Urgent reform is needed to ensure the NDIS is able to deliver on its primary objective, which is to provide a dignified life for Australians with a profound disability. Cost blowouts that make the scheme unsustainable must be addressed and top of the list is to cull benefits being paid to people for whom the scheme was not devised.
The evidence from an investigation by social affairs writer Stephen Lunn is that the NDIS system is being rorted to provide cover to children with autism who do not require or deserve it. Aided by compliant doctors, the NDIS scheme is in danger of morphing from being a compassionate lifeline to those most in need to becoming an entitlement for those challenged by what can be the difficult task of parenting. State governments share the responsibility because they have withdrawn their own mental health programs and folded them into a commonwealth-funded NDIS system that was not designed to cover everyone with a psychosocial illness.
Andrew Whitehouse, professor of Autism at the Telethon Kids Institute and the University of Western Australia, says it is without question that clinical behaviour has become biased towards making an autism diagnosis that will give families a better chance at receiving the support through the NDIS. In raw numbers, more than half of the 266,000 NDIS participants aged 18 and under have autism and 20 per cent have developmental delay. About one in 10 of all boys aged 5-7 are on the NDIS and 4 per cent of girls. Once someone is in the NDIS system, very few exit. About one-third of all NDIS participants have autism as their primary diagnosis, with packages ranging from a few thousand dollars a year to six-figure sums for those who need around-the-clock support. Under current NDIS guidelines, autism is categorised into three levels of severity, with levels 2 and 3 “being likely to meet the disability requirements” for entry to the scheme. Funding guidelines have skewed the diagnosis towards more serious impairment. Professor Whitehouse says some clinicians admit they have not diagnosed someone with level one autism for many years because it would not provide that family with a good chance of receiving NDIS funding. Regional variations in how cases are diagnosed show there is a lack of discipline in how rules are being applied and policed. The influx of cases is pushing the forecast cost of NDIS to $90bn a year in the next decade.
Policymakers have a responsibility to rein in a situation that should never have been allowed to develop, and doctors must be more realistic in considering their Hippocratic oath to first do no harm and extend it beyond the person in front of them to include taxpayers and those who badly need it but who will lose support if the NDIS is allowed to fail. The problems with the NDIS are not new. As Henry Ergas wrote in November, the NDIS scheme has much to commend it but its sustainability was fatally compromised by the legislation that created it. Faults included a lack of precision in coverage, which has led to an explosion in cases of autism. The scheme lacked oversight and gave too much power to health professionals without subjecting them to independent, expert review. Cost-shifting by the states has seen commonwealth outlays soar and a demand-driven model has left taxpayers badly exposed. Legislative constraints made it difficult for the Coalition to tackle the issues once they became apparent.
Labor says it is justifiably proud of the NDIS scheme it created. NDIS Minister Bill Shorten must use the current review to cut out the defects introduced in the original system, clamp down on over-servicing, and put the NDIS on a secure financial footing for those who will depend on it into the future.