The Market Does Not Provide: A Left Critique of the NDIS

The National Disability Insurance Scheme (NDIS) is a hugely significant piece of Australian social policy. It has broad-reaching implications, not only for people with disabilities and their carers, but for the future of all social service delivery in Australia. Given this, I find it concerning how quiet the Australian Left has been regarding its introduction, and how few critiques have been issued from a Left standpoint.

Of course, critiquing the NDIS is a challenging political and moral space. In the face of the many people whose lives have been dramatically improved by the NDIS, broaching a critique is daunting. But although there are stories of great success, the NDIS seeks to replicate a market, and in a market there are winners and losers. The shift to marketised social services has gone hand-in-hand with the erosion of the safety net role historically played by social services, leaving the ‘losers’ of the NDIS in a terrifyingly precarious position. This alone necessitates digging deeper and working to develop a nuanced critique of the NDIS.

Over the next few months I will be producing a series of articles for Flood Media exploring the NDIS, its broader implications, and how the Left can respond. This first article provides a grounding for these future deeper discussions through briefly introducing the National Disability Insurance Scheme, where it came from, and how it works in practice.


What is it?

The National Disability Insurance Scheme is the new Australia-wide approach to funding disability services. It encompasses physical disabilities, intellectual disabilities, autism, brain injuries, profound deafness and blindness, and psychosocial disabilities (the new word for people with a mental illness that has a ‘significant impact on [their] day-to-day life and [their] ability to participate in the community’). It is founded on market-based principles where people with disabilities are viewed as consumers, who obtain choice and control through being given purchasing power in a market of social services. It will all but replace existing disability services funding in Australia’s states and territories.

Previously, individual state and territory governments were primarily responsible for the provision of disability services, with some financial support and grants from the federal government. What this looked like was state governments providing block funding to non-profit organisations, who then delivered services to people with a disability. This previous model was not without flaws. It was significantly under-funded and had a tendency to try and put square pegs in round holes. It failed or completely missed many people with a disability.

It is, however, important to note the vast differences in funding when considering critiques of the previous system. The combined Australia-wide annual budget for the previous system was around $7 billion. When the NDIS is fully rolled out - which is currently estimated to happen around 2020 - its annual budget will be triple this, at around $22 billion.


Where did it come from?

While there has been discussions in the Australian political class around implementing a social insurance scheme for people with disabilities since the Whitlam era, the NDIS in its current form was primarily the brainchild of Bruce Bonyhady.

Bruce Bonyhady is an ex-banker, whose two sons with cerebral palsy sparked his interest in disability reform. With the help of John Walsh, an insurance expert from PricewaterhouseCoopers, Bonyhady created the initial proposal for the NDIS. This proposal was pitched as one of the ‘big ideas’ at Kevin Rudd’s 2020 Summit in 2008. Some key Labor ministers took interest in the proposal and in 2011 it was referred to the Productivity Commission.

John Walsh was appointed as one of the commissioners for the Productivity Commission Inquiry into Disability Care and Support. The report this inquiry produced contained the first fleshed out version of the NDIS.

Some of the underpinning ideas of their initial NDIS proposal, and the following Productivity Commission report, are encapsulated in the following quote from Bonyhady:

“...once people with disabilities become consumers who are free to choose, the market will drive innovation and provide individuals with value for money, much more effectively than so-called quality systems, which really are form-filling exercises. Individual choice and the market are the best ways for people to maximise their well-being, recognising that in some cases people with disabilities will need support, through advocacy, in their decision making.” 

The principles that emerge are: people with disabilities should have a choice and control over their lives and the support they receive; and giving people with disabilities purchasing power in a market of disability services is the best way to provide this.

Following the release of the Productivity Commission's report, the National Disability and Carer Alliance, excited by the prospect of people with disabilities having a greater say, launched the ‘Every Australian Counts’ campaign calling on the Australian Government to implement the NDIS.

In 2013, the Australian Government passed the National Disability Insurance Scheme Act 2013. The scheme had bipartisan support from Labor and the LNP.


How does it work?

To be included in the National Disability Insurance Scheme, you first need to meet access requirements. To do this, you apply to the National Disability Insurance Agency or NDIA (an independent statutory agency tasked by the Australian Government to implement the National Disability Insurance Scheme) to see if they meet these requirements. If you have been engaged with state disability services over a long period of time, you might automatically meet the access requirements and you can skip this step. If not, and it’s likely you won’t have if you have an intellectual disability, psychosocial disability or other ‘less visible’ disability, you will need to go through an arduous process of gathering what can be a lifetime of evidence to prove you're permanently disabled and have a reduced functional capacity.

