We provide below a summary of the key quantitative and qualitative evaluation evidence relating to the disability sector and its workforce.
3.6.1 The disability sector
Evidence from large scale surveys
As the roll-out of the NDIS progressed, changes were identified in the provision of disability supports. The average number of services provided by disability support providers and self-employed providers declined over time. In particular a decrease in the proportion of organisations offering advocacy, information and communication support, and early interventions occurred.
Community access and personal support were the two most common service types provided by disability organisations, while self-employed providers most commonly reported providing therapeutic and early intervention services. This did not change over time.
Most of the planning by disability service providers to adapt to the new demand arising from the NDIS occurred in wave 1; only around a quarter of provider organisations were planning to expand their range of supports further in wave 2.
By wave 2 providers were much more certain about the impact the NDIS had had on their organisation. While many providers continued to feel that this impact was positive, the proportion reporting negative impacts from the NDIS rose sharply by wave 2.
The expected positive impacts of the NDIS reported by providers in wave 1 (on employment, support charges, wage growth and overall performance), were largely consistent with the actual and expected future impacts identified in wave 2.
The number of activities being undertaken by providers in response to the NDIS increased over time. In particular, in wave 2 more disability service providers reported engagement with LACs, expansion of their workforce and changing staff types to meet service demand.
The total funding received by disability service providers for the provision of disability supports had increased considerably by wave 2. Moreover, as the proportion of funding received from the NDIS increased, the proportion from government, non-government and private donations declined. Self-employed providers also experienced a decline in funding from user fees/direct payments.
Evidence from in-depth qualitative interviews
Market changes were slow to materialise, due to a slowly adapting or emerging provider sector. The NDIS had prompted the need for disability service providers to change their business models. In some cases this was reported to have led to less personalised service provision.
Many disability service providers were still receiving some block funding. As such, the full financial impact of the NDIS was not yet considered to have hit the sector. However, concerns about financial viability continued throughout the evaluation and included reports around unfunded work, funding for cancelled appointments, adaptation to the payment in arrears system and NDIS pricing.
Providers were concerned about their capacity to deliver supports to the same standard as before the NDIS, citing the NDIS model of individualised funding and caps on service prices as a constraint.
The entry of new providers into the NDIS trial sites was widely reported in wave 2. Most new entrants were small or solo allied health practices. The emergence of new internet based labour-for-hire services led to concerns about safeguards and the future quality of disability support services.
Increased merger and acquisition activity were also reported in the disability sector over time.
Some exits from the sector were noted, either through organisational closure or a decision to cease providing disability support services due to the loss of state government funding. Reports were also provided of allied health professionals disengaging from the NDIS due to issues with pricing and best practice.
Most NDIS participants reported receiving services from disability support workers and were highly satisfied with the quality of care they received.
Overall disability workers reported high levels of job satisfaction. They were particularly satisfied with the work itself and the sense of achievement gained. Disability workers were also confident that they had sufficient skills and abilities and were able to use these in their work.
Although the size of the disability organisations surveyed varied considerably, the average organisational size increased from wave 1 to wave 2 (from 71 to 84 employees).
The most common direct care occupations in the disability sector across both waves 1 and 2 were disability support/residential support workers. The proportion of workers in this role grew from two-thirds of the workforce in wave 1 to three-quarters in wave 2. The occupational profile of the remainder of the direct care workforce changed little over time.
The disability sector is a female-dominated industry; three quarters of the direct care workforce in both waves 1 and 2 were female.
Although permanent employment remains the most prevalent form of employment for the disability workforce, a growing trend of casualisation was seen over time.
The length of employee tenure had declined by wave 2, and particularly for allied health workers. This could be indicative of growing issues with staff retention in the sector.
The use of agency workers decreased over time. Agency staff were most commonly used to fill disability support/residential support worker positions.
Contrary to concerns raised in the qualitative interviews, the level and type of training provided to disability support workers was relatively stable across time.
Low levels of under-skilling and skill shortages were reported in both waves 1 and 2. Skill shortages were primarily attributed to a lack of specialist knowledge and were most commonly reported for disability support/residential support roles.
A majority of disability service providers reported having no staff vacancies. While few unfilled vacancies were reported overall, the number of service providers unable to fill allied health worker positions doubled between wave 1 and 2. This corresponds with the qualitative evidence and suggests that allied health workers are in shortage.
The proportion of organisations intending to hire new workers over the next 12 months increased over time. Strong future demand for disability support/residential support workers, service or programme administrators/manager/coordinators, personal care/home care workers and allied health staff was noted.
Experience and motivation were the two most common attributes disability providers reported looking for in new applicants. These were considered to be relatively more important than formal qualifications and references.
Evidence from in-depth qualitative interviews
The workforce was reported to be expanding in wave 2; however, this was occurring in the context of concerns about skill shortages, employee recruitment and retention, increased turnover and churn, unfunded work, more casual and less well-paid work, remote provision and lower quality of provision.
Some providers were reported to be having to hire agency staff due to recruitment issues. NDIS participants expressed considerable concern about the quality of these workers and their lack of specialised training.
Concerns about conflict between industrial relations responsibilities and NDIA pricing constraints were persistent throughout the evaluation. These concerns included paying staff award rates within NDIS pricing levels, managing minimum shift hours under industrial awards against NDIS participant requests for shorter services, and implications for working conditions.
Opportunities for training, student placements and supervision had reduced within the NDIS trial sites. Concerns were also expressed about the future impact that this could have on the skilling of the workforce and the ability to attract new workers into the sector.
3.6.3 The NDIA workforce
One of the chief impacts of the introduction of the NDIS has been the creation of a major new workforce within the disability sector – the NDIA workforce. Interviews with NDIA staff allowed the evaluation to examine this workforce and their experiences of rolling out the NDIS.
NDIA staff reported that the quality of their workforce was a positive aspect of the NDIS. Staff retention was a concern, however, and was projected to become more difficult as the NDIS roll-out progressed.
NDIA staff across all trial sites and positions reported a high workload, which contributed to considerable work stress. Work stress was linked to high rates of resignations and in some cases negative health impacts for staff. Concerns regarding stress and burnout amongst NDIA staff increased over time as the NDIS moved towards full roll-out.
Respondents identified areas where further training would benefit NDIA staff and provide better outcomes for participants. This included improving the ability of staff to identify and monitor participant capacity to implement their plan, support for self-management, and training about specific disability types to assist with reasonable and necessary decisions.
There were a number of challenges that differentially impacted on NDIA staff. The role specific challenges for planners were primarily related to workload but also to high administrative burden arising from planning processes. Challenges specific to the role of LACs related largely to perceptions that they were not doing what they were employed to do. Many felt the specific skills and connections to the community that they brought to the position were not being utilised. The principal challenge identified by PSCs related to the pressures of workload, and in finding time to undertake plan implementation and community engagement.
NDIA staff reported several areas of improvement which were required. NDIA staff wanted to be able to utilise their skills more fully and for the agency to offer improved career opportunities to enhance both job satisfaction and retention of staff. More support from supervisors to manage workplace stress and high workloads was also highlighted. Moreover improvements were required in managing the support needs of NDIA staff with disability including ensuring access to assistive technology, setting up desks appropriately and better understanding of the services available to support these staff.
