Everything we know about foundational supports

The words ‘foundational supports’ have been on everybody’s lips, since the term was first coined by the NDIS Review late last year.

But while the words might be new, the idea behind them is not. Quite simply, foundational supports are disability supports other than the NDIS. If you are thinking: what disability supports outside of the NDIS? Well, dearest reader, you have put your finger right on the problem! As we’ll discuss in more depth later, there’s a massive shortage of supports available for people ineligible for the NDIS.

In the past, foundational supports have been called Tier 2 (a name nobody could ever accuse of being catchy) or Information, Linkages and Capability Building (ILC).

The government still has not formally responded to the NDIS Review’s Final Report. But foundational supports are the only recommendation that we know will be implemented in some form. The day before the Report was publicly released, National Cabinet reached a decision to fund foundational supports, through a 50-50 split between the Commonwealth and State & Territories. And in February, the Commonwealth announced $11.6m in funding to develop a Foundational Supports Strategy.

So, this is happening people! It’s time to get our heads around the details of one of the Review’s most consequential recommendations, and what it might mean for people with disability and the sector.

The Problems

Unsurprisingly, the NDIS Review concluded that there are not enough disability supports for people not eligible for the NDIS, compared to the level of the need. That is why the NDIS has been described as an oasis in the desert, the only lifeboat in the ocean or a funding cliff. While the situation has fertile ground for speech writers partial to a visual metaphor, it is, according to the Review, an unfair system. It also places financial pressure on the Scheme - because if there is only one lifeboat, people are going to do whatever they can to get on it.

According to the Review’s Supporting Analysis 2018 data from the Australian Bureau of Statistics (ABS), it showed that 4.4 million Australians live with a disability. Of those people, approximately 1.4 million are under the age of 65 and need assistance with daily living activities. This is compared to the 630,529 people on the NDIS. Meaning there is a huge number of people who need daily support but are not able to access Australia’s main disability support system.

The Review found that the cohorts most likely to fall through this rather large gap are children with disability, people with psychosocial disabilities and people with chronic health conditions. Between 2013-22, a quarter of all people found ineligible for the NDIS had a psychosocial disability, and half had a chronic health condition.

The Review believes that governments have come to rely on the NDIS as the dominant or only source of disability supports. Based on the Productivity Commission’s annual report on government expenditure, alongside data governments gave to the Review, they estimate Australia spends $2.67bn on disability supports other than the NDIS. Of that, $1.76bn is from the Commonwealth government, of which 73% goes to Disability Employment Services.

The Review also concluded that the ILC program lacks a clear strategy and has been ineffective. Which is not surprising, given the scale of the need and the program’s grant budget of $153m a year (in 2023). Meanwhile Local Area Coordinators (LACs) have, rather predicably, been caught up with planning, and had limited time to pursue their initial mission of supporting people not eligible for the NDIS.

What needs to change?

The NDIS Review says that for people with disability not eligible for the NDIS to be appropriately supported, three things need to change:

Community attitudes needs to improve
Mainstream services need to be more inclusive and accessible
Foundational supports must be more widely available.

An additional three major reforms are needed to deliver foundational supports:

More funding
An expansion of the type of support available
Improved design and service delivery.

Targeted v General foundational supports

The Review recommends governments fund two types of foundational supports: general supports and targeted supports.

General:

General foundational supports are available to all people with disability under 65. They include the types of supports that were traditionally funded (or underfunded) by the Informational, Linkages and Capacity Building program.

Based on the Review’s recommendations, general supports would include:

Information, advice and capacity building - These supports would be about ensuring that people with disability and their families have the information and advice they need and have opportunities to build their independence. This might include peer support, community capacity building, self-advocacy, and support to build decision making skills. The Review recommends moving to a long-term funding model for organisations that provide these supports, so they don’t have to constantly re-apply for grants.
Navigation - Navigators would help people access and use mainstream, foundational and NDIS supports. In the long term, the Review sees Navigators replacing the role of Support Coordinators, Psychosocial Recovery Coaches and Local Area Coordinators. Check out our article on Navigators to learn more.
Individual advocacy - The Review found that disability advocacy services are underfunded, and often tied up with NDIS matters. Advocacy services are also inconsistently available between jurisdictions. The Review recommends an increase in advocacy funding and better coordination between the Commonwealth and states & territories to ensure national consistency.
Systemic advocacy for LGBTIQA+SB people with disability - There is currently no Disability Representative Organisation (DRO) working in this area, despite the high prevalence of disability amongst LGBTIQA+SB people. The Review recommends funding a DRO to strengthen the representation of this cohort.
Capacity building for care givers - Support to give family members the information and resources they need to make informed decisions.
Employment services - The Review said the current system to support people with disability to find and keep a job is fragmented and has failed to achieve the desired outcomes. They recommend the Department of Social Services (DSS) and the NDIA develop a joint action plan for how the NDIS, Disability Employment Services (DES) and other employment services can work together and achieve better results. The Review also says more should be done to promote the role of peer work in the NDIS.

