Repairing disability access in competitive environments: drivers of inclusive service provision for people with intellectual disabilities

ABSTRACT

In many countries around the world, individualised budgets are replacing ‘block funding’ as the primary way in which disability service provision is funded. These models assume that dynamics of competition improve services for people with disabilities. This article presents the findings of research on the accessibility and inclusiveness of mainstream services for people with intellectual disabilities in four Australian cities in the wake of the rollout of individual support budgets. We use the concept of ‘repair’ and the conceptual framework of ‘landscapes of care and support’ to analyse interviews with mainstream service managers. Our findings reveal that not-for-profit organisations perform crucial tasks in persuading for-profit service providers to collaborate with them to improve their accessibility and inclusion. When these services collaborate to repair service access, not-for-profit organisations often take on associated responsibility, costs and risk to encourage reparative adjustments in for-profit services. Not-for-profit organisations are also more likely to be tasked with the relational and interpersonal work that is crucial for successful service repair. Our findings challenge assumptions that free-market competition is the main driver of more accessible and inclusive service delivery and suggest how policy can support more equitable collaborative repair work.

Résumé

Dans de nombreux pays autour du monde, le financement individualisé est en train de devenir le système principal pour les services destinés aux personnes en situation de handicap, replaçant ainsi le financement global. Ce modèle repose sur l’assomption que les dynamiques de la compétition vont améliorer le soutien aux personnes handicapées. Cet article présente les résultats d’une étude sur l’accessibilité et l’inclusion des services de base pour les personnes en situation de handicap mental dans quatre grandes villes australiennes pendant le déploiement du financement individualisé. Nous nous servons du concept de « réparation » et de la structure conceptuelle de « panoramas de soins et de soutien » pour analyser les entretiens avec les responsables des services généraux. Nos observations révèlent que les organizations à but non lucratif accomplissent une tâche essentielle en persuadant celles à but lucratif de collaborer pour améliorer leur accessibilité et leur inclusion. Quand ces services travaillent ensemble pour réparer l’accès aux prestations, les organizations à but non lucratif prennent souvent en charge les responsabilités, les frais et les risques résultants afin d’encourager les ajustements rectificatifs chez les prestations à but lucratif. Elles sont aussi plus susceptibles de se retrouver chargées du travail relationnel et interpersonnel qui est essentiel pour le succès de la réparation. Nos observations remettent en question l’idée reçue que la libre concurrence est le principal facteur pour des prestations de services plus accessibles et plus inclusifs. Elles suggèrent aussi des moyens par lesquels les stratégies peuvent soutenir des travaux de réparation collaboratifs plus équitables.

Resumen

Enmuchos países del mundo, los presupuestos individualizados estánreemplazando la “financiación en bloque” como la forma principalen que se prestan los servicios para la discapacidad. Estos modelossuponen que la dinámica de la competencia mejora los servicios paralas personas con discapacidad. Este artículo presenta los resultadosde una investigación sobre la accesibilidad y la inclusión de losservicios generales para personas con discapacidad intelectual encuatro ciudades australianas tras la implementación de presupuestosde apoyo individuales. Utilizamos el concepto de “reparación” yel marco conceptual de “paisajes de atención y apoyo” paraanalizar entrevistas con administradores de servicios convencionales.Nuestros hallazgos revelan que las organizaciones sin fines de lucrorealizan tareas cruciales para persuadir a los proveedores deservicios con fines de lucro a colaborar con ellos para mejorar suaccesibilidad e inclusión. Cuando estos servicios colaboran parareparar el acceso a los servicios, las organizaciones sin fines delucro a menudo asumen responsabilidades, costos y riesgos asociadospara fomentar ajustes reparativos en los servicios con fines delucro. También es más probable que las organizaciones sin fines delucro tengan la tarea de realizar el trabajo relacional einterpersonal que es crucial para una reparación exitosa delservicio. Nuestros hallazgos cuestionan los supuestos de que lacompetencia del libre mercado es el principal impulsor de unaprestación de servicios más accesible e inclusiva y sugieren cómolas políticas pueden respaldar un trabajo de reparacióncolaborativo más equitativo.

KEYWORDS:

• National Disability Insurance Scheme (NDIS)
• learning disability
• neoliberal service regimes
• exclusion
• discrimination

MOTS CLEFS:

• National Disability Insurance Scheme (NDIS) (Régime national d’assurance invalidité)
• troubles des apprentissages
• régimes néolibéraux de prestations de services
• exclusion
• discrimination

PALABRAS CLAVE:

• Plan Nacional de Seguro de Incapacidad (NDIS)
• discapacidad de aprendizaje
• regímenes de servicios neoliberales
• exclusión
• discriminación

Introduction

In Australia, individualised budgets have replaced block commissioned services as the primary way in which disability support services are funded (O’Keeffe & David, 2022). At the same time, people with disabilities are encouraged to use mainstream services, in addition or instead of, disability specialist services. Under block commissioning, the state allocates funding mostly to public, but also some private, organisations to provide specialist disability support (Macpherson et al., 2023). However, as argued in the report that underpinned funding restructuring in Australia, block commissioning creates ‘incentives for providers to “please” governments, and weaker incentives to please service users, since the government agency will decide whether to renew funding’ (Productivity Commission, 2011, p. 152). Concerns about such dynamics led to the introduction of individualised budgets in many countries around the world, with the intention to give people with disabilities more ‘choice and control’ to use mainstream or specialist services and to withdraw their funding from service providers that do not meet their needs (O’Keeffe & David, 2022). Personalised funding mechanisms such as Australia’s National Disability Insurance Scheme (NDIS), are thus being implemented to improve the quality and quantity of services for people with disabilities via an encouragement of competition between service providers (Productivity Commission, 2011).

