1 May 2012

Is Disability A Private Matter?

By Eleanor Gibbs
Why the widespread support for the National Disability Insurance Scheme, a voucher scheme for disability cover? We don't rely on the private sector to deliver health or education - disability services are no different, writes Eleanor Gibbs
Given its genesis in conservative think tanks such as the Institute for Public Affairs (IPA), the proposed National Disability Insurance Scheme (NDIS) is a strange beast for progressive political groups to hitch their electoral wagon to.

The NDIS is a model for disability funding proposed by the Productivity Commission to address the lack of support for Australians with a disability. Under the scheme, individuals with a disability will be directly funded so they can purchase services as needed.

However, the voucher model in other social services such as education and health has been soundly rejected by progressive political groups in the past. Why is disability funding suddenly different?

In 2006, the IPA proposed that:

"Consumers of disability and mental health services should be funded through a voucher arrangement.

State and federal governments should accelerate the introduction and spread of individualised funding arrangements across a range of services and programs for people with disabilities and mental illnesses and their families."

This is consistent with other conservative approaches to education and health care — individualised funding packages allowing citizens to equally go out and purchase services, severing them from inefficient state bureaucracies and giving people choice.

Traditionally progressive politics has argued that services such as education and health should be provided as a universal right to all citizens; that is, funded through collective revenue. This model is meant to ensure equal access for all, regardless of the ability to pay.

As the Australia Institute argued of school vouchers:

"On the basis of the available evidence, universal voucher schemes do not appear to be a cost-effective policy option because they are likely to be expensive, pose a significant risk to social cohesion and equality of opportunity, and are unlikely to significantly mprove average academic outcomes."

So why, when it comes to disability services, are progressives embracing a voucher system?

Firstly, the NDIS is based on an economic and medical model of disability, rather than a social one. Emphasising the social construction of disability has been a key objective of progressive advocates, emphasising that disability is not "created" at the individual level but at the social.

As peak disability rights orgnaisation People with Disability argue:

"The social model posits that 'disability' is the result of the interaction between people living with impairments and an environment filled with physical, attitudinal, communication and social barriers. It therefore carries the action implication that the physical, attitudinal, communication and social environment must change so as to enable people living with impairments to participate in society on an equal basis with others."

A social model of disability looks at structural and societal barriers to people with a disability being able to fully participate in the world. This model promotes accessibility of public spaces, not the NDIS emphasis on private accessibility in the home.

If the NDIS worked within this model, there would have been recommendations for funding to ensure all transport and public spaces were fully accessible. Most public and private transport, particularly outside the inner city, is not accessible. Footpaths are poorly maintained or non-existent. Many of the busiest rail stations in Sydney are completely inaccessible, and universal accessible housing guidelines are still voluntary.

Secondly, Australia has one of the lowest workforce participation rates in the OECD for people with a disability, rendering disability invisible and hidden from public view. Disability service providers and workers are not well connected with existing progressive institutions, such as unions. Disability advocacy groups have been focused, rightly, on urgent and desperate battles with state governments to obtain meagre resources. While GetUp! has campaigned on increased mental health services, they have never run any campaigns focused on accessibility or people with a disability.

There are very few people with a disability in parliaments, corporate board rooms or on prime time television. Funding for disability services has been minimal, piece-meal and sporadic, leaving people with a disability without essential services.

Thirdly, most progressive politicians take their cue on issues related to disability from the key service providers in the sector, which have on the whole responded positively to the NDIS, despite the very real and profound changes ahead for much of the community and not-for-profit sector.

Some of the larger not-for-profit service providers have dismissed concerns about the impact of private companies being funded to deliver services for people with a disability under the NDIS. In an op-ed on ABC's The Drum, Peter Kell, CEO of Anglicare Sydney wrote:

"One criticism of the proposed NDIS is that it may open the door for private service providers to cream off part of an individual's funding package as a fee-in-kind. On this basis critics argue that establishing a market for disability services and giving individuals greater control of how they spend their funding packages will make them more vulnerable to private providers and effectively undercut value for money in service provision.

This scenario would indeed be a waste of tax payers' money and fail to deliver greater value in services for those with a disability. But there is nothing to suggest that this will actually happen. The proposed NDIS is also designed to guard against exploitative behaviour by private service providers."

I hope Kell is right, but I am far less optimistic. There is ample evidence that opening up social services to the market leads to profound changes for the community sector, not always positive.

As a point of comparison, in 1997, the then Howard government opened up for tender all employment services that were previously run by government or not-for-profit agencies. After three rounds of tenders, there are now far fewer small, local employment agencies, with many large for-profit companies providing services.

