Response to the inquiry by the

Joint Standing Committee on the NDIS

September 2018

Shop 4019, Level 4, Westpoint, 17 Patrick Street, Blacktown NSW 2148 • PO Box 8034, Blacktown Westpoint NSW 2148 Infoline: 1300 452 679 • Reception: (02) 9912 5800 • Fax: (02) 8814 9656 Email: welcome@at-aust.org • Web: www.at-aust.org ABN 44 103 681 572

Assistive Technology Australia – our role

The Independent Living Centre NSW, trading as Assistive Technology Australia (AT Aust) has been a leading provider of quality impartial advice and independent information on assistive technologies and modifications to those who need it, for more than 40 years. Our clients include people with disabilities, older Australians, carers, service providers and allied health professionals. From our display in Blacktown NSW, our model of information service is multichannel: info-line, visits and appointments. Our digital presence is through Facebook, YouTube and our website (www.at-aust.org). We manage a comprehensive database of AT supply across Australia and are able to assist people to find items that will meet their needs and link them to suppliers and/or assessment providers. The model exists in Europe, the UK, in Japan, the USA and in South America.

The AT Aust database is internationally recognised as the Australia national database. We are the Australian partner to the European Assistive Technology Information Network (EASTIN) with our database being one of the seven databases connected to the EASTIN search portal. (www.eastin.eu)

AT Aust is a founding member of the Coalition for Rehabilitation Engineering and Assistive Technology, Asia (CREATe Asia). CREATe Asia is developing an EASTIN style search portal (Pan Asian Linked Database of AT) for Asia, funded by the Singapore government. Our database is the test database for PALDAT. The databases of Japan and China are being prepared for connection and Thailand and Taiwan are in the process of developing their databases for connection, as is New Zealand.

AT Aust is also a registered training organisation, delivering nationally recognised training and competencies in Access Consulting, Home Modifications and in AT Mentoring. The Certificate IV in AT Mentoring was developed for the NDIA as part of the development of the NDIA AT Strategy. In addition, but outside the scope of the RTO, AT Aust delivers education to allied health professionals on AT, with a focus on new and emerging AT.

Response to the Terms of Reference

Introduction

The Independent Living Centre NSW, trading as Assistive Technology Australia (AT Aust) is pleased to have the opportunity to comment on the delivery of assistive technology (AT) to Australians with disability, within the NDIS.

The role of this company is to also support those people with disability who do not receive a funded package of support, but should be supported within the Information Linkages and Capacity Building Framework (Tier 2) of the NDIA and for whom AT is a key component to their lives. Some commentary will also be directed to the needs of this group.

In October 2015 the NDIA launched its AT Strategy[1]. This strategy was developed following a considerable consultation process and overseen by the Assistive Technology Sector Reference group, and is evidence based. Many of the difficulties associated with the AT process can be linked to the slow implementation of this strategy.

AT Aust will respond to three questions:

The role of the current state and territory programs in assistive technology process
The role of the NDIA in approving equipment requests
Any other related matters

The role of the current state and territory programs in assistive technology process.

The current state-wide AT programs have been crucial in supporting the NDIS transition process. In states such as NSW, the equipment program has provided procurement services to the NDIA and clinical oversight, supporting the decisions of the planners. Enable NSW also operates a well utilised repairs and refurbishment service. It is our understanding that the current relationship between the NDIA and the NSW Ministry of Health will cease in June 2019, meaning the current support role to the NDIA may cease.

The AT Strategy has a number of strategic goals. One of these is to “Deliver a financially robust sustainable scheme that generates economic and social value”[2]. There is opportunity within this goal to utilise the procurement processes of Enable NSW. Enable NSW has been able to generate great cost savings to the public purse whilst still delivering a level of choice and control. If bulk procurement processes were utilised for the very commonly required or prescribed items, great savings could be gained and the speed of supply would increase. As an Australia-wide market would be large, the number of items that could be procured in bulk may be much greater than currently procured for NSW.

The role of the NDIA in approving equipment requests

There is no question that the NDIA has a significant role in approving equipment requests. The role should be in determining the reasonable and necessary nature of the item requested, that the request is generated from the goals and aspirations of the participant, and that the participant has lead the assessment and prescription process.

