While it is a smaller sector than aged care, the disability care sector is a large employer with a similar growing need for new workers, and the jobs are almost exclusively publicly-funded.
In 2019 the Australian Government estimated that the disability care workforce would need to almost double in five years—from 100 000 to 190 000 workers by 2024—making the NDIS 'one of the largest job creation opportunities in Australian history'.
However, a number of inquiry participants have provided evidence suggesting that jobs in disability care have become less secure since the introduction of the National Disability Insurance Scheme (NDIS) in 2016.
This chapter discusses this evidence, noting that the committee considered the disability care sector in its first interim report, On-demand platform work in Australia. In particular, the report discussed the introduction and growth of online platforms in the disability carer sector.
As such, issues of workforce insecurity in the disability care sector are considered briefly in this report, with some general comments and recommendations made. The committee intends to revisit the issue of platform work within the NDIS in its final report.
The disability care sector
The introduction of the NDIS altered how disability funding was provided. Instead of giving funding to service providers, who would then provide services to people with disabilities, funding now 'rests with the NDIS participant so that they can exercise choice and control'.
In 2020 there were 390 000 participants in the NDIS. The number of 'active providers' had also increased almost four-fold since 2017—from 4005, to 14 882 in June 2020. According to the Queensland Nurses and Midwives Union (QNMU), the NDIS not only increased the number of small providers, it 'propelled the rapid emergence of gig type arrangements'.
Total payments made as part of the NDIS increased from $2.18 billion in 2016–17 (the scheme's first year) to $16.11 billion in 2019–20. Funding for the NDIS is provided by the Commonwealth and state governments and through an increase to the Medicare Levy.
The NDIS Rules allow participants to either manage their own funding and arrange their own supports, or have the National Disability Insurance Agency (NDIA) manage their funding with one of two options:
the participant chooses their own supports; or
the NDIA manages their supports.
The National Foundation for Australian Women (NFAW) submitted that it is 'supportive of the principle of increased choice and control for those receiving care'. However, the NFAW is 'greatly concerned' that the design of the NDIS is negatively impacting workers, which flows onto care recipients.
According to the NFAW, funding in the disability care sector has been structured in a way that forces providers 'beyond efficiency into cost-cutting'. The NFAW referred to recent research suggesting the amount of funding provided to meet the hourly rate for a Disability Support Worker 'has been set too low to enable the minimum … Award conditions to be met':
The study also found that the pricing model did not reflect existing employees' classification levels and provided inadequate allowance for training, workers' time not spent providing face-to-face support (3 minutes an hour), travel between clients (providers can include a 20-minute journey but without any adjustment for support to be provided), and supervision (both levels and workloads). These assessments are supported by findings of an employer survey in which two-thirds of respondents disagreed with the statement 'NDIS prices enable us to meet our industrial obligations'.
According to the NDIS National Workforce Plan 2021–2025, there will be 353 000 workers 'in the NDIS-funded workforce' by 2024:
90 per cent will be support workers—66 per cent home-based and 23.7 per cent community-based;
7.4 per cent will be allied health workers; and
3 per cent will be 'other'.
The Health Services Union (HSU) submitted that approximately 80 per cent of workers in the disability sector are employed part-time and 40 per cent are employed on a casual basis—'and rising'.
The Australian Services Union (ASU) confirmed these figures, adding:
Many workers work irregular hours in multiple locations.
Many do not receive minimum legal compensation (including for time spent traveling between locations, and other essential job functions. …
Staff turnover is extremely high: around 25 percent per year for the workforce, and over 35 percent per year among casual employees.
The average number of hours that employees work in a week is low and falling to just over 20 hours per week.
The workforce reflects a high concentration of women workers, and older workers: 70 percent are women, and 44 percent are 45 years or older.
