06/01/2026
Why the failed NDIS is a story of preventable harm and institutional negligence
The view from the frontline of NDIS service delivery is bleak. Providers must often choose between safe care and financial survival, and too many participants, and workers, are at risk.
The National Disability Insurance Scheme was meant to be one of Australia’s great social reforms: practical, humane and safe. It was meant to take people with disability out of neglect, provide meaningful support, and give families confidence that their loved ones would be cared for long after they were gone.
Today, I believe the NDIS has failed at that task.
This is not a claim made lightly, nor from the sidelines. It comes from years of frontline experience watching a system unravel – not because of a lack of funding, but because of a lack of competence, common sense and safeguarding.
Before the NDIS, disability support was not perfect, but it was professional. Workers were trained, clinically aware, and supported by systems that understood disability as both a medical and social reality. There were career pathways, expectations of competence, and at least some accountability. Under the NDIS market model, that professionalism has been stripped out and replaced with slogans, paperwork and labour churn.
The results are not theoretical. Lives have been shortened. People have died. And many more are living with preventable deterioration – avoidable infections, pressure injuries, aspiration pneumonias, unmanaged wounds, escalating behaviours, medication mismanagement – the kind of unnecessary comorbidities that both diminish lives and inflate costs for everyone.
The information blackout
Providers are legally expected to safeguard participants. Yet the system routinely withholds the very information required to do it safely.
And it’s not just provider-to-provider handover that is failing. The NDIA and the NDIS themselves must be part of handover – because they also provide next to nothing. They hold the plan, the funding status, the history of supports and changes, and often the only centralised record of what has been funded or flagged. Yet frontline services are frequently expected to operate blind.
In practice, basic, non-negotiable information is missing or withheld: relevant medical history, comorbidities, swallowing risks, behaviours of concern, medication risks, hospital discharge instructions, and whether guardianship orders apply. Participants are often told they don’t have to disclose their disability, their plan or even whether funding remains.
That isn’t “choice and control”. It is an information blackout.
The consequences are immediate. Incomplete handover produces incomplete risk assessments – by definition. Complex participants receive the wrong care, staffing is mismatched to need, and preventable crises become “incidents”. Participants drain plans because the system funds fragmentation and emergency response rather than continuity and competence.
Some become labelled “unserviceable” – not because they are beyond support, but because the system has made safe support impossible.
Unnecessary hospital admissions follow, and with each admission a person’s health baseline often drops.
The NDIA accepts no responsibility for capacity, no responsibility for handover and no responsibility for outcomes – yet expects providers to carry all legal and financial risk. That is not regulation. It is institutional negligence.
Handovers are not administrative niceties. They are sometimes life or death.
Unqualified gatekeepers
A major driver of this chaos is the rise of pseudo-professional gatekeeping.
Support co-ordinators increasingly hold the keys to the kingdom – access to providers, access to reports and influence over participant decision-making – despite there being no consistent mandatory qualification standard across the role. Many do excellent work. But too many are placed in positions of extraordinary power without the training required to understand complex disability, clinical risk, mental illness, capacity, guardianship law or supported decision-making.
Worse, some behave as though they own participant reports and information. They don’t. Reports belong to participants – not providers, not practitioners, not support co-ordinators.
Yet it is increasingly common for new providers to be asked to “take responsibility” without receiving history, behaviour plans, assessments or clinical recommendations. In some cases, handovers are refused outright. And this problem is not confined to support co-ordination. It occurs with behaviour practitioners and other so-called professionals too – information is treated as currency, and handover is drip-fed, delayed or withheld.
That is not safeguarding. It is structural risk.
A scheme built for physical disability
The NDIS is structurally skewed toward physical disability and functional capacity. It routinely fails to account for intellectual disability, cognition, psychiatric complexity and fluctuating capacity – the factors that most often drive safeguarding risk and intensive support needs.
Australia has, in effect, created a pseudo mental illness dumping ground, with complex participants funnelled into a disability marketplace that is not designed to care for them.
Direct support workers are expected to manage trauma, psychosis, suicidal ideation, aggression, self-harm and profound behavioural distress – often without clinical training, without supervision and sometimes without even basic handover.
