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Speaker: Mr John Walsh, AM, Partner, PriceWaterhouseCoopers - Support and long-term care for people with disability in Australia - transcript

MR WALSH:  Thanks very much, Norman, and thank you Comcare for inviting me to talk to you today.

I don't know how many of you have been up here but you can't actually see what's going on out there.  But believe me, you are more comfortable at the moment than I am, so we'll see how we go.

I've been asked to talk about support and long-term care for people with a disability in Australia, focusing mainly on the recent developments of the recommendations for a National Disability Insurance Scheme and a National Injury Insurance Scheme.  And, to talk a little bit about the way in which that blends into what you guys are doing as injury managers and coordinators in the large workers compensation system.

So, basically, today I'm going to talk a little bit about the conference objectives, and how I see those as being relevant to the NDIS and the NIIS and then go a little bit to the actual recommendations of the PC both with respect to the NDIS and the NIIS and again, come back to the relevance of those recommendations to Comcare and the Comcare client group.  And, we are going to talk a little bit then about the notion of an insurance model, which is something that is very different in welfare concepts.  It's not dissimilar to the sort of liability management that injury compensation schemes like Comcare, manage on a day-to-day basis, but in applying that sort of model and frame of mind to a welfare portfolio is something that government and government officials struggle with little bit.

To make it work, a lot of change needs to happen, and I gather that over the last couple of days, you guys have been talking a lot about what sorts of change needs to happen in a workers comp environment, particularly one which has a major challenge in its management of psychological injury.  I think there are many commonalities between what needs to happen for the NDIS and what needs to happen for a successful workers comp system.

Then, a little bit about where we are now.  We've had 12 months since the release - - or nearly 14 months now since the release of the PC's report, and the government's sharing the vision of that report, so I'll give a bit of a run down on what's happened in the intervening 12 months and where we are now, and where we are likely to be in the future.  And finally, and perhaps most importantly, the role of community, the environment, and business, including Comcare in making the NDIS a successful reality.

So, first of all, my understanding of the conference objectives:  the overall theme of the conference is build, connect and support, and Comcare wants to lead the conversation in this area of supporting mental health and broader well-being.  I think that Comcare has done that largely over the last couple of years.  It's been very proactive in bringing out people like Sir Mancel Alwad (?) with respect to the Work Wellness Program and the idea that a supportive and well functioning workplace can actually make a huge difference on the level of absenteeism and the rate of workers comp and claiming for other sick leaves. So, I think Comcare needs to be congratulated for that initiative.

The sub objectives are build, build capability and awareness, very relevant to the NDIS; connect people for better work ability; and, support people in recovery and return to work.  And, if in those latter two dot points you substituted participation in society for work, you would have two of the major objectives of the NDIS.  So, you're talking about trying to get people back to work.  The NDIS is trying to get people, as you will see as I go on, out of an isolated, restricted, life, into community participation.

And, all of those sub objectives I think are equally relevant. Ideas like continuous improvement, contribute to individual and organisational resilience.  Resilience is a massive thing for someone with a disability, probably the most important thing to allow someone to have the strength to challenge the world on a day-to-day basis. Awareness of people management - I'm not sure I would put that one in that way.  People management sounds very much like something that's done to people.  I think the idea is more about people empowerment, and working with people to understand what their real potential is, particularly for people with a psychological injury or mental illness.

Development of networking opportunities - absolutely.  Social capital is one of the strongest facilitators, will be one of the strongest facilitators for the NDIS, and we've been working a lot with service providers, disability service providers, large support organisations, to try and understand how they can transform from being service providers, managing people, to being people supportive, which means building social capital, building links into the community, and engaging with local government and local business to provide opportunities for people.

And finally, information ideas and strategies. Clearly,  there's a lack of research in the area of disability.  I don't know how well you guys are acquainted with the NH&MRC, which is the major research funder in the health system.  The NH&MRC spend something like $800 million a year on research, and there is additional state funding, which means the total health research budget is something over $1 billion.  The amount that is spent on research in disability is a bit less than $10 million, so about 100th of what is spent on health research.

