Submission to the Parliamentary Inquiry General Issues around the

      Implementation and Performance of the NDIS

              Independent Assessments

Summary:

Proposed mandatory Independent Assessments need much more investigation because:

The Productivity Commission did not recommend Independent Assessments in the manner proposed.
The detailed Tune report (at considerable expense and consultation) did not recommend Independent Assessments
AAT decisions have not found Independent Assessments to be accurate.
The appeal process is unacceptably long and favours the privileged. Independent Assessments will not result in the equity imagined. That NDIA consider fewer appeals is pie in the sky.
The pilot was abandoned and lacks transparency.
The Occupational Therapy Association was not consulted and has many concerns.
The Disabled Community has not been consulted and overwhelmingly fears loss of supports.
Finally why now, in such an awful year?

My Submission to this Parliamentary Inquiry is due to deep concern about the proposed Independent Assessments impact on my family and many vulnerable participants.

My family have now been through two torrid AAT cases two years apart, three day hearings both times, including adversarial cross-examination

by outsourced barristers. The participant won both cases. My vulnerable family, with complex needs, live their lives with uncertainty contrary to the Objects and Principles of the NDIS Act.

The NDIA acknowledges that decision-making cannot be automated because people are complicated multi-layered individuals and deserve to be treated as such. This is one of the reasons NDS staff have been entrusted with connecting with people and supporting them through their individual NDIS journey. In keeping with this philosophy, it is also necessary to accept that for some people, even a suite of assessments will not provide all the details that are needed. Independent Assessment Framework August 2020.

I do not believe I am alone in losing all trust in NDIA staff to be sufficiently trained to assess test results along with other reports and circumstances. There is no reason to believe the current situation will be improved. Existing valid reports and circumstances are frequently ignored already. Evidently the brief assessment is intended to override better information. The result may now be catastrophic for many.

Please consider recommending much more careful investigation before implementation of compulsory Independent Assessments

Equity:

Intuitively it may seem that giving every participant a set test will standardise the plans equitably. Not so, the equity gap could widen, as there are those privileged with resources to advocate and those without.

An appeal is likely to take 2 years to have a decision put right by AAT. Certainly one issue of not being able to afford an assessment needs a process to address this but not at the exclusion of existing reports.

Harm: The lack of validity of a short 3 hr. assessment could result in serious harm of invalid exit, lack of access or underfunding. See Occupational Therapy Association full comment later “it remains a clinically flawed tool, something we will continue to draw to the attention of the NDIA.”.

Then there is harm from the process itself. Many participants, on social media have expressed distress at being forced to attend an assessment by someone they don’t know. Some even said they would be suicidal. Parents have said their child could refuse to engage or become violent or have behavioural concerns that may take a time to resolve.

So called “sympathy bias”

This notion came from a survey cited by the NDIA statement (Guscia, Harries, Kirby and Nettelbeck (2006). There were only 29 disabled people surveyed by their support workers with a questionnaire, not part of the proposed tools, and administered two years apart.

Frankly this is a notion that is an insult to professional integrity.

AAT decisions comment on Independent Assessors:

Both women were denied access for two years, maybe forever if not for AAT appeals.

Ray and National Disability Insurance Agency [2020] AATA 3452 (8 September 2020) “The Tribunal considers the observations made by Ms Barry are more reliable than those made by (the independent assessor), as Ms Barry has seen Mrs Ray on approximately 50 to 60 occasions, including out of the comfort and familiarity of her home environment, whereas (the Independent Assessor) had only seen Mrs Ray once for a period of three hours in her home environment.” My bold

“My NDIS access journey with Mrs Ray and her family has now extended to almost two years, and her journey is even longer than that with earlier reviews and rejected applications extending back the previous year. I have been extremely concerned by the NDIA’s use of an independent assessor. Jenny provided extensive quality reports and personal experience accounts of her disability to the NDIA for its access decision. Despite this the NDIA inflicted an independent occupational therapist on Jenny, who travelled from Queensland to regional Victoria for a short assessment in her home. It should be alarming to all stakeholders that a person living with disabilities must rely on an unfamiliar professional – one who was not chosen by them and who might not have a full understanding of the individual nuances of their disability – has the power to assess and decide on your needs and access to a fulfilled, happy, safe life.” Cathy Saleta, Disability Advocate for Gippsland Disability Advocacy Incorporated (GDAI)

Arnel and National Disability Insurance Agency [2019] AATA 4778 (18 November 2019)

Review of decision made on 8 December 2017 Time without access 2years and 1 month.

