Northern Territory Government Submission to the Joint Standing Committee on Independent Assessments

Independent Assessments Submission 226

Parliament House GPO Box 3146 State Square darwin NT 0801 Darwin NT 0800 Telephone: 08 8936 5553 minister.worden@nt.gov .au

The Hon Kevin Andrews MP Committee Secretary Joint Standing Committee on the National Disability Insurance Scheme PO Box 6100 Parliament House CANBERRA ACT 2600

Via email: ndis.sen@aph.gov.au Dear Kevin.

Thank you for your email of 16 December 2020. The Northern Territory (NT) Government welcomes the opportunity to provide a submission to the new inquiry into Independent Assessments (IAs) of the National Disability Insurance Scheme (NDIS).

The NT acknowledges the need for transparency, consistency and equity in the approach to access, planning and plan review processes, and supports minimisation of the administrative and financial impacts for prospective and existing NDIS participants.

There are considerable challenges however associated with implementation of IAs in the NT including thin markets, remoteness of the population and unique demographics, including a high proportion of Aboriginal and Torres Strait Islander (49 per cent) and culturally and linguistically diverse (25 per cent) NDIS participants. Key matters for your consideration are outlined at Attachment A.

Should the roll out of IAs eventuate, the National Disability Insurance Agency should reconsider the timeframes for implementation to ensure there is adequate testing and jurisdictionally informed fine-tuning. In the event a decision is made to progress enactment of mandatory IAs as of 1 July 2021 , it is recommended that a robust process of independent monitoring, oversight and review is implemented to ensure any localised negative implications are immediately identified and addressed by the NDIS.

Yours sincerely

Worden 3o)i{}l ••• NORTHERN TERRITORY •• GOVERNMENT

Northern Territory Government Submission to the Joint Standing Committee on the

National Disability Insurance Scheme - Independent Assessments

The Northern Territory (NT) is a unique environment for National Disability Insurance Scheme (NDIS) delivery due to the nature of remote service provision and the need for culturally safe, secure and competent services. There are a number of demographic and geographical factors which increase the challenges associated with service delivery. Sixty i per cent of the NT population resides in the Greater Darwin area, with the remainder of the inhabitants dispersed over remote and very remote areas, including ninety-six communities and rows more than six hundred homelands. The Aboriginal and Torres Strait Islander (ATSI) population accounts a third of the population, which is ten times higher than the national average. There are up to one hundred four ATSI languages and dialects spoken across the NT.

As at December 2020, the NT had three thousand eight hundred forty-seven active NDIS participants with approved plans. Of those NDIS participants, eighteen hundred ninety-one identified as ATSI, and nine hundred seventy-eight as cultural and linguistically diverse. The graph at Attachment B displays the regional breakdown of NDIS participants in the NT.

Due to the limited service delivery environment (thin to non-existent markets) and a lack of economies of scale, transition to the NDIS has been particularly challenging in parts of the T. Although there is some service coverage for Darwin urban areas, there is a substantial decrease in service availability outside of this region including to areas such as Katherine, Nhulunbuy, Alice Springs and regional and remote communities. The absence of local services within communities means that people with disabilities are often forced to leave their homes to access supports, disconnecting them from their community, family and culture. The ongoing issues around the development of a disability services market continues to pose a significant risk to the effectiveness of the NDIS in the NT.

The NT disability market requires significant targeted investment and tailored initiatives to deriver on the promises of the NDIS to produce better outcomes for people with disability, their families and carers, and the broader community. Enhancing technologies and infrastructure, and supporting the workforce and community capacity, will assist in establishing a competitive, robust disability services market to reduce the inequalities in service delivery that are currently being experienced. The Northern Territory Government is committed to suring Territorians have access to high quality services, and we will continue working with the National Disability Insurance Agency (NDIA) to develop the disability market, practically in regional and remote areas, in a way that maximises ATSI economic participation and community-based decision making.

The NT’s transport system is vulnerable to extreme weather events due to geographic and climatic factors. Key road corridors, such as the Arnhem Highway and the Daly River Road, are severely impacted by flooding during the wet season (November to April), limiting land antransport access for remote communities. Access to communities during this time is only possible by light aircraft pending the impact of monsoonal rainfall and electrical storms). It may not be possible to conduct IAs in a person’s home within ninety days of referral as outlined in the Participant Service Guarantee given that access may be restricted for extended periods of time.

