Our reform blueprint

Applying to the NDIS

Access to the NDIS should be based first and foremost on significant functional impairment and need - and only secondly on medical diagnosis. A focus on functional impairment will enable multiple disabilities to be considered - which when taken together, result in significant functional impairment.

We recommend significant reform to the access process to make it more equitable (see Actions 3.1 and 3.2). This includes making the process of applying for the NDIS clearer and simpler; clarifying definitions of key eligibility criteria for section 24 and section 25 of the NDIS Act; and standardised approaches to determine whether eligibility criteria are met.

Many participants receive automatic access to the NDIS through an access list. These lists were introduced during transition to the full scheme to accelerate access for some people with disability likely to be eligible for the scheme. However, they have led to a focus on medical diagnosis rather than function and disability-related support needs. They have also led to inequity, with some participants automatically eligible while others are not and favouring those with means to obtain a diagnosis. We recommend removing automatic access under the access lists.

Complete assessments to understand need and set a budget

Planning meetings currently combine an assessment of support need, budget setting and planning in a complicated and stressful experience for people with disability. We recommend changing what is now described as planning into three separate steps to create a process that is clear, transparent and focused on support needs.

We recommend a transparent process for information gathering as part of the assessment of support need. This has been designed to ensure a participant’s disability-related support needs are at the centre throughout. The person leading the assessment will be the person agreeing the NDIS budget with the participant. They should be an agent or employee of the NDIA with high level expertise in disability, and spend sufficient time with participants so they feel heard. Only essential information should be collected.

Evidence to support the assessment should come from the participant, any treating professional if required, and take into account holistically the participant's life circumstances. Where assessments may assist the process, they should be transparent, valid, accepted by people with disability and appropriate to the circumstances of the participant.

Where additional information is needed, the NDIA should commission and pay for professional assessments and reports. This will remove a significant inequity in the current process, which favours those who have the ability and means to collect or purchase additional information.

Assessments should be the basis of long-term plans and forward-looking, for instance, taking account of progressive conditions. They should be more flexible for participants and take account of life transitions, including finishing school, moving out of home or seeking employment.

Receive a budget

NDIS budgets should be set at a whole-of-person level, rather than built line by line for each support need. This was always the intention of the scheme. Budget setting should focus first and foremost on support needs and intensity, which should be determined through the previous stage.

Participants should be informed of the outcome from the budget setting process by the same person who led the assessment.

Develop a plan of action

Once the budget has been set, participants and their families should receive more help creating a real plan of action, using their funds to achieve their goals. Detailed planning should be undertaken once the budget is set. This should have much more flexibility in how funds are spent than now.

The NDIA should take a trust-based approach in how participants use their budget and make it easy for participants to comply with rules. Compliance should be encouraged through guidance and support, with more hands-on interventions used where there are serious risks or history of issues.

All participants should have access to a Navigator to help plan and access their supports. Navigators should be the agents of participants and help them find and coordinate the supports they need across mainstream, foundational and individualised budgets in the NDIS (see Recommendation 4).

Navigators will also have an important role in amplifying and giving voice to people with disability and ensure people with intellectual disability, or who find it difficult to express their needs and preferences, have access to support for decision-making (see Recommendation 5).

Ensuring existing participants experience a smooth and fair transition to the new participant pathway

We understand that one of the most fundamental objectives of the NDIS is to provide certainty. Certainty for people with disability. Certainty for families and especially, certainty for ageing parents. This is reflected in one of the key objectives for this Review: restore trust, pride and confidence in the NDIS.

The finer details of this new approach to budget setting and plan implementation, including approaches to assessment and the way information is used to set a budget, should be the subject of deep engagement with the disability community.

While we have laid out a blueprint for reform, much work remains in implementation. We urge all governments to continue to work in partnership with people with disability, their families, providers and organisations to implement these changes. These processes need to be transparent, valid and based on lived experiences so they can be trusted.

