Hayley's Journal - Deafness Forum Australia

A deep dive into current disability issues and the NDIS by Hayley Stone, Deafness Forum Australia’s Director of Disability Policy & Advocacy. Feel free to reach out to Hayley by email.

APR 2024: The National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill (proposed law) is here and it’s clear that the Government isn’t messing around with its plans to roll out major reforms to restore the original intention of the NDIS. But is the Government listening to the voices that matter at this critical stage, and how will it get buy-in if it doesn’t?

It’s been a hectic time in the disability policy space. On 26 March, we had the shock news that State and Territory Premiers had convened an urgent meeting to call on the Federal Government to reconsider its plans to introduce foundational supports until there was a guarantee that they’d be consulted before funding was committed to this new system of care.

The idea of ‘foundational supports’ is they can be accessed by people who are not eligible for the NDIS. There would be general foundational supports for all people with disability, and targeted supports for people with specific disability-related support needs.

The NDIS Independent Review, commissioned by the Government, recommended in its final report last December that state-coordinated foundational supports be created to reduce pressure on the NDIS as an ‘oasis in the desert’ for people with disability who had little to no support options outside the scheme.

The Independent Review report proposed that a multi-tiered system of support would allow a return to the original vision of the NDIS as a scheme to exclusively support those with permanent and significant disabilities, which would operate within a broad ecosystem of state-based supports and services for people that were not eligible to join the NDIS.

Originally, the States and Territories had agreed to work in partnership together with the Commonwealth to develop foundational supports, with 50% of necessary funding to come from the Federal Government. It appears that now the Federal Government is drawing up the finer details the Premiers are concerned that the new laws around foundational supports don’t require states and territories to be consulted on any funding changes, which could leave them out of pocket across other areas of spending.

While we didn’t expect the states and territories to take a collective stand against the government in such a public way, it was clear funding foundational supports was going to be a pressure point that needed to be managed carefully, which begs the question of why the Albanese government seems to have ridden roughshod over the States and Territories when determining whether they’d have a say in funding changes.

While Minister Shorten has given assurances that he wants people with disability, their families, disability representative organisations, and the States and Territories to all be involved in the transformation of the NDIS, it feels like the Government is intent on pushing through as many recommendations as possible, at the expense of the codesign and consultation which is critical for the success of the reforms.

As a case in point, the bold actions of the Premiers earlier this week didn’t stall Minister Shorten from tabling the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No. 1) Bill 2024 in Parliament the next day (27 March).

His speech in Parliament speech introducing the Bill is worth reading in full. Minister Shorten also spoke about the Bill in Question Time. In an op-ed, Minister Shorten said that the Bill is the next step of NDIS reforms that ensure the Scheme can continue to provide life-changing outcomes for future generations of Australians with disability and make sure every dollar in the Scheme gets to the participants for whom the scheme was designed.

He said that the Bill should give participants greater clarity on what they can spend their funds on and in what time period and that it will be clearer what’s ok to use NDIS funding for and what isn’t.

The Minister also advised that the Bill should make it clearer how long a plan is supposed to last and stop participants being encouraged to spend their plans too quickly by providers.

Shadow Disability Ministers Michael Sukkar and Senator Hollie Hughes have issued their own commentary on Getting the NDIS Back on Track Bill No. 1., saying that the Coalition will work constructively with the Government on this NDIS overhaul, but “it is concerning to see its failure to convince Labor premiers on these changes.”

“The new legislation has left many questions unanswered with key measures in the Bill failing to be finalised ahead of its release. This Bill, although participant-focused, fails to address provider fraud and price gouging which are two major issues contributing to cost blowout within the Scheme. If the legislation passes, it will take 12-18 months for the measures to become operational, putting further uncertainty on participants, families, carers, and providers.”

This Bill is one of a series of legislative reforms that roll out successive changes to the Scheme. Unfortunately, those hoping to understand how the changes will impact them won’t get a lot of clarity from reading the Bill itself.

While it gives us an understanding of the direction the Government is planning to take, much like a scaffold it doesn’t give much detail about any of the changes. We’re not going to get any nuts-and-bolts information about what the changes practically mean until the release of the Rules and other legislative instruments that accompany the legislation.

