NDIA Accountability Project

Making the NDIS fairer for people with an intellectual disability and their families

‹ PrevPage 1 of 6 · Source p. 1Next ›

. . www.inclusionaustralia.org.au GS Inclusion Australia admin@inclusionaustralia.org.au

1300 312 343

Joint Standing Committee on the National Disability Insurance Scheme PO Box 6100

Parliament House Canberra ACT 2600

28 February 2022

To the Joint Standing Committee on the NDIS

Please find following our short submission to the Current Scheme Implementation and Forecasting for the NDIS inquiry. We have also attached several recent submissions to other consultations that cover similar issues for your consideration and refer to them in our submission.

The latest reports say that 19% of NDIS participants have an intellectual disability and over 60% of NDIS participants have a cognitive impairment.

Making the NDIS fairer for people with an intellectual disability and their families is central to our advocacy.

In 2017, Inclusion Australia told the Productivity Commission’s inquiry into NDIS costs that: “Our intention is to ensure that the NDIS is successful, for if not, the cost of spending $22 billion will not just be about poor value for money, but a failure to support people with intellectual disability to have a good life equal to that of Australians without disability — which is a far greater cost in terms of consequences for the very people the NDIS is meant to serve.”

Inclusion Australia receives little funding as a national peak organisation, limiting our capacity to deliver on the wide range of submissions and consultations that are requested, including with often short and competing timeframes.

People with an intellectual disability and their families have a strong interest in the NDIS, now and into the future, and we would urge the Joint Standing Committee to prioritise the needs of people with an intellectual disability.

We appreciate your time and thoughtful consideration of our concerns.

Kind regards,

Catherine McAlpine Chief Executive Officer Inclusion Australia

About Inclusion Australia

Inclusion Australia is the national Disability Representative Organisation (DRO) representing the rightsand interests of Australians with an intellectual disability and their families.

We have state members in New South Wales, Queensland, South Australia, Tasmania, Victoria and Western Australia:

e Council for Intellectual Disability (CID), NSW

e Parent to Parent (P2P), QLD

e South Australian Council on Intellectual Disability (SACID)

e Speak Out Association of Tasmania (Speak Out)

e Victorian Advocacy League for Individuals with Disability (VALID), and

e Developmental Disability WA (DDWA).

Current Scheme Implementation

One in five of the people that use the NDIS are people with an intellectual disability. People with an intellectual disability and their families were central to the campaign for an NDIS, and are some of the Scheme’s biggest supporters.

But there are many aspects of how the NDIS is being implemented that aren’t working for our community.

We have attached our submissions to both recent NDS consultations - Home and Living Options and Support for Decision Making. These two submissions outline in detail many of the current issues for people with an intellectual disability and their families, and also our suggestions for improvements.

Inclusion Australia also raised issues about the implementation of the NDIS in our submission to the inquiry into Independent Assessments.

In addition, we have covered issues to do with NDIS employment supports in our recent submission to the reform of the Disability Employment Services. There are many common themes among each of these.

The key issues are:

  • Lack of choice and control
  • Complexity
  • Segregation
  • Long term security
  • Forecasting for the NDIS and funding

Inclusion Australia has significant concerns with the actuarial approach that the NDIS takes to determining economic value. We are also worried about the increasing use of a very narrow definition of ‘value for money’ when determining individual supports.

The detailed actuarial report! about the forecasted growth of the NDIS, also known as the Taylor and Fry report, said that a number of factors were contributing to higher than expected costs of the NDIS. These are:

  • Continuing high numbers of Scheme entrants.
  • The risk of low ongoing exit rates.
  • The assumed reduction in base inflation.
  • The potential for higher superimposed inflation.

We believe these do not accurately reflect what is happening with the NDIS.

The NDIS now represents the only mechanism for disability support in Australia. This was not the original Productivity Commission vision for the NDIS, nor what every review, including the Tune Review, has called for.

State and territory governments, while contributing to nearly half the costs of the NDIS, have also reduced their provision of disability supports, including in the health system.

This provides significant pressure for people with disability to have to get NDIS supports because there is no other option.

1 https://www.dss.gov.au/disability-and-carers-programs-services-government-international-disability-reform- ministers-meetings/reports-and-publications

The original Productivity Commission model saw a significant role for Tier 2 disability support organisations, who would link people with disability who need lower levels of support with mainstream services.

This has not been delivered on, and is a big missing piece in making the NDIS work.

There is a continued misuse of declining functionality in the actuarial reports that does not recognise the reality of the lives of people with an intellectual disability and their families. The need for disability supports will fluctuate during a person’s lifetime, with their changing circumstances and needs. This is exactly what the NDIS was meant to deliver certainty on. But increasingly, there is a focus on a rehabilitation-style measurement of function that is detrimental to people with an intellectual disability, who will use the NDIS for the rest of their lives.

