Growing evidence shows giving citizens greater control over the public services they use may be entrenching administrative burden. An article in the Australian Journal of Public Administration examines the burden of the National Disability Insurance Scheme (NDIS).
Over the last 30 years, governments have sought to give citizens greater choice and control of the public services they use. This has led to the creation of various forms of public sector markets through contracting and tendering processes.
More recently, choice and control has extended to individualised or personalised care budgets. This is where individuals are given money to purchase services that meet their needs. Personalisation has been driven by two agendas:
Both emphasise service recipients as active agents at the centre of their own care. For government efficiency, this emphasis comes from the market model and draws on the concept of individualism which sits at the heart of neoliberal agendas. In human rights, it is driven by beliefs about the rights of individuals to exercise choice and control over their lives, including the services they use.
The NDIS reflects this broader trend in social care service provision towards personalisation. To be eligible for the NDIS, a person must have a ‘permanent and severe disability’ and be aged 65 or under. At full implementation, it is expected that around 500,000 Australians will be on the scheme.
Eligible individuals can apply to be an NDIS participant through the National Disability Insurance Agency (NDIA). Individuals must complete an access form which details basic demographic details and disabilities experienced. Along with this form, applicants must compile evidence from their health and medical practitioners, other service providers, and government agencies to build a case for eligibility.
Once deemed eligible, NDIS participants undertake a planning meeting. Planning meetings are done either in person or over the phone, Participants set goals with the planner and decide upon necessary supports for achieving them. Plans are reviewed on a 12-month basis where the purpose is to allow participants to re-set goals and change supports.
Once a participant has a plan, it is then up to the individual to identify and engage service providers from disability service markets. Participants experience administrative pain points throughout this process: from gaining access (e.g. compiling paperwork), through to obtaining a plan, ensuring it meets their needs, and implementing that plan.
There has been wide-spread media coverage and internal government inquiries noting challenges with the administrative systems of the NDIA. The paper’s empirical research is consistent with these reports and paints a picture of administrative complexity.
This complexity begins with initial planning meetings. As the largest and most extensive foray into personalisation in Australia, few participants are likely to have previous experience of planning meetings within such systems. However, beyond this the system itself is described as onerous and convoluted.
It is also frequently described as time consuming by participants across a range of studies identified. Confusion is exacerbated by inaccurate and inconsistent information given to participants and service providers which has been noted in a range of reviews into the scheme.
The studies of NDIS experiences suggest that successfully navigating the administrative systems of the scheme requires a specific set of skills and resources. Personalisation schemes put unprecedented emphasis on participants to be able to clearly articulate their goals, needs, and then access services/supports to achieve these.
Challenges with skills and resources for navigating the NDIS appear to be exacerbated for already vulnerable or disadvantaged groups. This includes people from culturally and linguistically diverse backgrounds (CALD communities) and Indigenous people.
For CALD communities, there is a lack of information in different languages or access to translators. For Indigenous communities, there appears to be a lack of cultural sensitivity in terms of what it means to have a disability and be part of an Indigenous community, or how government services are experienced.
After approximately five years of implementation, the paper’s review of the current evidence of participant experiences suggests a highly inequitable scheme. Individuals with markers of disadvantage such as CALD background and Indigeneity more likely to be excluded from the scheme altogether. If they gain access, they are more likely to face barriers to gaining services and supports.
A step towards achieving systems which do not disadvantage groups would be to include those groups in the design of the administration. In the case of the NDIS, this includes the planning process, community engagement and requirements for access. For this co-design to be effective, it must be respectful of culture, as well as be part of a sustained process which provides opportunity for active participation from development through to outcome evaluation.
Administering inequality? The National Disability Insurance Scheme and administrative burdens on individuals - Gemma Carey, Eleanor Malbon & James Blackwell, Australian Journal of Public Administration, August 2021
The original article is available via individual subscription to the journal or institutional access through a library service such as a university library, state library or government library.
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