The Federal Government has assured us that the Rules will be developed in consultation with Disability Representative Organisations and people with disability but it will be critical that advocates make it clear that the sector doesn’t want more consultation – we need genuine co-design – and this will take time that the Government doesn’t seem to want to spend.

Here’s an initial taster of some of the changes in the new legislation. We will provide a follow-up article detailing further changes as we work through the legislation in more detail.

Access and Eligibility.

The Independent Review recommended that the NDIS place less emphasis on diagnosis and functional capacity as the mechanisms for determining eligibility, funding and supports. It recommended the scrapping of the Access List in preference of a uniform assessment process to determine eligibility based on self-reporting and strength-based interviews – and we now know that the Government is moving forward on this approach.

The Draft Bill sets up a new framework for determining eligibility and requires the National Disability Insurance Agency to provide participants with clear information about what they will need to demonstrate to meet the eligibility requirements.

We know that tools for determining eligibility will include self-reporting and will be strength-based, but the Bill doesn’t give any detail. The Bill does provide that if a child is approved for early intervention, a decision will also be made at the same time about whether they are also eligible for the NDIS, once they reach the age threshold, or whether they would be expected to receive ongoing support via the foundational supports system.

Changes to a ‘whole of person’ budget with more flexibility.

Under the new legislation, all participants will eventually transition to a reasonable and necessary framework plan with a ‘whole of person’ budget, as opposed to the current model where budgets are built around the specific supports that the participant is determined to need.

We understand that plans will be:

Flexible: meaning that the funds will not be tied to particular supports and can be used flexibly within a range of approved items, or
Specified: meaning they must be spent on particular supports, for example, assistive technology, or
A combination of flexible and specified.

There may be increased stipulations on how specified funding can be spent by participants, for instance that a support is provided by a specified person or class of persons, or that a particular process is followed as a condition of receiving the funding.

The Government plans to transition all participants onto reasonable and necessary framework plans across the next five years, but for anyone concerned about being transferred, there’s no indication that the process will start anytime soon since there’s still a significant amount of work to be done in setting up the framework.

The new legislation will tighten rules on overspending and inappropriate purchases, expressly providing that a NDIS participant who receives an amount for NDIS supports must spend that amount according to their plan.

We’ll need to carefully look through the rules that provide specific details on these changes to make sure there are no unanticipated negative impacts for participants, particularly those in areas with thin markets, or participants who exhaust their budgets through no fault of their own.

Another important change to funding and supports is that the National Disability Insurance Agency will consider the extent to which a participant can access services outside the NDIS (including foundational supports) and any lump sum compensation amounts they may have received when determining their plan.

While this makes sense in terms of the Scheme’s sustainability, it’s the first time we’ve seen limitations to funding and supports like this and we’ll have to see how it plays out in practice.

A new reasonable and necessary budget framework.

This change could be significant and may impact participants’ existing supports.

The Bill tightens up the types of supports participants will be able to access, in line with the original purpose of the NDIS as an insurance scheme, introducing new criteria to be demonstrated before a support will be approved.

Under the new changes, a support will only be approved if:

It’s necessary to support the person to live and be included in the community, and to prevent isolation or segregation of the person from the community.
It will facilitate personal mobility of the person in the manner and at the time of the person’s choice.
It’s a support, mobility aid, device, assistive technology, live assistance, or some form of intermediary, which will facilitate personal mobility of the person.
It’s a health service that the person needs because of the person’s impairment or because of the interaction of the person’s impairment with various barriers.
The support is a habilitation or rehabilitation service.
It’s a service that will assist the person to access a health service or a habilitation or rehabilitation service.
It will minimise the prospects of the person acquiring a further impairment or prevent the person from acquiring a further impairment; or
The support is provided by way of sickness benefits.

The legislation also provides for an assessment tool (or tools) that will be used for determining a participant’s needs.

While it doesn’t state what tool or tools will be used, the explainer for the Bill states that any tools used will be evidence-based, highly technical, and developed in consultation with the disability sector and medical and professional experts, as well as relying on international learning and best practice.

While a consistent method for determining supports may lead to greater equality for participants, it’s concerning what these changes could mean when participants transfer over to the new framework.

We expect that existing plans will be reassessed based on the new tools and this could mean people lose some of the supports that they have grown to rely on if the supports don’t fit within the new criteria.

