For an inclusive needs-driven National Disability Insurance Scheme

August 13, 2021
The main problem with the NDIS is that it is being funded according to neoliberal priorities. Photo: Moritz320/Pixabay

The National Disability Insurance Scheme (NDIS) purports it will “support a better life” for hundreds of thousands of people with “a significant and permanent disability and their families and carers”.

It says it will mean “peace of mind” for every Australian and “anyone who has, or might acquire, a disability”.

However, since its launch in 2013, the NDIS has failed to meet even this basic goal.

Graham Matthews, Steve Warren, Terry Townsend and Lisa Macdonald argue that while they suport greater funding for the NDIS they oppose its market-based service delivery model. They wrote the following policy for the Socialist Alliance

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While we welcome more funding for disability services and support the principle of self-directed and individually-tailored supports, we oppose the market-based service delivery model enshrined in the NDIS in which service providers compete for the disability “consumers” funding allocation.

The problems of providing disability services with a market-based funding system include:

  • Where governments have moved to a system of competitive tendering to provide human services, smaller community-run organisations have been squeezed out by larger organisations with greater economies of scale. A marketised distribution of funding has a similar effect and will almost surely wipe out those community-based organisations struggling to survive with too few resources. This will reduce choice and enable some to get rich at the expense of people with disability.
  • The state-based systems have already demonstrated that a marketised system of service delivery cannot provide the full range of necessary supports. For people living in remote and regional areas, or with very specific needs, there is often no choice of service provider, or no appropriate service available.
  • Under a marketised system, service users will generally try to extend their funding by seeking the lowest-cost provider. This can lead to people with disability being used as a wedge to drive down the wages and conditions of workers in the sector. Already people with disability (or their families) have been advised by NDIS staff that they can increase the hours of direct support they receive by directly employing support staff themselves on lower wages, or even as “private and domestic” workers, who are exempt from the entitlements and protection of industrial law.

Undermining the NDIS

Despite these fundamental flaws, the funds provided through the NDIS are welcome. If re-elected, the federal Coalition government will destroy the NDIS in all but name.

By introducing “robo-planning” and making changes to the NDIS Act to undermine the concept of “reasonable and necessary” supports, the Coalition intends to reduce NDIS to a mere shell, offering only the most basic level of support.

The government claims, disingenuously, that the cost of the NDIS has far outstripped expectations and is unaffordable. It claims that, unless changes to the program are made to reduce the average cost per participant, the scheme will continue to grow in scale, undermining its ability to pay for it.

In fact, the government has known for years that the cost of the NDIS, when the project matures in 2024–25, would rise to around $30 billion a year, to fund support for the approximately 500,000 people allowed to participate in the system.

Funding a reasonable life for people with disability, a life of dignity, independence and certainty, is simply not a priority for the Coalition, which is more concerned with providing subsidies to mining companies, large pastoralists and big retailers.

Prime Minister Scott Morrison has claimed his government wants to safeguard the NDIS for future generations by ensuring its costs remain in check. He has claimed that the costs of the NDIS have grown far more quickly than predicted by any of its original designers and that, unless it is reformed, it risks collapsing altogether.

The Coalition intends to “reform” the NDIS in two ways:

  • Introducing an access assessment process that will enable the government to limit the number of participants and the supports they are provided with (initially proposed as a so-called “independent assessments” process); and
  • Amending the NDIS Act to remove the requirement that NDIS must fund supports deemed “reasonable and necessary”.

No to robo-planning

The former government services and NDIS minister Stuart Robert began a trial of so-called “independent assessments” for those applying to become NDIS participants and those seeking to renew their plans, in 2019. As late as April, Robert claimed that independent assessments would be introduced for all applicants and participants in the near future, in spite of opposition from a coalition of disability advocacy groups.

The assessments, carried out by allied health professionals appointed by the government, would have involved a series of “yes or no” questions, combined with a series of mechanical tasks. Based on their answers to the questions and their performance in the tasks (including chores such as peeling a vegetable or emptying a garbage bin), individuals would have been assigned a score determining whether or not they were granted access to the NDIS and the scale of funding they would receive.

The “independent assessments” plan which, in effect, reduced people with disability to numbers, rather than recognising the complexity and social parameters of disability, was described as “robo-planning” by Bruce Bonhady, inaugural chairperson of the National Disability Insurance Agency, which administers the NDIS.

