Evaluation of the ndis final Report Kostas Mavromaras, Megan Moskos, Stéphane Mahuteau, Linda Isherwood

How has Choice and Control over Supports Changed over Time – Evidence from Large Scale Surveys

4.7.1 Has choice and control changed over time for NDIS participants?

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  Using the longitudinal information gathered by the surveys conducted with people with disability, changes over time in perceptions of choice and control for both the NDIS participant and the comparison groups were examined.
  
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  Figures 4.15 and 4.16 show the levels of satisfaction reported by people with disability about the amount of say they have over which supports they receive. Each figure shows the responses in wave 1 and 2 in order to examine changes over time.
  
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  Looking at the figures, we see that the proportion of respondents who were satisfied and very satisfied with their say over supports was smaller for the comparison group (Figure 4.15) than in the trial group (Figure 4.16), for both waves of the survey. Furthermore for both groups, the proportions of those who were satisfied/very satisfied with their say over their supports slightly decreased between wave 1 and 2.
  

Figure 4.15 Person with disability: Satisfaction with the amount of say about what supports the person with disability received (Comparison, Adults, wave 1 vs. wave 2)

Figure 4.16 Person with disability: Satisfaction with the amount of say about what supports the person with disability received (Trial, Adults, wave 1 vs. wave 2)

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  Figures 4.17 and 4.18 show levels of satisfaction regarding the amount of choice people with disability have over where they get their supports. Again the figures reported on the wave 1 and 2 responses of the comparison and NDIS trial groups enable us to see the changes over time in these responses.
  
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  Similar observations can be made for perceptions of choice over where supports are obtained, as made previously when exploring say over which supports are received. The proportion of people with disability who report high satisfaction is considerably lower for the comparison sample than for the trial sample across both waves (estimations of the impact of the NDIS in wave 1 show that most of these differences are due to NDIS participants joining the NDIS). In addition, the proportion of people with disability from both groups reporting high levels of satisfaction decreased between wave 1 and 2.
  

Figure 4.17 Person with disability: Satisfaction with the amount of choice about where people with disability get their supports (Comparison, Adults, wave 1 vs. wave 2)

Figure 4.18 Person with disability: Satisfaction with the amount of choice about where people with disability get their supports (Trial Adults, wave 1 vs. wave 2)

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  The transition tables presented below document the changes that occurred in the choice and control of NDIS participants between wave 1 and 2 based on the disaggregated change experienced by each individual. It is important to note that in this data presentation, if one person moved from satisfied to very satisfied and another person moved from very satisfied to satisfied, these two movements will be recorded and presented – this is not the case in usual tabulations which would have recorded the same overall number of people in these two categories. Table 4.2 shows the transitions that occurred in perceptions of say over decisions about what supports are received, while Table 4.3 shows changes which occurred in levels of choice about where these supports are received. Those for whom the level of say or choice increased between wave 1 and 2 are to the top right of the table above the top left to bottom right diagonal of the table. Those for whom it decreased are to the bottom left, below the diagonal. The diagonal from top left to bottom right includes those who reported the same level of say in both waves.
  

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  The transition Tables 4.2 and 4.3 document the change that occurred between the two waves, showing that 26 per cent of NDIS participants who reported having no say over decisions about the types of supports they received in wave 1, reported in wave 2 that they now have a lot of say (Table 4.2). Similarly, 22 per cent of NDIS participants who reported having no choice over where to obtain supports in wave 1, reported that they have a lot of choice in wave 2 (Table 4.3).
  

Table 4.2 Person with disability: Transition in level of say over decisions about what supports received - wave 1 and 2 evidence (Trial, Adults)

Wave 2 Level of say

Wave 1 Level of say	Wave 2 No say	Wave 2 Little say/ varies	Wave 2 Some say	Wave 2 A lot of say	Total
No say	42%	18%	13%	26%	100%
Little say/varies	9%	32%	30%	29%	100%
Some say	2%	25%	39%	34%	100%
A lot of say	3%	14%	22%	61%	100%
Total	7%	20%	28%	45%	100%

Table 4.3 Person with disability: Transition in level of choice about where to obtain supports - wave 1 and 2 evidence (Trial, Adults)

Wave 2 Level of say

Wave 1 How much choice over where you currently obtain supports	Wave 2 No choice	Wave 2 Little choice/ varies	Wave 2 Some choice	Wave 2 A lot of choice	Total
No choice	33%	18%	27%	22%	100%
Little choice/varies	12%	30%	35%	23%	100%
Some choice	4%	25%	40%	31%	100%
A lot of choice	3%	14%	27%	56%	100%
Total	8%	21%	33%	39%	100%

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  At the same time, 28 per cent of NDIS participants reported a decrease in the amount of say they have over decisions regarding the types of supports they receive. A further 24 per cent of NDIS participants reported an increase in their amount of say, while 49 per cent reported no change¹¹.
  
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  In terms of choice over where supports are obtained, the quantitative data indicates that 30 per cent of NDIS participants reported a decrease in their level of choice between wave 1 and 2, 26 per cent reported increased choice and 44 per cent reported no change.¹²
  
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  The improvements seen over time with regards to choice and control seem, however, to be concentrated in the upper end of the distribution. In other words, those who already reported having some say/choice in wave 1 see their situation improve further by the second wave of the survey. Improvements are less common amongst those who reported adverse outcomes at the first wave of the survey.
  