It will largely depend on how strictly the new provisions are interpreted by the NDIA – but there’s plenty of loaded language here, like ‘necessary’ and ‘needs’ and the focus on health services as opposed to services more broadly. It will be very interesting to see how the new framework interacts in practice with the choice and control of participants, as foundational principles of the Scheme.

We also note that mobility aids and devices, assistive technology, and live assistance all focus on physical impairment, so it will be important for disability representative organisations representing the interests of Deaf/deaf people or those who are hearing-impaired/hard of hearing to emphasise the importance of approving these types of supports to facilitate communication as well.

Changes to a ‘whole of person’ budget with more flexibility.

We understand that plans will be:

Flexible: meaning that the funds will not be tied to particular supports and can be used flexibly within a range of approved items, or
Specified: meaning they must be spent on particular supports, for example, assistive technology, or
A combination of flexible and specified.

There may be increased stipulations on how specified funding can be spent by participants, for instance, that a support is provided by a specified person or class of persons, or that a particular process is followed as a condition of receiving the funding.

The Government plans to transition all participants onto reasonable and necessary framework plans across the next five years, but for anyone concerned about being transferred over, there’s no indication that the process will start anytime soon since there’s still a significant amount of work to be done setting up the framework first.

The new legislation will tighten up rules on overspending and inappropriate purchases, expressly providing that a NDIS participant who receives an amount for NDIS supports must spend that amount per their plan.

The NDIS CEO will be able to request additional information from a participant, or another person, to confirm a participant’s status or request that they have an assessment to confirm their status as a participant.

This is a very significant change, and the introduction of these new powers is something that we will be considering very carefully.

Currently, the NDIS CEO doesn’t have any capacity to request additional information from a participant or request that a participant have an assessment or an examination to determine their status as a participant of the Scheme.

The new legislation will give the CEO or their delegate the power to do this, with the participant being able to choose which professional they use. While this is presented as a positive thing – to ensure that the CEO is making decisions based on the most up-to-date information about the participant, so the most appropriate supports can be provided – it can also be used to revoke a participant’s status as an NDIS participant, and we don’t yet know the circumstances in which the CEO might use such power.

As foundational supports are established, and ongoing eligibility for the NDIS is tightened to only those who have significant, and permanent disability there may come a point where this power is used as the basis to assess people’s ongoing eligibility for the Scheme. We’re speculating here, but it’s important to explore all possibilities.

These are only some of the changes that have been canvassed in the Bill – we’ll follow up with the rest of the changes in the next blog.

The next step is for the Bill to go to a Parliamentary Committee, which will allow disability representative organisations, and the disability community to provide feedback on the proposed changes and highlight any unintended consequences or elements of the Bill that create cause for concern.

It is important to keep in mind that any practical changes for participants are still some way off, and there is still scope for some change at this point.

Deafness Forum Australia will be providing feedback on the reforms, and as always, we welcome your thoughts and opinions.

MAR 2024: The Minister for the National Disability Insurance Scheme, Bill Shorten commenced a review of the NDIS in October 2022.

The Review had three main objectives: to put people with disability at the centre of the NDIS, restore trust, confidence, and pride in the NDIS, and ensure sustainability for future generations.

It had significant community engagement, receiving 4,000 submissions before releasing a final report on December 7, 2023, which detailed 26 recommendations and 139 supporting actions to get the scheme ‘back on track’.

While the federal, state, and territory governments have yet to formally respond to the Review’s recommendations, there have already been changes made to the Scheme since Minister Shorten took over the portfolio in June 2022. Some of this work started before or during the Review. Other actions have commenced as a direct consequence of the Review’s recommendations.

Here’s what we understand has already been done, or is in the works:

Legislative reform

All Australian Governments have committed to implementing legislative reform and making other necessary changes to support the NDIS Review’s vision of an expanded ecosystem of supports and services for people with disability. This includes legislative changes to both the National Disability Insurance Scheme Act and the introduction of a new Disability Services and Inclusion Act to replace the Disability Service Act 1986.

While we are yet to learn much in the way of details about the changes being planned to the National Disability Insurance Act, we know that the Government has had conversations with some Disability Representative Organisations on draft changes to the Act which have been flagged as going out to public consultation soon. When we have access to the changes, we’ll review them, and let you know what has been proposed.

The new Disability Services and Inclusion Act strengthens quality and safeguarding arrangements for people with disability who access services outside the NDIS. The new ACT introduces a mandatory code of conduct and certification for any person who receives Commonwealth funding to provide activities or programs to support people with disability.

