Parent of a young adult with a disability, wish to remain anonymous, thank you.

Submission to Joint Inquiry into Independent Assessment

Introduction

Thank you for the opportunity to respond. I am a mother of an 18 year old young man with Autism and AOHO. We have been in the NDIs since 2017. We have had two scheduled reviews and one internal review.

Will Parliament act to prevent the rushed passing of legislation that will see the Independent Assessment given funding powers?

The wonderfully empowering Scheme is at risk of being systematically destroyed.

Many friends have not bothered to access the Ndis for their kids - they look at us in the Scheme and decide their lives cannot take the extra stress and anger and distress at the incompetence, distain, and suspicion we encounter every year from our local office. Many friends who are on the Scheme just accept what ever they are given as the fight has been knocked out of them. Those who have financial means use their own personal funds and don’t rely on the capriciousness of the Agency who is not delivering the Scheme the way it was intended.

Parliamentarians do not know that most of us have not met or spoken with a NOIA Planner, nor are we entitled to, despite requesting direct contact. It is another way we are kept at arms length and deliberately kept uninformed.

Independent Assessments are the NOAA’s tool to ensure more control of the NDIS budget and fulfil the mission of financial sustainability whilst proclaiming to be in the best interests of the people with disability for whom the Scheme was designed to serve. The NOAA’s proposed changes to the legislation surgically removes the heart of the Scheme: the participant’s goals. Currently the goals are centre around which the funding is built. The NOAA wants the IA to be the centre around which the funding is legally determined. The new draft legislation that was leaked to the media on the 27 March 2021 was foretold here:

The new Planning Policy..starting in late 2021 .. will progressively apply to all participants in line with the gradual rol/out of independent assessments and subject to the passage of legislative amendments

Planning Policy for Personalised Budgets and Plan Flexibility. Ndis Consultation Paper November 2020 (page 4)

The NOAA is hurling a spanner in the mechanics of the most innovative and leading world class social and economic initiative for the human rights of the people with disability in the world. Remember how the NOIS was launched - let us preserve this:

It is therefore no surprise that the NDIS is described as ‘ground-breaking’ and a ‘once-in- many-generation reform’. NDIS Costs Productivity Commission Study Report 201

NDIS Consultation Paper: Planning Policy for Personalised Budgets and Plan Flexibility November 2020

Points raised here are in the category a. Development, modelling, reasons and justification for the introduction of the IA into the NDIA g. The implications of the IA for NDIS planning, including decisions related to funding reasonable and necessary supports i. Opportunities to review or challenge the outcomes of IA

“Personalised budgets” (heading)

1. At the moment under the current Legislation, the plan budget is built around the goals of the participant and what is reasonable and necessary to achieve those goals. This is as personalised as it can be.

2. What is being proposed is that new legislation be passed so that the plan budget be determined by functional levels decided by Independent Assessment (IA). This is not personalised at all.

3. Goals will be secondary and limited to whatever the participant can afford from the assigned budget.

“This policy w/11 enable us to provide greater plan flexibility” (page 5)

4. There is greater plan flexibility being proposed but look how easily flexibility was granted during the COVID lockdown (eg instantly being granted permission to buy assistive technology like iPads to access Zoom or access support coordination without having a plan review); so the NOIA has demonstrated that it has the power and autonomy at any time to increase flexibility as a stand alone change if it has the desire or will power to do this.

5. If the NOIA wanted to it could make the whole plan budget flexible. The NOIA is not beholden on a “policy of IA informing a participants reasonable and necessary level of funding” in order to increase plan flexibility.

“with funds released at Intervals” (page 5)

6. In complete to opposition to the premise of flexibility.

“.. evidence exists that the current approach to assessing a persons’ functional capacity Is leading to Inconsistent and Inequitable plan budgeting decisions” (page 6)

7. What exactly is the “current approach to assessing functional capacity”? This should be explained as part of this consultation paper and all the “evidence “associated with it. If the NOIA already have a system that they use that they want to change, are asking for public consultation and lobbying for a change in legislation, then they should qualify this statement with all the relevant information.

