apparent. Early evidence suggests that many (but not all) NDIS participants are receiving more disability supports than previously, and they have more choice and control. In the transition the NDIA has focused too much on quantity (meeting participant intake estimates) and not enough on quality (planning processes), supporting infrastructure and market development. For the scheme to achieve its objectives, the NDIA must find a better balance between participant intake, the quality of plans, participant outcomes, and financial sustainability. Greater emphasis is needed on preplanning, indepth planning conversations, plan quality reporting, and more specialised training for planners. A significant challenge in the transition phase is developing the supply of disability services and growing the disability care workforce. It is estimated that 1 in 5 new jobs over the next few years will need to be in disability care, but workforce growth remains way too slow. Emerging shortages should be addressed by independent price monitoring and regulation, more effective coordination among governments to develop markets (including intervening in thin markets), a targeted approach to skilled migration, and equipping participants to exercise choice. The interface between the NDIS and other disability and mainstream services is critical for participant outcomes and the financial sustainability of the scheme. Some disability supports are not being provided because of unclear boundaries about the responsibilities of the different levels of government. Governments must set clearer boundaries at the operational level around ‘who supplies what’ to people with disability, and only withdraw services when continuity of service is assured. NDIS funding arrangements should better reflect the insurance principles of the scheme. Governments need to allow flexibility around the NDIA’s operational budget and commit to establishing a pool of reserves. Overview 1 About the National Disability Insurance Scheme The National Disability Insurance Scheme (NDIS) is a new scheme designed to change the way that support and care are provided to people with permanent and significant disability (a disability that substantially reduces their functional capacity or psychosocial functioning). The NDIS is currently being rolled out across Australia. At full scheme, about 475 000 people with disability will receive individualised supports, at an estimated cost of $22 billion in the first year of full operation. The NDIS is based on the premise that individuals’ support needs are different, and that scheme participants should be able to exercise choice and control over the services and supports they receive. The scheme differs from previous approaches in a number of ways: trial,
arrangements, and collaboration between the Australian and State and Territory Governments. The workforce is not growing fast enough As the NDIS provides more individualised supports for people with disability, the workforce needed to provide those supports will need to both increase and become more diverse. There is broad consensus that the number of fulltime equivalent positions will need to roughly double over the transition period — at a local level, some regions will need to triple their workforce or more to meet demand (figure 8). Figure 8 Variation in workforce growth required in different regionsa Each dot represents the growth in the amount of fulltime equivalent (FTE) employees needed relative to the current situation, both in terms of the number and proportion, between 201516 and 201920. a The NDIA’s market position statements provide ‘low and high’ estimates for the number of FTE disability workers at present and what will be needed in the future. To derive estimates for growth, the midpoints of each range are used. No data are available for Western Australia. Regions are areas consisting of several local government areas. Several policy changes are recommended to mitigate the potential workforce shortage over the term, including: meeting the desires of many existing workers — who are qualified and experienced, and usually work parttime — to work additional hours trialling different approaches to help fund volunteer organisations to provide participant supports allowing for skilled migration where residual shortages remain persistent.
Governance Recommendation 11.1 The National Disability Insurance Scheme Act 2013 (Cwlth) should be amended to change the process for agreeing to Category A Rules to reduce the time it takes to implement or amend those rules. The amendment should not change the requirement that there be unanimous agreement among the Australian Government and the host jurisdictions for implementing or amending Category A Rules. Recommendation 11.2 At full scheme, the annual operating budget for the National Disability Insurance Agency should be set within a funding target of 7–10 per cent of package costs with the expectation that, on average, it would sit at the lower end of the band. The National Disability Insurance Agency should be required, in its annual report, to the reasons why it has not met this target in any given year. Recommendation 11.3 The Australian Government should remove the cap on staff employed directly by the National Disability Insurance Agency. Recommendation 11.4 The Western Australian Government and Australian Government should put in place arrangements for Western Australia to transition to the National Disability Insurance Scheme. Any decision to join the national scheme should be made public as soon as possible. Recommendation 11.5 The National Disability Insurance Agency should publicly report on the number of unscheduled plan reviews and reviews of decisions, review timeframes, outcomes of reviews and stakeholder satisfaction with the review process.