4.12.1 Development and implementation of plans – Evidence from large scale surveys
A large majority (92 per cent) of NDIS participants had approved support plans in both waves 1 and wave 2. Most participants reported that they received assistance from others when making decisions about their plans, primarily from family members and NDIA planners.
4.12.2 Development and implementation of plans – Evidence from in-depth qualitative interviews
The planning process seemed to be smoother for NDIS participants and their family members and carers by wave 2, which in part related to general familiarity with NDIA processes. NDIS staff appeared to be more familiar with these processes too, leading to more efficient communication among participants and the NDIA.
Where choice and control over the development of the plan was greatest, this appeared to be primarily where participants had good advocacy/support.
At wave 2, it was more common to have funding for support coordination or case management included in plans. For most, this was reported to be a valued service which removed the burden and stress of communicating and co-ordinating with providers. For some, however, it was reported that little benefit was experienced as a result.
Restricted choice of providers or longer waiting lists for services reduced the amount of choice respondents felt they had over the implementation of their plan.
Greater attention to the family context in the planning process, in particular the potential for parents/carers to receive support and respite continued to be requested by respondents.
4.12.3 Choice and control over supports – Evidence from large scale surveys
When comparing pre-NDIS with early experiences in the NDIS, most participants felt that their choice and control (over the type of supports received and where these were obtained) had either improved or stayed the same. However, a sizeable minority (around 13 per cent) felt that their choice and control had worsened since joining the NDIS.
Once in the NDIS, around two-thirds of NDIS participants reported having either a lot or some choice and control over their supports; little further change was seen in wave 2. However, about a fifth of all participants in both waves 1 and 2 reported having little choice and control over their support Carers reported very high levels of satisfaction with the choice and control they were able to have over the supports of the person with disability they cared for in both waves 1 and 2.
In wave 1, 64 per cent of NDIS participants were able to access more supports once in the NDIS than previously. Fifteen per cent of participants reported that they had fewer supports once in the NDIS. Those receiving fewer supports also reported having less choice and control under the NDIS.
The majority of people with disability wanted to have more choice and control over the supports they receive. They said so in both waves 1 and 2.
NDIS participants felt that they had a greater say over the supports they received compared to the comparison group. Using a binary measure of choice and control (i.e. having a lot of say over supports choice or not), NDIS participants were 54 per cent more likely than people with disability not in the NDIS to report having a lot of say over their supports.
However, the positive impact of the NDIS on perceptions of say over supports was smaller for adults with a mental/psychosocial disability (36 per cent) than for NDIS participants with any of the other types of disability.
No significant difference in the impact of the NDIS on say over the supports received was found between NDIS participants in urban and rural areas.
Carers also reported that the NDIS had enabled them to increase their say over which supports the person with disability they cared for received (the impact of the NDIS was 46 per cent for carers of adult participants and 41 per cent for carers of child participants).
The positive impact of the NDIS on say over supports, however, was lower for carers of participants (and particularly adults) with a mental/psychosocial disability. Notably, the impact of the NDIS on say over supports was negative for carers of older NDIS participants with a mental/psychosocial disability.
With regard to choice over where supports are obtained, NDIS participants reported greater levels of choice than the comparison groups. Indeed using a binary measure for this outcome (i.e. having a lot of choice over where to obtain supports, or not), NDIS participants were 114 per cent more likely to report having a lot of choice regarding where to obtain their supports.
No significant differences regarding the impact of the NDIS on choice about where supports were obtained were found for NDIS participants according to disability type.
Although still positive, the impact of the NDIS on the perceptions held by carers of adult participants of their choice over where supports are obtained was less than that reported by NDIS participants themselves (45 per cent compared to 114 per cent). The impact of the NDIS on choice over supports was smaller for carers of child participants (36 per cent).
The impact of the NDIS on choice over where supports were obtained was less for carers of NDIS participants with a mental/psychosocial disability.
The NDIS was found to have a relatively small but positive impact on the ability of carers of adult participants (14 per cent) and child participants (8 per cent) to take adequate breaks from their caring role.
In both waves 1 and 2, NDIS participants were more likely to report satisfaction with their choice and control (both the say they had over which supports they received and where these were obtained) than the comparison group. However, the proportion of people with disability in each group reporting satisfaction decreased slightly between waves 1 and 2.
Examining changes in the levels of choice and control reported by NDIS participants over time, produces a mixed picture about exactly what happened between waves 1 and 2 and to whom. There are differences between waves for both trial and comparison groups, as well as differences between trial and comparison groups within each wave. When these are presented together in simple tabulations they produce an inconclusive picture which can only be resolved adequately by looking at specific subsets of the data and/ or through using multivariate estimations.
There remains a non-negligible proportion (about a quarter of the NDIS participants) who report that they have either no say about what supports they get or where these are obtained. Those who report having no or little say over what supports they receive are typically the same group of individuals who also report having no or little choice over where they obtain these supports.
Estimation analyses found a positive incremental impact of the NDIS on the choice and control of people with disability. We find 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. This indicates that the overall impact of the NDIS has been to improve the choice and control NDIS participants are able to exert over their supports.
Exploring changes in the choice and control of carers over time in the NDIS, again the changes observed were generally positive. However, around a quarter of carers reported that their levels of choice and control had declined between waves 1 and 2.
The qualitative evidence suggests that overall, the NDIS had increased choice and control for almost all respondents. There was evidence of increased choice as respondents became more familiar with the NDIS ‘world’, and consequently were becoming more confident in changing service providers over time.
There was also evidence of improved flexibility in the timing of supports (providers accommodating requests for appointments which were outside usual working hours), the location of supports (offering supports both in the home and community), and the provision of supports (being able to use different services/providers).
While service flexibility was said to have increased, providers were still reported as being reluctant to provide services on a casual ‘as needed basis’.
Wave 1 evidence suggested that NDIS participants sought more frequent and more intensive support rather than necessarily choosing different types of services. By wave 2, NDIS participants and families appeared more confident in changing support providers or approaching the NDIA to request additional or different types of supports. However, this was frequently impeded by a lack of service providers and long waiting lists, in particular outside the main urban centres of the trial sites.
Constraints to choice and control continued to be highlighted at wave 2 and included limited provision of information about provider options, and limitations in both the numbers and capacity of registered service providers. The formalisation of relationships between services providers and NDIS participants via the use of service contracts was suggested to inhibit choice and control.
NDIS participants had improved understanding of processes and the concepts/language used by the NDIA over time. This improved their interactions with the NDIA. However, a need for better advice and assistance (including lists of eligible and accessible services) remained. All respondent groups recommended the use of advocates (either paid or unpaid) who were familiar with the NDIS system.
4.12.5 Self-managed plans – Evidence from large scale surveys
The proportion of NDIS participants who reported that the funding of their disability supports was self-managed increased from pre-NDIS (28 per cent) to joining the NDIS (46 per cent in wave 1). No further increases in levels of self-management were seen with time spent in the NDIS (in wave 2).
4.12.6 Self-managed plans – Evidence from in-depth qualitative
Self-management was uncommon, with many NDIS participants being reluctant to undertake the additional administrative work they perceived self-management would require. Those who decided to self-manage funding were positive about the benefits of doing so, principally in relation to greater choice and flexibility in accessing non-NDIS service providers and in the support workers that they engaged.
While the flexibility of self-managed funding was thought to be advantageous, fears were expressed about the potential risk of fraud or mismanagement of funds by those undertaking self-management. Disability service providers, workforce stakeholder organisations and NDIA staff were concerned that the NDIS lacked sufficient safeguards.
