3.1
This chapter examines the boundaries and interface of National Disability Insurance Scheme (NDIS) service provision and mainstream services.
3.2
In particular, it provides background on the interfaces of the NDIS (where and how the Scheme interacts and intersects with other supports) as well as the Australian Government’s Information, Linkages and Capacity Building program.
3.3
This chapter also explores evidence provided to this inquiry from the Australian Government and other witnesses and submitters, in relation to the matters highlighted above.
NDIS interfaces
3.4
Outside of the NDIS, people with disability, their families and carers can access a wide range of services—including mainstream and community supports—for their care and support needs and to maintain the quality of their lives.
3.5
‘Mainstream supports’ are those funded by state, territory or Commonwealth governments and include, for example, health, education, justice, housing and transport services. These services are available to all Australians regardless of their disability status.
3.6
People with disability, their families and carers can also access ‘community supports’ provided by community organisations, such as local councils or not-for-profits.
3.7
By design, the NDIS is intended to complement these other supports, not replace them. But, for the scheme to operate effectively, sustainably, and to ensure good outcomes for participants, the interface between the NDIS and other disability and mainstream services must be as seamless as possible.
3.8
As outlined in the sections below, there are a number of frameworks which attempt to set out and clarify the boundaries of the NDIS and its interfaces with other service systems.
Legal Framework
3.9
Section 34 of the National Disability Insurance Scheme Act 2013 (NDIS Act) requires the Chief Executive Officer (CEO) of National Disability Insurance Agency (NDIA), when funding reasonable and necessary supports, to be satisfied that:
[T]he support is most appropriately funded or provided through the National Disability Insurance Scheme, and is not more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body…
3.10
The National Disability Insurance Scheme (Supports for Participants) Rules 2013 (NDIS Rules) also outline the perimeters of supports appropriately funded or provided through the NDIS, in accordance with paragraphs 34(a) to (e) of the NDIS Act.
Principles to determine the responsibilities of the NDIS and other service systems
3.11
In 2015, the former Council of Australian Governments (COAG) agreed on a vision for ‘an inclusive Australian society that enables people with disability to fulfil their potential as equal citizens’.
3.12
COAG agreed to a set of six ‘Principles to determine the responsibilities of the NDIS and other service systems’ (Principles) which clarify the responsibilities of the NDIS compared with other service systems, in funding and delivering supports to achieve this vision.
3.13
In addition to the six Principles, all governments also agreed to the Applied Principles and Tables of Support (APTOS) tool, which details the division of funding responsibilities between the NDIS and the following sectors:
early childhood development
child protection and family support
higher education and vocational education and training
housing and community infrastructure
Operational guidelines
3.14
The NDIA have also developed a range of operational guidelines, which describe what information needs to be considered in decision-making processes under the scheme.
3.15
The guidelines are based on the NDIS Act and NDIS Rules and cover a range of aspects of the Scheme, including:
NDIS boundaries and interfaces
plan decision making and reviews
the range of supports available under the Scheme
3.16
Of particular relevance to this chapter, is the NDIA’s Mainstream and Community Support Guideline. This guideline describes what mainstream and community supports are and aims to explain the division of funding responsibilities between the NDIS and mainstream services, as well as how these decisions are worked out.
Disability Reform Ministers’ Meetings
3.17
Following the Prime Minister’s announcement in May 2020 that COAG would be replaced by a new inter-governmental body, National Cabinet, the Disability Reform Ministers’ Meetings forum was established.
3.18
As described in Chapter 1 of this report, Disability Reform Ministers’ Meetings are held several times a year, providing a forum for all Commonwealth, state, and territory ministers responsible for disability policy to drive national reform in disability policy, including through the National Disability Strategy and the NDIS.
3.19
Through this forum, disability ministers regularly consider NDIS interface issues.
