The inquiry into the implementation of the national disability insurance scheme and the provision of disability services in New South Wales
On 21 June 2018, the New South Wales state parliament announced an inquiry into the policy and systematic issues concerning the provision of disability services and the implementation of the National Disability Insurance Scheme in New South Wales. The Legislative Council Health and Community Services Portfolio Committee No 2 is hearing the inquiry. The submission period closed on 9 August 2018. Public hearings are planned for September and October.
Refugees living with a disability are a unique group: most arrive with little or no aids or equipment and most have had access to specialised care prior to arrival. A significant number have immediate needs on arrival requiring the immediate purchase or hire of equipment such as incontinence pads, wheelchairs, and framed beds. Some arrive with a severe or moderate condition that is undiagnosed or not formally diagnosed, arrive as adults with a condition that is typically diagnosed in childhood, or arrive with poorly managed condition.
These needs pose particular challenges for the NDIS, whose users typically are people whose disability has developed since birth or as a result of an accident. Newly arrived refugees living with a disability require streamlined, triaged access to services and extensive case management. In contrast, the implementation of the NDIS been characterised by long waiting times, and high levels of bureaucracy. It is well suited to individuals who can articulate their needs into the language of the NDIS, not necessarily those who don’t have any English nor any understanding of what their options are.
NDIS need support so they can be included and can participate in Australian society. This submission highlights some of the issues and challenges that refugee communities experience in accessing disability support services in NSW, including through the NDIS, as well as for service providers who work with refugees with a disability.
This submission includes recommendations to improve support and access to services for members of refugee communities with a disability.
Background on Australia’s Refugee and Humanitarian Program
Australia’s Refugee and Humanitarian Program has two main components. In the offshore component, people are resettled to Australia from overseas, usually after either being referred by the United Nations High Commissioner for Refugees, or being sponsored by a person or organisation in Australia. In the onshore component, people apply for refugee status (also known as seeking asylum) after arriving in Australia, and are found to be in need of Australia’s protection.
Before 2012, Australia’s Refugee and Humanitarian Program discriminated against people with a disability. To receive a visa through the offshore program, a person must meet the health requirements set out in Public Interest Criteria 4007. These require the Immigration Minister to refuse a visa if a person has a “disease or condition”, and providing health care or community services for that person is likely to “result in a significant cost to the Australian community in the areas of health care and community services”. In effect, those with a disability or other health concern were therefore unable to be resettled in Australia.
In 2012, the policy changed after a Parliamentary inquiry into the treatment of people with a disability in Australia’s migration system. Now, while a person must still meet the health requirements, those requirements can be more readily waived for a person applying for resettlement. This change only applies to the humanitarian program. Migrants with disabilities are still subject to the discriminatory health waiver processes.
Since July 2012, this has resulted in more refugee and humanitarian applicants with a disability arriving in Australia through the resettlement program. The vast majority of people have been settled in Sydney, with much smaller numbers in Newcastle and Wollongong. The exact number remains unknown, and there is a significant lack of reliable and accurate data on the prevalence of refugee and humanitarian entrants to Australia that have a disability. Better data collection and dissemination are needed to support the full social and economic participation of people with a disability from a refugee background.
Refugee support and health services, who had previously little experience with the disability sector, developed strong links with the then Department Ageing Disability and HomeCare (ADHC) to facilitate access to services. Health services were also able to develop relationships with disability service providers to facilitate access to services. When the National Disability Insurance Scheme (NDIS) rolled out from 2013, block funding to disability services ceased and services had limited capacity to respond to newly arrived refugees with urgent cases. As NDIS was rolled in, ADHC’s disability services ceased. Pathways for urgent newly arrived cases became difficult.
In 2015, Australia also agreed to take an additional 12,000 refugees fleeing conflict the Syrian conflict, with the majority arriving in the 2016/17 financial year. The majority settled in the Fairfield LGA. This increased the proportion of arrivals needing access to disability supports such as appropriate housing, equipment and specialised care, therapy support, and opportunities for supported education and work. This increase coincided with the NDIS roll-out in South Western Sydney.
Australia’s federally-funded Humanitarian Settlement Program (HSP) does provide some support to refugees arriving with a disability. It provides on-arrival settlement support and orientation to most people who are resettled in Australia from overseas, and also to some people who arrived in Australia with a valid visa and then sought asylum. This program is designed to assist humanitarian entrants in the first eighteen months of arrival. SIS and HSP provide invaluable support in getting clients to health appointments, establishing benefits, securing housing and connecting them to support groups. However, HSP program does not provide intensive specific support for people with a disability through to NDIS services. Instead, it is a referral support program that assists new arrivals to access mainstream services. As such, caseworkers in these programs are not trained to work with people with a disability or to be aware of the services and programs available to support this group of people.
HSP is contracted by DSS to provide mobility equipment for the first 28 days only. While a service extension can be requested from DSS, this is rare, and typically donated equipment is sourced, or hire options offered.
The Specialised and Intensive Services (SIS) component of HSP is geared to assist complex cases for people who have arrived in Australia under five years. SIS is available to people who experience multiple barriers to settling which require more casework support. Many people with a disability are eligible, but not all. Disability alone is not necessarily assessed as an eligibility criterion.
SIS does not provide extensive case management. Rather, it is funded to provide a range of occasion-limited services. For example, it funds a SIS case manager to assist the person to access up to 6 health appointments only. This is easily used up when multiple appointments for diagnostic and other assessments to access the necessary ongoing supports are required. Service cap increase requests must be approved by DSS. SIS is not specifically funded to educate clients about the NDIS, or to assist clients make an application to NDIS, but rather to assist them to access services that may be able to assist.
SIS is also time-limited, with most people exited at 6 months. As the process of getting NDIS funded services typically takes longer than 6 months, SIS is not able to provide case management throughout the NDIS application process. Most clients are exited from SIS before NDIS services are in place, and, depending on the timing, can be exited before an NDIS Planning meeting has occurred. Likewise, SIS is not likely to still be engaged if a review of a plan was required.
The longer-term case work required to get a client though the NDIS is predominantly provided by local refugee health providers, with smaller numbers being supported by General Practitioners (GPs). NSW has various refugee health models operating including nurse-led assessment clinics or GP-led models. In metropolitan Sydney, the NSW Refugee Health Service has a small disability support team, staffed by 3 full-time equivalent positions, to assist clients with the process of applying for NDIS, ensuring sufficient evidence for eligibility, determining needs, monitoring progress, and ordering necessary support equipment, and advocating on a case by case and systemic basis.