Is Disability A Private Matter?

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.