Family and Community Development Committee s1

T R A N S C R I P T

FAMILY AND COMMUNITY DEVELOPMENT COMMITTEE

Inquiry into social inclusion and Victorians with a disability

Melbourne — 5 May 2014

Members

Mrs A. Coote Mrs J. Powell Ms B. Halfpenny Ms D. Ryall Mr J. Madden

Chair: Ms D. Ryall Deputy Chair: Ms B. Halfpenny

Executive Officer: Dr J. Bush Research Officer: Ms V. Finn Administrative Officer: Ms N. Tyler

Witness

Mr I. McLean, chief executive officer, Golden City Support Services.

5 May 2014 Family and Community Development Committee 1 The CHAIR — Welcome and thank you for your time in appearing today before the committee for our inquiry into social inclusion and Victorians with a disability. As is noted in the guide you were provided with by the secretariat, all evidence in this hearing is taken by the committee under relevant legislation, including the Parliamentary Committees Act 2003, and attracts parliamentary privilege. Anything said outside this hearing is not afforded such privilege. We are recording the proceedings through Hansard, and you will be provided with a copy of that proof to make any factual or grammatical corrections as necessary. I ask you to introduce yourself, giving your position, and perhaps provide the committee with a 15minute presentation and then we will have the opportunity to ask some questions.

Mr McLEAN — My name is Ian McLean. I am the CEO of Golden City Support Services, which has its offices based up in Bendigo and provides services within the Loddon and Mallee areas of Victoria to Victorians who require support. Traditionally the organisation started back 36 years ago now, and it was one of the organisations that took the opportunity with a group of families to provide accommodation support to their family members with an intellectual disability. The families had kept their kids out of institutions, and so they had taken the opportunity to have an adult life in the community back then in 1978, about when the organisation started. Is that enough about the organisation? We provide support to anyone who requires support. They can be in the area of ageing and dementia or mental health, can have a cognitive disability or can have a physical and/or sensory disability.

I am not, obviously, going to speak to the detail that I have handed to you, but the information that I start with is in ‘Organisational capacity and people who at times exhibit challenging behaviour’, the paper that I submitted to the panel. I wrote this for a national disability services February newsletter as we were preparing for the NDIA and looking at what organisational attributes are required to support this group of people to have a good life in the community.

I have slides that I can talk to in detail if you have questions already from that paper, so I have more resources, but I would like to take a slightly different tack for my 15 minutes, if I may. First of all I would like to present the first slide. A guy called Eric Emerson, who is one of the three researchers in intellectual disability, over time in the UK looked at the experience of people as they came out of institutions and what was the experience of hundreds of people in institutions — in large institutions, smaller institutions and smaller homes within residential settings. He looked at the amount of engagement in the activities of daily living or in just daytoday life that people had.

What the chart and his research show quite clearly is that living in a community provides an opportunity that institutional support, in even smaller institutions, does not give. But, challengingly, his research also shows that you could have an institutional life in a small home in the community in that it is not just the physical environment that creates and limits opportunity but it is what staff and the community, but largely staff, do that also limits opportunity. So the line that you see, the square box and the end of it, was the average in each of those settings, from large institutions and medium institutions to small homes in the community with about five or six people. The line shows the variation that was found in each one of those settings. You could have on the bottom right a poorer life than someone living in a large institution in regard to engagement in your own life. So what occurs is that living in the community provides a golden opportunity, gives much more opportunity, than an institutional setting gives. But when someone requires staff support to be functional, it is the practice of staff that determines whether someone maximises the potential that community living brings.

I suppose I focus on that because I am going to put the main focus of my discussion today on a quite marginalised group within our community, as the paper talks about — that is, people who exhibit severe challenging behaviour at times in their life. When they do not understand, cannot communicate well, are frustrated or have pain, others around them might not be explaining what is coming next in their lives. There is a whole range of reasons. It is that group that I really want to focus on.

