Chapter 3A decade of committee oversight of the NDIS
3.1As the NDIS has grown and evolved over its first 10 years of operation, the committee has provided consistent oversight and scrutiny of the scheme, and the National Disability Insurance Agency (NDIA), though its ongoing General Issues inquiry and self-referred investigations. The committee has collected a substantial body of evidence, including over 1700 submissions from participants, carers, family members, service providers, disability advocates and government agencies. It has also held 78 public hearings and published 25reports examining matters including:
accommodation and housing;
services for people with psychosocial disabilities;
early childhood intervention;
workforce matters; and
the disability services market.
3.2A number of government and independent reviews have also been conducted since the launch of the scheme. However, the committee is the only body to provide ongoing oversight of the NDIS.
3.3This chapter charts the evolution of the scheme, in parallel with the work of the committee and other reviews. It examines key issues and themes that have arisen as the scheme matures, and considers progress on the many recommendations that the committee, and other reviewers, have put forward.
The NDIS—establishment and trial phase (2013–2016)
3.4Designed and implemented following the Productivity Commission's 'landmark' report, Disability Care and Support (2011), the NDIS was intended to replace the existing 'grants-based' model of disability support.
3.5The scheme was designed according to two critical principles; to provide (1)'reasonable and necessary' supports, along with (2) 'choice and control', to support the independence and socio-economic participation of people with disability. The NDIS represented a completely new approach to funding and providing supports, entirely replacing the existing 'inadequate and indefensible' Commonwealth disability services grants system. However, the NDIS was not intended as a substitute for informal supports or existing community and mainstream services.
First progress report (2014)
3.6In its first report, tabled in July 2014, the committee acknowledged that the NDIS was a 'massive reform', and commended the significant work that had gone into setting up the NDIA. The committee's report was informed by evidence the committee collected, along with the findings of the January 2014 review of the capabilities of the NDIA (the Capability Review), which noted that the NDIA was 'like a plane that took off before it had been fully built and is being completed while it is in the air'.
3.7In the Capability Review, Mr Jeff Whalan AO, Dr Peter Acton and DrJeffHarmer AO, observed that the NDIA's sole focus had, understandably, been on commencing the scheme according to an ambitious timeline. This left limited time for forward planning, exposed weaknesses in human resource management and internal and external communications, and resulted in an interim ICT system that was not 'fit for purpose'.
3.8The Capability Review identified priority areas in which the NDIA needed to improve, including:
better communication and stronger relationships with stakeholders, including state and territory governments;
organisational structure and governance;
improved processes and data; and
greater clarity around the role of planners, and what constitutes 'reasonable and necessary'.
3.9Tabled six months later, the committee's first progress report similarly identified a set of key 'challenges', and articulated concerns regarding:
NDIA culture and communications;
appropriateness of the guidelines for funding early intervention supports for children;
the need to strengthen the role of participants in the planning process and empower participants to self-manage;
the need for 'advocates' to provide accessible information and guidance on accessing the scheme;
impacts on service providers of the shift from block funding to a fee for service model; and
the dire need for suitable housing for people with disability.
3.10In this initial report, the committee noted that the 'ability of the NDIS to connect participants with mainstream services in transport, health, education and housing will be crucial to its long-term success'. The committee also highlighted the need for the Commonwealth and state and territory governments to adopt a philosophy of 'continuous improvement'.
3.11The report included 17 recommendations aimed at improving implementation, communication and administration of the scheme. In early 2015, the government tabled its response to the report, in which it 'agreed or agreed in‑principle' to all of the committee's recommendations, and acknowledged the committee's 'important and ongoing' role.
Second progress report (2015)
3.12Over the years 2013–2015, the NDIS was trialled in nine locations, starting with:
Hunter area, New South Wales (NSW)
Barwon, Victoria
South Australia, for ages zero to 14.
Tasmania, for ages 15 to 24.
3.13The next trial sites were the Australian Capital Territory (ACT), Perth Hills (Western Australia), and Barkly (Northern Territory) in July 2014. By June 2015, over 17000 people were receiving NDIS support. In July a trial was launched in Nepean Blue Mountains (NSW) for ages zero to 17. Then, in April 2016, ahead of the national rollout, the NDIA launched final trial sites in NorthernQueensland: Townsville and Charters Towers for ages zero to 17, and Palm Island Aboriginal Shire for ages zero to 64.
3.14The committee's second progress report, tabled in November 2015, outlined the generally positive experiences of people included in the trials—the scheme had 'transformed' lives across the trial sites. While acknowledging the scheme's outstanding achievements, the committee also identified areas of concern, including:
inconsistent decision-making across different trial sites;
a gap in information and support for people before they enter the scheme and in the early stages of planning, and an ongoing need to build capacity for self-management;
the need to balance flexibility and integrity by adopting a risk-based approach to approval and funding of supports;
the need to support providers to transition to the NDIS in a sustainable way;
market growth and integrity;
the need to expedite bilateral agreements between the Commonwealth and state and territory governments to clarify areas of responsibility, including in relation to Tier 2 services (Information, Linkages and Capacity building (ILC)) and mainstream services; and
the need to address the priority issues of housing, support for Aboriginal and Torres Strait Islanders with disability, mental illness and psychosocial disability, and workforce issues.
