Catherine Needham, University of Birmingham and Helen Dickinson, University of Melbourne
In July 2016, the full national roll out began of Australia’s National Disability Insurance Scheme (NDIS).
This scheme, which has been piloted in several localities in the last three years, constitutes a major new investment in disability services in Australia. We have been undertaking research and writing on the implementation of NDIS and comparing it to our earlier research on personalisation and a critique of individual budgets and personalisation in English social care services.
Australia had to some extent been an international laggard in disability support. An OECD study in 2009 found that Australia was one of the worst performers of the 27 nations in terms of quality of life for people with disability. The promise of $22 billion of investment in disability services – funded in part by an increase in the Medicare levy (a tax paid by Australian residents for access to the public health system, currently approximately 2% of taxable income) – constituted a radical shift in the political profile and commitment to disability support.
At a casual glance, the Australian reforms look similar to the personalisation reforms being undertaken in England, where people with disabilities have had access to individualised funding for several decades. Key policy enterpreneurs from both countries – Simon Duffy from the UK and Bruce Bonyhady from Australia – are known to have spent time looking at system design on the other side of the world. Even some of the language is the same as these images show:
Australians celebrate the national roll-out of the NDIS
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In England, Think Local, Act Personal launched the Making it Real campaign to focus attention on implemention of personalised approaches.
However the underlying principles of the two systems are quite different. Australia’s approach is modelled not on England’s personal budgets but on existing no-fault motor insurance and workplace compensation schemes in Australia and New Zealand. Given the insurance focus there is a strong role for actuaries in the design and implementation of NDIS, and optimism that the scheme will save money through early investment and risk management. Heroic assumptions have been made about potential cost savings, as Baker notes.
The [Productivity] Commission also listed potential efficiency gains – for example, every 1 per cent increase in productivity in the disability sector could lower the scheme’s costs by $130 million.
In contrast, personal budgets in England were not designed to save money over a person’s lifetime. Any savings were seen as likely to come from a better match between what people needed and what they got – addressing the costs of what Seddon calls ‘failure demand’ – and there has more recently been an acceptance that the broader personalisation agenda is unlikely to save money at all.
Despite the difference of design, early implementation in Australia so far looks to be surfacing similar issues to those that have been evident in England. Two in particular stand out:
- Under-investment in early intervention: The Australian system is designed to give a strong incentive to invest in early intervention. As part of the scheme there is a commitment to funding Information, Linkage and Capacity (ILC) services for those people who do not yet have a severe enough disability to qualify for an individual funding package. The aim here is to better connect up disabilities with mainstream services. However, this ILC strand of NDIS was very underdeveloped at the time of writing, and had not been part of the piloting of NDIS, with focus going instead on individualised packages for people with a high level of need. Similarly, early intervention was one of the four principles of England’s personalisation reforms and successive governments have remained committed to it. However early intervention has proved difficult to deliver. This is due in part to the splits between different services (e.g. health and social care), and the disincentives that different parts of the system have to spend money in one area when the financial benefits will be recouped in another service.
- Lack of information to make individualised spending choices: In England there have been concerns that people do not have sufficient information to make effective choices about using their personal budgets. Similarly in Australia, there has been concern that people do not have sufficient information or advice to opt for something different than they had in the past. As a Citizens’ Jury report on the NDIS concluded: ‘The plans for most participants appeared to emphasise funded supports with existing disability providers, with little evidence of participants being connected to mainstream services’. The recent launch of My First Plan by the National Disability Insurance Agency has been particularly controversial, as it appears to encourage people with disabilities to continue with existing support during the first year of joining NDIS rather than undertaking the individualised goal setting which was designed to underpin the new approach.
So despite being very differently designed schemes, with different underpinning rationales, the move to individualised funding in Australia looks set to struggle with the same implementation challenges that England has been working on for the last two decades.