The Productivity Commission has released its report on Disability Care and Support, which recommends the creation of a National Disability Insurance Scheme (NDIS) to provide insurance cover for about 410,000 people with significant disability.
The Scheme will be overseen by a newly created National Disability Insurance Agency, which will provide assessments and funding to individuals and to organisations.
Calling for the scheme’s funding to be a core function of government, the report says the aim of the NDIS is to fund long-term high quality care and support but clarifies the insurance will not act as income replacement.
Other roles of the NDIS include creating better links between the community and people with disabilities and providing information to help break down stereotypes, ensure quality assurance and best practice among providers.
The Report also proposes the creation of National Injury Insurance Scheme (NIIS) to address serious injuries from accidents. This Scheme will entail a set of state-based, no-fault arrangements that will provide a lifetime of care and support by building on existing state-based initiatives. It will have the same basic goals but is to be funded differently.
What are your impressions of the Report?
There are some important changes between this final report and the draft and that’s the inclusion of people with psychiatric disability. This takes the number of people who will benefit from the Scheme from about 380,000 to 410,000 but that’s shown to not really have a negative economic impact.
It also recommends a public inquiry of the disability support pension, to bring it into greater alignment to the goals of the NDIS. It suggests that the inquiry look at the current disincentives for people wanting to join the workforce.
One of the strengths of the Report is that there’s more in it about community engagement and support to get pople in the community to engage with people with disabilities, so it’s looking at both sides.
There’s much greater emphasis on community participation and engagement and the community capacity building required to achieve this.
This is a fantastic outcome and a really good report. One of the small changes is that the previous report talked about case managers and that’s now changed to local area coordinators. This latter model has been shown to be successful in Western Australia in terms of getting people into local communities and working with the community.
Why do we need a scheme like this?
As the Report states, the current disability system is underfunded, fragmented, unfair and inefficient.
I think this accurately captures the experience of people with disabilities and their families, as well as what research has shown over the last 20 years. And obviously it needed changing.
What are the current arrangements for people who need a high level of care and support?
Currently, there’s a split of responsibility between the states and the Commonwealth under the national disability agreement, which tries to set the overarching policy but funding is variable between states.
There’s also a high level of unmet demand and the quality of arrangements and assessments are different in different states.
Eligibility varies between states, so there’s no commonly accepted access or entitlement to get services and support that meet your needs.
The Report acknowledges the benefits of a national scheme for people’s well-being as well as in terms of economics, which is also important.
The Report emphasises tailoring support to individual need, how much of an impact will this have?
If you take a 40-year-old person with an intellectual disability who’s living with an 80-year-old parent, for instance. This Scheme means she has the right to be assessed to see how she wants to live her life – whether she wants to continue living at home with support or move out and gain more independence perhaps by living with one or two other people in the locality where she has always lived, or in a small supported accommodation setting. Giving people this choice is very important.
The changes might also mean she could stay in the family home with the right to support when her parents pass away. At the moment, this person gets very little until her parent passes away and she’s in a crisis. It’s impossible for her to plan for her future.
It will also mean that her needs could be re-assessed as she gets older so it’s a dynamic process that takes you through a life course and this is obviously an improvement from the current system.
The Scheme promises to stop people falling in the cracks between the various service systems used by people with a disability: aged care, health, transport, housing and so on, by high level agreements.
How likely is the Government to accept the Report’s recommendations – what is the likelihood of the recommendations being watered down?
It’s clear that the government has taken the first step towards implementation by providing funding to work out the technical details and how it’s going to work with the states and territories; that’s fantastic.
There’s no outright commitment to it but the Government is clearly taking the first step toward implementation by saying they’re going to start the ball rolling.
Can the Australian Government afford to implement the Report’s recommendations?
They have to afford to be able to implement it because of there’s enormous public support that’s been voiced around it.
They’re saying 410,000 people will be affected but indirectly it will affect the whole community.
There’s been an enormous public campaign and politically, it’ll be hard to go back – there’s bipartisan support for it.
The government can afford anything – it’s about priorities.
The Report mentions another option would have been to increase disability funding and that was to preserve the current arrangement and add more funds. Why is this not one of its recommendations?
The current system fails to provide certainty about support or early intervention.
At the moment, there’s enormous variation between states and continuing the current system wouldn’t overcome fragmentation.
The system needs reforming so that it’s based on individual choice and individualised funding. This is a fundamental reform of the way services are delivered and it puts the person with the disability at the centre.
A separate no-fault National Injury Insurance Scheme is recommended for people needing lifetime care and support for catastrophic injuries. This will be funded differently – how likely is this to come about?
I think it’s very likely. A number of states already have their own systems.
This Scheme would be for a smaller group of people. The idea is that each state brings their system into line but runs it by itself. But NDIS will be a national system that’s funded by the Commonwealth Government and administered by an independent National Disability Insurance Authority.
Some have voiced concerns that shortfalls in accommodation and disability support staff and technology will block the implementation of the Report’s recommendations. How likely is that?
The scheme will include specialist accommodation for people with disability. So it’ll be funding some accommodation for people with a disability and won’t rely totally on access to mainstream social housing. Though of course, people with a disability will also have a right to be tenants in the social or private housing markets.
There’s a set of recommendations in the Report about paying attention to workforce training and recruitment. The Productivity Commission clearly recognises that these are issues that need to be dealt with.
The Productivity Commission draws on the experience of New South Wales about having a media campaign around the role and value of working with people with a disability. This goes toward changing community perceptions of support workers – towards making the role a valued rather than a devalued one.