To finish in regard to people with cognitive disabilities, if staff provide institutional care, then the amount of privacy, personal possessions, selfdetermination, personal relationships, physical activity and engagement in your own life can be diminished. The same goes for the number of people who are supported in the setting in which you live. The work that I have given you here was written by the advocacy group in New South Wales back in 2006. It presents evidence in regard to community living. One of the conclusions they came to was that it is clear from the research that as the number of people who are supported in an accommodation setting rises, the amount of privacy, personal possessions, selfdetermination, personal relationships, physical activity and engagement in your own life diminishes. One thing does go up, and that is the amount of medication that you

5 May 2014 Family and Community Development Committee 2 take. While you live in a place, the more beds there are, the more medication you take and the less of those other things you have access to.

Setting the scene, the interesting thing is that Professor Jim Mansell, who passed away a couple of years ago now, was the second researcher within the UK who made a significant contribution to the field of intellectual disability support. He says through his research that it is people with severe challenging behaviour who show the greatest steps forward of anyone with a cognitive disability who moves out of an institution into the community because they get the opportunity to show and exhibit skills that they do not have the opportunity to within institution care, because the setting of institutional care maximises their challenging behaviour. That is, the degree of restrictions and seclusion that they have within an institutional setting actually maximises their challenging behaviour; it does not address the fundamental issues of their challenging behaviour. They live in a world where they do not have the opportunity to even exhibit their skills, which living in the community brings.

The document that you have, Transforming Care — A national Response to Winterbourne View Hospital, was produced by the English Department of Health. Back in 2011–12, there was a major scandal. Privately run treatment centres which housed up to 24 people with severe challenging behaviour were subject to a BBC expose where an undercover person had gone in and uncovered enormous abuse of people. These people were being restrained just for asking for ordinary things in life. One of the supervisors was recorded putting their foot on the head of a person who was restrained to the ground with a twoperson restraint. It was quite a large amount of abuse. This report identifies the number of people who were charged and went through to jail. But the UK Department of Health did something else: they reviewed their whole service system to people with challenging behaviour. For that reason, I submit it for your interest, because the conclusions that were drawn in 2011–12, which are the basis for what they are still implementing to this day, were that this group of people had not got the best services. I will turn to a number of pages of the report to highlight this. The first is page 5. I have highlighted some things for you in yellow.

The report states that the Winterbourne event and the subsequent investigation has catalogued:

… failings at all levels, both from the operating company and across the wider system. The report goes on to say that this event has exposed a wider issue in the UK of a care system that is not supporting this group of people and that too many people are staying too long within hospitals or within residential homes when they should be living in the community. The report says this practice must end.

It then makes a really telling statement, which is a pivot for looking at what I am presenting today:

We should no more tolerate people being placed in inappropriate care settings than we would people receiving the wrong cancer treatment. That is why the minister dealing with this issue is asking councils and clinical commissioning groups, or the funders, to put these issues right as a matter of urgency.

I will move on to page 9. At the top of the page it says that the UK government believes that people with severe challenging behaviours have the right to have support and to live in their community just like everyone else — alongside their family, their neighbours and their friends.

Down in item 12 on that same page it says that:

… vulnerable people, particularly those with learning disabilities and autism — need to —

receive safe, appropriate, highquality care. The presumption should always be that services are local and that people remain in their communities … Their expectation is — and mine is also — that there will be a subsequent reduction in the reliance on inpatient or other specialist care by these groups of people.

The finding of the UK government was that largely the service system was not using the best practice that had been outlined within the Mansell report that was first delivered by Jim Mansell in 2007. He updated it, but the first one was in 1997, I think. I provided you with that particular document, which is Services for People with Learning Disabilities and Challenging Behaviour or Mental Health Needs. Professor Jim Mansell wrote this

5 May 2014 Family and Community Development Committee 3 not as an article to publish but as a document to be picked up by the UK government in regard to how to support this group of people.

Let us jump to page 49 of the green document. The conclusion of this document, which I will let you read at your own leisure, states that ‘people with challenging behaviour have … been too much out of sight’ and that ‘in too many places the needs of this highly vulnerable group of people’ have not been addressed.

