QLD Market Position Statement (PDF 3.7MB)

Market Position Statement Queensland

• with Townsville module

i

Foreword The National Disability Insurance Agency (NDIA) is pleased to present this Market Position Statement (MPS), the third of a series being developed to inform market stakeholders and help current and prospective providers of supports and services prepare for the opportunities that the National Disability Insurance Scheme (NDIS) will create in coming years.

The MPS seeks to share information about the emerging NDIS marketplace, allowing providers to better understand areas of expected demand growth and the characteristics of particular markets around Australia both broadly at a state level and more specifically local markets.

The NDIA values the role of providers and sees them as a critical part of the NDIS in terms of delivering high quality, person-centred supports to help participants achieve their aspirations. The NDIA would like to see a market with a diverse array of providers that maximises choice and control for participants but also enables strong links with mainstream services and family and community support to help achieve the overall NDIS aspirations of increased social and economic participation for people with disability.

The NDIS provides an unprecedented opportunity to collect disability market performance data based on early NDIS experiences to date and use this to drive continual market development as the NDIS evolves.

This MPS contains a ‘high-level’ look at Queensland and within that, a particular focus on the Townsville, Charters Towers and Palm Island early transition site as the first Local Market Assessment module. The objective is to make this MPS as practical as possible for current and prospective providers, incorporating the information most useful for commercial decision making. To achieve this, the NDIA is committed to sharing data about the market as it becomes available, despite some limitations.

As the NDIS market continues to develop and the number of participants in the Scheme grows from approximately 25,000 current participants to 460,000 participants by 2020, the growing information base will allow the scope and detail of the future MPSs to be expanded. In the spirit of the NDIA’s mantra of ‘Listen, Learn, Build and Deliver’ we welcome feedback about what additional information would be most valuable for inclusion in future MPSs.

David Bowen

CEO

National Disability Insurance Agency

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Contents

Foreword ............................................................................................................................ i

Contents .............................................................................................................................ii

Market highlights ............................................................................................................... 1

1. Overview .................................................................................................................... 4

What is this document and who is it for?.............................................................. 6

Markets forward work program ............................................................................ 7

2. Queensland regions ................................................................................................... 8

Demand: Participants by service region .............................................................. 9

Demand: Funded supports by service region .................................................... 10

Demand: Participant characteristics .................................................................. 13

Demand: Supports by category ......................................................................... 15

Supply: Information Linkages and Capacity Building ......................................... 18

Growth: From current supply to future demand.................................................. 20

Growth: Estimated workforce required ............................................................... 22

3. Townsville, Charters Towers and Palm Island early transition site ............................ 24

Site profile ......................................................................................................... 24

Demand: Participants by Local Government Area ............................................. 26

Demand: Phasing of participants entering the NDIS .......................................... 27

Supply: Current market landscape..................................................................... 28

Supply: Current market concentration ............................................................... 29

Supply: Provider aspirations and challenges ..................................................... 30

4. Additional resources and Scheme experience .......................................................... 36

Outcomes Framework ....................................................................................... 36

Quarterly Reports .............................................................................................. 39

Organisational readiness and training resources ............................................... 41

Rural and Remote and Aboriginal and Torres Strait Islander Strategies ............ 42

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Market highlights

2 May 2016 | Queensland Market Position Statement



1. Overview The NDIS creates new and expanded opportunities to provide innovative and personalised supports to people with disability in an open market.

Central to the NDIS is a shift to directing funding and resources to NDIS participants who will then drive and shape the market through their individual choices. This fundamentally changes the funding relationships that have characterised the disability support system in the past. Delivering on the aspiration of providing empowered choices of open, inclusive and independence building supports requires reform within disability support sectors and more open and inclusive involvement from communities and the broader Australian economy.

The NDIS market will expand dramatically in coming years, creating significant opportunities for the existing service sector and for new entrants, as well as mainstream businesses that make their services accessible and inclusive. Nationally, the level of expenditure on disability supports will more than double, reaching approximately $22 billion p.a.1 supporting 460,000 participants, once the NDIS is fully implemented.

Queensland represents the third largest market with around 91,000 NDIS participants, up from approximately 48,000 people with disability currently receiving funded supports. In dollar terms the Queensland market will grow from approximately $1.8 billion2 to $4.3 billion in the next three years. This growth represents the largest increase in market size in any of the three eastern mainland states. This means more people and more funding across every region in Queensland.

NDIS-generated growth presents significant opportunities for an expansion in service provision. With this opportunity comes the challenge to deliver high quality, capacity building, value-for-money supports. To succeed and thrive in the more open market environment market leaders are already embracing this task and are ready to consider new business models and products, and explore new ideas, collaborations, technologies and service offerings that are responsive to individual choices.

The NDIS will also be a major driver of new jobs and career pathways in the sector as well as creating employment opportunities in communities. Although the NDIS is in its infancy, there are many examples of providers restructuring, aligning practices with the NDIS model and beginning to thrive.

Developing the market will take time

The NDIS aims to harness the power of vibrant, competitive and efficient markets to create value for participants, the community and the overall economy. Effective markets will allow people to express their preferences and needs, and reward providers that can respond quickly and effectively. However developing a strong, contestable market for disability supports is a long term project. All stakeholders in the market will require time to build capability, confidence and systems to support the market mechanisms. Participants, possessing greater consumer power, are learning to make choices and explore different service options. Providers are building an understanding of their customer base and preferences, positioning service offers and transforming their operations. The NDIA is building an evidence base of the current market

1 This figure includes the Agency’s operating costs. 2 Inflated to 2019-20 dollar values.


to provide a comprehensive basis for decision making and is progressively developing the market infrastructure including defining key business systems and rules.

The NDIA’s approach to market development during the transition seeks to expand the supply and range of supports while delivering a transition to the Scheme which is as smooth as possible and ensures long term Scheme sustainability. Whilst the NDIA currently regulates the market by setting maximum prices for some supports, over time as competition grows, demand is being met and where the exercise of choice is evident, prices for most supports will be deregulated.

But the market is already responding and growing

Whilst the NDIS is still in its infancy, the market is already growing and diversifying in response to new demand generated by participants, with greater and growing flexibility to explore new supports. In a vote of confidence in the Scheme, there are currently over 2,300 registered providers in the NDIS, representing a growing range of supplier business types and service models. To date, around 130 organisations have applied to register as a provider of NDIS supports in Queensland. Assessing and approving registrations for providers who have expressed an interest in operating in service regions which will be transitioning into the NDIS during the 2016-17 financial year will be a priority for the NDIA as the commencement of transition approaches.