1. The independent assessor expressed an opinion in her report that there was no functional impairment related to the Applicant’s diagnosis of CRPS restricting her from driving her partner’s manual transmission vehicle. She also suggested that the Applicant replace her partner’s car with an automatic vehicle, or take lessons with a driving instructor in her partner’s vehicle to improve her confidence in operating this type of car.

46.The Tribunal accepts the Applicant’s evidence concerning her capacity to drive. It cannot accept the evidence of the independent assessor that there is no functional impairment restricting the Applicant from driving her partner’s manual transmission vehicle. The evidence of Dr Chandler, an experienced specialist pain management physician, that CRPS causes a change in the brain so that at times the brain isn’t able to understand that a limb is there and cannot control it, is preferred. Given the pain that she suffers in her right leg, which of course operates the brake and the accelerator, there is a substantial impairment to her capacity to drive. Particularly so, if the brain is unable to control her right leg and foot. This also needs to be viewed with a degree of realism. If the Applicant were to drive a manual vehicle suffering from this syndrome, there is a distinct and real probability that she may not be able to properly or effectively, control the vehicle which poses a risk to her, any passengers in her vehicle, other road users, and potentially pedestrians nearby. This risk is obviously heightened if she undertakes a longer journey such as one from Ballarat to Melbourne or Geelong (the journeys to Geelong being for vital medical treatment). A risk present whether she drives a manual or an automatic vehicle. Therefore, it must be concluded that the effect of her CRPS on her capacity to drive results in a substantially reduced functional capacity to undertake mobility within the meaning of section 24(1)(c)(iv) of the Act.

My bold

The current Operational Guidelines Planning:

The NDIA will only request further information or require a participant to undergo an assessment or examination where it is reasonably necessary to prepare, or decide whether to approve a statement of participant supports. For example, the NDIA may consider it necessary to make one of the requests outlined above for participants with very complex care needs.

Also, before requesting further information or requiring that a participant undergo an assessment or examination, the NDIA will review existing information. Where existing information is inadequate or inconsistent, for example where older assessments do not accurately reflect a participant’s current support needs, the NDIA will consider making one of the requests outlined above.

The power to request information or to require a participant to undergo an assessment or examination must be exercised carefully and in accordance with the objects and general principles in the NDIS Act.

My Bold 1111

Are the Objects and Principles of the NDIS Act to be abandoned?

The Pilot:

The pilot was cited as being voluntary and ran only in NSW – across 9 regions, from November 2018 – April 2019. It was later

stated that ‘70% of those who were asked to participate

volunteered for the pilot’

The Pilot only included three diagnostic types (of all ages) – autism spectrum disorder, intellectual disability and psychosocial disability
The participant satisfaction rate is 91% but there is no data around what the participants were asked nor how participants

were engaged.

The total number of participants in the pilot project was 513 individuals (in the November 2018 – April 2019 pilot)
The second part of the pilot was discontinued on the 19th of March because of the pandemic emergency and because the

assessments required face to face contact with participants

It was scheduled to have run until June, 2020
The second pilot was due to have commenced to participants in the Nepean Blue Mountains, Western Sydney, Northern Sydney,

Illawarra Shoalhaven and Southern NSW

There is no available data or information about impact on marginalised communities, including regional and remote

Australians, Aboriginal and Torres Strait Islander people and

people from CaLD backgrounds

The pilot process was initially carried out by a single provider, the Benevolent Society in NSW. The later material says the pilot was

conducted by a ‘health professional from APM’, a national disability employment provider who are contracted to run some of the LAC program in WA, QLD and the NT. We assume APM were involved

in the second, five month pilot, which has no reported detail.