We recognise that change for participants can be very difficult. We have recommended a guide to transition (see Action 26.2) to ensure participants are given time to understand and have a say in changes before they are affected by them. Changes to access and budget setting processes for children and young people should only be implemented once widespread foundational supports are in place.

Create a continuum of support for children under the age of 9 and their families

Approximately 20 per cent of children experience learning difficulties, developmental concerns, developmental delay, or are found to have disability.²¹ In other words, learning difficulties and disability are mainstream issues.

This is why we recommend significant changes to the way the disability support ecosystem and the NDIS support children and families (see Recommendation 6). We want more and better support for children, both in and out of the scheme to improve outcomes.

Our approach includes:

• significant investment by governments in foundational supports outside the NDIS for children in the early years (under the age of 9) (see Action 1.12).
• better screening to pick up developmental concerns as early as possible in mainstream settings (see Action 2.13).
• early intervention services based on best practice principles and evidence (see Action 6.2). Support should be guided by a Lead Practitioner (key worker). Support should be delivered in natural settings wherever possible - homes, early childhood settings and schools.

We want children and their families to have every opportunity to lead ordinary lives, included in their local communities.

Our recommendations will support more children in existing services, such as maternal and child health, integrated child and family centres, early childhood education and schools - reducing the need for families to access the NDIS and leading to better long-term outcomes for children.

Introduce a new approach to NDIS supports for psychosocial disability, focused on personal recovery, and develop mental health reforms for people with severe mental illness

We propose a new approach to NDIS supports for people with psychosocial disability (see Recommendation 7), focused on personal recovery. This should be combined with broader mental health reforms outside the NDIS to better support people with severe mental illness.

As part of foundational supports, we recommend an investment in what the Productivity Commission described as ‘the missing middle’ of mental health and psychosocial disability supports.²² This investment has long been called for by mental health experts and community mental health organisations. It is an important underpinning to NDIS sustainability.

We also recommend a new pathway into the NDIS for participants with psychosocial disability together with better workforce training. This pathway should be based on early intervention, best practice psychosocial supports and specialist navigation to improve outcomes.

Housing and living supports which are fair, consistent, more diverse and innovative

Many participants with housing and living supports in their plans still have limited choice over where, how and with whom they live. There is inconsistency in what are considered reasonable and necessary housing and living supports, including who receives funding for single living arrangements with no sharing of supports or only sharing of overnight support.

Housing and living supports need to be provided in a fair, consistent way. Participants with similar levels of need, in similar circumstances, should have access to similar levels of funding. They should promote choice, recognise rights and be consistent with the long-term sustainability of the scheme (see Recommendation 8).

The budget setting process should be more transparent and be based on shared support, except in specific circumstances. These shared supports should promote social and community participation and enhance natural safeguards. Most importantly, this does not mean housing arrangements need to be shared - participants should have greater flexibility in how they use their funding. This is evidenced by reforms in Western Australia before the introduction of the NDIS, which led to the development of individualised living options. We anticipate this will be a catalyst for more innovative housing solutions.

There is a critical shortage of affordable and accessible housing in Australia. To address this, Australian Governments should publish a targeted action plan for housing under Australia’s Disability Strategy. This should include a requirement to build all new social housing to Gold Level Livable Housing Design Guidelines or equivalent, and a commitment for all remaining jurisdictions to sign up to the National Construction Code Livable Housing Design Standards.

The supply of Specialist Disability Accommodation (SDA) is not always meeting the needs of participants. To enable the delivery of best practice sharing of living supports, and stop ‘closed system’ houses operated by support providers, there should be a new category of SDA (see Recommendation 9).

Markets and support systems that empower people with disability

The NDIS was designed to offer choice and control to people with disability through a market-based system of supports. However, NDIS markets have not encouraged innovation and in some cases has resulted in further segregation and isolation, placing people at risk of exploitation and abuse. The regulatory framework has not responded to changes in the market, and we have heard growing concerns about over servicing, over charging, fraud and sharp practices.