The NDIS has also triggered growth for sole traders and Small Medium Enterprises (SMEs). Across Australia, new providers have also emerged in NDIS trial sites to fill gaps in the market, for example delivering new community participation offerings to young people in areas where supports have not historically been located.

The NDIS is also encouraging many providers to expand beyond State borders for the first time as well as changing their structures and business offerings and entering into new partnerships to take advantage of the new opportunities the NDIS provides. It is likely that given the growth in demand for services driven by the NDIS, that providers from adjacent sectors such as health, aged care and other human services will increasingly enter the market.

Whilst this transformation is undoubtedly challenging for existing providers, experiences in trial sites are demonstrating many examples of providers restructuring, aligning practices with the NDIA model, adapting and beginning to thrive, with the overwhelming majority upbeat about their growth prospects in the NDIS.


What is this document and who is it for?

Facilitating a vibrant and competitive market for services and supports is a core part of the role of the NDIA. To encourage this, the NDIA is committed to providing as much information about the future NDIS market as possible. As soon as they are finalised, this will include clarity on the “rules of engagement” and details about systems, processes and interfaces. It also includes sharing information about the developing NDIS commercial landscape and opportunities widely, as the market grows.

Current and prospective providers are indicating they are enthusiastic about growth in the NDIS but need more information about market demand and supply to inform investment decisions about where to grow, or how to re-orient supports to ensure they become providers of choice in the new market. This MPS however should not be considered as advice from the NDIA, but rather point in time information. Providers are encouraged to ensure they undertake extensive market research before making strategic decisions about growth or changing their service types to account for the NDIS.

This MPS aims to help providers, as well as participants and service intermediaries such as plan management and support co-ordination agencies, understand the developing local markets they operate in, so that they can make informed decisions now and identify challenges and opportunities for the future.

The MPS is separated into two modules. The first focuses on the projected demand for the NDIS across Queensland, organised by existing Queensland Government disability sub/regional areas. The second is a more in-depth look at the market in the Townsville, Charters Towers and Palm Island early transition site which falls within the broader Townsville Service region identified in the Bilateral Agreement. The Townsville service region covers Townsville, Hinchinbrook, Burdekin, west to Mount Isa, and up to the gulf.

Demand for supports is based on the NDIA’s work modelling the full Scheme participant population. In order to estimate demand at a service region level a number of assumptions have been made to estimate the prevalence of disability in each area. The specific mix of severity of disability in each area cannot be determined and hence this is assumed to be constant across service regions.

National service type benchmarks have been used to estimate supply of supports and services as specific geographical variation is not yet available. Hence, the more detailed geographical data presented in this report should be assessed with this in mind.

This MPS is the first market information product developed by the NDIA providing key State-wide information for Queensland. It is expected that the content of future MPSs will evolve based on feedback from the market and to incorporate successively greater levels of information and data obtained by the NDIA as the NDIS evolves.


Markets forward work program

This MPS is part of a number of market information resources the NDIA will develop and release to support current and prospective providers to adapt, grow and thrive whilst delivering high quality, person centred supports to help participants achieve their individual goals.

From this MPS, further State-wide overviews with individual service region modules will be developed and the NDIA welcomes feedback from providers on this MPS on the sort of information that will be of most value to support providers in their NDIS preparations.

As the NDIS is implemented and a greater level of participant and provider performance information is captured, a wider range of market metrics can be analysed and shared with the market. Some of the information types the NDIA intends to develop include:

• Regional supply mapping; • Further reporting on implementation of the Outcomes Framework and relative market

performance; • Greater detail of registered providers – e.g. service offerings, organisational types; • Prevalence of plans by area including different characteristics; and • Specific sub-market analysis, for example regional and remote, assistive technology

and specialist housing.

The NDIA’s capacity to monitor the market will also evolve and enable a better understanding of the share of spending across different supports, all of which will continue to change as participants shape the market through their individual choices.

Given the Agency’s commitment to continual improvement, we would like to hear your feedback to allow us to improve future MPSs. In particular:

• What information you found useful? • What needs further clarification? • What additional information would you like to know that the NDIA can provide? • Whether this MPS was easy to read/understand?

You can provide feedback to [email protected] with the subject heading ‘Feedback on Queensland MPS’.

mailto:[email protected]


QUEENSLAND

2. Queensland regions Queensland has a population of 4.7 million, representing 20.1 per cent of the Australian population. In the Bilateral Agreement for transition to an NDIS the Commonwealth and Queensland Governments agreed that transition in Queensland will be implemented on a geographical basis using existing Queensland disability sub/regional areas. These 13 “service regions” are identified in Figure 1.

Figure 1 Queensland service regions

Source: Scheme Actuary


QUEENSLAND

Demand: Participants by service region

The distribution and growth of NDIS participants has been estimated using population projections and phasing as per the Bilateral Agreement between the Commonwealth and Queensland (Table 1). From 1 January 2016 early transition commenced for people aged 0-17 in Townsville and Charters Towers and all people who meet the access requirements in Palm lsland. By 30 June 2016 it is expected that 600 participants will have entered the Scheme. This is expected to increase to around 15,000 participants by 30 June 2017 as the remaining eligible population in the broader Townsville region3 commence transition from 1 October 2016 and the Mackay and Toowoomba regions from 1 November 2016 and 1 January 2017 respectively.

In year two of transition, participant numbers will increase to around 31,000 participants as the Ipswich, Bundaberg and Rockhampton service regions transition into the Scheme. In year three of transition, participant numbers are expected to triple to around 91,000 as all remaining service regions will transition into the Scheme during the 2018-19 financial year.

Participant numbers and participant density across each service region varies considerably. Five service regions (Cairns, Mackay, Rockhampton, Toowoomba and Townsville) have a participant density of less than five participants per 100km2 which will present challenges to providers operating in these areas.