There is no clarity about the qualifications of the proposed assessors, nor in which circumstances they will be used, nor what

level of choice and control disabled people will have around

accessing them

A tender1 went out in June of this year (2020) for allied health professionals – there is an open letter from the Australian

Association of Psychologists Inc below about issues with the

tender requirements (provided as supplementary evidence that

there should be widespread consultation about the implementation

of this proposal)

The plan is that from 2021, independent assessments will be required as part of the plan review process and that disabled

people will not be able to have a plan or budget without an

independent assessment first

The information provided says there will be fewer automatic reviews and that they will be based on life stages but every plan review requires an independent assessment but ironically appealing an incorrect independent assessment will trigger an independent assessment!
The assumption that there will be fewer appeals is laughable. The reasons given for the implementation of the plan to use independent assessors is that it was a recommendation in both the Tune Report (Jan 2020) and the 2011 Productivity Commission repo What does the Tune Report say?
The Tune Report2 (handed down in 2020) is being cited as being contributory to this decision because of a recommendation contained in the report about access to assessments. In 4.27 of the report, Tune notes that;
A single contractor was used to conduct the assessments, the Benevolent Society, with only 500 participants taking part
Pilot evidence indicated that there were ‘more consistent decisions and more equitable plan outcomes for participants with similar characteristics’ but did not specify how many of the plans were appealed or if participants were satisfied with the level of support Crucially, Tune also stated that the change in approach will require extensive consultation with participants, the disability sector, 2 https://www.dss.gov.au/sites/default/files/documents/01%202020/ndis-act-review-final-accessibility-and-prepared-publishing1.pdf
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service providers and the NDIA workforce. There has been no such
consultation (see response from Occupational Therapy Association).

The report also stated that the roll out would represent a change of role for partners and that it would be dependent on the willingness of prospective partners and participants to work with NDIA approved functional assessors and that the assessors should provide truly independent functional capacity assessors and not be perceived as agents of the NDIA or a tool to cut supports from participants.

Tune also states that the Act should be amended to support the use of functional capacity assessors, but there should be key protections, including the following;

a. participants having the right to choose which NDIA-approved provider in their area undertakes the functional capacity assessment b. participants having the right to challenge the results of the functional capacity assessment, including the ability to undertake a second assessment or seek some form of arbitration if, for whatever reason, they are unsatisfied with the assessment c. the NDIA-approved providers being subject to uniform accreditation requirements that are designed and implemented jointly by the NDIA and appropriate disability representative organisations d. the NDIA providing clear and accessible publicly available information, including on the NDIS website, on the functional capacity assessments being used by the NDIA and the available panel of providers.

Tune identifies that there will be issues for people from Aboriginal and Torres Strait Islander Backgrounds, CaLD backgrounds and for those have a psychosocial disability.

Tune concludes the following –

‘Given this, the depth of the NDIA-approved panel of assessors must be sufficient to mitigate any engagement risks for these cohorts as well as any other issues relevant in specific locations, communities, or for particular disability types.

4.37. Therefore, this review considers that, in at least the short term, the NDIA should not implement a closed or deliberatively limited panel of providers to undertake functional capacity assessments. Rather, engagement issues need to be monitored closely and the panel of approved providers should be dynamic and evolve to ensure the new approach does not drive disengagement. Where structural or localised engagement risks are identified, the NDIA should actively engage with participants and the market to ensure the availability of appropriate providers of functional capacity assessments.’ (pp67)

The NDIA have not followed this recommendation and the Scheme may be in peril as a result.

What did the Productivity Commission say about Independent Assessors?

It is a stretch to cite the Productivity Commission’s report as ‘recommending’ the model that the Australian Government intends to put in place.

The Productivity Commission’s take on ‘assessors’ was clearly adopted by the NDIA with the ‘planner’ undertaking this role. The ‘suggested assessment process for Tier 3’ illustrates the way this was intended to work. (Figures 7.2 and 7.3, pp 337, Productivity Commission report) 3

3 https://www.pc.gov.au/inquiries/completed/disability-support/report/disability-support-volume1.pdf

Figure 7.2 Suggested initial assessment process

There would be a publicinl0<mation campaign prior to tile commencement of tile scheme, and tts rollout would take place over five years. Public information sessions would inform people about how the assessment process and the scheme wm work.

