A call to confront the ‘elephant in the room’ on NDIS funding drew spontaneous applause from healthcare leaders, exposing deep tensions over who the system is really serving.
When a room of healthcare leaders breaks into spontaneous applause during the Australian Financial Review Healthcare Summit, it’s a sign something deeper is simmering beneath the surface.
The “Big Picture” policy panel discussion had led to a personal story by “health system expert” Dr Nick Coatsworth. He shared that his mother had dementia and he and his brother were desperately trying to keep her out of hospital.
But as she doesn’t have enough home care funding nor an aged care place, she will probably end up back in hospital in the next few weeks.
“This is the reality of the situation. We talk about funding. We have to address the elephant in the room.”
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Of the top five things funded in the Australian budget, health, aged care, defence, NDIS and interest payments, Dr Coatsworth highlighted that four benefitted 26 million taxpayers, but the NDIS only benefitted 800,000 people.
“When are we going to transfer some of that NDIS funding into people who pay taxes all their lives and are stuck now?” he asked.
The question hung in the air, and then the room erupted into applause.
NSW minister for health Ryan Park didn’t push back on the sentiment.
“It can’t come soon enough for me. I’ll be honest that we need as much as we can going into that system, it’s not fair on these individuals,” he said.
He highlighted that there were 1206 people in NSW hospitals today who shouldn’t be in hospital.
“That’s the size of Mount Druitt and Westmead hospitals taken offline this morning,” he said.
But he also warned against a blunt solution.
“What we can’t do is forget about those patients, because otherwise we’re just moving the problem from one area to another. And that’s what it feels like running a health system at the moment,” he said.
There was no disagreement at the summit that NDIS funding needed to reduce. Earlier in the morning, federal health minister Mark Butler admitted the scheme was off track.
“It lacks those disciplined design features of a good social program, and we’re determined to get it back on track,” he said.
“We’re in the process of getting the cost down from 22% growth when we came to government, to 8%. I’m working now to make sure we’re on track to achieve that.”
Later, during the NDIS and disability panel, there was a robust discussion about where the scheme went wrong and how it needed to be fixed.
Martin Laverty, the CEO of Aruma, highlighted that the NDIS wasn’t designed for the numbers that it currently supported.
“When the NDIS was designed, the Productivity Commission in 2011 foresaw a system that would support 400,000 Australians with really significant disabilities.
“If we want to know why the scheme is twice as expensive as was originally intended, it’s because twice as many people have now entered,” he said.
Mr Laverty argued the legislation allowed this to happen.
“It set up an expectation that the taxpayer would fund reasonable and necessary support.
“We perhaps missed an opportunity, and we should have said the taxpayer was willing to fund essential and required supports where evidence existed,” he argued.
Part of this is because there is now a lack of state and territory support. He said during the trial of the NDIS, the NDIA wasn’t meeting its enrolment targets and the states and territories saw an opportunity.
“They saw the cost shift to a principally federally funded scheme, and state and territory governments left the field,” he said.
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This left the scheme with more people, including those with milder conditions, that it was never designed to support.
Psychologist Clare Rowe argued it was impossible to talk about the NDIS without talking about autism.
“It’s 40% now of the NDIS, and many are children,” she said.
“We have inadvertently now created a system that rewards dependence, does not reward recovery for mild conditions,” she said.
She works with many children with profound intellectual, cognitive autism who were nonverbal. However, it’s those with milder forms that have ballooned on the NDIS, she said.
“It is a question for society to answer, what are we as a taxpayer prepared to fund now?
“If we are prepared to fund every single mild ailment of a mild speech delay or a mild social skills delay, which I would argue for a lot of kids is along the strengths and weaknesses personality profile,” she speculated.
The link between funding and diagnostic level needs to be dissolved and should be based more on functional impairment, Ms Rowe said.
This was particularly shown with autism, she said. Autism has three levels, ranging from mild level one to severe level three. The NDIS funds level two and three.
“Since the NDIS came into existence, I have never seen an assessment report that has diagnosed level one autism. It got cut. You have level one autism, you’re now bumped up to level two,” she said.
Pelin Akyol, Research Manager, e61 Institute raised the fiscal concerns of the NDIS. Participants have rigid individual budgets that grow with price caps, so they are not price sensitive, he said.
“There is little variation, especially for services like occupational therapy, speech pathology.
“These are important factors that increase the fiscal cost, because in a normal market, we expect providers to compete over prices or quality and participants to shop around to find better services,” she said.
Aruma CEO Mr Laverty also highlighted the concern about the lack of regulated providers. Currently, 93% of providers are unregistered, making it hard for the regulator to monitor spending, quality, or fraud.
“How can you have a proper handle around where either fraud or sharp practices are in place if you can’t see your market?” he asked.
But beyond fraud, he said, a more fundamental question remains unanswered:
“Are we getting outcomes for participants? Is the taxpayer receiving a return?”
The panel admitted that politically and culturally it was very hard to take things away once they’ve been given.
However, Australians need to stop seeing the NDIS as a general, diagnosis-triggered entitlement system, he said. Instead, it’s an insurance scheme for those with the most serious, functional impairments.
“We’ve built a Rolls Royce scheme for what was intended to support a normal life. We’ve raised expectations too high that the taxpayer will fund an exceptional life. When in fact, the NDIS was about enabling a normal life,” Mr Laverty concluded.
