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Foundational disability supports for every Australian with disability

There are currently a range of disability-specific supports that are available for people with disability, families and carers outside of NDIS individualised budgets. These supports have a long history in the disability support system, both before and after the introduction of the NDIS. They were described as ‘tier 2’ supports by the Productivity Commission, and the Information, Linkages and Capacity Building (ILC) program from 2015.24

We propose to build on the original idea through an improved framework of disability support that we call foundational supports. We believe the term foundational supports best describes what they are - the supports that offer people with disability a foundation to live a good life, included in the community, regardless of whether they are in the NDIS or not. Foundational supports are essential to a joined-up disability support ecosystem that ensures people with disability inside and outside the NDIS can access the right support at the right time and place.

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There is a lack of accessible and affordable foundational supports

A fair and equitable Australia is one where people with disability not only have access on equal terms to mainstream services and supports, but also complementary foundational supports to meet their disability-related needs.

The NDIS was designed to deliver individualised supports to roughly one-in-fifty Australians, with the vast majority of the one-in-five Australians living with disability supported through community-based foundational supports and mainstream services. The scheme was designed to be one part in a much larger ecosystem of supports to make everyday life inclusive and accessible to Australians with disability.

The Melbourne Disability Institute found that 90 per cent of people with disability, families and carers surveyed in a 2022 study believe current supports and services outside the NDIS are inadequate in meeting the needs of people with disability.25 This research is consistent with the feedback from people with disability, both inside and outside the NDIS, families and carers, the disability sector, researchers and governments about the lack of available and appropriate foundational supports.

We have heard people want greater access to support and more help to find it.

Outside the NDIS there is very little available to support children with disability and their families both in terms of specialist disability supports, and mainstream services.

- Healthy Trajectories Child and Youth Disability Research Hub 26

There was a home and community program in my community - but nobody told me about it. I could have got help earlier if I had of known about it.

- Person with disability 27

We have also heard that the support that is available is unaffordable for many.

The overwhelming majority of Australians with disability are reliant on programs outside of the NDIS to access supports and services… Many people living with disability struggle to access the support and services they need and must either self-fund or go without.

- MS Australia 28

Without access to the NDIS, people with communication disabilities are extremely limited in avenues for speech pathology support. Whilst there has been much discussion of Tier 2 supports, in practice these are restricted and many supports - such as independent community hubs for assistive technology - have been shut down.

- Speech Pathology Australia 29

The gap between those inside and outside the NDIS is unfair. People with disability who are eligible for the NDIS have access to a wide range of tailored supports, while those who are ineligible struggle to find the right support to meet their needs. This leads to poorer outcomes for people with disability. Ultimately it impacts on NDIS sustainability as more people seek access to an individualised NDIS budget to meet their support needs.

The advent of the NDIS has heightened the delineation between activities and supports that are offered on a commercial basis (fee for service) and those offered on a non-commercial basis (generally available to all people with disability regardless of whether the person has an individualised budget)

- Swinburne University, ILC Research Activity 30
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The lack of foundational supports reflects decisions taken during the NDIS roll-out

The over-reliance on the NDIS reflects decisions taken during its roll-out. The significance and complexity of introducing the NDIS saw governments prioritise transitioning people into the scheme as quickly as possible. While this was the right approach at the time, it came at the expense of disability supports outside the scheme that all people with disability rely on.

With the introduction of the NDIS, all governments significantly increased funding for disability services. Over the past decade, this has increased from $8.2 billion in 2012-13 to $31.3 billion in 2021-22.31 This expenditure has been primarily focused on NDIS support. Supports within the NDIS made up more than 93 per cent of all disability funding in 2021-22.32

All Australian governments continue to increase their contributions to the NDIS each year. This commitment has not wavered, reflecting the strong ongoing political and public support for the scheme.

At the same time, there has been a lack of clarity on responsibilities for disability support outside of the NDIS. The Productivity Commission noted the need to resolve uncertainty about responsibilities for disability services outside the NDIS in both the 2017 review of NDIS costs and the 2019 review of the National Disability Agreement (NDA).33

All governments agreed to the implementation of the ILC program and Local Area Coordination (through the Partners in the Community program), alongside the roll-out of the NDIS, to ensure all people with disability would have opportunities to participate in their community. Unfortunately, issues with the implementation of both programs meant some people with disability were left without support - in particular people outside the NDIS.

