Centacare Townsville Submission to the Productivity Commission’s Disability Care
and Support Inquiry

Who we are
Centacare Townsville is the community services arm of the Townsville Catholic Diocese and a not for profit organization located in the northern region of Queensland.     Centacare has been providing a range of supports to people with disabilities since we were established in 1979. We provide Disability Services throughout the Northern region of Queensland, from Mt Isa to Townsville. We provide a range of flexible services to both children and adults with disabilities and their family members/Carers.  Through the supports we provide, the employment of a staff member with disabilities, the extensive networks we have established and the weekly inquiries we receive from the community trying to access Disability supports, we believe we have a deep understanding of the unmet needs of people with disabilities in our regional and remote communities.

We strongly support the establishment of a Disability Care and Support Scheme that 
would fund the support needs of people with disability throughout their lives. 

Introduction 
Centacare has become acutely aware that too many Australians with a disability, their families and carers struggle to achieve a basic quality of life. Without adequate support and resources, many find themselves unable to participate meaningfully in the economic, social, cultural and political life of the nation. While Australia prides itself on being the land of the “fair go” this has not been extended to people with a disability, who 
find themselves excluded, marginalised and forgotten. This is no longer acceptable. It is time to introduce a disability support system that meets the needs of Australians with a disability, their families and carers in the 21st century and beyond. 

Australia ratified the United Nations Convention on the Rights of Persons with Disabilities in 2008. While an historic and significant moment, ratification is 
simply a first step on a long journey to ensure the rights enshrined in the 
convention are not only protected but, more importantly, able to be fully 
realised. While it is clearly not the only factor to be considered, it is important 
to acknowledge that rights can remain elusive if adequate resources are not 
provided. 

Centacare’s vision is an Australian society that ensures the full and equal social, 
economic, cultural and political participation of people with a disability, their 
families and carers. The Commission’s concise summary of the goal of any 
new scheme is therefore a good one – “to enhance the quality of life and 
increase the economic and social participation of people with a disability and 
their families” (p9). 

Resources are important but not sufficient. Any long term care and support 
scheme should sit within the National Disability Strategy currently being drafted by the Council of Australian Governments. The role of the strategy is to address the systemic changes that must be made so that people with a disability, their families and carers are able to enjoy the same rights as other members of the community. This includes making provision for a strong independent advocacy movement. 

The Commission’s detailed issues paper gives some indication of the depth and 
breadth of questions that must be answered before a new scheme can be developed and implemented. But equally important to dealing with the detailed questions of design and implementation is establishing the principles which should underpin the scheme. If the foundations are not adequate the scheme will ultimately fail to deliver the kinds of reforms people with a disability, their families and carers and the organisations that support them have long been seeking. Centacare believes the principles of equity, self determination, efficiency and sustainability should determine the development and implementation.

Guiding Principles 
Centacare believes that any new National Disability Insurance Scheme needs to have a commitment to the realisation of the rights enshrined in the UN Convention on 
the Rights of Persons with Disabilities. The intent of any disability support scheme should be to ensure people with a disability receive the support they require to be active, engaged, productive and participating members of the community. The scheme should be a mechanism by which people should be able to exercise the full range of their 
rights as outlined by the UN Convention. 

Equity and Eligibility 
The system should be fair. All people with a disability should be entitled to the support they require to be full and equal participants in the economy and the community, regardless of how they acquire their disability. People born with a disability or who acquire a disability through accident, illness or progressive medical condition should all be eligible for assistance. The scheme should also   provide support to those with a psycho-social disability (mental illness). The scheme should be no fault and should provide support for people who have a permanent disability which has a significant impact on their daily life. Support should not be restricted to people with a severe or profound disability but people with a more moderate disability should also be eligible for assistance. 

In other nations around the world there is a legislated entitlement to support. No such right exists in Australia. People with a disability, their families and carers should be entitled to the support they need to be active, engaged members of the community. Eligible individuals should be entitled to the support they require based on a simple and transparent assessment of their needs. As needs and circumstances change so too should the support provided. Any assessment process therefore needs to be flexible and 
responsive to changes over the lifecourse. The scheme should ensure national 
consistency in eligibility and access. Families and carers should also be entitled to the support they require to continue to sustain their role in supporting their family member with a disability. 

The scheme should not only establish equity between all types of disability but 
between people with a disability and the rest of the community. In short, the 
scheme should recognise the additional costs of living with a disability. One of 
the ways to address the continuing inequity between people with a disability 
and those without is through the provision of adequate services and support. 
This should always be a separate consideration to the provision of income 
support. 

It is also important to remember that the provision of adequate support and 
services should not reduce the obligation on communities and government to 
become more accessible and inclusive. The onus should not be on the 
individual to use their entitlements to address inaccessibility and exclusion. Centacare 
believes the insurance scheme should in fact have a strong interest in addressing structural and systemic issues such as inaccessible public transport because it would have a long term interest in reducing costs. In this way the interests of the scheme and the interests of the individual would be aligned. 

