Ensuring better insurance for Australians

Though some of its most pressing issues remain unsolved, the National Disability Insurance Scheme has so far gone largely unmentioned in Australia’s election campaign, Gemma Carey writes.

For such a large and contested policy, the National Disability Insurance Scheme (NDIS) has received surprisingly little attention in the run-up to the election. This was, at least in part, due to Scott Morrison’s strategic move to make major funding commitments to the scheme before announcing this year’s Budget.

The Coalition Government argues that one of the strengths of the proposed 2019 Budget is the $2.1 billion surplus it offers. Out of the five major savings, the largest comes from the underspend on the NDIS – contributing $1.6 million to the bottom line. This was attributed to a “slower than expected transition of participants into the NDIS”.

While seemingly a banal issue of administration, this statement masks the struggles and vulnerabilities of those trying to use the scheme.

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Individuals who have not been able to ‘transition’ into the scheme face long waits without access to services; all the while, the previous disability support system is now all but unravelled in preparation for the NDIS.

What is not mentioned in the justification behind the underspend is that many participants have money in their plans they haven’t been able to spend, which is then repurposed across the scheme.

This is because the new national disability markets, from which NDIS participants purchase services and supports, are still developing. Participants may have the money, but there are no services to buy.

‘Plan underspend’ – or ‘Budget surplus’ in this case – represents unmet needs within the community. While the Coalition has argued that tax relief will be welcomed by ‘hard-working Australians’, this is at the expense of some of the most vulnerable Australians.

In its strategic pre-Budget move, the Coalition has also raised prices within the scheme. Substantial increases will be seen in two key areas: one-to-one care and community participation.

A recent report released by The Centre for Social Impact UNSW in conjunction with National Disability Services found that, across the disability sector, organisations are struggling to remain financially viable at the current pricing arrangements. The boost in prices will enable more providers to stay afloat, offering more choice and control to participants while keeping the vision of the NDIS alive.

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The NDIS has been widely criticised for having ambiguous eligibility criteria. The NDIS Act states that people must have a permanent disability, and once eligible, they will be issued with resources to cover ‘reasonable and necessary supports’.

The line between health conditions and disabilities is naturally blurry: health can lead to disability, but problems with access and social exclusion associated with living with disability can lead to poor health.

As a result, people have been refused access on the basis that they have a lifelong and permanent health condition rather than a disability. Those with short life expectancies, unclear diagnoses, or relapsing-remitting conditions – like multiple sclerosis – are sometimes excluded from the scheme despite experiencing functional difficulties.

Additionally, what constitutes a ‘reasonable and necessary’ service is left to the discretion of frontline government officials who might have varying notions of how needs should be met under the scheme. An overall boost in funding could see less harsh eligibility criteria.

Bill Shorten has promised in a sweeping statement that, should it be elected, the Labor Party will “get the NDIS back on track”. While a welcome gesture, Shorten has hardly offered any detail. Really, the only clear policy action that has been offered so far is a promise to lift the staffing cap on the main implementation agency – the National Disability Insurance Agency.

The NDIS has been subject to a range of government audits and inquiries, which all found that the scheme was under-resourced and under pressure.

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Enabling the Agency to hire more staff will relieve some of the associated burdens while helping participants transition into the scheme in a timelier and smoother manner.

In early May, Labor responded to public pressure around the scheme by announcing plans to create an NDIS Future Fund. Underspent funds from the NDIS that currently go to other areas of government will return to the scheme under the new initiative. This is a welcome development, but a Futures Fund alone will not address the implementation challenges which are hurting many – and often the most vulnerable – Australians.

A return to the original blueprint would see a more functional and sustainable NDIS into the future. There are also key features of the scheme – Local Area Coordinator roles and community capacity building projects, for example – which have fallen away that should be reintroduced. Regardless of the election outcome, transparency around NDIS funding and spending should be a priority alongside the removal of the staffing cap.