May 16, 2018

Commonwealth Ombudsman finds NDIA reviews too slow

The Commonwealth Ombudsman’s report into the NDIA’s process for reviewing plans has found the process is too slow, the backlog too large, and the processes not helpful to participants, noting:

“Without significant efforts to improve the timeliness of NDIA’s administration of reviews and communication with participants, there remains a risk that participants’ right to review will be undermined and review processes will continue to lack fairness and transparency and continue to drive a high volume of complaints”

This confirms what advocates are seeing in the field: cases where the process is taking so long that participants have a new plan before the original one is reviewed and people going without supports they need because the plan is inadequate but the review is delayed.

For example, the report found:

  • A backlog of 14,000 reviews yet to be conducted at December 2017
  • In January 2018, 12 weeks after a backlog team was assembled it had triaged only 3,400 reviews and actually conducted 1,500 reviews
  • the NDIA is receiving 620 new requests each week

The Ombudsman’s report also highlights distressing inconsistencies in the NDIA’s responses to review application, including:

  • lack of information about what process is actually taking place, and the timing of those processes
  • confusing decision letters to applicants, so it is not clear whether what has been done is an actual internal review or an informal review that is not ‘reviewable’ or subject to an external review by the AAT
  • failure to advise applicants of their rights, such as the right to review by the AAT.

Clearly the NDIA has underestimated the demand for internal reviews and consequently under-resourced the internal review process. They appear to have recognised this and increased staffing, but the Ombudsman’s report demonstrates that they have some way to go in getting on top of this, reducing the backlog and making review times more reasonable.

More worrying, perhaps, is the underlying cause of the volume of internal reviews.

Is it driven by KPIs? Rumours abound of NDIA planners working to KPIs for numbers accepted into the plan and for plan budgets. Naturally we’d expect the agency to be monitoring numbers across locations, and to have estimates for likely numbers of participants. However, people in the sector fear the agency has turned those estimates into KPIs for staff. Doing so will inevitably mean that deserving applicants will not gain access and that some plans will not provide reasonable and necessary supports, and there will be demand for reviews.

Is it driven by public mistrust? If people believe that the NDIA routinely tries to unjustly constraint participant numbers or participant support budgets, then people will routinely request reviews. The worst outcome is something like this scenario:

  1. the NDIA routinely rejects valid claims or prepares plans with insufficient funds
  2. those decisions get reviewed and the majority are adjusted in favour of the applicant
  3. it becomes accepted wisdom in the sector that every decision should be reviewed

The review process will get completely out of control if this scenario unfolds, the scheme will suffer, participants will suffer, and the cost of administration will soar. Money will be spent on bureaucrats, systems and lawyers instead of being spent on the supports for people with disability – the people the NDIS is for.

The Ombudsman’s report includes 20 recommendations for working through the backlog, improving internal processes, clarifying information to applicants and making their rights and options clearer.

That the Ombudsman has to make these sensible, rational and fair recommendations is a disappointing reflection on the NDIA.