While the idea of competition as a catalyst for innovation has proven persuasive, research on individualised budgets has shown that a competition-based approach erodes the ability of service providers to coordinate their support for individual clients (Green et al., 2018) and reduces service access and quality for people with complex needs, and for people who lack social supports and advocates in their personal networks (Macpherson et al., 2023). This erosion occurs in contexts where some services were already inaccessible or unsafe to people with disabilities prior to restructuring. Restructuring for greater competition places workers and people with disabilities in a service landscape that is more fragmented, opaque and precarious (Macpherson et al., 2023), while they are also charged with the ongoing work of repairing a broken service system to make services more accessible and equitable for people with disabilities. While some research has previously focused on collaboration and competition (Green et al., 2018; Milbourne, 2009), this work has not analysed how competitiveness shapes reparative processes of service change towards greater accessibility and inclusion. This article offers a novel conceptualisation of competitiveness that reveals how collaborative work towards service repair is incentivised, enabled and performed in landscapes of care and support. The article applies this conceptualisation in the form of an empirical analysis of three pairs of organisations that collaboratively seek to make services accessible for people with intellectual disabilities under different conditions of competition, but all in the context of Australia’s NDIS.

Throughout this article, we distinguish between specialist disability organisations and mainstream organisations. Specialist organisations are for- and not-for-profit organisations that specialise in delivering services to people with disabilities. This includes agencies that contract out disability support workers to people with an individualised NDIS budget to help with a combination of tasks related to self-care, mobility, and community access. We use the term ‘mainstream’ organisations to describe those organisations that are not specifically designed for people with disabilities but that serve a wider population of users. This includes organisations such as for-profit businesses, community sports clubs and public libraries that do not commonly employ staff with specialised knowledge and experience on disability access and inclusion.

We present the findings of research on the accessibility of mainstream services for people with intellectual disabilities that was conducted in four Australian cities from 2018 to 2021, after the introduction of the NDIS. We analyse a subset of data that relates to mainstream services that entered collaborations with either other mainstream or specialist services to improve disability access. In analysing how service workers engaged with differently positioned workers across the boundary of their own organisation, the article demonstrates that for-profit mainstream services were commonly persuaded to make adjustments by not-for-profit mainstream and support services, and that not-for-profit organisations disproportionately carried the burden of risk and costs in cross-sector collaborations. The article therefore argues for a de-centring of entrepreneurial competition in disability support restructuring and stronger support for the collaborative repair work across services in planning disability inclusive cities. This article responds to the promises of disability inclusion and quality of service under free market competition that accompanied the NDIS, and for that reason we now first discuss important characteristics of this Scheme.

Australia’s national disability insurance scheme

The National Disability Insurance Scheme (NDIS) was rolled out in stages between 2013 and 2020 to introduce individualised disability support budgets in Australia. Prior to the roll-out of the NDIS, disability support was significantly underfunded in Australia (Productivity Commission, 2011). At this time, some services received block funding, meaning it had no impact on a provider if a person with disability left a service when that service was inadequate or even dangerous. The funding stayed with the service, rather than the person. As a result, people with intellectual disabilities had limited opportunities to access support that enabled them to engage in community life on their own terms.

The NDIS was designed to address limited choice and subpar service delivery in the block funded model by allocating funding to individual people with disabilities who can choose how to spend it. The Scheme is based on the ideas ‘choice and control’ and ‘mainstreaming’ (Wiesel et al., 2022). ‘Mainstreaming’ holds that people with disabilities should be able to use mainstream rather than specialist services, so that they are not segregated in a siloed service sector. Removing this segregation was thought to increase people’s choice as allocating funds to individuals was expected to make mainstream and specialist providers vie for the business of those individuals, which in turn, would improve service access and quality for people with disabilities (O’Keeffe & David, 2022). Because services no longer need a government contract to offer services and because disability support funding tripled with the NDIS, a wider variety of organisations now offers disability support and this now also includes many new organisations that emerged in response to the NDIS. Presently, for-profit and not-for-profit organisations offer services under the NDIS, and some of these organisations are specialised in supporting people with disabilities while others are not.

