The authors say ‘you can’t fix the NDIS without fixing everything around it’.
Setting up services outside the National Disability Insurance Scheme such as support for children with developmental delays and focussing access away from specific diagnoses towards assessment of “significant functional impairment” are among a raft of recommendations made in the scheme review’s landmark report.
The 329-page report includes 26 recommendations and 139 “supporting actions” to be implemented over the next five years.
“The NDIS has delivered a better deal for hundreds of thousands of Australians, breaking down many of the barriers that shut people with disability out of the everyday lives that their fellow citizens take for granted,” the review panel wrote in their report.
“But there is still more to do to achieve the vision for the NDIS.”
Led by co-chairs Professor Bruce Bonyhady AM and Ms Lisa Paul AO PSM, the review panel examined the design, operations and sustainability of the NDIS.
They travelled to every state and territory (including regional and remote communities) and heard directly from more than 10,000 Australians. They worked with disability organisations to hear the testimonies of more than 1000 people with disability and their families, recorded more than 2000 personal stories and received almost 4000 submissions.
In a joint final message released today, the review panel said they had designed all recommendations and supporting actions to work together and “they must be considered as a total package of reforms”.
“Our view is that you can’t fix the NDIS without fixing everything around it,” they wrote.
“Our recommendations go beyond the NDIS. We want to create a new connected system of support, including accessible and inclusive mainstream services and a new system of foundational supports, as well as the NDIS.
“We want to make sure the 2.5 million Australians with disability under the age of 65 receive the support they need when and where they need it.
“People came together to fight for the NDIS more than ten years ago. We hope everyone will come together now to make sure the NDIS delivers on that promise.”
The report had much to say about the number of children accessing NDIS funding support.
“With so few supports outside the NDIS, it is not surprising that parents are fighting to get their children with developmental concerns or disability into the NDIS,” they wrote.
“After receiving early intervention supports, they are reluctant to leave the scheme for fear of being left without support. In addition, early intervention has not always been based on best practice and there has been too little support for families. All have combined to produce poor outcomes for children and families. These failings have also placed financial pressure on the scheme.
“The prevalence of disability and developmental concerns in children, currently 20% of all Australian children, makes this a mainstream issue requiring a mainstream response. With children making up half of all NDIS participants, it is clear mainstream supports aren’t meeting the needs of children and families, who are turning to the NDIS as the only source of support.”
The review was among the most comprehensive and accessible commonwealth review in history, said NDIS Minister Bill Shorten.
“This is a significant moment in Australian history, particularly for people with disability and their families, and the disability sector. Our nation will reap the rewards of the review’s work,” he said.
“The objectives of the Review were to restore trust, ensure sustainability and give participants a better experience and more control, by making the NDIS more about people and less about bureaucracy through greater equity, transparency and consistency.”
He said it the government had made a commitment to “humanise the scheme and ensure every dollar goes to the participants for who it was intended”.
“It is important that Australians understand changes are not going to happen overnight and any reforms adopted by the Albanese Government will be developed with the disability community to ensure a better NDIS,” he said.
The federal government met with state and territory leaders at National Cabinet on Wednesday to committed to the NDIS reform.
National Cabinet agreed to implement legislative changes to the NDIS to restore the original intent of the scheme to support people with permanent and significant disability within a broader ecosystem of supports.
Leaders also agreed to jointly design and commission an additional “Foundational Supports” program particularly for children with mild autism and developmental disorders/delays.
The federal government’s full response to the review will be released in 2024.
Key recommendations of the review included:
- Legislation: The review recommended a range of legislative reforms to return the scheme to its original intent and improve the experience of participants. This included legislation to improve eligibility and access, as well as an early intervention pathway for children.
- Foundational supports: The review recommended disability specific supports that would be available to people with disability and, where appropriate, their families and carers. The review said these supports should be available to all Australians with disability, whether they are on the NDIS or not. Foundational supports would interconnect with existing mainstream services like childcare and schools.
- Early childhood intervention: The review said there was not enough support for children in everyday settings, where they live, play and learn. It recommended children with disability and developmental concerns or delays are identified early and get the support they need. This could include earlier checks and screening to pick up developmental concerns and provide support.
- New approaches to psychosocial disability and mental health: The review recommended a new, dedicated approach for people with psychosocial disability that better meets their episodic needs and is focused on personal recovery. It recommended access to mental health services should be improved and there should be a strengthened interface between mental health systems and the NDIS.
- Service navigation: The review recommended the introduction of navigators to help people with disability, find and access all services available to them across mainstream services, community supports, foundational supports and the NDIS.
- Fairer housing and living support: The review recommended consistency should be introduced to housing and living support budgets to make it fairer for NDIS participants. The panel recommended a more flexible and innovative approach to housing supports to help people access solutions that suit them better.
- Registration: The review recommended all providers should be enrolled or registered, with the level of regulatory requirement being determined by the risk and complexity of the different supports they provide.
Early reaction to the report has been mixed.
RACGP president Dr Nicole Higgins welcomed the report, but said it was concerning that it did not deeply delve into healthcare for people with a disability, including general practice care.
“The government must recognise that GPs play a vital role in disability care, and barriers do exist,” she said.
“For example, there is no Medicare patient rebate for NDIS paperwork. This puts a huge burden on the patient to attend a consult, and it is even more onerous for Aboriginal and Torres Strait Islander patients because they require more paperwork to support their NDIS applications.
“If GPs are better utilised, we can help make the scheme more efficient. We have in-depth knowledge of our patients and their individual circumstances. So, if we are supported to liaise directly with NDIS service provides, we can ensure the right kind of support and avoid duplicated services. Let’s make sure that GPs are a key part of the process of improving the NDIS, otherwise it will be a massive, missed opportunity.”
Dr Higgins said the report did contain many “promising recommendations”.
“It is positive news that the report recommends investing in foundational supports and improving information and advice for people with disability,” she said.
“We have long called for clear information on NDIS processes and concerted action to ensure funding is allocated as fairly as possible.
“I support improving connections between mainstream services and the NDIS. There must be much greater collaboration between GPs, other healthcare professionals and the disability sector so as not to fragment care. The college also welcomes the report’s recommendation concerning a fairer and more consistent participant pathway.”
Peak industry body Occupational Therapy Australia (OTA) says changes as a result of the NDIS Review could make accessing necessary funding more complex and burdensome.
“We are concerned that whilst cost-sharing across the state and federal entities will undoubtedly create improved budgetary outcomes for the federal government, the cost shifting to another or separate scheme administered by another tier of government has the potential to make accessing necessary supports and funding more complex for participants and more burdensome for therapists,” said OTA CEO Sam Hunter.
“We welcome the opportunity to co-design changes to ensure they are valuable, efficient and effective to participants and the workforce that supports them. Support for people with disabilities is a responsibility for all levels of government, to ensure the NDIS could continue to change lives into the future, which equates to less burden on the economy.
“We are hopeful that ways of working and access to services can be harmonised before participants feel the impacts or fall between the gaps.”
You can access the full report and the supporting documents here.