8. I had no idea the NOIA had assigned my son a functional capacity or level of function.

Should the NOIA as part of ethics or the privacy act asked us to provide our consent for the information to be used in this way? Should we be informed a) that they have assigned him a level b) what the criteria is being used and what part of reports provided have been uscd c) what funding level that it equates to. Why is this sort of information being withheld from the participants and their families? The NOIA have asked us for input on these consultation paper and how can we truly comment when we have been in the dark about “current approach to assessing a persons’ functional capacity”.

a) In the NDIS Quarterly Reports:

Figure E.38 Average committed support by level of function (including participants with Supported Independent Living supports) - active participants with initial plan approvals as at 2020-21 Q2 compared with active participants with initial plan approvals as at 2020-21 Q1 - National

b) From: McKinsey&Company: Independent Pricing Review NDIS February 2018 (Page 99)

Participants are streamed into four categories - General, Supported, Intensive, and Super Intensive, with the greater the intensity the more time/effort required to be sspent on participant.

e As participants progress to the planning phase, they are assessed using a Disability Severity Indicator, which measures of the impact of the disability on the participant’s day-to-day life, to determine their level of functional impairment. The level ofunctional impairment, together with to the participant’s age and location, arc used to dctermine the level of funding a participant receives. Participants are allocated a rating between 1-15 describing thcir lcvcl of functional impairmcnt, as follows: 1-5 Low levcl of disabilitv-high functiona! capacity; 6-10 Medium functional capacitv; (11-15) High lcvel of disability-low functional capacity.

Independent Assessments

Submission 261

The information I have only discovered. "Fair budgets.. (dellvered by).. hollstic Independent assessment to Inform a participant’s reasonable and necessary level of funding\

understanding of his therapeutic history. Accordingly, the Tribunal is not prepared to dismiss Ms Cohen’s and Ms Greiner’s recommendations for the reasons contended by the NOIA, in preference for Ms Parsons’ recommendations.

“ .. one standard way to provide evidence on the Impact of a person’s dlsablllty or dlsabllltles .. Independent assessments wlll provide this consistency (page 6)

15. The NOIA will continue to show poor governance forcing an IA standardised test administered by a therapist unknown the participant over some hours. We will have no choice.

16. Ray and National Disability Insurance Agency [2020] AATA 3452 (8 September 2020) the Tribunal determined that a therapist who is known to the person and has seen the person over a many of hours was more reliable than a therapist who is unknown to the person and has only seen them once for a few hours. This describes an Independent Assessment!

Ray and National Disability Insurance Agency [2020] AATA 3452 (8 September 2020)

   78. The Tribunal considers the observations made by Ms Barry are more reliable
   than those made by Occupational Therapist X, as Ms Barry has seen Mrs Ray on
  approximately 50 to 60 occasions, including out of the comfort and familiarity of her
 home environment, whereas Occupational Therapist X had only seen Mrs Ray once
    for a period of three hours in her home environment...

   103. Again, the health professionals who have treated MrsRay seem to hold a very
    different opinion from Occupational Therapist X in respect of Mrs Ray's capacity to
   learn new things.

15. The NOIA ask for yearly reports for each plan review to justify supports purchased.

McKinsey&Company: Independent Pricing Review NDIS February 2018

  The NOIA has set the expectation that providers are required to develop progress
   reports for participants, the Price Guide states 'Therapists will be expected to
  provide progress reports to the participant and NDIS at agreed times'. (Page 85)

16. Our son has had 5 functional assessments over 4 years: one for access (which we paid for) and three as routine part of reports to the NOIA (OT and Psychology). One extra functional assessment in 2020 was part of a Planner’s triumphant specific conditional request even though she knew IA were coming in 2021. So my son will have to have another one this year as the new IA are rolled out. The reports already in the system already accurately describe his functional level each by a different therapist. They concur. He does not need another one. Why doesn’t the NOIA use current or submitted reports?

17. The NOIA said that “sympathetic bias” was the reason they don’t trust reports from our therapists that ironically they themselves insist on the therapists submitting. This seems an insult to the professionals who write these reports, From 460,000 participants there must

Independent Assessments

Submission 261

be millions of reports generated over the 8 years of the Scheme which the NDIA has decided not to trust or use. Which is a big waste of money especially when the AAT has ruled that these are more reliable.

The IA will also be conducted by one of three types of allied health: speech, occupational therapy or psychology as a stand alone assessment, without reference to prior previous reports and without consultation with a second therapist. The participant will chose. However, there is still the flaw that each has training in one field and will only be truly reliable in the assessment of any domains in that field. The IA will cover areas in in which the allied health professional is not trained but will be expected to make an expert judgement.

Ray and National Disability Insurance Agency [2020] AATA 3452 (8 September 2020)

107. As indicated above, the Tribunal considers Ms Barry’s evidence about her observations in respect of Mrs Ray to be more reliable than those of Occupational Therapist X, given that Ms Barry has seen Mrs Ray approximately 50 to 60 times in total and Occupational Therapist X has seen Mrs Ray on only one occasion. The Tribunal also considers that Ms Berry’s qualifications as a psychologist would better enable her to assess Mrs Ray’s learning capacity, than the qualifications of an orth occupational therapist which are held by Occupational Therapist X.