I suppose this rings a chord for me within our work and within the state of Victoria. The results that I see show a service system that has not grappled with the best practice framework that is outlined here — we will get to that next — and is largely using the same interventions of physical restraint, of chemical restraint, of punishment, of seclusion and of putting on more and more staff. These folk get the tag of being both violent and also dangerous.

The answer to that is not better practice within our service system at the moment; it is more and more staff. So you have about 1800 people on restricted interventions, according to the Office of Professional Practice — the old senior practitioner title — and you have, within Jim Mansell’s calculation, in the UK about 24 people per 100 000 of general population that will exhibit serious challenging behaviour. That is about 1500 people in Victoria that we would expect to exhibit frequent, episodic, serious challenging behaviour if the world is not going well for them. Of course the world does not go well for those around them when that happens either.

That is to say, and it does not take away, that services to people with intellectual disability can expect to see challenging behaviour very frequently within their services. It is running at about 15 per cent to 35 per cent of people with intellectual disability exhibiting severe challenging behaviour four or five times in a year. I am not putting that category as the group we are talking about — that is, about 15 000–25 000 Victorians who will exhibit serious challenging behaviour within a year within a service setting, four or five times a year — but I am talking about people who without the right support will exhibit serious challenging behaviour on a daily, if not weekly basis, if not supported well. The question for this group in looking at inclusion within the community is what are the right supports to get it right for this group of people to not be marginalised and have a good and contributing life to the community — not just be contained because their behaviour is escalating through wrong support.

I will go to page 54 before I finish with this particular document. It relates here that providers should ‘provide effective and appropriate leadership, management, mentoring’ within their organisations; that there should be ‘a whole organisation approach to positive behaviour support training’; and that organisations should recruit for values and ensure that staff have training for skills — mandatory training — which would include positive behaviour support, types of communication, including nonverbal, active support and engaging people in meaningful activities, having regard to mental health capacity.

It is those areas that need attention, and people who are funded to provide services within Victoria — in fact it is an Australian issue, not just Victorian — are largely funded without a request or a check of what skills they bring to support this group of people in a positive way with that training and those skills. We therefore have a service system that is — I suppose I did hear Arthur use this word once — stuffed at the moment in regard to this group of people. It is lucky I am under parliamentary privilege, is it not?

This is a group that I would put to you has never had a service system developed for them, at least within recent times. Behaviour intervention support teams were developed 25 to 28 years ago and were headed up by Gary Radler, who is now a clinical psychologist in Victoria. We have not had a revisit to a service system with current knowledge since then in regard to practice and service, and it is time that we did.

Let me go on to the services for people with learning disabilities. I will only refer to three pages, if I may, but I would submit this whole document as being really interesting to look at inclusion for this group of people in the Victorian — —

The CHAIR — Ian, if I could interrupt, could I ask you to just summarise to finalise your presentation so that we can move on to the asking of questions?

Mr McLEAN — Okay. I would just like to go to the dot point on page 25. Jim outlined the exact skills that were required. When you look at staff training, you can see he has identified that what is required is personcentred active support, positive behaviour support, total communication approaches, recognising and

5 May 2014 Family and Community Development Committee 4 responding to mental health problems and personcentred planning. This seemed to be absent in the review of services, even though this was published prior to the review. Part of the UK government’s response was to develop an accord that was signed by organisations to get back on track and to put this way of working into place within people’s local community.

I suppose to summarise I will give two examples of people who we support who are deidentified. One is a person who I have referred to in a submission in your kit. A piece of research was done by La Trobe University into that person’s history before they came to what is called Welcome Support Services here, which is Golden City Support Services. I apologise for some of the pages being upside down. When you read it you can see that this is a person who would be regarded as having serious challenging behaviour. This is what is able to occur with that list of supports over time and over years. This is the incidence of challenging behaviour of that particular person within months. You can see from his support history — coming with us through to where he is now — that this fellow, who was largely within other organisations down in Melbourne, had what we call agency staff brought in by the organisation concerned because they could not get their own staff to support him. Agency staff would stay for between 15 minutes and the whole shift, and they would leave and the person would seriously selfinjure or seriously damage property. He now goes on vacations at holiday resorts with everybody else, jumps into the spa with other members of the public and is learning about work. He has his first milk run delivering milk to organisations on a Monday. It is the start of something different for this lad.