Finally the principle of equity should extend to the funding of the scheme. The 
cost of supporting people with a disability should be borne by the broader 
community – the determining principle should be that as disability is something 
facing everyone in the community, the whole community should share the cost 
of support. As the Commission rightly points out in its issues paper, social 
insurance is therefore the most appropriate approach as private insurance 
would function neither “efficiently or equitably”. 

Self Determination 
The scheme should institutionalize mechanisms to ensure people with a 
disability, their families and carers are able to exercise choice and control. The 
scheme should be person centred and individualised, based on the choices of 
the person with a disability, their family and carers. The services and supports 
able to be purchased through such a scheme should be broad and diverse, 
determined by the individual needs and circumstances of those assessed as 
eligible. 

There is strong evidence from around the world, including Australia, which 
demonstrates the positive impact of self determination and control on health 
and wellbeing. The scheme should create a culture of independence rather 
than foster continuing dependence. It should create and support a marketplace 
for services and supports which will drive innovation and efficiency, improving 
value for money. 

The scheme should also recognise that the introduction of choice and control 
requires an investment in information, resources and advocacy to ensure 
people with a disability, their families and carers are provided with the tools 
they need to make informed choices. The scheme should recognise that some 
individuals will require greater support to plan and exercise choice than others and some will require a range of mechanisms to ensure safeguards are in place in order to uphold and protect individuals human rights.  

Efficiency and Effectiveness 
The scheme should redirect attention from short term costs to long term 
outcomes, identifying and developing those services and supports which 
maximise independence, productivity and participation. In this way services 
and supports should be reframed as investment rather than charitable 
handouts. In this way too the interests of the individual and the interests of the 
scheme will become aligned - both have the goal of ensuring every individual 
has every opportunity to reach their full potential. While such a scheme would 
obviously be interested in reducing long term costs, individuals are most 
interested in identifying and using those services and supports which maximize their independence and participation. This is most obviously seen in investment in early intervention, but is also seen in other services and supports such as home modifications or the provision of timely and appropriate aids and equipment, including communications devices. 

In maximising efficiency and effectiveness, the scheme should also establish 
national standards and ensure portability across jurisdictions. The scheme 
should also provide an entitlement to services over time rather than a lump 
sum payment from which individual should pay for the services they require 
(although larger sums may sometimes be necessary for the purchase of 
equipment). In this way the scheme would automatically balance the risks that 
some people will live longer than expected and others shorter, while some will 
have more severe disabilities than expected, while for others the impact of 
their disability may be less than anticipated. 

Another important aspect of an efficient system is data collection, research, 
identification of best practice, support for innovation and benchmarking. All of 
these are currently not in evidence and should be features of the new system. 

Sustainability 
Sustainability should be achieved on four levels. Individuals should be 
sustained over the lifecourse. Individuals with disabilities require certainty in order to plan meaningfully for the future. They need certainty that should their needs and 
circumstances change, the system will respond appropriately. Families and 
carers too should be sustained and nurtured in their caring role, equipped with 
the tools and resources they require to appropriately support their family 
member with a disability. A sustainable system must also address such issues 
as capacity, workforce development, infrastructure, research and innovation 
etc. It must ensure supports and services are available through a diverse 
range of organisations, which must be viable and sustainable. 

And finally the entire system itself should be sustainable. Any new scheme 
must be affordable over the economic cycle and take account of demographic 
and social trends. The number of people with a disability is increasing and the 
number of people willing and able to provide unpaid care is decreasing. Any 
new scheme must ensure the needs of all are able to be met both now and in 
the future. The scheme must account for both the social and economic needs 
of the nation and ensure they can be met in a fiscally responsible manner. 

Conclusion – The Importance of Insurance 
Simply tinkering with existing system will not deliver these outcomes. The 
current system is fundamentally flawed and far beyond minor reform. It may be 
possible to design a system that delivers some of these principles. But we 
believe all of these principles are best achieved by a social insurance 
approach. That is why we support a National Disability Insurance Scheme. 

The scheme is not beyond the nation’s capacity to deliver. While there may be 
additional funding required in the short term, in the long run we believe the 
scheme will not only deliver better outcomes but also savings over time. In working to ensure people with a disability, their families and carers receive the 
support they require to be productive, participating members of the community, 
the interests of individuals, the interests of the scheme and the interests of the 
nation are all aligned. 

People with a disability their families and carers have waited many years for 
change. And there have been reforms introduced which have made a 
difference to their lives. But their effectiveness has been limited by their 
location within a fundamentally flawed system. The time for piecemeal reform 
is over. The time for a transformation change has come – the time for a 
National Disability Insurance Scheme has come. 

Dr.  Tony McMahon
Director