Joint Standing Committee on the National Disability Insurance Scheme

Parliament House, Canberra ACT 2600

Monday 29th of March 2021

Re: Submission to the Inquiry into Independent Assessments under the NDIS

dear committee,

Thank you for the opportunity to forward a submission into the inquiry into independent assessments under the NDIS. I am writing as an individual, a carer of a disabled person, a PhD student and a mental health clinician working within neurodevelopmental psychiatry.

For clarity I will include the term of reference information and my response.

   the development, modelling, reasons and justifications for the introduction of independent assessments into the NDIS;

Within their submission to this inquiry DSS and NDIA have noted that the reforms being introduced are to will deliver an NDIS that empowers participants and provides choice and control along with flexibility. 1 I applaud the continual attempt to improve the NDIS however feel that compulsory independent assessments do not align with these goals of empowerment, choice and control and flexibility for participants. Specifically;

 -   the ongoing responses from many disability organisations, including the joint statement with 25 signatory organisations 2 highlight that the disability community has not been afforded choice, empowerment or flexibility in relation to the introduction of the independent assessments. If the implementation of significant changes within the NDIS do not even adopt a co-design process or recommended consultation process (as per the Tune Review), then it cannot be a change that empowers,
 -   independent assessments as proposed will require a potential or current participant to go through their personal history, current functioning, challenges and strengths with a complete stranger – an experience that several people have called retraumatising within the pilot assessments. There is no choice or control to opt out of this process.

I also have concerns about the reliability and validity of the data achieved through the pilot independent assessment program. The data that was previously released was grossly inadequate for making any claims about the pilot outcomes. Within the ongoing pilot program, I am altered by the fact that some participants are being offered cash incentives to participate. While a reimbursement

for time is not unheard of within research, it raises questions about the potential biases introduced and the ethics of the pilot.

Furthermore, as a carer of a participant I was forwarded a letter to participate, which I accepted. I have heard no further, despite the apparent need for participants. As I have been vocal with my concerns about the process of implementation and the lack of data, I can’t help but wonder if potential participants like myself are screened out of the process. Perhaps not, however the lack of transparency means people like myself are left to try and connect the dots.

   the impact of similar policies in other jurisdictions and in the provision of other

government services;

Some within the disability community have noted that the introduction of the independent assessments resemble the demoralising job capacity assessments undertaken by Centrelink. Furthermore, a shift away from reasonable and necessary and back towards impairment-based funding rather than individual goal-based funding is a step backward to the disempowering model existing prior to the NDIS.

   the human and financial resources needed to effectively implement independent
   assessments;

In many areas around Australia, disabled people already face long waitlists for therapeutic support providers. This is further heightened in rural, regional and remote areas. The uptake of qualified and experienced providers into the independent assessor roles will potentially reduce the workforce available for therapeutic and other services.

While independent assessments were listed as a step towards financial sustainability in the NDIA strategic plan one cannot look past the addition financial resources that this measure will require. Not only will the assessors require payment, but the FOI requests and appeals budget is likely to increase. Furthermore, additional costs will fall upon services and supports that will be required to address the high incidence of mental health needs due to the new compulsory process that increases the burden and uncertainty. The extensive economic analyses undertaken prior to the implementation of the NDIS highlighted the significant long-term financial benefit of the provision of adequate supports to disabled people, therefore this dramatic change that is not welcomed by the people it affects, seems short sighted. If there are concerns about the financial sustainability of the NDIS, I would encourage key stakeholders to engage DPFOs to co-design a better way forward.

   the independence, qualifications, training, expertise and quality assurance of assessors;

While independent assessors do not work for the NDIA, they will be engaged by organisations that tender for the contract with the NDIA. Given that the introduction of independent assessments was considered part of the financial sustainability of the NDIS and that the actual assessments will come at a significant cost in both delivery and appeals, there implies a cost limiting or saving element to independent assessments despite the framing. With this, it is not a far stretch to consider that

• organisation data will be monitored and those that have a higher proportion of clients with more significant needs identified (and attached to more funding delivery), will struggle to be competitive in any ongoing tender process.

   the appropriateness of the assessment tools selected for use in independent assessments
   to determine plan funding;
  

I undertake functional assessments within my current role. The assessment occurs over a lengthy period, including engagement with the person, carer, school, other providers and the review of medical and allied health records along with further clinical assessments and functional measurement tools. Standardised measurement tools should only ever be an adjunct to a clinical, therapeutic or support need assessment and used to gain basic information.

   the implications of independent assessments for NDIS planning, including decisions
    related to funding reasonable and necessary supports;

Returning to a funding model based on one’s perception of a person’s impairment only threatens to increase inequities among people with a disability. I understand the funding level will be determined by standardised assessments not fit for purpose and cannot be challenged. Only after that decision, persons will be able to consider their goals within the funding allowance provided.

    opportunities to review or challenge the outcomes of independent assessments;

I was informed that participants will not have the opportunity to review the information that is recorded or challenge the outcome of the independent assessment, which is alarming if indeed true and would breach the typical standards of privacy and collection of personal health related information.

   the appropriateness of independent assessments for people with particular disability

disability types, including psychosocial disability;

The independence of the assessor may offer some advantages for some people who cannot access services, however, likely introduces risk for participants with complex needs or an invisible disability. Pople with complex needs require a holistic approach ascertained from ongoing long-term therapeutic or support involvement. A cross sectional assessment of functioning by a new clinician, unknown to the person will be inadequate and place disabled people at risk. It is surprising that DSS and NDIA will consider such a measure that introduces significant risk.

  any other related matters

By constantly changing the access requirements and format for funding, through changing the NDIS into another system that potential harms disabled people and discounts their views, you induce despair and desperation within an entire community of people. If the people with the power to make decisions really wished to empower people with a disability, they would involve them in all key

stages of all decisions

Furthermore, if the NDIS wishes to change the way supports were funded and progress from the space where people feel they need to account for their worst day to have their needs met – then the way forward is to create security for the community.

As a clinician, I must comment on the suggestion that provider’s reports are misguided through “sympathy bias”. This statement was offered as a justification for independent assessment. Providers are required to uphold standards of practice and work in an ethical and accountable manner. The suggestion implies that the support recommendations are not required for the participant to lead an ordinary life – a judgement made by someone outside that therapeutic relationship who is not privy to the full story. However, the statement is also interesting as it suggests to me that there is an awareness that people with a disability face constant systemic challenges and that their providers may be inclined to want to reduce the burden of those challenges. Disability is not something that warrants sympathy or pity. If the supports for disabled people were appropriate without fight, stigma was gone, and the wider society was accessible, the many things the NDIS was to work towards – there could be no claim to “sympathy bias”.

If you only take one point away from this personal submission, I ask you Committee, to please hear the voices of the people who will be directly affected by the implementation of independent assessments.

With thanks,

Pieta Shakes | PhD Candidate, MHN MN(Mental Health), PGCC&AMHN, BN (Hons1)

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