Photo: ABC’s The Dreamhouse/Artemis Films.
As the National Disability Insurance Scheme (NDIS) enters its fourth year, there are growing concerns from disability advocates about whether it can provide the choice and control it promised to individuals with disabilities.
The NDIS, which had a target of 120,000 enrolled participants by July 2017, is currently estimated to be behind by up to 20,000 people.
With the Senate debating an increase of the Medicare levy from 2% to 2.5% to fund the $22 billion program, there are fears that it will cost far more than projected.
Concerns about underfunding have been compounded by reports that enrolled participants are not being equipped with an appropriate level of care, because of the scheme’s cost-saving assessment tactics.
Planning assessments are supposed to establish what “reasonable and necessary support” a person requires under the scheme. But many participants have disclosed that they have struggled to access face-to-face planning interviews, which have in some cases been reduced to a half hour phone conversation.
In a study released by the ACT’s Council of Social Service (ACTCOSS) last week, the shift to phone interviewing was described as “disempowering” and contradictory to the scheme’s original insurance approach that valued higher investment in the early phase of the package to reduce long-term costs.
“Planning by phone increases communication difficulties and reduces the ability to clearly present participant goals and needs, and compromises accurate assessment by the planner,” the report stated.
Such difficulties, the report argued, “will potentially increase the long term costs of the NDIS.”
Gemma Cooney, the Regional General Manager of the disability support provider House With No Steps, says that while all of her clients in supported living in northern Sydney and the Illawarra region have received face-to-face interviews, she is concerned by the increasing prevalence of phone interviews among other clients.
“I think it’s fraught with lots of challenges,” she said.
“It’s really disappointing for those families that can’t get face-to-face interviews to really explain what they need. And it’s good for coordinators to actually meet the person – to put a face to a name and see that they are dealing with a person, not just a voice at the end of a phone.”
South Australian Dignity for Disability MP Kelly Vincent, the youngest woman ever elected by any Australia parliament, says that this issue underlines the need for the NDIS to fulfil its “choice and control” philosophy in all aspects of the planning process.
“The move to phone interviews certainly seems to be a cost cutting measure, as well as an efficiency measure since they are quite behind schedule,” she said.
“But I think it’s important to give participants an option because for some people a face-to-face interview will get them the best outcome but for others with, for instance, mobility issues or chronic pain, it may be easier to do it on the phone.”
The study from ACTCOSS also concluded that excessive administrative hurdles, confusing plan formats, and the use of complex language has prevented many people from being able to manage their plans independently.
As outlined in this report and reiterated in a recent University of Melbourne study involving researchers with disabilities, complicated planning processes are likely to lead to further systemic inequality in the provision of care under the scheme.
Those who are better equipped to deal with planning issues will “get plans that better reflect their goals and needs… and higher funding” and people “without these skills or access to skilled advocates don’t,” the ACTCOSS report said.
Ms Vincent says that the National Disability Insurance Agency (NDIA) that oversees the scheme could do more to ensure it is accessible for people who are marginalised in multiple ways.
“People with low literacy, low level education, with intellectual disabilities or brain injuries for example may find it difficult to navigate a brand new system and they can and should take advocates with them,” she said.
“I think a lot of the communication from the NDIA around issues like this hasn’t been as clear as it could be, particularly for people who are already marginalised.
That includes people living in regional and rural areas. It’s all well and good for them to have choice and flexibility in the philosophy of their plan but if there are only one or two service providers in their area then their options may be very limited.”
Those suffering from mental health conditions also risk exclusion because of their difficulty in demonstrating a “permanent and significant disability”; a criterion required to qualify for the scheme.
Ms Cooney says the NDIS has not yet proved that it will actually help people with mental health problems.
“Most of my clients in the inner west of Sydney have serious mental health conditions and I’m concerned that they will actually lose out in the NDIS.
“We don’t know at this stage if people with serious mental health conditions will get the level of help that they deserve under the scheme to maintain and improve the quality of life that they currently have.”
Despite a litany of challenges currently facing the scheme, however, Kelly Vincent is adamant that it is an essential service for people living with disabilities in Australia.
“There are no shortages of problems with the scheme. In a reform of its size I think some of these are to be expected,” she said.
“But on the whole it is a really positive reform that has to keep progressing given the huge investment it makes in the lives of people with disabilities to be more autonomous and better able to contribute to society.
It’s a scheme that we can’t afford not to have.”
As published in City Hub Newspaper, June 2017.