NDIS review released, calling for more disability support outside scheme to ensure sustainability

NDIS review released, calling for more disability support outside scheme to ensure sustainability
  • PublishedDecember 7, 2023

Creating more services outside the National Disability Insurance Scheme (NDIS), including support for children with developmental delays, and hinging access on impairment instead of medical diagnosis, are among the key recommendations from a long-awaited review.

The landmark report followed a year-long inquiry into the scheme, which was called over concerns the NDIS had become an “oasis in the desert” for people with disability and its cost was growing at an unsustainable rate.

Today’s 329-page report made 26 recommendations to be implemented over the next five years.

Australians would no longer have automatic access to the NDIS based on specified medical diagnoses, but would have to prove they had “significant functional impairment”.

The review called for the removal of “access lists” that provide automatic entry to the scheme, including for conditions like autism diagnosed at level 2 under the Diagnostic and Statistical Manual of Mental Disorders.

Instead, it called for entry to be based on “significant functional impairment and need”, which is the impact the disability has on a person’s life.

It said access lists had led to inequity, where some participants were automatically eligible, while others were not.

The review’s co-chairs, Bruce Bonyhady and Lisa Paul, said the reforms recommended “a complete rethink” of operations.

Bruce Bonyhady wearing a suit and tie and smiling.
Professor Bruce Bonyhady co-chaired the review into the NDIS. (ABC News: Marcus Stimson)

“We must return to the principle that NDIS eligibility is based first and foremost on functional impairment rather than medical diagnosis,” they wrote.

“We must ensure the NDIS experience is centred around the whole person and their disability-related support needs.”

More support needed in schools, call to fix workforce shortage

The review also called for more investment in disability support services for children with developmental delays in mainstream health and education settings and said “the gap between those inside and outside the NDIS is unfair”.

Commonwealth and state and territory governments confirmed on Wednesday they had reached an agreement to set up and fund the new category of support.

As well as setting up more support for people with disability outside of the NDIS, called “foundational supports”, the review said governments needed to take steps to fix serious workforce shortages, such as trialling ways to attract and retain workers.

Other key recommendations were that all providers should be enrolled or registered and there needed to be a new approach to psychosocial disability and mental health and a revamped pricing framework.

There are currently more than 630,000 Australians on the NDIS and many of the recommendations are designed to ensure more mainstream support is available to the estimated 4.4 million Australians with disability not on the NDIS.

Participants and their families have been worried about changes to a vital lifeline that has helped many people with disability access basic support for the very first time.

NDIS Minister Bill Shorten said the government’s full response to the review would be released next year, and would continue conversations with the disability community over the coming months. 

He told the National Press Club that dealing with the NDIS should be “simple and fair”.

“As has always been the case, choice and control, and ‘reasonable and necessary’, will remain at the heart of the scheme,” Mr Shorten said. 

“Evidence-based supports that deliver real, beneficial outcomes — they’re in … crystal therapies, overseas cruises and dolphins — they’re out.

“If assessments are needed, they should be paid for by the NDIA.

“Access to the scheme shouldn’t depend on whether someone can afford to pay for expensive reports.”

Positive step forward, details need to be worked through, advocate says 

President of People with Disability Australia Nicole Lee described the report as a “positive step” forward, but disability advocates still needed to “work through the nuance of the details”.

She welcomed discussion around increased supports for all people living with disability. 

Nicole Lee at Parliament House
People with Disability Australia president Nicole Lee said more foundational supports would benefit the wider community. (ABC News: Tahlia Roy)

“This investment in foundational supports benefits … everybody in the community, not just people in the NDIS, and those that sit just outside the NDIS, but everybody in the community in general,” Ms Lee said.

“Like anybody whose ever been near a public hospital in the last few years, you’ll know that health, allied health and mental health are failing everyone, not just NDIS participants.”

She said the conversation had been moving away from just diagnosis.

“It’s an acknowledgement that we need to, and have always been sort of speaking to moving away from, that medical model of disability and that … we’re not necessarily the product of a diagnosis, it’s more around how that disability interacts with your day to day … functioning,” Ms Lee said. 

“And for some people with the same disability, you might have less … day-to-day impairment versus somebody with the same disability [who] might have more day-to-day impairment.”

How did we get here?

The recommendations follow a year-long inquiry, commissioned after the 2022 federal election amid various concerns including the scheme’s financial sustainability.

Participants complained about overpriced services, fraudulent providers and frustrating bureaucracy.

Annual NDIS spending has grown to more than $35 billion, becoming the second-most expensive federal program after the aged pension.

The federal government plans to reduce the scheme’s growth rate to 8 per cent, in an effort to bring down costs.

The current growth trajectory of 14 per cent would see spending on the scheme reach $97 billion by 2032-33.

Since the program’s launch, support outside the NDIS – including that run by state and local governments – has dried up significantly and some people have found themselves caught in gaps between services

Modelling released in 2021 by think tank Per Capita, showed that for every dollar spent on the NDIS, $2.25 was delivered back to the economy.

How to divide the cost of the NDIS in the future has been the subject of intense debate between state and federal governments in recent weeks.

While funding was initially split 50-50 between the states and Commonwealth, the federal government currently pays about two-thirds.


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