NDIA Accountability Project

Opposition to Mandatory Independent Assessments for All NDIS Participants: Queenslanders with Disability Network Submission

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Submission to the Joint Standing Committee on the National Disability Insurance Scheme

OUEENSLANDERS WITH DISABILITY NETWORK

NOTH INGABOUTUSWITHOUTUS

March 2021

Submission to Joint Standing Committee on NDIS Page 1

Contents Introduction ………………………………………………………………………………………………………………. 4

Detailed Responses …………………………………………………………………………………………………… 6

Foundational Principles of the NDIS ……………………………………………………………………………… 6

Independent assessments ………………………………………………………………………………………….. 9

Mandatory .................................................................................................................         9

Importance of trusted healthcare professionals ..................................................................             9

Inadequacy of 'one-size-fits-all' approach ........................................................................              11

 Duplication and inefficiency ..............................................................................................           13

 Fair process .................................................................................................................    13

 Conflicts of interest ..........................................................................................................          14

Monthly and quarterly release of NDIS funds ...................................................................                  15

 Alternative approaches to independent assessments .................................................      16

Assessor qualifications and supply ...................................................................................           16

Co-design of further consultation and trials .................................................................     17

Conclusion ……………………………………………………………………………………………………………… 18

Submission to Joint Standing Committee on NDIS Page 2

About Queenslanders with Disability Network (QDN)

Queenslanders with Disability Network (QDN) is a state-wide organisation of, for, and with people with disability. QDN’s work is centred around a strong network of people with disability across Queensland to inform, connect, lead and influence change to deliver an inclusive Queensland community. Our motto is

Introduction

This submission responds to the Joint Standing Committee on the National Disability Insurance Scheme Inquiry into Independent Assessments in accordance with the Terms of Reference. QDN welcomes the opportunity to provide a submission to this inquiry. QDN has undertaken extensive consultation with QDN members, including through online and paper surveys, facilitated workshops and direct written feedback and this submission is informed by this consultation.

QDN recognizes the need for systemic reforms to the National Disability Insurance Scheme (NDIS). For almost 45,000 Queenslanders with disability, the NDIS has delivered critical access to services and support for the very first time as new participants. Whilst Queenslanders with disability acknowledge the positive impacts of the NDIS, they also also acknowledge that there is a need for change to improve the processes and outcomes for people with disability as end users of the scheme. Fundamental to this change process is the authentic consultation and meaningful engagement of people with disability, their families, providers and the broader sector.

QDN members have raised their concerns with regards to specific elements of the reforms including the introduction of mandatory independent assessments, changes to the planning process, right to appeal and release of funds for people self-managing.

Through this feedback, QDN members have told us they do not see that the proposed changes will deliver the intended fairer outcomes. Feedback from members, including people who have participated in the trial have said it is challenging and moves away from the fundamental elements of the scheme - to deliver an individualized planning process that gives people with disability access to the reasonable and necessary reports they need based upon the foundations of choice and control.

Good planning is based upon quality information. QDN members believe that the development and review of NDIS plans need to be informed by quality data and quality clinical evidence, including professionals who have an ongoing relationship with the person, involving the person with disability. The National Disability Insurance Scheme Act 2013 (Cth) also outlines the commitment to delivering a scheme that enables people with disability to exercise choice and control in the planning and funding of their supports under section 3 (1) (e).

QDN members have identified that a ‘one-size fits all’ does not work for the diverse needs of people with disability across disabilities, age, gender, cultural background, geography and where they live, and intersectionality with other service systems that increase a person’s marginalization and vulnerability.

Submission to Joint Standing Committee on NDIS Page 4

QDN particularly sees the one-size fits all approach will deliver a range of challenges for people with disability including:

  • Aboriginal and Torres Strait Islander people
  • People from Culturally and Linguistically Diverse backgrounds
  • People who live in rural, remote and regional areas
  • People leaving the criminal justice system
  • People experiencing homelessness
  • People with psychosocial disability
  • Children in the child safety system, and parents with disability interacting with the child safety system.

The Productivity Commission Disability and Care Report in 2011 outlined that

the broader disability sector to further refine and develop these reforms to deliver on the important outcomes for people with disability in accessing essential reasonable and necessary supports in their lives so they can socially and economically participate in Australian community;

  • ensure that state and territory governments continue to have a role in decision-making as a partner and investor in the NDIS and ensure shared responsibilities and governance.

It is important that any reform of the N DIS is driven by, and responds to, the perspectives of people with disability, their families, carers, and providers. In doing so, the NDIS will deliver on the intention and foundations of the NDIS to deliver choice and control to people with disability and access to reasonable and necessary supports they need to live their everyday life.