Table 1 Number of participants by year and service region (cumulative)

Service region 30 June 2016

30 June 2017

30 June 2018

30 June 2019

Participants per 100km2

Beenleigh 0 0 0 9,900 660 Brisbane 0 0 0 15,300 1,140 Bundaberg 0 0 3,300 3,300 50 Caboolture/Strathpine 0 0 0 9,100 450 Cairns 0 0 0 4,700 <5 Ipswich 0 0 8,000 8,000 60 Mackay 0 3,100 3,100 3,100 <5 Maroochydore 0 0 0 7,500 70 Maryborough 0 0 0 5,100 10 Robina 0 0 0 8,400 630 Rockhampton 0 0 4,900 4,900 <5 Toowoomba 0 6,600 6,600 6,600 <5 Townsville 600 5,300 5,300 5,300 <5 Total 600 15,000 31,200 91,200

Source: Phasing proposed as per the Queensland Bilateral Agreement.

3 Townsville Service Region comprises Townsville, Hinchinbrook, Burdekin, west to Mount Isa, and up to the gulf.


QUEENSLAND

Demand: Funded supports by service region

The NDIS in Queensland is expected to require funding of approximately $220 million in 2016-17, $920 million in 2017-18, $2.7 billion in 2018-19, and $4.3 billion by the end of 2019-20 (Table 2).

Figure 2 Estimated value of NDIS supports – annualised as at 30 June 2020


QUEENSLAND

The service regions which will experience the largest increase in the value of supports demanded will be Toowoomba ($100m) in year one of transition, Ipswich ($240m) in year two of transition and Brisbane ($470m) in the third year of transition.

Table 2 Estimate value of NDIS supports by year, Queensland

Service region 30-Jun-17 30-Jun-18 30-Jun-19 30-Jun-20 Beenleigh $290 $470 Brisbane $470 $750 Bundaberg $100 $100 $150 Caboolture/Strathpine $270 $430 Cairns $150 $250 Ipswich $240 $240 $360 Mackay $40 $80 $80 $130 Maroochydore $230 $370 Maryborough $160 $270 Robina $260 $410 Rockhampton $140 $140 $220 Toowoomba $100 $190 $190 $290 Townsville 80 $160 $160 $240

Total $220 $920 $2,710 $4,340 Source: Scheme Actuary. Values rounded to nearest $10m. Totals may not add due to rounding.

When considering the total value of supports in each service region it is also important to consider the expected distribution of support packages for participants at full scheme (see Figure 3).

Figure 3 Estimated distribution of support packages

Source: Quarterly reports

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Annualised committed support band


QUEENSLAND

Over 60% of participants are expected to have an annualised package of supports totalling less than $30,000, while only around 7% are expected to have an annualised package of supports totalling more than $100,000.

Across trial sites, there have been some variations in actual scheme experience compared to the expected distribution of support packages which may be indicative of scheme experience in Queensland. In particular, in the Victorian trial site (which covers all ages and cohorts and therefore is a good indicator of potential full scheme experience) there has been a lower proportion of low cost participants and a higher proportion of mid-range support packages than expected. Further information comparing actual scheme experience to expectations across trial sites is available in the Quarterly Reports and Quarterly Dashboards (see section 4.2).


QUEENSLAND

Demand: Participant characteristics

At 31 December 2015, in the Barwon trial site4, approximately 37 per cent of participants with approved plans were aged 0-14 years and approximately 15 per cent of participants are aged over 55 years. Over time this distribution is expected to change in line with demographics and as participants age in the Scheme; however, this age distribution is likely to be similar across service regions as the NDIS rolls out in Queensland, with some differences resulting from the relative age profile of the general population.

Figure 4 Participants with an approved plan by age group (Barwon)

Source: Based on NDIS quarterly dashboards – see Section 4.2

Further, at 31 December 2015, approximately 30 per cent of participants in the Barwon trial site indicated that their primary disability was intellectual disability and 22 per cent indicated that their primary disability was autism. The distribution of disability types is not expected to differ significantly across service regions as the NDIS rolls out in Queensland. It is currently not possible to determine the distribution of disability for service regions outside of NDIS trial sites, however, as the NDIS rolls out, variations in participant profiles across different service regions will be able to be identified and tracked over time.

4 As Queensland did not host a trial site local data is not available. The Barwon trial site in Victoria has been in operation since July 2013 and is available to all people with a disability aged 0-64 who meet the access requirements. As such, the Barwon trial site is considered to provide the best indication of potential full scheme experience.

0%

5%

10%

15%

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25%

0-6 yrs 7-14 yrs 15-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55-64 yrs 65+ yrs


QUEENSLAND

Figure 5 Participants with an approved plan by primary disability (Barwon)

Source: Based on NDIS quarterly dashboards – see Section 4.2

1%

3%

3%

3%

4%

4%

7%

10%

14%

22%

30%

0% 5% 10% 15% 20% 25% 30% 35%

Other

Multiple Sclerosis

Other Sensory/Speech

Global Development Delay

Cerebral Palsy

Other Physical

Developmental Delay

Other Neurological

Psychosocial Disability

Autism and Related Disorders

Intellectual Disability


QUEENSLAND

Demand: Supports by category

The NDIS is being rolled out across Australia to assist people with disability to live ‘an ordinary life’. It is expected that participants will use the funding available in their package to assist them to fully realise their potential, to participate in and contribute to society, and to have a say in their own future – just as other members of Australian society do.

The NDIS Outcomes Framework5 has been co-designed with the NDIA Independent Advisory Council and other stakeholders to monitor the progress of participants and their families and carers towards the goals they have set in key life domains. The framework was developed to measure the medium and long-term benefits of the NDIS for participants and their families and will help the NDIA to understand what types of supports lead to good outcomes and identify areas that need development. Organisations that intend to provide supports to NDIS participants should understand the Outcomes Framework and be aware of the individual goals the participants they work with have identified in their plans.

Figure 6 Goals in participant plans by life domain, % (Barwon)

Source: NDIS Quarterly report – December 2015 – see Section 4.2

Figure 6 provides information on the proportion of participant goals that have been identified in each of the life domains in the Framework. Participants can identify more than one goal within and across each life domain and the most common life domains for participants to identify goals are in the areas of Daily Living and Independence.

5 Further information on the Outcomes Framework is available in Section 4.1

96%

58%

21% 17% 17% 13% 13%

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10%20%30%40%50%60%70%80%90%

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QUEENSLAND

Supports provided to participants need to align with the support categories funded in a participant’s plan and should also be tailored to assist each participant to achieve their goals. The largest support category, by committed funding is Assistance with daily life at home, in the community, education and at work.

