30 March 2021
To whom it may concern,
I am an Occupational Therapist of 16 years post-graduate experience. I have been working as a provider to participants of the NDIS since 2014 when the scheme was being trialled. Currently I run my own private practice in Sydney, employing 19 Occupational Therapists. We service a large caseload of NDIS participants with varying levels of disability. Many of our clients present with either intellectual disability, physical disability and / or psycho-social disability.
As the NDIS has evolved in recent years, I have become increasingly concerned with regard to the inner workings and operation of the agency. The proposed reforms are alarming and raise a number of issues with respect to scheme access, planning and budgets. I have significant concerns for the well-being of our participants. The experience of some who have been through the independent assessment pilot has resulted in formal complaints to the agency. I have outlined below my response to the JSC terms of reference and thankyou for the opportunity to raise these for consideration.
a. the development, modelling, reasons and justifications for the introduction of independent assessments into the NDIS;
The agency’s arguments for the need for reform are flawed and clearly reflect a mistrust in the treating professionals working with NDIS participants. Certainly, there is a need to provide equity when it comes to accessing information required to present evidence for access to the scheme. However, providing access via a panel selected by the NDIA utilising assessment tools also selected by the NDIA, hardly represents an independent process.
Treating professionals currently working with participants, have the best insight and knowledge when it comes to their support needs. It is no different to seeing your GP to obtain a referral to a specialist. The GP knows your medical history, has an understanding of your clinical needs and can refer to the appropriate specialist to address those. If that results in a referral where the specialist recommends surgery, there are no accusations raised of sympathy bias or otherwise. Yet that is how the NDIA are labelling the therapists working with potential participants. It is offensive and unfair for the many therapists that are simply providing service within their clinical code of conduct.
b. the impact of similar policies in other jurisdictions and in the provision of other government services;
In considering this term of reference
I have sought information on the provision of similar assessments in the UK. These have resulted in significant poor outcomes and even death for a number of people. Please refer to links below regarding this:
- https://www.wsws.org/en/articles/2020/07/29/maln-j29.html
- https://www.disabilitynewsservice.com/atos-pays-out-for-negligent-pip-assessment-after-visit-from-debt-enforcement-officers/?fbclid=IwAR2D6XBxg5p5Nxay6enFTJFb7J1niep0SRFUIcklrvCswx13gZnZfF7glCI
- https://www.disabilitynewsservice.com/court-orders-atos-to-pay-disabled-woman-5000-over-dishonest-pip-assessment/?fbclid=IwAR1y6eOkrtpgF9UZBVU2TuZeDAoFU01yjyrksBezYMdTo3G6Y1bNll6i398
- https://www.independent.co.uk/news/uk/home-news/benefits-uk-disability-assessment-company-report-finds-government-cuts-a8208271.html
- https://www.disabilitynewsservice.com/atos-nurse-struck-off-over-pip-assessment-lies/?fbclid=IwAR1NNxI9AfuHiWLLXWAcwvygaTh5xnMAIiY3-xDeDJWET9tnti3aCpI9R-c
- https://www.liverpoolecho.co.uk/news/liverpool-news/how-disabled-people-liverpool-fighting-17693760?fbclid=IwAR1NNxI9AfuHiWLLXWAcwvygaTh5xnMAIiY3-xDeDJWET9tnti3aCpI9R-c
c. the human and financial resources needed to effectively implement independent assessments;
For the OT profession we are already experiencing significant shortages in therapists across the country. I’ve advertised on multiple platforms since the start of 2021 and had no applicants. Diverting therapists away from intervention services to conducting independent assessments, is not an effective use of the profession. There are simply not enough allied health professionals to conduct the number of assessments that will be required. Providers of these services will resort to utilising new graduate therapists and completing assessments via telehealth which will only be to the detriment of participants.
d. the independence, qualifications, training, expertise and quality assurance of assessors;
The NDIA has indicated a minimum of one years post graduate experience will be required for the assessors. This is not sufficient to manage the complex presentation that many NDIS participants have. The ability to develop rapport and understand complexity in presentation is something that only comes with experience. No intensive training program can replace this.
e. the appropriateness of the assessment tools selected for use in independent assessments to determine plan funding;
The issue with the assessment tools are that when used in isolation, they simply cannot capture the information required to ensure appropriate levels of funding are included within a participants plan. A full and comprehensive functional assessment is the only way to determine the exact support needs that person with a disability requires. The assessment tools are limited in the functional domains they cover, but also the specific tasks within those
Implications
f.
the implications of independent assessments for access to and eligibility for the NDIS;
The assessment tools when used in isolation, cannot determine the level of functional capacity that a person with disability presents with. Access to the scheme requires the consideration of significant functional impact within one of the six domains of function. Without a comprehensive assessment of function, there is considerable risk that participant’s true eligibility will be overlooked.
g.
The implications of independent assessments for NDIS planning, including decisions related to funding reasonable and necessary supports;
This is probably the most concerning of these changes. There is absolutely no way these tools can determine the level of funding a person requires to be safe and independent. The tools cannot take into account the availability or lack of informal supports a person has. The tools cannot take into account the capacity for improvement or development of new skills that a person has. There is significant risk of underfunding occurring as a result.
h.
The circumstances in which a person may not be required to complete an independent assessment;
There should be a list of disabilities which do not require these assessments occur. People with significant intellectual disability or those with spinal injuries for example, should not be subjected to these assessments in order to access the scheme. It is demeaning and humiliating to request this of a person with such a disability.
i.
opportunities to review or challenge the outcomes of independent assessments;
A second opinion or further independent assessment should involve a full and comprehensive functional assessment. I expect there will be considerable numbers of review requests and challenges as a result of the implementation of these assessments. There needs to remain the opportunity for a review to consider information provided by the participants treating professionals.