Submission to Joint Parliamentary Inquiry into the NDIS
Dr Arthur Chesterfield-Evans
A bout the author: The author is an ex-NSW MLC, and ex-tobacco activist with an interest in politics and history and degrees in occupational health, political economy and surgery, currently working as a medical practitioner. This submission tries to integrate this experience into a perspective that the committee may find helpful.
A Perspective The NDIS is effectively a privatisation of the welfare system. It may be dated from legislation which allowed profits into the welfare system. It is a top-down system that manages money and is poorly integrated into community support systems.
| am advocating a “Caring Society” model with an alternative grassroot-up model for the NDIS, which requires a re-think of how care is delivered and to whom, an extension of the market, a registration of those who offer caring and helping functions, and a greater reliance on community nurses as first-line advisers.
M y previous experience in this field
| was on a NSW Parliamentary committee that considered the welfare system and asked the question, ‘How many people have disabilities that need help?’ There were effectively two answers. One was to add all the people on all different types of social welfare systems. The other was to look at data from the Australian Institute of Health and Welfare and see what percentage of the population has a degree of disability. The latter method gave a figure about 5 times the former, so it was obvious that any system that tried to meet all the needs of all people was going to create a huge logistic and financial problem. A rationing of the amount of support that can be provided is probably necessary and the important thing is to set a standard and meet it equitably.
A gain, the Committee heard many articulate advocates for having services for disabled people as private commodities that could be purchased. These were often ageing parents with disabled children, who were keen to examine alternatives and set up ongoing plans to lock after their children when they died. Their perspective was understandable, but when a market is created to replace a publicly funded system, it has to be assumed that the market will be fair and regulated and those participating in it do so willingly and with full knowledge of the cost and options. | would argue that, while this may have been true for the advocate group mentioned above, it is in no way true for most people with a disability.
T here were endless submissions criticising the existing institutions in that there were a variety of services that had evolved historically and tended to lag behind changes in need with poor home help and a shortage of institutional facilities, particularly in mental health or dementia. There were also no systematic waiting lists, with beds available at random and given to whoever happened to apply when one became available.
I t was simplistically assumed that a ‘market’ would fix all these problems, as supply would rise to meet demand. This was fine as far as it went, but if Australia could not organise a
number of well-intentioned but underfunded institutions, it was indeed a radical assumption that it could organise, supervise and control a far greater number of enterprises, at least some of whom were merely profit-seeking and keen to extend a market that was already many times larger than the one previously served.
One of the features of the NDIS is that occupational therapists or similar come in and evaluate situations, recommending a certain level of package to be spent in an NDIS market. HHowever well qualified the assessor is, a few facts must be faced. Firstly the evaluation is based on an interview at a point of time. Secondly, the assessor may not be made aware of all the other support that the client has or lacks, as the assessor has no personal knowledge of the client. Thirdly, the assessor who recommends a certain money package may or may ot have input into how that money is spent, wisely or not. Finally, the assessor cannot judge the relative need of that person relative to others in similar situations. In other words, if there is a shortage that results in effective rationing, those who have the packages will be fine, and those who have not will not; a very inequitable result. The system is bureaucratic and ‘top-down’ working in terms of managing money allocation, losing track of those on the ground and having an inability to know enough to stop systemic fraud or poor value services.
in short, the NDIS has a number of major problems:
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There is a disconnect with those who actually know and work with the problems and those who have the power. Managers who do not know the clients at all have put in another layer of assessors.
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There is a profit motive and an incentive not merely to meet the demand but actively to increase it.
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Governments have given away the expertise to manage cases so have a poor knowledge base to supervise contractors. They award huge contracts to a few organisations and have no real idea how much money actually gets to individual clients, as they avoid the alternative of trying to supervise a large number of smaller or practitioners because they can never achieve this at an individual service level.
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There is now a powerful lobby to keep this privatised system
A ‘Caring Society’ model
My answer is to try to reform the NDIS by having it as part of a ’caring society’ model. What is needed to deal with the problem of an ageing population and greater equality of opportunity for people with disabilities is to build a society where people care for each other and this is encouraged as an ethos by governments. People already care for their friends aud relatives, and the NDIS would be an extension of this rather than the current top-heavy bureaucratic system.
The government would allow people to register as offering ‘care functions’. These could be simply common tasks such as gardening, shopping, cleaning and cooking, or could be more personal such as aspects of physical care, like nursing. The government would keep a egister and insure people applying for these classifications and they could be certified after a TAFE course that would define the roles and responsibilities with clear ethical guidelines. They could then deliver services on a person to person basis with word of mouth referral or small scale advertising on registered sites. There could be quality control such as exists for
Capability and Culture of the NDIA
Submission 186
The services offered through Uber and Airbnb could exist as a marketplace where individuals purchase services. This would establish recognized pricing for those services becoming well known. Government oversight includes complaints systems & inspectors who can withdraw registrations or impose sanctions against unethical behavior. Community nurses may participate in their current roles or expand them assessing/advising on requirements; they possess knowledge about an individual’s environment including supports available (or lacking). This allows NDIS development specialized support based upon community foundations—making survival difficult for low-value offerings.
Current registration gaps permit companies claiming rostering quality control while prioritizing overhead profits over direct worker compensation – minimized within individualized provider models expanding markets via competitive forces. Ground level involvement from these professionals facilitates flexible tailored arrangements preventing packages being secured solely due marketing tactics targeting uninformed consumers. Notably there are numerous qualified regulated trustworthy nursing practitioners exceeding most other care professions. While not encompassing all needs, such personnel routinely consult specialists knowing appropriate assistance providers given circumstances.
A crucial shift involves transitioning NDIS away top down financial management towards grassroots communal aid with supplemental resources provided when needed - implemented gradually originating locally rather than distant administration structures. Person to person model expansion necessitates government accreditation empowering both people alongside caregivers controlling service suppliers contributing regulatory frameworks. Assuming employer supervision merely presumes corporations maintain reasonable rates avoiding profit maximization — requiring corporate monitoring too! History demonstrates banks casinos aged facilities often prioritize gains above ethical conduct so assuming better performance by individuals is unrealistic creating employment setting benchmarks limiting client charges threefold compared payment received delivering services which frequently occurs presently: the question remains whether governmental courage will facilitate this reform.