Breaking Up Is Risky Business: Personalisation and Collaboration in a Marketised Disability Sector

Abstract

The marketisation of disability support driven by individualised funding brings new dilemmas for multi-agency collaboration, in particular how to provide personalised supports while remaining commercially viable. This article explores the challenges, risks and adaptations of organisations to navigate the tensions of personalisation and collaboration. Framed by street-level research and using the context of Australia’s National Disability Insurance Scheme (NDIS), this article draws on interviews with twenty-eight organisational managers. Multi-agency challenges are highlighted when several providers are delivering parts of a NDIS participant’s plan, blurring organisational responsibilities and accountabilities. Interviews also revealed the paradox of organisational disconnection and organisational dependence concerning quality support provision and described the collaborative responses organisations implement to ensure their sustainability. There is commitment among organisations to build a trusted ecosystem of providers, but this is largely discretionary and there is a need for further policy mechanisms to enable organisations to negotiate a way through multi-agency dilemmas.

Agendas of Reform: Continuity and Change in Australia’s National Disability Insurance Scheme (NDIS)

“…First, the low attention on rights in policy documents across the period only adds to the scepticism that rights-based discourse is more often part of the persuasive techniques of government that do not necessarily translate in practice without perseverance and an ongoing commitment (Barnes, 1995). In the case of the NDIS, this underattention to rights in documentation is significant because unlike other areas of welfare such as social security, where rights are realised once eligibility and compliance conditions are met, or healthcare where there is a right to a basic standard of publicly funded services through Medicare (Foster et al, 2012), the right to disability supports is far more ambiguous, reliant on the interpretation of multiple 'reasonable and necessary' criteria which are often in conflict (Venning et al, 2021;Hummell et al, 2023).…”

‘You’re out on a limb, on your own’: Social care personal assistants’ (PAs’) reflections on working in the Covid-19 pandemic ‐ implications for wider health and care services

“…At the same time, this PA employers’ report found PAs were not able to afford to hire PAs via brokers or agencies due to the additional costs [ 7 ]. Highlighting the situation from an international perspective, a study from Australia [ 27 ], drawing on interviews with 28 organisational managers of disability support providers, noted difficulties reconciling competition, marketisation and multi-agency working in a direct payment marketplace.…”