‘Learn From Our Mistakes’ – UK Expert Warns On Australian NDIS Transition

Drawing on the experience of the United Kingdom in delivering a social care approach similar to the National Disability Insurance Scheme (NDIS), a high-profile UK analyst has urged Australia to learn from their successes and mistakes.

Visiting Australia for a series of public speaking events, Dr Shereen Hussein from King’s College London said the UK experience provided many lessons for Australia about what might work well, and the pitfalls to avoid.

Hussein told Pro Bono News that at the top of the list of things “to-do” was establishing “adequate mechanisms to monitor, regulate and support the social service market and its workforce, to safeguard people using care services, their families and the workers”.

“The UK experience can provide many lessons to Australia of what can work well, and what to watch out for particularly in relation to the potential implications on care service quality and integration with health and other social services,” Hussein said.

“In England we don’t have an insurance scheme for people with disability but rather we have a strong trend towards ‘cash for care’ or what we call ‘personalised care’ which basically achieves the same goal of the ‘marketisation’ of care.

“It has been going for quite a long time and the UK was one of the first to initiate the idea of cash for care. There has been a strong movement particularly from the disability groups to bring this to the social service area which has been quite successful because it provided an alternative.”

Hussein said the most recent Care Act in England in 2014 stipulated that every person who was eligible for funding from the state, under a means-tested system, had to be considered and offered the personalised care budget.

“You need a strong regulatory framework for this to work. There has to be a mechanism to monitor and safeguard any system that’s in place. In the UK there is the Care Quality Commission, that is like a star rating that has authority as part of the government to rate the various elements of the services offering things such as home based care etc,” Hussein said.

Drawing on studies from across the UK and Europe, Hussein highlighted the increased risks of worker stress and burnout in a market-based model; the importance of developing strong worker training and qualification models; and strategies for recruiting and supporting a wider pool of people to meet the growing workforce need.

“Safeguarding individuals using care services, their families and workers should be at the heart of these policy developments. Collecting adequate and comprehensive data would allow timely and evidence-based interventions and policy developments,” Hussein said.

“The geography and diversity of the Australian population call for careful considerations of potential challenges associated with the NDIS, such as thin markets, viability of services for people with multiple or complex needs, and availability of quality workers.”

She said there had already been a lot of discussion and debate about training and qualifications in the care sector.

“This can be a thorny topic because basically the needs exceed the supply so that when you have that situation it is very difficult to set very strong standards,” Hussein said.

“There are two areas within this. First you have the professional staff and you can’t compromise with their training and then you have staff called ‘personal assistants’ or ‘care workers’. You are looking at a different set of people who have really diverse skills for very different groups of people. So setting standards and qualifications can be quite tricky.

“There have been some developments in the UK such as the introduction of ‘care certificates’. The idea of these certificates is that anybody in the arena of ‘care’ should be offered training post-employment, and not be a requirement for employment, and they should complete a set of training modules within a number of weeks of working in the sector and then this training would be transferable.

“They don’t have to do that every time they work with a different employer or agency and this training would be transferable across all sectors.”

Hussein said the UK was also extending the early implementation of the care certificates.

“Now it is agreed to be overseen by the employer… but to have some elements of ‘inspection’,” she said.

“Here in Australia it’s the right opportunity to discuss these things because this is a workforce that is likely to see huge growth in the future and huge demand from people who are vulnerable and who need to be assured the person who will look after them has minimum standards and qualifications.

“If you look at the care components not all of them are technical. A lot have to do with culture competency, communication body language – all what we call soft skills that you have to have when you deal with people in these types of situations.”

Hussein said there was also a need to have an independent organisation different from the employer, perhaps linked to a higher education institution or authority, that is able to set curriculum and standards.

“Not necessarily the NDIS but this is really collaborative work and you have to have a partnership going on. I would suggest that you also need to have some kind of outside inspection and not leave it entirely to the employers. Many small organisations don’t have the infrastructure to offer the training,” she said.

“It’s a very wise time to look at things like the care certificate where you are likely to retain workers rather than lose them.”

She said the importance of data and research could not be overlooked.

“You need to be able to test the market, produce projection models and look at the workforce and where they come from, and target certain groups to be culturally diverse,” Hussein said.

“You are starting from afresh so you need to look ahead and find evidence rather than relying on anecdotal information.

“There are workforce pitfalls that we are also struggling with in the UK. These relate to the concept of the viability of the market. That care is now a commodity and for the market to progress you want a competitive arena, and for consumers to be able to exercise authority in their choices.

“If you are a person with complex needs you may not have enough markets to meet those needs. There are organisations that cannot provide for all of those needs simply because there are not enough consumers in that group. So then you would be left with no choice or a very expensive choice. So the market forces are quite weak.”

Hussein said there had to be a system in place and a compliance system that empowered people so as to create competition for those services.

“This is OK in urban areas but in regional or remote areas this may not work well,” she said.

“The NDIS provides an exciting opportunity for Australians to exercise more control over the types and nature of services they receive. To ensure the availability and accessibility of quality services to everyone, it is essential to establish adequate mechanisms to monitor, regulate and support the market and its workforce.”

Hussein said she was aware there were already early warning signs in a new Australian Disability Workforce Report of disability support workers in Australia facing less work overall, less ongoing full-time jobs and more casualisation.

The inaugural report revealed a sector growing rapidly and experimenting with work arrangements and recruitment approaches – with more casual employees in the disability sector than in the aged care sector.

The report by the National Disability Services (NDS), tracked six quarters of workforce data showing consistent net growth, an increase in casual employment, and (among allied health professionals) increased use of fixed-term, as opposed to ongoing, employment.

“Indicators such as labour turnover show relative stability, with casual turnover rates much higher and less predictable than those for permanent workers,” the report said.

Hussein said in reducing costs “you’re reducing job security, reducing the hourly rate and maximising the amount of work within a limited time”, something they were seeing in the UK.

“We see a lot of aggregation of a workforce that is already vulnerable The majority of them are women they are middle aged and usually have a lot of other responsibilities and they are losing their job security at a fast rate,” she said.

“You can create a fair market for the workers that ensures that they have employment rights, ensures they have job security. But basically what you are saying and what I have been hearing is that this is not happening with the increasing casualisation of work.

“There are two differences between flexibility and casualisation. You can still create flexibility but you have to put protections in place. If you remove the protection under the guise of flexibility then you create insecurity and you create categorisation and also you create the turnover of people and that will have a direct impact on quality of care.”

Hussein said the NDIS was an exciting opportunity to bring the issues of people with disability and long-term care needs to the front of the national agenda.

“But a market-based approach is not the solution and without the proper mechanisms in place it may fall. And it may not provide services to everybody especially the most vulnerable,” she said.

“There is a huge role for not-for-profit organisations here to fill the gaps where the market cannot, especially for people with complex needs.”

Hussein is a guest of the Future Social Service Institute and RMIT University as an International Visiting Fellow giving a series of lectures and presentations.