Specialist disability support services

Around 339,000 people

were active participants in the National Disability Insurance Scheme (NDIS) at 31 December 2019.

4 in 10

(40%) active NDIS participants are aged 14 and under

About 157,000 people

received open employment services under the National Disability Agreement (NDA) in 2018–19.

On this page:


Introduction

People with disability who need support can use specialist disability services, mainstream services, and/or be supported by informal carers. They may also receive financial assistance to help with daily activities (see Income support for more information on financial assistance).

This section focuses on one part of this broader, and interacting, system of supports—specialist disability support services funded or provided by government.

In 2018–19, support was provided to people with disability under both the National Disability Agreement (NDA) and the National Disability Insurance Scheme (NDIS). In that year total government expenditure on specialist disability services provided under the NDA decreased to $4.2 billion in 2018–19, from $6.7 billion in 2017–18 (SCRGSP 2020). In the same time, committed support to the NDIS increased, from $7.7 billion in 2017–18, to $14.5 billion in 2018–19 (NDIA 2019).

Specialist disability support services are now largely provided through the NDIS. Most, but not all, NDA services, and the people using them, have transitioned to the NDIS. 

 This section provides information on:

  • all services provided under the NDA up to 30 June 2019, when most services transitioned to the NDIS
  • eligibility for and service provision in the NDIS
  • met and unmet need for formal services (from the Australian Bureau of Statistics’ (ABS) Survey of Disability, Ageing and Carers (SDAC)).

What are specialist disability support services?

Specialist disability support services help people with disability participate fully in daily life. They may supplement other support a person receives, such as that provided by mainstream services, the community and/or informal carers.

Disability support services may include:

  • assistive technology (for example, wheelchairs, hearing aids, voice-recognition computer software)
  • case management
  • early childhood intervention services
  • life skills development
  • specialist accommodation and home modifications
  • support to live in the community (for example, personal care and domestic assistance)
  • support to participate in community activities
  • respite care
  • employment services.

Specialist disability support services are primarily aimed at people aged under 65, but support is also available to eligible people aged 65 and over.

Disability service provision is changing

In 2013, the NDIS was introduced in trial sites. It is being progressively rolled out across Australia from July 2016, with the scheme scheduled to be fully operational by 2020. At that point, the NDIS is expected to have largely replaced the provision of services under the NDA, except open employment services.

The NDIS changes how services are provided to people with disability. Eligibility is assessed against common criteria. Each participant receives an individual support plan and a funding package to pay for their support. The NDIS is not means tested and is an uncapped (demand-driven) scheme (Buckmaster 2017). Under the NDA, eligibility requirements varied between states and territories and service providers were mostly funded to deliver places in a set number of assistance programs.


Support provided under the National Disability Agreement

In 2018–19, around 230,000 people used National Disability Agreement (NDA) specialist disability support services, at a cost of $4.2 billion (AIHW 2020). This is 5.3% of the estimated 4.4 million people with disability in Australia (ABS 2019a; AIHW 2020).

The number of NDA service users has decreased in recent years as eligible service users progressively move to the National Disability Insurance Scheme (NDIS)—down from 280,000 in 2017–18 and 331,000 in 2016–17.

Of NDA service users:

  • the average age was 39
  • most (95%) were aged under 65
  • almost 3 in 5 (57%) were male
  • 5.5% were Aboriginal and Torres Strait Islander people
  • the most common disability groups were:
    • psychosocial (32% as a primary disability and 46% including primary and other significant disability)
    • physical (25% and 42%)
    • intellectual (15% and 18%)
  • 1 in 3 (33% or 77,000) used services largely expected to move to the NDIS (AIHW 2020).

The most commonly used NDA services in 2018–19 were:

  • open employment services (68%), which help people gain and/or retain employment in the open labour market
  • community support (21%), which help people with disability live in a non-institutional setting (AIHW 2020) (Table SERVICES.1).
Table SERVICES.1: NDA service type outlets and service users by service group, 2018–19

Service group

Service type outlets(a)

Service users

Change in service users

(2017–18 to 2018–19) (%)

Accommodation support

3,070

12,777

–54.9

Community support

1,339

48,131

–54.2

Community access

1,005

18,563

–47.9

Respite

799

12,933

–51.1

Open employment

3,612

156,789

15.2

Supported employment

243

7,692

–48.1

Advocacy, information, alternative forms of communication

190

. .

