NDIS cannot be a magic pudding

In caring for many of Australia’s most vulnerable people, the National Disability Insurance Scheme is great social policy that defines our society as civilised and generous. Australians of goodwill on both sides of the political spectrum want to see it thrive long term, which is why it is a good thing that it features in two key economic reports released this week – the Business Council of Australia’s blueprint for productivity growth, Seize the Moment, and the latest intergenerational report. If decision-makers are to be soft-hearted towards those who need the scheme, they must be hard-headed to ensure its viability, especially as the population ages and the ratio of working taxpayers to retirees declines. Spending on health, aged care, defence, interest payments to service debt and the NDIS will blow out by more than $140bn a year across the next 40 years, worsening the structural budget crisis facing future governments.

The NDIS and interest on government debt are projected to be the fastest-growing categories during the next decade, underlining the need to contain costs. Without comprehensive review and reform, spending on the care economy, including the NDIS, aged care and hospitals, will become unsustainable, the BCA blueprint warns.

Bruce Bonyhady, the father of the NDIS, put the issue in context a few days ago when he said: “We must stop thinking of the NDIS as though it is a limitless magic pudding. What has become clear is that, often without intending to, ­governments, service providers and some people with disability and their families have all started to treat the NDIS as a limitless ­resource.” That included state and local governments. Professor Bonyhady, who, with former public servant Lisa Paul, is co-chairing a review of the NDIS for the government, is well placed to influence its future. The report is due in October and it will be considered by national cabinet in November. The latest figures show the costs of the scheme rose to $35bn in 2022-23 as the number of participants rose to 610,000, up almost 76,000 in a year. What is more worrying from a budgetary perspective is Professor Bonyhady’s concern that the scheme’s costs may be rising faster than currently understood, putting national cabinet’s 8 per cent cost growth target by 2026 in doubt. NDIS Minister Bill Shorten, who said in April that the scheme needed an urgent reboot and had lost its way, put his finger on one of the main problems when he told Sky News on Tuesday that the government needed to “clarify eligibility” when it cames to joining the scheme. “What we need to do is recognise that nearly half the scheme are kids so there’s a challenge there in how we help young kids with developmental delay,” Mr Shorten said.

At a time when 11 per cent of boys aged five to seven and 5 per cent of girls of the same age are NDIS participants, with autism their main diagnosis, the issue of eligibility cannot be sidestepped in the review, by national cabinet or the Albanese government. As Mr Shorten told the National Disability Summit on Tuesday: “Why is the NDIS, the lifeboat in the ocean, the only lifeboat of the ocean? We need to understand why there are a lot more kids on the NDIS than was initially expected. And we need to make sure that the NDIS has a sensible trajectory of growth.”

Professor Bonyhady says developmental concerns in early childhood need a complete, urgent rethink. “Twenty per cent of children experience learning difficulties, developmental concerns, developmental delay or are found to have disabilities,” he said. “In other words, learning difficulties and disability are mainstream issues. Unless there is a need for clinical intervention, (early intervention) needs to be delivered mainly in homes, early childhood settings and schools.” The severity of autism suffered by prospective NDIS patients, including children, must be taken into account when applications are made. But the states cannot abrogate their responsibilities in assisting families to deal with the issue.

Mr Shorten was correct when he told a Labor Enabled event on the sidelines of the party’s national conference that “not everything is an NDIS matter”. State-run hospitals, he said, had handballed too many pro­cedures to the NDIS. “We need to restart the debate (about) what does disability inclusion look like (for) people with a disability who don’t qualify for the NDIS.” But when funding is on the line, Canberra can expect pushback from the states.