The other thing that occurs, which is exemplified in what I said, is that it is cheaper in this person’s case to do this work right than to do it wrong. Over this time we have saved $300 000 a year. Over this guy’s lifetime that will be a saving of over $25 million to $30 million if you add 3 per cent for the costofliving adjustment.

It is similar for another woman who came from child protection services at the age of 18. She was being supported by two staff all the time, day and night, continually. She is now supported by one staff member and is going to continuing education where she does not need a staff member’s support anymore — she just goes along as a student and is starting to take taxis on her own. For the staff who used to support this person the strategies were a twoperson drop to the ground in restraint or putting the person outside until they had socalled ‘calmed down’, which meant that they were stripped naked and left to wear themselves out. Something different has occurred for this woman now. I put it to you that something different can be done and we need to have a service system that is developed for this group of people, a renewed service system, because 25 to 28 years is a long time since they have been revisited.

The CHAIR — Thank you very much, Mr McLean, for your presentation. Can I clarify, or perhaps summarise correctly in case I may be wrong, that the basis of the support system centres on education — specialisation of service providers in a deinstitutionalised setting for people with challenging behaviours?

Mr McLEAN — That is true. It needs more than that. It needs skills for staff; it needs organisational capacity to be able to resource support, crisis manage and develop with their staff support teams the responses to the challenging behaviours as they occur. But it needs the staff to have proactive, reactive and developmental learning skills that are not often developed, or applied, within staff teams in Victoria. It needs the organisation to know more than its staff and have expert skill to resource those staff teams in their daytoday work and to be present enough so that when there is something untoward that might be going on where staff feel like it is over their head, you have skilled practitioners to support those teams as they develop their proficiency and their expertise as well.

The CHAIR — Given that and given the two case studies you have provided, is there somewhere in this state or within Australia that does this exceedingly well?

Mr McLEAN — There are very few examples of it being done.

The CHAIR — But is there somewhere that does this very well?

Mr McLEAN — We have at Golden City enough moments of excellence to get things right with people we support. We still have moments of ordinary and we still have moments of failure. We support about 600 people but have about 15 people who have had reputations of having serious challenging behaviour for many years in their past.

The CHAIR — So you would see the model that you have as one that could be replicated?

5 May 2014 Family and Community Development Committee 5 Mr McLEAN — Yes. What needs to be replicated is that we need specialist clinical services that are skilled in doing assessments in regard to clinical psychology, speech pathology and OT in regard to sensory assessments et cetera; and in the mental health field the psychiatry needs to be involved at the assessment level. You then need organisations with those skills that I pointed out within Jim Mansell’s list and then you need staff to be trained on a recurrent basis and coached, not just left out there. It is the practised competency that counts here, not the verbal competency of training.

The CHAIR — To go back to that, you would consider in your instance, and you have examples, that the model you use which incorporates these things could be something that could be rolled out?

Mr McLEAN — Yes. There are also the clinicians within Anglicare in Launceston in Tasmania who presented at the ASID conference in Sydney last year. They presented a really interesting paper — it is here somewhere — that I would submit to you in regard to looking at and reviewing using nonaversive reactive strategies instead of punishment and diversion.

In answer to that, just let me give you a quick example of what they found. The benefit is that it is Australian, but you see it within Lavigna’s work from the States and you also see it in the work of Professor David Allen from Wales. They looked at aversive therapies within their own services. They looked at what was used by staff and what happened when staff used aversive therapies, which was, ‘If you keep on doing this, you won’t go to McDonald’s’, ‘If you keep doing this, if you don’t stop now, we’ll call the police’. That is the aversive therapy. The challenging behaviour in that event escalated about 50 per cent of the time when they said that, it did not change behaviour 40 per cent of the time and it resolved 10 per cent of the time.