The new Act also simplifies funding processes for these activities. We anticipate that the Disability Service and Inclusion Act will be the primary legislation governing foundational supports. We have provided further details later in this article.

Market reform

The NDIS marketplace has been a particular focus for the Minister, who has publicly called out fraud, overservicing of participants, and excessive pricing for NDIS clients amongst a broad range of concerns. The Australian Government has invested $10.2 million in funding for repairing the NDIS market and developing better ways to access and pay for supports.

In November 2022, a month after the Independent Review of the NDIS was announced, the Government established a Fraud Fusion Taskforce, jointly administered by Services Australia and the National Disability Insurance Agency. A key priority of the Taskforce is to support the safety of NDIS Participants and ensure that NDIS funding is utilised appropriately.

Another initiative, which was announced more recently is a new NDIS Provider and Worker Registration Taskforce, chaired by lawyer and disability advocate Natalie Wade. The purpose of the task force is to provide expert advice to the Government on how to move forward on the Review’s recommendations for increased regulation of NDIS service providers while balancing the need to preserve consumer choice and control and maintain a robust marketplace.

In addition to these welcome changes, we understand there are also positive legislative

reforms on the cards to address the overcharging of NDIS participants by unscrupulous providers – and we look forward to reviewing the specific details of these changes in due course.

Foundational Supports

The Independent NDIS Review noted that supports for people with disability who were not participants in the NDIS either did not exist or were difficult to find.

The Review recommended the development of ‘foundational supports’ which could be accessed by people who were not eligible for the NDIS and spoke to the need for two different ‘streams’ of foundational supports – general foundational supports for all people with disability, and targeted supports for people with specific disability related support needs.

While the vision of a two-tiered system for foundational supports was the brainchild of the Review Panel, reestablishing state and territory-level supports for those excluded from the NDIS was already on the Federal Government agenda.

Eight months before the release of the Review’s final report, Minister Shorten stated:

“There needs to be investment in community-based programs – sports, recreation, education – and ensuring these programs are better integrated into the support mix for NDIS participants, because the NDIS in isolation can’t deliver independence, and because it was never conceived or promised to support every Australian with any disability.”

National Cabinet agreed in January this year that the Commonwealth, states, and territories will work together to co-fund and co-commission the establishment of foundational supports for Australians with a disability aged under 65 – we now know it’s not a matter of whether foundational supports will be introduced, but rather, when they will commence.

For those who are close to 65 or older this raises two key questions:

Will the Government recant on its decision to cap foundational supports to those over 65, and acknowledge that the distinction between disability supports and aged care is primarily an arbitrary one, and
Will those who have access to foundational supports prior to turning 65 be able to retain the foundational supports they have grown to rely on after they turn 65?

We predict that unless we push back strongly, foundational supports will become an extension on the inequalities that currently exist between the NDIS and Aged Care systems, and yet another example of older Australians being left behind.

To date, the Commonwealth has invested $11.6 million over two years to develop and implement a Foundational Supports Strategy, to be directly informed by the disability community, families, carers, and researchers. We know that the NDIS Review recommended that the Foundational Supports Strategy should be developed with an advisory group of disability representative organisations and people with lived experience of disability, and we anticipate that the Government will follow through on this recommendation. Having said this, we’re yet to learn if such a group has been set up, and if not, what organisations and people with lived experience will be invited to the ‘table’. This is particularly relevant to advocates for people who are Deaf or hearing challenged since the Government has previously explicitly highlighted people with hearing loss as a cohort that is anticipated to benefit from targeted foundational supports.

The Government has advised that plans for the Strategy will be put to the National Cabinet for consideration in the latter part of this year.

Improving effectiveness.

In the 2023-24 Federal Budget, the government committed a massive $910 million over 4 years to improve the effectiveness and delivery of the NDIS. Of this amount $429.5 million has been committed to building workforce capacity and

systems, $54.6 million for reforming the processes around determining budgets, $3.6 million has been earmarked for foundational work on the development of a best-practice system of early childhood supports and $49.7 million has been put towards improved home and living options.

Since October 2023, the NDIA has been slowly rolling out a new computer system to improve delivery of the NDIS, which will apply to both participants and providers. The NDIA released a new Supported Decision-Making Policy to empower participants to make decisions around applying for the NDIS, goal setting, and using plan supports.

