Markets in social care: outsourcing administrative burden to citizens and the third sector
We know that the NDIS is a lot of administrative work for scheme participants, but the administrative burden isn’t just borne by people with disability. Today’s post comes from Ellie Malbon (Centre for Social Impact), Gemma Carey (CSI), Helen Dickinson (Public Service Research Group), Megan Weier (CSI), and Gordon Duff (National Disability Services), who have done some research on the administrative burden of the NDIS for service providers.
Administrative burden is the costs incurred from carrying out social service administration – the bureaucratic processes involved in applying for and maintaining access to social services. This includes things like the paperwork involved in proving evidence of citizenship or employment, or the complex process of qualifying for social housing. As the conversation about administrative burden progresses, we understand more and more that the marketisation of social care outsources administrative burden to citizens (Herd & Moynihan, 2019), but something less often highlighted is that marketisation can also outsource administrative burden to the third sector and industry. Administrative burdens have very real consequences, shaping the effectiveness and outcomes of public programs (Herd & Moynihan, 2019).
We looked at the way the marketisation of the disability sector through the National Disability Insurance Scheme (NDIS) was impacting administrative burden in the sector. The disability sector is made of up not-for-profit providers as well as for-profit providers, and we saw increased administrative load across both types of providers. Our work shows that administrative burden was one of the most commented on challenge for NDIS disability service providers.
Many providers commented on the fact that the NDIS is a complex system that can be difficult to navigate for providers. We would expect that a new system of this size and scope would be complex in nature. In the shift from block contracting to individually purchased plans there are understandably some additional transactional costs. However, providers expressed concern at just how much additional administrative work is being generated:
Endless paperwork, courtesy of Unsplash
Most of our work involves cumbersome administration. In fact admin work accounts for 80% of hours. (P349)
Another provider explained why this situation has arisen:
Administrative burden now enormous—transactional nature of business, requirements to have service agreements with every customer, data capture huge to provide evidence, back office increase dramatically to be able to get paid and manage transactional nature of scheme, quality and safeguarding has added another layer of burden and additional cost (no funding for external audit process). (P203)
As this quote demonstrates, it’s not just transactions that cause the extra administrative burden, but also the work of providing feedback to the NDIA and a lack of coordination between government agencies. Also, the NDIS has had a challenge to support NDIS participants to keep up with the administrative burden of the program, and because of their close relationships with people with disability, many service providers often step in to meet this challenge, distributing the burdens to the provider rather than the government:
There is too much reliance on disability organisations to do the work of the NDIA in terms of upskilling the participants, the public and their families. There is too much reliance on the goodwill of disability organisations to support participants [administratively] when things go wrong with the planning process. (P349)
The implications of increased administrative burden mean that many service providers have exited the NDIS, and more are considering exiting:
Many of my colleagues have dropped out of providing services to NDIS customers because the system is administration heavy and services more complex . . . Many of us will probably drop out once our registration is up because the process of maintaining registration seems expensive and administratively heavy . . . When things are working well the system is good—payment is easy and quick. But when things go wrong it is a large, faceless organisation that is difficult to talk to (but is getting a bit better). (P230)
Herd and Moynihan’s (2019) work suggests that redistribution of administrative burden is “policy making by other means” (p. 2). What this means is that this shift in administrative burden is not an accidental result of systems of government, but rather this work is purposely redistributed in ways that meet political and ideological goals.
Although Herd and Moynihan (2019) are primarily concerned with redistribution of administrative burden to individual citizens, and understandably so, this insight also affects the third sector and for-profit providers. It’s clear from our research on the NDIS that these new administrative burdens, and also the time providers spend helping their clients to navigate their NDIS-related administrative burdens, have put unprecedented pressure on some service providers.
We know that quality and safeguarding practices are essential for safety and respect in the NDIS, but in order to address these issues, additional administration around payments, quoting and adjustment to bureaucratic processes should be reduced for providers and NDIS participants alike.
References
Herd, P., & Moynihan, D. (2019). Administrative burden: Policymaking by other means. Russell Sage Foundation.
Carey, G., Dickinson, H., Malbon, E., Weier, M., & Duff, G. (2020). Burdensome Administration and Its Risks: Competing Logics in Policy Implementation. Administration & Society, 52(9), 1362–1381. https://doi.org/10.1177/0095399720908666