The gendered nature of job insecurity and low wages in disability care is similar to that in aged care. Australian Services Union (ASU) NSW & ACT Secretary, Ms Natalie Lang said:
… it is a significant issue that has led to the undervaluation of female dominated industries for many generations in this country … a certificate III in disability support should be just as valuable as a certificate III in fitting and turning.
Many NDIS workers are engaged in insecure work, across multiple sites and employers. Ms Lang suggested that the NDIS should be viewed as 'an entire scheme', but instead employment is becoming more fragmented. The funding model has led to 'a rise' in platform service providers employing different models based on the use of independent contractors, or casual employment models, that do not always facilitate consistent client/worker relationships.
Like aged care, the disability care workforce is female-dominated. The NFAW said the NDIS is increasing casualisation in the disability care sector. The growth rate for the permanent disability care workforce was 1.3 per cent per year; while the growth rate for the casual workforce was 26 per cent (in 2017). It is estimated that less than 10 per cent of NDIS workers have permanent full‑time jobs.
Multiple job holding is common. The McKell Institute Victoria submitted 2020 survey data from the University of New South Wales which found 14 per cent of disability support workers 'currently worked for more than one employer', and 36 per cent 'had worked for two or more employers in the last 12 months' (28 per for two employers, 8 per cent for three or more).
The workforce of the NDIA—the government agency that manages the NDIS—itself has a high proportion of labour hire and contractor roles:
At 30 June 2020, the total NDIS workforce was 11,550, including 4,396 [Australian Public Service] employees, 1,692 labour hire contractors and consultants, and 5,462 people employed by NDIA's partners.
The contribution of the NDIS to insecure work
A number of inquiry participants submitted that working conditions and job security have 'deteriorated' in the disability care sector because of the NDIS.
Dr Fiona Macdonald from RMIT University submitted that insecure work among 'frontline disability support workers', who make up 90 per cent of the workforce, 'has grown and intensified under the NDIS', including with:
growth in smaller service providers' use of casual employment arrangements;
some larger service providers organising permanent part-time work as on-demand work;
emergence and growth of digital platform and other third-party brokers/mediators of support labour and the use by these organisations of independent contracting models;
individual NDIS participants' and registered and non-registered NDIS service providers' use of independent contracting arrangements for engaging disability support workers; and
NDIS participants' direct employment of disability support workers.
A report produced by the Australia Institute's Centre for Future Work in 2019, Precarity and Job Instability on the Frontlines of NDIS Support Work, concluded that:
Disability service workers are facing a whole new set of pressures arising from the NDIS's market-driven approach, including:
Instability in work and income, associated with fluctuations in demand for work from individual participants.
Unpaid work associated with traveling to and from clients, performing various overhead and administrative tasks, etc.
Inadequacies in the NDIS's 'unit price' model of establishing cost parameters for particular care functions or services.
An absence of institutional support for training, supervision, mentoring, and professional development (since agencies have few resources under the NDIS pricing system to provide these broader functions).
High levels of staff turnover, made worse by the lack of training and support given to the new workers recruited to meet the rapid expansion in service delivery as the NDIS is rolled out.
The Chief Executive Officer of the care services platform provider, Hireup—a platform that directly employs its workers—submitted:
… from my seat as the CEO of a large disability service provider I can see more general trends in the disability sector which worry me. Precarious work is increasing as the proportion of people formally employed by the traditional not-for-profit providers, and more modern, tech enabled providers like us, falls and the proportion of sole traders—or independent contractors—rises.
The NFAW said while ethical employers continue to try and pay fair wages, dipping into their own reserves, many employers in the disability care sector are using strategies to try to cut costs and survive under the NDIS model, including:
'moving employees to different award classifications';
limiting or changing the hours worked by individual employees 'to avoid the risk of a casual conversion occurring'; or
circumventing the industrial relations framework 'altogether' by facilitating 'individual contracting' of workers by clients.