So, let's talk a bit about the actual recommendations of the Productivity Commission.  The background to it, before I get into it, is that about nearly 10 years ago there was some interest by State and Commonwealth Finance Ministers and Treasurers to look at the tort law liability legislation around Australia.  You will remember we had HIH go broke in the late 1990's, and UMP, which is Australia's largest medical defence organisation, nearly go broke.  So, we had a major - the IP Review it was called - review of tort law liability in the late 90's and early 2000's and, one of the things that came out of that was the idea that for people with the most severe injuries, people with catastrophic spinal cord injury and brain injury, maybe the common law process, the tort law liability process, was not the best way to go.  So, there was a bit of work done for what's called the Insurance Ministers Council that recommended a national long-term care scheme for people with spinal cord injury and brain injury, not dissimilar to what already existed in the Victorian TAC and the Tasmanian MAIB, and the New Zealand ACC.

So, a recommendation went to those Ministers' Councils and like last year's sharing of the vision, they shared the vision, but not much happened, except in 2006 the New South Wales Government under John Della Bosca who - I will give a plug for Della, is the best Minister I have worked with -  initiated a New South Wales lifetime care and support scheme, and that sparked a bit of interest in this model, and lead to, in 2008, the idea of a National Disability Insurance Scheme being put to the Australia 2020 Summit that was convened by the former Prime Minister, Kevin Rudd. And, that led to a group called the Disability Investment Group which in turn - - it's a bit of a long and iterative story. The disability investment group published a report called The Way Forward which recommended that government look at the feasibility of a National Disability Insurance Scheme as a new way of funding disability in Australia.

The government's response to that - and I was a member of the Disability Investment Group - was to put a reference to the Productivity Commission to look at the feasibility of a National Disability Insurance Scheme, and I was asked to be an Associate Commissioner on that inquiry.  The other commissioners were Patricia Scott and David Kalisch, who is now the Director of the Australian Institute of Health and Welfare.

So, let's talk about the findings of the Productivity Commission.  First of all, it recommended two schemes, a National Disability Insurance Scheme, which is the big scheme to take over the funding and support of all people with a significant disability in Australia, which I'll talk a bit more about in a minute, and also a National Injury Insurance Scheme, which is not dissimilar to the Lifetime Care Scheme which was recommended a few years earlier.

We've been asked why not just one scheme, why don't we roll them into two schemes.  The main reason is that there were already existing state schemes, but the funding basis of the state accident compensation schemes was fundamentally different to what would be needed in a national disability scheme and couldn't easily be transferred without a massive injection of retrospective funding.

The idea also was that injury is something that, unlike most disability, is associated with risk, so in concept, anyway, can be prevented or minimised.  So, there was an opportunity in leaving injury insurance with the states in a premium model, to have risk incentives to the pricing model.  I'm not sure that works as well as it does in theory, but it was one of the reasons, anyway.  And also, the idea of the existing state schemes were that they were models for the NDIS, so it didn't really make sense for the tail to wag the dog and for you to collapse the existing schemes into what was the new and untested model.

And finally, we recommended that in 2020 the government do a review of whether or not it was sensible and functional to have two separate schemes, an injury scheme and a disability scheme.

So, what were the findings of the PC in respect to the NDIS? And, these words have come into folklore over the last 12 months. Any of you who have been to any conferences on the NDIS would have heard these words.  Basically, the Commission found that the current disability system is underfunded, unfair, fragmented, and inefficient, so not a lot going for it, and to try and address those four shortcomings, we recommended, first of all, with respect to underfunding, pretty much double the funding from about $7 billion up to - we said $13.6b. That's since been tested by the Australian Government Actuary and broadly supported, but because of the recent - - mainly because of the recent Fair Work Award, a modern award which has recommended a major increase to the  wages of care workers in the community,  the Government Actuary, Peter Martin, recommended that the government should work on a number of $15b as the gross cost. 

In respect of unfair - - and what we meant by unfair was really whether or not you got a disability support package meant that - - depended on where you lived, whether someone else who could talk better, got in before you, and basically, was not at all related to your support needs or natural supports.

