Choice and control in disability services

Choice and control are words that are used a lot in relation to the new National Disability Insurance Scheme (NDIS).  Australia’s disability services have traditionally been underfunded and found to be lacking in comparison to those in a number of other countries.  The NDIS promises profound shifts in these services and to put control in the hands of individuals with disabilities.

However, meanings of choice and control are not as straight forward as they might appear.  We might have a wealth of choice and yet none of those choices may be things that we want.  We might have control over spend of, say, care budgets but lack offerings that we would want to choose.  While these sound like good concepts (and I believe should be afforded to people accessing disability services) we need to ensure that they are effectively supported if they are to be realised.

This process requires more than just greater critical thinking about the concepts of choice and control, or even getting more adept at better market management.  There is a great deal of political courage involved in facilitating an outcomes-focus.  If we are truly to afford individuals control over the spend of their individual budgets then we will need a shift in the way that we see welfare services.  Rather than considering these services to be a ‘gift’ and focus on input equity as many systems traditionally have; we need to turn our attention to outcome equity.  This means that sometimes people will spend public money in very different ways than in traditional services.

Today I published a piece in the Conversation reflecting on these issues in relation to disability services in Australia.  Drawing on evidence from other countries that have rolled out similar sorts of systems and their experience to date I reflect on whether Australia is ready for a similar sort of system.  The piece can be read in full here.

 

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