MARK RILEY: Mark Butler has a delicate operation on his hands if he wants to save the NDIS

Mark Butler has obviously learnt a thing or two in his time as Health Minister about the benefits of adopting an empathetic bedside manner.

His demeanour this week in announcing the most radical changes to the NDIS since its inception was akin to that of the smiling GP who so cheerily offers to assist a sick patient by spearing them in the buttocks with a horse needle.

“This is going to hurt, but you’ll be much better for it in the long run,” was Butler’s general message.

And he was right. Even the majority of the disability sector accepts that.

The NDIS, in Butler’s words, is costing too much, growing too fast and heading towards failure.

That can’t be allowed to happen.

Too many people rely on this scheme for the ability to engage in daily life.

Without the support the NDIS offers, hundreds of thousands of Australians with disabilities would be out of their jobs, out of their homes and in institutional care or the hospital system.

It isn’t just too big to fail, it is much too important to fail.

But the fact that the NDIS is in desperate need of a major overhaul has been obvious for years.

Linda Reynolds as NDIS minister and then-prime minister Scott Morrison recognised that in 2021.

A major part of their proposed response to the cost blowouts was to subject all participants to independent assessments of their “functional capacity”.

Those assessments would be used to determine whether the participants’ real level of functional disability — and not just their medical diagnosis — justified their plan being upgraded, downgraded or even removed.

Bill Shorten, Labor’s then-NDIS spokesman and the original chief political architect of the scheme, was angrily opposed to those assessments.

Shorten headlined a thunderous #SaveOurNDIS campaign for the Labor opposition, backed by the majority support of the disability sector.

That campaign eventually forced the Morrison government to dump its plan as it headed towards the 2022 election loss.

Five years later, the cost of the scheme has exploded. Originally predicted to top out at $13.6 billion a year, the NDIS will go over $50b this year and is heading towards $70b in 2030.

The original prediction of 410,000 participants at maturity has ballooned to 760,000 this year and with 90 per cent of transactions attracting little or no financial oversight, the NDIS being routinely rorted, defrauded and gamed mercilessly at extraordinary taxpayer expense.

Mark Butler says it has become “an ATM for shonks, grifters, fraudsters and crooks”.

A well-intentioned scheme is staring into a bottomless well of self-destruction.

And what is the central remedy Labor will now employ to bring it back under control? Individual functional capacity assessments.

This time, Labor says its literal objective is to save our NDIS — no hashtag required.

Those assessments and the diversion of children under nine with autism to the new Thriving Kids program will see 160,000 people moved off the NDIS by 2030.

The disability sector says the burning question is what services will they be moved into?

The States agreed in 2023 to build alternative “foundational services” as part of a seminal agreement through National Cabinet that built a nexus between hospital and disability funding.

That agreement, though not yet fully endorsed by Queensland, has largely allowed the Federal Government to shift responsibility for the care of young children with autism back to the States in exchange for accepting greater responsibility for the funding of hospitals.

They agreed to joint funding of $6b to build the foundational services and $4b for the Thriving Kids programs. That’s $10b all up, half from the Commonwealth and half from the States and Territories.

Butler now says the Federal Government expects to save $35b across the next four years by diverting people out of the NDIS, cutting the average plans of those remaining on it from $31,000 a year to $26,000 and adding much needed financial integrity by introducing a digital payments system that will provide oversight of every transaction.

In return, the States have agreed to accept $35b in extra hospital funding and GST top-ups across the next four years — the exact same amount saved by the NDIS changes.

It all sounds neat on paper, but it is the real impact these changes have on the lives of people with disability that really matters.

And minimising that impact will require Mark Butler to exercise his best bedside manner.

Mark Riley is the Seven Network’s political editor