So, what we recommended was to introduce a national assessment process for eligibility and entitlement based on support need, which comes to one of the features of the insurance model that funding should look at need rather than last year's supply, and it's a fundamental and critical component of the whole model.  I will talk a bit more about it later.

With respect to fragmented, we recommended that a national disability insurance agency be set up to ensure portability of support packages around Australia, but nevertheless, to look at the local area coordination that has been successful in Western Australia and the UK.  So, to still focus on localised support and coordination and local innovation.  So, the model was very much that there needs to be a national funding model and national monitoring and consistency, but with local support and innovation.  The last thing we wanted to do was to create another big Canberra bureaucracy, which we found in other areas is quite divorced from the reality of on the ground support.

And, the last thing we recommended was with respect to inefficient, to replace the current block funding model whereby support organisations pretty much tender for a big block of money, to ration out to their members or their clients, to replace that block funding model with one which followed the individual based on their support need, so more an individual package type model which introduced choice and control for the individual, and again this follows the themes that are coming out around the world around human rights for people with a disability, and the in control model of the UK has been quite a leader in that regard.

So, all of that sums up to the National Disability Insurance Scheme.  It sort of can be characterised in three tiers.  At the broadest level, there's an insurance type concept which covers the whole of the Australian population, so that - - at the moment, if you acquire a disability, there is no guarantee that you will get any funding for support.  There is not a system like Medicare where you can go to the GP and your service will be paid for by government, or largely paid for by government.  If you have a disability, and you front up to ADIC in New South Wales or Human Services in Victoria, you will only get support if there is money available.  The government is not obliged to provide a support package.  So, it basically defaults to your family, your natural supports, and if they're not available, well, you probably end up in Kings Cross sleeping in the streets or in jail.  That's probably a bit dramatic, but nevertheless, the idea of entitlement is a pretty important idea.  And, the idea of universal coverage is also a different model.

There is a rider to that.  When we worked on the DIG Report we did work at whether this should attempt to look at disability in ageing, and it was found that that would really not be feasible, both because it would greatly increase the cost, which is already scaring governments, but also the motivations and the incentives that we wanted to embed in younger people with a disability, are fundamentally different from those that you want to do in an aged care system.

Tier 2 is around supporting everyone with a disability.  And, about 4 million people in Australia, according to the Bureau of Statistics, report as having a disability, and at some level are at risk of that disability deteriorating, getting worse, and knocking on the door of the NDIS.  So, Tier 2 is a very important building block or pillar in supporting people in the community, in business, in local government, so to the extent possible, they don't need to go into the NDIS. It's part of the risk management of the NDIS.

And finally, Tier 3 - and note that in Tier 2 that we've got 800,000 primary carers, so still the total cost of disability support need is largely propped up by families and by friends and by business colleagues, community.  The NDIS by itself could not fund the total need of all people with a disability.  And finally, Tier 3 is those people - about 400,000 we estimate - who do have a support need which is significant enough to require an individual assessment and package.  And, to give an idea of the extent to which those 400,000 people are currently covered, at the moment there's about a bit over 300,000 receiving any sort of package from the disability agreement or the home and community care agreement, under 65.

So, people have said, well, you know, 400,000 is not enough.  You're going to get people knocking on the door as soon as the scheme takes off.  That hasn't been the experience in other schemes like this, and the fact that we think most people who have a very significant disability, would probably be registered somewhere. We don't think there is a massive crowd of people out there who will be getting nothing, but there are a lot of people out there who are getting not enough.  So, the 400,000 people we think will be sufficient to cover pretty much everyone who knocks on the door, if the door is a robust enough and if Tier 2 works well enough.

So, what are the types of disability that we expect will come into the NDIS? And, this, I guess, is where it starts to depart most fundamentally from workers comp.  Very few people who sustain a workers comp injury would have a disability which ends up severe enough to warrant the need to go into the NDIS.  I will show you.  I'll go back to the previous slide.  There's no need to flick it back, just talking generally.