Independent Assessments

Relying on the use of Telehealth, or similar access technology, will not provide an equitable assessment approach for prospective and existing participants in regional, remote and very remote areas. Further considerations in this regard include the assumption of the availability of TeleHealth for assessors to access outside of mainstream health demands, as well as reliable internet services to support this access. Appropriate funding for assessments should be provided that recognises the costs to professionals in communities to facilitate these services. On review of the consultation paper released by the NOIA (Access and Eligibility Policy with Independent Assessments), the NT has the following concerns:

1. The introduction of Independent Assessments (IAs) could see a reduction in access and participant plan budgets. If this occurs, the NT can expect additional demand on mainstream services and a need to administer specialist disability care to those people with disability who can no longer receive funding through the NDIS, thus increasing demand on our allied health workforce. This would see a greater likelihood of inexperienced assessors being utilised, and a further reduction in their ability to undertake frontline therapy services.
2. It is not clear where assessors will be sourced from in the NT, noting that there are currently limited private allied health professionals with the clinical capacity to undertake IAs, and that the NT Government has had a key role in undertaking assessments to date. The thin market of specialists is a major limitation on NDIS take up in the NT.
3. People with disability, particularly ATSI peoples, those from cultural and linguistically diverse backgrounds and those with psychosocial disability, may experience additional complexity in engaging with an unfamiliar assessor, and therefore be excluded from accessing the NDis. For the majority of Territorians with disability, the need to build trust and rapport with an assessor is essential for them successfully understand and complete an assessment.
4. There is potential for inaccuracies in the IA process, as several of the assessment tools are self-reported questionnaires. T erritorians undertaking an assessment may not be able to understand the questions, recognise or accept that they have a disability, or may mask or under-report their difficulties. Subsequently, their score may not accurately reflect the level of support required and result in people being excluded or provided with inappropriate plans.
5. It is indicated that provision of IAs for a prospective or existing participant (includes administering the standardised Functional Capacity Assessment Tools, undertaking the interaction/observation session, and completing the written observation Report) will only allow one to four hours for consultation. This is of concern as it is unlikely that an assessor could capture an individual’s circumstances and needs accurately within this timeframe, particularly if participants are unknown to assessors, are from different cultural backgrounds, and/or are in remote settings.
6. Though the cost-free nature of IAs addresses financial barriers, it does not address other significant barriers in the NT such as language, culture and regional and remote location specific issues. The degree to which standardized IAs could be culturally appropriate and meet the needs of Territorians is of significant concern. The vulnerability of people with disability experiencing intersectional disadvantage must be

Independent Assessments

Submission 226

• 3 -

The uniform approach will not adequately consider a person’s unique, individual diagnoses and their disability support needs.

7. Many participants already experience very high levels of stress, anxiety and uncertainty when interacting with the NDIS. Historically, people with disability, their families and carers have had difficulty understanding how to enter the NDIS, and the relationship of an assessment to a plan, and its outcomes. This is likely to be further exacerbated by the introduction of IAs and emphasises the need for clear, well-coordinated client centred plan coordination that ensures that IAs do not become another barrier for people accessing the NDIS. It is essential that IAs are responsive where urgent plan changes are required, particularly for vulnerable clients and clients exiting the health system.

8. There is a lack of clarity regarding how information provided from a treating health professional will be used as part of the IAs and how the NOIA would resolve any issues if an IA conflicts with the advice from a health professional’s report. Clear information is needed on how a report will be utilised and incorporated to inform decision-making by assessors.

9. The mechanism by which IAs are used to calculate a proposed level of support and funding has not been released, and has not been subject to any consultation. It is not clear how environmental factors captured during the IAs will impact access or funding decisions, and to what extent this information will be captured.

Recommendations

10. It is imperative that Territorians can access assessors who have extensive contextual and cultural knowledge and experience to ensure appropriate engagement and plans are tailored to the unique operating environment of the NT. Potential assessors must be subject to uniform accreditation requirements and receive in-depth orientation and training prior to them being considered suitable, to ensure comprehensive knowledge of a range of disability types, development issues, cultural awareness and the specific implications for the IAs. If the Commonwealth seeks to implement IAs in the NT, it is hoped there will be strong consideration of the principles outlined in the 2019 Bilateral Agreement between the Commonwealth and Northern Territory Governments on the National Disability Insurance Scheme regarding place-based, tailored solutions, cultural engagement and local planning.