To say that it is a busy time in the evolution of the NDIS is an understatement. To my mind, this makes sense – the Albanese Government has a limited timeframe to make as many foundational changes as possible before the next federal election and a vested interest in the NDIS as a Labor-driven scheme. The challenge is getting the balance right – if the Government wants to put people with disability back at the centre of the NDIS, and restore trust, confidence, and pride in the Scheme, people with disability must have an investment and ownership in its evolution – and this can only come through genuine consultation and co-design. These processes take time.

Another reflection is the extent to which the Review appears to have provided legitimacy for decisions already made by Government – it’s as if Government has drafted up a plan and laid the foundations, with the Review then providing the scaffolding and materials to realise that plan.

While we don’t see this as a negative, given the strong investment the government has in the NDIS as a cornerstone of our social support system, and noting that the Review was explicit from the beginning in advising that it would not wait to make recommendations for change, it indicates that this is not simply Government responding to the disability community. There is a broader political agenda here, and a little bit of scepticism will be a good thing across the sector as we get into the nuts and bolts planning.

Deafness Forum Australia has direct links to the National Disability Agency, aka NDIA (the government body that manages the NDIS) through sector co-design and stakeholder manager meetings which we’ve used to promote the interests of our constituents. In addition to these activities, over the last three months, we’ve provided the NDIA with a report on our NDIS Independent Review Survey, contributed to a joint position paper collated by the Australian Federation of Disability Organisations on preliminary concerns with the review’s recommendations, and provided feedback on the NDIA’s draft Agency strategy.

We will continue to advocate the interests of our stakeholders and inform you of any new information as it becomes available to share.

Are you aware of any other changes to the NDIS we’ve missed? Do you have thoughts that you’d like to share? Please feel free to reach out to me directly by email.

FEB 2024: How will people who receive funded aged care services live active, self-determined, and meaningful lives while we still medicalise age-related disability and persist in defining support for older people as ‘care’?

Over the past few years, we’ve had the opportunity to spotlight the multitude of problems in our disability and aged care sectors. Older Australians, those with disabilities, and their supporters have shared harrowing stories – of abuse, exploitation, violence, and neglect, forcing governments to address the dysfunctionality of the support structures that should provide people with additional support needs decent quality of life.

We’ve also seen the full implementation of the National Disability Insurance Scheme (NDIS), as a world-first, comprehensive support system for people with permanent and significant disability under the age of 65, which has, for the first time, guaranteed people with disability choice and control about the supports and services they need to live their best lives.

For those in policy, comparing the approaches in addressing, what are in many ways, very similar problems, across the aging and disability sectors, is both fascinating and frustrating.

We have different government departments, and different ministers, and the way we draw an arbitrary line in the sand at age 65 around support says much about how as a society, we think about older people and the aging process.

Australia’s Aged Care Scheme is managed by the Department of Health and Aged Care, under the authority of a Minister with the same name. The name of the scheme to my mind is critically important, since it frames the support that it provides in a particular way.

When we think about caring for older people, we think of things like help with showering, home modifications, or support to perform basic daily tasks like cooking or cleaning. We might think about assistive technology, wheelchairs, walkers, and hearing aids. But there’s no association with independence or autonomy.

This view reflects the medicalised model of disability, which links a disability diagnosis to an individual’s physical or cognitive condition. It focuses on the diagnosis, cure, or management of a person’s limitations. Under the medicalised model, a person can be fixed, or at least supported to manage more effectively in society, through targeted support.

Unfortunately, what so often happens is that the individual is lost in the focus on their physical or cognitive limitations. There is little to no scope for the individual to have any choice and control – because they can either do something, or they can’t – with an emphasis on the can’t. As a person’s physical or cognitive limitations increase, so do their supports.

It’s a model that focuses on the reduction of the individual into various deficits to be assessed, and then responded to, through some type of intervention.

It’s not unusual for people with disability who are over 65 years of age to tell me that they wish they could access the National Disability Insurance Scheme instead of the Aged Care Scheme, and I’ve come to understand that a great part of what they are comparing between the two schemes, either consciously or not, is how disability is firstly conceptualised and then addressed in a practical sense to funding and supports.

