The National Disability Insurance Scheme (NDIS) reflected a watershed moment in the Australian disability sector and community. It signified a commitment to the rights of people with disability (PWD) that saw significant reforms across the disability landscape.
Underpinning these changes was a shift from ‘block funding’ to individualised funding, where funding is provided to NDIS participants rather than to service providers. Previously, block funding was distributed to service providers for a group of participants in a block. The group would often be determined by the nature of the disability or activity. For example, a service that provided day placement would receive block funding for several participants or a group home or residential care would be ‘block’ funded to provide support for a number of residents. Individualised funding, in contrast, is informed by a person’s goals in consultation with a NDIS planner and enables the NDIS participant to pick and choose their service providers.
The assumption was that individualised funding would stimulate a quasi-market of service providers and boost choice, driving competition and innovation through demand and supply. Unlike the previous block funding model, NDIS participants are empowered to choose where they take their business. This has worked well for many people, particularly when people can exercise choice and control from an array of services and supports when there is an abundant market of service providers.
However, many people in RRR (Regional, rural and remote) areas have not experienced the empowerment that comes with choice and control due to thin markets. In fact, the shift from block funding to individualised funding has left many PWD without access to adequate services and supports.
Since its inception, there have been a range of opinions on the NDIS. Some viewed it as a positive move toward improved rights for PWD that afforded them with a better choice and control. Some used the UK experience as an example of how the NDIS would be unworkable or too expensive a program to pursue.
This article was written by a DA advocate, Grant Murray who has worked under both NDIS and previous block funded supports. It is intended to look at the positives and challenges of both funding arrangements and highlight what is good about the NDIS.
Block Funding VS NDIS
Block Funding: Financial security for services
Pro’s of block funding
- Secure funding and service provision: Funding seemed more ‘secure’ for PWD as there were no annual planning meetings (as there with the NDIS) that focused upon negatives to justify keeping or increasing funding. This means there was no need for costly annual updated assessments that make recommendations on future funding levels.
- Better investment in staff development: Services had financial security and so they ‘invested’ in their staff through training, team meetings, supervision etc.
- Quality of Care: Services had greater control of funding and could therefore allocate time and resources to regular team meetings services. This meant they could attempt to ensure consistent practice across teams through regular review of behavioural support plans etc. This was vital when supporting clients with challenging behaviours, mental health issues or high support needs.
- Staff rosters: Services ran their own rosters, and this assisted with staff retention by providing longer shifts for those working in ‘outreach’ or with ‘drop-in’ support.
- Investments in service provision: Agencies could invest in their service and ensure quality through policy and procedures, management support and resources for staff such as access to cars and telephones.
- Regular and routine audits: The funding body, the NSW Department of Ageing, Disability and Home Care (ADHC), would audit the funded non-Government service provider or ADHC service to ensure that expected documentation and processes were in place. This helped to ensure (though could not guarantee) a standard of quality and compliance.
Con’s of block funding
- Uneven distribution of funding: The way block funding was used often did not reflect the funding provided to individual clients. Service providers would allocate funding for dollar amounts to each client. However, the support provided to the individual clients was not always in line with the amount that had been allocated to each client. Services had the discretion to use funding that had been allocated to one client for another, meaning that some clients missed out on supports while others received more.
- Power imbalance: Funding structure inadvertently encouraged services to put their interests over their clients and could lead to a ‘power over’ client's situations. E.g., meetings often did not include a client and so the client's goals were lost or forgotten.
- Staff-centric rosters: Rosters would often suit staff over clients. E.g., some clients would have evening meal support between 3pm and 5pm or between 7pm and 9pm to suit a roster rather than what suited the individual client. Similarly, this would occur for morning routine shifts.
- Costly overheads: There was a perception of an element of ‘waste’ at times with services having too many managers, large offices, and inefficient bureaucracy.
- Quantitative over qualitative quality: The audits were quantitative rather than qualitive. There was often a tendency to simply tick boxes that appropriate documentation was being kept but not be overly interested in the quality of the information being recorded.
NDIS
Pro’s
- Empowering the participant: The NDIS participant is - in theory- empowered to control their own funding. They decide who and how they are supported and have ‘voice, choice & control’.
- Reduced overheads: More money can be returned to participants to fund support rather than service provider infrastructure. NDIS participants can decide when they want the support. If they want support with morning routines, at mealtimes or on a Sunday and if the funding is available and a provider can provide it, participants can schedule workers around their routines and/or goals.
- Focus on Capacity Building: This is a strength and a challenge for the NDIS. Block funding could lead to stagnation and no attempts to assist people with disabilities to grow and to enjoy new experiences. Admittedly for many the structure and routine that this afforded was necessary but for others it didn't stimulate them. The focus on capacity building when coupled with goal setting gives participants of the NDIS an opportunity to develop and grow.
