Joint Standing Committee on the National Disability Insurance Scheme
Online submission
RE: Joint Standing Committee on the National Disability Insurance Scheme: New inquiry into
The Public Advocate (OPA) and Disability Advocate, thanks the Joint Standing Committee on the National Disability Insurance Scheme for the opportunity to participate in the consultation about the New inquiry into Independent Assessments.
The Disability Advocate works closely with the Public Advocate and has consulted broadly with South Australians about their experience with the NDIS since late 2018. These consultations have provided a unique insight into the experience or people with disability, their families as well as a range of stakeholders as the NDIS has rolled out in South Australia.
The Office acknowledges that the NDIS is a complex and evolving scheme and recognises the continued work of the NDIA to improve the experience of people with disability.
We thank you once again for the opportunity to provide input into the NDIS and advocate for South Australians and look forward to future opportunities to collaborate to improve outcomes and the experience of South Australians with the NDIS.
Anne Gale David Caudrey Public Advocate Disability Advocate
Office of the Public Advocate
South Australia
Joint Standing Committee on the National Disability Insurance Scheme New inquiry into Independent Assessments
March 2021
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Contents
Joint Standing Committee on the National Disability Insurance Scheme: New inquiry into Independent Assessments ……………………………………………………………………… 3 Terms of reference ……………………………………………………………………………………………………. 3 Introduction ………………………………………………………………………………………………………………….. 4 Office of the Public Advocate ………………………………………………………………………………….. 4 Disability Advocate …………………………………………………………………………………………………… 4 Responses to the Inquiry …………………………………………………………………………………….––––– 5
The development, modelling, reasons and justifications for the introduction of independent assessments into the NDIS. ……………………………………………………………….. 6
The impact of similar policies in other jurisdictions and in the provision of other government services. …………………………………………………………………………………….———–– 7
The human and financial resources needed to effectively implement independent assessments. …………………………………………………………………………………………………..———— 7
The independence, qualifications, training, expertise and quality assurance of assessors. …………………………………………………………………………………………………………………. 8
The appropriateness of the assessment tools selected for use in independent assessments to determine plan funding. ………………………………………………………..––––– 9
The implications of independent assessments for access to and eligibility for the NDIS. ………………………………………………………………………………………………………………………….. 9
The implications of independent assessments for NDIS planning, including decisions related to funding reasonable and necessary supports. ……………..––––– 9
The circumstances in which a person may not be required to complete an independent assessment. ………………………………………………………………………………………. 10
The appropriateness of independent assessments for particular cohorts of people with disability, …………………………………………………………………………………….––––– 11
The appropriateness of independent assessments for people with particular disability types, including psychosocial disability. ……………………………………………… 11 Conclusion ………………………………………………………………………………………………………………….. 12 Bibliography …………………………………………………………………………………………………..————— 13
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Joint Standing Committee on the National Disability Insurance
Scheme: New inquiry into Independent Assessments
As part of the committee’s role to inquire into the implementation, performance and governance of the National Disability Insurance Scheme (NDIS), the committee has decided to conduct an inquiry into independent assessments under the NDIS.
An independent assessment is an assessment of a person’s functional capacity, which will be used to inform decisions about eligibility for the NDIS and about funding in a participant’s plan. The National Disability Insurance Agency (NDIA) proposes to introduce independent assessments as part of the NDIS access and planning processes in 2021.
Terms of reference
As part of the committee’s role to inquire into the implementation, performance and governance of the National Disability Insurance Scheme (NDIS), the committee will inquire into and report on independent assessments, with particular reference to:
a. the development, modelling, reasons and justifications for the introduction of independent assessments into the NDIS; b. the impact of similar policies in other jurisdictions and in the provision of other government services; c. the human and financial resources needed to effectively implement independent assessments; d. the independence, qualifications, training, expertise and quality assurance of assessors; e. the appropriateness of the assessment tools selected for use in independent assessments to determine plan funding; f. the implications of independent assessments for access to and eligibility for the NDIS; g. the implications of independent assessments for NDIS planning, including decisions related to funding reasonable and necessary supports; h. the circumstances in which a person may not be required to complete an independent assessment; i. opportunities to review or challenge the outcomes of independent assessments; j. the appropriateness of independent assessments for particular cohorts of people with disability, including Aboriginal and Torres Strait Islander peoples, people from regional, rural and remote areas, and people from culturally and linguistically diverse backgrounds; k. the appropriateness of independent assessments for people with particular disability types, including psychosocial disability; and l. any other related matters.