Targeted:

Targeted foundational supports will be for people with disability under 65 who are not eligible for the NDIS, but still require early intervention or less intensive support.

Targeted foundational supports might include:

Home and community care - The NDIS Review recommends providing home and community care for people with disability not eligible for the NDIS, including people with chronic health conditions. This can be done by expanding existing state and territory Home and Community Care (HACC) programs, and other similar initiatives. The Review suggests these programs should aim to support about 1.5% of the adult population. They also recommend the Australian government, along with states & territories, develop minimum standards of support per person, and a way of publicly reporting on programs against quality and coverage indicators.
Aids and assistive technology - According to the Review, access to assistive technology (AT) outside the NDIS is ‘underfunded, fragmented and complex.’ Therefore, they recommend that DSS and states & territories work out a good mechanism to get people the equipment they need.
Psychosocial disability supports - In 2020, the Productivity Commission estimated there are 154,000 people with significant psychosocial disabilities that are not receiving support from the NDIS or any other government program. The Review recommends expanding the Commonwealth’s Psychosocial Support Program, and other similar state & territory programs. The NDIS would continue to be available for people with psychosocial disabilities who have higher support needs.
Early intervention - 1 in 5 Australian children have a disability or developmental concern, yet there are significant gaps in the availability of supports. The Review wants to see a continuum of support available to families, including support from mainstream services, foundational support and, for children with more significant support needs, the NDIS. Children not eligible for the NDIS will have access to a Lead Practitioner, who can support them and their families to ‘build their skills and participate in everyday activities.’ The Report also recommends that the Australian government trials new initiatives to support children with developmental delays, and to scale them up if they show promising results. There are signs the government has started doing this already, for example with the Inklings program for infants showing signs of autism in WA.
Support for life transitions - The Report found that teenagers and young adults with a disability continue to find it more difficult to manage key life transition - like going to high school, moving from school to higher education, or entering the workforce. The Review recommends funding programs and initiatives for young people with a disability, aged 9-21, to help them manage these transitions. These programs should be closely linked with the work of mainstream services, like employment and education.

Foundational Supports Strategy

The Review recommended developing a Foundational Supports Strategy. The Strategy would aim to make sure foundational supports are high quality and widely available. A Strategy can also help coordinate implementation across Australia, without it being a shitshow (my word, not the Review’s).

As mentioned in the introduction, the Commonwealth has committed $11.6m to the development of the Foundational Supports Strategy. It will be led by the Department of Social Services (DSS), working alongside the NDIS and States & Territories. The Review recommended that the Strategy be developed with an advisory group made up of DROs and people with disability.

According to the Review, the Strategy should aim to:

Ensure effective planning, coordination, and accountability
Reduce the funding cliff between those inside and outside the NDIS
Prioritise the supports that are needed most
Get buy-in from local governments
Support an effective and sustainable NDIS.

The Review also wants to see the Strategy include:

An outcomes framework
An implementation plan
Government mechanisms to ensure accountability.

Who doesn’t love accountability?

A media release from Minister for Social Services Amanda Rishworth and NDIS Minister Bill Shorten, says the Strategy will be presented to National Cabinet for approval in the second half of the year. So, they better get crackin’!

Accessing foundational supports

The Review envisions people being supported by their Navigator to access foundational supports. People also might be referred by the NDIA, DROs, carer organisations, mainstream services providers (like schools, hospitals, childcares) or community organisations. People with disability and their families should also be able to access these services directly, without support.

People over 65

People with disability over 65 might be feeling understandably a bit miffed that the Review recommends most foundational supports be available only to people under 65. The Review believes that people over 65 might be able to benefit from some foundational supports, like information and advice. Foundational supports should also work closely with the aged care system. However, they say the intention of foundational supports is not to replace aged care supports. The Review says people over 65 ‘should receive most of their supports from the aged care system, or a combination of the NDIS and the aged care system.’

That’s everything we know about foundational supports for the time being. But there’s likely more news on the horizon, particularly if they are going to get Foundational Supports Strategy done and dusted this year. We promise to keep you posted.

If you are partial to some further reading, you can find:

The NDIS Review Final Report
The Review’s Supporting Analysis - it’s a tome, but if you have the time, the details are worth it!
The Review’s fact sheet on foundational supports