Submission - Case Study: John

Date: 15th December 2022

To: Committee Secretary Joint Standing Committee on the National Disability Insurance Scheme Department of the Senate Parliament House CANBERRA ACT 2600 AUSTRALIA

Re: NDIS General Issues Inquiry Submission – case study: John

My name is Samuel Antonio and I have experience in dealing with the NDIS through my employment in a community health service working as a mental health social worker in Melbourne, Victoria. This letter is a submission to the Joint Standing Committee on the National Disability Insurance Scheme, which aims to shed light on my difficult experience with supporting clients to access the NDIS.

Firstly, I would like to highlight an ongoing occurrence that I have experienced where there has been unreasonable assessment of eligibility for NDIS access applications by NDIA delegates. This is often despite significant supporting evidence from health professionals that is contrary to the findings of the NDIA. Secondly, I would like to raise the issue that there is no external body that exists solely to provide oversight of NDIA decision-making in relation to people attempting to access the scheme, essentially meaning that there is no accountability for when NDIA engage in unreasonable decision-making relating to access decisions.

I would now like to reflect on my client John and my experience when attempting to gain John access to the NDIS to demonstrate some of the issues faced when attempting to access NDIS. John is a single male in his 60’s, living alone in a suburb in Melbourne and informally supported by his sister. John’s accommodation, finances and other administrative matters are managed by his sister, with John receiving additional daily support with self-care (prompting with showering and changing clothes), medication management, laundry and meal preparation from a private carer that was previously employed as a carer for his elderly mother. John’s home is very disorganised and unhygienic, with John requiring ongoing cleaning support. John has a well-established and long-standing diagnosis of bipolar affective disorder, which was the basis of John’s NDIS application. John appointed me to act as his plan nominee to support him with applying for the NDIS. John is unable to access the scheme independently due to his psychosocial disability, requiring support with undertaking complex tasks such navigating and gathering evidence to access the scheme.

As part of John’s first attempt at access to the NDIS, evidence was provided to the NDIA including a fully completed access request form, as well as supporting evidence from his general practitioner, private psychiatrist, and myself as a social worker. Also included was a primary mental health assessment by an occupational therapist and carer statement from John’s sister. This information was submitted to the NDIA with the aim of supporting John with accessing the scheme; however, John was declined. His second attempt is currently in process, however additional information has been provided from John’s drug and alcohol worker in addition to an occupational therapy report.

The information gathered as evidence of John’s chronic psychosocial disability and support needs clearly identifies that John’s formal and informal supports are in agreement that John requires lifelong psychosocial disability support. John’s lifelong psychosocial disability, cognitive difficulties and support needs have been well established by his treating health professionals in the documented evidence submitted to the NDIA. Furthermore, recommendations by his treating health professionals advocate for John to be granted access to the NDIS for the purpose of support with a range of complex functional needs and to minimise unfavourable physical, mental and social outcomes over the course of John’s life.

In mid-2022, John was supported to submit an access request for NDIS, along with supporting evidence outlined previously – totalling 12 evidence documents in total. Less than two weeks later, correspondence from the NDIA indicated that John had been declined access to the scheme based on the NDIA deeming John’s impairment as not likely to be permanent and that not all treatment options had been explored. This is contrary to expert opinion from health professionals that John’s psychosocial disability was chronic in nature and it being indicated in the access request form that all available treatment options likely to cure or remedy the impairment had been explored.

Submission to the Joint Standing Committee

I supported John with submitting an internal review within the NDIS. During the review process, the internal review officer did not respond to my query of what further information was needed to support John’s access to the scheme. The outcome of the review was much the same – being that permanency could not be deemed met until all available treatment options had been explored. The internal review officer stated that John had not engaged in drug and alcohol support or occupational therapy support as recommended by a clinician during a one-off primary mental health assessment and could therefore not be deemed having a permanent impairment.

The recommendation for John to engage with drug and algebra support was in no way a means to substantially relieve John’s impairment, but rather a way to promote a healthier lifestyle – a recommendation that John had taken on board, demonstrated by him engaging with a drug and alcohol counsellor. Furthermore, engagement with an occupational therapist is not a means of alleviating John’s permanent impairment and can’t be considered a treatment likely to remedy John’s impairment. In the evidence, it was specifically outlined that all evidence-based treatment and interventions that are likely to substantially relieve John’s impairment had been explored, however not given any merit. This was raised by myself during an internal review and was not acknowledged or addressed by the NDIA internal review officer.

The reasoning that the internal review officer used to find John as not having a permanent impairment is an example of the reason for this submission to the Joint Standing Committee. I have found that eligibility criteria is often applied in a misconstrued and unreasonable manner by NDIA delegates, with rationale for rejection being poorly articulated and poorly demonstrated on their behalf. NDIA collaboration with service providers and applicants around supporting access to the scheme did not occur, despite a value of the NDIA being to work collaboratively.

