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RE: Presentations for review [SEC=OFFICIAL:Sensitive] — on behalf of NDIS Review Liaison Office to s22(1)(a)(ii) - irrelevant material (2023-06-14)

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DOCUMENT 1

From: redacted: s47F - personal privacy on behalf of NDIS Review Liaison Office To: redacted: s47F - personal privacy @pmc.gov.au; Cc: redacted: s47F - personal privacy @pmc.gov.au; NDIS Review Liaison Office; redacted: s47F - personal privacy @pmc.gov.au; redacted: s47F - personal privacy @pmc.gov.au; redacted: s47F - personal privacy @pmc.gov.au; Subject: RE: Presentations for review [SEC=OFFICIAL:Sensitive] Date: Wednesday, 14 June 2023 6:14:24 PM

Hi Gary

Thank you for the opportunity to review your redacted: s22(1)(a)(ii) - irrelevant material and ‘Cost Drivers’ presentation packs. Please find attached feedback from a policy and research perspective, and from a data and analytical perspective.

Overall:

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  • Cost Drivers
    • This appears to contain three separate topics of investigation — access (for those with secondary disabilities), redacted: s22(1)(a)(ii) - irrelevant material
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    • The information collected by the NDIA on a participant’s secondary disabilities and/or conditions is limited. As such, inferences should not be drawn given the lack of confidence in the data.
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Thanks Regards Kirsten

redacted: s47F - personal privacy NDIS Review Liaison Office National Disability Insurance Agency E: redacted: s47F - personal privacy @ndis.gov.au NDIA logo.png

The NDIA acknowledges the Traditional Custodians of Country throughout Australia and their continuing connection to land, sea and community. We pay our respects to them and their cultures and to Elders past, present and emerging.

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From: redacted: s47F - personal privacy @pmc.gov.au> Sent: Tuesday, May 30, 2023 11:01 AM To: redacted: s47F - personal privacy @ndis.gov.au>; redacted: s47F - personal privacy @ndis.gov.au> Cc: redacted: s47F - personal privacy @pmc.gov.au>; redacted: s47F - personal privacy @pmc.gov.au>; redacted: s47F - personal privacy @pmc.gov.au>; redacted: s47F - personal privacy @pmc.gov.au>; redacted: s47F - personal privacy @pmc.gov.au>; redacted: s47F - personal privacy @ndis.gov.au>; redacted: s47F - personal privacy redacted: s47F - personal privacy @ndis.gov.au>; redacted: s47F - personal privacy @ndis.gov.au> Subject: Presentations for review [SEC=OFFICIAL]

OFFICIAL redacted: s22(1)(a)(ii) - irrelevant material

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Key takeaways and points of review for Cost drivers work

Please find the following attached analysis of cost drivers. These are the following key takeaways:

  1. Participant complexity among new entrants is declining based on occurrence of co-occurring conditions redacted: s22(1)(a)(ii) - irrelevant material

We would particularly appreciate any checks/views the NDIS has on:

  • Decrease in co-occurring conditions (slide 4 to 5):
    • Is this data that is typically collected by the NDIS or submitted by participants at access?
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  • Accessing mainstream supports (slides 6 to 8):
    • To what extent do co-occurring conditions affect planning decisions? (e.g. does the NDIS explicitly fund supports for co-occurring anxiety/depression, and if so does it require a threshold/ diagnostic assessment for co-occurring conditions to affect planning)
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redacted: s47F - personal privacy (he/him)

Advisor | NDIS Review Secretariat Department of the Prime Minister and Cabinet Phone: redacted: s47F - personal privacy

Ngunnawal Country, One National Circuit, Barton ACT 2600 | PO Box 6500 CANBERRA ACT 2600 e. redacted: s47F - personal privacy @pmc.gov.au w. pmc.gov.au

The Department acknowledges and pays respect to the past, present and emerging Elders and Traditional Custodians of Country, and the continuation of cultural, spiritual and educational practices of Aboriginal and Torres Strait Islander peoples.

