Inquiry Into Independent Assessments Under the National Disability Insurance Scheme

29.03.21 I am an NNDIS registered Occupational Therapist with 20 year’s experience, including in private enterprise, the commonwealth government, and am about to undertake some University teaching work. Currently I am the owner and Managing Director of an Occupational Therapy business. I am also the carer of 2 special needs kids who have access to NDIS.

As part of the committee’s role to inquire into the implementation, performance and governance of the National Disability Insurance Scheme (NDIS), the committee has decided to conduct an inquiry into independent assessments under the NDIS.

An independent assessment is an assessment of a person’s functional capacity, which will be used to inform decisions about eligibility for the NDIS and about funding in a participant’s plan. The National Disability Insurance Agency (NDIA) proposes to introduce independent assessments as part of the NDIS access and planning processes in 2021.

Terms Of Reference

As part of the committee’s role to inquire into the implementation, performance and governance of the National Disability Insurance Scheme (NDIS), the committee will inquire into and report on independent assessments, with particular reference to:

• the development, modelling, reasons and justifications for the introduction of independent assessments into the NDIS; The NDIS’ own documentation indicates that independent assessments were recommended to remove ‘sympathy bias’ of health professionals (Independent Assessment Framework, August 2020).

This inherently indicates that the Independent Assessments seek to be ‘unsympathetic’. That alone is a scary prospect for me as an Occupational Therapist and parent of 2 special needs kids who have access to NDIS. Who in their right mind would want to go to an assessment that has specifically been set up to be ‘unsympathetic’. That concept fills me with fear and dread as I expect to be treated in a demeaning and inhumane way. It makes me just want to drop out of NDIS. As a carer, the last thing I need is a lack of humanity and decency. I’d be curious to see the job ad: ‘Wanted: Unsympathetic health professionals’. That is an oxymoron. The only people I can imagine who would go into a helping profession who are unsympathetic, either accidentally chose the wrong career or have something wrong with them (ie. personality issues).

The other thing the Framework assumes is that health professionals are unable to perform the duties they are trained for. We are trained at university as part of our degree to undertake assessments in an unbiased way - to be aware of our own bias and set it aside. We can however, provide empathy to Participants (as rapport is likely to lead to more accurate assessment results), and advocate for the process (not the participant or NDIS) - but for the process of fulfilling the purpose of the scheme.

b.

the impact of similar policies in other jurisdictions and in the provision of other government services; Clearly the NDS is half trying to copy Centrelink in relation to current DSP assessment processes. The issue with this half-way attempt is that Centrelink used exactly the same model for several years from 2006 when it outsourced DSD assessments to external providers. As they were of poor quality (due to the commercial nature of them and the drive to make money) and didn’t understand the application of the legislation properly, all those assessments had to be re-done by Centrelink Assessors a few years ago (at great financial cost to Australia’s budget and great moral cost for the health professionals who had to undertake the DSP Medical Reviews). Either get Centrelink Assessors (who understand the application of legislation and have experienced the learnings first hand of the DSP Medical Reviews) to do the Assessments, with careful consideration of ALL medical evidence provided; or DESIGN a VALID (accurately measures what it sets out to) evidence based tool (with norms established through research) to use; or leave the process as it is, but fund the assessments that people need to apply for access to the scheme.

c.

the human and financial resources needed to effectively implement independent assessments; Only desperate or deskilled therapists will be willing to do Independent Assessments after the dust has settled after the initial roll out, once the assessors who initially do the assessments realise what is involved. Inherently the assessments will then be flawed in that respect.

d.

the independence, qualifications, training, expertise and quality assurance of assessors; The assessments will be driven by commercial interests of making money so they will cut every corner they can. Money will be wasted by numerous appeals and reviews. NDIS funds will be wasted paying therapists to undertake more assessments and reports for the appeals and reviews, instead of progressing towards the Participants goals.

e.

the appropriateness of the assessment tools selected for use in independent assessments to determine plan funding; The client group I work with (Autism) thrive in a one on one environment with an adult (ie like the environment of the Independent Assessment). It’s only when placed in a group environment with less predictable and less accommodating peers, that their issues really come out. An Independent Assessment would be unable to capture that at all.

f.

the implications of independent assessments for access to and eligibility for the NDIS; It does appear that Participants who are most likely to gain from the scheme (ie those who with some therapy could actually get a job and keep it for the first time and their lives and therefore pay tax – and funding the scheme at least in part) seem destined to be kicked off the scheme or not given access. They will then not get work or pay tax. It does not make financial sense. Through the NDS, as a parent I have gone from thinking that my son will be unable to hold down a job (ie will be on DSP) or live independently (ie live at home or need carers), to thinking he will be able to work and live independently.

g.

the implications of independent assessments for NDIS planning, including decisions related to funding reasonable and necessary supports; The NDIS is already very rigid in the way it funds ‘reasonable and necessary supports’. Therapy (whilst extremely valuable) often adds to a carers and Participants demands (through expecting change, and skills practice between sessions, with little funds provided for therapy aids or support workers to help the Participant carry out the treatment in their everyday lives between sessions). In order to reduce stress, resources need to exceed demands. Yet the NDIS seems to act as if Core supports are not as important as therapy. This will just get worse with Independent Assessments because they will not have a true

• understanding the what the person needs. How can they then recommend reasonable and necessary supports? h. the circumstances in which a person may not be required to complete an independent assessment; I’m not familiar with this. i. opportunities to review or challenge the outcomes of independent assessments; There seems to be a view that requesting reviews is nearly impossible to get a different outcome. I just hope there is a proper appeals process and involvement of AAT1 and 2 as required. j. the appropriateness of independent assessments for particular cohorts of people with disability, including Aboriginal and Torres Strait Islander peoples, people from regional, rural and remote areas, and people from culturally and linguistically diverse backgrounds; As mentioned before, people with Autism will function their best at an Independent Assessment as it will not capture the situations (ie groups of people) where they most struggle. Those situations (ie groups of people) reflect a normal workplace full of groups of people, or even a family in a home. Independent Assessors would be better off going in to a Participants home before they wake up for the day, observe their morning routine, try them in a workplace for work experience for the day, and then observe their evening and sleep routine. k. the appropriateness of independent assessments for people with particular disability types, including psychosocial disability; and Independent Assessments will exacerbate psychosocial disabilities through the stress of the knowledge that the process will be inherently flawed, and purposeful lack of sympathy. l. any other related matters The NDIS was a world leader in this space and has the opportunity to change the world for the better by setting the example. Now the NDIS is ending up as bad as the other schemes in the world that are not respected and are ridiculed. This further discriminates against people with disabilities. Would the politicians who thought this was a good idea like to see a financial advisor to determine their financial future, or a doctor to determine their health care, that they knew was employed to be purposefully unsympathetic towards them and their plight?

I can imagine the NDIS will bring in Provider Star rating soon like the Job Network and Disability Employment Services have. This is likely to result in corrupt practices from high pressure commercial organisations hell-bent on making money at any cost, and providers not taking on the Participants who most need the support as they will be seen to lack the ability to make measurable progress, but rather taking the ‘easy’ Participants. It would also be tricky from an AHPRA Advertising guidelines point of view.

NDIS says providers need to involve Participants in the development of policies etc, yet the NDIS itself seems to not do that until after they’ve already made a decision. It’s very disappointing.