Australia’s National Disability Insurance Scheme (NDIS) promises to “support a better life for hundreds of thousands of Australians with a significant and permanent disability” (Australian Department of Human Services 2017a). The AU$22billion scheme – a shift from block-funded disability services to a personalised funding model - was preceded by a strategic and coordinated campaign involving people with disability and their families and carers calling for reform of the service system (Every Australian Counts 2011). Enacted in 2013, the objects of the NDIS Act include providing “reasonable and necessary supports, including early intervention supports, for participants”; and enabling people with disability “to exercise choice and control in the pursuit of their goals and the planning and delivery of their supports” (Australian Government 2013).
Interviews with early participants of the scheme revealed disappointment that their preferences were overlooked in the process of planning their care, and frustration that boundaries between services they wanted to combine remained pronounced (Warr et al 2016). Gaps between the scheme’s promises and participants’ experiences stem from inconsistent interpretation of “choice and control” and “reasonable and necessary support” in implementation (Australian Department of Human Services 2017b; Productivity Commission 2017; United Nations 2006 Article 19). While the NDIS promises participants choice and control, their options for support are bounded by cost-benefit analysis and discretionary decision-making on the part of the scheme’s care planners. Of particular interest from an implementation standpoint is the scheme’s firm stance that it will not fund support that should be offered to people with disability by mainstream public services “even if the system responsible does not provide it” (Australian Department of Human Services 2017c p.2). Variations in the funding and organisation of non-NDIS supports across jurisdictions means there is no nationally consistent basis on which the NDIS can engage with other systems (Council of Australian Governments 2015 p.1).
This challenge is not unique to the NDIS, but it has significant ramifications in this case. A review of NDIS costs in 2017 flagged that “interface between the NDIS and other disability and mainstream services is critical for participant outcomes and the financial sustainability of the scheme” (Productivity Commission 2017). The scheme’s emphasis on “mainstream interface” suggests a need to work across service boundaries to achieve its goals, but it has manifested as delineation of fiscal responsibility. Drawing on the literature on boundary spanning (eg O’Flynn, Blackman & Halligan (eds) 2013), public value (Moore 1995), and public service markets (eg Carey et al 2017), this paper will explore implementation challenges for the NDIS in relation to ‘who supplies what’ to people with disability. More broadly, it will question whether funding regimes built on economic modelling tied to systems beyond their sphere of influence can promise individuals choice and control in the use of their allotted funding, and explore options to balance expectations and resources in those circumstances.