The diversification of service provision under the NDIS is important context for understanding how it incentivises improvements in access. Specialist providers are commonly not-for-profit organisations, and they are not formally required to develop programs in collaboration with mainstream providers. However, some service users with disability engage specialist providers to facilitate and support the community access and participation components of their personalised plans. For such organisations, collaboration with mainstream providers towards greater disability access and inclusion might strengthen their reputation and their ability to attract more NDIS participants. The NDIS funding level was costed to include a percentage of overhead margins, which can cover some costs related to partnership work. The NDIS thus offers specialist providers some ways to charge individual NDIS participants so that their funding can be used to support mainstream access on behalf of NDIS participants. However, mainstream access work that occurs under the NDIS is not necessarily occurring due to the NDIS as some organisations might have retained existing relationships with mainstream services.

While specialist providers have some reputational incentives to improve mainstream access, there are currently no direct incentives for mainstream organisations to improve service access for people with disabilities beyond market competition for service users. The original design of the NDIS included a funding component, the Information, Linkages and Capacity Building (ILC) grants, that supported mainstream organisations to become more accessible for people with disabilities (e.g. Ramcharan et al., 2020). However, pressures to reduce the cost of the NDIS led to a watering down and then complete removal of this component. The absence of incentives for improvements in mainstream service quality and access means that mainstream and disability specialist organisations are left with limited resources to promote disability access and inclusion beyond access for individual NDIS budget holders. For this reason, the NDIS is being critiqued for having ‘also re-cast community inclusion within [its] market model […] making it dependent on this funding’ (Wilson et al., 2021, p. 38). The funding dynamic also overlooks the insights discussed above that competition erodes some important work practices that can improve service for people with disabilities (Green et al., 2018).

Wavering NDIS investment in mainstream service access means that improvements in the accessibility of mainstream services has come to depend almost exclusively on market dynamics. However, Australian mainstream services have thus far made few adjustments to ensure accessibility for people with intellectual disabilities (Wiesel et al., 2024). We have previously demonstrated that when mainstream services have made adjustments, these were not competitively motivated, but based on aspirations to meet organisational values or contractual obligations (Wiesel et al., 2022). We also found that support workers’ initiative, knowledge and networks commonly facilitated entry into new services for people with intellectual disabilities and that their relationship with a mainstream service helps these workers see that service as suitable for the person with whom they work (Van Holstein, 2021; Wiesel et al., 2022). These tensions between the NDIS promises and realities documented on the ground shape our objective to analyse the effects of a competitive environment on services’ ability to perform the work of making services accessible and inclusive for people with intellectual disabilities. We hope this work offers geographers more refined conceptual tools with which to understand both competition in service landscapes and the labours of care and repair these competitive environments require.

Collaborative repair in competitive landscapes of care and support

‘Landscapes of care’ is a conceptual framework that acknowledges that service provision is ‘both product and productive of social and political-institutional arrangements for care’ (Milligan & Wiles, 2010). ‘Landscapes of care’ draws simultaneous attention to care’s structural circumstances (e.g. the restructuring of funding, changing caring responsibilities) and to the practices and experiences that shape caring relationships (see Gleeson & Kearns, 2001; Milligan & Power, 2010). The framework has been used to analyse the effects of differently designed disability support arrangements while also considering how people who give and receive support shape care through their practices (Bowlby, 2012; Milligan & Wiles, 2010; A. Power & Bartlett, 2018). The framework explicitly adopts a multi-directional understanding of care as the outcome of caregivers’ and care receivers’ practices that are structured by changing societal beliefs and norms about who deserves care, who should perform it and under what conditions.

In this article, we adopt ‘landscapes of care’ as a socio-spatial framework to analyse how the idealisation of competitiveness creates access gaps that require repair work to make services inclusive for some people with intellectual disabilities. While this framework deliberately positions care recipients as active contributors to care, it is important to note that the concept of ‘care’ continues to carry connotations of dependency. This is why many people with disabilities prefer the word ‘support’ and we follow Macpherson and colleagues (2023) in their expansion of the concept to ‘landscapes of care and support’. In preparing the framework for our analysis we also develop its conceptual sensitivity to the dynamics of competition and inter-organisational collaboration.

In analyses of deregulated care markets (Hall, 2009, 2011), geographers commonly understand competition as a background against which they analyse service users’ experiences of increasingly individualised service provision and workers’ experiences of increasingly precarious work. These approaches have created important insight into the shortcomings of market dynamics for disability inclusion, as it has shown, for instance, that it encourages an understanding of cost reduction as an ‘improvement’, even when this goes at the expense of inclusion or quality (Macpherson et al., 2023). However, the approach has left competition itself beyond scrutiny. We expand the framework by following Schoenberger (1998) who distinguished between competitiveness as discourse and as practice. As a discourse, ‘competition’ and ‘competitiveness’ are persuasive concepts that are now firmly embedded in common sense ideas about ‘the economy’. The concepts have ‘social immunity’, because they originally described an entity’s ability to continue to exist (Schoenberger, 1998, p. 5).

Competitiveness is commonly misunderstood and misrepresented, for instance when market dynamics that apply to corporations are projected onto nation states and governments (Krugman, 1994) or when the causal relationships between the supply, demand and price of staple goods on an open market are projected onto services that are inelastic in price, supply or demand (Hay, 2012). Conceptual slippage also occurs when competitiveness is confused with a business’ ability to accumulate capital and to maximise profits (Schoenberger, 1998). This is why it is important that the landscapes of care and support framework distinguishes between competitiveness and profit maximisation, and between competitiveness as discourse and competitiveness as practice.

