Integrating care for people with the most complex needs: the Integrated Service Response.

Introduction: The Australian National Disability Insurance Scheme (NDIS) offers an approach to disability support that is personalised via the provision of an individual budget which can then be used to 'purchase' services by NDIS service providers who compete for NDIS clients as part of a social care market. The scheme is prefaced on the concepts of 'choice and control' with individuals at the centre of decision making in relation to their budgets. However, individuals with complex needs themselves may be unable to organise their own care because of the situation they are in, or they may need supports that go beyond the boundaries of the NDIS, or they cannot purchase services because services do not exist in the market to meet their needs. This means that those individuals have a higher need for integration or are at higher risk of negative social and health outcomes. Aims and objectives: This paper will reflect on the example of the Integrated Service Response (ISR) which was a highly structured add-on to the NDIS created by the New South Wales State Government in Australia to increase inter-agency collaboration around the needs of people with extremely complex needs who were in a crisis situation that could not be easily resolved. The program aimed to 1) meet the needs of the individual and 2) join up the system to make it work more collaboratively going forwards. The ISR program involved a 3-month service which aimed to connect those services and agencies relevant to the individual and situation and develop a strategy to meet their needs. Highlights: We will describe the program and examine its effectiveness at meeting its aims by drawing on process observation and interview data. We will pay close attention to the validity of ISR and ISR-like programs that act at a systemic level to address client needs, but do not actually engage with the client/patient themselves beyond their consent to participate. Is this saving the client from being drawn into fixing a mess imposed by the system, or is it cutting the client out of decision making and therefore the antithesis of personalisation? Conclusions: We will look at the possibilities posed by these types of programs in operation in Australia more generally and their sometimes-complex relationship with the personalisation agenda of the NDIS and similar programs. [ABSTRACT FROM AUTHOR]