Day 1: Quality and Safety in the NDIS conference, 20-21 August 2019 in Sydney

 
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Day 1: Unpacking quality compliance and understanding the audit process, engaging leadership, the impact of a Royal Commission

The conference keynote was given by Graeme Head AO, Commissioner, NDIS Quality and Safeguards Commission. He started by describing the role of the Commission and went on to highlight that families should feel free to make complaints about services delivered to their family members – his goal is to build the capacity and knowledge of providers. The Commission has been developing a number of tools for both participants and providers that cover the new Practice Standards and Code of Conduct. Re providers: 100,000 people have now started the Worker Training module which is mandatory for all staff in the scheme. Re participants: They have a new campaign “Speak Up Speak to Us”.  “The NDIS audit process is a tool for change not just something you have to get through” and he said they are monitoring audit costs quite closely. He reminded the audience that it is best to do the online form to see what the scope of your audit should be and then ask the auditing companies for a quote – to ensure that it is proportionate to your business. For the Commission, the most complex area they are dealing with is restrictive practices as this was previously State regulated. The Code of Conduct also applies to the LACs, NDIA and NDIS Commission itself.

 
Figure 2 Graeme Head, NDIS QS Commissioner

Figure 2 Graeme Head, NDIS QS Commissioner

 

Belinda Drew, CSIA and Kerry Stubbs, Northcott held a panel discussion about unpacking the biggest challenges for NDIS service providers and what the Royal Commission will mean. Kerry said that,  “we have a responsibility to make the scheme the best it could be” – the difficult bits are health, education and housing as disability services alone are not the solution. She described the “cultural transition” into the NDIS and how Northcott was still doing that in terms of getting the staff and services right. Quality and Safety is an investment in building a quality service and should never be seen as a cost.

Kerry Presser, Executive Manager Operations of CARA spoke about strengthening the audit and service improvement process – CARA has 750 customers and 1000 staff with growth this past 3 years. She said collaboration is important across the sector – and spoke about her key priorities for CARA: govern responsibly, value our people, transform our business with systems development and strengthening quality systems, strengthen customer engagement and grow, sustain and mature alliances with like-minded organisations. Regarding their experience of working with the Commission, Kerry felt that the framework for complaints resolution was unclear and there was inconsistency across states and territories. The NDIS portal should be more efficient and the level of reporting is very high especially for CARA as they have a lot of complex customers (not called clients). There is a pilot project now to export CSV’s into the NDIS portal. CARA is a member of the Ability First Alliance  - Ability First Australia is a strategic alliance of 14 leading disability service providers working to ensure that every Australian living with disabilities, and their families, has access to programs that maximise their potential by creating opportunities for them to make their own choices.

She went on to speak about CARA’s experience with the audit process – it is important to start early on a self-audit as it’s a big job; all documentation, training and systems should reference NDIS legislation, rules and guidelines [1]. They are using “workplace “ on a FB page to share activities with customers which they can use for education purposes.

[1] Centro ASSIST software solution provides the unique ability to map policy and processes to the NDIS rules and guidelines

 
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Peter Frendin, QIP GM Health and Human Services – “The changes we are facing are of a magnitude and complexity never before experienced”. Peter spoke about engaging leadership and why we need to build leadership capacity in organisations across Australia. Peter said that QIP is a not-for-profit and he described the ambit of QIP’s audit work covering 17 different QS frameworks. They have 10,000 clients with some of the largest providers in Australia including in rural and remote areas. Peter spoke about organisational leadership – there has been a shift to quality outcomes for NDIS participants that include independence, employment and community participation. There will be an increasing use of data collection and benchmarking against other services. Universities will be increasingly used to evaluate any new programs. Looking to the horizon, he said that providers should use the workforce to provide insights and strengthen the workforce using a mentoring system. Engaged leadership starts at the Board level –

 
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NFP Good Governance principles from the AICD Good Governance Principles and Guidance for Not-for-profit Organisations 2019

The need for clarity for board directors

The right group of people on the board

An appropriate vision, purpose and strategies

Recognition and management of risk

Build and maintain organisational capability to deliver on purpose

A healthy culture & ethics in the boardroom and throughout the organisation

Effective stakeholder engagement

 
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Lisa Giacomelli, COO of YMCA spoke about the lessons learned from the Royal Commission into Institutional Responses into Child Sexual Abuse. The YMCA has 1800 staff in 100 locations in NSW and ACT.

