A Submission from Villa Maria to the Productivity Commission Inquiry: 
Disability Care and Support

Contact:
Valerie Lyons
Chief Executive Officer

T: (03) 9855 7777
valerie.lyons@villamaria.com.au

August 2010

Table of contents
Introduction	5	
A.	Equity and self determination	6	
B.	Sustainability and workforce	7	
C.	Efficiency and effectiveness	8	
D.	Relationship between disability and ageing	9	

INTRODUCTION

Villa Maria began as the Catholic Braille Writers Association in 1907 and thus has a history of more than 100 years of providing support and services to people with a disability.  Today, Villa Maria is a not-for-profit, values-based organisation providing a wide range of disability services including individual support, shared supported accommodation, day programs, respite services, education services, early childhood intervention and our newest service, the ‘my future, my choice’ initiative at Austin Street, Alphington - a purpose-specific home for young people with high level complex care needs (including Acquired Brain Injury) who would otherwise be living in an aged care nursing home.
The Australian Government ratified the United Nations Convention on the Rights of Persons with Disabilities in 2008.  It is imperative that the rights enshrined in the Convention and the Victorian Charter of Human Rights and the Disability Act 2006 are also embedded in any new scheme that seeks to provide support for people with a disability.  The development of any new scheme to provide the support needed to enable people with a disability, their families and carers to have the quality of life and level of economic and social participation of other Australians must be based on the principles of equity, self determination, efficiency and sustainability.  A National Disability Insurance Scheme would deliver on all of these.

In its Issues Paper, the Productivity Commission has identified a number of issues and questions relating to the provision of care and support for people with a disability.
This submission concentrates on three key areas of concern, those being:
A.	Equity in levels of and access to support
B.	Sustainability and workforce issues with case studies
C.	Efficiency and effectiveness  
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A.	EQUITY AND SELF DETERMINATION
Equity
Currently, disability services are provided through approximately 60 different funding streams across Australia, with responsibility resting with both the Commonwealth and State and Territory governments and various compensation schemes such as the TAC in Victoria and WorkCover.  The various funding programs and services have developed over time in response to specific needs.  Whilst this demonstrates a willingness on the part of government to respond to needs it has of itself resulted in a plethora of funding schemes/providers which in turn has inevitably led to differing models of needs assessment and levels of support provided.
Any new system must be fair with everyone with a disability entitled to a level of support no matter how they acquired their disability, that will enable them to be active participants in the community and the economy.  In line with the National Disability Strategy currently being drafted by the Council of Australian Governments, aimed at providing a national vision and direction for consistent disability services across Australia, any new funding system should be national.  This would provide a consistent/more equitable means of assessing, monitoring and delivering the wide range of disability services required.  There should be a single national scheme whose sole focus is on providing the most progressive and responsive support it can for people with a disability based on equitable use of resources and available capacity.  This would also improve on the current system of measuring outcomes and reporting.
The scheme should be a “no fault” one, should provide support to people who have a permanent disability which impacts on their daily life in a significant way and should cover people with varying degrees of disability.
To ensure the equity which is so important in a democratic, multi-cultural country like Australia, and which is one of the principles of the UN Convention, there needs to be a simple, single, accessible and transparent assessment process which is also flexible and able to respond to changes in a person’s needs and circumstances.  As we move through our lives changing needs and circumstances are part of the journey and people with a disability should not have barriers and onerous assessment processes put in their way to prevent achieving seamless service change in line with their life changes.
Any new system must also be equitable in terms of who carries the cost of supporting people with a disability.  The UN Convention acknowledges the standing that people with a disability have as part of the community and fabric of life in a country.  That being the case, everyone in the community has a role to play in supporting them as the community supports education, health and safety.  To this end, Villa Maria supports the Commissions suggestion that a form of social insurance is the most appropriate approach to take.
Self determination
The development and introduction of a national system of disability support should also be underpinned by mechanisms to ensure choice and flexibility for those receiving the support.  This is best achieved with a person centred and self-directed approach focusing on the individual and enabling those assessed as eligible, their families and carers to purchase the services and supports they need from a broad and diverse range determined by individual needs and circumstances.  Individual support packages (ISPs) are currently one mechanism available for achieving this.
A system which provides greater choice and control for those receiving support has been shown both here and overseas to have a positive impact on health and wellbeing, to foster a culture of independence rather than dependence and to drive improvements in service provision and value for money.  Such a scheme allows for greater emphasis on rehabilitation and early intervention already recognised as being so important in supporting people to be active and participate in their community.
This inquiry provides a great opportunity to develop a new approach to funding and providing support and services to people with a disability which will ensure greater equity and allow people to reach their potential and achieve their aspirations. 
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B.	SUSTAINABILITY AND WORKFORCE
Sustainability
The capacity for sustainability is critical in the development of any new scheme or system.  Sustainability of the whole scheme needs to take into account possible changing economic circumstances, demographics and social trends.
The support provided to individuals needs to be sustained over that person’s life  and be able to respond to changing needs as they occur.  This ensures certainty that their needs will be met as things change and thus the current levels of anxiety experienced by people with a disability and their carers/families would be lessened.
To sustain the “informal care/support” that many people have there needs to be investment in the support, training and necessary tools to enable that to happen.  The contribution both economically (in terms of reduced costs of caring) and socially such informal care makes is hard to estimate, but it is important that it be supported effectively.
An important area of sustainability is that of the service providers.  Whilst there is a solid argument that ISPs will allow market forces to determine who will survive in the market place based on quality of service and care, it is also a fact that there are services provided which are important to consumers but not often recognised as such.  Case management/service co-ordination is one of these.  The introduction of choice and control through such mechanisms as ISP certainly meets the self determination criteria, but at the same time it places a high level of uncertainty on service providers in being able to maintain a core level of staffing for those administrative tasks and coordination/case management processes that people with a disability and their families/carers often find hard to value or seek to have this external coordination as they do not wish to expend this time themselves or feel unable to do so.  The scheme needs to recognise that some individuals will require greater support to plan and exercise choice than others.
Issues such as capacity, workforce development and training, infrastructure, innovation and research also need to be addressed.  For service provision to be responsive to changing needs and the changing environment, all of these factors must be addressed. A case can be made that any new scheme allows for service providers to be accredited and receive a base level of funding ensuring that base staffing and administration is possible.  The providers then operate in the open market place with others and their level of service and efficiency will determine their growth and development.  Any new scheme must ensure supports and services for people with a disability are available through a diverse range of organisation – enabling choice – which must be viable and sustainable.
Workforce
One of the fundamental issues for both people with a disability, their families and carers and disability service providers is being able to access a committed, trained, qualified and reliable workforce.  The current system of funding means that many providers are forced to pay minimum award wages and offer low numbers of hours of work.  The issue of workforce reliability and availability needs to be addressed and one of the key ways of doing this is to provide support funding at a level which allows people to receive a wage that is competitive and appropriate.

