Maathumai Ranjan, Robert Breunig | Two changes to NDIS would make all the difference

The stresses on the system are growing, with rising costs for all governments."

In 2023, despite a decade of opportunity, arguably the only thing that has changed is that the system is no longer "underfunded".

To address those stresses, Australia needs to shift the emphasis of its support system away from a medicalised and overly prescriptive model towards a social model that gives people with disability greater control over the way they choose to access support.

Such a shift will also bring to a close a decade of exponential growth in the cost of disability support.

Gerard Quinn, UN Special Rapporteur on the rights of persons with disabilities, speaks of the shift under way in systems of disability support, moving from a medical model towards a social model and onward to a human rights model.

Societies are moving from the institutional segregation of people with disability, towards integrating the needs of people with disability into their systems and ultimately onto recognising disability as a natural part of human diversity and enabling people with disability to exercise their rights to the same extent as others.

Despite Australia signing on to the UN Convention on the Rights of Persons with Disabilities (CRPD) 15 years ago, that shift in ideology has not translated into a meaningful shift in the architecture of our institutions.

Pervasive discrimination and exclusion of children and youth with disability continues at all levels of the education system and employment rates of people with disability have changed little over the past 15 years according to the OECD.

Stories from the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability have promulgated how the systemic neglect of people with disability continues even while familiar debates about inclusive versus segregated service in sectors like education, housing and hospitals rage on.

While government expenditure on disability supports has increased exponentially over the last decade, little commitment was given to building safe and inclusive communities within mainstream supports.

The latest budget projected $92.5 billion in the 2026-27 financial year for disability services including income support, carer support, employment services and the NDIS. Only 0.3 per cent of this targets community capacity building, quality and safeguards. Commonwealth funding for individualised disability supports (excluding income support) increased from $2 billion in 2010 to a projected $54.4 billion in 2026-27.

Over the same period, total state and territory government funding remained unchanged (in real terms) and has been redirected away from community supports and into the NDIS. While the NDIS has improved the lives of many people with disability, it has also propelled expectations of individualised funding in lieu of building and supporting safe and inclusive communities.

Without an inclusive system of mainstream support, the NDIS will continue to grow to meet the strong latent demand for services from people with disability.

In the short term, this demand stems from the unprecedented number of children accessing the scheme. In the long term, significant pressure will come from the addition of an estimated 4 million aging Australians with a disability, who will inevitably seek earlier access to generous individualised NDIS packages over those available in other systems.

Ultimately, this may result in the government having to limit access to the NDIS, leaving people with the highest level of need without critical and timely support.

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Australia is not moving on the journey from a medical to a social model of disability, despite spending more per capita than most OECD countries. Two things need to change.

First, we need to refocus the NDIS back into an insurance scheme built on its three interdependent tenets. A "fair, objective and consistent approach" that avoids current biases of delegates handling administration is needed to assess eligibility and individualised support packages for those with the highest level of need.

Allocated supports need to be "reasonable and necessary" at a package level, not at a support item level as currently applied by the Administrative Appeals Tribunal.

And in the active presence of the first two tenets, "choice and control" for participants would mean flexible use of allocated packages to optimise their own individual personal utility.

Second, we need to shift priorities and expenditure towards building an ecosystem within the mainstream sector that can service the latent demand for support from the whole population with disability.

Scheme sustainability will depend on this shift towards the establishment of an inclusive and safe community within mainstream systems just as much as it will on the refocusing of the scheme, recognising the fundamental interdependence of the three tenets highlighted above.

To ensure compliance with the UN CRPD while implementing a sustainable solution, Australia needs to engage the powerful voice of the disability sector so that it can radically transform its systems from those steeped in the medicalised biases of the past into an inclusive system that meets society's needs.