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Introduction
Office of the Public Advocate
The South Australian Public Advocate is a statutory official appointed by the Governor to implement the provisions of Section 21 of the Guardianship and Administration Act 1992, (the GAA). The Public Advocate is supported by the Office of the Public Advocate (OPA) to assume guardianship, and provide advocacy, support, and education to people with mental incapacity and the systems and services around them. This includes speaking for and on behalf of people and their families, carers, and supporters, educating the sector and identifying areas of unmet need for reporting to the Minister.
The Public Advocate acts as guardian of last resort for people with impaired decision- making capacity, when appointed by the South Australian Civil and Administrative Appeals Tribunal (SACAT) under the GAA. The SACAT will only appoint the Public Advocate as a person’s guardian if it is satisfied that no other order would be appropriate. What this means in practice is that the Public Advocate will only be appointed if there is no one else in a person’s life able or willing to make necessary decisions, or if there is family conflict meaning that agreement on decisions is difficult or not possible. Consequently, the Public Advocate often must make decisions for people who have complex needs or experience complex situations and who may be without support networks.
The Public Advocate’s role as guardian is to make decisions, including giving the relevant consent about a person’s care, where there is the requisite authority to do so under the guardianship order. However, the Public Advocate as guardian is not responsible for arranging and coordinating a protected person’s package of care and services.
Disability Advocate
The Disability Advocate is a position located within the Office of the Public Advocate and was established in November 2018. The purpose of the role of the Disability Advocate is to “ensure that South Australians with a disability and their families are getting a good deal from the National Disability Insurance Scheme (NDIS).”
Throughout 2019 the Disability Advocate attended over 150 meetings with people with disability, family, advocates, and carers to speak with people about their experiences with the NDIS, what was working well and areas for improvement. Regular reports were presented to Ministers and senior State and NDIA officers.
The role has since been extended with funding for the next 3 years. COVID-19 and other work (such as the Safeguarding Taskforce) made it difficult to undertake face to face meetings in 2020 however the Disability Advocate managed to conduct over 270 meetings with external stakeholders during the year. Meetings have recommenced in 2021 and we are again looking at writing regular reports for the NDIA and state ministers. The Disability Advocate will focus on topics that we neglected in 2019 including Culturally and Linguistically Diverse (CALD), Aboriginal and Torres Strait Islander (ATSI) and Rural & Remote communities and Children’s services.
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Responses to the Inquiry
The following response to the Joint Standing Committee on the National Disability Insurance Scheme, New Inquiry into Independent Assessments (the Inquiry) is drawn from the experiences of the OPA in NDIS access, planning and review activities and through forums and stakeholder meetings of the Disability Advocate. In addition, NDIS participant comments on social media and opinions from multiple service providers of the independent assessments process were taken into consideration when developing this response.
Does anyone else feel as though they have no dignity everytime
they have to do a new assessment to keep the NDIS happy?
Explain yourself over and over again, not to mention lack of privacy.
I get it that they have to justify everything its just so soul destroying
and kind of defeats the purpose to me. – Facebook.
When the OPA provided a response to the Submission to the Review of the NDIS Act 2013 (the Submission)1 the Disability Advocate reported that participants and their families were confused by all the working parts of the NDIS. The Disability Advocate recommendations were that program parameters were simplified, and roles clarified. When gathering information for The Safeguarding Report2 it was reported that participants or their nominee (usually a family member) were overwhelmed by the abundance of players and functions of the NDIS. The Safeguarding Report continues by advising that participants and nominees end up doing all the advocacy, lobbying, chasing-up and coordination themselves (i.e. case management hasn’t been done away with – it has lobbed back with the participant and/or their families, to their detriment). Disability Intermediaries Australia3 (DIA Discussion Paper) state “public policy continues to overestimate the capabilities that people possess to access and navigate the scheme as well as underestimate the capability required of both government and providers, to ensure markets truly address the needs of all people”.