Despite a recent review, the Federal Government's Social Inclusion Board found that one of the barriers for jobless families with complex needs was "the competitive nature of the JSA [Job Services Australia] model" that inhibited cooperation with other agencies.

Employment writer Elisabeth Wynhausen commented:

"The agencies had all adopted a business model that had them creaming off the more promising job-seekers and parking the rest with the growing pool of long-term unemployed.

"Yet the government has swathed the system in so much red tape that Jobs Australia, the peak body for the non-profit agencies, has found its members spend half their time administering and complying with the 3000 pages of requirements written into the contract, including nine minutes in every hour on paperwork that duplicates information collected by Centrelink. No doubt the boxes all get ticked — and yet half the people on the books fail to get any job at all, not even a casual job for half a day a week."
Large charities have the skills and staff to navigate contracts, negotiate fairly with private sector partners and tick off on funding requirements. They have the ability to weather the potential unpredictability of individualised funding through centralised back-end services, not available to the local community centre.

Why does this matter? Surely it is the right of every person to choose the service they want? Won't that weed out the shoddy operators and reward good services? Maybe, but those ideas are reliant on a faith in the fairness of the free market that I just do not have.

The Productivity Commission report makes explicit the expectation that private, for profit, providers are to be part of the proposed NDIS. Their incentive for participation is to make money, not a commitment to the human rights of every Australian. Would they operate in regional and remote areas? With people from culturally and linguistically diverse backgrounds? With Aboriginal and Torres Strait Islander peoples? Would they specialise in the needs of people with complex disabilities?

The Productivity Commission itself highlights "the greater risk they [service providers] would face in a world where block funding had virtually disappeared" and the need for greater competition.

As someone with a disability, I want to see service provision equally available for every Australian who needs it. But whether this model of the NDIS will deliver that, I'm yet to be convinced. I want all progressive political groups to cast a more critical and sceptical eye over the Productivity Commission recommendations and their implementation.

Otherwise, I fear a world where large corporates dish out minimalist, homogenised service packages, no structural universal access is achieved and small, passionate, local not-for-profit community organisations no longer exist.

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grumpyoldman2
Posted Tuesday, May 1, 2012 - 14:31

grumpyoldman2

Just another poorly thought thru' attempt by labour to pull some chestnuts from the fire. They have not sought to define the "Disabilities" to be covered. Look out now as the alcoholics and drug dependers prove their disabilities are worthy of further support.

Grumpy293
Posted Tuesday, May 1, 2012 - 15:49

Is Disability A Private Matter? NO not for genuine cases, as for self inflicted, yes it is a private matter and NOT the burden of the tax payer.

martyns
Posted Tuesday, May 1, 2012 - 20:28

In answer to the question, NO. Disability, like everything else of importance, should be a public matter. The Private sector is there for profit, and that has its place, but not regarding people's welfare.

Homerjunior
Posted Wednesday, May 2, 2012 - 10:23

Dear Eleanor,
Thanks for your article. Whatever the design of service delivery, an important thing is the people who deliver the service and how good they are. I have seen program delivery held together by several extremely competent and motivated individuals, I have also seen bureaucrats waste time and resources on stupid issues. Perhaps what will be needed is an Ombudsman to make sure the system will work. The worst impediment to the empowerment of the disabled is attitudinal and it's very hard to change prejudice.

AxeEugene
Posted Wednesday, May 2, 2012 - 11:00

What we need is a mental health system.

As some one is now on disabled pension from work related busted body parts at fifty years old I'm looking at zero employment till death do us part. Being diagnosed with serious depression late in life, I like the many mental cases worked any job we could get includes all the dangerous hostile environments no normal person would ever do. Result is high work related accident rates.

Early diagnoses and treatment of mental health problems would prevent many a work place injury happening in the first place.

roma
Posted Wednesday, May 2, 2012 - 17:15

I am dismayed to read that the NDIS is going to be run by private operators. When old people's homes became nothing more than corporate money-makers, many oldies had terrible experiences, and there was little they or their families could do. Our society needs to look at what we really think all our vulnerable citizens need and deserve.

Craig Wallace
Posted Wednesday, May 2, 2012 - 20:48

Grumpies - I do not agree with the judgemental comments here about ‘self inflicted’ disabilities. There are in fact a very small number of people who fit that ‘profile’ on any sort of support and often this is bound up with mental illness and abuse. May we walk in each other’s shoes and let he or she who is without sin cast the first stone!

