In August 2011, the Australian Productivity Commission released its landmark report on disability care and support (Productivity Commission 2011). The report was highly critical of the care and support available to people with disability and their carers within Australia and argued for the need for deep and far reaching change. The main recommendation of the report was the setting up of a national insurance scheme to improve the quality and enhance the equity of disability service provisions across Australia. A series of Council of Australian Government agreements were reached between the Australian Commonwealth and State and Territory governments, which formalised transition arrangements from the old system to the new National Disability Insurance Scheme. The Intergovernmental Agreement for the NDIS Launch was signed by the Commonwealth and all States and Territories at the Council of Australian Government meeting of 7th December 2012. The National Disability Insurance Scheme Act 2013 established the National Disability Insurance Agency (NDIA) and gave birth to the NDIS.
The trial of the NDIS, originally known as DisabilityCare Australia, began in July 2013 in SA, TAS, the Barwon region in VIC and the Hunter area in NSW. The ACT and the Barkly Region in the NT joined the launch in July 2014, and Western Australia conducted and evaluated its own independent trial. The Nepean Blue Mountains area of NSW became the first NDIS site to transition to full rollout, starting in July 2015. In July 2016, the NDIS finished its trial period and the full Scheme began rolling out across Australia.
In May 2013 the Australian Government Department of Social Services (DSS) commissioned a consortium led by the National Institute of Labour Studies (NILS) at Flinders University to conduct the evaluation of the trial of the NDIS (the NDIS evaluation).1 The evaluation was originally planned to take place between 2013 and 2016 and cover SA, TAS, the Barwon region in VIC and the Hunter area in NSW from 2013 and the ACT from 2014. In 2014 the NDIS evaluation was extended to include the Barkly Region in the NT. Two additional studies were commissioned one exploring the impact of the NDIS on mainstream health, mental health, education and employment sectors and another exploring the impact of the NDIS on older people with disability and the aged care sector. In 2015 the end date of the whole evaluation was extended to 2017 in order to accommodate the actual timing of the NDIS trial roll-out, especially the late ACT roll-out.
In this report, generic references to ‘trial sites’ refer specifically to the whole of SA, TAS and the ACT, the Barwon region in VIC, and the Hunter area in NSW. Reporting on the findings of the evaluation in the Barkly NDIS is included in Chapter 11. The NDIS evaluation does not include any further NDIS trial sites.
Reporting Framework for the NDIS Evaluation
The NDIS evaluation has now been running for four years and this Consolidated Report is the third of three major reports. The Initial Report was delivered to DSS in December 2015 and was made publicly available in December 2016. The Initial Report described the first stage of the evaluation work, namely how the evaluation was put together and how the large data collection that underpinned it had commenced. The Intermediate Report was delivered to DSS in September 2016 and was made publicly available in December 2016. The Intermediate Report provided the first synthesis of the evidence collected up to mid-2016 from all different sources and methodologies of the NDIS evaluation on a limited number of themes and their related key evaluation questions (KEQs).
A separate document under the title The Evaluation Framework was published in February 2015 detailing the original design of the evaluation.
The precise objective of the NDIS evaluation was to assess the impacts of the NDIS in SA, TAS, the Hunter area in NSW, the Barwon region in VIC and the ACT on:
As described in Section 1.1, the NDIS evaluation also extends to the Barkly Region in the NT, and includes two additional studies that examine the impact of the NDIS on mainstream health, mental health, education, and employment sectors and on older people with disability and the aged care sector. The NDIS evaluation is also intended to evaluate high-level processes, focusing on elements of the NDIS which impacted on the intended positive outcomes.
In this report we present quantitative and qualitative evidence in a thematic way in order to inform the evaluation of the potential synergies between first, the depth of understanding qualitative evidence offers and second, the overall representativeness of quantitative survey data. The combining and integrating of these numerous sources of data is a core element of evaluation’s design.
Key Evaluation Questions, Main Themes and the Structure of this Report
In the background of the thematic analysis and presentation of this report is the set of Key Evaluation Questions (KEQs) that the evaluation has been designed to address. The DSS originally identified a total of 58 such questions to be answered by the NDIS evaluation.
