Go to the Australian Productivity Commission website and find the link to the Commission’s 2017 report on National Disability Insurance Scheme costs.
The 533-page report outline alone takes up 48 pages. Also on the website page is a note in fairly small print that says, “There has not yet been a government response to this study.
This week’s election campaign returned to the economy and the cost of living, with the release of quarterly inflation figures. But the campaign debate over the cost of living is a gnarly little thing: the government running around saying it’s not their fault, the opposition saying it is.
Most of the factors that contribute to the surge in inflation are indeed beyond the influence of any government.
Governments controlled – or at least influenced – much more: interest rates, wages, and other prices and markets through things like tariffs and quotas.
Deregulation has robbed politicians of their ability to manage most parts of the economy these days – something many might take as cause for celebration.
But they are not spectators of all markets, nor of all policies. Yet in the very areas where governments do wield influence, they seem unable to act to solve the problems.
Disability services are a classic example. For the group of people who need these services – estimated by the Productivity Commission in 2017 at 4.3 million people (yes, you read that right) – there is no more compelling question about the cost of life than what happens to the NDIS.
The NDIS has become the oasis in the desert
The NDIS – and the massive cost explosions it faces – have now become a cause celeb for an array of people who love nothing more than signs that governments can’t do anything right.
There is plenty of evidence that there are a lot of things governments can’t do right. And the cost explosion of the NDIS is indeed substantial.
Cost explosion is reduced to governance issues; transparency issues; issues of “too many people” joining the program (implicit suggestion that people somehow benefit from the payload); and/or the argument that the whole idea behind an “insurance-based” approach is just too ambitious and wrong.
The focus is on the exorbitant cost of consultants and the bloated process of appeals to the Administrative Appeals Tribunal by people whose plans have been cut.
The opposition has promised a review. The Prime Minister has pledged that the scheme will be “fully funded”, whatever that means.
But if anyone bothers to read the Productivity Commission’s 2017 report, they might discover a few things about the NDIS that might help them think through the very complex issues that have arisen as they have burst onto the scene over the past decade as the biggest experiment in social policy since (at least) Medicare.
The latest monthly data from the NDIS for March shows a 15% annual increase in the number of participants to 518,668, and an even more alarming 21% increase in funding provided: from $16.78 billion to 20 .36 billion.
Everyone wants to know – or have an explanation – why this happened. An increasing number of children with conditions such as autism joining the program is a glaring statistical factor. Just as it was originally planned that people would eventually leave the program.
And that didn’t happen. Why not? Because, as one analyst put it, the NDIS has become the oasis in the desert for the provision of desperately needed services.
Better solutions simply aren’t available
If you have a child with autism, you will want to do everything possible to provide them with the services they need. You will seek them from a service that provides them, rather than staying out and being limited by the number of therapy services you can get through Medicare, or even just accessing services in now largely outdated professions, from speech therapists to psychologists.
Similarly, if you’re in the NDIS, but getting older, you’ll want to stay under its banner rather than move into an even less well-funded aged care sector.
As the 2017 PC report notes:
“Many are concerned that as disability support programs are integrated into the NDIS, people using these services (including those who are not eligible for the NDIS) may no longer be able to receive ongoing support. is a major risk to the financial viability of the NDIS – and one over which the NDIA has little control.”
Mental health services are an area of particular concern, CP noted:
“Obviously, there needs to be support for people with mental illness outside of the program – a responsibility that falls (largely) to state and territory governments. However, governments are withdrawing their funding to some number of mental health support programs and use this funding to offset a portion of their contribution to the NDIS.
And it’s a story that repeats itself in all areas of disability service delivery.
The NDIS was designed to work in an environment where governments and not-for-profit operators would continue to provide many services – simple things like home and community local councils helping you get to shops; to more complex areas such as mental health.
But many of them, as the PC said five years ago, fell through.
This means that solutions that would work better for people with disabilities and their families, and which would be more cost effective for taxpayers, simply do not exist.
For example, teams of paramedics in schools could support several children with disabilities on site, instead of requiring them to research each of the individual NDIS plans.
We need to have a proper conversation about these realities
Likewise, the NDIS itself is understaffed — thanks to federal government staffing caps — and is staffed by people who often simply don’t have the skills to assess people’s needs.
And outside of the NDIS itself, as the 2017 report states, “it is estimated that one in five new jobs over the next few years will need to be in disability care, but the growth of the workforce -work remains much too slow”.
So the NDIS is a microcosm of so much that is wrong with the way we deliver services in the care economy, from people with disabilities to elderly care, to health care and education . It sucks and reveals the shortcomings of the rest of our social services.
We’re getting old. More of us are disabled than we thought. The market reveals it as one of the great engines of job creation that the government likes to brag about. But we don’t celebrate these workers or pay them properly.
The price signals could be all wrong. But the people they represent aren’t going to stop needing the services if you just change the governance of the system.
We need to be able to have a proper conversation about these realities. And it’s damn complicated.
As the half-million people supported by the NDIS – and the millions who support and know them – cast their ballots, our major political parties don’t seem to be able to offer them any assurances that this will happen anytime soon. .
Laura Tingle is the main political correspondent for 7.30.