The section integrates and summarises the quantitative and qualitative findings relating to reasonable and necessary supports.
The evaluation finds that:
NDIS participants have a high satisfaction over whether they believe that their NDIS supports are reasonable and necessary;
the satisfaction of those who joined the NDIS trial earlier was a bit lower than of those who joined it later;
satisfaction about supports being reasonable and necessary increases with longer time in the NDIS as people understand the system better;
however, those unable to understand the system and effectively articulate their support needs were considered to be at risk of poorer outcomes;
satisfaction varies by disability type and the age of NDIS participants;
there remains a minority who do not consider they are receiving reasonable and necessary supports from the NDIS and several key factors that contribute to this are identified by the evaluation;
dissatisfaction arises due to variability and service gaps in NDIS plans, by inequality in the plans of participants with the same type of disability and needs, by funding inconsistencies across the trial sites and by lack of transparency as to how decisions are made;
evolving guidelines were a source of concern as the NDIS kept rolling out;
despite the initial concerns about the conceptual difficulties in forming a consensus on what is a reasonable and necessary support during the NDIS roll out, most of the difficulties recorded by the evaluation appear to have been of a practical rather than a conceptual nature; and
overall, the evaluation finds that NDIS participants are in their majority highly satisfied about their supports being reasonable and necessary under the NDIS.
Satisfaction with supports being reasonable and necessary
Both the quantitative and qualitative evidence suggest strongly that the majority of NDIS participants and their family members and carers were satisfied that their disability supports were reasonable and necessary. Moreover, the quantitative evidence found that being in the NDIS had a strong positive impact on satisfaction with supports being reasonable and necessary; NDIS participants were more likely to be highly satisfied that the supports they received were reasonable and necessary compared to people with disability who were not in the NDIS. Very little change was observed in these findings over waves 1 and 2.
However, both quantitative and qualitative evidence shows that a minority of NDIS participants and their families and carers in both waves 1 and 2, did not believe that the supports they received were reasonable and necessary.
The quantitative evidence examined which cohorts of NDIS participants and carers were more likely or less likely to be satisfied that their supports were reasonable and necessary. Satisfaction was found to vary by disability type and by the age of the person with disability.
NDIS participants who had a developmental or congenital disability were most likely to be satisfied that their supports were reasonable and necessary, while people with an intellectual or mental/psychosocial disability were least satisfied that their supports were reasonable and necessary. When looking at the impact of the NDIS on carer perceptions of reasonable and necessary supports, the impact was highest for carers of adult participants with an intellectual or developmental disability and lowest for those caring for a person with a mental/psychosocial disability. No discernible differences by type of disability were found for carers of child participants.
There is quantitative evidence that the perceptions of carers as to whether funded supports were reasonable and necessary differ by the age of the NDIS participant they care for. The impact of the NDIS on the satisfaction of the carers rose for the carers of child participants from age 0 to age 10, and declined thereafter. For the carers of adult NDIS participants, the higher ages of the participant, were associated with a lower impact of the NDIS on satisfaction that supports were reasonable and necessary. The relationship between age and satisfaction with supports was less clear among NDIS participants themselves; however, the quantitative evidence suggested that younger adults were on average more satisfied than older adults that their supports were reasonable and necessary.
Both quantitative and qualitative evidence found that satisfaction with supports being reasonable and necessary increased with time spent in the NDIS. NDIS participants who had joined the NDIS during the early period of roll-out were less likely to report that their supports were reasonable and necessary compared to people with disability joining later. The qualitative evidence provided additional understanding of the reasons why satisfaction improved over time. With longer time in the NDIS, participants were reported to become more knowledgeable about the language and processes used in the NDIS. As a consequence some NDIS participants were able to have previously unfunded supports included in their plans at review. However, not all people with disability were seen as being equally able to develop and use this knowledge. Those unable to understand the system and effectively articulate their support needs were considered to be at risk of poorer outcomes.
Concerns around reasonable and necessary supports
The qualitative interviews identified a number of factors which contributed to perceptions that funded supports under the NDIS were not always reasonable and necessary. These factors centred on perceived variability in supports which were funded under the NDIS and service gaps in plans.
Variability and inequity in the plans of participants with the same type of disability and needs were reported in the qualitative interviews. Inconsistencies in funded supports were also noted across the different trial sites. In addition, variability as to whether supports received pre-NDIS would be funded under the NDIS was reported. This particularly pertained to the funding and flexibility of early intervention packages. A lack of transparency as to how decisions about reasonable and necessary supports were made by the NDIA was further noted.
Instances of inconsistencies about whether supports were assessed as being reasonable and necessary, which influenced the decision to fund them under the NDIS, were attributed in part to the variable skills and experience of NDIA planners. In general, planners were considered to need additional understanding of specific types of disability (including mental health issues) and also knowledge of allied health roles and interventions in order to avoid such inconsistencies. NDIA staff themselves described the challenges of achieving consistency in planning processes and outcomes, especially in an environment where guidelines around reasonable and necessary supports were evolving continually.
While overall many people with disability felt that the NDIS had led to an increase in supports, dissatisfaction that certain items and supports were not being adequately funded in NDIS plans were also evident. Supports considered under-funded included family supports, alternative therapies, social/recreational activities, respite, support co-ordination, behaviour management and employment skills. Issues were also noted around the funding of supports related to mainstream services such as education, health and recreational activities and for complex home modifications or equipment. A lack of funding for supports which were deemed not to be reasonable and necessary was shown to have contributed to decisions by people with disability to withdraw from the NDIS.