3.15These matters would inform the committee's future workplan.
3.16In its response to the committee's second progress report, dated January 2016, the government agreed or agreed in-principle with all recommendations, and revealed that the NDIA and Department of Social Services (DSS) had already commenced work on implementing a number of the committee's recommendations.
3.17Key developments that addressed committee concerns included:
development of new pre-planning resources;
release of a new plan format and price guide;
commencement of a review into the Operational Guidelines and practices in relation to participant plan reviews;
signing of additional bilateral agreements; and
continued cross-jurisdictional work on definitions and responsibilities for Tier 2/ILC supports.
Housing (2015–2016)
3.18In addition to progress reports one and two, the committee completed an inquiry into housing during the NDIS's trial phase, tabling Accommodation for people with disabilities and the NDIS in May 2016. The terms of reference for this inquiry noted that 'the lack of adequate accommodation can limit people's ability to fully exercise their individual choice and control' and 'to fully participate in society and live an ordinary life like any other Australian'.
3.19The report made six recommendations, including that governments should:
examine and update the Building Code of Australia to improve accessibility;
include accessible housing in the development of affordable and social housing;
consider funding initiatives to increase housing options; and
explore 'capital sharing, securitisation, and joint ownership options' to increase the supply of appropriate accessible housing.
3.20The government response was provided in October 2017. It noted that there had been a number of developments since the committee's inquiry. Specifically, support for specialist disability accommodation had become available under NDIS plans from July 2016, and NDIS Rules to support NDIA decision-making on accommodation were registered in March 2017. The government agreed with five of the recommendations and noted the sixth, indicating that work was underway to increase the stock of affordable and accessible housing more broadly.
National rollout (2016–2020)
3.21With bilateral agreements now signed with most of the states and territories, the national rollout of the NDIS was formally announced on 1 July 2016. This was also the go-live date for the new ICT system, MyPlace, which was developed to replace the initial system which was not fit-for-purpose.
3.22An independent review into the MyPlace ICT portal, conducted by PricewaterhouseCoopers (PwC), commenced shortly after, and was completed in September 2016. The portal review identified a series of compounding issues which had led to early failures in the system, including participants and providers not being paid for three weeks.
3.23Timing was a key factor, as PwC found the NDIA had decided to launch the system on 1 July despite inadequate contingency planning, staff training, data quality, and system 'readiness'.
3.24PwC made recommendations aimed at improving management and governance of the system and workflows. It suggested the NDIA implement and embed a Service Delivery Operating Model and 'enhance program management fundamentals'. Calling for a review of the resourcing model, including staffing and expertise, PwC said the NDIA was 'not yet equipped to manage the transition to full scale ramp-up'. Finally, the review also called for a 'comprehensive Stakeholder and Change Impact Assessment', with a view to implementing a 'customer-centric change approach'.
3.25As the rollout progressed, the committee continued its program of review and scrutiny, collecting evidence on the implementation and administration of the scheme, as well as conducting inquiries into specific matters. The committee sought to understand the extent to which the scheme was operating according to its key principles—providing reasonable and necessary supports in a way that maximised choice and control for people with disability.
NDIS Quality and Safeguards Commission (2016)
3.26In September 2016, the Council of Australian Governments (COAG) Disability Reform Council agreed to a new national framework for quality and safety for the NDIS. The NDIS Quality and Safeguards Commission was established in 2018, as an independent agency, to 'regulate NDIS providers, provide national consistency, promote safety and quality services, resolve problems and identify areas for improvement'. Establishment of the commission was, in part, in response to the Senate Standing Committee on Community Affairs' 2015 report on violence, abuse and neglect against people with disability in institutional and residential settings.
3.27The NDIS Commission commenced operation state-by-state, as jurisdictions rolled out the full scheme. In 2020, the NDIS Commission began operating in Western Australia, which was the final jurisdiction to join the scheme.
3.28The committee would later conduct an inquiry into the NDIS Commission, tabling a report on 30 November 2021. This inquiry was launched following the tragic death of Adelaide woman, Ms Ann-Marie Smith, while under the care of an NDIS service provider.
3.29The substantial report concluded that the creation of the Commission was 'an important point in the progress of respect for and upholding of the rights of people with disability in Australia'. However, it also identified areas for improvement. The report made 30recommendations, in areas including:
communications and awareness;
transparency and reporting;
the need to be proactive and embed co-design;
provider registration requirements and the cost of audits;
complexity of the complaints function and treatment of complainants; and
adequacy of commission staffing, training, ICT and resourcing.
3.30The government response was tabled in April 2023, noting that action had already been taken on many of the committee's recommendations. For example, the NDIS QSC put in place a Communications and Engagement Strategy in May2021 to cover all stakeholders and was in the process of developing a specific strategy for First Nations participants. The government supported 21 recommendations and referred the remaining nine to the independent NDIS Review for further consideration.