QDN does not support legislation that implements mandatory independent assessments and removes individual rights and moves away from the fundamental principles of the scheme.

QDN looks forward to continuing to work with the Commonwealth Government, the National Disability Insurance Agency and State Governments to deliver a world quality national scheme for all Australians.

Detailed Responses

The following outlines the position of QDN and our members on the proposed Independent Assessments as part of the NDIS reforms. This response takes into consideration foundational principles of the NDIS and the impact of the changes that deviate from these. The NDIS has for the first time provided all Australians with disability the opportunity to participate fully in social and economic life - the same opportunity that we all expect. This response also identifies the specific areas of the proposed Independent Assessment process itself and the impacts on individuals with disability as participants of the scheme. In moving forward it is critical that people with disability remain at the centre of these reforms, involved in the planning, design, delivery and evaluation of these changes.

Foundational Principles of the NDIS

The creation of the NDIS and the associated reform of disability service provision has changed the lives of many Australians with a disability. At its core, the NDIS is about improving the lives of people with a disability in Australia and this must remain at the forefront of any changes. It is important the fundamental principles of the NDIS must stay at the forefront of any changes to the Scheme including:

  • people with disability front and centre of any change and indeed of the scheme itself
  • choice and control

Submission to Joint Standing Committee on NDIS Page 6

  • focused on goals and the reasonable and necessary supports to achieve these

Choice and control is a foundational principle of the NDIS and must be front and centre of all reform. The commitment to delivering a scheme that enables people with disability to exercise choice and control in the planning and funding of their supports is required by s 3(1 )( e) of the National Disability Insurance Scheme Act 2013 (Cth). Indeed, the NDIS has provided many people with disability choice and control over the funded supports, and their lives, for the first time.

QDN members have provided feedback that they see the foundations of choice and control are undermined in the current proposal for Independent Assessments in a number of ways:

  1. Participants will only be able to choose their preferred assessor

necessary supports that relate to the participant goals are able to be discussed.

Independent assessments in detail

QDN members have raised a range of concerns and issues with the proposed introduction of mandatory Independent Assessments to assess the functional capacity of people with disability using standardised assessment mechanisms and the impacts this will have on them, their families and carers and the potential consequences to their individual supports and plans.

Mandatory QDN supports NDIS reforms that enable improved and equitable access to assessments. From our work across Queensland we know that there are costs and access barriers for many participants in gaining the information, assessments and reports needed to prove eligibility for the NDIS.

QDN supports optional government funded assessments to enable fair and equitable access to the N DIS regardless of their financial capacity. However this has to also enable choice and control over who is best placed to deliver assessments and reports that assist with proof of eligibility, disability and functional impact.

NDIS/$ recipients should have the choice of therapists to do their functional capacity assessments. It would be very stressful for a person with disability to have to relate and report their medical &for psychiatric needs from scratch. This could trigger them and exacerbate their already fragile state. Furthermore, removing choice of therapist and being forced to be assessed by a government approved therapist totally removes all autonomy for the person with a disability. (QDN Member)

RECOMMENDATION: That review of the reform agenda include independent assessments as optional for new participants entering the scheme without the financial means to pay for assessments themselves.

Importance of trusted healthcare professionals

People with disability are the experts in their own lives, their health, and support needs. Many QDN members with positive NDIS experiences often attribute the success of their plans to relationships with medical and allied health professionals that were built on a shared understanding of their individual needs and a mutual trust that developed over time.

Submission to Joint Standing Committee on NDIS Page 9

Consequently, feedback from QDN members on the proposed reforms to the NDIS has focused on the importance of the information, relationship and knowledge that is held by trusted and skilled professionals in individuals’ lives.

Additionally, for many QDN members, the episodic nature of their impairment means that their ‘functional capacity’ is not a clearly observable fact or may change on any given day. For these people with disability, the time limited and standardised nature of Independent Assessments will simply not suffice.

It is broadly acknowledged that because of historical experiences as well as cognitive and intellectual disability, there is a broad range of people with disability who will acquiesce to professionals, and who will mask their disability and the impact it has on their lives. Working with trusted professionals, over a long period of time, is critical to adequately capture the true functional impacts of a person’s disability on their day-to-day life.