IMPORTANT: This message, and any attachments to it, contains information that is confidential and may also be the subject of legal professional or other privilege. If you are not the intended recipient of this message, you must not review, copy, disseminate or disclose its contents to any other party or take action in reliance of any material contained within it. If you have received this message in error, please notify the sender immediately by return email informing them of the mistake and delete all copies of the message from your computer system.

IMPORTANT: This e-mail is for the use of the intended recipient only and may contain information that is confidential, commercially valuable and/or subject to legal or parliamentary privilege. If you are not the intended recipient you are notified that any review, re-transmission, disclosure, dissemination or other use of, or taking of any action in reliance upon, this information is prohibited and may result in severe penalties. If you have received this e-mail in error please notify the sender immediately and delete all electronic and hard copies of this transmission together with any attachments. Please consider the environment before printing this e-mail

IMPORTANT: This message, and any attachments to it, contains information that is confidential and may also be the subject of legal professional or other privilege. If you are not the intended recipient of this message, you must not review, copy, disseminate or disclose its contents to any other party or take action in reliance of any material contained within it. If you have received this message in error, please notify the sender immediately by return email informing them of the mistake and delete all copies of the message from your computer system.

IMPORTANT: This e-mail is for the use of the intended recipient only and may contain information that is confidential, commercially valuable and/or subject to legal or parliamentary privilege. If you are not the intended recipient you are notified that any review, re-transmission, disclosure, dissemination or other use of, or taking of any action in reliance upon, this information is prohibited and may result in severe penalties. If you have received this e-mail in error please notify the sender immediately and delete all electronic and hard copies of this transmission together with any attachments. Please consider the environment before printing this e-mail

IMPORTANT: This message, and any attachments to it, contains information that is confidential and may also be the subject of legal professional or other privilege. If you are not the intended recipient of this message, you must not review, copy, disseminate or disclose its contents to any other party or take action in reliance of any material contained within it. If you have received this message in error, please notify the sender immediately by return email informing them of the mistake and delete all copies of the message from your computer system.

IMPORTANT: This e-mail is for the use of the intended recipient only and may contain information that is confidential, commercially valuable and/or subject to legal or parliamentary privilege. If you are not the intended recipient you are notified that any review, re-transmission, disclosure, dissemination or other use of, or taking of any action in reliance upon, this information is prohibited and may result in severe penalties. If you have received this e-mail in error please notify the sender immediately and delete all electronic and hard copies of this transmission together with any attachments. Please consider the environment before printing this e-mail

IMPORTANT: This message, and any attachments to it, contains information that is confidential and may also be the subject of legal professional or other privilege. If you are not the intended recipient of this message, you must not review, copy, disseminate or disclose its contents to any other party or take action in reliance of any material contained within it. If you have received this message in error, please notify the sender immediately by return email informing them of the mistake and delete all copies of the message from your computer system.

DOCUMENT 1.1 FOI 24/25-0761 - DISCLOSURE LOG

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Cost Drivers

General

  1. The ‘Cost Drivers’ presentation appears to contain three separate topics of investigation — access (for those with secondary disabilities), redacted: s22(1)(a)(ii) - irrelevant material

Access

  1. The information collected by the NDIA on a participant’s secondary disabilities and/or conditions is limited. At 31 March 2023, secondary disability information was recorded for 31% of active participants. Of participants with any secondary disability recorded, the majority (67%) have only one condition listed. File reviews on participant samples indicate there is likely to be a significant under-reporting of secondary disabilities in the data. As such, inferences should not be drawn given the lack of confidence in the data.
  2. The trend showing a declining rate of participants with ‘co-occuring’ conditions may reflect the phasing pattern of the Scheme, with those transitioning from existing State/Territory or Commonwealth programs having more severe or complex conditions than more recent entrants (many of whom are children).

