Independent Assessments Submission 300
1. Introduction
Thank you for the opportunity to submit comments on the NDIA proposal to alter the NDIS Act to introduce compulsory functional assessments of all NDIS applicants and all NDIS participants. There is so much one could write. I have tried my very best to limit my response. I would welcome any opportunity to answer questions from Committee members.
2. About me
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I am an NDis participant on my second annual plan.
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I have been a quadriplegic (C6/7 complete lesion) wheelchair user for 37 years after a swimming accident caused irreversible and incurable spinal cord damage.
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I am currently Chief Executive Officer of 2 Ndis registered non-government, charitable disability support providers based in Canberra. Community Connections Inc., supports over 200 NDIS participants by providing intermediary services (support coordination and / or plan management). My Choice My Support Inc., provides direct at-home, personal care and community participation supports through a hosted support worker, self-rostering platform managed by over 60 participants. The two organisations are legally separate and wholly independent of one another operationally. Across both organizations we employ over 80 people.
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I was – for almost 2 years between October 2012 and July 2014 – Executive Branch Manager of the National Disability Insurance Scheme Transition Agency responsible for Communications and Engagement. Among many other responsibilities our Branch was responsible for preparations for the launch of the NDIs by Prime Minister Kevin Rudd on 1 July 2013, the formal opening by Prime Minister Tony Abbott of the interim Head Office of the NDIA in 2014, the design and content of the first iteration of the NDis web site, and extensive stakeholder engagement (including co-design activity) leading up to and following the launch of the NDIS.
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I currently Chair the ACT Government’s disability advisory body (the DRG) and Co-Chair of the ACT Governments Disability Justice Strategy Reference Group.
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Finally (for transparency’s sake) I have been an active and vocal member of the Every Australian Counts campaign, including a period employed by National Disability Services to help support and develop this non-government lobbying alliance between people with disability, carers and disability support providers which was instrumental in persuading the Parliament of Australia to approve unanimously the Ndis Act in 2013.
3. My views on the NDIA’s proposals for so-called independent assessments
- I support the joint statement endorsed by over 100 local, state and national disability sector organisations representing people with disability, carers and non-government disability service providers across Australia.
The full statement is available here: https://everyaustraliancounts.com/au/ndis-sector-statement/ (Again, for transparency’s sake, I played no part in drafting the statement. I simply agree with it 100%).
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I agree with media statements attributed to Professor Bruce Bonyhady (inaugural Chair of the NDIA Board), including:
‘It is disturbing that the NDIA intends to replace the current planning process with an almost total reliance on independent assessments”.
The proposal “puts people in boxes before they have had a chance to outline what they would like to achieve or the ways in which they hope their lives change.”
And. “it is clear that the [proposal] has created enormous fear, stress and concern amongst NDIS participants, their families and carers”.
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I agree the statement attributed to David Bowen PSM (inaugural CEO of the NDIA) that the proposal appears to be “a way of controlling the amount of funds that go into each plan, through determining that plan value through an assessment tool, rather than through a personalised plan.
The Tune Review (Recommendation 7) proposal – that there should be a discretionary power in the NDIS Act, implemented through an open panel of accredited assessors – is the polar opposite of the NDIA proposal of a legislated, compulsory process implemented through a closed panel of approved providers.
Drawing on my own experiences as an NDIS participant:
o I submitted a valid functional capacity assessment to become an NDIS participant
when I made my access request. I used a form supplied by the NDIA. It was
accepted. Both me and the NDIA already know I am a C6 quadriplegic.
o My access request went beyond diagnosis. It outlined all functional capacity
limitations the NDIA needed to know to build my first plan and funds.
I am paralysed in all for limbs and, therefore, need mobility aids and
personal care.
I am incontinent in both bladder and bowel and, therefore, need support
from others trained (among other things) in “complex bowel care”.
I have severely limited sensation throughout my body so need attention
to skin care to prevent pressure sores.
I need reasonable adjustments at work (where I am a CEO) and at home
(through minor and major home modifications).
I have lived a sedentary life for over 36 years in a wheelchair and I am,
as a result, moderately overweight.
o That short list of my functional capacity is more than a Committee of MPs needs
the NDIS Act. Use the power case by case rather than as a blunt tool for everyone.