New National Disability Strategy
3.20
The Australian Government launched Australia’s Disability Strategy 2021–2031 (the Strategy), on 3 December 2021. The Strategy sets a national disability policy framework for all people with disability (not just NDIS participants).
3.21
The Strategy replaced the previous National Disability Strategy 2010-2021 and set out the Australian Government's plan for continuing to improve the lives of people with disability in Australia over the next 10 years. The Strategy was signed and agreed to by all jurisdictions and levels of government and was developed in close consultation with the disability community. The strategy is intended to:
provide national leadership towards greater inclusion of people with disability
guide activity across all areas of public policy to be inclusive and responsive to people with disability
drive mainstream services and systems to improve outcomes for people with disability; and
engage, inform and involve the whole community in achieving a more inclusive society.
Productivity Commission 2017 comments on NDIS interfaces
3.22
In 2017, the Productivity Commission (the Commission) noted that effective interfaces between the NDIS, other disability services and mainstream services 'are essential for good outcomes for scheme participants and sustainability of the scheme'.
3.23
The Commission warned that disparities in support between the NDIS and other disability and mainstream services might create disproportionate incentives to obtain (and retain) an NDIS plan. Therefore, 'to provide the right incentives' the Commission considered that 'services available to people who just qualify for the NDIS, and those who just miss out, should be as seamless as possible', and that this would require coordination of services within and outside the NDIS. The Commission explained that:
It is important that people with disability do not see the NDIS as an oasis of support, surrounded by a desert, where little or nothing is available.
3.24
Recognising the key requirement of the scheme that supports provided under the NDIS should be most appropriately funded by the scheme, and not another service or system, the Commission noted that:
For the NDIS to be successful and financially sustainable, there must be clear lines of responsibility between mainstream services and the scheme. Also, as people with disability can require supports across a number of service systems, it is essential that service systems work well together so that people receive the right services and achieve the best possible outcomes.
3.25
Emphasising that the NDIS should complement mainstream services, the Commission observed that, while, in theory, there is a clear boundary between NDIS and mainstream services, this boundary is not as clear at an operational level.
3.26
During the trial and transition phases of the scheme, the NDIA had reported three key challenges in relation to mainstream supports:
lack of clarity around some interfaces
different understanding of mainstream obligations, by each jurisdiction and the NDIA
difficulty in holding mainstream services accountable.
3.27
The Commission warned that 'a lack of clarity around responsibilities between the NDIS and mainstream services has the potential to impact on NDIS costs, and on the effectiveness and efficiency of service delivery in multiple ways'. These included scope creep; cost shifting from mainstream services to the NDIS and vice-versa; gaps in service provision; inconsistent support access decisions; and duplication of services.
3.28
The Commission identified particular emerging issues with respect to NDIS interfaces with the justice system, emergency, transport and mental health services, but considered that, at the time, it was still too early to identify service gaps. Nevertheless, it recommended a formal process be established (through COAG) for working through interface questions. The Commission also thought that the Information, Linkages and Capacity Building program and Local Area Coordinators 'can play a role in ensuring mainstream services are better informed about their roles and responsibilities'.
3.29
The Commission also paid particular attention to the interface with aged care, highlighting that:
There are aspects of the design of the NDIS, and how it interfaces with the aged care system, that create incentives for people to stay in the NDIS after the age of 65 years, and encourage people nearing the age of 65 years to apply for the NDIS. This raises some issues that will need to be addressed, but given the complexity involved, this should be done with the benefit of data from experience at full scheme.
3.30
The Commission considered that the Australian Government should review the interface between the NDIS and the aged care system as part of the 2023 review of NDIS costs.