We have heard people want to see change to how the market operates. They want improved information, changes to pricing and an increase in both the size and quality of the workforce. Our recommendations go directly to addressing these issues and provide governments with a pathway for people with disability to have better access to safe, quality and timely supports, including addressing gaps in thin markets.

Invest in digital infrastructure to provide more useful information

Providing more useful information (see Action 10.2) to participants, governments and providers is essential to improve quality and help participants find supports that suit their needs. In addition, the NDIA needs to move to electronic payments to ensure scheme integrity. No organisation or worker supporting people with disability should be able to fly under the radar.

Reform pricing and payments

We recommend governments take a more active role by shifting away from a ‘one-size-fits-all’ market approach and reforming the pricing and payment regulatory frameworks (see Recommendation 11).

Responsibility for advising on pricing should be transitioned to the Independent Health and Aged Care Pricing Authority (IHACPA) to ensure pricing is transparent, better balances cost considerations with quality and outcomes, and ensure governments use their buying power in the market. IHACPA should use a data-driven approach and consult with the Department of Social Services, the NDIA, the new National Disability Supports Quality and Safeguards Commission (National Disability Supports Commission) (see Recommendation 12) and the broader sector when advising the Australian Government on prices.

Prices should be differentiated to recognise complexity of participants’ lived experiences and should cover the cost of having suitable qualified, skilled and supervised workers in the services that support them.

Over time, as we better understand how to measure outcomes for participants, we should carefully explore how prices could better reward providers to support participants’ independence and connection to community.

Raise the standard of service delivery

The highest quality service providers should be rewarded and low quality service providers must improve (see Recommendation 12). There should be a new dedicated Deputy Commissioner for Quality in a new National Disability Supports Commission. Continuous improvement will also be enabled through better data and market monitoring. Transition to electronic payments and improved information data collection from Navigators will help strengthen market monitoring and coordination of NDIS markets (see Recommendation 13). Provider of last resort policy and arrangements are also needed urgently to ensure continued access to critical supports where markets fail.

Improve access to supports for First Nations participants across Australia and for all participants in remote communities through alternative commissioning arrangements

It is clear community-led and place-based alternative commissioning approaches would improve outcomes for First Nations communities and for all participants in remote communities (see Recommendation 14). A lack of culturally-safe supports often means First Nations participants need to choose between supports that are not culturally safe or not getting supports at all. Drive-in drive-out and fly-in fly-out models in remote communities are not working to communities’ satisfaction.

Alternative commissioning is an opportunity for communities to create their own services. The effective implementation of the NDIS in these communities needs to be built community-by-community.

Governments should partner with local Aboriginal Community-Controlled Organisations and build on local governance structures in line with the priority reforms in the National Agreement on Closing the Gap. A whole-of-community approach should be explored to join-up service delivery across other care and support systems, such as aged care and health.

Attract, retain and train a workforce that is responsive to participant needs and delivers quality supports

Workforce reform is another critical issue. Our recommendations provide a path to build a more capable workforce (see Recommendation 15). We propose a renewed focus on recognising workers’ qualifications and experience and quality of services, as well as better workforce planning across the entire care and support sector.

To improve worker training, we recommend continuing to develop micro-credentials and portable training and sick and carers leave schemes, so their training credentials and leave credits would travel with workers as they move across the care and support sector. These skills and qualifications could be linked to worker screening, so they are visible when new workers are employed.

Deliver safeguarding that is empowering and tailored to individuals, their service needs and environments

The Disability Royal Commission made clear that much more needs to be done to protect against harm, exploitation and abuse. We recommend improved safeguarding that responds to differing needs and circumstances (see Recommendation 16) and developing and delivering a risk-proportionate model to regulate all providers and workers (see Recommendation 17). There also needs to be a stronger drive to reduce and eliminate the use of restrictive practices (see Recommendation 18).

As part of a new effective quality and safeguarding architecture across the entire disability support ecosystem (see Recommendation 19), a new Disability Supports Quality and Safeguarding Framework should be agreed by all Australian governments (see Action 19.1). The current framework was developed for the transition to the NDIS and is out of date.