I should say that I thought I knew the disability system.  I've been in a wheelchair for 40 years, and I get support and pretty much been around various organisations.  I had no idea, until I got into the Productivity Commission's inquiry - - we had over 1,000 submissions and we had over probably 100 hours of public hearings, where people came and told their story in every capital of Australia - we went around twice.  I had no idea of the extent of difficulty, disadvantage, and deplorable conditions that some people live in, and it really is an eye opener.  Disability has been hidden.  It talks about being hidden, but believe me, the isolation and lack of potential or lack of opportunity that's given to so many people with a disability and their families, is something that a civilised society like Australia should have as its core business to fix.  That is what really moved the Productivity Commission, and I have to say that the Productivity Commission is not a bunch of bleeding hearts, they're a group of very dry, market economists, and from starting from a, you know, you've got to be joking, John, we're not going to double the funding, to by the end, saying that this is the core business of government and it has to do it, was really a manifest declaration of an unmet need.  So anyway, types of people covered.  Thank you, next slide.

It is very different from workers comp.  So we're talking about people with intellectual disability, people with autism, severe autism, the Aspergers part of the spectrum hopefully can be managed largely in Tier 2, a lot of them.  Congenital or acquired severe physical disability - and in that group we have cerebral palsy, muscular dystrophy, musculoskeletal injuries, severe musculoskeletal injuries.  For the NDIS, people who have previously had a spinal cord injury or an acquired brain injury, would come into the NDIS.  People who have a new spinal cord injury or acquired brain injury, would go into the NIIS, so there's a bit of a dual coverage for that type of condition.

Neurological disabilities like spina bifida, multiple sclerosis, motor neurone disease, profound sensory disability, sight impairment, hearing impairment and deaf blind.  We saw some very impressive deaf blind people. And, finally, and probably most relevantly to Comcare, significant and enduring psychiatric disability, people who had community support needs, in addition to any clinical support that may be diagnosed for their condition.  So, it's very different from someone with a lower back strain or a soft tissue injury.  I'll get on to the relevance to Comcare in a minute.

I think Comcare has a huge role in making sure that people with those - - at the time of injury at least, fairly minor injuries, don't escalate to the level that they are in the NDIS.  I've done quite a number of reviews of workers comp systems, and some of the long-term outcomes of claims that should have been pretty simple, are really pretty disgraceful.  And so, the advanced management of minor injuries I think is an opportunity for workers comp to mitigate the need for those people to end up in an NDIS type scheme.  Thank you.

So, on to the National Injury Insurance Scheme, this model was a federation of State based schemes, and we already have the New South Wales lifetime care, Victorian TAC and Tassie MAIB, which cover the major injuries on a no fault basis for their future care and support for motor injury, but not for other types of injury.

So, the recommendation was that other states, Queensland, South Australia, W.A. and ACT introduce no fault motor schemes as a first priority for the long-term care, and that later on, all states introduce no-fault coverage for major injuries, care and support, for other types of injuries.  So, for criminal assault, which is one of the major causes of brain injury, and sporting injuries like diving into shallow water, football, are major causes of spinal cord injury.  And, we recommended a small national coordinating unit between the NIIS and NDIS would probably be housed with the NDIA. There's only about 1,000 new entrants we expect into the scheme per year, mainly spinal cord injury and brain injury, and we estimated the total gross incurred cost of close to $2 billion or close to $1 billion extra to be funded by the states.  And, part of the model of the Productivity Commission was that the Commonwealth Government would take on the funding responsibility for the NDIS after offsetting what's currently funded by the states, and that would mean that the Commonwealth had very strong leverage for the states to sign up for the NIIS.  So, the Commonwealth could say well, we're bailing you out in terms of your disability system but, hey, you guys better set up decent injury systems.  Because the Commonwealth has walked away a little bit away from that funding model, some of the leverage to make NIIS a reality, has been lost.