By making it harder for applicants to receive NDIS support and reducing payments to existing participants, the “independent assessments” were expected to save the government $700 million over four years.

The cost to people with disability, however, would have been incalculable.

In the face of implacable opposition from disability rights advocates, the government announced on July 10 that it would “shelve” the “independent assessments”.

However, there can be little doubt of the Coalition’s intention to roll out this cost-cutting plan in some other form, should it win the next federal election.

No to funding cuts

Section 34 of the NDIS Act states that participants will be funded for “reasonable and necessary” supports. The supports “will assist the participant to pursue the goals, objectives and aspirations included in the participant’s statement of goals and aspirations”.

It is liberally used by NDIS staff to justify their refusal to fund supports requested by participants. Relying on NDIS operational guidelines, which stress that supports must be “value for money”, they frequently knock back requests for home modifications (to enable access, or make bathrooms accessible, for instance) and assistive technology (such as wheelchairs), based on cost.

Nevertheless, successful appeals to the Administrative Appeals Tribunal have established the fact that the NDIS must consider a participant’s needs individually and that when a support requested can be shown to be “reasonable and necessary”, the NDIS must fully fund it.

Until now.

According to The Saturday Paper, “Now, the term ‘reasonable and necessary’ will describe a participant budget” as a whole, rather than any specific request for support. This “would allow rationing of support without an avenue for legal challenge,” based on the agency as a whole meeting stricter budgetary controls.

If the government has its way, the NDIS will no longer be expected to fund supports for people with disability to enable them to live a reasonable life. People with disability will be taught to tailor their expectations of what constitutes a reasonable life to the confines of what the NDIS may easily afford to fund.

Details of funding cuts have not yet been made public. Nevertheless, people with disability may expect less funding for state-of-the-art assistive technology, which while life changing is also expensive, and fewer hours of funded care: parents, partners and other “informal supports” — disproportionately women — will be expected to fill the gap.

The Coalition has not always considered the NDIS a looming liability. Between 2017–19, it ripped more than $10 billion from the NDIS to pay for its budget shortfalls elsewhere.

Over three years, the total “underspend” on NDIS exceeded $10.4 billion — exceeding the $7.1 billion surplus the government projected for 2019–20 by 46%.

It is only now that the NDIS is reaching its expected maturity and may no longer be used as a cash cow that the government has suddenly discovered that NDIS funding is unsustainable.

To provide for a reasonable standard of life for the approximately 500,000 people who will access the NDIS when it is fully rolled out, funding must be guaranteed in the short term, through increased taxation on wealth and big business.

While Socialist Alliance maintains that the NDIS should be replaced with a genuine needs-based support system, funding for the NDIS must be guaranteed in the meantime.

Who receives support

All people with disability should have access to the NDIS on the basis of self-assessment, regardless of the severity, or their age, employment or visa status.

Unfortunately, it is proving to be a struggle for many people with disability to even access the scheme, especially those with cognitive disability or severe mental health problems.

Remove age discrimination

Those aged over 65, unless already “participants” in the scheme, are ineligible for NDIS funding, leaving older people with disability stranded, particularly as state governments wind back their services as the NDIS is rolled out.

No to means testing

Currently, access to the NDIS is not means tested. All citizens (but not those on visas or aged over 65) are entitled to apply to become NDIS participants. An applicant’s income/assets are not assessed and pose no barrier to access.

However, almost all other social security supports provided by federal and state governments are means tested (income and assets) in some form. Those applying for an aged-care Home Care Package through the federal government, for instance, must provide detail of their income and assets and may be required to make a co-payment, depending on their means.

In New South Wales, people with disability older than 65, or those who are not citizens and not eligible for the NDIS, are required to make a co-payment to receive funding for assistive technology items from Enable NSW.

For those individuals earning more than $42,000 a year, or couples earning more than $70,000, the payment is 20% of the cost of items over $800. For state-of-the-art assistive technology, this could run into thousands of dollars.

Means testing for the NDIS is not Coalition or Labor Party policy. However, there is no guarantee that means testing will not be introduced.

Already, NDIS planners request that participants divulge their family income on a voluntary basis. How long will it be until this information is not only compulsory, but used to determine a level of co-payment for services delivered?

Funding for disability services must be provided on a needs basis.

People with disability should not be forced to justify why they need ongoing funding.