In the context of the NDIS, competition is the foundational idea that promises improvements in service access, quality and inclusion for people with disabilities. The expectation that competition will generate these benefits rests on the assumptions about demand, supply and pricing practices described above (Hay, 2012). Regarding demand, it assumes that people with an NDIS budget will realise it when service is better elsewhere, that they are able to move to an alternative provider, and that their support networks are willing and able to accommodate the change. Regarding supply, it assumes that staff have the skills and resources to identify and remove access barriers. Regarding price, it assumes that offering service to people with disabilities requires the same staffing levels and generates equal profit as servicing customers without disability. For many people with intellectual disabilities, mainstream service access relies not only on the accessibility of the service in question, but also on the availability of additional support to facilitate travel and communication. Assumptions about the ability of people with disabilities to change services have already been debunked where people were unable to acquire the support or transport that was necessary to facilitate the change (e.g. Macpherson et al., 2023).

When the complexity of a service landscape obstructs service access, additional work is required to make services accessible (Hewitt & Cook, 2023). Recent innovations conceptualise this work as a form of ‘repair’ to create analytical sensitivity to work that is pivotal to the operation of social systems but that is structurally undervalued (Stokes & De Coss-Corzo, 2023). This undervaluation enables structural underpayment of people who perform repair work and it simultaneously obscures repair work in ways that hold up the image of systems as stable and reliable (Graham & Thrift, 2007). However, repair work is a structural and inherent part of any system, not an exception to it, as systems are in continuous states of decay and disrepair, whether by design, or due to neglect or use (Jackson, 2014). Repair requires attention because the practice highlights the brokenness of support systems that are inaccessible (E. R. Power et al., 2022).

Conceptualising the inter-organisational work of third sector employees of referring, advocating and brokering for disability access as a form of repair, highlights that this work is integral to the service system, that it requires particular skillsets and resources and that it is performed under precarious conditions. However, we also recognise that work across services can have detrimental impacts on access and quality for marginalised service users. For instance, researchers found that collaborative relationships tend to be initiated and maintained by select individuals who are uniquely able to speak the languages of the mainstream and the support organisation, and that this can make service access depend on the ongoing presence of those individuals (Herman & Yarwood, 2015; Milbourne, 2009). Rather than taking a normative approach that valorises collaborative repair work, our analysis remains open to the possibility that this work can also further complicate and obstruct service access.

By introducing ‘competitiveness’ and ‘repair’ into the landscapes of care and support framework, we attune our analysis to the roles that variously positioned organisations and individual workers play in making mainstream services accessible for people with intellectual disabilities in an increasingly competitively orientated environment. This way, we bring new attention to the circumstances that compel and enable a service provider to act beyond the perimeter of their own service domain to advance the interests of people with intellectual disabilities who might otherwise experience exclusion or diminished service quality.

Method

This article draws on a three-year study into the factors that shape access to mainstream community services for people with intellectual disabilities. Data collection took place between 2018 and 2020 across four research sites in two Australian states, New South Wales and Victoria. Western Sydney, a subregion of the State’s capital city, and Newcastle, a medium-sized city approximately 120-kilometre North of Sydney are located in New South Wales. Two comparative sites were selected in Victoria: the metropolitan subregion North-eastern Melbourne and the medium-sized city Geelong, approximately 75-kilometre west of Melbourne. Interviews with people with intellectual disabilities explored their experiences of mainstream services they used. Interviews with the staff of mainstream services that were mentioned by participants with intellectual disability subsequently sought their accounts of adjustments they had made to enable participation of people with intellectual disabilities. As explained above, in this article, we focus on interviews with people who work in mainstream services that collaborate with other organisations to make their service accessible to people with intellectual disabilities.

A total of 49 interviews were conducted with mainstream service staff across the four sites. All interviews were digitally recorded and transcribed verbatim. These data were coded thematically using NVivo software, following a hybrid inductive and deductive approach to the generation of codes. Some interviews were double coded by two authors to ensure consistency in coding. All interviews with participants with intellectual disabilities were conducted in person before the pandemic. Interviews with service providers were initially conducted in person, however during periods of lockdown or other public health restrictions interviews were done over the phone. The study was approved by the University of Melbourne’s research ethics committee and all participants gave written consent. We now present three different types of collaboration that facilitated service access for people with intellectual disabilities. The first is between a mainstream for-profit organisation and a not-for-profit specialist service provider; the second is between a government and a not-for-profit mainstream service provider, and a third between a for-profit mainstream housing provider and a mainstream not-for-profit advocacy organisation.

