Overview

The National Disability Insurance Scheme (NDIS) has changed the way disability supports are delivered. The current market-based approach to deliver NDIS supports has provided many participants with greater choice and control in their lives.

We also know that, in some areas, market challenges are limiting the ability of the NDIS to deliver on its promise for participants to live an ordinary life.

Many of these market challenges are already well known. Many reviews have outlined the issues with taking a ‘one-size-fits-all’ approach to the NDIS. Yet these challenges are still plaguing the scheme today – and leaving some participants behind. Gaps in delivery are particularly evident for both First Nations and remote communities who are being left behind under the rigid market approach.

The National Disability Insurance Agency (NDIA) has taken some important first steps to trial more flexible market approaches in the NDIS. This includes starting to build partnerships with communities. However, these are just first steps – more needs to, and can, be done.

Governments can play a more active and flexible role as ‘stewards’ of the NDIS market. Throughout the NDIS Review, we will continue to work with you to come up with solutions on how we can strengthen market stewardship in the NDIS to deliver outcomes for all participants.

Some steps can be taken now to address persisting market gaps in remote and First Nations communities.

Alternative commissioning – where a ‘commissioner’ contracts a provider to support a group of participants – is not a new idea. Many past reviews of the NDIS have called for these arrangements to be used when competition in markets are failing participants.

When placed-based and community-driven, alternative commissioning could help the NDIS to deliver more culturally appropriate, efficient and sustainable supports for First Nations communities and remote communities. Partnerships between First Nations organisations and experienced disability service providers will also be critical in building understanding of disability and capability to deliver supports in a culturally safe and inclusive way for communities. Over time, communities should be supported to buy and coordinate the supports for themselves. Where they wish to, communities could design the approach and lead the commissioning process.

Over the coming months, we will work with First Nations representatives, communities and governments on how alternative commissioning approaches could be implemented in the NDIS.

Key points

Over the past decade, significant market development in the NDIS has improved outcomes for many participants.
For others, a fully individualised and market-driven approach has left them with limited access to supports. This includes gaps in delivery for First Nations participants and in remote communities who are being left behind under the rigid market approach, and a persistent lack of culturally appropriate supports. Ten years on, available data shows that a small number – including just 40 members of the National Aboriginal Community Controlled Health Organisation (NACCHO) – are providing supports as registered NDIS providers.
While increases in remote and very remote price loadings and more flexible pricing arrangements (for example, to cover telehealth) have addressed some challenges in these areas, persistent market gaps remain.
In remote and very remote Australia, over one in three participants – who have been in the NDIS for over one year – are not accessing daily activity supports, and over one in four are not accessing therapy supports.
Over the past five years, many reviews have repeatedly called for alternative commissioning approaches to address persistent market gaps, particularly in remote communities. While the NDIA’s thin market trials have explored a few commissioning approaches, efforts to date to improve market functioning have been too narrow.
A more active and flexible role for governments, as stewards of the NDIS market, is needed. The Review is exploring how a range of market mechanisms could be applied and scaled up in the NDIS to address persistent market challenges. Even so, steps should be taken now to address the most pressing market gaps.
Addressing market gaps for both remote and First Nations communities requires a different market approach that can better coordinate supports. In these cases, alternative commissioning arrangements that are placed-based and community driven could lower the cost of service delivery by offering service providers greater certainty of demand. This could also increase their ability to achieve scale and continuity of supply.
Alternative commissioning arrangements would enable culturally appropriate supports to be delivered by a more localised workforce. These approaches could also improve outcomes for participants and drive a more sustainable care and support ecosystem over time.
Ongoing, meaningful and on-the-ground partnerships with First Nations representatives, communities and participants will be key to success. The National Agreement on Closing the Gap, its Priority Reforms and the Disability Sector Strengthening Plan offers a framework to progress alternative commissioning in genuine partnership with the First Nations people with disability, families, communities and organisations.
Expanding too far, too fast is a significant risk. Time is needed to build commissioning capability and roll out alternative commissioning approaches across both remote and First Nations communities. Piloting approaches will help to understand what works and allow time to develop and strengthen community partnerships.