This section integrates and summarises the quantitative and qualitative findings relating to fairness, equity and access. In particular the findings focus on eligibility and navigating the NDIS, review and dispute resolution processes, and equity and fairness.
The evaluation finds that:
the experiences of the transition into the NDIS were mixed;
difficulties were mostly encountered by those who could least ‘fend for themselves’;
the eligibility process could be lengthy and complicated;
the boundaries between the NDIS and mainstream services were often confused;
compared to pre-NDIS processes, it took less time to get the supports, but more time to do the paperwork, the difference covered by the families and carers who often had to step in;
information about access to supports was often considered inadequate and this persisted into the later stages of the evaluation;
satisfaction with the processes was variable, about half found them better within the NDIS, one third about the same, and about one in seven felt they were worse off;
most were satisfied with the frequency and outcome of their plan reviews, but about one fifth found aspects of them unsatisfactory;
the review and planning process has been changing, causing much dissatisfaction and frustration;
the NDIS works best for those who can advocate for themselves, causing fairness concerns; and
a wide range of concerns was raised, many right from the start of the NDIS and many still remaining unresolved or getting worse at the later stages of the evaluation.
Eligibility and navigating the NDIS
The qualitative evidence shows that the experiences of people with disability who join the NDIS and those of their families and carers were mixed. Some respondents had experienced an easy transition into the NDIS; these were typically people with disability who had received formal assistance to enrol, or had other family members in the NDIS, or were seeking services for the first time. In contrast, others raised concerns that the process of establishing eligibility for the NDIS could be lengthy and complicated. Administrative issues, additional assessments being required to establish diagnoses, and high workloads within the NDIA had contributed to delays.
Specific cohorts of people with disability were identified in the qualitative interviews as particularly struggling with the complexity of NDIS processes and documentation. These included people with psychosocial disability, those with literacy problems or cognitive impairment, and people from CALD or Indigenous backgrounds. Concerns also persisted across the evaluation, that people with psychosocial disability were experiencing higher rates of ineligibility and consequently had lower levels of NDIS participation. In addition, unclear boundaries between the NDIS and mainstream sectors (and the health sector in particular) were seen as adding to confusion around the eligibility of some people with disability.
The quantitative evidence explored the perceptions of NDIS processes, in particular the time taken for support arrangements to be put in place under the NDIS. While NDIS participants commonly reported that (compared to before the NDIS) it now took less time to find and get supports, many carers felt that the time taken for these activities was unchanged. In contrast, NDIS participants and their carers typically reported that it took more time under the NDIS than previously to complete the necessary paperwork to obtain supports. In general these perceptions did not change with longer time spent in the NDIS.
The quantitative evidence at the later stages of the evaluation (wave 2) found that a majority of NDIS participants and their carers still felt that they needed more information about how to access disability supports. Indeed a sizeable minority of participants and carers reported that they had very little current understanding of how to access supports.
Review and dispute resolution processes
The quantitative evidence shows that most of the NDIS participants surveyed had undergone at least one review of their disability support plan by wave 2. While a majority of participants were satisfied with the review process and the frequency and outcome of reviews, a fifth of NDIS participants expressed dissatisfaction with aspects of their plan reviews.
The qualitative interviews provided further detail of participant and carer experiences of the plan review processes. Inconsistencies were found about understanding whether the review processes were conducted on a fixed schedule or whether they were dynamic and ongoing. The experience of reviews was often different to the initial planning, as review meetings were typically conducted in an NDIA office or by phone (rather than at a home visit). Moreover, the often encountered lack of consistency of NDIA planners between the initial planning and the review was perceived to disrupt established relationships and understanding of support needs. As with the concerns expressed about the experiences of initial planning, the variability of planner knowledge about particular disability types remained an area of concern. Frustration was also commonly expressed about delays in conducting review meetings, or the time it took for plans to be finalised following the review.
Equity and fairness
The need for equity and fairness is a fundamental ethical underpinning of the NDIS and has been expected to be present in the design and the working of the NDIS. This is particularly difficult to implement in the context of creating a new system of individualised provisions for a large group of people with very diverse needs. Mistakes are bound to be made, but the main question that needs to be answered is if the system has been able to learn and correct these mistakes. The findings from the evaluation are mixed on this front, as we have found many problem areas have been corrected and other areas have not. It is in this context that the performance of the NDIS must be judged.
Factors contributing to perceptions of the fairness and equity of the NDIS were explored in the qualitative interviews. The NDIS was considered to work best for participants and families who were able to strongly advocate for themselves. In order to ensure equitable access to funding for all participants, the importance of advocacy (either formal or informal) was highlighted. Concerns were raised, however, about a lack of funding for formal advocacy support under the NDIS.
The qualitative evidence found further concerns relating to the equity and fairness of the NDIS. Inconsistencies across plans for people with similar disabilities and support needs were observed. Moreover, NDIS participants with intellectual disability, psychosocial disability and complex needs; those from CALD backgrounds; and participants with older carers facing their own health issues were considered to be particularly at risk of being allocated lower levels of funded supports. NDIS participants living in regional and remote areas were also considered to be at a disadvantage compared to their urban counterparts in terms of limited service availability. Safeguards within the NDIS were still perceived to require strengthening in order to protect vulnerable participants.
Considerable concerns were also raised in the wave 2 qualitative interviews regarding service provision for people with disability who were outside the NDIS. As a consequence of reduced state government disability service provision, some non-NDIS participants were found to be receiving fewer services than before, with others reported to be receiving no services at all. Without active intervention, it was feared that outcomes for people with disability who were ineligible for the NDIS would deteriorate further.