Inquiries into specific matters
3.31Committee inquiries conducted into specific matters in this period:
Provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition, 15 August 2017;
Provision of services under the NDIS Early Childhood Early Intervention Approach, 7 December 2017;
The provision of hearing services under the National Disability Insurance Scheme, 21 June 2018;
Market readiness for provision of services under the NDIS, 20 September 2018;
Provision of assistive technology under the NDIS, 12 December 2018; and
NDIS ICT Systems, 21 December 2018.
3.32The reports on psychosocial disabilities and early childhood intervention were particularly significant, and are discussed in detail below.
Psychosocial disabilities (2016–2017)
3.33In its psychosocial disabilities report, the committee outlined evidence suggesting the NDIS was difficult to access and navigate for people with psychosocial disabilities. Eligibility criteria based on diagnosis, rather than functional impact, was leading to inconsistent outcomes for applicants. The planning process was not well-designed to support these participants, with planning meetings often conducted over the telephone, without support from family or carers. NDIS Plans for participants with psychosocial disability also lacked the required flexibility to respond to 'fluctuating needs'.
3.34In its report, the committee made recommendations aimed at better supporting people with psychosocial disability through the NDIS, and outside of it. In its response, received March 2018, the government supported many of the recommendations, and outlined work underway in:
developing a standardised assessment tool for assessing eligibility;
introducing guidance for medical practitioners to assist them in navigating the NDIS with their patients;
providing better training for assessors and planners; and
progressing work with the states and territories to support continuity of care for people with psychosocial disability transitioning to the NDIS.
3.35However, the government did not support the first and second recommendations, which called for a review of the requirement that conditions be 'permanent', and that an exemption to this rule be made for psychosocial disabilities.
Early childhood intervention (2017)
3.36During this inquiry, the committee recognised the work being done by the NDIA to 'continually improve' the Early Childhood Early Intervention (ECEI) approach. It also illuminated difficulties faced by certain participants, including those with Autism Spectrum Disorders (ASD) and their families, in accessing the scheme. The committee identified problems including:
poorly understood and inconsistently applied eligibility criteria;
poor knowledge of recommended interventions for children with ASD;
suggested inappropriateness of the PEDI-CAT tool for assessing functional capacity for children with ASD;
delayed and under-funded plans, and a cost-reduction approach to the provision of assistive technology; and
issues with service availability for Aboriginal and Torres Strait Islanders and those in rural and remote areas.
3.37The government noted, agreed, or agreed in part, to all of the committee's 20recommendations, stating that work was already underway on:
material to clarify the different roles of the NDIA and mainstream services;
a review of the ECEI access pathway for applicants, including better information and guidance;
public material on how the NDIA uses PEDI-CAT and other assessment tools;
development of standardised diagnostic and intervention guidelines for children with ASD; and
changes to allow participants to use their funding to purchase 'low value and low risk' items more easily.
Transitional arrangements and performance of the NDIS (2018 and 2019)
3.38The committee published a report into Transitional arrangements for the NDIS on 15 February 2018. In this report, the committee noted that the rollout of the scheme was progressing more slowly than forecast, with complexities in the application and planning processes causing significant delays. Other problems with the roll out included 'boundary issues'—disputes around which government is responsible for funding supports, particularly in the areas of health, aged care, education, transport, housing and justice. These issues would emerge again as an ongoing concern, and are further discussed in Chapter 6 of this report.
3.39Administrative complexity, workforce shortages and 'inadequate' pricing caps were impacting providers transitioning to the scheme, and insufficient levels of funding for the ILC program was leading to potential 'service gaps'. The committee was also concerned about the low numbers of people from Culturallyand Linguistically Diverse (CALD) backgrounds accessing the scheme, and the absence of a 'comprehensive NDIS CALD Strategy'. Finally, the committee urged the NDIA to prioritise 'pre-rollout and pre-planning' with Aboriginal and Torres Strait Islander communities, and to develop cultural competency among its staff.
3.40In its response to the transitional arrangements report, the government acknowledged that 'a number of implementation challenges have emerged during the transition period' and outlined work that was planned or underway to address some of the committee's concerns. This included:
working through the Disability Reform Council to resolve boundary issues and 'respond to complex cases including those involving health interfaces' (for example, people being discharged from hospital and requiring assistance to secure appropriate accommodation);
changes to operational and funding guidelines to better support participants with transport funding;
piloting a new participant pathway which would be tailored for participants from vulnerable groups, and developing a 'Hard to Reach Strategy';
developing an ILC Investment Strategy to 'guide national investment to increase inclusion for people with disability';
developing a Market Intervention Framework which would 'set out how the NDIA will monitor the marketplace';
releasing a CALD Strategy in early 2018;
working with Aboriginal and Torres Strait Islander communities to roll out culturally sensitive pathways; and
exploring opportunities to boost Aboriginal and Torres Strait Islander employment in, and through, the NDIS.
