Tough love is needed to protect National Disability Insurance Scheme

Federal Health Minister Mark Butler has bowed to reality in accepting that new limits to eligibility for the National Disability Insurance Scheme must be imposed in an effort to put it on a pathway to financial sustainability.

Without action to cut the growth in costs, the NDIS will place an unmanageable burden on the federal budget and ultimately destroy the scheme itself.

The problem is acknowledged across the political spectrum. Anthony Albanese said this week it was never envisaged that 40 per cent of the population would be on the NDIS. Former Victorian Liberal premier Jeff Kennett and former West Australian Liberal premier Colin Barnett said the federal government had been warned when the scheme was introduced that costs would blow out because of its poor design and the inability of the commonwealth to manage things on the ground. But state governments must share much of the blame for what has happened because they exploited the NDIS to shift more of their own health cost burden to the federal government.

Former NDIS minister Bill Shorten made an effort to root out rorts and identify savings. But the existing cap on growth of 8 per cent a year was never enough. The fact the NDIS has been demand-driven rather than capped is a structural problem. But the bigger issue has been the inclusion of conditions that were never intended to be covered for high-cost, ongoing care.

Top of the list is mild autism, which is now widely diagnosed among children in the community. In an address to the National Press Club on Wednesday, Mr Butler finally conceded that “eligibility will need to change” and that growth in costs must be contained to between 4 and 5 per cent a year across the long term.

This still would represent real cost growth in a system that was supposed to act as a safety net for the most severely and permanently disabled. Mr Butler said too many autistic children were on the scheme and that access to the NDIS for young Australians needed to change fundamentally. Confirmation the NDIS now services as many as one in six boys in year 2 at primary school is outrageous. It represents a complete failure on the part of the mainstream health system.

It is also a poor reflection on a medical establishment that has been prepared to refer patients to the NDIS with little regard to the cost or what it would mean for those whom the system was designed to protect.

Taxpayers have been willing to support what was a much-needed scheme to provide a safety net for the one in 50 Australians with a profound and permanent disability. But, as Mr Butler outlined, 10 in 50 young people currently were being diagnosed as having developmental delay or autism.

The anecdotal evidence has been that once a young person is put on to the NDIS they are likely to continue to receive support into their adult life. This must be changed in favour of a system with more rigorous monitoring for ongoing eligibility.

Mr Butler is correct to say children with mild to moderate developmental delay or autism need a robust system of supports to help them thrive, but diverting them over time from the NDIS is an important element of making the scheme sustainable and returning it to its original intent.

It is part of a bigger challenge to break what is now a widespread community expectation that it is possible for government to cater for every need. The federal government has made a rod for its own back with the emphasis it has put on prioritising the so-called care economy.

The problems with the NDIS were predicted and have been obvious for a long time. Finally, the government appears to be summoning the courage to act.