What makes the National Disability Insurance Scheme so unique in an Australian context – indeed, worldwide, is that the NDIS is a social support scheme founded on a social model of disability. This contemporary approach rejects the idea that the person is the ‘problem’. It recognises that disability is an inherent part of the human condition and that the person with disability is limited not by their characteristics, but instead by external factors that we all have a responsibility to address. These external factors can be physical, attitudinal, or legal.

In recognising the equal value of the individual with disability, the social model acknowledges that that person should have access to the same rights as anyone else, including freedom of expression, self-determination, and decision-making – as seen in the phrase that has become synonymous with the promotion of the NDIS ‘choice and control’ and this is why a NDIS participant can, in theory, make decisions about the individual supports they want to align with their personal goals.

The Royal Commission into Aged Care Quality and Safety was established in October 2018 to inquire into the quality of aged care services in Australia, including whether these services met the needs of older people and their families.

The Commission presented its final report in 2021, giving 148 recommendations on improving aged care services. The commission’s first recommendation was that the Government review the Aged Care Act and create a new Act to provide for a system of aged care that allows older Australians to live active, self-determined, and meaningful lives.

The Commission emphasised that the Act should give older Australians the same rights of social participation as other members of society, allow them to make decisions about their care, pursue physical, social, emotional, and intellectual development opportunities and be active and engaged members of their communities, irrespective of age, or level of physical or cognitive capacity – in essence, to bring the Act in line with the social model of disability.

And to the Federal Government’s credit, the draft of the new act does include provisions that should strengthen the rights of older Australians, including a clear statement that the Act is intended to give effect to Australia’s obligations under the International Covenant on Economic, Social and Cultural Rights and the Convention on the Rights of Persons with Disabilities.

But I have doubts that the Act will fully comply with the Royal Commission’s aspirations, so long as we continue to conceptualise our support for older Australians as ‘care’.

To be clear, we certainly do need to provide basic care for any older Australians who require it. All older Australians should have access to basic home and care supports, but what about supports that facilitate aging well, or that support older people to realise personal goals around community participation, capacity building, or learning?

Should older Australians be able to access exercise classes and physiotherapy under the Aged Care Scheme as preventative measures to age better? Should they be supported to participate in community activities that we know will keep them psychologically and cognitively fit and active longer? Paid employment or volunteer work?

What about support and funding to do courses and training if this would support them to live happy, socially connected lives? I believe all these activities should be accessible under our Aged Care Scheme, simply based on common sense –because we know that happy, engaged individuals live healthier.

But there is no way these activities would be defined as ‘care’, and that’s the limitation of our current Aged Care Scheme. The scheme’s basic framing doesn’t facilitate a holistic view of support for older Australians that includes the right to realise their rights as citizens and members of the community in the same way that their NDIS counterparts do, and while this remains the case, it will continue to minimise the Act’s capacity as an instrument to realise the rights of older people in line with our domestic and international obligations.

So, how would we go about addressing this? For a start, we need to go back to basics and reconceptualize the whole scheme to broaden the scope of supports and services available to support older Australians. We’d need to revisit the types of support available to individuals dependent on their individual needs.

It is also important to redefine the portfolio to support the needs – not just care- of older Australians and separate it from the health portfolio to ensure the distinction between the two portfolios doesn’t become blurred.

We also need to change community attitudes around aging. People are living and working longer. They’re working into their 60s or 70s, participating in the volunteer workforce, and often balancing informal caring commitments to older or younger relatives, but as a society, we’ve been slow to adjust our attitudes and expectations around what aging now looks like, and what we should be able to expect in terms of support as we age. The Hon. Bill Shorten, once said to me (and I paraphrase) that the Aged Care Act was great for its time – until we had the NDIS. The reform of the Aged Care Act is a once-in-a-lifetime chance to redefine how we, as a society, support our Elders, both now and into the future.

By acting on the lessons learned from the National Disability Insurance Scheme and integrating a social model of disability, we can reimagine ageing not as a decline to be managed but as a phase of life rich with potential. The reform of the Aged Care Act offers hope for a future where aging is celebrated as a vibrant part of the human experience, ensuring that our elders are respected, valued, and empowered to live good lives. We can take this opportunity to redefine the narrative of ageing in Australia to one of dignity and respect. For everyone of us, no matter their age, it’s personal.