3.41The committee's first 'general issues report', tabled 29 March 2019, explored a number of key issues further, including the ECEI approach, psychosocial disabilities, and hearing services. The report made additional recommendations in these areas, building upon those made in the previous reports. These recommendations were aimed at addressing pricing and eligibility issues, expediting the development of tailored pathways, developing better guidelines, and increasing transparency through providing more detailed data and reporting.
3.42The committee also looked at workforce issues, the NDIS Quality and Safeguards Commission, and NDIA communications and engagement with participants and service providers. These investigations led the committee to recommend:
a review of pricing in order to better support providers, including sole traders;
a review—to be conducted by the NDIS Quality and Safeguards Commission—of the impacts of its regulatory requirements on sole traders and small to medium sized businesses; and
a change to the National Disability Insurance Scheme Act 2013 (the Act) to incorporate an engagement or 'co-design' principle, requiring the NDIA to 'systematically engage and collaborate with the disability sector and people with disability in the development and review of its operational plans and guidelines'.
3.43In its 2019 progress report, the committee included a table outlining progress made against the committee's previous recommendations. Despite government support, implementation of a number of recommendations had not progressed or had limited progress, including:
development of a validated fit-for-purpose assessment tool for psychosocial disability;
providing more flexibility for minor adjustments to be made to NDIS plans for people with psychosocial disability;
public reporting on the level of engagement of carers in the planning process (co-design);
development of a strategy to address the service gaps that exist for rural and remote communities;
initiatives to reduce waiting times for applicants and participants;
an Aboriginal and Torres Strait Islander workforce strategy;
clear guidelines on eligibility for applicants whose children experienced developmental delay; and
information about how List D is determined and how new conditions are incorporated.
3.44In its response, dated 4 March 2020, the government supported most of the committee's recommendations and revealed that the NDIA had recently increased price limits to better support providers, and commenced investigating ways to 'improve effectiveness of the NDIS market'. Work was also underway to reduce the regulatory burden on small businesses and sole traders, and the government had committed to bringing forward plans to amend the Act to include an engagement principle.
Other key developments during this phase
3.45A number of significant developments occurred during this period that would impact the implementation of the NDIS. In 2018, as the establishment of NDIS Quality and Safeguards Commission was being progressed, cross-jurisdictional work started on developing Australia's Disability Strategy 2021–2031, which was eventually launched on 3December2021.
3.46The strategy, agreed by all Australian governments, provides a national framework for 'continuing to improve the lives of people with disability in Australia', over a ten-year period. Its areas of focus are:
Employment and financial security:
Providing jobs and career opportunities for people with disability and making sure they have enough income to meet their needs.
Inclusive homes and communities:
Increasing the number of accessible, affordable and well-designed homes and creating a community that is inclusive and accessible.
Safety, rights and justice:
Ensuring the rights of people with disability are promoted, upheld and protected, and people with disability feel safe and enjoy equality before the law.
Personal and community support:
Providing people with disability access to supports so they can live independently and engage in their communities.
Education and learning:
Supporting people with disability to access education and learning throughout their lives so they reach their full potential.
Health and wellbeing:
Increasing support and capability in the healthcare sector to meet the needs of people with disability, and ensuring disaster preparedness and emergency responses include the needs of people with disability.
Community attitudes:
Recognising the positive contribution people with disability make to society, and building confidence in the community to work and engage with people with disability.
3.47Following on from the 2015 Community Affairs Inquiry, in April 2019, the Disability Royal Commission was established to investigate 'widespread reports of violence against, and the neglect, abuse and exploitation of, people with disability'. The Royal Commission would continue until late 2023.
3.48Also commencing in 2019 was the independent Review of the National Disability Insurance Scheme Act 2013, conducted by Mr David Tune AO PSM (theTuneReview). The Tune Review found that the NDIS was improving outcomes for many participants. However, some participants reported that the scheme was confusing, frustrating and complex, that planners were failing to treat participants as 'experts in their disability', and that NDIA staff did 'not understand disability or appreciate the challenges people with disability face as part of everyday life'.
3.49The Tune Review commended the achievements of the scheme so far, and urged governments to work together to resolve 'outstanding policy issues'; it recommended:
… improvements to the legislation and operations of the NDIS … to strengthen its participant focus and ensure the NDIS is fit for purpose as it moves from a transition phase to a more mature system [and] … a greater range of policy information, including in a wider range of accessible formats, to help participants better understand why certain decisions have been made.
3.50A core recommendation of the Tune Review was the establishment of a Participant Service Guarantee to set agreed timeframes and service standards for the NDIA. DSS conducted a public consultation from August to October 2019 to inform the design of a Participant Service Guarantee.
Full scheme realisation (2020 onwards)
3.51From 1 July 2020, the NDIS became available to all eligible Australians, in every jurisdiction. ByJune2020, there were almost 400000 NDIS participants around the nation. The Participant Service Charter was launched in August 2020, along with the Participant Service Improvement Plan, which set out how the NDIA would implement the Tune Review's recommendations.
