Reform in disability is harder than you think

Twenty years ago, it was widely believed that indigenous disadvantage in Australia could be overcome by throwing money at the problem and trusting the country’s bureaucrats to get on and fix it. Today, a similar fantasy surrounds reform in disability. If only more money could be given to services and a single national bureaucracy could replace of the states and the commonwealth, everything would be fine.

The reality is very different. No one in Australia believes anymore that indigenous demoralisation can be solved with more money or more services. But the disability services industry and the Productivity Commission still seem to think that these measures will do the job for the 20 per cent of Australians with a disability and their families.

The Productivity Commission's Draft Report on Disability Care and Support, released in February, recommended a pooling of existing Commonwealth and state disability funding (a total of $6.2 billion annually) to be administered by a new Canberra quango, a National Disability Insurance Agency. The Commonwealth would then reallocate this money to people with disabilities in person-centred formats, with a provision for mechanisms for self-directed and self-managed support. It also recommended that funding for disability support be doubled, that is, increased by an additional $6.3 billion each year.

Normally, assignments given to the Productivity Commission require it to investigate inefficiencies and potential productivity gains that may flow from revised industry arrangements. But in this case, the disability industry escaped scrutiny. The Commission's Inquiry accepted, at face value, the services industry's claim for $6.3 billion in additional taxpayer funding, without any audit of existing inefficiencies or waste in the system.

The truth is no-one knows how much additional funding, if any, is required to meet unmet needs in disability support. Without an audit of the economic cost of the current fragmentation in service provision, the Commission cannot know how much extra funding is needed. There is no integrated information system in disability that crosses service and disciplinary boundaries. There is no method for accounting for the financial cost of multiple assessments, constant form filling, service duplication, and perennial turnover of personnel.

Nor does anyone know how many people with disabilities require funded supports in a restructured system. The Draft Report states that 360,000 of the four million Australians with disabilities will receive funded support in a new system, but this too appears to be a figure plucked out of the air. Assessments of eligibility for supports have been highly variable and discretionary over the last 30 years. Some people with disabilities and their families receive regular interstate holidays at taxpayers’ expense. Others with high level needs receive nothing. Many who encounter a dysfunctional service system drop out, preferring to be left alone than to constantly jump through the system's hoops.

For these reasons, the Commonwealth should politely reject the claim by the industry for an additional $6.3 billion until a restructured service system is in place. Only then will it be possible to determine, with any precision, the size of the budget required.

In Victoria, people with disabilities and their families are finding that service providers are routinely deducting 40 per cent of the value of an individual support package in administration and brokerage fees. These deductions are in many cases theft by another name. Families who self-manage these packages can reduce the administration costs to 3 per cent. Without large-scale use of systems and tools for self-management of support packages, additional disability funding will simply disappear into the coffers of the industry.

The Commonwealth should also reject the Draft Report's recommendation that a spanking new Canberra quango be created as a kind of Super Ministry on all things disability. As it stands, the Draft Report assigns decision-making about eligibility to the same Insurance Agency that will manage the financial liabilities of the Agency. This is a conflict of interest, a fundamental structural flaw, and a recipe for continued injustice.

A large bureaucracy is not needed in a revised disability support scheme. Restructuring $6.2 billion in block grants by allocating this money to 360,000 individuals in person-centred formats is not rocket science. New technology makes the use of self-management tools viable and inexpensive, even though provider bodies in disability have been highly resistant to the introduction of user-based innovations over the last 30 years while every other industry has embraced their advances.

Australians have an opportunity to restructure the disability support system by building a genuinely person-centred system and cutting out the middlemen. Self-determination, without the gatekeepers and middlemen, is the key to reform in disability, as it is in indigenous affairs.