:format(webp))
The NDIS has reached a crucial point in its history. The sector is now at the bottom of a hill, ready for the avalanche to hit as we wait to uncover how the political class will attempt to alter the Scheme. Both major parties have flagged significant changes, just 12 months away from a scheduled election. While we are all in the brace position picturing worst-case scenarios, now is as good a time as any for reflection. July 31st will mark a decade since the Productivity Commission released its report recommending the NDIS. Inspired by Team DSC’s podcast with one of the Scheme’s architects, John Walsh, I recently revisited the report. On the surface, it seems a lot has changed in the intervening decade. On closer inspection, though, some of the same problems remain.
In particular, the Executive Summary of the Productivity Commission Report provides proof that the same policy implementation problems that the disability sector has constantly confronted remain. The opening paragraph reads: “The current disability support system is … inefficient.… People with disabilities, their carers, service providers, workers in the industry and governments all want change.” Sounds familiar, doesn’t it?
One section of the summary highlights the inequities of the disability sector before the NDIS. In a table titled “Overcoming the Problems of the Present System,” the Commission identifies the problems of state government-run disability policy and how the Scheme as designed would address these issues. The table cites the disempowered and devalued role of families and carers, insufficient engagement with the community, inefficient and weak governance, and little future planning as key barriers to effective policy development. If Minister Reynolds wants to develop IAs that work, she should look at that table and evaluate how IAs will fix the problems it identifies.
It is notable that the problems highlighted in 2011 – the same ones the sector is facing now – are not the responsibility of individual participants or even a group of participants. These are all bureaucratic issues that are complex but can be remedied by thoughtful policy development. Yet, the problems are no closer to a solution. What is getting lost in the policy translation?
It is easier to identify the problems of the Scheme than it is to provide sustainable solutions. How do we change decision-making on the fundamental level so there are more positive outcomes for participants? Positive results for participants and their families lead to efficiencies. After all, if they are satisfied, participants are less inclined to question decisions, which leads to less paperwork, fewer reassessments and reports, and the elimination of procedures, ultimately reducing the need for bureaucracy and cumbersome systems. The Coalition Government may have to outlay some of these costs initially. Still, these efficiencies are economically sustainable, which was one of the critical tenets of the NDIS in the first place. However, governments do not tend to plan beyond election cycles.
The initial NDIS rollout is complete. Many of the approaches that evolved during the rollout phase were designed to facilitate the transfer of state-based systems into the NDIS. The sector is now embarking on what is effectively another monumental period of change. Cutting the wrong elements of the Scheme and threatening how individual plans are assembled is not the way forward. However, there is scope to change some of the Scheme’s critical principles.
All policy frameworks need constant evaluation. Part of this process involves returning to the principles created during the initial phases of the policy cycle and measuring them against how they are used in contemporary practice.
Before researching this article, I had not revisited the Productivity Commission report for many years. Rereading it was an eye-opening experience because it demonstrated how far the Scheme has wandered off its intended path. Sometimes this deviation has been positive, but it also allows the Government to argue that the NDIS is not achieving its aims.
A look at some of the key planks in Table 1.1, “Problems of the Present (State Government-run) System,” in the Executive Summary of the 2011 report provides an excellent guide to seeing what issues remain concerning.
WHAT IS “REASONABLE AND NECESSARY”?
The concept of “reasonable and necessary” could be revisited, as its original intent appears to have been diluted. According to the Productivity Commission report, “reasonable and necessary” was intended to provide certainty for disability planning because:
People with disabilities and their carers do not get the certainty of lifelong support needed for proper life planning and cannot avoid the extreme anxiety about the adequacy of future funded support…
The quote above puts the original intent of “reasonable and necessary” in an entirely different context, separate from how it is used by participants themselves – including me – support coordinators, and allied health professionals.
The “reasonable and necessary” wording was initially derived from acting as part of the often neglected “Insurance” part of the Scheme, which was modelled on the New South Wales and Victoria programs that were developed long before the NDIS was introduced. According to its original definition, as outlined in the quote above, “reasonable and necessary” represented the minimum amount of support required for a participant. Through a decade’s worth of implementation, this component’s intent appears to have been distorted. “Reasonable and necessary” has gone from an assessment tool for finding a basic level of support to a “test” that ascertains whether that support is required.
ECONOMIC SECURITY AND SUSTAINABILITY
In 2011, the Productivity Commission argued that handing over the provision of disability services to the federal government was one of the significant benefits of the NDIS. Theoretically, the NDIS would allow funding to be streamlined, as the disability sector was stalled by duplications in the state and federal bureaucracies. A more straightforward system would transform the disability funding system from being “crisis based” to one that would also provide certainty. Nationalising funding would also allow the federal government to have greater control over spending in the long term. This control over financing has yet to come to pass, according to the prime minister.
Part of this is unavoidable. The NDIS will continue to remain a large-scale policy, and governments are not used to implementing or maintaining policy systems of such complexity. Parallel to these challenges, those directly involved with the Scheme often feel like funding is about to be taken away. The Productivity Commission was particularly strong in arguing that the NDIS was not the only tool in developing disability policy but one significant part in a suite of disability policies outlined in the National Disability Strategy. Where has that strategy gone?
Sustainable funding of the NDIS is a challenge that needs to be addressed immediately. The Productivity Commission report stipulated it is at the discretion of the federal government to determine sustainable funding. The Commission did not have specific powers to determine how the NDIS would be funded in the long term, leaving the Scheme vulnerable to cuts. The lack of specificity in long-term funding makes service delivery and funding commitments subject to the political cycle between elections, leaving integrity subject to political posturing.
The Morrison Government has continually flagged that it is not comfortable with the Scheme’s sustainability in its current form. The recent 2021-22 Federal Budget announced a further $13.2 billion worth of funding over four years to cope with growing demand. This announcement acts as a placeholder until the next federal election campaign when both major parties will need to come up with long -term solutions to address the growing angst over escalating costs while continuing to ensure the Scheme is effective for its participants.
FEEDBACK
The other problems that the Productivity Commission addressed in its Executive Summary are more nebulous and cannot be easily addressed with specific policy measures. Participant and advocate satisfaction rates are hard to quantify because they rely on anecdotal evidence. The way to convert these subjective measures into objective data is to have regular large-scale consultations that measure participant satisfaction precisely and comprehensively. To some degree, the Agency has begun this process. Still, the individual planning process should include a more explicit opportunity for participants to provide feedback on their previous plans, which can be adequately measured.
CONCLUSION
A lot of positive reform has occurred in the disability sector over the past decade. However, the NDIS needs another comprehensive and systematic review for these changes to last for decades to come. In 2011, the Productivity Commission advised that an NDIS was a bold yet complex path to reform the disability sector. A decade later, the problems appear to be even more challenging. There are no easy answers, but further change is necessary to ensure the Scheme’s long-term viability.
