Spotlight on Disability Royal Commission

One in five people in Australia live with a disability. The final report of the Disability Royal Commission was handed down in September this year. In this interview, Fiona Payne FAICD, Chair of Therapy Focus and Chair Elect of disability employment provider Good Sammy Enterprises, based in WA, highlights what directors need to know..

Most disability service providers are challenged by issues around financial sustainability, compliance, workforce and safeguarding. They are also considering the implications of the 222 recommendations of the Disability Royal Commission. Specifically those that relate to governance and safeguarding, those that relate to closure of services over time and for those supporting people with NDIS funding, the potentially seismic changes proposed by the NDIS Review Panel.

Which three findings of the final report do you see as most important for directors and boards?

The findings I think that are most important for all directors and boards are those that highlight the need to establish a Disability Rights Act as a legislative framework to underpin the UN Convention on the Rights of Persons with Disability. It is suggested the Disability Discrimination Act would then be amended to require a positive duty to avoid discrimination, as we have seen for sexual harassment in the workplace.

Other important findings relate to the importance of hearing from people with disability who use services and involving them in service design and decision-making. There are many ways this can happen and it will be interesting to learn from others about the different approaches taken, and importantly, evaluate the impact.

The third group of findings are of importance to directors and boards of disability service providers and they relate to quality and safeguarding, and the interface with risk. Systems must be in place to monitor data about feedback, incidents, workforce, training, compliance and risks. The data must be analysed closely to identify trends, variations from targets or benchmarks and exceptions. These systems must include directors being out and about in the business, talking with people, seeing services in action and listening deeply. The challenge exists to uphold the ‘dignity of risk’ principle, which acknowledges the rights of an individual, in the context of the organisation’s risk appetite.

On your boards, which are the most important issues you will deal with in terms of the RC recommendations?

Many of the recommendations are not a surprise to those who have been following the DRC since it began in 2019, and progress has been made towards some of the recommendations, including those related to the voice of people with disability in governance and quality and safeguarding.

At the moment, the boards I’m involved with are considering the final recommendations, especially those that relate to governance and the disability services they provide, and accessing diverse sources of commentary on them, while awaiting the responses from government due in March next year.

In terms of governance, the recommendations are comprehensive and include:

• Reviewing governance arrangements to ensure they are fit for purpose, are grounded in human rights and involve people with disability in decision-making;
• Reviewing board composition and engaging people with disability, where their skills and experience are required and will add value
• Reviewing how decisions are made to ensure people with disability are involved, including consideration of formal mechanisms such as committees that report to the board
• Reviewing director skills, experience and training to ensure people are operating within a human rights framework and where appropriate, some directors have experience with disability service delivery.
• Reviewing the way risks are managed, including systems in place to support their identification and management, with particular consideration of dignity of risk and the organisation’s risk appetite.
• Reviewing the nature of, and the way in which data is used to monitor performance and inform decision-making. In the human services context, data from site visits, complaints, incidents and WHS reporting can be used to detect patterns of behaviour that may be of concern.

For those boards where the recommendations discuss the gradual phasing out of ‘segregated’ services such as group homes, special schools and Australian Disability Enterprises (ADEs), there will be important conversations around purpose and people that must begin, if they have not already.

Do you think disability service providers will be able to implement these findings or will they find that difficult? What will the main hurdles be?

Many of the recommendations will fall to government for implementation, and those will be some of the most important in terms of providing stronger foundations for an inclusive Australian society.

For those that are within the remit of disability service providers, many are issues contemporary organisations are already considering.

Disability service providers will be awaiting some indication of the interface between these recommendations, the response from governments due at the end of March next year and the findings of the NDIS Review Panel due mid-November to guide their decision making. As we have seen in the aged care sector, significant hurdles are anticipated.

Many of the changes recommended will require significant change – in attitudes, policy, practice, legislation, recruitment, training, service design and service delivery and these will require resources – time, money and people, to action.

The issue that keeps me awake at night is what I don’t know as a director when it comes to service quality and customer experience. Services are delivered in so many different places, in many different ways, by people with varying skills, experience and values, and maintaining oversight of that is a huge challenge for boards. We want to believe that people will do the right thing, but as we have seen, this is not always the case…which is why attitudinal change is key to upholding the rights of people with disability.

Do you think the sector will change for the better as a result of the Disability RC? If so, why? If not, why?

My hope is that our whole community will change for the better because of the DRC. This would be a just outcome for the many people who had the courage to speak up, and those who couldn’t.

What the DRC has shown is that there are significant changes that can be made by government to enable the human rights of people with disability to be upheld. Disability service providers are part of the solution, but greater potential for change lies in recommendations that relate to mainstream services such as health, education, employment, housing and transport, as they aim to level the playing field.

Should there be more people with lived experience of disability on boards? If so, how can this be achieved?

It is recognised that diversity is an important enabler of good governance and can improve organisational performance. Almost one in five Australians is a person with a disability, which is a large segment of our community.

As such, when reviewing the skills and experience required on a board, consideration should be given to whether the lived or personal experience of disability is required. For some organisations, such as those providing disability services, aged care or services to people with mental health issues, it is becoming, if not already, mandatory to include these stakeholders in governance. For others, the size and diversity within this group may mean they are a customer segment that is not well understood, where great opportunity lies for service re-design and new offerings.

The AICD is working closely with the Australian Network on Disability to offer opportunities for people with disability to undertake governance education and therefore be able to take up the important opportunities these changes in practice provide. A parallel project seeks to provide current directors with learning opportunities about the skills and tools required to include people with disability on their boards.

Disability service providers need to deal with the NDIS. Is this process manageable and if not how can it be improved at a management/board level?

In its 10 years since commencement, the NDIS has been designed, built, piloted, rolled out in various ways, reviewed and redesigned, all while delivering a potentially transformative experience for people with permanent and significant disability. This has been exciting, life changing, frustrating and in some cases, unintentionally detrimental. The continual change is enormously challenging for disability service providers.

Some disability service providers are reviewing their strategy, risk appetite and sustainability and choosing to exit services, or segments of them, funded by the NDIS. An increasing number are entering the market as non-registered providers with different pricing and compliance obligations.

Some of the strategies adopted to deal with this environment include revisiting purpose and strategy, significant investment in business analytics, diversification of revenue, targeted stakeholder engagement - especially with people using services - and establishing partnerships to further mission, support philanthropy or generate income and fostering innovation, both through service design and use of technology.

What trends are occurring on boards in the NFP sector, especially in disability? For example, are more directors with clinical governance skills now in evidence or not?

Many boards in the human services sector have rightly focused their attention on their people – those they serve and those who provide those services. In terms of the people who use services, boards increasingly seek to ensure their voice is heard around the table and these perspectives are considered in decision-making. There is also a focus on ensuring services delivered are safe and effective and uphold the rights of the people being served.

In terms of the people who provide those services, boards are focused on ensuring the working environment is safe, people have the appropriate training and support to do their jobs well and they feel comfortable to speak up when things could be improved or haven’t gone as planned. There is increasing competition for a very limited workforce, so modelling a culture that upholds the values of the organisation and supports the achievement of purpose is vital.

I am also seeing increased use of external and/or independent advisors to provide expert, objective advice on matters of strategic importance or high risk such as clinical governance, quality and safeguarding, cyber security and WHS.

The demands on NFP directors continue to increase and I am seeing colleagues evaluating their capacity to contribute to their various roles and stepping away from those they feel they can no longer serve well. Passion for organisational purpose is essential, as serving on an NFP board is not for the fainthearted.