More choice, better outcomes: NDIS architect David Bowen

By David Donaldson

March 11, 2016

There’s a lot riding on the success of the National Disability Insurance Scheme ahead of its big ramp up in July.

Apart from the clear human need that drove the introduction of a comprehensive system to help people with disability, there’s a lot of excitement in the policy community about demonstrating the value of the new so-called “person-centred” approach that’s already beginning to transform other health and human services.

“I’m a big believer that as we prove this model successful it will be picked up and applied elsewhere,” said David Bowen, CEO of the National Disability Insurance Agency.

Bowen (pictured) has been involved in the process the whole way through, from sitting on the advisory committee for the Productivity Commission’s inquiry into a disability scheme to leading the set-up of the NDIS itself.

Now it’s on the brink of a swift scaling up after three years of trials. By the end of this financial year around 30,000 people will have joined; the agency expects to enrol perhaps 15,000 in the following quarter alone as it begins transforming to a national program.

“The trajectory of the trial site experience to full scheme suggests all is OK on both numbers and costs as a total,” he said in a wide-ranging interview with The Mandarin. “It’ll be a very big ramp up from July 1, we’ve built our systems to deal with that and we’re getting a new ICT system up and running.”

More choice, better outcomes — and different risks

At its core, the NDIS is founded on the idea of giving Australians with disability the chance to make decisions about their own support and care, moving away from standardised services that often don’t fit individuals very well.

“The evidence overwhelmingly shows that when people choose services and supports that leads to better outcomes than when they don’t,” Bowen said.

While it’s expensive to provide personalised support to such a large number of people, it’s hoped the benefits of assisting people to live independently and productively will lower costs in the long term. “Good outcomes are the best form of cost control,” he said.

Inevitably, transferring control from bureaucrats to citizens means accepting a different level of risk. “It’s a deliberate decision around what we call risk enablement,” Bowen argued. “Sometimes people will make bad choices but, like all of us, they’ll learn from having exercised the choice and that will make them more capable to self manage into the longer term.”

Indeed, as a program that plans to eventually enrol 450,000 people into a significantly new way of working, there’s risk in the entire undertaking. But the NDIA is tracking the challenges closely.

“We’re very data rich in that we monitor progress against those assumptions.”

“We have within the agency a very large actuarial team,” Bowen explained. “We’re very data rich in that we monitor progress against those assumptions.” The agency has a “culture around test, refine, apply and then re-test it again”.

This monitoring has already come in handy as it emerged diagnoses of autism and developmental delays in children up to the age of 14 in South Australia during the trial stage was about double that anticipated. The ACT has also seen an overrun in diagnosis rates. New South Wales and Western Australia have both come in under predictions, Bowen notes, as there has not been a uniform approach to diagnoses in the early stages.

“This is a really good example of where good data can identify an issue and help inform a response,” the CEO said.

The NDIA has responded by inviting consumer service providers and academic experts to discuss the problem. The resulting plan, released at the end of last month, is to roll out the diagnostic system used in NSW across the country.

“It’s around having a wide gateway for all children with disability to enter, and then through that gateway provide some basic supports … and through better observation and assessment then devise more individualised support packages for those children who need it at the level they need it, rather than defaulting to a sort of one-size-fits-all therapy package,” Bowen said.

Given the big information asymmetry that exists between customers and providers in this area, the agency is developing an e-marketplace with the Department of Human Services. In the longer term Bowen hopes customers will be able to rate suppliers and the agency will be able to include information on whether they’re meeting outcome targets.

‘I had to rebuild the whole leadership team’

The NDIA is fairly unusual in that it’s located in Geelong, which is positioning itself as something of an insurance agency centre — the bayside city an hour south-west of Melbourne also hosts state agencies Worksafe Victoria and the Transport and Accident Commission.

But there were some initial staffing challenges when it officially sprang into existence and moved out of its original Canberra home inside the Department of Families, Housing, Community Services and Indigenous Affairs.

“… we’ve been able to build quite a strong agency presence …”

“Only myself and one senior executive made the move, so I had to rebuild the whole leadership team of the agency in early 2014 while I was still building all the systems,” Bowen explained to The Mandarin.

The location added complexity to recruitment. “At that time we seemed to attract people at both ends of the spectrum — those who were perhaps getting towards the end of their career and wanted to be involved in something they personally felt was very important, and then younger people who were willing to take the risk to make the move quite early in their career.

“You would have to say there was uncertainty about what the longer term would be. Since then as the scheme has continued and there are very clear indications from government of having a continued commitment to it, and as the full scheme bilateral agreements were met, we’ve been able to build quite a strong agency presence in Geelong.”

Despite the initial challenge, Bowen is happy with the staff they’ve attracted, with a good spread of both executives and lower-level employees.

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