to work in the public service. And, yet, it's almost a it's misleading around the depth that's needed. And I'm I'm talking to someone who would understand that because of your contact with remote communities.
So, is that something that the NDIA may explore? Because it certainly opens up opportunity through recognition of prior learning of people who have done that commitment of learning and not necessarily relying on a base level of 45 minutes of training.
MR McNAUGHTON: No, Counsel, I think incredibly important points, and we are very open to exploring what is the what is the next step in terms of the cultural competency, a stronger curriculum around working with First Nations people, especially into remote. And that's definitely something we are happy to explore more and invest in.
COMMISSIONER MASON: Just one more, following on, is my experience working in remote communities and, indeed, in NPY Women's Council we started exploring this idea of having a capability framework in relation to management. I think there's a lot of lots to benefit from, from a cultural capability framework, as in the levels of responsibility cascading down from senior levels down, including inside the NDIA, around the performance of staff members, as well as those that work in the field and still even including First Nations people.
Because what what has come through this week is that level of inconsistency. And there needs to be, I think, much more of certainty around capability of working in this area, particularly with First Nations people. I point to point to the witnesses this week. You've got witnesses who who would have quite strong educational backgrounds for English as a first language, then those with disability, nonverbal, or reluctant to speak up.
And so, again, it's a broad spectrum of self determination. So, can't rely on the individual actually being proactive; it's actually the service provider. I will put it that way. So, thank you. Thanks, Mr Griffin.
MR McNAUGHTON: I appreciate that, Commissioner. Thank you.
CHAIR: Mr Griffin, can I just inquire what the likely course of events, from a temporal point of view
MR GRIFFIN: You can indeed.
CHAIR: will be from this point?
MR GRIFFIN: I've concluded my questions of these two witnesses.
CHAIR: You have?
MR GRIFFIN: I have. And before I resume my seat, can I take the opportunity to acknowledge Mr Matt Templeton of Cairns Charts & Maps to prepare the maps we have been using today and during the week. He gave priority to our late request, and we understand, particularly with those following the hearing online, it's been a great assistance to understand the context in which the evidence was given.
CHAIR: Thank you very much, Mr Griffin. I will ask first, Commissioner McEwin, if you have any questions?
COMMISSIONER McEWIN: Yes. Thank you, Chair. The one topic I would like to ask both of you about is the interface between the NDIS and other, you know, government departments and programs. I know it's a big topic. What are the particular learnings what are the particular specific learnings or the major learnings, from a First Nations remote perspective, in your work and the observations? So you talked a bit about transport. In the example you gave, you fund someone to go back to Country. That begs the question is, what is the Northern Territory doing about public transport? So do you have some ideas that you can give us about the interface?
MR McNAUGHTON: Yes. Do you want me to start? Yes, thanks, Commissioner. The mainstream interface is always an area that we are working closely with our state and territory colleagues. Transport is a good example. There are just very limited public transport or accessible transport in anywhere, really, outside of Darwin in in the Northern Territory. So, that's a real area of focus. Schools. The transition from early childhood into schools is really important. The provision of appropriate disability supports in the school to keep children engaged in the school settings is a really important area of focus for us.
The other one is around community mental health. The importance of, you know, states and territories very well and acute mental health, but we do see there's a really important need for community mental health supports. For people not only participants, but people who might have a psycho social disability who may not be a participant of the scheme, the ability to access community mental health supports in those communities are really important areas of focus for us and I know Ministers as well. Thanks, Commissioner.
MS PAPADOPOULOS: And, sorry, I will just add to that. From a from a policy point of view, we're strongly engaged in Closing the Gap. So, we have representation from the NDIA on various working groups around Closing the Gap, and I'm personally on the working group. When we meet there is opportunity from representatives from different government departments to present about their initiatives, and there's always really good engagement and discussion about how we can learn and adopt their ideas and use them in our own organisations. So, that's been fantastic.
We my team meets with DSS on a monthly basis, and they're engaged in other initiatives that complement our work in remote markets. So, we talk about building the local care workforce, which is a $60 million initiative. We talk about the workforce strategy, and we have also been talking about models of integrated care, potentially, so how NDIS services can work better with Veterans Affairs and Health services in particular communities, because an integrated approach really has to be considered. So, that's been really promising.