When they saw restrictive practices being used, which were seclusion, people dropping to the ground or locked doors, there was a 50 per cent increase in challenging behaviour when those were applied, no change for 40 per cent and a deescalation in 12 per cent of cases.

Then when they used nonaversive reactive strategies, which was trying to divert people to a preferred activity, to come and help you to try to get them through the event, it resolved for about 50 per cent of the time, it deescalated 20 per cent of the time, continued for 25 per cent of the time and escalated for 7 per cent of the time. When you know the function of someone’s behaviour you can actually resolve it for them. If you are going to the supermarket and you are doing something and someone passes a cream bun shop and wants a cream bun and you say, ‘No, you’re on a diet. You can’t have a cream bun’, if someone has a kitbag of challenging behaviour at that moment, you may have bit of an issue for everyone in that local community. So you have got a choice. Many staff, of course, if they are not trained and coached well, will say, ‘No, you’re on a diet. We’re doing shopping. We’ve got to go do that’, instead of actually strategically capitulating at that moment, giving the cream bun, because that will resolve the challenging behaviour completely, and then coming back to the staff team and saying, ‘Okay, what do we do next time if they can’t have the cream bun?’. Because what they showed, which is in the literature too, that if you actually understand the function of someone’s challenging behaviour and they get what their need is and it is resolved, it resolves it 100 per cent of the time. This has not just got ramifications for quality of life, it has got major ramifications for the safety and wellbeing — that is, the occupational health and safety — of staff.

The CHAIR — Thank you. We might now move to further questions.

Ms HALFPENNY — Going back to the government’s role in this issue and in this inquiry, as I understand it, the government pays money to mostly nongovernment organisations; it contracts out the care of people with disability. At the moment there is not really any say in how much money is spent per person. It might be that $200 000 is provided per person in this situation but maybe only $100 is spent on actually caring for the person. As I understand it, there is not really any accountability in terms of once money goes from government to an organisation you do not really know where the money is spent and the AuditorGeneral does not have any role to investigate these things. In a lot of these places, as you were saying, there are agency staff, with a lot of casual workers on the lowest of pay, so I do not understand how you can really do the training in that situation. Do you think that government needs to do a bit more? You say the government should mandate training. How do you see that working based on how things are working today or how it operates today?

Mr McLEAN — About 50 per cent of services are provided by the nongovernment sector and 50 per cent by the government sector in regard to community accommodation.

5 May 2014 Family and Community Development Committee 6 Ms HALFPENNY — I have been to one place which had this issue with challenging behaviour and it was terrible, and it was a governmentrun unit.

Mr McLEAN — Sure. If I can deviate before I answer, one of the things that is in the documentation is that the commissioning, the funding, the purchasing of services — whichever you want to call it — needs to come with expectations. For this group of people it needs to be expectations of skill support; otherwise why would you leave people to be supported in such negative and downhill spiralling lives?

Back to the training. Every organisation is responsible for training. The funding, or the unit price within disability services that gets struck every now and then — maybe not in the future under the NDIA — has a component for training. It is only a small component, but all organisations would train their staff on top of that in regard to lifting, in regard to orientation and in regard to occupational health and safety within general training. For us at Golden City we have made a strategic decision to put strategic direction and emphasis on this sort of training, because I cannot see how you can keep staff safe when working with people with an intellectual disability when about 15 000 a year will exhibit challenging behaviour. At that moment you have got to have skilled staff to be able to deal with it.

Ms HALFPENNY — So for this group of people, which is not large from what you are saying, how does government deal with that? You are saying that they have already determined what people will be employed, or do they get a certificate IV or something like that? Is that what you mean? How much money should be spent on training the person?

