NDIS hiccups are expected, as with any large scale reform

Here is a piece I wrote recently for the Conversation on the NDIS.

<p>Disability services were widely recognised to be in a <a href=”http://www.pc.gov.au/inquiries/current/ndis-costs/issues/ndis-costs-issues.pdf”>parlous state</a> and there was bipartisan support for the development of a national scheme that would address their identified inadequacies. In recent months, this enthusiasm and excitement has been replaced by a more critical discourse. National rollout of the scheme began last year, but already there have been reports of the NDIS being “<a href=”http://www.abc.net.au/news/2017-03-12/ndis-rollout-plagued-with-problems-foi-documents-reveal/8346892″>plagued with problems</a>”.</p>

<p>However, one of the problems with judging success and failure is that they often look the same part way through. We shouldn’t be surprised that such a huge reform process is encountering challenges in the implementation process and these issues don’t mean that the NDIS is failing overall.</p>

<h2>Problems with the scheme</h2>

<p>The <a href=”https://www.ndis.gov.au/participant-portal-user-guide”>online portal</a> that facilitates payments to providers received extensive <a href=”http://www.abc.net.au/news/2016-08-10/ndis-providers-entering-their-eighth-week-without-payment/7711754″>critical attention</a> for delays and technical glitches. In November 2016, the NDIS was criticised for <a href=”http://www.abc.net.au/news/2016-11-14/ndis-struggling-to-meet-target-quarterly-report-shows/8022196″>struggling to meet enrolment targets</a>. From July to September 2016, only 7,440 people were enrolled in the scheme instead of the targeted 20,264.</p>

<p>This problem was rectified in the next three months, when 26,000 people signed up to the scheme. But in return, there was <a href=”http://www.abc.net.au/news/2017-03-03/ndis-enrolments-surging-despite-difficulties-accessing-plans/8321232″>criticism</a&gt; this had been at the expense of the <a href=”http://www.theage.com.au/victoria/its-like-a-fiveyearold-wrote-it-disability-advocates-slam-ndis-care-plans-20161026-gsbsdm.html”>quality of the planning process</a>. </p>

<p>Then came concerns about a <a href=”http://www.abc.net.au/news/2017-01-20/national-disability-insurance-scheme-government-announces-review/8198574″>potential cost blowout</a> due to the increased prevalence of autism, debates over <a href=”http://www.abc.net.au/news/2015-05-31/ndis-confusion-victoria-state-federal-government-agreement/6506840″>state and federal responsibilities</a> and reported <a href=”http://www.abc.net.au/news/2017-02-25/ndis-report-warns-major-cities-not-prepared-for-implementation/8303276″>workforce shortages</a>. Due to this, the Productivity Commission was asked to undertake an <a href=”http://www.abc.net.au/news/2017-01-20/national-disability-insurance-scheme-government-announces-review/8198574″>independent review</a> into the overall costs of the scheme, its value for money and long-term sustainability.</p>

<p>Recently we have seen extensive reporting on the failures of the scheme and concerns that the various pressures on it might be <a href=”http://www.theaustralian.com.au/opinion/editorials/time-to-make-the-ndis-workable-and-affordable/news-story/f4575a0570ce875249c3526b2cc7768c”>overwhelming</a&gt;. There also seems to be agreement from some quarters that the implementation of the NDIS is <a href=”http://www.theaustralian.com.au/news/inquirer/monster-that-ate-the-national-disability-insurance-scheme/news-story/92b7c5e7b5719290741966c9b1983500″>failing</a&gt;.</p>

<p>By 2020 the NDIS is expected to have around 460,000 participants at a cost of A$22 billion. It should empower people with disability and their families and support individuals to participate more fully in society and the economy.</p>

<p>Such a process involves massive changes to several areas. These include who delivers services and how; power relationships between people with disability, their families and service providers; and the involvement of people with disability in Australian economic and social life.</p>

<p>This vast reform is being implemented at <a href=”https://theconversation.com/four-lessons-the-ndis-must-heed-to-avoid-a-pink-batts-disaster-35385″>break-neck speed</a>. Different levels of government are rushing to divest themselves of the provision of disability services, create a market for disability services and individualise services all at the same time. </p>

<h2>Historical comparisons</h2>

<p>England embarked on a similar reform process a few decades ago – although over far greater timescales. This started with the creation of a market for disability services in the 1980s, the introduction of direct payments in the late 1990s and the expansion of individual funding to all groups around <a href=”http://pf7d7vi404s1dxh27mla5569.wpengine.netdna-cdn.com/files/2011/10/UKDPfinal.pdf”>a decade later</a>. </p>

<p>Although these initiatives were developed over a period of nearly a quarter of a century, they still encountered a number of implementation challenges as they have been <a href=”https://pure.york.ac.uk/portal/en/publications/the-evaluation-of-the-individual-budgets-pilot-projects-ibsen(1ac4b7b7-fc13-4d85-9153-50d784a616ee)/export.html”>rolled out</a>. These include different levels of take up of these options across disability and age groups, reports of inadequate budgets and challenges in planning processes. </p>

<p>In some ways, the comparison to the English experience of implementing individual budgets is not a good one. In England, support for disability services remains focused around a small group of individuals. The development of the NDIS as a major new funding initiative required extensive support and as a result emphasised the potential benefits for the whole population. </p>

<p>The <a href=”http://www.everyaustraliancounts.com.au/”>Every Australian Counts</a> campaign argued people with disabilities should be treated as full citizens and made an appeal to universality. It argued that the NDIS was needed for “peace of mind” in the sense that everyone could be at risk of disability either directly or through a family member.</p>