- Funding linked to goal setting: The NDIS participants use their funding on activities that address their goals, and this ensures that ‘person-centeredness’ is the focus of the funding being used. This is very powerful when done properly and is the main strength of the NDIS.
- Goal setting maximizes use of resources: Focusing support on goals and person-centeredness potentially resources are saved to be used on other participants. Through linking funding to participant goals, the NDIS ensures that participants are engaging in meaningful and interesting activities. Under block funding, a service could follow the recommendations of a well-intentioned therapist that a client could benefit from a skills building program, even if it were something the client was not interested in.
- Qualitative over quantitative control: The participant can tell the NDIA what is working and not and provide therapist recommendations as to support needed to assist the participant to pursue their goals. If a goal has been achieved, then perhaps there are new goals? If a goal has not been achieved, then what barriers are there to achieving the goal? Can extra support be added to the plan to assist the participant to achieve the goal in the next planning cycle?
Con’s
- Capacity to engage in NDIS plans: The NDIS is complex to navigate. Many NDIS participants may not have the capacity to understand how to control their funding and will often rely upon family members or funded service providers (e.g., support coordinators). This potentially undermines the benefits of ‘voice, choice and control.’
- Less regulated market-led environment: Service provision is market driven, which creates competition between service providers. In a relatively unregulated environment this can lead to unscrupulous and unethical practices, and even fraud. (see our report, ‘Thin Markets, Thin Hopes: The NDIS in regional, rural, and remote NSW)
- Risk of lack of professionalism: Regular team meetings for support staff are not funded, as the participant is in control of funding. This could lead to inconsistent practice and participants deciding which staff they ‘like’ rather than professional staff. Additionally, it may lead to a blurring of professional boundaries and staff replacing others in participants’ lives as ‘friends’.
- Availability of workers and staff retention: If there is high demand for support workers between 7-9 am or 5-7 pm, this is difficult to manage. Services struggle to maintain rosters as clients choose support times. Staff leave agencies and can set up their independent support business or leave the industry. Independent support workers do not necessarily have policies & procedures and there are questions around quality assurance.
- Thin markets in regional, rural, and remote areas: The free-market approach can be great where there is a functioning market where there is a wide variety of providers to choose from. But in rural and regional areas there is a limited choice. The end to block funding seems to exacerbate ‘thin markets’ where there is scarce or absent supply if services providers are struggling to maintain staff.
- Short-term focus and capacity building: With its ‘Insurance’ focus the NDIS seeks to make short term investments in a participant. Then through the planning process, some planners often expect capacity gains, so funding should be withdrawn. The irony is that participants must have a permanent condition. Therefore, capacity building will not be possible for some, or it will not be as substantial as the NDIA staff member conducting an annual review may expect.
- Unregistered providers and quality assurance: Service providers are required to go through the process of registration to provide services to ‘Agency-managed’ participants. As this can be an expensive process many providers, particularly new ones, may choose to not get registered but only focus upon ‘Plan’ or ‘Self-managed’ participants. It is a disincentive to work with clients who are Agency managed and often they will be clients with higher support needs. Again, this exacerbates the issue of thin markets. With the extra costs associated with becoming registered, there may be few or no registered agencies in rural or regional areas and those with high support needs or challenging behaviours who need to utilise registered providers as their funding is agency managed, will have little or no choice and often they will have to have their funding plan managed.
Where to next?
The NDIS has always had its critics, and whether we like it or not, it is the system we are working with and we need it to work.
With its quasi-market model, we see service providers competing in a market-driven environment where clients are now customers. With this, we are seeing corners being cut to maximise profits and in a minority of cases it can lead to corrupt practice or even fraud. The current federal government has set up a taskforce to address this issue. However, more work needs to be done, particularly for RRR areas (see our Thin Markets, Thin Hopes: The NDIS on regional, rural, and remote NSW).
As The Productivity Commission (2017) has previously argued:
The National Disability Insurance Scheme (NDIS) is a complex and highly valued national reform. If implemented well, it will improve the wellbeing of people with disability and Australians more generally.
The NDIS has substantially improved the lives of many PWD. However, the transition from block funding to individualized has not been smooth sailing. On one hand, the implementation of the scheme has seen many PWD fall through the gaps that were once eligible for block funded services. Many PWD who are unable to access the NDIS do not have adequate access to support, particularly those who live in regional, rural, and remote areas.
On the other hand, many PWD have been afforded with greater choice and control. When there is thriving market of good quality service providers, and PWD are equipped with the resources to navigate the NDIS, the scheme can contribute to better quality of life. There is a need for greater consistency and equity.
So, what will it take for the scheme to become more equitable? While we cannot propose quick fix solutions, we propose one core foundation that has been put forward by The Productivity Commission that noted, the scheme’s success ‘is not only the responsibility of the National Disability Insurance Agency (NDIA), but also that of governments, participants, families and carers, providers, and the community.’ That is, banding together to find solutions is a crucial step forward. A good starting point, we suggest, is to look back on what has not and has worked.