NDIS Minister Bill Shorten yesterday announced a “reboot” of Australia’s National Disability Insurance Scheme and six major areas of reform. Getting the NDIS back on track, Shorten said, will require reform across all disability services.
It’s a difficult time to announce an NDIS reboot. The federal budget is weeks away and, in the context of a cost-of-living crisis, some argue NDIS costs need to be reined in.
At the same time, two major pieces of work are underway and due to report later this year: the royal commission into violence, abuse, neglect and exploitation of people with disability; and the independent review of the NDIS exploring how it can be made sustainable over the long term.
Shorten has continuously said any changes to the scheme need to be guided by people with disability, meaning it would make it difficult to make announcements about substantive changes ahead of the review reporting.
So what do we know so far, and what are the key challenges to overcome?
Tackling bed block
Since Labor came to government last year, the government has made a number of changes to the scheme, including decreasing delays to NDIS participants being discharged from hospital.
Delayed discharge means a person is medically fit to be discharged from hospital but they cannot return home safely as appropriate supports are not in place.
In his speech to the National Press Club yesterday, Shorten explained that last year, NDIS participants in Victoria waited, on average, 160 days after they were medically fit to be discharged from hospital.
After significant action from the National Disability Insurance Agency (NDIA), this fell to a 29-day average wait to be discharged. This is a better outcome for the people involved and is estimated to have saved the health system A$550 million.
This shows the NDIS does not exist in a vacuum. How the NDIS operates has implications for the costs of mainstream services such as health and education – and, conversely, how mainstream services operate has implications for the NDIS and its costs.
6 ways to reboot the NDIS
The government will focus on six areas for reform to ensure the NDIS is fit for purpose, which won’t come as a surprise to those familiar with the scheme.
Very little detail has been announced about these reforms and in many cases we will need to wait for the independent review to report and outline precisely how these will be achieved.
1) Increase the size of the NDIA workforce, make sure staff are appropriately trained and the agency has the technology and capacity to do its work.
2) Move participants to longer plans, where appropriate, rather than needing a new plan every year. This will give participants more certainty and allow them to focus on making their current plans work.
3) Make sure all money is spent effectively. This means not spending on “shoddy therapies” and ensuring supports are evidence-based and benefits are maximised for participants.
4) Review supported independent living services. Around $10 billion of NDIS funding goes into these services each year and supports around 30,000 people with significant disabilities to live independently. Yet too often, they don’t support participants and families in the ways that they want. The Royal Commission has also heard significant abuse and neglect occurs in these settings.
5) Target misuse of NDIS funds. This involves targeting fraud within the scheme, but also unethical practices by some providers who overcharge for services or pressure people into spending money on services that they may not want or need.
6) Increase community and mainstream supports so people who aren’t eligible for the NDIS can access other services. This isn’t focused on the NDIS but the services that sit around it.
These six areas target many of the areas that are in need of reform within the scheme and some have already seen some initial reform attempts. The real question is how these will be delivered and whether there is genuine commitment to co-design with people with disability around these areas.
More to disability care than the NDIS
The NDIS was never designed to be accessed by all people with disability. The initial scheme design supported participants via a tiered system:
Tier 2 was for all Australians with disability and their carers by providing information and referrals to relevant services outside the NDIS (for example, mainstream services such as health and education). This tier also aimed to link people with disability into their local communities.
Tier 3 was designed for people with disability who have significant and permanent impairments. It provides access to specialised disability supports funded directly by the scheme and allocated via individual budgets.
While much of the attention on the scheme is around Tier 3 supports, a major driver of costs is a lack of investment in Tier 2 services. If we do not see adequate investment in mainstream and community services, such as in health and education, people with disability are more likely to require Tier 3 services.
The NDIS has been called the “oasis in the desert” where people need to get services and supports through the scheme because there is a lack of other mainstream supports available. Research shows 90% of disabled Australians who didn’t have NDIS funding and took part in the research were unable to access the services and supports they needed.
We have seen particular growth in the number of young people with autism and developmental delay entering the NDIS, far beyond what was originally projected at scheme design. One in ten boys aged between five and seven have an NDIS plan when starting school.
While this could indicate the original scheme estimates were not correct, it’s likely that a significant proportion of demand for scheme entry is being driven by a lack of other available supports through mainstream services.
The government seems committed to disability services reform but it won’t be quick or easy. It will involve more than just changes to the NDIS – we need a rethink of all disability services. And this can’t be done without people with disability who need to play a strong role in designing this new scheme.