The NOIA shows poor stewardship by disregarding the Tribunal’s merits review. The Tribunal contributes to broader goals of maintaining high quality government decision- making and accountability. These judgements seem to be ignored, disputed or disregarded by the NDIOA. In my mind this makes the NDIANO untrustworthy.

The Tribunal’s decisions provide guidance to decision-makers more generally in elation relation to the interpretation of law and policy for decisions that it reviews. The Tribunal’s decision in one matter can be applied to future decision-making in the same area. While the Tribunal’s interpretations of legislation are not binding on decision-makers in the same way that court decisions must be followed, the Tribunals Tribunals decisions are persuasive.

The Administrative Appeals Tribunal - Its Role in the Regulation of the Insurance Industry https:llwww.aat.gov.aulabout-the-aatlengagementlspeeches-and-oaperslthe-honourable- jus justice-garry-downes-am-former-preslthe-administrative-appeals-tribunal-its-role-in-th

21. The NOIA goes as far as assigning the Independent Assessor a contractor status so in order that the functional level decided by the IA is not a reviewable decision by the NOIDOA .

22. If by a change of legislation the IA determines the supports or plan budget then the AAT has limited scope to find in favour of the participant. The participant has no avenue to appeal the function level or the budget either at the NDIOA or and very little traction at the AAT level. How can the NDIANO be allowed to stack the cards in its favour so that there is so little procedural fairness for the participant?

Independent Assessments

Submission 261

“Where the total reasonable and necessary level of funding may no longer be\sufficlent…a new Independent assessment wlll be required” (page22)

22. This clause will not help many participants. It assumes that more funding is needed because of a change in functional capacity. It says to the participant “prove you are more disabled to get more funding”.

“Where an Independent assessment shows an Improvement In functional capacity,\ this may lead to a reduction In the level of funding” (page 23)

23. Reducing a level of funding which has resulted in the improvement may result in function declining, in which the participant is ultimate loser.

24. The NDIS also hope to exit participants from the scheme based on the IA.

NDIS Costs Productivity Commission Issues Paper Response (Jaqueline Pierce and Associates 2017)

Scheme exit if highly improbable (page 1)

25. The Government and the NOIA may justify this drastic change to the NDIS and the NOIA Legislation because at this point the NDIS is ‘mature’. This was not the opinion of the company the NDIS commissioned in their pricing review two years ago.

Mckinsey&Company: Independent Pricing Review NDIS February 2018\https://www.ndis .gov. au/providers/price-g u ides-and-pricing/independent-pricing-review

Once the NDIS reaches maturity, it is intended that the market itself will set the price of supports. (Page 3) The NDIS is too young and the available data too incomplete to make a definitive assessment.. (page 58)

26. The NDIS infer that the Scheme is imminently under threat of being financially unsustainable, which is untrue. The NDIS received advice that the Scheme is financially sustainable.\nMckinsey&Company: Independent Pricing Review NDIS February 2018

Beyond the next 24 months, the IPR team believe it is possible to implement the IPR recommendations and manage the Scheme so that it is financially sustainable and within the current budget estimates. (Page 94)

The test of whether the price caps set by the NOIA are adequate is whether participants can access the quality supports and services required to achieve their goals. (Page 6)

25. The news reports suggest that current participants are paying for reports out of their own pockets which is untrue; reports are borne as a cost to the Scheme.

26. The cost of these routine yearly reports are affordable according to the accounting report:

McKinsey&Company: Independent Pricing Review NDIS February 2018

  The impact on participants of allowing therapists to be reimbursed for the
  development of ND/A-required progress reports is expected to be small, as it should
  occur no more than once or twice a year. (Page 86)

27. The total cost of implementing the IA has not been revealed so we are not sure of the amount of this added cost to running the Scheme. This should be disclosed as a point of transparency.

28. AAT also ruled that multiple choice questions with yes or no were not nuanced enough for the complexity that makes up disability. This was echoed in the

Progress report Joint standing committee on NOIA 2019 Other issues raised … 12.93 The accuracy of disability assessments involving multiple-choice questionnaires.

Inequality: 11Participants in the highest socio-economic cohorts are receiving more funds in their plans than those who are disadvantaged.. payments are 23% higher..for children .. and 13% higher for adults“ (page 6)

In the media the Hon Stuart Roberts said that richer suburbs got more money and the postcode of the participant decided the plan budget.

These are the figures released to the ministers: Plan budgets will be fairer regardless of socio-economic area; currently both plan budgets and payments differ depending on where a participant lives, with participants in higher socio-economic areas receiving average plan budgets that are nine per cent higher than participants in the lower socio-economic areas (see Figure 1). (Page 9)

https://www.ndis.gov.au/about-us/publications/quarterly-reports Report to disability ministers for Q2 ofY8

30. There is more analysis needed on this point:

• The ministers are told 9%, the public are told 23% and 13%.

