Contents
1.) Introduction
2.) About This Submission
3.) Summary
4.) Terms Of Reference:
d.) The Independence, Qualifications, Training, Expertise And Quality Assurance Of Assessors;
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 Assessment;
5.) Improving Outcomes
Introduction
I am a legally trained Advocate and Carer. I am also a Registered Nurse qualified in Mental Health. Previously I was the Senior Advocate for Carers Queensland. My major role was appearing for clients before The Queensland Civil and Administrative Tribunal (QCAT) in Guardianship matters.
CurrentIy I am assisting a visually impaired participant in a complex home modifications application. The NOIA are attempting to impose an Independent Assessment (IA) on him despite there being no need and consent has not been provided.
The participant has submitted 13 reports supporting his application. This includes comprehensive functional assessments from two Occupational Therapists. At no time has the NOIA identified deficiencies in these reports.
About this Submission
The matter in which I am involved is currently under appeal at the AAT. Thus, I will confine my submission to general issues which arise from the case rather than specifics and the identity of the participant. In this submission I will be addressing three Terms of Reference.
Summary
a.) Independent Assessments are invasive and potentially harmful.
b.) They are inherently discriminatory as they impose conditions on people with disability (PWD )which would not be tolerated by people without disabilities.
c.) IA’s remove the participant’s choice and control. This breaches the principles and objects of the NDIS Act. Also, the UN Convention of the Rights of People with Disabilities (CRPD).
d.) IAs are unethical as they take away the right of review and eliminate consent.
4.) TERMS OF REFERENCE
d.) the independence, qualifications, training, expertise and quality assurance of assessors;
(i)There is grave doubt about the independence of assessors. To quote Queensland Advocacy Incorporated (QAl)1 “the purported ‘independence’ of assessors is doubtful since they will essentially be paid by the National Disability Insurance Agency (’the AgencyJ. A conflict of interest will tarnish their assessments and will call into question issues of procedural fairness. The government is urged to learn the lessons from similar arrangements in other areas, such as the use of job capacity assessments to determine Centre/ink applications and the subsequent appeals to the Administrative Appeals Tribunal (’AATJ, or the problems with Independent Medical Examiners engaged by WorkCover as discovered by the Victorian Ombudsman during their investigations.”
(ii) It is difficult to understand why many well qualified professionals with sufficient expertise will be persuaded to becoming Independent Assessors. This is because of the widespread criticism this policy has attracted. Also, the likelihood that they will be breaching the various boards’ Code of Conduct whereby consent is essential.2 This could subject them to complaints to the Australian Health Practitioner Regulation Agency (AHPRA). To become an NOIA assessor may be seen as a career limiting move. What training these assessors will receive is not sufficiently known. The concern is they could be new graduates with insufficient experience in disability. It is assumed training will consist of acquainting them with the assessment tools which they will be using. Given their limitations for complex needs, this doesn’t inspire confidence. Participants should be provided with the qualifications and experience of the assessors. There is also concern that the assessor’s qualification is appropriate for the particular disability. A participant named Aaron shared his experience of an IA on Facebook. His disability is autism and the assessor was a physiotherapist. This was inappropriate and is an example of an assessor operating out of the scope of his qualifications and training.
(iii) There is considerable doubt about quality assurance. A time limited assessment by a stranger using a one size fits all approach is not going to result in a quality report. Many participants have disabilities which fluctuate from day to day. There can be no doubt that there will be inaccuracies and omissions. h.) the circumstances in which a person may not be required to complete an independent assessment;
1 QAI open letter to the Minister for the NDIS re: Independent Assessments. 2 Occupational Therapists Board’s Code of Conduct s.8.7 P19.
(i) No one should be subjected to an Independent Assessment. Especially when the participant has many comprehensive reports. Case law provides that assessments made by professionals known to the participant are to be preferred over NOIA Independent Assessors.3 In the case I am involved in a number of reports were not even considered by the agency. I am in agreement with QAI who in their open letter to the Minister4 state “the mandatory requirement for people with disability to undergo an Independent Assessment regardless of whether the person needs or wants one, goes against the very objectives and principles of the Scheme. The law requires the NOIS to enable participants exercise choice and control in relation to their goals and the planning and funding of their supports.”
(ii) Participants are deprived of privacy and dignity from such an invasive process by a stranger. Those with psycho-social disabilities are particularly vulnerable to harm from Independent Assessments.
(iii) A participant who has not provided Informed Consent should not be forced to have an IA. Coerced consent is not consent. It must be freely and willingly given rather than the participant being bullied into providing it.
i.) opportunities to review or challenge the outcome of an Independent Assessment
(i) It is of great concern that the participant will not be provided a copy of the assessment in order to check its accuracy. Clearly a summary is inadequate.
(ii) The right of review is a basic tenant of Natural Justice. That this is being denied to eople with a disability is discriminatory. An inaccurate assessment should be able to be challenged and reviewed.
4.) IMPROVING OUTCOMES
(i) An important principle of the NOIS is choice and control. This is under threat with the proposed changes. It is imperative the scheme remains participant driven. The NOIS needs to be fair, provide choice and help participants live an ordinary life.
(ii) There should be free access to functional assessments for NOIS applicants, through Medicare or the PHN network.
(iii) Participants should be able to use their NOIS funds to get a full functional assessment from a Therapist of their choice.
(iv) The NOIA should determine which tests are required, but to allow the participant’s Therapists to add functional tests as needed, and to gather relevant information from the participant.