NDIS ‘markets’ are not yet working for all participants. The current approach to the market relies too much on competition. Not all participants have access to the supports they need.
What you told us is not working
From what you told us we understand:
- There is not just one market in the NDIS, there’s many sub-markets in many locations.
- Participants find it hard to search for good services and connect with providers.
- Providers find it hard to respond to what participants need.
- Governments don’t have the information they need and don’t know if the supports being provided are working to help participants to reach their goals.
- In some places the number of providers or participants in the NDIS is too small for a market to work well or at all. This ends up in what we call a ‘thin market’.
- Gaps in delivery are particularly evident for First Nations and remote communities who are being left behind under a rigid market approach. Too many participants who live in a remote community are not getting daily activity supports, or the therapy services they need. The NDIS should align with Closing the Gap.
- The main way the market is currently managed is, by setting rules around how much and the way providers are paid. This includes ‘price caps’ which are set by the NDIA to say the maximum amount a provider can charge a participant.
- Price caps aim to ensure providers do not drive up prices and that their services are value for money. However, the blunt and non-transparent way price caps are set is not helping providers respond to the needs of participants or encouraging innovation. We’ve heard from some providers this also makes it hard to invest in the capability of workers. It is also fuelling a fee-for-service mentality amongst providers.
- While price caps are slightly higher for participants with complex needs, past reviews have heard that the current price caps don’t do a good job at supporting access for participants with complex needs.
- We know that providers often charge participants at the maximum price. In the NDIA’s 2020-21 Financial Benchmarking Survey, over four in five providers (83%) reported always setting prices at the price cap. We also know participants may not change their provider when prices change, so there is little reason for providers to compete by lowering their prices or improving the quality of supports.
- As the NDIS grows, more workers are needed to support people with disability. Both service providers and participants report that it is hard to find and keep workers with the right skills, values and attitudes, especially for complex clients and in remote areas. Jobs can be short term with poor conditions and many workers aren’t staying.
- Many of the challenges facing NDIS workers are similar for workers in aged care and veterans’ care, and some people work across the care and support sector.
- Coordinated action is needed across the care support sector. Making care and support work more attractive, as well as making it easier for workers to move across the sector may open up more career options and encourage people to join and stay.
Regional and remote areas have limited supports, limited safeguards and poorer quality supports. Market based systems do not work in thin markets. People with disability in regional and remote areas are afraid to complain about the few supports they have in case they are withdrawn
Workforce shortages are real and impacting the sector across the board. It reduces the capacity of support providers to provide consistent and reliable supports.
Despite living in an area of 'on paper' good service provision… accessing services for my daughter has been difficult - many providers have 'closed books', or have such limited availability as to not be a viable option… Limited providers also mean sticking with a 'known' provider even if you aren't satisfied with the service, for a lack of alternative options.
What we want to know now
How can the markets be better designed, structured and supported?
Prompts to help you answer this question:
- What needs to be done to ensure the markets serve the interests of people with disability, rather than the other way round?
- What options would help when supports and services are not available in your region?
- What information do you need to understand what good service looks like?
- How could the pricing structure be redesigned to reward outcomes rather than the volume of transactions?
- What would attract and keep workers who have the right skills, value and attitudes?