Tennis classes with specialist support

In this section we discuss a collaboration between a for-profit tennis school and a not-for-profit specialist organisation in Newcastle. The owner of the tennis school reported that he had been approached by disability support workers employed by a specialist organisation with a request to run tennis classes for a small group of their service users with intellectual disability. The example illustrates a common pattern we found across mainstream services in the four cities whereby mainstream services had been persuaded by a support providing organisation to adjust their service. The tennis teacher recalled during the interview that he started the collaboration tentatively:

First of all, it was a trial a year and a half ago and now they just come every week and absolutely love it.

The owner recounted that he had initially been hesitant about the idea:

I was a bit nervy about starting with them I’ll be truthful. I wasn’t sure what to do or what - I wasn’t sure where I’d start with them and how I’d go. I thought a possibility could be it’s a waste of time, but it’s absolutely been 100 per cent in the other direction.

The quote illustrates the teacher’s initial lack of confidence and demonstrates that this lack was overcome by starting the tennis class as a trial. When collaborations between mainstream and specialist providers came up in other interviews, these collaborations were always initiated by specialist providers. We can infer from this that specialist providers are taking on the task of persuading mainstream providers to adjust their service for people with intellectual disabilities and to take the risk of doing something new. For mainstream providers such as this tennis school, competitiveness is thus not what drives repair. Rather, the specialist organisation is the entity creating service innovation. This persuasive and creative repair work that support providers perform to make mainstream services accessible is largely undocumented.

Since their initial trial, the tennis school and the specialist workers have developed a long-term collaboration in which the two parties contribute different skills and assets to create a disability inclusive tennis class. The tennis coach contributes tennis specific expertise and equipment. He uses his experience as a tennis coach to ‘think on his feet’ and to come up with creative ways to teach tennis skills in ways that align with the students’ ability. He shared the following example of an adjustment:

I was trying to teach them that playing tennis is more than just hitting one ball. How can I get this through to them that tennis is … they hit one ball and they’d stop what they were doing and thought that was it. So, I got the big tennis ball out and we started rallying by throwing the ball over and back over the net, right? Then I slowly got into their heads that the idea of playing tennis is to keep the ball going back and forth until someone misses it.

The interviewee explained that he has been a tennis coach for a long time, and he speculated that teaching students with intellectual disability may be more difficult for coaches who are less experienced.

This mainstream provider also gave examples of being assisted in rendering his service accessible by the specialist providers:

If I’m struggling, the [specialist staff] will reinforce what I say. My favourite line with [the students] - and [the specialist staff] burst out laughing when I first used to say it to [the students] – ‘I’m only going to tell you this once’. [Specialist staff] used to burst out laughing because obviously with these guys you’ve got to repeat yourself 500 times and then it sinks in. So, if [the staff] think I’m saying something and [the students] are not quite getting it [the specialist staff] will say it a different way and I’ll pick up on that as well. […] The two people from [the specialist organisation] have been unbelievable, they’ve made it very easy.

Importantly, this quote illustrates that collaboratively working alongside disability specialist staff affords mainstream service staff an opportunity to develop their disability inclusion skills and confidence.

Additionally, this interviewee highlighted that the dual presence of mainstream and disability orientated staff created circumstances in which students could be more engaged in the class than they might otherwise be. The familiarity that the students had with their support workers provided the teacher with a tool to increase the motivation of the students:

Then I drag the couple of people from [the specialist organisation] into the game part of the lesson [because] I find that with the two staff in there, the guys get on really well with them, and when they’re involved as well, the guys try harder.

The interpersonal relationships and familiarity that specialist staff contribute to the collaboration strengthen the inclusionary effect of repair efforts that occur between disability specialist and mainstream services. Through the presence of these staff, the familiarity and fun that characterises the relationships they have with service users with intellectual disability and their ‘getting on really well’ can extend into the spaces of another service in which people with intellectual disabilities are yet to become comfortable with new people and learn a new skill.

This example also shows that collaboration and skill sharing between services can be a fruitful way to remove hesitation in mainstream staff and to build up their skills for creating disability inclusive activities in mainstream spaces. As such, collaboration may have lasting outcomes in mainstream services that can benefit other people with intellectual disabilities in the future. However, in the larger research project we did not find evidence of mainstream providers independently continuing adjusted services that started in collaboration with a specialist provider after such a collaboration ceased. It is also important to note that the ongoing presence of support staff externalises the cost of mainstream inclusion to support providers and deepens the reliance of people with intellectual disabilities on disability support funding for access to mainstream services (Wiesel et al., 2024).

Discounted and supported membership to a public sports centre

In this section we describe a collaboration between a leisure centre, which is a local government-owned sports facility and a not-for-profit community centre in Melbourne. When asked about any adjustments that the leisure centre had made to ensure inclusivity towards people with intellectual disabilities, the manager detailed a discounted subscription that made the leisure centre available to a select group of people at reduced rates. He explained that this program was managed by the neighbouring community centre.

We subsequently interviewed the manager of the community centre and she explained that she initiated the discounted subscription program:

We knew [the leisure centre was] run by Council. Council has those policies in place about inclusion and about access. […] When you know what policies people have in place, it’s really important to inclusion, because you can say well you have a health and wellbeing plan in place that has these targeted areas - you’re not meeting these targeted areas. […] We think we know how [you could meet them], because people have told us they can’t access the gym because it’s a financial burden.