3.31
Finally, the Commission considered the interface with the National Injury Insurance Scheme (NIIS), noting that, in 2011 it had recommended that an NIIS be established and operate in parallel to the NDIS. Of the four 'streams' envisaged for the NIIS, only two streams were ultimately progressed, with the remaining streams to be supported through the NDIS. In 2017, the Commonwealth's position was that the states and territories should take up the funding obligation if the full NIIS was not delivered, but this was not the view expressed by a range of state governments who made submissions to the inquiry. The Commission, however, agreed with the Commonwealth and recommended that, if the remaining two streams of the NIIS were not implemented, state and territory governments should 'bear the additional costs borne by the [NDIS] because of the absence of these streams'.
3.32
The Commission also commented on the need for increased reporting and monitoring in relation to mainstream services outcomes, such as the number of participants and people with disability receiving support from local area coordinators.
Information, Linkages and Capacity Building program
3.33
In July 2017, the NDIA established the Information, Linkages and Capacity Building (ILC) program under the NDIS, to provide funding to organisations to deliver community-based projects that can be accessed by any Australian with a disability, as well as their families and carers. The ILC program currently has annual allocated funding of approximately $136 million.
3.34
ILC is primarily a grants program, which funds projects that are intended to create and build connections between people with disability and their communities, build confidence and capacity of people with disability, and improve access to community and mainstream services. The program comprises four ‘streams’ of supports:
(a)
National Information Program: to provide access to up-to-date, relevant information linking people to supports and services in the community.
(b)
Mainstream Capacity Building: to improve the capacity of mainstream services to respond to and include people with disability, increase accessibility and use of mainstream services.
(c)
Economic and Community Participation: to connect people with disability to activities, employment, community supports and opportunities and help communities and employers to be inclusive and responsive to people’s needs locally and nationally.
(d)
Individual Capacity Building: to establish and support organisations run by people with disability, for people with disability, assisting people with disability to improve their skills and confidence to achieve their goals.
3.35
ILC funding is available to all people with disability in Australia, including those who are not NDIS participants. However, the original focus of the program was to provide supports to people with disability who are not participants of the scheme to improve their outcomes, in turn reducing the likelihood they would require funding under the NDIS.
3.36
The Australian Government describes the ILC program as ‘only one component of a broader ecosystem of disability supports’ and complementary to other policies and programs that are available, such as those funded and delivered by state and territory governments.
3.37
Responsibility for the ILC program initially sat with the NDIA, however responsibility was transferred to the Department of Social Services (DSS; the department) on in October 2020.
Ongoing review of the ILC Program
3.38
DSS has been reviewing the ILC program since it took hold of responsibility of the program from the NDIA to understand the gaps and unmet needs. The department has engaged Swinburne University of Technology as part of this process.
3.39
The department released an overview of the review process in March 2021, which included information on the scope of the review and next steps. The summary highlights some areas of concerns, many of which have persisted since the inception of the program. These include:
significant implementation delays
low participant engagement
a lack of flexibility and responsiveness in the administration of ILC grant funding; and
a lack of meaningful data and evaluation information collected about the program.
3.40
The summary also identified a range of issues in need of further consideration throughout the ongoing review process, including:
the strategic intent of ILC
the challenge of achieving national coverage including rural and remote
the distribution of funding across jurisdictions
the role of intermediaries such as Local Area Coordinators
the method of distributing funds
how to share data and learnings across projects; and
how to improve application and funding processes and minimise duplication of services.
Productivity Commission 2017 comments on the ILC program
3.41
In 2011, the Productivity Commission had recommended a bridging and capacity building service for all people with disability, to connect with mainstream and community services. In their original vision for the NDIS, this was 'Tier 2' (with 'Tier 1' encompassing all Australians, who may one day need to receive disability support, and 'Tier 3' being access to funded individualised supports for people with significant care and support needs).
3.42
In 2017 the Commission explained that the ILC program was the realisation of the proposed 'Tier 2' supports. However, given that the ILC program had not been part of the NDIS trials, in 2017 there was limited opportunity for the Commission to examine the adequacy of the program. The Commission noted however that the program is a key component of the scheme, and that it was 'important not to see the ILC program as something separate to the… success and sustainability of the NDIS'. The Commission found that it would be a 'false economy to have too few resources for ILC activities', and that the program was also an important tenet of the insurance model for the scheme, intended to reduce the demand for individualised supports over time, reduce the need for support to be provided through individualised supports, and make supports more effective in achieving a person's goals.
