Coordinated care for people with disability is at risk under the marketisation of the National Disability Insurance Scheme (NDIS), with providers fearful information sharing could reduce their competitive edge, new research reveals.
The Centre for Social Impact at UNSW Sydney's (CSI UNSW) latest report examined competition and collaboration between service providers in the NDIS, and found "the long established environment of goodwill and shared responsibility" between providers was under threat.
Report author, associate professor Gemma Carey, warned a lack of care coordination would diminish the overall quality of care provided under the NDIS.
"A lack of care coordination will be a major problem within the scheme if it can't be supported. And we're starting to see some of those really negative outcomes already," Carey told Pro Bono News.
Carey said this could create problems for people with disability in custody, and could also mean people were not able to be discharged from hospital, as there would be no one clearly coordinating care for a person to be released into.
The report said while collaborative efforts were largely perceived to be continuing, there were signs organisations were shifting to "more competitive relationships" in the new "quasi market" created by the NDIS.
This could result in reduced trust and information sharing between providers, the report said, and have an effect on staff resources and time management.
The report warned this would have "significant implications for care coordination".
"Being able to look holistically at a client's needs and provide integrated services has in the past been achieved through organisations working together to coordinate care of an individual," the report said.
Service providers interviewed for the study noted that sharing information had the potential to reduce an organisation's competitive edge and viability.
Given the funding restraints on providers, Carey called on the social sector to work together to ensure care coordination did not diminish under the scheme.
"If providers can't afford to fund [care coordination] themselves then it may not be able to happen," she said.
"So I think there is perhaps a need for the sector to come together and raise this collectively, around the price of care coordination, to make sure it doesn't drop off.
The lack of funding for care co-ordination for those with disability who are not able to do it themselves has been a shortcoming of NDIS from the beginning. This has put pressure on many older carers who are having to do it for their family member and causing a lot of stress to people with disability. Discharge from rehabilitation and/or from the criminal justice system must be a nightmare when there is no agency funded to be responsible for the coordination of multiple services when required.
Whilst ensuring value for money and quality is important there are surely better ways than a competitive market place to enable it – cooperation between agencies and services is more likely to be cost effective and have better outcomes surely.
Care and support has always been fragmented in the disability service system, and it is disingenous of providers to claim that we once had a golden age of integrated care. NDIS held out the promise of replacing this with person-centred coordinated care under the self-direction of each person and their family, but in reality, a provider-centric system of care remains in place. It is provider-centricity, not competition, that is the problem. At the moment, there is no genuine competition between providers, because all the institutional power and capacity in the market still resides with providers and practitioners. Only when there is a shift in power and capacity to users of services, and away from providers, will we get competitive pressures forcing downwards movement in costs.
The disability sector is a lot like the national energy sector at the moment: concentrations of market power among suppliers and undeveloped power and infrastructure amongst consumers mean there is no downwards pressure on price and no upwards pressure on quality. In both sectors, we have the results of failed policy approaches which are historically provider-centric, and have still to be brought into the consumer-centric world of the 21st century.
So true Vern. And it won't happen because the new providers are same as the old providers, with the same managers and incompetent staff.