Anne-Marie Smith: Why Her Death Was Inevitable

Excerpt from the dictionary highlighting the word 'inevitable' in bold to highlight the topic of Anne-Marie Smith and the NDIS' failings.

No, I’m not talking about Anne-Marie Smith in particular – rather the tragic scenario that has exposed significant failings in the NDIS and specifically, accountability of the Providers who are responsible for the welfare of the participants they serve.

So… What really went wrong? The answer is simple in some respects, yet more complex in others. To get a complete picture, we need to look at some key milestones along the relatively short NDIS timeline.

It’s not a secret that the NDIS has been behind the eight ball from very early on. Back in 2017 and 2018 a week wouldn’t go by where the NDIA wasn’t under fire for one thing or another. This included the lethargic uptake from Providers and Participants, to unsustainable pricing caps, to the significant cost blowouts required to help the Scheme gain momentum. This was a time when each state and territory government oversaw their own provider registration and compliance. These varied from state to state, which meant there was no national uniformity or standardisation of rules and regulations.

Nevertheless, the NDIS, established by bipartisan agreement, had to succeed, no matter what. The existing system was clearly not working and there was little oversight of the industry, particularly relating to what providers were doing on the ground.

The NDIS was brought about as a new way to stop the abuse and neglect and bring ‘choice and control’ back to those the disability support system was meant to support. However from the get-go growing whispers began to circulate, questioning whether the NDIS would solve the systemic issues of the old system and actually deliver on its promises.

As the NDIS began to grow, the market saw an influx of new providers, lured by the promise of a massive $22 billion in annual funding, of which they could be part. A number of these operators were later identified as businesses that had been booted out of family day care and other government-funded systems – often because of fraudulent or unethical behaviour. These operators became known as ‘industry hoppers’ and posed a significant problem for the NDIS.

Unfortunately, at this point the NDIA didn’t have any real way to monitor what was actually going on in the market. There was little oversight of provider behaviour or a way to gauge participant experience, let alone industry performance. This meant unethical behaviour was going unchecked and providers whose focus was more about making a quick dollar rather than actually helping those more vulnerable in our community were doing just that.

Then came the NDIS Quality and Safeguards Commission (the NDIS Commission) – one body to rule them all! The introduction of the NDIS Commission brought with it the promise of:

  • consolidation of provider regulation under a federal banner;
  • improved regulatory mechanisms for greater market transparency; and
  • a way to pull everyone in to line and boot those not playing by the rules out.

New South Wales became the first State to make the transition. Within 12 months, the NDIS Commission reported over 500 cases of abuse and neglect. This was surely a hint as to what was to come once the other states and territories moved across in the following months and years.

At this point, we saw media scrutiny distinctly intensify. More cases of abuse and neglect came to the surface and the NDIS Commission realised they needed to do something. They appointed a dedicated 100-person Fraud Taskforce to put a stop to ‘dodgy providers’ – however by this stage, the problem was already too big. Whilst several big busts by the Taskforce hit the front page of newspapers across the country, many are still operating and hidden from plain sight (for the moment).

So, where are we today? According to the latest COAG Disability Reform Council Quarterly Report (March 2020), we now have a market with over 15,000 providers (not all active), serving 364,000 participants across Australia – and the NDIS Commission is still struggling. There is a percentage of providers still not being held to account and subsequently, participants still experiencing varying degrees of abuse and neglect.

To add fuel to the fire, there is a growing spate of unqualified, private organisations posing as consultants, training experts or other specialists offering poor advice and support to new (and existing) providers. Many of these services offer the world but fall dramatically short in practice. They too are trying to make a quick dollar out of the Scheme, but this time off the providers themselves.

This means the problem of fraud is extending from beyond those unethical providers to those supporting providers. What’s of particular concern is the potential long term, systemic risks associated with the ‘quality of provider’ now operating in the market: a problem that will very difficult to address by the government agencies trying to regulate the Scheme as time goes on.

What’s the NDIS Commission’s response to this? To close ranks and declare the problem is outside of their remit. By saying ‘we don’t endorse consultants’ which is essentially saying, ‘it’s not our problem to fix’. Whilst this move by the NDIS Commission does acknowledge there is a problem, it doesn’t address the elephant in the room that will directly impact what the NDIS Commission is trying to achieve. The said elephant is allowing Providers to be ‘supported’ in a way that neither aligns with the NDIS Quality and Safeguarding Framework, best practice or ethical behaviour. This issue will ultimately help continue the cycle whereby participants are placed at risk of harm.

It’s important to acknowledge that the NDIS Commission has and continues to take measures to help providers register and operate as good NDIS providers. However, the complexity of the scheme and its compliance requirements mean that providers often need dedicated and individualised time, guidance and practical support to understand and implement their obligations. The flow on effect is growing demand for good industry support bodies, including quality consultants.

What can the NDIS Commission do now?

  • Look outwards. By increasing collaboration with industry and credible private enterprise, it will be able to facilitate quicker action and still maintain control and direction of the marketplace.
  • Be brave. Do things differently. After all, it’s a fundamental principal that underpins the Scheme. Make sure decisions are based on what the industry needs, not the politics of the day.
  • Learn from the mistakes and shortcomings across other industries or marketplaces. Aged Care is showing how badly things can and do go wrong.

Let’s bring it back to Anne-Marie Smith. A shocking example of why the system meant to improve services to people living with a disability still has a long way to go.

Ann-Marie Smith had been receiving full-time care, six hours a day, seven days a week since 2013. She had been supported by the state-based Disability SA until 2018, when the introduction of the NDIS meant she moved to Integrity Care. Ultimately, we have all now been witness to a tragedy that shouldn’t have happened.

Amergin is committed to helping providers understand their responsibilities and stay on top of ever-changing industry and government requirements.

We do this through our social impact consulting services and our dedicated provider compliance platform amerginhub.