The NDIS Social Policy SWP302

The NDIS Social Policy

Outline the historical development of the policy including other linked policies highlighting key changes

The Productivity Commission (PC) in 2004 conducted a review of the 1992 Disability Discrimination Act which revealed two areas of greatly needed improvement: social participation and inclusion, and the planning and funding of disability service provision (PC 2004, p. 674, p. LXIX). It was one of the first documents that revealed the necessity of change in the Australian disability sector and began the process of creating the NDIS. In 2009 the National People with Disabilities and Carer Council released a report that drew significant attention to the shut out nature of experiences that individuals with disabilities faced, the lifestyle of being excluded from society and finding themselves socially and emotionally isolated (NPDCC 2009, p. 1). A lack of social inclusion was noted as the primary concern voiced by service users and carers in participant submissions and consultations, as more than fifty-six percent of contributors described the difficulties of social segregation (NPDCC 2009, p. 12). Because of social exclusion, a lack of economic participation was also reported, with high unemployment voiced as a strong issue within the disability community (NPDCC 2009, p. 40). A lack of sufficient (or available) services and provisions was noted, the services that were available being of poor quality, unreliable, and a universal one-size-fits-all approach (NPDCC 2009, p. 4). Different to the PCs report, this paper emphasised the need for change at a more individual level, rather than legislative. On August 10, 2011 the Productivity Commissions Disability Care and Support Inquiry Report was published. This report outlined the current state of the disability sectors capacity for providing care considering both the immediate moment and the long term, specifically considering funding and workforce trends (PC 2011, p. IV).

The report also functioned to design and propose a new method of disability service provision and consider all design issues that may arise (PC 2011, p. V). The new design proposed was called the National Disability Insurance Scheme (NDIS) (PC 2011, p. 2). To compliment the PCs proposal of the NDIS, PricewaterhouseCoopers (PwC) in the same year reported in their Disability Expectations assessment that the cost of maintaining the same methods of service provision would cost more in 2025 than the NDIS if it was implemented (PwC 2011, p. 21). Recommending the NDIS, PwC not only closely detailed funding and budget potentials, but also described future possibilities of theory models, underpinning principles, and the benefits of the proposed scheme (PwC 2011, p. 21-26).

On the 19 of August 2011 the Council of Australian Governments (COAG) reviewed the PCs recommendations in their COAG Meeting Communiqu (COAG 2011). The recommendations were well received and wholeheartedly accepted, with the council agreeing to meet again and review progress on the implementation at the next meeting in July 2012 (COAG 2011, p. 4). The following Meeting Communiqu began the process of organising launch sites in several states, scheduled to be commenced in July 2013 (COAG 2012, p. 1). On 21 March of 2013 the official NDIS Act was passed and the National Disability Insurance Scheme Launch Transition Agency (NDIA) was also established (National Disability Insurance Scheme Legislation Act 2013). Amendments to the Act followed later in the same year, and again in 2016 and 2017 changes including increasing the number of board members of the NDIA and establishing the Quality and Safeguards Commission and Other Measures in 2017 (NDIS Legislation Amendment Act 2013; NDIS Legislation Amendment Act 2016; NDIS Legislation Amendment Act 2017). In 2013 the NDIAs first annual report was released and provided information from their trial sites, the most noteworthy information being that more was needed to be done to improve transition speed as the delivery capacity was behind what was expected (NDIA 2013, p. 12).

Since the beginning of the NDIA it has released reports each year detailing current trends and figures, as well as predicting future developments and suggesting recommendations. The NDIS Savings Fund was introduced in October 2016, and while it has not yet passed a second reading in Parliament, its purpose would be to assist the Commonwealth in meeting its funding requirements to source the costs for the NDIS (NDIS Savings Fund Special Account Bill 2016). A recent suggestion of 2018 (which was later rejected) was to increase the Medicare Levy for all Australians from two percent to two and a half percent, raising $8bil for NDIS funding in four years, however this was deemed an unnecessary tax increase (Borys & Belot 2018; Department of Finance 2018).

Critically discuss key issues and issue drivers identified within the policy and government literature in relation to relevant commentary and scholarly literature. In particular, critically examine the core values, beliefs and assumptions underpinning the policy

One of the key issues of the PCs 2011 report was to examine funding processes for the disability sector and suggest new methods that would improve the quality of the program. The review determined that there was a severe lack of funding for most programs and individuals (PC 2011, p. 6). Another key problem was the lack of stability in funding, as financial capacity varied from year to year in budgets (2011, p. 3). The government was asked to front an estimated $6.5 billion annually in addition to the current funding (PC 2011, p. 3). However, originally estimated at $13.5 billion in 2011, the cost has now risen to an estimated $22 billion annually, and Baker estimates the funding will eventually cost $29.5 billion annually in the 2020s, more than double the original assessment (Baker 2012, p. 2; NDIS Legislation Amendment Act 2013). One of the governments attempts to raise the necessary funds included increasing the Medicare Levy by half of a percent, however, this suggestion has now been retracted in favour of other, less reliable methods of raising funds (Thorne 2018; PC 2017, p. 44). There has since been speculation on where the replacement $8 billion will come from in the future as tax revenue will not always be a constant variable (Thorne 2018).