Mr McLEAN — It would be great for certificate IV to be upgraded — if that changed, yes — and to be relevant. There would be a lot of industry partners that would say that. The malaise within the skills to support people with high needs with challenging behaviour at times in their life has been occurring for about 20 to 22 years, so it has been over successive governments. I am saying that, yes, it does need government focus, it needs policy direction. The dilemma is, as the UK found, we are crisisdriven. Someone with challenging behaviour gets so severe that it has to be solved, and it gets solved in that crisis time and often in the wrong way, and it becomes more and more costly. You talk about sums of $200 000. We are talking about sums of $800 000 to $1.2 million. We are talking about very large sums. I am saying that you can come down to $380 000 and then even less as people develop their activities of daily living skills and do not need staff support during the day and they can do things for themselves. You do not need to support them during that time, so there is even more savings to staff. This involves groups that often are called twotoone people, and some in Victoria are three to one.

Ms HALFPENNY — How does the government make sure this happens? Does it monitor it at all to get that, rather than what the cost is?

Mr McLEAN — All governments become aware of individuals with this group of people when their challenging behaviour gets so severe that it becomes a problem. I am suggesting that we start to do something different and that we develop a service system that is proactive for this group of people, and that ends up being able to be afforded within the current amount of what it is costing. To do services badly for this group of people costs the same, if not more, than doing supports well. Just for those two people I talked about, we are saving $600 000 a year. Now surely that could in the future move over into a service system development that had skilled practitioners for other organisations and skilled clinical groups of people to support and get more of this outcome for other people as well, not just within Golden City

Mrs POWELL — You gave two really good examples of people with challenging behaviours who over time were supported and their behaviour was modified. When we talk about serious challenging behaviour, things like violence, a person who has a sexual deviation, or selfharm in rural areas — and you are from a rural area — what sort of accommodation do you think we could provide to support those people while they are having those services, given that in regional Victoria you might have community accommodation with five or six people accommodated with some staff, and you cannot find a place in that accommodation because the behaviour is not something that you can put in with a home group of people? How do we accommodate those people while they are getting that support over the time, because we are talking about people with serious challenging behaviour?

Mr McLEAN — I have got a list there of the types of behaviours that I am talking about, and I think they are the types of behaviours that you are in fact alluding to as well. Let me first of all say that the research in this

5 May 2014 Family and Community Development Committee 7 area shows clearly that the model of five people with serious challenging behaviour in the one home is a failed model. It does not link to good outcomes. It needs to be highly individualised. For people who are often on the autism spectrum, it is not that they all have to live on their own, although for many that is in fact a better option, but they need to live to what their needs can cope with. They find the activity of other people often quite confusing, and so to put them into fivebed or sixbed places with other people with challenging behaviour — —

There has been 15 to 20 years of research now that shows that that is one of the failed models that should not be funded; and, what is more, it ends up being expensive. We had a service that did not have five people in it with challenging behaviour, but we were going to have two. We had one staff member for each of those two people individually in this fivebed home funded — we were going to concentrate on those two people all the time in the fivebed home — and then one staff member for the three others that did not have severe challenging behaviour. We negotiated back then — this was back in the early 1990s during the Kennett era — for one of those staff to not be in the group home but to support someone in their own home. It was just as expensive, but the outcomes for that fellow who is living in Echuca on his own were good. I do not think we have had an episode of challenging behaviour for maybe six months or a year from him. Let me say quickly that we have been supporting him since 1992, so there has been a lot of support and water gone under the bridge since then. However, at the same time, with this group of people, the higher their challenging behaviour and the more specific their support needs, the more time it takes. They do not have to live with other people, and it is not more expensive. Very often this group of people has onetoone or twotoone in a group setting anyway to contain or to control them. I am asking to swap to developing and supporting, instead of putting all the energies into containment and control.

Mr MADDEN — Thanks for the presentation; it has been fantastic. You have highlighted the fact that for the individual with a serious challenging behaviour, or severe challenging behaviour, and for the state there is enormous merit in the cost benefit of an improved service. I suppose it is not unusual for general members of the public who do not necessarily have a great deal of interaction with individuals like this to have a memory of a serious incident somewhere in public — as you said, somebody walking past a shop — and that actually forms a perception in the general public’s mind, because obviously a situation like that has a fairly significant impact on the local area. The sense I have is that that becomes in itself a barrier to inclusion —

Mr McLEAN — Yes, it does.