3.52The year 2020 was also marked by the emergence of the COVID-19 pandemic, which had the potential to severely impact people with disability. The NDIA implemented a range of initiatives to support participants and providers, and ensure essential services could continue to be provided for people with disability. At the end of 2020, the NDIA reported that the 'rate of infection amongst participants [was] two and a half times lower than the general population'.
3.53In October 2020, the Australian Government passed the National Disability Insurance Scheme Amendment (Improving Supports for At Risk Participants) Bill 2021 to 'protect participants from the risk of abuse, neglect and exploitation'. Then, in December 2020, the NDIA launched the myNDIS app, which made claiming quicker and easier. Independent assessments were also first announced in 2020.
Supported independent living and the NDIS planning process (2019–2020)
3.54The committee's work over the late half of 2019 and first half of 2020 focussed on the operation of NDIS funding category 'supported independent living' (SIL), and on the NDIS planning process. The committee's general issues inquiry continued to receive evidence, as did its inquiry into the implementation of the NDIS.
3.55A substantial report into SIL funding and supports was tabled in May2020, and made 45 recommendations. While less than 7 per cent of NDIS participants accessed funding for SIL, the committee noted that, in 2020, SIL represented 31per cent of total funding under the scheme. The committee's recommendations were directed towards 'maximising choice and control for participants and reducing unnecessary financial hardship for providers'.
3.56Recommendations covered issues including:
The process for determining the SIL needs of participants
The length and complexity of the SIL quoting process and the lack of participant involvement
Limited public information and guidance on the provision of SIL
Funding for SIL
Oversight of participants accessing SIL services
Issues with the vacancy management process
Availability of decision support and advocacy for people seeking SIL.
3.57In its August 2020 response, the government stated that the NDIA is 'undertaking significant work' to reform how SIL is funded. This included setting price limits and increasing participant input to the SIL process. However, the government only supported (or supported in-principle) 25 of the 45recommendations, noting the other 20.
3.58The committee's second report in 2020 focused on the NDIS Planning process. This was the final report for an inquiry that was launched in August 2019. An interim report had been tabled in December 2019, which noted that concerns about the planning process were 'not new' and had been raised in previous inquiries. The interim report made 14 recommendations aimed at improving the planning process in the 'immediate term', while initiatives to secure more substantial improvements were developed.
3.59The final report, tabled in December 2020, made a further 42 recommendations, which were 'intended to bring greater transparency, consistency and accountability to how the NDIS [was] administered and implemented'. Recommendations related to:
The experience, expertise and qualifications of planners;
The value of informal supports and the role of families, carers and health practitioners in the planning process;
The interface between the NDIS and other service systems;
The planning experience in particular communities of need, such as those in rural and remote communities, Aboriginal and Torres Strait Islander people and those from Culturally and Linguistically Diverse backgrounds;
The timeliness and transparency of the internal review process; and
The availability of advocacy support and access to legal services for people seeking external review of NDIA decision-making.
3.60The committee recognised significant work already underway to improve participant experience in the planning process and committed to continue overseeing the rollout of these reforms.
3.61The government response to this report highlighted progress on implementing significant reforms, including (among others) reforms to simplify the planning process and make plans more flexible, and reforms to increase the availability of information and support for participants during application and planning.
Independent assessments (2020–2021)
3.62On 10 December 2020, the committee decided to conduct an inquiry into the government's proposal to introduce independent assessments under the NDIS. Independent assessments involved the use of government-contracted allied health professionals to conduct interviews with applicants and participants, to assess eligibility and funding needs. Independent assessments would be an adjunct to, or replacement for, assessments from applicants' own medical specialists, and would feed into individualised plan budgets.
3.63The NDIA and the government argued that independent assessments were 'necessary' and would provide 'improved fairness and equitability in funding decisions and reduced postcode inequality', reduced potential for 'sympathy bias', and would improve the financial sustainability of the NDIS.
3.64It should also be noted that, during the inquiry, some submitters suggested that the Productivity Commission had specifically called for a needs and aspirations assessment, rather than a functional assessment, that is, that the assessment process should 'identify the supports required to assess an individual's reasonable and necessary care and support needs across a broad range of life activities, and should take account of an individual’s aspirations and the outcomes they want to achieve' (Recommendation 7.1).
3.65As the NDIA trialled independent assessments, the committee collected evidence from trial participants and their advocates, along with experts. The inquiry uncovered serious concerns about the policy among a majority of stakeholders, including: people with lived experience, state and territory governments, health professionals, academics and peak bodies. The committee described opposition to the proposed reform as 'almost universal'.
3.66People with disabilities and their advocates outlined their concerns, including:
Their fear and anxiety about the assessment process, meeting with a stranger, and how assessment results would be used in decisions;
That independent assessments would not be accurate for people with fluctuating or episodic conditions;
That independent assessments would not be transparent or subject to review; and
Their agreement that the NDIS needs to be financially sustainable, without using independent assessments in the model proposed.
