The establishment of the National Disability Insurance Scheme (NDIS) in 2013 was a milestone for Australia and has been one of the most significant health reforms seen in this country since the introduction of Medicare last century.
The aims of the NDIS are laudable and rightly ambitious, aiming to support Australians with a significant and permanent disability achieve a better life through access to the supports they need. The Scheme was designed to place people with disabilities at its heart, and banked on a marketised system to deliver services, improve quality and drive innovation within the disability sector. Control and choice are driving mantras of the scheme and its introduction included a move from a system of block funding services to operating on a system where individuals are provided with funding to purchase the supports they determine they need. It is a deeply regulated market, however, with the National Disability Insurance Agency (NDIA), a government statutory agency regulating access to the market through assessing potential clients, regulating the level of resourcing provided for individuals, regulating the rules and costs for services provided through the scheme.
The scheme has been operating in the ACT since 2014 and has been fully implemented in the Territory since 2016. Given we are one of the first jurisdictions to be fully operational and given the scale of this reform, it is unsurprising that we have experienced some challenges in how NDIS has rolled out. It is important that we now assess how well the scheme is meeting the objectives of control and choice and reflect if there are any adjustments that we need to make.
Marketisation and competition are premised on the fact that demand will drive services, and competition will positively impact on both efficiency (ie cost) and quality. However, we are starting to see some areas of potential market failure. For instance, this week, Marymead, one of the few remaining services that provide overnight respite to young people with disabilities, announced that they would no longer be able to provide this service to many Canberra families. They pointed to inadequate funding provided by the NDIA for this type of service and stated that despite many discussions with the Agency, they have not been able to find a cost structure that meets community expectations around duty and care for staff and clients.
There is an argument that this is how the market should be operating, and overnight respite is a hangover from a system that wasn’t working properly in the first place. In a world in which the NDIS was delivering a new paradigm of caring, people with disabilities would be adequately supported within their community, and families would not be in the situation of needing respite to sustain them in intensive and undervalued caring roles. If the NDIS was working this way, there would not be the need to fund band-aid solutions such as respite to help families cope, and instead adequate supports would enable families to have typical and normal relationships with their family members. We are a long way off from this reality however, and this transitional phase has demonstrated that we are probably falling short with providing the right level of resourcing and support, with huge increases in complaints regarding the NDIA in the last 12 months being reported – primarily due to dissatisfaction with the planning process, where decisions are made regarding how much funding and what supports people with disabilities can access.
While we continue to operate in a deeply regulated market, Governments cannot abdicate their duty of intervening when the market starts to fail. This is one of these times, and we need to see swift action to ensure that there are services provided to our local community and that choice and control do not diminish as a result of the introduction of the NDIS.
I think there is a role for Government to work with the NDIA and others to ensure we don’t see market failure in parts of our local disability sector. What do you think?
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