This Final Report draws from each source of the NDIS evaluation data collection activities to provide a synthesis of the evaluation evidence around 10 main themes. These themes form individual chapters of this report. A brief description of each is presented below and the related KEQs that underpin each theme/chapter are documented in Appendix 1.1. With Chapter 1 being the Introduction, we begin with Chapter 2.
Chapter 2: Supply and demand of support services – this theme examines the impact of the NDIS on the demand, supply and quality of disability support services. We also identify areas of unmet demand for services and supports.
Chapter 3: The disability sector and its workforce – as the NDIS is expected to bring wide-ranging change to the disability sector, this theme explores the current and anticipated impacts of the NDIS on provider markets, service providers and workers.
Chapter 4: Choice and control (including self-management) – the concepts of choice and control are central to the NDIS. This theme examines the extent to which the NDIS has improved the choice and control of people with disability and their carers over the planning and delivery of their supports.
Chapter 5: Reasonable and necessary supports – the NDIS funds reasonable and necessary supports to address the support needs and goals of participants. This theme considers the extent to which NDIS participants and their carers are satisfied that their supports under the NDIS are reasonable and necessary.
Chapter 6: Wellbeing – the NDIS aims to improve the quality of life and wellbeing of people with disability and their carers. This theme assesses the extent to which the NDIS is achieving this aim.
Chapter 7: Participation (social, economic and educational) and aspirations (goals) – a central focus of the NDIS is to improve the social, educational and economic participation of people with disability and their families and carers. This theme explores whether the NDIS is contributing to changes in participation. Furthermore, this theme examines the extent to which the NDIS has enabled participants and carers to achieve their goals and assisted with life transitions.
Chapter 8: Fairness, equity and access – this theme focuses on experiences of eligibility processes, navigation of the NDIS, and review and dispute resolution processes. It also examines whether the NDIS is equitable and fair for all people with disability and their carers.
Chapter 9: Mainstream interface – this theme explores the impact that the NDIS has had on mainstream sectors such as health, mental health, education and employment. The interface between the NDIS and mainstream services and the changes which have occurred in the provision and use of mainstream services by people with disability are examined.
Chapter 10: Older people with disability – as entry into the NDIS is only available to people with disability under the age of 65 years, older people with disability can receive disability funding and supports from several different funding sources. This theme compares the supports and satisfaction of older people with disability who are part of the NDIS with those who are ineligible to join.
Chapter 11: NDIS in the NT (with a focus on the Barkly trial site) – this theme presents finding from the evaluation of the NDIS in the Barkly region of the NT. It explores specific issues regarding the operation of the NDIS in a remote location including the supply and demand of disability supports, the disability sector and its workforce, and the outcomes for NDIS participants and their carers.
The reader must note that the above themes and the underpinning evaluation questions (and the chapters they are organised in) are inter-dependent and not mutually exclusive. There are several evaluation questions that are important in the context of several themes and in many instances the themes themselves can be overlapping. There is no clear-cut categorisation, so the evaluation is guided primarily by the policy questions, objectives, and concerns in a pragmatic manner.
Chapters 2 to 8 are presented in a way that bring out the differences between quantitative and qualitative evidence and then integrates them under the umbrella of the core policy questions addressed by each chapter. Each of these chapters begins with an integration of key findings. These integrated findings have been designed to be read independently from the body of the chapter and are provided to enable a reader with limited time to review these two sections rather than delve into the detail of the findings. We focus on the aggregate trends that the evaluation uncovers. We then continue with our detailed analyses: in the quantitative section we utilise sophisticated data estimation techniques and in the qualitative section we delve deeper into the respondents’ narratives. These detailed analyses form the backbone of the evaluation’s evidence, and we focus on those trends that are identified at the aggregate level to be experiencing either poorer or better outcomes. We do this to understand the factors that are most closely associated with more positive or negative outcomes stemming from the NDIS. Each of the first seven chapters (numbered 2 to 8) is concluded with a summary of the key findings arising from the quantitative and qualitative evaluation evidence presented in the chapter, the objective being to highlight the differences in the evidence that is generated by the different methodologies we use.
The three final chapters in the report describe the findings of three additional stand-alone studies conducted in conjunction with the main evaluation (relating to the mainstream sectors, older people with disability and the NDIS trial in the Barkly region of the NT). As these were purely qualitative studies, these chapters do not include an integration of findings, and are instead preceded with the summary of the main findings of each of the studies.