3.67Comments below, from Ms Christian O'Connell, typified participant sentiments about the reform:
Nothing about independent assessments is positive for a person like me. It was my ongoing relationship with all of my doctors that meant they were able to identify and act on their concerns…I'm very afraid that a doctor who doesn't know me and doesn't have highly specialised skills…will incorrectly diagnose me, after I've been through so much to determine what my disabilities are…I'm terrified that, even if I don't lose access to the NDIS, my plan will be changed and it will not reflect my needs… The NDIS is imperfect but these changes will make it worse. We're vulnerable and we face enough hurdles as it is. Please do not hurt us.
3.68Expert evidence provided to the committee by medical professionals was reported in the media, including testimony that independent assessments could (re)traumatise vulnerable people. SBS reported that Melbourne-based NDIS local area coordinator (LAC), Carl Thompson—an NDIS participant with cerebral palsy—resigned from his position due to deep anxiety about the policy.
3.69By the time the committee's substantial report was tabled in October 2021, the government had abandoned plans to introduce independent assessments. This decision was made in response to substantial community pressure, including through the committee's inquiry, and a lack of support from state and territory disability ministers.
3.70The committee commended the government for making this decision and made recommendations aimed at avoiding a similar policy design in the future. These included defining and embedding co‑design into the Act to guide future scheme reforms, and suggesting government should consider funding bulk-billed consultations for the purposes of NDIS assessments and reviews.
3.71The report's concluding remarks noted that the committee plays a 'key role' in providing a safe space for participants and their advocates to raise concerns, without fear of losing their funding. The committee urged the government and the NDIA to focus on 'rebuilding trust' with people with disability and the disability sector:
…the committee welcomes the Minister's advice that the government has committed to extensive consultation and co-design to develop a new person‑centred assessment process. The committee also takes this opportunity to reiterate that changes to key features of the NDIS should only be approached through undertaking a development process that centres consultation and co-design on people with lived experience of disability, their families and the networks of practitioners, carers, and others providing them support.
3.72A government response to this report was not provided until March 2023, after a change of government and minister. In its response, the government reported:
Implementation of the government response has already commenced with legislation to embed a co-design approach to the NDIS passing through Parliament in April 2022 with bipartisan support. The government will also work in partnership with those with lived experience of disability through both the NDIS Review, and the Independent Advisory Council (IAC) and disability representatives, on the co-design of a new person-centred model…
General issues and implementation reports (2020 to 2022)
3.73In December 2020, the committee tabled its third general issues report (the first in the 46th Parliament). Key issues explored in this report included:
the NDIA's response to the pandemic;
ongoing issues relating to psychosocial disabilities under the NDIS;
supporting Aboriginal and Torres Strait Islanders with disability;
supporting people with disability who are experiencing homelessness;
the need for the NDIA to implement better communication with participants; and
support for families and carers dealing with the death of a participant.
3.74In its May 2021 response, the government supported eight out of ten recommendations, noting the two relating to homelessness. The response outlined work underway to improve communications, including a review of the NDIS Operational Guidelines to 'make them simple, clear and easy to use'. Other work being undertaken at the time included:
a review of the COVID-19 response;
a national consultation the Psychosocial Recovery Coach Framework;
the provision of grants to build capacity in the Aboriginal and Torres Strait Islander disability sector, and creation of a framework to build cultural competency in the NDIA; and
the establishment of a new Bereavement Support team.
3.75In relation to supporting people with disability experiencing homelessness, the government reiterated its view that 'homelessness related services [are] primarily the responsibility of states and territories'. However, it also noted that the NDIA has a network of Health and Justice Liaison Officers who 'support both participants and mainstream systems to understand and connect to the NDIS, including participants who have experienced, or may be experiencing, homelessness', and that LACs work with mainstream services to identify people who are 'homeless [and] may be eligible for the NDIS'.
3.76The committee tabled its fourth general issues report in November 2021 (report number two of the 46th Parliament). At that time, there were approximately 484700 NDIS participants, and 13600 children receiving support through the Early Childhood Approach. Legislation to codify the Participant Service Guarantee and implement 14 recommendations from the 2019 Tune Review was before the Senate, and the Royal Commission had just been extended by 17months, to 29September 2023.
3.77In this report, the committee took stock of progress made against recommendations from the committee's previous reports. It noted with enthusiasm that the NDIA had implemented some of the committee's recommendations, including by establishing a new national Bereavement Support team 'to improve interactions and support for family members after a participant's death'. However, the committee was concerned about a lack of progress or support for a number of other recommendations, and urged the government to 'revisit the evidence base for these recommendations and reconsider its position'.
3.78Areas where the committee remained concerned included:
a perceived failure of the NDIA to consult with people with psychosocial disability;
inadequate support for engaging people experiencing homelessness in the NDIS;
inadequate measures to engage with participants in custody;
inadequate procedures and training on supporting participants experiencing family violence; and
lack of transparency around the outcomes of decision reviews.
3.79This report also contained an interim report for the committee's inquiry into current scheme implementation and forecasting for the NDIS, which commenced in October2021. This inquiry was set up to specifically look at the long-term sustainability of the scheme, the role of state and territory governments, Tier 2 supports and the Information, Linkages and Capacity Building grants program, scheme funding, and other related matters.