Key features of both schemes: universal insurance coverage, so with NDIS and NIIS operational, anyone who acquires a major disability or injury would be covered for their future support needs.  What that brings with it is risk, so we know - - you guys know in Comcare that once you've got someone who's got an injury and an expectation of entitlement, there is a risk of cost blowout and so there's a need for an insurance based governance framework.  There's a surety of funding base, so our recommendations said that let's replace the current annual argy-bargy between the Commonwealth and the States about who funds what, with a legislated formulaic premium based on the support needs of people covered.  And, that support would be based on reasonable and necessary support need.  And that's where this gets tricky.  What is reasonable and necessary support need, and why isn't that everything that people want?  And, that's where the governance and management - you would be familiar with this in your claims management of the workers comp system - how does that get managed?

And finally, the last two, support focused on the individual and the carers, and the idea of choice and control being introduced so that the person's future is determined by them, and their support need is just a facilitator to achieve that potential, rather than the support need being a service which is delivered in a way over which the individual has no control.  Thank you.

So, what's the relevance to Comcare?  There's probably some direct impact through people with spinal cord injury and brain injury.  The industry and injury profile of Comcare means that you won't get a lot of people that have these major traumatic injuries, but there will be a few.  The PC didn't recommend that workers comp be part of the NIIS, but it did acknowledge that most workers comp insurance, including statutory authorities, do not have as their core business, the support needs of people with major catastrophic injury like spinal cord and brain injury. So, there was a suggestion that the management of these claims, if they occur in a workers comp environment, might be transferred over to the NIIS which would be expert in working with the support needs of people with spinal cord injury and brain injury.

There will be, as I mentioned earlier, some claims which have a less severe injury, and these will be particularly soft tissue injuries that are badly managed, and psychological injuries which deteriorate.  There will be some claims that fall out of workers comp, and end up being taken over by the NDIS.  There are currently about 800,000 people receiving a disability support pension, and you will remember that I said that there would be 400,000 in the NDIS Tier 3.  A large number of people who receive a disability support pension are people who have not a really bad support need, but are unable to work by nature of their mainly psychological injury or mental illness or deteriorating musculoskeletal soft tissue injury.  So, those sorts of people often do come through the workers comp system.

Another, commonality is the attention to psychosocial and environmental influences on injury and disability.  They're equally relevant to both types of system, and they are fundamental to achieving good outcomes.

I was talking to Paul O'Connor, before, and he asked me to mention some work I did in South Australia around rehabilitation and claims management, and Allan Clayton and I did a major review of South Australia a few years' ago.  And, we recommended a new system that we thought looked okay on paper and would reduce the liability and the premium rate for the South Australian workers comp system.  But, we made it very clear in those recommendations that these findings and these premium reductions and liability reductions, are contingent on you changing the culture of your scheme, on your claims managers, your injury managers, your employers and workers, starting to acknowledge that psychosocial influences and motivators are the most important things in getting people back to work.  So, if you don't change the notion of an injured worker as someone who is out to rort the system, and if you don't change the direct supervisor of that person in their workplace who is not prepared to support the injured worker to come back to work, you are not going to achieve premium reductions and liability reductions, because no matter how manageable an injury is, if a person who is sustained that injury doesn't feel culpable in returning to work, but if the work place doesn't feel comfortable in bringing that person back, the claim will deteriorate and you will end up with a long-term liability. 

The last commonality that I put here - and I am sure there are many others - is the notions of Tier 2 and Tier 1 in terms of community awareness and support.  And they resonate very strongly with the Comcare objectives of workplace health and wellness.  And I think Comcare, which Paul told me employees or covers over 400,000 workers, 4% of the Australian workforce, Comcare can be a leader in demonstrating awareness and support for people with a disability.

So, just going back to - - I was going to make the point, but I've already made it, that Tier 2 and Tier 1 provide an opportunity for Comcare to build that social participation opportunity, and to help with information referral and services around knowledge and disability.  Next slide.

