Disabled people are facing a major attack from the Morrison government with the introduction of so-called ‘independent assessments’ for the National Disability Insurance Scheme (NDIS). While sold in terms of saving people time and money, independent assessments are designed to cut costs and will further restrict access to the NDIS.
Independent assessments and any other attempts to restrict access to the NDIS must be resisted. But we can’t limit our campaign to a defence of the NDIS as it already exists.
Anyone with experience dealing with the NDIS will know that it has major, longstanding issues. Having to fight tooth and nail to access the scheme, excessive administration, lack of services (what the NDIA calls ‘thin markets’), and underqualified workers who face poor pay and conditions—these are problems that stem from the design of the NDIS as a competitive market of disability services available to only 12 per cent of the disabled population.
This is not the NDIS people thought they were getting when they were promised ‘choice and control’.
We need to stop the NDIS heading in the direction the government and NDIA are taking it: further exposure to ‘market forces’ and cost-cutting. A society that values and respects disabled people would make sure that they receive high-quality support from a well-resourced disability service. This means the government taking responsibility for providing disability services, not outsourcing these to the market. This is what we should fight for.
COVID-19: a warning from the aged-care sector
If we needed a warning about the dangers of relying on the market to provide care it was provided by the hundreds of deaths in residential aged care in 2020. This tragedy was the fault of a privatised aged-care sector. According to the Australian Nursing and Midwifery Federation there were 655 deaths as a result of COVID-19 in Victorian private residential aged care. No-one died in the state-run facilities. While public aged-care facilities make up only 9 per cent of the total and are concentrated in regional areas where infection rates were low, the comparison is stark.
According to Kathy Eagar, professor of health-services research and director of the Australian Health Services Research Institute at the University of Wollongong, ‘If you depend on a low-paid casual workforce who go from home to home, then you can expect COVID-19 to just spread, which is exactly what has happened in Victoria’.
These exact conditions for the spread of a pandemic exist in the disability sector, and are getting worse as public disability services are increasingly privatised with the rollout of the NDIS.
According to the peak provider organisation, National Disability Services, around 40 per cent of disability workers are in insecure work (34 per cent casual and 6 per cent on fixed-term contracts). Disabled people remain at great risk if they rely on a casualised workforce with no sick leave.
Although vaccinations will begin in 2021, we will be living with the COVID-19 pandemic for some time yet, to say nothing of potential mutations or other pandemics. It’s urgent that we end insecure work in the disability sector and provide workers with the pay, conditions and training they need to work safely with disabled people.
Workforce
Most disability workers care deeply about participants and do their best to provide good-quality support. But the system fails them. The market cannot provide NDIS participants with consistently high-quality support.
According to a recent report by the UNSW’s Social Policy Research Centre:
Since the NDIS commenced in the trial sites in 2013, strong evidence has emerged about the ways in which the Scheme enables market-based models, inadequate employment regulation and poor resourcing to converge to undermine employment conditions, including job security and working time arrangements, making it difficult to consistently provide high quality services and supports.
The introduction of a market into the disability sector is designed to reduce costs through competition. On one hand, lower costs mean higher profits for private owners of disability services. On the other hand, it results in downward pressure on workers’ pay and conditions and a tendency to employ underqualified, less experienced (and cheaper) staff. Experienced and better-qualified staff are forced to leave the sector because there is no prospect for career progression.
A good-quality disability sector relies on well-trained, well-paid and experienced workers. A market-driven NDIS undermines this.
The UNSW report explains that:
Workers from across disability service settings said work patterns and working conditions had worsened since the NDIS was rolled out. Common problems related to unsuitable work-time arrangements, unpaid work, lack of training and supervision, and understaffing.
The UNSW report was based on workers in unions, and the authors caution that the reality is likely to be worse than what is outlined in the report.
Wage theft is rife in the disability sector, with workers often doing unpaid work. According to the National Secretary of the HSU, ‘For every paid hour of work, low-paid disability workers donate an average of 4.6 minutes of unpaid time. This is equivalent to 36.8 minutes for a full working day’.
Workers are having to donate their own time and money where the NDIS is not providing enough funding, for example having to use their own car to transport participants or their own money to pay for participants’ meals. In effect, to do their job, casual workers are forced to subsidise their employers.
Furthermore, many providers avoid their employment obligations through sham contracting. As online platforms like Hireup and Mable further penetrate the NDIS market, casualisation will get worse. The UNSW report shows ‘that among those who had used an online platform, there were disproportionately high numbers of workers who were casual, self-employed or on fixed term contracts in their main role’.
These trends make it difficult to attract and retain experienced staff who want to make a career out of working with disabled people. The Department of Social Services predicts that the NDIS workforce will need to recruit 90,000 full-time equivalent workers by 2024. It will be hard to stop standards deteriorating without an expansion of secure, public-sector employment.
Quality and safety
The horrifying violence, abuse and neglect outlined in the Disability Royal Commission points to a desperate need for a disability sector with a well-trained workforce.
