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Last Friday, the Independent Review into the NDIS handed down its Interim Report, ahead of its final Report that’s due in October. It’s exciting times, as we’ve all been wanting a peek inside the heads behind this high-stakes Review. The Report includes a summary of the issues raised during the consultation process, and a call-out to the community for help developing solutions.
We can be damn sure that every topic identified by the Review will be the focus of considerable government and NDIA attention over the coming years. You only need to watch the NDIS Minister Bill Shorten when he’s asked a curly question in media interviews- he makes it pretty clear he’s expecting the Review to fork out the big answers.
The first part of the Report is dedicated to what the Review Panellist’s consider the top 5 most pressing challenges the Scheme faces. The second half explores the 10 areas of improvement raised during community consultations. Each section includes consultation questions focused on finding solutions. This Report in many ways marks a turning point, with the Review putting a line under ‘problems’ and a question mark next to ‘solutions'.
5 key challenges
The top 5 most pressing issues facing the Scheme, as identified by the Review Panel, are:
*drum roll please*
- Why is the NDIS an oasis in the desert? The Report notes that there are very few supports available for people with disability outside the NDIS. This is ‘deeply unfair’ and has significant impacts for Scheme sustainability.
- What does reasonable and necessary mean? Can you imagine a world where we are not constantly fighting over what’s reasonable and necessary? I find it easier to picture world peace, but that’s probably a failure of imagination on my part.
- Why are there many more children in the NDIS than expected? The Report speculates that this is partly due to higher than previously identified levels of disability amongst children and the lack of supports outside the Scheme. They also found that Early Intervention supports are not always best practice.
- Why aren’t NDIS markets working? The Review found that competition has not always produced ‘improved quality, innovation or diversity of services’ in all locations.
- How do we ensure that the NDIS is sustainable? Particularly, how can we provide certainty for participants and families that the NDIS will remain an uncapped, needs-based Scheme, while also ensuring costs are acceptable to the government and the public.
10 areas for improvement
The Report details the 10 areas of improvement that came up during the consultation process. While the bulk of the it focuses on what’s going wrong, the questions for the community centre around possible future solutions.
The 10 areas for improvement are:
1. Applying and getting a plan
The Review has heard that access and planning processes basically… well… suck. Applying to the Scheme is ‘confusing and difficult’, overly focused on diagnosis and people aren’t clear about what evidence is required. And once you are in the Scheme, the planning process often divulges into an argument. It also focuses on what people can’t do, rather than what they can. In both stages, participants are not recognised as the experts of their own lives, with a higher emphasis placed on expensive reports from specialists. These problems are exacerbated in First Nations or culturally and linguistically diverse (CALD) communities.
2. A complete and joined up ecosystem
As discussed above, there is not a cohesive system of support for people with disability outside the NDIS. Apparently in 2021-22, 93% of all disability funding went to the NDIS. The Report also says that more time is spent arguing over who should pay for what than figuring out how to make the entire ecosystem work (and ain’t that the truth!). Further, the Information, Linkages and Capacity Building (ILC) grants program ‘has not provided sufficient investment to match its ambitions.’ And Local Area Coordinators (LACs) and Early Childhood Partners have been unable to fulfil their community capacity building role.
3. Defining reasonable and necessary
As raised above, the Review has heard that there is not a shared understanding of what reasonable and necessary means. It touches on one of the curliest questions facing the Scheme: how to ensure the NDIA’s decisions are both individualised and consistent.
4. Early childhood supports
The Report says that early intervention is ‘frequently not best practice’, and that there are few incentives or mechanisms to ensure supports are evidence-based. Moreover, the needs of children and families are often not considered holistically, and there is not enough focus on supporting children and families in their everyday environments.
5. The support and service marketplace
The Report argues that there is a lot that’s not working in the NDIS marketplace. For one thing, participants and governments don’t really have a good way of figuring out whether a provider is delivering high quality services. Price caps are also criticised as a ‘blunt and non-transparent’ instrument, that does not incentivise innovation or supporting people with complex support needs. We also face issues with thin markets (which are markets where the supply of a support doesn’t match the demand) and workforce shortages.
6. Measuring outcomes and performance
The Report argues that we don’t have a good mechanism to measure how well the NDIS is working. Moreover, provider’s services are not measured or rated, making it hard to incentivise offering great supports.
7. Achieving long term outcomes
The Review has heard that the planning process is more focused on a person’s immediate needs, rather than the long term outcomes that might help them live a good life. The Report also says that in some instances, rather than fostering inclusion, the NDIS has led to an ‘an over-reliance on paid services and increased segregation and vulnerability.’
8. Help accessing supports
The Report says that the roles of intermediaries- like LACs, early childhood partners, support coordinators, plan managers and remote community connectors- ‘overlap, leave gaps and are confusing.’ People need the support of intermediaries because they do not have the information needed to independently choose providers. But because the NDIS is such a complex web of confusion, intermediaries spend most of their time helping people navigate NDIS systems, rather than connecting to their community or services. The Review also heard that in some cases working with intermediaries becomes ‘just another frustration.’
9. Supported living and housing
Home and living is one area where the Review is not pulling any punches. The Report says that contemporary housing models haven’t really got off the ground, and Supported Independent Living (SIL) homes where ‘there is significant risk of harm and abuse’ still dominate the market. Moreover, there is too much ‘large, old and poorly designed’ Specialist Disability Accommodation (SDA). Meanwhile the NDIA is not considering home and living in a holistic way and is making inconsistent planning decisions. All this is contributing to a situation where people are not able to ‘exercise enough choice and control over their living situation.’
10. Participant safeguards
The Report says that the NDIS has not done enough to ensure the safety of participants. Many people felt the system focused too much on compliance and box ticking. There also hasn’t been a focus on strengthening people’s natural safeguards by ensuring they have people in their life that care about them. And while some unregistered providers are offering very high quality support, the regulatory framework has not responded well to the growing unregistered market.
We’ve only provided a brief summary of the Report, you can find the full version here. Compared to other NDIS reports we've seen, its quite readable and they’ve had mercy on us by keeping it at 26 pages. It’s also peppered with questions about how we can actually go about solving these big, thorny issues. We all have things that we want to see change in the Scheme, and this is probably one of the best opportunities we’re going to get to have our voices heard. With the speed this year is moving, October and the Final Report will be here before you know it. So make sure you don’t let this chance pass you by!
