NDIS reforms may be necessary, but they’re also morally fraught

In a speech to the National Press Club, Health Minister Mark Butler announced a series of sweeping changes that the federal government will make to the National Disability Insurance Scheme (NDIS). In the thirteen years since it was legislated, the growth of the NDIS has surpassed all expectations. By 2030, the Productivity Commission projected that the scheme would cover around 550,000 people and cost about $40 billion. This year there are already 760,000 people on the scheme at a cost of $50 billion. On the current trajectory, by the end of the decade there will be 900,00 people on the NDIS and it will cost $70 billion per year — this would represent a greater expenditure than Medicare and the Pharmaceutical Benefits Scheme put together. Concerns over the affordability of the NDIS are nothing new, and since returning to government Labor has repeatedly indicated their intention to curb its growth (even if, while in opposition, they resisted the Coalition’s efforts to do the same). But in an economy threatened by high inflation and at a time of increasing cost-of-living pressures — from fuel and food to housing — it is understandable that the federal government would feel a certain urgency to bring the NDIS under control, not least for the sake of the long-term viability of the scheme. And yet, what was telling about Butler’s speech was the way he proceeded to justify the radical changes the government has in store for the NDIS — which include removing around 160,000 people from the scheme by 2030 and reducing the projected annual cost by $15 billion. He swiftly pivoted from its long-term viability to its declining “community support, or social licence”. Citing research conducted by Talbot Mills, Butler claimed that 70 per cent of Australians think the NDIS has “gotten too large and struggles with dodgy providers” and that 60 per cent think the scheme is “broken”. He went on to detail mistakes in design and “structural flaws” that make the NDIS susceptible to fraud. He drew particular attention to criminal behaviour on the part of unaccredited “third-party” service providers and neglect by unqualified support workers. Given the dearth of qualified, registered, sufficiently committed carers, it was perhaps inevitable the NDIS would become “a soft target for shonks and rorters”, as Butler described them. It is, frankly, baffling that there wouldn’t be tighter government regulation over who could qualify to be paid to provide such support in situations that demand attentiveness and care. But some of the criticism that is now being levelled at the design of the NDIS threatens to besmirch its original moral genius: the provision of support to those with a disability in the form of personalised budgets, such that those in need of care would be accorded the dignity of “choice and control” over the form their care would take. Which is to say: it turned people with a disability from those for whom everything must be done, those who are a societal “problem” needing to be solved, and who must rely on the “good graces” of others; to those who are rightfully accorded agency in their own pursuits on an equal basis with other Australians. While this approach effectively created a competitive “disability services market” over which there has been far too little oversight, such a market is also the condition of possibility for the type of agency and equality the NDIS promises. This raises a number of dangers lurking beneath the government’s proposed reforms. In addition to the inherent danger that the expressed intention to reduce the number of people covered by the NDIS will see some people denied the care and support they are entitled to, there are a range of unintended moral consequences that accompany the reputational damage done to the NDIS itself. If we accept that the NDIS is noble if flawed, that it was a worthy aspiration for a nation like ours and represents a tremendous collective achievement which nonetheless needs to be p