Michelle Ananda-Rajah (Victoria, Australian Labor Party) | Hansard source

The NDIS is a vital piece of social infrastructure. It was born of a simple but powerful idea that people with disability deserve to live in dignity and security and participate in wider society. Prior to the NDIS, for families and participants, it was a living hell. They were effectively segregated and lived in the shadows, so the NDIS has indeed been transformative for thousands of participants and their families. It has brought them relief from carer stress and the rigours of looking after people with disability.

However, in order to protect the NDIS for future generations and the current generation, we must confront some hard truths. Growth has been unsustainable, the scheme is riddled with fraud and it has suffered from mission creep beyond permanent and significant disability, with particular growth seen in autism spectrum disorder. It has far too much variation because it lacks consistency, standards and quality.

On the topic of costs, costs have ballooned. The scheme now costs $50 billion for 760,000 participants. This contrasts, for example, with Medicare, which costs $40 billion for 28 million people. The scheme is at genuine risk of losing social licence amongst the Australian public because costs are accelerating out of control.

On the topic of diagnostic inflation, autism is the fastest-growing category on the NDIS. Currently, there are around 300,000 participants with autism. I'm concerned about this overmedicalisation we've seen of neurodiversity, and it turns out I'm not alone. Prominent neuroscientist Professor Uta Frith also raised similar issues and concerns around autism diagnosis. Reported in the Times recently, she said:

The spectrum has become so accommodating that I fear that it has now been stretched so far that it has become meaningless and is no longer useful as a medical diagnosis.

As a former medical professional, I know that orthodoxy is often challenged when new evidence emerges in medicine. This orthodoxy that has been present and which has seen this diagnostic inflation and massive growth in self-diagnosis of autism has been challenged now by the very person who did the seminal research and work on autism. This means that we all need to sit up and pay attention. We all need to sit up and pay attention. That's one aspect—diagnostic inflation.

Then we have all the other issues, including fraud. Those issues have been well described and are due to systemic design failures in the scheme. The reforms in this bill for the NDIS are designed to address these gaps. They will fight fraud and stop the rorts, slow the rapid acceleration in cost and apply clear, standardised eligibility criteria that will be grounded in functional capacity so that we move away from this overmedicalisation of disability and we move away from medical diagnosis as an entry, a gateway, to the NDIS. As a doctor, I am staunchly against overmedicalising anything, and I think this is what I mean—this is what I speak of when I talk about mission creep.

We're also aiming to deliver better-quality services to participants. These reforms are not about winding back the NDIS. To the contrary, they are all about strengthening the NDIS.

On the issue of eligibility, we'll be standing up a technical advisory group that will bring together clinical, allied health, disability and lived-experience expertise to help thrash out what assessment and thresholds around functional capacity look like.

On the issue of social and community participation changes, these are also very contentious, and we heard a lot about this from people during the hearings. But, again, this particular aspect of the scheme has seen rapid, rapid growth—a tripling in just the last five years. We will be constraining that and moving away from this individualised support to a more inclusive program that is embedded in the community. We will also be setting up a $200 million communities fund in order to integrate disability with mainstream society—and that is really important. These reforms are much needed and they are long overdue.