3.80The interim report identified a set of key issues that warranted further inquiry; they were:
supports for people with disability outside the NDIS
the adequacy of the Information, Linkages and Capacity Program
interfaces between the NDIS and mainstream services
decision making in relation to access and planning decisions
actuarial and other data related to the NDIS, and
trust between the NDIA and people with disability.
3.81As the 46th Parliament was drawing to an end, the committee took the opportunity to recommend that, when it is re-established in the 47th Parliament, the committee should continue this inquiry, using evidence already received.
3.82The final general issues report was tabled on 31 March 2022, and provided a summary the work of the committee in the 46th Parliament.
3.83In its response to the general issues report, tabled February 2023 (during the 47thParliament, after a change of government), the government agreed with the committee's views regarding the previous government's response to recommendations around supporting people with psychosocial disabilities, and said:
The government is committed to meaningful engagement with people with psychosocial disability, including through development of the NDIS Psychosocial Disability Recovery-Oriented Framework.
3.84In relation to its implementation of the Tune Review, the government assured the committee that it was 'committed' to monitoring the performance of the NDIA's advocacy and support measures, and Appeals Program, to ensure 'people with disability across Australia can access advocacy support in a way that suits their needs and preferences'.
3.85In relation to committee concerns around people with disability in custody, and those experiencing family violence, the government highlighted its upcoming independent review of the Scheme (the NDIS Review). The government also supported the committee's recommendations to continue the inquiry into scheme implementation and forecasting.
NDIS workforce (2020–2022)
3.86In February 2022, the committee tabled a final report for its inquiry into the NDIS workforce, which had run since 6 February 2020. The committee had previously tabled an interim report for the inquiry, in December 2020, which outlined a number of measures the committee believed should be included in a national workforce strategy. In this final report, the committee considered evidence collected after the release of the Australian Government's NDIS National Workforce Plan: 2021–2025(the Workforce Plan), published by DSS on 10 June 2021.
3.87The Workforce Plan aimed to better support existing care sector workers, grow the workforce, promote innovation in the sector, and ensure service quality. Itincorporated 16 initiatives in three priority areas:
(a)promoting the sector and strengthening entry pathways;
(b)enhancing skills, training and recognition for the NDIS workforce; and
(c)encouraging innovation through reducing 'red tape' and facilitating new service models.
3.88In its final workforce report, the committee acknowledged that attracting and retaining a sufficient workforce was 'proving a substantial challenge'.Reflecting on evidence collected, the committee looked at workforce conditions, the problem of 'thin markets' (locations where there are not many service providers, such as in remote and regional Australia), employment of people with disability, education and training, and NDIS workforce planning.
3.89Assessing the government's NDIS Workforce Plan, the committee expressed 'disappointment' that two important issues 'received minimal attention in the plan'; namely the need to improve job security and employment conditions for disability care workers, and the need to support the employment of more people with lived experience of disability.
3.90The committee was also concerned that the plan may be too 'high level' and warned that 'without adequate attention from the Commonwealth Government in this plan, many of the issues experienced by the NDIS workforce identified throughout this inquiry will continue to persist'.
3.91The committee made eight recommendations, highlighting the need for:
better national data and research on new employment models, such as online platform work;
ongoing, meaningful consultation, and the use of co-design when developing policy proposals;
innovative training and capacity building programs and partnerships; and
setting 'clear and measurable outcomes' for the initiatives in the Workforce Plan.
3.92A government response has not yet been received for the final workforce report.
Capability and culture of the NDIA (2022–2023)
3.93The committee's most recent work has focussed on the capability and culture of the NDIA. This issue was first reviewed during the trial phase of the NDIS, with the committee, and an independent panel, making recommendations aimed at improving NDIA structure and governance, knowledge and attitudes among staff, processes and guidelines, ICT and data quality, and consistency of decision-making across the organisation.
3.94In September 2022, the committee agreed to self-refer an inquiry into the capability and culture of the NDIA, with a particular focus on:
operational processes and procedures, and nature of staff employment; and
the impacts of NDIA capability and culture on the experiences of people with disability and NDIS participants trying to access information, support and services.
3.95The committee tabled an interim report for this inquiry in March 2023, noting that experiences reported to the committee raised 'pressing' issues. The committee urged the government to 'learn from these experiences and take action to improve the NDIS for all participants, their families and carers'. In particular, the committee expressed concern that, while some of its recommendations had been 'swiftly implemented', others had been 'repeated over many years to successive governments', and never progressed, such as the recommendation that NDIS participants receive a draft plan before a final plan is agreed to by the delegate.
3.96Noting that the NDIA was in a 'transition phase', with a number of reviews, including the NDIS Review, underway, the interim report recommended the NDIA implement:
comprehensive training for staff in disability awareness and anti‑discrimination;
measures to increase planners' skills and knowledge in specific disabilities;
removal of staffing caps to reduce staff turnover;
improving the 'quality and transparency of decision-making';
adopting a 'participant-led, user-centred design approach to improve the participant experience'; and
addressing participant concerns that underspending their plans may impact future funding.
