Navigating the complexity of disability services in Australia

There is little doubt that Australia’s disability support system is complex. While the National Disability Insurance Scheme (NDIS) is a major part of the support landscape, it sits alongside myriad other services provided by different levels of government, some targeted at people with disability and others for the whole community.

For many users, navigating the system can feel like wandering through a labyrinth in the dark, with a dizzying array of options leading down paths unknown.

Does anyone have the time, resources, patience and knowledge to navigate a system like this to get the support they need?

Clearly the system can be confusing. The consequence is that many people struggle to access the right services at the right time, meaning they bounce between service systems. This chews up service capacity, fails to deliver outcomes for participants and leads to a more costly system overall for government.

Investing in system navigation will improve outcomes and drive down costs

To address these challenges, some people have argued for radically simplifying the system. But we think that ruthlessly pursuing simplicity would come at the cost of ensuring choice and meeting the varied needs of all users.

Instead of simplification, we think there's a strong case for embracing the complexity – and giving people support to navigate it.

Investing in system navigation will be like giving people a torch, a map and a guide to help them through the labyrinth.

Done right, this can help to facilitate access to programs or services, promote and facilitate continuity of care, identify and remove barriers to care, and promote effective and efficient use of the system. It will deliver on a social insurance scheme’s goal of reducing the lifetime cost of support.

Our starting point in improving system navigation must be to put the person with disability at the centre. This draws on decades of research into human-centred design, which shows it is fundamental to the uptake and effectiveness of services.

So what does human-centred design look like when it comes to system navigation? It means listening deeply to the person with disability, as well as their family and friends, to understand what they want for their life now and into the future.

We know that navigation can reduce system-wide costs and lead to better outcomes for people accessing services. For example, under the previous disability system in Western Australia, local area coordinators (LACs) helped people make the best use of existing services. LACs would help people with disability, their families and carers to navigate housing, allied health or community-based programs. This prevented presentation in more expensive acute services. (Eddie Bartnik and Ralph Broad have written more about local area coordination in their book “Power and Connection”.)

Successful system navigation involves five qualities

From our work with service providers and our exploration of the issues involved, we believe there are five qualities that are essential for successful system navigation.

1. Navigators need to seek system-wide solutions. Navigators need to think of themselves as supporting anyone with disability – not just people in the NDIS or using specialist disability services. System navigation involves all local services and informal supports that surround people with disability, including education, housing, child protection and local community organisations, as well as local governments and businesses.
2. Navigators need to sit in mainstream systems and the NDIS. Many service systems are investing in system navigators, including NDIS navigators in Victorian specialist schools and Justice Liaison Officers from the National Disability Insurance Agency. It is a strength, rather than a sign of duplication, to have navigators in different parts of the broader service ecosystem. Creating a network of networks will help people move through the different systems.
3. Navigators need the right skills. Navigators need to combine a deep understanding of the needs of people with disability, knowledge of their local system, and an array of soft skills – empathy, influence, and people skills – to build relationships with people with disabilities and local services. The challenge for the system is to develop a workforce with this mix of skills.
4. Governments need to relinquish some control. Each person with a disability has their own unique circumstances. Good system navigation requires governments to accept that decisions and approaches will be determined at a local level, based on local systems and the needs of the individual.
5. Conflicts of interest need to be managed. System navigators may also provide other disability services. In these instances, there is a potential conflict of interest that needs to be carefully managed so that navigators are serving the interests of the person with a disability rather than their own commercial interests. It may be necessary to separate different services – such as support coordination, services and housing. This is important for system integrity, participant safety and service quality, even if it adds complexity.

We need to invest to keep the system sustainable

The system is complex and that complexity is here to stay. Instead of trying to simplify it, we should focus on helping people with disabilities navigate their way through the system in a way that is tailored to their needs.

All people with disabilities may need navigation support at some point, even those who will not end up in the NDIS. For the sake of people with disability, and the sustainability of the system, we need to invest in navigation.