If the NDIS bursts, what happens to our patients?

5 minute read

The scheme is great in theory, but its workings are an unaccountable mystery, and it’s on track to become unsustainable.

Was anyone really that surprised?

Apparently, there has been an increase in children are being diagnosed with more severe forms of autism, with the suggestion being, it is in order to become eligible for NDIS funding.

According to the “rules”, there are three levels of severity of autism, with level one being the least affected and not attracting any funding, while if you are classed as either of the other two levels you can get government help.

Basically, the accusation is being levelled at the clinicians for “making the shoe fit”, that is, erring on the side of a funding-attracting diagnosis following their subjective interpretation of a child’s behaviour.

And, really, I get it. The child needs help, warrants help, and without the subsidy they may not get it – it’s not as though the clinician gets anything out of it.

But the problem is, of course, the NDIS is, by many accounts, on track to becoming completely unsustainable financially. According to the financial report from the scheme’s governing body, the National Disability Insurance Agency, this year the NDIS is expected to cost the government about $35 billion, providing services to more than 530,000 clients.

That’s a lot of money! And that’s a lot of clients.

What’s more, the same financial report (ironically titled the Annual Financial Sustainability Report) predicts that by 2031, the scheme will cost $89 billion annually!

My biggest issue is, where are the checks and balances of this scheme? Where is the evidence the right help is going to those who need it most? And how on earth are we (as in taxpayers) going to be able to afford $89 billion a year in eight years’ time?

I don’t know how you are finding it, but in my experience the workings of the NDIS are a complete mystery, with little if any accountability factored into the system.

I have a patient in her late 50s who is basically blind (she can only discern two fingers with one eye and the other eye is glass) whose NDIS application was rejected, while another patient with a self-diagnosis of fibromyalgia (never seen a specialist – have no idea who supported the application) has been on the scheme for years.

I have people getting funded for obscure services such as Russian lessons or art classes and other people getting paid as an NDIS carer while also receiving the services of a carer on the NDIS. There seems an awful lot of waste.

Of course, I also have patients with a disability who could not manage without the NDIS. And, of course, we need to look after people with a disability. It is in everybody’s best interest that all people have access to the tools and services they need to overcome the limitations of their disability and lead productive and satisfying lives.

All I’m saying is that without any accountability process in place, without anyone overseeing that the right services are being delivered to the right people by the right people, this behemoth of an organisation is likely to implode – the costs will become overwhelming. And where will that leave my poor 42-year-old office worker with cerebral palsy? Or my paraplegic 30-year-old writer?

As much as I don’t want to sound like I want more bureaucratic paperwork in my inbox, I get the impression that GPs are not key players in the NDIS challenge. Maybe it is just me, but I have only been asked to be involved in less than a handful of applications to the scheme. And have only been made aware of a couple of reviews. I am not sure who is writing the reports. Who are the authorities asking?

Back in 2021, the government mooted the possibility of independent assessors to determine whether an applicant’s functional incapacity qualified them for the NDIS. Given the scheme only became fully operational in 2020, the very fact that such a proposal was made suggested the warning signs of a blowout were evident early.

However, the proposal was soundly rejected courtesy of a backlash from community disability groups who argued it was a cost-cutting exercise and was likely to deliver lower funded, inappropriate packages and risked “dehumanising” clients, potentially traumatising them.

That might well be the case and obviously independent assessors weren’t the answer, but something needs to be done.

It’s tricky of course. Once a person is awarded a regular payment it is very, very difficult to then reduce that payment or stop it. So then, if you turn it around and make it more difficult to access the NDIS in the first place you run the risk of leaving people in need without help.  

But surely something can be done to stem the waste.

The NDIS looks headed for that ever-expanding pile of government initiatives labelled “Great concept! Disastrous reality!” and then where will that leave our most vulnerable?

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