Table 3 Committed funding by support category, % (Barwon)

Support Category Total committed

Assistance with daily life at home, in the community, education and at work (incl. supported independent living)

69.3%

Improved daily living skills 10.2%

Improved life choices 4.7%

Transport to access daily activities 3.7%

Assistive technology 2.9%

Finding and keeping a job 2.6%

Increased social and community participation 2.4%

Improved relationships 1.3%

Improved health and wellbeing 1.0%

Assistance with daily life at home, in the community, education and at work

< 1.0%

Home modifications < 1.0%

Improved living arrangements < 1.0%

Vehicle modifications < 1.0%

Improved learning < 1.0%

Source: Based on NDIS quarterly dashboards – December 2015 - see Section 4.2

The mix of supports will change over time.

Participants are at the centre of the NDIS and will shape the market through their individual preferences. It is envisaged that the current array of supports and services the market offers will change significantly as increasingly empowered participants demand new supports and services and assess value and price and as providers respond to this consumer demand. However, it will take some time for participant capacity to grow and drive the market, as many people with disability, their families and carers have not been able to exercise extensive choice and control over the supports they receive.

It will also take time for supply side innovation to occur and for new supports and services to emerge in response to this new demand. In the longer term, the NDIA intends to be less prescriptive about the supports and services participants receive in their plans, in favour of these being driven by participants and aligned to outcomes.

In the short term, the trends from trial sites provide useful insight for the market. Since the commencement of the NDIS trials in mid-2013 in Hunter and Barwon, participant goals are most commonly identified in the domains of daily living and independence, which is


QUEENSLAND

consistent with the objective of the NDIS to boost social and economic participation for people with a disability. Both the Barwon and Hunter trial sites are representative of potential longer term full scheme experience, due to the NDIS trials in these regions being in place the longest and being available to people aged 0-64 years.

Further, as the support category with the highest expenditure in both Hunter and Barwon is Assistance with daily life at home, in the community, education and at work (incl. supported independent living) and intellectual disability and autism are the most prevalent primary disability types in these trial sites to date, there are some clear early indicators for providers about where most of the funding and resources in the NDIS are being directed.

Whilst there will be many opportunities in the new market of the NDIS for a wide range of service providers to respond to emerging consumer demand and for new innovations and products, (particularly for current providers) is how well aligned their service offering is with the overall direction of the NDIS, in particular the sort of outcomes participants will be seeking to achieve.


QUEENSLAND

Supply: Information Linkages and Capacity Building

Information, Linkages and Capacity Building (ILC) will connect people with disability, their families and carers, including people who are not NDIS participants, with disability and mainstream supports in their communities. This will help build a more inclusive society in which the economic, education and social participation of people with disability is maximised.

The Productivity Commission recognised that not everything that was important for the achievement of a person’s goals could or should be achieved by individualised funding. Rather it is important to work within a community to identify activities that are accessible and welcoming of people with disability and that can offer valued information and community based services that connect a person with a disability to others with similar interests.

Figure 8 Quality of life experiences and the sustainability of the scheme require funded and unfunded supports to drive outcomes for individuals

The NDIA works to strengthen these connections through the Information, Linkage and Capacity Building Framework. Some of these activities serve as effective early intervention and importantly explain and promote the use of mainstream services.

A key role for NDIA Local Area Coordinators (LACs) will be to build on this mapping and identify areas in which targeted investment aligned to the ILC Framework can deliver meaningful outcomes for people with disability. LAC services are an important part of the NDIS, as they will work with participants on the ground to help enter, and make the most of the NDIS - while supporting individuals to build strong, inclusive relationships in their communities.

In Townsville, Charters Towers and Palm Island the LAC function is being performed by the Agency and staff seconded from the Queensland Government. Over time, the NDIA may source Local Area Coordination Partners across Queensland to commence activities as


QUEENSLAND

required by the Bilateral Agreement. In remote areas, the Agency will work with each community to establish the most effective way to support individuals.

Figure 9 LACs work to connect a person with disability to existing activities in the community

An ILC Commissioning Framework has been developed and outlines the five priority investment areas that the NDIA will be seeking to grow over time. These include activities in the following areas that can demonstrate outcomes for people with disability and their families and carers:

• Specialist or expert delivery of information and referral supports; • Cohort focused delivery for specific groups of people or locations; • Multi-regional solutions to drive efficiencies; • Remote solutions; and • Delivery by people with disability for people with disability.

ILC enables the NDIS to fund supports not directly tied to an individual through an individual funding package to enable the economic and social participation of people with disability. Over time, this can reduce the demand for, and level of support required through individually funded responses. This funding will be through a commissioned grant process following finalisation of the consultation process on the overall framework and in accordance with the transition arrangements to be agreed with the Queensland Government.

The framework can be found at:

http://www.ndis.gov.au/community/ilc-home/ilc-commissioning-framework-consultation/ILC-comm-fw-draft




QUEENSLAND

Growth: From current supply to future demand

By full scheme the total number of people receiving funding for disability supports in Queensland is estimated to increase by 90%, while the estimated value of the supports these participants will demand is expected to be more than double the value of those currently provided in Queensland. The NDIS therefore represents a significant growth opportunity for existing and new providers of disability supports in Queensland.

Figure 10 Comparison of current supply and estimated demand in Queensland

Source: Scheme Actuary estimates of supply and demand

The service regions which will require the largest growth in supply, in absolute terms, for both the number of participants and the value of supports are expected to be Beenleigh (5,600 participants and $320m), Brisbane (4,800 participants and $290m) and Caboolture/Strathpine (4,900 participants and $270m).

