Catholic Health Australia has made a submission to the first public consultation on a possible commissioning approach for part of the Supported Independent Living market. CHA supports the objective, and considers that commissioning can strengthen quality and safeguarding in SIL provided it is designed as a proportionate and sustainable intervention rather than a separate layer of compliance.

Where additional oversight adds most value

Commissioning has the greatest potential value where the ordinary safeguards of the NDIS are less effective. In most of the Scheme a participant receiving poor support can raise concerns themselves, have a supporter raise them, or move to another provider. Where those mechanisms are limited or not practicable, additional oversight becomes an important safeguard.

CHA does not support defining those circumstances through fixed participant categories. Support needs and living arrangements change, and categories such as continuous versus occasional support will both capture participants who do not need additional oversight and miss participants who do. The submission instead proposes four broad risk markers that may overlap and compound: participant vulnerability, support complexity, the household and living environment, and market conditions. Thin markets in rural, regional and remote areas should be treated as a risk marker in their own right, not simply as a service availability challenge.

What high-quality SIL looks like

High-quality SIL is support in which the participant is engaged in their own life rather than having it managed around them. Active Support provides the foundation, but adopting the model alone does not guarantee consistent practice. Practice leadership is what translates a model into what happens in people’s homes, and it requires frontline leaders to observe, coach and model good practice rather than manage staff through rostering and compliance.

The submission sets out six characteristics of high-quality SIL, including observation-based measurement of practice quality, accessible information so families can compare providers, and protection of individual choice in shared settings. Commissioning should focus on the capability and outcomes a provider demonstrates rather than prescribing a particular service model, organisational structure or proprietary measurement tool.

Safeguards that work at every level

Safeguarding in SIL requires more than a single mechanism. CHA proposes safeguards operating at the participant, household, provider and system levels, working together rather than relying on any one measure. Risk should be assessed at both the individual and household level and reviewed as circumstances change, with the use of restrictive practices treated as a risk indicator.

Participants and those supporting them need accessible avenues to raise concerns, including an avenue independent of the provider, and commissioning should provide confidence that concerns are acted on. CHA also brings a broader care system perspective: many SIL participants move between disability, health and aged care, and risk increases at those transitions, including hospital discharge and the risk of inappropriate entry into residential aged care.

The effectiveness of any of this depends on the capacity of the NDIS Quality and Safeguards Commission to monitor and enforce it. Commissioning will create additional monitoring and reporting requirements, and those should be matched by appropriate regulatory capacity and resourcing.

Innovation measured by what changes for participants

Innovation in SIL should not be defined by the adoption of new technology. The test should be whether an innovation produces an observable improvement for participants, with providers able to demonstrate what changed rather than that a new product or process was introduced. Technology can contribute where it supports rather than displaces quality interactions between participants and workers, and it should not replace human judgement in decisions about a participant’s circumstances.

Choice through a panel, not a single provider

Choice and control are foundational principles of the NDIS, and a commissioning model that allocates SIL to a single provider for a cohort or region would reduce the practical choices available to participants. CHA recommends commissioning operate through a panel of multiple approved providers, so that commissioning determines which providers meet the quality and safety threshold while participants retain the ability to choose between them.

Choice should extend beyond selecting a provider to meaningful input into who a participant lives with, who supports them and how their day is structured. Where a competitive panel is not achievable, the Department should be transparent about the trade-off, and additional safeguards should apply. Panel entry requirements should not be set so narrowly that they exclude smaller, community-based or culturally specific providers.

Funding the standard being asked for

Provider viability and participant outcomes are closely connected. Practice leadership requires funded time away from direct rostering, observation-based quality measurement needs systems and the workforce to operate them, and workforce continuity requires remunerating and supporting staff sufficiently to retain them. Each carries a cost that commissioning and pricing arrangements need to recognise.

A higher quality requirement without corresponding funding would create pressure on providers to reduce workforce investment, limit the supports they can sustainably offer, or withdraw from the market, which would reduce the availability and choice that commissioning is intended to protect. Commissioning should also avoid a procurement model in which providers compete primarily on price.

The six recommendations

1. Commissioning should be targeted at participants and SIL households displaying identified risk markers across a broad spectrum of risk, rather than fixed participant or service categories. Thin markets should be recognised as a risk marker in their own right.
2. Commissioned SIL providers should be required to demonstrate practice leadership capability and use structured, observation-based measures of practice quality. The commissioning model should recognise additional cost of delivering SIL to this standard.
3. Commissioning should require providers to demonstrate a multi-level approach to safeguarding, including participant and household risk assessment, accessible avenues for raising and resolving concerns, rights-based decision-making, and transparent reporting of quality and safeguarding indicators. Commissioning should also be supported by sufficient regulatory capacity to monitor and enforce these requirements.
4. Commissioning should recognise innovation based on its contribution to participant outcomes, rather than the adoption of technologies or models. Providers should be expected to demonstrate the outcomes of innovative approaches and share relevant evidence to support improvement across the sector.
5. Commissioning should operate through a panel of multiple approved providers that meet defined quality and safety requirements rather than allocating commissioned SIL to a single provider for a particular cohort or region. Participants should retain choice over their provider and living arrangements, with additional safeguards where competitive choice is not available.
6. Commissioning should assess provider sustainability through demonstrated workforce, governance, practice and quality capability, and commissioned SIL should be funded at a level that reflects the reasonable cost of delivering the required standard of support. Commissioning should reward quality and capability rather than create incentives for providers to compete primarily on price.