3.43
Some participants in the Commission’s study were concerned that the ILC program was underfunded, while others worried that the scope for the program was too narrow. At the time the NDIA also reported that ILC funding had initially been used to preserve some legacy state and territory-based programs to ensure the 'ILC-like' services under those programs continued to be delivered. The Commission reflected on the need to build an evidence base on which to inform decisions about the activities funded through ILC:
The evidence base should provide information on how effective, and by how much, ILC activities improve the outcomes for people with disability and reduces their need for, or reliance on, individualised supports. This information can then be used to better fund activity areas where there is a shortfall in services, and where it is best value for money.
3.44
The Productivity Commission pointed to the next review of NDIS costs as an opportunity to 'review the effectiveness of the ILC program, including the scope of the ILC Policy and Commissioning Frameworks, and the magnitude of any benefits from increasing its funding'.
Submitter and witness views
Mainstream supports
3.45
The availability of supports outside of the NDIS for people with disability was a key concern raised in submissions received before the committee's interim report was tabled in December 2021. For example, the 'missing middle', for mental health supports for people with disability, was highlighted as particular gap left following the introduction of the NDIS and subsequent reduction in mental health supports previously provided by the Commonwealth and state and territory governments.
3.46
As noted in the committee's interim report, the committee heard different views about the ILC program, some positive, and others raising a range of concerns. Melbourne Disability Institute told the committee that the policy scope for the program is far too broad to be achieved with the current funding commitments assigned to the program.
3.47
Local area coordinators are also intended to assist with navigating community supports, but the committee has heard for a long time that these positions have largely been focused on planning rather than connecting to community supports through the earlier stages of the scheme. Professor Bonyhady commented:
The NDIS was intended to be at the centre of a new ecosystem, where people with disability not only had access to specialised disability services but they had much better access to mainstream services. That hasn't happened—in part, because local area coordinators have been diverted into full-time planners.
Interfaces
3.48
Where there is a question of jurisdictional responsibility for providing support to someone with an NDIS plan, the committee heard that this has also caused significant problems for some people with disability.
3.49
Mr Patrick McGee, Australian Federation of Disability Organisations (AFDO) stated that the NDIA's approach to interface questions has been 'very belligerent' leading to a 'belligerent dynamic' between the NDIA and other services systems. Mr McGee provided examples of people with disability being detained through the criminal justice system past the cessation of their sentences 'because there is no accommodation or support that can be provided by the NDIS'. Mr McGee emphasised that this issue especially affects Aboriginal and Torres Strait Islander people who have been incarcerated, explaining that some are held in jail longer because supports are not arranged for them.
3.50
The committee is also aware of media reports of NDIS participants having prolonged hospital stays as a consequence of disputes over provision of supports, and equally concerning accounts have been provided to the Disability Royal Commission around delays in provision of support for people in custodial settings. The committee heard that such disputes should be resolved through a 'person centred' approach, which could involve the agency of first contact supplying the support at the time needed by a participant, and seeking reimbursement from the responsible agency, department, or jurisdiction following provision of that service.
3.51
Submitters highlighted the importance of continuing to support shared governance of the scheme to work towards resolving a range of these issues.
3.52
While the committee also heard positive responses from stakeholders about the new disability strategy, witnesses also cautioned that, while the strategy looks at the 'big picture' and has been committed to by state governments, this:
doesn't mean that the issues won't happen with a big system like the NDIS…. [state government's commitments to the strategy] doesn't mean that those same state governments' health systems, justice systems and education systems might not also be, in effect, at war with the NDIA about funding or committing to some supports for an individual participant. It seems too hard, for some reason, to get all of these systems to play well together in the interests of an individual.