The NDIS is a most welcome innovation in Australia that enshrines respect for the individual participant and their ability to exercise choice over such matters as “who provides services” and to exercise control over precisely how those services are delivered. The scheme succeeds in giving eligible participants more support than they ever had before from State-run systems, without waiting lists and without rationing. However, the introduction of the independent assessment process has raised widespread concerns amongst NDIS participants, families, advocacy groups, service providers and allied health professionals. Of great concern is that the National Disability Insurance Agency (NDIA) are powering ahead with the introduction of the independent assessment process despite genuine community concerns of the efficacy of the process.
1 South Australian Office of the Public Advocate and Disability Advocate, Submission to the review of the NDIS Act 2013, September 2019 2 Kelly Vincent and Dr David Caudrey, Safeguarding Task Force (Supplementary Report, September 2020) Government of South Australia <https://dhs.sa.gov.au/__data/assets/pdf_file/0004/90832/Safeguarding-Task-Force-Report-31-July-2020.pdf>. 3 Disability Intermediaries Australia, NDIA Planning Policy for Personal Budgets and Plan Flexibility Discussion Paper, February 2021
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The Department of Social Services (DSS) and the NDIA prepared a joint submission to the Joint Standing Committee inquiry on Independent Assessments4 (DSS/NDIA Joint Submission).
The development, modelling, reasons and justifications for the introduction
of independent assessments into the NDIS.
The NDIA conducted a large number of information sessions on independent assessments and sought feedback from NDIS Participants and other interested parties. On the 26th February 2021, three days after the closure date for feedback, the NDIA announced the six organisations who were appointed to the Independent Assessment panel. For the NDIA the commencement of individual assessments was never in question, consultation and feedback was sought only on aspects of the process.
In the OPA response to the National Disability Insurance Agency (NDIA) Consultation Papers, February 2021 (OPA Response)5 it was acknowledged that the current access process can be costly and involve long wait times. However, in the new process the prospective participant is still responsible to pay the costs of meeting the eligibility criteria of age, Australian residency, and permanency of disability. The Disability Advocate has heard that this process can be particularly onerous for some prospective CALD participants. There can be a long wait for citizenship. Gathering evidence of disability can be problematic as the individual may not have a regular general practitioner.
There were concerns that the original Independent Assessment Pilot and subsequent evaluation was based on a very small cohort of participants which may not be reflective of the larger NDIS population’s experience. By implementing the proposed system of independent assessments, the NDIA appears to be moving away from the fundamental principles of participant “choice and control”. The DSS/NDIA Joint Submission6 offers no certainty with the statement “as much as possible, people will have choice about who they work with to assess their functional capacity and inform decisions on their access request or development of their plan”.
The NDIA has raised concerns about inconsistency and bias in the current access process. However, the same concerns have been raised about the independent assessments process:
- The validity of information that is provided by the assessor - is this simply a “tick and flick” exercise.
- Insufficient time for the potential participant to be observed in numerous settings such as home/school/work/hobbies and with friends.
- Insufficient time for comprehensive report writing.
The Submission7 stated that the rigid assessment requirements of access requests were unclear to participants and that the solution was more guidance in the assessment process for participants, families, and health professionals. This was to ensure that assessment reports could better reflect the functional capacity impact. The Review of The National Disability Insurance Scheme Act 2013 Removing Red Tape And Implementing The NDIS Participant Service Guarantee, David Tune AO PSM December
4 Department of Social Services, National Disability Insurance Agency, Joint Submission to the Joint Standing Committee on the National Disability Insurance Scheme’s Inquiry into Independent Assessments, March 2021 5 Office of the Public Advocate, South Australia, NDIA Consultation Papers: Access and Eligibility Policy with Independent Assessments/Planning Policy for Personalised Budgets and Plan Flexibility, 17 February 2021 6 Department of Social Services, Joint Submission to the Joint Standing Committee on the National Disability Insurance Scheme’s Inquiry into Independent Assessments, March 2021 7 South Australian Office of the Public Advocate and Disability Advocate, Submission to the review of the NDIS Act 2013, September 2019
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20198 (Tune Review) recommended prospective participants should undergo assessments and specifically stated that NDIA-approved providers should undertake those assessments. In addition, the Tune Review stated the NDIA should not implement a closed or deliberately limited panel of providers. Should the NDIA simply have provided guidance to the sector on how they required assessments to be completed to avoid confusion for both the Participant and clinician?.
