Are market forces failing us? The case of the National Disability Insurance Scheme

But perhaps it’s more accurate to say that it is our misplaced faith in market forces that is failing people with disability.

Just as reforms of the aged care system have aimed to make the system more ‘consumer directed’, the major rehaul of the disability support system represented by the National Disability Insurance Scheme (NDIS) aims to enhance the choice and control people with disability exercise over their support services.

The prevailing belief of governments across the political spectrum in Australia and abroad has been that devolving government responsibilities for direct service provision to a market of service providers will increase:

  • The quality of the care and support received by service users,
  • The efficiency of support services, and
  • The accountability of service providers.

To these ends, the NDIS provides an individual funding package to eligible participants, which they can then use to purchase support services of their choice within a mixed marketplace of private for profit and not for profit providers.

So what does the research tell us about how these assumptions about the market are panning out?

Research into the operations and outcomes of the NDIS show that in some contexts and for some people, these claims are true – but certainly not for all. Some participants report more choice and control over their services, while others report significant barriers accessing the support they need or little material change in their circumstances.

The marketisation of disability services has exacerbated existing inequalities. The traditional fault lines of gender, ethnicity, socioeconomic status, and urban/rural Australia are determining factors in who become the winners and losers within the scheme. Women, people from low income backgrounds, Indigenous Australians and people from culturally and linguistically diverse background experience disadvantage: they are all less likely to be participants within the scheme, and if they do gain access, they are less likely to receive a support package that meets all their needs. People with a support network of family and friends are able to negotiate the complicated planning process and services market more easily than those that don’t have access to this kind of help.

COVID-19 has highlighted the conditions of precarity and vulnerability that people with disability and support workers often live and work within. Like staff within the aged care context, disability support staff comprise a highly mobile workforce, working across multiple service sites, including private homes. A by-product of client directed care is that irregular hours and therefore casualisation of support staff has increased and will continue doing so. And while for some clients and some workers this delivers much appreciated flexibility, for others it increases precarity.

When the NDIS was first rolling out there was significant concern about predatory for profit providers moving into the disability support space. But the stories we are hearing from the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability show that private for profit providers by no means hold a monopoly over cases of underhanded financial dealings or abuse and neglect. In fact, government and non-government charitable and religious providers are the worst culprits just because historically these have delivered the lion’s share of services. And systems that cause intense harm and damage through the way they respond – or fail to respond – to people with disability transcend provider type.

People with disability experience different potential vulnerabilities within the new marketised and individualised funding and services environment. As representatives from Women with Disabilities Victoria and Children and Young People with Disability Australia have observed, although individualised support can be empowering, one to one support provision does carry the potential for violence and abuse because it can occur in an isolated context.

The death of South Australian woman Ann-Marie Smith after she was subject to gross neglect by her support provider earlier this year sparked a State and Federal Government inquiry and a State funded taskforce to investigate how such treatment was allowed to happen. Until she transitioned onto the NDIS in 2018, her support services were provided by government agency Disability SA. The Taskforce report identified over a dozen safeguarding and oversight gaps and made a series of recommendations. Amongst these were recommendations to strengthen the community visitors scheme, in which independent members of the community ‘check in’ on clients of support services, and increased investment in individual advocacy services. Perhaps the most powerful recommendation is that State and Local Government agencies take responsibility for better access and inclusion so that people with disabilities can fully participate in society.

So, to turn back to the question in the title: are market forces failing people with disability?

Well, yes and no. There are certainly ways we can better regulate and steward the disability services market and there are numerous systems reforms needed to reduce the complexity and barriers the NDIS market puts its participants through and achieve better outcomes.

But perhaps it’s more accurate to say that it is our misplaced faith in market forces that is failing people with disability.

We live in a society that is accustomed to accepting a level of segregation for people with disability that directly contradicts their rights under the United Nations Convention on the Rights of Persons with Disabilities (CRPD), and particularly Article 19 of the CRPD, the right to live independently and participate in the community.

Inclusion, as Trevor Parmenter states, is a mutual responsibility of our community. Being connected is the best safeguard, and this is not something that the NDIS or service providers can achieve on their own.

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Dr Laura Davy is a Research Fellow in the Public Service Research Group at the School of Business, UNSW Canberra. Her research focuses on disability studies and social policy.

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