3.97The final report, tabled in November 2023 captured submitters' concerns that the NDIA's culture may not reflect the NDIS's key objective: to provide reasonable and necessary supports for participants and enable people with disability to exercise choice and control regarding those supports.
3.98Despite significant investment in the capability of the NDIA's workforce, systems and processes, the committee was concerned that the NDIA's policies, practices and approach were still premised on a 'deficit model of disability', rather than around 'goals, aspirations and ambitions'—that the NDIA 'focuses on what's missing, rather than what's possible'. This is disempowering, can be traumatic, and marginalises people with disability.
3.99The committee reported that participants often feel the NDIA 'does not recognise them as individuals, or understand the totality of their disability'. NDIA staff still do not have adequate understanding of invisible, episodic and psychosocial disabilities, or rare genetic disorders, and there is a 'culture of mistrust of people with disability by the NDIA'.
3.100The committee recommended:
removing the requirement to nominate a 'primary' disability, and 'secondary' disabilities;
improving staff knowledge and acceptance of invisible, episodic, rare, and psychosocial disabilities, and recruiting staff with specialist knowledge in these areas;
focussing compliance activities on service providers, not participants;
measures to uphold the rights and wishes of participants on guardianship and trustee orders, and those in Supported Residential Services;
a review and redesign of the Information, Linkages and Capacity Building program, including administrative arrangements, and the provision of long‑term funding for effective, trusted service providers;
better consideration of accommodation needs during the planning process, including the need for safe housing where there is risk of family violence;
improving access to culturally appropriate services for Aboriginal and Torres Strait Islanders with disability;
building NDIA staff capability through diversity training; and
embedding key human rights within the scheme and the planning process.
Committee view—key issues across the decade
3.101The NDIS has achieved a great deal in its first ten years of operation. The scheme has revolutionised the way supports are provided for people with disability and has vastly enhanced choice and control for many participants.
3.102It is important to recognise and reflect upon the substantial effort and energy that went into establishing the NDIA and launching this innovative, world‑leading scheme.
3.103The committee also wishes to acknowledge the unstinting work of the disability sector, experts, and people with lived experience of disability, who have striven to make the scheme better and fairer.
3.104Since the early trial phase, throughout the national roll out, and into the scheme's maturity, a philosophy of continuous improvement persisted. All governments and the NDIA have shown commitment to the scheme, investing in initiatives to ensure the NDIS can meet its objectives.
3.105Meanwhile, this committee has kept a close watch, working to interrogate every aspect of the scheme, and providing a vehicle to convey stakeholders' concerns and ideas to government and the NDIA. The committee's observations and recommendations have been informed by testimony generously provided by individuals and organisations impacted by the scheme. The committee is grateful to all those who have shared their expertise, knowledge and ideas, and personal stories with the aim of improving the scheme for the future.
3.106Three distinct 'themes' have emerged across the ten years of the committee's scrutiny:
(a)the need to work in partnership with people with disability, advocates and the sector, at every stage, and in relation to every aspect of the scheme (co‑design);
(b)the challenge of ensuring the scheme is designed and implemented in a way that empowers people with disability, increases their independence and capacity, and delivers the supports that individuals really need, in a way that works for them (choice and control); and
(c)responsibility of ensuring the scheme remains viable, delivers on its objectives, and is part of a broader ecosystem of supports for people with disability (sustainability).
3.107Issues relating to these key themes have dominated the committee's work over the last ten years and are the areas where significant work is still needed.
3.108There is still work to do to meaningfully embed co-design within the NDIS, at the levels of:
scheme design, architecture and interaction with state-based and mainstream services;
design and review of specific policies and procedures; and
within the planning process itself (at the level of individual plans).
3.109Issues such as poor communication with participants, a lack of transparency, inadequate recognition of the knowledge and experience of people with disability, and failure to adequately consult on policy changes, have continued to arise through multiple inquiries over the decade.
3.110The committee has recommended draft plans be provided to participants multiple times, across several reports, spanning four Parliaments. However, this remains unresolved.
3.111Problems with the definitions, evidence requirements, and design of plans for children with ASD and developmental delay have only partly been addressed. The NDIA's understanding and capacity to handle rare, episodic, invisible and psychosocial disabilities remains poor, and is impacting choice and control for people impacted by these conditions.
3.112The scheme's focus on deficits, and the lack of flexibility in planning, continue to marginalise and disempower some people with disability.
3.113As identified in the NDIS Review, many 'boundary issues' remain unresolved. The future sustainability of the scheme will rely on the Commonwealth, and state and territory governments, working together to build an 'ecosystem' of supports.
3.114The committee also notes that the issues of housing/accommodation supports, services for Aboriginal and Torres Strait Islanders with disability, outreach to those experiencing homelessness and disability, and engaging with disabled people in state custody remain largely unresolved.
3.115In the following chapters of this report, the committee discusses these key issues in more depth.