Dr Macdonald said her research suggests the NDIS is designed in a way that is actively reshaping the workforce towards insecure, self-employment models. This is because 'an explicit goal for the NDIS' is to increase the proportion of recipients who manage their own funding; and those who manage their own funding are more likely to engage workers that are not employees, that is, independent contractors or directly employed support workers:
So, like other cash-for-care schemes that provide direct payments to people requiring care, the NDIS is designed to enable engagement of support workers without the involvement of a traditional service provider or employing organisation. … As the proportion of self-managing and plan‑managing NDIS participants grows there is likely to be growth in direct employment of support workers and engagement of workers as independent contractors.
Hireup raised concerns about the proliferation of on-demand platforms leading to a 'race to the bottom' on wages and conditions for disability care workers, saying it is understandable that individual NDIS participants may choose to engage workers who charge under award wages. However, participants may not understand that the workers are missing out on 'entitlements, protections and award wages'.
Mr Jordan O'Reilly, co-Founder and CEO of Hireup, cautioned that if the government does not move to regulate around on-demand platforms in the care sector, 'that's where the future will go—more and more independent contractors working in the disability sector', and the loss of stable, permanent jobs.
Maurice Blackburn Lawyers was concerned that the information provided by government to potential NDIS service providers does not include 'any requirement that the organisation must have a good track record in satisfying employment and industrial relations requirements'. Not mentioned in materials at all, Maurice Blackburn argued that these requirements 'should be central to any government procurement process for the provision of services/staff'.
Participants were also concerned that on-demand platforms in the disability care sector are 'shirking' responsibility for work health and safety (WHS). (This issue was covered at length in the committee's first interim report.) The current legal framework leaves some ambiguity around who bares the obligation to provide and maintain a safe working environment—a person with a disability who engages a worker, the worker themselves, or the platform through which they are engaged. The committee observed:
According to the current guidance, it appears conceivable that an individual person with a disability, engaging a worker through a platform using their NDIS funding could be considered a [person conducting a business or undertaking].
While the committee acknowledges that NDIS participants should have the freedom to choose to be a PCBU, it is concerning that the current system may result in participants unknowingly becoming a PCBU, particularly in cases where participants would be unwilling to adopt that responsibility if given the choice.
Impacts of insecure work
The HSU was concerned that care workers engaged through platforms or labour hire agencies—especially those who are independent contractors or sole traders:
… often lack consistent access to collegiate and managerial support and supportive environments; safe work practices and safety training; access to ongoing and paid professional development opportunities; and access to fair and adequate industrial and legal representation. Modes of engagement that subvert the traditional employment relationship do so at a cost to building a stable, highly skilled, well-resourced and supported workforce.
Dr Macdonald warned that the current insecure employment arrangements have resulted in 'significant problems of insecurity and precarity' for workers, including:
… increased worker isolation, reductions in training, reductions in supervision, loss of opportunities for peer support, increased time pressures on workers and high levels of underemployment … working time insecurity, income insecurity, employment and job insecurity and risks to health and safety. Insecure work under the NDIS carries unacceptable risks for workers and for people with disability as well as impacting on workforce sustainability.
The committee was told about a growing body of international research which indicates that 'cash-for-care schemes' promoting independent contracting and direct employment arrangements 'produce very poor outcomes' for low-paid care workers and care recipients in the disability support and other care sectors. Poor outcomes are emerging, relating to:
decreased employment security and substandard conditions;
'undermining workforce sustainability'; and
increasing gender inequality in employment.
Dr Macdonald was concerned that the NDIS is designed in a way that relies on insecure model of employment 'to achieve its objectives'. As such, Dr Macdonald considered it 'critical' that the government act to improve 'employment conditions and protections for current and future disability support workers … through mechanisms available outside the NDIS and in the sphere of industrial regulation'.
The ASU similarly stated that the 'signal feature of the community and disability sector is the precarity of employment'. The ASU said the community and disability sectors are 'unique' in that 'this feature of the sectors is a deliberate and indeed legislated policy of government'.
The committee's views and proposals for reform are included in the next chapter of this report.