When the Hawke government recast Whitlam's Medibank as Medicare in 1984, it was described as the one of the largest social reforms in the country's history.
The introduction of the National Disability Insurance Scheme, or NDIS, will be as far-reaching - and as difficult to initiate - say providers and developers.
Speaking with those responsible for providing a new complex of Ballarat homes designed specifically to address the needs of people with disabilities, and with providers more broadly, all agreed there were benefits and challenges ahead of the NDIS as it expands.
From just 90,000 participants in 2016-17, the scheme now how has almost 300,000 participants and is growing exponentially; with a forecast 460,000 people aged under 65 enrolled at its peak.
Established by the National Disability Insurance Scheme Act 2013 (NDIS Act), the scheme is a complex and wide-reaching series of reforms designed to remove the focus from short-term government policy and return it to the individual for an 'all-of-life' approach to care.
Administered by the National Disability Insurance Agency (NDIA), the philosophy of the NDIS is to turn away from 'welfare' and focus on 'independence' for the individual.
But how that philosophy transfers to action is the crucible of the reforms being introduced.
The Courier spoke to three developers and providers involved in the NDIS and the challenges facing them.
Developer Carra Property has built nine new Specialist Disability Accommodation (SDA) dwellings in partnership with disability services provider CareChoice, following previous developments in Ballarat where the company provided disability service-compliant homes for Active Community Housing.
SDA is a funding component of the NDIS which allows approved individuals to live in a specialist housing solution.
Carra Property director Tom Carra says the new dwellings fit parameters set by the NDIS, based on guidelines published by Livability Housing Australia, a partnership between consumer groups, government and industry
Design issues such as surface thresholds, doorway widths, shower accesses, room sizes and circulation areas are all part of the considerations needing to be made at a minimum, says Mr Carra, as well as further requirements such as 'luminance contrasts' for the vision-impaired or fire sprinklers for mobility-impaired people.
He says the building of new dwellings is preferable to the retrofitting of an existing building, and the federal government has indicated the construction of new housing is a priority.
"The good news with SDA is that it provides people with disability the opportunity to choose and control where they live, whom they live with and who provides the support services," Mr Carra said.
"In the past, you might have been told, 'you're going to live in a group home in Ararat with 11 other people,' and if you didn't like it - bad luck.
Their biggest concern is not death; it's 'What's going to happen to my child when I go?Tom Carra, Carra Property
"Now there's a choice. By separating housing provider and supported living provider, if the person is not happy with the care support, they can effectively vote to appoint someone else without the threat of losing their accommodation."
But there are issues to be overcome, says Tom Carra.
"One of the big issues is it takes longer to do the paperwork than it does to build these dwellings. There are people that desperately need housing; that may be homeless or facing homelessness," he said.
"The process is taking an incredible amount of time, but participants or their support coordinators don't necessarily want to speak up because of concerns about retribution from the NDIS."
Mr Carra said the review of decisions was creating a massive backlog of work, and families were scared to criticise the scheme.
"SDA is terrific for those who get it. The challenge remains for those people with disability who don't receive it, estimated to be up to 94 per cent of NDIS participants. The broader issue of housing affordability is overlaid with the need to be able to share support costs with other participants.
"It is difficult to gain any economies of scale in support services when the people you want to share with cannot secure housing in the same location."
Tom Carra eloquently and sharply articulates the hidden grief and growing fear of many Australians.
"For parents of children with intellectual disability, who are ageing, their biggest concern is not approaching death; it's 'What's going to happen to my child when I go?'
"The private sector is in its infancy in developing solutions for these people, with very limited options currently available. As the market for SDA matures, it is possible that more flexible and innovative housing models may emerge for people with disability.
"A key part of this will be providing increased certainty for housing providers, so that they will invest in developing and maintaining housing options for people with disability."
Rebecca Cattermole is the manager of Services for CareChoice, a disability provider for 14 years. CareChoice has entered a partnership with Carra Property, and other developers, to provide support to NDIS participants, including the latest SDA homes.
These services include making sure participants are eligible for and attract the right amount of funding from the NDIA, and conducting matching processes for residents who might potentially share SDA.
"You might have two residents in a home, for example," Ms Cattermole said.
"They might be in a wheelchair; they might have mobility issues around their upper limbs. Our support workers then provide round-the-clock support in a shared roster to assist with things you and I do and take for granted: getting out of bed, maybe using a lifting machine; getting showered, getting dressed. Going to the toilet can be an issue; cooking meals, cleaning"
Rebecca Cattermole says CareChoice will only employ people qualified in the disability sector, with working experience, because of the complex, varied situations which occur. Not only do carers deal with people with disability; they also engage parents and family members, guardians, allied health services, psychologists - and the NDIA itself.
"The NDIS can be simple and complex at the same time," Ms Cattermole said.