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  It has been difficult to form an overall view on the combined evidence on change between wave 1 and 2 as this is presented in the Figures 4.15 to 4.18 and the transition Tables 4.2 and 4.3. The evidence is mixed as it reflects partly the fact that trial and comparison groups are exercising different choice and control over their supports, and partly that for both trial and comparison groups change is happening differently among those who are ‘doing well’ in terms of choice and control (that is those who answer that they are ‘satisfied’ or ‘very satisfied’ and those who are not doing as well (that is those who report ‘about the same’, ‘dissatisfied’ and ‘very dissatisfied’).
  
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  In spite of these overall improvements in choice and control, we note that there remains a non-negligible proportion (about a quarter of the NDIS participants) who reported that they have no say either about what supports they get or where these are obtained. Moreover, those who reported having no or little say over what supports they receive are typically the same group of individuals who also reported having no or little choice over where they obtain these supports.
  
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  Further econometric analyses were conducted to explore the incremental impact of the NDIS on the choice and control of people with disability. Appendix Table 4.23 shows that, overall, there was a positive effect over time for NDIS participants in both the amount of say they have over what supports they get and the amount of choice they have with regards to where they get their supports. This means that, notwithstanding the micro-evidence we have that those with the lowest choice and control do not necessarily fare better with time in the NDIS, we also have statistically robust and significant evidence that for the majority of NDIS participants more time in the NDIS has improved the amount of choice and control they are able to exert over their supports.
  

4.7.2 Has choice and control changed over time for carers?

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  Tables 4.4 and 4.5 document the changes that occurred in the levels of satisfaction reported by carers about the choice and control they have over the supports received by the NDIS participants between wave 1 and 2. Those for whom the level of satisfaction has increased between wave 1 and 2 are to the top right part of the table. Those for whom the level of satisfaction has decreased between wave 1 and 2 are in the bottom left part of the table and those who gave the same answer in both waves are in the diagonal running top left down to bottom right in the table.
  
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  As with the previous transition tables for the NDIS participants themselves, change over time is mixed. Of those carers who reported in wave 1 being very dissatisfied with their say over the supports received, 26 per cent were now satisfied and 21 per cent were very satisfied in wave 2 (Table 4.4). Similarly, for those carers who in wave 1 had been dissatisfied with the amount of choice they had over where supports were obtained, 27 per cent were now satisfied and a further 20 per cent were very satisfied.
  
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  However, some negative changes were also revealed around carer perceptions of say over supports. For example, 17 per cent of carers who reported being very satisfied or satisfied with their amount of say over the types of supports the NDIS participant received in wave 1, were dissatisfied in wave 2.
  
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  Overall 30 per cent of carers reported a decline in their level of satisfaction with the amount of say they have over decision regarding the types of support the NDIS participants receive, 19 per cent reported an increase in their levels of satisfaction and 51 per cent reported no change¹³.
  
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  In terms of carer satisfaction with the amount of choice they have about where NDIS participants obtain their supports, 26 per cent reported a decrease in satisfaction between wave 1 and 2, 20 per cent increased satisfaction and 54 per cent reported no change¹⁴.
  

Table 4.4 Carers: Transition in level of satisfaction with amount of say about what supports person with disability receives - wave 1 and 2 evidence (Trial, All ages)

Wave 2 Level of satisfaction

Wave 1 Level of satisfaction	Wave 2 Very dissatisfied	Wave 2 Dissatisfied	Wave 2 Neither dissatisfied nor satisfied	Wave 2 Satisfied	Wave 2 Very satisfied	Total
Very dissatisfied	5%	32%	16%	26%	21%	100%
Dissatisfied	0%	26%	8%	45%	21%	100%
Neither satisfied nor dissatisfied	4%	15%	13%	45%	23%	100%
Satisfied	0%	12%	10%	51%	26%	100%
Very satisfied	0%	5%	5%	31%	59%	100%
Total	0%	10%	8%	39%	43%	100%

Note that a very small number of wave 2 carers who responded to the survey are not the same care who answered in wave 1. Excluding these does not alter the proportional distribution of changes over time

Table 4.5 Carers: Transition in level of satisfaction with the amount of say about where person with disability obtains supports - wave 1 and 2 evidence (Trial, All ages)

Wave 2 Level of satisfaction

Wave 1 Level of satisfaction	Wave 2 Very dissatisfied	Wave 2 Dissatisfied	Wave 2 Neither dissatisfied nor satisfied	Wave 2 Satisfied	Wave 2 Very satisfied	Total
Very dissatisfied	9%	9%	27%	27%	27%	100%
Dissatisfied	0%	13%	8%	54%	26%	100%
Neither satisfied nor dissatisfied	3%	5%	28%	40%	25%	100%
Satisfied	0%	9%	11%	45%	34%	100%
Very satisfied	0%	4%	3%	26%	67%	100%
Total	0%	6%	8%	34%	51%	100%

Note that a very small number of wave 2 carers who responded to the survey are not the same care who answered in wave 1. Excluding these does not alter the proportional distribution of changes over time