• Are plans in the “wealthier” areas actually at a reasonable level of funding for the mix of participants and the supports they receive? i.e. is it fair for their funding to decrease because of their postcode?

Participant Service Charter and Participant Service Improvement Plan

Figure 1: Average annualised plan budgets by the ABS Index of Education and Occupation
(IEO) deciles, for non-SIL participants aged 0-64 - 31 December 2020
"""----UI041>0   60,000
+'N
     GI           0                                                                                         57,600             IC1I        N
  -a   ...
                  :::II  GI                                                                                 55,600      .0 .0
  C E                                              53,900          54 000  54,5oo      _g  GI            52,900  53,200   53,100  53, 200           53,300           '          Cl. u
     ,:s  GI
     GI Q
     UI .-1  50,000       =t'f'I
  C    IC1I
  c:::II ._C
 C  ,:s
 C C
    GI  GI
         IC1I  ...
    ._C CGI
    GI >.

~ GI .c +’ 40,000 1 2 3 4 5 6 7 8 9 10 Socio-economic decile ■0-64 (1 being the lowest socio-economic decile and 10 being the highest socio-economic decile).

• Are the “poorer” suburbs entitled to this bigger level of funding as well? i.e. should the value of the plans in those “poorer” suburbs increase in line with those in more well off suburbs? • Has the NOIA looked into the disparity of service provision? i.e. even with more funding those in poorer suburbs may not be able access equal supports. There should be more done to equalise the opportunities in those suburbs. • At present the Planner holds the key to the value of each plan. Has the NOIA looked into the performance of each LGA NOIA Planning Office? Each regional office approves the plans for their local jurisdiction, so is there a pattern between post codes? Maybe the NOIA offices in the poorer areas reach their target KPl’s for lower value plans to a greater degree. Maybe the offices in the “’richer” areas are more generous. The public are not privy to these KP l’s. • What has the NOIA done about Planner education and inconsistency which has been noted in previous Parliamentary Inquiries? • Has the NOIA given figures on which suburbs ask for internal plan reviews? It has been noted that internal reviews and AAT reviews often award participants with more generous plans. Maybe the “poorer” suburbs need education on when and how to ask for a review.

Independent assessments w/11 provide participants with a clear understanding of

what’s needed“ (page 9)

31. How on earth will IA give the participant a clear understanding of what’s needed? What are they talking about? Reading the submissions of those who have had an IA, the IA has nothing to do with helping a participant understand anything about what they eed. The participant is trying to help the assessor and therefore the Planner have a clear idea of what is needed (which they would know already if they read the submitted eports).

The IA is conducted by a contractor and only NOIA employed delegates can have their decisions reviewed. The IA result will not be able to be reviewed.

The NOIA has rejected the proposal that an IA may not be accurate so once it is completed it is not revisited, revised or corrected.

Regardless of whatever other ancillary decision the Planner makes (which can be eviewed) the whole basis for the dollar value in the plan will be based on the IA (which cannot be reviewed). The participant has had their power of appeal severely curtailed.

Independent Assessments wlll ensure participants get the right funding In their plan based on their functional capacity, support needs and goals. (Page 9)

32. This is misleading. IA only establish function. They do not assess what support is eeded to achieve goals because they have no link to goals at all.

e·g two participants at the same functional level may differ in their choice of employment supports: one person has a micro-enterprise and requires 1 :1 support for 24 hours a week, another person attends a programme that has a 1 :3 ratio of support for 24 hours a week.

There is no guarantee that the Planner will give the first participant the extra funding. Once the goals and reasonable and necessary supports are removed from legislation, will here be any basis for asking for a review? The change in legislation to feature IA as aasis of funding will remove the power from the participant and give it to the NDIA.

The conclusion:

We need better communication, accurate information and more transparency

Progress report Joint standing committee on N/D/A 2019

3. 35 In its 2017 Progress Report as well as other inquiries, the committee received much evidence around poor N/D/A communication and engagement with inquirers. In previous inquiries, submitters raised issues around the lack of of clarity, consistency and accuracy of information provided by the N/D/A;

Real work on the problems already identified in past Joint Parliamentary Inquiries

The committee recognizes that participants, their advocates, disability advocacy organizations and providers may experience inquiry fatigue, with Every Australian Counts summing up the position of many:

We are all trapped in some version of NDIS Groundhog Day where we keep identifying the same problems and potential solutions.. What is missing is action

A preserved separate budget for the NDIS.

Hope for the future: please preserve the NDIS and our voice!

No machine-readable text was extracted from this page.