Recently an article was written (see News Room – NDIS News) by DSC called “Support worker contractors, the whole debate” Feb 2023. It is an interesting debate with a significant number of interrelated issues that in many instances has polarised opinions around the merits and risks of the contractor model.
From our perspective, specialising in the support of individuals with complex needs and having decades of industry and lived experience within our leadership team, the answer is relatively simple: yes, contractors for non-complex participants who can exercise informed choice and contribute to service planning and design, have sufficient insight into their own support needs and can subsequently self-advocate should services fall below expectation – yes, contractors are a viable cost effective option offering significant choice and control and self-directed flexibility with regard to service delivery.
However for participants with complex needs, who lack insight into their own support needs, capacity or capability to reliably contribute or engage, may be involuntary, may live with a cognitive impairment and/or enduring mental health concern and subsequent lack testamentary capacity; I.E. people with complex needs can present with any number of interrelated compounding comorbidity factors contributing to their high and exceptional support requirements. These services require employees. The reason for this is also relatively simple – disability support staff supporting participants with complex needs must operate collaboratively and strategically with their employer (participant provider) in conjunction with other key stakeholders (coordinator, behaviour support practitioner, guardian, participant, family, other therapy) to deliver collaboratively developed support plans responding to independent living and behavioural support needs. There are a number of significant benefits of an organisation providing disability support staff for participants with complex needs, especially within a Supported Independent Living (SIL) scenario.
- Teams: a provider organisation can coordinate a team of disability support workers. This is much more efficiently and effectively delivered by an employer who takes responsibility for ensuring all staff have read and understood all support plans, and coordinating staff meetings with other stakeholders to discuss behaviours and update strategies accordingly.
- Accountability: a participant can complain about or seek to modify a support workers performance via the employer. Of course a participant may have this conversation directly with a contractor, however these types of discussions can be difficult, and can be much more effectively delivered by a line manager. Plus any employer following best practice will performance manage their staff following due process that will be documented, and can include training to repair the deficiency, thus resulting in better performance for the participant.
- Reporting: reporting requirements incumbent on disability support staff within service delivery for people with complex needs is significant (behaviour incidents_risk, behaviour ABC charts_observtions, restrictive practices, PRN usage, appointment outcomes, notifiable). Contractors may have capability to report to this high degree, but given the important nature of the reporting and the needs of other stakeholders on the outcomes, it Is a highly practical solution to have an employer provider support their staff with understanding of the processes involved, provide consistent reporting templates, and ensuring compliance with NDIS legislative standards.
- Performance: an employer as provider are legislatively required (Work Health and Safety Act 2012) to keep people safe. This includes safe from stress caused by unclear work duties and functions. An employer operating under best practice will therefore ensure their team is screened, trained, and competent in all work areas including NDIS Code of Conduct and NDIS rules relevant to the service type.
In short, while contractors can present as a cost effective option and positive application of choice and control, the quality of their conduct and capability to meet NDIS quality standards will differ from individual to individual. Outside of complex needs, the model is suitable. However when a group of individual support workers need to worker together as a competent, cohesive high performing team, this is when having an employer provider actively building and coordinating this team can be of critical importance.
Coordinators as Contractors
Contracting arrangements have bourgeoned within the NDIS world for coordinators also. The concerns with contractor coordinators are considerable. The issues stem from the structural arrangement between contractors and their staff versus that between an employer and their employee’s. As per point 4. above an employer is legislatively required (Work Health and Safety Act 2012) to keep people safe including safe from stress caused by unclear work duties and functions. This in turn means that specialist and level two coordinators as staff need to be trained, guided and supported in how to complete their tasks in a safe and competent manner. With contractors there is no such legislatively based responsibility for their coordinators. This does not necessarily mean any given contractor is not supported in their role, it just means the level of support provided is discretionary – the amount and type of support is at the discretion of each individual contract business owner.
Essentially employers of coordinators, directed by safe work legislation and guided by human resource best practice provide the following for their staff:
- A workplace for staff; office space, computer, phone etc
- Training, in particular the roles and responsibilities as a registered NDIS provider of support coordination, plus the essential practice standards of coordination; collaborative practice (working within multidisciplined multiagency teams), professional communication, self-reflexive practice, support planning, and trauma informed practice.
- A team including regular team meetings as a resource for individual coordinators to share ideas, resources and strategies – essential for learning and development.
- Access to a line manager and senior practitioner to ensure understanding and practice standards are being met and to seek advice when facing challenging situations.
- Professional supervision from a line manager (to discuss, monitor and manage caseloads, work conditions and personal challenges from the relationships within the role).
- Clinical supervision from an external senior practitioner in support of the individual’s resilience and capability from experiences and challenges endemic to the role.
Coordinators as employees therefore are well supported to be able to efficiently and effectively fulfill the requirements of the coordinator role as detailed in the NDIS legislation. However the benefits extend beyond the development of the skills, knowledge and capacity of the individual coordinator.
As a participant and/or stakeholder of a participant’s support network, having a coordinator as a member of an actively managed team can bring the following benefits:
- Understanding: a coordinator as an employee is more likely given training and team environment to have sufficient comprehension not only of the NDIS practice standards and quality indicators directly related to their role, but also of the core rules and guidelines underpinning best practice around which coordinators are expected to exhibit understanding and guidance.
- Accountability: should a coordinator as an employee not exhibit the practice standards expected as per NDIS guidelines or breach the industries code of conduct, a participant or stakeholder can approach a line manage to have concerns addressed. This is a fundamental deficit in the contractor model. No line manager equals to accountability for the actions and outcomes of individual contractor coordinators. Again the level of follow-up into the conduct of a contractor is at the discretion of the business owner.
- Value for Money: a coordinator as an employee is more likely given training and team environment to present a greater value for money given immediate and ongoing access to extensive and intensive knowledge skills and experience of fellow practitioners within their team.
Contractors within the disability sector can present as a complex argument, however the key issues we find to be simple, detailed extensively within human resource literature. The training, supervision and workforce development requirements for the majority of staff working in the disability sector are sufficient to warrant a relationship with a provider legislatively responsible for delivering best practice as per NDIS legislation, and legislatively responsible for ensuring the safety and wellbeing of employees. For coordinators, burnout is a consequence of working in isolation without access to the full breadth of skills, knowledge and experience needed to perform the role. It would be nice to think people as individuals have the discipline and due diligence to ensure personal practice standards align with legislative requirements, however in most cases they don’t. This isn’t to say some individuals with sufficient experience, knowledge and skills over many years of commitment to best practice and continuous improvement don’t warrant being able to work as contractors, or, in the case of disability support workers, a participant has the understanding and resources to self-monitor and manage outcomes. In either case these are the exceptions. Contractors in the disability sector can be accepted as the exception, not as the norm.