Support staff are also frequently placed in dangerous situations due to inadequate funding models and inadequate knowledge – sent into high-risk environments without enough staff, without continuity, and without clarity about a participant’s history, triggers, clinical needs or legal orders.
And here’s the part nobody wants to say out loud: there is no safeguarding for support staff. The workforce is exposed – physically and psychologically – while the system debates ideology. When something goes wrong, it’s framed as a provider failure or a staff failure, rather than a predictable outcome of a model that withholds information and rewards churn.
Restrictive practice, behaviour management and capacity: a collision course
This is where the scheme’s internal contradictions become potentially lethal.
Restrictive practice frameworks and behaviour management are constantly in tension with capacity and appropriate care. Providers and staff are warned that intervening may constitute a restrictive practice. Guardianship orders – made under state law to protect individuals who lack capacity – are too often treated as optional, made effectively null by “choice and control” and fear of accusations, even when clinical best practice is clear.
The result is predictable: participants are left to make decisions they cannot understand, providers are left legally exposed, and staff are left at risk. “Choice” becomes a shield used to justify avoidable harm.
Australia needs a mental capacity bill – not an end-of-life directive, but a living framework that clearly defines how decisions are made when capacity is impaired or fluctuating, and restores legal clarity to supported decision-making in the real world. Guardianship orders must be respected, not overridden by ideology.
A workforce treated like domestic labour
Care has been broken into transactions, rosters and invoices. Too often, direct support providers are reduced to labour-hire companies supplying domestic servants.
This is not a criticism of domestic support – many people need it – but complex disability care cannot be delivered by a rotating cast of undertrained workers who don’t know the participant, don’t have the history and don’t have continuity. A system built around shifting casual labour cannot deliver safeguarding for high-complexity participants. It can only deliver tasks – until the inevitable crisis occurs.
It is hard to believe, but there are support workers operating without so much as a first aid certificate – in a sector where choking risk, seizure risk, falls risk and medication risk are routine.
Even more confronting is the lack of consistent, enforceable safeguards around child-related work in this space. In the wake of intense national scrutiny over childcare safety and screening, it is astonishing that the NDIS has not faced comparable attention. Gaps remain where workers can be placed – sometimes unsupervised – in a private home with a disabled child, with unclear screening requirements, minimal training and limited oversight. If this is unacceptable in childcare, it should be unacceptable here.
Ideology is shrinking choices
Many people thrive in group homes or intentional communities, yet these options are increasingly dismissed by ideological narratives that refuse to acknowledge diversity of need and preference.
“Nothing about us without us” has quietly become “nothing about us without some of us”.
People with disability are not a monolith. Neither are families. A functioning system has to make room for different preferences – including models that prioritise stability, relationships and safety over slogans.
South Australia knew — and still nothing changed
We have known for years that the market cannot safely carry the most complex participants.
In South Australia, a 2017 productivity report recognised that the market lacked the competence to safely care for some people, and that the state would need to retain responsibility for around 500 individuals rather than hand them into a fragmented marketplace. Those people remain under state management today. South Australia is effectively operating as one of the country’s largest providers inside a scheme supposedly built on market delivery.
That reality is not a success story. It is an admission that the model fails where safeguarding matters most – and, despite the warning, the system largely carried on as if nothing had been learned.
Providers are collapsing — and the reasons are not what Canberra pretends
The provider market is cracking, and it isn’t just because “businesses can’t adapt”. Providers are collapsing because the system pushes them into an impossible choice.
Either you deliver exactly what the plan funds – even when you can see it is inadequate or unsafe – or you step beyond it because the moral liability is confronting in real time. Many do the second. They keep the participant safe. They plug the gaps. They absorb the fallout of missing information, underqualified intermediaries, unrostered realities and crises that were entirely foreseeable.
And that decision bankrupts them.
Price points don’t match the real cost of safe, competent care – especially for complex participants. Providers cross-subsidise, they carry unpaid hours, and they deliver “unfunded care” because the alternative is harm. The NDIS doesn’t just fragment care; it quietly shifts the true cost on to providers until they fail.