$0m $200m $400m $600m $800m0 4,000 8,000 12,000 16,000

Townsville

Toowoomba

Rockhampton

Robina

Maryborough

Maroochydore

Mackay

Ipswich

Cairns

Caboolture/Strathpine

Bundaberg

Brisbane

Beenleigh


QUEENSLAND

Table 4 Current and estimated demand in Queensland – participants and cost

Service region Participants Cost ($ millions)

Current Full Scheme Growth # Growth % Current Full Scheme Growth # Growth %

Beenleigh 4,300 9,900 5,600 130% 150 470 320 213%

Brisbane 10,500 15,300 4,800 46% 460 750 290 63%

Bundaberg 1,500 3,300 1,800 120% 50 150 100 200%

Caboolture/Strathpine 4,200 9,100 4,900 117% 160 430 270 169%

Cairns 3,000 4,700 1,700 57% 100 250 150 150%

Ipswich 3,400 8,000 4,600 135% 130 360 230 177%

Mackay 1,400 3,100 1,700 121% 50 130 80 160%

Maroochydore 4,000 7,500 3,500 88% 140 370 230 164%

Maryborough 2,200 5,100 2,900 132% 80 270 190 238%

Robina 4,300 8,400 4,100 95% 150 410 260 173%

Rockhampton 2,500 4,900 2,400 96% 90 220 130 144%

Toowoomba 3,400 6,600 3,200 94% 140 290 150 107%

Townsville 3,200 5,300 2,100 66% 110 240 130 118%

Total 47,900 91,200 43,300 1,810 4,340 2,530 Total

Source: Scheme Actuary – estimates of demand based on Bilateral Agreements

Some service regions are also expected to experience increases in the value of support demanded which are significantly greater than the expected increases in the number of participants. This difference may indicate a higher prevalence of unmet demand in these service regions, not only for people who will receive supports for the first time through the NDIS but also for those already receiving supports.

The most significant of these areas are Maryborough which is expected to experience a growth of 132% in participants, but a growth in expenditure of 238% and Cairns which is expected to experience a growth of 57% in participants but 150% in expenditure.

Overall, there is a consistent trend across Queensland which shows strong growth in participant numbers and even stronger growth in funding.


QUEENSLAND

Growth: Estimated workforce required

The workforce engaged in providing disability supports in Queensland is currently estimated to be approximately 13,550 – 16,550 full time equivalent (FTE) employees. It is estimated that the workforce which will supply the increased volume of supports demanded under the NDIS will need to more than double by the end of 2018-19. As the prevalence of part time and casual workers in the disability support workforce is high, the actual number of additional workers required to meet increased demand will be greater than the required FTE increase in the workforce.

Figure 11 Comparison of current workforce and estimated workforce required



QUEENSLAND

Further, the required increase in the workforce will not be evenly distributed across each service region, as shown in Figure 11 above and Table 5 below.

Bundaberg, Beenleigh and Maryborough are expected to require the largest proportional workforce increase, as the current estimated workforce is less than 40 per cent of the estimated NDIS workforce. Brisbane is expected to require the smallest proportional workforce increase, as the current estimated workforce is greater than 80 per cent of the estimated NDIS workforce.

Table 5 Current and future workforce in Queensland

Service region Current Workforce Estimated Required

Workforce

FTE range FTE range Beenleigh 1,100 - 1,350 3,200 - 3,900 Brisbane 3,400 - 4,150 5,100 - 6,250 Bundaberg 400 - 450 1,050 - 1,250 Caboolture/Strathpine 1,250 - 1,500 2,900 - 3,600 Cairns 700 - 850 1,650 - 2,000 Ipswich 1,000 - 1,250 2,450 - 3,000 Mackay 350 - 450 900 - 1,100 Maroochydore 1,100 - 1,300 2,500 - 3,100 Maryborough 600 - 750 1,800 - 2,150 Robina 1,100 - 1,350 2,800 - 3,400 Rockhampton 650 - 800 1,500 - 1,800 Toowoomba 1,050 - 1,300 1,950 - 2,400 Townsville 850 - 1,050 1,650 - 2,000 Total 13,550 - 16,550 29,450 - 35,950



TOWNSVILLE, CHARTERS TOWERS AND PALM ISLAND

3. Townsville, Charters Towers and Palm Island early transition site

This module focuses on the local government areas (LGAs) of Townsville, Charters Towers and Palm Island.

From 1 January 2016, early transition to the NDIS commenced in Queensland in Townsville and Charters Towers for people aged 0-17 and in Palm Island for all people who meet the access requirements. The early transition allows for 600 people with disability to phase into the Scheme by 30 June 2016 with a further 1,000 people with disability phasing in between 1 July 2016 and 30 September 20166.The Commonwealth and Queensland governments have agreed that around half of these participants will be existing users of Queensland government specialist disability services and the other half will include new people7.

These three LGAs represent a significant proportion of the market in the broader Townsville service region8 as around 75 per cent of participants are expected to reside in the Townsville, Charters Towers and Palm Island early transition site. The region also has diverse geographic circumstances and cultural representation.

Site profile

The Townsville early transition site has an overall population of around 189,000 people (4% of the Queensland population). In recent years there has been rapid growth in the area, particularly in the Townsville LGA where the resource and tourism industries have attracted people to live in the area.

There is a significant population of individuals in the area who identify as being from an Aboriginal or Torres Strait Islander background. In the Townsville LGA around 6.5% of individuals identify as being from an Aboriginal or Torres Strait Islander background, in Charters Towers this proportion increases to 8.4% while in the Palm Island LGA around 95% of the population identify as being from an Aboriginal or Torres Strait Islander background.

The Townsville area also has varying levels of socio-economic advantage and disadvantage as measured by the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA). Of the three LGAs, Palm Island has the greatest extent of relative socio-economic disadvantage compared to all other LGAs across Queensland, Charters Towers is close to the midpoint and Townsville has the lowest levels of relative socio-economic disadvantage. However, both Charters Towers has some pockets of socio-economic disadvantage in and

6 See section 3.3 for further information on access requirements for the early transition site. 7 This will include other eligible participants, including users of Commonwealth government programs. 8 The Townsville service region coves Townsville, Hinchinbrook, Burdekin, west to Mount Isa, and up to the gulf.



around the Charters Towers city centre, while Townsville also has pockets of disadvantage in areas with close proximity to the Townsville Airport.

The unemployment rate9 for the Townsville area is higher than the Queensland wide rate of 5.9%, with an unemployment rate of 7.5% in the Townsville LGA and higher in Charters Towers Region and Palm Island.

The introduction of the NDIS in these regions provides significant workforce opportunities.

9 Source: Small Area Labour Market Department of Employment, Dec 2015



Demand: Participants by Local Government Area

There are currently 2,525 people across the Townsville service region receiving some level of support funded by the Queensland Government. The number of NDIS participants in the region is estimated to be 4,000 by 2019. Estimates of the number of people currently receiving disability supports and the expected number of NDIS participants in 2018-19 by LGA are presented in Figure 12 below.

