Response to Joint Standing Committee on the NDis Independent Assessments

31 March 2021

Committee Secretary Joint Standing Committee on the National Disability Insurance Scheme Independent Assessments PO Box 6100 Parliament House Canberra ACT 2600

to whom it may concern

Please note that I wish for my submission to remain anonymous, as I fear retaliation due to the nature of my employment.

Thank you for providing this opportunity to provide comments relating to Independent Assessments.

I am a person with multiple comorbid disabilities. I have relevant tertiary qualifications, have worked in the human services field for a number of years, and am an NDIS participant myself. My comments are my own and do not represent those of my employer, nor do they prevent me from completing the duties required of me by my employer. I decline to identify ymysel here in order to make this very clear to both the Joint Standing Committee, and anone associated with my employer who may read this submission.

With regards to the terms of reference, within the scope of my capacity to comment:

a. the development, modelling, reasons and justifications for the introduction of in dependent assessments into the NDis;

The Senior leadership at the NDIA have consistently ignored, overlooked and dismissed any criticism of the Independent Assessments (IAs), including those of countless p participants, the original NDIA CEO, Bruce Bonyhady, the Commonwealth Ombudsman, and over twenty peak bodies. They consistently dismiss the valid fears people with disability (PwD) have regarding their implementation, utility and efficacy. It is true that the Productivity Commission suggested Independent Assessments as early as 2011. However, the Productivity Commission also talked about the concerns PwD would have regarding IAs, and recommended co-design - I note that the leaked legislation removes all references to co-design.

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It is evident that the Senior leadership at the NDIA are thoroughly disinterested in

enabling PwD to be equal partners in this process, and are reinterpreting and

misinterpreting both this and recommendations in the Tune Review to suit a cost-cutting

(“scheme sustainability”) agenda. This is evident in the misuse of, and redesign of

clinical assessment tools such as the WHODAS and PEDI-CAT, which were never

designed to be used to assist in funding decisions, excluding the tools that were

recommended by the Productivity Commission, and the glaringly obvious lack of PwD at

Senior levels of NDIA leadership.

There have been zero disabled people on the NDIA Board since August 2020. There has

been plenty of time to rectify this, and it has not happened. If there were zero women on

a Women’s Services Board, there would be widespread outrage. But evidently the Senior

leadership and the CEO are disinterested in giving PwD any voice at the table, let alone

an equal or senior one.

    d. the independence, qualifications, training, expertise and quality assurance of
   
   assessors;

It is difficult enough for Scheme participants to access allied health services in the first

place. Occupational Therapists in particular have lengthy waiting lists, my understanding

is that even in densely populated areas of capital cities most providers have 4-6+ week

waiting lists, even longer rurally. It could be argued that siphoning these professionals

into gatekeeping roles, as opposed to therapeutic and capacity building ones, will either

have a negative effect on these wait times, or only newly graduated or inexperienced

allied health professionals will be attracted to assessor roles, which defeats the purpose

and raises questions as to the appropriateness of the IAs.

    e. the appropriateness of the assessment tools selected for use in independent
  
  assessments to determine plan funding;

Please refer to my previous comments in Part A. The tools being used are specifically

invalid for use in funding decisions or calculations. This has been deliberately ignored.

g. the implications of independent assessments for NDIS planning, including

decisions related to funding reasonable and necessary supports; The implications are devastating. It was indicated to me in one forum that the IAs and funding calculations will be “adjusted” to reflect the statistic at participants spend, on average, 70% of their plan budgets. I interpret “adjusted” to mean “reduced” in this instance. It is evident that instead of investigating and working to address the barriers participants face in using their NDIS plans, such as the lack of providers in rural and regional areas, barriers experienced in obtaining culturally appropriate services, skills shortages, and the confusing rules and regulations that participants don’t necessarily understand without adequate support, the NDIA Senior leadership are more interested in cost-cutting. I fear that this will, in particular, affect participants with psychosocial disability, who are culturally or geographically isolated, or who do not have proactive informal supports.