<p>Many <a href=”https://www.ndis.gov.au/chair-speech-reducing-inequality”>have described the NDIS</a> as the largest social policy reform since Medicare.
So Medicare might be a better comparison than the disability reforms in England, and Medicare’s history is instructive in terms of the time it takes to achieve large-scale reform. Although today Medicare is relatively settled in the policy context and supported by the public, its history is more <a href=”https://theconversation.com/explainer-what-is-medicare-and-how-does-it-work-22523″>contentious</a&gt;. </p>

<p>Medicare started in 1984, but an earlier version, Medibank, was introduced in 1975 after extensive political debate that even led to the <a href=”https://www.whitlam.org/gough_whitlam/achievements/healthandsocialsecurity”>double dissolution</a> of Parliament in 1974. </p>

<p>Medibank was abolished in 1981 and only reintroduced after a significant increase in those without health insurance. Other similar large-scale reform processes follow similar patterns. Change doesn’t come quickly and we need to be patient.</p>

<h2>Lessons to learn</h2>

<p>We are less than a year on from the roll-out of the NDIS nationally. Given the size and scale of this reform agenda we can’t expect to see change emerge overnight. Some of the current commentary around the scheme goes too far in making definitive statements about success and failure. We should expect some challenges to arise as the NDIS is implemented and this doesn’t mean that the idea is fundamentally flawed. </p>

<p>But having patience doesn’t mean ignoring these problems either. The government needs to ensure appropriate mechanisms are put in place to learn from issues as they arise. The scheme is certainly in need of <a href=”http://www.theage.com.au/comment/cuts-to-the-22-billion-ndis-behemoth-would-cost-more-in-the-long-run-20170408-gvgy8k.html”>refinement</a&gt;, but we should not abandon this altogether given life prospects for those with disability are significantly worse than for the general population, and <a href=”https://theconversation.com/is-australia-ready-to-give-people-with-disability-real-choice-and-control-over-services-50312″>well below</a> those of other comparable nations.</p>

<p><span><a href=”https://theconversation.com/profiles/helen-dickinson-113022″>Helen Dickinson</a>, Associate Professor, Public Service Research Group, <em><a href=”http://theconversation.com/institutions/unsw-1414″>UNSW</a></em></span></p&gt;

<p>This article was originally published on <a href=”http://theconversation.com”>The Conversation</a>. Read the <a href=”https://theconversation.com/ndis-hiccups-are-expected-as-with-any-large-scale-social-reform-75693″>original article</a>.</p>

Robo-debt, Centrelink and collaborative working

There is a story that has featured fairly prominently in the Australian media of late that hits many of research interests.  The story focuses on Centrelink, which is a program that sits within the Department of Human Services and delivers a range of different government payments and services for those who are unemployed, people with disabilities, carers, parents, Indigenous Australians and others.  The majority of Centrelink’s work is in relation to disbursing social security payments.

Last year an automated debt recovery system (the snappily titled Online Compliance Intervention) was designed with the aim of recovering $4.5 million in welfare debt every day.  This computer program compares data gathered from other government agencies (e.g. the Australian Tax Office) and compares it to what has been reported to Centrelink.  The aim here is to work out where people have been overpaid benefits and then to work to reclaim these.

In the past the same kind of system was used but referrals were passed to a Centrelink officer who would investigate before sending out a letter asking for more information about any discrepancies.  Between July and December of last year 170,000 compliance notices were automatically sent out, where previously only about 20,000 a year were issued.

The problem came about because many people reported not receiving these letters (some went to old addresses or they did not check their MyGov account) and then they were contacted by private debt collectors who work for the department.  Essentially if you don’t respond to one of these letters in 21 days and provide more information, this is assumed to be evidence of an overpayment and the process is started to reclaim monies owed.

 

Although the offical figures aren’t known, it has been suggested that about 20 per cent of those receiving these notifications are in error.  By the nature of the work that Centrelink do, this typically means that these are individuals and families in the lowest socio-economic groups that are being pursued wrongfully for debts that they don’t owe.  In some cases people were being asked for information (such as payslips) going back to 2012 and were having to pay back debts they did not owe because they couldn’t prove that they didn’t owe this money.

As this story hit the news it gained the moniker of ‘robo-debt’ and there were a number of stories initially that blamed the robots for incorrectly calculating figures.  Stories tended to talk about decisions being made that would not have got past “human” quality control such as the fact that robots calculate fortnightly income by dividing the annual income by 26 or they don’t pick up on mis-spellings of employer names and other egregious flaws that resulted in people being inappropriately pursued for debt.

I’ve been getting interested in the use of robots in public services of late (more to follow soon) and here were the robots being blamed for poor people being pursued for money they didn’t owe.  What seems to be fairly well established now is that the robots weren’t to blame for this outcome – they were just doing what they had been programmed to do.  What had been changed is that the quality control had been removed and the algorithms that were used to identify debts had not been revisited given what we know about the number of cases that were initially identified in the old system and which were actually followed up.  The processes of communication with those being pursued for debts was in practice more problematic than the initial process of identification and had led to the distress of many of those caught up in this process.

The final bit of the story that has come out more recently is even more interesting with respect to what has gone wrong.  In a recent ABC news story, Henry Belot found that there was no formal briefing on this issue between the Department of Social Services (DSS) and the Department of Human Services (DHS).  Broadly speaking the DSS has responsibility for developing policy relating the debt recovery policy, which DHS then leads on the implementation of.  So the department that developed the policy didn’t formally brief the department that implemented it.

 

 

 

 

 

 

What this shows is the importance of developing policy with those that implement it and the challenges that arise when you don’t do this.  This is a stark illustration of the policy implementation gap, which is a key theme of the new research group that I head – the Public Service Research Group at UNSW.  This example further demonstrates the importance of collaborative working and what happens when different agencies don’t work together.  You can find more analysis on this and expert commentary on this from me and others in Henry’s piece which is here.