. .

Other support

93

. .

. .

Total

10,351

229,752

–18.0

. . Not applicable.

(a) A service type outlet (STO) delivers a specific NDA service type at or from a discrete location. An STO is managed by an ‘agency’, which is usually a legal entity funded under the NDA to provide 1 or more types of services at 1 or more locations.

Source: AIHW 2020.

How many NDA service users will move to the NDIS?

In the Disability Services National Minimum Data Set (DS NMDS), once a service user has an approved NDIS plan and funding is available through the NDIA, they are considered to have transitioned to the NDIS.

During 2018–19, around 29,200 NDA service users moved to the NDIS (as reported in the DS NMDS). This is in addition to the 82,400 who made the transition since the NDIS began in 2013–14 (AIHW 2020).

Most, but not all, NDA service users are expected to transition to the NDIS. Some will not be eligible, such as those aged 65 and over who are not already participants. Also, some specialist disability programs, such as open employment services, are not included in the NDIS and will continue to operate separately. In 2018–19, around:

  • around 10,800 NDA service users were aged 65 and over (or 4.7% of NDA service users)
  • 153,000 NDA service users of any age only used open employment services (67%) (AIHW 2020).

In 2018–19, the remaining NDA service users were less likely, than those who transitioned to NDIS, to:

  • have an intellectual or learning disability (41% compared to 69%)
  • always or sometimes need assistance with activities of daily living (75% compared to 89%)
  • use supported employment services (6.1% compared to 16%)
  • have an informal carer (54% compared to 65%) (AIHW 2020).

NDIA data published on people with an approved and active NDIS plan will not match the DS NMDS data on NDA service users who moved to the NDIS. There are several reasons for this. In particular, NDIA data include people who have not been reported as part of the DS NMDS. This includes:

  • those who used services not reported to the DS NMDS
  • those referred directly to the NDIS
  • NDA service users who exited NDA services before their NDIS plan approval date.

In such cases, people will not appear in the DS NMDS as having transitioned to the NDIS.


Support provided through the National Disability Insurance Scheme

The National Disability Insurance Scheme (NDIS) is designed to provide Australians with ‘permanent and significant disability’ with the ‘reasonable and necessary support’ needed to participate in everyday life.

Active participants

At 31 December 2019, there were around 339,000 active NDIS participants with approved plans (with another about 2,700 Early Childhood Early Intervention participants) (NDIA 2020).

Of those active NDIS participants at 31 December 2019:

  • 4 in 10 (40% or 136,000) are aged 14 and under
  • more than 3 in 5 (63% or 210,000) are male (excluding gender ‘not stated’)
  • 7.6% (or 20,500) identify as Aboriginal or Torres Strait Islander people (excluding 70,800 with Indigenous status ‘not stated’)
  • 67% live in Major cities and 1.4% live in Remote and very remote areas
  • the most common disability groups are autism (31%), intellectual disability (23%, including those with Down syndrome) and psychosocial disability (9.1%)
  • 28% have a low level of function, 44% have a medium level of function and 27% have a high level of function, in terms of level of disability
  • 3,900 are younger people in residential aged care (aged under 65) (NDIA 2020).

See NDIS quarterly reports for the latest data.

How is remoteness defined?

The remoteness categories used in this section are based on the Modified Monash Model to define whether a location is a city, rural, remote or very remote (NDIA 2016). The classifications are based on the ABS’ Australian Statistical Geography Standard – Remoteness Areas framework and utilise Census data. For more information see Modified Monash Model

Eligibility

At 31 December 2019, 85% (or 379,000) of applicants to the NDIS were ever eligible.

Eligibility varies by age and gender. More than 4 in 5 (86% or 368,000) applicants aged 64 and under were ever eligible for the NDIS. Almost half (47% or 178,000) ever eligible applicants are aged 18 and under:

  • 15% (or 57,700) aged 6 and under
  • 24% (or 92,400) aged 7–14
  • 7.2% (or 27,400) aged 15–18.

