Joint Standing Committee on the National Disability Insurance Scheme

PO Box 6100, Parliament House, Canberra ACT 2600.

31 March 2021

To Whom It May Concern:

I am writing in regards to my concerns about the effectiveness of the proposed Independent Assessment Panel (IAP) in the accurate measurement of disability under the National Disability Insurance Scheme. We reference to the terms of reference of the committee, I have concerns over two aspects of the IAP in particular:

• The appropriateness of the assessment tools selected for use in independent assessments to determine plan funding;
• The independence, qualifications, training, expertise and quality assurance of assessors

I feel the outcome will be the inaccurate measurement of disability. This inaccurate assessment of disability has consequences for people and I am not talking about the discretionary things in life. For the clients I see as an occupational therapist, these are in the fundamental tasks of life such as physical help with going to the toilet. Without the right mix of physical help available in the community, in tasks that cannot be avoided or postponed, we as a society find ourselves having to resort to other means to manage this.

Because of the inaccurate assessment of disability, a client who needs two care workers to safely get them out of bed, go to the toilet, have a shower and get ready for the day, may only get funding for one through the NDIS.

• We therefore find ourselves with no other option but to use psychotropic drugs to manage challenging behaviours to allow one worker assist him.
• We therefore find ourselves with no other option but to recommend residential aged care for another client at the age of 45 because their community funding does not accurately cover their needs.

This is at the same time as the Disability Royal Commission has identified the fundamental problem of overuse of psychotropic drugs in disability services and the Royal Commission into aged care identifying younger people in aged care as a fundamental issue that needs to be addressed.

We are at risk of having an almost farcical situation where one arm of government is voting on legislation that is likely to result in what the other arm of government is being outraged about. As a disability sector we need to get the fair and assessment of people with disabilities right to have a disability sector that is fair, accurate and sustainable. I am concerned that the IAP assessment model will not achieve this but instead exacerbate the problems we already have in the disability sector.

The context in which I address this problem from:

As an occupational therapy service under the NDS, at our occupational therapy service we work with people with physical disabilities who need the assistance from a support worker to physically help them with personal care. That is the daily and necessary tasks of as getting out of bed, going to the toilet and having a shower. We help create this personal care routine so that the client and support worker are safe, the care is efficient so only the numbers of workers that are needed are assigned and care is quality.

My Concerns:

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

It is unclear at this stage whether the IAP use of standardised tools is for a) just eligibility for the NDIS or b) eligibility and funding under the NDIS where functional capacity is measured. If it is the former, the IAP could offer a standardised way of assessing eligibility. If it is the later, we could find ourselves with the over estimation of disability or the under estimation of disability.

We could over estimate disability: The goal of the NDIS is to capacity build meaning a client and supports develop the skills to manage their disability as efficiently as possible. With an overestimation of disability, a participant could get too much in their package meaning that the NDSI wastes money in achieving this aim

We could under estimate disability: Under estimating disability has consequences for people under the NDIS and I will give an example in relation to the clients we see in doing personal care routines. A standardised measure would ask about physical abilities for example – can move by themselves or not.

Let’s say we have a two clients who cannot:

• Client A: The 35-year-old gentleman with intellectual disability who is unsteady in standing and follows all directions.
• Client B: The 35-year-old gentleman with intellectual disability who is unsteady in standing and kicks and hits staff.

We advise clients of the NDIS on the safe, efficient and quality movement of people with disabilities during personal care. This includes how many workers are needed in the two cases above.

With the variable between these two clients being one hits and the other doesn’t, this could mean that Client A can needs one worker and Client B needs two workers. However, this is not possible to determine until the routines are viewed because the variables can be so varied in getting this right. With each client needing approximately 4 hours per day to attend to personal care that is 28 hours per week. The number of workers needed for this is about a task analysis and the work demands for it to be safe, efficient and quality for client and the person helping them. If the IAP model gets this wrong, a client can be over or under by 1456 hours per year of care.

The Disability Royal Commission

At the end of September 2020, the Disability Royal Commission heard from witnesses on the misuse of psychotropic drugs in the disability sector.

One witness reported:

“Adults with intellectual disability have long been one of the most medicated groups in society with psychotropic drugs commonly prescribed. Psychotropic medications are frequently used to manage challenging behaviour, raising concerns that their prescription is not linked to the diagnosis of mental illness.”

If we get the allocation of care wrong, services have no other option but to resort to psychotropic drugs because the disability does not go away. Alternatively, we find they cannot be managed safely in the community and we find ourselves resorting to residential aged care. We need to get the accurate measure of disability right.

b) the independence, qualifications, training, expertise and quality assurance of assessors

Eligibility for the scheme and determination of funding under the scheme are two very different things. If it is about funding, this becomes a functional capacity assessment to accurately measure the disability in terms of resources needed to manage the disability.

Occupational Therapists complete a three year degree in Australia where functional capacity assessment is part of every element of what they learn. It is a process that is fundamental to what they do – like an electrician knows electricity. Under this model, in the completion of the functional capacity assessment to measure disability, the proposal is that other disciplines other than occupational therapists doing these functional capacity assessments – such as speech pathologists and other allied health professionals.

As an occupational therapist, my concern about this is not about protecting my professional turf. It is about a quality outcome – the accurate assessment of disability. It is about competence and capability to complete the job at hand. Getting a speech pathologist to do a functional assessment is like getting a doctor to pull teeth or a plumber to do the job of an electrician. Whilst the doctor could do it, the dentist would do a much better job and get a better outcome for the client at hand and the funder of that service. Similar with a plumber and electrician. We spend millions of dollars here in Australia training a strong calibre of health professionals to fulfil roles in our society. It makes sense to get the ones whom we have trained to do a certain job, in this case functional capacity assessment, to do that job and do it well and then enable those trained in other skills to do what they do well.

Thank you for the opportunity to submit my concerns to the standing committee.

Kind Regards,

Occupational Therapy Service in NSW