This was the forth session at the Advocacy Sector Conversations forum held at Queen Victoria Women’s Centre on 14 November 2019.
The Victorian office of the NDIS Quality and Safeguards Commission has been established and opened for business on 1st July 2019. Rachel Mathison, Director of Complaints- Victoria, discusses the scope and processes for making complaints and provides information about other work and functions that the new office is undertaking
Links to resources mentioned in this presentation can be found at the bottom of this post.
Transcript & Audio
MELISSA HALE, DARU COORDINATOR:
We’re coming towards the last two sessions of the day. Like I said at the start of the day, we have to be a bit flexible with this one. We’ve only got one interpreter for the last two sessions. This session will go from 2.30 to 3.15 and we will have a short 20-minute break and then from 3.35 to 4.00 o’clock we will have our last session of the day.
This next session is about the NDIS Quality and Safeguard Commission in Victoria and I would like to introduce you to the Director of Complaints Rachel Mathison.
Rachel Mathison, Director of Complaints, NDIS Quality & SafeguarDs Commission Victoria
Thanks Melissa and thank you everybody for having me here today. As Melissa said, I’m the Director of Complaints for the Quality and Safeguards Commission in Victoria. What I’m going to talk to you about today is our office here in Victoria and what our functions are, some of the broader functions of the Commission that are undertaken in other parts of the business and then focus specifically on complaints, how we manage complaints and how they can be lodged and those types of issues.
The NDIS Quality and Safeguards Commission is an independent Commonwealth organisation and the purpose of us being established was to improve the quality and safety of NDIS service delivery.
Graeme Head is our Commissioner, he is an independent office holder and he reports directly to the Minister for the NDIS Steward Robert. We sit in terms of Government we sit within the Social Services portfolio.
What are role is – we regulate the NDIS market and we took over the registration of NDIS service providers from the NDIA. That’s taken affect in all States and Territories now with the exception of WA. WA come on board into the Commission on the 1st July 2020.
We provide guidance to NDIS service providers and practice information on how they can comply with their responsibilities including how to provide culturally responsive and appropriate disability services and supports.
We regulate all providers who deliver NDIS services, whether they’re registered or not and those providers that are used by both plan and or self-managed participants.
The aim of what we’re here to do is to have a look and support a shift in the quality of services that are delivered, the conduct of the NDIS providers and then support the principles of the NDIS as a whole to ensure that participants are getting choice and control and services delivered in a quality manner.
What we did with these complaints about NDIS service providers – we are different to the NDIA who deal with issues about plans and plan management and we deal solely with the service delivery side of things. We look at developing providers by using education and compliance tools and I will talk a bit about those later on in the presentation with the intent of trying to improve the skills and knowledge of the NDIS service providers out there.
As I said, from 1st July next year WA will come on board with us but until then they’re covered by state safe guarding responsibilities and then the rest of the country is covered by us.
While we regulate providers, what we’re looking to do is in bed the quality and safeguarding framework into the principles that providers apply when they’re delivering all of their services. To key points in all of that are the human rights so everything we do obviously is underpinned by the UN convention on the rights of a person with disabilities.
The framework starts with the presumption that people want to use choice and control in obtaining their services. That’s the key focus of the framework that underpins our work. The other principles about how we work with the providers so we regulate them in a range of other spaces in addition to what I’ve just outlined there.
This is the three areas that underpin the work that we do in the Commission. In the developmental domain that’s where we look at strengthening the capability of providers as well as people with disability to ensure that they understand what is out there, how we can assist and what is required of a service provider and their workers.
That’s not necessarily a regulatory function that we provide or that we undertake. But it’s there to support the safeguarding and quality frameworks. Measures in the preventative domain, which is the middle one up on the board that’s intended to prevent the harm and ensure quality services, are delivered to people with disability. That’s where a lot of our work in the complaints area fits and that’s what I will talk about in a bit more detail later on.
The corrective domain is intended to resolve problems, identify improvements and look at trying to avoid the same problems reoccurring and providing a level of oversight over the system. If we were to get success in the corrective domain, it means in turn it becomes a developmental exercise again and the cycle starts over again.
They work together. We expect the providers are working in all of these domains when delivering their services and when working with us in relation to any of the functions that we have.
