Senate Inquiry into NDIS Independent Assessments
The committee’s role to inquire into the implementation, performance, 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 in dependent 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 NDIA; 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
Submission from Rena O’Sullivan and Neville Horner
Rena O’ Sullivan is a social worker who before recent retirement used to work for the who provides services for disabled generally younger people. Neville Horner is guardian for his brother, Mark Horner. Mark sustained an Acquired Brain Injury as a result of a motor vehicle accident whilst he was aged 20. For the 36 years since then, Mark has been receiving government funded disability support. For the last 3 years this has been provided by NDIS, itially the WA NIDS scheme and now the national NDIS scheme. For the last 6 years since Mark and Neville’s mother passed away, Neville has been managing support for Mark.
Summary
We are strongly opposed to the use of independent assessments unless they are only used as an optional means of assessment.
Any independent assessment must have an easy to use and fair appeals process.
Response to Terms of Reference a. the development, modelling, reasons and justifications for the introduction of in dependent assessments into the NDIS One of the justifications in the Tuning report was that “It would also decrease the likelihood that a p participant would need to undergo further assessments …” yet here we are requiring a further assessment. Participants are usually assessed by health professionals that are currently providing s support. They are already known to the participant and most of the information needed to produce a report is already known to them, from their long history of engagement with this individual. An in dependent health professional will in most cases not know the individual and a lengthy interview will be required. Most participants will see this as invasive and will not understand why they have to go through their case history with yet another person. In my brother’s case I don’t want to explain all the case history again and nor does my brother. It has already taken a long time for his current health professionals to fully understand his situation.
The Tuning report stipulated “a number of key protections that need to be embedded as this ap proach rolls out, including: a. participants having the right to choose which NDIA-approved provider in their area undertakes the functional capacity assessment b. participants having the right to challenge the results of the functional capacity assessment, including the ability to undertake a second assessment or seek some form of arbitration if, for whatever reason, they are unsatisfied with the assessment; …”. We were certainly not given any choice when NDIS engaged an allied health consultant when we submitted a change of circumstances last year, and the only avenue of appeal open to us was through the Administrative Appeals Tribunal. If this system is implemented, I think it is imperative to give participants a real choice in who undertakes this assessment and a better appeals process is required. Participants will want to have someone carrying out the review with experience in their area of disability. They should have the choice, not someone from NDIS who will not know them that well. An appeals process must be quick and must be overseen by practitioners with experience in the participants type of disability. The Administrative Appeals Tribunal doesn’t meet either of these objectives.
A n independent assessment pilot study was conducted from November 2018 to April 2019. Despite the government promoting their consultation with the community the report of this study has not been released. Instead all we have is a summary which is short on detail. What is known is that 513 people from 9 NSW metro areas participated in this study. No mention of how many were asked to d participate in this study has been made. It is likely that this pilot was biased from the outset as people who would have found an independent assessment process difficult would have not participated. Only three types of disability representing 63% of the those in the NDIS were covered. So more than a third of people with disabilities, my brother included, were not considered. Only 14% of the partici pants were over 25. So again, older people with disabilities, my brother included, were net considered. Of the 513 that participated, only 145 (28%) completed the feedback survey. Whilst ap parently were supportive, this still means that the majority did not say they were supportive.
- justify the introduction on a biased not representative pilot of about 0.1% of the NDIS participants of which 62% did not say they supported this scheme is ridiculous. This would not pass any pub test yet here we have the NDIS saying that they are introducing this scheme as it received overwhelming support during the pilot. There is no indication that the NSW pilot sought participants from minority groups and obviously not from rural areas. The review should be based on fact and not just spin doctor material.
b the impact of similar policies in other jurisdictions and in the provision of other 政府 services no comment
c the human and financial resources needed to effectively implement no comment
d the independence, qualifications, training, expertise and quality assurance of assessors The NIDS have advised that “A qualified allied health professional from the independent assessment organisation will go through the standardised assessment tools with you”. My second key area of concern is the competency of an allied health professional from an independent organisation to make this assessment. Our experience in this area is not good. Mark’s WA NDIS draft plan issued on 4th November 2019 based on the report which was issued on 22nd July 2019. The therapy hours in the plan were cutback 26% from the recommended hours in the therapy report. I was advised that the cutback had been directed by an allied health consultant who thought that Mark was not high needs. This consultant had never met Mark nor contacted his therapists. I could not believe that my brother who is permanently in a wheelchair and needs 24 hour care to help toilet, shower, dress, eat, drink etc is not considered high needs. I am not aware of any independent organisation who has experience in all areas of disability. This is just such a wide field. So how can a health professional from an organisation selected by NDIS make an accurate assessment across all manifestations of disability. If a participant is already using health professionals to provide support, surely they are in the best position to understand his needs and make an assessment.
If competent independent assessors are to be used they will need to be drawn from a wide variety of organisations. However this will present more work for NDIS and from their current search processes for such organisations is clearly not what they want to do. The NDIS have now advised that they have selected eight organisations. However none of these organisations have a focus on acquired brain injuries, so how will one of these organisations be able to assess my brother. An accurate assessment needs to be carried by health professionals with significant experience with the type of disability. Not many health professionals in these organisations will have the requisite level of experience and I am concerned that individuals with less experience will be used due to availability and funding constraints. My brother needs support with all his personal care, with all tasks of daily living and all communication. His injury has left him with complex needs requiring high levels of support. At the moment my brother’s assessment is carried out by senior practitioners with at least 10 years clinical experience. However the NDIS have only insisted on a minimum of 12 months full time clinical experience for the independent assessors. This is totally inadequate to assess someone with complex needs.
