14 April 2021
The whole model of the NDIS is wrong. It is all about turning care into a commodity for private profit. The con was that the people with disabilities would have ‘choice’ and could buy services from a range of providers, who would compete to give great service. But there are big structural faults.
Firstly, big corporations want big profits, so this creates an overhead so there is less money available.
Secondly, people are assessed by ‘experts’ so how much money you get based on a single interview. They are not people who actually do the job and could allocate compare the needs of different people in an area. The assessors are an overhead- another layer of managers.
Thirdly, once the money is allocated, those who have it will be encouraged to spend it whether they need it or not. And of course, this will favour those who present well (usually the middle class) and totally disfavour those who did not get a ‘package’.
Fourthly, the ‘market’ model does not work. Those who need the services do not necessarily know who can give them what they need. They are vulnerable to sales pitches from a limited number of providers and they may not even know about other options. In some geographical areas there may be only one provider, so there is no competition anyway; the provider can set the price and the profit.
Finally, the government can just lessen the amount of money and packages available.
When I was in a Parliamentary Committee looking at disability, the first thing we tried to find out what how many people were disabled. No one had wanted to keep records. People who had tried to get services from a provider and been knocked back because there were no places assumed that there would be a list there and if a place came up they would be offered it. Wrong. Usually there was no list, and a new person got the place if they happened to know someone or turn up at the right time. But at a broader level, experts we asked about how much disability there was either told us how many people were on various schemes and tallied these up, or looked at AIHW (Aust. Institute of Health and Welfare) figures, which said what percentage of the population had a disability and multiplied this by the population. The second method gave figures that were about 10x the people on benefits. So it was very obvious that if there was a supposedly universally available system the cost was going to blow out enormously because of the unrecognised demand.
The solution in my view was to have a universal support system that was community-based, like a district nurse model, and then ask the people actually doing the job, who needed more, and who could be helped to get their own home help from a number of people who would be registered in classes of carers. The government would then buy services in response to the needs identified and quantified by those doing the job. The essence of this was the empowerment of those actually doing the job. NDIS actually does the opposite. It is about the government shovelling money to the private sector with some middle ranking experts supposedly swooping in and saying how much money is needed. If they were embedded in the service delivery framework, they would be discussing needs and relative needs with those actually delivering services.
But modern management and politics assumes it knows best and those at the bottom need to be ‘managed’, i.e. told what to do. My experience is that people doing a job usually know more about it than anyone else and the intelligent use of their expertise is the most solid base for management. My experience is also that putting people in charge who are there for the money rather than the job are unlikely to do a better job than those who are more concerned with the job than the money.
I put this in a paper to Kevin Rudd’s’ 2020 Vision’ in 2000, but never even got an acknowledgement. The NDIS, like the Aged Care Act of John Howard seems to have used ‘choice’ as a Trojan Horse for a market model and privatisation. We need to start again. This is just a suggestion of a better model, but given the power of money in politics I am not hopeful of change.
A new article in The Saturday Paper 10/4/21 looking at the cost blowout and blaming those who need the services has a depressingly familiar ring. The blowout was eminently predictable and cost control by victim-blaming at the bottom is more likely than looking for corporate rip-offs at the top. This is what I see every day in Workers Compensation and CTP insurance.