Breaking: Summary of the NDIS Review's major recommendations

At long last! The Final Report of the NDIS Review has been publicly released. If you’ve clicked on this article, you probably don’t need to be told this is a big deal. But hell, let’s say it anyway, loudly for those at the back: this is a big, big deal. Some of the changes proposed are monumental. However, it's important to note that this is just one milestone in a long process.

We still don’t know what recommendations will be accepted, what legislation will get through, and what the final product will look like. However, in his National Press Club address today, NDIS Minister Bill Shorten did emphasise that these recommendations must be considered as a whole package.

For context, Minister Shorten established the Review in October 2022. Its remit was to investigate the major issues facing the NDIS, including poor participant experience, the interaction between the NDIS and other parts of government, market stewardship, quality and safeguarding, Scheme sustainability, the breakdown of trust, and pretty much anything NDIS-related you can think of!

This is a mammoth report, and every element of it demands proper attention. In the coming months, we’ll be diving into it in much more detail. Make sure you are subscribed to our mailing list to stay informed (there’s a subscription box at the bottom of the page).

In the meantime, here’s a summary of the Report’s recommendations.

1. Develop a unified system of support for people with disability

Foundational supports

Whether your preferred metaphor is an oasis in the desert or the only lifeboat in the ocean, it's widely accepted that there’s a shortage of support available for people not eligible for the NDIS. Research from the Melbourne Disability Institute has recently found that the Information Linkages and Capacity Building (ILC) program spends the equivalent of $33 a year on people with disability outside the Scheme, which in 2023 supermarket prices is the equivalent of about 1 packet of pringles.

There will be two types of foundational supports:

General: Things that all people with disability can access, including Information, advice and capacity building, systemic advocacy, peer support, disability employment services.
Targeted: For people with lower level support needs who are not eligible for NDIS. Supports can include:

Home and community care
Aids and equipment
Psychosocial supports
Early intervention for kids with developmental delays
Support for young people navigating key life transitions
Support navigating all these supports

Yesterday, National Cabinet reached a landmark agreement that will see the Commonwealth, states and territories all pitch in to fund foundational supports. Shorten described it as an example of political systems actually working. You can read more about the deal here.

Improve the participant experience of the NDIS

The NDIS Review partly came about because many people with disability were reporting rather poor experiences of the NDIS. The NDIS Review has recommended a number of changes to the participant pathway, including:

Access and Eligibility: More consistent and robust methods for making eligibility decisions and measuring functional capacity and creating a new access form and guidance materials.
Assessments: Develop a new assessment process to better evaluate a person’s support needs. At the Press Club, Minister Shorten emphasised that this process would be very different from the Independent Assessments proposed by the last government. Assessments would be conducted by a Needs Assessor, who is a trained allied health professional, social worker, or has similar disability expertise. The Needs Assessor would be the funding decision-maker. The assessments would not be time limited and participants would have an opportunity to provide input on the findings.
Planning:
- Setting budgets at a whole of plan level, rather than line-by-line
- Plans will be made of three components: flexible budget (based on assessments), home & living, and one-off assistive technology and capital
- Adopt a trust-based approach to oversight of how people use their budget (can’t wait to see how certain not-to-be-named-for-legal-reasons parts of the media respond to that)

You best believe we’re going to be covering this in more depth soon! Keep an eye on your inbox.

Replacing Support Coordinators, Local Area Coordinators (LAC) and Psychosocial Recovery Coaches (PRC)

One of the most substantial recommendations in the Report is replacing existing Support Coordination, LAC and PRC services with the introduction of a new ‘Navigator’ function. The Navigator role underpins many of the other recommendations, with a much greater focus on support and people outside the NDIS than our current intermediary roles. Here’s what has been proposed:

Navigators would be responsible for things like supporting NDIS participants and other disabled people to connect with mainstream services, apply for the NDIS, implement their NDIS plans and more.
Specialist Navigators would be responsible for supporting people with more complex life circumstances
They would be commissioned and funded by NDIA, outside of participant plans (likely by tender). The idea of this is to allow the amount of support to flex up and down as people need it, rather than the current set up of a fixed number of hours set in advance.
Psychosocial support and support to navigate home & living would be additional services Navigators provide
Every NDIS participant would be able to access a Navigator
There is a strong focus on Navigators being local to their communities, based out of ‘hubs’ where possible and with strong local connections
They would be independent from other service delivery, and would have nationally consistent governance, branding, online services, information management, monitoring and training.
There would be a gradual transition to this new approach, including significant consultation with the sector, pilots and efforts to transition the existing support coordination and LAC workforce to this new model. Read more detail here.

Making mainstream services a hell of a lot better for people with disability

It’s probably not that controversial to say that support for people with disability delivered by other government departments, such as Health, Justice, Education, etc, have, as a general rule, sucked (our words, not the Review’s). People with disability have become increasingly reliant on the NDIS because the rest of the government has let them down.

