Joint Standing Committee on the National Disability Insurance Scheme PO Box 6100 Parliament House Canberra ACT 2600
13 September 2020
Response to the Introduction of Independent Assessments to the NDIS
On 28 August 2020 it was announced by Stuart Robert, Minister for the NDIS, that from 2021, Independent Assessments will be introduced to the scheme for those seeking to access it, as well as making up part of the normal plan review process.
I am an Occupational Therapist of 14 years’ experience and have conducted Functional Capacity Assessments as requested within NDIS participants plans, as well as assisting participants with access, since the rollout of the scheme in Western Australia.
I will not spend any significant time critiquing the Assessment of Functional Capacity for NDIS – Development and Framework; as others more eloquent than myself have already done so. I also do not want to take away from the most important voice of all, those of people with disabilities – I will leave it to them and their advocates to decide if the introduction of Independent Assessors is something which they see will be of benefit to themselves as part of their scheme. However, if as it would appear, that this is not a welcome change from their point of view, I offer my perspective of possible solutions to both alleviate the concerns raised across many platforms with the impact that this will have on people with disability and to better meet the needs of the NDIS.
It appears there are three core concerns from the perspective of the NDIA in regard to the current status quo for Functional Capacity Assessment:
- Variability in information received by the NDIA regarding functional capacity
- The presence of bias
- Costs to prospective clients in accessing required assessments
Firstly, I would completely agree with the presence of variability that would occur within these assessments and the quality of the information which the NDIA would therefore receive. However, the issue lies in the lack of clarity from the NDIA as to what the information is that they expect to receive from those completing Functional Capacity Assessments. “Functional Capacity Assessments” where created in relation to the NDIS, without a clear indication of what it should entail – and therefore assessors have all gone down different paths in their interpretation of this. The framework that is currently being proposed, is something that if put in place from the inception of “Functional Capacity Assessments”, would have provided assessors with a level of guidance and gone a long way to providing the NDIA with the consistency they desire. Rather than the need for the introduction of Independent Assessors, I would suggest the same level of consistency will be able to be achieved, without duplication of costs for assessment and reporting by current providers, as well as an Independent Assessor, through the following:
- Refining and roll out of the Assessment of Functional Capacity Framework to current providers of these assessments; including the requirement to select from a suite of assessment tools that best meet the needs of the participant
- Introduction of a Functional Capacity Assessment template, as is currently provided for Assistive Technology Applications (and proposed for Independent Assessors), to ensure that reporting is consistent across providers and includes all information required by the NDIA in decision making
- Provision of compulsory training modules created by the NDIA for providers completing assessments to ensure greater consistency of assessment and reporting. Additionally, ensuring the availability of training in desired assessment tools is available will enhance the quality of assessment.
Essentially, these are all aspects which have been identified through the recent announcements and were to be provided for the Independent Assessor organisations. However, by making them accessible to current assessment providers, the consistency desired by the NDIA can be achieved without the need to implement another layer of assessment for participants.
Secondly, in relation to bias, and putting aside the afront to the professional reputation of many, many highly skilled allied health professionals; as regulated professions, there are already currently mechanisms in place if concerns arise in regard to the ethical behaviour of these professionals. If legitimate concerns are held for the behaviour of particular assessors, then this should be reported through AHPRA. In order to reduce any perceived bias, a well-designed template, as discussed above, will ensure appropriate clinical reasoning is detailed, to the level of specificity to which the NDIA requires. Perhaps if there are concerns about bias in particular instances, the NDIA, as decision makers, could contact the assessor to discuss further in these cases; this will also provide an opportunity for learning for the assessor. Through the use of Independent Assessors, bias, not via the person conducting the assessment, but through the assessment process itself, will create bias in the opposite direction, to such a negative degree, that with only a very basic understanding of the participant and their complex situation will enable adequate recommendations to be made. Although this could be wrong, and in fact, Independent Assessors (if not constrained by KPIs) may actually recommended a greater level of non-essential supports as they do not fully understand the situation after such a short period of assessment. This currently occurs with planners including equipment in plans that is not required, because they do not understand the person’s needs. Furthermore, where participants feel well supported and that a professional is appropriately advocating on their behalf, they do not have to “perform” at their worst to get the supports they require and therefore only supports truly required are recommended.
Finally, I commend the NDIA for seeking to rectify the challenges to access that many individuals face when they are unable to access quality assessment without a significant cost. Not everyone with a disability has a team of professionals supporting them, prior to engagement in the NDIS, such that gathering required evidence is extremely difficult. I would recommend that the following considerations being made:
- Where the individual has suitably experienced supports who know them well and are capable of completing the Functional Capacity Assessment template as discussed above, they are able to choose to do so.
- For those who do not have access to this, they be referred to providers who are registered as assessors (through an accreditation process, such as submission of several past Functional Capacity Assessment reports), with the costs born by the NDIA (if they meet the initial eligibility criteria).
This will eliminate the costs to the prospective participant, as well as maintain the capacity to utilise professionals who know them well.
An additional point that I would like to address are potential issues I envisage will arise if an Independent Assessor panel is implemented through tender. As stated in recent announcements, the tender aims to achieve reduced costs. It can therefore be assumed, with personnel costs likely to be the most significant cost in providing the service, that staff wages will be driven down. Therefore, it will not promote the recruitment of professionals with a high level of experience who are able to earn higher incomes in the open employment market. These positions will likely then be filled by newer graduates, without the necessary clinical experience to provide the high-quality assessments which the NDIA require. Furthermore, the NDIS system is so complex that for those not working within the system and providing supports, purely providing assessment only will not allow them to develop a greater understanding of how assessment fits into the larger picture for participants and therefore recommend the right supports for them.
Thank you for taking the time to consider position on these matters and I am happy to be contacted further if required.
Regards
Carlo Divita Director / Principal Occupational Therapist The Rehabilitation Collective