One of the ‘key themes’ raised in hearings about abuse in group homes in the Disability Royal Commission interim report is: ‘safety in group homes being undermined by the “casualisation” of staff, poor training of disability support workers and a punitive culture among staff’. All these things have been synonymous with the marketisation of the disability sector.
Evidence provided in the Disability Royal Commission draws the link between casualisation and a reluctance to report abuse. Lack of job security means staff are less likely to complain of malpractice because they’re afraid of losing shifts.
It’s shameful that there are still no mandatory minimum qualifications for disability workers. Yet the UNSW report suggests that the amount and quality of training has declined under the NDIS. This is dangerous for both staff and participants. Having to rely on an inexperienced and poorly trained workforce leads to excessive use of restrictive practices. The NDIS Quality and Safeguards Commission says that:
In the reporting period [1 July 2019 to 30 June 2020], the NDIS Commission received 311,040 reportable incidents. More than 97% of these reports relate to the use of an unauthorised restrictive practice on a person with disability.
Young people with disability in residential aged care
Despite a small reduction, around 6000 young disabled people are still in residential aged care. Private investment in Specialist Disability Accommodation (SDA) is supposed to end the practice of housing young disabled people in residential aged care. However, despite generous incentives for private developers to build SDA, supply is lagging behind demand because of lack of investor ‘confidence’ in the sector. This is another market failure. The Aged Care Royal Commission interim report is explicit about this:
The Royal Commission heard that the market alone is unlikely to provide sufficient Specialist Disability Accommodation to meet the expected levels and kinds of demand within a reasonable timeframe. In some rural and remote areas, the market may never provide suitable supply.
For Specialist Disability Accommodation, the market response has been slow and incomplete. That market response is likely to create inequities across the country. There is no evidence to suggest that this will change in the short term and the current level of market response is far too slow to meet the massive shortfall of specialist accommodation. This requires alternative approaches to increase the supply of Specialist Disability Accommodation.
An obvious solution is for the government to build and own specialist disability accommodation, increasing the public housing stock that disabled people rely on disproportionately.
What’s true of SDA applies to the NDIS as a whole. Where the market is unable to meet demand, for example in rural and remote areas, for Indigenous people and for particular disability cohorts, or when it cannot do so safely or fairly, the government must provide that support.
Choice and control
Defenders of the market say that a privatised market is the best way to provide participants with choice and control. But the market is failing to deliver the choice and control promised by the architects of the NDIS. The privatisation of state disability services has taken away the choice of a public provider with experienced and well-paid staff. The UNSW report found that:
Contrary to the person-centred ethos of the NDIS, two in five workers (40%) said they work under pressure to meet KPIs regardless of the actual needs of the people they support, and two thirds (64%) said they were worried that clients don’t get what they need from disability services.
The 2020 How is the Disability Sector Faring report explains that:
Capacity constraints to consumer choice continue to remain important concerns… Only a few providers (9%) say they plan to introduce any new NDIS-funded services in the next 12 months. Similarly, three-quarters (76%) of providers have received requests for services they were not able to provide in the past 12 months, a significant increase compared to 2018 (69%).
The NDIS we need
Proposals to fix the gaps in the NDIS market focus on tweaking NDIS pricing so that providers can be incentivised to offer better services. This is a flawed approach.
Any increase to the budgets of participants is welcome. But it won’t address the structural problems of the market. The NDIA intends to deregulate prices as the market ‘matures’. According to the neoliberal playbook, market competition will drive down costs.
In reality, with the removal of price caps we’re likely to see more price gouging by providers alongside downward pressure on workers’ pay and conditions, especially as more private, for-profit providers enter the market. Rather than a way to contain costs, a market model leads to rising costs alongside poor-quality services, excluding those who can’t afford to pay the gap fees demanded by more expensive providers. It leads to greater inequality, in terms of services provided as well as in the distribution of wealth.
Disabled people are familiar with providers cherry-picking profitable clients whose needs are cheapest and easiest to meet, leaving clients with more complex needs with little choice and control. A competitive market encourages and rewards this kind of behaviour.
A public, universal system would not allow this disgusting behaviour.
Our goal should be an NDIS that is publicly owned and run, well resourced and available to anyone who needs it. People shouldn’t have to jump through hoops to get essential services.
In the meantime we need to reverse the privatisation of disability services and fight for a ‘public option’ for people who don’t have that choice in the NDIS market.
It’s clear from the UNSW report that working conditions, support and supervision got worse when public disability services were transferred to the non-government sector. This means worse support for participants as well.
Calling for a public disability service doesn’t mean a return to the pre-NDIS system. For some participants the NDIS has been an improvement because at last they have some flexibility around the supports they receive, and when they receive them. This must be a key part of any future NDIS. A well-resourced public disability service would provide genuine choice and control.
We need a system based on solidarity between participants and the staff who work with them. Workers need better pay and conditions, and participants need better support. To win justice for disabled people we need disabled people and workers in the sector to unite and fight. Neither can move forward without the other.