Go to the website of Australia’s Productivity Commission and look for the link to the Commission’s 2017 report on the costs of the National Disability Insurance Scheme.
The overview of the 533-page report alone takes 48 pages. Also on the website page is a note in quite small print saying: “There has not been a government response to this study yet.”
The election campaign this week has pivoted back to the economy and the cost of living, with the release of the quarterly inflation numbers. But the campaign debate about the cost of living is a gnarled little thing: the government running around saying it’s not their fault, the opposition saying it is.
Most of the contributing factors to the inflation surge are, indeed, beyond the influence of any government.
Governments used to control — or at least influence — a lot more: interest rates, wages and other prices and markets via things like tariffs and quotas.
Deregulation has robbed politicians of their capacity to run most parts of the economy these days — which many might see as a cause for celebration.
But they are not bystanders in all markets, nor all policies. Yet in the very areas where governments do actually exert influence, they seem incapable of acting to fix problems.
Services to the disabled is a classic example. For the group of people needing those services — estimated by the Productivity Commission in 2017 at 4.3 million people (yes, you read that right) — there is no more compelling cost of living question than what happens to the NDIS.
The NDIS has become the oasis in the desert
The NDIS — and the significant cost blowouts it faces — have now become a cause celebre for a range of people who like nothing more than signs that governments can’t do anything right.
There’s plenty of evidence that there’s lots that governments can’t do right. And the blowout in the costs of the NDIS are indeed substantial.
The cost blowout is simplified down to being problems of governance; problems of transparency; problems of “too many people” joining the scheme (implicit suggestion that people are somehow freeloading); and/or the argument that the whole underlying idea of an “insurance based” approach it takes is just too ambitious and wrong.
There is a focus on the exorbitant cost of consultants and on the ballooning process of appeals to the Administrative Appeals Tribunal by people who have had their schemes cut back.
The Opposition has promised a review. The Prime Minister has given a commitment that the scheme will be “fully funded”, whatever that means.
But if anyone bothered to read the Productivity Commission’s 2017 report, they might discover a few things about the NDIS which might help them think about the very complex issues that have arisen as it has erupted onto the stage in the last decade as the biggest experiment in social policy since (at least) Medicare.
The latest monthly NDIS data for March reports a 15 per cent annual increase in participants to 518,668, and an even more alarming 21 per cent increase in the funding provided: from $16.78 billion to $20.36 billion.
Everyone wants to know — or has an explanation for — why this has happened. A burgeoning number of children with conditions like autism joining the scheme is one glaring statistical factor. As is that it had originally been anticipated that people would eventually move out of the scheme.
And that hasn’t happened. Why not? Because, as one analyst puts it, the NDIS has become the oasis in the desert for the provision of desperately needed services.
Better solutions just aren’t available
If you have a child with autism, you’ll want to do everything you can to get them the services they need. You will seek them from a service which provides them, rather than stay outside and be constrained by the number of therapy services you can get supported through Medicare, or even just access services in what are now largely overrun professions from speech therapists to psychologists.
Equally, if you are in the NDIS, but are getting old, you will want to stay under its banner rather than move into an even less well-funded aged care sector.
As the 2017 PC report noted:
“Many are concerned that, as disability support programs are rolled into the NDIS, people using these services (including those not eligible for the NDIS) may no longer receive continuity in support. This is a key risk to the financial sustainability of the NDIS — and one that the NDIA has little control over.”
Mental health services are an area of particular concern, the PC noted:
“Clearly, there needs to be support for people with mental health illnesses outside of the scheme — a responsibility that remains (largely) with state and territory governments. However, governments are withdrawing their funding for a number of mental health support programs and using this funding to offset part of their contribution to the NDIS.”
And this is a story that is repeated across the areas of service delivery for people with disabilities.
The NDIS was conceived as operating in an environment where governments and not for profit operators would continue to provide a lot of services — from simple things like local councils’ home and community helping get you to the shops; to more complex areas like mental health.
But many of these, as the PC said five years ago, have fallen by the wayside.
That means solutions which would work better for the disabled and their families, and which would be more cost effective to taxpayers, just aren’t there.
For example, teams of allied health professionals in schools could support multiple children with disabilities in situ, instead of requiring them to each seek out individual NDIS plans.
We need to have a proper conversation about these realities
Equally, the NDIS itself is short of staff — thanks to federal government staffing caps — and staffed by people who often just don’t have the skills required to assess people’s needs.
And outside the NDIS itself, as the 2017 report says, “it is estimated that 1 in 5 new jobs over the next few years will need to be in disability care, but workforce growth remains way too slow”.
So the NDIS is a microcosm of so much that is wrong with the way we deliver services across the care economy from disabilities, to aged care, to health care and education. It is sucking up and revealing the shortcomings of the rest of our social services.
We are getting older. There are more of us with disabilities than we realised. The marketplace is revealing it as one of the great engine rooms of the job creation the government likes to boast about. But we neither celebrate these workers or pay them properly.
The price signals might be all wrong. But the people they represent aren’t going to stop needing the services if you just change the scheme’s governance.
We need to be able to have a proper conversation about these realities. And it is bloody complicated.
While the half-million people supported by the NDIS — and the millions who support and know them — vote, our major political parties don’t seem to be able to offer them any reassurance that this will happen any time soon.
Laura Tingle is 7.30’s chief political correspondent.