SUBJECTS: NDIS hospital discharge

NIKOLAI BEILHARZ, HOST: The Federal Minister is, of course, Bill Shorten and he joins us now. Good morning, Bill Shorten.

BILL SHORTEN, MINISTER FOR THE NDIS AND GOVERNMENT SERVICES: Good morning.

BEILHARZ: How many NDIS recipients are languishing in hospitals around the country?

SHORTEN: I think on any given night there'd be about 1,500 people who are either likely eligible or currently on the scheme who are medically fit to be discharged from hospital. 
But because of poor planning processes, because of perhaps a shortage of housing, because of clunky bureaucracy, they're staying in hospital which is not good for them, their welfare, nor is it good for the taxpayers of Australia who fund our hospital system because it's the most expensive form of care.

BEILHARZ: What are you going to do about it?

SHORTEN: We’ve got to clear the backlog. What we've done is, first of all, set some goals. By that I mean that once someone is identified as being NDIS, or NDIS eligible, or once they make an enquiry about the NDIS that someone from the NDIA, actually goes to speak to them within four days. 

Then we want to build a plan, a sort of a hospital discharge plan with the hospital and the treating allied health clinicians and have that done within 15 to 30 days. Currently the numbers are like an average waiting time of 160 days. We heard your own Nat Cook, the Minister, who's very motivated, say that in South Australia it's a 100-day average which is just unacceptable.

BEILHARZ: But if there were places to put these people, they'd be in them.

SHORTEN: Well, yeah, I hope so. But I worry that in fact, some of it's about poor delayed planning. So I think vacancies are an issue that in some places there are vacancies, but the bureaucracy is too slow. I think in other areas, though, it's what you've said that there's not sufficient housing. But if that's the problem, let's identify it and let's fix it.

BEILHARZ: Okay, so how much extra money have you got to either put extra staff into the hospitals to give them a plan and find a pathway out of the hospital back into more appropriate accommodation, and how much money have you got to build more appropriate accommodation?

SHORTEN: It's not a case of extra money because we're spending the money now. We're currently housing them in a hospital. So do I think that we can- and all these people ultimately are eligible for NDIS and eligible for housing packages. So all it's doing is making sure that we just more fairly, equitably, and efficiently process their applications so they can get into the, you know, forever accommodation or for a place which is better than a hospital.

STACEY LEE, HOST: So are you saying that there are beds there for these- I think Nat Cook said it was between 120 and 130 people. That number changes obviously?

SHORTEN: In some…

LEE: There are beds out there for them. They're just not being moved through the system quickly enough?

SHORTEN: It's a bit of both. I think in some cases there are vacancies in beds, as you say. In other cases, there aren't. In parts of Australia- I mean, for example, Tasmania has a general housing crunch, so it's a harder problem there. But in some of our cities there are vacancies and it's bureaucratic red tape, slow processes which is causing the delay and that is surely what we can fix.

BEILHARZ: And- yeah, when you say bureaucratic red tape, what is it? There's not enough staff to physically process paperwork and forms and things like that, or they just sit on someone's desk for ages?

SHORTEN: So I'm not going to speak ill of the previous federal government, but I don't know. Like, there's just clunky, stupid processes. What I mean is that, you know how you might catch a train from- or public transport from where you live to a destination, and what happens, though, with the NDIA sometimes is every stop you've got to get off and wait for one decision to be made, and then you get back on and you do the next part of the trip, and then you get off again as you wait for the next approval. It's crazy. We don't do things concurrently enough. We do everything consecutively.

BEILHARZ: Right.

LEE: I don't think that there'd be many people out there who disagree with you that, you know, red tape needs to go and bureaucracy should get out of the way. But you're the Minister, so what practically can you do?

SHORTEN: Well, I just got elected. Yeah, I just got elected a couple of months ago and I've been shocked at what I've found. Practically, what I could do is help train up and put more experienced planners to work with the hospital clinician teams. 
Practically, we work with the states to identify whether there is a genuine housing blockage. Practically, we could give people who are working on these measures delegated decision making rather than every decision having to go up a change several levels to get approval for funding.

BEILHARZ: Okay. So you put these measures in place. What will it do to the waiting list?

SHORTEN: Well, hopefully it'll reduce the average time that people who are medically fit for discharge spend in hospital after they're medically fit to discharge.

