Monique Ryan (Kooyong, Independent) Share this | Hansard source

The Disability Services and Inclusion Bill 2023 will establish a new legislative framework for the funding and regulation of those new and existing disability related programs which operate outside the National Disability Insurance Scheme, the NDIS. The bill builds upon the Disability Discrimination Act 1992 and Australia's Disability Strategy 2021-2031. It prescribes statutory funding conditions aimed at ensuring good quality, safe supports and services for people with disabilities, their families and their carers. Its broad eligibility criteria will allow a range of services to be provided to those requiring disability services outside the NDIS. For example, people who have temporary disabilities or those who are living in Australia on a time limited visa will potentially be eligible for support under the DSIA, as may individuals aged more than 65 who are currently ineligible for NDIS services but hope that that situation may change in future.

This bill does not, but I feel it should, specifically address the provision of disability support services in circumstances where people are deprived of their liberty. This is especially important, given the significant representation of people with a disability in all types of places of detention in this country. The bill, in my opinion, should stipulate that eligible activities can include supports or services provided to people in immigration detention facilities—who, let's remember, spend an average of 711 days in detention in this country. This would be consistent with key recommendations of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability's final report in relation to Australia's commitment to the implementation of the optional protocol to the convention against torture. I've sought assurance from the minister that the explanatory memorandum of this bill will be amended to include that stipulation.

More than one in six Australians have a disability. The NDIS currently supports more than 600,000 people. The 3.8 million individuals with physical and mental disabilities who do not qualify for the NDIS have at times felt left out in the cold. We have to establish systems which enable supports and services which will benefit all people with disabilities.

The NDIS has moved many government supports from sole direct service provision to include person centred market models of service delivery and support. Almost from inception it has become a backup default service for most children and adults with developmental disorders, delays and disabilities as other disability supports and programs, particularly those funded by state and territory governments, have been defunded or become defunct.

Vacation of the space previously filled by community-based block-funded services has left a void for those people who have multidevelopmental delay or physical disabilities. This has resulted in development of massive inequities. Those on the scheme, the NDIS, receive much more support than nonparticipants. Melbourne Disability Services reports that 90 per cent of people without NDIS funding are unable to access the supports they need. This renders current clients desperate to retain their NDIS funding and others fighting to become eligible. When all you have is a hammer, everything starts looking a lot like a nail. This has led to the situation where 11 per cent of Australian boys aged five to seven years, and five per cent of five- to seven-year-old girls are NDIS participants. That's unsustainable and it demands change. It is my sincere hope that this bill will facilitate that change, in concert with the systemwide changes which I hope will be recommended by the forthcoming Independent Review of the NDIS Act.

The NDIS was established as a classic market based system, but the reality is that there are still shortages of many allied health disciplines and other disability sector providers. This thin and complex market means that appropriately skilled providers often can't be found or accessed. Establishment of a private marketplace of services funded by government has meant that there's little incentive for clients to cease their publicly funded support. The market model for providers incentivises repeat customers, not the provision of the high-quality outcomes-driven services that would lead to system exits. So we've seen numbers of participants on the NDIS increase because those participants are failing to leave the scheme.

The disability market fails where participants need more specialised supports and in areas where there are poor economics of scale. Because of the shortages of providers, those in the market have been able to raise their prices to the maximum permitted by the NDIS scheme, to levels above those supported by other services—the TAC, Veterans' Affairs and aged care—so that individuals in those other schemes are failing to compete. The siloing of funding in different schemes and the variability of funding that is provided have set up what is effectively a 'hunger games' for disabled individuals who are seeking care and support. We all know that the disability dollar is not unlimited. The NDIS is expected to cost $50 billion annually by 2024-2025, more than the annual budget for Medicare or even defence—nuclear submarines notwithstanding. And let's not forget that the NDIS serves only 600,000 of the 4.4 million Australians living with a disability.

This sort of legislation really matters. It's a shame that it has received such scant attention from the opposition, who failed to improve disability services for many years, who had not managed the market of service providers and who had not put into place adequate quality or standards monitoring for many of the services provided under the auspices of the NDIS. When done well, disability care generates both revenue and productivity by facilitating employment and facilitating engagement of people with disabilities, and by freeing their carers to return to the workforce. The multiplier effect of disability care is significant. In the NDIS, every dollar spent generates an economic contribution of $2.25. This is a service; it's not an expense. As a member of parliament and as a member of the parliament's Joint Standing Committee on the NDIS, I hear often from individuals with disabilities, their carers and their relatives about their frustration and anger with many aspects of our disability care. I hear from patients and families unable to find affordable and accessible psychologists, psychiatrists, dietitians, physiotherapists, speech pathologists or occupational therapists. I hear from older individuals who have acquired disability after age 65 and who have therefore been shut out of the NDIS. I've heard how we have forced disabled Australians and their partners, parents and carers to battle a system in which transparency and generosity have been sacrificed to red tape and mean-spirited bureaucracy.

Given those issues, I remain concerned that this legislation does not appear to make sufficient provision for robust and independent oversight of the quality and safeguards in disability services provided outside the NDIS. It's intended that details of how systems will be overseen and the consequences for breaches will be set out in individual funding agreements or delegated legislation. But this approach increases the risk of inconsistent and nontransparent oversight mechanisms. I note the Commonwealth Ombudsman's call for prescription of requirements for complaints and incident management by service providers and of consequences for breaches. This would deliver a more consistent approach to complaints handling across the programs funded by the network. Importantly, it would also be consistent with the key recommendations of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability.

Only this morning, the government proposed an amendment which will embed within this primary legislation a measure to ensure existing service providers are held to the same code of conduct as new entrants under the new act. This will mean that, once the legislative instruments are in place, all organisations that are currently receiving funding and whose legislative authority would fall under the new Disability Services and Inclusion Act 2023 for future funding arrangements will also have that code of conduct applied. This is a positive step, but you have to ask why it was made only today and why we can't have the details of oversight mechanisms and enforcement provisions in the body of this legislation rather than buried in the delegated legislation.

The question remains: how do we best support those needing help within and without the NDIS? We can, we should and we must do better with disability supports in this country. We have to increase access to, and provision of, community based programs for infants and young children with developmental delay, children with mild autism and neurodivergence, and adults with mild deficits. For those individuals, not only will group therapy result in better use of resources; it might also promote inclusion. We have to increase the range of community and mainstream supports for people without severe disability. We need to provide group therapy and services for all who are able to benefit from them. This model would need us to resile from our current premise that all disabled people must self-manage their care and should receive support individually. The model would also mean that, as a society, we accept our responsibility to include and support all individuals and their variations and imperfections, and to create a context accepting of their varying capacities and needs.

I commend this bill to the House, and I hope it will be effective in improving outcomes for all Australians with mental and physical disability.

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