Consequently the Review recommends:

Improve educational outcomes for children with disability
Allowing NDIS participants who turn 65 to receive funding for support through aged care and NDIS at the same time
The Commonwealth, states and territories develop unified and contemporary disability rights, inclusion and discrimination legislation- this relates quite well to the Disability Royal Commissions recommendation for a Disability Rights Act.
Build out the National Injury Insurance Scheme as designed by the Productivity Commission
All of government adopts Disability Impacts Assessments
A Disability Intergovernmental Agreement to replace the Applied Principles and Tables of Support (RIP APTOS?)
A strategy to improve the ecosystem for First Nations people with disability
Cease the use of ‘in-kind’ arrangements in the NDIS

Better support for decision-making

The Review has recommended that people with disability receive more support to make decisions about their lives. People should be provided with more accessible information and capacity building support. Plan nominees should also be provided training, and there should be more oversight over their decisions.

Support for children

The Review wants to see more support available to children in their own environments. It says a joined up continuum of support for children with disability and developmental concerns is an urgent priority for all governments - which is probably why much of this started to be introduced in October:

At the base of this continuum is mainstream support including proposals for national developmental monitoring and screening (reducing the need for expensive assessments) and inclusion in early childhood education and care and schools.
Layered on this would be foundational supports of capacity building for families and evidenced-informed best practice supports.
Specialist support from the NDIS would still be available to those with higher support needs but should be accessed through a fairer and more transparent access process. The Review wants children to receive a budget based on support needs determined through child-centred assessments rather than being driven by diagnosis.

The Report iterates that early intervention supports for children should be based on the evidence of what works to give children and families their best life and recommends:

All providers of capacity building support in the early childhood approach be registered to ensure uptake of best practice.
This would be complemented by a consistent approach to ongoing monitoring and evaluation of the effectiveness of early intervention for children.

Supports for people with psychosocial disabilities

The Review recommends changes to how the NDIS supports people with psychosocial disability, particularly to ensure a focus on personal recovery and independence. At the Press Club, Minister Shorten did emphasise that people with psychosocial disability will continue to be supported by the NDIS.

The majority of people with psychosocial disability entering the NDIS would enter through a specialised early intervention stream and transition to “lifetime supports” if and when it’s appropriate
Providers of psychosocial supports must be registered and will have to comply with a new specific Practice Standard
Greater coordination with public mental health care

The Review also recommends all of government improve supports for people with psychosocial disability, including as part of foundational supports.

Home and Living

The Review had a number of changes to Home and Living, many of which have been quietly introduced already over the last little while. Recommendations include:

A new Practice Standard should be introduced to mandate the separation of housing and tenancy
Changing the budget setting process to make sure it is ‘consistent and sustainable’, with the recommendation that funding for participants requiring 24/7 living supports should typically be based on an average shared support ratio of 1:3
People should only be funded to live alone (no shared supports) in specific circumstances such as where there is evidence of risk to self or others from living in a shared arrangement, participants with dependent children, and those with very complex needs.
Creating a process where people can try living arrangements before committing to them
Creating a function that allows people sharing supports to exercise joint decision making and pool their funds
Removing the Improved Livability Specialist Disability Accommodation (SDA) design category and review the other categories. Additionally, to create a new SDA category for people living in shared accommodation but not eligible for other categories.
The NDIA, in collaboration with states and territories, should commission SDA when needs are not being met by the private market.
All governments should develop a strategy for ‘upgrading or repurposing’ ageing SDA stock owned by states & territories.

2. Markets and support systems that empower people with disability

Investments in technology

There are multiple recommendations relating to suggested technology improvements for the NDIS, including a centralised platform for finding supports and a fully electronic payment system that would allow people to pay all providers, regardless of their registration status.

Plan management

The Review suggests that the introduction of this digital payments system will reduce the need for plan managers over time, with a strong implication that they will not be needed at all once the system is fully operational. This is major news for plan management providers. It’s important to stress here that the Review has been clear that these changes will not happen overnight and should be “coordinated well and communicated clearly and early”.

Pricing

The key recommendation on pricing is that the NDIA should hand over responsibility for pricing to the Department of Social Services and the Independent Health and Aged Care Pricing Authority (IHACPA). The Review suggests that these bodies establish a new pricing and payments framework that takes less of a ‘one size fits all’ approach to better reflect the costs associated with factors like supporting people with more complex needs, in different regions, in group-based settings, training, workers compensation, liability insurances and other indirect labour costs. The Review did not make specific recommendations on the price limit of any supports.

Risk-proportionate regulation

The Review has answered the sector's calls for more proportionate regulation, proposing four broad categories of regulation based on risk. In today’s Press Club address, Minister Shorten didn’t mince his words in stating that the NDIS will no longer continue to pay unregistered providers. The new proposed approach would require all providers to either be registered or enrolled to work in the NDIS. If implemented, here’s how it’s gonna work.