The leisure centre manager also explained that their connections to Council and Council’s ability to subsidise the program facilitated its financial sustainability:

This is all through Council funding. We’re fortunate – we’re part of the community division within [Council], and so it’s quite easy for us to gain support for these types of programs. […] We submit a bid for funding every budget phase in the year, and so with us and the [community centre], we brief together what it will be, how much it would cost us, and it goes to the executives and gets approval for funding that way.

The knowledge that the community centre manager had of the contractual obligations of the leisure centre enabled her to persuade the leisure centre to collaborate with her in offering a discounted membership. Each of the two organisations’ affiliation with local government provided a shared bureaucratic context in which they found financial support for their collaborative repair efforts and in which the community centre was able to hold the leisure centre to account for being too price driven in its decision making.

The community centre further invests in the inclusiveness of the leisure centre by managing the discounted subscription program for the leisure centre. When asked who is eligible for the membership, the community centre manager responded:

Well, that’s kind of up to us. The gym has left all the criteria, that side of things, up to us. Because sometimes services will ring us and say our community member, our person, could really do with seeing you and going to the gym.

The subscription comes with a condition that people regularly use their membership, but the community centre makes exceptions:

Because sometimes, we’ve had community members not be able to go because their carer hasn’t been available. Things like that. So, we don’t see that as a hard and fast rule [we wouldn’t say] ‘well, you haven’t gone every single week’. Because that’s unfair. So that’s where we’re a little bit more lenient.

The community centre thus takes on substantive responsibility for managing accessibility to the leisure centre. Both parties agree that the community centre is better placed to do the work of repairing access to the leisure centre because it has better networks and relationships and is more approachable. This enables their staff to identify people who would benefit from the opportunity and who need extra consideration.

For these same reasons, the community centre also takes on the tasks of preventing and managing conflict. The manager of the leisure centre said:

When we’ve had issues with participants in that program, when we try to address them directly, it’s not successful. […] Oftentimes [the community centre] has a longstanding relationship with them or knows more about their background that we’re not aware of and knows how we can navigate any of those challenges.

Again, both managers agreed that the community centre is better positioned for this task because they have done the prior ‘relational work’ (Carlsson & Pijpers, 2021) of developing trusting relationships with service users and acquiring detailed insight into subscribers’ personal circumstances. This familiarity also ensures that challenges are addressed in ways that do not disengage the person from the gym:

it allows [subscribers] to work with the [community centre] people that they’re really comfortable with, to manage it better, so they can work through those challenges with support. Because oftentimes what happens is that a person who isn’t comfortable with completing the paperwork in a typical manner, or can’t manage staying on top of their regular direct debits and they get behind - when they come in and get treated like your everyday member that doesn’t have any intellectual challenges, that experience is extremely challenging for them, to the point where they were leaving, and not coming into the gym at all.

In this example, the community centre takes on substantive responsibility for the inclusiveness of the leisure centre and this is motivated by the centre’s strong ties with individual people who experience exclusion for various reasons, including people with intellectual disabilities.

Although both organisations’ managers speak proudly about the program, the community centre manager explained that she had to fight to prevent its cancellation when the current leisure centre manager started in the role. Because he was not familiar with the program’s rationale and because he sought to strengthen the centre’s competitiveness, he suggested removing the discounted membership or increasing its fees. This shows that competitiveness can be promoted at the expense of disability inclusion and that inclusive adjustments can require pushing back against competitive practice. The example also shows that governments can play an important role in softening the ‘cruelty’ of competition (Schoenberger, 1998) when they make strategic guidelines available on equity and inclusion that can function as a lever in repair work. Furthermore, it shows that such documents can insure against the organisational change that comes with staff turnover as such turnover can make an organisation default to ‘common sense’ ideas and practices of competitiveness.

Collaborative access to private rental housing

In this section we analyse a collaboration between a for-profit real estate agency and a not-for-profit advocacy organisation that supports elderly people at risk of homelessness into private rental housing in Geelong. The advocacy organisation collaborates with a real estate agent who considers the advocacy organisation’s service users for rental listings. This way, the two parties have helped several elderly people with intellectual disabilities into mainstream housing. According to the real estate agent, the collaboration started when the advocacy organisation sought their help with finding affordable homes while homeowners sought to rent out houses through the agency for which he doubted he would find other suitable tenants:

The first thing I started to find is that some of the quality houses that we have are not suitable for renting, therefore I won’t take them on. So, I’d see a really bad place, I’d look at it and say, no, I’m not going to put anybody in here. […] Then suddenly [the advocacy organisation] called me and […] they said, well, we think this property is quite good for the affordability of our clients.

He explained that he could offer these houses for rent at a rate that was affordable for someone on a pension.

You won’t get much in Geelong for 280 dollars a week, but there are some properties that I believe are good enough [for] the affordability of those people rather than being on the street.

As further illustrated below, renting these houses out to people through the advocacy organisation afforded the agency assurances they do not enjoy with other tenants who apply for rental properties in the lowest price category.

