E&OE TRANSCRIPT
GERALDINE DOOGUE, HOST: So much of this week's public discussion has been on our big defence costs. We'll now focus on another very big spend as well, the National Disability Insurance Scheme, and how it can be made sustainable. The cost of maintaining this very good policy idea from the early 2010s is proving extraordinary. The NDIS is now making payments of $2.9 billion a month, according to recent analysis by The Australian newspaper. Estimates for next financial year suggest the total spend will hit almost $40 billion, possibly ahead of Medicare. The man who presided over the scheme at the outset and is back now in charge, Minister Bill Shorten, is midway through a review of the scheme. Given the significant, virtually monthly, rises in the scheme's costs, together with grasping the scale of budgetary challenges ahead for us all, it seemed the right time for an update on thinking about the scheme. So, Bill Shorten, welcome to Saturday Extra.
BILL SHORTEN, MINISTER FOR THE NDIS AND GOVERNMENT SERVICES: Hello Geraldine, lovely to be on your show.
DOOGUE: Look, these are massive figures, Minister. The NDIS is about to overtake Medicare in terms of its cost. How are you planning to rein this in?
SHORTEN: Well, first of all, I don't just look at the scheme in terms of the dollars. I look at it in terms of investing in people. So I could have equally introduced the NDIS and said there are 575,000 Australians, many of whom have profound and severe impairments, who are having life-changing experiences as a result of the investment of this money. Now, I think the truth is what I said, but I also accept the proposition that the scheme costs are growing faster than expected. So my challenge to both taxpayer- my challenge, which I accept on behalf of people with disability who I want to work with, and participants, but also taxpayers, is how do we make sure that every dollar gets through to the people for whom the scheme was originally intended to help, and that's our challenge. There's a lot of good news in the scheme and that- I guess, good news tends to be getting up in the morning when bad news is already dressed and off and running. But it is a life-changing scheme and it is making a world of difference to people.
But I am concerned that this scheme basically has been very inconsistently applied. I am very concerned that states and other departments now say: if it's a disability it must be an NDIS matter. The NDIS was never intended to be the only lifeboat in the ocean. I am concerned that there's overcharging, bordering to fraud and criminal activity, not by participants as a rule, but by people who see this as a honeypot of government money which they can then siphon off for their own profit.
DOOGUE: Yeah, yeah, that's right. There's the rorts which have already been identified, and these sort of, you might say, overly wide legal allowances for people to access the scheme. And maybe all of these are unintended consequences, but these are major dilemmas. You know, the average payment per participant rose from $57,600 to $58,500. So this just can't go on like this, can it?
SHORTEN: No. But when we use participants, these are not anonymous units on a page. Nearly every Australian knows someone, or a family member, with a profound impairment. So yes, I completely agree that we just can't have the rate of cost growth just continuing the way it is. I'll be blunt, that hasn't been invented by Labor in the last 10 months. We've inherited a system where we need to reinvest in the capacity of the agency and the planners. We've needed to reduce the number of people medically fit for discharge in hospitals eligible for NDIS, eligible to go home, but they just couldn't get a plan. We need to remove the legacy costs of all the court cases. So there's plenty to be done. And we are getting some things done.
DOOGUE: There was another- one in three people on the NDIS, as I understand it now, is a child with autism, and there are, amidst this, persistent reports that the numbers are skewed to those that live in relatively well-off areas. Now, that was not the original plan, was it?
SHORTEN: No, not at all. I think it's one in three people in the scheme have a diagnosis of autism and a lot of them are kids. It's not one in three in the whole scheme are kids with a diagnosis of autism. But it's still a very significant number. What's, I think, been happening is that there's been a lot of red tape in the system, so if you're from a disadvantaged group, English not your first language, if you're holding down three jobs, you've got three kids diagnosed with autism, the forms- you're not getting the same equitable access to the scheme as people are in better off financial circumstances. But having said that, I think the other challenge here is that the school systems are not doing enough for kids with disabilities in this country…
DOOGUE: And that's a state budget matter, isn't it? That's with the states.