We have a number of key functions in the Commission. The first of those is the registration process. That as I said earlier has come over from the NDIA. Unregistered providers are also regulated by us as well. There is the code of conduct that applies to unregistered providers and the code of conduct and the rules and the act applies to those who are registered.
We are responsible for compliance and monitoring of compliance activities, investigation and we have a range of enforcement actions that are open to us under the Act as well and again I will talk about those a bit later on.
We’ve got complaints, we’ve got reportable incidents. Where an incident occurs a provider as defined by the act a provider is required to report to us each incident and report an action. We also have a national oversight of behaviour support, which includes monitoring the use of restrictive practices with the aim to eventually reduce and ultimately eliminate the use of such practices.
Each of those functions with the exception of registration, each function I’ve described are undertaken here in the Victorian office and then together in our national office they also look after the worker screening checks. From the 1st July 2020 there will a national worker screening process in place that we will manage nationally out of our Penrith head office.
We also have a number of information sharing protocols that we have in place between us and other organisations such as the NDIA, other Commonwealth and State based organisations, people here in Victoria like the Disability Services Commissioner where we work closely with them to ensure that matters that come into our attention that might fall into their jurisdiction are looked after and transferred so they’re managed by the best appropriate area.
As I said here in Victoria that’s a brief structure of the sections, we have here in Victoria. We have the five sections in Victoria and as I said registration and the worker screening functions are undertaken in our national office in Penrith.
In terms of the code of conduct, the code of conduct sets what the minimum expectations are for a service provider in the NDIS world. It’s a clear statement and it’s there to empower both consumers and providers as to what’s expected and what people with disability can expect. Anybody can raise a complaint with us in relation to any concerns they have about an NDIS provider’s potential breach of the code of conduct.
There’s also some coverage in terms of conduct with programs such as the continuity of support program. The local area coordinators are also covered by the NDIS code of conduct. There are a few outside of direct service provision that are also covered by the code of conduct.
We can take a range of actions if we find a provider or individual worker has breached a code of conduct and we’ll go through that a little later. What we’re looking to do when responding to concerns about the code of conduct is primarily to educate and improve the practice of the provider or the worker that’s involved in the concern.
We can take corrective action to the point of deregistering NDIS providers so they can no longer operate in the NDIS market and there’s a range of other civil actions that we can take under that NDIS act as well.
In terms of obligations on providers as I said that chart on the screen gives you a brief outline of where the NDIS code of conduct and complaint processes come into it. As you can see up there the workers, screening is optional for unregistered providers but it’s mandatory for registered providers.
There are other elements of registration that will determine the other parts of responsibilities in terms of what we look after in our office here. Reportable incident management is something that every registered provider must undertake. Complaints processes must be under taken by both registered and unregistered providers.
They’re the sort of things we look at each time a complaint has come to us to determine what options are open to us to resolve a concern.
I just had a question about the definition of registered providers. If I’m using a service provider and I have a financial intermediary who knows the ABN and that but they haven’t registered officially are they considered to be a registered provider?
No a registered provider and I’m just about to move onto the provider registrations so this might answer your questions, that is provider registration. A provider is considered registered when they register with the NDIS Commission and when they undergo and continue to renew their registration on a registration cycle. You can use unregistered providers in instances where you’re allowed to do that and it can be any person that you choose to engage.
Yeah, but they’re not covered for screening or they don’t have to be screened?
No, screening for is optional for unregistered providers mandatory for registered providers. It’s up to the individual whether or not they want to engage an unregistered provider who is not part of that national worker screening check.
There is a range of services that if they are delivered by a provider the provider must be registered. They cannot choose to remain as an unregistered provider. Registration is quite a vital process in terms of how we can control what the market is doing and putting the necessary controls on providers.
We expect whether you’re a registered or unregistered provider, we expect the delivery of services and support is in a safe and of a high quality. That NDIS participants rights are upheld and that you follow the code of conduct.
To be a registered provider there are certain things you have to do. You have to have a complaints system you have to meet the new NDIS practice standards which outline what’s required of a provider, you need to make those reportable incidents and you need to report the use of restrictive practices and the management of behaviour support plans with the aim of reducing and eliminating those practices.