JAN 2024: Deafness Forum Australia analysed the Independent Review of the National Disability Insurance Scheme’s Final Report, examining and contemplating its extensive findings and recommendations.

The NDIS was established in 2013 as a collaborative funding effort by the Federal Government and state and territory governments. Its primary objective is to provide necessary and reasonable supports for eligible individuals with disability.

In 2022, the Government initiated an independent review with the express aim of realigning the NDIS with its core mission: placing individuals with disability at the forefront. The review aimed to rebuild trust, confidence, and pride in the NDIS.

The review’s final report was published in the weeks before Christmas 2023. Titled “Working together to deliver the NDIS,” the report outlined 26 key recommendations and 139 specific actions to enhance the scheme over the next half-decade.

Like many organisations in the disability advocacy sector, Deafness Forum Australia was concerned about what the report might mean for the future of the NDIS and its participants – especially given ongoing public concerns around higher-than-predicted participants and the increasing costs associated with the Scheme.

While the review calls for significant readjustment to how the NDIS operates, there were no obvious red flags. The review’s 26 recommendations and 139 integrated actions provide a detailed blueprint for reducing cost projections, addressing many pain points of the Scheme while also expanding supports to cover people under 65 who currently fall through the cracks.

The recommendations go beyond the NDIS, calling for a well-coordinated, national effort towards designing, operating, and governing a new disability support ecosystem, and call for a massive investment in resources and services over the next five years, in addition to a shifting of responsibilities back to States and Territories for a new category of supports.

But nothing has been decided yet.

While states and territories have expressed commitment, in principle, to the reforms, we anticipate some pushback once planning gets underway. At the same time, the proposed five-year rollout would extend into the tenure of a new government, so it’s vitally important to have the solid commitment of the Opposition.

We’ve put together a summary of the review’s significant recommendations, with our initial thoughts.

1. A new model for disability support.

The report has recommended replacing Tier 1 and 2 supports with an expanded range of foundational supports that would be available to people with disability under 65, irrespective of whether they are participants of the NDIS or not.

Targeted foundational supports would be for people with specific, but less intense, disability support needs, and would include things like aids and equipment, and home maintenance services.

General foundational supports would include services like peer support, information, and advice, as well as disability employment services.

What’s good about this model is that it will potentially expand the supports available to people with disability who are ineligible for the NDIS, but there’s limited information on precisely what supports would fit under the ‘foundational’ umbrella or whether this will mean that participants of the NDIS will have their supports split across foundational supports and their individualised plans, which could be challenging to navigate.

We also don’t know whether NDIS participants might be expected to transition off the Scheme if the supports they need can be accessed as foundational supports. It also doesn’t appear that foundational supports will be available for people aged 65 years and older – a missed opportunity for the review to address the inequity between the NDIS and Aged Care.

Another issue is that the proposed model transfers significant responsibility back onto states and territories to administer and provide funding for foundational supports. While this isn’t a new idea, we know that many state-funded services have been eroded over the past decade. Significant work will be required to rebuild those services to achieve the interconnected disability support ecosystem necessary for this recommendation to work in practice.

2. Introduction of systems navigators.

Another recommendation is the introduction of navigators to support all people with disability under 65 years of age to access the support and services they need. The expectation is that navigators will have consistent training and national oversight but will be locally based to ensure they understand local communities. Systems navigators would be available to all people with disability under 65 years of age.

If a person with disability wanted to apply for the NDIS, the navigator would assist them in understanding the scheme and support them through the application process. Once a budget and plan have been set, the navigator could support the participant in accessing services in their local communities.

As we all know, the complexity of the disability support landscape is a significant barrier to people with disability getting access to the supports they need when they need them.

Navigators are used effectively in several other public service contexts, including healthcare and could significantly improve the experience of people with disability interacting across various elements of both the NDIS and the broader disability support ‘ecosystem’, but we need the right people for this vital role.

Navigators need to be unbiased and impartial. Service providers or entities affiliated with service providers should be excluded from providing navigation services to ensure that people with disability are appropriately referred, based on their preferences and requirements. We’ve also recommended that any navigator scheme be extended to support people with disability aged 65 years and older.

3. A new system for determining NDIS eligibility, funding and supports.

The review has proposed that the NDIS place less emphasis on diagnosis and functional capacity as the mechanisms for determining eligibility, funding and supports.

