NDIS Minister Bill Shorten yesterday announced a “reboot” of Australia’s National Disability Insurance Scheme and six key reform areas. Getting NDIS back on track, Shorten said, will require reform of all disability services.
It’s a tough time to announce an NDIS reboot. The federal budget is still weeks away and, in the context of a cost-of-living crisis, some argue that NDIS costs should be capped.
At the same time, two major works are underway that will be reported later this year: the royal commission to violence, abuse, neglect and exploitation of people with disabilities; and the independent assessment of the NDIS exploring how to make it sustainable in the long run.
Shorten has consistently said that any changes to the scheme would need to be led by people with disabilities, meaning it would be difficult to make announcements about substantive changes ahead of assessment reporting.
So what do we know so far and what are the key challenges to overcome?
Addressing bed blockage
Since Labor entered government last year, the government has made a number of changes to the scheme, including fewer delays in the discharge of NDIS participants from hospital.
Delayed discharge means that a person is medically fit to be discharged from the hospital, but cannot return home safely because there is no suitable support.
In his address to the National Press Club yesterday, Shortening explained that last year NDIS participants in Victoria waited an average of 160 days after they were medically fit to be discharged from hospital.
Read more: NDIS participants wait too long in hospital beds due to bureaucratic delays
After sweeping action by the National Disability Insurance Agency (NDIA), this dropped to an average wait time of 29 days to be discharged. This is a better outcome for the people involved and has saved an estimated A$550 million for the health system.
This shows that the NDIS does not exist in a vacuum. How the NDIS works impacts the cost of regular services such as healthcare and education – and, conversely, how regular services work impacts the NDIS and its costs.
6 ways to reboot the NDIS
The government will focus on six areas of reform to ensure the NDIS is fit for purpose, which should come as no surprise to those familiar with the scheme.
Very few details have been announced about these reforms and in many cases we will have to wait for the independent evaluation to report back and indicate exactly how they will be achieved.
1) Increase the size of the NDIA workforceensure that staff are properly trained and that the agency has the technology and capacity to do its job.
2) Move participants to longer plans, where appropriate, rather than needing a new plan every year. This gives participants more certainty and allows them to focus on making their current plans succeed.
3) Make sure all money is spent effectively. This means not spending money on “bad therapies” and ensuring that support is evidence-based and that the benefits for participants are maximized.
4) Rate assisted independent living. Each year, approximately $10 billion in NDIS funding goes to these services and supports approximately 30,000 people with significant disabilities to live independently. Too often they don’t support participants and families in the way they want. The Royal Commission has also heard that there is a lot of abuse and neglect in these environments.
5) Target misuse of NDIS funds. This includes tackling fraud within the scheme, as well as unethical practices by some providers who overcharge for services or pressure people to spend money on services they may not want or need.
6) Increase community and mainstream support so that people who do not qualify for the NDIS can access other services. This is not aimed at the NDIS, but at the services that surround it.
These six areas focus on many of the areas to be reformed within the scheme and some have already seen some initial reform efforts. The real question is how these will be realized and whether there is a genuine commitment to designing around these areas with people with disabilities.
Read more: Everyone is talking about the NDIS – we spoke to participants and asked them how to solve it
More to disability care than to the NDIS
The NDIS was never designed to be accessible to all people with disabilities. The initial scheme design supported participants through a tiered system:
Tier 2 was for all Australians with disabilities and their carers by providing information and referring them to relevant services outside the NDIS (e.g. mainstream services such as healthcare and education). This level also aimed to link people with disabilities to their local communities.
Tier 3 is designed for people with disabilities who have significant and permanent limitations. It provides access to specialist support for people with disabilities funded directly by the scheme and allocated through individual budgets.
While much of the attention for the scheme is on Tier 3 support, a major driver of costs is a lack of investment in Tier 2 services. If we don’t see adequate investment in mainstream and community services, such as in health care and education, people with disabilities are more likely to need Tier 3 services.
The NDIS has been called the “oasis in the desert” where people need services and support through the program because of a lack of other mainstream support. Research shows 90% of disabled Australians who did not have NDIS funding and participated in the study did not have access to the services and support they needed.
We mainly see growth in the number of young people with autism and developmental delay entering the NDIS far beyond what was originally projected when the scheme was designed. One in ten boys between the ages of five and seven have an NDIS plan when they enter school.
While this might indicate that the original estimates of the scheme were incorrect, it is likely that a significant portion of the demand for participation in the scheme is due to a lack of other available support through mainstream services.
The government seems determined to reform disability care, but it won’t be quick or easy. It’s about more than just changes to the NDIS – we need to rethink all disability services. And this cannot be done without people with disabilities who have a strong role to play in designing this new scheme.
Read more: What the NDIS needs to do to restore trust, in the words of the people who use it