This final section of the chapter provides a summary of the key 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.
8.5.1 Eligibility and navigating the NDIS system – Evidence from large scale surveys
As shown in wave 1, the NDIS has impacted on how long support arrangements take for the majority of NDIS participants and their families and carers.
Compared to before the NDIS, NDIS participants and their families and carers reported that it takes more time under the NDIS to complete paperwork for supports. While NDIS participants were most likely to report that under the NDIS it takes less time to find and get supports, carers did not believe that the time taken for these activities had changed.
Over time in the NDIS, the majority of participants and carers experienced little change regarding how long it takes to find supports, do the necessary paperwork, and to get the supports.
The carers who were surveyed in wave 2, reported higher levels of understanding of how to access funded disability supports compared to the NDIS participants themselves. Despite this, 50 per cent of carers reported that they needed more information about supports. In addition, around a fifth of NDIS participants and 12 per cent of carers felt that they had very little understanding of how to access supports.
8.5.2 Eligibility and navigating the NDIS system – Evidence from in-depth qualitative interviews
There was a concern held by all groups interviewed about the accessibility of the NDIS (particularly for people with psychosocial disability and of CALD or Aboriginal and or Torres Strait Islander backgrounds).
Respondents (including NDIA staff) noted the complexity of NDIA processes and documentation. Various examples were provided of people with literacy problems or cognitive impairment struggling to understand and complete the requisite forms.
Concerns were also held in regard to the responsiveness of the new system with respondents providing examples of the negative impact of bureaucratic processes. These included respondents having to follow-up initial contact with the NDIA due to problems with receiving paperwork or having paperwork mislaid, and needing to complete multiple applications. Respondents also reported that additional assessments were often required to establish a diagnosis for eligibility for the NDIS.
NDIS participants criticised the often lengthy and complicated process of establishing eligibility. This was reported to have been exacerbated by administrative issues within the NDIA which resulted in delays between first and subsequent contact. These difficulties were acknowledged by NDIA staff who also reported high workloads which reduced contact with individual participants and prevented a more customised service.
There were still concerns in wave 2 that higher rates of ineligibility and lower levels of participation persisted for people with psychosocial disability. The co-location of NDIS offices with Centrelink was also considered to further undermine their engagement with the NDIS.
8.5.3 Review and dispute resolution processes – Evidence from large scale surveys
The majority of NDIS participants in both waves 1 and 2 had a current support plan in place. Of these, only eight per cent had not yet undertaken a review of their plan in wave 2.
NDIS participants who had undergone a plan review most commonly reported being either satisfied or very satisfied with the process (41 per cent), the frequency with which they were able to have their NDIS plan reviewed (46 per cent), and with the outcome of their plan review (49 per cent).
Around a fifth of NDIS participants, however, were either dissatisfied or very dissatisfied with aspects of plan reviews: the plan review process itself (22 per cent), the frequency with which they were able to have their plan reviewed (20 per cent), and the outcome of their last plan review (19 per cent).
8.5.4 Review and dispute resolution processes – Evidence from in-depth qualitative interviews
There were inconsistencies in how participants and carers understood the plan review process; some believed it to be a dynamic ongoing process while others believed plans could only be changed at annual or bi-annual review meetings.
The experience of review was different from initial planning. Home visits were generally not offered. Most respondents noted visiting the NDIA office for the review appointment and several reviews were conducted by phone.
Plan reviews were generally undertaken by a different planner to the one that had put together the initial plan. This appeared to be in part due to high NDIA staff turnover and staff movement between NDIA offices. A lack of planner consistency was largely unwelcome as it disrupted previously established relationships.
NDIA staff experience and knowledge of particular disability types was again raised in wave 2 as being an important factor that influenced satisfaction levels in the plan review process.
8.5.5 Equity and fairness – Evidence from in-depth qualitative interviews
Respondents continued to report that the NDIS worked best for those participants and their carers who were strong advocates for themselves or their child. Some also considered that outcomes were dependent on disability type and planner knowledge or understanding.
Perceptions of fairness were also based on continued observations of inconsistencies across plans for people with equivalent disabilities and support needs.
The importance of advocacy (whether a formal advocate or a parent/carer) to ensure that all participants achieved equitable access to funding was highlighted at both time points. However, the fact that funded advocacy is unavailable under the NDIS, raises concerns about the future fairness and equity of the NDIS.
The primary concern for those living in regional areas was the limited availability of services. Respondents were faced with the potentially costly decision to travel to access these elsewhere, or to wait until services could be sourced locally.
Outcomes for NDIS participants with psychosocial disability appeared to be poorer than for those with physical support needs, who were typically better able to articulate their needs.
Considerable concerns were raised in wave 2 regarding service provision for people with disability who were not part of the NDIS. A reduction of state-provided disability services was reported to be occurring and this was having an adverse impact on services for this cohort. Some existing disability clients were noted to be receiving fewer services than previously, while others were falling through gaps in service provision and were getting no supports at all. It was feared that more of these individuals would be affected if state governments continued to withdraw from the provision of disability services.
Finally, respondents were not satisfied that safeguards to protect vulnerable NDIS participants were effective. Many were concerned that the NDIA had still not released a quality framework to ensure quality service provision.
