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Disability Care and Support

Inquiry report

This inquiry report was released on 10 August 2011. An errata has been issued with this report.

Download summaries of the report

The overview booklet contains the key points, an extensive summary of the Commission's analysis and recommendations.

If you want to see the detailed supporting material, please download the full report below.

The Commission has also prepared an Executive Summary of the Proposed Scheme, together with Easy English and Plain English versions of this. These can be downloaded below. The Easy English version is written in an easy-to-read way, and uses pictures to explain some ideas.

  • Key points
  • Contents
  • Appendices
  • Errata
  • Most families and individuals cannot adequately prepare for the risk and financial impact of significant disability. The costs of lifetime care can be so substantial that the risks and costs need to be pooled.
  • The current disability support system is underfunded, unfair, fragmented, and inefficient, and gives people with a disability little choice and no certainty of access to appropriate supports. The stresses on the system are growing, with rising costs for all governments.
  • There should be a new national scheme - the National Disability Insurance Scheme (NDIS) - that provides insurance cover for all Australians in the event of significant disability. Funding of the scheme should be a core function of government (just like Medicare).
  • The main function (and source of cost) of the NDIS would be to fund long-term high quality care and support (but not income replacement) for people with significant disabilities. Everyone would be insured and around 410 000 people would receive scheme funding support.
  • The NDIS would have other roles. It would aim to better link the community and people with disabilities, including by using not-for-profit organisations. It would also provide information to people, help break down stereotypes, and ensure quality assurance and diffusion of best practice among providers.
  • The benefits of the scheme would significantly outweigh the costs. People would know that, if they or a member of their family acquired a significant disability, there would be a properly financed, comprehensive, cohesive system to support them. The NDIS would only have to produce an annual gain of $3800 per participant to meet a cost-benefit test. Given the scope of the benefits, that test would be passed easily.
  • The scheme should involve a common set of eligibility criteria, entitlements to individually tailored supports based on the same assessment process, certainty of funding based on need, genuine choice over how their needs were met (including choice of provider) and portability of entitlements across borders. There would be local area coordinators and disability support organisations to provide grass roots support. The insurance scheme would take a long-term view and have a strong incentive to fund cost effective early interventions, and collect data to monitor outcomes and ensure efficiency.
  • The above features would be best met by a having a single agency overseeing the NDIS - the National Disability Insurance Agency. It would be created by, and report to, all Australian governments. It would have strong governance arrangements, with an independent commercial board, an advisory council of key stakeholders, clear guidelines to ensure a sustainable and efficient scheme, and legislation that protected the scheme from political influences.
  • It would be the assessor and funder, but not the provider of care and support. Services would be provided by non-government organisations, disability service organisations, state and territory disability service providers, individuals and mainstream businesses. Increased funding, choice and certainty are the key features of the recommended scheme. Advocacy would be funded outside the scheme.
  • An alternative but inferior option would be a 'federated' NDIS. This would give state and territory governments control over their own systems, but with some common core features. Such an arrangement could easily revert to the current flawed and unfair system, with 'agreements' breaking down into disputes about who is to pay, how much and for what.
  • People would have much more choice in the proposed NDIS. Their support packages would be tailored to their individual needs. People could choose their own provider(s), ask an intermediary to assemble the best package on their behalf, cash out their funding allocation and direct the funding to areas of need (with appropriate probity controls and support), or choose a combination of these options.
  • The NDIS would cover the same types of supports currently provided by specialist providers (but with sufficient funding), give people more opportunity to choose mainstream services, and encourage innovative approaches to support.
  • The Australian Government currently provides funding to the disability sector of around $2.3 billion, while state and territory governments provide funding of around $4.7 billion - a total of over $7 billion.
  • Current funding for disability is subject to the vagaries of governments' budget cycles. People with disabilities have no certainty that they will get reasonable care and support over the long run. Resourcing might be good one year, but insufficient the next, with many people missing out. The Commission estimates that the amount needed to provide people with the necessary supports would be about double current spending (an additional $6.5 billion per annum).
  • The Commission proposes several options for providing certainty of future funding. Its preferred option is that the Australian Government should finance the entire costs of the NDIS by directing payments from consolidated revenue into a 'National Disability Insurance Premium Fund', using an agreed formula entrenched in legislation. The amount needed could be funded through a combination of cuts in existing lower-priority expenditure, fiscal drag, and if necessary, tax increases.
  • A less preferred option is that all governments could pool funding, subject to a long-run arrangement based on the above formula, and with pre-specified funding shares. This would need to be closely monitored by transparent accounting and penalties for failure to meet commitments.
  • The scheme would gradually be rolled out from mid-2014. It would start in a few regions. That would allow fine-tuning of the scheme, while providing high quality services to many thousands of people. In 2015-16, the scheme should cover all regions of Australia for the highest priority groups, and should progressively expand until the scheme covered all people by the end of 2018-19.
  • A separate scheme is needed for people requiring lifetime care and support for catastrophic injuries - such as major brain or spinal cord injuries. Currently, many Australians get poor care and support when they acquire such injuries because they cannot find an at-fault party to sue.
  • A no-fault National Injury Insurance Scheme, comprising a federation of individual state and territory schemes, would provide fully-funded care and support for all cases of catastrophic injury. It would draw on the best schemes currently operating around Australia. State and territory governments would be the major driver, developing a comprehensive scheme by 2015.