The desire to provide greater choice and flexibility through ISPs and other forms of individual funding can be at odds with ensuring the type of workforce we all want in the disability sector. Meeting the expectations of people requiring support with a stable consistent workforce that will inevitably change over time is a conundrum facing service providers in the climate of individualised funding and self directed services. A planned workforce strategy that requires a larger team approach that can provide long term flexibility and stability to support individuals requires ongoing recruitment, selection and training from funds allocated to individuals which they may not consider necessary.  

As with the issue of sustainability, discussed above, service providers need to be certain that they will have sufficient funding to recruit, train and pay a workforce that will meet the current and future needs of people accessing their services.

C.	EFFICIENCY AND EFFECTIVENESS
Much of the service development and funding programs within disability are focused on meeting short-term goals, including costs, rather than looking at long-term outcomes.  If we view funding of disability services through a National Disability Insurance Scheme as an investment in the future of people with a disability in particular and the Australian community as a whole, then those services which maximise independence, productivity and participation should be identified and developed.
The earlier interventions can be made in the lives of people with a disability, no matter when they acquire them, the greater the potential for them to develop real independence and reach their full potential.  To assist in attaining maximum effectiveness and efficiency any new national funding scheme should establish national standards and portability across jurisdictions.
A national scheme also provides greater efficiency and effectiveness in data collection, research, identification of best practice, support for innovation and benchmarking.

D.	RELATIONSHIP BETWEEN DISABILITY AND AGEING
There is a blurred interface between disability and ageing.  Currently, people with a disability often have ageing parents/carers and as they become increasingly unable to deliver that caring role, the current funding systems make it very difficult for them to find a solution to the dilemma of their funding not meeting the increasing needs.  A new scheme needs to ensure that it is able to meet changing life needs.
The definition of “aged” also needs to be addressed.  Generally, people with a disability age earlier than other Australians.  However, the capacity for them to access aged care is limited.  There needs to be consideration given to the relationship between aged care and disability to ensure that people are able to access the level of care they need when they need it – not when a magical number of years is reached.