The proposed removal of s34 of the NDIS Act 2013 and the term “reasonable and necessary” is also disturbing to many of us. These cookie-cutter “one size fits all” assessments cannot possibly encompass every individual’s unique circumstances, and are at the discretion and interpretation of the assessor. My needs as a PwD are very different to someone else with the same functional capacity or disability, due to a number of factors including- my own personal goals, what informal supports I have, my personal identity (including gender, age, race, culture and sexuality), and my personal preferences and lifestyle choices.

I will give an example from my own lived experience. As part of my NDIS plan, I paid for and use a shower chair and low cost assistive technology for personal care. However, an assessor would probably tick a box indicating that I can shower or bathe myself without assistance of another person, as I can theoretically do this- albeit at significant risk of falling on wet floors, fainting under hot water due to the effects my conditions have on my body’s ability to regulate temperature, the tremors in my hands and numbness in my feet, and dyspraxia. An assessor would possibly also state that I do not need help with bowel care, yet I do experience both constipation and incontinence, and my disability

• makes handling my menstrual hygiene incredibly difficult. The tools proposed do not

• acknowledge the nuances I have described here.

• I do not see any evidence that the IAs consider the roles of informal supports, or the

• wishes, aspirations, goals and future needs of participants in either their process or

• application to funding decisions.

h. the circumstances in which a person may not be required to complete an independent assessment;

This is the part that raises the most ire for me individually.

To access the Scheme, I had to prove that my conditions were, or were likely to be, lifelong. I should not have to do so again. To force participants to undertake invasive and intensive assessments with complete strangers, and to threaten to withdraw all support if they do not, is a form of administrative violence. We are not performing monkeys, and should not have to disclose over and over again. It is a source of trauma and a trigger for many of us, and is paternalism at its worst. A person must not be required to complete an IA where they are already a participant.

i. opportunities to review or challenge the outcomes of independent assessments;

It appears that there are no opportunities to challenge the result of an IA, as it in itself is not touted as a reviewable decision. This needs to be addressed and changed.

k. the appropriateness of independent assessments for people with particular disability types, including psychosocial disability;

I see no evidence that the IAs are suitable for people with a psychosocial disability. I also see no evidence that the IAs consider the episodic nature of psychosocial disability, although I do note that the leaked revised version of the Act acknowledges that such disabilities can be episodic. I see no evidence that the IA process is trauma-informed, person-centred, or considers the ways in which top-down assessment models can be exhausting, triggering and a major source of anxiety for people with psychosocial

• disability. It appears that Senior leadership at the NDIA do not care about this at all, and

are determined to proceed regardless of this.

The Scheme was never appropriately designed for people with psychosocial disability. The introduction of compulsory IAs would undermine the good work the NDIA has done to address this, and to introduce the psychosocial pathway.

         l. any other related matters

I repeat here my statement that IAs, where made compulsory, constitute a form of administrative violence. Administrative violence is a key mechanism through which structural inequality is reproduced entirely legally. As a PwD, I am constantly expected to disclose and explain my need for supports over and over again. Through this legal reproduction of structural inequality, thus cast PwD “become and remain the problem” for a government that is determined to cut costs as much as possible, and whose Ministers have openly described PwD as a “burden” on society and the economy.

I dispute the claim that allowing participants and applicants to provide their own evidence leads to “sympathy bias”. Every allied health professional registered with a professional body knows in their applicable code of ethics that they have the responsibility to use funding appropriately, to not over-service or over-quote, and to ensure that their services are fit-for-purpose and do not overstep their level of qualification or experience. Sympathy bias itself is a poorly referenced and misapplied term in the Tune Review, which cites a single academic source for the term- published nearly ten years ago in 2011. The NDIA does not provide clear guidance and templates for functional capacity assessments in the way that it does assistive technology.

Perhaps this would be a better place to start.

I reject IAs in all forms. There is little doubt that the Scheme needs some reform. This proposed IA process is not one of them.

Thank you for considering my submission.