And, in addition, we have good relationships with our state and territory government counterparts. They are always involved in our market interventions, and a great example is the South Australian Government and their commitment in the APY Lands. They've walked alongside us the whole time, been involved in detail in most of what we have done there, and we continue to talk about how their initiatives can work hand in hand with our initiatives so that the overall offering of what we're doing in APY lands is really well coordinated.
COMMISSIONER McEWIN: Perhaps to bring this to a close, is it fair to say that there is some promising practices amongst states and territories, particularly from a rural or a remote point of view and First Nations point of view? Or do you think we will continue to see what we might call the shifting or the, you know, passing the buck so to speak. Is it fair to say broadly there are some promising practices at state and territory level? And perhaps other Commonwealth departments?
MR McNAUGHTON: Well, I think the example that Kitsa just gave in South Australia is a good one. We've had really good support from the Northern Territory government here around places like the Ngukurr trial and others. So there are some promising things happening in some of those communities, yes, Commissioner. More work to be done, of course. But there are some promising things.
MS PAPADOPOULOS: Sorry, and state and territory governments continue to invest in initiatives that complement the NDIS, which is really, really great to see.
COMMISSIONER McEWIN: Thank you, both. Thank you for your evidence.
CHAIR: Commissioner Mason, do you have any additional questions?
COMMISSIONER MASON: I just want to say one thing, that I look forward to hearing through the Closing the Gap report next year more information from the NDIA and what's working, but also where work still needs to happen in activating those relationships and funding and supports, particularly in Northern Australia. But I just want to say a big thank you to both of you, Ms Papadopoulos and Mr McNaughton, for your evidence over the last two days and the attention that you have given to responding to the questions and also, I mean, your openness in terms of drawing on your own experiences.
So, it's such a critical area for First Nations communities to see this working. You had witnesses, First Nations witnesses this week talking about the NDIS and the promise, and we we heard from Emily Carter talking about the issue of overpromising and under-delivering. And, so, really, from this Royal Commission, we're really looking to see positive reform and change in the future. So, thank you very much.
MR McNAUGHTON: Thank you.
MS PAPADOPOULOS: Thank you.
CHAIR: One of themes that has emerged that perhaps we haven't explored in detail concerns the understanding of the reasons for decisions. We've heard that people First Nations people and those who may be supporting them consider that decisions are made that they don't really understand, the reasoning is not clear, it's not clear why there might be inconsistencies between apparently between one person's application or the contents of that person's plan and somebody else somebody else's plan.
The discussion today, I think, reinforces that a lot of the criteria both in the statute and as developed as policies by the NDIA allow for very considerable range of discretion. You can't get anything more general than the concept of reasonable and necessary, as what as I remarked before, that Julia Stone categorised as a category of indeterminate reference. There's a dilemma here. The dilemma is between flexibility, about which we have heard a great deal, which involves individual discretion being exercised, for example by planners who are effectively decision makers.
And then, the alternative of trying to set out principles or rules specifically as possible, which then creates the risk of bureaucratisation, inflexibility, and so on. There's no easy answer to that, but it does occur to me that the concept of face to face communication with people during the currency of a plan so that somebody, including a person with disability, First Nations person in a remote community, or that person's representative one way or another, can actually have a conversation with somebody about what's going on, and, "Please explain to me. Don't just give it to me in a letter that's drafted in standard form."
I understand completely why letters are drafted in standard form, but there's an opportunity or, really, an obligation. If people are to understand what is happening, they need to be able to communicate with a decision maker, or with somebody who can explain to them, and they have an opportunity to discuss it and perhaps even to negotiate. What we've got now is plan's approved, planners made the decision, and then off you go with the support coordinator who may or may not be effective and may or may not be an effective advocate.
It just seems to me that if there some mechanism that we can that can be introduced based upon the principles that we have been talking about of the community and respect for culture and so on that something somebody and some presence there in the community, you will be able to address a lot of these issues. It's just the remoteness of it and the impersonality of the decision-making process. It's fundamental to the operation of the law, judicial decisions.