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We have heard about a range of issues with current foundational supports

Our recommendations for foundational supports have been informed by extensive consultation with people with disability, their families and the disability community. People’s priorities included:

  • The current ILC program was intended to provide information, advice and capacity building supports for people with disability. We have heard that the program has largely funded short-term supports, not provided adequate and effective supports, and has not sufficiently increased inclusion or made mainstream services more accessible.
  • The current Partners in the Community program (LACs) has been directed by the National Disability Insurance Agency (NDIA) to prioritise planning for participants because of resource constraints in the NDIA. Consequently, they have not had sufficient time to help people with disability outside the NDIS.
  • Individual disability advocacy plays a critical role in promoting, protecting and defending the human rights of people with disability. We have heard there is approximately twice as much demand for advocacy in comparison to supply. This means advocacy organisations are unable to meet the support needs of all people with disability.34
  • There are significant supports gaps across foundational supports for disadvantaged communities. We have heard that there is a lack of available and appropriate supports for Aboriginal and Torres Strait Islander people, culturally and linguistically diverse communities and rural and remote communities. There is also no dedicated Disability Representative Organisation for LGBTIQA+SB communities, which has left a critical gap in the prioritisation of a safe and inclusive society for gender and sexually diverse people with disability.
  • There are limited supports focused on early intervention, prevention or low intensity support needs for people with disability outside the NDIS, including children with emerging developmental concerns and disability, and adults with psychosocial disability or chronic health conditions.
  • Home and community care (HACC) programs that support people under 65 years of age with less intensive disability needs, including for people with chronic health conditions, are inconsistent and underfunded in most states and territories. The NDIS and HACC or equivalent programs are poorly connected, and there are insufficient HACC-style supports outside the NDIS, including for people who lost access to these supports during the transition to the NDIS.35
  • Assistive technology for people outside the NDIS is under-funded, fragmented and complex.36 There are approximately 108 different schemes in addition to the NDIS where assistive technology can be provided, each with different eligibility criteria.37 In comparison to the NDIS, these schemes often have long wait-times, co-payments and poor ongoing support. The Independent Living Centres which provided free and independent advice on assistive technology before the NDIS have closed.
  • Psychosocial support programs outside the NDIS are inadequate and fragmented. Many people are unable to access the supports they need, negatively affecting their quality of life and employment opportunities. In 2020, the Productivity Commission estimated that around 154,000 of the 290,000 people with severe and persistent mental illness were unable to access psychosocial supports.38
  • Support for children with disability or developmental concerns outside the NDIS is lacking. In 2021, 22 per cent of Australian children were developmentally vulnerable on one or more domains of the Australian Early Development Census by the time they reached school.39 This represents one in five children. The inadequacy of mainstream and foundational supports outside the NDIS results in poor outcomes for families and children and drives many to seek access to the NDIS because there is nowhere else to go. Situating early supports inside the NDIS disconnects children from mainstream services that promote positive child development.
  • Adolescents and young adults with disability continue to fare poorly in comparison to their non-disabled peers across a range of indicators.40 There are few supports available outside the NDIS for adolescents and young adults as they transition to independence.
  • Current approaches to disability employment are not working. Over half (53 per cent) of people with disability aged 15 to 64 are in the workforce, compared with 84 per cent of people without disability.41 This gap of over 30 percent remains largely unchanged since 200342. The combination of discrimination, low expectations, poorer school outcomes and less higher education results in limited opportunities for paid employment, lower incomes and reliance on government payments. A lack of affordable supports outside the NDIS also presents significant challenges to people with disability accessing the support they need to enter the workforce.

We have found that as a result of these issues, many people with disability apply for and stay in the NDIS for fear of a lack of support outside of it, even when supports outside the scheme might better meet their needs. People who cannot access the scheme are missing out on vital supports and services, which only serves to increase their future needs. This leads to poorer outcomes and puts pressure on the NDIS.

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