SHORTEN: It is. The NDIS was never- although the states get a lot of funding from the Federal Government for disability in schools. I'm not sure we see always the value of it. Our challenge is that we can't have the NDIS becoming the residual default safety net for an education which finds some kids with disabilities to be square pegs in round holes. But one of the other challenges, even before we get kids to school, is that if the only support available is in the NDIS then what we're seeing is the diagnosis follows the money. And I can understand why allied health professionals or people say they've got a family, their child's not developing or learning in the way that you hoped, a beautiful little baby or a young child or toddler, then they're getting referred into the NDIS. So I'm interested in how we improve early childhood intervention. There's great work being done in Western Australia by the Telethon Institute, by La Trobe uni and Melbourne University, the older Tennyson Centre. The evidence is in, we don't need to prove this point. If we can diagnose kids between 9 and 14 months then they're not all going to end up on the NDIS. A lot of them will end up having mainstream schooling experiences. The earlier we get to them, the better.
DOOGUE: But this is terribly difficult politics, isn't it? At both the individual, personal level, and also at the states' level. So you've got to navigate that, and clearly that's a vital area of your review.
SHORTEN: Absolutely. If you imagine an old-fashioned train line between Melbourne and Mildura where in some parts just one track, one train, one thing happening. This NDIS is like the Tokyo underground. There's so much going on in so many directions all at the same time. It's complicated but it's exciting. Australia and Australians are to be commended. I actually think they think the NDIS is a good use of taxpayer funding, it's right up there with Medicare…
DOOGUE: But not the growth of it, Minister. I think that's startling to people.
SHORTEN: No, I think what they think is that we should be making sure every dollar gets through to the people upon whom the scheme was designed for, and that's what I want to do. So this is not about, you know, slashing…
DOOGUE: But the question- did they think it was designed for children with autism? That's the point.
SHORTEN: I think it's case by case. A diagnosis of autism doesn't mean that you- shouldn't mean that you end up on the NDIS. But for some kids with autism, they should be on the NDIS. What we've got to do is get better at looking at people as individuals and not trying to do just mass categories and diagnoses and everyone's in this, or everyone's out of that. I think if you actually spoke to people on the scheme, and that's for whom it's set up, you'll find most of them never want to go back to the disaster, crisis-ridden system we had beforehand.
DOOGUE: Yes, but…
SHORTEN: But I think everyone wants to make sure that there's no inappropriate expenditure. That we're not investing in therapies that don't work, that we're not seeing- I mean…
DOOGUE: So why not have an independent assessor, then, Bill Shorten? That's the area- the Productivity Commission initially recommended independent functional assessments to happen in all areas of…
SHORTEN: Geraldine, I know after five minutes everyone wants to go to the solution of the scheme. But I'm going to stand up for the scheme. At no point am I saying to you that we don't need to review the costs and are we getting the values. But what I want to put to you is this: why is it that when we start that we say: is it the child with autism who shouldn't be on the scheme? Or is it the service provider who, when they hear that a family's got an NDIS package, the price of the bath chair, the shower chair, doubles? We've got to tackle- so, you are right. We've got to make sure that the entry point to the scheme is working in the way it was intended. But the way we make the entry point to the scheme work as intended is we make sure there are supports outside of the scheme for people whose disabilities are milder. At the moment it's a wasteland.
DOOGUE: Well, why can't you do that together with- I just don't understand why you're leery of independent assessors? Because it happens in all areas of…
SHORTEN: I didn't say I was. Sorry, I didn't actually say I was leery of it. What I was doing- so, I didn't say that, and I'm happy to replay the tape…
DOOGUE: Well, you have, though, elsewhere, you've been very…
SHORTEN: No, I was leery of- sorry, if you're talking about that sort of cave dweller structure that my predecessors put in, where they just wanted to hand out contracts to multinationals and just make every person with a disability re-justify their disability, of course I'm leery of stupid processes. But you're right. We need to make sure that we have consistency in decision-making. But again, I just caution: we want to make sure the scheme is working in the interests of participants. We want to make sure that people are not getting ripped off. We want to make sure that there's not price-gouging. Isn't there a conversation to be had in this country? This view that if it's government money somehow I'm allowed to pay for the second storey on my beach house by charging more to the person with the government money. NDIS…
DOOGUE: Okay, so you're saying that it's in the provision, you're saying it's in the providers, are you? That you're seeing the problems?
