In the UNCRPD, the definition of disability is crucial to its entire rights framework. The idea that disability arises from the interactions of effects of impairment, social attitudes and values as well as from environmental barriers, shows these processes as responsible for a high level of vulnerability for people with disability. That understanding also informs us that it is at this level that remedies to the generally socially devalued position of people with disability must be found. In other words: to reduce their vulnerability and advance their wellbeing. Inclusionary disability principles and rights, enshrined in law and strategies, have been hard-won, and stand on the shoulders of decades of activists, practitioners and researchers. One would expect that any new approaches in funding services, such as those in the proposed national long-term care and support scheme (or NDIS), are coherent with these. Unfortunately the current NDIS proposal is not.
The Productivity Commission's draft report grounds its beliefs and assumptions in a market-based approach. The starting points are cost-effectiveness and efficiency with competition a driver towards their maximization. Not disability principles and rights towards being recognized and treated as inherently, equally worthy citizens who have their needs met in quality, integrative approaches. I do not remember any disability movement's call for 'revolutionising' disability services through efficiency, for example. Yet the draft report, and the public campaign that is so strongly entwined with it, despite the artifact of the Commission's 'Independent Panel', tells us that such an approach represents fundamental change. It apparently believes that efficiency is all we need. Not that it talks much about our needs, or their nature.
The Productivity Commission's report mentions the CRPD, but portrays it in a pale light, achieved through quotes from submissions which appear to suggest that the Convention is a light on a hill, but not something we have to hurry towards. It does not frankly endorse the Convention as a national commitment to a values change, one to be pursued now - not tomorrow. Perhaps then on the never-never?
The Draft report says there is no one definition of disability. This is true, but our most advanced understanding of disability, contained in an international legally-binding agreement, is that of the UNCRPD. Besides the UNCRPD and World Health Organisation (WHO) definitions, the report also takes those of the Australian Institute of Health and Welfare, and that used in the Australian Bureau of Statistics (ABS), which describe disability from a view of deficiency, focused on impairment. In its own synthesis of these definitions, the Productivity Commission's report then advances its interpretation of what should be, in its words, a different 'way of talking about disability.' By that it means reframing contemporary understanding of disability by re-asserting the importance of a medical understanding of it. As it puts it: "a more scientific approach to disability would see [disability] as both a social and medical phenomenon" (1.6, Vol 1). Back to the future: impairment once again equaling "medical."
The reasons for this reframing seem to arise from a need to cost the scheme's projected expenditure. It mainly does so by costing a set of 'core interventions' to people who have significant impairments. Core interventions are those services and therapies that are linked to medically labeled impairments and can be represented in impairment tables, used in eligibility assessments. The problem is, when primarily linked to assessments of cost-effectiveness of the interventions (why cannot we just say 'assistance?') such processes are more likely to lead to ticking boxes of cost-effective 'interventions' than towards realising an aim of social inclusion. In fact, the report's values-free approach also circumvents the CRPD's right to supported living in the community by opaquely suggesting that funding integrated or segregated disability service or support ultimately depends on their cost-effectiveness, not inclusionary principles. For example, it states:
...it may be difficult to fully meet all the community's objectives of a new scheme, reflecting the need for any scheme to be financially sustainable and practical. There may also be tradeoffs between some goals. For instance: effective integration of support services may be costly if there is a large amount of supporting infrastructure required to do this, or significant implementation costs in changing from one type of approach to another. (1.12)
In any case, it is otherwise ominously silent on the issue of segregated or integrated approaches to being of service.
Of course all expectations cannot be met, but we are entitled to demand an NDIS that would explicitly support the UNCRPD's objectives towards having real choices about living, working and recreating alongside everyone else: i.e.full inclusion.
Could it be that we have stopped hearing the earlier campaign talk about a quest for our 'good lives', and escape from 'apartheid' because these are a bad fit with this report's recommendations? Of course, financial costs matter. So does impairment, as one part of the disability definition. But in having these factors trumping disability principles and rights, the report reframes a prevailing understanding of disability as primarily socially-created, to one of an economic/medical issue. Now that creates a fundamental problem for disabled people because such a stance stands in the way of our social inclusion. The motivations and attitudes underlying the provision of a wheelchair or support service do matter. They determine how well these things are matched to our needs, to their quality, and whether they mean sitting in a cost-effective wheelchair in a day-care centre or, living and working alongside everyone else, to our level of capacity, fulfilling our human potential.
Still, we should not be surprised that this report takes a market-based, economic cost approach. It is our society's, and governments' religion. So too this is how this campaign was first conceived. It took a severe and profound category of people with disabilities to get its first, actuarial, bearings: Cost first. Not needs. Marketing next. IIl-serving our social inclusion.