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DOCUMENT 1.2 FOI 24/25-0761 - DISCLOSURE LOG

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NDIA Feedback on the NDIS Review’s ‘Cost Drivers’ report

Recording disabilities on a participant’s CRM record

  1. When an applicant accesses the NDIS, access delegates are required to assign a ‘primary disability.’ a. If a participant meets access based on a diagnosis on an Access List, that condition is recorded as the participant’s primary disability. b. For all other participants, the Access Request Form (ARF) requests treating health professionals designate a primary disability, being the disability “that has the greatest impacts most on your daily life”2
  2. As well as primary disability, the ARF asks applicants ‘Do you have any other disabilities that substantially affect your everyday life?’ Access delegates are required to assess disabilities against the NDIS access criteria, and add up to four ‘secondary disabilities.’
  3. While the National Access and Reassessments Branch has rigorous processes in place for adding secondary disabilities to a participant’s CRM record, other NDIA business areas (i.e. planners) are able to add or change participants’ disabilities, and there is anecdotal evidence of disabilities being added to a participant’s record with lower evidentiary standards.

Changes in the data over time

  1. The NDIS Review notes that there has been a decrease in additional disabilities being recorded over time. There are several hypotheses for this trend: a. Changes in NDIS cohorts over time – as observed by the Review, during the Scheme launch and transition years NDIS entry was focussed on those with higher needs, generally these were people who were transitioned from existing state schemes. During this transition delegates may have simply copied the disabilities that were listed in the records of those from State and Territory schemes into the NDIS system. b. Changes in agency processes over time – It is likely that over time access delegates have become better at assessing and then only listing conditions which met the access criteria.
  2. CRM records are not intended to provide a full summary of a participant’s disability and health circumstances. Listing conditions on a participant’s CRM record is primarily for data collection purposes and to record the disabilities for which a participant may receive funded supports.
  3. We expect that CRM data significantly underestimates the rate of co-occurring health and mental health conditions. For instance, it has been observed in cases at the Administrative Appeals Tribunal that many participants request supports in relation to conditions and impairments which are not listed on their CRM records.

The concepts of ‘additional disabilities’ and ‘co-morbid health and mental health conditions’

  1. The NDIS Review’s slide pack describes ‘secondary disabilities’ as ‘co-occurring conditions,’ and the analysis implies that often co-occurring conditions require supports which could best be described as treatments and which are the responsibility of mainstream services.
  2. This analysis has correctly identified a dynamic which contributes to cost-shifting to the NDIS. However, there are nuances to be aware of:

2 The Providing evidence of your disability, Operational Guideline.

a. There are conceptual challenges with distinguishing between ‘disabilities’ and ‘co-morbid health and mental health conditions.’ In general: i. Disability arises from permanent impairments; ii. Comorbid health and mental health conditions are impairments which are in their nature responsive to and most appropriately addressed by treatment — and therefore are not ‘permanent’ according to NDIS legislation. b. Many of the conditions listed as secondary disabilities on participants’ records will have been assessed as permanent, and may be appropriately considered to be part of the participant’s disability.

  1. In addition, many conditions listed as secondary disabilities are in fact indistinguishable from the primary disability in a clinical sense. For example, its noted that anxiety/depressive disorders are a common secondary disability. However, where these co-occur with a primary psychosocial disability, the extent to which they can be regarded as separate and distinguishable in nature is questionable. For example, treatment for the mental health condition and disability support for the psychosocial disability may in fact take place through the same intervention, i.e. a session with a psychologist.

Implications of research

  1. The co-occurring conditions section of the pack focusses on the implications of the distinction between disability and mental health by focussing on the provision of psychology supports to NDIS participants with co-occurring conditions such as depression and anxiety. This focus is appropriate, though there are broader implications.
  2. There is a large cohort of participants who experience a range of chronic health conditions (e.g., backpain, obesity, arthritis, diabetes, COPD) which are highly prevalent in Australian society, and not most appropriately addressed by specialist disability supports through the NDIS.
  3. Disparities in the service footprints of the NDIS and mainstream service systems incentivises participants and their health professionals to define health and mental health conditions in disability terms to have them recognised as part of the participant’s disability in the NDIS.
  4. Other suggested areas of focus for this kind of analysis include: a. The broad range of chronic health conditions in the NDIS (e.g., backpain, obesity, arthritis, diabetes, COPD) b. People applying to the NDIS with life-limiting terminal conditions, where their support needs are most appropriately addressed through the palliative care system