Tuesday, November 24, 2009

National Disability Insurance Scheme: Panacea or just more of the same flawed system of services and care for people with disabilities

The Rudd Government has announced that the Productivity Commission will investigate whether Australia should bring in a "no fault" governnment funded National Disability Insurance Scheme to cover the cost of care and support for people with disabilities.

The Prime Minister's overblown rhetoric was in full display when he claimed upon announcing the Inquiry that this was "a historical social reform". The Federal Parliamentary Secretary for Disabilities Bill Shorten also ratcheted up the rhetoric claiming that this was historical reform and the opportunity to replace the existing crises driven system with a new approach that addressed the needs of people with disabilities.

Regardless of the fact that initiating an Inquiry is hardly "historical social reform", there is also concern about the Productivity Commission's credentials to do this work. The Productivity Commission's mandate is to achieve economic productivity and efficiency. I am not clear how that role equips it to pursue a root and branch review of disability services.

Then there is the time frame. The Productivity Commission won't report till June 2011. Any reform that might result from the Inquiry is years away, far too late for many of the families struggling with caring for a person with a disability. A point not lost on one parent quoted in the press today.

My colleague Erik Leipoldt, who has been a disability advocate and activist for two decades, has written a number of challenging and brave pieces here and here and here on his blog questioning whether the NDIS is the vehicle for delivering significant improvements in the lives of people with disabilities and their families. Erik does not dispute the need for a no-fault disability insurance scheme, nor the need for significant reform in the funding and delivery of disability services.

His concern is that the NDIS framework, despite its best intentions, will be built on the same architecture, using the same combination of "market" frameworks and service provider dominated models that have created the currently flawed service system. He writes:

The NDIS proposal states that the disability service system was “not properly designed and structured, but has developed in an ad hoc and deeply inequitable way over several decades”. What it does not explore is where the causes for the unresponsive system lie. They are found as much in the disability industry’s values, fears and ignorance as those that shut people with disabilities out from our society. And often they are cemented in by the same managerialism and application of market forces to human wellbeing that Kevin Rudd says he is concerned about. This goes beyond tweaking or buying better quality service.

So what does NDIS propose? That its implementation will create quality service through industry-wide competition in a “a new competitive marketplace for service provision” driving” efficiency and effectiveness”.

Erik's point is that the assumption that a market and competitive paradigm can improve the lives of people with disabilities is what makes the NDIS deeply incoherent and points to its real agenda which he argues is simply more money and reducing cost.

Given the Prime Minister's announcement that the case for the NDIS will be investigated by the Productivity Commission, a body dedicated to the application of economic and market models and principles in the delivery of human services, there are good reasons to agree with Erik's analysis.

I am with Erik on this one. The not-for profit sector, including the disability services sector, have enthusiastically embraced (or not challenged in any serious way) the market and competitive models that governments have used to transform the delivery of human services and care and support services over the last two decades.

There are many reasons for this. Partly the sector has had no choice and has simply accepted and gone along with the reforms imposed on it by successive governments over 2 decades. Partly, as Vern Hughes argues in a recent piece, it is has been about the self interest of service providers who benefit from the outsourcing of public services to the sector.

Partly it has been motivated by a belief (and the hope) that these processes would improve service delivery for people. But there is no doubt, as Erik correctly points out, that there is a lack of understanding in the sector about the impact of these market and competitive models and business approaches, and an unwillingness (or inability) to seriously question and challenge the core assumptions on which the sector operates.

Erik continues:
"Money alone is not the answer, but it is a seductive one. Truths about the devalued social position of people with disabilities are expressed in numerous reports, including the recent Shut Out report from the National Disability Strategy Review, and in the feedback pages on the NDIS Plan website itself. These reports show two noteworthy things:
  1. The deepest felt needs, expressed by people with disabilities, involve their social acceptance and inclusion as a valued human being;
  2. Such acceptance cannot be bought, yet there is a pervasive feeling that if only enough money were available to enable any services to be available to anyone who needed it, that all would be well. A sense of relief, security and safety would result.

But we also know, re-stated by 56 per cent of submissions to the current Strategy Review report, "that services and programs act as a barrier to, rather than a facilitator of, their participation". We don’t need an NDIS that would entrench this".

To read more of Erik's views on the NDIS scheme his blog can be found here.

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