The advocacy organisation put the motivation of the real estate agency to take on their applicants as tenants in the following terms:

A number of their rental properties are in […] the lower socio-economic areas of Geelong. I think they had quite a few problems getting: a) tenants who were interested in living in those areas, because there is a higher crime rate and there is quite a lot of public housing, and b) getting suitable tenants who would pay the rent and look after the property, and there wouldn’t be any anti-social behaviour or any trouble with not paying the rent et cetera. So, it worked in their favour, but it’s worked in our favour as well.

According to the real estate agent, the collaboration is successful because the advocacy organisation ‘keep[s] an eye on these people throughout their journey with us’. Again, the success of the collaborative efforts relies on the not-for-profits ‘relational work’ (Carlsson & Pijpers, 2021) of investing in trusting relationships with their clients and the development of detailed insight into their needs. Further reassurance was offered by the fact that many people with intellectual disabilities opt to have their rents immediately deducted from government payments prior to these funds entering their bank account. This lowers risk for the real estate agent, who said:

It’s a big selling point now when we deal with anybody that may show signs of financial difficulty, it reassures me that [the government department that pays support] will automatically take that amount out each week to pay their rent. So that keeps them in front all the time.

The agent explained that these conditions make people with intellectual disabilities attractive tenants:

those people are lifers, generally lifers. When they rent a property, you could almost say we don’t have to worry about it again until their life ends. They have proven to be very, very stable people to have. Yeah. Easy to deal with, easy to help, they pay their rent on time, they’re looked after, we’re looked after, it’s a great relationship.

Because of these circumstances, the advocacy organisation’s clients offer the real estate agency a form of security that it does not enjoy with other applicants who seek to rent affordable homes in low socio-economic parts of the city. These insights illustrate that the competitive practices of the real estate agent interact with differences between potential tenants with and without disability and that demand for this service is thus not interchangeable.

While the discretionary power of this real estate agent to favour people on support payments in tenant applications makes mainstream housing accessible for some people with intellectual disabilities, the real estate agent simultaneously also worsens mainstream housing access by using this power to discriminate in pricing. According to the advocate we interviewed, the agent increases rents for these tenants:

The rent that our clients pay is a bit higher than sort of the norm. Like I noted that this house that was in [a suburb of Geelong]. […] there was a house that was in a better condition that was three houses down. When it came up through another real estate agent, it was $40 a week cheaper. So, they can name their price a little bit more.

The advocate added that being offered the lease gave their service users an important opportunity to build up a record of rental history and increased their opportunity to rent elsewhere in the future. However, it is also evident from these quotes, that the marginalisation of people with disabilities on the housing market interacts with the profit maximisation strategies of a mainstream business in ways that make them subject to higher rents and that this exploitation can occur as part of reparative service collaborations that facilitate access.

Discussion: how competitiveness shapes service repair for disability access

In this article we have shown how repair is performed collaboratively between organisations when a landscape of care and support is competitively orientated. Policy that evolves around individualised budgets, such as the NDIS, place competition centrally in their theory of change for greater disability access. However, competition as it applies to trade in goods does not apply to trade in services (Hay, 2012) making it important to understand how competitiveness works out in this context. The article has shown that a competitive environment changes how repair is practised. Competitiveness has different effects on different actors and incentivises some forms of repair while disincentivising the repair practices of others. Our results reveal that competitiveness introduces a field of momentum and friction for repair work into a landscape of care and support. By variously encouraging and inhibiting repair work, competitiveness shapes the conditions for access that people with disabilities experience in that landscape.

The idea that services will automatically and uniformly become accessible when placed in a competitive environment, and the discursive centrality of competition in disability inclusion policy has been critiqued by others (Green et al., 2018). Building on this work, we argue that improving access relies on continuous repair work. The distinction between the discourse and practice of competitiveness borrowed from Schoenberger (1998) and between practices related to supply, demand and price (Hay, 2012), helped reveal that the concept of competitiveness insufficiently addresses differences between demand for service by people with and without intellectual disability. The recurring reliance of access and inclusion on a mainstream staff member’s judgement on whether to make adjustments or not, highlights that a marketplace of care also emphasises competition for service between people with and without disability and between people with different degrees or expressions of intellectual disability. In a context where services are already structurally more inaccessible for people with more severe intellectual disability, competitiveness creates risk that adjustments will not be uniformly devised for all people with intellectual disabilities, but only for those deemed to be deserving, motivated, profitable, and presenting low risk.

Conceptualising collaboration on a service’s accessibility as repair work enriches the landscape of care and support framework by highlighting the ‘relational distance’ (Carlsson et al., 2022) between people with intellectual disabilities and mainstream services. This is especially pertinent in the context of a group of service users who commonly rely on multiple, well-coordinated sources of support to access a service (Macpherson et al., 2023; Wiesel et al., 2022). Scholars in repair studies highlight that repair is a creative process (Graham & Thrift, 2007) and our work extends this insight to show that adjustments for disability access rely on multiple sets of expertise, including detailed insights into service users’ needs that are generated through long-term investment in interpersonal, relational work (Carlsson & Pijpers, 2021). This conceptualisation shows that collaboration on disability access facilitates the flow of expertise about disability access from specialist and experienced services to mainstream services where staff are commonly less well informed.