"It is fair to say there are some issues, but on the flip side of that it's important to understand that this particular part, the specialist disability accommodation funding part of the NDIS is very new, in the biggest social reform we've seen since Medicare - and as with all big reforms there are going to be teething problems.
It's sometimes very difficult to get over if you don't understand the bureaucracy, so we're putting resources in place to help people get past that. It won't solve the housing crisis, but it is an attempt to help people through that process."Rebecca Cattermole, CareChoice
"It is cumbersome; there are a lot of administrative hurdles to get through whether you are a service provider, a developer, a builder, an investor, a participant, a family member or an advocate."
Ms Cattermole says there are some bottlenecks in the scheme, creating delays in getting SDA plans processed.
"We know there is incredible demand for housing; unfortunately it stretches beyond the disability sector," she says.
"We have a housing crisis more broadly. It's positive to see SDA plans starting to come through. It's improving.
"We've identified an opportunity for investment in staffing; we're putting structures in place so we can deliver some amounts of in-kind support to assist participants who aren't quite ready to get in front of that SDA panel under the NDIA for that allocation, to help them over that last little hurdle.
"It's sometimes very difficult to get over if you don't understand the bureaucracy, so we're putting resources in place to help people get past that. It won't solve the housing crisis, but it is an attempt to help people through that process."
PINARC'S DEPUTY CEO
Sara Cavanagh is adamant that the majority of people are better off under the NDIS. The deputy CEO of Pinarc Disability Support in Ballarat, a registered NDIS provider, says of the almost 300,000 people who have entered the scheme, about 100,000 have never accessed a service before.
Pinarc employs around 200 people, supporting just under 1000 clients in the region.
"Yes, there are issues with local area coordinators, planners, decision-making processes, inconsistencies in allocations in plans - people putting forward the same information, requesting the same thing and getting totally varied plans which don't make any sense," says Ms Cavanagh.
"But working in disability is rewarding, and we need to encourage people to work within the disability sector. One disincentive is awards in the hospital sector are higher than the disability sector. People are looking to go into private practice to make more money. And the work is challenging: Complex needs, behaviours, families."
The NDIA is listening to the needs of providers and participants, and change is happening, Ms Cavanagh says. But there is a lot to do yet.
"About 60 per cent of first plans are unspent; families don't know what to do with them, participants don't know what to do with them, where to go to spend them," she says.
"Sixty per cent of funding across 300,000 people is a lot of money. They're given no guidance and direction about how to go about it; they've got no support coordination for the majority of people, so they have no-one to help them implement their plan; and there are not enough services to support this massive increase of funding in the sector.
There are not enough providers; if you think of therapy services in particular, everywhere has a waitlist for therapy. There are not enough in-home supports, there are waitlists for those; for community access, for day programs.Sara Cavanagh, deputy CEO, Pinarc
"There are not enough providers; if you think of therapy services in particular, everywhere has a waitlist for therapy. There are not enough in-home supports, there are waitlists for those; for community access, for day programs.
"Accommodation, SDA - only something like six per cent of people qualify for supported disability accommodation, and there's not enough accommodation on the ground at the moment to cover that six percent, let alone other people who want to move out of home."
But the NDIS is here to stay and we have to make it work, says Ms Cavanagh. Equipment shortfalls such as hoist and wheelchair provision are being overcome. 'Information, linkages and capacity building' grants, aimed at getting more therapists in the system and more people qualified to work in the disability sector, are being supplied.
"We're seeing much clearer communication processes; there are not nearly so many plans in review. But this is a huge process, and it's going to take some time."
THE NDIA RESPONDS
A spokesperson for the NDIA answered a series of questions from The Courier on delays in the system and allegations of retributive behaviour, saying the NDIA takes prompt action if it appears that there is a high risk of harm, neglect or abuse.
"The NDIA recognises that complaints provide opportunity for us to improve the way we do things. We are aware that some people are uncomfortable providing feedback or making a complaint," the spokesperson wrote.
"We encourage anyone with concerns to contact the NDIA directly, or participants can choose to speak with their Local Area Coordinator. Any allegation of retributive behaviour will be taken seriously."
The NDIS Quality and Safeguards Commission, which opened in Victoria recently and is responsible for regulating NDIS providers, was also available to any participant or provider with a complaint, the spokesperson said.
"The NDIA works with providers to ensure they meet necessary requirements for registration. For example, Specialist Disability Accommodation (SDA) needs to meet specific design standards for safety and accessibility. SDA providers are responsible for meeting these compliance requirements.
"The NDIA does not place or allocate participants to live in a particular dwelling or dwelling type. Eligible participants, as part of their individually-tailored plan, receive funding to source an SDA-approved dwelling best suited to their needs. This choice also includes the SDA provider."