Outline the historical development of the policy including other linked policies highlighting key changes
In Australia, the support and services provided for people with disabilities has long been underfunded, inequitable, and inefficient. In which has given people with disability’s little choice and no certainty of access to appropriate services (Reddihough, Meehan, Stott & Delacy, 2016). Often, individuals did not receive services nor support required and were often isolated and financially disadvantaged (Reddihough, Meehan, Stott & Delacy, 2016). People with Disabilities were often refused the basic rights that others take for granted. They were ignored, hidden, cursed and treated as unwanted (Verick, M, 2015). However, in 1908, the Australian Government introduced the Invalid pension that provided little independence to people with disabilities as well as acknowledging them to an extent, while also recognising them as members of society (Verick, M, 2015).
In 1975 the United Nations proclaimed the declaration of ‘Rights of Disabled Persons’ defining a number of social, economic, civil and political rights for those with disabilities (Schulze, 2009). Furthermore, 1981 became a turning point for people with disabilities, as the first World Assembly in Singapore was held by the United Nations. ‘The International Year of Disabled persons’ with the theme being breaking down barriers. (Verick, M, 2015).
In 1985, the Handicapped Person Review was undertaken which led to the ‘Commonwealth Disability Service Act’ in 1986. The Act provided a complete framework for funding and provision of disability support services. Additionally, the Act led to the DSA disability services program being established (Phillips, J, 2008). Furthermore, in 1986 the Australian Human Rights Commission Act was introduced in which provided the commission the power to hear and respond to complaints of discrimination (Humanrights.gov.au) Later in 1992, the Commonwealth Disability Discrimination Act (DDA) was brought about. The legislation prohibits discrimination against a person with a disability, it is preceded by State and Territory anti-discrimination legislation however the legislation varies across jurisdiction as there are different definitions held about disability across Australia (Pwd.org.au).
In 2007, the Rudd government introduced the ‘National Disability Strategy’ that helped the Senate inquiry into the Commonwealth State/ Territory Disability Agreement (Soldatic, K & Pini, B 2012). Since 2007 they have been major changes in the disability policy field which have seen positive and negative changes in the disability community. Additionally, in May 2008, the United Nations Convention on the ‘Rights of Person with Disabilities’ (CRPD) came into force. In which intends that people with disabilities must enjoy all human rights and fundamental freedoms. (Verick, M, 2015). This lead to Australia became one of the first Countries to sign the Convention in which has had a significant change to disability rights movement in Australia (Soldatic, K & Pini, B 2012).
Later in 2009, the National People Disability and Carers Council (NPDCC) released a report called Shut Out, in which investigated the daily experience of discrimination, exclusion and material deprivation disability people endured. The report was part of the Rudd government election platform to develop the National Disability Strategy, in which aimed to provide a governing framework for the design (Soldatic, K & Pini, B 2012 & Deane, 2009). The report also discovered the direct challenge of government funding that suggests the disability sector needed new funding mechanisms and service delivery models. (Soldatic, K & Pini, B 2012). Additionally, in 2009, a report on consultation found that there was still little social inclusion, poor quality disability services and high levels of unemployment (Ramcharan, P, 2016). Due to block funding that went directly to the provider of goods and services, not the person requiring the service. Nevertheless, due to the limit of services provided they weren’t able to respond to the diverse needs of people with disabilities (Ramcharan, P, 2016). This issue was also highlighted in the Productivity Commission 2011 report that found block funding gave people with disabilities little choice and no certainty of accessing appropriate support. It was clear Australia was in need of change, as the funding and services were at breaking point with major gaps in accessing equitable goods and services across one’s lifespan were lacking.
The hope of this change from a welfare-driven to an insurance-based model would improve equity of services delivered, levels of participation and overall quality of life among Australians with disabilities and their families (Reddihough, Meehan, Scott & Declay, 2016). From all the historical milestones, they have helped push towards what we know now as the NDIS today. NDIS began to take shape in 2013, where the legislation was passed through parliament. The scheme was created to give individuals independence and control over the services and supports they receive.