BEILHARZ: But people listening to this, reasonably, pushing beyond just the rhetoric, what could they expect? Fifteen hundred people around the country are waiting right now to be discharged.

SHORTEN: Well, I'll tell you what reasonable people make…

BEILHARZ: … You want to halve it in 12 months? Is that a reasonable expectation?

SHORTEN: I want to reduce it. We don't know how far we can reduce it until we try. I think reasonable people will say this current status quo is unacceptable. But what we also have to do is- a lot of this data hasn't been kept. Like, you'd be surprised that the, in my opinion, the lack of common sense at the federal level in some of the decision making processes. So I don't know how well we can do, but I know that if we don't try, we're guaranteed to fail.
But if you're asking me for a particular number on a particular day, I don't know and no one can give you that answer.

LEE: Might just return to Nat Cook briefly, the State Minister for Human Services. So Nat Cook, as Bill Shorten just said, in Tasmania it sounds like there's a housing problem. Is that the case here? Are those 120 to 130 people here in South Australia not being discharged from hospital because there aren't houses for them to go to?

NAT COOK, SA MINISTER FOR HUMAN SERVICES: So there is a balance. The guy I talked about yesterday, he owns his own home. So that is absolutely the classic bureaucratic nonsense that he's caught up in that has been glacially slow and has held up this fellow from going home, to his own home, okay? So that is a terrible situation. 

We identified immediately in- a couple of months ago that there are 165 vacant disability accommodation properties that could be used for people to exit from hospital or transition. But the funding currently doesn't allow for that under the rules of the NDIA. This is what we've been talking at and leading this national conversation, and it is not- it's not going to happen overnight, but I think this will happen fairly quickly because we've got a determined Federal Minister and every state and territory is being represented very, very strongly. And this conversation is something which is urging, urging change. 

So I'm very confident that we will see this portion of people who could get to a suitable accommodation quicker go, and people who are being held up by nonsense actually liberated, if you want to use a term, because these people just need to get on with their lives and they're being held back by a process, like Bill said, one bus stop at a time, which is ridiculous.

BEILHARZ: Bill Shorten, if we can return to you. I know you've talked about- you feel that it's overly bureaucratic, there's too much paperwork. Is there a risk, though, that if you push things too far the other way - I mean, there need to be checks and balances, you need to make sure a patient is getting an appropriate level of care, that it's being done at a reasonable cost to the taxpayer - is there a risk that if you cut too much paperwork out, it gets a bit loose and slipshod?

SHORTEN: Oh, no, not with profoundly severely disabled people who require seven day a week, 24-hour, around the clock care. 

Once you're in that condition, you're not out there doing that so you can get an extra nice cushion on your wheelchair. I think if that becomes the problem, then we'll monitor it. But I'm going to deal with the problems that I have right in front of me. 

I think there's a lot of people in the system trying to do their best. Federally, state, in the hospitals, you name it, and of course the person with the disability at the centre of it. But I know of a case where they'd approved the home mods eventually, then they approve the wheelchair, but they were arguing over the ramp or they're arguing over a $2,000 cushion on a $35,000 wheelchair. 

You know, we've got to give a bit more trust to our decision makers at the- delegate some power down the food chain to the people dealing with these people so they can just say yes, no, let's get on with it.

I don't pretend that everyone's going to have a much better outcome by the end of the year or a particular date. There are some people whose cases are really complex. There is- and if you've got severe psychosocial conditions, which mean you need robust housing and very trained staff, that will take time. 

But for other matters that I've seen in the last two and a half months since becoming the Minister, there are things which you just want to slap your head- slap your forehead and go, why can't someone just make a decision? So that's what I want to do. Encourage a culture of delegation and trust rather than six different people handling a decision and second-guessing each other.

BEILHARZ: Okay. Well, we'll keep an eye on it and we'll get you back on in six months, a year, and we'll find out whether it's worked.

SHORTEN: Well, maybe even before then and we can talk, because there's plenty of other issues in the NDIS we've got to fix up. But thanks very much for your interest, and I will give Nat Cook a shout out. She comes from the disability sector and she's got a level of passion and reforming zeal, which is what people would hope they see in their politicians. But that's what you've got in South Australia.

LEE: Okay. Bill Shorten, thanks for your time.

SHORTEN: Good on you. Cheers.

LEE: And also Nat Cook, the State Minister for Human Services, as part of that conversation as well. Thank you to her, too.