The Panel’s Vision for the Scheme
The NDIS is a revolutionary scheme, well-intentioned with ambitious initiatives. A decade since its inception, it is evident that the NDIS and supporting government services have yet to achieve their original objectives, as there is still a significant gap between what is happening and the intent of the legislation written in 2013.
The NDIS Review is a chance to put people back at the centre of the NDIS, restore pride and confidence in the scheme.
The year-long enquiry was commissioned after the 2022 federal election, driven by mounting concerns about the precarious state of Australia's disability support system, including an over-reliance on the NDIS with limited alternatives, as well as the scheme’s escalating costs, fraudulent providers, and frustrating bureaucracy.
In 12 months, the independent NDIS Review Panel heard from over 10,000 Australians in each state and territory, including regional and remote communities, and received close to 4,000 submissions.
The inquiry's findings result in 26 recommendations and 140 actions, with a five-year implementation timeline to address the systematic shortcomings of the over 630,000 NDIS participants and the 4.4 million Australians with disability outside the NDIS.
This blog doesn’t cover every recommendation and action, so be sure to check out the Final Report: Working together to deliver the NDIS, with an Easy Read Version available too.
More mainstream services outside the NDIS
Australia has an unbalanced disability support service relying too much on the NDIS as the only substantial support, with a lack of mainstream alternatives available for people with disabilities, ‘the gap between those inside and outside the NDIS is unfair’.
To facilitate this, the state and territory governments have been asked to take more responsibility to provide disability support services in the community.
Annual NDIS spending has reached over $35 billion, becoming the second-most expensive federal program after the aged pension. While funding was initially split 50-50 between the states and Commonwealth, the federal government currently pays for about two-thirds of the scheme. The state and local governments were supposed to implement tier 2 services alongside the NDIS rollout, but the existing services dried up significantly, along with a lack of funding for establishing new services meant tier 2 wasn’t implemented.
The state governments “stepping up” will include the introduction of foundational supports for those with less severe disabilities who don’t require individual plans, delivered through health, early childhood and education settings. Some examples of foundational support include help cleaning and cooking, personal assistance, early supports for children, and teenagers and peer support.
The funding of these new supports would be split 50-50 between the Commonwealth and states and territories confirmed after the national cabinet on last Wednesday, with these supports phased in over time and backed up with federal legislation in the first half of 2024.
Read more: Inclusive mainstream services coordinated with the NDIS and Foundational disability supports for every Australian with disability.
Improved screening for developmental concerns
More children have entered the NDIS than anticipated - over 150,000 NDIS participants (a quarter of all participants) are under nine - and are the fastest growing category of participant.
Due to a lack of support outside the NDIS, participants are on the scheme for developmental concerns that weren’t initially intended to be funded under the legislation. In Australia, one-in-five children have a disability or developmental concerns.
‘This means that support for children with disability and learning difficulties is a mainstream issue, not a marginal issue and must be addressed systemically.’
The review noted there should be far more robust support outside of the NDIS for children and their families to reduce the pressure on having to access the NDIS to receive assistance. Establishing a holistic, continuum of support and monitoring developmental delays to provide support options as early as possible is recommended as an urgent priority for all governments.
Read more: Better support for children and their families inside and outside the NDIS.
Hinging access on impairment instead of medical diagnosis
Eligibility for the NDIS was intended to be on a degree of functional impairment, not diagnosis. But in practice, eligibility has relied on diagnosis and the availability of well-written, expensive reports favouring more resourced applicant or those able to navigate a complex system.
Proving a permanent disability has been difficult to demonstrate, especially for psychosocial disabilities where no mental illness-specific conditions were included on the list of conditions likely to meet access requirements for the scheme.
Decisions on access are too often being influenced by the amount or type of supporting evidence provided to the NDIA, rather than need.
The report recommends the removal of access lists, like the use of access lists under autism at a level 2 diagnosis under the DSM, to now prove “significant functional impairment” and needs assessment.
The report also suggests clarifying definitions of key eligibility criteria such as what’s “reasonable and necessary”, and consistent approaches to whether someone meets that measure to provide an overall fairer participant entry pathway.
Read more: A fair, consistent and empowering NDIS experience.
All providers should be enrolled or registered
Last financial year there were 16,000 NDIS registered providers compared to 154,000 unregistered providers working in the sector.
Despite the increased participant choice and control by having the option to work with unregistered providers, the review concluded not requiring providers to be regulated means some workers don't have the skills and knowledge they need to deliver high-quality support.
