The National Disability Insurance Scheme was a recommendation from the Australian Productivity Commission in 2011. It was promoted by the first Australian Minister for Disability Issues, Bill Shorten, championed by PM Julia Gillard, and passed into legislation in 2013. It was to be a universal federal disability scheme, funded out of taxation and levies, state and federal.
It's a similar model to the New Zealand ACC scheme – but while ACC only covers injury by accident, the NDIS theoretically covers impairment from any cause. It is overseen by the National Disability Insurance Agency (NDIA), which seems to have a similar role to ACC:
The NDIS is a key plank in the National Disability Strategy 2010–2020, a cross agency cross jurisdiction agreement between all federal and state governments …. While the Strategy is the overarching Australian policy approach to disability, the NDIS is its most prominent—if not iconic—contemporary element. As such, the NDIS has been widely debated, because its architecture, implementation, and implications, hold considerable importance for disability and indeed Australian social policy in general. (Goggin and Wadiwel, 2014)
It is aligned with the principles of the UN CRPD
The NDIS is, at least rhetorically, informed by a rights approach, in the form of the United Nations Convention on the Rights of Persons with Disabilities. The NDIS legislation specifically states an aim to ‘give effect to Australia’s obligations under the Convention’ … and cites other international obligations, such as that under the International Covenant on Civil and Political Rights. (ibid)
Before it could be rolled out agreement was required from all states which had to agree to give up some of their state disability budgets for the national scheme. Additionally there was a lot of work done aligning ICT systems, assessment, support pathways and other requirements. Some of the states which had fully agreed to the scheme under state Labour leadership changed their minds or made funding less of a priority after Coalition wins. However, there is now a general agreement on the existence of the scheme itself (again similar to political manoeuvrings over ACC) and varying levels of state support.
In 2013 while at a conference in Adelaide I heard from some of those involved with developing the scheme that eligibility would be wide and anybody could come through the door and ask for support. There would also be attractive funding packages for people to choose their own provider for wrap-around person centred support, and it would be easy to change if they wanted as there would be multiple providers vying for their business, or they could employ their own.
States were able to decide their own implementation priorities and how to roll them out. For example, South Australia chose to start with children. The state implementations had just started when the Gillard government lost office. The Abbott government promised to keep the, by then, already popular scheme.
Last month I went to a symposium on the NDIS at the University of New South Wales in Sydney. The speakers mainly came from critical disability studies and associated disciplines with varying degrees of hands on involvement with the scheme (eg disabled people’s organisations, provider organisations, advocacy or evaluation). My colleague (a wheelchair user) and I went with some degree of NDIS envy - which was the title of his keynote - which bemused our Australian colleagues, and it didn’t take us long for us to have a reality check.
One of the early sites of political contestation in relation to the development of the NDIS was the question over which supports would be considered ‘reasonable’ to be provided by the Scheme … After a public review conducted by the National Disability Insurance Agency, the supports that are now considered ‘reasonable and necessary’ are largely restricted to those supporting ‘daily personal activities’ and employment related support. (Wadiwel and Goggin, 2014)
We also learned:
- Only 10% of disabled people are currently considered to be eligible. Eligibility criteria and assessment is very tight and age restricted to under 65 (which also means certain impairments such as those with post polio syndrome which mainly affect older people are not covered). There is a tier hierarchical system of funding.
- Disability and support are apparently not defined in the Act so decisions are largely left to the all powerful NDIA about who is eligible and what supports are needed.
- The state government of NSW agreed to give all its budget to the federal scheme so has nothing left for monitoring or evaluation or other disability provision.
- Housing support is provided but not housing itself – so shortages of suitable housing cause problems (like in NZ).
- There is limited success in working across sectors/silos. For example, it is still unclear how things like adaptive technology such as for children with autism who need it at home and at school, will be funded or provided.
- Remoteness and racism mean much of the Aboriginal population and other minority groups have minimal access to the scheme.
- Advocacy and political participation which were part of the original alignment with human rights principles are contentious and not funded.
Sadly, far from the ideals I had heard only two years earlier.
So the NDIS is still a great idea in theory but implementation depends on political whim and good faith. Many aspects of the original ideas have apparently been easy to undermine while others are still evolving. There are many similarities to our history with ACC – regular cut backs, sudden change, expansion, little stability or predictability. As with any insurance scheme, actuarial objectives, not equity principles, prevail. However, having one federally-controlled disability insurance system is valuable and needs protection and development as it is better than the fragmented, inequitable system it succeeded. Private, contestable disability insurance will never provide as affordable or widespread cover.
With political support New Zealand could extend ACC into a universal disability scheme, learning valuable lessons on implementation from the NDIS.
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National Disability Insurance Scheme http://www.ndis.gov.au/
Goggin, Gerard and Dinesh Wadiwel (2014). ‘Australian disability reform and political participation’ Australian Review of Public Affairs http://www.australianreview.net/digest/2014/09/goggin_wadiwel.html (full article online via this link - both these writers were impressive speakers at the symposium I attended).