By Neena Bhandari
Sydney, 11.11.2021 (Hireup): John Walsh, a long time former National Disability Insurance Agency board member and one of the authors of The Productivity Commission (PC) report that recommended the design of the National Disability Insurance Scheme (NDIS), explains the reasons why the NDIS was geared for a specific disability cohort – and why in his opinion, it shouldn’t cover Aged Care. Walsh has lived with quadriplegia since an accident during a rugby league game in his early twenties.
NB: What was the reasoning behind limiting NDIS to under 65-year-olds?
JW: There were very clear definitional, economic and ideological reasons why the NDIS should focus on younger people with disabilities.
First, the `Terms of Reference’ for the PC Report specifically required its scope to be targeted at “… people with disability not acquired as part of the natural process of ageing…”, and moreover “… replaces the existing system funding for the eligible population”. The existing system being that agreed under the Commonwealth State and Territory Disability Agreement (CSTDA), which funded people up to age 65.
Secondly, funding under the CSTDA was far lower on a per capita basis than that provided for Aged Care at the time the PC report was requested (2008-09). An earlier report estimated that the per capita funding per person with severe/profound disability under age 65 was $6,833 compared to $11,959 for people aged over 65. Therefore, it was not as pressing an imperative to further fund aged care at the time, and a parallel 2011 PC report into Aged Care received very little attention.
Thirdly, the rights debate, and specifically the United Nations Convention on the Rights of People with Disability, had called for governments to provide people with disability the opportunity to participate in the social and economic dimensions of life. The NDIS was intended to help in building the capacity of people, who had sustained a disability, to participate as contributing members of society. It was something they had not experienced for most part of the 20th century. It was not envisaged as a welfare/care scheme, but rather as a capacity building and opportunity scheme, providing appropriate and equitable funding for each eligible individual person with a disability to understand their decision-making ability and their potential to participate and contribute in society.
Fourthly, the other ideological reason was the notion of the insurance model, whereby a typical insurance product is meant to cover a rare, unexpected and expensive event. For a younger person to acquire a disability, either through birth or through early life trauma or a health condition, is rare and usually unexpected. In this context it is an insurable event. In an older person, disability is typically related to the predictable onset of chronic health conditions that come with ageing, and the incidence curve of disability accelerates rapidly after age 65. So, the epidemiology calls for a direct funding approach related to care provision and less of an insurance approach.
NB: Should the NDIS be extended to all Australians with a disability, irrespective of age? How would including aged care with the NDIS change its dynamic and outcome objectives?
JW: I feel very strongly that the NDIS should not cover aged care, and that shortages in the Aged Care budget should be remedied by a review of the Aged Care system rather than by extension of the NDIS.
The PC acknowledged that this approach means that some people will miss out – particularly people who unexpectedly sustain a very severe disability onset after the cut-off age of 65, for example as a result of an injury leading to spinal cord or brain injury. The solution proposed for these types of occurrences was to extend the existing state-based lifetime care and support schemes from just motor vehicle accidents and workers compensation to cover all types of traumatic onset – this was the so-called National Injury Insurance Scheme (NIIS) proposal, which had the added advantage of also covering hospital and rehabilitation care, thereby mitigating the difficulties of bed block in hospital for many people with disabilities.
The NDIS proposed by the PC has never been properly implemented. Tier 1 of the NDIS was intended to raise awareness of the entire Australian population regarding the potential of younger people with disabilities, and to ensure improvement and accessibility of state-based mainstream services, including through the National Disability Strategy 2010-2020, which was effectively abandoned. And the NIIS was allowed to just wither on the vine.
Tier 2 of the NDIS particularly was intended to build a community capacity that would invite people with disability to participate in mainstream services and to be able to maximise the opportunity of their individual funding packages. It was poorly targeted and failed to adequately fund any grassroots capacity building in the community.
So, we’re left with a badly implemented NDIS and an Aged Care system in crisis. The solution for the latter should not be to further bastardise the former.
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