SUBJECTS: NDIS hospital discharge

NADIA MITSOPOULOS, HOST: Many times on this program you have heard me asking the experts about how to stop ambulance ramping and how to reduce the pressure on emergency departments. In other words, how to make sure you can get the healthcare you need when you need it, and the answer always comes back to beds, freeing up beds inside the hospital. 

Well, today, I can tell you that 177 of those beds in WA are being occupied by people on the NDIS who don't even need to be there. They are medically fit to be discharged but there's nowhere for them to go.

Bill Shorten is the NDIS Minister. He's got a plan, he says, to fix this and the Minister joins me now. Good morning and thank you for your time.

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

MITSOPOULOS: This has been a long-term problem. Can you explain why these people are still in hospital and why this is such a hard nut to crack?

SHORTEN: Well, upon the election and becoming the Minister for the last couple of months, I've been talking to hospital administrators, clinicians, people with disability, a range of other people. I've formed the view that there's a whole basket of reasons why people who are medically fit for discharge, who are eligible for the National Disability Insurance Scheme, are spending countless nights still in hospital, which is not great for them and it obviously has all the other problems blocking up the health system. I think it happens partly because we've got cumbersome processes. It's as basic as too much red tape, too slow decision making, right through to more complex issues like do we have appropriate housing to move people to.

MITSOPOULOS: So it's more than just cost?

SHORTEN: Yes, it's more than just cost.

MITSOPOULOS: How much is it costing?

SHORTEN: Well, my estimates from my investigation over the last 10 weeks is that it's costing north of $2,000 per person with a profound disability who's deemed medically fit to discharge from hospital. Every night that they're staying there is about- or it's north of $2,000. So if that's 1,500 people, that's $3 million a night throughout Australia.

MITSOPOULOS: And what could you do with that money, Minister?

SHORTEN: I'm sure the health system could do a lot with it. But it's also about the people. Like, there's 1,500 people who are profoundly disabled who- we need to be setting up for their forever accommodation. Some of these people are able to move back home and it just requires home modifications, get the physiotherapist's reports, get the quotes. Others will require teams of care around the clock. So it takes time to assemble a roster of carers to care for someone seven days a week, 24 hours a day. Whilst these are- and for some people they might have severe psychosocial conditions whereby, frankly, they can't just go into an ordinary house. The housing needs to be robust.

Now, in parts of Australia and parts of the Northern Territory and Western Australia and North Queensland, there's just not housing. But that doesn't explain why everyone's still being kept in hospital. So I think we've just got to put in teams of wranglers who sit down with the clinicians and the allied health professionals and hospitals and say: all right, this is John or this is Betty. What do they need? What's their plan? 

I'm finding a lot of the times, in some of the systems I examine, each decision is taken as consecutively. So you have one decision, is that person eligible? Then once they've worked that out, then they go to the next decision about what are their assistive technology needs or home modifications. The next decision might be if they've got a- where's an appropriate house, if they're appropriate people to live with, that decision. Then, they work out a care team around them. It seems as if everything's very binary and we never make decisions concurrently. A lot of these things, I think, could be done at the same time, rather than the cumbersome decision making process that's in place.

MITSOPOULOS: It seems they're operating in silos.

SHORTEN: Yeah, exactly. And you'd think, Nadia, it shouldn't- the critique shouldn't be as simple as that, but I think it is in part. Don Punch is your West Australian Minister; he's very seized of this issue. He wants to work with us. I've had to get the data from the states and from hospitals. I think we can make progress. Some people have told me it's impossible. I don't accept that. The only thing which is impossible is if we don't try. Not everyone will be as easy to work through issues as every other person. But 160 days' average waiting time across Australia is just madness.

MITSOPOULOS: I've got Bill Shorten, the NDIS Minister, on the phone talking to you this morning at 8:53. 
You've got a plan, it's called the Hospital Discharge Operation Plan. So can you just give me the specifics of how that will work?