QDN members are concerned that Independent Assessments will be used to reverse hard- fought access decisions and reduce funding for essential supports. The unnecessary stress this will cause, and is already causing, participants and their families cannot be overstated.

misjudged or disregarded by assessors without expertise and specialty in these areas. As outlined in Women with Disabilities Australia’s submission on the consultation papers, one of the most common instances of this occurs in women and girls with autism, who already have low participation rates in the NDIS compared to men and boys, despite Autism Spectrum Disorder (ASD) being the largest primary disability category in the NDIS.3

QDN members have identified that a “one-size fits all’ does not work for the diverse needs of people with a disability across disabilities, age, gender, cultural background, geography and where they live, and intersectionality with other service systems that increase a person’s marginalisation and vulnerability. Particularly QDN sees a risk of negative impacts and challenges for people with disability including:

  • Aboriginal and Torres Strait Islander people
  • People from Culturally and Linguistically Diverse backgrounds
  • People who live in rural, remote and regional areas
  • People leaving the criminal justice system
  • People experiencing homelessness
  • People with psychosocial disability
  • Children in the child safety system and parents with disability interacting with the child safety system

QDN members overwhelmingly expressed concerns that the proposed process will lead to people with disability once again relying on standardised testing and funding packages to meet their basic, everyday needs. The N DIS was established to replace standardised models as it was widely acknowledged that this approach led to inadequate and inappropriate support for people with disability, and in many cases, no support at all. People with disability do not want to go back to the experiences in the old system.

experiencing additional marginalisation. Our experience is that successful outcomes for people with disability from these cohorts require person-centred, individualised support to navigate complex government systems and ensure they have access to quality, safe and inclusive services, both NDIS and mainstream. For these groups of people, focussed and extensive support is required to gather the information needed to access the scheme and reap the full benefits it can bring, including improved educational and employment outcomes, access to health and housing services, and opportunities for social inclusion.

assessment. Bureaucratic information request processes are inappropriate and unnecessary.

  • Limited access to appeal of the final assessment and decision making removes the right for people with disability to be involved in decision-making that affects them. The Independent Assessments will be used to inform decisions about what supports a person is funded in their plan. If the information in the assessment is incorrect and not representative of the actual functional capacity of a person, there must be a right of review. QDN members have raised concerns about the proposal to refuse a person with disability’s right to review the information about them and if it is incorrect, to request a review. The N DIA’s assertion that people will not get another assessment just because a person disagrees with the results of sound and robust independent assessments. QDN does not see that a framework will address these issues nor deliver consistency of experience of individuals.
  • Failure to provide meaningful choice in the provider of the Independent Assessment limits decision making and choice and control as outlined earlier; and
  • Limiting access to the NDIS to only those that agree to an Independent Assessment as part of plan review and plan renewal. QDN members see this as a breach of their rights and QDN does not support reforms that impact upon people’s rights, safeguards and fairness.

RECOMMENDATION: ensure access to safeguards for people with disability to right of review or appeal the information in an independent assessment which is used to ‘make decisions’ about the level of supports that are provided to a participant to ensure consumer rights are upheld and there is fair process.

Conflicts of interest

QDN members have expressed doubt over the independence of any assessors engaged through the process outlined in the consultation papers, as there will be a contracted relationship by the National Disability Insurance Agency (NDIA).

A conflict of interest, whether real or perceived, can impact upon the outcomes of assessments and may open up questions about fairness of the scheme. Such issues were highlighted in investigations into similar arrangements under other systems, including the use of job capacity assessments to determine Centrelink applications and the subsequent appeals to the Administrative Appeals Tribunal (‘AAT’), or issues with Independent Medical Examiners engaged by WorkCover as outlined by the Victorian Ombudsman.

‘performing’ for a stranger who I have reason to mistrust (NDIA affiliate).” (QDN Member)

The concerns surrounding conflicts of interest are compounded by the fact that the NDIA’s approach appears to be contracting only a small number of organisations to deliver Independent Assessments. This is in direct contradiction of the Tune Review which clearly stated that “…the NDIA should not implement a closed or deliberatively limited panel of providers to undertake functional capacity assessments…”4

Conflicts of interest, real or perceived, run the risk of undermining confidence in the system and as noted by the Tune Review, the risk of disengagement of people with disability with the scheme is high if reforms are not handled well. This is particularly the case for Aboriginal and Torres Strait Islanders, those from CALD backgrounds and those with a psychosocial disability.5 It is critical that all steps are taken to assure current and potential scheme participants of the independence of any proposed reform.

If the aim of these reforms is to ensure all eligible Australians have fair and consistent access to the scheme, then it is imperative that people with a disability can trust the transparency, fairness and safeguards that are in place to deliver independent services without conflicts of interest.