Advanced registration: At the highest end of the regulation scale we have advanced registration where supports are considered high-risk or require high-level technical competence. For example supports delivered in high-risk settings such as group homes. These providers would be required to have observational audits against both general and support specific standards - we imagine this would look similar to the current approach of core plus specialist modules.
General registration would be for medium-risk supports, applying graduated approaches to regulatory requirements based on risk including observational and/or desktop auditing. For example: High intensity daily personal activities and supports that include significant 1:1 contact with participants.
Basic registration is proposed for all lower-risk supports, applying lighter-touch registration requirements that sounds similar to the current verification pathway. Though the services that are in scope look to be far wider and include sole traders and smaller organisations, social and community participation, and those who have limited 1:1 contact with participants. The Review suggests this basic registration would be based on a self assessment and attestation of compliance with Practice Standards rather than an audit, which will no doubt be welcome news for many of the small guys.
Enrolment is a new alternative to registration and would be a simple light-touch online process for providers of the lowest-risk supports to enable full visibility of the market. Minister Shorten confirmed in his address today, that the intention is for all service providers to be visible to the NDIA and NDIS Commission (or new body - more on that later). The Review says this would apply to supports where general protections under Australian Consumer Law are sufficient, such as consumables, equipment, technology, and home and vehicle modifications.

Mandatory Worker Screening

Under the current system only workers of registered providers in risk assessed roles are required to undergo mandatory screening. Under the proposed NDIS 2.0 this would continue to apply to all registered providers (with a wider registration net across the three above categories), as well as to workers of enrolled providers that directly deliver specified services or have more than incidental contact with people with disability.

Mandatory NDIS Practice Standards

Currently all providers are required to comply with the NDIS Code of Conduct, under these proposals all providers would also need to comply with the NDIS practice standards (noting not all providers will be audited as above).

Reduction and elimination of restrictive practices

The Review has called on efforts to urgently reduce and eliminate the use of restrictive practices.

It wants to see a joint government plan to collaborate and enforce corrective action against providers that use restrictive practices as well as review practices that may be harmful. This would align with the National Framework for Reducing and Eliminating the Use of Restrictive Practices in the Disability Service Sector.
It calls for immediate action to enable sharing of information, nationally consistent authorisation, banning prohibited practices and stronger compliance action against providers inappropriately or illegally applying restrictive practices.
Key priorities include working with behaviour support practitioners and providers to urgently improve the quality of behaviour support plans, enhancing quality of life for participants and eliminating poor provider practices.
A clear action plan is needed that prioritises practice leadership, behaviour support practitioner capability uplift, ensuring that regulatory and market settings support best practice.
The Review says there needs to be further consideration of alternative models for funding providers to develop and implement behaviour support plans to ensure timely access and adequate funding for quality behaviour support.

Regulating the full ecosystem

The Review calls for a Disability Support Ecosystem Safeguarding Strategy to coordinate safeguarding activities across the disability support ecosystem (including foundational supports) with strong connections to mainstream regulators.

They have recommended that a Disability Supports Quality and Safeguarding Framework supersede the 2016 NDIS Quality and Safeguarding Framework to provide full oversight
The NDIS Quality and Safeguards Commission to be expanded to a National Disability Supports Quality and Safeguards Commission which regulates all Australian Government funded disability supports.

3. Stewardship of the united ecosystem

Going way beyond the bounds of the NDIS, the Review recommends changes to the way that governments collaborate on disability to ensure every dollar of disability funding is well spent and delivers benefits for people with disability. To achieve this, the Review proposes the creation of a new Disability Intergovernmental Agreement (IGA), which would include:

Shared responsibilities for an inclusive and accessible Australia consistent with the UNCRPD
Clearer funding arrangements in a new multilateral Federation Funding Agreement, reinforcing shared accountabilities for mainstream services, foundational supports and the NDIS
Rebalanced incentives, roles and responsibilities across governments to ensure risk and investment is shared
Creation of an independent body and processes modelled on Closing The Gap, including people with disability to report on progress meeting government commitments and on creating an inclusive Australia
A dedicated schedule that shows how governments will prioritise and uphold commitments to First Nations people under the National Agreement on Closing the Gap and UNDRIP
A performance reporting framework to measure agreed performance targets in the Disability Support Outcomes Framework

A proposed Disability Outcomes Council would independently hold all governments accountable for investment, delivery and outcomes, and give people with disability certainty that the right supports are available when they need them.

The Review also calls on all governments to invest more in research, evaluation and knowledge translation. This will help demonstrate the value of the NDIS to governments and taxpayers and help participants meet their goals through innovative and evidence-based supports.

4. A five year transition

The Review has recommended that the government learn from the rollout of the NDIS, which was criticised for its focus on short term targets and unrealistic deadlines. They suggest a five - year transition period for their recommendations, and a careful focus on the sequence with which changes are implemented.

Some recommendations that they highlighted for short term action include foundational supports, updating access guidance, and workforce measures.

They also suggested the process should be genuinely designed with people with disability, and that existing participants should have a smooth transition.

Wow! What a day. We imagine you’re all feeling the big emotions, and all of this will take a while to process. But remember, we’re just at the beginning of a very long journey. And while we have some idea what the final destination will be, there are sure to be changes and reroutes along the way as things are tried, tested and evaluated.

Keep an eye on your inbox, because we’re going to be covering all of this in a lot more depth soon.

And you can read the full report here, including an Easy Read version, guide for participants and families, and supporting analysis.

You can also watch the Press Club address here. And look out for Sara, the blurry red dot in the corner of the crowd.