Person approaches the scheme, in person or by phone or email to seek a funded pacl<age

Person needs Person is dir&eted to information services on Short set of questions to inform::rtion ··- ·- ····· l web or whare ~~pprop~~te, inform..ition determine whether the services provided by a trained NDIS advisor person is likely to be eligible f0< a funded clearly meel criteria a aItema tive service. th aI could help them ·-·-·-·- ‘Warmrequiredref..-ra1’•.•.•..• Trcained staff would employ lheir networi< of contacts to provide a ‘warm referral’ ;;and would !’ aetivety connect indrl/id u~Js wit, the &&tvice& person likely to be eligible they reauire outside of the NDIS for NOIA services 1 The NOIA provide& illfonnation on ‘where to next’ inoludifl:9 on th4 &elf report que&tionnaite and the Tier3assessmert assessment process. Information woold be - process provided in a range of accessible formats including brochures and dvds

Figure 7.3 Suggested assessment process for tier 3

            Following on from figu-e 7.2

The NOIA provides information on ‘where to next’ induding on the sett report questionnaire an::I the assessment process. Information would be provided in a range of accessible formats including brochures and dvds ··················–·

Person (or their carer or family member) fils in a self report questionnaire (induding an initial personal plan) or meets with trained staff who fill in the form based on the person’s responses or views. The person can provide permission to obtain medical information and to contact med.Cal practitioners/specialist service providers if confirmation/darification is required

♦ A trained assessor reads the self report and the required medteal reports (with a clear focus on using existing medical reports). Considers the current supports provided. Assessor contacts the person to advise what information will be needed at the assessment

The assessor and the local area coordinator visits the person to better understand their circumstances. The local area coordinator will have regular on~oing contact with the person.

A meeting between the person, their carer (if appropriate) and the trained assessor to assess needs. A separate assessment of the needs of the carer if they wish. ,I,

Trained assessor sends assessment to NOIA after any necessary darifications or checks

NOIA costs the assessment and compares the assessment to the benchmark average profile of needs to see if it looks right NOIA contacts the assessor for any clarifications
```
          ~                             Person            Individual referred to internal review
                                                                      process, where a new person  The NOIA determines a draft support package.    ······-····  disagrees   ..........
```
This will indicate for example the hours of with package reviews the assessment attendant care, the aids and appliances to be ; funded, the supports for community participation. i This is then subject to discussion with the person, ! matter not resolved their Local Area Coordinator, the trained assessor ; and where a person elects, a OSO. There will be matter resotvec}•-·····J ,i, scope for small adjustments to be made Matter now investigated and ! l t::Yic:wt:U lJy lh t: l11::tl,)t::~lu1 Gt:IIC:l i:11 Person agrees to package (see chapter 9)

NOIA finalises package of supports. Person informed. I -·····matter resolveclf—J

The person can now choose to take charge of their package through self4directed funding of their budget (chapter 8), or have one or several service providers provide funded supports to them, or have a OSO manage their package.

The Productivity Commission did say that the NDIA could contract out
services externally. However, the view was as follows;

‘Assessments would often (but not always) be contracted out to

independent assessors, but with their accuracy and reliability subject to
constant monitoring (see later and chapter 7). ‘

They also described inherent risks in failing to control the assessment

process.

‘There are several major motivations for the NDIA to control this (though

not necessarily through direct provision). First, systematically high
assessments of required supports would pose a risk for the sustainability
of the scheme, while systematically low assessments or unreliable ones,
would be unfair to people with disability. (It would create another lottery
for people with disability since they might get less than they needed if
the assessor was a ‘hard marker’ or if the assessor was simply sloppy
that day.) Therefore, the NDIA must be able to monitor assessors’
accuracy and reliability — and advise (or even fire) them if they lie
outside the appropriate performance bands. Second, the NDIA would
need to monitor the performance of the assessment tools to ensure that
they gave accurate and reliable measures of people’s reasonable needs
for funded support.’

The Productivity Commission also made observations about maintaining

professional objectivity, but described a process that was significantly
different from that currently proposed.

Use of Job Capacity Assessors and Government Contracted Doctors in Australia

The use of assessors in Australia4 (Centrelink assessors for work capacity as well as overseas) is well known for being problematic5.

Some of the issues (and histories) are outlined below.

The issues with ‘government assessors’ have been clearly and repeatedly articulated in the past. Prior to 2015, all DSP medical assessments were conducted by Dept of Human Services staff employed as Job Capacity Assessors (JCAs). They were health or allied health professionals. The JCA determined whether the claimants medical condition had been fully diagnosed, treated and stabilised and assessed the appropriate impairment rating. Prior to 2015, the JCA was followed by final determination of the claim and was usually accepted by the final decision maker. In 2015, a second medical review was introduced to new DSP claimants under 35 who were living in a metropolitan area. It was called a DMA (Disability Medical Assessment) and was conducted by a government contracted doctor (GCD). It occurred only if the JCA determined that a person was medically eligible for the DSP. From July 2015 all new DSP claimants were referred for a DMA if the JCA determined they were medically eligible for DSP.