As a priority, the NDIS Commission must focus on implementing a risk-based and proportionate approach to safeguarding and regulation, and expand on quality of supports delivered to participants.

The NDIS Commission needs to urgently increase trust by becoming more responsive to participants’ needs.

Once the urgent priorities to do with the NDIS are met, a new National Disability Supports Commission should have responsibility for the regulation of all Australian Government funded disability supports across the entire disability ecosystem - expanding the coverage of the current NDIS Commission (see Action 19.2).

The National Disability Supports Commission should work closely with state and territory disability regulators and other agencies in the disability supports ecosystem. The right parties must have the right information at the right time to take action to prevent or respond to risks of abuse, violence, exploitation and neglect. Digital capabilities, data analytics skills and an enhanced regulatory intelligence function within the National Disability Supports Commission and a proactive approach to keeping people with disability safe will be essential (see Action 19.3).

Stewardship of the unified ecosystem

We propose governments plan, fund, operate and govern an ecosystem of support for all people with disability - not just the NDIS.

Create a new compact between Australian governments

A new compact between Australian governments will see a refreshed approach to working together (see Recommendation 20) and clear accountability for sustainability and governance of the disability ecosystem (see Recommendation 21). The compact should be underpinned by a Disability Intergovernmental Agreement (Disability IGA) (see Action 20.1). The Disability IGA should bring together all aspects of disability support in a unified disability support ecosystem. This includes aligning incentives and cost shares to deliver better outcomes for people with disability (see Action 20.2) and close gaps in support provision. This alignment of interest, which has been absent in the financial arrangements in the first ten years of the scheme, will be an important driver of system sustainability. It will also lead to fewer debates about which system should be responsible for supports and who will pay on a case-by-case basis.

The National Agreement on Closing the Gap is a commitment by all governments and First Nations people to work in new ways to drive better outcomes. The National Agreement on Closing the Gap identifies strengthening the community-controlled disability sector as a priority. The Disability IGA should include a dedicated schedule that embeds First Nations decision-making and an independent accountability mechanism (see Action 20.4).

To ensure genuine action and a focus on outcomes, we recommend the creation of a Disability Outcomes Council (DOC) (see Action 20.5). The DOC will comprise people with disability and other experts who will hold all governments to account for creating a more inclusive Australia. This idea is similar to the National Agreement on Closing the Gap between governments and Aboriginal and Torres Strait Islander peaks. The DOC will offer a high status, public report to Parliament on progress for people with disability in the same way that occurs for First Nations people under Closing the Gap reporting. We also recommend embedding a highly skilled, person-centred, disability aware culture across all disability agencies and governments (see Recommendation 22). This is a necessary condition for effective implementation of our proposed reforms.

Measure what matters, build an evidence base of what works, and create a learning system

Building the quality, availability and use of disability data is essential to increasing our understanding, improving transparency and making evidence-based decisions about the future of the disability ecosystem. To be successful, our approach needs to be supported by comprehensive disability data and data improvements that reflect the experience of all people with disability (see Recommendation 23). Investment in integrated and longitudinal data is needed now so we can respond to the needs of people with disability throughout their lives (see Action 23.4).

A new Disability Research and Evaluation Fund (see Action 23.3) will support the ongoing research and evaluation efforts of governments, academics and community researchers. The Disability Research and Evaluation Fund could be seeded with funds from the NDIS ‘Reserve Fund’ with the interest used to fund research. These investments can build the foundations for a culture of continual learning and innovation for the NDIS and the broader disability ecosystem.

An NDIS Evidence Committee (see Action 23.2) should provide guidance on what disability supports should be considered reasonable and necessary.

A five-year transition

These reforms are significant. Taken together, they represent wholesale reform of the disability ecosystem. To work, they need to be implemented as a package, with careful sequencing to ensure the most important foundations are in place before other reforms occur. That’s why the implementation process will take time and require further engagement with people with disability, the sector, and all levels of government.

