Alison Barrett writes:
Disability advocates have this week released a set of priority recommendations that governments can take now to improve the lives of people with disability.
Disability Advocacy Network Australia (DANA) CEO Jeff Smith said the Priorities Project Report distils key issues from the National Disability Insurance Scheme (NDIS) Review and Disability Royal Commission, outlining “practical changes that could be up and running within a year or two”.
“With complex reform processes impacting the disability community underway, it was important to have some clear actions to take forward,” Smith said.
The six priorities include:
- improving access and eligibility for disability support
- housing
- reforming the Quality and Safeguards Commission, which currently focuses on providers, not complaints
- establishing foundational supports
- representation and inclusion
- advocacy.
Smith said that housing as a key priority “came up in every single conversation DANA had with fellow disability advocates while writing the report”.
“One of the actions we’re proposing is a new scheme which would make home modifications more accessible to people not on the NDIS,” he said.
Meanwhile, following the tabling of the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill 2024 on 27 March 2024, The Conversation published a series of articles about choice and control in the NDIS, exploring what new proposals could mean for people with disability.
Following is a summary of those four articles.
Whitegoods as disability support
The proposed new approach to NDIS prioritises evidence-based supports and will “hopefully” allow more flexibility in how NDIS budgets are spent, moving towards needs-based assessment, according to Professor Helen Dickenson, Professor of Public Service Research at UNSW Sydney.
The proposed changes in the NDIS bill include how NDIS support packages are calculated and introducing definitions “of what constitutes an NDIS support”.
Whitegoods are among the items on the not-to-be-funded list, as well as groceries and payment of utility bills.
Dickinson says that “at first glance, whitegoods might not seem like important disability supports”, but whitegoods are not just appliances.
People with disability seek to use many different products and applications that support them in daily tasks.
For example, items such as a combination washer-dryer appliance or multicooker – that chops, mixes, and cooks – may enable them to independently tackle household tasks without the aid of a support worker.
Banning these types of “NDIS supports will likely increase costs and could reduce independence for NDIS participants”.
Dickinson points out that a combination washer-dryer is “likely to be more cost-effective over the long term” than a support worker.
“Narrowly defining disability supports could serve to reduce innovation within the scheme and result in poorer care outcomes,” Dickinson concluded.
Mandatory registration
One of the most controversial proposals of the NDIS is mandatory registration of all service providers, according to Dr Sam Bennett and Hannah Orban at Grattan Institute’s Disability Program.
Many people in the disability community are distressed by this plan as they fear it will reduce their ability to choose people and services they know and trust, Bennett and Orban write.
The NDIS review proposes using just one dimension to determine the risk level of a service provider – the kind of service being provided.
However, this doesn’t give NDIS participants ownership of screening workers themselves, according to Bennett and Orban.
“Deciding who supports them matters to most people with disability, especially when support workers are in their homes and helping them with the most personal of care,” they write.
Stringent registration requirements may mean many already established support arrangement become unviable.
Bennett and Orban suggest the Government should be able to keep track of “dodgy providers or workers” through the NDIS’ new payment system that records providers’ business name, ABN, bank account and location details.
“People with disability deserve a more nuanced approach to regulating disability services – one that retains choice while enhancing regulatory and other protections in the settings where it is most needed,” they write.
Housing independence
Currently, most NDIS participants who require access to full-time support live in “old housing stock that is not fit for purpose”, Adjunct Associate Professor Di Winkler and Professor Jacinta Douglas of La Trobe University report from findings in the NDIS review.
According to Winkler and Douglas, building contemporary models of disability housing and redesigning services will improve the lives of people with a disability and help sustain the NDIS.
The NDIS review recommends that funding for full-time living supports be based on a ratio of one support worker to three people needing support.
Winkle and Douglas write that for a variety of reasons, this has caused some NDIS participants and families to be anxious, with concerns it will reduce choice. For example, “some housing providers could interpret the 1:3 ratio as a signal to stop building single-occupancy dwellings”.
There are also concerns that reform plans such as this “could deny people with disability the option to choose where they live and with whom,” Winkler and Douglas write. This is in opposition to the United Nations Convention on the Rights of Persons with Disabilities principle for policies that enable and increase choice and independence.
“To be in line with our human rights obligations, the next iteration of the NDIS should foster a range of living arrangements including living with a partner, children, friends with or without a disability, or alone,” they write.
Winkler and Douglas also highlight the need for better data on housing and support needs and preferences of people who require access to full-time support.
Choice and safety
Choice is an important factor in an individual feeling safe, according to Dr Sophie Yates and Dr Laura Davy at the Australian National University.
As outlined above, concerns have been raised that some of the proposed NDIS reform plans may limit the choices of people with disability.
Yates and Davy write that recent media coverage about the NDIS “frames the choices of people with disability as a threat to their safety or the safety of others”.
However, “research indicates people with disability are more likely to be safe and free from abuse when they have choice over what services they receive and who provides them”.
Yates and Davy quote an NDIS participant they interviewed who said: “Safety for me means being able to work with people that I know have relevant qualifications and people that are embedded in my community.”
Having access to limited service options, especially in regional, rural and remote areas, disempowers people with disability.
“Reforms that restrict participant choice could have a detrimental effect on many people’s NDIS experiences,” Yates and Davy say.
In addition to regulatory oversight, they recommend the following to support safety:
- empower NDIS participants with up-to-date information on their rights
- peer support to promote networks
- strengthen the NDIS complaints process
- invest in “nationally consistent access to individual disability advocacy services”, as recommended in the NDIS review
- diversify housing and living supports
- strategies to build and retain a high-quality, well-paid and safe workforce.
They also recommend the “need to foster natural safeguards – the relationships with family, friends and the community that keep everyone safe”.
“Supporting all people with disability to build and sustain these relationships should be a priority,” they conclude.
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See Croakey’s archive of articles on the NDIS.
