This section integrates the quantitative and qualitative findings relating to the supply and demand of disability support services. We outline the impact of the NDIS on (i) the demand and supply of disability services; (ii) the quality of these supports; and (iii) areas of unmet demand for services and support.
The evaluation finds that:
the types and number of supports received by NDIS participants has increased and is in most cases better than before and better than what is presently received by NDIS non-participants outside the trial areas;
the NDIS has improved satisfaction with the quality of the supports for people with disability and their family and carers;
concern has been voiced about the quality of supports from a minority of NDIS participants;
the supply of supports in number and quality is not growing sufficiently to meet the additional demand created by the NDIS;
many NDIS participants and their families and carers experienced continuing difficulties in accessing disability supports for which they were receiving NDIS funding;
the incidence of unmet demand did not reduce over the length of the evaluation; and
overall, the evaluation finds that demand for disability services and supports is now exceeding supply in the sector.
The impact of the NDIS on types and volume of disability support services
The overwhelming majority of NDIS participants need assistance on a daily basis. While most of the required assistance is provided informally by family members outside the economic market structure, just under a third of respondents also utilise market provisions. Over the course of the evaluation there was a modest shift away from family care and towards paid care.
Both the quantitative and qualitative sources of evidence clearly indicated that many people with disability are receiving more disability supports as a consequence of joining the NDIS. This included increased hours of support, greater frequency of services, as well as access to a wider range of supports. The quantitative data additionally indicated that the average number of supports received increased further with time participating in the NDIS. Commonly funded supports included aids and equipment, therapy services, personal care, leisure activities, transportation and respite.
Both sources of evidence identified that funding for support co-ordination/case management services had increased with the NDIS. While the quantitative evidence showed access to transport services had also improved, the qualitative data highlighted instances where this was not consistent and where a lack of funding for transport made it difficult and costly for participants to attend activities, especially those not in the local area. The qualitative data further suggested better access to equipment, allied health services, early intervention, and more tailored support services under the NDIS.
Despite a key focus of the NDIS on enhancing the social and economic participation of people with disability, both sources of evidence indicate there is limited supports to access work and study.
The quantitative evidence found that a majority of family members and carers felt that the NDIS had improved their capacity to provide support to the person with disability that they care for. The qualitative data suggested that better access to supports enabled NDIS participants to have more independence and less reliance on family members.
Both sources of evidence found that, while the number of supports received had increased for most NDIS participants, the majority of NDIS participants did not change providers upon joining the NDIS. The qualitative data suggested that uncertainty contributed to choosing to stay with the same provider, with evidence emerging that, as NDIS participants and carers increased their knowledge and experience of the NDIS, they became more confident about changing service providers over time. Wave 2 quantitative data continued to indicate that only a minority of NDIS participants changed providers. The qualitative evidence showed, however, that by wave 2, participants were increasingly moving across service providers and demanding more flexible services.
The qualitative data suggested that disability service providers were responding to the changing demand for supports brought about by the NDIS. Many providers were undergoing an expansion of their services, client numbers and workforces. Particular services that were experiencing expansion included individualised supports, support co-ordination, therapeutic supports, respite, and accommodation services. Some providers were also extending their hours of operation in order to enable greater flexibility around the timing of service provision.
However, while adaptation to the impact of the NDIS on demand for supports was occurring, the sector was experiencing persistent shortages in the supply of some types of disability supports. The qualitative interviews suggested that shortages could be particularly problematic for allied health services including speech pathology, occupational therapy and psychology.
Furthermore, the qualitative evidence revealed concerns about the future provision of disability services. These related to perceptions that some supports were underfunded by the NDIS, including one-to-one community supports, mental health services, group services, and services for people with complex needs. With the forthcoming ceasing of block funding arrangements, the future financial viability and provision of these supports was questioned.
An important finding that emerges very clearly from both sources of evidence is that whilst the overall picture of the NDIS is one of increased services and support, not all people with disability are achieving improved outcomes under the NDIS.
Both sources of evidence identified that access to supports for family members and carers to directly assist them in their caring role was limited under the NDIS.
The qualitative evidence also indicated that some people with disability were experiencing poorer outcomes under the NDIS and were receiving a lower level of services than previously. These were particularly people with disability who were unable to effectively advocate for services on their own behalf and/or those people who struggled to manage the new and sometimes complex NDIS processes. NDIS participants with a psychosocial or intellectual disability were considered to be at greater risk of poorer outcomes.
The qualitative evidence identified that the NDIS was having a negative impact on the services and supports accessed by people with disability who were not part of the NDIS. Supports were becoming more expensive, less readily available and, at times, no longer free for non-NDIS participants.
The impact of the NDIS on the quality of disability support services
Both sources of evidence showed that in general NDIS participants and their family members and carers were satisfied with the quality of the disability supports they were receiving under the NDIS. Moreover, their satisfaction levels were much higher compared to those of people with disability and their family members and carers outside the NDIS.
However, the quantitative evidence shows that satisfaction with the quality of supports was not consistent across all NDIS participants. People with mental/psychosocial disability were less satisfied with the quality of their supports under the NDIS compared to participants with other types of disability. Participants who had experienced unmet demand for supports and carers of younger children were also less satisfied with support quality.
Qualitative evidence highlighted concerns around the quality of disability support services across both waves 1 and 2, at a worker, organisational and sector level.
The quality and skills of disability support workers was a concern, especially with regards to agency workers. A lack of funding provision for staff training within the NDIS was considered to be undermining the quality of the disability workforce. Many respondents reported that NDIA planners did not have an adequate understanding of the needs of people with disability, which was having a detrimental impact on the quality of supports funded and received by NDIS participants.
At a provider level, NDIS participants and their family members and carers were concerned about the reliability and continuity of care provided by some organisations. Concerns were also expressed about the quality of unregistered providers who could be hired by NDIS participants self-managing their own funding. A perceived erosion of existing governance structures and a lack of regulation were felt to be negatively impacting on service quality at a sector level as the NDIS kept being rolled out.
Has the NDIS created new unmet demand for disability support services?
Despite evidence of positive changes to the amount of disability services received by people with disability as a result of joining the NDIS, both sources of evidence indicate that many NDIS participants and their families and carers experienced continuing difficulties in accessing disability supports for which they were receiving NDIS funding. The incidence of unmet demand did not reduce over the length of the evaluation. Services that were now more challenging to access included allied health, early intervention supports, respite and accommodation.
Both sources of evidence concurred that unmet demand was primarily a consequence of long wait times or a lack of a local provider. The quantitative evidence also shows that a lack of quality service provision contributed to unmet demand, while qualitative evidence highlighted potential difficulties accessing supports due to a continuing inflexibility of the support hours offered by service providers.
Unmet demand for disability supports was found by quantitative evidence to vary across different cohorts participating in the NDIS. Participants with an intellectual disability, those aged seven-15 years, or those who had entered the NDIS at a later stage, were shown to experience higher levels of unmet demand. In contrast, male participants and those with a higher household income were shown to be less likely to experience unmet demand for supports. Qualitative evidence enriched this finding by suggesting that unmet demand was more prevalent for people with disability living in rural and remote areas.
Both sources of evidence indicate that many NDIS participants continue to access supports that are not funded in their NDIS plan. Such unfunded supports include alternative therapies and social and recreational activities. The incidence of self-funded supports increased over time. It was reported that NDIS participants and/or their family already pay out-of-pocket expenses for accessing such services.