 
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Some facts about the IRCSA Royal Commission

• 3 year timeline

• 42,041 calls handled

• 25,964 letters and emails received

• 8,013 private sessions held

• 2,575 referrals to authorities (including police)

• 57 public hearings which heard from 1,200 witnesses over 400 days

The budget was similar to that of the current Royal Commission into Violence, Abuse, Neglect and Exploitation of PWD  ($527 mm).

Why is the experience of YMCA relevant

• This Royal Commission will have personal stories

• This Royal Commission will talk about those most vulnerable

• This Royal Commission will talk about how trust is betrayed

• Most people in the community will be connected to the Royal Commission or will understand how they could be

• The stories will be media and public interest worthy

Lisa spoke about Case 1 - an employee who had been a camp leader. The YMCA had 70 policy and procedures about how to keep children safe – no one read them as the language was too hard. The biggest finding from the Royal Commission was that there was a lack of leadership about the safety of children in the organisation. 30 projects for improvement came out of Case Study 2 alone. 7000 pages of documents were provided by the YMCA to the Commission over a 3 year period and it consumed 4 senior executives full time for 6 months.

 She summarised the failures identified in Case Study 2 from the YMCA:

• Recruitment and Onboarding processes not understood or followed

• Policies and procedures too confusing

• Lack of organisational understand of abuse

• Lack of a culture of reporting

• Lack of leadership in regarding to child safety

• No investigative process internally

• No understanding of external reporting frameworks

Kasy Chambers, Anglicare was on a panel with Matthew Harding,  HWL Ebsworth Lawyers unpacking the potential impact of a Royal Commission that includes the NDIS. Anglicare has 29000 staff and volunteers nationally.

 
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She said that the Royal Commission is NOT A FAIR HEARING – it is not a court – it is there to hear stories. She said it was imperative that service providers start preparing now.

  • Get records in order

  • Look for gaps in records esp. if offices have moved or there have been fires

  • Talk to clients/families and let them know what’s happening

  • Put the Royal Commission on the Board’s agenda and keep it there with monthly updates

  • Keep records safe, introduce better record management systems, dedicate more resources to this area as it will be good for reputation as well

  • Use the Governance standards of the ACNC - All courses run by AICD are about culture – “the fish rots from the head”.

  • Good clinical governance needed now for disability services (not just for health services)

  • Make sure Board Directors also hear from clients

  • Ensure that you have a good staff and Board orientation package

  • The Royal Commission will go for 5 years and this will affect the self-esteem of your staff – it’s a long time to have the lens focused on you

  • It is an opportunity to learn about the gaps in policy and services

Kasy fears that dignity of risk may disappear as providers become more risk averse.

Matthew Harding said, “there is transformational change after a Royal Commission with a change in societal attitudes”. The YMCA made a “cause analysis report (put all the pieces together)” and an “effective Governance report” – all staff could enter issues into a central database. “Culture is about everything – and is reinforced by training ensuring that lessons are not forgotten”. In the case of the YMCA it was all about recruitment – they did not complete a reference check even though it was a policy to do this. In 5 years time when the Royal Commission is completed, the NDIS will be a better scheme and the community a more inclusive one.

 
Figure 4 Matthew Harding, HWL Ebsworth Lawyers; Kasy Chambers, Anglicare and Belinda Drew, CSIA

Figure 4 Matthew Harding, HWL Ebsworth Lawyers; Kasy Chambers, Anglicare and Belinda Drew, CSIA

 

 

Teresa Dao