On the 1st of July this year any provider that was registered with the NDIA automatically become an NDIS registered provider and they then start the reregistration process with us as a new commission within the first twelve months of operation of the commission here in Victoria.
As I said before the practice standards set the benchmark for the expectations of a provider. There’s a core module that apply to service providers and then there are supplementary ones depending on the nature of the services that you’re delivering.
All registered providers are either audited or go through a certification process against these practice standards and that’s the registration process we do in the first twelve months with all the Victorian providers. SA and NSW have been in operation for 12 months already so their providers are already going through the registration process to become a registered NDIS provider under the Commission registration process.
When we look at the audit process, it looks at all information held by the Commission in relation to a provider. Complaint information, reportable incident information, anything that’s held by our behaviour support teams is all accessible by the auditors for that registration and renewal process.
The process itself is proportionate to the size of the business. There’s no one size fits all approach when it comes to the audits and there’s a panel of auditors that have been approved by the Commission that can undertake that work. The type of audit that is undertaken depends on the type of business that you run and the type of supports that you provide.
I’m just wondering if you have particular regiments against the convention and rights of person with disabilities in particular measurements when auditing or for service provision for the human rights laws.
All of our work is underpinned by that. In terms of auditing there’s a core set of modules that incorporate all of those values and the same when we come to complaint management there’s a whole range of things that we take into account when we look at what a complaint issue is. Likewise, in the same space with reportable incidents and behaviour support, which is why some of the goals in behaviour support is around reducing and eliminating the use of restrictive practices?
Worker screening, as I said from the 1st July 2020 there will be a new national scheme in place. It replaces all of the processes that are in place in the states. As you can imagine it’s quite an effort to align every state and territory to come into one national process and that’s as I said earlier being managed out of our national office.
A worker whose registered and cleared and is in our database is accessible by all registered NDIS providers and by participants who self-manage. The scheme because it’s national means if there is a worker that’s banned or excluded from working in the disability sector it’s accessible by people in every state around the country.
I just wanted to ask if a non-registered provider wanted to get their worker screened is that okay through this process?
Yes. For non-registered providers it is optional and the intent obviously is that if you self-manage and use unregistered providers as your own safe guard you may want to see that they are part of that national scheme so you can opt into that scheme as a provider.
Reportable incidents, as I said earlier there is a range of incidents outlined on that slide. If they occur in connection with the delivery of NDIS supports and services, then a provider has an obligation to make a report to us.
There’s also obligations of providers at a state level and then the national scheme doesn’t replace those obligations. In some instances, providers are having to report some of these events to multiple people.
Most instances that fit these categories need to be reported to us within 24 hours of key personnel of that provider becoming aware of the incident. Then there’s a more detailed report that can be obtained at the five-day mark and a final report at 60 days if that’s warranted.
If an incident is reported to you, does that incident get investigated or is it just from what the provider says?
There is a couple of components. We need to ensure there are safeguarding measures in place to reduce the incident reoccurring. We require the provider to tell us what it’s done to prevent, lessen the harm, and stop it occurring whatever it is depending on the nature of the incident.
If we’re not satisfied with their response or continue to have concerns then we ask for more detailed information from them. We don’t actually do the investigations ourselves we analyse the information the provider gives us.
So does it not come from the point of view of the participant as well?
We require that the provider has involved the participant and heats required under the rules, the participant is involved in the notification of and the management of.
What if that participant is nonverbal?
We expect whoever is their representative is the person the provider would consult with as we would in the case of complaints.
Okay eve had an incident where this has happened where a provider has called up about a participant and an incident that has occurred at a provider’s day service. They called but as well as that the parent, the carer called. The incident was reported on both sides.
Basically the participant’s mother called back to find out what the NDIS was doing about the situation because she felt her son’s voice was not heard and the incident had occurred that she felt was because of communication reasons and the staffing that wasn’t appropriate.
I’ve gone backwards and forwards. What happened then, it’s quite a lengthy thing but I then came on board because there was no response from your NDIS Quality and Safeguards and rang directly and spoke to someone. They said until a meeting is arranged with both parties that you could not help.
We had the meeting, came back from the meeting I reported what had happened but I just kept getting back that that initial call was the complaint they would listen to and that was the only initial complaint they would listen to.