The Townsville LGA is expected to have the largest number of NDIS participants (growing from 2,325 to 3,675 participants), followed by Charters Towers (growing from 175 to 275 participants).

Figure 12 Estimated NDIS participants by LGA, current and expected demand by participant numbers

Source: NDIA modelling based on the Queensland Bilateral Agreement

Current Full Scheme



Demand: Phasing of participants entering the NDIS

The Commonwealth and Queensland governments have negotiated a phased approach for participant intake in the Townsville, Charters Towers and Palm Island early transition site. People aged 0-17 in Townsville and Charters Towers and aged 0-64 in Palm Island have been eligible to apply for early transition to the NDIS since 1 January 2016. Up to 600 participants are expected to receive plans by 30 June 2016 and a further 1,000 participants in these cohorts are expected to phase into the Scheme between 1 July 2016 and 30 September 2016. From 1 October 2016, all other people with disability who meet the access requirements will phase into the Scheme.

Figure 13 Phasing schedule for transitioning to the NDIS, by LGA and Age Cohort

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Palm Island (0-64yrs)



Supply: Current market landscape

Organisations providing disability supports currently operate around 70 service provider outlet locations in the Townsville, Charters Towers and Palm Island area market. These organisations are a combination of not-for-profit and for-profit providers of different sizes and support offerings and provide an indication of the existing market landscape in the Townsville, Charters Towers and Palm Island area. The overwhelming majority of disability service providers have their outlets located in or near the Townsville city centre (see Figure 14) with few being located in the Charters Towers and Palm Island LGAs.

Figure 14 Location of provider outlets, Townsville service region

The physical presence of provider outlets provides an indication of the current market; however this may not comprehensively represent all current markets and sub-markets within the Townsville, Charters Towers and Palm Island area. Some supports such as personal care can be delivered by mobile workforces in the home, from outlets outside of the region, whether it be by large organisations, individuals or new emerging online service models. Further, some service types, such as community participation and recreation services can be provided in mainstream community settings, such as local government facilities and other community assets which are not represented as disability service outlets.

The early transition of the NDIS is already causing the market to mobilise and respond in a practical way. Providers in Townsville, Charters Towers and Palm Island are getting behind the NDIS and new businesses are emerging in response to the Scheme.



Supply: Current market concentration Figure 15 Comparison of market concentration Queensland and Townsville

Source: Queensland National Minimum Data Set 2013-14

Figure 20 provides an indication of the concentration of the disability support market in the Townsville, Charters Towers and Palm Island area in comparison to Queensland.

The Townsville, Charters Towers and Palm Island market is characterised by a higher proportion of small and medium sized providers than the broader Queensland market. This is evidenced by the largest 20% of service providers in the region providing services to around 75% of existing support users whereas across Queensland the largest 20% of service providers account for 86% existing support users.

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QLD market density Townsville market density



Supply: Provider aspirations and challenges

The NDIA continues to engage with current and potential providers to understand their business models, aspirations and any potential barriers to their operations under the NDIS. As part of a Local Market Assessment of the early transition site in the Townsville, Charters Towers and Palm Island LGAs (the “transition site”), the NDIA interviewed with 17 current and prospective providers (of different sizes, service offerings and business types) with an interest in the transition site market.

The objective of this engagement was to better understand:

• Provider aspirations and readiness for the NDIS; • Provider understanding of the regulatory and operating environment of the NDIS and

their ability to operate in this framework; • The extent to which providers had invested in service adaption and expansion ahead

of the NDIS; • Workforce capacity and skills development; • Financial, operational, and ICT capacity of providers; and • Need gaps identified within the market.

This engagement provided useful insights into the aspirations of providers and a better understanding of potential market risks through transition to full scheme.



Key Themes:

1. Providers are preparing for transition to the NDIS

The signing of the Bilateral Agreement by the Queensland Government and the Commonwealth has provided clarity on NDIS transition arrangements and timeframes for providers. The introduction of the early transition site in Townsville, Charters Towers and Palm Island in January 2016 (which will see 600 participants enter the Scheme by June 2016 and a further 1,000 by September 2016) will allow providers to increase their experience and understanding of the Scheme before the remaining eligible population in Townsville10 and other service regions transitioning into the Scheme.

Providers interviewed in the transition site were actively preparing to transition to the NDIS and all had intentions to grow and/or expand services. Some of these providers indicated that they planned to grow selectively and this strategy had been determined through organisational NDIS readiness planning. Some providers also indicated that their growth intentions would be influenced by a need to expand on a financially sustainable basis.

NDIS readiness activities that providers are undertaking have focussed on: understanding unit costs of service delivery, modernising business systems and processes, workforce planning, market research to understand participant needs and align support offerings, and increased investment in marketing.

Other preparation activity reported by providers included engaging with interstate providers who currently operate in NDIS trial sites and participation in other readiness activities arranged by the NDIA, Queensland government, and peak bodies.

Many providers are making changes to their service delivery models and organisational structures. Examples include reforms to middle management structures, back-of-house functions, and moving from outreach models to hub and spoke methods of service delivery. A particular provider area of priority is how they can efficiently deliver supports to participants outside of major population centres. Some providers are also reviewing their governance and leadership models.

Providers in the transition site also identified a number of challenges as they transition to the NDIS. Some of these challenges are similar to those faced by providers in other markets transitioning to the NDIS while others are specific to the site. These include:

• Demography: 10 per cent of the transition site’s population identify as being from an Aboriginal and Torres Strait Islander background. This is higher than the state average of 4 percent. Providers, particularly new entrants to the market, will need to tailor their support offerings to these communities. This includes the adoption of

10 The Townsville service region coves Townsville, Hinchinbrook, Burdekin, west to Mount Isa, and up to the gulf.



culturally sensitive practices such as different styles of communication and perceptions of disability.

• Pricing: A majority of providers noted that operating within NDIS pricing for personal care and community participation will be challenging. Providers also reported that their costing activity involved understanding the differences between the costs of service in major population areas like Townsville compared to remote areas such as Palm Island. Some providers noted that this will influence decisions of where they offer services or where service expansion occurs. Pricing arrangements for therapy, other allied health supports, and early childhood intervention services was generally considered sufficient and/or profitable for providers.

• Transport: Many providers identified the need for both sufficient transport funding and an increase in the supply of accessible transport. Providers noted the importance of transport availability as an enabler to access services, particularly in rural and remote areas of North Queensland.