The impact of similar policies in other jurisdictions and in the provision of other government services.
In order to provide a service across the nation to over 460,000 people the requirements to achieve equity and similar package arrangements based on need have led to a host of rules and benchmarks that need to be followed, auditors to be satisfied and budgets to be met. The review of independent assessments has occurred at the same time NDIS viability is being debated at the Government level. There is justifiable suspicion that this is just a vehicle that will lead to greater difficulty to access the scheme and smaller packages so that scheme costs do not blow out.
Bruce Bonyhady9 advises that the basis of independent assessments lies in no-fault accident compensation schemes that was a recommendation of the initial 2011 Productivity report. He goes on to advise why these assessments would not be suitable in the NDIS environment as there is no consideration of individual goals, capacity building and informal supports.
Is the NDIA an insurance scheme based on a transactional approach or a human services scheme based on a relationship approach? It appears that the transactional approach is winning out and if it does become the predominant culture then the NDIS will feel to the participant just like Centrelink and Medicare. (efficient at their functions but will not sweat along with the clients who struggle in the system, have complex needs or sudden changed circumstances).
The human and financial resources needed to effectively implement
independent assessments.
The NDIA Chief Executive Martin Hoffman talks of changes to the NDIS in his interview with Tom Burton,10 and advises that “they want to move away from a line by line welfare rationing culture.” The traditional, core, capacity building and capital support categories are to be replaced by fixed and flexible budget lines. On the surface it would appear the idea of moving to this system will make it easier for the participant to make choices to shift monies around when purchasing supports.
It has already been established however, that for a large number of participants and their families find the NDIS is overly complex and burdensome.
- Will the ability to shift monies around when purchasing supports create additional problems if monies are inadvertently overspent and funds run out?
- With the introduction of a 5-year plan will there be consideration of annual indexation and monies be increased automatically that reflect changes in the NDIS Price Guide when update?
8 David Tune, Review of the National Disability Insurance Scheme Act 2013: Removing Red Tape and Implementing the NDIS Participant Service Guarantee (Final Report, December 2019). 9 Bonyhady, Bruce, ’An analysis of the NDIA’s proposed approach to Independent Assessments: A response to the national Disability insurance Agency (NDIA) Consultation.’. February 2021 10 Tom Burton, ‘Redesigning the complex disability services system’, Financial Review (online, February 11 2021) <https://www.afr.com/politics/federal/redesigning-the-complex-disability-services-system-20210113-p56tq4>
- Will participants be allocated additional funding to be supported to understand the new planning process and funds allocation through support coordination or management of NDIS funds.
There had been a general concern in relation to rural and remote areas and the availability of suitably qualified assessors in an already “Thin Market”. In 2019 the Disability Advocate met with a number Aboriginal and Torres Strait Islander stakeholders. Participants highlighted the need for a culturally responsive service and a highly trained and skilled workforce were acknowledged as being necessary to build relationships and trust. At meetings in 2021 it was discussed that lack of understanding of foster and kinship arrangements hinders the progress of access and planning for numbers of younger ATSI participants. The lack of understanding of trauma leads to disengagement and again hinders access and planning processes for ATSI participants.
The Disability Advocate has been made aware that interpreting services are not provided until the person is an NDIS participant. An interpreter must be provided to explain the independent assessment process to any prospective participant who requires this service. This would include providing all information in a format that suits the communication needs of the person, including easy read or sign language.