An additional issue recognised was the high level of confusion felt by most service users, as legislative and jurisdictive differences combined with unclear jargon amassed to a support system that was difficult to comprehend (PC 2011, p. 7). One of the by-products of this was a system that allowed for very little mobility when changing plans or moving locations (PC 2011, p. 8). Users reported that when trying to move from one area to another, their services were often cut off or severely reduced, leaving them at a disadvantage (PC 2011, p. 7). The issue was compounded when users didnt understand the services they were being offered and couldnt navigate their way through the system. Since the NDIS has been commenced, unfortunately, some users feel that there is either the exact same amount of confusion or even more than before, despite a main goal of the scheme being to reduce confusion (Melbourne Social Equity Institute 2017, p. 35; PC 2011, p. 3). One of the many concerns participants shared in consultation was about the Myplace portal service, used for planning and tracking service provision, as many users feel that it is too ambiguous and frustrating to use, and the process of being between plans is too vague, with no end-goal in sight (Melbourne Social Equity Institute 2017, p. 33).

Choice and control is a core principle of the NDIS (NDIS 2018a). As identified in the PCs 2011 report, the old system of service provision had high regulation and restriction on service providers which granted the users highly unreliable control over their own care (p. 2). One user noted a take it or leave it attitude towards service provision, with only one basic plan made available for them and no other providers to turn to (PC 2011, p. 9). The PC, as well as other institutes, also recognised that regional areas were often deprived of more varied options (PC 2011, p. 548; Melbourne Social Equity Institute 2017, p. 8). Since sector reforms have begun, there has been recognition that users have increased self-direction, as there are now more providers to select from (Centre for Applied Disability Research 2016, p. 11; PC 2011, p. 2). An increase of nearly sixty percent of users exercising their own control has also been observed (Centre for Applied Disability Research 2016, p. 9). This growth demonstrates the governments success in providing a more tailored service with a greater person-centred approach (PC 2011, p. 36). Despite this, however, the Department of Social Services (DES) still has found it to be lacking in options (DES 2018, p. 23). Areas of needed improvement are the selection of providers, mode of service delivery, direct planning, control through increased funding, and increasing the flow of information to allow for better decision making (DES 2018, p. 24-28).

Issue drivers that pushed for government action were primarily key political and ideological movements, concerns with funding, and government objectives already set in place. In 2009, the Labor Party, classically neo-liberal in viewpoint, requested for the PC to report on the national disability sector, which later became the 2013 NDIS Act (Hesmondhalgh et al. 2014, p, 7; NDIS 2018a). In 2013 when the Liberal Party reclaimed control, a significant amount of attention was focussed on the implementation of the NDIS, generating substantial pressure to continue the scheme (Cassidy 2013). Media and public attention was also intense as twenty years of the Disability Discrimination Act was commemorated, serving to increase pressure to continue the NDIS (Australian Human Rights Commission 2018). Funding was a substantial influencer, as Baker had exposed that the NDIS in the long-term would cost less than the current budgeting of the disability sector; the financial focus of which greatly appealed to the neo-liberalist agenda of the Labor Party as well as its penchant for outsourcing services as the NDIS proposed.

The NDIS website lists four main values that the scheme is built upon and aims to follow (NDIS 2018a). These are: choice and control, a life-time perspective, an insurance-based approach, and an individual plan for each person (NDIS 2018a). While there has been an increase in choice and control for some, there is a failing of the principle not only for certain demographics, but in the planning stages for most users care (Brien, Page & Berman 2017, p. 39; McFadden 2017; NDIS 2018a; Spencer & Collings 2016, p. 739; PC 2011, p. 70). Many users also described feeling as if their life-time perspective was not being drawn on by planners, and that only immediate fixes, or very short-term plans were being provided (NDIS 2018a, p. 13). The insurance-based approach of the NDIS signifies the disability sector shifting away from a welfare support system model to a more empowering method of distributing resources (NDIS 2018a). An aim of the NDIS is to provide insurance cover for all Australians should they become injured, as well as support those already accessing programs (PC 2011, p. 10). A key point of the PCs 2011 report was that individual care that would be ensured, as providers would be working closely together with users to create plans (PC 2011, p. 2). The DES, however, believe that individual support has not been provided adequately, with only the bare minimum being met by most providers (DES 2018, p. 9).