I might just move quickly through this one.  I'm probably using up too much time.  I thought I'd put this one up, which is the consumer perspective on disability.  This is a graphic from the Productivity Commission report, and you will see that the person with a disability is focused at the top, and that the funding body, the support organisations and the service providers, are blocks on which the person is supported, and really I think in a workplace return to work model, in a workers comp model, that sort of graphic has equal relevance.  It doesn't have to say that the person with the disability gets everything that they want, but it does say that to return an injured worker to work, you need to listen to them and understand what their issues are.  Very rarely are their issues the injury.  By profession, I am an actuary, and we've done a lot of work over many years and your actuary, Adrian Guild, is in the audience. We have done a lot of work on what are the predictors of a long-term claim outcome, and things like injury type, injury severity that are recorded, that type of injury, are not very good predictors of outcome.  I'm sure what a good predictor of outcome would be is if you ask someone four weeks after their injury, do you think you are going to go back to work?  That would be the best predictor of the outcome of the claim.  So, where the person's head is at, is in many ways the best predictor of where the claim is going to end up.

So, where are we up to?  Key features of the insurance model.  I'll go through this pretty quickly.  The benefits of insurance approach.  Risk pooling - - I talked a bit about that before. So, the acquisition of a severe disability is a rare and expensive event, beyond the means of most people and their families, so it's a natural for an insurance type model.  But, not for a commercial risk premium based model.  The people who are most at risk would least be able to afford the premium they'd be charged, so what we recommended is a community pooled model, if you like, everyone contributing to the pool of money required to support an NDIS.

Individual entitlement or claim in a commercial insurance language I've talked about before.  The idea of risk estimation or underwriting, is this notion that the budget, the $15 billion, is estimated from an analysis and an estimate of what is the reasonable and support need of the disability system.  It's very different from what happens traditionally whereby welfare systems have a budget, which escalates from year to year based on supply, based on what the welfare agency is able to argue to Treasury and Premiers of where their services are going to go - very little attention to what is actually needed in the context of if we put a support under this system, what would it cost?  It implies short-term cost escalation, but long-term benefit.

We've had a look at the drivers of cost in the disability system, and the typical scenario is that you have an ageing parent who is supporting a middle-aged person with a disability and has done for 50 years or so, can't do it any more.  They're just getting a bit of respite, and they can't get by any more with that respite.  There's not enough money in the system to give them a reasonable package, so in the end, they're left with the question - we heard a lot of it in the inquiry - what do I do when I die?  What does my son or daughter do when I die?  Who will take care of them?  And, what has to happen is that for that ageing parent, often in their 70s or 80s, to relinquish care.  So effectively, they dump their son or daughter on the system.  The system has no choice but to find a place.  That's expensive because it's an emergency response, $150,000, $200,000.  So what the system has to do is withdraw lower-level support and respite from maybe 10 or 20 other families, putting them in a situation of crisis, and so you can see the snowballing effect leads to cost escalation.

So, the NDIS is an attempt to short-circuit that debt spiral as we called it, and it leads to short-term increase in costs, doubling in funding, but if you look at the rate of escalation of costs in the disability system at the moment, within a reasonably finite number of years the cost of the current system would exceed that of the NDIS, and people with a disability get better outcomes.

The prudential governance, number 4, I've talked a bit about before.  That's really managing the cost of the scheme.  Planning for positive outcomes is the insurance equivalent of claims management.  You'll remember I talked at the start about the focus of the conference being building better support, living better return to work.  Those things are equally important in the NDIS, and they have an investment notion, if you invest in early intervention, if you invest in mitigating the impact of disability, you're going to get better outcomes and long-term cost reductions.

And, finally, constant surveillance and transparency.  You can't run a system like this or you can't run a system like Comcare without daily data, and that again, is a thing that's foreign to welfare systems.  Typically, we get a report from the Australian Institute of Health and Welfare, which is 18 months after the year is over, and it's a summary of something that happened two years ago.  A system like this needs operational data that allows it to manage on a day-to-day basis.

So, the model for change - and this is a recurring theme - is that we need change through the whole system.  The NDIS is a funding opportunity.  It can be a driver of social and cultural change, but only if stakeholders at every level of the system buy into it.  So we need massive capacity building among disability service providers, among health professionals, among disability support workers and about culture.  So, that capacity building is something I would be doing if I was running the show.

