At Clickability, we’re hearing from various stakeholders about long waiting lists for everything from support coordination to allied health. Why is this happening when we know that there’s so much demand that organisations can’t possibly meet it? My guess is either resistance to change, the ego-driven belief that it makes the organisation look good, or fear of scarcity. I think it’s important we tackle these issues, so I’m going to explain why I think there are no good reasons for a waiting list and why I think that, by having waiting lists in a marketplace, we’re causing harm and negatively impacting human rights.
We had waiting lists in a block-funded environment because ostensibly there was no other choice. It was EITHER stay on the waiting list and MAYBE get a service eventually, or get nothing.
Companies create waiting lists for parties, events, hotels. Why? To get some social kudos. It’s cool to sell out! It means my event is desirable and everyone wants a piece of me. To get more money! Look at how much airlines oversell their seats.
We know that the disability services industry has more demand than supply; in fact, at the recent NSW NDS Conference, an academic said that 53% of organisations aren’t able to, or won’t be able to, meet the demand.
It might be ok if we were talking about a party, a show, an event. That’s not the case here; we’re talking about meeting basic human rights for vulnerable Australians.
It might be ok if consumers were consistently being told where on the lists they were, and what their other options were – assuming other options exist. A consumer I spoke with said, “For me it is more the typical lack of transparency. If I’m in a queue for the loo at the tennis, I can see how many people are in front of me, how quickly it’s moving, and whether people are queue-jumping. I can make an informed decision whether to pee behind a bush instead. Disability service lists are opaque, usually.” If waiting lists are not transparent, participants most likely won’t look further… when they could be getting their urgent needs met elsewhere.
Also, by the time people move off a waiting list, it is likely that their needs will have become far more acute and even emergent. Some will be forced to meet their needs elsewhere for an unknown amount of time. These are problems that the NDIS is supposed to fix, and won’t be able to if we keep waiting lists.
The other problem is a moral one: it’s not ethical to try to deliver more than your organisation has the capacity to deliver. Quality will go down. In the disability sector, that’s a violation of human and consumer rights. Having waiting lists, or overcommitting to intake when services can’t currently match incoming participants, often means human resources being taken from service delivery and put into managing the waiting lists – essentially raising overheads and reducing capacity. Apart from causing hectic internal budgeting problems in an NDIS pricing model, where overheads need to be slimmed down, the extra burden can overwhelm the organisation, resulting in frontline workers being pressured to spend less time with the participants they already have. Consequently, participants might receive a lower quality service. We know from data we’ve collected and reported on at Clickability that customers feel these structural problems on the frontline.
Waiting lists are a marketing problem too! Everyone in marketing in this sector is saying the same thing: do only what you’re capable of doing, fill a niche, and do it well.
You might say, but we’re hiring new staff right now! Sure. But I don’t think it’s realistic for organisations to think they can hire appropriate frontline staff at a quicker rate than they can pick up new customers in a world where there’s more demand than supply, and additionally, where we know there’s a shortage of qualified frontline workers.
For me, the real ironic kicker is that there are waiting lists for organisations that are supposed to be providing Support Coordination, a service which actually helps people access the help they really need and are already entitled to through NDIS! Waiting lists for support coordination are essentially gatekeeping the entire NDIS.
Waiting lists don’t make economic sense. They don’t make moral sense. They don’t make cultural sense. They put pressure on the organisation. They’re bad customer service practice. They’re completely counter to vision and mission statements to do good (or even to do no harm).
You might say, but there’s nowhere else to go. It’s a waiting list or nothing.
Well, my thought on that is that “nothing” is a risk of using a market model to deliver social services. If the market is supposed to respond, it needs to respond. If the market can’t respond, the government needs to intervene. Either way, waiting lists falsely absorb the problem: not only lacking transparency for participants, but for potential market stewards. A problem can’t be solved if it’s being hidden. In order for NDIA, DSS or state governments to respond they need to know there’s an issue.
Responding at a federal or state level might include stepping back to small pieces of block funding (for example what’s already planned in rural and regional areas), better education and more urgent investment in workforce. At a micro level, it might mean more small businesses starting up. At a meso level – and this is something that can be controlled by service provider – it might involve inter-organisational referrals to competitors.
The other thing that’s really important is for consumers to know about their rights! As a customer in any sector, an essential part of your rights is knowing what’s on offer. If someone tells you they’re putting you on a waiting list, ask how long it will be until you get a service. Ask how far down the list you are. Ask what your other options are. Ask what the organisation is doing to raise their capacity. Ask everything you need to ask until you feel like you can make an informed decision. You have a right to the information you need.
Aviva Beecher Kelk
Aviva Beecher Kelk is co-founder and co-director of Clickability. She’s really interested in the interaction between economic and social issues. She’s been told on more than one occasion that she thinks too much.
|This post is brought to you by Clickability. We’re working towards a better disability service sector by helping users share their ratings and reviews. We invite you to write a review.|