The Joint Standing Committee on the National Disability Insurance Scheme Planning Interim Report 201911 recommends additional training and skills development to NDIA and Local Area Coordination (LAC) partner staff to ensure that these people become familiar with the wide range of disabilities experienced by participants and the specific needs of CALD and ATSI people.
All of these costs need to be factored into the implementation of independent assessments when meeting the needs of people living in rural and remote communities, ATSI and CALD participants.
The independence, qualifications, training, expertise and quality assurance
of assessors.
In the Safeguarding Report12 comment was made that the LAC role had been sidetracked from its original intent to support people to access the wider community and mainstream services. The LAC’s focus became getting people into the Scheme rather than connecting them into the community. How can we be assured that Independent Assessors will remain independent, not be biased or be reassigned into other roles when the NDIA is paying for their services?
On the 26th February 2021, the NDIA announced which organisations would make up the Independent Assessment panel. These organisations have won the contract for 3 years, with the opportunity for it to be extended by 2 years. Requirements are for assessors be an allied health practitioner with at least 12 months of full-time equivalent clinical experience. The assessor must be able to use standardised assessment tools appropriate to their specific qualifications and have experience working with a ‘wide variety of clients’.
It is recommended that assessors are trained appropriately by the NDIS to understand a range of disabilities. There is a concern that, as assessors will come from a specific discipline, that their knowledge base may not be sufficiently broad to have a sound understanding of the needs of the person they are interviewing. The assessors must also
11 Joint Standing Committee on the National Disability Insurance Scheme, Commonwealth of Australia, NDIS Planning (Interim Report, 2019). 12 Kelly Vincent and Dr David Caudrey, Safeguarding Task Force (Supplementary Report, September 2020) Government of South Australia <https://dhs.sa.gov.au/__data/assets/pdf_file/0004/90832/Safeguarding-Task-Force-Report-31-July-2020.pdf>.
have knowledge of the specific needs of those prospective participants from CALD and ATSI backgrounds and integrate this into their processes. An appreciation of the varied communication styles of people with disabilities and a willingness to work with the individual at their level is essential
In an already “Thin Market” it is now to be seen whether the agencies will be able to recruit and maintain staff in these positions. This work will be repetitive and may use little of the allied health providers skills. We have seen the constant changing of NDIS staff especially those in planning roles that are similarly repetitive in nature. We may also see this trend with the independent assessment staff.
The appropriateness of the assessment tools selected for use in
independent assessments to determine plan funding.
The DSS/NDIA Joint Submission13 points out that the suite of tools for independent assessment has been selected to ensure they are disability neutral so they can be used across all disability types. The independent assessments are designed to ensure that assumptions are not made based on disability and diagnosis, the priority being to accommodate individual differences whilst implementing a consistent approach. It could be argued that disability neutral assessments may not be appropriate for some disability cohorts and that specific information relating to the persons disability would assist the planners in making better access decisions.
Bruce Bonyhady in his analysis of independent assessments advises that there are no functional assessment tools that have been designed to provide accurate and reliable estimates of the funding for all disability types. The NDIA have not been forthcoming in providing the information on how the independent assessments will translate into a dollar figure.
The implications of independent assessments for access to and eligibility
for the NDIS.
The implications of independent assessments for NDIS planning, including
decisions related to funding reasonable and necessary supports.
How will standardised assessment tools translate into a dollar figure and how can goals be considered when a budget is already prepared for what was originally the planning meeting, that now appears to have morphed into the implementation meeting? The NDIA have not clearly articulated how this will occur.
Again, it must be stated that there is suspicion amongst participants, families, advocacy agencies and service providers that the introduction of independent assessments will leave to less access to the scheme and reduced packages to enable scheme viability.
Martin Hoffman14 advises that every person is an individual and that goals are important in people’s lives. It is difficult to see how funding for goals can be taken into consideration when the budget appears to be set prior to the planning meeting. The planning meeting now is an opportunity to work our how to use or ration your funds. The planning meeting should be an opportunity to discuss your goals to be considered and funded above your functional capacity and circumstances that may be similar to other peoples.
