Figure 2 - Data on mature participants who at still not accessing the supports they need
Mature participants are those who have been in NDIS for over a year.
The following percentage of mature participants had a budget for daily activity supports but did not claim any supports during 1 July 2022 to 30 September:
- 23% in metropolitan areas
- 26% in regional areas
- 34% in remote areas
- 36% in very remote areas.
The following percentage of mature participants had a budget for therapy supports but did not claim any supports during 1 July 2022 to 30 September:
- 24% in metropolitan areas
- 31% in regional areas
- 32% in remote areas
- 37% in very remote areas.
Figure 5 - Outline of NDIS Market Stewardship tools
A range of market tools that can be used in NDIS markets to ensure effective delivery of supports:
Level 1: Competition in the market can deliver strong incentives for providers to be more focused on participants' needs.
Level 1.1: Market coordination tools include:
- Market facilitation - engagement and information sharing to improve participant and provider connection
- Intermediaries - someone to help participant find and connect with services.
- Market deepening - participant can pool funding and coordinate demand to attract providers.
Level 1.2: Market settings include: pricing and payment approaches and market access settings (e.g. who can enter in the market).
Level 2: Contestable arrangements drives competition for the market. It can ensure a provider faces a credible threat of replacement if it underperforms, where competition between multiple providers is not possible.
Level 2.1: Alternative commissioning includes:
- Direct commissioning - where supports are directly purchased on behalf of a group of participants. Supports can be purchased from non-government or government providers – who should ideally be separate from the funding body to ensure a level playing field.
- Integrated commissioning - involves selecting a provider to provide supports across multiple services types for a defined area. What services types are commissioned and how they are delivered is based on identified community needs.
- Community commissioning - is where communities are empowered, or use cooperative approaches, to lead the commissioning process. Communities, rather than governments, determine the services and providers that best meet their needs. Community commissioning may be implemented using direct or integrated commissioning.
Level 2.2: Provider of last resort arrangements help to maintain continuity of service when a provider cannot deliver services to some or all users. Governments can coordinate other providers to take on users, bail out a failing provider, increase funding to the provider, identify other providers, or directly provide the service.
Figure 7 - Timeline representation of alternative funding and alternative commissioning approaches recommendations
A timeline outlining relevant recommendations from 2017 onwards.
2017 Productivity report on NDIS costs suggests a tailored response to NDIS thin markets.
2018 Joint Standing Committee on the NDIS Inquiry (JSC NDIS) into Transitional Arrangements suggested exploring alternative funding models. NDIA & DSS commenced development on the NDIS Thin Market Approach
2019 relates to JSC NDIS recommends testing approaches other than 'fee-for-service'; NDIS thin Markets Framework developed; Tune Review recommended more defined powers for NDIA to intervene in markets.
In 2020, Disability Reform Council agreed to a more flexible approach to thin markets; NDIA began Thin Market Trials.
In 2021 Queensland Productivity Commission Inquiry on the NDIS Market in Queensland recommended alternative commissioning.
By end of 2022, 39 NDIS Thin Market Trials are completed or underway across Australia.
Figure 13 - Graph of NDIS market support concentration in relation to Modified Monash Model
Bar graph looking at market concentration using the Herfindahl-Hirschman Index (HHI), for different groups of supports and by remoteness.
HHI for all supports: ranges from 0.002 to 0.004 in metropolitan, regional and rural areas; rises to 0.016 in remote areas, and 0.013 in very remote areas.
HHI for daily activities and social, community and civic participation supports: ranges from 0.002 to 0.006 in metropolitan, regional and rural areas; rises to 0.025 in remote areas, and 0.020 in very remote areas.
HHI for capacity building supports (excluding support coordination and plan management): ranges from 0.002 to 0.003 in metropolitan, regional and rural areas; rises to 0.015 in remote areas, and 0.030 in very remote areas.
Figure 14 - Commissioning cycle
A 4 stage cycle where:
Stage 1 relates to understanding community needs through strengths-based assessment and analysis of community’s needs.
Stage 2 relates to exploring and designing solutions. This includes how community and NDIA decides if, and what, alternative commissioning approaches are needed - such as direct commissioning, intergrated commissioning and community commissioning.
Stage 3 is implementing the alternative commissioning approach through: culturally appropriate, outcome-based commissioning. procurement policies and processes; and fit for purpose enablers.
Stage 4 is about monitoring, evaluating and improving through a practical and community-driven approach. This needs to consider Indigenous data sovereignty, with best practice Indigenous evaluation and a National Disability Data Asset (NDDA)
Throughout the cycle, effective alternative commissioning approaches – particularly for First Nations communities – must be underpinned by overarching and local governance structures that share decision-making power with communities, and are driven and embedded within the community.
Figure 15 - Data on mature participants who at still not accessing the supports they need
Four alternative commissioning approaches to the 4 priority reforms under Closing the Gap:
- First Nations people and governments share decision-making authority over what alternative commissioning approaches are used in their communities.
- Alternative commissioning approach builds a strong and sustainable First Nations community-controlled sector.
- Alternative commissioning approaches transform government services to be more culturally safe, inclusive and responsive.
- First Nations people have access to, and the capability to use, locally relevant data and information to set, monitor and evaluate outcomes.