It took 10 years to get to where we are today, and we should not expect changes of the scale we are proposing to happen overnight. Some actions can be prioritised to make short-term improvements to the participant experience, while other long-term reforms will require a staged roll out and, therefore, more significant design, engagement and testing.

To set transition up for success, governments should work with the sector to develop a five year implementation roadmap (see Action 26.1). This should take into account critical dependencies, implementation risks, community engagement and necessary legislative reforms.

These reforms will affect everyone with a stake in the NDIS, including people with disability and their families, Disability Representation Organisations, service providers, workers and governments. Implementation arrangements should be sensitive to this and ensure inclusive and representative governance with people with disability (see Action 4.1), a best practice approach to implementation that gives stakeholders a genuine voice in the process, and a smooth transition for participants already in the scheme (see Action 26.2).

Some of our proposed reforms will require changes in relevant legislation. Governments will need to coordinate and consult closely with the disability community on any changes (see Recommendation 25).

To build trust in the process of this reform, we recommend creating an NDIS Review Implementation Advisory Committee (see Action 24.1), to include people with disability and monitor and advise government on implementation. This should be supported by the right coordination and expertise in government to deliver a holistic and well-designed package of reforms.

This reform will take time, but our recommendations and actions will deliver a social and economic dividend for decades.

Sustainability as an outcome of our reforms, not the driver

Our terms of reference sought recommendations from us on how to support the sustainability of the scheme. During the course of our work, National Cabinet agreed to an NDIS Financial Sustainability Framework with a target to contain annual growth in the scheme to 8 per cent by 1 July 2026.

From the beginning of the Review, it has been our belief that the NDIS must be well-managed. It should support those most in need, based on a clear, fair and consistent assessment of reasonable and necessary needs.

We have looked beyond the NDIS. In our view, you cannot improve the NDIS without fixing the ecosystem in which it sits. We believe a sustainable scheme to be an outcome of our reforms, not the driver. A person-centred, fairer NDIS, embedded in a balanced ecosystem of support that is easy to navigate and delivers high quality supports will result in a sustainable scheme.

By improving the NDIS and the ecosystem around it, it is possible to get better outcomes for all people with disability in a more efficient and cost-effective way.

All governments are accountable for the sustainability of the disability ecosystem. It is impossible for the NDIS to be sustainable without a commitment by governments to improve foundational supports outside the NDIS and make mainstream services more accessible and inclusive. This is the most important way to improve scheme sustainability and reduce pressure for NDIS support.

The reformed participant pathway is designed to give an improved experience where people are supported, valued and heard. The needs-based approach to budget setting will prioritise evidence based supports that lead to a more predictable and manageable scheme. Our recommendation for Navigators will help participants access NDIS supports, better manage their budget and choose supports that improve their lives and long-term outcomes.

Investing in data collection, quality and sharing data will improve outcomes, move the scheme towards an evidence based scheme and promote value for money investments.

An enhanced near real time payment system will improve the transparency of transactions, deter fraudulent and sharp practices and make the scheme less wasteful.

We understand that amongst the disability community, the term sustainability has become synonymous with cuts. We want to be clear that we have not designed these reforms to fit targets agreed by government. We have been focused on securing the enduring success of the NDIS - one which improves participant experiences and outcomes and provides value for money.

Based on Review analysis, our proposed reforms will help secure the future of the scheme and will meet National Cabinet’s NDIS Financial Sustainability target over the medium and long term.

A Final Word

To the disability community, we want to be clear these reforms are for you. You have played an essential role in shaping this Review. You have shown through your extraordinary and extensive engagement that you are ready to be part of the next stage of this incredible journey of world-leading reform.

Every person with disability, every family member, every carer, every disability service provider, every worker and every government is a custodian of the NDIS.

Now, we must work together to realise the promise to make every Australian count.

We must do this for people with disability and their families today and for future generations.

It was a united disability sector, together with all governments and all political parties, which gave Australia the NDIS.

Now, more than ever, we need to Work together to deliver the NDIS.