While the NDIS has made some positive inroads, it has some way to go to fulfil its ambitious mandate, writes Nicholas Haines.
THE MAIN ACHIEVEMENT of the National Disability Insurance Scheme (NDIS) is to triple the total funding for disability support in Australia from $7 billion per year under the previous state and territory-based system to an estimated $22 billion after its roll-out. We should not underestimate this gain.
Tens of thousands of people who languished on waiting lists under the old state and territory-based system are now receiving support services for the first time. Julia Gillard and Bill Shorten deserve credit for the political skill they used to legislate this scheme.
But we can express thanks for this milestone while noting that the conceptual basis of the NDIS is deeply flawed. We can welcome the extra funding while expressing misgivings about the design of the scheme. The NDIS is, in essence, a voucher program. It takes an individualist frame to what is, at heart, a structural and systemic challenge: to make our society inclusive of everyone, regardless of disability status.
The NDIS does not conceptualise disability support as a collective, social good. It avoids structural and systemic changes to our society. It conceives of disability support as a consumer good. It casts the participants as consumers, hands them a voucher and tells them to go shopping in a “marketplace” of support services. Poor outcomes can be blamed on “the market”.
In the 2011 report that laid the conceptual underpinnings of the NDIS, the Productivity Commission was ambiguous about the need for professionally skilled support workers. The Commission observed that most disability support is informal and unpaid.
The Commission appeared to set a low bar for the quality of paid support workers, namely that they merely need to be no worse than the unpaid, unsupervised and untrained family members who provide most of the support.
The Commission did not acknowledge a distinctive value that professional workers can add. Good disability support workers are not unskilled; they need to be able to manage complex interactions with government and non-government agencies, communicate in a sophisticated way, exercise high levels of emotional intelligence, and respond empathetically and effectively to challenging behaviours.
In 2011, the Productivity Commission claimed that the new system would lead to greater pay and better working conditions for disability support workers. Eight years later, the scheme has fallen far short of this vision for the disability workforce. What has happened instead is that paid work in the disability sector has become more casualised and precarious.
The prices are not enough to cover disability workers’ needs to document their work. The prices do not account for time needed to hand over to the next shift worker, drive from client to client, debrief with managers and colleagues and follow up participants’ concerns. The prices do not cover the workers’ needs to be supervised, managed and trained.
The Federal Government does not take direct responsibility for ensuring that the services will be there when people need them. The NDIS's voucher mechanism allows the government to wring its hands while lamenting the "thinness of markets" in certain regions of the nation and in certain aspects of disability care.
The National Disability Insurance Agency (NDIA) sees itself as a “market steward”, not as a public agency with direct responsibility for guaranteeing quality services for all who need them. This approach is inferior to a well-resourced public agency proactively shaping the disability workforce.
Disability support work is an inescapably labour-intensive vocation with limited scope for productivity growth. In this context, an emphasis on "consumer choice and control” tends to promote low wages coupled with increasingly precarious conditions of employment.
The gendered undervaluation of social care work is a major structural cause of weak workers’ rights in the disability sector. The NDIS does not truly envision a distinct, valuable contribution for professional disability support alongside unpaid familial care.
The Productivity Commission’s assumption was that paid supports and family supports are almost interchangeable. This allows the government to set low expectations for paid support and to justify low wages and insecure employment arrangements for support workers.
Disability support for individuals is essential, but by itself, it is not enough. We also need well-resourced structural responses to exclusion such as:
- Making all buildings, facilities, streets and civic spaces accessible to people with restricted mobility, visual disability, and sensory sensitivity;
- Scaling up print accessibility services that produce braille, large text, audio and e-text versions of documents for people with a visual disability;
- Employing enough ASLAN interpreters to meet the demand for this service. Today there is not a single full-time ASLAN interpreter in the entire Northern Territory; and
- Using fiscal policy to ensure no underemployment, no hidden unemployment and no unemployment apart from frictional unemployment (the one or two per cent of the labour force who are moving between jobs at any given time).
A fully employed economy would massively increase the bargaining power of workers, which would force employers to design jobs and workplaces that suit the circumstances of everybody, including the long-term unemployed and people with disabilities.
The NDIS brings a welcome infusion of funds for disability support services. However, the NDIS is undermined by a market orientation that ignores the social and collective nature of social care. This has worsened workers’ rights (which were not strong to begin with) and it has damaged the quality of the work by neglecting to fund training, supervision, management and other back-office functions on which support workers depend.
The NDIS would become much more effective if the Federal Government took direct responsibility for assuring adequate amounts of quality services. Providing a voucher to an individual is pointless if the voucher cannot be redeemed. In addition, the Federal Government needs to fund structural responses to the discrimination and exclusion experienced by people with disabilities. Support services for individuals are not enough.
Nicholas Haines works in the disability support sector in Brisbane, Australia. He has a Master’s Degree in Development Practice from the University of Queensland.
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