It's often said that the most important part of reasons for judgment is to explain to the losing party. Not to the winning party. The winning party knows things are good. Doesn't need to read the judgment. It's the losing party that needs to why they lost. And it's a similar principle here. And I just wonder whether there mightn't be some consideration given to how a process of communication with people in a language and a manner that can readily be understood can assist in not just navigating, but understanding what's actually going on. It's just a thought.
MR McNAUGHTON: No, I think thank you, Chair. That has come through very strongly this week, the need to be able to help First Nations people in remote understand their plan, how they can use their plan, how they can access supports flexibly and the value of having someone there they can talk to, I think, is key. I agree with that totally. We need to work towards that.
CHAIR: Do you want to add anything?
MS PAPADOPOULOS: I would just add that it's where we're heading as an agency generally for all participants. We hear that from all participants. And there's a lot of work going on currently that will boost the implementation support that participants get. There's a lot of work around participant empowerment. We've got a great participant experience division in our agency that's continuing to make investments in that regard. But I agree, it's very it's critical for the operation of the scheme that our participants are empowered to spend their plan.
COMMISSIONER MASON: Can I just add something, Chair. I know I'm interrupting.
CHAIR: Of course.
COMMISSIONER MASON: Ms Papadopoulos, you have a really critical role. Perhaps something for you to take on board in terms of learning from this hearing is in terms of the terminology and language you use, to start to inquire about First Nations words that actually can explain those words that you are saying. I know this is a public hearing and you're using words for the record, but even in this public hearing, to have someone of your seniority actually use First Nations language as a way of explaining the concept, that would just be an enormous relief, that someone of your seniority and calibre is actually practising cultural capability. So to the Chair's point, which is communication.
CHAIR: Provided you don't use the word "learnings". I have not accustomed myself to that word. Just one final question for each of you. What have you learned this week that you didn't know before? What are the important things, if any, that you learned from the evidence this week?
MR McNAUGHTON: I have personally found this week to be incredibly insightful and made a point of coming here from the start and listening to all the witnesses. And a couple of things from me. A few witnesses said the NDIS has made people better off, which is great, but there's a lot more work to be done, that sometimes our policies and guidelines and practices seem to fit Sydney or Melbourne but may not fit Nhulunbuy or Galiwin'ku, and we need to spend more time communicating and listening to communities. And there's probably a whole range of other things, but they've been some of my key takeouts. Thanks, Chair.
CHAIR: Ms Papadopoulos, do you want to comment?
MS PAPADOPOULOS: Yes, I would. I would like to thank everybody who has been involved in this week, because it's been a really important experience for me. And to your comments earlier, Commissioner, I have learnt a lot, but it's just the start. I've got much more to learn, and the gravity the gravity of what we are working with has certainly hit me. It's been a very, very heavy week in that regard. I take very seriously everything I've heard from the range of witnesses.
My my teams work one on one with many of the organisations we have heard from, and they know participants, and they have that experience on a daily basis, and they share it with me, and we talk about it all the time. But there's nothing like having a week immersing yourself in that personal stories and personal experiences. That's been transformational for me, and I really look forward to taking everything away and working with Scott and the rest of the agency to take the scheme forward in the next phase and make improvements.
CHAIR: Thank you. Mr Hodge, I just want to check, do you wish to ask any questions?
MR HODGE: Chair, I don't think I want to ask any questions, but I might just indicate something that I know you're aware of. There were quite a number of questions that were asked this morning about registration and auditing of support coordinators and service providers. And I know you're aware that's not actually the responsibility of the NDIA. And so whilst these witnesses have done their best to answer those questions, I think, as they indicated quite a number of times, it's not their responsibility. But there were some questions I think that flowed out of it, and we will have the NDSC respond to those, if that would assist.
CHAIR: Right. Thank you very much. May I thank you both for your evidence, it being quite a long time giving oral evidence, and each of you has provided detailed written statements. This kind of constructive dialogue is really very important. It's all very well for Royal Commissions or any other inquiries to make recommendations that's very important and we will be doing that but it's much better that there be a continuing process that is informed by a whole range of inquiries and insights.
And I think, on behalf of the Commissioners, we are grateful for your indication that you are prepared to take into account the matters that have arisen in the evidence and the themes that have emerged during this week. So, thank you very much.
MS PAPADOPOULOS: Thank you.