• Workforce: Providers identified a need to increase their workforce to respond to the opportunities arising from the implementation of the NDIS. Sufficient workforce supply across a variety of support areas including Allied Health professionals, interpreters, and disability support workers is a key issue and area of focus for providers in the transition site. However, given higher levels of unemployment in the area, there may be opportunities to attract new workers to the sector.

• Interfaces with other support systems: The need for an effective interface between the disability system with adjacent systems including health, aged care, and justice was noted by providers. In circumstances where people’s support needs occur across multiple support systems there is a need for a clear understanding of how these systems operate in concert yet define a clear demarcation of responsibilities.

• Early Childhood Intervention: In February 2016 the NDIA released the Early Childhood Early Intervention (ECEI) approach. The ECEI approach is nationally consistent approach to supporting children with development delay or disability, and the Queensland early transition site will be one of the first areas to utilise this approach. Further analysis on the implications of this approach for market and supply will emerge over time, however early indications are that there is likely to be substantial demand for increased market capacity and diversity in effective early childhood early intervention appropriate for children with disability.

• Assistive Technology: Prescription of assistive technology supports was identified as a challenge, particularly in remote areas, as an item of equipment may initially require adaption multiple times and bringing together the participant, therapist, and supplier can often be challenging to coordinate.



2. Service demand and supply considerations for remote and very remote areas

The diverse geographic profile of Queensland means considering both the opportunities and challenges of working in remote and very remote regions. Some providers noted that recent new entrants to the market had predominately established a presence in major population centres such as Townsville, Cairns, and Mackay.

The ability to offer financially sustainable services in more remote townships and communities is an important consideration for providers. Recruitment and training of local community members will take time and travel time and associated costs (e.g. accommodation, vehicle costs etc.) particularly in situations where companion travel is required, will contribute to higher service delivery costs where supports are not available locally. Current and prospective providers in remote regions are encouraged to familiarise themselves with the remote and very remote price guides as part of their preparation for the NDIS.

Innovation will be important in addressing supply gaps in remote and very remote regions. There are a variety of businesses, health councils, and organisations, including those run by Aboriginal and Torres Strait Islander communities that provide community and social services. There is potential to expand these services to provide additional disability supports, particularly in areas such as Palm Island and Charters Towers where existing providers already deliver a wide range of supports in adjacent sectors.

Key ingredients for transition: The NDIA’s consultations with providers across the country have also revealed some key provider readiness themes including:

• Preparation and planning: - understanding unit costs of supports; - to adapt business and operating models to the NDIS in line with the transition

timeframe and to modernise systems/processes to maximize efficiency; and - develop training capacity to potentially re-orient service capability and invest in

new service offerings. • Strong governance and a mandate from the senior executives/Board of the

organisation to align business practices with the NDIS model. • Identifying growth as a strategic priority and having targets in place to support broader

plans to boost market presence or potentially re-orient services. • Knowing strengths and weaknesses of the business in the market and undertaking

market analysis and modelling to assess barriers and opportunities for optimised service delivery, including the identification of gaps in the market.

• Willingness to enter new markets in disability supports outside of current service offerings and locations, including:



- extending existing offering to different cohorts (i.e. extension of personal care supports and supports to participants under 15 years);

- providing new products and supports; and - providing existing and new supports in new locations.



4. Additional resources and Scheme experience

Outcomes Framework

The NDIS was established to provide people with disability with the reasonable and necessary supports they need to live an ordinary life. It is expected that participants will use the dollars available in their package to assist them to fully realise their potential, to participate in and contribute to society, and to have a say in their own future, just as other members of Australian society do.

The NDIS Outcomes Framework has been co-designed with the NDIA Independent Advisory Council and other stakeholders. The NDIS Outcomes Framework will monitor the progress of participants and their families and carers in key life domains.

The purpose of the Outcomes Framework is to:

• Assist with planning; • Establish indicators of Scheme performance so Scheme progress can be tracked; and • Identify drivers of good outcomes for individuals.

The Outcomes Framework has been piloted with a sample of participants and their families and carers in trial sites. There were different versions of the Outcomes Framework for different life stages: children from birth to school age, children from school age to 15, young adults 15 to 24, adults 25 to 55, and older adults over 55. There are different family/carer versions for participants aged 0 to 15, 15 to 24, and 25 and over. Easy English/pictorial versions have also been developed. For the adult participant versions there are eight domains: choice and control, daily living, relationships, home, health and wellbeing, lifelong learning, work and social, community and civic participation.

The summary report of this pilot study can be found on the NDIS website at:

http://www.ndis.gov.au/document/outcomes-framework-pilot

As outlined above, one of the purposes of the Outcomes Framework is to identify drivers of good outcomes, and this may include identifying providers who achieve good outcomes. It is important to note that other characteristics of participants were also taken into account in these investigations.

The tables on the next page show the domains of life around which the outcomes framework is based. These domains apply to both participants and their families/carers and differ depending on the life stage of the participant.

http://www.ndis.gov.au/document/outcomes-framework-pilot


Table 7 Outcome framework domains – participants

Domain 0 to school School to 15 15 and over

1 Children gain functional, developmental and coping skills that are appropriate to their ability and circumstances

Children grow in independence

Choice and Control

2 Children show evidence of self-determination in their everyday lives

Children are welcomed and educated in their local school

Daily Living Activities

3 Children participate meaningfully in family life

Children form friendships with peers and have positive relationships with their family

Relationships

4 Children participate meaningfully in community life

Children participate in local social and recreational activities

Home

5 Specialist supports assist children to be included in families and community

Health and Wellbeing

6 Lifelong Learning

7 Work

8 Social, community and civic participation


Table 8 Outcome framework domains – families/carers

Domain 0 to 15 15 to 24 25 and over

1 Families understand their children’s strengths, abilities and special needs

Families understand their young person’s strengths, abilities and special needs

Families have the support they need to care

2 Families know their rights and advocate effectively for their children with disability

Families know their rights and advocate effectively for their young person with disability

Families know their rights and advocate effectively for their family member with disability

3 Families help their children develop and learn

Families help their young person become independent

Families are able to gain access to desired supports, programs, and activities in their community

4 Families feel supported Families feel supported Families have succession plans

5 Families are able to gain access to desired supports, programs, and activities in their community

Families are able to gain access to desired supports, programs, and activities in their community

Families enjoy health and wellbeing

6 Families enjoy health and wellbeing

Families enjoy health and wellbeing


Quarterly Reports

The NDIS Actuary is responsible for monitoring scheme performance and financial sustainability. Each quarter, the Actuary produces a public report to the COAG Disability Reform Council (which can be found at: http://www.ndis.gov.au/about-us/information-publications-and-reports/quarterly-reports). In addition to this report, the Actuary publishes participant and market dashboards, which are described below.