Critically discuss key issues and issue drivers identified within the policy and government literature in relation to relevant commentary and scholarly literature. In particular critically examine the core values, beliefs and assumptions underpinning the policy
The National Disability Insurance Scheme, is a scheme that provides support for people with disabilities. While ensuring individualised, long-term funding to help support people with disability. The NDIS is governed and funded by the Commonwealth and participating states and territory governments (Buckmaster, 2013). However, the scheme intends to replace the current system of shared provision and funding of disability services by the Commonwealth and State and Territory governments under the ‘National Disability Agreement’. The NDIS has many expectations about the extent, standards and distribution in which it will provide to people with disabilities but it may be likely to disappoint. The scheme additionally will change people’s lives for the better, but will also need to overcome complex challenges (Buckmaster, 2013). The NDIS works under a set of principles that help fund, support and provide services for participants. The first principle is choice and control; in which people with disabilities have the choose and control when and where their support is provided from. Secondly, Individual circumstance and individualised funding; participants receive the support they need to pursue their goals and to be more independent in the community. Thirdly, Lifetime view; looking beyond immediate need for the person’s lifetime such as looking at goals and aspirations, living arrangements and carer support. The last principle is Insurance based approach; that spreads the cost and sustainable funding for disability services and support across the community (Coag.gov.au., 2015)
An important challenge that needs to be faced is the disability service providers that will have the capacity to meet the increased demand for support. As the potential cost pressure overtime may demand higher support and expectation from the NDIS participants due to the level of funding that will be available to them and the cost of the services provided (Buckmaster, 2013). The issue has also been highlighted in the National Disability Services 2017 Sector report, in regard to the uncertainty and inadequate price setting by the National Disability Insurance Agency (NDIA) as it has discovered business confidence and financial stability of disability provides at an all-time low in the past 12 months (Wahlquist, 2018). Additionally, it was reported that the 50% of disability service providers could not afford to reduce the cost of services in order to fit within the NDIS resulting in reduced quality of services provided (Wahlquist, 2018).
Reducing the cost of services will shut organisations down in regional or remote towns due to the price structure set by the NDIS as it doesn’t cover the actual cost of the service (Wahlquist, 2018). A report published by the university of NSW found that the support work for disability has been under-priced in the NDIS. The price for care have been set by the NDIA in a ‘Reasonable Cost Model’ that does not offer minimum Award conditions to be met, this prevents employers who offer award conditions from meeting legal obligations (Cortis, Macdonald, Davidson, and Bentham, 2017). The prices don’t recognise the time that is required to deliver service to NDIS participants. This is having an impact on support workers when trying to deliver quality services, due to being under pressure and not having enough time to build rapport with clients, follow up, communicate, complete paperwork, debrief or do handover (Cortis, Macdonald, Davidson, and Bentham, 2017). All these are reasons in which low quality support and increased risk for participants have increased. Additionally, underfunding isn’t only affecting participants it’s also affects workers due to overworking they endure and the lack of support given. They endure physical injuries, exhaustion, stress and negative psychological impact due to unsafe working conditions (Cortis, Macdonald, Davidson, and Bentham, 2017). Furthermore, Ken Baker CEO of National Disability Services raised the point of recognising the need to focus more on improving the quality of the NDIS experience for both the participant and provider (Wahlquist, 2018).
People with disabilities and their families suffer from social and financial burden, while being placed amongst the most disadvantaged in Australia. Those with disabilities are more likely to experience poor health, lower education, training and employment, social exclusion and lack of goods and services while suffering discrimination (ProductivityCommission2017). The NDIS was designed to help deliver support and improve the outcome for participants, their families and carers. With the importance on personalising support, to pursue goals and maximise independence, living independently and fiting within the community. Individualised support funding under the NDIS is restricted to what is reasonable and necessary. This concept however is not defined in legislative scheme, the NDIS does not provide guidance on whether the support is reasonable or necessary.
Finding it hard to make the scheme individualised due to the rule and guidelines of the NDIS. The wording reasonable or necessary can be interpreted in different perceptions in which what supports are. With the lack of knowledge about different types of disability’s impacts their ability to identify what supports are reasonable and necessary for scheme participants (ProductivityCommission2017).
The NDIS is improving the lives of participants, families and carers. The increase of support, choice and control provided as well as the improvement in participants quality of life has all been a contributor to their overall wellbeing. An evaluation found that 44 per cent of participants surveyed have had great say over their support, while 46 per cent had more choice over who provided their support (ProductivityCommission2017). However, some participants have reported poorer outcomes due to the NDIS. Some say the lengthy wait; lack of local providers and quality provision is unmet especially for those living in rural and remote areas (ProductivityCommission2017). Ensuring the services provided in rural and remote areas are sufficient and culturally appropriate is difficult. Complex challenges steam from pricing, economies, climate, geography, culture, workforce shortages and safety. Additionally, it was discussed in the Productivity Commission report, that people who lived in remote and rural communities are at risk of market failure. In regard to the shortages, less competition and poorer outcomes for participants (ProductivityCommission2017).
Some participants are not benefiting from the NDIS as they would have liked. Those at risk of having less positive experiences include, psychosocial disability, complex and multiple disabilities, language and cultural barriers. Also, those participants transitioning into the community from the criminal justice system, homelessness or socially isolated. (ProductivityCommission2017).