At the launch sites which are currently happening, we would be actively engaging in those launch sites to build capacity.  Those principles - I won't go through them.  They came out of a function a report PWC wrote last year, that the four fundamental principles for disability support re those equal rights, facilitation by society, choice and inclusion.

So, what needs to be done?  And, this is sort of where we were 12 months' ago, and I think where we still are in many respects.  I'm not sure if some of these fundamentals have changed in the last few months.  There's an agreement called the National Disability Strategy which sits alongside the NDIS and was agreed by COAG as part of the planning for the National Disability Agreement, and it commits funding and support by all government agencies, so departments of housing, transport, education, employment, all have commitments to disability targets by I think it's 2021.  That National Disability Strategy needs to happen to support the NDIS.  There's not much point giving someone a support package to allow them to get a job if they can't get a bus to get there or they can't get a house to live in.  So the NDIS needs to be supported by agency and government support at all levels.  And again, public reporting is critical.

So, where are we now?  So, as Norman said, we've come a long way, but we've got a long way to go.  We had agreement last year by COAG on the principles that underpinned the NDIS, and the past 12 months have really been spent in developing government and system understanding of the NDIS concepts.  I had no idea, and neither did our other commissioners, on the frenzy of activity that would happen once the government agreed to the NDIS.  There have been so many committees and subcommittees and senior officers working groups set up around the country that you wouldn't believe it, and it's been incredibly frustrating for someone like me and others who have been involved for a long time.  But, I've sort of came to the realisation that is necessary thing for government to actually understand what NDIS was all about.  It's a very different animal, and I think they needed the 12 months to basically get their head around it and hopefully we can move forward now.

What has happened is that they have worked on building blocks of key infrastructure for the NDIS.  Unfortunately, those putting blocks have been worked on independently from each other so it's a bit like, you know, building a house with 10 different builders.  You hope it all fits together at the end, but some of the building blocks are things like eligibility and assessment, support packages, sectoral and workforce capacity, information technology, and there's a bunch of others.  And, there's been a lot of discussion.  It's been in the media around the appropriate funding responsibilities and governance structure.

So, happily, we've recently had the establishment of an NDIS launch transition agency, which has responsibility for building the NDIS launch in agreed locations, and it's starting to attract experience from the disability sector and insurance.  All of the working groups and committees that were active over the last 12 months, really I think the main qualification was that you work in Canberra, so there were a lot of groups built up with not a lot of knowledge on the staff.  I think they have developed over the last 12 months.  And the launch transition's agency is working on system development and capability.

There are five launch sites agreed.  One is in the Hunter, which is a large one.  $10,000 whole of population, which is the sort of launch site which was recommended by the PC, and there was some technical and scientific reasoning for the design of the launch sites which has been a bit lost, but the Hunter is one example of what we regard as a good model.  In Victoria there is about a $5,000 whole of population model.  In the ACT, about $6,000 and in South Australia and Tasmania there are statewide cohort launch sites for children and adolescents.  W.A. has been resisted to NDIS, mainly because W.A. has a system which I think is probably the best in Australia and are quite resistant to being taken over by a Canberra or national agency.  I can understand that reluctance, but we heard during the inquiry that there are many things still to be addressed about the W.A. system, and hopefully we can learn from the W.A. system in building the national system and ensuring portability between states.  Queensland is not yet participating in a launch, and the NIIS is progressing slowly, but because of some difficulties around the funding models the incentives of states to sign up for the NIIS are not as strong as they might have been.

So, one more slide.  And, that is the role of community, environment and Comcare.  So, going back to this notion of the NDIS itself can't fix the solution, can't fix the system, the entire support need of people with a disability is provided by family, friends, community and business as well as the NDIS, so it needs to work with the National Disability Agreement which I spoke about earlier and the National Disability Strategy to rebuild community awareness and understanding. These next two dot points are a bit of a hangover from another conference on accessible homes and buildings, but nevertheless, very relevant.  But, the last dot point there is that the ultimate solution is a combination of funding enhancement, improved infrastructure, and an evolved culture, and I think Comcare can be a leader in starting to move towards that.  Thank you.  Last slide.  [Acclamation.]

Page last updated: 18 Jan 2018