Submission to the Joint Standing Committee on the National Disability Insurance Scheme
I make this submission in my personal capacity, as the family member of a person with a disability.
In summary, I am extremely concerned about the proposed use of ‘independent assessments’ (IAs) because:
- IAs will be relied on as the ‘key input’ for decisions, at the expense of other forms of evidence.
- Assessors will not be genuinely independent.
- IAs are unlikely to be of sufficiently high quality.
- There are alternative options which are more appropriate.
Intention to rely on IAs as the ‘key input’ for decisions
in its November 2020 Information Paper, the Department of Social Services (DSS) has stated that IAs will be ‘the key input used for NDIS access decisions for disability support or early intervention’ and ‘a key input informing the value of a plan budget’. I am very concerned that the DSS proposes that a report written by a stranger after 1-3 hours of contact will be treated as ‘the key input’ for access decisions, and ‘a key input’ for determining plan budgets. This approach by necessity devalues other evidence that a person may offer.
Individuals may hold a large amount of complex information from their treating practitioners, including professional notes and reports prepared over years and documenting a person’s fluctuating capacity and needs in great detail. This is particularly the case for people with complex and/or poorly understood disabilities. Under the proposed changes, this high-quality personal evidence will be devalued compared to a boilerplate IA prepared by a person who may have no experience or knowledge of managing the relevant disability or disabilities.
Automatically valuing an IA over a person’s own medical evidence is:
- unfair to the person,
- insulting to health practitioners’ expertise and professional obligations, and
- a clear decision-making error as outlined in Ray v NDIA [2020] AATA 3452.
Professor Bruce Bonyhady AM has warned against over-reliance on IAs, and described this as a move towards ‘robo-planning’. This approach threatens to undermine the core objective of the NDIS, which is to provide individualised supports.
The NDIA has the ability – and the duty – to properly weigh evidence depending on its actual value. If a health practitioner’s report does not appear to be properly justified, the NDIA does not need to accept its recommendations but currently it must be able to explain why it would favour other evidence. Under the proposed scheme, the NDIA would categorically favor IAs even without a proper basis to do so.
Independent Assessments
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2. Lack of Genuine Independence
It is already challenging to ensure an NDIS plan focuses on individual reasonable and necessary supports. Under the proposed changes, IAs will be prepared by service providers who are engaged by the Australian Government. Service providers will regard the NDIA as their client. They will – without being asked – attempt to deliver IAs which meet the administrative and budgetary needs of the NDIA, rather than assessments focused on an individual’s actual needs.
Service providers seeking the Australian Government’s business will have a strong incentive to churn out IAs which support ‘robo-planning’, understate a person’s support needs, and recommend lower budgets. The DSS has not proposed any specific measures to counterbalance this incentive or to provide assurance that IAs will be rigorous and fair.
For many people with disabilities, having to explain their history and needs to a new health practitioner is extremely stressful even if:
- they know the health practitioner is an expert in their disability or disabilities,
- the engagement is voluntary,
- the practitioner is directly accountable to them, and
- the purpose of the engagement is to build a therapeutic partnership. None of these characteristics are part of the proposed model. The proposed model is much more like an adversarial workers’ compensation assessment process than a genuinely independent evaluation focused on individual needs. The use of IAs is likely to be stressful to the point of being traumatic, as people’s most fundamental needs depend on the outcome and there is no real assurance of quality.
3. Quality Concerns
i do not believe ias will be of sufficient quality to form the ‘key input’ for ndia decisions because of: a. the low likelihood that assessors will be able to establish rapport, b. the lack of any clear plan for providing culturally sensitive assessments, c. the lack of clear proposed qualification requirements for assessors, and d. the proposed reliance on assessment tools.
A. Building trust and rapport is an essential precondition for a high-quality evaluation of that person’s needs. Due to the lack of genuine independence in the proposed model, the fact that iais will be involuntary, and the very short contact times proposed, it is very unlikely that assessors will be able to establish the rapport required to properly assess a person’s needs.
B. Providing culturally sensitive assessments would require serious engagement with Aboriginal and Torres Strait Islander people, and with other culturally and linguistically diverse
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The communities, to establish agreed frameworks and additional resourcing for these assessments. This is not something which can or should be left to service providers to sort out.
c. The proposed qualification requirements are vague, and early reports suggest that some IAs have been prepared by assessors whose professional background is not relevant to the needs of the person being assessed.
d. Professor Bonyhady has noted that despite the DSS’ claims that it is possible to comprehensively assess a person’s needs using assessment tools, there is no set of existing tools which is proven to be fit for this purpose.
4. Alternative options
While there are issues with the accessibility and consistency of the scheme, the DSS’ proposed use of IAs is far more likely to undermine the NDIS than further its purposes.
The DSS has claimed the use of IAs will be justified partly by improving access for people who are not able to obtain assessments privately (due to cost or location). This justification does not explain why IAs should be mandatory. The objective of improving access could alternatively be met by creating Medicare benefits or other rebates for health practitioners to assess individuals (including via telehealth) and prepare reports for NDIA decisions.
The DSS has also claimed that IAs are justified for the sake of consistency, as a single set of assessment tools are proposed to be used. Professor Bonyhady has noted that there is no set of assessment tools with a sufficient evidence base to actually rely on in the proposed manner. If there were such tools, the Australian Government could promote consistency of evidence for NDIA decisions by creating Medicare benefits or other rebates for health practitioners to administer these tools.
i urge the Australian Government to halt its plans for the use of IAs, and to develop alternative options for improving the NDIS through genuine consultation.
Penelope Rumble 31 March 2021