13 Department of Social Services, National Disability Insurance Agency, Joint Submission to the Joint Standing Committee on the National Disability Insurance Scheme’s Inquiry into Independent Assessments, March 2021 14 Tom Burton, ‘Redesigning the complex disability services system’, Financial Review (online, February 11 2021) <https://www.afr.com/politics/federal/redesigning-the-complex-disability-services-system-20210113-p56tq4
Opportunities to review or challenge the outcomes of independent
assessment.
The NDIS Consultation paper: Planning for Personalised Budgets and Plan Flexibility15 commence the section on appeals rights and complaints saying that planning decisions will continue to be reviewable decisions and this process will not change. They go on to advise that disagreeing with the results of “sound and robust” independent assessments will not be sufficient for the NDIA to fund another assessment. As independent assessments are not decisions that an NDIS delegate makes under the NDIS Act assessment results are not directly reviewable by the Administrative Appeals Tribunal (AAT).
The DSS/NDIA Joint Submission16 document that independent assessors will not make decisions about a person’s access to the NDIS or their plan funding- these decisions will continue to be made by an NDIS delegate. Prospective participants and participants will be able to request a review or appeal decisions made by the NDIA if they feel the decision is wrong.
There is a general lack of clarity about the appeals process for access decisions. Participants and their families are already overwhelmed by the NDIS, this is another complexity to add to the confusion.
The circumstances in which a person may not be required to complete an
independent assessment.
The NDIA advise that there are limited circumstances where it may not be appropriate to request an independent assessment, the risk to health and safety or where other sources of information may be more valid.
There are certain populations where there should be an assumption of eligibility so that people naturally make an access request. Examples include people aged less than 65 who are under the guardianship of the Public Advocate. A person would not be under guardianship if they did not have a cognitive impairment of some kind. If a person is referred to the NDIS and is found ineligible (other than based on age or residency) then the question would need to be asked – “does the person have cognitive capacity?” If “no” then he/she should be eligible for the NDIS – if “yes” then the person should not be under guardianship at all.
Another example is that of people living in Supported Residential Facilities; these are congregate care hostels, mostly providing basic accommodation, board and support for people who have had mental health issues. Again, people would most likely not be living in an SRF if they did not have a cognitive incapacity caused by a brain injury, intellectual disability or (most often) an enduring mental health condition (i.e. a psychosocial disability).
The Disability Advocate has become aware that agencies representing specific cohorts of NDIS participants are recommending that their client groups should be exempt from the independent assessment process. Corrections and Mental Health Services believe that their client groups would be better served by an assessor who is known to the person. Individual advocacy groups are raising concerns relating to trauma and trust and whether people who have experienced trauma will be able to communicate effectively and tell
15 National Disability Insurance Scheme, Planning Policy for Personalised Budgets and Plan Flexibility (Consultation Paper vol. 1, November 2020) 16 Department of Social Services, National Disability Insurance Agency, Joint Submission to the Joint Standing Committee on the National Disability Insurance Scheme’s Inquiry into Independent Assessments, March 2021
their story to a stranger. There is concern that an assessor not known to the person will not be able to engage and elicit appropriate information which will adversely affect the outcomes for a number of people.
If the numbers of cohorts requesting exemption increases, the remaining groups who are not exempt will again likely be those people, whose voice is not strong enough to be heard.
The appropriateness of independent assessments for particular cohorts of
people with disability,
- including Aboriginal and Torres Strait Islander peoples,
- people from regional, rural and remote areas, and
- people from culturally and linguistically diverse backgrounds.
Those participants who can articulate their circumstances and clearly identify the parameters of their disability in language that the assessors both understand and expect are likely to get a better plan. It is highly likely that these people will be able to navigate the new system and continue to receive better outcomes. Not being fluent in English was reported as a significant barrier to the NDIS according to some of the participants and carers.