It did not require and will not require again a so-called independent but
action for breach of confidence.
If my needs change in the future I can request an NDIS plan review (which
to know but less than the NDIA already knows. But I have a point.
It did not require and will not require again a so-called independent but
actually compulsory functional capacity assessment to give this and other
functional capacity information to the NDIA. To require it of me again
would be wasteful of scarce taxpayers’ dollars that ought to go to service
provision. Multiply that observation 432,000 times.
Even if the compulsory functional capacity assessment yielded any
advisory services or professional advice provided under s17(8) - legal privilege.
Independent Assessments
Submission 300
The NDIA already possesses (and it wouldn’t) that’s not what the NDIS actually needs to consider. For example:
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The NDIA knows I cannot walk. We don’t need another capacity assessment. We require a detail needs assessment, e.g., manual or powered wheelchair? Which particular wheelchair cushion out of the thousands of possibilities — literally thousands – should Dougie sit on every day of his 36 years in a wheelchair because he has no sensation, he risks pressure sores, but no two quadriplegics’ bottoms behave in the same way. A three-hour functional capacity assessment has nothing to add to say about that individualised need requiring a tailored solution.
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It is exactly the same for specific support needs in other areas – bowel care (and trained, qualified staff), vehicle and home modifications, exercise physiology. We already know my functional limitations; What the NDIA delegate needs is independent (from me, from providers, from equipment suppliers) specialist advice and expertise about best fit solutions to this particular NDIS Participant’s reasonable and necessary supports. Multiply that challenge by 432,000 also.
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Not every NDIS participant has as comparatively straightforward but nevertheless severe and profound (to use Australian Bureau of Statistics terminology) disabling conditions as people with spinal cord injury. That’s why the Tune Review was correct to recommend a discretionary power to require – on a case-by-case basis – sensitively implemented assessments.
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The NDIA is either taking a sledgehammer to crack an assessment process nut (and the NDIS has no need for sledgehammers) or the NDIA intends to use the compulsory assessment regime for some other purpose that is more likely to be related to the organisational anxieties of the NDIA and its quarterly reports on sustainability than it is to be focused on half a million people with disability.
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If it is a cost-cutting tool, I’d respect the NDIA more if it simply said so.
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4. The Tune Review, independence (or not) & NDIA disregard of “discretionary”
- I reject the NDIA’s spurious assertion that its proposed compulsory assessments meet any definition of the word, “independent”.
o They will be mandated by legislation (unless Parliament accepts Recommendation 7 of the Tune Review that a “discretionary” power be enacted).
o The assessment process, its outsourced and sub-contracted providers, and the results of the process (the assessment reports) will be controlled, paid for and the results wholly owned by the purchaser (the NDIA). Nothing independent there.
o In contravention of the principles of the NDIS Act (2013) and ignoring the Tune Review’s reminder that the objectives of the Act seek to “maximise a participant’s ability to exercise choice and control over the disability supports they need to achieve their goals and aspirations“ (Tune, page 63), participants will have no right to read or receive an assessment report before it is submitted by the sub-contracted assessor to the NDIA (which is buying the report).
o Contrary to recommendations in the Tune Review report:
The NDIA has unilaterally chosen a “closed or deliberatively limited panel of providers to undertake functional capacity assessments” (see Tune, page 67).
The NDIA proposes a compulsory assessment regime for all NDIS applicants and all 432,000 existing participants in direct opposition to Tune’s view that,
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the NDIA should be given a “discretionary” power, and that,
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the NDIA “will need to develop clear operational guidelines for decision makers in exercising this discretion”. (Tune, page 67)
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assessments should focus not on every single NDIS participant but on “every person with disability who would like to test their access for the NDIS or who require further evidence to support decision-making about the supports in their plan” (Tune, page 65). The NDIA fundamentally misunderstand or chooses deliberately to ignore the distinction between everyone (a one size fits all approach long-discredited in human services planning and implementation) and those (a smaller number than everyone)
Independent Assessments
Submission 300
The NDIA demonstrably failed (time and again over a lengthy period) to take the advice of the Tune Review that the change to a discretionary regime of individualised assessments furthering participant choice and control should follow “extensive consultation with participants, the disability sector, service providers and the NDIA workforce” (Tune, page 66). The NDIA has resisted all appeals to consult and co-design.