Eligibility generally decreases with age for males and females:

  • 98% of male applicants aged 6 and under were ever eligible compared with 78% aged 55–64
  • 97% of female applicants aged 6 and under were ever eligible compared with 66% aged 55–64.

The majority of eligible applicants are males, although with increasing age, females make up a larger proportion:

  • 70% (or 104,000) aged 14 and under (excluding gender ‘not stated’) are males
  • 53% (or 25,900) aged 55–64 are males (Figure NDIS.1).

What does ever eligible mean?

Ever eligible is a count of people that have ever gained access to the NDIS. It includes people that have now had their access ceased or revoked. Access can be ceased or revoked for a number of reasons including: death, benefit early intervention conclude, self-elected exit.

Figure NDIS.1: Eligibility of NDIS applicants, by age group and gender, as at 31 December 2019

Stacked column chart showing the proportion of NDIS applicants who are males and females that are ever eligible or ineligible by age groupings 0–6, 7–14, 15–18, 19–24 then 10-year age groupings from 25–34 to 55–64 then 65+. The chart shows 69% of ineligible applicants aged 7–14 are males compared to 38% of those aged 55–64.

Eligibility does not vary by whether the applicant lives in an urban or remote location. Eligibility also does not vary by whether or not an applicant identifies as Aboriginal or Torres Strait Islander people.

Eligibility does vary by disability group, for example of those aged 64 and under, for the 3 disability groups with the most applicants:

  • 95% (or 112,000) of applicants with autism were ever eligible
  • 95% (or 72,100) of applicants with intellectual disability were ever eligible
  • 68% (or 34,100) of applicants with psychosocial disability were ever eligible (Figure NDIS.2).

Figure NDIS.2: Eligibility of NDIS applicants aged 0–64, by disability group, as at 31 December 2019

Stacked bar chart showing the proportion of NDIS applicants aged 0–64 who are ever eligible or ineligible by 17 disability groups. The disability groups are listed from most applicants (autism) to least applicants (spinal cord injury). The chart shows, among the 5 disability groups with most applicants, 96% of applicants with developmental delay are ever eligible compared to 47% with other physical disability.

Differences in eligibility are also evident among disability groups by age group and gender. For example:

  • 52% of ever eligible applicants aged 14 and under have autism and 0.2% have psychosocial disability
  • 43% aged 15–24 have autism and 3.1% have psychosocial disability
  • 5.9% aged 25–64 have autism and 21% have psychosocial disability (Figure NDIS.3).

Figure NDIS.3: Eligibility of NDIS applicants aged 0–64, by broad disability group and broad age group, as at 31 December 2019

Stacked column chart showing the proportion of NDIS applicants aged 0–64 with 5 broad disability groups that are ever eligible or ineligible by age groupings 0–14, 15–24, 25–64, and total. The chart shows 27% of ineligible applicants aged 0–14 have sensory or speech disability (including hearing and/or visual impairment, and other sensory and speech) and 56% of ineligible applicants aged 25–64 have physical or diverse disability (including acquired brain injury, cerebral palsy, multiple sclerosis, spinal cord injury, stroke, other neurological and other physical).

About the National Disability Insurance Scheme (NDIS)

The NDIS is a fundamental shift in the way Australians with significant and permanent disability access supports. It is founded in insurance principles to provide eligible Australians who have a permanent and significant disability, with the reasonable and necessary supports they need (NDIA 2019).

Once the NDIS is fully rolled out, the National Disability Insurance Agency (NDIA) estimates that the NDIS will provide around 500,000 Australians (478,000 aged under 65) with funding for supports and services. People with disability are directly funded under the NDIS, as distinct from the previous system of block funding to agencies and community organisations that provided disability support services under the National Disability Agreement (NDIA 2018).


Met and unmet need for formal services

An estimated 40% of people with disability living in households need assistance from formal providers (excluding those who do not know). These providers are most often private commercial organisations (for 61% of those receiving formal assistance) or government providers (46%) (a person can receive support from more than 1 provider) (ABS 2019b).

