This section summarises the qualitative findings relating to the interface between the NDIS and the mainstream sectors.
The evaluation finds that:
the interface between the NDIS and related mainstream sectors is taking time to be defined, with many uncertainties remaining at the end of the evaluation period;
despite the many communication channels already established, the NDIA was perceived by mainstream sectors to be largely unresponsive and difficult to communicate with;
the supply and demand in the two sectors are partly inter-related. For example NDIS emphasis on early intervention, increases demand for related mainstream provisions, but there are also concerns about cost-shifting and other adverse impacts;
insufficient sharing of information between the NDIS and mainstream sectors leads to both services duplication and gaps and longer waiting lists, through uncertain sector boundaries and responsibilities, and unduly complicated processes;
the NDIS is forcing mainstream sectors to use new, untested and more formal referral pathways;
the individualised funding model of the NDIS has presented the mainstream sector with new and costly administration and staff training challenges;
in line with the whole evaluation, the NDIS is working well for most who use it, but at the same time it is making specific minorities worse off, particularly the most vulnerable;
the ability of the NDIA to be responsive to mainstream problems is questioned, with the rollout speed and the associated uncertainties often being mentioned as the causes;
the mainstream sector has been responding, but these responses too are often considered to be inadequate;
overall, the continuing complexity of the NDIS is impacting negatively on its capacity to work well with related mainstream providers.
Interface between mainstream sectors and the NDIS
The interface between the NDIS and the mainstream sectors was not perceived to have been a priority (at least initially) for the NDIA. While clearer boundaries about sector responsibilities had developed over time, unresolved issues remained at the end of the evaluation period. These were primarily around responsibilities for funding shortfalls and, for the health sector, about the support of people with complex or chronic health conditions and those requiring rehabilitation services. Greater clarity was also required within the education sector about the funding of school transport, personal care in schools and the provision of allied health services during school hours.
Communication was occurring between the NDIS and mainstream sectors across all levels of operation. Interagency and intergovernmental communications had been valuable in the provision of information and exploring unresolved issues. At a local level, most mainstream organisations had a dedicated individual or team who managed the interface with the NDIS.
Challenges in communication with the NDIA were noted by many mainstream organisations including difficulties contacting the NDIA (and particularly head office) and in receiving timely responses. A lack of consultation with mainstream organisations and ongoing changes to NDIA policies and staffing also hampered effective communication.
Changes in supply and demand of mainstream services
The NDIS had led to changes in service provision by mainstream organisation, particularly in the health and education sectors. Increased demand for therapy services and early childhood early intervention (ECEI) services and assessments were noted. Moreover, education organisations reported an increased demand for therapy provision within the school environment. However, many schools had ceased allowing in-school therapy due to concerns of the adverse impact on student education.
Child protection organisations reported an increased demand for case management services to assist their clients to navigate the NDIS. While employment organisations were yet to experience a change in the demand for their services, it was anticipated that the NDIS would have a greater impact in the future.
Service gaps
Several services gaps had emerged as the roll-out of the NDIS progressed. These included concerns around the ability of children with disability to remain in foster care after the age of 18 years without their foster parents having to become registered NDIS service providers. A lack of funding for accommodation for children living in voluntary out-of-home care was also identified. Service gaps were also noted relating to mental health services, prosthetic services, and rehabilitation for people with brain injury. Moreover, people with disability who were ineligible for the NDIS were reported to be experiencing increasing issues accessing services.
A lack of shared information around client participation in the NDIS had led to duplication of service provision. Within the health sector, delays in transitioning people with disability into the NDIS was perceived to be contributing to longer waiting lists for outpatient services and lengthier hospital admissions.
Several factors were identified by mainstream organisations as contributing to these service gaps. These factors included uncertainly regarding sector boundaries and responsibilities, poor communication between the NDIS and mainstream organisations, and NDIA processes contributing to delays in referral and access to services. In order to minimise the impacts of these service gaps, mainstream organisations were continuing their in-kind service agreements with the NDIA beyond the length of the original agreement.
Impacts on referral pathways
Prior to the NDIS, referral pathways from mainstream organisations to disability services were described as being largely informal but effective. These pathways had been dissolved with the introduction of the NDIS and had hampered the transition of clients between the mainstream and disability sectors. However, mainstream organisations reported that relationship building with the NDIA and the re-establishing of these referral networks was taking place to ensure that collaboration could again occur.
Individualised funding
The individualised funding model of the NDIS had led to additional work for administrative and frontline staff within mainstream organisations. Moreover, organisations who were registered service providers under the NDIS, reported that gaining access to the NDIA portal had necessitated costly changes to their IT systems.
The activities of mainstream provider organisations had also changed with the individualised funding approach of the NDIS. There was now a greater emphasis on case management activity including assisting clients to navigate NDIA processes and advocating for clients around their funding and support needs. Some mainstream sector staff had had to upskill their knowledge of working with people with disability and around NDIS processes.
Equity, fairness and navigating the NDIS
Although the impact of the NDIS was perceived by mainstream organisations to be largely positive, the NDIS was seen to be working less well for particular cohorts of people with disability. These cohorts included participants from Indigenous and CALD backgrounds, those with high support needs or limited capacity to advocate for themselves, and individuals who were new to the disability sector. As a consequence of limited service provision and difficulties engaging with the NDIA due to limited access to the internet, NDIS participants living in regional and remote areas were also identified as having poorer outcomes under the NDIS.
The ability of the NDIS to be responsive to the needs of people with mental health issues and psychosocial disability was also questioned by mental health organisations.
The speed of the NDIS roll-out was considered to have had a negative impact on the implementation of the NDIS. Delays due to NDIS processes (around eligibility and planning) were leading to longer waiting lists, bottlenecks in mainstream services, and were contributing to gaps in services. A further area of concern was that NDIS systems were too complex for many people with disability to effectively navigate.
As a result of delays in NDIS planning processes, mainstream organisations reported that they were providing interim services to people with disability. However, it was acknowledged that mainstream staff often lacked disability specific skills to deliver quality services. In addition, disability service provision to people with complex needs was felt to be lacking, leading to these clients inappropriately ending up in mainstream health services. To address these concerns, a need for greater quality control and regulation of the disability provider market was highlighted.
Mainstream organisations recommended improved collaboration, communication and information sharing between the NDIA and mainstream sectors. This would assist the transitions of clients into the NDIS and also future transitions into education, employment and health/mental health services. Improved education and assistance for people with disability and their families was also recommended to aid understanding and navigation of NDIS processes. This included having better access to plan management support to assist in the implementation of services.
