Above: The two volumes of the PC draft report Disability Care and Support.

By Stephen Easton

The Productivity Commission (PC) released its draft report Disability Care and Support yesterday, containing recommendations on Australia’s disability support system designed to dovetail with those on aged care from its January draft report, Caring for Older Australians.

The draft recommends the creation of two new national insurance schemes to cover all Australians: the National Disability Insurance Scheme (NDIS), for most disabilities, and the National Injury Insurance Scheme (NIIS), to support people with catastrophic injuries following major accidents, particularly for cases where there is no party at fault who can be sued for damages.

The NIIS would be a federation of state and territory-based agencies, replacing those that currently provide support after motor accidents, a reform process the PC sees being mainly driven by state and territory governments.

If accepted by the Commonwealth, state and territory governments, reforms would begin in 2014 and extend to the entire country in 2015.

The inquiry, led by presiding commissioner Patricia Scott, found that “the current disability support system is underfunded, unfair, fragmented and inefficient, and gives people with a disability little choice and no certainty of access to appropriate supports”.

So underfunded, in fact, that spending on disability support will need to be doubled, adding a further $6.3 billion to the $6.2 billion spent by federal, state and territory governments in 2009-10, according to the PC’s preliminary estimates, which is likely to come from higher taxes and cuts to spending on lower-priority areas.  

“Both schemes are about long-term care and support, about things like helping with showering, toileting, mobility, communications and daily planning,” Ms Scott said. “They will cover more cases in a larger variety of circumstances.”

“The larger one [NDIS] is to cover, for example, people born with congenital birth defects, Down’s syndrome, or who get a degenerative disease and end up with lifelong disabilities. The accident scheme [NIIS] will provide a lifetime of care, but only for catastrophic accidents.

“People would be given individualised funding packages – we had some very competent people giving evidence who would certainly be able to manage their own affairs.”

Individualised packages would be based on assessment, portable across state and territory borders and as flexible as possible, including the option to ‘cash out’ individual funding, a reform the Caring for Older Australians inquiry decided was not appropriate for aged care.

Ms Scott said flexible financial support, including the option to ‘cash out’, suited the needs of people with a disability, a very large and diverse group that have, in many cases, little in common with each other.

Drawing the line

The NDIS would not cover people who acquire a disability after they reach pension age, and the draft report suggests two possible ways to manage the interaction between the two publicly-funded systems. Commissioners have requested any other ideas from stakeholders on the funding division, but are leaning towards a simple, flexible approach.

The PC’s preferred option is to allow people accessing disability support through the NDIS before they reach pension age to choose whether they keep their existing arrangements, or move to the aged care system instead.

Funding after the pension age is reached would come from the aged care budget, regardless of which option the person chose, and aged care co-contributions would be required from those who could afford them, as recommended in Caring for Older Australians.

“It would be inequitable if there were no such co-contribution requirement,” the report’s overview states. “Moreover, it would prevent people with assets or high incomes from attempting to enter the NDIS prior to the pension age to escape the co-contribution arrangements in the aged care system.”

Older people with catastrophic injuries from accidents would be supported for life by the NIIS in any case.

The second option is for the NDIS to continue footing the bill after pension age, with any additional support required from then on, due to ageing, funded by the aged care sector.

“Some countries try to apportion costs between disability care and aged care, but it’s quite complex and difficult to manage,” Ms Scott said. “You end up with a lot of judgements having to be made about what is a natural part of ageing.”

Memoranda of understanding between the disability health, mental health, aged and palliative care sectors are also recommended in the draft report, “to ensure that individuals do not fall between the cracks of the respective schemes”.

Uniting Care Australia national director, Lin Hatfield Dodds, came out in support of the proposals yesterday, saying the report was a “very welcome paradigm shift” and that it was “encouraging to see consideration of how aged and disability sectors will intersect and align, so that people drive what support they get, and from where in the service system”.

Workforce Pressures

Perhaps the most difficult issue identified by the inquiry is how to attract more aged and disability care support staff, identified in census data as the one occupation, as reforms are implemented and both systems expand in the near future. The report also notes that the general squeeze on the workforce caused by the ageing population will only add to the problem.

“There is mixed evidence about the current severity of shortages in support workers, but in the future, there is the potential for severe shortages as the disability sector expands and with pressures from population ageing”, the reports states. “There are strong emerging pressures on the aged care sector, which will draw workers from the labour pool that is also the source of disability workers. The effect is potentially large.”

The option to ‘cash out’ funding would alleviate some of this pressure, as would offering more hours to part-time staff, according to Ms Scott. Other solutions included higher wages, subsidised training and promotion of careers in disability support as well as more support for informal carers. 

The draft has received strong support from both the Australian Medical Association, who urged the Commonwealth not to waste the opportunity presented by it, and National Seniors Australia, whose chief executive, Michael O’Neill, said the NDIS was “long overdue in a hugely underfunded sector”.