As Bruce Bonyhady says in the recent update on the pilot NDIS locations, the National Disability Insurance Scheme is “the biggest social policy reform in 30 years”. But in the current rhetoric about customer satisfaction and average package costs it is easy to lose track of, arguably, the most important issue the scheme should address: what defines a “good” outcome for NDIS clients, and for Australia more broadly?
Better long-term health and life outcomes for Australians living with disability will hugely decrease the expected acceleration in healthcare costs over the next 20 years. In order to achieve this benefit the scheme can’t just achieve short-term satisfaction, or targeted costs — it has to deliver innovative, integrated and better services to people living with disability.
Existing services are often excellent, but they are fragmented and the balance of service provision is not managed to get to the best long-term results. The NDIS addresses this through the creation of individualised plans for people, plans that should take into account a well-articulated model of how services today lead to better outcomes, not just tomorrow but in 20 years’ time.
Creating such a plan requires expertise, vision and sometimes even debate with the person for whom the plan is developed, or with their family. At the moment the National Disability Insurance Agency is tasked with this planning, and any measure of the quality of the plans developed is conspicuously absent from the NDIA update. The agency talks about “implementing a way of measuring outcomes for participants, their families and carers”, but it is about more than this: it’s about measuring outcomes for Australia. It’s about fewer disabled Australians excluded from productive, profitable work; about lower costs of palliative treatment in the future because we invested wisely now in remedial or pro-active strategies to reduce future need and even dependence.
Working towards such a desirable and challenging vision requires more than consultation and participation: it requires leadership. When Movember made the challenging decision five years ago to go beyond simply providing money to organisations working in the field of prostate cancer and to develop a “strategic plan for survivorship” that would guide their investment (and that of others) they instituted a very complex and expensive process. It involved clarifying exactly what “good survival” looked like (and it was more than just the medical metrics; it was about how people with prostate cancer experienced the changes they were living through). And it involved working with a vast range of experts to agree what plan was most likely to get to the desired outcomes.
NDIA’s challenge is to invest the time and resources to establish what “good” living with disability looks like — for the individual in the short-term (of course), but also for the longer-term and for their community and Australia. Australia’s disabled population constitutes the majority of our under-employed workforce, according to most analyses. This clarity of direction needs input from disability experts, advocates and health economists.
It must then feed into plans that are designed by experts who are able to understand the drivers of the desired outcomes, and can wisely figure out how to balance services for the best overall benefit, short and long-term.
The latest report announces that NDIS is “on track” and “on budget” … but we still need to know that it is “on mission” to deliver a better Australia for people living with disability, and for all of us.
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More at The Mandarin: NDIS: best practice policy? ‘Perfect run’ for scheme