CEO’s lessons from the NDIS: scaling individualised services

The seven National Disability Insurance Scheme trial sites have confirmed the accuracy of the Productivity Commission’s financial modelling and are also teaching the public servants running the scheme valuable lessons about how to perform a market stewardship role.

When the PC designed the scheme in 2011, the use of trial sites to test its assumptions before a full roll-out was always part of the plan. The mandarins at the time were pretty cocky about how it all came together — Jeff Harmer, who was secretary at the Department of Families, Housing, Community Services and Indigenous Affairs called it a rare example of “perfect” policymaking — but safeguards were still necessary for a project of this scale.

This week, at the National Disability Insurance Agency’s New World Conference in Brisbane, chief executive David Bowen offered five lessons from those trials. The first was that those assumptions and the costings they informed were essentially correct.

“It’s is pretty close to what was expected, and where we’re finding variations, some of that is a natural variation,” Bowen said. “For example the 15-24-year-old age group are a bit more costly than older adults … and we’ve factored that in going forward.”

Progress towards the full roll-out in 2019 is apparently progressing on time, on budget and with a high level of satisfaction. There are currently 19,807 participants in the seven trials, which is only about 5% of the total number who will participate in the scheme once it has fully unfurled.

There are also significant variations between states. Bowen said there was a “very big difference” in the apparent prevalence of autism between different jurisdictions, for example. While the NDIA still isn’t certain why, he said it was probably due to some states having better support systems at the early childhood stage leading to more people with autism spectrum disorders being in “mainstream” schools and jobs later in life, and not requiring formal support services.

The second lesson, Bowen says, is the trial sites also showed the NDIS “insurance approach” to providing care and support was delivering good outcomes for people so far, based mainly on anecdotal stories. He is “keen on … converting that to quantifiable measures of outcomes” and to that end the agency has built a new “outcomes framework” in consultation with service providers. Consultation with people with disabilities is next.

“It is the experience of people in the scheme and their outcomes that becomes the best evidence of the best kinds of support,” said Bowen, and gathering that evidence, he explained, takes time.

As well as the aim of maximising choice and control by creating a competitive market for services, the insurance-based approach is what makes the NDIS so different to traditional welfare. It is intended to encourage people with disabilities to purchase products and services that increase their independence, and enable greater social and economic participation.

NDIA chair Bruce Bonyhady said that while federal funding for disability support would eventually double from 0.5% to 1% of GDP, the scheme would boost GDP by a full 1%, based on the PC’s forecast of it getting 320,000 people with disabilities and 80,000 carers into employment.

The road to a mature market

The third lesson is that the seven trials also demonstrated the importance of the NDIA sticking with “absolute best practice in everything the agency does” in terms of the person-centred, empowering approach, according to Bowen.

He commented that “when things are built in a hurry, you tend to build them with a great deal of complexity” and said his staff were working through a major program of simplification.

“Hopefully we’ve made the engagement with people with disability much more supportive and accessible,” he said. “I do believe we’ve built up a culture in the agency that … the person with a disability is the expert on their own life.”

It was also important for the agency to have a “learning culture” so it can change over time based on experience and feedback, and what the PC christened “Information, Linkages and Capacity Building” would allow individuals to adjust their supports to find the right ones, and as their needs changed.

“We also think that we need to be far more flexible in how people choose to engage with the scheme,” Bowen said.

In terms of market stewardship — an issue covered in detail by the agency’s Esther Kerr-Smith at a recent public administration conference — the NDIA has learned is that “markets take a long time to develop”.

For the fourth lesson, Bowen hinted it could take longer than 10 years to have a “mature” market, while in rural and remote areas, Kerr-Smith accepts it might never happen at all. The CEO assured the audience he was not “postponing” the market stewardship work which Kerr-Smith is in charge of, but said it was “very difficult and requires input from lots of different parties”.

“We see ourselves as building a bit of a framework, not limiting the ability of others to play in that space … but making sure it at least meets some minimum standards,” said Bowen.

The final lesson, he acknowledged, is that there is still the huge amount of work still left to do. The agency has released its assistive technology strategy, and has draft strategies for rural and remote areas and “indigenous engagement” soon to be finalised. It is “still waiting for guidance” about its role in the difficult issue of housing and work has begun on fixing the “broken interface” between disability and employment services.

A new quality and safeguards framework is also in the works and Bowen is pushing for it to be based on “individualised risk assessment” rather than a “heavily rules-based, restrictive framework” that ministers might instinctively prefer.

Person-centric doesn’t end at roll-out

And he offered a final warning: the NDIS can’t solve every issue for people with disabilities. He urged Australian governments to ensure the National Disability Strategy is put into action.

The decision to hold a conference of NDIS participants, service providers, public servants and technologists and suppliers of enabling products is itself a key part of the agency’s approach to being the steward of a person-centred market for disability services.

It appears to have been somewhat successful as an opportunity for people with disabilities, carers and care providers to learn more about the emerging system and join in discussions and debates with the public servants who run it. The agency is considering whether to run another, and according to some of its executives, there was already strong interest in doing it all again even before the end of the first day.