With John being declined and the internal review failing, it was evident that there was no external body that existed to provide oversight of NDIA decision-making in relation to people attempting to access the scheme other than taking the matter to the Administrative Appeals Tribunal. This process can be costly and time consuming, meaning that many people in John’s situation may be discouraged to pursue such course of action. In this situation, there was no accountability for the decision made by the NDIA delegate, who unreasonably ruled against John accessing the scheme, contrary to the recommendations of his supports. Furthermore, there was no opportunity for rebuttal and any questions to NDIA delegates around this decision were not addressed. There was no accessible or meaningful means to contest the decision and review outcome other than taking the matter to the Administrative Appeals Tribunal.

A formal complaint was made to the NDIA by myself in mid-late year of 2022, which was handled internally by the NDIA complaints team. In the complaint, I requested that the complaint be responded to via email for record-keeping purposes. I received an email response from a complaints officer who stated that they had unsuccessfully attempted to contact me via phone, despite me not providing my phone number in the complaint submission and requesting email only. The response from the complaints officer provided confirmation of the NDIA’s decision to decline John’s access, failing to acknowledge the details of my complaint. I was not given any response regarding the issue that I raised where I challenged the decision of the internal review officer as being unreasonable.

I was also not given a response as to why the delegate was not returning my attempts at communication, which I requested to be addressed as part of resolving my complaint. The way that my complaint was handled demonstrated an unwillingness for NDIA to accept any accountability for their actions or provide me with any sense of resolution. Following the complaint response, I contacted the complaint officer asking that the outcomes that I was seeking in the complaint form be addressed, with no response. I am unaware of any accountability that currently exists to address such an issue.

John has since been supported to reapply to the NDIS and is currently in progress of attempting to access the scheme. John’s second attempt at accessing the scheme has come after further evidence had been gathered to address the reasons as to why his previous application had been rejected. At the current point in time, an NDIA access accessor has sent a letter to John and myself, requesting more information to confirm that:

• John’s disability is caused by an impairment.
• John’s impairment is likely to be permanent.
• John’s impairment substantially reduces his functional capacity.
• John’s permanent impairment affects his ability to work, study or take part in social life.
• John will need the NDIS for his whole life.

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The letter goes on to detail further information that is needed:

• any treatments that John has previously undertaken to relieve or cure their impairment.
• any treatments that John is currently undertaking to relieve or cure their impairment.
• the outcomes, or expected outcomes, of any current and/or previous treatments.
• any available and appropriate treatment options that John has not yet explored, and that are likely to relieve or cure their impairment. If there are known treatment options that John
• cannot undertake, their treating professional must provide information about why this is the case.

Unfortunately, such information has already been addressed in the supporting evidence submitted to the NDIA. It is very discouraging when NDIA have been provided adequate evidence that clearly identifies a significant impact in daily functioning and permanence of impairment from health professionals and carers, and still request more information, appearing as though the evidence submitted has not been regarded. This experience is not the first time I have seen NDIA unreasonably use a person’s evidence against them to justify their decision to decline someone access to the scheme. John is fortunate enough to be able to get support from his sister whilst being unable to successfully gain access to the NDIS. However, if John – and others who also experience a significant and debilitating psychosocial disability – are continued to be declined access to the scheme, the health and social outcomes for some of our most vulnerable members of our community will have been neglected by Australia’s disability service system.

Recommendations: After considering my experience in supporting people to access the NDIS as partly outlined above, I would like to offer the following recommendations for the committee’s consideration: 1. An external body able to independently assess people’s access requests and determine their eligibility e to the scheme. This entity should not have any vested interests in the financial outcomes of the scheme’s operations. With this, it is hoped that the process of determining people’s access to the scheme is not unfairly biased. 2. An external body that provides oversight on all aspects of how the NDIA are operating, including the ability to investigate, scrutinise and overrule any unreasonable or unfair decisions and conduct by NDIA employees. An ability to provide corrective and/or disciplinary action would also be recommended. This provides a mechanism for accountability to exist within the scheme that is accessible to all people. 3. Further investigation into the managerial culture of the NDIA as to why there is unreasonable decision-making occurring. Organisational reform at a management level is also necessary to promote pro-social values that better align with the values, capabilities and behaviours that the NDIA claim to be committed to.

Thank you for taking the time to consider my submission to the committee.

Please do not hesitate to contact me if you require further information or would like to discuss my experience further. I have not included any of John’s documents in this submission but am able to provide de-identified copies of these if requested by the committee.

Kind regards,

Samuel Antonio Occupation: Community mental health social worker