There are many assumptions in the NDIS, the largest being the definition of disability itself. The government takes on a highly medicated view of disability, greatly emphasising the difference between abled and disabled, and accentuating the structural inequality of ableism and disablism (Young 2017). In addition, this contrast also relates to the idea of the deserving and undeserving poor. An example of this ideology is the provision of funding to reasonable and necessary supports for individuals, the first question being what the NDIS considers reasonable and necessary, and what criteria they are basing these assumptions on (NDIS 2018a, p. 6). The whole concept of providing choice and control to users assumes that users both want and can use this new freedom. It assumes a certain level of competency and desire to manage ones own affair and take on that extra burden and responsibility. This passing on of responsibility to the users is also a common neo-liberal process, creating the perfectly self-reliant neo-liberal individual. Another huge assumption is the funding of the NDIS. At this point in time, funding will be taken from general tax revenue, however, this revenue is not static year to year, and is subject to fluctuations (Thorne 2018). While this method of funding may work for the current year, beyond this point the government is assuming Australia will have the funds to continue the program.

Discuss key findings from evaluation of the policy including government and non-government evaluations highlighting strengths and weakness (800) (2,050)

The NDIS has been under close scrutiny since it was first proposed by the PC and has been subject to intense criticism and evaluation, the majority of which highlighting purely its faults and drawbacks. The only source of approval for the NDIS comes from government sources that originally created and continue to fund the NDIS itself (NDIS 2018b). Strengths identified include a high user satisfaction, with a report in 2018 detailing that 84% of participants reported either good or very good experiences with the scheme (NDIS 2017, p. 4; NDIS 2018b, p. 17). Similarly, a government media release detailed that 68% of participants felt that they had more choice and control in their services, indicating a high satisfaction rate as well (NDIS 2018c). Another noted area of strength was the schemes insurance method of service provision, as a 2017 report discussed how this technique revealed pressures on the system early, allowing for intervention. An example of this being the introduction of the Early Childhood Early Intervention package specifically targeting young children (NDIS 2017, p. 6). The Department of Social Services in particular considers the number of people supported through the scheme a strength, as several publications list the high numbers of members and approved plans (NDIS 2017, p. 18; NDIS 2018b, p. 17: NDIS 2018c). However, despite the governments high praise of the scheme there are many other sources, administrative or otherwise, that disagree (Branley 2016; Conifer 2018; Dickinson 2017a; Green 2014; McFadden 2017).

The largest concern voiced is that there isnt enough money in the scheme to either reach every member to the extent they need, or sustainably provide life-time support as the NDIS promises (Dickinson 2017b; Sachi 2014, p. 3). Families with multiple children using the NDIS supports are particularly concerned, as funds have been subject to suddenly diminishing without explanation (Conifer 2018). Smith-Merry along with over fifty other stakeholders are particularly concerned about the NDIS on many issues, one of which being its lack of funding and support for users (Smith-Merry 2018, p. 5). Part of the issue with a lack of funding to reach all users is that some consider the NDIA more concerned with the quantity of new users signed on, rather than the quality of care given (NDIS 2017, p. 2; Smith-Merry 2018, p. 5). Dickinson is particularly concerned at the rapid pace of user enrolment, and the seeming lack of improvement in the quality of care, despite government reports revealing its deficiency (Dickinson 2017; NDIS 2-17, p. 2). A particular lack of care is noted for those of a diverse background, including those from overseas, or part of an Aboriginal and/or Torres Strait Islander community (Smith-Merry 2018, p. 2). Another reason for the poor quality of care is a lack of workers and service providers for approved plans within the disability sector (Conifer 2017). Green also believes that workers within the sector are either given no opportunity to further their own training and development or leave to find other work due to uncertain working conditions and contracts (Green 2014, p. 32, 33). Collateral damage of this fast-paced recruitment of users is that plans are approved too fast and without proper input from clients, with plans often containing mistakes because of this (McFadden 2017).

In 2018 the NDIS conducted a review that showed how the scheme had failed to provide accurate plans that were of a high quality, and indirectly reduced the level of choice and control users are supposed to experience (NDIS 2018a, p. 6; Smith-Merry 2018, p. 5). In addition to this poor level of user input in the planning stages, the system as a whole has been hailed as too confusing to allow for informed decisions to be made, especially for those that struggle with or are unaccustomed to English as a first language (NDIS 2018a, p. 6; Smith-Merry 2018, p. 11). An inability to make an informed decision undermines the schemes entire pitch of increased choice and control, as one cannot make an educated choice if the options are not clear and understandable.