Tuesday, October 6, 2009

NDIS - Could it be a barrier to disability service?

 Welcome back.

Here is a piece that outlines my more detailed views of NDIS. Your comments are welcome!

A National Disability Insurance Scheme - A Barrier to Service?
(c) Erik Leipoldt PhD
September 2009

A proposal for a National Disability Insurance Scheme (NDIS) is on the table. But is it worth having in this form?

Some twenty percent of Australians have some kind of disability. You may not have one today, then Bang, you too join the club. Accidents, old age, illness, congenital impairment. It’s part of life and they happen to you and me. Not just to someone else.

But you cannot really insure against disability, just against some of the financial costs of it. The reason you cannot is that the experience of disability is largely determined by social attitudes towards people who have impairments of some sort. Physical, mental, sensory or whatever.

Those social attitudes ensure social exclusion, isolation, abuse, unemployment and poverty for many people who have disabilities and their families. And these effects bother disabled people far more than the fact that they cannot walk, see or hear.

No insurance against disabling attitudes

Significant disabling attitudes are those that see the person as a tragedy, and a medical problem. Or as a worthless deviant with no economic role to play. Or treat them as a commodity in multi-billion dollar disability services and “care” industries.  As someone with long-time personal experience of quadriplegia and involvement in the disability area, I know that in a society like ours no insurance premium can buy you the status of a valued person, to be included in our society’s work, learning and playing activities, alongside everyone else.

There is of course a case for a no-fault disability insurance. I think of it as erasing the anomaly between those who might become disabled in a car accident, and receive a big compensation pay-out, or receive nothing if you did the same thing by being dumped on your head by an ocean wave, or acquired a disability at any time, whatever the cause. Or the anomaly where a legally blind person receives a means test-free disability support pension, but no one else does – while many impairments involve higher disability-related costs of living. At least a straight no-fault disability insurance scheme might compensate somewhat for the significant disability-related extra costs of living, thereby relieving some disability-related poverty.

There is now a proposal for a no-fault National Disability Insurance Scheme (NDIS) on the table. It wants a public, tax payer levy like Medicare or superannuation to pay for disability services and equipment for people with disabilities, whether born with an impairment or acquired one as a result of an accident. It says the results will be “transformational” for people with disabilities and their families but the scheme will not provide income support. And it says nothing about transforming disability services towards meeting fundamental needs.  Just the same disability services we’re getting now, but more of them, along the same lines of existing managerial service ideology. This, even as the NDIS proposal says the disability services system is not good enough, which is a notion I support.

Grounds for opposing NDIS

I oppose NDIS in its current form on several grounds. The main one is that you cannot make mango juice out of a lemon. We don’t need more of the same. We need something fundamentally different. Something based on the meaning of Care, not industry-based competition. Some approach that genuinely meets individual needs. Secondly, in doing so we need to honestly and transparently separate the budgetary needs of the disability industry and government Treasuries from the human needs of the people that this is all for: people with disabilities - and not let the first two ride over the third. Lastly, we need to pause and acknowledge that a similar levy-based scheme, called Medicare, has not so far led to an equitable, high quality, needs-based health system. So why would NDIS?

Disabling barriers within disability services

The NDIS proposal states that the disability service system was “not properly designed and structured, but has developed in an ad hoc and deeply inequitable way over several decades.” What it does not explore is where the causes for the unresponsive system lie. They are found as much in the disability industry’s values, fears and ignorance as those that shut people with disabilities out from our society. And often they are cemented in by the same managerialism and application of market forces to human wellbeing that Kevin Rudd says he is concerned about. This goes beyond tweaking or buying better quality service.

So what does NDIS propose? That its implementation will create quality service through industry-wide competition in a “a new competitive marketplace for service provision” driving” efficiency and effectiveness” That people can have more “case management”, a discredited managerial tool. That we can have “training, development and access to work to build self esteem...” Do you go to work for that reason? It says this perpetuation of the system, of which it also says does not work, will be “transformational” for people with disabilities. Sadly, making such calls about what people with disabilities need may actually get NDIS over the political line as people with disabilities and families grasp this straw in their desperation. But the security and safety actually being offered appears indeed as no stronger than that. Those are not the fundamental needs we need met. NDIS seems deeply incoherent and its real agenda apparently is simply more money and reducing cost.

Money alone is not the answer, but it is a seductive one. Truths about the devalued social position of people with disabilities are expressed in numerous reports, including the recent “Shut Out” report from the National Disability Strategy Review, and in the feedback pages on the NDIS Plan website itself. These reports show two noteworthy things:

1) The deepest felt needs, expressed by people with disabilities, involve their social acceptance and inclusion as a valued human being;

2) Such acceptance cannot be bought, yet there is a pervasive feeling that if only enough money were available to enable any services to be available to anyone who needed it, that all would be well. A sense of relief, security and safety would result.

But we also know, re-stated by 56% of submissions to the current Strategy Review report, "that services and programs act as a barrier to, rather than a facilitator of, their participation." We don’t need an NDIS that would entrench this.

Money cannot buy you love

We all know what happens when you try to buy love – it becomes a commodity and is thereby perverted. Paid service therefore always needs strong safeguards against its abuse: the pornography of care. The disability industry has few strong ones. One safeguard is to entrench service values, structures and practices in fundamental, individual needs, with care.

At heart, what people with disabilities need is full acceptance into the social fabric of Australia, and true service that enables them to be supported and celebrates the aspiration of their full human potential. Doing this will reduce many of the disabling effects of our impairments.

Yes, of course some of this needs money. But let’s not start with that. At the core of it is priceless attitudinal change. A society that attempts to buy it, with money or with managerial tools, will find that is impossible. It actually takes some hard yakka to create a welcoming community. And there are also some examples of good service to build on. A society that cannot do this with its most vulnerable members is unsustainable because of the underlying NDIS premise: We’re all in this together.

Let’s first look anew at the whole concept of insurance against disability, where being of service is more important than the disability services industry. Perhaps then, together we can craft an NDIS that supports good lives for people with disabilities.


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