In 2018, the National Social Security Rights Network carried out a project around DSP after the changes in 20156. They found;
that the JCA had consistently made findings inconsistent with treating health professionals written medical evidence – that in only one of four cases did the government contracted doctor contact the treating health professional – that there were significant issues with mistakes made (which were overturned upon appeal)
In 2017, the Joint Committee of Public Accounts and Audits conducted an inquiry based on the Auditor General’s report which found that there was further scope for administrative and risk management improvement to the DSP program7. It also found that due to a lack of publicly available material it was ‘difficult to externally analyse the efficiency or effectiveness of the assessment or review processes’. 8
Many submissions were made by organisations and individuals to the Joint Committee of Public Accounts and Audit which detailed9 issues with Job Capacity Assessors.
An DEEWR independent inquiry held in 2011 said that there were concerns that independent assessors are not conducted by a person with significant expertise in the key issues which need to be addressed.

Page 15

be examined (pp28, Independent Review of the Job Seeker

Compliance Frameworkredacted: s47 - Trade secrets or commercially valuable information

redacted: [https://docs.employment.gov.au/system/files/doc/other/impactsofthenewjobseekercomplianceframeworkreportoftheindependentreview.rtf](https://docs.employment.gov.au/system/files/doc/other/impactsofthenewjobseekercomplianceframeworkreportoftheindependentreview.rtf)

Other concerns:
It is generally held that assessment of a disabled person’s needs requires a relationship with that person over time and cannot be described by the results of standardised assessment tools with a clinician who the person has never met.
The 2011 Disability Care Productivity Report is also being cited as contributory to this decision. However, the model that was adopted as a result of extensive consultation did not include independent assessors who were externally contracted to the scheme in the way that is currently proposed.
There are already significant shortages in the market for occupational therapists, physiotherapists, occupational therapists and other health and allied health professionals11
The pilot did not test people with a range of disabilities including those with complex needs, those living in regional and remote communities, Aboriginal people or people from CaLD backgrounds. No consultation was undertaken about this exercise before implementation
It has been reported by participants that eligibility reviews are increasing for all ages and there is no accountability for NDIS staff who trigger them. A participant was recently put through the

process because the staff member did not believe their condition

was a disability, even though they were granted access through an

AAT decision. If your independent assessment shows that you no

longer need the NDIS, the assessment will help show the ’gains

you have made in your functional capacity’ and it is predicted that

 it will be used to remove users from the scheme - despite them

initially having to prove that they had a permanent disability that

required them to be supported daily.

There are significant issues with standardised assessment tools which are well documented. In addition, there are issues for those

of us who have more than one disability. The NDIA only records

one ‘primary’ disability. A standardised assessment cannot

possibly capture the interaction between multiple disabilities, which

generally would require a number of clinicians to assess. A

disabled person is the best person to provide information about the

functional impact of their individual or combined disabilities, not a

government appointed assessor.

There are further concerns that there will be perverse KPIs and incentives, given the government’s interest in the NDIS

underspend (used to ensure the government was in surplus at the

last election). The Productivity Report said in the 2011 report on

Disability Care – ’’however, if the scheme anticipates that govt will

automatically take back any surplus, then it reduces the NDIA’s

incentives for ongoing cost minimisation.‘’

Occupational Therapy:
Part of the Address to the OTA Virtual Exchange 2020 Michael Barrett, OTA National Manager Government and Stakeholder Relations 15 September 2020

NDIS Independent Assessments

I turn now to the vexed issue of NDIS Independent Assessments.

On Friday 28 August, the Minister for the NDIS, the Hon. Stuart Robert MP, anounced several changes to existing arrangements.

These included the release of a new Participant Service Charter and Participant Service Improvement Plan, which set out how the NDIA will deliver on the Participant Service Guarantee. These reforms set new services standards and clearer timeframes for decision making by the NDIA.

While these reforms are welcome, and in line with the recommendations of the review of the scheme conducted by Mr David Tune, one new reform is of considerable concern to OTA members.