This is why the scheme feels unsustainable, but what is more frightening is not the cost. It is the scale of failure despite the cost.
For a small number of participants, lifetime public investment can reach tens of millions of dollars – and in rare cases, as high as $100m. Taxpayers could reasonably expect that level of spending to purchase competence, continuity and safeguarding. Instead, we have built one of the most expensive social programs in the country around a model that still cannot reliably deliver basic handover, baseline standards or clear responsibility.
And while governments may find ways to stabilise large, established organisations when they wobble, there will be no bailout for the broader sector. When small and mid-sized providers go under, the participant doesn’t get a rescue package. They get an ambulance.
Disability is not a DNR
The failure doesn’t stop at the NDIS boundary. It follows people with disability into hospitals.
Too many people enter the health system and encounter staff untrained in disability, poor handover between services, and assumptions about “quality of life” that would be unthinkable in other contexts. Families and providers have raised cases where Do Not Resuscitate orders are discussed, pressured or applied without proper consultation – and in some cases without the individual’s knowledge or genuine informed consent.
Disability is not a terminal diagnosis. It must never be treated as one.
Australia needs a health equality bill to protect people with disability in medical settings: to ensure disability alone can never justify treatment limitation; to strengthen consent processes; to require proper communication supports, and; to prevent quiet, unaccountable discrimination dressed up as “clinical judgment”.
A market made for rorting
The NDIS has become a giant public funding stream with too few gates. In parts of the system, an ABN is effectively a passport to vulnerable people and taxpayer money. Verification is weak. Oversight is inconsistent. And too often, no one can clearly track where money ends up.
That is not a small compliance issue. It is an open invitation.
Organised crime thrives where supervision is thin and payouts are large. Add offshore money movement and the risk extends beyond rorting into national security territory. We cannot keep pretending the worst-case scenario is “a few dodgy invoices”. The possibility of funds being funnelled into criminal or extremist networks is a risk that must be treated seriously, not waved away as politically inconvenient.
While there has a been a fraud fusion taskforce set up by the government, it is fighting an uphill battle given the scale of the scheme and the rorting, and the years of catch-up required. And with unregistered providers still a big part of the system, they haven’t closed the door behind them.
‘Backdoor’ immigration
The workforce crisis has been compounded by misuse of the international student visa system.
International students can obtain ABNs, establish NDIS “businesses”, and deliver high-risk care with minimal training and supervision. Disability support has quietly become a backdoor labour and migration pathway, while genuine workforce development – professional training, supervision, career structures and standards – has been neglected.
This is unfair to participants, unfair to workers, and unfair to migrants who deserve proper training, lawful conditions and clear professional pathways. Disability care is complex, skilled, high-risk work. It cannot be treated as casual labour.
Voices drowned out — and silence enforced by fear
Australia has poured enormous time and money into inquiries and reviews, including a royal commission and the NDIS Review. Yet on the ground, ideological dogma has increasingly replaced competence and reality.
The voices of people with disability, families, frontline workers and providers are too often drowned out – not by evidence, but by moralised narratives that don’t survive contact with complexity. Many providers will tell you privately they won’t speak publicly, because in this climate it only takes one wrong sentence to trigger a pile-on. That silence protects the system, not the people inside it.
Good intentions do not prevent harm. Competence does.
The hard truth
A system that withholds information cannot claim it values safeguarding. A system that treats capacity as an inconvenience cannot claim it values rights. A system that sends unqualified workers into private homes – including homes with disabled children – cannot claim it values safety. And a system that exposes support staff to danger without proper safeguards is not “participant-centred”. It is workforce-blind.
The NDIS doesn’t need another slogan. It needs honesty: about capacity, about competence, about who holds information, about who carries risk, and about who pays when ideology meets reality.
Because if we keep funding a scheme that cannot reliably safeguard the people it serves – and cannot even safeguard the workforce delivering it – the final bill won’t just be measured in dollars.
It will be measured in preventable harm. And in the moment a family realises the only handover it is going to get is from a hospital bed.
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Claire-Louise McCrackan is the chief executive officer of Carers and Advocates Australia
