The following section integrates, and provides a summary of, the main quantitative and qualitative findings relating to the disability sector and its workforce.
The evaluation finds that:
response to the NDIS was slow to start with evidence of lack of preparation, but change is happening now;
overall, the sector started by viewing the NDIS positively, responding with more specialisation, more NDIS-related flexibility, and increased activities;
perceptions deteriorated during the trial period and whilst funding volumes had increased, the sector was far from settled by the end of the trial period;
there is concern about funding, pay structures and financial sustainability;
the full impact of the NDIS on employment will take time to be realised. Presently the workforce is predominantly female, casual, with marked specific-skills shortages, low sector retention and dissatisfaction with conditions;
some concerns with pay and quality of service provision are present;
availability of the necessary training appears to be adequate;
a new NDIA workforce is emerging with concerns about working conditions, inadequate training, high workloads and stress, and high turnover, and in need of improvement;
the sector contrasts unfavourably with the Aged Care workforce, where after recent reforms there is less casual work, higher retention, fewer skill shortages and less overall uncertainty; and
overall the evaluation concludes that at the end of the trial period the disability support sector still faces serious uncertainties and remains in an unsettled state.
The quantitative and qualitative data provided evidence of changes that were occurring within the disability sector as the NDIS roll-out progressed.
The quantitative evidence suggested that disability service providers were becoming more specialised with the average number of services each organisation provided declining over time, and the provision of some specific services also declining over time. A decline was particularly evident in the proportion of providers offering early intervention services and supports relating to advocacy, information and communication. Only a minority of disability service providers reported plans in wave 2 to expand their range of supports in the future.
The qualitative evidence pointed out that while slow to adapt to the roll-out of the NDIS, by wave 2 service provision was starting to become more flexible with greater choice offered to people with disability. Moreover, a growth in services which supported NDIS transition (such as support with planning and plan implementation) was identified.
Both the quantitative and qualitative evidence indicate that disability service providers and self-employed disability service providers are undertaking many supply-related activities in direct and indirect response to the trial and roll-out of the NDIS.
The level of these activities (and particularly those centred on engagement with LACs, expansion of the workforce and changing staff types to meet service demand) increased over time. The qualitative data also showed that business models were changing within the sector with a move towards more market-driven practices. With the adoption of more commercial business practices, concerns were raised of a detrimental impact both on client-provider relationships and on collaboration between provider organisations.
The quantitative and qualitative data appear to contradict one another when considering the reported impact of the NDIS on the disability sector, indicating a mix of change and uncertainty.
Most providers participating in the quantitative survey felt that the NDIS was having a positive impact on their organisation; these positive impacts centred on employment, support charges, wage growth and overall performance. However, provider sentiment of the impacts of the NDIS became considerably more negative over time.
In contrast, the qualitative data suggests that the NDIS has had considerable but mixed impacts for disability service providers. By wave 2, new providers were emerging in the NDIS trial sites. While these were mostly allied health practices, the emergence of new internet based labour-for-hire services was also noted. Evidence was also provided of established provider organisations moving into the NDIS trial sites. Over time some exits from the disability sector were reported as a consequence of organisational closure or a decision to withdraw from disability service provision (either completely or as a registered provider under the NDIS). Increased merger and acquisition activity was also occurring by the wave 2 interviews.
Both data sources provided information about funding within the disability sector. The quantitative data indicated that sector funding had increased between waves 1 and 2 and as the proportion of funding from the NDIS grew, funds from other sources had declined. The qualitative interviews highlighted widespread perceptions that NDIS pricing structures did not adequately cover the full costs of service provision. However, the full impact of funding and pricing changes was yet to be realised as many disability service providers continued to receive some block funding during the transition to full NDIS roll-out. Concerns regarding the future financial viability of disability organisations persisted throughout the period of the evaluation.
While the full impact of the NDIS on the disability workforce was yet to be realised, an expansion of the workforce was observed by wave 2 in both the quantitative and qualitative data. In particular, the average number of employees in the disability organisations surveyed increased considerably over time. A majority of provider organisations reported future hiring intentions, with demand for disability and residential support workers, programme administrators and allied health staff particularly strong.
The quantitative data provided an overview of the composition of the disability sector workforce. Disability and residential support workers form an expanding majority within the direct care workforce. The occupational profile of the remainder of the workforce changed little over time. The disability workforce is also predominantly female.
Both the quantitative and qualitative findings highlighted a growing trend towards the casualisation of the disability workforce. However, a lack of agreement was found as to the use of agency workers within the sector. While the quantitative survey data showed that the use of agency workers was decreasing over time, some providers were noted in the qualitative interviews to be continuing to hire agency workers in order to address issues with staff recruitment. Concerns were raised about the skills of these agency workers by both disability service providers and by NDIS participants and their family members and carers. Moreover, indications that staff retention may be becoming more problematic were found at wave 2. The quantitative data showed a decline in the length of tenure of disability workers, while examples of experienced staff leaving the sector were noted in the qualitative interviews.
Further evidence of the impact of the NDIS on working conditions in the disability sector was shown in the qualitative data. Issues relating to the ability to pay staff award rates within NDIS pricing levels, and managing the dichotomy between minimum shift hours under industrial awards and NDIS participant requests for shorten services were highlighted. Concerns were also raised about increased workloads in relation to administrative and financial aspects of the NDIS.
Discrepancies between the two data sources were found regarding the impact of the NDIS on the training of the disability workforce. Evidence was provided in the qualitative interviews that NDIS pricing structures were negatively impacting upon opportunities for training within the NDIS trial sites. In contrast, the quantitative data indicated that access to disability training remained unchanged over time.
Low levels of vacancies and evidence of skill shortages within the disability sector were reported in the quantitative data. However, as substantiated in both the quantitative and qualitative evidence, over time allied health workers positions became more difficult to fill. The qualitative data also found that new roles within the sector were typically being offered at lower rates of pay and skill levels than before the NDIS. This perceived de-professionalisation of the disability workforce led to concerns about the quality of service provision.
The qualitative interviews (and in particular those conducted with NDIA staff) provided evidence about a major new workforce within the disability sector – the NDIA workforce. While the quality of the NDIA workforce was considered to be good by those working within the agency, high workloads and work stress were negatively impacting upon staff wellbeing and retention. These concerns grew over the course of the evaluation. Different occupational groups within the NDIA reported specific challenges in their work. Many planners were concerned about the high administrative burden arising from planning processes, LACs that the expected community engagement aspect of their role was not a key focus, and PSCs were struggling to undertake both plan implementation and community engagement.
Several areas of improvement were recommended for the NDIA workforce. Respondents across all interview groups highlighted that further training was required by NDIA staff, including greater understanding of disability types and associated needs, how to better support plan implementation and self-management, and role-specific training. NDIA staff themselves also identified strategies that could better support their workforce. These included improved career opportunities, more effective management of workplace stress and high workloads, as well as specific strategies to address the support needs of NDIA staff with disability.