3.53
Mr McGee also suggested that additional mechanisms may be needed, on top of the quarterly disability ministers meetings, to effectively address interface questions:
The view is that the disability ministers meeting will conduct all of the business of disability in this country at their quarterly meetings! It's a big ask, isn't it? What's missing is the mechanism of conversation… So, if there's no mechanism, then the question I have is: how can systems talk to each other? How do the feds and states talk to each other?
Government view
NDIS interfaces
3.54
DSS and the NDIA told the committee that the Commonwealth and state and territory governments are committed to working through interface issues. Ms Debbie Mitchell PSM, Deputy Secretary, Disability and Carers at DSS told the committee:
The Commonwealth continues to work with state and territory governments to address interface issues between mainstream services and the NDIS, ensuring that the NDIS and mainstream services including health, justice, child protection, transport, mental health and education all operate effectively together as an important way to meet the needs of Australians with disability.
3.55
In DSS and the NDIA’s supplementary submission it was noted that:
All governments (state, territory and Commonwealth) agreed on a vision for an inclusive Australian society that enables people with disability to fulfil their potential as equal citizens. To achieve this vision, all Australian governments, non-government organisations, business and the wider community have a role to play. The interactions of the NDIS with other service systems will reinforce the obligations of other service delivery systems to improve the lives of people with disability, in line with Australia’s Disability Strategy.
3.56
In their initial submission to the inquiry, DSS and the NDIA told the committee that work is underway between the Commonwealth and states and territories to resolve NDIS interface matters, including:
the ongoing review of the ILC program since responsibility was moved to the Department of Social Services
Australia's Disability Strategy
continued discussions and work commissioned by the Disability Reform Ministers’ Meetings; and
Department of Health initiatives to work with disability support systems under the National Health Reform Agreement 2020-2050.
3.57
The supplementary submission provided more detail on a range of actions progressed through the former Disability Reform Council and current Disability Reform Ministers' Meetings in relation to supports delivered to people with disability across interfaces with the NDIS including in relation to mental health, justice, child protection, health and transport. It also noted that work currently underway on priority areas under the National Health Reform Agreement 2020-2025 includes work to 'inform solutions to address the interface issues between the health, aged care and disability systems'. Other measures include psychosocial disability and mental health support and a National Roadmap for Improving the Health of People with Intellectual Disability.
3.58
In response to a question about the government’s plans for monitoring and tracking scheme costs into the future, Mr Hoffman, NDIA CEO, noted the commitment by the ministerial council (currently the Disability Reform Ministers meetings) to review scheme costs. Mr Hoffman noted that the next review is due to be completed by the end of 2023 and is a ‘significant piece of work commissioned by state, territory and Commonwealth ministers’ which would review costs and update forecasts.
Information, Linkages and Capacity Building program
3.59
The supplementary submission noted that the ILC program is 'only one component of a broader ecosystem of disability supports'. As outlined at the beginning of this chapter, the supplementary submission noted that DSS has been reviewing the ILC program since its transfer from the NDIA, to understand the gaps and unmet needs of the program and has engaged Swinburne University of Technology as part of this process.
3.60
DSS released an overview of the review process in March 2021, which included information on the scope of the review and next steps. The summary highlights some areas of concern, many of which have persisted since the inception of the program. These include:
significant implementation delays
low participant engagement
a lack of flexibility and responsiveness in the administration of ILC grant funding; and
a lack of meaningful data and evaluation information collected about the program.
3.61
DSS and the NDIA submitted that, through a combination of surveys and interviews, this review process has included analysis of data on current ILC grants and targeted consultations with the sector and current ILC grant recipients.
3.62
DSS and the NDIA further noted that the ongoing analysis ‘is a precursor to planned consultations with people with disability, the disability sector and other key stakeholders on future directions for the ILC’.