Background information

Ralph Lattimore (Assistant Commissioner) 02 6240 3242

  • Preliminaries
    • Cover, Copyright, Letter of transmittal, Terms of reference, Contents, Acknowledgments and Abbreviations
  • Overview - including key points
  • Recommendations
  • Chapter 1 Introduction
    • 1.1 What has the Commission been asked to do?
    • 1.2 Definitions and some key facts
    • 1.3 Ways of thinking about disability
    • 1.4 Rationales and objectives
    • 1.5 Some design elements for a new scheme
    • 1.6 Inquiry processes
    • 1.7 Structure of the report
  • Chapter 2 Why real change is needed
    • 2.1 Introduction
    • 2.2 Disadvantage and disability
    • 2.3 Insufficient support provision
    • 2.4 Underfunding in the current system
    • 2.5 The need for structural change
    • 2.6 Conclusions
  • Chapter 3 Who is the NDIS for?
    • 3.1 Introduction
    • 3.2 A tiered approach to providing supports
    • 3.3 Tier 1 - minimising the impacts of disability
    • 3.4 Tier 2 - ensuring appropriate support from any system
    • 3.5 Tier 3 - individually tailored funded supports
    • 3.6 Taking account of the broader context of service delivery
    • 3.7 How many people are likely to receive individualised supports
    • 3.8 Implementation issues
  • Chapter 4 The role of the community and the NDIS
    • 4.1 Introduction
    • 4.2 The importance of community participation and inclusion of people with disabilities
    • 4.3 Engaging the community
    • 4.4 NDIS issues
  • Chapter 5 What individualised supports will the NDIS fund?
    • 5.1 Introduction
    • 5.2 Specialist disability supports
    • 5.3 The role of 'mainstream' services
    • 5.4 Income support
    • 5.5 The basis for providing specialist disability supports
    • 5.6 Means testing, front-end deductibles and co-payments
  • Chapter 6 Aligning the Disability Support Pension with goals of the NDIS
    • 6.1 Reform strategies
    • 6.2 Altering expectations
    • 6.3 The incentives to work are often blunted by current arrangements
    • 6.4 Work bonuses and other approaches to address the fixed costs of working
    • 6.5 Social impact bonds and other innovative approaches
    • 6.6 Engaging employers
    • 6.7 An anomaly: the treatment of the blind
    • 6.8 Using data for optimal interventions
    • 6.9 Some other presumptions should be re-assessed
    • 6.10 Some caveats
    • 6.11 More scrutiny of the DSP is needed
    • 6.12 What about the Youth Disability Supplement?
  • Chapter 7 Assessing care and support needs
    • 7.1 Introduction
    • 7.2 What is being assessed?
    • 7.3 What is the purpose of the assessment process?
    • 7.4 Desirable features of assessment tools
    • 7.5 The current suite of assessment tools
    • 7.6 A single tool or a 'toolbox'?
    • 7.7 Who should conduct assessments?
    • 7.8 When should assessments occur?
    • 7.9 Should carers have their own assessment
    • 7.10 How assessment might work in practice
    • 7.11 Diligent use of the assessment tool
    • 7.12 The transition to a fully-fledged assessment toolbox
  • Chapter 8 Who has the decision-making power?
    • 8.1 Person-centred approaches
    • 8.2 Defining 'self-directed funding' in more detail
    • 8.3 Reasons for self-directed funding
    • 8.4 Impacts, benefits and costs
    • 8.5 Design of self-directed funding
    • 8.6 Exercising power at the family level
    • 8.7 What services should be covered?
    • 8.8 Self-directed funding needs to be structured carefully
    • 8.9 What about spending options in regional and remote Australia?
    • 8.10 Employing people directly
    • 8.11 Paying relatives for care
    • 8.12 Take-up of self-directed funding and the need for support
    • 8.13 What about the general risks of self-directed funding?
    • 8.14 Implementing individualised funding
  • Chapter 9 Governance of the NDIS
    • 9.1 Introduction
    • 9.2 Defining the scope of governance in the NDIS
    • 9.3 The role of the NDIA and others within the NDIS
    • 9.4 Creating a National Disability Insurance Agency
    • 9.5 Measures to encourage high performance
    • 9.6 Why have just one agency?
    • 9.7 Managing the funding pool
    • 9.8 Complaints and dispute resolution
    • 9.9 Other functions
  • Chapter 10 Delivering disability services
    • 10.1 Disability support services
    • 10.2 Navigating the disability system
    • 10.3 Safeguarding quality