<THE WITNESSES WITHDREW
CHAIR: Mr Griffin, I think there are some closing directions.
MR GRIFFIN: They are. And I understand they were circulated to the parties with leave this morning. But have you had a chance to consider them, Chair?
CHAIR: Yes. What I will do, is to read out the proposed directions. If any party represented wishes to make any comment or suggest any amendment, I will give that opportunity once I have read the directions, and then they can be finalised. You can, by all means, step down and do whatever you think you would like to do in Alice Springs at lunchtime.
The following are the directions that are proposed:
1. Any witness who took notice on questions during this hearing should provide any answers in writing to the Office of the Solicitor Assisting the Royal Commission by 29 July 2022. The answers should be targeted and concise, and not address additional or unnecessary matters. Counsel Assisting the Royal Commission may tender those responses into evidence.
2. By 5 August 2022, Counsel Assisting the Royal Commission will provide a list of all documents he wishes to tender into evidence, including responses to questions on notice on a confidential basis to the parties with leave to appear at this hearing.
3. Parties with leave to appear should advise the Office of the Solicitor Assisting by 12 August 2022 if they wish to suggest any additional documents for tendering by Counsel Assisting. At the same time, they should identify any parts of documents to be tendered that they consider need to be removed before the documents are made public with reasons.
4. Counsel Assisting will tender those documents into evidence which he considers appropriate and will do so in Chambers by 9 September 2022.
5. Counsel Assisting the Royal Commission will prepare written submissions following the hearing. By 23 September 2022, these submissions will be provided on a confidential basis to parties with leave to appear and may be provided on the same basis to any witness or recipient of a procedural fairness letter from the Office of Solicitor Assisting the Royal Commission in preparation for this hearing.
6. Any responses to Counsel Assisting's submissions should be sent to the Office of Solicitor Assisting by 7 October 2022. Those responses should be concise and should not include any additional evidence.
Is there any represented party who wishes to comment on those proposed directions? If not, they are the directions, then, that I will make, and they provide the timetable for the further developments arising out of this public hearing.
Mr Griffin, is there anything further that you wish to say?
MR GRIFFIN: Not in relation to this hearing, but can I indicate that I understand the next Public hearing of the Royal Commission will commence at 10 a.m. on Monday, 29 August in Parramatta, New South Wales.
CHAIR: Thank you, Mr Griffin. This has been a quite extraordinary hearing. And, obviously, the Commissioners would wish and do thank everybody who has been involved in the preparation for the hearing and the conduct of the hearing. I just want to say something about the degree of preparation that goes into a hearing like this. This Royal Commission will hold, in total, about 30 Public hearings. I have mentioned on previous occasions that an enormous amount of time, effort and skill goes into preparing each of these hearings.
This involves not merely preparing evidence of the kind that one would expect to be brought forward in a Royal Commission, but enormous amounts of attention and care to ensuring that witnesses and, in particular, of course, witnesses who are people with disability can give their evidence safely without the risk of re traumatisation and in an environment that allows them to tell their stories comfortably and clearly. These are matters that require a great deal of skill and effort, and that is characteristic of each and every one of the hearings that we have held.
This hearing has been particularly challenging to prepare, and it is a great credit to all those who have been involved that it has evolved in the way that it has. Throughout the course of the hearing, we have received evidence and heard stories about witnesses, their families, and clients that the witness may support living in a variety of places in remote and very remote areas throughout Australia. These include, in the Northern Territory, Alice Springs, Tennant Creek, Gunbalanya and Darwin. In Queensland, Aurakun, Cairns, Lockhart River, Mapoon, North Weipa, Thursday Island. In Western Australia, Broome, Fitzroy Crossing and the Fitzroy Valley, the Pilbara, many communities throughout the Kimberley region including Beagle Bay, Bidyadanga, Derby, Kununurra and Halls Creek. In South Australia, Anangu Pitjantjatjara Yankunytjatjara that is, the APY Lands and the NPY Lands, which span across South Australia, Western Australia, and the Northern Territory.
It only takes a moment's reflection to appreciate the phenomenal amount of work involving travel, support, preparation that goes into attaining evidence from communities scattered far and wide across Australia and, as we've heard during the week, present considerable challenges of one kind or another, not least getting there in a time of COVID and in the light of the difficulties that even things like regular wet weather patterns can create.