Eleanor - Thanks for this piece but I have to say this reads as a simplistic approach that essentially says because individualized funding is being suggested in other contexts by some right wing think tanks it’s bad. Conflating the NDIS with proposals for vouchers in schools is unhelpful - that is not what’s on the table from the Commission and nor do many people with disabilities receive services within a similar context. Saying the NDIS should fund access upgrades to transport and public spaces is also simplistic and ignores the reality that this is a legal (and moral) responsibility for local authorities among others.

Progressive organisations like PWD support an NDIS because a rights based individualized approach – backed up with proper advocacy – can be all about the social model. A difference between disability and health or education is that we often require personalised supports tailored to us as individuals and delivered in the home or community - many of these supports could be marshalled from mainstream systems at the right price point.

To give an example, why should we only be able to receive respite in a specialised facility with green walls and staff with attitude when using a holiday cottage with a support worker might be better, cheaper and more effective?

If disability is inherently and solely a Government matter then it hasn’t done it well or owned it properly. Over the years Government - and some NGO;s - have managed to run and fund special schools, institutions, medical model aged care and other places which embed a medical model of disability. You may be critical of the Jobnetwork but let me tell you that the CES didn’t have a dazzling track record either.

On the subject of ringfencing if some old style service providers get undercut by well-managed, flexible private operators who aren’t wrapped up in endless demarcation issues and can change lightbulbs as well as the bedsheets then good.

The NDIS also means more funding getting into a system which is rationed, broken and underfunded and that’s a good start. Hopefully better standards for workers too.

In short the shift is about becoming a customer (treated as a person of value and served by people who know their stuff and who can be removed if they don’t step up) as opposed to client (treated like charity cases and served by people in an oldstyle public servant mindset who clock in and out and have no stake in the outcomes). Let the debate continue.

Craig Wallace

grumpyoldman2
Posted Thursday, May 3, 2012 - 07:42

grumpyoldman2

Craig, your first paragraph is not at all correct at least as it relates to the area in which I live. I was not being judgemental just observant. There are many, not a few, who get along just fine on disability support pensions, aided and abetted by compliant Doctors who provide the necessary documentary support to Centrelink. These people never have their mental state examined nor questioned, in fact most are really clever system manipulators.

Craig Wallace
Posted Thursday, May 3, 2012 - 21:41

Grumpy - what I really don't undertand is why folks like you are observant in the first place. Why worry so much about what others get? Do you really believe that you will be happier if someone else gets cut off a benefit thats on the poverty line anyway?

The most any of us can do is have integrity in our own lives and only claim what we are entitled to (and actually need). I'm guessing you live your life like that which is good. So why not be satisfied with that and lead by example rather than worrying about others? Bet you'd feel less grumpy!

fightmumma
Posted Saturday, May 5, 2012 - 15:12

Yes I agree - this faith in the free-market - and this tendency to design generic, one-size-fits-all approaches - it is a very serious problem! It does NOT match the real world with all its vast tapestry of variance, diversity and humanism! I still think that the welfare services shouldn't be business ventures, though they should be accountable and not wasteful. We make grave errors in treating human beings as commodities in business models - esecially with our most vulnerable and marginalised citizens. Though these dominant-culture values most definitely suit and are comfortable to the mentality of individualism and blaming the victim...people with disabilities do not fit with individualism so much as collective efforts are usually needed to fulfil their/our needs. Social support is lacking in all western communities and societies - we see its impacts in mental illness, substance abuse, criminality, poor education outcomes. When will we learn to put the humanbeings back into a society and remove the free-market from segment of life where it does NOT belong?

fightmumma
Posted Saturday, May 5, 2012 - 15:22

grumps - this is an interesting topic youse raise - how accountable is society to people with substance abuse? Is this a disability or is it just that their behaviour disables them? I don't know! I'd assume healthy welladjusted people generally don't abuse themselves?
I had a friend who was supposed to seek employment after her son turned 7 as Centrelink requires of parenting payment recipients. She and all her friends are hopeless alcoholics (her phrase not mone). She got a exemption due to mental health problems and just sits on her bum drinking, working cash in hand and not worrying about Centrelink. Even though I have a child with a disability and suffer anxiety and bouts of depression (at the time of my youngest turning 7) but I WANTED to find employment. So I decided to remain on the Centrelink obligations in order to get the assistance finding work...but this also involved a great deal of stress, shame etc - as working with Centrelink really truly is a de-humanising experience. Centrelink was very reluctant to give me an exeption either on the groundsof child with disability OR my own mental health - but my friend quite easily got her exemption!
Suffice to say though - I've been working, earning money and now studying offcampus at uni and my friend is still in her same place. But does she have a disability?

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