We provide below a summary of the key findings arising from the evaluation evidence assessing the impact of the NDIS on (i) the demand and supply of disability services; (ii) the quality of these supports; and (iii) areas of unmet demand for services and support.
The total number of services accessed by NDIS participants increased both after joining the NDIS and with time in the NDIS. The average number of supports received increased from 1.94 supports pre-NDIS to 3.23 in wave 1, and 5.78 in wave 2.
This increase in the number of services accessed was not spread evenly across all types of services. While access to plan/case management, transport services and leisure activities doubled as a result of the NDIS, access to supports with work and study declined.
Although providing considerable levels of informal care to NDIS participants, a majority of carers did not access any carer-specific supports (76 per cent in wave 1 and 83 per cent in wave 2).
Evidence from in-depth qualitative interviews
The qualitative data shows clearly the multifaceted change in the supports accessed by NDIS participants and the diversity and heterogeneity of circumstances and outcomes.
Respondents who had received supports prior to the NDIS generally reported increased levels of supports including better access to therapy services and equipment, as well as more tailored support (in and out of the home). This enabled greater independence and less reliance on family members to provide support.
In general, respondents described accessing the same range of services in wave 2 as they did in wave 1. While the types of disability services and supports included in plans varied and were largely dependent on the age of NDIS participants, common supports included:
aids and equipment;
therapy (psychology support, physiotherapy and speech therapy);
personal care and support with independent living; and
respite.
The NDIS had led to an increased demand for disability services. In response to changing consumer demand, some providers were expanding the range of their services. Types of services that were reported to be experiencing growth included one-on-one support services, support coordination and financial management, therapy, respite and accommodation services.
By wave 2, evidence was emerging that NDIS participants were increasingly choosing different service providers and requesting more flexible services.
Several concerns were raised in both waves 1 and 2 regarding the funding and provision of supports:
Funding for family supports was inconsistently included in plans and limited in scope.
The NDIS had negatively impacted, or was expected to have a negative impact on, the services and supports accessed by people with disability not in the NDIS. These impacts included cost increases, needing to pay for previously free services and reduced availability of services.
A decline in group based services was viewed as decreasing social participation opportunities for NDIS participants and their families as well as limiting transdisciplinary collaborations between service providers.
Not all NDIS participants were felt to be achieving improved outcomes under the NDIS. Those unable to effectively advocate for services on their own behalf, including some people with psychosocial disability and/or those who struggled to manage complex NDIS processes, were reported to be experiencing poorer outcomes under the NDIS and receiving a lower level of services than pre-NDIS.
2.5.2 Quality of services and supports
Evidence from large scale surveys
Upon joining the NDIS, a similar proportion of participants reported that the quality of supports they received under the NDIS was either better (43 per cent) or had not changed (43 per cent) compared to prior to the NDIS. However 14 per cent of participants felt that the quality of their supports were worse.
Once in the NDIS, a high proportion of NDIS participants were satisfied with the quality of the supports that they were receiving. This did not change over time in the NDIS.
The impact of the NDIS on satisfaction with the quality of supports was estimated. On average, NDIS participants were 33 per cent more likely to report being very satisfied with the quality of their supports compared to if they had not joined the NDIS.
Important differences in satisfaction with the quality of supports by disability type were found. NDIS participants with mental/psychosocial disability reported lower levels of satisfaction compared to NDIS participants with other types of disability.
The impact of the NDIS on the quality of supports did not differ for participants living in rural or urban areas.
Carers also reported higher satisfaction with the quality of supports when the person with disability they cared for was in the NDIS. The impact of the NDIS on support quality was 10 per cent for the carers of adults and 12 per cent for carers of children.
Evidence from in-depth qualitative interviews
While NDIS participants and their carers were generally satisfied with the quality of the services they were receiving, concerns were raised in both waves 1 and 2 about the reliability of some services and the continuity of care provided.
Respondents also questioned the quality of the support workers who were referred to them and the lack of specialised disability training. Others expressed considerable concern about the general standard of agency provided disability care workers.
The quality of NDIA staff was also questioned with many reporting that planners did not understand the specific needs and supports required for particular disability types.
Service providers and key stakeholder organisations considered staff training to be underfunded within NDIS pricing structures; this undermined workforce quality.
2.5.3 Unmet demand for services and supports
Evidence from large scale surveys
In wave 1, unmet demand was reported by 32 per cent of NDIS participants who were unable to access a support for which they had funding under the NDIS. The incidence of unmet demand did not decrease over time.
Unmet demand was primarily due to wait times, a lack of a local provider or the lack of quality provision. Only a small proportion (around 10 per cent) reported they could not access their supports because they were too expensive.
In wave 1, 26 per cent of NDIS participants reported accessing services that were not funded by the NDIS. This increased considerably to 39 per cent in wave 2. Non-funded supports most commonly related to therapeutic interventions and leisure activities, and were mostly paid for by the family and the participant.
People with disability who entered the NDIS later were estimated to be 14 per cent more likely to experience unmet demand compared to those who joined in the early roll-out of the NDIS.
In addition, children aged seven-15 years were about eight per cent more likely to experience unmet demand than their adult counterparts.
NDIS participants with an intellectual disability were more likely to experience unmet demand compared to people with other disability types.
Evidence from in-depth qualitative interviews
The qualitative data indicated that all groups interviewed in both waves 1 and 2 reported that NDIS participants and their carers experienced problems with accessing supports.
A number of factors were seen to be limiting access to disability supports including small numbers or low capacity of service providers in local areas, lengthy waiting lists for some providers or types of support, and inflexibility of support hours by service providers.
NDIS participants reported that supply had not been adapting to the changing demand for services, particularly in rural/remote areas. Some providers were feared to be reaching capacity constraints.
The types of services that were reported to be experiencing strong demand in wave 2 included one-on-one support services, support coordination and financial management, therapy, respite and accommodation services.
While providers reported shifting to individualised supports, concerns were expressed about financial viability. Many were unable to provide services at the NDIS pricing levels, resulting in cross-subsidising between services. Services considered underfunded by the NDIS were one-to-one community participation, mental health services, group services and services for people with complex needs. A lack of funding for respite and employment services was also noted. Organisations anticipated ceasing particular services when block funding ended.
NDIA staff also identified that demand of supports had increased. This had led to challenges in terms of shortages, rural/remote provision and ‘transitioning out’ arrangements.
Supply constraints were reported to be real and persistent. Shortages were particularly identified for speech pathology, occupational therapy and psychology services. While adaptation to unmet demand was occurring, it was very diverse and in many cases incomplete and unsettled.
Other concerns relating to unmet demand included the quality of support workers, rigid structures in the NDIS claiming systems and funding for therapist travel.
