Submission to the Joint Standing Committee on the National Disability Insurance Scheme Inquiry into Assistive Technology

I am an NDIA participant. My feedback is a combination of my own experience and the feedback I have been hearing from therapists that I have good relationships with.

My feedback relates to four of the areas of “particular reference” you list on the submission website, namely:

a. the transition to the NDIS and how this has impacted on speed of equipment provision; c. whether market based issues impact the accessibility, timeliness, diversity and availability of assistive technology; d. the role of the NDIA in approving equipment requests; g. any other related matters.

Areas of Particular Reference

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

From my personal perspective:

• I have been very pleased with the two planners I have met with. I found them extremely helpful
• I did quite a lot of preparation for both my planning meetings, which included my goals, support needs, and how my AT equipment requests linked to my goals in all areas of my life.
• In my first plan I was given an AT budget that included the AT I had obtained quotes for in the lead up to the planning meeting. The understanding being that this budget was dependent on an OT report being lodged and accepted by the NDIA. I liked this process as it gave me an indication that my equipment needs could be necessary and reasonable, but would need to be assessed and formally deemed so by due process. When my reports were submitted the approval time was within a couple of weeks,

4. In my second planning meeting I went with quotes as per mu first meeting. However, when I received my second plan my AT budget it did not include those quotes in my budget. I was told that the process had changed and there would be no pre allocated budget for items that required an OT assessment and report. I will wait and see how the process works with this change, but from a personal point of view it puts up a mental “block” and makes me inclined to think that approval will be a longer process.
5. One point of frustration in regards my second plan is that I have not been given any details on who my LAC is. The planner was an NDIS planner, I was advised that an LAC would be in contact with me however that has not happened (3 weeks into my new plan).
6. Now to the process of being assessed and having reports written. This was the big hold up for me. The shortage of prescribing therapists with the skills to deal with a customised wheelchair script meant that it took about a month to be able to have an appointment with a therapist I trusted. Her feedback was that she is inundated due to the lack of therapists. I have two therapist I contacted prior to the one I ended up working with, and both of them said they do not do NDIS work because the approval process for several reasons, more on this later.
7. As a wheelchair user for more that 38 years, with some experience of scripting wheelchairs, I filled out the wheelchair script and used the therapists as a check to ensure I had measured correctly. Then we spend 4-5 hours wasting the time of suppliers and the therapist’s time so that we could say we had tried different brands of chairs and had quotes. The therapist cost of the equipment trials and quotes was around $900, and of course had to happen over several days due to coordination of dealers and the therapist and my time.
8. It then took approximately 6 weeks for the therapist to do the report. Followed up several times but again she said she was flat out and was working through the assessments systematically. The shortage of therapists is a big issue. Also the priority therapists give to doing assessments over writing reports (understandable) needs to be addressed. From a personal perspective I will negotiate this with my next assessment, specifying that I require the report from the therapist within a given time after the assessment.
9. In the end the OT cost for the assessment and report application was around $1,300. This represented approximately 20% of the cost of the equipment. Personally I find this staggering and indicates that the efficiency of the process needs to be

addressed. I have heard cases where the assessment costs have way exceeded the cost of the equipment! 10. Added to the cost is the time delay in the process. Due to a combination of a shortage of therapists, the time to do assessments and trial 3 different chairs, the time to get the report done, the inadequate format of the report template it took 3 months. Add to that the approval time it was about 3.5 months from beginning to end, this for something that was basically a replacement of an existing essential piece of AT. 11. I know of five highly skilled private therapists who refuse to do NDIS work. Five may not sound like a lot, but in the overall landscape of complex AT this represents a significant number and is only the ones I am aware of. The reasons they report are: a. Frustration with the assessment process b. Frustration with the lack of understanding that many of the NDIA assessors have about different disabilities and how they impact on individuals – which often results in unskilled assessors rejecting the recommendations of highly skilled therapists. c. Frustration with the review process when critical AT is rejected. This eats up time and energy and is emotionally challenging as they desire the best for their clients. d. Frustration with the inadequate request for approval template that has to be used when lodging a request. It does not allow them to explain how critical the equipment is and the reasoning behind the need for it. 12. My final bit of feedback on the process is regards the initial planning meeting. As a participant I have, as already stated, been really pleased with both the planners I have been allocated. One thing I think would be really useful is that, at the end of the planning meeting, I be given a copy of what will lodged so I can review it and confirm that it is accurate regards the information we have discussed during the meeting.

d. the role of the NDIA in approving equipment requests;

• We are finding our staff spending a significant amount of time with therapists/end users who have had equipment requests rejected. Some of this is caused by therapists not being skilled report writers, hence failing to link the equipment to the NDIS plan goals and/or failing to quantify how equipment can empower the participant and reduce costs in other areas such as the need to assistance.

• Many times it is that the assessors within the NDIA do not have significant knowledge about what the Assistive Technology is, what the challenges of specific conditions such as spinal cord injury or MND are, and how these two factors intertwine to provide a reasonable and necessary piece of equipment.

• We are also finding that assessors, who appear to have very limited knowledge of Assistive Technology and conditions. will over rule the expert advice of Occupation Therapists. This has been a cause of frustration and we know of several skilled Occupational Therapists who now refuse to do NDIS related work.

• The time from application to approval can be significant. We don’t understand why this should be the case giving the amount of work gone into assessment and application report writing.

g. any other related matters.

• I have experienced confusion regards funding categories within my plan. How the funds can be spent is not always explained or clear.

The current NDIS portal is inadequate, and not designed to be accessible for all types if conditions. The funding categories in the Portal do not always match the terminology within the plan, which causes further confusion.

• Phone calls to the NDIA for clarification have resulted in different answers from different consultants.

I do want to finish on a positive note. I have found the staff at the NDIS and NDIA extremely helpful and with a genuine desire to help me. The introduction of the NDIS has been an overwhelmingly positive thing in my life, and my wife’s life.

Thank you for the opportunity to provide feedback.

Best Regards