In addition, these reports do not look at the holistic impact of the NDIS, both on people with disability and their families, but also on employment and local economies. Until the actuarial reports start to include these other economic indicators, they will not provide an accurate economic picture.

A recent report from Per Capita? found that:

e The NDIS employs over 270,000 people over 20 different occupations, and contributes to the employment of tens of thousands more workers indirectly;

e The economic impact of the scheme is likely very large, even compared to other types of government spending. A conservative estimate of the multiplier effect of the NDIS would be in the range of 2.25; and

e Such a multiplier effect would mean that the economic contribution of the NDIS in 2020-2021 is around $52.4 billion.

In addition, the economic impacts on informal family and caregiver supports, the health and wellbeing of people with an intellectual disability, as well as the employment of people with an intellectual disability in open and self-employment must be accounted for when looking at the future impact of the NDIS.

Inclusion Australia is also concerned by the impact that a lack of market regulation is having on people with an intellectual disability and their families, including on the costs of the supports they use.

The current Quarterly Report shows some information about the concentration of large providers, with 12 per cent of payments were paid to the largest 10 providers for people with Agency managed plans. However, this represents an increasingly small number of people with disability, showing the need to release this kind of information for self and plan managed plans. Having accurate market information is essential.

In our submission to the Productivity Commission inquiry on costs, we said that: “Tt is critical that the NDIA publish provider outcomes as a critical strategy to ensure informed participant choice of providers based on performance results. This provides a strategy to drive market quality and value for money through informed participant choice. Publishing results also ensures that poor provider performance incurs a consequence through an increasing number of participants choosing higher performing providers.”?

This is still an outstanding issue.

Many of the largest disability service providers have grown rapidly over the last few years, with the majority of their income coming from the plans of people with an intellectual disability, particularly for Supported Independent Living. At the same time, the choices of people with an intellectual disability and their families have reduced.

The Disability Royal Commission

Public Hearing 13%

The Disability Royal Commission, in public hearing 13%, has heard from people with an intellectual disability and their families about ‘service capture’ - where a person with an intellectual disability receives their housing, daily supports, support coordination and employment from the same disability service provider.

This service capture distorts the market by creating service monopolies, and leads to increasing segregation for people with an intellectual disability. This model also does not provide the kind of long-term certainty for people with an intellectual disability and their families, as it is not integrated into the community, provides little to no supported decision making or capacity building.

We urge the committee to include these matters when considering future forecasting and sustainability of the NDIS.

What supports are or should be available for people with disability in addition to the NDIS

People with an intellectual disability are often excluded from mainstream services, and for those not eligible for the NDIS, they receive no support.

As stated earlier, the NDIS now provides the only mechanism for disability support. This means that many other areas of government and private services that people with an intellectual disability and their families use are not accessible or available. These include such employment, health, education, justice and housing.

Inclusion Australia supports the development and funding of the National Roadmap for improving the health of people with an intellectual disability? to address the health disparities and lack of services in the health system.

All levels of government have obligations under Australia’s Disability Strategy to include people with disability. However, people with an intellectual disability and their families are often overlooked. We believe that there needs to be an Associated Plan for the inclusion of people with an intellectual disability as part of Australia’s Disability Strategy to provide a comprehensive blueprint for the inclusion of people with an intellectual disability and their families in parts of mainstream Australia.

Inclusion Australia believes there needs to be significant investment in Tier 2 of the NDIS, with a focus on people with an intellectual disability and their families. These Tier 2 disability support organisations would be run with people with an intellectual disability and their families, and provide peer support, independent information and systems navigation.

In our submission to the NDIS consultation on Home and Living options (attached), we said:

“community based capacity building supports are poorly funded. This issue has been worsened by the redirection of state and territory disability funding towards federal grant schemes like the ILC. Peer support networks, self advocacy groups and decision making capacity building activities have recently been propped up by one-off, short-term ILC grant funding, or by not-for-profit organisations with little to spare. Now that the responsibility for ILC has moved to DSS and no plans for the scheme have been published beyond this financial year, it is not clear to these capacity building support providers how they will continue to run.”°

In our submission to the NDIS consultation on support for decision-making (attached), we raised concerns about the lack of independent resources to support a person with an intellectual disability’s decisions about their NDIS supports, as well as other parts of their lives. We recommended: “that independent decision-making support is best placed within independent advocacy organisations and Disability Representative Organisations (DROs) to reduce conflict of interest or undue influence, and to harness the supported decision-making skills and capacity already present in these agencies.Independent advocates and DRO staff have been supporting people with disability to make their own decisions for decades.”