The Government’s review of the National Disability Insurance Scheme was published this month. In the Working together to deliver the NDIS report, there are 26 recommendations with 139 actions to improve the scheme over the next five years.
The NDIS is jointly funded by the Australian, state and territory governments. The NDIS was established in 2013 to provide funding for reasonable and necessary supports for eligible people with disability. Funding for each NDIA participant is determined through the development of a participant plan, which sets out the participant’s goals and aspirations, the reasonable and necessary supports that they require and will be funded, and how that funding will be managed.
In 2022, the Government started an independent review to put people with disability back at the centre of the NDIS. The purpose was to restore trust, confidence and pride in the scheme. The review looked at the scheme’s design, operations and sustainability; and how to build a more responsive, supportive and sustainable market and workforce.
Minister for Disabilities Bill Shorten addressed the National Press Club this month and issued the NDIS Review report.
Nothing will change right away. The federal government’s full response to the review will be released next year. Even though an action is recommended in the report, it doesn’t mean it will be implemented by the Government, but we can be optimistic.
Shadow Minister for NDIS Michael Sukkar said the review left many questions unanswered.
“The government will now have to outline which changes they support and how they plan to transform these recommendations into tangible action.”
“There is still very little detail on how the Scheme’s 8 per cent growth cap will be met.
“Participants also remain in the dark on what the new Foundational Supports will look like, whether these will ever be comparable to the NDIS, and when these supports will commence.”
The NDIS should be one part of a big system that supports people with disability. The report’s recommendations provide a blueprint to renew the promise of the NDIS and deliver a more accessible and inclusive Australia.
The interfaces with mainstream sectors are critical to the success of the NDIS, given the Scheme’s defined goal of supporting inclusion and participation of people with disability in all areas of the community. Mainstream services like health, education, and transport, etc. work together with the NDIS but it will take champions in every government department and agency to raise all boats.
Green’s senator Jordan Steele-John says it is going to take years for these services to work for Australians with disability.
“Everyone agrees there must be strong services available to disabled people in the community and through the NDIS. However, we know that right now our education, health, housing systems are drenched in ableism. It’s going to take years for these services to be operational and work for disabled people. We will not accept NDIS supports being removed with nowhere for people to turn to.
“Today, our community’s message to the government is clear — we will not be your political football and we will not accept any changes that will make life worse for anyone in our community.”
Addressing the Accessibility and Affordability Gap.
The National Disability Insurance Scheme was created to provide individualised support to approximately one-in-fifty Australians, leaving the vast majority of the one-in-five Australians living with disability to rely on community-based foundational supports and mainstream services. The NDIS was intended to be a component of a larger ecosystem of support, fostering inclusivity and accessibility for all Australians with disability.
A recent study by the Melbourne Disability Institute revealed that 90 percent of people with disability, along with their families and caregivers, believe that existing supports and services outside the NDIS are inadequate in addressing the needs of people with disability. This disparity between those inside and outside the NDIS is inherently unjust. Those eligible for the NDIS have access to a wide array of tailored supports, while those ineligible struggle to find appropriate support to fulfill their needs.
The over-reliance on the NDIS can be attributed to decisions made during its initial rollout. The urgency to transition individuals into the scheme quickly overshadowed the needs of disability support systems outside the NDIS that all people with disability depend on for essential services.
It is true that throughout the past decade, governments substantially increased funding for disability services, but the bulk of this funding was directed towards their share of the costs of the NDIS, accounting for over 93 percent of all disability funding in 2021-22. Regrettably, these investments left people who are not eligible for the NDIS without the support they need.
It is imperative that individuals with disability not only have equal access to mainstream services and support but also affordable Foundational Supports tailored to meet their disability-related needs.
The first of the NDIS review’s 26 recommendations is a group of disability services, called Foundational Supports, outside the scheme and accessible to many more people with disability.
An article in The Conversation explains, establishing “…Foundational Supports outside the scheme is the end of a long battle – the states have cried poor, while the Commonwealth has insisted the NDIS cannot be the only source of services to people with disability. Many supports which have been sucked into the NDIS could be removed from the scheme and funded on a more sustainable basis.
“For example, providing services through schools and early childhood centres means more children get early intervention. These children might not need a NDIS plan but rather the reasonable adjustments these settings are already obligated to provide.”
Foundational supports could also include help with shopping and cleaning, or assistance navigating the system.
Bruce Bonyhady, one of the co-chairs of the NDIS review was on the ABC’s Afternoon Briefing program:
“[This would] ensure that all children receive the supports they need is early in life as they need them. It means that developmental concerns are going to get picked up much earlier in maternal child centres.