Our analysis also places a spotlight on shifting responsibilities within landscapes of care and support, by revealing who is doing the work of repairing access to which services. Expertise about disability access and knowledge about the needs and circumstances of individual people with intellectual disabilities that are common in not-for-profit organisations and specialist organisations are a crucial but structurally overlooked motivation and source of knowledge for facilitating access. Considering competitiveness and repair together showed that organisations that have these relationships become saddled with responsibility to perform repair work in for-profit organisations. Where work across institutional and sectoral borders has previously been demonstrated to change power dynamics and agency in relationships between workers and institutions (Newman, 2012), our contribution shows that this work also changes distributions of responsibility and risk. When applied to disability inclusion, the concept of competitiveness shows that a drive for profit does not on its own motivate organisations to become disability inclusive and that it pushes costs and risk onto not-for-profit organisations. Inter-organisational collaboration across for- and not-for-profit domains can force not-for-profit organisations to accept for-profit rationale in order to secure access for a client with disability.

Concurrently, the logics of competitiveness and profit maximisation encourage for-profit organisations to incorporate NDIS-generated demand in ways that minimise interruptions to their business practices, for instance by accommodating customers with intellectual disability in geographical locations and timeslots of low demand. While these business practices did effectively result in mainstream service access, the framework of competitiveness helps show that people with intellectual disabilities are being granted access on different supply, demand and price terms than their peers without disability. The practice of price gouging we found in this study aligns with research by Foster et al. (2022) that demonstrated that financial incentives could encourage providers to make adjustments on inequitable grounds. The framework of landscapes of care and support shows that when ‘competitiveness’ is introduced into disability service provision, the dynamics by which customers compete for service access does not receive sufficient attention and risks of harm and exploitation can become understated as a result.

Our analytical combination of competitiveness and repair brings the insight that competitiveness can reduce incentives for repair work (Graham & Thrift, 2007) into scholarship on landscapes of care and support. For organisations that are already meeting their bottom-line, competitiveness offers no motivation to perform repair work. For organisations that struggle to meet their bottom-line, such as the leisure centre, the imperative to be competitive can disincentivise repair. In the example of the leisure centre, the analytical distinction of competition as discourse and as practice also illustrates that organisations that have disability inclusive practices in place can revert to exclusionary practices when staff turnover causes a default to the dominant overriding logic of competitiveness. This example illustrates the importance of local governments’ interventions in the form of subsidies and strategic direction. Third-sector employees’ repair work entails understanding the circumstances of another organisation, which includes its competitive bottom-line but also its responsibilities by government guidelines and regulation, and using these as levers to persuade that organisation to make adjustments.

The distinction between competitiveness as discourse and as practice also highlights that, paradoxically – or perhaps by design – any successes of not-for-profit staff to repair for-profit services can strengthen the discourse of competitiveness by serving as ‘evidence’ of private enterprises’ ability to creatively and competitively respond to the new business opportunity that was created by NDIS budgets. This aligns with arguments by repair scholars that repair is structurally obscured and undervalued and that this serves to hold up the image that the overall system is stable, reliable and functioning as intended (Graham & Thrift, 2007; Jackson, 2014). In the context of disability support funding, the politics by which repair work tends to go unnoticed (Graham & Thrift, 2007) and the tendency for competition to be validated as encouraging progressive change risk exacerbating the increasing precariousness of care and repair work.

Conclusion

Our analysis foregrounds that, in the context of Australia’s NDIS, not-for-profit organisations’ commitment to individual service users are a driving force behind mainstream service adjustments. This finding challenges the assumptions that underpin similarly individualised disability support funding mechanisms in other countries with high levels of market-based service provision, that private market entities, driven by competition, will independently make services accessible and inclusive. Investment in the idea that competition between specialist services and between mainstream services will incentivise disability inclusion in each sector has deprioritised collaboration across service domains. As a result, for-profit mainstream services are not independently incentivised to enhance their accessibility and are being offered opportunities to offload this responsibility onto not-for-profits. The NDIS’ move away from funding mainstream service access deepens the importance of other government initiatives that create strong incentives for mainstream services to improve their accessibility for people with intellectual disabilities., Our research shows that competitive dynamics place a disproportional responsibility on not-for-profit organisations and can sustain discriminatory practices in for-profit service delivery. Meanwhile, the NDIS is making people with intellectual disabilities more reliant on specialist organisations that ensure access to mainstream services by continuing the repair work that is required to secure access to service systems (Stokes & De Coss-Corzo, 2023). The article thus shows that the NDIS’ emphasis on competition is misguided, and that it is at least equally important to encourage and facilitate collaborative repair.

Acknowledgments

This research was supported by ARC Discovery Grant DP180102191. The authors wish to thank all research participants for investing their time and expertise into this project. We are also grateful to the three anonymous reviewers and the editor for their constructive and insightful feedback.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by the Australian Research Council [DP180102191].