NDIS needs sustainable footing

The Albanese government and the states are set for a brawl over cost-shifting for the National Disability Insurance Scheme when a review of the scheme goes to national cabinet this month. Before they get into the funding fight, they should recall why the NDIS was created – to achieve “funding to eligible people with disability to gain more time with family and friends, greater independence, access to new skills, jobs or volunteering in their community, and an improved quality of life”.

But the inevitable arguments over which levels of governments pay what will obscure a fundamental problem for spending on health and human services – how to pay for a scheme where demand will always soak up all available funds, and then some. Without timely action, disability ministers acknowledged last month, the NDIS is projected to have more than one million participants and cost up to $100bn a year by 2032. The current cost is $42bn a year.

Short of spending caps, one alternative is a combination of vigilance against inefficiencies, rorting by service providers and mission creep. The other is productivity improvements. That there is maladministration in a scheme Bill Shorten calls “complicated, bureaucratic and unfair” is beyond doubt. That provider malfeasance takes money away from the scheme’s clients is assured. The Australian National Audit Office also reports autism is the “primary disability” for 34 per cent of NDIS participants, and 64 per cent aged under 15. Payments for participants with autism grew 23 per cent in the year to September 2022.

As Stephen Lunn has reported, “children are being diagnosed with more severe autism than their characteristics warrant to give them a greater chance of securing a place on the NDIS”. It is neither disrespect nor disregard to the challenges families face to suggest that NDIS funding must go to those whose disability is greatest, ahead of those with parents determined to find a better life for their children. These problems must be addressed but they, or others like them, will always exist.

The bigger challenge with hope for change is to reduce the overall share of resources it takes to deliver actual services to each client. And that means improving productivity. This is not easy to do in public services, where work – at least for now – generally requires a human touch and there are no technological efficiencies of scale. Even so, there are opportunities to explore.

The NDIS administration confuses bureaucracy for care, and public servants have a horror of incentives, assuming providers will always try to do less for more. Such orthodoxy needs to be challenged. There should be continuing trials in everything from funding systems to organising client services. The vast amount of data the system holds includes evidence for service improvements. AI can help make lives easier, with speech recognition software, individualised teaching programs and systems of the kind now appearing in school education. Robots, doing everything from going to the shops to providing companionship, are surely on the way.

The Productivity Commission made the case for the NDIS in 2011: “It would aim to better link the community and people with disabilities … It would also provide information to people, help break down stereotypes, and ensure quality assurance and diffusion of best practice among providers.” Despite billions of dollars and the efforts of vast numbers of disabled people and their carers, we are not there yet. We need hard decisions on how and where funding is allocated, and creative thinking to make the NDIS all Australia needs.