“This is about making sure that all children, whether they are in the NDIS and receive an individual package, or they are outside and don’t receive an individualised package, get the support they need to get the best start in life.”
Foundational supports would be jointly funded by the states and Commonwealth, and delivered via the health sector, early-childhood education and schools. National cabinet agreed they would be rolled out in 2024.
Making mainstream services available should curb escalating demand for the professional diagnoses and reports currently needed to get into the NDIS.
“More foundational supports will help the NDIS budget, too. If more disability services are available to people outside the NDIS, fewer people with disability will have to join the scheme to get what they need. It should mean people with higher intensity needs will be directed into the NDIS where they can get specialised services.”
Integrating GPs into the NDIS Improvement Process.
The Royal Australian College of GPs is concerned that the report falls short in its exploration of healthcare for individuals with disability, specifically in the context of general practice care.
One significant barrier is the absence of a Medicare patient rebate for NDIS paperwork. This places a substantial burden on patients, necessitating them to attend a consultation solely for administrative purposes. This issue becomes even more challenging for Aboriginal and Torres Strait Islander patients, who require additional paperwork to support their NDIS applications.
The Royal Australian College of GPs points out that better utilisation of GPs can enhance the efficiency of the NDIS. GPs possess in-depth knowledge of their patients and their unique circumstances. By enabling GPs to directly liaise with NDIS service providers, the right type of support can be ensured, and duplicated services can be avoided.
The Royal Australian College of GPs stresses the importance of strengthening connections between mainstream services and the NDIS. Greater collaboration between GPs, other healthcare professionals, and the disability sector is essential to prevent fragmentation of care.
Simplifying the NDIS application process is crucial, as GPs often spend significant time navigating red tape to help patients access the scheme. Integrating NDIS forms with general practice clinical information systems can streamline this process.
The report’s recommendation for improved access for Aboriginal and Torres Strait Islander patients is also endorsed by the Royal Australian College of GPs. This has been a consistent call, particularly since these individuals face unique barriers in accessing support services. Culturally safe disability services and supports are essential to address their specific needs.
Better Systems Navigation for People Inside and Outside the NDIS.
Australian Federation of Disability Organisations was happy to see the review report recommend the creation of a way for all people with disability to navigate mainstream, foundational and NDIS service systems. The intended purpose of the ‘Navigator’ arrangement is to support people with disability under the age of 65 who are not eligible for the NDIS, as well as NDIS participants and their families.
“(However,) It is imperative that equivalent navigation services are also available to people with disability over the age of 65 to ensure equality of opportunity.”
Lack of Attention to Systemic Advocacy.
Australian Federation of Disability Organisations believes it is imperative that systemic advocacy is adequately funded into the future.
“While the report itself does include a few passing references to aspects of the intended reforms being informed through “co-design”, the term is not used anywhere in the list of recommendations and supporting actions. While some of the supporting actions do refer to “consultation”, there is no reference to the need to consult with disability representative organisations and disabled persons’ organisations. This goes against the aspirations of the Convention on the Rights of Persons with Disabilities.”
Urgent Attention Needed for Workforce Challenges.
The disability sector is currently facing significant financial challenges, compounded by chronic workforce shortages. The successful implementation of reforms relies on the existence of a viable disability sector. Unfortunately, the latest figures indicate that this is not the reality, as many providers grapple with financial sustainability challenges.
There is a call for the establishment of a NDIS Reform Implementation Taskforce and recommendations for the creation of an NDIS Review Implementation Advisory Committee. This advisory body, led by individuals with disability, their representatives, providers, and critical stakeholders, along with government funding, is essential to ensure a co-designed, safe, and practical implementation of the proposed reforms.
The announcement of an independent pricing mechanism is also welcomed. Claims of price gouging by some providers damage public confidence in the scheme.
Exclusion of people who acquire a permanent life-altering disability after their 65.
If you acquire a disability after the age of 65, the National Disability Insurance Scheme will not fund you.
NDIS recipients receive more in support on average than My Aged Care recipients.
“There are people in the community who say that the quality of disability care after the age of 65 is inferior to the quality of disability care before 65,” NDIS Minister Bill Shorten told reporters early this year. “I think they have a point.”
“[The] NDIS, despite all of its challenges, is still a scheme that looks better for people in aged care than what they have.”
“There is a challenge for disability care for over 65, whether or not the solution’s an NDIS – which is very expensive – or an improvement in the quality of disability care and aged care. That will be a matter for the whole of the government.”
It is vital that the NDIS eligibility criteria be reviewed so that it is targeted to the broader ageing population.