People with disability should be central to all decision-making. As a first step, a person with disability, or their representative, must be able to negotiate directly with the NDIS planner in an open and transparent process to ensure that their needs are properly met, eliminating the need for stressful and time-consuming reviews.

People with disability should have full control over all government funds provided to them to meet their needs.

The practice of the NDIS seeking to recoup “debts” supposedly incurred by participants who have spent some of the funds allocated to them on items and services to meet their needs, but which have not been formally approved by the NDIS, must stop.

Participants’ and providers’ interests

The NDIS encourages participants to negotiate lower payment rates with their support providers (“providers”), effectively driving down the wages of support workers. In this way, the NDIS turns the interests of participants against those of the providers and their (generally low-paid) staff.

Employment platforms, such as Mable and Hireup, institutionalise this exploitation, ensuring that disability support workers are among the lowest paid in the workforce. This is not only unfair, it is also leading to a shortage of disability support workers.

The interests of people with disability and those who are paid to care for them are aligned and the attempt of the NDIS to turn them against each other must be rejected.

It is in the interest of people with disability that those who work in the disability sector are properly paid and not forced to work additional hours or additional jobs just to make ends meet.

Equally, it is in the interests of disability workers to ensure that the people they provide services for are given the best possible support to maximise their ability to engage as full citizens in society.

No to deregulation of NDIS pricing

Currently, the NDIS regulates the “maximum” price that a provider may charge a participant for services. The price depends on the skill level of the provider and the way the services are provided — individually or as part of a group — and is modified by other factors, including additional payments made during the COVID-19 pandemic.

However, from its very beginning, the NDIS was designed to drive down the costs, paid by the government, by forcing providers to compete (on price) between one another.

Complete deregulation of prices is one of the aims of the NDIS. The NDIS Pricing Strategy 2019 states that it is “a critical component in transitioning the NDIS markets to cope with significant demand growth, reaching the longer-term goal of price deregulation and improving efficiency and quality of care”.

The NDIS’s drive for “efficiency” is undeniable. However, the term has one meaning for government and employers and another for workers, for whom it usually means worse wages and working conditions.

Deregulation of prices puts the whip in the hands of the bosses, and sets NDIS participants’ interests against those of their carers and providers.

While deregulation may make disability services cheaper, it will not be people with disability who pocket the extra money. Rather, participants will be allocated smaller packages and told to take their money to the market and negotiate the best deal they can.

Even before the price of disability services is deregulated, there is growing evidence of super exploitation, particularly of lower-skilled workers, in the sector.

Disability bosses are demanding increasing “flexibility”, which may lead to the introduction of zero-hour contracts, as used in Britain and other countries, where a worker’s hours can be reduced from full-time to zero without notice.

The reduced conditions for disability workers may place disabled people at greater risk.

The NDIS has paved the way for NDIS entrepreneurs, who are investing millions on the expectation of guaranteed revenue (and profits) from the NDIS over the years to come.

Put people with disability in charge of their care

The framework for disability care provision must be decided by people with disability themselves.

Empowering people with disability to make the decisions about their lives, including the form and content of a national disability support scheme, is important.

In that context, Socialist Alliance has adopted the following policy points.

  • Make all infrastructure — housing, public and commercial buildings, transport, education, employment, recreation and culture — fully accessible;
  • Private, for-profit organisations should not receive public funding;
  • Democratise governance of all disability funding-support bodies, including the NDIS; fundamentally reorganise the NDIS with governance provided by a board with the majority members being people with disability;
  • NDIS eligibility must not apply a medical model to disability; it must meet the needs and reflects the interests of all those with disability, and be inclusive, regardless of type, severity and episodic nature, age, visa status and how disability was acquired; psycho-social disability must be included; access to the system should not be means tested;
  • Assessment of requirements for services, support, equipment and aids must be guided by a self-assessment of the person with disability as the expert of their personal and life situation;
  • Oppose any attempt to categorise workers in the disability services sector as being in a “private and domestic” relationship with the person/people they support;
  • Ensure all workers providing support and other services funded by government receive, as a minimum, the same wages and conditions as those currently working within the state public sector; and
  • Ensure NDIS is an equitable system across all states and territories, and across urban, regional and rural areas; where relevant services are not readily available (e.g. culturally specific or a service located in a remote or regional area), government must ensure that these services and supports are provided. 

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