Although there have been several reviews and inquiries during its first 10 years of operation, the recent independent NDIS Review is the most significant, and is likely to transform both the scheme and the broader disability support ecosystem.
The 26 recommendations (and 139 supporting actions) cover many topics, including: supports outside the scheme, access, planning, supported decision-making, psychosocial disabilities, housing, information and market stewardship, First Nations participants, workforce, quality and safety, and implementation and governance. It is impossible to summarise them all here, so we will focus on some of the biggest and most controversial recommendations.
One contributor to rising scheme costs is a greater number of participants than planned, rising from original 2011 estimates of 411,000 participants to more than 610,000 today. This mismatch may have been partially driven by incomplete data when estimates were made, but is also thought to be driven by states and territories scaling back their disability support. This means that in some places the NDIS is the only support for people with disability.
To address this ‘oasis in the desert’ problem, the review recommends foundational supports, jointly funded by state and territory governments (50:50 with the Commonwealth) and delivered outside the NDIS. These might include information provision and linkages to services, plus more targeted services like home-based support (e.g. shopping and cooking), aids and equipment, early childhood support and psychosocial support.
The NDIS was never intended to be the only way to get disability supports in Australia, so this recommendation will assist people with disability who aren’t on the NDIS to access supports and will decrease the inequality between those on the scheme and the far bigger group who aren’t.
There are likely to be some big changes to scheme access and planning. The lists that allowed some people automatic access based on their diagnoses will be removed, and participants will instead be granted access based primarily on functional need rather than medical diagnosis – although the tools to effectively assess functional need across a wide range of disability types do not yet exist.
Currently, once people have been accepted onto the scheme, their individual budgets are determined by setting out support needs on an activity-by-activity basis. In the new system, people will instead have their budgets set based on high-level needs (which already occurs in similar systems such as in England). Rather than having funding tied to highly specified activities, there will be more flexibility about how people can use their budgets. Doing this will focus less on specified activities and more on outcomes, which may be a way to drive more innovation in services and supports.
A new Navigator role will be created to help all people with disability access supports. Each person will be allocated a Navigator, funded through the new foundational supports system and not from individual budgets. They will help people outside the scheme access foundational supports, assist people to apply to the NDIS, and help those on the scheme to learn about the NDIS and use their plans. Specialist Navigators will focus on particularly complex areas like housing and psychosocial disability.
Approximately half of all NDIS participants are children, a far greater proportion than anticipated. This has increased costs, but the review team also heard that the way the NDIS scheme supports children is often not based on best practice.
The review panel suggested children would be better served accessing foundational supports in homes, early childhood centres and schools, rather than relying on individual budgets for clinical interventions in specialised and segregated settings. This will require significant investment by governments in foundational supports for children under the age of nine.
One of the most controversial recommendations relates to quality and safeguarding. Most NDIS payments currently go to providers who are registered with the NDIS Quality and Safeguards Commission, but there are relatively few registered providers and they tend to be larger organisations. Unregistered providers are much larger in number, but tend to be smaller in size, and take a smaller percentage of NDIS funds overall (see NDIS Review, p. 911).
To improve quality and safety, the review recommends mandatory registration for all providers, including light touch “enrolment” for low-risk providers such as suppliers of consumables. But our research shows that some NDIS participants depend on unregistered providers – for example, suppliers of assistive technology, allied health practitioners, cleaners/gardeners and sole trader or directly-employed support workers. This is especially important in non-urban areas that have few (or no) registered providers, and some say it is vital for their choice and control over supports.
It is important to note that registration does not equate to safety or quality under current arrangements. We are not aware of any evidence (and the review report does not provide any) that using unregistered providers is overall less safe or more expensive. As Grattan Institute Disability Program Director Sam Bennett has said, the review might be “using a sledgehammer to crack a nut on this one”.
There is a lot of detail to work out following the review’s high-level recommendations. How they are implemented will be crucial. As the review notes, implementation has often not been done well throughout the first decade of the NDIS.
The report emphasises that the substance of many of these recommendations will need to be co-designed and implemented with stakeholders, particularly the people with disability (and their families) who depend on the NDIS to live inclusive lives. But this won’t be straightforward. After years of exclusion, poor policy implementation, lack of co-design and broken policy promises, many in the disability community have very little confidence that seemingly well-intended recommendations will be implemented by governments or the NDIA in a way that improves the scheme.
For example, one detail that has some stakeholders nervous is a proposed shared support ratio of 1:3 (1 worker to every 3 participants) for daily living supports. While the report says this won’t necessarily mean people have to live together, some are concerned that it will work against ongoing efforts to dismantle group-based segregated living arrangements.
If the reforms are to achieve any of their intended effects, implementers will need to address this trust deficit to achieve genuine co-design with the disability community.