Then if the NDIA has given you the ‘tick’, it’s on to preparing for your planning meeting. If you want to be in with a shot of getting a plan that meets your support needs, you will need to gather further ‘proof’ from your support services, your carers, psychologists, occupational therapists etc. about your reduced capacity. You will also need to develop a range of goals that you would like to obtain funding/supports to achieve. These goals can theoretically be anything you want from getting your driver's license to going on a holiday. However, the NDIS also has its own goals: increasing your independence, participation in the mainstream community, and employment prospects.

It’s important to note here that no services in Queensland have been funded to support people to gather this evidence and prepare for their planning meeting or their access request. The NDIA will tell you that you can get help with the process from your Local Area Coordinator (workers funded by the NDIA to assist people in getting an NDIS plan), but it is likely that you will find them swamped with a large caseload with no time to even answer your calls.

After the planning meeting, the NDIA will send you your plan. The plan will include specific amounts of money for support categories that the NDIA planner has deemed ‘reasonable and necessary’ for you’. It is now up to you, or maybe your family or close friends depending on your emotional and cognitive capacity, to ‘shop’ for support services. This will include negotiating contracts with service providers and managing what can be quite a significant budget over a year. Each year the NDIA will review your plan and might adjust your funding amount (you can find an example of what an NDIS plan looks like here). If you struggle to spend all your budget and you don’t document why this happened throughout the year, you are likely to have your funding reduced next year. Rather than spending time with you to explore why you weren’t able to spend all your budget- perhaps you live remotely and the services you need just don’t exist or perhaps the whole process was downright confusing- the NDIA often assumes it is because you simply didn’t need it.

Sound complex? It is. I’ve heard from university professors who can’t completely get their head around this process for their own children who have a disability. It is particularly complex if you are also grappling with other sources of disadvantage - if you are coming out of the criminal justice system, or have found yourself homeless, or have dual diagnosis of an intellectual disability and a debilitating mental illness.

In practice, this complexity largely translates to a replication of existing inequalities. You are best placed to do well under this system if you have strong existing networks of support and a pool of resources to draw upon. If you are already marginalised by existing societal structures and systems, it is likely you will also be marginalised by the NDIS. In an era where the remaining tatters of our social safety net are being destroyed, this is deeply concerning. With the funding of old disability support services being rolled into the NDIS, if the NDIS fails you, there are few places left where you can turn for support.

The shift to marketised social services has gone hand-in-hand with the erosion of the safety net role historically played by social services, leaving the ‘losers’ of the NDIS in a terrifyingly precarious position.


This sounds like a disaster … why did people want this again?

To explore this, I think it is useful to return to two of the core principles that underpin the initial NDIS proposal from Bonyhady and the Productivity Commission: that people with disabilities should have a choice; and that the market is best placed to provide this.

The first principle, of course, sounds fantastic and is something that the vast majority of Australians agree with unequivocally. You should agree with this. The Australian Left should agree with this. Unfortunately this is not the whole picture.

Arguably it is the second principle - that affording purchasing power to people with disabilities is the best way to achieve this -  which needs to be heavily scrutinised. Perhaps the unquestioning acceptance of the NDIS’ market ideology by disability rights activists, NGOs, and peak advocacy bodies can be explained by the hegemony of neoliberalism across vast sections of Australian society. Or perhaps, in the context of the historical failure of the desperately underfunded Australian disability services system, people were understandably quick to grasp at any offering of an alternative, of hope for a better life.

To me, the NDIS appears as an incredibly clever piece of political framing by neoliberal actors. For disability rights activists, NGOs and peak advocacy bodies, the language around ‘self-determination’, ‘independence’ and ‘choice and control’ used within the Productivity Commission report, and broader political discourse around the NDIS, fits nicely within their existing demands. And these demands are entirely legitimate and immensely important. My critique is not of the demands but of the way they have been captured to legitimise mass scale privatisation and marketisation of social services. The question then becomes: do we believe that a marketised system of disability services will be able to truly provide people with a disability with the support they need to live a meaningful and full life?

If the answer is no, then it is incumbent upon us, the Left - as a political force that seeks to challenge and transform capitalism’s unjust systems - to respond critically. But how can a critical and meaningful Left response take shape, given the seeming inevitability of the NDIS, and the challenging political and moral space it occupies? In the forthcoming articles in this series I will grapple with this question, develop further analysis and propose ways forward. Spoiler alert: the market does not provide.

Nicole is a Greens organiser and agitator who has recently decided to go back to her roots in community services. She has spent the last 6 months exploring the impact of the NDIS on community mental health support services.


Photo by Louis Blythe on Unsplash