The recommendations propose scrapping the Access List in preference of a uniform assessment process to determine eligibility based on applicants’ needs. The assessment would be based on self-reporting and strength-based interviews. The same assessor who conducts the assessment would support a successful applicant to plan their budget and supports.

It’s clear that the proposed assessment model is not a rebranding of the independent assessment model that was fiercely opposed in 2021. The proposed model doesn’t work to an algorithm, it doesn’t use the same diagnostic tools and looks to have scope for assessors to seek supporting information from an applicant’s treating professionals.

If the new assessment model is adopted and implemented well, we anticipate that it should address current inequities around evidence

requirements for people with different types of disabilities, while ensuring people continue to receive customised supports.

If the new assessment model is confirmed, we will need to be assured that the tools are evidence-based, that the assessors have the skills and training necessary to administer the assessments, and that people with disability have the time and supports necessary to fully articulate their needs.

4. Continuum of supports for children and young people with disability.

Addressing the needs of children and young people with disabilities and their families was a key priority in the review. The report recommends additional screening processes to identify children with disabilities and developmental delays as soon as possible through general community screening, and a continuum of supports for children and young people with disability, irrespective of whether they are NDIS participants or not, to the age of 21,

Changes would include expanding the early intervention program to age 9, new supports and services for children and young people aged 9-21 to prepare for key life transition points, including secondary school and employment, and targeted funding for a capacity-building program for parents and caregivers.

Children would be assessed via a whole-of-person needs-based assessment and monitored to track how well supports were working.

While we welcome these changes in principle, we’ve requested more details. We want to know how the impacts of supports would be assessed in practice and whether there is scope to optimise the universally available child development check for screening. We also need to be confident that needs-based assessments are evidence-based, age-appropriate, and conducted by people with the right skills and expertise.

Any capacity building programs for parents and caregivers, must be developed in co-design with people with disability and be identity affirming. We’d also recommend the development of a national database to track lifetime progress against measured outcomes, with scope for interventions as needed, to ensure that all Australian children with disability can reach their full potential.

5. Enhanced access to assistive technology supports.

The review noted that access to assistive technology for people outside the NDIS is underfunded, fragmented, and complex, with an estimated 108 different schemes to access assistive technology outside the NDIS.

The review has called for the Department of Social Services, with States and Territories, to develop a nationally consistent approach for delivering aids and equipment outside the NDIS with a focus on improved planning and coordination of aids and equipment between the NDIS, Health, and Aged Care.

While we would welcome a centralised, national program to link people with disability to the aids and technology they need, further detail is necessary to understand how such a scheme would be funded and coordinated.

6. A digitalised market with increased quality and safeguarding mechanisms to protect consumers.

The report proposes significant changes across the market, including introducing a new pricing and payments framework, a complete transition to electronic payments, and developing a centralised online platform to help participants find service providers in their local area.

The review panel also recommends that the National Disability Supports Quality and Safeguards Commission actively monitor the market to identify and respond to poor service

delivery and introduce a new graduated risk-proportionate regulatory framework.

Under the proposed framework, all disability service providers must be enrolled or registered with the National Disability Supports Quality and Safeguards Commission. Providers would have graduated regulatory obligations increasing depending on the risk associated with the services the provider is delivering. There would be minimal ‘red tape’ for service providers who provide low-risk services.

These recommendations represent a good balance between providing regulatory safeguards for consumers and facilitating their choice and control by encouraging a robust, diverse marketplace. We can anticipate that these reforms would reduce fraud, price gouging, and over-servicing.

So, what comes next?

It’s now a matter of wait and see how many recommendations are picked up and the response from the Australian Government, States, and Territories to the five-year implementation target. Until then, we’ve been told by the NDIA that participants should expect things to be business as usual.

Our key priorities across the implementation of the reforms will be making sure Governments and the NDIA commit to genuine co-design with people who require hearing and speech supports and people whose first language is Auslan. We’re aiming to influence and and inform decision-making around the practical implementation of the changes and will continue to advocate for increased supports for those who are deaf or hard of hearing who are over 65 years of age.

We’ll keep you informed as we learn more about changes and will be reaching out for your thoughts and input over the next few months once we know the plan for the NDIS moving forward. In the meantime, there are some resources on the recommendations, including fact sheets on key topics and an easy-read version of the final report, on the NDIS Review website.

Hayley’s Journal