Could the “user pays” model under NDIS also apply to PwD outcomes?

  • Can the ‘choice and control’ concept from NDIS be extended to disability employment to improve outcomes for PwD and employers?
  • If so, can current government funding for DES be rechanneled to PwD, employers as well as DES?

Under the National Disability Insurance Scheme (NDIS), the ‘choice and control’ principle introduces a ‘user pays’ model allowing recipients to choose their own disability service provider. Could this concept help improve outcomes for both people with disability (PwD) and employers, by redirecting some of the funding that currently goes to disability employment services (DES)?

My own interest is in disability employment and improving outcomes for PwD, particularly for people with acquired disability (PWAD) who represent a significant and growing proportion of PwD in the workforce.

I recently attended a conference in Sydney hosted by the Centre for Applied Disability Research (CADR). The first national conference sponsored by National Disability Services (NDS), it brought together researchers and NDIS representatives to share what they are currently doing to instill a culture of evidence-based research that delivers practical solutions in the provision of disability services. This fits with the NDIS insurance principles of spending on activities that work effectively and bring down lifetime costs.

As part of the NDIS ‘choice and control’ principles, the government allocates money to individuals (or their support team, as appropriate) under an approved plan allowing them to choose their disability service provider. As a result, service providers are starting to adopt a customer driven approach to service delivery, representing a major culture change.

One of the keynote speakers was Professor Tom Shakespeare from the UK’s University of East Anglia. He outlined the user pays approach seems to have helped move the service provider industry forward in delivering more of what customers want. (We’ll leave the question of price for the moment.)

People are talking about creating an environment where DES providers are not the only or even most important link between PwD and employers. As with disability service providers, the DES receive most of the money to enable PwD to get 13 week or 26 week work outcomes with employers (with the goal of securing longer term employment). Currently, the government is spending more than a billion dollars per year on these services, with a success rate of about 25%. If you talk to many PwD, they are not happy with these outcomes, although employers and PwD themselves probably need to take some of the blame.

It seems to me that we could redirect some of the government funding to replicate the NDIS ‘choice and control’ model in the area of disability employment, giving far more choice and control to PwD and employers. The desired outcome will be a DES sector focused on developing more appropriate services to meet customer needs, by working with incentivized participants.

For example, 25% of the money for disability employment could be given directly to the individual PwD to spend on the DES services of their choice.

Equally, 25% might go to employers as incentives to retain the growing number of PWAD, and to change the organizational culture for hiring PWD. Some of the money could also be directed to DES for providing services to employers such as advice on working with PwD and integrating them into the workforce.

In this way, government funding would give choice and control to the key players, i.e. individual PwD and employers. In addition, the DES would broaden their services: from just unemployed PwD to employed PwD; through to significantly more advisory services to employers. The available DES funding would fundamentally remain the same, but there would be greater stakeholder choice on how and where the money will be spent.

Posted by Mark Glascodine

BonnieSue Nevin

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