The First Disability Network Australia 2013 10-point-plan17 recognised that the vast majority of ATSI people do not self-identify as people with disability. This occurs for a range of reasons including that in traditional language there is no comparable word for disability. It was found that the first priority for ATSI people was having basic needs met such as food, bedding, clothing and basic goods. Participants highlighted the need for a culturally responsive service and a highly trained and skilled staff were acknowledged as being necessary to build relationships and trust There is an assumption that people from ATSI communities will identify that they have a disability and will engage with the NDIS. Whilst people’s basic needs remain unmet this is unlikely to occur. There needs to be recognition that for many ATSI communities significant work is required around the stigma related to disability and building trust and a safe place.
There also remains a poor uptake of the NDIS within CALD communities. The NDIS is not the first priority for new migrants, who are looking for jobs, schooling and accommodation. Better education and information about the NDIS is required for CALD communities. Interpreters need to be engaged at all stages of the NDIS process including appointments with a GP.
The appropriateness of independent assessments for people with particular
disability types, including psychosocial disability.
The Office of the Public Advocate Victoria18 advised that many community mental health services closed as the NDIS was implemented, this was also reported to the Disability Advocate as occurring here in South Australia. Further the episodic nature of mental illness and that mental health treatments are recovery focused makes it difficult to prove permanent functional impairment and difficulty in gaining access to the NDIS.
The NDIS is now close to full scheme in SA, so the hectic transition of participants into the Scheme, either as new applicants or as transfers from State services, is nearly complete. The main remaining cohort is people with psychosocial disability. The Productivity Commission’s estimate of the number of people in SA with a primary
17 ‘Ten Priorities to Address Disability Inequity’, First Peoples Disability Network Australia (Web Page, 2018) <https://fpdn.org.au/ten-priorities-to-address-disability-inequity/>. 18 Office of the Public Advocate, “Decision Time, Activating the rights of adults with cognitive disability”, February 2021.
diagnosis of psychosocial disability is approximately 4,800, based on a national estimate of 64,000. However, it appears from the last NDIA quarterly report (December 2020) that about 2,617 participants with a plan in SA have a primary psychosocial disability. That is only half of expectation and remains a significant gap. Why there has been a slow uptake depends on many factors including referral rates from existing mental health services and the need for assertive approaches to clients who are unwilling or unable to take the initiative to seek participation in the NDIS.
Conclusion
The Public Advocate and Disability Advocate acknowledge the ambitious task of rolling out a national scheme at such a rapid rate. In doing so this has presented challenges for people with disability and their families who formerly had a ‘go to’ person to assist them to navigate the system and coordinate services. With a new and ever evolving scheme presents significant challenges and barriers for the person with disability to access the scheme. The independent assessor is yet another additional player in the process of accessing the scheme. For people newly entering the scheme there is benefit to having an independent assessment as this is one less cost the individual must incur in paying for assessments. For those who are currently in the scheme the independent assessment appears to be some form of economic rationalisation to try to reform an ever growing and costly scheme. The NDIA has made a concerted effort to engage participants in the independent assessment trials and consult around the independent assessment. These engagement activities have however steered away from the fundamental question of the introduction of a new assessment process but the focus has been on aspects of the process.
For those participants who can articulate their circumstances and clearly identify the parameters of their disability in language that the assessors both understand and expect are likely to get a better plan. It is highly likely that these people will be able to navigate the new system and continue to receive better outcomes. The DSS/NDIA Joint Submission19 state people making their own decisions about what supports they obtain and from whom is fundamentally empowering’. This statement demonstrates the NDIA’s lack of understanding of a large percentage of client group they are supporting. Participant and carer fatigue and burnout is a real issue faced by individuals, families and nominees in the ever changing landscape. The introduction of another NDIS representative” unknown” to the participant into the expanding cast of players will only cause more confusion and therefore lack of engagement with the NDIS and their processes.
Bruce Bonahady an architect of the National Disability Insurance Scheme (NDIS) wants the federal government to scrap its overhaul of eligibility testing for the program, saying the changes have spread fear and stress among Australians with disabilities.
19 Department of Social Services, National Disability Insurance Agency, Joint Submission to the Joint Standing Committee on the National Disability Insurance Scheme’s Inquiry into Independent Assessments, March 2021
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