Great expectations of the NDIS need to be managed

The National Disability Insurance Scheme, founded under the Rudd and Gillard governments and built up by the Coalition for eight years, reflects the decency of our nation. It is a program this newspaper has backed from its inception because supporting people with permanent and significant disabilities to live their best lives gives them and their loved ones certainty and peace of mind. It is too precious ever to be undone, which is why it must be sustainable.

Stephen Lunn’s front-page report last Saturday revealing that the NDIS is on track to cost more than $40 billion a year within three years — a $10 billion blowout on federal budget projections released only a fortnight ago — has focused attention on the scheme’s costs. The blowout will occur, a new quarterly report to federal and state governments by the ­National Disability Insurance Agency warns, “if recent rates of growth in average payments and new entrants are extrapolated, without mitigating actions”.

There are no simple answers. Curtailing some services, tightening eligibility (21,000 people joined in the final quarter of last year) or means-testing some benefits for some participants would be easier said than done and would provoke outrage in some quarters. Neither is there any desire by authorities or the community for a Medicare-style levy as mooted at the outset. The services provided to the scheme’s 450,000 participants are comprehensive, high quality and therefore not cheap. Depending on individual need, they range across assistance with daily living, respite care, travel assistance, equipment such as walkers, home modifications, the costs of specialist disability accommodation, support workers to allow participation in social and community events and recreation, assistance dogs and their support, education support, and services such as psychologists, physios, exercise physiology and occupational therapy. Individual plan management is vital in many cases.

According to the NDIA report, average payments to participants have increased by 42 per cent across three years to $53,200. The scheme will cost taxpayers $23 billion this financial year. Debate over the future cost of the scheme has ratcheted up in the wake of last Saturday’s story. Several points are clear. First, the integrity of the scheme must be maintained. And one element of that is transparency in the reporting of overall costs. Second, those worried about rising costs should remember the NDIS is an insurance scheme for all and anyone may need to use it if they suffer an unfortunate accident, as NDIA inaugural chairman Bruce Bonyhady, a driving force behind the scheme’s creation, says. That said, taxpayers are not a bottomless pit. They are entitled to know the scheme is being run efficiently and is not being rorted. And third, expectations need to be managed.

One option being considered by the government, and backed by the NDIA, is the use of mandatory independent assessments to determine eligibility and funding. The goal of such assessments would be to create equity between participants with the same disability, but the agency also considers it a means to scheme sustainability. Disability advocates are deeply suspicious of such “robo-assessments”, which they claim would be designed to make cuts to the scheme and would be traumatic for people with disability to have to navigate. The Australian takes the view that a well-designed independent assessment scheme would be no bad thing if it made the NDIS more sustainable, provided participants did not suffer unreasonable hardships. Last month, Government Services Minister Linda Reynolds slowed moves to introduce such assessments after a backlash from disability advocates. She is expected to make a decision on them later this year. It will be a tough policy call. But assessments could encourage consistency and transparency as the scheme continues to grow to the point where it helps an expected 530,000 Australians in another two years. They would be useful, for example, in determining whether children suffering different levels of autism should be assisted by the scheme.

Given the complex needs of severely disabled Australians, Inclusion Australia chief executive Catherine McAlpine makes a valid point when she says “low-hanging fruit” in containing costs will not come from the relatively small number of participants whose packages cost more than $1 million a year (450 people) or between $500,000 and $1 million (5100 people). Those people, as she says, are not “swanning around living the high life”. In a civilised society, they need and deserve all the help available. Although the NDIS is a demand-driven scheme, its resources are finite. As it approaches its full size in terms of participants during the next two years, finding the fairest and most efficient system for allocating those resources will be one of the nation’s major social policy challenges.