Nevertheless the increased resources that the NDIS draft report offers, along with other proposals for individual funding, could represent improvements in the lives of people with disabilities. Including a flexible interphase between aged and disability 'systems', and its proposed attention to Aboriginal people with disabilities. However, the report's beliefs and assumptions about disability and its remedies negate their benefits. Most of the problems in this report arise from them. It raises many questions that require answers.
The report, like the campaign, proposes fundamental reform. But its nature is structural, not fundamental, as it merely takes a prevailing marketisation trend in human services, and puts it on steroids in the disability area. In the spirit of the accountability and transparency that it says it prizes, clearly the onus is on it to provide evidence of the effectiveness of its market-based approach towards social inclusion. That it fails to do so, should set off alarm bells. There simply doesn't appear to be any! It does, of course, offer some of the literature showing benefits of person-centred individual funding. But this is no substitute for justifying its market-based approach, as person-centredness starts with an understanding of personal needs in dynamic relational settings, not with cost-effectiveness, assessment technologies and contracts. Under this NDIS, individual funding, subject to an impersonal, 'independent' assessment through a 'tool kit' will be driven by cost effectiveness.
Many of the problems associated with this report arise from its philosophical orientation which works more to the benefit of government Treasuries and financial sustainability of services than people with disabilities, the least powerful party. Vital conflicts of interest left unexplored. Yet the campaign is overwhelmingly delivered in our name. Curiously however, the brokenness of the disability services system that the inquiry takes as its rationale, and the campaign trumpets, is not examined in the report. But how many of the barriers that 56% of Shut Out respondents identified arise from disabling service values, meaning ill-targeted needs and unnecessary bureaucracy? Big savings might be made if it did, leading to immediate improvements, well before 2018. However, that would require engagement with principles, and with that same disability service industry. And engagement with substantial, complex issues has been absent from the entire NDIS marketing campaign. It mainly counts heads, not what's in them.
Consistent with early exclusionary processes in the pre-NDIS inquiry process, the report forgets to recommend our meaningful participation at every level of the NDIS bureaucracy and services it funds, excluding us from its governance on a proposed commercial board, with the scheme's effectiveness overseen by the obvious experts in disability - treasury. Of course, we hang off that structure in the obligatory appendage: an advisory group - together with the usual bevy of other interests, as per our ineffective National Disability Council. All under control - just not ours. We should question what sort of entitlement this is.
What does it come down to? Disabled Australians are in dire need of fundamental, and real change - a values change. There are serious present and near-future challenges to our safety and wellbeing that demand it. We see government and Opposition demonizing anyone who is not working, as an unproductive burden. They play a double game in apparently supporting improvements to our lives, while serving their economic agenda: slashing the numbers on a DSP; meeting industry demand for workers; saving money by privatising disability services. It's all about money - a singularly weak buttress to our wellbeing, as social inclusion cannot be bought and the economic future is wobbly. How can we believe otherwise, when the government has a dismal record in employing us in its revenue-funded public service, but wants to push us into the private - cost-saving - market - patronizingly, for our own good, without itself walking the talk?
Further, increasing 'natural' disasters associated with unfolding effects of climate change will also challenge Treasuries' capacity and willingness to support us unproductive unfortunates. A severe global energy shortage is as close as 2013, as the conservative International Energy Authority has been trying to warn governments for years. At the same time these developments will further increase the vulnerability of disabled people. The report's oblivion to the imminent impacts on us of these issues seems astounding, especially given the actuarial and economic credentials it rests on.
A disability movement that backs this market-based NDIS initiative is confusing our need for more individual choice, and independence, where admittedly we come from a very low base, with that of the self-interested kind of consumer choice and competition that is the market. We need real choices in living good, integrated lives where independence means being supported to reach our individual human potential. A disability movement betting on the market is actually undermining a social inclusion agenda, an agenda that should be ours.
The Draft report believes that "the key test of a new scheme will be the extent to which it can address existing deficiencies in an equitable, efficient, cost-effective and accountable way." Should that not be to what extent it can support people with disabilities in having our needs met, in ways that maximise our social inclusion - our Good Lives?
Social inclusion involves relational processes of engagement with difficult issues, respect, trust and openness. Not top-down marketing and appeals for 'unity' where substantial issues are never really explored. Perhaps we should not wait for the Promised Land of an NDIS - not this sort anyway. It seems high time for putting our limited energies into strategies, practices and coalitions that can do, and advance, social inclusion today. An NDIS with such an orientation, having some market notions as its servants, not its master, might work.