Australia will not see an increase to the Medicare Levy to help pay for the Disability Insurance Scheme as both Labor and Liberal insisted the scheme will be fully funded through a taxation hike (Borys & Belot, 2018). The Coalition proposed the Medicare Levy in the last budget cut, however in the recent budget the government believes that the Medicare Levy would no longer be necessary. As the economy began to strengthen in the past year leading to recovery of tax revenues which would help fund the NDIS within the budget (Murphy, 2018).
No matter where they got the funding from there’s no certainty the finding will be around in two, four or even ten years. What happens when the economy drops and funding is moved to elsewhere in which the government believes is more entitled to. This funding through tax is not a permanent funding option and something needs to be done. The Medicare Levy would have been a more permanent option that would never fall and would always ensure money was available even through an economy crisis. People with disabilities don’t live and die around an election, they are ordinary people who deserve the same rights as everyone else (Murphy, 2018).
Discuss key findings from evaluation of the policy
The NDIS is a major Australian social innovation that has brought change to the disability sector in improving the lives of those with disabilities, their families, carers and the workforce, providers and services, stakeholders and the wider community.
The evaluation of demand for support found that most NDIS participants and their families and carers reported that they have more choice and say over the support they receive, timing and the use of different service and providers (Mavromasras, Moskos and Mahuteau, 2016). Additionally, it was found that most had experienced an increase of satisfaction, however those who reported dissatisfaction with quality noted the impact on quality of support and support workers due to the pricing constraints and time (Mavromasras, Moskos and Mahuteau, 2016). Furthermore, it was also found that people who are experiencing poorer outcomes and receiving lower levels of services, were those who were unable to advocate services on their own behalf or those who struggled to manage the complex NDIS process. However, it was also evident that the lengthy waiting list for providers, lack of local provider and lack of quality provision were also an issue that was an unmet demand for those living in rural and remote areas and for older participants of the NDIS (Mavromasras, Moskos and Mahuteau, 2016).
Supply of support was another issue covered in the evaluation that indicated service providers were increasing the amount of their services provided to help support and expand their range of services. However, the NDIS is impacting the expanding workforce with the concern of skill shortages, employee recruitment, unsatisfied training, underfunded work, more casual positions and lower quality of provision. When joining supply and demand together it was found that unfunded support was leading to families paying out of pocket expenses for accessing services such as alternative therapies and social and recreational activities (Goode, Walton, Smith, Wei and Flavel, 2018).
Choice and control has been an overall improvement in the NDIS experience. It was found that half of the participants were better off, a third reported to be the same as before the NDIS, while 15 percent believe they were worse off. The participants who reported to have less choice and control over support were those with mental health and psychosocial disability’s (Goode, Walton, Smith, Wei and Flavel, 2018). furthermore, Families who were unable to navigate the NDIA website in order to find what services and providers were available as well as those unable to expressive support needs were less likely to have good choice over their support. Additionally, choice was also restricted to those living in remote and rural areas with less fewer service providers. Furthermore, participants and carers felt they had insufficient information when trying to choose their service providers confidently (Mavromasras, Moskos and Mahuteau, 2016). This resulting from the NDIA website being hard to navigate, inhibiting their access to information leading to uninformed choices. It was also indicated that participants spend more time doing paperwork rather than finding and getting support (Goode, Walton, Smith, Wei and Flavel, 2018).
The wellbeing of those who acquired a disability at birth or later in life, reported to have a major impact on both the life of the person with the disability and their family. These impacts include social, economic, education and family relationships. Additionally, choice and control and the unmet demand under the NDIS have been connected to personal wellbeing (Mavromasras, Moskos and Mahuteau, 2016). Those who had choice in the decision on the support they receive reported to have higher wellbeing. Whereas, those who experienced the unmet demand reported a significantly lower level of personal wellbeing. However, those who received better services than previously and gained independence reported to have increased wellbeing. These improvements were associated with better living conditions, feeling happier, meeting goals and aspirations since joining the NDIS (Goode, Walton, Smith, Wei and Flavel, 2018). Furthermore, when removing the burden of family members and carers, the improvement of social and economic participation allowed those with disabilities to be involved in activities such as employment, social activities, and quality time with family members that was before not possible. Nevertheless, moving the funding from individualised support instead of group services had a negative impact on social participants who now do not attended programs in which they previously did (Mavromasras, Moskos and Mahuteau, 2016).
The NDIS was a good step for people who had an eligible disability. However, those whose disability was not eligible for the NDIS reported to be receiving fewer services while others were falling through the service gaps while not receiving any type of support.