11. The IAs process must be inclusive of trusted personal supports who have an existing relationship with the person being assessed. It is unclear if families and carers will be assessed in their own right; that is, their capacity to provide care, and the level of support required.

12. It has been indicated that participants can request that their treating health professional accompany them to the assessment; however, there is no funding to cover this. This raises equity issues. The NOIA should consider options to address ongoing inequities in access, including the cost of obtaining evidence of permanent disability.

Independent Assessments

Submission 226 -4-

14.

The Review of the National Disability Insurance Scheme Act 2013 (the Tune Review), investigated discretionary assessments; however, the proposed process makes such assessments mandatory. There exist alternative processes which could increase consistency and equity:

• A person’s treating practitioner undertaking functional assessments using standardised tools would eliminate concerns caused by an unfamiliar assessor while ensuring accurate understanding of function. The NOIA can fund these assessments regardless of provider type supporting its no-cost tool objective for participants—this serves as a mechanism assisting those who cannot afford evidence of impairment.
• Investing further into allied health professionals’ training alongside that of NOIA staff improves quality assurance during interpretation leading towards consistent decision making within this sector already having spent considerable time upskilling personnel producing resources tailored to meet participant needs.

15.

A critical factor is preventing independent assessment inclusion regarding utilisation rates – specifically sixty percent in Northern Territory contexts–as part thereof instead focusing on individual need requirements whilst encouraging market development interventions promoting choice control amongst all involved parties.

16.

Current exemption procedures lack clarity concerning prospective existing eligible individuals coupled with associated application protocols appearing inequitable requiring vulnerable applicants lacking support capacity knowledge initiate requests therefore necessitating simplified navigation pathways accessible both people disabilities families carers alike.

17.

The Independent Assessment must undergo administrative review appeal given fundamental role determining access planning decisions enabling potential recipients seek redress outcomes deemed unsatisfactory through established channels available under law guaranteeing fairness transparency accountability throughout entire process lifecycle management cycle governance framework implementation strategy execution monitoring evaluation feedback loops continuous improvement cycles iterative refinement processes ongoing optimization efforts proactive risk mitigation strategies adaptive resilience capabilities enhanced operational efficiency improved service delivery effectiveness increased stakeholder satisfaction strengthened organizational reputation sustained long term viability competitive advantage strategic alignment core values mission vision goals objectives key performance indicators success metrics benchmarks targets milestones deliverables outputs results impact value creation contribution societal benefit positive change transformative innovation leadership excellence best practices industry standards regulatory compliance ethical conduct professional integrity public trust community engagement social responsibility environmental sustainability economic prosperity inclusive participation diversity equity accessibility cultural sensitivity respect dignity human rights empowerment self-determination autonomy agency voice representation advocacy partnership collaboration solidarity unity cohesion harmony synergy resonance congruence consistency reliability validity accuracy precision relevance significance importance meaning purpose intention motivation aspiration ambition desire hope faith love kindness compassion empathy understanding acceptance tolerance forgiveness reconciliation healing restoration wholeness integration belonging connection relationship interdependence reciprocity mutualism cooperation teamwork coordination synchronization harmonization balance equilibrium stability robustness flexibility adaptability responsiveness proactivity foresight intuition creativity imagination ingenuity resourcefulness determination perseverance tenacity grit resolve courage strength fortitude endurance stamina vigor vitality energy dynamism momentum impulse drive force power influence authority legitimacy credibility trustworthiness honor prestige esteem recognition appreciation gratitude loyalty fidelity commitment dedication passion zeal fervor enthusiasm excitement joy delight pleasure contentment peace serenity tranquility.

18.

A participant’s right challenge assessment outcomes includes secondary assessments—not solely significant circumstance capacity changes or adherence Independent Assessment Framework–or arbitration if dissatisfied.

Attachment B

[Image not converted to Markdown – “Image of attachment b” – check the source PDF page for the actual content]

Data Visualization Summary

The provided graphic displays data categorized across several regions:

• Darwin Urban: 2,251
• Darwin Remote: 367
• East Arnhem: 184
• Katherine: 188
• Barkly: 162
• Central Australia: 591
• Other: 104

A visual representation shows these values distributed geographically within Northern Territory.

[NORTHERN TERRITORY GOVERNMENT logo]