I want to make that point because sometimes there is a view expressed and one can understand it readily that it's a pity that the Royal Commission can't actually investigate through hearings even more matters than we have or will investigate in the 30 Public hearings that we will hold. There are limits to what the Royal Commission can do, and this hearing indicates just how much of the resources of the Royal Commission go into the preparation of just a single hearing. We are certainly going to do the best we can to cover as much of the Terms of Reference of the Royal Commission as is humanly possible, but this indicates just how much effort goes into the preparation of a hearing and this hearing in particular.
I want to thank all of the witnesses who have given evidence, in particular, First Nations people who have given evidence this week. It has been so impressive, so powerful, and has generated so much very useful, constructive discussion and ideas. We heard from Daisy, who was accompanied by her son Joziah. We heard from Ms Jody Barney, the founder of Deaf Indigenous Community Consultancy. Ms Kunmanara Smith Margaret Smith. Ms Kim McRae.
The Namok family, including Boyzie, from Torres Strait. Ms Joanne Houghton, founder and managing director of Creative Consulting Proprietary Limited. Marmingee Hand, who gave evidence about her son Tristan. Jazsikah, who gave evidence about her sons with disability, Little Fella and Big Fella. Ms Stella Jackamarra, Topsy. Ms Ronita Jackamarra, who gave evidence about her son, a person with disability. Mr Eric Bedford Mudge about whose evidence we heard this morning. Ms Emily Carter, the Chief Executive Officer, Marninwarntikura Women's Resource Centre. Paulette.
Mr Damian Griffis, the Chief Executive Officer of First Peoples Disability Network who, of course, has given evidence at other hearings and contributed to the Commission in many ways, as has Aunty June Riemer, the Deputy CEO of the First Peoples Disability, Network, from whom we heard. Ms Patricia Turner, the Chief Executive Officer, National Aboriginal Community Controlled Health Organisation, NACCHO. Ms Jenny Bedford, Chief Operating Officer, Kimberley Aboriginal Medical Service. Ms Jody Broun, Chief Executive Officer, National Indigenous Australia Agency.
We are extremely grateful to each of those witnesses who have contributed so much to this hearing and to our understanding of the issues that need to be addressed. The names that I have read out, of course, include First Nations people with disability if I may refer to them as such. I know that there are issues concerning the use of the word "disability" within First Nations community, but just in order to use terminology in a consistent way as we have throughout the Royal Commission.
We also heard evidence about other First Nations people with disability who couldn't participate in the hearing more directly. They included Betty and Alan, two First Nations people with disability who are the subject of guardianship orders, and I'm pleased to say that the Commissioners were able to meet with Betty and Alan outside the hearing room. We heard about Little Fella and Big Fella, the two young First Nations boys with disability whose mother, Jazsikah, shared their stories with the Royal Commission. Tristan, whose parents Marmingee Hand and Geoff Davis gave evidence and also participated in videos that were shown through the hearing. And Mudge shared with us evidence about his son Bubbaboy. And Ronita gave evidence about her son.
We also heard from other witnesses, and I won't go through them in detail, but we are grateful for the contributions that each and every one has made to this hearing.
I want also to thank and I won't do it in detail at the hearing, but there will be an opportunity shortly to express thanks to all of those members of staff, counsel, Office of Solicitor Assisting, those who have provided support to witnesses, the interpreting teams who have not only done their usual sterling job but have had to cope with a few additional complications in order to do the job on this occasion. To the IT people, Law In Order, who have done a magnificent job in ensuring that this hearing can take place successfully.
To those who are responsible for the logistic arrangements that are complicated, that involve an enormous amount of planning and coordination, and they have done a splendid job in ensuring that everybody who is meant to get here has got here and has been able to give their evidence, and that we have been able to make contact with all of those who have given evidence remotely in the various communities.
So we offer, from the Commissioners, our profound gratitude to everybody who has been involved in this hearing, which, as I said at the outset of these remarks, has been a really extraordinary hearing and one of great importance to the work of the Royal Commission, and I hope it proves to be of importance to the First Nations communities with which we have been concerned during this week. So, thank you everybody. We will now adjourn.
<ADJOURNED 1:09 PM