The most representative trial sites for full scheme are the Hunter and Barwon. This is due to those sites being inclusive of all ages, and having commenced on 1 July 2013, thus having the most experience and data.

The quarterly report to the COAG Disability Reform Council provides information about participants and the funding or provision of supports by the NDIA in each jurisdiction. The report includes:

• Progress against Statement of Strategic Guidance; • Summary Report on Management of Scheme Cost Drivers; and • Agency Performance, split into three parts:

o Participant Outcomes; o Financial Sustainability; o Community Inclusion.

This report can be found at:

http://www.ndis.gov.au/ndia-9th-quarterly-report

Participant Dashboards

The participant dashboard provides participant and plan statistics as at the end of each quarter. These include:

• Number of participants by eligibility and access type; • Approved plans by month, age group, primary disability, management type and cost

bands; and • Approved funded supports and actual committed supports.

These state based dashboards can be found at:

http://www.ndis.gov.au/about-us/information-publications-and-reports/quarterly-reports/9th-qr-dashboards

http://www.ndis.gov.au/about-us/information-publications-and-reports/quarterly-reports

http://www.ndis.gov.au/about-us/information-publications-and-reports/quarterly-reports

http://www.ndis.gov.au/ndia-9th-quarterly-report




Market dashboards

The market dashboard provides snapshots of providers and market demographics as at each quarter along with detailed participant goals, outcomes and support package information by age band. These include:

• Registered providers by type, support cluster and registered support item; • Participants with approved plans by age band, primary disability, cost band and

support category; • Number of males and females by goal type and age band; • Outcome statements for participants and family carers by age group; • Approved plans by cost band for each age group; and • Total committed cost by support category for each age group.

These state based dashboards can be found at:





Organisational readiness and training resources

Through the Sector Development Fund, a number of resources have been developed to assist providers and the sector in preparing for the transition to the NDIS. These resources are free to access and available to everyone. Two useful resources developed by National Disability Services are:

NDIS Provider Toolkit

The Toolkit incorporates a self-assessment and key financial tool.

• The self-assessment tool rates your organisation’s current state of transition towards the NDIS; and

• The key financial ratio tool, provides an insight into your organisation’s current revenue concentration, liquidity, debt and sustainability.

Completing the Toolkit online will allow automatic generation of valuable resources for your organisation.

• A gap analysis, of your current capacity against your desired position; • A benchmark report is available during the submission period, and provides a

comparison between like providers; and • An editable NDIS development plan.

The NDIS Provider Toolkit can be found at:

https://www.readiness.nds.org.au/

Costing and Pricing Learning Program

The aim of the Costing and Pricing Learning Program is to provide a suite of training and support resources for service providers that can be applied and accessed across diverse locations across Australia.

The focus of the tools are on small and medium service providers because these organisations constitute the majority of the sector and may have the least resources available to be applied to the challenges of a changing funding environment.

There is no universally accepted definition of ‘small to medium’ in the sector and not all organisations will require the same level of support or skills development. All organisations will have the opportunity to access the materials and pick and choose elements that they might find useful.

The need for understanding of costing and pricing is not limited to financial staff. The program includes material that is of relevance to management, operational and service staff across the organisation.

The Costing and Pricing Learning Program can be found at:

http://www.cplp.nds.org.au/learning-program

https://www.readiness.nds.org.au/

http://www.cplp.nds.org.au/learning-program


Rural and Remote and Aboriginal and Torres Strait Islander Strategies

Rural and Remote Strategy

The NDIA has developed a Rural and Remote Strategy which guides how to work with communities, governments and local service providers in rural and remote Australia.

One of the key outputs for the NDIA under this strategy is:

The range, choice and quality of disability supports available to a person in a rural or remote community is sustainable and as diverse as possible.

In rural and remote areas, geographic spread, low population density and limited infrastructure may adversely impact on the range and cost of available disability supports and services. Rural and remote communities may also experience difficulties in attracting and retaining a skilled workforce.

Supports and services may take on different forms or be provided in different ways in rural and remote areas. For example: leveraging off the high demand and success of tele-health, videoconferencing or support workers/therapy assistants working with support and professional supervision provided off site. In some instances, families, carers and informal support networks may play a greater role as there are fewer registered or mainstream supports and fewer people currently accessing disability supports.

At the same time there may be strong community networks that exist and local solutions that are already effective. These may be able to be further developed and strengthened to support people with disability, their families and carers to coordinate and integrate with other supports and services.

Where there are very few or no local providers or monopoly suppliers, specific intervention by the NDIA may be necessary to ensure the delivery of supports to maximise achievement of outcomes for participants.

The NDIA wants to work with communities, governments and service providers who are committed to building capacity in rural and remote communities. Under the Rural and Remote strategy the Agency identifies the need to work closely with all governments, identifying local strengths to build on, and using new and accessible technologies. There will be significant opportunities for innovation, including through mainstream services.


Aboriginal and Torres Strait Islander Engagement Strategy

Recognising that many people from Aboriginal or Torres Strait Islander backgrounds do not live in rural or remote areas, the NDIA has developed a separate Aboriginal and Torres Strait Islander Engagement Strategy.

The Strategy describes the Agency’s engagement approach and reflects the different needs of Aboriginal and Torres Strait Islander peoples with disability living in urban, rural and remote areas across Australia. It is built on strong collaborative working relationships including with State and Territory and Commonwealth Government partners.

Supporting the emergence and growth of the Aboriginal and Torres Strait Islander provider market aims to:

• create a competitive advantage for the NDIA by utilising local suppliers in their local communities,

• promote opportunities for Aboriginal and Torres Strait Islander suppliers • create new innovative solutions that will be attractive to the community and improve

outcomes for participants.

The NDIA Rural and Remote Strategy and Aboriginal and Torres Strait Engagement Strategy will be released by the Agency in the second half of 2016.

Documents

QLD Market Position Statement (PDF 3.7MB)