This is the rollout of new Independent Assessments, which will help determine eligibility for the scheme. In his media release, the Minister said Independent Assessments will: … deliver a simpler, faster and fairer approach for determining a person’s eligibility right through to developing more flexible and equitable support packages. Very significantly, this was not a recommendation of the Tune Review. Also significantly, the rollout of the assessments was announced before training modules for the assessments had been finalised, and without the release of the pilot project research and results which informed the development of the tool. For the last couple of months OTA has been a member of a working group, commissioned by the NDIA and led by Allied Health Professions Australia (AHPA), charged with developing the training modules to enable select allied health

professionals to become Independent Assessors for the NDIA, thereby helping
improve access to the scheme.

I am advised that the work of that group is not yet complete.

We appreciate the need to improve access to the scheme, and are aware that this is the ultimate driver for the development of the eligibility screening model. But it is unclear how the proposed screen will achieve this. OTA’s concerns are around: the relevance and scope of the proposed eligibility screen; what the experience will be like for consumers; the process for determining eligibility and; the effectiveness of the tools being used to determine eligibility.

Such were OTA’s concerns about these proposed assessments, we were drafting a letter to the CEO of the NDIA about them when the Minister issued his media release. Accordingly, the letter was instead addressed to the Minister, and was sent on 31 August. As a result of that correspondence, our CEO, Sam Hunter, met with a senior official at the NDIA last Tuesday to voice the considerable concerns of the membership.

It appears the role of Independent Assessor will be to conduct a suite of stipulated clinician measurement tools and a systematic observation of a participant carrying out a functional task to determine their eligibility for the scheme. The NDIA has chosen six allied health professional groups to be trained in the Independent Assessor role. They are:

Occupational Therapy;
Physiotherapy;
Psychology;
Rehabilitation Counsellors;
Social Workers and Speech Pathology. Each allied health professional group, of course, has a distinct role in the NDIA and operates out of a distinctly different scope of practice.

Accordingly, the training modules are aimed at developing general competencies.

It is unclear, however, how the eligibility screening process will improve access to the NDIS. Rather, it involves a layer of screening that will likely exclude many potential participants from the scheme before a proper assessment has been conducted.

First

First is the use and interpretation of functional assessments by professionals not trained to functionally assess clients carrying out occupational activities and tasks.

While we have been reassured that it is an eligibility screening process, the NDIA continues to use terminology pertaining to functional assessment, a practice that misleads all stakeholders.

Functional assessments as occupational therapists know them, require a distinct skill set that is core to occupational therapy practice. They cease to be a reliable or valid means of assessment if used by other professional groups in the diminished way currently proposed by the NDIA.
Observation of a participant carrying out a task cannot be reliably interpreted as a valid method for determining functional capacity unless the Independent Assessor is a qualified occupational therapist using specific professional reasoning, detailed task analysis, risk management and assessment tools.

Second, how useful, reliable and valid are the proposed tools in determining eligibility?

And third, how effective the independent assessment is for individuals.

There are two possible outcomes which give rise to concern.

The first is that the assessments will be perfunctory, with the focus on throughput rather than clinical decision-making. By all means, facilitate the process of determining eligibility for the scheme, but not by means of a flawed tool.

As one OTA member remarked after the Minister’s announcement:

How can a complex functional assessment be completed appropriately, and in enough depth, to inform plan funding, in 1 to 4 hours with only a minimum of 20 minutes of observation (as per tender documentation)?

The other possibility of concern is that the proposed assessments will in fact prove a barrier to accessing the NDIS.

The eligibility screen involves standard procedures being carried out in an objective and impersonal way, which is likely to prove daunting for many applicants.

We are concerned that an individual applying for access to the NDIS will find the

proposed eligibility screen very onerous and time consuming.

There seems to be little focus on getting to know the person and identifying their

needs.

Cognitive and psychosocial issues are poorly addressed in the battery of tools

being proposed; this is particularly concerning given the great difficulty clients with

mental health issues have had accessing the scheme to date.

Several members have questioned the appropriateness of independent assessment of those clients with rare or complex disabilities, and those with psychosocial

disability.

Mental Health Australia, of which OTA is a member association, has expressed concern that the measurement tools proposed are not appropriate for psychosocial assessment.

I am pleased to report that consumer groups in the mental health space have also been advocating on this issue. They are concerned about the mandatory nature of the proposed assessments, and the fact that highly vulnerable people will be assessed by complete strangers rather than the health professional they have come to know and trust. And, of course, how can the often episodic and fluctuating nature of mental illness be assessed in the context of a one-off engagement, lasting one to four hours, and with as little as 20 minutes of clinical observation?