The NDIA simply ignores Tune Review Section 4:34, particularly subsections b) a right to challenge the results of an assessment, c) co-design with “appropriate disability representative organisations”—an approach the 100+ signatories to the national statement indicate was conspicuous by its absence—and d) access to clear and accessible information” (Tune, page 66). There couldn’t be a more tortuous, Orwellian doublespeak.
5. The NDIA’s great fiction it is doing only what the PC Report suggested
Despite the claims of the NDIA (in its submission to the Joint Standing Committee) and through its selective but partial quotes from the 2011 Productivity Commission report on the NDIS, the PC – like Tune – did not recommend or propose any compulsory, outsourced, restricted panel assessment regime such as is now advanced by the NDIA. The opposite is true.
o Page 4 of the DSS / NDIA Submission quotes the PC Report: >“individually tailored supports based on the same assessment process, certainty of funding based on need, genuine choice over how their needs were met {including choice of provider}”.
o The NDIA submission does not advise the Committee that the NDIA’s own specification of work … directly contradicts the connection to the PC Report implied above when the Tender states: [Assessment] Panel Services do not include providing recommendations on the support needs of Participants or Prospective Participants, or providing any clinical or other professional advice to Participants or Prospective Participants“. (Tender reference number 1000724626, section 1.7, page 4)
o Either the PC Report direct link and guidance between assessments and tailored supports is correct or the NDIA Tender prohibiting such direct links and guidance
Independent Assessments
Submission 300 is correct. They are, however, mutually exclusive; not both true at the same time in the same universe.
The NDIA submission wants its readers to believe that the NDIA is only following orders (so to speak) from that most authoritative text, the two volume 1,100 page report on the NDIS. The Agency is being ‘economical with the truth’ to quote Robert Armstrong, former Cabinet Secretary to Margaret Thatcher.
- In Section 7.2 of the PC Report the Commissioners asked, “What is being assessed?”
- The DSS / NDIA and even Tune Review answered, “functional capacity”.
- In fact, the PC Report said the following matters should be considered and assessed if/when appropriate tools could be developed:
- Reasonable needs (page 306)
- Normative need (page 307)
- Comparative need (page 307)
- Felt need (page 307)
- Expressed need (page 307)
- Aspirations (page 308)
- Aspects of life (page 309)
- Knowledge, community and social participation (page 311)
No such silver bullet tool exists even today. If it did, we’d all be using it already. My day job would be much easier. But real life is more complex.
No ‘three-hour’ tick box questionnaire seeking answers to NDIA questions about functional capacity – does he take sugar? Can you make a cup of tea? Do you need assistance to have sex (of an unspecified type)? – comes close to the PC Report articulation of complexity in the lives of individual human beings who happen to be NDIS participants.
The tender document says differently (i.e., no direct link to funded needs).
Independent Assessments
Submission 300
The NDIS website states, ”Independent assessments provide you and the NDIS with an understanding of your functional capacity.” Except applicants and participants will have no right to read or receive reports.
pages 314 and 315 of the PC Reports note that there can be “extensive overlap” between the NDIS and other mainstream agencies when it comes to information about people with disability. The PC refers to three examples that “Illustrate” (PC Report emphasis, not mine) ways in which information could be required as part of an assessment process (not an assessment event).
- NDIA doers everything
- NDIA acts as a referral agency out to other mainstream services
- NDIS and other agencies share existing information to which other information could be added (if necessary).
the crucial point here is that the pc report did not recommend any single course action (as the DSS / NDIA submission asks us to believe).
the pc report in fact recommended a multiplicity of approaches,
“The NDIA and mainstream providers should identify opportunities to employ these and other models for information sharing”. (Page 315).
the ndia submission omits that subtle but important distinction between one public service Agency to rule them all and joined up government (which is always more responsive).
The unstated and unwritten inference by the NDIA is that the proposed regime of compulsory assessments is a natural development, an inevitable outcome of Chapter 7