What was in that initial complaint from the parent was that she wanted her son to go back without animosity. We had a lot more information after that meeting. I asked several times for NDIS to close down and reopen a new complaint, which was completely disregarded, and basically the whole backwards and forwards has been a waste of time.
Look I realise it’s only newly rolled out. But I feel there’s a lot of issues with your first point of call or complaints. I would really love to be able to have the opportunity to speak to you further about this.
More than happy to talk to you about specifics after this.
That would be great, thank you.
Our behavior support team they provide best practice and clinical leadership in the space of behaviour support and in particular around positive behaviour support and the reduction and elimination of the use of restrictive practices.
Under the new arrangements specialist behaviour support can only be provided by an NDIS registered practitioner whose been engaged and is registered with the NDIS Commission. That’s a bit of a change to what people have previously experienced in each of the states.
The positive behaviour support capability framework, outlines the capabilities that we would expect providers to have in order to become registered practitioners within the NDIS space. There’s been a range of processes undertaken to get that to what I think is just about a final version that’s almost available on our website in terms of that framework that’s available for anybody to use and obviously particularly behaviour support practitioners.
Now complaints. The important thing with the complaints world is that anybody can raise a complaint with us. You don’t need to be a participant, don’t need to be an advocate, don’t need to be a parent. You can just be somebody who has a concern about the quality of services being delivered to a person with a disability who’s in receipt of a NDIS delivered service.
As I said earlier, each registered provider is expected to and is audited against having an internal complaint mechanism process and that also includes the availability of that process to us to have a look at and to get involved in. They also need to make participants aware of the fact that we exist and that participants have the right to come and lodge a complaint with us.
It needs to ensure the providers needs to ensure that it’s system enables complaints to be made easily and to meet the needs of the people that are making the complaints in terms of communication preferences, and that they can do things like lodging complaints anonymously.
Part of the auditing process and part of a complaint process that they need to have in order to pass registration requires they need to keep a record of all the complaints that they’ve received.
In terms of what our process involves when people come to us, as I said before complaints can be made by anybody. They can be made in a matter that’s open so we know who you are and we tell the provider who you are and who the participant is. They can be anonymous you ring us up once, provide us with information, you’re not involved in the resolution process from there on out and we resolve that issue with the provider.
Or it can be confidential where your information or the participant’s information is withheld from the provider. We know who you are and we communicate with you but we don’t divulge your information to the provider.
When we’re looking at complaints, we can look at a range of information from the provider. We will look at things like their complaint management system, we can request copies of progress notes, communication diaries, medical records, staffing rosters, evidence of staff training. Whatever it is we believe is appropriate to address the concerns that have been raised with us.
Part of that process involves looking at policies and procedures a provider has in place to ensure they’re in place to minimise the risk of complaints being raised again.
I think it’s related I’m interested in the providers and I’m interested in the standard staffing and salary costs and levels. Is it standard across all tiers of salary or is it –
Within a provider?
That’s a decision a provider makes as to how they manage their staff.
There is no consistent if you are this –
No. That’s a business decision. We don’t get involved in that side of a business process that a provider might choose to undertake.
I was just wondering how many complaints you’ve received over this time and also interested to know how many complaints were upheld? Do you have any statistics or numbers you can give us related to that?
I don’t have any statistics on me today but I’m more than happy to send through some information to Melissa separately that she can distribute to you. I guess the one comment I would make is anecdotally we haven’t received as many complaints in Victoria as we expected we might in our first few months of operation. Not sure why that is.
Getting out to forums like this is certainly one of the things that we can do to help improve the numbers of complaints that we receive. The more we get out there and let people know who we are hopefully the more confidence people will have in coming to us to help them with their concerns.
There are a range of things that we can take complaints about. Essentially, it’s anything to do with the quality and service delivery that a NDIS provider has provided or hasn’t provided and should have provided. As long as the services have been delivered and paid for out of an NDIS plan it falls within our jurisdiction.
The one qualifier for that is we can’t look at things that have occurred prior to the 1st July this year. Our jurisdiction started on the 1st July this year and for events prior to that the Disability Services Commissioner is the body that still looks after those complaints.
As I said earlier the one thing that we do receive a lot of calls about is about NDIA plans and issues with plans and plan reviews and questions about why a plan has something in it that when it was meant to have something else in it. All of those actions that are taken by the NDIA are still dealt with by the NDIA.