    • 10.4 The implications of consumer choice for block funding, government-run services and rural areas
  • Chapter 11 Disability within the Indigenous community
    • 11.1 A snapshot of Indigenous disability
    • 11.2 Challenges to supporting Indigenous Australians with a disability
    • 11.3 Addressing the high rate of Indigenous disability
    • 11.4 Improving support to Indigenous people with a disability
    • 11.5 Conclusions
  • Chapter 12 Collecting and using data under the NDIS
    • 12.1 Introduction
    • 12.2 Deficiencies in the existing evidence base
    • 12.3 Why an effective evidence base under the NDIS is needed?
    • 12.4 Data systems
    • 12.5 Research
    • 12.6 Methods of analysis
    • 12.7 Other features of the evidence base under the NDIS
    • 12.8 Implementation
  • Chapter 13 Early intervention
    • 13.1 Introduction
    • 13.2 Nature and scope of early intervention
    • 13.3 The benefits of early intervention
    • 13.4 Targeting beneficial early interventions under the NDIS
    • 13.5 Interventions outside the NDIS
  • Chapter 14 Where should the money come from? Financing the NDIS
    • 14.1 The money can only come from several sources
    • 14.2 Tax design criteria
    • 14.3 Tax and revenue options
    • 14.4 Ensuring sustainable returns
    • 14.5 Fully-funded, pay-as-you-go or a hybrid?
    • 14.6 Federal or Australian Government financing of the NDIS?
    • 14.7 The Australian Government as the exclusive financier for the NDIS
    • 14.8 A pooled funding approach is a weaker alternative
    • 14.9 Achieving a fair effort by all jurisdictions
    • 14.10 The funding of the scheme is feasible and manageable
  • Chapter 15 Workforce issues
    • 15.1 A snapshot of the disability workforce
    • 15.2 Are there, and will there be, labour shortages?
    • 15.3 Attracting more workers to the disability services industry
    • 15.4 Alternatives to increasing the formal workforce
    • 15.5 Are labour supply concerns surmountable?
    • 15.6 Qualifications, working knowledge and career paths
  • Chapter 16 The cost of the NDIS
    • 16.1 Introduction
    • 16.2 Data
    • 16.3 Estimated number of people in tier 3
    • 16.4 Costs of the scheme in 2018-19
    • 16.5 Scenarios
    • 16.6 Cost of the NDIS - 2011-12 to 2018-19
  • Chapter 17 Insurance arrangements for injury
    • 17.1 Introduction
    • 17.2 What is catastrophic injury?
    • 17.3 Criteria to assess injury insurance arrangements
    • 17.4 Certainty, timeliness and quality of lifetime care and support
    • 17.5 Coverage of people acquiring a disability through a catastrophic injury
    • 17.6 Impacts on recovery and health outcomes
    • 17.7 People's freedom
    • 17.8 The value of 'justice'
    • 17.9 Providing incentives for people to avoid injuries
    • 17.10 Efficiency and costs
    • 17.11 The performance of common law systems of fault-based compensation
  • Chapter 18 A national injury insurance scheme
    • 18.1 A national injury insurance scheme is needed
    • 18.2 Implementing a no-fault approach for lifetime care and support of all catastrophic injuries
    • 18.3 How should NIIS claims be financed?
    • 18.4 What might the costs be?
    • 18.5 The scope of the NIIS beyond 2020
    • 18.6 Some other matters
  • Chapter 19 Implementation
    • 19.1 Implementation in outline
    • 19.2 Implementation of the NIIS
    • 19.3 Implementation of the NDIS
    • 19.4 Interaction between the two schemes
  • Chapter 20 The benefits of reform
    • 20.1 What are economic benefits?
    • 20.2 The potential economic gains from the NDIS are large
    • 20.3 But how much would the NDIS make a difference?
    • 20.4 A basic plausibility test
    • 20.5 The employment impacts on people with disabilities of the NDIS, DSP and employment service reforms
    • 20.6 How many carers could potentially re-enter the workforce?
    • 20.7 A more complex analysis of 're-distributive' effects of the NDIS
    • 20.8 A wrinkle or two
    • 20.9 The NDIS as an insurance product
    • 20.10 The bottom line
  • Appendix A Consultations
  • References

The following errata has been issued for the 'Disability Care and Support' inquiry report. The chapter on the website has been amended to reflect the errata.

Download the errata

Printed copies

Volumes 1 and 2 are only available online.

Printed copies of the overview can be purchased from Canprint Communications.

 

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