Mr MADDEN — because people have a bad experience just by being out in public when something like this happens, or that is what they recount or recall. In a sense it puts other sections of the community in a defensive position about inclusion. I would be interested to hear your comments about that.

Mr McLEAN — There are three elements that are important to understand for an organisation in regard to capacity and working with this group. One is the opportunity for environmental control. If you know that someone struggles with groups, then you do not take them to a group setting, because you know that the setting will probably be overwhelming and will cause challenging behaviour. You might work towards it in a year’s time, or something like that, being able to go to that setting and to develop a person’s resilience and skills, but it is the skill of the organisation to actually environmentally control aspects that the person cannot control for themselves. So if you are going shopping, and the person has difficulty with crowds, with groups or with uncertainty, it would be good not to do it at 5 or 6 o’clock at night.

Organisations that are unskilled will say, ‘Well, they have to learn’. Just saying ‘No’ and ‘Wait’ to someone who has severe challenging behaviour can be a major issue four times out of five when you can have serious challenging behaviour. Yet unskilled staff will often say, ‘But they need to learn to wait’. It may be that they can learn to wait, but it is not understanding the support that this person needs. There are other ways to communicate with someone than using the words ‘No’ and ‘Wait’ if there is something that they cannot have or cannot do, but those two words are serious confrontation times. They are also dangerous times for staff if they do not learn the skill of how else to communicate. That is very simple communication; there are a lot deeper skills that are required there.

Mrs COOTE — I would like to put on the record recognition of the terrific work that Golden City Support Services do. You answered a question earlier from the Chair about who does it well in this state, and I would like to put on the record that Golden City Support Services certainly do.

Mr McLEAN — Thank you.

5 May 2014 Family and Community Development Committee 8 Mrs COOTE — I know about the very difficult clients that you deal with. In answer to one of the other committee members, you spoke about the NDIA, and I think that we have to look at these very complex clients that we are dealing with in this certain cohort of people. Do you think Victoria is geared for the NDIA with the service provision that is going to be needed for this particular client group?

Mr McLEAN — At the moment, no.

Mrs COOTE — What do you believe should be being done to make quite certain that this particular group of people can be well catered for once they get their individual packages under an NDIA system, which should be rolled out by 2019?

Mr McLEAN — It is only hearsay that I have at the moment, but my understanding is in the startup or pilot site in Geelong that the suggested assessment for whether someone has challenging behaviour is the episodes of challenging behaviour and the severity of those per day. That means that many of the people whom we support who no longer have episodes per day but rely on skilled support every 5 minutes of the day are not going to be funded well and are going to reexhibit challenging behaviour. The assessment is wrong. My concern with the NDIA is going on the record now, isn’t it? We are a supporter at Golden City. We were right there from the start; we were up on the Gold Coast with Bruce Bonyhady and others when this was a twinkle in the starting for the lobby eye. We have a commitment to it as a firstorder change for people with a disability.

The dilemma I have is that the products on the NDIA shelf that they wish to purchase look a lot like attendant care and attendant care and attendant care. There is not a lot of product development within the NDIA for this group of people yet either. I am working hard with NDS and others to try to get a product on the shelf of the NDIA that is seen as legitimate and that is costed for the different components that are required.

You do need to have skilled assessment. An organisation does need to have organisational capacity; that costs to build. You do need skilled support. Of course those support staff turn over and you need to be reskilling and remotivating. All those three components need to be in place for a better system. We have pieced them together where we are, and it is great to see it work. What we need is a service system that sees it as being required, and we need an NDIA that sees it as required.

Mrs COOTE — So your thrust will be for social inclusion for this group of people?

Mr McLEAN — Absolutely.

Mrs COOTE — And that is the prime motivator under a personcentred approach?

Mr McLEAN — These people benefit most from a community life with skilled support. If we do not give the skilled support, then noone benefits.

Mrs COOTE — Thank you very much indeed.

The CHAIR — Mr McLean, thank you very much for presenting. On behalf of the committee, we really appreciate the time that you have taken today. Thank you.

Witness withdrew.

5 May 2014 Family and Community Development Committee 9