If there are services that are delivered that are not through an NDIS provider we obviously don’t have jurisdiction for those and also any decisions that are made in courts. Particularly where there might be issues, around guardianship, we can’t get involved in the guardianship decisions but we can consider the situations and the role of the guardian when dealing with a complaint.
One of the messages we do want to get out there is that we have a no wrong door policy. If somebody comes to us, with a complaint about one of these other organisations, we will take the complaint details off you and we will make a warm referral to the right organisation. We do that with the consent of the caller, we also offer the caller the opportunity to make that referral themselves and provide them with the correct information so they can approach that other organisation directly themselves if that’s what they want to do.
Part of those information-sharing processes that I spoke about earlier involve the warm referral of complaints so you don’t have to tell your story to multiple people. We can take all the information and forward that onto whomever is the appropriate body.
As I said before anybody can raise a complaint about the provision of services. You don’t need to be the recipient of those services in order to lodge a complaint with us.
We have I guess a range of people that we have had complaints from so far. We have participants who ring up themselves. We have carers for participants. We’ve had anonymous complaints come in as well. Most of those have come in via the web form. We’ve had them from a range of different people.
We do encourage people to talk to their provider first before coming to us. A lot of the complaints that we are receiving are where people have already done that and they’ve not received a satisfactory answer from the provider. What then forms part of the complaint issue in addition to the quality of service issue that they’re bringing to us is a complaint about the complaint management system of the provider.
Nearly all of our complaints will have an element of complaint management in them at this point in time. As I spoke about earlier, our educative focus is to get providers to improve those practices so that if people are comfortable in using a provider’s complaint process those processes will enable them to achieve a resolution without involving us unless it’s necessary.
Could I just get the microphone at the front of the room please for a question?
How long after making the initial complaint with the provider before we should be contacting you?
I guess it depends upon the nature of complaint that you’re making. Good complaint handling practices would be that the provider would tell you when you can expect to get a response. If by that stage you haven’t got a response we would encourage you to go back to the provider but don’t have to do that multiple times.
It would be preferable to give the provider an opportunity to respond to the concerns you’ve raised with them and then if they’re just not responding or if they’re responding but not resolving your concern that information can then come to us at that point.
Having said that, as I said, if you’re not comfortable if there are issues that have led to a communication breakdown or relationship breakdown then you don’t have to attempt that but we would encourage it particularly where’s there’s an ongoing relationship. We would encourage you to give the opportunity to the provider to resolve it before it comes to us.
As I said earlier, we’ve kind of got the cycle of how we deal with complaints and what we do. We attempt to resolve the complaints as informally and as quickly as we possibly can. What that involves is a lot of back and forth over the telephone between us and the provider and a complainant and a participant if the complainant is not a participant.
We will transfer information between the parties in an attempt to get a resolution. We also have more formal resolution processes we can take. One of those includes conciliation where we can ask the provider, and the participant or the complainant to sit in a room with us and facilitate a discussion in an attempt to get a resolution to the process.
There’s obviously then cases that can’t be resolved. Despite what we do the provider may not satisfy is that it’s met its responsibilities in addition to not satisfying the complainant of the resolution of the approach. That’s when we move into our compliance framework.
That triangle on the board gives you an indication of the sort of lower level stuff at the bottom where the bulk of our compliance and preventative action is under taken all the way through to the top which is to do with banning orders.
Where providers or individuals have breached their responsibilities and have not taken action to improve them or where they’ve breached their responsibilities where there might be issues such as criminal charges that have been laid against workers, that’s the sort of cases that make it to the pointy end of that triangle, which is the banning orders that are put in place.
Got a question at the back of the room.
Thanks so much, can you give us an idea about how many of those at the highest level have actually got through the system?
I can’t tell you the number but what I can tell you is that it’s available publically on our website. We have a list of all banned workers and providers on our website and that information is made publicly available for anybody to search and to have a look at.
There have been no banning orders made in Victoria yet; we’re only five months old so we haven’t got to that point yet.
What about the revocation of the registration?
That is just starting now. That cycle takes 12 months. In SA and NSW they’re sort of midpoint of their 12 month renewal process. All of that is underway but the banning orders take place separately to registration decisions. That’s publicly available for anybody to see on our website.