Survey of Disability, Ageing and Carers

Data in this section are largely sourced from the Australian Bureau of Statistics’ (ABS) 2018 Survey of Disability, Ageing and Carers (SDAC). The SDAC is the most detailed and comprehensive source of disability prevalence in Australia.

The SDAC considers that a person has disability if they have at least 1 of a list of limitations, restrictions or impairments, which has lasted, or is likely to last, for at least 6 months and restricts everyday activities.

The limitations are grouped into 10 activities associated with daily living—self-care, mobility, communication, cognitive or emotional tasks, health care, reading or writing tasks, transport, household chores, property maintenance, and meal preparation. The SDAC also identifies 2 other life areas in which people may experience restriction or difficulty as a result of disability—schooling and employment.

The severity of disability is defined by if a person needs help, has difficulty, or uses aids or equipment with 3 core activities—self-care, mobility, and communication—and is grouped for mild, moderate, severe, and profound limitation. People who ‘always’ or ‘sometimes’ need help with 1 or more core activities are referred to in this page as ‘people with severe or profound disability’.

The SDAC includes some information on the level of service people with disability receive from formal (or organised) service providers. These data are provided here for context and are not intended to be a direct evaluation of specialist service provision under the National Disability Insurance Scheme (NDIS) or National Disability Agreement (NDA). In particular:

  • the latest survey was conducted in 2018, which was part-way through the NDIS rollout
  • not all formal services are specialist services
  • formal services may or may not receive government funding.

Most (86%) people with disability who needed formal assistance with at least 1 activity received some support (from formal or informal sources). Most were satisfied with the quality and range of services:

  • 82% of people with disability, aged 15 and over, who received formal assistance with at least 1 activity in the last 6 months were satisfied with the quality of service (where level of satisfaction could be determined)
  • 73% of people with disability, aged 15 and over, who needed assistance with at least 1 activity from an organised service were satisfied with the range of services (where level of satisfaction could be determined) (ABS 2019b).

Not everyone with disability receives all the help they need from formal services. Common activities for which the need for formal assistance was unmet include:

  • cognitive or emotional tasks (34% of people with disability living in households who need formal assistance with that activity)
  • communication (31%)
  • property maintenance (29%)
  • household chores (26%)
  • health care (15%)
  • mobility (16%) (ABS 2019b).

The reasons given for not receiving any or more help from an organised service with at least 1 activity include:

  • service costs too much (33% of people with disability with an unmet need for formal assistance)
  • did not know of service (20%)
  • will not ask or pride (14%)
  • service does not provide sufficient hours (13%)
  • no service available (12%)
  • unable to arrange service (14%) (ABS 2019b).

NDIS outcomes framework

The NDIS outcomes framework questionnaires collect information on 8 life domains from participants, their families and their carers. It uses a lifespan approach to provide some measures of the medium- to long-term benefits to participants at different stages of life. This includes asking whether the NDIS has helped with various aspects of their life. For example, by 31 December 2019, for participants who have been in the NDIS for 3 years:

  • 49% of participants aged 15 and over are able to participate in community and social activities
  • 22% of participants aged 15 and over are able to participate in work
  • 96% of parents and carers, of child participants aged 0 to before starting school, think the NDIS has improved their child’s development (NDIA 2020).

Where can I find out more?

Data tables for this report.

NDA

Information on the use of specialist services under the NDA were collected and reported by the Australian Institute of Health and Welfare (AIHW) in the Disability Services National Minimum Data Set (DS NMDS). For more information, see AIHW Disability services and AIHW Disability Services National Minimum Data Set.

NDIS

Data on the NDIS is collected and reported by the National Disability Insurance Agency (NDIA)—an independent statutory agency whose role is to implement the NDIS. The NDIS website provides information about the scheme for people with disability, families and carers, services providers and the wider community. For the latest data on the NDIS see Data and insights and Quarterly reports.

ABS SDAC

Information on the Australian Bureau of Statistics’ (ABS) Survey of Disability, Ageing and Carers (SDAC) is available at ABS SDAC.

Use of disability services

Data on the use of disability services, including on met and unmet need for services, are available in the Productivity Commission’s Report on Government Services.