Over the ten years since the National Disability Insurance Scheme (NDIS) was launched, its design, operations and costs have been scrutinised by governments, the media, the legal system, researchers and people with disability and their advocates.

More than 610,000 Australians receive NDIS funding to purchase support and services to meet their disability-related needs. But the overwhelming majority of the 4.4 million people with disability in Australia are not NDIS participants. Whether and how their needs are met outside the NDIS has huge implications for the scheme’s future.

That issue sits at the heart of the NDIS review. The review’s findings and recommendations have not yet been publicly released, but NDIS Minister Bill Shorten and the review’s co-chairs have already called for state and federal services outside the scheme to step up supports.

What fell away when the NDIS was rolled out? And what are the chances of such services being revived?

How the NDIS ate other supports

Under the NDIS, many people have been able to get the support they need for the first time.

However, the movement of money from Commonwealth, state and territory governments to the NDIS meant people with disability who do not meet the scheme’s eligibility criteria lost access to some supports. The introduction of the NDIS also impacted the costs and availability of services.

What was glossed over in the transition to the NDIS was community, social and economic inclusion of all Australians with disability. As money flowed from other parts of government to the NDIS, there were no clear answers on how this cornerstone of the scheme should be delivered and funded.

An oasis surrounded by desert

Demand for support from the NDIS has outstripped all forecasts, putting pressure on the federal budget. But government has shown little will to tackle what is driving its growth.

Slow progress on improving accessibility in “mainstream” services and the erosion of access to supports like home and community care and community mental health services have left the NDIS an “oasis of support, surrounded by a desert where little or nothing is available”.

Research in 2022 revealed people with disability and their families were navigating disconnected and incomplete service markets, with inconsistent eligibility criteria. There were gaps in data informing policy. People without NDIS funding were relying heavily on family support and personal resources. In surveys for this research, 90% of people with disability outside the NDIS said they were unable to find the support they needed.

States have already said they need more funding to support people with disability outside the NDIS. That has to be a whole-of-government conversation.

When people with disability and their families cannot find or afford the support they need, and exhaust their own resources to the point of crisis, they ultimately need higher levels of support from the NDIS and government across the board.

We need a graduated support system for people with disability between being in or out of the NDIS.

A shakeup is likely

The NDIS review’s final report is likely to be publicly released in December, after National Cabinet has met to consider its recommendations.

The review has already signalled it will call for coordinated effort and investment across government. Review co-chair Bruce Bonyhady recently said there would be more focus on support needs rather than functional impairment in decisions about what is reasonable and necessary for the NDIS to fund.

The review is likely to propose a new disability inter-governmental agreement to encourage governments to develop and implement a foundational supports investment strategy for all people with disability together.

It is also likely to call for national commitments to deliver more effective supports for children who are slow to reach one or more developmental milestones compared to their peers – described as “developmental delay” - and for people with disability linked to mental health.

Translating those recommendations into action across federal, state, territory and local governments won’t be easy.

What should change? What should come back?

The NDIS review may finally force clarification of roles and responsibilities for funding and delivering services and supports between the NDIS and key policy areas like health, education, employment, early childhood, justice, transport, housing and aged care that cross government jurisdictions.

It may also clarify the relationship between the NDIS and Australia’s Disability Strategy 2021-2031, which is intended to provide national leadership to drive mainstream services and systems to improve outcomes for people with disability.

There have been numerous references throughout the review to a need for more access to home and community supports, to reduce the likelihood of people needing higher-cost individual supports.

We may also see a return to block-funding for some widely used supports to achieve economies of scale lost in individual purchasing models.

From diagnosis to inclusion

Service systems such as disability employment services and specialist schools, which parallel universal services, highlight tensions between how governments talk about inclusion and how services and supports for people with disability are designed and funded on the basis of diagnosis.

We have to explore new ways to design and fund services, drawing on the knowledge and expertise of people with disability, and address evidence gaps to better inform policy.

Looming negotiations between federal and state governments about who should pay for what in that landscape are likely to be tense and protracted. But people with disability must not be reduced to “costs” in that tussle.

The biggest lesson from the NDIS review may well be that governments cannot continue to treat 20% of Australians as outliers in designing universal services.

Sue Olney does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Sue Olney

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