My name is Patrick McGee from Australian Federation of Disability Organisations. Two questions how will – given that most complaints will actually come via an advocate probably, how will the Commission work with advocates to streamline the process so that that complaint, a complainant doesn’t have to continually tell their story throughout the process?
That’s the first question. The second question, given that this is very much a White-Anglo model complaint driven how will the Commission tailor what it does to make it culturally safe for indigenous Australians to also participate in the complaint process?
The first part of your question in terms of how involved advocates in our process –
The complaints are likely to get generated out of conversations with the advocates as a first point of call.
I guess anecdotally the majority of our complaints have not come from advocates to date.
That’s then a problem isn’t it because in fact what we know is that its individual advocates who people have the trust relationship with on the ground in the local area. If you’re not seeing advocates calling you up wouldn’t you say that’s a problem?
We are working as earlier I mentioned that forums like these are what we’re doing to get ourselves out there, to introduce ourselves to advocates. We’re working closely with a number of advocacy groups and bodies and peak bodies.
We’re working and are not too far off hopefully putting out some further information about exactly how we will work with advocates. There are a number of considerations that we need to take when we deal with advocates in terms of privacy.
We have some work being done around consent and sharing of personal information and all of that sort of stuff in the space of advocates. If you read our rules and principles we actually have a higher – I guess there’s a higher impost on us to ensure where advocates are involved or need to be involved that we get advocates involved.
It’s not going to come that way it’s going to come the other way around. It’s going to come from advocates.
We will work with the complainant whether it’s an advocate, a participant we will work with that person to get a resolution. I have forgotten your second question.
We are working on that and have strategies towards working with people from a range of different cultures not just Aboriginal and Torres Strait Islanders.
I’m talking about our First Nations People. What we need is cultural safe pathways for Indigenous Australians –
We are working with indigenous peak bodies to look at what we can do to help. We are only five months old and are still learning who are key stakeholders are at that stage and we’re establishing relationships with them and working with them to see how we can improve our service.
I know that’s not a specific answer.
It’s not specific at all. It says to me that you’re not actually ready and culturally safe for indigenous Australians to be complaining to you.
I don’t know that I would agree with that statement. Where we have people come to us with needs regardless of whether they are –
No but they’re not going to come to you if they’re not – if it’s not culturally safe.
We are working with the peak bodies to develop some strategies as to how we can get out there.
I’ve given you a hard enough time.
Thank you. The lady behind you had a question.
I just wanted to know what kind of education support programs you have. I know you mentioned a couple of modules but just wanted to know what kind of education you’re offering.
We don’t actually have any formal processes because we’re responding to requests at the moment. Whether it’s an education session like this, going out and talking to working groups who specialise in particular parts of the sector.
Our behaviour support team are working together with a number of peak bodies to talk to providers and educate providers in the behaviour support space. Our compliance guys are doing proactive education. Either off the back of referrals that we would make from complaints or from the reportable incidents space. They will go out, proactively work with providers one on one, and do some educative work in that space.
We’re really at the moment tailoring it to what the market is telling us it needs or is asking of us to deliver in that education space.
As I mentioned we have a few minutes left with the interpreter. If you can hold your questions, let her finish and then you can ask questions in the break.
I am just about finished. This is the second last slide.
As I’ve said the banning orders and the information on banning orders is all available on our website and that’s publicly accessible by anyone who wants to have a look at it.
We have a range of other measures that we can take as well including civil penalties and notices, infringement notices that can be issued to providers. We’re working through that range of tools now and as I said, most of those actions to date have been taken place in SA and NSW because they’re a more established jurisdiction that what here in Victoria is.
As I said, our website has a whole range of information that’s constantly being updated. There’s also a range of information packs available to download from the website. You can find out what it is that we tell providers in the education kits that we provide to providers, as much as you can find out the information we have available for participants as well.
That was the end of my presentation.
We can’t do questions right now, but I’m sure that Rachel will take questions through the break. We need to have a break for 20 minutes and then the next presentation will happen at 3.35 pm.
If you want to see, Rachel feel free. Thank you.Download provider fact sheets (off-site)
- Date published:
- Thu 14th Nov, 2019