SHORTEN: Oh, listen, in essence, a lot of hospitals have got a very skilled disability rehab clinician teams. We get someone- what happens with someone if they're deemed eligible for this National Disability Insurance Scheme, they get a package of support. So I get the people from the federal agency to get down to the hospital, to meet the people for whom the plans are needed, talk to the clinicians, and then they put it together. They get on the phone, they find out where the housing is or if it's home modifications, they get the physio reports, they check out what technology is required. 
And what I want to do is give the people from the federal government delegated decision making. In other words, rather than someone sort of sketching out what needs to be done and submitting it to someone above them, to someone above them, to someone above them to get a tick, get the people close to the actual participant to make the decision. 

I've heard of a case in Canberra where- Canberra Hospital, where they could agree on the wheelchair, which was tens of thousands of dollars, but then there was an argument over the cushion, which was $2,000. There is stuff going on which- there's low hanging fruit here as well as complex issues, and I at least want to pluck the low hanging fruit and get on with it.

MITSOPOULOS: You've given the NDIA some very specific targets, though. Can you talk me through those in regards to how quickly they need to act?

SHORTEN: Yeah. What I would like to see, and it's a stretch target, some people say it can't be done, but I think it can and if it can't be, I want to know why. 
What we're saying is that once the hospital or there's a participant who works out that they're coming to the end of their medical treatment time and they're going to need to be discharged, that the- they should notify their National Disability Insurance Agency. Within four days, a planner who's working out what happens to this person after they're discharged meets the person for whom the plans will be made. And within 15 to 30 days after that, a plan is constructed. Like, what does it look like? What do we need?

MITSOPOULOS: But Minister, isn't a big part of this problem, though the reluctance of providers to take on these people? Now I've spoken before to Nelson, for instance, and they were saying that they would like to take on some of these people, particularly those with very complex medical needs, but the NDIS funding is not enough. I mean, I think one of the examples they gave is they'd need around $1,000,000 a year and they just can't get that funding. And that's part of the problem here is that they're saying not enough money's being provided to actually care for these people. Do you accept that?

SHORTEN: I could accept it in an individual case. I don't think that generally is the problem. That could be right with- what you're saying if someone has a million dollars' worth of care. But that's not particularly common…

MITSOPOULOS: But it's meant that this person, it was not- were in hospital…

SHORTEN: Yeah. I'm not arguing with you about the case. I'm saying I accept- in individual. But as a general rule of thumb, I think it's slower decision-making as opposed to a lack of resources. 

One thing I do know is that it's more expensive on average to keep someone in hospital after they're ready to discharge than getting a package of support. One of the things- and there is enough money in the system to pay for these people's care, and it'll be cheaper for the taxpayer overall to have them- a person in their own home or an appropriate accommodation at the hospital. But one of the problems, I think, is that the states are responsible for the hospitals, the federal government's responsible for the National Disability Insurance Scheme, and too often levels of government don't talk to each other properly. And I've just got- I don't know. We've got to fix that and I want to use the challenge of hospital discharge to try and get people out of their silos, talking to each other. But the…

MITSOPOULOS: Apart from that, they- just to touch back on the funding issue, if a provider comes and says to the NDIA, look, we can take this person on, but you're going to have to provide us with more money, would the money be there to be able to meet that need?

SHORTEN: I don't see why not, I have to say. I mean, sure the NDIS is not a blank cheque book, but on the other hand if there's solutions which work for people, in my experience the NDIA is generous. I think part of our challenge, if you move beyond hospital discharges, some service providers are overcharging. But in the case of this, getting people out of hospital, I'm not convinced that that should be a deal breaker.

MITSOPOULOS: I'll leave it there, and I do appreciate your time. It's something that we do talk a lot about on this program, and with you, we'll continue to do so. Bill Shorten, thank you.

SHORTEN: Thanks Nadia, bye.

MITSOPOULOS: He's the NDIS Minister and I wonder what you make of what you have heard this morning.