Monthly and quarterly release of NDIS funds

QDN members, who are self-managing, have also raised concerns about the proposed changes to release N DIS funding in monthly or quarterly instalments. For many people with disability, their needs can change month to month or even over a year for a variety of reasons. For example, some members report needing greater support in winter because the cold limits their functional capacity. Additionally, external circumstances, such as those experienced during the peak of the COVID-19 pandemic can limit participants’ ability to access the community and utilise their funding.

It is critical that the NDIS continues to discharge funding to participants who are self-managing on an annual basis to provide the flexibility needed to respond to changing needs.

RECOMMENDATION: That the Commonwealth continue to discharge funding on an annual

4 Tune, D AO PSM, Review of the National Disability Insurance Scheme Act 2013 Removing Red Tape and Implementing the

NDIS Participant Service Guarantee, December 2019, page 67

5 ibid

Submission to Joint Standing Committee on NDIS Page 15

basis to participants who are self-managing.

Alternative approaches to independent assessments

There are a range of locally based responses that have been delivered in Queensland to address the specific needs of this state and the cohorts who have experienced most disadvantage in accessing the scheme.

QDN has delivered the Getting on the NDIS Grid, Peer to Peer Advocacy and most recently the Targeted Outreach Project. QDN also acknowledges the innovative and responsive work that has occurred in Queensland across several other targeted projects, including the Indigenous NDIS Pilot Project of National Significance delivered by the Institute for Urban Indigenous Health (IUIH).

These projects support participants who are deemed to be ‘hard to reach’ and who require a tailored, individualised and supportive process to participate in the processes required for access to the NDIS. Our recent project, the Targeted Outreach Project, combines the outreach support with the hands-on support and assistance required through the access process including assessments to prove eligibility and evidence for the access process. The significant outreach work required to locate people, build trust and establish a referral pathway to support people throughout the process of applying for access to the scheme requires a multidisciplinary approach from a range of allied health and specialist disability engagement workers who have particular understanding of the experiences, challenges, risks and issues involved. It is important that projects of this kind are led by the specific cohorts including Indigenous led, led by people from marginalised groups and to reach cohorts, people with intellectual disability, people with psychosocial disability and people from Culturally and Linguistically diverse backgrounds. 6

There is strong and ongoing need for targeted and alternative strategies for specific groups who experience additional challenges to accessing the NDIS, and once an NDIS participant, challenges with navigating, activating, and managing their NDIS supports.

QDN supports the inclusion of evidence of the outcomes achieved through projects such as these (and others across the country) to be considered by Disability Reform Ministers.

Assessor qualifications and supply

It is already understood that the workforce capacity for the disability sector is low. Overall, demand is outstripping supply and one of the fastest growing needs has been for allied health

6 The Targeted Outreach Project is being delivered QCOSS, and Aged and Disability Advocacy’s Aboriginal and Torres strait

Islander Disability Network of Queensland and in collaboration with the Assessment and Referral Team in Department of Seniors,

Disability Services and Aboriginal and Torres StraitIslander Partnerships.

Submission to Joint Standing Committee on NDIS Page 16

professionals. In addition, many existing entry level and allied health professionals lack disability experience, knowledge and expertise. A national workforce strategy is required for the disability sector in general and particularly in response to any reform plans. On behalf of WorkAbility Queensland, the Community Services Industry Alliance (CSIA) has been leading a research project to investigate the market and workforce impacts of the NDIS in Queensland.7 The research team of CQUniversity, CSIRO’s Data61 and Global Community Solutions have recently reported state-wide findings and the report will be published in coming months.

The N DIS Workforce Research Project included an industry survey that asked thirty-two disability sector employers about the workforce needs. The research found unmet demand for workers across all types of staff, with demand highest for client-facing roles (support workers, Allied Health Professionals, Plan Managers, Support Coordinators), administration staff and management. Most significantly, more than three-quarters (77%) of employers needed more direct support workers and over one-third (35%) of employers needed ten or more of these workers just to meet the needs of their existing NDIS participants.8

Qualitative data from the research project suggests that for some providers, the shortage of NDIS workers is a barrier to the growth of the NDIS market. The shortage causes delays for the delivery of services, particularly in regional and remote locations, and inhibits organisational growth. There appears to be unmet demand for NDIS workers to meet the current number of participants and, given the NDIS is currently supporting about 55,000 of the forecast 91,000 Queenslanders with disability, demand for these workers will continue to grow.9

QDN believes that these workforce challenges will be further compounded by the proposed introduction of Independent Assessments and the consequential increased demand for qualified assessors.