The NDIS AT Strategy has, in Appendix 5, a Participant Capacity Framework$^\text{3}$. This provides the framework for AT requests and approvals, based on the complexity of the AT, and the capacity of the individual to exercise levels of choice and control. The final table of this framework (table $\text{3}$$“Recommended level of professional support for AT selection, based on participant capacity and AT type”) attempts to align capacity and complexity of AT to the request and approval process needed. To date it appears that this framework has not been put into practice by the NDIA. Implementing the framework would free up all resources and processes related to the assessment, request and supply of AT. The framework also allows for the development of an individual’s capacity during a selection and prescription process.

People coming into the scheme who have not previously received funded support are potentially needing to give up the control of AT decisions they have had in the past. In other words, for many people, receiving AT funding actually means reduced control. If the AT Strategy were to be implemented these experienced participants would retain much of the decision making and control.

An additional element of this framework involves the development of the role of the AT Mentor. AT Mentors are people with lived experience of AT or carers who undertake the Certificate IV in AT Mentoring. This role, as outlined in the AT strategy: 1. replicates the informal processes existing in the community of people with disability providing trained peer support in AT selection 2. builds the capacity of individuals for greater choice and control in AT selection 3. relieves the pressure on allied health professionals, freeing them up to utilise their skills where they are most needed 4. provides training and employment opportunities for people with disabilities and their carers 5. is transformative in the manner in which information advice is delivered: trained peer mentors, alongside allied health professionals.

To date, the NDIA has provided funds to train and employ AT Mentors in WA. By the end of June $\text{2019}$ there will be $\text{14}$ trained AT Mentors. However, there will be no others funded in other jurisdictions at this time, even though NSW and the

On the importance and role of information and advice.

The UN CRPD, General Obligations: Article 4.h, requires signatories “to provide accessible information to persons with disabilities about mobility aids, devices and assistive technologies as well as other forms of assistance, support services and facilities”

In World Health Organisation terms, Assistive Technologies are essential medicines alongside Medications and Vaccinations. To this end the WHO has published a Priority Assistive Products List and commenced a Global AT collaboration

The NDIA is attempting to develop a participant led market place.

The AT Strategy points out that this is not possible without addressing information asymmetry, and quotes a report of the Queensland Government.

People with disabilities need access to impartial information and advice if they are to engage fully in the selection of their AT and make the best choices and decision. How are people with disabilities to make good and appropriate decisions in the absence of information?

The need for information and advice applies equally to those people with disabilities not in receipt of funded supports. These people need to be supported by information and advice within the Information Linkages and Capacity Building Framework of the NDIA.

The AT strategy also points out that information and advice needs to be multichannel to meet the differing information gathering needs of people.

Assessment and prescription providers and suppliers should provide information about their specific products and services but, people with disabilities in exercising choice and control, need access to unbiased independent information on the whole range of products available.

AT Aust and our colleagues at the other Independent Living Centres have provided quality information and advice within their states, for more than 40 years. Unfortunately the pressure of the developing marketplace has seen most become service providers, with some developing commercial arrangements, including collocating within supplier sites. The capacity for conflict of interest is great, as all are able to utilise their information services to funnel clients to them and away from the

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original assessment provider. Two ILCs are within government departments, ILC ACT and ILC SA, and are under-going immense change. The ILC ACT will all but close early in 2019. The ILC SA will go through a procurement process without security of ongoing funding.

AT Aust has been unsuccessful in its tender applications within the ILC Jurisdictional Grants process. We have applied to deliver multichannel, impartial information and advice and train and employ AT Mentors as part of a transformational process, in the ACT (twice), NSW and SA. These three jurisdictions are the only ones to have transitioned to the NDIA ILC framework. There is now no NDIA funded AT information service in those jurisdictions.

AT Aust is fortunate that the NSW government understands the importance of impartial information and advice on AT and has agreed to extend funding for a limited time.

Recommendations

AT Aust recommends the full implementation of the NDIA’s AT Strategy and in particular:

utilise the Participant Capacity Framework as the system and process for meeting AT requests
the NDIA recognise the work and experience of Enable NSW and consider replicating Enable NSW’ bulk procurement processes and the Enable NSW refurbishment program.
fund the training and initial employment out AT Mentors in each state
block fund AT Aust and other Independent Living Centres to provide quality advice and impartial information on AT to any person with a disability, carefully managing any perceived or actual conflict of interest.

Robyn Chapman Chief Executive Officer September 2018