Independent Assessments
Submission 316
The latest report is that the NDIS will not allow independent assessment companies to carry out assessments in areas where they provide other NDS services. But this is ridiculous. How else will they understand the requirements of disabled persons in these areas? To make an accurate independent assessment you need to have many years (certainly much more than 12 months) of practice in the relevant area of disability area. Independent assessment companies might hire health professionals with relevant experience, but this will only create another problem due to a shortage of health professionals in some areas. And as time goes on there experience will become less relevant.
e - The appropriateness of the assessment tools selected for use in independent assessments to determine plan funding In the response to the Tuning report the government advised that new assessments would be conducted by NDIS-appointed healthcare professionals using standardised tools. This I see as one of the key problem areas. Anyone who has worked in the disability sector for a number of participants will know that everyone’s situation is different. There is such a wide variety of conditions and there is such a wide variety of impacts for each condition which change each year. It may be useful to have a standardized assessment guide, but under this everyone needs to be treated as an individual. It might be convenient for the government to place everyone in a box, but this will not give an inaccurate assessment of their individual needs. Participants want to be treated as individuals, and yet here the government is proposing to put them in boxes. This might make it easy for an inexperienced health professional to tick boxes, but does not guarantee an accurate assessment.
to quote from the DSS website “(NDIS)… provides greater choice and control over how and when you receive your supports and ensures you receive the support you need over your lifetime” Participants still desire the person centred approach they were promised at the start of NDS. Inadequate/standardised assessments threaten to take the control from the participant and the family.
f - The implications of independent assessments for access to and eligibility for the NDIS no comment
g - The Implications of Independent Assessments For Ndis Planning, Including Decisions Related To Funding Reasonable And Necessary Supports My main concern is that an independent assessor with no or limited experience with acquired brain injuries will assess my brother, and on the basis of this his NDIS plan will have inadequate funding to cover his needs. Over the last 2 years I have seen a significant decline in my brothers mobility predominantly due to inadequate physio therapy. Part of this was due to Covid and part was due to an assessment by an allied health professional who didn’t think the hours requested by his health professional service providers was necessary. In the short term this saved the NDIS money, but in the long term his requisite support funding needs to be much higher. Of course my greater concern that my brother’s quality of life has significantly suffered.
h – The circumstances in which a person may not be required to complete an independent assessment
Independent Assessments Submission 316
There needs to be an option for an assessment to be provided by other than the one or two organizations the NDIS selects from the panel. Particularly when these organizations do not have experience with the type of disability.
i opportunities to review or challenge the outcomes of independent assessments
Up until May 2019, Mark was living in redacted with therapy services provided by redacted. Therapy services were being funded by redacted. In May, Mark moved to live in a group home in Rivervale. At this stage WA NDIS took over.
The WA NDIS draft plan issued on 4th November 2019 was based on the therapy report which was issued on 22nd July 2019. The therapy hours in the plan were cutback 26% from the recommended hours in the therapy report. I was advised that the cutback had been directed by an allied health consultant who thought that Mark was not high needs. This person had never met Mark nor contacted his therapists. I could not understand why someone who needed 24 hour care was not considered to be high needs. Despite complaints made to NDIS, we were not allowed to appeal against the decision made by the allied health consultant. It seemed that they were regarded as the independent experts so that was the end of the matter.
to add insult to injury the federal NDIS plan was approved on the 28th January 2020 but the therapy hours were just copied over from the WA NDIS plan which was based on the therapy report issued on 22nd July 2019. The more recent therapy report dated 12th November 2019, which had been provided as part of the federal NDIS planning process, was not taken into account.
i am very concerned that it will be very difficult to appeal against an assessment made by an independent consultant under the new scheme. Even if NIDS is forced to allow an appeal, they could easily make it an extremely difficult and lengthy process. Every delay in implementing a plan impacts on the wellbeing of the participant. The appeal process must not be so complex so as to dissuade people from making appeals.
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 To put it bluntly the NDIS do not know as the only pilot study completed did not cover any people with these backgrounds.
k the appropriateness of independent assessments for people with particular disabilities types, including psychosocial disability Assessors must have significant experience with the type of disability being assessed. However none of the organizations on the assessment panel have a focus on acquired brain injuries. I am sure there are other types of disabilities not covered by the panel. Where this is the case there needs to be an option for assessments to be completed by health professionals outside the panel. Dare I say it but the health professionals already providing support to the participant would be a good start.
l any other related matters
Independent Assessments
Submission 516
The following appears from the document:
it seems that the Government has focused its efforts on implementing these changes regardless of how they affect those involved. Recommendations outlined in the ’Tuning report’ were implemented selectivly and there was an attempt at gaining some practical knowledge through running trials prior to complete adoption; however, little effort appeared to go into determining whether or not such actions would actually provide any advantage to people receiving support under the National Disability Insurance Scheme (NDIS). in conclusion I believe it may simply reduce costs for agencies administering services.
rena o’sullivan redacted
March 30th, 2021 neville horner
march 30th, 2021