SHORTEN: I'm saying that, to go back to use- perhaps my Tokyo underground metaphor was a bit convoluted. There's lots of moving parts in this. What I'm not going to do is panic people with a disability and say, somehow, they're going to go back to the bad old days. They're not. But I also respect and am absolutely committed, and we'll see more as we go on in coming months, how do we make sure that the scheme is being run properly? The number of stupid decisions. You know, the agency, before my time, spent two-and-a-half years arguing with a participant about a CPAP machine, a machine to help you with sleep apnoea. And you know what? It was available on Medicare, but for two-and-a-half years there's to-ing and fro-ing. I know that there's hospitals in this country who, when they once upon a time would give a tube for a person to be fed with, would just do that from the hospital, now they say: that's an NDIS matter. So a lot of people have to step up if we're to make sure we get the NDIS functioning properly, and one of them is in the early intervention where you were going with assessments. I want to use evidence-based therapy, evidence-based tools to be able to give a little child at 9 months or 14 months or 18 months who's not developing in the way that people hoped, or going in a different path, how do we make sure we help that child get the best start in life? That may be…
DOOGUE: So they don't end up on the NDIS, by the sound of you- is the end of that sentence.
SHORTEN: No. So that they have the option of the NDIS, but if they don't need to be on the NDIS, they don't get funnelled there.
DOOGUE: All right. Now, I'm just going to ask you- because that's the young end of it. There were reports this week as well that 800 Australians over 65 have joined a class action challenging their exclusion from the scheme, and they're going to launch their proceedings within three months. Because people who were put on the NDIS before they were 65 retain their privileges, those who want to apply over 65 aren't eligible. Is this something that troubles you?
SHORTEN: Well, in light of all your previous questions that the scheme is costing too much, I don't know how you feel about adding on potentially hundreds of thousands of people to the scheme. For me the issue is pretty plain. When the parliament, in a bipartisan fashion, introduced the NDIS legislation in 2013 they made it very clear that their intent for this scheme was for people who develop their disabilities before 65. To go back 10 years and 13 years and 14 years, when I first started campaigning for an NDIS, age- we looked over the fence from the disability area into aged care. And aged care had assessment teams, individualised packages to some level, it was far superior to the crisis allocation of resources in disability. So the parliament, both under Prime Minister Gillard, then Opposition leader Tony Abbott, unanimously said: we're going to have a scheme for the people who develop their disability before 65. What's happened in the last 10 years is aged care has, you know, in many cases gone to hell in a handbasket, to put not too fine a term on it. So now there's people who are saying: well, we don't want to be in aged care, we want to be in disability. But the parliament made its intent clear. I do think that they have a legitimate issue, people over 65, that we need to better treat and support the cost of disability. But I, as a starting point, using the parliament's intent, think that that solution has to come from within aged care.
DOOGUE: So you're putting the bulk of your energies- you've got six months to go for this very, very important review. Where are you putting the bulk of your energies at the moment?
SHORTEN: Co-design with people with disability to identify how we can move from focusing just on a payment system to focusing on better outcomes for individuals. I think if we focus on better outcomes for participants on the scheme, that will actually sort out a lot of the cost growth issues. At the moment, what we have is a scheme where I don't think sufficient attention- my predecessors treated the NDIS with a bit of, in my opinion, a small vision. It's a payment system, just get the money out the door. There's been no focus on training the workforce of the future, no focus on how we check the payment system. You know, are the invoices coming in fair dinkum? Is there overcharging or are there rorts? There's been no focus on challenging the rest of our government system and community to provide support for people with milder disabilities outside the system, so that the system doesn't become a magnet for everyone. So there's a lot going on and it's a really exciting privilege. I just want to say, though, to those amongst your listeners who are either participants or have family members who are participants: we want to make the scheme strong into the future.
DOOGUE: All right. It will be very interesting to watch these moving parts, I must say. Thank you very much for joining us.
SHORTEN: Fantastic, Geraldine, lovely to catch up.