Perhaps of greatest concern is the fact that the person who will make the final etermination as to a person’s eligibility for the scheme will be an NDIA delegate without even the training of the Independent Assessor. So, an allied health professional will be expected to conduct an assessment using the generalist tools developed, but not drawing on their years of clinical experience or their powers of clinical reasoning – in effect ticking boxes. That person will then forward the raw data to an NDIA delegate who may or may not be a clinician – the NDIA does not intend sharing that detail, nor even the percentage of NDIA delegates who are clinicians.

The NDIA delegate, who may have no clinical background and who has had no particular training, will then decide whether the client is eligible for the scheme,

basing their decision on data collected (from tools not designed for this use), and

without knowing or seeing the client. Is that ideal? Is that in the spirit of a scheme

which is supposed to represent world’s best practice in disability support and which

the Productivity Commission estimates will ultimately cost about $22 billion a year?

We are also gravely concerned that the Independent Assessment model, itself, as

distinct from the training modules that will support it, was developed and put out to

tender by the NDIA without any consultation, as a fait accompli; certainly, OTA and

AHPA were not consulted. Let me repeat, for the record. OTA was not consulted

about the actual Independent Assessment model itself – which is quite astonishing.

Moreover, important data relating to a pilot of the Independent Assessment model

has not been released by the NDIA, despite Freedom of Information requests. OTA’s

basic concern is this: The Independent Assessment is in fact a screening device,

and its tools are unsuited to an assessment. That’s fine, as long as it serves merely

as a basic test of a person’s eligibility for the NDIS. Now, however, we learn that this

incorrectly labelled “assessment” will inform the participant’s plan. That is clinically

unsound. If the NDIA believes otherwise, it should release all data from the pilot.

OTA is concerned that while a number of these issues have been elevated to the

NDIA during the project, there has been no indication that these matters have been

addressed, let alone satisfactorily resolved. Given these outstanding concerns, it is

unsurprising that the Minister’s announcement of the assessments was light on

detail. OTA also notes concerns about the future of those smaller OT practices which

have been involved in assessment processes to date and might lose that work as a

result of the proposed reforms. What we do not want, is a panel of approved

providers as, all too often, these comprise a few large, impersonal, multinational

companies. And all too often, such arrangements – while bureaucratically convenient

– result in the termination of longstanding and hugely beneficial clinical relationships

between highly experienced clinicians working in small practices with often very

complex clients. This matter has been raised explicitly with the Minister. OTA

suggests an alternative model. This would involve a preliminary interview carried out

by Independent Assessors to identify clients’ concerns, needs and goals. An Independent Assessor with appropriate training could carry out these preliminary interviews, gathering information and referring the client on for an appropriate assessment by clinicians working within their scope of practice. When functional assessment of a person’s occupational performance is deemed necessary, we would

Page 23

obviously, and strongly, recommend referral specifically to an occupational therapist.

Occupational therapists are uniquely qualified to conduct assessments to determine a client’s ability to effectively and safely carry out activities and tasks they want and need to do, and to determine their ability to participate in productive occupations, and social and community activities. This model would provide a road map for improving the outcomes of clients with a disability, which is core to the intent and spirit of the NDIS. I am pleased to report that last week, both the CEO and I attended meetings with the NDIA, and these meetings were positive in tone and substantively proactive. We will continue to progress these discussions and voice our concerns.

We understand that promising news is on the immediate horizon, and be assured we will continue to update you as soon as we receive news. We have fiercely lobbied the NDIA around our concerns regarding the Functional Capacity Assessment Framework. We know that is not a functional assessment. It is at best a screening tool. And if it were a functional assessment, it would fall strictly within an occupational therapist’s scope of practice, not a generalist’s. Having said that, it remains a clinically flawed tool, something we will continue to draw to the attention of the NDIA. While they may persist with the tool, and we will advocate for improvements, OTA remains steadfast in our view that this tool requires renaming.

We are hopeful that we have been heard on this point, and look forward to a positive outcome soon. OTA will continue to lobby vigorously in this space, both as an independent association with issues specific to our profession, and in conjunction with AHPA to project a multi-disciplinary allied health voice. We will, of course, keep members informed of developments