Assistive Technology Senate Inquiry

Submission by Northcott

Northco tt is a not‐foor‐profit disability servicee provider. Northcott hass 68 therapissts who provide services primarily to NDIS participants from mmetropolitann and regional locations throughout NSW and the ACT.

a. the transition to the NDDIS and how this has impacted on speed of equipment provision;

The speeed of equipmment providinng following the transitioon to NDIS is quite variabble. At times equipmeent is provided very quickly, while at other times there are lengthy delayss. In our experience the delays tend to bee due to the approval proocess and these issues are discussedd under section d. of the submission. Some examples of the lengthhy delays include:

AA participantt waiting 2 years for a ra mp to access the family home and new wheelchair, wwhen the current situation means thhe carer is lifting an adult in and out oof the home (adult and chair weight approx. 150kg).
AA participantt waiting neaarly 2 years ffor new orthotics to be approved.a The participannt is still using orthotics made by children’s seervices and now has a pressure injuryy on their right foot from using these inappropriate orthootics.

NDIA provide no cleaar or transpaarent timefraames for Assistive Technology (AT) appproval. We have experienced a lack oof consistencyy around whhether AT reqquest are revviewed immeediately wheen submitted or they arre kept on hoold until the scheduled planp review. ThisT uncertainty makes planningp therapy services andd other suppoorts very diffficult for parrticipants to navigate.

b. whether thee estimated demandd for equipment to be sourceed through tthe assistive technology process in eaach roll out area was accurate;

No comment

c. whether maarket based issues impacct the accessibility, timeliness, diversity and availability of assistive technology;

Nortthcott therappists workingg in regional NSW locatioon report havving limited access to eqquipment locally. It is oftenn impossible for them to provide more than 1 quote for the AAT requestedd or to orgaanise trials too compare diifferent prodduct as currently requiredd by NDIA.
For vvery speciali sed equipmeent therapistts may need to look at international ssuppliers, where no trial is possible aat all. We hadd an examplee of a particiipant who reequired titan ium heavy duty crutcches for mobbility which couldc only bee supplied frrom the US. TrialT was nott possible, however triallss were comppleted of other products which were not suitable. The NDIA pplanner did not approve this equuipment as we couldn’t trial it, and chose to fundd less suitablee crutches despite the high likelihoood that they would requ ire much moore frequent replacemennt and greateer long term cost.

Unclear Process

In our experience the process around approval of Assistive Technology in NDIA is non‐transparent, and varies between NDIA offices and individual planners. This includes processes around:

the method to submit a AT Request Form
how AT approval or declines are communicated
available communication between planner and prescribing therapist to clarify aspects of the recommendations
who actually provides approval – NDIA planner, or the NDIA clinical support team

This variable process means unnecessary therapy time is spent in submitting and following up applications which means participants Improved Daily Living funds are used on this rather than supporting additional goals.

It would be very helpful if NDIA can use a priority system when reviewing AT requests. We have examples of participants who have been in urgent need for assistive technology due to pressure sores. These customers waited more than 6 months for equipment approval. This put these participants at significant risk and they had a poor quality of life being on bed rest until their equipment was approved.

A clear process would ensure participants and prescribing therapists have some security that their request is being reviewed, whilst also minimising lost paperwork, and reducing the time and funding required to follow‐up on requests or resubmit quotes or reports.

Communication with Planners

An overwhelming concern our therapists have in the AT approval process is the lack of consistency with being able to communicate with NDIA Planners about AT requests that have been submitted. Some planners are responsive and seek clarification while others are not which creates an inequitable system for participants.

On many occasions the approval or decline of an AT request has not been communicated from NDIA to the prescribing therapist.
If AT is declined the prescribing therapist is often given no opportunity to provide additional information or clarify aspects of the recommendation in a timely manner to prevent delays for the participant. It would be really helpful for the planner to talk to the prescribing therapist to answer questions before declining a request. This would be more cost‐effective for the NDIA and the participant as it takes longer for the OT to prepare an appeal.
We have one example where the NDIA planner declined to speak with the prescribing therapist over the phone regarding the participants AT request. In this instance the equipment was declined based on a misunderstanding of the NDIA planner. This planner

declined to speak to Management over the phone and did not respond to email attempts to
explain this misunderstanding. Instead, the NDIA planner continued to email to request that Northcott continue with AT trials, which used up the participant’s NDIS funding unnecessarily.
We have also experienced situations where participants are not being provided with the information about the request being declined in writing, which then leaves them with no ability to appeal the decision. Written advice on these decisions should be mandatory.
Then at the complete other end of the spectrum, therapists are at times being asked to further justify their recommendations on multiple occasions. It is common for these requests from NDIA Planners to be requesting information which is already outlined in the AT Request Form. Each occasion takes more Improved Daily Living funds from the participant’s plan which limits the other goals a therapist can work on. In the situations where there has been no additional Improved Daily Living funding available to allow the prescribing therapist to complete the NDIA request, the participant has experienced significant delays until their plan could be reviewed to allocate additional funding which allows the therapist to provide the additional information.
Therapists and participants are often unaware of the status of the AT Request once submitted. It would be very beneficial to receive a confirmation: o that the request has been received by NDIA, and o whether the request will be reviewed prior to their scheduled plan review or at the time of their scheduled plan review This supports the therapist and participant to plan for other supports or services required within the current plan period.
It would be helpful to have the contact details of the relevant planner available to the participant, so they could easily follow up on any AT requests.

NDIA AT Request Form

The current NDIA AT Request Form is not user friendly and uses headings that don’t appear to reflect the information required by NDIA Planners to make the approval decision. It would be useful to have access to: o a template of key information NDIA would like covered under each question o sample reports that they deem high quality o a front page checklist to ensure key information is covered
Currently multiple requests, such as hoist and sling and commode, need multiple AT request form completed which take more of customer funding to write separate reports. Often information is duplicated and could be covered in a single report making the process more streamlined and efficient.

Variables in who approves the AT Request

As prescribing therapists we see various situations around who within NDIA approves each AT Request. We understand NDIA planners receive all requests initially then some get sent to

Page 4

an internal clinical support team for further review. What is not clear is which requests go onto this higher level of review compared to others.

It does appear that the individual planner’s knowledge of Assistive Technology options has a significant impact on how smooth the approval process is. For some planners who have limited knowledge, therapists are often spending a long time educating them on basic customer needs and what the AT is. Examples of these discussions our therapists have has are:
- A planner had found a wheelchair online that comes with a headrest and queried why a wheelchair with the headrest being an additional cost was prescribed. The therapist has to educate the planner regarding the customer’s complex seating and pressure care needs and why a basic wheelchair is not suitable.
- Questioned whether psychologist to find out if a participant needs orthotics to walk, despite it being recommended by two physiotherapists in the AT Request
- Discussion with an NDIA planner who wanted to know why a wheelchair was not prescribed, instead of an activity chair. The AT Request Form had clearly explained the reasoning behind this recommendation including that the participant has a stroller and doesn’t need a wheelchair, and the activity chair would provide independence for the customer as the customer could get in and out of the chair by herself, as well as participate in activities with parents and siblings at different heights.
A lot of therapy time is spent advocating for customers to explain the complexities of the participant’s disability. This results in a lot of funding being used up to advocate for customers when it could be going towards getting the necessary equipment.

e. the role of current state and territory programs in the assistive technology process; No comment

  f.  whether the regulatory frameworks governing assistive technology are fit‐for‐purpose, and