In a statement by Dr George Taleporos, Independent Chair of Every Australian Counts said he was dismayed by this suggestion, that it will impact on participant’s rights to decide who comes into their homes and who provides their support.
‘There is a serious risk that forcing us to use registered providers will make it impossible to get the essential support that we need. People in regional and remote Australia, many of whom have little or no access to registered providers, are at greatest risk.’
The review panel and NDIS Minister Bill Shorten acknowledge these concerns, and plan to make the arduous registration process more accessible, phasing this step out over several years for participants not wanting to be cut off from individuals and services.
Read more: A new risk-proportionate model for regulation of providers and workers.
Transform disability housing
As highlighted in the disability royal commission and the NDIS quality and safeguard commission, group homes (the predominant model of disability housing) do not deliver good outcomes for participants.
Many participants in group homes receive round-the-clock care, and have limited choice in where they live and who they live with. In the last four years, there have been over 7,000 serious incidents of sexual misconduct, abuse or neglect in disability group homes.
The review suggests altering the housing funding mechanism, more flexible pricing for participants in 24/7 care and advocating for greater participant autonomy in selecting living arrangements that suit their needs.
This includes giving participants flexibility to choose living arrangements that suit them, the ability to trial facilities before committing to them and urging all Australian governments to increase accessible social housing.
Proactive strategic planning is essential to enable individuals with disabilities who would opt for supported accommodation alongside their peers (rather than residing with ageing family members or caregivers) within locations close to informal support networks.
To do this, a skilled and independent national workforce of housing navigators needs to be implemented, to ensure human rights of informed choice of where and whom to live with is upheld.
Read more: Housing and living supports that are fair, consistent and promote choice.
Introducing NDIS navigators
The review panel proposed the government introducing a new role, navigators, to see better support for people to navigate the entire disability system, not just the NDIS.
These navigators will not be NDIA employees and may replace the case managers and support coordination roles.
There would be two primary types of navigators – general navigators providing information on the available support services and specialists who help participants with complex needs.
General navigators will be for all people 65 and under. Their role is to be paired with an individual upon receiving a disability diagnosis to provide information and connect people to mainstream services, NDIS support and foundational services.
Specialist navigators will be for NDIS participants with more complex support needs. Participating in many of the same tasks as a general navigator, except they will have more expertise and time to meet the individual's higher support needs, like involvement in the health or child protection systems.
Other specialist navigators that have been recommended include: psychosocial recovery navigator, housing and living navigator, shared support facilitator and lead practitioner.
The review panel expects many of the functions of Local Area Coordinators, Support Coordinators and Plan Managers will be encompassed in this new navigator role, with opportunities for those in these roles to become navigators over the next five years.
Read more: Support for all people with disability to better navigate mainstream and disability supports and NDIS Review Frequently Asked Questions - Navigation.
New approach to psychosocial disabilities and the NDIS
NDIS participants with a psychosocial disability were anticipating the results of the NDIS review, after NDIS Minister Bill Shorten suggested diverting people with psychosocial disability from the NDIS to reduce participant growth back in June.
Currently, many people with severe mental illness who apply for the NDIS do not get access, and programs they previously received support from were defunded to fund the scheme.
For those who have access to the NDIS, the review heard while it has been life changing for many participants, those with a psychosocial disability experience poorer outcomes than other participants, experiencing an often traumatising system with planners and partners with little understanding of psychosocial disability.
The review suggests the NDIA implement a personal recovery and optimising independence approach to psychosocial disability, and invest in an early intervention pathway.
Currently NDIS providers have no obligation to try to improve a person’s recovery. Outside the NDIS, the review suggests all governments to prioritise foundational support and improve access to mental health services for people with psychosocial disability and severe mental illness.
Read more: Recovery-focused psychosocial supports in the NDIS and the broader mental health system
The recommendations provided in the review are merely suggestions at this stage. The onus is now on the government to implement reforms whilst co-deigning a new strategic direction with people with disabilities in Australia, placing their concerns at the forefront of the reform efforts.
NDIS Minister Bill Shorten said the government’s full response to the review will be released next year, in the meantime you can watch his Address to the National Press Club, and check out Dr George Taleporos’ interviews: NDIS Review: Big Changes Revealed with Co-Chairs Bruce and Lisa and Guide to the NDIS Review: Experts Have Their Say.