Co-design of further consultation and trials

Leadership and participation by people with disability is the cornerstone of the N DIS. It is critical that reforms are tested and trialled and results shared prior to any widespread reform. To date, there has been little publicly available data to show that Independent Assessments deliver improved quality of data about the person and their functional needs and therefore deliver improved plans.

Given the concerns raised by QDN members regarding the use of independent assessors as

7 The Disability Workforce Research Project is funded by Jobs Queensland and is delivered by CSIA on behalf of the WorkAbility

consortia.

8 Community Services Industry Alliance (2020) Industry Workforce Briefing www.csia.org.au

9 ibid

Submission to Joint Standing Committee on NDIS Page 17

Co-design of further consultation and trials (continued)

Leadership and participation by people with disability is the cornerstone of the NDIS. It is critical that reforms are tested and trialled and results shared prior to any widespread reform. To date, there has been little publicly available data to show that Independent Assessments deliver improved quality of data about the person and their functional needs and therefore deliver improved plans.

Given the concerns raised by QDN members regarding the use of independent assessors as

Submission to Joint Standing Committee on NDIS Page 17

outlined above, it is critical that changes are supported by both research and practice evidence. Additional trials are required, developed with people with disability, families, providers and the broader sector to ensure that any reform is effective and delivers the outcomes needed by people with disability.

The NDIS is a complex system. Through our work, QDN knows that there are many people with disability who require additional support to navigate through. Our experience of doing so provides us with clear guidance on what is working and what is not. It is only through hearing the voices of people with disability and their advocates can we minimise any risk. Co-design of reform must continue if the NDIS is to continue to live up to its promise of delivering social and economic independence for people with disability.

RECOMMENDATIONS: That the Commonwealth Government:

  • Undertake further evaluations, trials and consultation with people with disability, families, providers and the broader sector with regards to the implementation of independent assessments for existing NDIS participants.
  • Undertake consultation and engagement with people with disability, families, providers and the broader disability sector to further refine and develop these reforms to deliver on the important outcomes for people with disability in accessing essential reasonable and necessary supports in their lives so they can socially and economically participate in Australian community.

Conclusion

QDN supports the need for reforms of the NDIS and the need to improve the systems and processes that deliver on the scheme for over 460,000 Australians with disability. QDN acknowledges the significant work that has been undertaken over the past decade to respond to community need to design, build and deliver a scheme knowing that every person who was born with or acquired a disability under 65 would be able to access the supports they need to live their lives.

As Bruce Bonyhady said as the Chairperson of the NDIA at the New World Conference in 2015 in Brisbane, “The NDIS is revolutionary because it is taking an entirely new approach to disability services… an approach that is built around the needs and potential of the individual, an approach that sees the individual as a life-long investment rather than a year-to-year unit of cost, an approach that replaces the welfare model of disability services with an insurance model.” He said that the NDIS is a sound investment in our economy as well as our society.

QDN believes that any reforms to the NDIS need to ensure that the foundations of the scheme

Submission to Joint Standing Committee on NDIS Page 18 Independent Assessments

remain, and that people with disability, their families/carers and the disability sector are meaningfully engaged in reforms. It is critical in moving forward with any of these significant reforms which fundamentally shift away from the individualised approach in the planning, design, delivery and evaluation of changes. This enables people with disability choice and control, and that true consultation occurs to find solutions that will deliver benefits for people with disability and the broader scheme.

QDN acknowledges and supports the need for people with disability who are trying to access the scheme to have fair and equitable access to the assessments they need to prove their eligibility and the functional impacts of their disability. However, QDN does not support the introduction of mandatory independent assessments for every new participant rather an approach that is targeted where needed. QDN also does not support the mandatory requirement for every existing participant to undergo an independent assessment to be able to get their next plan. Many of the proposed reforms outlined in QDN’s submission are being delivered in a one-size fits all, and do not take into consideration the impacts and needs of the diverse groups and cohorts of people who are NDIS participants. It is important going forward that consideration is given to the implementation and the unintended consequences of these reforms and processes.

QDN appreciates this opportunity to provide input into this consultation, and the opportunity for QDN members to be able to have a say on the proposed changes and significantly the potential impacts this will have on their access to much needed reasonable and necessary supports to live their day to day lives.

QDN looks forward to continuing to work with the NDIA, Commonwealth and State Governments to ensure that the voice of people with disability, their families/carers and the disability and community service sector are included and inform the important decisions going forward to deliver a world quality national disability scheme for all Australians.

Submission to Joint Standing Committee on NDIS Page 19 Independent Assessments